. . THE 
ANATOMY AND PHYSIOLOGY 
OF THE 
* » 
HUMAN BODY. 
BY 
JOHN AND CHARLES BELL. 
THE WHOLE MORE PERFECTLY SYSTEMATIZED AND CORRECTED 
By CHARLES BELL, 
Professor of Anatomy and Surgery to the Royal College of Surgeons: 
of London, SfC. #c. 
IN TWO VOLUMES. 
<£Jje JWI) American 2£iJtUtw; 
(REPRINTED FROM THE SIXTH LONDON EDITION OF 1826 ) 
TI1E TEXT REVISED, WITH VARIOUS IMPORTANT ADDITIONS, FROM 
THE WRITINGS OF SOEMMERING, BICHAT, BECLARD, 
MECKEL, SPURZHEIM, WISTAR, &c. 
BY JOHN D. GODMAN, M.D. 
Professor of Anatomy and Physiology in Hylgtr's Medical Coll(gtf IV. 1" 
VOL I. 
NEW-YORK: 
PUBLISHED BY COLLINS & CO. 
1827. Southern District of New-York, ss. 
Be it remembered, that on the 4th day of October, A. D. 1827, in the 52nd year 
of the Independence of the United States of America, Collins & Co., of the said 
District, have deposited in this office the title of a book, the right whereof they 
claim as proprietors, in the words following, to wit: 
“ The Anatomy and Physiology of the human body ; by John and Charles Bell. 
The whole more perfectly systematized and corrected by Charles Bell, Professor of 
Anatomy and Surgery to the Royal College of Surgeons of London, &c. &c. In 
Two Volumes. The Fifth American edition : reprinted from the .Sixth London 
edition of 1826. The text revised, with various important additions from the 
writings of Soemmering, Bichat, Beclard, Meckel, Spurzheim, Wistar, &c. By 
John D. Godman, M. D. Professor of Anatomy and Physiology in Rutger’s Medi- 
cal College, New-York.” 
In conformity to the Act of Congress of the United States, entitled “ An Act 
for the encouragement of Learning, by securing the copies of Maps, Charts, and 
Books, to the authors and proprietors of such*’copies, during the time therein 
mentioned.” And also to an Act, entitled **An Act, supplementary to an Act, 
entitled an Act for the encouragement of Learning, by securing the copies of 
Maps, Charts, and Books, to the authop*and proprietors of such copies, during the 
times therein mentioned, and extending the benefits thereof to the art3 of de- 
signing, engraving, and etching and other prints.” 
' FRED. J. BETTS, 
Clerk of the Southern District of Kew-York. 
J. Sr J. Harper, Printers, Cliff-Street. PREFACE 
TO 
THE FIRST EDITION. 
To those, who are at all acquainted with books on anatomy, the 
appearance of a new one on the subject will not be surprising. 
To those, who are not yet acquainted with such writings, I have 
only to say, that I have written this book because I believed that 
such a one was needed, and must be useful. I have endeavoured 
to make it so plain and simple as to be easily understood ; I have 
avoided the tedious interlarding of technical terms, (which has 
been too long the pride of anatomists, and the disgrace of their 
science,) so that it may read smoothly, compared with the studied 
harshness and, I may say, obscurity, of anatomical description. 
If an author may ever be allowed to compare his book with others, 
it must be in the mechanical part; and I may venture to say, that 
this book is full and correct in the anatomy, free and general in 
the explanations, not redundant, I hope, and yet not too brief. 
If, in the course of this volume, I shall appear to have given a 
place and importance to theories far higher than they really de- 
serve, my reader will naturally feel how useful they are in preserv- 
ing the true balance between the looser doctrines of functions, and 
the close demonstration of parts. He will be sensible, how much 
more easily these things can be read in the closet, than taught in 
any public course; he will, I think, be ready to acknowledge, that 
I introduce such theories only, as should connect the whole, and 
may be fairly distinguished as the physiology of facts ; and he will 
perceive, that, in this too, I feel a deference for the public opinion, 
and a respect for the established course of education, which it is 
natural to feel and to comply with. 
Thus, perhaps, it is less immodest for an author to put down 
what he thinks he may honestly say concerning his own book, than 
to omit those apologies which custom requires, which give assur- 
ance, that he has not entered upon his task rashly, nor performed 
it without some labour and thought, and which are the truest signs 
of his respect for the public, and of his care for that science to 
which he has devoted his life. 
With these intentions and hopes, 1 offer this book to the public ; 
and more particularly to those in whose education I have a chief IV 
PREFACE. 
concern; not without a degree of satisfaction at having accom* 
plished what I think cannot fail to be useful, and surely not without 
an apprehension of not having done (in this wide and difficult sub- 
ject) all that may be expected or wished for. 
Every book of this kind should form a part of some greater 
system of education : it should not only be entire in its own plan, 
but should be as a part of some greater whole ; without which sup- 
port and connexion, a book of science is insulated and lost. This 
relation and subserviency of his own particular task to some greater 
whole, is first in an author’s mind : he ventures to look forward to 
its connexion with the general science, and common course of edu- 
cation ; or he turns it to a correspondence and harmony with his 
own notions of study; and if these notions are to give the com- 
plexion and character to any book, it should be when it is designed 
for those entering upon their studies, as yet uncertain where to 
begin, or how to proceed. 
Hardly any one has been so fortunate as to pursue the study of 
his own science under any regular and perfect plan ; and there are 
very few with whom a consciousness of this does not make a deep and 
serious impression at some future period, accompanied w'ith severe 
regret for the loss of time never to he retrieved. In medicine, 
perhaps, more than in any other science, we begin our studies 
thoughtless and undecided, following whatever is delightful, (as 
much is delightful,) neglecting the more severe and useful parts: 
hut as we advance towards that period in which we are to enter 
upon a most difficult profession, and to take our place and station 
in life, and when we think of the hesitation, anxiety, and appre- 
hension with which we must move through the first years of prac- 
tice, we begin to look back with regret on every moment that is 
past; with a consciousness of some idle hours; and (what is 
more afflicting still) with an unavailing sense of much ill directed, 
unprofitable labour: for there is no study which a young man 
enters upon with a more eager curiosity : but, not instructed in what 
is really useful, nor seriously impressed with the importance of 
his future profession, he thinks of his studies rather as the amuse- 
ment, than as the business of life; slumbers through his more la- 
borious and useful tasks, and soon falls off to the vain pursuit of 
theories and doctrines. 
If I were not persuaded of the important consequences, of the 
infinite gain or loss, which must follow the first steps in every pro- 
fession, 1 should not feel, but, above all, 1 should not venture to 
show, an anxiety, which may be thought affected by those who 
cannot know how sincere it must be : for, in our profession, this 
is the course of things, that a young man, who. by his limited for- 
tune, or the will of his friends, by absence from his native country, 
or by the destination of his future life, is restricted to a few years 
of irregular, capricious, ill directed study, throws himself at once 
into the practice of a profession, in which according to his igno- 
rance or skill, he must do much good or much harm. Here there PREFACE. 
V 
is no time for his excursions into that region of airy and fleeting 
visions, and for his returning again to sedate and useful labour: 
there is no time for his discovering, by the natural force of his own 
reason, how vain all speculations are :—in but a few years, at most, 
his education is determined ; the limited term is completed, ere he 
have learnt that most usefu of all lessons—the true plan of study; 
his opportunities come to be valued (like every other happiness) on- 
ly when they are lost and gone. 
Of all the lessons which a young man entering upon our profes- 
sion needs to learn, this is, perhaps, the first,—that he should resist 
the fascinations of doctrines and hypotheses, till he have won the 
privilege of such studies by honest labor, and a faithful pursuit of 
real and useful knowledge. Of this knowledge, anatomy surely 
forms the greatest share. Anatomy, even while it is neglected, is 
universally acknowledged to be the very basis of all medical skill. 
It is by anatomy that the physician guesses at the seat, or causes, 
or consequences, of any internal disease : without anatomy, the 
surgeon could not move one step in his great operations : and those 
theories could not even be conceived, which so often usurp the place 
of that very science, from which they should flow as probabilities 
and conjectures only, drawn from its store of facts. 
A consciousness of the high value of anatomical knowledge ne- 
ver entirely leaves the mind of the student. He begins with a 
strong conviction that this is the great study, and with an ardent 
desire to master all its difficulties : if he relaxes in the pursuit, it 
is from the difficulties of the task, and the seduction of theories too 
little dependent on anatomy, and too easily accessible without its 
help. His desire for real knowledge revives, only when the op- 
portunity is lost; when he is to leave the schools of medicine; when 
he is to give an account of his studies, with an anxious and oppress- 
ed mind, conscious of his ignorance in that branch which is to be 
received as the chief test of his professional skill ; or when, perhaps, 
he feels a more serious and manly impression, the difficulty and im- 
portance of that art which he is called to practice. 
Yet, in spite of feeling and reason, the student encourages in 
himself a taste for speculations and theories, the idle amusements 
of the day, which, even in his own short course of study, he may 
observe sinking in quick succession into neglect and oblivion, ne- 
ver to rev ive ; he aspires to the character of a physiologist, to which 
want of experience and a vouthfu! fancy, have assigned a rank and 
importance which it does not hold in the estimation of those who 
should best know its weakness or strength. The rawest student, 
proud of his physiological knowledge, boasts of a science and a 
name which is modestly disclaimed by the first anatomist, and the 
truest physiologist of this or any age. Dr. Hunter speaks thus of 
his physiology, and of his anatomical demonstration :—“ Physiolo- 
“ gy, as far as it is known or has been explained by Haller, and the 
“ best of the moderns, may be easily acquired by a student without 
“ a master, provided the student is acquainted with philosophy and VI 
PREFACE. 
“ chymistry, and is an expert and ready anatomist; for with these 
“qualifications he can read any physiological book, and understand 
“it as fast as he reads. 
“ In this age, when so much has been printed upon the subject, 
“ there is almost as little inducement to attend lectures upon phy- 
“ siology, as there would be for gentlemen to attend lectures upon 
“ government, or upon the history of England. Lectures upon sub- 
jects which are perfectly intelligible in print, cannot be of much 
“ use, except when given by some man of great abilities, who has 
“ laboured the subject, and who has made considerable improve- 
“ ments either in matter or in arrangement. 
“ In our branch, those teachers who take but little pains to de- 
“ monstrate the parts of the body with precision and clearness, 
“but study to captivate young minds with ingenious speculations, 
“ will not leave a reputation that will outlive them half a century. 
“ I always have studied, and shall continue my endeavours, to em- 
“ploy the time that is given up to anatomical studies as usefully 
“ to the students as I can possibly make it—and therefore shall never 
“aim at showing what I know, but labour to show and describe, 
“ as clearly as possible, what they ought to know. This plan rejects 
“all declamation, all parade, all wrangling, all subtilty : to make a 
“show, and to appear learned and ingenious in natural knowledge, 
“ may flatter vanity ; to know facts, to separate them from supposi- 
“ tions, to range and connect them, to make them plain to ordina- 
“ ry capacities, and above all, to point out the useful applications, 
“is, in my opinion, much more laudable, and shall be the object of 
“ my ambition.”* 
# Introductory Lecture published by Dr. Hunter. 
Edinburgh, Sept. 1 793. PREFACE 
TO 
THE SIXTH EDITION. 
In giving this edition of the Anatomy of the Human Body to 
the public, I have recast and arranged the whole, and have added 
several subjects to the original work. I have been careful to re- 
vise the descriptions, and have made some additions to them ; so 
that I hope these volumes will be found to have fewer errors, and 
to present a more perfect system. 
Of the first part of the work by my brother, I may speak more 
freely. And I may recommend it to those who superintend the 
education of students, to consider whether they have not in it a 
work calculated to open the minds of the pupils to the right un- 
derstanding of the important subjects of their studies, and to give 
them correct and liberal views of their profession. It will not 
soon be surpassed in correctness and minuteness of description. 
I have not dared to touch the History of the Arteries, as deli- 
vered by my brother; the rapid improvement in the surgery of 
the arteries, which followed as a consequence of the first publica- 
tion of this part of the Anatomy, has, with me, made it sacred. 
The nervous system is given here as I have taught it in my lec- 
tures of late years. And the discoveries which I have made in 
this department being now acknowledged, I have thought myself 
at liberty to incorporate the new views of the nervous system with 
this edition of the System of the Anatomy of the Human Body. 
CHARLES BELL. 
SoHo-SttuARE, London, 
Oct. 1826. CONTENTS 
OF 
THE FIRST VOLUME. 
ANATOMY 
OF THE 
BONES, MUSCLES, AND JOINTS. 
Page 
INTRODUCTORY View of the Ani- 
mal Economy, .... 1 
Of the Skeleton, ... 49 
Supplementary Observations on Osteo- 
geny, . . • 52 
Of the Trunk, .... 54 
OF THE SPINE, THORAX, AND 
PELVIS. 
Of the Spine—General View of the 
Spine—its Motions—and the Division 
of the Vertebrae. 
General Description of a Vertebra, 55 
1. Body of the Vertebra. 
2. Articulating, or Oblique Pro- 
cesses, .... 56 
3. Spinous Processes. 
4. Transverse Processes. 
Vertebrae of the Loins. 
Vertebr* of the Back, . . 57 
Vertebrae of the Neck, . . 58 
Atlas, .... 59 
Dentata. ... 60 
Medullary Tube and the Passage of 
the Nerves, . . 61 
Intervertebral Substance, . 62 
Motions of the Vertebrae, . 63 
Ribs and Sternum. 
i. Of the Ribs. 
General Description of a Rib—Divi- 
sion of the Ribs into true and 
false—Form of a Rib, and place 
of the Intercostal Artery. 
The parts of the Rib, as the Head, 
Neck—Surface for articulating with 
the Transverse Process—Nature 
of the Joint and Motion of the 
Rib—Angle of the Rib, . 64 
Size and Length of the Ribs—The 
Cartilages of the Ribs, . 65 
Page 
ii. Of the Sternum, and its three parts, 66 
Of the Pelvis, - . . 68 
i. Os Sacrum. 
ii. Os Cocctgis, . . 70 
iii. Ossa Innominata. 
i. Os Ilium, or Haunch-Bone—1. 
Ala—Spine—Spinous Processes, 
posterior andanterior-2. Dorsum. 
—3. Costa—4. Linea lnnominata, 71 
ii. Os Ischium, or Hip-Bone—1. 
Body—2. Tuber—3. Ramus, 72 
iii. Os Pubis, or Share-Bone—Bo- 
dy—Crest—Ramus, . 73 
Recapitulation of the chief Points of 
the Anatomy of the Pelvis. 
Size of the Pelvis in Man and Wo- 
man, 75 
Remarks on the Separation of the 
Bones of the Pubes during Labour, 76 
BONES OP THE THIGH, LEG, AND 
FOOT. 
Femur, . . . . 78 
1. Body. 
2. Head. 
3. Neck, . . . . 79 
4. Trochanter major. 
5. Trochanter minor. 
6. Linea aspera. 
7. Condyles, . . .80 
Tibia, . . . . 81 
1. Upper head. 
2 Body. 
3. Lower Head—Inner Ancle, . 82 
Fibula, 
1. Upper Head, . . . 83 
2. Lower Head—Outer Ancle. 
Rotula, or Patella, or Knee-pan, 84 
Tarsus, or Instep, . . . 85 
1. Astragalus. X 
CONTENTS 
Page 
1. Row forming the Wrist . 99 
1. Os Scaphoides. 
2. Os Lunare, . . 100 
3. Os Cuneiforme. 
4. Os Pisiforme. 
2. Row supporting the Metacarpal 
Bones, . . 101 
1. Trapezium. 
2. Trapezoides. 
3. Os Magum. 
4. Os Uncitorme. 
Metacarpus, 102 
Fingers, . . . 103 
OF THE SKULL IN GENERAL. 
Importance of the Anatomy of the Skull, 104 
The Tables and Diploe of the Bones of 
the Skull. 
Enumeration and Description of the 
Bones of the Cranium, . • 106 
The Sutures, .... 107 
Remarks on the Formation, Nature, and 
Use of Sutures, .... 108 
DESCRIPTION OF THE INDIVIDU- 
AL BONES OF THE SKULL. 
Os Frontis, . . . Ill 
1. Orbitary Plates, . . 112 
2. Fissura jEtbmoidea. 
3. Superciliary Ridge. 
4. Artery and Nerve. 
5. Pores. 
6. Superciliary Hole. 
7. Foramen Orbitale. 
8. Angular Processes. 
9. Nasal Process. 
10. Temporal Ridge, . . 113 
11. Frontal Sinuses. 
12. Frontal Ridge, or Spine, . 114 
13. Orbitary Processes. 
Os Parietale, . . .115 
Os Occipitis, .... 116 
i. External Surface, . . 117 
1. Transverse Spines. 
2. Crucial Spine. 
3. Posterior Tuberosity. 
ii. Internal Surface. 
1. Great Internal Ridge and Tento- 
rium CerebelloSuper-extensum. 
2. Hollows of the Occipital Bone. 
iii. Processes of the Occipital Bone. 
1. Cuneiforn. 
2. Condyles, . * . 118 
iv. Holes. 
1. Foramen Magnum. 
2. Hole for the ninth Pair of Nerves. 
3. Hole for the Cervical Vein of the 
Neck. 
4. Common Hole. 
Os Temporis. 
Squamous part, . . .119 
Petrous part. 
Processes. 
1. Zygomatic. 
2. Styloid. 
Page 
2. Os Calcis, . . . 86 
3. Os Naviculare, . . . 87 
4. Os Cuboides. 
5. J 
6- > Cuneiform Bones. 
7- S 
Metatarsus and its five Bones. 
Toes, .... 88 
Sesamoid Bones, . . .89 
BONES OF THE SHOULDER, ARM, 
AND HAND. 
Shoulder. 
i. Scapula, or Shoulder-Blade. 
1. The flat Side of the Scapula, 90 
2. The upper flat Surface. 
3. The Triangular Form of the Sca- 
pula—Costa—Basis. 
4. The Glenoid, or Articulating Ca- 
vity, . 91 
5. The Neck. 
6. The Spine. 
7. The Acromion Process, . 92 
8. The Coracoid Process. 
ii. Clavicle, or Collar-Bone. 
1. The Thoracic End and Joint, 93 
2. The Outer End, and its Union 
with the Scapula. 
Arm. 
Os Humeri. 
1. Head, ... 94 
2. Neck. 
3. Tuberosities. 
4. Groove for the Tendon of the Bi- 
ceps Muscle. 
5. Ridges leading to the Condyles. 
6. Condyles, - 95 
7. Articulating Surface for the El- 
bow-joint, and general Expla- 
nation of the Joint. 
8. Hollows for the Olecranon and 
Coronoid Processes of the Ulna. 
Ulna and Radius. 
Ulna, ... .96 
1. Greater Sigmoid Cavity, formed 
by 
1. Olecranon. 
2. Coronoid Process. 
2. Lesser Sigmoid Cavity for receiv- 
ing Head of the Radius. 
3. Ridges. 
4. Lower Head of the Ulna, . 97 
5. Styloid Process of the Ulna. 
Radius. 
1. Body. 
2. Upper Head. 
3. Neck. 
4. Point for the Implantation of the 
Biceps Flexor Cubiti, . 98 
5. Lower Head. 
6. Styloid Process of the Radius. 
7. Ridge and Grooves. 
Hand and Fingers. 
General Explanation of the Hand and 
Wrist. 
Carpus, Metacarpus, and Fingers. 
Carpus, or Wrist, . . 99 CONTENTS. 
XI 
Page 
3. Vaginal, . . . 119 
4. Mastoid or Mamillary. 
5. Auditory. 
Holes. 
For the Ear. 
1. Meatus AuditoriusExternus. 
2. Internus, 12 j 
3. Small Hole receiving a 
Branch from the fifth Pair 
of Nerves. 
4. Stylo-Mastoid Hole. 
5. Hole for the Eustachian 
Tube. 
For Blood Vessels, . . 122 
1. For the Carotid Artery. 
2. For the Great Lateral Sinus, 
called the Common Hole, 
as formed partly by the 
Temporal, partly by the 
Occipital Bone. 
3. Small Hole on the outside 
of the Temporal Bone. 
Os jEthmoides, . . 123 
1. Cribriform Plate. 
2. Crista Galli, . . 124 
3. Nasal Plate, or Azygous Pro- 
cess. 
4. The Labyrinth. 
5. Spongy Bones. 
6. Orbitary Plate, or Os Pla- 
num. 
7. Os Unguis. 
8. Cells, . . 125 
Os Sphenoidbs, . . 126 
Processes. 
1. Al*. 
2. Orbitary Process. 
3. Spinous Process. 
4. Styloid Process. 
5. Pterygoid Processes. 
External, . . 127 
Internal. 
6. Azygous Process. 
7. Clynoid Processes. 
Anterior. 
Posterior. 
Sella Turcica, and its Cells. 
Holes, . . . 128 
1. Foramen Opticum. 
2. Lacerum. 
3. Rotundum, . 129 
4. Ovale. 
5. Spinale. 
6. Pterygoid, or Vidian Hole. 
bones of the face and jaws. 
Ossa Nasi, . . . 130 
Ossa Maxiliaria Superiora, . 131 
Processes. 
1. Nasal. . . . 132 
2. Orbitary. 
3. Malar. 
4. Alveolar. 
5. Palatine Process 
Page 
Antrum Maxillare, or Highmoria- 
num, . . . 133 
Holes, .... 134 
1. Infra Orbitary. 
2. Foramen Incisivum, or Ante- 
rior Palatine Hole. 
3. Posterior Palatine Hole. 
4. Lachrymal Groove. 
5. Lateral Orbitary Fissure, 135 
6. Alveolar Foramina. 
Ossa Palati. 
Processes. 
1. Palatine Plate or Process. 
Middle Palatine Suture. 
Transverse Palatine Suture. 
2. Pterygoid Process. . 136 
3. Nasal Plate or Process. 
Ridge. 
Groove. 
4. Orbitary Process. 
Palatine Cells. 
Ossa Spongiosa, or Turbinata Infk- 
riora. 
Vomer, . . . 137 
Os Mac*, , . . 138 
Processes. 
1. Upper Orbitary. 
2. Inferior Orbitacy. 
3. Maxillary. 
4. Zygomatic. 
5. Internal Orbitary. 
6. Foramen. 
Os Maxill* Infbrioris. 
Processes, . . 139 
1- Coronoid. 
2. Condyloid. 
3. Cervix. 
4. Semilunar Notch. 
5. Alveolar. 
6. Spina Interna. 
Holes, . . . 140 
1. Large Hole on the inner Side for 
the Eutry of the Lower Maxil- 
lary Nerve and Artery. 
2. Mental Hole. 
Or the Teeth, by Mr. Charles Bell. 141 
Description of the Human Adult 
Teeth, 
1. The Incisores. 
2. The Cuspidati, or Canine 
Teeth, . ... 142 
3. The Bicuspides. 
4. The Molares, or Grinding 
Teeth. 
Of the first Set of the Teeth, the Milk 
or Deciduous Teeth, . . 143 
Of the Structure of the Teeth, . 145 
Of the Enamel. 
Of the central bony part of the Teeth, 146 
Of the Vascularity and Constitution 
of the bony part of the Tooth, 147 
Of the Gums, . • . 150 
Of the Formation and Growth of the 
Teeth, .... 151 
Of the Growth of the second Set of 
Teeth, and the shedding of the first, 154 XII 
CONTENTS. 
OF THE MUSCLES; 
Page 
Their Texture, and the Varieties 
in the Arrangement of their Fi- 
bres, .... 167 
MUSCLES OF THE FACE, EYE, 
AND EAR. 
Muscles of the Face. 
1. Occipito-Frontalis, . . 170 
2. Corrugator Supercilii, . . 17J 
3. Orbicularis Oculi, or Palpebrarum. 
4. Levator Palpebr® Superioris. 
Muscles of the Nose and Mouth. 
5. Levator Labii Superioris, et Alae 
Nasi, . . .172 
6. ■ — proprius. 
7. Levator Anguli Oris, or Levator 
Communis Labiorum. 
8. Zygomaticus Major, . .173 
9. Minor. 
10. Buccinator. 
11. Depressor Anguli Oris. 
12- Depressor Labii Inferioris, or Qua- 
dratus Genae, . . 174 
13. Orbicularis Oris. 
14. Depressor Labii Superioris et Al* 
Nasi, . . - ' 175 
15. Constrictor Nasi. 
16. Levator Menti. 
Muscles of the External Ear. 
17. Superior Auris, . . . 176 
18. Anterior Auris. 
19. Posterior Auris. 
20. Helicis Major. 
21. Helicis Minor. 
22 Tragicus. 
23. Antilragicus, . . • 177 
24. Transversus Auris. 
Muscles of the Eye-ball. 
General Explanation of these Muscles. 
25. Rectus Superior, . . 178 
26. Rectus Inferior. 
27. Rectus Internus. 
28. Rectus Externus. 
29. Obliquus Superior. 
30. Obliquus Inferior. 
MULCLES OF THE LOWER JAW, 
THROAT AND TONGUE. 
Muscles of the Lower J aw. 
30. Temporalis, . ' • 179 
31. Masse ter, . • • 180 
32. Pterygoideus Internus, or Major. 
33. Pterygoideus Externus, or Minor. 
Muscles lying on the fore part of 
the Neck, and moving the Head. 
1. Platysma Myoides, . . 181 
2. Mastoideus. 
Muscles of the Throat and Tongue. 
Explanation of certain Bones and Car- 
Page 
lilages forming the Basis of the 
Throat and Tongue, and the Centre 
of their Motions, . . . 182 
1. Os Hyoides.—Its Cornua.—Its 
Appendices, or perpendicular 
Processes. 
2. Larynx, Trachea, or Windpipe, 183 
1. Thyroid Scutiform, or Carti- 
lage. 
2. Cricoid Cartilage. 
3. Arytenoid Cartilages, and Ri- 
ma Glottidis formed by them. 
4. Epiglottis, . . . 184 
Recapitulation and View of the Con- 
stitution of the Larynx. 
i. Muscles of the Throat. 
1. Muscles which pull the Throat 
down. 
34. Sterno-hyoideus. 
35. Stemo-thyroideus, . 185 
36 Omo-hyoideus. 
Action of these Muscles. 
2. Muscles which move the Throat 
upwards. 
37. Mylo-hyoideus. 
38. Genio-hyoideus. 
39. Stylo-byoideus, . . 186 
40. Digastricus, or Biventer Max- 
illae Inferioris. 
3. Muscles moving the Parts and 
Cartilages of the Larynx upon 
each other. 
41. Hyo-thyroideus. 
42. Crico-thyroideus, . . 187 
43. Musculus Arytenoideus 
Transversus. 
44. Musculus Arytenoideus Obli- 
quus. 
45. Crico-Arytenoideus Posticus. 
46. Crico-Arytenoideus Lateralis. 
47. Thyreo-Arytenoideus. 
4. Muscles of the Palate and Pha- 
rynx, . . . 183 
48. Azygos Uvula*. 
49. Levator Palati Mollis. 
50. Circumflexus Palati, or Ten- 
sor Palati Mollis, 
51. Constrictor Isthmi Faucium, 189 
52. Palato-Pharyngeus. 
Phaiynx explained. 
53. Stylo-Pharyngeus, . .190 
54. Constrictor Superior. 
55. Constrictor Medius. 
56. Constrictor Inferior. 
57. CEsophagus. 
58. Vaginalis Gulas, . . 191 
ii. Mcscle8 of the Tongue. 
59. Hyo-glossus. 
60. Genio-hyo-glossus. 
61. Lingualis. 
Motions of the Tongue perform- 
ed by these Muscles. CONTENTS. 
XIII 
Page 
OF THE MUSCLES OF THE ARM, 
INCLUDING THE MUSCLES OF 
THE SCAPULA, ARM, FORE- 
ARM, AND HAND. 
Muscles of the ScAruLA, . . 192 
i. Muscles moving the Scapula up- 
wards and backwards. 
62. Trapezius. 
63. Levator Scapulae, or Levator 
Proprius Angularis, . 193 
64. and 65. Rhomboideus. 
1. Minor. 
2. Major. 
ii. Muscles which move the Scapula 
downwards and forwards, 
66. Serratus Major Anticus, 194 
67. Pectoral is Minor. 
68. Subclavius. 
Motions of the Scapula, 195 
Muscles moving the Os Humeri, or 
Arm-Bone. 
69- Pectoral is Major. 
70. Latissimus Dorsi, 
71. Deltoides, . • • 196 
72. Coraco-brachialis, . . 197 
73. Supra Spinatus. 
74. InfraSpinatus, . • 198 
75. Teres Minor. 
76. Teres Major, • ■ • 199 
77. Subscapularis- 
Motions of the Humerus, and Use 
and Effect of each of these Mus- 
cles in forming and strengthening 
the Joint. 
Muscles moving the Fore Arm, . 200 
i. Muscles bending the Fore Arm. 
78. Biceps Brachii Flexor. 
79. Brachialis Internus, . 201 
ii. Musclesextending the Fore-Arm. 
80. Triceps Extensor. 
81. Anconaeus, . . • 202 
Muscles situated on the Fore-Arm 
moving the Radius, Carpus, and 
Fingers. 
Fascia of the Arm. 
Arrangement of these Muscles, the 
Points of Origin and Insertion, and 
the Motions of Pronation and Su- 
pination, Flexion and Extension, 
explained, .... 204 
i. Flexors, arising from the Inner 
Condyle. 
82. Supinator Radii Longus, 205 
83. Supinator Brevis. 
84. Pronator Teres Radii, - - 206 
85. Pronator Qnadratus. 
86. Palmaris Longus. 
87. Palmaris Brevis, orCutaneus, 207 
88. Flexor Carpi Radialis. 
89. Flexor Carpi Ulnaris, . . 208 
90. Flexor Digitorum Sublimis. 
91. Flexor Digitorum Profundus, 
vel Perforans, . . . 209 
92. Lumbricales, • 210 
93. Flexor Longu* Pollicis. 
Page 
ii. Extensors arising from the Out- 
er Condyle, . . . 211 
94. Extensor Carpi Radialis Lon- 
gior. 
95. Extensor Carpi Radialis Bre- 
vior, . . 212 
96. Extensor Carpi Ulnaris. 
97. Extensor Digitorum Commu- 
nis. 
98. Extensor Minimi Digiti, or 
Auricularis, . . 213 
99. Extensor Primus Pollicis, > 214 
100. Extensor Secundus Pollicis. > 
101. Extensor Tertius Pollicis, ) 215 
102. Indicator. 
Muscles seated on the hand. 
General description of these Muscles, 216 
103. Abductor Pollicis, \ 
104. Opponens Pollicis, f 
105. Flexor Brevis Pollicis, ? 217 
106. Adductor Pollicis, ) 
107. Abductor Minimi Digiti \ 
108. Flexor Parvus Minimi Di-f 
giti, . . . T 218 
109. Adductor Minimi Digiti. * 
110. Abductor India's. 
111. Interossei Interni, 
112. Interossei Extend. 
MUSCLES OF RESPIRATION, OR 
OF THE RIBS. 
General Explanation and Table of these 
Muscles, . . . 219 
113. Serratus Superior Posticus, 220 
114. Serratus Inferior Posticus. 
115. Levatores Costarum. 
116. Intercostales. . 221 
117. Triangularis Sterni, or Ster- 
no-costalis. 
MUSCLES OF THE HEAD, NECK, 
AND TRUNK. 
Muscles of the Head and Neck. 
118. Splenius, . . 222 
119. Complexus, . . 223 
120. Trachelo-mastoideus. 224 
121. Rectus Minor. 
122. Rectus Major. 
123. Obliquus Superior, . . 225 
124. Obliquus Inferior. 
Muscles of the trunk. 
125. Quadrants Lumborum. 
126. Longissimus Dorsi, 226 
127. Sacro-Lumbalis. 
128. Cervicalis Descendens, 227 
129. Transversalis Colli. 
Arrangement of the intricate Set 
of Muscles filling up the Hol- 
lows and Interstices among 
the Spines and Processes of the 
Vertebra:. • • 228 
130. Spinalis Cervicis. 
131. Spinalis Dorsi, . . 229 
132. Semi-spinalis Dorsi. 
133. Mullifidus Spinse. XIV 
CONTENTS. 
Page 
153. Musculus Coccygeus, . 244 
Perinaeum,—the Point where all these 
Muscles are united, . . . 245 
Course of the Incision in Lithotomy. 
Muscles of the Female Perinaeum. 
MUSCLES OF THE THIGH, LEG, 
AND FOOT. 
MtlSCLKS MOVING THE THIGH-BONE. 
General Description of the Muscles,— 
Classification and Arrangement of 
them,— and Table of their Implan- 
tations, and of the Motions which 
they perform. 
Fascia of the Thigh, . . .246 
154. Musculus Fascialis, or Tensor 
Vaginae Femoris, . . 248 
155. Psoas Magnus. 
156. Psoas Parvus, : . * 249 
157. Iliacus Internus. 
158. Pectineus, or Pectinalis, - 250 
159 1 riceps Femoris. 
1. Adductor Longus. 
2. Adductor Brevis, - . 251 
3. Adductor Magnus, 
169. Obturator Externus. 
161. Gluteus Maximus, . . 252 
162. Glutaeus Medius, or Minor. 
163. Gluteus Minimus, . . 253 
165. i Gemini’ 
166. Pyriformis. 
167. Obturator Internus. 
168. Quadratus Femoris, . . 254 
Motions of the Thigh, and Action of 
these Muscles. 
Muscles of the Leg, . , . 255 
Arrangement of these Muscles. 
i. Extensors of the Leg. 
169. Rectus Femoris, or Rectus Cru- 
ris, .... 256 
170. Cruraeus. 
Sub-crur*i, being Slips only of the 
Crurfeus. 
171. Vastus Externus, . . 257 
172. Vastus Internus. 
Uses of these Muscles. 
ii. Flexors of the Leg, . . 258. 
173. Sartorius. 
174. Gracilis, or Rectus Internus 
Femoris, .... 259 
175. Semitendinosus. 
176. Semimembranosus. 
177. Popliteus, . • - 260 
178. Biceps Cruris. 
Fascia, .... 261 
Muscles of the Foot. 
Arrangement. 
i. Extensors. 
179. Gastrocnemius. 
180. Soleus, .... 262 
181. Plantaris. 
182. Peronoeus Longus, . 263 
183. Peronaeus Brevis. 
184. Peronaeus Tertius, ■ . 264 
ii. Flexors. 
185. Tibialis Posticus. 
• 186. Tibialis Anticus, 265 
Page 
134. Inter-spinalis Colli, Dorsi, et 
Lumborum, . . . 230 
135. Inter-transversales. 
Muscles on the fore part of the 
Head and Neck, completing the Ca- 
talogue of those belonging to the spine. 
136. Rectus Internus Capitis Major 
137. Rectus Internus Capitis Minor. 
138. Rectus Capitis Lateralis. 
139. Longus Colli. 
140. Scalenus, . . . 231 
OF THE MUSCLES OF THE AB- 
DOMEN, AND OF THE DIA- 
PHRAGM. 
Muscles of the Abdomen, . . 232 
Importance of the Anatomy of the Ab- 
dominal Muscles,—General Expla- 
nation of these Muscles,—their Uses, 
—Arrangement. 
141. Obliquus Externus, . . 233 
142. Obliquus Internus, 
143. Transversalis Abdominis. 234 
144. Recti. 
145. Pyramidalis, . - 235 
Explanation of the Lines, Rings, 
&c. of the Abdominal Muscles. 
1. Linea Alba. 
2. Linea Semilunaris. 
3. Sheath for the Rectus. 
4. Umbilicus, . . 236 
5. Ring of the Abdominal 
Crescent. 
146. Cremaster Muscle of the Tes- 
ticle. . - • , ■ 237 
6. Ligament of the Thigh. 
Explanation of the different Kinds 
of Hernia, and the Points at 
which the Bowels are protru- 
ded, .... 238 
Diaphragm. 
147. The Diaphragm. 
1. The Greater or Upper Muscle 
of the Diaphragm, . 239 
2. The Lesser Muscle of the Dia- 
phragm. 
3. The Tendon in the Centre of 
the Diaphragm. 
Vessels perforating the Diaphragm, 240 
1. Aorta. 
2. (Esophagus. 
3. The Great Vena Cava. 
The Tendon of the Diaphragm. 
Uses of the Diaphragm. 
THE MUSCLES OF THE PARTS 
OF GENERATION, AND OF THE 
ANUS, AND PERINAEUM. 
General idea of these Muscles, 241 
Fascia, or Aponeurosis. 
148. Erector Penis. 
149. Transversalis Perinaei, 242 
150. Ejaculator. 
151. Sphincter Ani. 
152. Levator Ani. CONTENTS. 
XV 
Page 
Mvscles of the Toes, 265 
187. Flexor Longus Pollicis. 
188. Flexor Longus Digitorum Pe- 
dis, Perforans, • . 266 
189. Massa Carnea J. Sylvii, or, 
Plant* Pedis, . . 267 
190. Flexor Brevis Digitorum, 
191. Lumbricales 
Extensors of the Toes, . . 268 
192 Extensor Longus Digitorum 
Pedis. 
193 Extensor Digitorum Brevis. 
194. Extensor Pollicis Proprius, 269 
Crucial Ligament. 
195. Abductor Pollicis, 1 
196. Flexor Brevis Pollicis, > 270 
197. Adductor Pollicis. 1 
198. Transversalis Pedis. 
199. Abductor Minimi Digiti, . 271 
200. Flexor Brevis Minimi Digiti 
201. Interossei Interni. 
202. Interossei Externi. 
Fascia of the Leg. 
Plantar Aponeurosis, . - 272 
Page 
OF THE MUSCULAR POWER. 273 
OF THE CELLULAR SUBSTANCE, AND OF 
THE TENDONS, LIGAMENTS, BURSjE, 
AND FASCIA, AND ALL THE PARTS 
WHICH BELONG TO THE BONES OR MUS- 
CLES, OR WHICH ENTER INTO THE CON- 
STITUTION OF A JOINT, 280 
General Explanation of the Tendons, Li- 
gaments, &c. 
Of the Forms of the Cellular Sub- 
stance. ' 
1. Its Cells, and their Use. 
2 Bursa Mucosa, . . 281 
3. Vagina, or Fascia. 
4. Tendons. 
5. Periosteum, . . 282 
6. Vagina, or Sheaths of Ten- 
dons. 
7. Capsules of the Joints, 283 
6. Ligaments of Joints. 
Recapitulation and Review of the Connex- 
ions of these Parts. 
Constitution and Nature of those less sen- 
sible Parts, .... 285 
Joints of the Head and Spine, . 287 
The Motions of the Head and Spine. 
The Provisions of these Motions, . 288 
i. Joint of the Head with the Neck. 
1. Articulation of the Occiput and 
Atlas. 
Form of the Joint and Capsules for 
the Condyles. 
2. Flat membranous Ligament from 
the Ring of the Atlas to the 
Ring of the Occipital Hole, 289 
3. Articulation of the Atlas with the 
Dentata. 
Capsules betwixt the Condyles of 
the Vertebra. 
Transverse Ligament embracing 
the Neck of the Tooth-like pro- 
cess—Capsular Ligament. 
Ligament betwixt the Tooth-like 
Process and Occipital Hole, 
ii. Joints of the Commou Vertebrae 
with each other. 
Intervertebral Substance, and 
Intervertebral Ligaments. 
External or Anterior Vagina, or 
Ligament of the Spine. 
Internal Ligaments, 
Ligamenta Subflava Crurum 
Processuum Spinosorum — 
Membranae Interspinales— 
Ligamenta Processuum 
Transversorum. 
Posterior or Internal Liga- 
ment of the Spine. 
Apparatus Ligamentosus Colli. 
Joint of the Lower Jaw, . . 290 
Ligaments of the Jaw, . . 291 
Ligaments of the Vertebral Column. 
Ligaments seen on making the Sec- 
tion of the Spine. 
OF THE JOINTS. 
Ligaments betwixt the Head and Up- 
per Vertebrae, 291 
Joints of the Ribs, . . . 292 
Ligamenta Capitelli Costarum. 
Ligamentum Transversarium Exter- 
num. 
Inter- 
num. 
Capsule and Ligaments belonging to 
the Cartilages. 
Ligaments betwixt the Rib and the 
Spine. 
Anterior Extremity of the Ribs and 
Sternum. 
JOINTS OF THE SHOULDER, ARM, 
AND HAND. 
Joints of the Clavicle, . . 293 
With the Sternum. 
With the Scapula. 
Joint of the Shoulder, . . 294 
Ligaments about the Shoulder, . 295 
Joint of the Elbow. 
Interosseous Ligament. 
Chorda Transversalis Cubiti. 
Ligaments of the Elbow Joint, 296 
The General Capsule of the whole Joint. 
The Lateral Ligaments, External and 
Internal. 
The Coronary Ligament of the Ulna. 
Wrist, .... 297 
Articulation of the Scaphoid and Lu- 
nated Bones with the Scaphoid Ca- 
vity of the Radius. 
Articulation of the Radius with the 
Ulna for the turning Motions of the 
Hand, ... 298 
Articulation of the Bones of the Car- 
pus with each other. XVI 
Page 
Articulations of the Metacarpus, 299 
Recapitulation of Ligaments. 
Joints of the Fingers. 
JOINTS OF TIIE THIGH, LEG, AND 
ANCLE. 
The Hip-Joint, . - . 300 
The Ligamentum Labri Cartilaginei 
Transversale. 
The Capsule of the Joint, . 301 
The Internal Ligaments. 
Recapitulation of Ligaments, . 302 
Knee-Joint. 
1. The External Ligaments. 
Capsule—and Ligamentum Posti- 
cum Winslowii, . • 303 
Lateral Ligaments. 
Ligamentum Laterale Internum. 
Externum Longius. 
Brevius. 
1. The Internal or Crucial Ligaments 
of the Knee. 
Posterior Crucial Ligament. 
Anterior , . 304 
Semilunar, or movable Cartilages. 
Ligamentum Mucosum—and Liga- 
mentum Alare Majus et Minus. 
LigamentaCartilaginurn Lunatarum, 305 
Ligamentum Transversale Com- 
mune. 
Burs® Mucos® of the Knee-Joint. 
Recapitulation, explaining the Consti- 
tution of this Joint, and Uses of its 
several Parts, . . . 306 
List of the Ligaments of the Knee- 
Joint, .... 307 
CONTE NTS, 
Page 
Articulation of the Fibula With the 
Tibia, 307 
Ancle-Joint. 
Ligamentum Superius Anticum, 308 
Posticum. 
Inferius Posticum. 
Capsule. 
Ligamentum Deltoides. 
Fibulae Anterius. 
- ■ - — Perpendiculare. 
Inter Fibulam of Astra* 
galum. 
Posterius. 
Recapitulation of Ligaments, . 309 
Union betwixt the Bones of the Tarsus. 
Joints of the Metatarsus and Toes. 
Aponeurosis Plarftaris Pedis. 
Bursae Mucosae of the Ancle and 
Foot, ... 310 
Conclusion and Enumeration of the 
Joints. 
Enumeration of the Burs® Mucosae, 311 
OF TIIE CIRCULATING SYSTEM* 
Qualities of the Blood, . 313 
Of the Red Globules. 
Coagulable Lymph, . . 315 
Serum, .... 316 
Life of the Blood. 
Chemistry of the Blood, . 317 
Influence of Air upon the Blood. 
1. In reddening the Blood. 
2. In communicating its stimulant 
Powers. 
3. In communicating Heat to the 
Body. 
Of the Heat of the Blood, . 322 
OF THE 
HEART, ARTERIES, AND VEINS. 
OF THE HEART. 
OF THE MECHANISM OF THE HEART. 
General View of the Circulating Sys- 
tem, .... 324 
Of the Parts of the Heart, . 329 
Ven® Cav®, . . . 330 
Right Sinus of the Heart. 
Tuberculum Lowed, . . 331 
Auricle. 
Auricular Valves. 
Right Ventricle, . . 332 
Pulmonic Artery, . . 333 
Sigmoid Valves. 
Left Auricle, . . . 334 
Semilunar Valves of the Aorta, 336 
Aorta. 
Of the Coronary Vessels, . . 336 
Eustachian Valve, . . . 340 
Irritability and Action of the 'Heart, 344 
Posture of the Heart, . . 348 
Pericardium, . . . 350 
Conclusion, . . . 355 
Of the Respiration of Animals, 356 
Of the Membranes of Cavities, and 
particularly of the Membranes of the 
Thorax, ... . . 3 57 
Of the Pleura, .... 359 
Of the Mediastinum, . . 361 
" Of the Pericardium, . . 364 
Of the Thvmus Gland. CONTENTS. 
XVII 
Page 
Of the Lungs, . . • 36i 
Of the Trachea, or Aspera Arteria, 366 
Bronchi*, . . . 367 
Bronchial Cells. 
Other Tubes or Vessels which enter 
Page 
into the texture of the Lungs, 368 
Course of the Blood of the Lungs, 369 
Introduction to the Study of the 
Circulatory System, . . 373 
RESPIRATION, continued. 
OF RESPIRATION, OR THE MANNER IN WHICH THE OXYDATION OF THE 
BLOOD IS ACCOMPLISHED IN VARIOUS ANIMALS. 
History of Opinions concerning the Mo- 
tions of the Lungs, . . . 379 
Different Species of Respiration. 
1. By a Diaphragm, . . . 381 
2. Respiration of Birds, . . 382 
3. Amphibia, . 385 
4. Fishes, . ■ 383 
5. Insects, • . 391 
6. Of the Motions of the Thorax, and 
of Respiration in Man, . 395 
OF THE PECULIARITIES IN THE 
CIRCULATION OF THE FCETUS. 
General View of the Peculiarities in the 
Anatomical Structure of the Foetus, 397 
Ductus Venosus, .... 398 
Foramen Ovale, . . . . 400 
Ductus Arteriosus, . . • 403 
Explanation of the Circulation of the F oe- 
tus. 
Critique of Opinions upon this Subject, 405 
OF MALCONFORMATIONS OF THE 
HEART. 
Of Malconformations of the Heart and 
Arteries, • . . . . 408 
Of the Effects of these Malconformations, 411 
Consequences from Malconformation of 
the Lungs, and their diseased condi- 
tion, .... 416 
OF THE ARTERIES. 
Structure of the Arteries, ■ 419 
Sheath of the Artery. 
External Coat, . ' . . 420 
Muscular Coat. 
Internal Coat. 
Vasa Vasorum, . . • 421 
Cellular Coat. 
Of the Motion of the Blood through 
the Arteries. 
General Pran of the Arteries, . 425 
Aorta. 
Right Subclavian, . 426 
Carotids. 
Left Subclavian. 
Thoracic and Abdominal Aorta, . 428 
Internal lliacs. 
External lliacs, . . . 429 
OF THE ARTERIES OF THE HEAD. 
Of the Carotid Arteries in general. 
General View of the Anatomy of the 
Carotid Artery, . . . 430 
External Carotid Artery, and Ar- 
rangement of its Branches, . 432 
1. Order, going forward to the Thy- 
roid Gland, Tongue, and Face. 
1. Arteria Thyroidea, . 433 
2. Arteria Lingualis, . 434 
3. Arteria Labialis, . . 435 
2. Order, going backward from the 
External Carotid, . . 437 
4. Pharyngea Inferior. 
5. Arteria Occipitalis, . 438 
6. Arteria Posterior Auris, . 439 ] 
3. Order, including- the Termina- 
tion of the External Carotid 
in the Temporal and Maxillary- 
Arteries, . . . 441 
7. Arteria Maxillaris Interna. 
8. Arteria Temporalis, • 445 
Conclusion, . . • 447" 
Of the Arteries of the Brain, Spinal 
Marrow, and Eye, . . 448 
Of the Arteries of the Brain. 
Internal Carotid, . . 451 
Division of it, . . • 452 
1. Arteria Media Cerebri, . 453 
2. Arteria Anterior Cerebri, . 454 
3. Arteria Communicans. 
Vertebral Artery, . . . 455 
1. Arteria Cerebelli Posterior, . 456 
2. Anterior, . 457 
3. Cerebri Posterior. 
Of the Arteries of the Spinal Marrow, 458 
1. Arteria Anterior Medull® Spina- 
lis 459 
2. Posterior, . . ' 460 
Arteries of the Eye. 
Arteria Lachrymalis, . • 461 
Arteria Centralis Retinae. 
Arteria Ciliares, . • • 462 
Arteria Muscularis Superior, . 464 
Inferior. 
Arteria iEthmoidalis Posterior. 
— Anterior, . 465 
Arteria Supra-orbitalis. 
Arteria: Palpebrales, • • 466 
. — Nasalis. 
Frontalis. XVIII 
CONTENTS. 
Page 
Conclusion, . 467 
OF THE ARTERIES OF THE ARM. 
I. Of the Subclavian Artery, . 470 
1. Arteria Mammaria Interna. 
2. Thyroidea Inferior, . 472 
3. Vertebralis, . 473 
4. Cervicalis Profunda. 
5. Cervicalis Superficialis, 474 
6. Intercostalis Superior. 
7. Supra scapularis, . 475 
II. Of the Axillary Artery, . 477 
1. Arteria Thoracica Superior. 
2. . Longior. 
3. Humeraria, 478 
4. A laris. 
5. Sub-scapularis, . 479 
6. Circumflexa Posterior, 480 
7. Anterior, 481 
General remarks upon the Axil- 
lary Artery. 
III. Of the Brachial Artery, 482 
1. Arteria Profunda Humeri Supe- 
rior. 
2. Infe- 
rior, . . . 483 
3. Ramus Anastomoticus Major, 484 
IV. Of the Arteries of the Fore Arm, 
viz. of the Radial, Ulnar, and 
Interosseous Arteries, . 485 
Division of the Artery of the Fore Arm, 486 
Arteri* Recurrentes,, . . 487 
Recurrens Radialis Anterior, 488 
Ulnaris Anterior. 
Posterior. 
Interossea, . 489 
Arteria Radialis. 
Arteria Superficialis Vote, . 490 
Dorsalis Carpi, . 491 
Dorsalis Metacarpi. 
— : Pollicis. 
Radialis Indicis, . 492 
Magna Pollicis. 
Pahnaris Profunda. 
Arteria Ulnaris, . . . 493 
Arteria Dorsalis Ulnaris, . 494 
Palmaris Profunda. 
Arteria Interossea, . . 495 
OF THE ARTERIES OF THE THORAX, 
ABDOMEN, AND PELVIS. 
Arteries of the Thorax, . . 496 
Aorta Thoracica. 
* 1. Arteria Bronchialis Communis, 497 
2. Dextra. 
3. — Sinistra. 
4. ■—- —Inferior. 
5. Arteria; (Esophage®, . . 498 
6. Intercostales Inferiores. 
Arteries ok the Abdomen, . 499 
Aorta Abdominalis. 
Arteriae Phrenic®, . . 500 
Arteries of the Stomach, Liver, and 
Spleen, . . 501 
Arteria Coeliaca, 
Page 
1. Arteria Coronaria Ventriculi, 502 
Its Branches. 
2. Arteria Hepatica. 
Its Branches, 503 
3. Arteria Splenica, . . 505 
Its Branches. 
Arteries of the Inthstinks, . 507 
Mesenteric Arteries. 
1. Mesenterica Superior. 
Colica Media, . . 508 
Dextra. 
Ileo-Colica. 
2. Mesenterica Inferior, . 509 
Arteria Colica Sinistra, . 510 
Arlerioe H*morrhoidales. 
Remaining Arteries of the Abdomen, 
viz. to the Kidnies, Testicles, 
&c. . . . 511 
Arteriae Capsulares. 
Renales- 
Arteria Spermatica, . 512 
Arteriae Adipos®. 
Ureteric*. 
Lumbares, . 51S 
Arteries of the Pelvis. 
Arteria Sacro Media, . . 514 
Iliaca Interna. 
Order First, The branches of the Hy- 
pogastric or Internal Iliac Artery, 
which remain within the Pelvis, 515 
Arteria Ileo-lumbalis. 
Sacrae Laterales. 
Hypogastrica, . 51C 
Vesicales. 
Haemorrhoidales. 
H*morrhoidea Media. 
Uterina, . . . 517 
Order Second, of Arteries which go out 
from the Pelvis to the Haunches, 
Hips, and Private Parts. 
Arteria Glut*a. 
Ischiatica, . . 518 
— Pudica Communis, . 519 
Perinaei, . . . 520 
Penis. 
Obturatoria, . . 521 
ARTERIES OF THE LOWER EXTRE- 
MITY. 
Iliaca Externa, . . . 522 
General Description of this Artery. 
Arteria Epigastrica. . . 523 
Arteria Circumflexa Ilii. 
The Femoral, or Crural Artery, 524 
Surgery of the Femoral Artery. 
Branches of the Femoral Arleryr. 
Arteria Profunda Femoris, 526 
Circumflexa Externa. 
— Interna, 527 
——— Perforantes, . . 528 
— Perforans Prima. 
— Secunda Magna. 
——— Terlia. . 529 
»— Quarta. 
Arteria Femoral is, . . 530 
Popliteal Artery, 531 CONTENTS. 
XIX 
, . Page 
Arteria Articularis Superior 
Externa, . . 532 
Arteria Articularis Superior 
Interna. 
— —— Media In- 
terna. 
— ... - Inferior Ex- 
terna, . . . 533 
— - — In- 
terna. 
Arteries of the Leg and Foot, 534 
Arteria Tibialis Antica. 
Page 
Arteria Recurrens, . . 534 
Malleolaris Interna, . 535 
■ - ■■■■■ Externa. 
— Tarsea, . . 536 
Metatarsea. 
Dorsalis Externa Halucis. 
Arteria Tibialis Postica . 537 
■ -— Plantaris Interna, . 538 
Plantaris Externa, . 539 
Peronaea Anterior, . 541 
Posterior, . . 542 
OF THE VEINS. 
General Character of the Veins, 542 
Functions or Uses of the Veins, 546 
Of the Veins, Branches of the Supe- 
rior Vena Cava, . 548 
Of the Veins of the Head and Neck 549 
External Jugular Veins. 
Posterior External Jugular Vein, 550 
Thyroid Veins. 
Internal Jugular Vein. 
Vertebral Veins, . . 551 
Veins of the Arm. 
Vena Cephalica, 
Vena Basilica. 
Vena Mediana, . 553 
Axillary Vein. 
Subclavian Veins. 
The Superior Vena Cava, the Vena 
Azygos, and Lesser Veins of the 
Thorax, . ... 554 
Of the Veins which unite to form 
the Inferior Vena Cava, . 555 
Of the Veins of the Leg and Thigh. 
Saphena Major. 
Saphena Minor, . . 556 
Anterior Tibial Veins. 
Posterior Tibial Veins. 
Venae Peroneae, . . . 557 
Popliteal Vein. 
External Iliac Vein. 
Vena Cava Abdominalis- . 558 
Renal Veins. 
Spermatic Veins. 
OF THE LYMPHATIC AND LACTEAL SYSTEMS 
OF VESSELS. 
Introductory Views, . . 559 
Of the Capillary Vessels. 
Of the Lymphatic System in parti- 
cular, .... 562 
Of the Glands of the Absorbent 
System, .... 563 
Origin of tfoe Lymphatics, and of the 
Doctrines of Absorption, . 564 
Of the Absorption of Solids, . 568 
Examination of some Opinions of Mr. 
Hunter on the subject of Absorption 
of Solids, ... 569 
Of the Cobrse of the Lymphatics, 572 
Of the Foot, Leg, and Thigh, . 574 
Of the Lymphatics of the Arm, 575 
Lymphatics of the Head and Neck, 577 
Of the Trunks ef the Absorbent System, 578 
The Trunk of the Absorbents of the 
Right Side, .... 579 
Of the Lacteals and Lymphatics of the 
Intestinal Canal. 
Origin of the Lacteals, . . 581 
Of the remaining Absorbents of the Solid 
Viscera, .... 583 CONTENTS 
OF 
THE SECOND VOLUME. 
ANATOMY 
OF THE 
BRAIN AND NERVES. 
Page 
Ox the Nervous System, . . 3 
Structure of a Nerve, . . 4 
Sensibility of Nerves, . 6 
Of Ganglions, . , 7 
An Exposition of the Natural Sys- 
tem of the Nerves, ... 8 
Cause of the Complexity of 
Nerves, 10 
The Spinal Marrow, . . 11 
Ot the Nerves which arise from the Spi- 
nal Marrow, . . . 13 
Comparison with the Nerves of the En- 
cephalon. 
Explanation of Plans, . . 18 
Ot the Nervous Circle which con- 
nects the voluntary Muscles with the 
Brain, . . . . . 19 
Of the System of Nerves called Respira- 
. 20 
Introductory View of the Anatomy 
of the Brain, . . .25 
Of the Cineritious Matter of the 
Brain, . . .27 
Of the Cerebellum, . . 29 
Of the Medulla Oblongata, . 30 
Os the Membranes of th • Brain, and of 
the Substance and Texture of the 
Brain itself, . . 31 
Of the Dura Mater. 
Glands of the Dura Mater, 33 
Arteries of the Dura Mater, . 34 
Of the Septa which intersect the 
Brain. 
Of the Sphenoidal Folds, . 35 
Of the Tunica Arachnoidea, . 37 
Of the Pia Mater, . 38 
Of the Substance of the Brain, 39 
Of the Observations made upon the 
Minute Structure of the Brain, 41 
Of the Brain, and principally of the In- 
ternal Parts, . . 43 
Of the Cavities of the Brain in ge- 
neral, , . .44 
Of the Corpus Callosum and Cen- 
trum Ovale of Vieusseus, . 46 
Oi the Septum Lucidum 47 
Pa ge 
Lateral Ventricles. 
Of the Parts seen in the Lateral 
Ventricles, . . 48 
Of the Hippocampi, or Cornua Am- 
monis, and of the Tenia Hippo- 
campi, 49 
Of the Third Ventricle, . 52 
Of the Infundibulum, . 53 
Infundibulum and Pituitary Gland, 54 
The Tubercula Quadrigemina. 
The Pineal Gland, . 5j 
Posterior Commissure, . 56 
Cerebellum. 
Of the Fourth Ventricle, . 57 
Of the Base of the Brain and Ori- 
gin of the Nerves. 
Crura Cere be Hi, . • 59 
Pons Varolii. 
Medulla Oblongata, . • 60 
Medulla Spinalis, . . 61 
Supplementary Observations on the 
Development of the Central 
parts of the Nervous System, 62 
Scheme and general Description of 
the Origin of the Nerves of the 
Encephalon and Spine, . 65 
First Pair, or Olfactory Nerves, 67 
Second Pair, or Optic Nerves. 
Third Pair of Nerves, Motores Ocu- 
lorum. . • 69 
The Fourth Pair of Nerves. 
Fifth Pair of Nerves, Trigemini, “0 
Sixth Pair of Nerves, or Abducentes. 
Seventh Pair of Nerves or Auditory, 71 
Eighth Pair of Nerves, . 72 
Ninth Pair of Nerves, or Lingual. 
The Tenth, or Sub-occipital Nerve, 73 
Of the Veins and Sinuses of the Brain. 
Of the Veins which are seen upon 
the Surface of the Brain, . 74 
Of the Internal Veins of the Brain, 
and of the Choroid Plexus, . 76 
Of the particular Sinuses, . <8 
Superior Longitudinal Sinus. 
Lateral Sinuses, or the first and se- 
cond of the Ancients. . 79 XXII 
Page 
Of the Inferior Longitudinal Sinus, 80 
Of the Internal, Straight, or Fourth 
Sinus, . , . 81 
Posterior Occipital Sinuses. 
The Inferior Lateral Sinuses, . 82 
Of the Lesser Sinuses in the Basis 
of the Skull. 
The Sphenoidal Sinuses. 
The Cavernous Sinus, . 83 
Emissaria Santorini, . . 84 
Of the Particular Nerves, . 86 
The First Pair of Nerves, or Olfac- 
tory Nerves. 
Second Pair, or Optic Nerves, . 87 
Third Pair of Nerves, or Motores 
‘ Oculorum. 
Fourth Pair of Nerves, Trochleares 
or Pathetici, . . 88 
The Fifth Pair, or Trigemini, or 
Grand Sensi tive Nerve of the 
Head. 
The Ophthalmic Branch of the Fifth 
Pair, . . 90 
The Second Branch of the Fifth 
Pair, viz. the Superior Maxillary 
Nerve, ... 92 
Third Branch of the Fifth Pair or 
Lower Maxillary Nerve, . 94 
The Sixth Pair of Nerves, Abdu- 
centes, or Motores Extern i. . 97 
The Seventh Pair of Nerves, . 99 
Further Illustration of the Functions 
of the Nerves of the Face and 
Head, . . 101 
Of the Respiratory Nerves, more par- 
ticularly, viz. The Glosso-Pharyn- 
geal Nerve, Par Vagum, Spinal Ac- 
cessorv, Diaphragmatic Nerve, and 
External Respiratory Nerve. . 107 
Origin of the Respiratory Nerves. 
Of the Muscles of the Trunk, 
which are brought in aid of the 
Common Respiratory Muscles, 108 
Anatomy of the Respiratory Nerves 
of the Par Vagum. . 109 
The Glosso-Pharyngeal Nerve. 
The Par Vagum, . 110 
Comparative View of these Nerves, 115 
The Functions of these Nerves far- 
ther illustrated, . 116 
On the Actions of Respiration in 
CONTENTS. 
. Page 
those who have suffered Fracture 
of the Spine at the Lower Cervi- 
cal Vertebrae, . . .HR 
Further Remarks on the Pathology 
of the Respiratory System of 
Nerves, . • . 122 
Of Smelling, as influenced by the 
Portio Dura of the Seventh Nerve, 124 
These Respiratory Nerves are Or- 
gans of Expression, . 125 
Of the Ninth Pair, Lingualis, or Hy- 
po-glossus, . . . 127 
Of the Cervical Nerves, . 129 
Recapitulation of the Distribution of 
the Cervical Nerves, . 131 
Of the Dorsal Nerves. 
Lumbar Nerves, - . 132 
Sacral Nerves, . . . 133 
Of the Great Ganglionic Nerve, or 
Intercostal Nerve. 
The Superior Thoracic Ganglion, 136 
Sympathetic Nerve in the Thorax. 
Semiluuar Ganglion and Coeliac 
Plexus, . . .137 
Coeliac Plexus. 
Superior Mesenteric Plexus, . 138 
Inferior Mesenteric Plexus. 
Hypogastric Plexus, . . 139 
Functions of the Sympathetic Nerves, 140 
Nerves of the Arm, Axdlary, or 
Brachial Plexus, 
Nerves of the Thigh, Leg, and Foot, 145 
Lesser Nerves which pass out from 
the Pelvis. 
Of the Cutaneous Nerves of the 
Thigh. 
Pudic Nerve, , . . 147 
Nerves of the Lower Extremity. 
Anterior Crural Nerve. 
Obturator Nerve, . . 148 
The Origin of the Ischiatic Nerve, 149 
Of the Lesser Nerves which go out 
of the back Part of the Pelvis. 
Of the Cutaneous Nerves of the 
Back of the Thigh, . . 150 
Of the Trunk of the Ischiatic 
Nerve in the Thigh. 
Tibial Nerve. 
The Plantar Nerves, . . 151 
The Fibular Nerve. 
The Metatarsal Nerves. 
THE SENSES. 
Introduction, • • 154 
Of the Organs of the Senses, 158 
OF THE EYE. 
Introductory View of the Principles 
of Optics, .... 159 
Simple Idea of the Construction of 
the Eye, . . . 163 
Of the Coats of the Eye, . . 169 
Of the Sclerotic Coat. 
Of the Cornea, .... 171 
Of the Choroid coat, . . 173 
Of the Ciliary Processes 175 
Of the Inis, . . . 177 
Of the Muscular Fibres of the Iris, 179 
Of the Retina, and Digression concern- 
ing the Seat of Vision, . . 181 
The Foramen of Soemmerring. 184 
Digression on the Seat of Vision, 185 
Further Observations on the Retina, 188 
Case I. of Nyctalopia, or Night Blind- 
ness, . .191 contents. 
XXIII 
Page 
Case II. of Nyctalopia, . 192 
Of the Membr ana Pupillaris, . 194 
Of the Humours of the Eye, . . 196 
Of the Aqueous Humour. 
The Vitreous Humour, . 199 
Of the Crystalline Lens. 
Of the Capsule of the Lens and Vi- 
treous Humour, . 200 
Action of the Lens on the Rays o! 
Light, . ... . 202 
Of the Distribution of the Central Ar- 
tery and Vein of the Retina. 
Of the V ascularity of the Pellucid Mem- 
branes, . . 204 
Some Surgical Observations connect- 
ed with the Anatomy of the Humours, 206 
Of the Eye-lids, of their Glands, and of 
the Course of the Tears, . . 208 
Of the Secretion and Course of the 
Tears. . . . 209 
Page 
Of the Tensor Tars!, . . 269 
Of the Motions of the Eye-ball and 
Eye-lids, .... 213 
Of the Actions of the Muscles of the 
Eye, and their natural Classification, 215 
Experimental Enquiry into the Action 
of these Muscles, . . 217 
On the two Conditions of the Eye, its 
state of Rest, and of Activity, 219 
Of the Expression of the Eye, and of 
the Actions of the Oblique Muscles 
in Disease, . . . 221 
The Fourth Nerve, . . . 223 
Of the Manner in which the Eve adapts 
itself to the Distance of Objects. 225 
Of Vision, 231 
Parallel Motion of the Eyes, . . 232 
Squinting. . ... 235 
OF THE EAR. 
Of Sound, and of the Ear in general, 237 
General View of the Varieties in the 
Ears of Animals, . . . 239 
Description of the Organ of Hearing 
in particular Animals, . . 243 
In the Lobster and. Crab. 
Of the Ear in Reptiles and Amphi- 
bious Animals, . . 245 
Of the Ear in Birds, . 247 
Of the Human Ear, . . . 248 
Of the External Ear. 
Of the Tympanum, or Middle Cavity 
of the Ear, and its Diseases, . 250 
The Anatomy of the Tympanum. 
Of the Membrana Tympani, 252 
Of the Chain of Bones in the Tym- 
panum. . . 25S 
Connexion and Motion of these 
Bones, . . 254 
Of the Muscles within the Tym- 
panum, . . 255 
Of the Diseasesof the Tympanum, 259 
Of the Labyrinth, . . 261 
Of the soft Parts contained in the 
Labyrinth, . . 266 
Of the Nerve, * . . . 267 
Of Hearing, . . . 268 
Of the Diseases of the Internal Ear, 273 
OF THE NOSE, AND ORGAN OF SMELLING. 
Of the Sense of Smelling, . 275 
OF THE MOUTH, SALIVARY GLANDS, 
THE ORGAN OF TASTE, &c. 
Of the Mouth and Tongue, . . 278 
Of the Salivary Glands. . . 280 
Velum Palatinum, Uvula, Arches of 
the Palate, and A mygdalje, 281 
Of the Sense of Tasting, . 283 
OF THE SKIN, AND SENSE OF TOUCH. 
Of the Skin, . ., 284 
Of the Structure and Growth of the 
Nails, .... 286 
Of the Hairs. 
Rete Mucosum, 287 
Vascular Membrane of the True Skin, 288 
Of the True Skin, . . 289 
Of the Organ of Touch. 
Function of the Skin, 290 XXIV 
CONTENTS. 
ANATOMY 
OF THE 
VISCERA OF THE ABDOMEN. 
INTRODUCTION. 
Page 
view of tub system of the viscera, 
and of the structure of glands, 293 
Of the Abdomen in general, and of the 
Peritoneum, . . . 302 
Of the Regions of the Belly, . 303 
Of the Peritoneum, • • 304 
Of the Omenta, . . . 308 
Of the Viscera of the Abdomen, 311 
Of the (Esophagus, . . 312 
Of the Stomach, . . 314 
Of the Seat, Form, Displacement of the 
Stomach. 
Of the Coats of the Stomach, . . 316 
Of the Pylorus, . . . 318 
Of the Action of the Muscular Coat. 
Of Rumination, . . 320 
Of Vomiting, . . . 321 
Of the Nervous or Vascular Coat, 323 
Of the Villous Coat. 
Of the Gastric Fluid, . . . 324 
OfDigestibn, . . . 325 
Of Hunger and Thirsty . . 326 
Of the Intestines, . . . 328 
Page 
Of the Muscular Coat of the Intestines, 332 
Of the Antiperistaltic Motion, . 334 
Of the Vascular Coat, . • . . 336 
Of the Villous Coat. 
Of the Glands, . . . 337 
Of the Function of the Small Intestines, 338 
Of the Great Intestines, . • 339 
Of the Solid and Glandular Viscera of 
the Abdomen, . . . 345 
Of the Liver. 
Of the Function of the Liver, and of the 
Secretion of the Bile, . . 355 
Case of Absence of the Vena Port*, 357 
Of the Pancreas, . . 359 
Of the Spleen, S61 
Opinions regarding the Use of the Spleen, 363 
Of thp Urinary Organs, . . 366 
Kidney. 
Minute Structure of the Kidney. S68 
Ruysch’s Doctrine, . . 369 
Bertin’s Doctrine, . . 370 
Of the Office of the Kidneys, 372 
Of the Capsul* Renales. 
ANATOMY 
OF THE 
VISCERA OF THE PELVIS. 
Of the Male Parts of Generation, 373 
Of the Parts within the Pelvis. 
Of the Bladder of Urine, . . 374 
Oi the Sphincter of the Bladder, . 375 
Of the Prostate Gland, . . 377 
Further Examination of the Parts hi- 
therto described as seated at the Neck 
of the Bladder—La Trigone de l a 
Vessie—La Luette—Uvula Vesi- 
c/E—Corpora Carnosa Morgagni— 
Third Lobe of the Prostate, &c. 378 
Anatomy of the Neck of the Bladder, 38i» 
Of the PifNis, Urethra, and Testes, 384 
Of the Penis. 
Of the Urethra, .... 386 
Of the Testes, . . . 388 
Of the Female Par?s of Generation, 403 
The External Parts of Generation. 
Of the Parts contained within the Fe- 
male Pelvis, . . . 409 
Of the Bladder of Urine. 
Of the Vagina; of its Shape, Connexions, 
&c 410 
Of the Uterus, . . 412 
Of the Ovaria, . . . 416 
Of the Muscularity of the Uterus, 438 
Of the Mammae, . . . 445 
Explanation of Plates, . . 447 
APPENDIX. 
Of the Foetal Brain, . . 451 
Of Absorption from the Digestive Canal, 457 
Of the Chemical Constitution of the So- 
lids .and Fluids of the Human Body, 464 INTRODUCTION* 
Human anatomy is apart only of a more general science, which 
embraces the knowledge of the structure of all classes of animals, 
from the most simple to the highest; but it is by far the most impor- 
tant part. It should be kept before the anatomist and naturalist, 
as a subject of suitable dignity and usefulness, not only to animate 
their endeavours, but to point them, to give them a direction, and 
to prove a criterion of their success in the pursuit of useful know- 
ledge. On the other hand, human anatomy cannot be highly cul- 
tivated without the assistance of what is called comparative anatomy. 
It cannot be considered a liberal study, nor properly preserved in 
relation to general science, without a continual reference to natural 
history, and the chain of animal existence. 
Whether there be a perfect chain and gradation of existence, 
some will doubt; that is to say, when the naturalist has arranged 
animals according to their exterior appearance, the anatomist de- 
ranges his ideas, by exhibiting, in the internal structure, transitions 
and gradations which he did not contemplate, and principles of ar- 
rangement which he had not foreseen. But this does not contro- 
vert the general principle, that there is a chain of existence through 
the whole of nature. It only throws us back, mortified that we do 
not perfectly comprehend the system ; a conclusion which, how- 
ever humbling, is exactly what man experiences in the pursuit of 
every other department of knowledge, whether the subject of his 
contemplation be the earth he inhabits, the creatures which partake 
it with him, or his own faculties and nature, and his condition in 
creation : and let us make the best of this truth; let us view it as 
promising to us an inexhaustible field for inquiry, and an ever new 
hope of discovery. 
In respect to animals, there are principles in operation, and a 
structure or organization, which extend, with a certain resemblance, 
through the whole. There is a system of parts to give form; there 
is a substance the seat of irritability; there are parts the seat of 
sensibility and enjoyment; and the powers or endowments of those 
parts, however different, are supplied through the same means. 
They have a circulation of fluids more or less perfect (as we use 
the expression;) they receive new matter under the influence of 
Vol.I.—C 18 
IVi'KomJCTIOiV. 
the same appetites ; and they perfect or animalize it, and appro- 
priate it, by similar organs. 
In all the more perfect animals we have a texture of bones, con- 
stituting the skeleton, and giving form and stature ; both bearing up 
the soft parts and protecting them, and at the same time receiving 
the influence, and adjusting the effects, of the contractile parts of 
the body : for the bones are moulded with a regard to the motions 
to be performed, and their shapes give a direction to the efforts of 
the muscles. 
The muscles constitute, properly, the fleshy part of the body. 
They consist of a fibrous texture, and are possessed of a peculiar 
animal and living power of contraction : in them, motion is originated 
by the influence of nerves; and by their operation on the bones, the 
motions and agency of the body are produced. 
The nerves are like white cords, which are every where tracea- 
ble through the where sensibility and motion can be perceived. 
They extend betwixt the brain and the muscular frame, combine 
the muscles in their actions on the bones and joints, and convey to 
them, the influence of the will. 
But these muscles and nerves have powers peculiar to them as 
living parts ; and all living properties are propagated and continued 
through the influence of the circulating blood : so that, although 
in the nerves, muscles, and bones, we see all that is necessary to the 
mechanism of the frame, we find every where accompanying them, 
arteries, veins, and lymphatics, which are necessary to their consti- 
tution as living parts. 
To knit the bones together, and form the articulations, to be a 
bed and proper support for the muscles, to constitute a general 
bond of union betwixt bones, muscles, nerves, and blood-vessels—a 
certain cellular texture is necessary. This common cellular sub- 
stance extends over the whole frame, unites the rudest parts, as the 
bones, and sustains the most delicate vessels, and such as are not 
visible to the naked eye; it constitutes, therefore, a very large pro- 
portion of the body, and is common to all animals. 
Still, in what is here described, we have only the common tex- 
ture of the frame of animal bodies; and, suppose them so consti- 
tuted and possessed of their endowments, to feel or suffer, to re-act 
and to move symmetrically, how are these powers to be continued, 
and the delicate textures to be preserved 1 This consideration leads 
to the second division of the Anatomy, the viscera, the organs for 
the reception and assimilation of new matter. 
To the circumstances of volition and locomotion, are owing the 
necessity for an alimentary canal. The vessels of vegetables, ex- 
tended in their roots, draw nourishment from the soil; but animals 
must have these vessels and absorbing mouths internal, and the nu- 
tritious matter conveyed to them through an intestinal canal. In 
this canal, various processes are performed, suiting the contained INTRODUCTION. 
19 
matter to its new condition, and fitting it to be received into the 
living vessels, and gradually assimilating it to the condition of the cir- 
culating blood. In man, the food requires no preparation but of 
mastication, and is directly carried into a digesting stomach. Di- 
gestion is the first and the most essential change wrought upon the 
food: after that it is sent into the intestines and subjected to the 
operation of certain secreted fluids, which separate, and, as it 
were, refine the pure and nutritious fluid of digestion. It is then 
subjected to the absorbent mouths of the lacteals of the intestines, 
by a process as curious as any to be observed in the animal func- 
tions, and incapable of being explained on the common principles 
of fluids acting on dead matter out of the body. By the lacteals, 
the fluid destined to supply the waste of the body is carried into 
the circulating system. 
The circulating system consists of heart, arteries, and veins, a 
set of tubes continuous throughout, which transmit the blood through 
the whole body. The blood is sent outward by the arteries, and 
returns by the veins, and thus moves in a continual stream, urged 
on by the contraction of the containing tubes and cavities. 
In animals which have a circulation, the blood is a vehicle which 
is constantly receiving from the alimentary canal, what it furnishes 
to all parts of the body for their growth. It is in its distribution to 
the extremities of the arteries that it effects those purposes of nu- 
trition. In the very lowest animals, some physiologists have per- 
suaded themselves that the vessels carry the fluid directly from the 
stomach to the parts of the frame, to nourish them. But in the 
more perfect animals, we know that it is not so. 
The new fluid which has come from the organs of digestion and 
assimilation, is not fit for the purposes of nutrition, until it has 
suffered the influence of the lungs. Nor is the blood, which returns 
from the body by the veins, capable of sustaining the endowments 
or properties which distinguish the different textures as living 
until it be submitted to the same operation. 
Lungs, therefore, are an essential part of the organic functions 
of all living beings. Vegetables, and those animals which have no 
true circulation, respire through the whole of their surface, or they 
have the air admitted into the interior of their bodies through dif- 
ferent foramina, and by air vessels, which accompany the blood- 
vessels in their distribution to the body. It is a beautiful display, 
to see minute tubes distributing air and mingling with those carry- 
ing blood, as if they were as necessary to the health and exercise 
of the living properties : and so it is proved by the survey of 
animated nature, to be in some way essential to the existence of 
life, that the blood and the pure air shall mutually influence each 
other. 
In the more perfect animals, the lungs admit the air in contact 
with the blood : they consist of innumerable cells, having connexion 20 
INTRODUCTION. 
with the wind-pipe or trachea, and by the muscular apparatus of 
the chest or thorax, these cells are expanded and compressed al- 
ternately ; so that the atmospheric air is alternately permitted to 
press or sink into these cells in inspiration, and is again discharged 
in expiration. To the cells of the lungs, a grand division of the 
circulating system of vessels is transmitted: arteries carrying the 
blood to them, and veins returning that blood again to the heart. 
—By means of these vessels the blood in the lungs is exposed to 
the influence of the atmospheric air, and through its influence it is 
purified. 
This is the meaning of what is termed the double circulation, 
and the double heart; for in the higher and warm-blooded animals, 
there is a heart consisting of two cavities for receiving the blood 
from the body and transmitting it to the lungs, and there is another 
heart of two cavities for receiving the blood from the lungs and 
transmitting it to the body. 
These four cavities are tied together by the interlacement of 
their muscular fibres; and their walls being animated by the same 
nerves, are in every respect combined, and subject to the same 
excitement: so that as the principal force of circulation is in the 
heart, (for so we call the union of the four cavities,) the circula- 
tion in the body and the circulation in the lungs are regulated by 
the heart’s excitement, and always correspond. 
The air respired must contain oxygen, or vital air; the air re- 
turned from the lungs is loaded with carbonic acid gas. The blood 
which had received the operation of the oxygen upon it was venous, 
dark coloured, and unfit for the offices of life ; but, on returning 
from the lungs, it has parted with its carbon,—it has become 
purer in colour ; it is the bright vermilion-coloured blood which, 
from its being transmitted through the body by the arteries, is 
called arterial blood. 
No animals respire by a particular organ except those that have 
a real circulation of the blood ; because, in them, the heart and 
vessels are so ordered, that no blood is transmitted to the. body, 
unless the whole or part has been subjected to the offices of the 
lungs and purified, and made capable not merely of conveying the 
nutriment and material of the bodily frame, but also of supporting 
the vital energies, whatever these may be. Whether it is the nerve 
which has to feel, or the muscle to contract, no quality of life can 
be long supported in the organ without the supply and actual con- 
tact of the pure or arterial blood. 
In this introductory survey of the animal economy, we perceive 
that the functions may be divided into three distinct orders. 
We perceive that if animals required no support, and if they 
held an independent existence, the faculties of sensation and mo- 
tion would suffice, and nerves and muscles would constitute the 
whole active frame. These are the functions which anatomists 21 
INTRODUCTION. 
call the animal functions, by which we might suppose the lower 
properties of our nature were meant; but the term is used in con- 
tradistinction to vegetable life, which enjoys neither sense nor 
motion. 
In opposition to the animal functions are the vital functions, by 
which are meant those which serve for the preservation and reno- 
vation of the machine; such as the offices of digestion, absorption, 
circulation, respiration, and the excretions. 
Finally, the duration of each individual is defined and limited. 
There is a continual change and renovation of the frame, an intes- 
tinal motion, a separation and an absorption of its particles, by 
which the body is ever new; but the life, the active principle, suf- 
fers change in infancy, youth, maturity, and the debility of age and 
death. Such is the law of animal existence. By which we see 
the necessity of a system of superadded parts, and a third order of 
functions: organs of generation, by which the individuals that 
perish are replaced by others, and by which the existence of each 
species of animals is maintained. 
On the whole, and surveying what is common to all animals, we 
perceive,—and all men who do not allow their passions to inter- 
fere with their philosophical opinions, must acknowledge,—that 
there is a principle of life which holds those bodies which enjoy it, 
subjected to a different law from inanimate matter; that the prin- 
cipal character of this power is to withdraw the bodies it animates 
from the influence of those mere chemical affinities to which, from 
the multiplicity of their component parts, their mixture, moisture, 
and temperature, they would have a strong tendency, and to which 
they are immediately exposed on death, and whereby their tex- 
tures* are reduced to their original elements. 
* Bichat, the illustrious founder of the science of General Anatomy, classified the ele- 
mentary tissues, from which all the textures of the body are formed, in the following 
manner: 
8 Osseous, 
9 Medullary, 
10 Cartilaginous, 
11 Fibrous, 
12 Fibro-cartilaginous, 
13 Muscular of animal life, 
14 Muscular of organic life, 
15 Mucous, 
16 Serous, 
17 Synovial, 
18 Glandulous, 
19 Dermoid, 
20 Epidermoid, 
21 Pilous. 
1 Cellular, 
2 Nervous of animal life, 
3 Nervous of organic life, 
4 Arterial, 
5 Venous, 
6 Exhalants, 
. 7 Absorbents and their glands, 
General or 
Primitive < 
Tissues. 
Special or 
Secondary 
Tissues. 
The defect of this classification is obviously that of making too many tissues, since seve- 
ral of those above specified are but modifications of the same. Various writers on the sub- 
ject have proposed new classifications. We do not think it necessary to give any other 
than those of Beclard and J. F. Meckel. 
Beclard divides the tissues into 11 classes:—1. cellular and adipous; 2. serous mem- 
branes; 3. tegumentary membranes; 4. vascular system; 5. glands; 6. ligamentous 
tissue; 7. cartilages; 8. osseous system; 9. muscular system; 10. nervous; 11. acci- 
dental productions. 
Meckel makes ten elementary tissues:—1. the mucous; 2. the vascular; 3. nervous; 
4. osseous; 5. cartilaginous; 6. fibrous; 7. fibro-cartilaginous; 8. muscular; 9. se- 
rous ; 10. dermoid.~J. P. G, S UPPLEMJEN TARY INTRODUCTION. 
THE AMERICAN EDITOR. 
The sentiment expressed by the Author, in the preceding paragraph, itf 
entirely accordant with the definition given by Bichat, in his immortal 
Treatise on Life and Death. From this work we shall here condense 
the excellent observations made in relation to the two remarkable modi- 
fications of life, termed by him, animal and organic. 
Life is the sum of the functions which resist death. The measure of 
life being in general the difference which exists between the effort of ex- 
ternal agents, and that of the internal resistance; the excess of the former 
announces the feebleness of life; the predominance of the latter is the 
index of its strength. 
Such is life considered in the aggregate ; but examined in detail, it ex- 
hibits two remarkable modifications; one of which is common to vegeta- 
bles and animals, the other belonging exclusively to animals. The vege- 
table exists only from within, havihg no relation with surrounding bodies, 
except those of nutrition ; it commences, grows, and perishes, fixed to the 
soil that first received the germ. The animal has connected with this 
internal life; which it enjoys in the highest degree, an external life, which 
establishes numerous relations between it and surrounding objects, 
unites its existence with that of all other beings, separates or approaches 
them according to its fears or necessities, and seems, in appropriating to 
itself every thing in nature, to refer the whole to its peculiar existence. 
Hence animal functions form two very distinct classes ; one concerned 
in the actions which assimilate extraneous materials to the sustenance of 
the body, and reject matters which have become effete, constituting the 
internal life. The other which enables it to perceive surrounding ob- 
jects, reflect upon its sensations, move voluntarily according to their influ- 
ence, and most commonly express by the voice, its desires, fears, plea- 
sures or pains. 
The sum of the first class of functions, may be called organic life : 
that of the second we name animal life, because it is the exclusive ak- 
tcibute of the animal kingdom, 24 
SUPPLEMENTARY INTRODUCTION. 
Generation does not enter into the series oi’ phenomena of either oi 
these modifications of life, which relate to the individual; while genera- 
tion refers to the species, and is but indirectly connected with most of 
the other functions; commencing long after the other functions have 
been in operation, and ceasing long before they are discontinued. 
Animal and organic life are both composed of two orders of func- 
tions, succeeding and connected with each other in an inverse manner. 
The first order in animal life, is established from the exterior of the body 
towards the brain. The second from that organ towards those of loco- 
motion and voice. The impression of objects successively affects the 
senses, nerves, and brain. The senses receive, the nerves transmit, and 
the brain perceives the impression, which being thus received, transmit- 
ted, and perceived, constitute our sensations. 
A very exact proportion exists between these two orders of functions ; 
the developement of one being attended by increased energy of the other: 
vividness of sensation being always allied with vivacity of motion. 
A double movement also is in operation in organic life; on e of which 
incessantly composes, and the other decomposes the animal. Hence the 
elements are continually changing, though the organization remains the 
same. The nutritive molecules are successively absorbed, rejected, pass 
from the animal to the plant, thence to dead matter, again return to the 
animal, and are again reabsorbed. To this constant circulation of mat- 
ter, organic life is adapted by two orders of functions. 1st. The assimi- 
lative, consisting of digestion, circulation, respiration, and nutrition. 
2d. The dis-assimilative, absorption, circulation, exhalation, and se- 
cretion. 
The sanguineous system occupies a middle rank, having the molecules 
which are to be assimilated, circulating along with those which have 
already been employed. This system constitutes the centre of organic, 
as the brain is of animal life. There is not the same relation existing 
between the two orders of functions of organic life, as is found between 
those of animal life : the feebleness of assimilation, does not necessarily 
cause diminution of the dis-assimilating actions. 
The marks which essentially distinguish the organs of animal from 
those of organic life, are 1st. The regularity of the organs of animal life. 
The sense of sight is derived from two globes corresponding precisely 
in character ; the sense of hearing from two organs in all respects cor- 
respondent ; and that of smell from an organ of which one portion 
is throughout a copy of the other. The organ of taste is symmetrical, 
being separated by a median line, although covered bv an undivided 
membrane; and the skin, although extended universally over the surface, 
is not deficient in traces of separation, which show that the organ of SUPPLEMENTARY INTRODUCTION. 
25 
touch is formed in an analogous manner. The depressions below the 
nose, middle of the lips and chin ; the navel, raphe of the perineum, pro- 
jection of the spinous processes, and hollowing of the middle of the back 
of the neck, serve to indicate the fact. 
The nerves of the organs of sense, excepting that of touch, are evi- 
dently arranged in symmetrical pairs. The nerves of locomotion, the 
muscles, bones and their dependences, the larynx and its accessories, 
have all a regularity which is never to be mistaken. 
The brain, the organ which receives impressions, is remarkable for the 
regularity of its forms. The parts which are in pairs resemble each other 
exactly, while the central parts are separated by a median line, and are 
perfectly symmetrical. Symmetry is, in fact, so peculiarly the charac- 
teristic of animal life, that the moment the muscular and nervous sys- 
tems become irregular, they no longer pertain to the animal functions. 
The muscular fibres of the heart and intestines, and the irregular distri- 
bution of the trisplanchnic or ganglionic nerve, may suffice in proof of 
this statement. 
2d. The irregularity of the Viscera of organic Life. 
The viscera of organic life are of an entirely opposite character. Of 
the digestive system, the stomach, intestines, spleen, liver, &c. are all 
irregularly disposed. In the circulatory system, the heart, great vessels, 
such as the arch of the aorta, the vense cavae, azygos, vena portae, and 
arteria innominata offer no trace of symmetry. Continual varieties pre- 
sent themselves in the vessels of the extremities, and what is remarkable, 
is, that the irregularities of arrangement on one side are not necessary 
accompanied by irregularity on the other. 
The respiratory apparatus at first sight appears exactly regular. \et 
the right bronchus differs in length, diameter, and direction from the left; the 
right lung has three, while the left has but two lobes. There is an obvious 
difference in volume between the right and leff tong. The pulmonary 
arteries are unlike in their courses and : the mediastinum upon 
which the median line falls, deviates sensibly to the left ; all of which, 
circumstances show, that the con^non 1&W °f irregularity suffers no ex- 
ception in relation to the respiratory organs. 
The organs of exhalation, absorption, the serous membranes, thora- 
cic duct, the great lymphatic vessel, the secondary absorbents of all 
parts, have throng*10111 an unequal and irregular distribution. In the 
glandulou3 system, we see the crypts or mucous follicles distributed 
irregularly in their respective membranes. The pancreas, liver, and even 
the salivary glands, although at first sight more symmetric, are not found 
to be so exactly beneath the median line. The kidneys differ from each 
other by their position, the number of their lobes in the child, the length 26 
SUPPLEMENTARY" IXTRODUCTIOX. 
and size of their arteries and veins, and especially by their frequent 
varieties. 
From all the foregoing observations, it is evident that animal life is dou- 
ble ; that its phenomena executed at the same time on both sides, form 
on each of these sides a system independent of the opposito*system, one 
of which may exist, although the other has ceased to act, being, doubt- 
less, destined reciprocally to supply each other’s place. This we see 
occur in common morbid affections, where the animal sensibility and 
mobility being weakened or entirely suspended in one of the symmetric 
halves of the body, does not preserve any relation with surrounding ob- 
jects. In this case the individual is on one side nothing better than a 
vegetable, while on the other he preserves all the characters of animality, 
by the sense and motion which remain. 
Organic life, on the contrary, forms a single system, where all is allied 
and co-ordinate, where the functions of one side cannot be interrupted 
without necessarily extinguishing those of the other. Disease of the 
left side of the liver, influences on the right, the state of the stomach ; if 
the colon on one side cease its action, the opposition portion must also 
suspend its movements ; the same stroke which arrests the circulation in 
the great venous trunks and right side of the heart, must also check it in 
the left portion and the great arteries. Should all the viscera of organic 
life have their actions suspended on one side, death must inevitably fol- 
low. Nevertheless, this assertion is general, and relative to the aggre- 
gate of organic life, and not to all the insulated phenomena; some organs 
of this system being actually double, and like the lungs and kidneys, being 
able on one side to supply the place of the other. 
The viscera of organic life are not only subject to individual irregulari- 
ties, but frequently the whole of the organs within the chest and abdo- 
men have been found transposed ; those of the right being found on the 
left side, and the com*ary. it is in the viscera of organic life that we 
find by far the greatest nun,qer 0f deviations from the normal structure. 
The actions of the functions of animal life, are characterized by a har- 
mony, equal to their perfect symmeiiy • while the actions of organic life 
are as discordant as the viscera thereto are irregular in their 
conformation. 
The precision of sensation appears to be in proportion to the exact simi- 
larity of the two impressions, of which each is the collection. The right 
is imperfect, when one eye being stronger than the other i& more vividly 
affected, and transmits a stronger image to the brain. It is to avoid this 
confusion, that we close one eye when the other is artificially increased in 
power by a convex glass, which interrupts the harmony of the two organs. 
Yfe have the same effect produced naturally, when in squinting we turn SUPPIiOIJSI'iTARV INTRODUCTION. 
27 
the weaker eye from the object, while the stronger is fixed upon it, and 
thus avoid the inequality of impression. 
The same sort of observation may be extended to all the organs of 
sense; according to their peculiar characters, the harmony of action of 
two symmetric organs, or of two similar halves of single organs, being 
essential to the perfection of sensations. The perfection of the internal 
senses, derived immediately from external sensations, the memory, ima- 
gination, and judgment, depend on the harmony existing between the 
two portions of the brain, in which the nerves of sense terminate. 
Should one hemisphere of the brain be more perfectly organized than 
the other, more developed at all points, and therefore more susceptible of 
vivid impressions, the perception will be confused, for the brain is to the 
intellect what the senses are to the brain. Thus, if the want of harmony 
in the external sensitive system disturbs the perception of the brain, why 
will not the intellect perceive confusedly when two hemispheres of une- 
qual force do not reduce to one, the double impression they have 
received ? 
The opposite of all this harmony of action is to be observed in the 
functions of organic life, and it is sufficient to refer to those of respira- 
tion, circulation, and secretion, to supply multitudes of examples of the 
truth of the statement. 
In the organs of animal life, we see throughout regular alternations of 
activity and repose. The organic functions are continued without inter- 
ruption throughout life, or if at ail suspended, at the hazard of its imme- 
diate destruction. All the secretions are performed without interruption, 
and if some periods of remittance are observed, as in the bile during diges- 
tion, or the saliva during mastication, these periods refer to the intensity 
and not to the entire exercise of the function. Exhalation and absorption 
incessantly succeed each other;—nutrition is never inactive ; the double 
movement of assimilation and disassimilation from which it results lias no 
other limit than that of life. 
The difference between organic and animal life is still farther shown 
by their difference of duration. The functions of organic life commence 
the first actions of the embryon. Animal life cannot be said to begin 
until after birth, unless we suppose that some indistinct sensation of touch 
is caused by the striking of the fetus against the sides of the womb. The 
organic actions, though differing in force and activity from what they 
become at a more advanced age, are nevertheless in constant operation, 
and require but a short time after birth to attain their entire perfection. 
The organs of animal life, after birth, are but just commencing their 
actions, and require a long continued education to arrive at their greatest 
degree of excellence.  28 
sUFPLEMEXTAitV INTRODUCTION. 
The distinction between the two modifications of life continues to be 
kept up in their different periods of decline and extinction. Natural 
death terminates the animal life, nearly altogether, before organic life is 
much impaired. The animal functions fail successively. Sight grows 
feeble, indistinct, and is lost. Sounds affect the ear but slightly and con- 
fusedly until the function is entirely lost. The skin withers, wrinkles, 
has little circulation, and becomes obtuse in its sensibility. Smelling is 
no longer performed, and taste, although it lingers to the last, is at. 
length altogether extinct. With the senses the understanding disappears 
—perception, imagination, memory fade away. Memory, however, 
faithful to the vividness of early impressions, remains capable of recalling 
the past, even when the senses no longer are capable of exciting ideas of 
the present. The aged differ from infants in this; the latter judge 
according to immediate sensations, the former from those heretofore ex- 
perienced. Both conditions are liable to great errors, since both the pre- 
sent and past are equally necessary in our sensations, to the correct- 
ness of judgment; when either is wanting they cannot be compared, and 
the judgment cannot be correct. 
We thus readily perceive, that the external functions, or of animal life, 
are necessarily extinguished in the old man, while the functions of organic 
life continue in activity. In this respect, the state of an animal dying a 
natural death, approaches the state of one in the maternal womb, and 
even to that of a vegetable, which only lives internally, and to which all 
nature is in silence. 
If we now recollect, that sleep retrenches more than one third of the 
duration of animal life, and add to its entire inaction during the first 
nine months, the almost total inactivity to which it is reduced during the 
last period of existence, it will be easy to see how great is the dispro- 
portion existing between the duration of animal and organic life. 
The idea of our last hour is only painful, because, in terminating our 
animal life, it arrests all the functions which place us in relation with sur- 
rounding objects. It is the privation of these functions that scatters fear 
and dread upon the borders of the grave. It is not pain that we fear : 
for how many dying persons would purchase a continuance of existence 
at the price of uninterrupted sufferings ? Observe the animal that lives 
but little, except within, and whose external relations have reference 
solely to his material wants ; the immediate approach of death is accom- 
panied by no uneasiness. 
If it were possible to suppose a man in whom death affecting only the 
internal functions, as circulation, digestion, secretion, &c. would leave 
the whole functions of animal life untouched ; such an individual would 
behold with indifference the approach of the end of organic life ; because SUPPLEMENTARY INTRODUCTION. 
29 
he would be sensible that the good of existence is not attached thereto, 
and that after such a death he would be in condition to feel and enjoy 
nearly all that previously constituted his happiness. 
If animal life cease by degrees, if each of the ties which connect our 
lives with pleasure are successively broken, we relinquish our enjoyments 
without perceiving the loss, and have already forgotten their value when 
we yield to the stroke of death. Thus, the decay of the old man resem- 
bles the perishing of a vegetable, which without external relations, and 
having no consciousness of life, is equally free from the consciousness 
of death. OSTEOGENY. 
ON THE 
FORMATION AND GROWTH OF BONES. 
It is not easy to explain, in their natural order, the various parts 
of which the human body is composed ;* for they 
have that mutual dependence upon each other, that 
continual circle of action and reaction in their va- 
rious functions, and that intricacy of connection and 
close dependence, in respect of the individual parts, 
that as in a circle there is no point of preference 
from which we should begin to trace its course, there 
is in the human body no function so insulated from 
the other functions, no part so independent of other 
parts, as to determine our choice. We cannot begin 
without hesitation, or hope to proceed in any perfect 
course ; yet, from whatever point we begin, we may 
so return to that point, as to represent truly this 
consent of functions, and connection of parts, by 
which it is composed into one perfect whole. 
As dead parts, the bones are the most permanent, unchangeable 
parts of all the body ; while as living parts, and partaking in the laws 
of the living system, their substance changes continually. We 
see them exposed to the seasons, without suffering the smallest 
change; remaining for ages the memorials of the dead; the evi- 
dence of a former race of men, or of animals which have ceased to 
exist since the last great revolution of our globe ; the proofs of such 
changes on our globe as we cannot trace but by these uncertain 
marks. It is from such circumstances that we are apt to conceive, 
that even in the living body, bones are hardly organized, scarcely par- 
taking of life, not liable, like the soft parts, to disease and death. 
But minute anatomy, the most pleasing part of our science, unfolds 
and explains to us the internal structure of the bones ; shows their 
* This figure represents the skeleton of the arm of the foetus; it is dried, and 
while the cartilages have shrunk and become of a dark colour, the portions of the 
bones which have begun to form are visible in the scapula, clavicle, humerus, radius, 
and ulna, the metacarpal bones, and some of the phalanges of the fingers. 32 
OF THE FORMATION 
myriads of vessels, and proves them to lie as full of blood as the most 
succulent and fleshy parts, and as subject to change ; having, like 
them, their periods of growth and decay ; that they are more liable 
to accidents, and as subject to internal disease. 
The phenomena of fractured bones first suggested some indistinct 
notionsof the way in which bone might be formed. It was observed, 
that in very aged men, a hard crust was often formed upon the 
surface of the bones ; that the fluid exuding into the joints of gouty 
people, sometimes coagulated into a chalky mass. Le Dran had 
thought that he had seen in a case of scrophulous bone, an exuda- 
tion which flowed out like wax, and hardened into perfect bone. 
Daventer that he had seen the juice exuding from a split in a bone, 
coagulate into a bony crust; and they thought it particularly well 
ascertained, that callus was but a coagulable juice, which might bo 
seen exuding directly from the broken ends, and which gradually 
coagulated into hard bone. The best physiologists did not scruple 
to believe, that bones, and the callus of broken bones, were formed 
of a bony juice, which was deposited by the vessels of the part, and 
which passing through all the successive conditions of a thin uncoag- 
ulated juice, of a transparent cartilage, and of soft and flexible bone, 
became at last, by a slow coagulation, a firm, hard, and perfect 
bone, depending but little upon vessels or membranes, either for its 
generation or growth, or for nourishment in its perfect state. This 
opinion, erroneous as we now know it to be, once prevailed ; and if 
other theories were at that time proposed, they did not vary in any 
very essential point from this first notion. De Heide, a surgeon of 
Amsterdam, believed that bone or callus were not formed from a co- 
agulable juice, but from the blood itself. He broke the bones of 
animals, and, examining them at various points of time, he never 
failed (like other speculators) to find exactly what he desired to find. 
“ In every experiment,” he found a great effusion of blood among 
the muscles, and round the broken bone; and he as easily traced 
this blood through all the stages of its progress. In the first day red 
and fluid; by and by coagulated ; then gradually becoming white, 
then cartilaginous, an-d at last (by the exhalation of its thinner parts) 
hardening into perfect bone. 
It is very singular, that those who abjure theory, and appeal to ex- 
periments, who profess only to deliver facts, are lelfst of all to be 
trusted ; for it is theory which brings them to try experiments, and 
then the form and order, and even the result of such experiments, 
must bend to meet the theories which they were designed to prove : 
it is by this deception that the authors of two rival doctrines arrive 
at opposite conclusions, by facts directly opposed to each other. 
Du Hamel believed, that as the bark formed the wood of a tree, add- 
ing, by a sort of secretion, successive layers to its growth, the peri- 
osteum* formed the bone at the first, renewed it when spoiled, or 
* The periosteum is a strong fibrous membrane, covering the whole surface of 
the bones except where their articular extremities are tipped with cartilage, and 
having inserted into ft the tendons, ligaments, and aponeurotic expansions. It is in 
infancy soft, thick, and readily separable; in adult life, it is more compact, and 
thinner in texture, adhering firmly to the bones, in consequence of having secreted Veil! 
' d/w ~ -A<- ci/yj 
dY&itrn try t/ie A c/ys *M/7n A/y<4ccdonj 
r i2 
jC+&rny, •be. 
a . lAc . Am r/ /odyed cm, otic h dAs ’d/emacA it-tiei 
c /Ac (JJriArjft t tec Ay od&e? eyzectd AeAd. d lAe /YacAe-ce 
d*e*/ ncAenyr fote/ccrdd dAs /Anya. e e dAe dr*/e A/s nyyys,r/rryAA/y 
Tesy «4'dzc?,AA&.y/'/ccccd dou/n /olAe AAcAArne ./d3 o/Acnytec/2, dsA 
A 4vv crrirncdcc/de conduct undA/Ac AAccnyo Of comm ccncccc/'. ny 
uddA cdi> dAeof/Ctz {cAAi■ dAc AoAj *vce AAA /s/iendnyj dy u 
/Ac yAA corrc-mccndeeide too/AdA An nyd id tcddAone ctncdAei . AND GttOYVTII OP BONES. 
33 
cut away, and when broken, assumed the nature of bone, and re- 
paired the breach. He broke the bones of pigeons, and, allowing 
them to heal, he found the periosteum to be the chief organ for re- 
producing bone. He found that the callus had no adhesion to the 
broken bone, was easily separated from the broken ends whidi re- 
mained rough and bare; and, in pursuing these dissections, he found 
the periosteum fairly glued to the external surface of the new bone ; 
or he found rather the callus or regenerated bone to be but a mere 
thickening of the periosteum, its layers being separated, audits sub- 
stance swelled. On the first days he found the periosteum thick- 
ened, inflamed, and easily divided into many lamellae, or plates ; but 
while the periosteum was suffering these changes, the bone was in 
no degree changed. On the following days, he found the tumour of 
the periosteum increased at the place of the fracture, and extending 
further along the bone ; its internal surface already cartilaginous, and 
always tinged with a little blood, which came to it through the ves- 
sels of the marrow. He found the tumour of the periosteum 
spongy, and divisible into regular layers, while still the ends of the 
bone were unchanged, or only a little roughened by the first layer of 
the periosteum being already converted into earth, and deposited 
upon the surface of the bone: and in the next stage of its progress, 
he found the periosteum firmly attached to the surface of the callous 
mass. By wounding, not breaking the bones, he had a more flat- 
tering appearance still of a proof; for having pierced Jhem with 
holes, he found the holes filled up with a substance, proceeding from 
the periosteum, which was thickened all round them. In an early 
stage, this plug could, by drawing the periosteum, be pulled out 
from its hole : in a more advanced stage, it was inseparably united 
to the bone so as to supply the loss. 
Haller, doubting whether the periosteum, a thin and delicate 
membrane, could form so large a mass of bone or callus, repeated 
the proofs, and he again found quite the reverse of all this : That 
the callus, or the original bone was in no degree dependent on the 
periosteum, but was generated from the internal vessels of the bone 
itself: That the periosteum did indeed appear as early as the cartilage 
which is to produce the bone, seeming to bound the cartilage, and 
give it form ; but that the periosteum was at first but a loose tissue 
of cellular substance, without the appearance of vessels, or any mark 
of blood, adhering chiefly to the heads or processes, while it hardly 
touched the body of the bone. He also found that the bone grew, 
became vascular, had a free circulation of red blood, and that then 
osseous matter from its internal surface. Its fibres, except in the flat bones, are 
commonly arranged according to the length of the bones, the outer layer being 
longer and the inner shorter; fibres appear to pass thence into the bone accompany- 
ing the blood-vessels which enter them from this membrane, making its adhesion 
much stronger. The periosteum receives blood-vessels from the adjacent arteries, 
which divide minutely in its substance, sending the branches just mentioned. The 
lymphatic vessels are few in number, and the nerves must be exceedingly small, as 
no sensibility is evinced by the periosteum, except when injured while in a state of 
inflammation. The uses of this membrane, as may be readily gathered from what 
has been said, is to convey the blood-vessels to and from the bone, regulate the 
growth of the bone, &c.—J. D. G. 34 
OF THE FORMATION 
only the vessels of the periosteum began to carry red blood, or to 
adhere to the bone. We know that the bones begin to form in 
small nuclei, in the very centre of their cartilage, or in the very cen- 
tre of the yet flexible callus, far from the surface, where they might 
be assisted by the periosteum ; and here it is justice to add, that, 
while these questions were agitated on the continent, Dr. William 
Hunter had proved that the callus of broken bones was organized, 
and that the secretion of bone into it proceeded from the arteries 
taking on them a new action, and secreting the earthy matter into 
the first formed subtance. 
Thus has the formation of bone been falsely attributed to a gela- 
tinous effusion, gradually hardened ; or to that blood which must be 
poured out from the ruptured vessels round the fractured bone ; or 
to the induration and change of the periosteum, depositing layer 
after layer, till it completed the form of the bone. 
But when, neglecting theory, we set ourselves to examine, with an 
unbiassed judgment, the process of nature in forming the bones, as 
in the chick, or in restoring them, as in broken limbs, a succession 
of phenomena presents themselves, the most orderly, beautiful, and 
simple of any that are recorded in the philosophy of the animal 
body : for if bones were but condensed gluten, coagulated blood, or 
a mere deposition from the periosteum, they were then inorganized, 
and out of the system, not subject to change, nor open to disease; 
liable, indeed, to be broken, but without any means of being healed 
again ; while they are, in truth, as fully organized, as permeable to 
the blood, as easily hurt, and as easily healed, as sensible to pain,* and 
as regularly changed as the softer parts are. We are not to refer 
the generation and growth of bone to any one part. It is not formed 
by that jelly in which the bone is layed, nor by the blood which is 
circulating in it, nor by the periosteum which covers it, nor by the 
medullary membrane with which it is lined ; but the whole system 
of the bone, of which these are parts only, is designed and planned, 
is laid out in the very elements of the body, and goes on to ripeness, 
by the concurring action of all its parts. The arteries, veins, and 
lymphatics, exist in the cartilage or the membranes, before bone 
is formed. At a certain regular period, the arteries, by a deter- 
mined action, deposite the bone; which is formed commonly in a 
bed of cartilage, as the bones of the leg or arm are; sometimes be- 
twixt two layers of membrane, like the bones of the skull, where true 
cartilage is never seen. 
My readers understand that cartilage is a substitute for bone in 
the early months of the foetus ; that at a regulated period in each 
bone, at a given point, and in a perfectly regular manner, portions 
of the cartilage are absorbed, and bone deposited. 
This cartilage never is hardened into bone; but, from the first, it 
is in itself an organized mass. It has its vessels, which are at first 
transparent, but which soon dilate ; and whenever the red colour of 
the blood begins to appear in them, ossification very quickly fol- 
* The obscurity on this subject is from the neglect of defined terms. We shall 
presently see that the sensibility possessed by the bones, and the kind of pain to which 
tliey»are subject, differs from the sensibility and pain of the skin and soft parts. and growth of bones. 
35 
lows.* The first mark of ossification is an artery, 
which is seen running into the centre of the car- 
tilage, in which the bone is to be formed. Other 
arteries soon appear, overtake the first, mix with 
it, and form a net-work of vessels; then a centre 
of ossification begins, stretching its rays according 
to the length of the bone, and then the cartilage 
begins to grow opaque, yellow, brittle ; it will 
no longer bend, and the small nucleus of ossifica- 
tion is felt in the centre of the bone, and when 
touched with a sharp point, is easily known by 
its gritty feel. Other points of ossification are 
successively formed; always the ossification is 
foretold by the spreading of the artery, and by the 
arrival of red blood. Every point of ossification 
has its little arteries, and each ossifying nucleus 
has so little dependence on the cartilage in which 
it is formed, that it is held to it by vessels only; and 
when the ossifying cartilage is cut into thin slices, 
and steeped in water till its arteries rot, the nu- 
cleus of ossification drops spontaneously from the 
cartilage, leaving the cartilage, like a ring, with a 
smooth and regular hole where the bone lay. This is because the 
cartilage was a substitute for the bone, and, because preparatory to 
the formation of the nucleus of bone, the cartilage is absorbed, and 
a bed prepared for the new formation. 
The colour of each part of a bone is proportioned exactly to the 
degree in which its ossification is advanced. When ossification be- 
gins in the centre of the bone, redness also appears, indicating the 
presence of those vessels by which the bony matter is to be poured 
out. When the bony matter begins to accumulate, the red colour 
of those arteries is obscured, the centre of the bone becomes yellow 
or white, and the colour removes towards the ends of the bone. In 
the centre, the first colouring of the bone is a cloudy, diffused, and 
general red, because the vessels are profuse. Beyond that, at the 
edges of the first circle, the vessels are more scattered and asunder, 
distinct trunks are easily seen, forming a circle of radiated arteries, 
which point towards the heads of the bone. Beyond that, again, 
the cartilage is transparent and pure, as yet untouched with blood ; 
the arteries have not reached it, and its ossification is not begun. 
Thus, a long bone, while forming, seems to be divided into seven 
various coloured zones. The central point of mo3t perfect ossifica- 
tion is yellow and opaque. On either side of that, there is a zone 
of red. On either side of that, again, the vessels being more spa- 
ringly distributed, form a vascular zone, and the zone at either end is 
* This figure represents the tibia of a foetus cut through. The central part (dia- 
physis) is already bony; but the extremities are yet cartilage. The red blood is, 
however, entering the arteries and veins in the cartilaginous extremities; and the 
black spots in the midst of the cartilage mark the beginning of ossification, and for- 
mation of the epiphysis. 36 
OF TIIE FORMATION 
transparent cartilage.* The ossification follows the vessels, and 
buries and hides those vessels by which it is formed: The yellow and 
opaque part expands and spreads along the bone: The vessels ad- 
vance towards the heads of the bones: The whole body of the bone 
becomes opaque, and there is left only a small vascular circle at 
either end ; the heads are separated from the body of the bone by a 
thin cartilage, and the vessels of the centre, extending still towards 
the extremities of the bone, perforate that cartilage, pass into the 
head of the bone, and then its ossification also begins, and a small 
nucleus of ossification is formed in its centre. Thus the heads and 
the body are, at the first, distinct bones formed apart, joined by a car- 
tilage, and not united till the age of fifteen or twenty years. 
Now we know the difference of apophysis, and epiphysis, for ana- 
tomists make a sort of juggle betwixt these names, as if they were 
engaged in important matters. The apophysis is a process, or pro- 
jection of bone. The epiphysis is the distinct portion of the bone, 
which is formed in a distinct nucleus of bone, and becomes afterwards 
joined and incorporated with the main body of the bone, and may 
then be described as an apophysis. 
It is more important a great deal to observe, that as the extremi- 
ties of the long bones forming the articulations are joined to the bo- 
dies or shafts by cartilage in childhood and adolescence, they are 
subject to be torn off, and to present a very puzzling case, that is, a 
fracture without crepitus ; for as the crepitus of the fractured bone 
arises from the irregularity of the broken ends, and as in this sort of 
fracture [or diastasis] the surfaces are smooth, the surgeon is liable 
to be deceived, and the patient to permanent lameness and distor- 
tion. I have some specimens in my museum of this accident. 
The vessels may be seen entering in one large trunk (the nutritious 
artery) into the middle of the bone.t From that centre they ex- 
tend towards either end, and the fibres of the bone extend in the 
same direction ; there are furrows betwixt the rays, and the arteries 
run along in the furrows of the bone, as if the arteries were forming 
these ridges, secreting and pouring out the bony matter, each artery 
piling it up on either side to form its ridge; yet tli6 arteries of a 
bone branch with freedom, and with the same seeming irregularity 
as in other parts of the body. The arteries do not exude their se- 
cretion from their sides, so as to pile up the ridge of bone in their 
* It is curious to observe how completely vascular tlie bones of a chicken are be- 
fore the ossifications have fairly begun ; how the ossifications being begun, overtake 
the arteries, and hide them, changing the transparent and vascular part of the bone 
into an opaque white; how by peeling off the periosteum, bloody dots are seen, 
which show a living connexion and commerce of vessels betwixt the periosteum and 
the bone ; how by tearing .up the outer layers of the tender hone, the vascularity of 
the inner layers is again exposed, and the most beautiful proof of all is that of our 
common preparations, where, by filling with injection the arteries of an adult bone, 
by its nutritious vessels, and then corroding the bone with mineral acids, we dissolve 
the earth, leaving nothing but the transparent jelly, which restores it to its original 
cartilaginous state: and then the vessels .appear in such profusion, that the bone may 
be compared in vascularity with the soft parts, and it is seen that its arteries were not 
annihilated, but its high vascularity only concealed by the deposition of the bony 
parts. 
t This is an important, point of demonstration, because the artery, though small, 
acquires importance from its place. See Demonstration of the Femur and of the 
Tibia. AND GROWTH OF BONES. 
37 
course. The secretion is performed in their very extremities. The 
body of the bone is supplied by its own vessels ; the heads of the 
bone are in part supplied by the extremities of the same trunks which 
perforate the dividing cartilage like a sieve : the periosteum ad- 
hering more firmly to the heads of the bone, brings assistant arteries 
from without, which meet the internal trunks, and assist the ossifica- 
tion ; which, with every help, is not accomplished in many years. 
It is by the action of the vessels that all the parts of the human 
body are formed, fluids and solids, each for its respective use : the 
blood is formed by the action of the vessels, and all the fluids are in 
their turn formed from the blood. We see in the chick, where there 
is no external source from which its red blood can be derived, that red 
blood is formed within its own system. Every animal system, as it 
grows, assimilates its food, and converts it to the animal nature, and 
so increases the quantity of its red blood : and as the red blood is thus 
prepared by the actions of the greater system, the actions of particu- 
lar vessels prepare various parts : some to be added to the mass of 
solids, for the natural growth ; others to supply the continual waste, 
or to allow new matter to be received; others to be discharged 
from the body as effete and hurtful, as the secretions into the intes- 
tines, and from the kidney and from the skin ; others again to perform 
certain offices within the body, as saliva, bile, or pancreatic fluid. 
Thus the body is furnished with various apparatus for performing 
various offices, and for repairing the waste. These are the secre- 
tions, and the formation of bone is one of these. The plan of the 
whole body lies in the embryo, in perfect order, with all its forms 
and parts. Cartilage is laid in the place of bone, and preserves its 
form for the future bone, wfith all its apparatus of surrounding mem- 
branes, its heads, its processes, and its connection with the soft parts. 
The colourless arteries of this pellucid but organized mass of car- 
tilage keep it in growth, extend, and yet preserve its form, and gra- 
dually enlarging in their own diameter, at last receive the entire 
blood.* Then the deposition of earthy matter begins. The bone 
is deposited in specks, which spread and meet and form themselves 
into perfect bone. While the bone is laid by arteries, the cartilage 
is conveyed away by the absorbing vessels; and while they convey 
away the superfluous cartilage, they model the bone into its due form, 
shape out its cavities, cancelli, and holes, remove the thinner parts 
of the cartilage, and harden it into due consistence. 
If the organization of arteries and veins, arteries to deposit bone, 
and absorbents to take up the cartilage, and make room for the os- 
seous matter, be necessary in the formation and growth, it is no less 
necessary for the life and health of the full formed bone. Its natural 
* Previous to the formation of bone, (or the preparation for it) in the cartilage, 
there is no proof of there being vessels in it. But we presume, that the cartilage 
must have vessels, because it grows with the growth of the animal, previous to the 
formation of bone in it. 
However, the change, previous to the deposition of bone, has not been very accu- 
rately noticed : the firm cartilage suffers a change : there is a tract from the circum- 
ference to the centre of it, in which the firm cartilage is dissolved, and in the spot 
where the first particle of bone is to be deposited, there is a little soft well of matter, 
different from the firm substance of the cartilage. 38 
OF THE FORMATION 
condition depends on the regular deposition and re-absorption, 
moulding and forming the parts ; and by various degrees of action, 
bone is liable to inflame, ulcerate, and spoil, to become brittle by too 
much secreted earth, or to become soft by a deficient secretion, or 
by a greedy diseased absorption of its earthy parts. The cartilage is 
in itself a secretion, to which the full secretion of bone succeeds. 
In the re-union of a fractured bone, we have to observe nearly 
the same phenomena which accompany its first formation. 
The first effect is the tearing of the periosteum and surrounding 
cellular textures, and perhaps some part of the muscular substance. 
The consequence of which is, that the broken extremities are sur- 
rounded with coagulum of blood. The extravasated blood being 
absorbed, an effusion is poured out by the vessels of the broken 
bone. This matter is a regular secretion : it appears to the eye 
like a uniform jelly; but so does the embryo itself. It is bone in 
embryo, the membranes and vessels, arteries, veins, and absorbents 
are in it; the arteries of the surrounding parts do not shoot into it, 
but veins, as well as arteries and absorbents, inosculate with the ves- 
sels of this new formed matter ; and whatever vessels may, by ac- 
cidental contact, inosculate with this substance, whether coming 
from bone, muscles, or membrane, still bone is formed, because it is 
the destined constitution of the new formed mass, or rather of the 
vessels which are already in it to form bone. 
If the broken limb be too much moved during the cure, then are 
the secreting arteries interrupted in their office, perfect bone is 
never formed, it remains a cartilage, and an unnatural joint is at 
length produced : but by injuring the bone the vessels are opened 
again, the process is renewed, and the bones unite; or even by rub- 
bing, by stimulating, by merely cutting the surrounding parts, the 
vessels are made active, and their secretion is renewed.* During all 
the process of ossification, the absorbents proportion their action ; 
they remove the cartilage as the bone is laid; they continue re- 
moving the bony particles also, which the arteries continually renew. 
Nothing can be more curious than this continual renovation and 
change of parts, even in the hardest bones. We are accustomed 
to say of the whole body, that it is daily changed; that the older 
particles are removed, and new ones supply their place; that the 
body is not now the same individual body that it was; but it could 
not be easily believed that we speak only by guess concerning the 
softer parts, what we know for certain of the bones. It was disco- 
vered by chance that animals fed upon the refuse of the dyer’s vats, 
received so much of the colouring matter into the system, that the 
bones were tinged by the madder to a deep red, while the softer parts 
were unchanged ; no tint remaining in the ligaments nor cartilages, 
membranes, vessels, nor nerves, not even in the delicate vessels of 
the eye. It was easy to distinguish by the microscope, that such 
colour was mixed with the bony matter, resided in the interstices 
only, but did not remain in the vessels of the bone, which, like those 
of all the body, had no tinge of red; while our injections again fill 
* Those principles become of the utmost importance in the practice of surgery. AND GROWTH OF BONES. 
39 
the vessels of the bone, make all their branches red, but do not af- 
fect the colours of the bony part. When madder is given to ani- 
mals, withheld for some time, and then given again, the colour ap- 
pears in their bones, is removed, and appears again with such a sud- 
den change as proves a rapidity of deposition and absorption, ex- 
ceeding all likelihood or belief. All the bones are tinged in twenty- 
four hours; in two or three days their colour is very deep; and if 
the madder be left off but for a few days, the red colour is entirely 
removed. . ■ ■. . 
This tinging of the bones with madder, was the great instrument 
in the hands of Du Hamel, for proving by demonstration, that it was 
by layers from the periosteum that the bone was formed; and how 
very far the mind is vitiated by this vanity of establishing a doctrine 
on facts, is too easily seen here. Du Hamel, believing that the pe- 
riosteum deposited successive layers, which were added to the bone, 
it was his business to prove that the successive layers would be de- 
posited alternately red, white, and red again, by giving a young 
animal madder, withholding it for a little while, and then beginning 
again to give it. Now, it is easy to foresee that this tinging of the 
lamellae should correspond with the successive times in which the 
periosteum is able to deposit the layers of its substance, but Du 
Hamel very thoughtlessly makes his layers correspond only with the 
weeks or months in which his madder was given or withheld. It is 
easy to foresee also, that if madder be removed from the bones in a 
few days, (which he himself has often told us,) then his first layer, 
viz. of red bone, could not have waited for his layer of white to be 
laid above it, nor for a layer of red above that again, so that he should 
have been able to show successive layers : And if madder can so 
penetrate as to tinge all the bones that are already formed, then, 
though there might be first a tinged bone, then a white and colour- 
less layer, whenever he proceeded to give madder for tinging a third 
layer, it would pervade all the bone, tinge the layer below, and re- 
duce the whole'into one tint. If a bone should increase by layers, 
thick enough to be visible, and of a distinct tint, and such layers be 
continually accumulated upon each other every week, what kind of 
a bone should this grow to ? Yet such is the fascinating nature of a 
theory, that Du Hamel, unmindful of any interruptions like those, de- 
scribes boldly his successive layers, carrying us through regular 
details, experiment after experiment, till at last he brings up his re- 
port to the amount of five successive layers, viz. two red layers, and 
three white ones. And in one experiment he makes the tinge of 
the madder continue in the bones for six months, forming successive 
layers of red and white, although in an earlier experiment (which 
he must have forgotten in his hurry) he tells us, that by looking 
through the transparent part of a cock’s wing, he had seen the tinge 
of the madder gradually leave the bones in not many days. 
I have before me preparations in which we see three distinct 
layers ; and of the general fact there can be no doubt. If I doubt 
the exhibition of six layers, yet we may draw the same important 
conclusion from three as from six. Mr. John Hunter said, that in 
the growth of bone, the inner part was absorbed, while the outer 40 
OF THE FORMATION 
surface had addition; and that the whole bone did not extend, but 
that the extension of the shaft resulted from an addition to the extre- 
mity. But be it at the same time understood, that while the addi- 
tional increment is on the surfaces and the extremities of the bone, 
the whole substance of the bone is submitting to change. 
By these experiments with madder, one most important fact is 
proved to us ; that the arteries and absorbents, acting in concert, 
alternately deposit and re-absorb the earthy particles, as fast as can 
be conceived of the soft parts, or even of the most moveable and 
fluctuating humours of the body. The absorption of the hardest 
bones is proved by daily observation ; when a carious bone disap- 
pears before the integuments are opened; when a tumour, pressing 
upon a bone, destroys it; when an aneurism of the temporal artery 
destroys the skull; when aneurism of the heart beats open the tho- 
rax, destroying the sternum and ribs; when an aneurism of the 
ham destroys the thigh-bone, tibia, and joint of the knee; when a 
tumour coming from within the head, forces its way through the 
bones of the skull;—in all these cases, since the bone cannot be 
annihilated, what can happen, but that it must be absorbed and con- 
veyed away ? If we should need any stronger proofs than these, we 
have mollities ossium, a disease by which, in a few months, the 
bony system is entirely broken up, and conveyed away by a high 
action of the absorbents, with continual and deep-seated pain ; a 
discharge of the earthy matter by the urine; a gradual softening of 
the bones, so that they bend under the weight of the body ; the 
heels are turned up behind the head; the spine is crooked ; the 
pelvis distorted ; the breast crushed and bent in : and the functions, 
beginning to fall low, the patient, after a slow hectic fever, long and 
much suffering of pain and misery, expires, with all the bones dis- 
torted in a shocking degree, gelatinous, or nearly so, robbed of all 
their earthy parts, and so thorougldy softened as to be cut with the 
knife. 
Thus every bone has, like the soft parts, its arteries, veins, and 
absorbent vessels; and every bone has its nerves too. We see 
them entering into its substance in small threads, as on the sur- 
faces of the frontal and parietal bones: we see them entering for 
particular purposes, by a large and peculiar hole, as the nerves 
which go into the jaws to reach the teeth: we find delicate nerves 
going into each bone along with its nutritious vessels ; and yet we 
dare hardly believe the demonstration, since bones seem quite insen- 
sible and dead. We have no pain when the periosteum is rasped 
.and scraped from a bone : we have no feeling when bones are cut 
in amputation ; or when, in a broken limb, we cut off with pincers 
the protruding end of a bone : we feel no pain when a bone is tre- 
panned, or when caustics are applied to it; and it has been always 
known, that the heated irons, which the old surgeons used so much, 
made no other impression than to excite a particular titillation and 
heat, rather pleasant than painful, running along the course of the 
bone. But there is a deception in all this A bone may be exqui- 
sitely sensible, and yet give no pain ; a paradox which is very easily 
explained. A bone may feel acutely, and yet not send its sensa- AND GROWTH OF BONKS. 
41 
tions to the brain. It is not fit that parts should feel in this sense, 
which are so continually exposed to shocks and blows, and all the 
accidents of life; which have to suffer all the motions which the 
other parts require. In this sense, the bones, the cartilages, liga- 
ments, bursae, and all the parts that relate to joints, are quite insen- 
sible and dead. A bone does not feel, or its feelings are not convey- 
ed to the brain ; but except in the absence of pain, it shows every 
mark of life. Scrape a bone, and its vessels bleed ; cut or bore a 
bone, and its granulations sprout up ; break a bone, and it will heal; 
or cut a piece of it away, and more bone will readily be produced; 
hurt it in any way, and it inflames ; burn it, and it dies. This is a 
deep subject, but a very curious one. The meaning attached to 
common terms of speech are not applicable here; and hence the 
obscurity. We would require to define sensation, sensibility, and 
pain; the liability of the part to be injured and excited to inflame, 
and the perception of that injury. I come to this conclusion :— 
The sensation of pain is bestowed as a safeguard to the frame, forc- 
ing us to avoid whatever is hurtful. To this effect, sensibility varies 
in different parts, and in general the sensibility of the more super- 
ficial parts, being sufficient protection to the parts beneath, the deep 
parts are but little sensible. The sensibility possessed by the skin 
would not be sufficient protection to the eye ; such parts differ in 
kind of sensibility as well as in degree. Experiments have been 
made by cutting and burning the bones and tendons, and the con- 
clusion has been, that they were insensible. But when a man 
sprains his ankle-joint, he is in extreme pain, though he can easily 
satisfy himself that the pain he feels is notin the skin, but must be 
in the joint and tendons. It appears, then, that such parts, usually 
thought insensible, feel pain, and can propagate that pain to the 
sensorium ; and further that the peculiar sensibilities are so suited as 
to allow of the free and natural motion, and of the necessary degree 
of attrition, but are bestowed for the purpose of making us avoid 
that degree of violence, which would endanger the texture or healthy 
function of the part. 
We have further to understand, that if there be any doubt of the 
sensibility of a bone, it is only when it is in health ; for when inflamed, 
it becomes exquisitely sensible. When the texture of a bone is 
loosened by inflammation, its feeling is roused ; and the hidden sensi- 
bility of the bone rises up like a new property of its nature: and as 
the eye, the skin, and all feeling parts have their sensibility increased 
by disease, the bones, ligaments, bursae, and all the parts whose 
feeling, during health, is obscure and hardly known, are roused to a 
degree of sensibility far surpassing the soft parts. The wound of a 
joint is indeed less painful at first, but when the inflammation comes, 
its sensibility is raised to a dreadful degree : the patient cries out 
with anguish. No pains are equal to those which belong to the bones 
and joints. 
Ossification is a process which, at first, appears so rapid, that we 
should expect it to be soon complete ; but it becomes in the end a 
slow and difficult process. It is rapid at first; it advances slowly 
after birth; it is not completed till the twentieth year; it is for- 42 
OF THE FORMATION 
warded by health and strength, retarded by weakness and disease. 
In scrophula'it is imperfect, because there is an imperfect assimila- 
tion of food, and the earth of bone is not furnished or not secreted 
into the bone; and so children become ricketty, when the bones 
soften and swell at their heads, and bend under the weight of the 
body. And why should we be surprised, that carelessness of 
food or clothing, bad air, or languid health, should cause that dread- 
ful disease, when more or less heat, during the incubation of a 
chick, prevents the growth of its bones ; when the sickness of a 
creature, during our experiments, protracts the growth of callus; 
when, in the accidents of pregnancy, of profuse suppuration, or of 
languid health, the knitting of broken bones is delayed, or prevented 
quite ? 
This process, so difficult and slow, is assisted by every provision 
of nature. The progress of the whole is slow, that so long as the 
body increases in stature, the bones also may grow ; but it is assist- 
ed in the individual parts, where some are slow, some rapid in their 
growth, some delayed, as the heads of joints, that their bones may 
be allowed to extend, and others hastened, as the pelvis, that it may 
acquire its perfect size early in life. Ossification is assisted by the 
softness of the cartilaginous bed in which the bone is formed ; by 
those large and permeable vessels which carry easily the grosser parts 
of the blood ; by a quick and powerful absorption, which all along 
is modelling the bone; and, most of all, by being formed in detach- 
ed points, multiplied and crowded together, wherever much bone is 
required. 
We have understood that the bones of the head have membranes 
is their substitutes, as the long bones have carti- 
age. The ossification, for example, of the frontal 
jr parietal bones begins in a point (as here repre- 
sented) ; a few delicate meshes of bony matter 
ire formed in the interstices of the membrane. 
The membrane is by this means split into two 
other membranes we afterwards recognise under the names of 
pericranium and dura mater. In this figure we have the com- 
mencement of the one half of the frontal bone. On the extreme 
margin we see through the meshes or network of new bone ; but 
other layers of bone similar to this are su- 
peradded, and the interstices of the first 
layer being opposed to the wire-work of 
the second, a solid appearance and opa- 
city is produced. In a further state of ad- 
vancement the bone assumes this appear- 
ance, and the filaments diverge regularly 
from the centre, which was the original 
spot where the ossification commenced. 
It is then that in the bones* of the skull, ossification goes from 
* The ossification of the flat bones is a subject too curious to be omitted in this dis- 
sertation. The brain of the fcetus, while of the size of a hazel'nut, is invested with 
a membrane, in which there is as yet no speck of bone. In the third month the ossi- 
fication of the cranial bones commences, and the first process exhibits a very beautiful and growth of bones. 
43 
one or more central points, and the radiated fibres meet the radii 
of other ossifying points, or meet the edges of the next bone. The 
thick round bones which form the wrist and foot, have one ossifi- 
cation in their centre, which is bounded by cartilage all round. 
The processes are often distinct ossifications joined to the bones, 
like their heads, and slowly consolidated with them into firm bones. 
In the original cartilage of the long bones, there is no hollow, nor 
cavity ; it is all one solid mass. When the ossification first ap- 
pears, the cavity of the bone also begins, and extends with the 
ossification : at first the cavity is confined chiefly to the middle of 
the bone, and extends very slowly towards the ends. This cavity, 
in the centre of the bone, is at first smooth, covered with an inter- 
nal membrane, containing the trunks and branchings of the nutritious 
vessels, which enter by a great hole, in the middle of the bone; and 
the cavity is traversed with divisions of its lining membrane, which, 
like a net-work of partitions, conduct its branches to all parts of the 
internal surface of the bone : and its nets, or meshes, are filled with 
a reddish and serous fluid, in the young bone, but secrete and con- 
tain a perfect marrow in the adult bone. 
The whole substance of a bone is not only fibrous, as appears 
outwardly, but is truly lamellated, consisting of many distinct and 
delicate plates of bone, which lie over each other, in regular order, 
and might suggest the notion of successive ossifications of the peri- 
osteum forming the bone.* These lamellae, or plates, are more 
net of ossific wire-work. In a circle, the diameter of which is half an inch, we see 
a perfect net-work, resembling a fine lace, or the meshes of a spider’s web. Upon 
this first layer another is deposited, and this superimposed net-work of bone is finer 
than the first: the meshes being smaller and the bony matter more abundant. The 
holes of the second net are not opposite to those of the first, so that the eye no longer 
penetrates the bone although the structure be quite light and porous. While the se- 
cond and third layer of bone is deposited on the outside of the first, the inner layer 
is extending in threads diverging from the centre, between which delicate processes 
of bone intervening ribs are formed irregularly, still resembling the texture of the 
spider’s web ; and the diverging line of bone, being the stronger, it appears as if the 
cranial bones formed in diverging radii, while the edge of the bone extends in fine 
net work, like to the first formed speck of ossification. 
It is further worthy of remark, that this is the texture of true bone, and that what 
are called morbid ossifications, as of the coats of arteries and other membranes are 
merely the deposit of earthy matter without organic structure. 
* “ The fibres and lamellae forming the bones, are not simply applied upon each 
other, so as to be extended throughout the length, breadth, or thickness of the bone, 
or passing from the centre to the circumference. They are inclined towards each 
other in so many different ways, and are so frequently united by transverse and 
oblique prolongations or appendices, that great anatomists have been misled by this 
arrangement, and doubted the fibrous structure of bone. Such an opinion is not en- 
tirely correct. Notwithstanding the inflexions and anastomoses of fibres, the fibrous 
structure remains always apparent, and it is accurate to state, that the dimension in 
length exceeds the two others in the texture of bone. Thi3 predominance is espe- 
cially marked in the first periods of osteogeny, for, at a later period, the fibres are 
accumulated upon each other in such a manner as scarcely to be distinguishable. But 
these longitudina 1 fibres never exist alone ; there are a great many oblique and trans- 
verse fibres from the first periods of formation ; and are even at first so multiplied, 
that the number of longitudinal fibres do not exceed them so much as at a more ad- 
vanced period, when the fibres are more closely approximated ; so that the transverse 
become oblique, until at length, the mass of the bone, which is constantly growing, 
appears at first sight to be entirely composed of longitudinal fibres. The transverse 
and oblique fibres do not compose a separate system, but are uninterruptedly con- 
tinuous with the longitudinal, with which they unite reciprocally.” J. F. Meckel, 44 
OF TIIE FORMATION 
condensed and firm, towards the outer surface, and are more loose, 
separate, and spongy, towards the internal surface of the bone ; and 
it is easily seen, during the growth of a young bone, that the inner 
and more delicate plates are separating from the walls of the bone, 
and receding towards its cavity : and these plates, being again 
crossed by small bony partitions, form a net-work, or spongy mass, 
which fdls the whole cavity of the bone. In the middle of the bone, 
the cavity is small, the walls thick, and having all their bony plates ; 
the cells of net-work few, and large ; but towards the ends, the bone 
swells out, the cavity also is large; but it is not like that in the 
middle, a large tubular cavity : it is so crossed with lattice-work, 
with small insterstices and cells, that it seems all one spongy mass 
of bone: and so many of the inner layers are separated, to form this 
profusion of cells, that the whole substance of the bone has degene- 
rated into this lattice-work, leaving only a thin outward shell. This 
reticular form is what anatomists call the cancelli, lattice-work, net- 
work, or alveolar part of the bone ; it is all lined with one delicate 
membrane, and inward partitions of the same lining membrane cover 
each division of the lattice-work, forming each cell into a distinct 
cavity. In these cavities, or cells, the marrow is secreted. The 
secretion is thin and bloody in children ; it thickens as we advance 
in years ; it is a dense oil, or marrow, in the adult. The marrow is 
firmer and more perfect in the middle of the bone, and more thin and 
serous towards the spongy ends. The whole mass, when shaken 
out of the bone, is like a bunch of grapes, each hanging by its stalk. 
The globules, when seen with the microscope, are neat, round, and 
white, resembling small pearls, and each stalk is seen to be a small 
artery, which comes along the membrane of the cancelli, spreads 
its branches beautifully on the surface of the bag, and serves to se- 
crete the marrow, each small twig of artery filling its peculiar cell. 
'To this, an old anatomist added, that they had their contractile 
power, like the urinary bladder, for expelling their contents ; that 
they squeezed their marrow, by channels of communication, through 
and among the bony layers ; and that their oil exuded into the joint, 
by nearly the same mechanism by which it got into the substance of 
the bone, which is now known to be pure fancy, and to have no 
foundation. 
While the constitution of a bone was not at all understood, anato- 
mists noted with particular care every trifling peculiarity in the forms 
or connections of its parts ; and these lamellae attracted particular 
notice. Malphighi had first observed the lamellated structure of 
Manuel, p. 293. vol. i. This view of the fibrous structure of the bone is the most 
accurate that has yet been given, and wili be confirmed by all who examine for them- 
selves. Scarpa published a treatise in 1795, entitled De Penitiori Ossium Struc- 
tura, in which he showed by observations and experiments, that the animal matter of 
the bones is altogether cellular or spongy. His views are correct, in reference to the 
primordial condition, as well as the ultimate analysis of bone ; but are inaccurate in 
relation to the state of the texture when merely deprived of the earthy matter, with- 
out prolonged maceration, which destroys the fibrous arrangement above described. 
See a translation of Scarpa’s treatise, in Chapman’s Journal, and in the “Anatomical 
Investigations.” by John D. Godman, M.D. Phila. 1824. AND GROWTH OF BONES. 
45 
bones, likening them to the leaves of a book. Gagliardi, who, like 
Hippocrates, went among the burial places of the city, to observe 
the bones there, found in a tomb, where the bones had been long 
exposed, a skull, the os frontis of which he could dissect into many 
layers, witli the point of a pin.* He afterwards found various bones, 
from all parts of the body, thus decomposed ; and he added to the 
doctrine of plates, that they were held together by minute processes, 
which, going from plate to plate, performed the offices of nails: 
these appeared to his imagination to be of four kinds, straight and 
inclined nails, crooked or hook-like, and some with small round 
heads, of the forms of bolts or pins.f 
Another notable discovery was the use of the holes, which are 
very easily seen through the substance of bones, and among their 
plates. They are, indeed, no more than the ways by which the 
vessels pass into the bones ; but the older anatomists imagined them 
to be still more important, allowing the matter to transude through 
all the substance of the bone and keep it soft. Now, this notion of 
lubricating the earthy parts of a bone, like the common talk of fo- 
mentations to the internal parts of the body, is very mechanical, and 
very ignorant; for the internal parts of the body are both hot and 
moist of themselves, and neither heat nor moisture can reach them 
from without: the bone is already fully watered with arteries ; it is 
moist in itself, and cannot be further moistened nor lubricated, un- 
less by a fuller and quicker circulation of its blood. It must be pre- 
served by that moisture only which exists in its substance, and 
must depend for its consistence upon its own constitution ; upon 
the due mixing up of its membrane, cartilage, and earth. Every 
part is preserved in its due consistence by the vessels which supply 
it; and I should no more suppose fat necessary for preserving the 
moistness of a bone, than for preventing brittleness in the eye. This 
marrow is, perhaps, more an accidental deposition than we, at first 
sight, believe. We indeed find it in such regularity of structure, as 
seems to indicate some very particular use ; but we find the same 
structure exactly in the common fat of the body. When, as we ad- 
vance in years, more fat is deposited in the omentum, or round the 
heart, we cannot entertain the absurd notion, of fat being needed in 
our old age, to lubricate the bowels or the heart; no more is the 
* Notwithstanding what is here delivered, there is no proof of the bones being 
lamellated ; as to the exfoliation of bone, the dead portion is more generally irregular 
in its thickness, and rugged on its inner surface. This exfoliation of bone is a pro- 
cess of the living bone, and the inner living surface recedes from the outer one by 
absorption of its particles, because that outer surface is injured or dead. The nature 
of the injury, or the depth to which the bone has become dead, determines the extent 
and form of the portion cast off. When a scale only is thrown off, it is because the 
bone is only dead upon the surface. In regard to the breaking up of the surface of the 
cranial bones, when they lie exposed, the scales are similar to those from stones or 
metals exposed to the influence of the air, the, moisture, and varying temperature : 
the thickness and succession of exfoliations depend on the operation of the weather, 
not on the original formation of the bone. I have never seen heat produce a lamel- 
lated decomposition of bone. 
t These nails Gagliardi imagined were no more than the little irregularities, 
risings, and hollows of the adjoining plates, by which they are connected. 46 
OF THE FORMATION 
marrow (which is not found in the child) accumulated in old age, 
for preventing brittleness of the bones.* 
The internal periosteum is that membrane which surrounds the 
marrow, and in the bags of which the marrow is formed and con- 
tained. It is more connected with the fat than with the bone ; and 
in animals, can be drawn out entire from the cavity of the bone ; 
but its chief use is to conduct the vessels which are to enter into the 
substance of the bone. 
The periosteum, the outer membrane of bone, which was once 
referred to the dura mater,t is merely condensed cellular substance ; 
of which kind of matter we now trace many varied forms and uses, 
for so close is the connexion of the periosteum, tendons, ligaments, 
fasciae, and bursae, and so much are these parts alike in their nature 
and properties, that we reckon them but as varied forms of one com- 
mon substance, serving for various uses in different parts. The pe- 
riosteum consists of many layers, accumulated and condensed one 
above another ; it adheres to the body of the bone by small points 
or processes, which dive into the substance of the outer layer, giving 
a firm adhesion to it, so as to bear the pulling of the great tendons, 
which are fixed rather into the periosteum than into the bone. It 
is also connected with the bone by innumerable vessels. The layers 
of the periosteum nearest to the bone are condensed and strong, 
and take a strong adhesion to the bone, that the vessels may be 
transmitted safe, and the fibres of this inner layer follow the longi- 
tudinal directions of the bony fibres. The periosteum is looser in 
its texture outwardly, where it is reticulated and lax, changing im- 
perceptibly into the common cellular substance. There the fibres 
of the periosteum assume the directions of the muscles, tendons, or 
other parts which run over it. Any accident which spoils the bone 
of its periosteum, endangers the life of the bone itself. The surface 
of the bone becomes first affected, and then it exfoliates ; the acci- 
dental wounds of the periosteum, deep ulcers of the soft parts, as on 
the shin, the beating of aneurisms, the growth of tumours, the pres- 
sure even of any external body, will, by hurting the periosteum, 
cause exfoliation. 
The cartilages are also a part of the living system of the bone ; 
and we see too well, in the question of the bones themselves, how 
unphilosophical it must be, to deny organization and feeling to any 
part of the living body, however dead or insulated it may appear ; 
for every part has its degree of life,—the eye, the skin, the flesh, the 
tendons, and the bones, have successive degrees of feeling and cir- 
* If we look to the difference there is in the adipose membrane, we shall find it 
more apparent than real. The fat on the soles of the feet and palms of the hands is 
particularly firm, but this firmness results from the strong intertexturc of filaments of 
a tendinous strength. The fat in the exposed parts of the limbs is less firm, in the 
orbits of the eves more delicate, but in the bones it lies in transparent membranes, 
and is quite soft and compressible. The difference, however, is only in the manner 
in which the bags containing the fat are bound up and protected ; where the substance 
is exposed to pressure, it is firm ; where it lies concealed, it is less so; but where it 
is altogether within the protection of the bones, the membranes are very delicate, 
and the fat takes the appearance of marrow. 
t See what is said under the head of membranes. ANIJ GROWTH OF BONES. 
47 
culauon. We see, that where even the lowest of these, the bone, 
is deprived of its small portion of life, it becomes a foreign body, and 
is thrown off from the healthy parts, as a gangrened limb is sepa- 
rated from the sound body ; and we speak as familiarly of the death 
of a bone, as of the gangrene of soft parts. How, then, should we 
deny organization and life to the cartilages ? though surely, in re- 
spect of feeling, they must stand in the very last degree. 
We now understand the constitution of a bone, and can compare 
it fairly with the soft parts in vascularity, and in feeling ; in quick- 
ness of absorption ; in the regular supply of blood necessary to the 
life of the bony system ; in the certain death of a bone, when de- 
prived of blood by any injury of its marrow, or of its periosteum, as 
a limb dies of gangrene, when its arteries are cut or tied ; in the 
continual action of its absorbents, forming its cavity, shaping its pro- 
cesses and heads, keeping it sound and in good health, and regula- 
ting the degree of bony matter, that the composition may neither be 
too brittle nor too soft. From this constitution of a bone, we could 
easily foresee how the callus for uniting broken bones must be form- 
ed ; not by a mere coagulation of extravasated juice, but by a new 
organization resembling the original bone. 
The primordium of all the parts of the body is a thin, gelatinous- 
like mass, in which the forms of the parts are laid ; and the prepa- 
ration for healing wounds, and for every new part that needs to be 
formed, is a secretion of a fluid which coagulates, which is soon ani- 
mated by vessels coming into it from every point. In every external 
wound, in every internal inflammation, wherever external parts are 
to be healed, or internal viscera are about to adhere, matter of this 
kind is secreted, which serves as a bed or nidus, in which the ves- 
sels spread from point to point, till the part is fully organized, and 
it is in this manner that the heart, the intestines, the testicle, and 
other parts, adhere by inflammation to the coats which surround 
them, and which are naturally loose. It is by a process not dis- 
similar that the broken ends of bones unite. 
When we find the substance of the oldest bone thus full of ves- 
sels, why should we doubt its being able, from its own peculiar ves- 
sels, to heal a breach, or to repair any loss ? How little the con- 
stitution of a bone has been understood, we may know from the 
strange debates which have subsisted so long about the proper 
organ for generating callus. Some have pronounced it to be the 
periosteum ; others the medullary vessel, and internal membrane ; 
others the substance of the bone itself. In the heat of this dispute, 
one of the most eminent anatomists produced a diseased bone, 
where a new bone was formed surrounding a carious one, and the 
spoiled bone rattled within the cavity of the sound one : here we 
should have been ready to pronounce, that bone could be formed 
by the periosteum only. But presently another anatomist produced 
the very reverse, viz. a sound young bone, forming in the hollow 
cylinder of a bone which had been long dead ; where, of course, 
the callous matter must have been poured into the empty cavity of 48 
OF THE FORMATION 
the spoiled bone, from the ends which still remained sound, or must 
have been secreted by the medullary vessels. But the truth is, that 
callus may be thus produced from any part of the system of a 
bone.* if we pierce the bone of any animal, and destroy the 
marrow, the old bone dies, and a new one is formed around the 
old: if we kill the creature early, we find the new bone to be .a 
mere secretion from the old bone ; and if we wait the completion 
of the process, we find the new bone beautiful, white, easily in- 
jected, and thick, loose in its texture, and vascular and bloody, but 
still firm enough for the animal to walk upon ; and in the heart of 
it we find the old bone, and that it has become dead and black.j 
If we reverse this operation, and destroy the 
periosteum only, leaving the nutritious vessel* 
entire, then the new bone is formed fresh and 
vascular by the medullary vessels, and the old 
one, quite black and dead, surrounds it.i 
The effect of injury to a living bone, is very 
curious. But the manner in which the bone re- 
sumes its pristine form is still more worthy of 
observation. At first the outward exfoliation is 
attended with a proportionate filling up of the 
cavity of the bone: and the injury to the centre 
and body of the bone produces a new bone 
around the old one, and the old one at last dies, 
and is absorbed or discharged. But after years 
these changes are again reversed, and the new 
bone contracts its diameter, and the cavity be- 
comes of its natural dimensions, so that the 
evidence of the changes which the bone has 
undergone are quite removed. This is a very 
beautiful example of the influence of that prin- 
ciple which controls the growth of all the parts 
of the body, which may have its operation de- 
ranged by violent injury or by disease; but 
* In the experiments and observations which I have made, neither the periosteum 
or marrow seemed to have formed the bone; and I conclude that nothing but bone 
can form bone, by the continuation of natural actions: and that in the case of ne- 
crosis, the old bone inflames and begins the new formation, before the continued irri- 
tation in the centre kills it.—C. B. 
t The figure represents the necrosed bone, the new bone, soft and irregular around 
the old. 
I When I Injure the marrow of the bone necrosis is the consequence. When I 
divide the bone of its periosteum and surround it with a bit of bladder, I find the 
whole surface exfoliates, and the cavity of the bone fills up ; but this is not a conse- 
quence of the destruction of the vessels of the periosteum, but of the contact of fo- 
reign matter with the surface of the bone. An effect precisely similar is the conse- 
quence of the sloughing of the soft parts over a bone, fot the dead slough lying on the 
surface of the bone causes an exfoliation.—C. B. OF THE SKELETON. 
49 
which will at last by slow degrees restore the 
part to its natural form and action.* 
The diseases of the bones arc the most fre- 
quent in surgery ; and it is impossible to express 
how much the surgeon is concerned in obtaining 
true ideas of the structure, constitution, and dis- 
eases of bones ; how tedious, how painful, and 
how loathsome they are ; how often the patient 
may lose his limb, or endanger his life ; how very 
useful art is; but, above all, what wonders 
nature daily performs in recovering bones from 
their diseased state. 
OF THE SKELElC 
The skeleton is the assemblage of bones which sustains the soft 
parts, and gives form to the human body. The bones may be con- 
templated in their three offices:—1. As columns under the weight 
of the parts ;—2. As levers on which the muscles act, to give activity 
and locomotion ;—and, 3. As covering and protection to the softer 
and more delicate organs. In all the higher links of the chain of 
animal existence, there is a texture resembling the composition of 
hone, to sustain or protect the soft parts. In the corals, we may 
see a skeleton common to the whole family. In testacea it is an 
external shell, a calcareous foliated texture for their protection. In 
creatures that creep, the muscles are attached to their skin; while 
in the crustacea there is a calcareous crust, which is at once skin 
* This figure is a plan of the necrosis. The shaft of the old bone is dark ; the 
new bone is in outline ; and now we perceive how the new bone encloses the old1, 
and how it forms the medium of union between the two extremities after the old bone 
is loose or altogether cast. out. 50 
OF THE SKELETON, 
and skeleton, since the shell is in distinct parts, and articulated, and 
these parts have the muscles inserted into them. In reptiles and 
Fishes, there is an internal system of bones, or a true skeleton. The 
peculiarity of their skeleton is not merely in the form and ar- 
rangement of the bones, but in their possessing more elasticity than 
belongs to the skeleton of birds and quadrupeds. 
The composition of a bone has reference to its uses. The weight 
of the frame bears upon the bone; in the activity of the body we 
pull upon the bone ; and in the various operations of the spine and 
extremities, the bones must sustain a circular or twisting motion. 
Sometimes they are performing an office like a column, sometimes 
as a rope, sometimes bearing a jar like an axle-tree. This is stated, 
because it is practically useful to observe the various forces ope- 
rating on the skeleton, and because it leads us to observe that admi- 
rable provision manifested in the structure of the bones, fitting 
them to their uses. 
Bone accordingly contains phosphate of lime, to which it owes its 
hardness and ability to support weight: this is contained within a 
strongly fibrous tissue, which enables it to resist when pulled upon ; 
and the combination of all the materials of its composition gives that 
elasticity which preserves it from fracture when jarred in the exer- 
cise of the body. 
The next thing admirable in the composition of the skeleton, is 
the relation of its parts; the manner in which all its parts are 
planned at once, forming a system which, in our methods of pro- 
ceeding, we are apt to forget. For, studying the individual bones 
with great minuteness, we neglect the relation which is established 
betwixt all the parts of the skeleton of any one animal. 
To exemplify this : If an anatomist and naturalist should pick up 
a bone of the leg of some animal, he may observe that it is not form- 
ed to turn with that extent of motion which belongs to an animal 
having the paw and the toes free. He will then conclude that the 
bones of the foot were embraced by a hoof, and not armed with 
claws. He will reflect, that as there were no claws, neither could 
there be carnivorous teeth. Ascertaining the form of the teeth, he 
in a manner knows the corresponding form of the jaws ; and if of the 
jaws, the muscles which move them ; and if the muscles of the jaws, 
the form of the head. Returning to the contemplation of the bone 
he has picked up, he will find in that, the proof of a restrained posi- 
tion and limited motion, a limb directly under the animal, for loco- 
motion only, or for swiftness. He will know the form of the shoul- 
der-joint, the form of the spine, the form of the extremities, and the 
form of the head 1* 
As the plan and intention, if I may so express myself on such a 
subject, is thus obvious, in contemplating the whole skeleton, so is 
it in observing the form and processes of each bone individually and 
* The scientific world is especially indebted to Cdvier for first declaring and ex- 
tensively demonstrating the truth ol the proposition above stated. By the applica- 
tion of this principle, the illustrious zoologist has been able, from the fragments of 
fossil skeletons, to prove the existence and specify the characters of multitudes of 
animals, at present utterly extinct. For the description of his mode of investiga- 
tion, the reader may advantageously consult the introduction to his work “On Fossil 
Hfetnftihsor Mitchell's,edition of Cutlet's “Theory of the Earth.”—P. G. OF THE SKELETON. 
51 
separately. It' a bone be destined to protect the contained parts*, 
then we shall find that it assumes the form of an arch, and that the 
arch is strengthened by additional substance, or groined, as an archi- 
tect would say, under the part most exposed to pressure. If the bone 
sustain weight, the material is arranged so as to give the most resist- 
ance with the least expense of material; it is cylindrical, as we see 
in the thigh-bone. If the shaft of bone supports incumbent weight, 
but at the same time is exposed in the motion of the limb to pres- 
sure and the danger of fracture in a particular direction, it is strength- 
ened with spines where the pressure is the greatest. It is to this 
that we have to attribute the variety of shapes of the bones : and 
thus the student sees a meaning in the demonstration of the 
bone. By the form, he is made to comprehend the motion of the 
part, and the stress it bears ; and hence he learns to understand to 
what accidents it is exposed: and thus anatomy furnishes the ele- 
ments of surgery. Omitting these obvious deductions, the demon- 
stration of a bone is inconsequent, and like a tale told by an idiot. 
The learner is taught to believe, that the form of the bone is pro- 
duced by the pressure of the muscles,—that it is, therefore, acci- 
dental ; and so he is gradually initiated into thn notion, that what lie 
cannot comprehend in animal structure is accident, and he gives 
himself no further trouble. 
Some, with a singular unhappiness of disposition, will contem- 
plate the chain of animal existence, and see in it only a mechanical 
principle of adherence to a certain original type or model; and they 
have more gratification in giving a catalogue of things useless, (that 
is to say, of parts, the beauty or usefulness of which they do not com- 
prehend,) than of contemplating the whole, and allowing their minds 
to receive that natural influence which the system of nature is cal- 
culated to produce. 
The four divisions of the upper extremity exist in all the anterior 
extremities of the class mammalia. A curious inspection of the gra- 
dations will prove parts dissimilar in form, to be a new appropriation 
of the same bones. In the fin of a whale we may recognise the 
bones of the human hand. Strip the integuments off the anterior 
fin of the dolphin or porpoise, and we recognise, somewhat modifi- 
ed, a scapula, humerus, forearm, and carpus, metacarpus, and finger 
bones. It should surprise us less, that in the wing of a bird we 
should see the bones of the anterior extremity of a quadruped; 
or recognise in the fine bones which stretch the membranous 
wing of a bat, the phalanges of the fingers. Although there be no 
resemblance betwixt the outer form of animals that walk, and those 
that fly, and those that creep, yet in all of them, the skeleton is re- 
cognisable as the same system of bones, variously modified. 
But the question returns upon us,—can there be an adaptation of 
parts better calculated to their end, or more obviously designed, or 
better evidence of a system pervading all nature, and that the whole 
has been cast out, at once, from a power omnipotent ? 
There is not a more curious proof of adaptation of the texture of 
the skeleton to the condition and habits of animals, than we have 
in the bones of birds and fishes. In the former, the dimensions, and 
consequently the strength, is increased without adding to the wfeight. 52 
OF THE SKELETON. 
by admitting a. communication betwixt the lungs and the cavities of 
the boneas By which air is admitted into them. In fishes, the bones 
are light, not only by having a lesser quantity of earth in their com- 
position, but by having spermaceti or oil deposited in their cavities. 
In the spermaceti whale, the head is made buoyant by a large quan- 
tity of spermaceti lodged within the skull. 
The bones of the human skeleton have been divided into the fiat 
and cylindrical bones. It is incorrect, and therefore unscientific. 
Their forms are too much varied to admit of this sort of arbitrary 
division. There can be no other division of the skeleton, than into, 
1. The bones of the trunk. 2. The bones of the extremities. 3. 
The bones of the head. 
The bones are united in a manner varying with their form and 
uses. They are immoveably fixed together, by having their pro- 
cesses fixed into corresponding cavities, like cabinet-work; or, 
where the texture of bone is delicate, they are simply laid together, 
and a line marks their union ; or they are laid over each other, and 
spliced together ; or conical processes are, in a manner, inserted 
into corresponding cavities, like a nail in a board ; or the bones arc 
firmly joined, yet so as to give some elasticity, and to take oft the 
jar of contact, by intermediate cartilage. Finally, the bones arc 
constituted with a relation to free motion at their articulation ; for 
which purpose their extremities are covered with smooth cartilage, 
and joined by ligaments. 
It is an interesting subject of study, to consider the uses of the 
parts, and to observe with what felicity and curious skill (so would 
we express ourselves of things of human invention,) the strength, 
forms, and processes of the bones are adapted.* 
lmmobilis 
junctura 
.sive sy- 
narthro- 
sis ; viz. 
l.Sulura. 
2. Har- 
monia. 
3. Sutura 
Squamo- 
sa. 
4. Gom- 
phosis. t 
5. Syn- 
chondro- 
sis. 
6. Diar.- 
throsis 
sive mo- 
bilis junc- 
tura. 
SUPPLEMENTARY OBSERVATIONS ON OSTEOGENY. 
[from BECLARB.] 
The bones, which arc originally liquid, like all other parts, suc- 
cessively become, 1. soft, mucous or jelly like ; 2. cartilaginous, 
and sometimes fibro-cartilaginous ; 3. osseous. The bones shortly 
after conception are mucous, transparent, and colourless ; they then 
grow by vegetation, and form a continuous whole, which is divided 
at a more advanced period. The cartilaginous bones, or the tem- 
porary cartilages, do not appear at all, until two months after the 
time of conception. This condition can only be perceived in bones 
or parts of bones which harden somewhat later, for in those which 
ossify very early, it is doubtful whether they pass through the carti- 
laginous state. This state appears rather designed to perform pro- 
visionally the functions of bone, than to be a period of ossification. 
* The young student, before entering on the demonstration of the bones, should 
make himself familiar with the meaning of such terms as the following: Fovea, 
Fossa, Celia, Sinus, Fissura, Sulcus, Foramen, Meatus, Cervix, Condylus, 
Apophysis, Spina, Crista, Stylus, fyc. For although this anatomy is written with 
a desire to substitute the full and pure English description for the barbarism of the 
terms used in anatomical works, it is not always possible to avoid the use of such 
terms, in describing the infinite varieties in the form of bones. 53 
OF THE SKELETON. 
The osseous condition commences successively in the different 
bones, from about a month after conception for the most early, 
until about ten or twelve years after birth in the last perfected ; 
certain accessory osseous points do not commence their formation, 
until from the fifteenth to the eighteenth year. 
Ossification of the clavicle begins at the end of the first month, and 
successively in the lower jaw, femur, tibia, humerus, upper jaw, 
and in the bones of the forearm, where it commences in about 
thirty-five days. Ossification begins about the fortieth day in the 
fibula, scapula, palate, and subsequently in the central portion 
of the occipital, frontal, the arches of the first vertebra?, the ribs, 
the great wing of the sphenoid bone, the zygomatic apophysis, the 
phalanges of the fingers, the bodies of the middle vertebrae, the 
nasal and zygomatic bones, the ilium, metacarpal bones, the pha- 
langes of the toes, the occipital condyles, and then in its basilar 
portion, the squamous part of the temporal; the parietal, and the 
vomer ; in all these bones ossification is begun about the middle of 
the seventh week. In the course of the same week it commences 
in the orbitar process of the sphenoid, and finally in the metatarsal 
bones and phalanges of the great toes, and in the last joints of the 
fingers. During the ten succeeding days ossification begins in the 
body of the sphenoid, in those of the first sacral vertebras, and in the 
circle of the tympanum. At about the second month and a half 
it is manifested in the costiform appendix of the seventh vertebra ; 
before the end of the third month in the labyrinth, and towards the 
end of the third month, in the ischium and internal pterygoid 
apophysis ; about the middle of the fourth month in the bones of the 
tympanum ; at half the term of uterine life in the pubis, os calcis, 
the last joints of the great toes, in the lateral portions of tho 
ethmoid, and in the spongy bones of the nose ; the first pieces of 
the sternum begin to ossify somewhat later : about the sixth month 
the body and tooth-shaped process of the second vertebra, and 
the anterior and lateral masses of the pelvic or sacral vertebrae, and 
afterwards, the astralagus begin to ossify. About the seventh month 
the ethmoidal pyramids ossify ; the crista galli next : the first coc- 
cygeal vertebra, and the anterior arch of the atlas are ossified about 
birth. At a year old the coracoid process, os magnum, and un- 
ciforme of the carpus, and the first cuneiform bone are solid ; about 
three years old the patella and triquetral bones are ossified ; at four 
years, the third and second cuneiform ; at five the scaphoid of the 
tarsus, the trapezium and lunare ; at eight years of age the scaphoid 
of the carpus ossifies ; at nine the trapezoid, and finally the pisiform 
at about twelve years of age. 
Ossification does not uniformly result from the change of carti- 
lage into bone. The diaphyses of long, and centres of very pre- 
cocious broad bones, pass immediately from the mucous to the 
osseous state. The other parts of the system are at first cartila- 
ginous, and in them it is, that we can best observe the successive 
phenomena of ossification.* 
* Beclard, Anat. Generate, p. 461. et seq. OF THE TRUNK. 
THE BONES OF THE SPINE, PELVIS, AND THORAX. 
The demonstration of the bones should begin with those of the 
spine, as it is the centre of muscular action, and the part of most 
common relation ; for the spine is placed upon the arch of bones 
which form the pelvis, and supports the head, and is at the same 
time the bond of union of the bones of the thorax or chest. 
The bones of the trunk consist of these : the chain of bones 
forming the vertebral column or spine ; the bones of the pelvis : 
the ribs ; and the sternum or breast bone. 
OF TIIE SPINE. 
Uses of 
the spine. 
The spine is so named from certain projecting points of each 
bone, which, standing outwards in the back, form a continued ridge ; 
and the appearance of continuity is so complete, that the whole 
ridge is named spine, which, in common language, is spoken of as 
a single bone. This long line consists of twenty-four distinct bones 
named vertebrae, from the Latin vertere, to turn. They conduct 
the spinal marrow, secure from harm, the whole length of the spine, 
and support the whole weight of the trunk, head, and arms ; they 
perform, at certain points, the chief turnings and bendings of the 
body ; and do not suffer under the longest fatigue, or the greatest 
weight which the limbs can bear. Hardly can any thing be more 
beautiful or surprising than this mechanism of the spine, where 
nature has established the most opposite and inconsistent functions 
in one set of bones ; for these bones are so free in motion, as to 
turn continually, yet so strong as to support the whole weight of 
the body ; and so flexible as to turn quickly in all directions, yet 
so steady within, as to contain and defend the most material and 
the most delicate part of the nervous system. 
The vertebras are arranged according to the neck, back, and 
loins, and the number of them corresponds with the length of these 
divisions. The vertebrae of the loins are five in number, very 
large and strong, and bearing the whole weight of the body. Their 
processes stand out very wide and free, not entangled with each 
F other, and performing the chief motions of the trunk. The ver- 
tebrae of the back are twelve in number. They also are big and 
strong, yet smaller than those of the loins ; their processes are laid 
over each other; each bone is locked in with the next, and em- 
barrassed by its connexion with the ribs : this is, therefore, the 
steadiest part of the spine ; a very limited motion only is allowed. 
The vertebrae of the neck are seven in number : they are more 
Classifi- 
cation of 
the 24 
vertebrae. 
Five of 
the loins. 
Twelve of 
the back. 
Seven of 
the neck. OF THE TRUNK. 
55 
Simple, and like rings; their processes hardly project; they are 
very loose and free; and their motions are the widest and easiest 
of all the spine. 
The seven vertebras of the neck, twelve of the back, and five of 
the loins, make twenty-four in all, which is the regular proportion of 
the spine, But the number is sometimes changed, according to 
the proportions of the body ; for, where the loins are long, there 
are six vertebrae of the loins, and but eleven in the back ; or the 
number of the pieces in the back is sometimes increased to thir- 
teen ; or the neck, according as it is long or short, sometimes has 
eight pieces, or sometimes only six. However, these varieties are 
very rare. 
The general form, processes, and parts of the vertebrae, are best 
exemplified in a vertebra of the loins ; for in it, the body is large,1 
the processes are right-lined, large, and strong; the joint is com- 
plete, and all its parts are very strongly marked. Every vertebra 
consists of a body, which is firm, for supporting the weight of the 
body, and hollow behind, for transmitting the spinal marrow: of 
two articulating processes above, and two below, by which it is 
jointed with the bones which are above and below it: of two trans- 
verse processes, which stand out from either side of the bone, to 
give hold and purchase to those muscles which turn the spine ; and 
of one process, the spinous process, which stands directly back- 
wards from the middle of the bone : and these processes being felt 
in distinct points all the way down the back, give the whole the 
appearance of a ridge ; whence it has the name of spine. 
The body of the vertebra is a large mass of soft and spongy 
bone ; it is circular before, and flat upon the sides. It is hollowed 
into the form of a crescent behind, to give the shape of that tube 
in which the spinal marrow is contained. The body has but a very 
thin scaly covering for its thick and spongy substance. It is tipped 
with a harder and prominent ring above and below, as a sort of 
defence; and within the ring, the body of the vertebra is hollowed 
out into a sort of superficial cup, which receives the ligamentous 
substance, by which the two next vertebral are joined to it; so that 
each vertebra goes upon a pivot, and resembles the ball and socket 
joints. In many animals it is distinctly a joint of this kind. 
On the fore and back part of the body of the vertebra are several 
holes, which are for the transmission of blood-vessels and for the 
attachment of ligaments.* 
The body is the main part of the vertebra, to which all the other 
processes are to be referred: it is the centre of the spine, and bears 
chiefly the weight of the body : it is large in the loins, where the 
weight of the whole rests upon it, and where the movements are 
rather free : it is smaller in the vertebrae of the back, where there 
is almost no motion and less weight; and in the vertebrae of the 
neck, there is hardly any body, the vertebrae being joined to each 
other chiefly by the articulating processes. 
General 
descrip- 
tion of a 
vertebra. 
Particular 
descrip- 
tion of 
the body. 
Shape. 
The hard- 
er ring j 
hollowed 
above and 
below. 
Forami- 
na. 
* These foratuiria enlarge in the beginning of the scrofulous inflammation of th«f 
bone. 56 
OB’ THE TRUNK. 
The arch. 
The ring or circle of bone, or the arch which, together with the 
body itself, forms this circle, next attracts our notice; for the 
arches of the vertebras, forming a continued tube, give passage to 
the spinal marrow. VVe observe a notch on each side of the arch 
for transmitting the nerves which go out from the spinal marrow. 
The articulating pkocess is a small projection, standing out 
obliquely from the body of the vertebra, with a smooth surface, by 
which it is joined to the articulating process of the next bone ; for 
each vertebra has a double articulation with that above and with 
that below. The bodies of the vertebras are united to each other 
by a kind of ligament, which forms a more fixed, and rather an 
elastic joining ; and they are united again by the articulating pro- 
cesses, which make a very moveable joint of the common form. 
The articulating processes are sometimes named oblique processes, 
because they stand rather obliquely. The upper ones are named 
the ascending oblique processes, and the two lower ones are named 
the inferior or descending oblique processes. 
The spinous processes are those which project directly backwards, 
whose points form the ridge of the back, and whose sharpness gives 
the name to the whole column. The body of each vertebra sends 
out two arms, which, meeting behind, form an arch or canal for the 
spinal marrow ; and from the middle of that arch, and opposite to 
the body, the spinous process projects. Now the spinous, and the 
transverse processes, are as so many handles and levers, by which the 
spine is to be moved ; which, by their bigness, give a firm hold to 
the muscles, and, by their length, give them a powerful lever to 
work their effects by. The spinous processes, then, are for the in- 
sertion of these muscles, which extend and raise the spine, and for 
the attachment of a ligament which runs from point to point in the 
whole length of the spine, and which checks the bending of the 
trunk forward. 
The transverse processes stand out from the sides of the arms 
or branches which form this arch. They stand out at right angles, 
or transversely from the body of the bone ; and they also are as 
levers, and long and powerful ones for moving and turning the 
spine. Perhaps their chief use is not for turning the vertebra, as 
there is no provision for much of a lateral motion in the lower part 
of the spine ; but the muscles which are implanted into these are 
more commonly used in assisting those which extend and raise the 
spine. 
These, and all the processes, are more distinct, prominent, and 
strong, more direct, and larger in the loins, and more easily under- 
stood than in the vertebras of any other class. But this prepares 
only for the description of the individual vertebra, where we find a 
variety proportioned to the various offices and to the degrees of 
motion which each class has to perform. 
Of the vertebra: of tiie loins.—I have chosen to represent 
the general form of a vertebra, by describing one from the loins, 
because of the distinctness with which all its parts are marked. In 
the lumbar vertebrae, the perpendicular height of the body is short, 
the intervertebral substance is thicker than in the other parts of the 
The 
notch. 
The arti- 
culating 
process, 
called also 
oblique. 
The spi- 
nous pro- 
cesses. 
Trans- 
verse pro- 
cesses. 
Peculiari- 
ties of a 
lumbar 
vertebra. OF THE TRUNK. 
57 
spine, and the several processes stand oft* from each other distinct 
and clear ; all which are provisions for a freer motion in the loins. 
The arch of the lumbar vertebra is wider than in the back, to admit 
the looser texture of the spinal marrow. 
The body of a lumbar vertebra is particularly large, thick, and 
spongy, and its thin outer plate is perforated by many arteries going 
inwards to nourish this spongy substance of the bone. The length 
of the body is about an inch, and the intersticial cartilage is very 
considerable ; so that the vertebrae of the loins present to the eye, 
looking from within the body, a large, thick, and massy column, fit 
for supporting so great a weight. 
The spinous process is short, big, and strong. It runs hori- 
zontally and directly backwards from the arch of the spinal marrow. 
It is flattened, and about an inch in breadth ; and it is commonly 
terminated by a lump or knob, indicating the great strength of the 
muscles and ligaments which belong to it, and the secure hold 
which they have. 
The transverse PROCESS is longer and finer than in the other 
vertebrae ; it goes out laterally and horizontally, and is provided for 
the origins of powerful muscles. We find the spinous process 
divided into two unequal parts by a spine running from the inferior 
articulating process ; in the same manner we see the transverse 
process divided by a ridge extending from the superior articulating 
process. 
The articulating processes of the lumbar vertebras stand so 
directly upwards and downwards, that the name of oblique pro- 
cesses cannot be applied here. They are tuberculated and strong, 
partaking of the peculiarity which marks the general form of those 
vertebrae of the loins. 
Of the vertebras of the back.—The character of the ver- 
tebras of the back is directly opposite to that of the loins. The 
bodies of the vertebras are smaller, though still large enough to 
support the great weight of the trunk ; but they are much deeper, 
proportionably, than those of the loins, and their intervertebral sub- 
stance is thin, for there is little motion here. The spinous pro- 
cesses in the vertebrae of the back are very long and aquiline. 
They are broad at their basis, and very small or spinous at their fur- 
ther end ; and in place of standing perpendicularly out from the 
body, they are so bent down, that they do not form a prominent 
nor unsightly spine, but are ranged almost in a perpendicular line, 
that is, laid over each other, like the scales of armour, the one 
above nearly touching the one below, by which the motions of these 
vertebrae are abridged ; and the further to sustain the column, 
there is a groove on the under surface of the spinous process, 
which receives the superior edge of the one below. The trans- 
verse processes are short and knobby : in place of standing free 
and clear out, like those of the loins, they stand obliquely back- 
ward, are tramelled and restricted from motion, by their connection 
with the ribs ; for the ribs are not merely implanted upon the bodies 
of the dorsal vertebrae, but they are further attached firmly by liga- 
ments, and by a regular joint, to the transverse process of each 
Spinal 
canal 
larger. 
The body 
large and 
broad. 
The spi- 
nous pro- 
cess short. 
Trans- 
verse pro- 
cess di- 
rect. 
Articulat- 
ing pro- 
cess per- 
pendicu- 
lar. 
Of the 
dorsal 
vertebra. 
Body 
deep. 
Spinous 
process 
long, 
oblique, 
grooved. 
Trans- 
verse pfo- 
cesses 
directed 
back- 
wards. 
Impres- 
sion on 
the trans- 
verse pro- 
cess. 58 
OF THE TRUNK. 
vertebra. Now the rib being fixed to the body of one vertebra, 
and to the transverse process of the vertebra below, the motions of 
the vertebrae are much curbed. We get another mark by which 
the dorsal vertebra; may bd known : for each vertebra bears two 
impressions of the rib which was joined to it, one on the flat side 
of its body, and the other on the fore part of its tranverse process. 
On the extremity of each of these transverse processes, a tubercle 
projects backward, giving advantage for the attachment of mus- 
cles. The articulating processes are so short, that they can hardly 
be described as distinct projections, as they stand out so directly 
from the transverse process, appearing as parts of it. The surfaces 
of these processes present more obliquity, and they are simpler in 
form, and smoother, than those of the loins. 
We may distinguish the first vertebra of the back, by its having 
the whole of the head of the rib impressed upon its side. 
The 12th, or lowest dorsal vertebra, has also the entire head of 
the rib impressed upon it, and it has no articulating surface on the 
extremity of the transverse process. 
Of the vertebras of the neck.—The vertebrae of the neck 
depart still farther from the form of those of the loins. The body 
is very small in all the vertebrae of the neck. In the uppermost of 
the neck there is absolutely no body ; and the next to that has not 
a body of the regular and common form. There is not in the ver- 
tebrae of the neck, as in those of the loins, a cup or hollow for re- 
ceiving the intervertebral substance; but the surfaces of the body 
are flat or plain, and the articulating processes are obliquej and 
make, as it were, one articulation with the body ; for the lower 
surface of the body being not hollow, but plain, and inclined for- 
wards, and the articulating processes being also inclined backwards, 
and oblique, the two surfaces are opposed to each other ; the one 
prevents the vertebrae from sliding forwards, and the other prevents 
it from sliding backwards, while a pretty free and general motion is 
allowed. The spinous processes of the neck are short, and project 
directly backwards ; they are for the insertion of many muscles, 
and therefore they are split, and have small tubercles on their ex- 
tremities. This bifurcation of the spinous process is not absolutely 
peculiar to the cervical vertebrae ; for sometimes, though rarely, 
the others are so : and it is only in the middle of the neck that 
even they are forked : for the first vertebra is a plain ring, with 
hardly any spinous process, because there are few muscles attached 
to it; and the process of the last vertebra of the neck is not bifur- 
cated, so that it approaches to the nature of the dorsal vertebras ; 
the spinous process is long and aquiline, is depressed towards the 
back, and is so much longer than the others, as to be distinguished 
by the name of vertebra prominens. 
The transverse pkocesses of the neck are grooved and bifur- 
cated, because there are a great many small muscles attached to 
them. But the most curious peculiarity of the transverse processes 
is, that each of them is perforated for the transmission of the great 
artery, which is named vertebral artery, because it passes 
Two im- 
pressions 
on the 
body. 
Articulat- 
ing pro- 
cesses. 
More 
oblique. 
The first 
and last 
dorsal 
vertebra 
distin- 
guishable. 
Cervical 
vertebrae. 
Their 
bodies 
small. 
Articulat- 
ing pro- 
cesses 
oblique. 
Spinous 
pro cess 
bifu rcat- 
ed, short, 
and hori- 
zontal. 
Lower 
vertebra 
of the 
neck, the 
vertebra 
promi- 
nens. 
Trans- 
verse pro- 
cess bi- 
furcated ; 
perforat- 
ed. OF TIIE TRUNK. 
59 
through these holes in the vertebrae which form altogether a bony 
canal for the artery. 
So that the character of these cervical vertebrae is, that they are 
calculated for much free motion ; and the marks by which they are 
distinguished are, that the bodies are particularly small, the articu- 
lating processes oblique, with regard to their position, and almost 
plain on their surface. The spinous process, which is nearly want- 
ing in the uppermost vertebrae, is short and forked in all the lower 
ones; the transverse process also is forked ; and the transverse pro- 
cesses of all the vertebrae, except sometimes the first and last, are 
perforated near their extremities with the large hole of the vertebral 
artery. 
ATLAS and VERTEBRA DENTATA.—But among these 
vertebrae of the neck, two are to be particularly distinguished, as of 
greater importance than all the rest; for though the five lower ver- 
tebrae of the neck be ossified and fixed, if but the two uppermost 
remain free, the head, and even the neck, seem to move with ease. 
The first vertebra is named atlas, perhaps because the globe of 
the head is immediately placed upon it; the second is named den- 
tata or axis, because it has an axis or tooth-Jike process upon 
which the first turns. 
The atlas has not the complete form of the other vertebrae of the 
neck, for its processes are scarcely distinguishable : it has no body, 
unless its two articulating processes are to be reckoned as a body ; 
it is no more than a simple ring ; it has hardly any spinous process ; 
ancf its transverse process is long and perforated, but not forked. 
On the upper margin of the ring may be observed the mark of the 
ligament, which unites it to the margin of the occipital bone ; and 
on the lower margin of the ring the mark of attachment of a similar 
ligament, which attaches it to the circle of the dentata. The body 
is entirely wanting : in its place, the vertebra has a flat surface 
looking backwards, which is smooth and polished for the rolling of 
the tooth-like process ; there is also a sharp point rising perpendi- 
cularly upwards towards the occipital bone, and this point is held to 
the edge of the occipital hole by a strong ligament. The smooth 
mark of the tooth-like process is easily found ; and upon either side 
of it, there projects a small point from the inner circle of the ring : 
these two points have a ligament extended betwixt them, called the 
transverse ligament, which, like a bridge, divides the ring into two 
openings ; one the smaller, for lodging the tooth-like process, em- 
bracing it closely ; the greater opening is for the spinal marrow: 
the ligament confines the tooth-like process; and when the ligament 
is burst by violence (as has happened), the tooth-like process, 
broken loose, presses upon the spinal marrow ; the head, no longer 
supported by it, falls forward, and the patient dies. On the inside 
and lateral part of the circle, the origin of the lateral ligaments of the 
processus dentatus may also be observed. 
The articulating process may be considered as the body of this 
vertebra ; for it is at once the only thick part, and the only articu- 
lating surface. This broad articulating substance is in the middle 
General 
character. 
Atlas. 
Wants the 
body. 
Spinous 
process 
short. 
Has a 
sharp 
point or 
process. 
Articulat- 
ing sur- 
face of 
the pro- 
cessus 
dentatus. 
Points of 
attach- 
ment of 
the trans- 
verse liga- 
ments. 
Origin of 
thelateral 
ligament. 
Articulat- 
ing sur- 
faces. 60 
OF THE TRUNK. 
of each side of the ring: it has two smooth surfaces on each side ; 
one looking upwards, by which it is joined to the occiput; and one 
looking directly downwards, by which it is joined to the second ver- 
tebra of the neck. The two upper articulating surfaces are oval, 
and slightly hollow to receive the occipital condyles : they are also 
oblique, for the inner margin of each tips downwards; the outer 
margin rises upwards, and the fore end of each oval is turned a little 
towards its fellow. Now, by the obliquity of the condyles, and this 
obliquity of the sockets which receive them, all rotatory motion is 
prevented, and the head performs, by its articulations with the first 
vertebra or atlas, only the nodding motions; and when it rolls, it 
carries the first vertebra along with it, moving round the tooth-like 
process of the dentatus. The articulation with the head is a hinge 
joint in the strictest sense : it allows of no other motion than that 
backwards and forwards: the nodding motions are performed by the 
head upon the atlas, the rotatory motions are performed by the atlas 
moving along with the head, turning upon the tooth-like process of 
the dentatus as on a centre. 
Now the upper articulating surfaces of the atlas are hollowed, to 
correspond with the condyles of the occipital bone, and to secure the 
articulation with the head ; but the lower articulation, that with the 
vertebra dentata, being secured already by the tooth-like process of 
that bone, no other property is required in the lower articulating 
surfaces of the atlas, than that they should glide with perfect ease ; 
for which purpose they are plain and smooth ; they neither receive 
nor are received into the dentata by any hollow, but lie fiat upon the 
surfaces of that bone. It is also evident, that since the office of the 
atlas is to turn along with the head, it could not be fixed to the ver- 
tebra dentata in the common way, by a body and by intervertebral 
substance ; and since the atlas attached to the head moves along with 
it, turning as upon an axis, it must have no spinous process ; for the 
projection of a spinous process must have prevented its turning 
upon the dentatus, and would even have hindered, in some degree, 
the nodding of the head; therefore the atlas has a simple ring behind, 
and has only a small knob or button where the spinous process 
should be, which is somewhat irregularly notched. The trans- 
verse process is not forked, but it is perforated with a large hole 
for the vertebral artery; and the artery, to get into the skull, makes 
a wide turn, lying fiat upon the bone, by which there is a slight 
hollow or impression of the artery, which makes the ring of the 
vertebra exceedingly thin. Sometimes, instead of the groove for 
the artery, there is a perforation in the ring. 
But the form of the vertebra dentata best explains these pecu- 
liarities of the atlas, and this turning of the head. 
The VERTEBRA DENTATA, ODONTOIDES or AXIS, 
is so named from its projecting point, which is the chief charac- 
teristic of this bone. When the dentata is placed upright before us, 
we observe, 1. That it is most remarkably conical, rising all the way 
upwards by a gradual slope to the point of its tooth-like process. 
2. That the ring of the vertebra is very deep, that is, very thick in 
its substance, and that the opening of the ring for transmitting the. 
The upper 
hollow 
oblique. 
Forming 
with the 
condyles 
a hinge 
joint. 
The lower 
surface 
plain, 
smooth. 
Turning 
on the 
dentata. 
No spi- 
nous pro- 
cess. 
Trans- 
verse pro- 
cess per- 
forated for 
the ar- 
tery. 
Impres- 
sion of 
the ar- 
tery. 
Dentata, 
general 
form. OF THE TRUNK. 
61 
spinal marrow is of a triangular form. 3. That its spinous process, 
though short and thick, yet projects beyond the level of the three spi- 
nous processes immediately below it; and that it is turned much 
downwards, so as not to interfere, in any degree, with the rotation 
of the atlas. 4. That its tooth-like process, from which the bone is 
named, is very large, about half an inch in length ; very thick, like 
the little finger ; that it is pointed ; and that from this rough point a 
strong ligament goes upwards, by which the tooth is tied to the great 
hole of the occipital bone. We also observe a neck or collar, or 
smaller part, near the root of the tooth-like process, where it is 
grasped by the transverse ligament of the atlas; while the point of 
the process swells out a little above. We find this neck particularly 
smooth ; for it is indeed upon this collar that the head continually 
turns. And we see on each side of this tooth-like process a broad 
and flat articulating surface. These articulating surfaces are placed 
like shoulders ; and the atlas being threaded by the tooth-like pro- 
cess of the dentata, is set flat down upon the high shoulders of this 
bone, and there it turns and performs all the rotatory motions of the 
head. 
On the side of the tooth-like process we may observe the rough- 
ness for the insertion of the lateral ligaments, and its point is irregular 
where it is grasped by the perpendicular ligament which comes 
down from the occipital bone. 
We may observe, that while the superior articulating processes 
are horizontal, answering the purpose of a body, the lower surface 
of this vertebra is in all respects like the other vertebrae of the neck. 
Spinous 
process 
short, and 
strong. 
Its tooth- 
like pro- 
cess. 
Neck of 
the pro- 
cess. 
Articulat- 
ing sur- 
faces. 
Insertion 
of the 
lateral 
ligaments. 
Articulat- 
ing sur- 
face hori- 
zontal. 
Of the SPINE generally. 
All the vertebrae conjoined make a large canal of a triangular or 
roundish form, in which the spinal marrow lies, giving off and dis- 
tributing its nerves to the neck, arms, and legs ; and the whole 
course of the canal is rendered safe for the marrow, and very smooth 
by lining membranes, the outermost of which is of a leather-like 
strength and thickness, and serves this double purpose ; that it is at 
once a hollow ligament to the whole length of the spine upon which 
the bones are threaded, and by which each individual bone is tied 
and fixed to the next; and it is also a vagina or sheath which con- 
tains the spinal marrow, and which is bedewed on its internal surface 
with a thin exudation, keeping the sheath moist and soft, and making 
the enclosed marrow lie easy and safe. 
All down the spine, this spinal medulla is giving off its nerves : 
one nerve passes from it at the interstice of each vertebra ; so that 
there are twenty-four nerves of the spine, or rather forty-eight 
nerves, twenty-four being given towards each side ; these nerves 
pass each through an opening or small hole in the general sheath; 
there they pass through the interstice of each vertebra ; so that 
there is no hole in the bone required, but the nerve escapes by going 
under the articulating process. This, indeed, is converted into 
something like a hole, when the two contiguous vertebrae are joined 
to each other. 62 
OF THE TRUNK. 
The bodies of the vertebrae are somewhat peculiar in structure, 
being light and spongy bones, covered with a thin cortex : and it 
is from these circumstances that they are very liable to scrofulous 
caries. 
The INTERVERTEBRAL SUBSTANCE.—The interverte- 
bral substance is that which is interposed betwixt the bodies of two 
adjoining vertebras, and which is (at least in the loins) nearly equal 
in thickness to the body of the vertebra to which it belongs. We 
give it this undefined name, because there is nothing in the human 
system to which it is entirely similar; for it is not ligament, nor is it 
cartilage, but it is commonly defined to be something of an 
intermediate nature: it is a soft and pliant substance, which is 
curiously folded and returned upon itself, like a rolled ban- 
dage with folds, gradually softer towards the centre, and with the 
rolled edges as if cut obliquely into a sort of convex. The cut 
edges are thus turned towards the surface of the vertebra, to which 
each intervertebral substance belongs : it adheres to the face of each 
vertebra, and it is confined by a strong ligament all round ; and this 
substance, though it still keeps its hold on each of the two vertebra; 
to which it belongs, though it permits no true motion of one bone 
on another, but only by twisting of its substance, yields, nevertheless, 
easily to whichever side we incline, and it returns in a moment to 
its place by a very powerful resilience. This perfect elasticity is the 
chief character and virtue of this intervertebral substance, whose 
properties indeed are best explained by its uses ; for, in the bendings 
of the body, it yields in a very considerable degree, and rises on the 
moment that the weight or the force of the muscles is removed. In 
leaping, in shocks, or in falls, its elasticity prevents any harm to the 
spine, while other less important joints are luxated and destroyed ; 
and it gives to the whole column that fine elasticity which guards the 
head from sudden shocks, and the brain from vibration. This extent 
of ligamentous binding in the texture of the vertebral column is ano- 
ther cause of its being very subject to scrofulous disease. During 
the day, it is continually yielding under pressure ; so that we are 
taller in the morning than at night; we are shorter in old age than in 
the maturity of manhood; and the aged spine is bending forwards by 
the yielding of this part. These curious facts were first observed by 
a sort of chance, and have since been ascertained with parti- 
cular care. 
Since pressure, in length of years, shortens the fore part of the 
column of the spine, and makes the body stoop, any undue inclina- 
tion to either side will cause distortion: the substance yields on one 
side, and rises on the other; and at last the same change happens in 
the bones also, and the distortion is fixed, and not to be changed : 
this is peculiarly apt to happen with children whose bones are grow- 
ing, and whose gristles and intervertebral substances are pe- 
culiarly soft; so that a tumour on the head or jaw, which 
makes a boy carry his head on one side, or constant stooping, 
such as is used bv a girl in working at the tambour, or the carrying 63 
OF THE TRUNK. 
of a weakly child always on one arm by a negligent or awkward 
nurse, will cause in time a fixed distortion. 
We are now qualified to understand the motions of the vertebrae, 
and to trace the degree of motion in each individual class. The 
degrees of motion vary with the forms of the vertebrae, in each part 
of the spine : the motion is freest in the neck, more limited in the 
loins, and in the back (the middle part of the spine) scarcely any 
motion is allowed : the head performs all the nodding motions upon 
the first vertebra of the neck: the first vertebra of the neck performs 
again all the quick and short turnings of the head, by moving upon 
the dentatus: all the lower vertebrae of the neck are also tolerably 
free, and favour these motions by a degree of turning; and all the 
bendings of the neck are performed by them. The dorsal vertebra3 
are the most limited in their movements, bending chiefly forwards by 
the yielding of their intervertebral substance. The vertebrae of the 
loins again move largely, for their intervertebral substance is deep, 
and their processes less entangled. To perform these motions, 
each vertebra has two distinct joints, as different in office as in form: 
first, each vertebra is fixed to those above and below by the interver- 
tebral substance, which adheres so to each that there is no true mo- 
tion : there is no turning of any one vertebra upon the next; but the 
elasticity of the intervertebral substance allows the bones to move a 
little, so that there is a general twisting and gentle bending of the whole 
spine. The second joint is of the common nature with the other 
joints of the body, for the articulating processes are faced with carti- 
lage, surrounded with a capsule, and lubricated with a mucus. I 
conceive this to be the intention of the articulating processes being 
produced to such a length, that they may lap over each other to pre- 
vent luxations of the spine ; and they must, of course, have these 
small joints, that they may yield to this general bending of the spine.* 
RIBS and STERNUM. 
Of the ribs.—The ribs, whose office it is to give form to tiie 
thorax, and to cover and defend the lungs, also assist in breathing ; 
for they are joined to the vertebrae by regular hinges, which allow 
of short motions, and to the sternum by cartilages, which yield to 
the motion of the ribs, and return again when the muscles cease 
to act.. 
Each rib, then, is characterized by these material parts : a great 
length of bone, at one end of which there is a head for articulation 
with the vertebrae, and a shoulder or knob for articulation with its 
transverse process ; at the other end there is a point, with a socket 
for receiving its cartilage, and a cartilage joined to it, which is im- 
planted into a similar socket in the side of the sternum, so as to com- 
plete the form of the chest. 
The ribs are twelve in number, according to the number of the 
vertebrae in the back, of which seven are named true ribs, because 
their cartilages join directly with the sternum, and these are the 
Classifi- 
cation of 
the ribs ■ 
Seven 
true. 
* Sec further of the Spine, in the Review of the Skeleton 64 
OK THE TRUNK. 
Fire false. 
preservers, the custodes, as protecting the heart; and live are 
named false ribs, because their cartilages are not separately nor 
directly implanted into the sternum, but are joined one with another ; 
the cartilage of the lower rib being joined and lost in that of the 
rib above, so that all the lower ribs run into one greater cartilage. 
But there is still another distinction, viz. that the last rib, and com- 
monly also the rib above, are not at all implanted in the sternum, 
but are loosely connected only with the muscles of the abdomen, 
whence they are named the loose or floating ribs. 
The ribs are, in general, of a flattened form, their flat sides being 
turned smooth towards the lungs. But this flatness of the rib is 
not regular; it is contorted, as if the soft rib had been seized by 
either end, and twisted betwixt the hands : the meaning of which 
is, to accommodate the flatness of the rib to the form which the 
thorax assumes in all its degrees of elevation ; for when the rib 
rises, and during its rising through all the degrees of elevation, it 
still keeps its flat side towards the lungs. Though of a flattened 
form, the rib is a little rounded at its upper edge, is sharp and cut- 
ting at its lower edge ; and its lower edge seems double ; for there 
is a groove, which in some measure gives security to the intercostal 
artery and nerve. 
On each rib we find the following parts : 1. The head, or round 
knob, by which it is joined to the spine. The head of each rib has 
indeed but a small articulating surface ; but that smooth surface is 
double, or looks two ways. For the head of the rib is not im- 
planted into the side of one vertebra, it is rather implanted into the 
interstice betwixt two vertebrae ; the head touches both vertebra;; 
all the vertebrae, except the first and bear the mark of two ribs, 
one above, and one below. The mark of the rib is on the edge 
of either vertebra, and the socket may be said to lie in the interver- 
tebral substance betwixt them. 
2. The neck of the rib is a smaller part, immediately before the 
head. Here the rib is particularly small and round. 
3. About an inch from the head, there is a second rising, or 
bump, the articulating surface by which it touches and turns upon 
the transverse process of the vertebra below. These two articula- 
tions have each a distinct capsule or bag: each is a very regular 
joint; and the degree of motion of the rib, and direction in which 
it moves, may be easily calculated from the manner in which it is 
jointed with the spine ; for the two articulating surfaces of the rib 
are on its back part: the back of the rib is simply laid upon the side 
of the spine ; the joints, with the body of the vertebra, and with 
its transverse process, are in one line, and form as if but one joint; 
so that the rib being fixed obliquely, and at one end only, that end 
continues firm, except in turning upon its axis : the two heads roll 
upon the body of the vertebrae, and upon the transverse process ; 
and so its upper end continues fixed, while its lower end rises or 
falls ; and as the motion is in a circle, the head being the central 
point, moves but little, while the lower end of the rib has the widest 
range: 
4. Just above the second articulating surface there is a second 
1 
Two float- ] 
ing ribs. 
Their 
form flat, ( 
Twisted. I 
Upper ! 
edge • 
rounded. 
A groove ' 
on the j 
lower 
edge. 
The head 
having 
two arti- 
culating 
surfaces. 
Cervix. 
Tubercle. 
Articulat- 
ing with 
the trans- 
verse pro- 
cess. 
A second 
tubercle. OF THE TRUNK. 
65 
tubercle, which has nothing to do with the joints, but is intended 
merely for the attachment of the ligaments and muscles from the 
spine which suspend and move the rib, and for the attachment of 
the anterior slips of the longissimus dorsi muscle. 
5. The angle of the rib is often mentioned, being a common 
mark for the place of surgical operations. There is a flatness of 
the thorax behind, forming the breadth of the back ; the sharpness 
where this flatness begins to turn into the roundness of the chest 
is formed by the angles of the ribs. Each rib is round in the place 
of its head, neck, and tubercles: it grows flatter a little, as it ap- 
proaches the angle : but it is not completely flattened till it has 
turned the angle which is the proper boundary betwixt the round 
and the flat parts of the rib ; into these angles of the ribs the sacro- 
lumbalis is inserted. This anatomy of the ribs is sufficiently simple, 
but it is not equally easy to observe how it bears on the practice of 
surgery. It is in some degree useful in the more advanced parts of 
anatomy, to remember the names ; and it is necessary, even in 
speaking the common language of surgeons, to know these parts, 
viz. the head of the rib ; the tubercle, or second articulating sur- 
face ; the angle, or turning forward of the rib ; the upper round, 
and the lower flat edge ; and especially to remember the place and 
the dangers of the intercostal artery. It is, however, more impor- 
tant to consider the connexions of parts ; as the seat of the artery, 
the manner in which the ribs are lined with the pleura, and their 
nearness to the surface of the lungs. The ribs increase in the 
obliquity of their position from the highest to the lowest, and their 
anterior extremities expand, and are more distant from each other. 
There are some peculiarities in individual ribs, the chief of which 
are these : the length of the rib is increasing from the first to the 1 
seventh, but again decreases from the seventh to the twelfth ; the J 
curve of the ribs gradually decreases from the first to the last, the 
first being exceedingly short and circular, the lower ones longer, 
and almost right lined, making a small portion or segment of a large 
circle ; so that the thorax is altogether of a conical shape, the upper 
opening so small, as just to permit the trachea, oesophagus, and 
great vessels to pass ; the lower opening so large, that it equals 
the diameter of the abdomen ; the first rib is consequently very 
short; it is thick, strong, and of a flattened form ; of which flat- 
ness one face looks upwards, and another downwards, and the great 
axillary artery and vein lie upon its flat upper surface. We do not 
see any groove on the lower surface for the intercostal artery. It 
is also particularly circular, making more than half a circle from its 
head to the extremity where it joins the sternum ; it has, of course, 
no angle, and wants the distorted twisting of the other ribs : the 
second rib is also round, like the first rib.. The eleventh and 
twelfth, or the floating ribs, are exceedingly small and delicate, and 
their cartilage terminates in an acute point, unconnected with the 
sternum : and, lastly, the heads of the first, and of the twelfth ribs, 
are rounder than any of the others ; for these two have their heads 
implanted into the flat side of one vertebra only, while all the others 
have theirs implanted betwixt the bodies of two vertebrae, Anti 
The 
angle. 
Recapitu- 
lation of 
the anato- 
my of the 
rib. 
Peculiari- 
ties of in- 
dividual 
ribs. 66 
OE THE TRUNK. 
there is this further difference, that in the eleventh and twelfth ribs 
there are no tubercles for the articulation with the transverse pro- 
cesses. The cartilages of the ribs become longer as they descend 
and approach nearer to each other ; they complete the form of the 
thorax, and form all the lunated edge of that cavity ; and it is from 
this cartilaginous circle that the great muscle of the diaphragm has 
its chief origin, forming the partition betwixt the thorax and the 
abdomen. The farther end of each rib swells out thick and spongy, 
and has a small socket for lodging the cartilage; for these cartilages 
are not joined, like the intervertebral substances, with their hones ; 
but there is a sort of joint very little moveable indeed, hut still 
having a rude socket, and a strong capsular ligament, and capable 
of luxation by falls and blows; the implantations into the sternum 
are evidently by fair round sockets, which are easily distinguished 
upon the two edges of that bone. These cartilages may be enu- 
merated thus : The cartilages of the first and second ribs descend 
to touch the sternum. The cartilage of the third rib is direct. 
The cartilages of the fourth, fifth, and sixth ribs rise upwards, in 
proportion to their distance from this central one. rl he first five 
ribs have independent cartilages. The eighth, ninth, and tenth 
ribs run their cartilages into the cartilage of the seventh rib. And 
the eleventh and twelfth ribs have their cartilages small, uncon- 
nected, and floating loose. 
By the motion of the ribs, the thorax is alternately dilated and 
diminished in capacity, the lungs thereby having their play. A rib 
has two motions: 1. Its sternal end rises and falls, the centre of 
motion being in the articulation with the spine. 2. It moves on 
its own axis ; a line drawn through the two extremities is the 
centre of this motion. The former motion enlarges and diminishes 
the diameter of the thorax, from the spine to the sternum ; this 
enlarges the lateral diameter of the thorax. The importance of 
attending to the motion of the ribs is obvious in practice ; for when 
the rib is broken, the ends jar and rub against each other, in con- 
sequence of the anterior extremity moving through a greater space 
than the posterior ; and the business of the surgeon is to interrupt 
this. Besides, the fracture of the rib, most commonly of little 
consequence, is sometimes attended with the most serious symp- 
toms, and even death ; for if the fractured extremity punctures the 
membrane of the lungs, the air is drawn into the cavity of the 
chest, and from thence is pressed into the cellular substance, and 
the man is blown up in a prodigious degree. 
The sternum.—The sternum is that long and squared bone, 
which lies on the fore part of the breast over the heart, and which 
being joined by the cartilages of the ribs, completes the cavity of 
the chest; it is for completing the thorax, and defending the heart, 
for a medium of attachment to the ribs, and for a fulcrum or point, 
on which the clavicles may roll. 
We find the sternum consisting in the child of eight distinct pieces, 
which run together in the progress of life, and which, in old age, 
are firmly united into one ; but in all the middle stages of life, we 
fihd three pieces in the sternum, two of which are properly bone. 
Sockets in 
the ante- 
rior ex- 
tremity of 
the rib, 
and of the 
cartilage. 
Motion of 
the ribs. 
Situation. 
In the 
child eight 
pieces. 
In middle 
age three. OF THE TRUNK. 
67 
the third remains a cartilage till very late in life, and is named the 
ensiform cartilage, from its sword-like point. 
It is found to have eight pieces, even in the child of six years old : 
some years after, it has but five or six ; and the salient white lines 
which traverse the bone, mark where the intermediate cartilages 
have once been. 
1. The upper piece of the sternum is very large, roundish, or 
rather triangular, resembling the form of the heart on playing-cards : 
it is about two inches in length, and an inch and a half in breadth ; 
and these marks are easily observed. The apex, or point of the 
triangle, is pointed downwards, to meet the second bone of the ster- 
num. The base of the triatvgle, which is uppermost, towards 
the root of the throat seems a little hollowed, for the trachea passing 
behind it. On each upper corner, it has a large articulating hollow, 
into which the ends of the collar bones are received (for this bone is 
the steady fulcrum upon which they roll.) A little lower than this, 
and upon its side, is the socket for receiving the short cartilage of 
the first rib ; and the second rib is implanted in the interstice be- 
twixt the first and second hone of the sternum ; so that one half of the 
socket for its cartilage is found in the lower part of this bone, and 
the other half in the upper end of the next. 
2. The second piece of the sternum is of a squared form, very 
long and flat, and composing the chief length of the sternum : for 
the first piece receives only the cartilage of the first rib, and one 
half of the second ; but this long piece receives on each side or edge 
of it, the cartilages of eight ribs ; but as three of the lower cartilages 
are run into one, there are but five sockets or marks. The sockets 
for receiving the cartilages of the ribs are on the edges of the ster- 
num ; they are very deep in the firm substance of the hone, and large 
enough to receive the point of the finger with ease : and whoever 
compares the size and deepness of these sockets with the round 
heads of the cartilages which enter into them, will no more doubt of' 
distinct joints here than of the distinct articulation of the vertebrae 
with each other. 
3. This is, in truth, the whole of the bony sternum ; and what is 
reckoned the third piece, is a cartilage merely, and continues so 
down to extreme old age. This cartilage, which ekes out, and 
lengthens the sternum, and which is pointed like a sword, is thence 
named cartilago mucroxata, the pointed cartilage ; or carti- 
eago exsiformis, or xiphoides, the sword-like cartilage. One half 
of the pit for the attachment of the seventh rib is on this portion. 
This cartilaginous point, extending downwards over the belly, gives 
a sure origin and greater power to the muscles of the abdomen, and 
that without embarrassing the motions ofthe body ; but this cartilage, 
which is commonly short and single-pointed, is sometimes forked, 
sometimes bent inwards, so (it has been thought) as to occasion 
sickness and pain ; and once was produced to such a length, as to 
reach the navel, and ossified at the same time, so as to hinder the 
bending of the body, and occasion much distress. 
The sternum and the ribs, and all the chest, stand so much ex- 
posed, that did we not naturallv sruard them with the hands, frae- 
Triangu- 
lar por- 
tion. 
Apex. 
Base up- 
wards, 
hollowed 
for the 
throat. 
Articu- 
lates with 
' the clavi- 
cle. 
Socket for 
the first 
rib. 
Part of 
the second 
rib 
touches 
this. 
Central 
portion 
oblong. 
Five pits 
for the 
attach- 
ment of 
eight ribs. 
The third 
piece. 
Cartilag* 
ensifor- 
mis. 
Some- 
times 
forked. 
Surgical 
remarks. 68 
OF THE THUNK. 
lures must be very frequent; but indeed when they are broken, and 
beaten in, they hurt the heart or lungs, and not unfrequently the 
most dreadful consequences ensue. The sternum is, like the body 
of a vertebra, spongy and covered with a thin cortex of bone, and 
sheathed with ligaments ; and being exposed, it is very subject to 
scrofulous inflammation. 
The fracture of the sternum is a most serious accident ; for when 
there is not death in consequence of the injury of the heart, there is 
a grating and rubbing of the broken surfaces : for the lower extre- 
mity of the sternum is carried forward in inspiration ; and therefore, 
when there is a fracture, the lower part moves upon the upper part, 
and if not restrained, it will cause inflammation and suppuration 
beneath. 
PELVIS. 
To give a steady bearing to the trunk, and to connect it with the 
lower extremities by a sure and firm joining, the pelvis is interposed ; 
which is a circle of large and firm bones, standing as an arch betwixt 
the lower extremities and the trunk. Its arch is wide and strong, so 
as to give a firm bearing to the body ; its individual bones are large, 
so as to give a deep and sure socket for the implantation of the thigh 
bone ; its motions are free and large, bearing the trunk above and 
rolling upon the thigh bones below ; and it is so truly the centre of 
all the great motions of the body, that when we believe the motion 
to be in the higher parts of the spine, it is either the last vertebra of 
the loins bending upon the top of the pelvis, or the pelvis itself roll- 
ing upon the head of the thigh bones. 
The pelvis is named from its resembling a basin in its form ; or, 
perhaps, from its office of containing the urinary bladder, rectum, 
vagina, and womb: it consists in the child of many pieces, but in 
the adult it is formed of three large bones and a smaller one ; viz. 
the sacrum, and ossa innominata, and os coccygis. 
Os sacrum.—The names, os sacrum, os basilare, &c. seem to 
relate rather to its greater size than to its ever having been offered 
in sacrifice. This bone, with its appendix, the os coccygis, is called 
the false spine, or the column of the false vertebrae : authors making 
this distinction, that the true vertebrae are those of the back, neck, 
and loins, which possess motion, a column which grows gradually 
smaller upwards; the false vertebrae are those of the sacrum and 
coccyx, which are conical, with the apex or point downwards, and 
the base, viz. the top of the sacrum, turned upwards to meet the true 
spine, and which have no motion like the pieces of the spine. 
The bones of which the sacrum is composed had originally the 
form of distinct, small vertebrae. These distinctions are lost in the 
adult, or are recollected only by the marks of former lines ; for the 
original vertebrae are now united into one large and firm bone. 
We can recognise the original vertebrae, even in the adult bone; 
for we find it regularly perforated with holes, for the transmission of 
the spinal nerves : we find these holes regularly disposed in pairs : 
we see a distinct white and rising line, which crosses the bone, in 
Pelvis 
consisting 
in the 
child of 
many 
pieces, in 
the adult 
of four. 
The sa- 
crum. 
The false 
vertebrae. 
The sa- 
crum ori- 
finally 
istinct 
pieces or 
vertebrae. 
Which we 
recognise 
in the 
adult 
bone. OF THE TRUNK. 
69 
the interstice of each of the original vertebra?, and marks the place 
where the cartilage once was ; and by these lines, being five in 
number, with generally five pair of holes, we know this bone to have 
consisted once of five pieces, which are now joined into one. The 
remains of former processes can also be distinguished, and the back 
of the bone is rough and irregular from the projection of the spinous 
processes. 
The os sacrum, thus composed, is among the lightest bones of the 
human body, with the most spongy substance, and the thinnest 
tables ; but then it is a bone the best cemented, and confirmed by 
strong ligaments, and the best covered by thick and cushion-like 
muscles. The os sacrum is of a triangular shape ; the base of the 
triangle turned upwards to receive the spine ; its inner surface is 
smooth, to permit the head of the child in labour to glide easily 
along ; and its outer surface is irregular and rough, with the spines 
of former vertebrae, giving rise to the great glutsei muscles (which 
form the contour of the hip,) and to the strong muscles of the back 
and loins, the longissimus dorsi and sacro lunibalis, which are for 
raising the spine and sustaining the body. 
It has in it a triangular cavity under the arch of its spinous pro- 
cesses ; which cavity is continued from the canal in the vertebrae of 
the spine ; and this cavity of the sacrum contains the continuation and 
the end of the spinal marrow, which being, before it descends to this 
place, divided into a great many thread-like nerves, has altogether 
the form of a horse’s tail, and is therefore named cauda equina. 
From this triangular cavity the nerves of the cauda equina go out 
by four, sometimes five, great holes on the fore part of the sacrum, 
holes large enough to receive the point of the finger : grooves are 
seen running from these holes, for the passage of the sacral nerves. 
The first three nerves of the sacrum joining with the last two nerves 
of the loins, form the sacrosciatic nerve, the largest in the body, 
which goes downward to the leg, while the two lower nerves of the 
sacrum supply the contents of the pelvis alone. 
The back of the sacrum is also perforated with four holes, whose 
size is nearly equal to those on its fore part: these transmit no great 
vessel nor nerve, and seem to be merely for diminishing the weight 
and substance of the bone. 
All the edges of the sacrum form articulating points, by which 
it is joined to other bones. The base, or upper part of the sacrum 
receives the last vertebra of the loins on a large broad surface, which 
makes a very moveable joint; and, indeed, the joining of the last 
true vertebra with the top of the sacrum, is a point where there is 
more motion than in the higher parts of the spine. The sacrum, 
has two articulating surfaces which stand perpendicular, and corres- 
pond with those of the lower lumbar vertebra. The apex, or point 
of the sacrum, has the os coccygis joined to it; which joining is 
moveable till the age of twenty in men, and till the age of forty-five 
in women ; and the meaning of its continuing longer moveable in 
women is very plain, since the lower point of the coccyx in women 
is felt yielding in the time of labour, so as to enlarge greatly the lower 
opening of the pelvis. The sides of the os sacrum form a broad, 
Substance 
spongy. 
Form tri- 
angular. 
Concave 
within. 
Irregular 
on the 
back part. 
Its cavity. 
Triangu- 
lar. 
Foramina. 
Base arti- 
culated 
with the 
vertebra. 
Articulat- 
ing pro- 
cesses. 
Apex with 
the os 
coccygi*. 
Lateral 
articuTat- 70 
OF THE TRUNK. 
ing sur- 
face. 
rough, and deeply indented surface, which receives the like rough 
surface of the haunch bones, by that sort of union which is called 
synchondrosis : but here the surfaces are so rough, and the cartilage 
so thin, that it resembles more nearly a suture ; and by the help of the 
strong ligaments, and of the large muscles which arise in common 
from either bone, makes a joining absolutely immoveable, except by 
such violent force as is in the end fatal. 
Thus the original state of this bone is easily recognised and traced 
by many marks ; it stands in a conspicuous place of the pelvis, and 
its chief ollice is to support the trunk : to which we may add, that it 
defends the cauda equina, transmits its great nerves, forms chiefly 
the cavity of the pelvis, and that it is along the hollow of this bone 
that the accoucheur calculates the progress of the child’s head in 
labour. 
The os coccygis, so named from its resemblance to the beak of a 
cuckoo, is a small appendage to the point of the sacrum, terminating 
this inverted column with an acute point, and found in very different 
conditions in the several stages of life, in the child it is merely 
cartilage, and we can find no point of bone ; during youth it is ossi- 
fying into distinct bones, which continue moveable upon each other 
till manhood ; then the separate bones gradually unite with each 
other, so as to form one conical bone, with bulgings and marks of 
the pieces of which it was originally composed ; but still the last 
bone continues to move upon the joint of the sacrum, till, in ad- 
vanced years, it is at last firmly united, later in women than in men, 
with whom it is often fixed at twenty or twenty-five. The first bone 
is flat, with two transverse processes ; the others become gradually of 
a roundish form, convex without, and concave inwards, forming, with 
the sacrum, the lowest part of the pelvis behind, it has no distinct 
holes, but the last sacral hole is frequently completed by a groove 
on the upper surface of the first bone ; it has no communication 
with the spinal canal, but points forward to support the low'er part 
of the rectum. The prolongation of this appendix to the spine by a 
succession of additional bones, forms the tail in quadrupeds; while, 
in man, the coccyx is turned in to support the parts contained in 
the pelvis, and to afford an elastic extremity to the spine, on which, 
in some measure, we rest in sitting : in women it continues so movea- 
ble as to recede in time of labour, allowing the child’s head to pass. 
This bone is apt to be dislocated by our falling with the breech on a 
projecting corner, or, more ignominiously, by kicks in the same 
place. YVdien dislocated, it gives rise to very considerable distress, 
and to disorder of the function of the rectum and neck of the 
bladder. 
The ossa innominata are the two great irregular bones forming 
the sides of the pelvis, which have a form so difficult to explain by 
one name, that they are called ossa irmominata, the nameless bones. 
But these bones having been in the child formed in distinct and sepa- 
rate pieces, these pieces retain their original names, though united 
into one great bone : we continue to explain them as distinct bones, 
by the names of os ilium, os ischium, and os pubis. The os ilium, 
the haunch-bone, is that broad and expanded bone on which lie the 
Os coccy- 
gis an 
appendix 
to the sa- 
crum in 
the child 
cartilage. 
Moves on 
the sa- 
crum. 
In ad- 
vanced 
years 
united to 
it. 
It has no 
cavity. 
Os inno- 
miuatum. 
Divided 
into three. OB’ THE TRUNK. 
71 
strong muscles of the thigh, and which forms the rounding of the 
haunch. The os ischium, the hip-bone, the lowest point of the pel- 
vis, that on which we rest in sitting. The os pubis, or share-bono, 
on which the private parts are placed. Ail these bones are divided 
in the child ; they are united in the very centre of the socket for the 
thigh-bone ; and we find in the child a thick cartilage in the centre 
of the socket, and a prominent ridge of bone in the adult; which 
ridge, far from incommoding the articulation with the thigh-bone, 
gives a firmer hold to the cartilage which lines that cavity, and is the 
point into which a strong ligament from the head of the thigh-bone 
is implanted. 
The os ilium, or haunch-bone, is named from its forming the 
flank. It is the largest part of the os innominatum. It rises up- 
wards from the pelvis in a broad expanded wing, which forms the 
lower part of the cavity of the abdomen, and supports the chief 
weight of the impregnated womb (for the womb commonly inclines 
to one side). The os ilium is covered with the great muscles that 
move the thighs, and to its edge are fixed those broad fiat muscles 
which form the walls of the abdomen. This fiat upper part is named 
the ala, or wing ; while the lower, or rounder part, is named the 
body of the bone, where it enters into the socket, and meets the 
other bones. 
The ala, or flat expanded wing, has many parts, which must be 
well remembered, to understand the muscles which arise from them. 
1. The whole circle of this wing is tipi w ith a ridge of firmer bone, 
which encircles the whole. This is a circular cartilage in the child, 
distinct from the bone, and is ossified and fixed only at riper years. 
All this ridgy circle is called the spine, and is the origin for several 
muscles. The external oblique muscle of the abdomen is inserted 
into the outer edge or labium, and from this margin the gluteus me- 
dius arises. The internal oblique arises from the middle rough line, 
and the transversalis from the inner edge of the spine. 2. The two 
ends of this spine are abrupt, and the points formed upon it are conse- 
quently named spinous processes, of which there are two at its fore 
and two at its back end. The two posterior spinous processes are 
close by each other, and are merely two rough projecting points 
near the rough surface, by which the os ilium is joined to the os 
3acrum : they jut out behind the articulation, to make it firm and 
sure ; and their chief uses seem to be the giving a firm hold to the 
strong ligaments which bind this joint. Where the spine terminates 
in this process the great muscle of the hip, the gluteus maximus, 
takes its rise. 3. The two anterior spinous processes are more dis- 
tinct, and more important marks ; for the anterior superior spi- 
nous process is the abrupt ending of the spine, or circle of the ilium, 
with a swelling out: from which jutting point the sartorious muscle, 
the longest, and among the most beautiful in the human body, goes 
obliquely across the thigh, like a strap, down to the knee ; another, 
which is called the tensor vaginae femoris, also arises here ; and from 
this point departs the ligament, which, passing from the os ilium to 
the pubis, or fore point of the pelvis, is called the ligament of the 
thigh. The lower anterior spinous process is a small bump, or 
Os ilii. 
Ala. 
Spine. 
Spinous 
processes- 
Posterior, 
superior, 
and infe- 
rior. 
Anterior 
superior. 
Anterior 
inferior. 72 
OB' THE TRUNK. 
little swelling, about an inch under the first one, which gives rise to 
the rectus femoris muscle, or straight muscle of the thigh, which lies 
along its fore part; and upon the inside of the process there is a de- 
pression lodging the iliacus interims and psoas magnus. 
The back, or dorsum of the os ilium, is covered with the three 
great glutaci muscles. We remark in a strong bone a semicircular 
ridge, which runs from the upper part of the anterior inferior spinous 
process to the lower part of the notch, and which marks the place of 
origin of the gluteus medius. The inner surface is hollowed, so as 
to be called the cup or hollow, or sometimes the venter. 
This bone (the os ilium) has a broad rough surface, by which it is 
connected with the os sacrum at its side; the very form of which de- 
clares the nature of this joining, and is sufficient argument and proof 
that the joinings of the pelvis do not move. 
The acute line, which is named luxe a innqminata, is seen upon 
the internal surface of the bone, dividing the ala, or wing, from that 
part which forms the true pelvis. This line composes part of the 
brim of the pelvis, distinguishes the cavity of the pelvis from the 
cavity of the abdomen, and marks the circle into which the head of 
the child descends at the commencement of labour. This bone 
enters into the composition of the socket for the thigh-bone, in a 
manner to be presently explained. 
In many parts of the bone we see holes for transmitting vessels ; 
we find one particularly large in the cup. 
The os ischium, or hip-bone, is placed perpendicularly under the 
os ilium, and is the lowest point of the pelvis upon which we sit. It 
forms the largest share of the socket, whence the socket is named 
acetabulum ischii, as peculiarly belonging to this bone. The bump 
or round swelling upon which we rest is named the tuber ischii; and 
the smaller part which extends upwards to meet the os pubis, is 
named the ramus, or branch, which meets a similar branch of that 
bone, to form the thyroid hole. 
The body is the uppermost and thicker part of the bone which 
helps in forming the socket; and among the three bones, this one 
forms the largest share of it; nearly one half. From the body, a 
sharp-pointed process, named spinous process of the ischium, is 
projected backwards; which, pointing towards the lower end of the 
sacrum, receives the uppermost of two long ligaments, which, from 
their passing betwixt the ischium and sacrum, are named sacro- 
sciatic : by this ligament a semi-circle of the os ilium, just below the 
joining of the ilium with the sacrum, is completed into a large round 
hole ; which is in like manner named the sacro-sciatic hole, and 
gives passage to the pyramidalis muscles, and to the great nerve of 
the lower extremity, named the great sacro-sciatic nerve. 
From the tuber, or round knob, being the point upon which we 
rest, this bone has been often named os sedentarjum. The bump is 
a little flattened where we sit upon it. It is the mark by which the 
lithotomist directs his incision, cutting exactly in the middle betwixt 
the anus and this point of bone. It is remarkable as being the point 
towards which the posterior or lower sacro-sciatic ligament extends, 
and as a point which gives rise to several of the strong muscles on 
Dorium. 
Cup. 
Articula- 
tion with 
the sa- 
crum. 
Linea in- 
uomiuata. 
Acetabu- 
lum. 
O* ischii. 
Body. 
Spinous 
process. 
Notch of 
ilium. 
Tuber. Ob' THE TRUNK. 
73 
tiie back of the thigh, and especially to those winch ibrm the hum- 
strings, semi-tendinosus, semi-membranosus, and long head of the 
biceps cruris. 
Between the scabrous surface on the tuber, and the edge of the 
acetabulum, there is a smooth surface rather depressed which is 
called the cervix. It is covered with a cartilage which allows the 
tendon of the obturator to move easily. 
The ramus, or branch, rises obliquely upwards and forwards, to 
join a like branch of the pubis. This branch, or arm, as it is called, 
is flat, and its edges are turned a little forwards and backwards; so 
that one edge forms the arch of the pubis, the other edge forms 
the margin of the thyroid hole. 
The os pubis, or share-bone, is the last and smallest piece of the 
os innominatum, and is named from the mons veneris being placed 
upon it, and its hair being a mark of puberty. It forms the upper, or 
fore part of the pelvis, and completes the brim; and, like the 
ischium, it also is divided into three parts, viz. the body, angle, and 
RAMUS. 
The body of the os pubis is thick and strong, and forms about one 
fifth of the socket for the thigh-bone. It is not only the smallest, 
but the shallowest part of the socket. The bone grows smaller, as 
it advances towards its angle ; it again grows broad and flat, and the 
two bones meet with rough surfaces, but with two cartilages inter- 
posed. Over the middle of this bone, two great muscles, the iliac 
and psoas muscles, pass out of the pelvis to the thigh ; and where 
they run under the ligament of the thigh, the pubis is very smooth. 
On the angle or crest there is a process which is frequently called 
tuberous angle : from this process there are two ridges traced ; one 
goes to meet the line on the ilium, forming the brim of the pelvis, and 
forms the linea ileo pectinea, or linea innominata; the other goes 
down towards the edge of the acetabulum : between these two ridges 
there is a flat surface giving origin to the pectineus. The ramus, 
or branch, is that more slender part of the pubis, which, joining with 
the branch of the ischium, forms with it the arch of the pubis, and 
the edge of the thyroid hole. Just under the body of the bone, 
there is a groove, which forms that part of the thyroid hole which 
transmits the obturator nerve and artery. 
This completes the strict anatomy of the pelvis; but when we 
consider the whole, it is further necessary to repeat, in short defini- 
tions, certain points which are oftener mentioned as marks of other 
parts. 
The promontory of the sacrum is the projection formed by the 
lowest vertebra of the loins, and the upper point of that bone. The 
hollow of the sacrum is all that smooth inner surface which gives out 
the great nerves for the legs and pelvis. The lesser angle, in dis- 
tinction from the greater angle or promontory of the sacrum, is a 
short turn in the bone near where it is joined writh the os coccygis. 
The crest of the pubis is a sharper ridge or edge of the bone over 
the joining or symphysis pubis. The posterior symphysis of the 
pelvis is the joining of the sacrum with the ilium, while the symphysis 
pubis is distinguished by the name of anterior symphysis of the 
Cervix. 
It am us . 
Os Pubis. 
liody. 
Crest. 
Lines ileo 
pectinea. 
Itamus. 
Groove of 
the os 
pubis. 
Promou- 
tory of 
sacrum. 
Hollow. 
Lesser 
angle. 
Crest of 
pubis. 
Symphy- 
ses. 74 
OF THE TRUNK. 
pelvis. The spine, the tuber, and the ramus of the ischium are 
sufficiently explained. The ala, or wing, the spine, the spinous 
processes, and the linea innominata of the ilium, have been 
already sufficiently explained. The acetabulum, so named from its 
resemblance to a measure which the ancients used for vinegar, is the 
hollow or socket for the thigh-bone, composed of the ilium, ischium, 
and pubis ; the ridge in its centre shows the place of its original car- 
tilage, and points out what proportion belongs to each bone ; that it 
is made, two-fifths by the os ilium, two-fifths by the os ischium, and 
one-fifth only by the os pubis: but the ischium has the greatest 
share ; the ischium forming more than two-fifths, and the ilium less. 
On the lower part of the margin there is a deficiency of bone; 
which, however, is made up by a ligament, and yet not so perfectly, 
but that dislocation of the head of the femur sometimes takes place 
in this direction. 
The brim of the pelvis is that oval ring which parts the cavity of 
the pelvis from the cavity of the abdomen : it is formed by a conti- 
nued and prominent line along the upper part of the sacrum, the 
middle of the ilium, and the upper part or crest of the pubis. This 
circle of the brim supports the impregnated womb, keeps it up 
against the pressure of the labour pains; and sometimes this line has 
been u as sharp as a paper-folder, and has cut across the lower seg- 
ment of the womb and so, by separating the womb from the va- 
gina, has rendered the delivery impossible ; and the child escaping 
into the abdomen among the intestines, the woman has died.* The 
outlet of the pelvis is the lower circle again, composed by the 
arch of the pubis, and by the sciatic ligaments, which is wide and 
dilatable, to permit the delivery of the child, but which being some- 
times too wide, permits the child’s head to press so suddenly, and 
with such violence upon the soft parts, that the perineum is torn. 
The thyroid hole is that remarkable vacancy in the bone which 
perhaps lightens the pelvis, or perhaps allows the soft parts to 
escape from the pressure, during the passage of the head of the 
child. 
The marks of the female skeleton have been sought for in the 
skull, as in the continuation of the sagittal suture ; but the truest 
marks are those which relate to that great function by which chiefly 
the sexes are distinguished : for while the male pelvis is large and 
strong, with a small cavity, narrow openings, and bones of greater 
strength, the female pelvis is very shallow and wide, with a large 
cavity, and slender bones, and with every peculiarity which may 
conduce to the easy passage of the child. And this occasions that 
peculiar form of the body which the painter is at great pains to mark, 
and which is indeed very easily perceived ; for the characteristic of 
the manly form is firmness and strength ; the shoulders broad, the 
haunches small, the thighs in a direct line with the body, which gives 
a firm and graceful step. The female form again is delicate, soft, 
Acetabu- 
um iscliii, 
Brim of 
the pelvis. 
Outlet. 
Thyroid 
hole. 
Peculiari- 
ties of the 
female 
pelvis. 
* This condition of the brim is exhibited in a skeleton, in the collection of Wind- 
mill Street. The woman died in child-bed, and it was found that the arm of the 
child had escaped from the womb at the place, where it was cut by the sharp spine 
of hone. OF THE TRUNK. 
75 
and bending'; the shoulders are narrow ; the haunches broad ; the 
thighs round and large ; the knees, of course, approach each other, 
and the step is unsure : the woman even of the most beautiful form, 
walks with a delicacy and feebleness, which we come to acknowledge 
as a beauty in the weaker sex. 
The bones of the pelvis compose a cavity which cannot be fairly 
understood in separate pieces, but which should be explained as ar 
whole. Though perhaps its chief office is supporting the spine, still 
its relation to labour deserves to be observed ; for this forms at least 
a curious inquiry, though it should not be allowed a higher place in 
the order of useful studies. 
We know, from much experience, that where the pelvis is of the 
true size, we have an easy and natural labour : that where the pelvis 
is too large, there is pain and delay ; but not that kind of difficulty 
which endangers life ; that where, by distortion, the pelvis is reduced 
below the standard size, there comes such difficulty as endangers 
the mother, and destroys the child, and renders the art of midwifery 
still worthy of serious study, and an object of public care. 
There was a time when it was universally believed, that the join- 
ings of the pelvis dissolved in every labour ; that the bones departed, 
and the openings were enlarged ; that the child passed with greater 
case ; and “ that this opening of the basin was no less natural than 
the opening of the womb.” By many accidents, this opinion has 
been often strengthened and revived ; and if authority could deter- 
mine our opinion, we should acknowledge, that the joinings of the 
pelvis were always dissolved as a wise provision of nature for facili- 
tating natural, and preventing lingering labour, compensating for 
the frequent deviations both in the head and pelvis, from their true 
and natural size. This unlucky opinion has introduced, at one 
time, a practice the most reprehensibly simple, as fomentations to 
soften these joinings of the pelvis in circumstances which required 
very speedy help ; while, at another time, it has been the apology 
for the most cruel unnatural operations of instruments, not merely 
intended for dilating and opening the soft parts, but for bursting up 
these joinings of the bones. And those also, of late years, who 
have invented and performed (too often, no doubt,) this operation 
of cutting the symphysis pubis to hasten the labour, say, that they 
do not perform an unnecessary cruel operation, but merely imitate 
a common process of nature. 
How very far nature is from intending this, may be easily known 
from the very forms of these joinings, but much more from the 
other offices which these bones have to perform ; for if the pelvis 
be, as I have defined it, an arch standing betwixt the trunk and the 
lower extremities on which the body rolls, its joinings could not part 
without pain and lameness, perhaps inability for life. 
One chief reason drawn from anatomy, is this : that in women 
dying after labour, the cartilages of the pelvis are manifestly softened ; 
the bones loosen ; and though they cannot be pulled asunder, they 
can be shuffled or moved upon each other in a slight degree: all 
which is easily accounted for. The cartilage that forms the sym- 
physis pubis is not one cartilage onlv. as was once supposed, but 
Of the 
change in 
the joining 
of the 
pelvis. 76 
OF THE TRUNK. 
a peculiar cartilage covers the end of each bone, and these are 
joined by a membranous or ligamentous substance: this ligamentous 
substance is the part which corrupts the soonest: it is often spoiled 
and in the place of it, a hollow only is found ; that hollow of the 
corrupted ligament may be called a separation of the bones ; but 
it is such a separation “ as equals only the back of a common knife 
in breadth ; and will not allow the bones to depart from each other 
the joining is still strong, for it is surrounded by a capsular ligament, 
not like the loose ligament of a moveable joint, but adhering to 
every point of each bone : and this ligament does perform its office 
so completely, that while it remains entire, though the bones shuffle 
sideways upon each other, no force can pull them asunder : “ Even 
when the fore-part of the pelvis is cut out, and turned anti twisted 
betwixt the hands, still though the bones can be bent backwards 
and forwards they cannot he pulled from each other the tenth part 
of an inch.” These inquiries were made by one, who, though par- 
tial to the other side of this question, could not allow himself to 
disguise the truth, whose authority is the highest, and by whose 
facts I should most willingly abide. 
Now, it is plain, that since a separation, amounting only to the 
12th part of an inch, occasions death, this cannot be a provision of 
nature ; and since the separation in such degree could not enlarge 
the openings of the basin, there again it cannot be a provision of 
nature. I know that tales are not wanting of women whose bones 
were separated during labour ; but what is there so absurd, that we 
shall not find a precedent or parallel case in our annals of monstrous 
and incredible facts ? Or, rather, where is there a fact of this de- 
scription which is not balanced and opposed by opposite authorities 
and facts ? I have dissected several women who have died in linger- 
ing labour, where f found no disunion of the bones. I have seen 
women opened, after the greatest violence with instruments, and 
yet found no separation of the hones. We have cases of women 
having the mollities ossium, a universal softness and bending of 
the bones, who have lived in this condition for many years, with the 
pelvis also affected ; its openings gradually more and more abridged ; 
the miserable woman suffering lingering labour, and undergoing 
the delivery by hooks, with all the violence that must be used in such 
desperate cases, and still no separation of the bones happening. 
How, indeed, should there be such difficult labours as these, if 
the separation of the bones could allow the child to pass ? 
If it he said, “ the joinings of the pelvis are sometimes dissolved,”* 
I acknowledge that they are, just as the joint of the thigh is dis- 
solved, that is, sometimes by violence, and sometimes by internal dis- 
ease ; hut if it be affirmed that kt the joinings of the pelvis are dis- 
solved to facilitate labour,” 1 would observe, that wherever separa- 
tion of the bones has happened, it has both increased the difficulties 
of the labour, and been in itself a very terrible disease; for proofs of 
which, I must refer to Hunter, Denman, and others, to whose pecu- 
* I hare known the synchondrosis pubis burst by straining. The man stood over 
the weight which he strained to lift, and felt something give way. The case ter- 
minated in suppuration around the joint and caries of the ossa pubis. See my Col- 
lftCtfolk OP THE TRUNK. 
77 
liar province such cases belong. But surely these principles will be 
universally acknowledged: that the pelvis supporting the trunk is 
the centre of its largest motions: that if the bones of the pelvis were 
loosened such motions could no longer be performed: that when, 
by violence or by internal disease, or in the time of severe labour, 
these joinings have actually been dissolved or burst, the woman has 
become instantly lame, unable to sit, stand, or lie, or support herself 
in any degree; she is rendered incapable of turning, or even of being 
turned in bed; her attendants cannot even move her legs without in- 
tolerable anguish, as if torn asunder : * there sometimes follows a col- 
lection of matter within the joint (the matter extending quite down 
to the tuber ischii), high fever, delirium, and death ;t or, in case of 
recovery (which is indeed more frequent), the recovery is slow and 
partial only; a degree of lameness remains, with pain, weakness, 
and languid health : they can stand on one leg more easily than on 
both ; they can walk more easily than they can stand ; but it is many 
months before they can walk without crutches ; and long after they 
come to walk upon even ground, climbing a stair continues to be 
very difficult and painful. In order to obtain even this slow re- 
union of the bones, the pelvis must be bound up with a circular 
bandage very tight; ami they must submit to be confined long : 
by neglect of which precautions, sometimes, by the rubbing of the 
bones, a preternatural joint is formed, and they continue lame for 
years, or for life or sometimes the bones are united by ossification ; 
the callus or new bone projects towards the centre of the pelvis, and 
makes it impossible for the woman to be again delivered of a living 
child.§ 
Now this history of the disease leads to reasons independent of 
anatomy, which prove, that this separation of the bones (an accident 
the existence of which cannot be questioned) is not a provision of 
nature, but is a most serious disease. For if these be the dreadful 
consequences of separation of the bones, how can we believe that it 
happens, when we see women walking during all their labour, and, 
in place of being pained, are rather relieved by a variety of postures, 
and by walking about their room ? who often walk to bed after being 
delivered on chairs or couches? who rise on the third day, and often 
resume the care and fatigues of a family in a few days more ? or can 
we believe, that there is a tendency to separation of the bones in 
those who, following the camp, are delivered on one day and walk on 
the following ? or in those women who, to conceal their shame, have 
not indulged in bed a single hour ? or can we believe, that there is 
even the slightest tendency to the separation of the bones in those 
women whose pelvis resists the force of a lingering and severe labour, 
who suffer still further all the violence of instruments, who yet reco- 
ver as from a natural delivery, and who also rise from bed on the 
third or fourth day ? I have only to add to this catalogue of evils 
attending the separation of the symphysis or synchondrosis in the 
female pubis, that I have known the bones separated by violence in 
man, and the accident was attended with tedious suppuration and 
hectic. 
* Denman. } Dr. Hunter, Med. Observ. and Enquir. Vol. ii. p. 321. 
t Denman says twenty-five or thirty years. § Spence’s cases. BONES OF THE THIGH, LEG, ANI) FOOT. 
The thigh bone is the greatest, bone of the body, and needs to 
be so, supporting alone, and in the most unfavorable direction, the 
whole weight of the trunk; for though the body of this bone is in a 
line with the trunk, in the axis of the body, its neck stands otf almost 
at right angles with the body of the bone; and in this unfavourable 
direction must it carry the whole weight of the trunk, for the body 
is seldom so placed as to rest its weight equally upon either thigh 
bone, as commonly it is so inclined from side to side alternately, that 
the neck of one thigh bone bears alone the whole weight of the body 
and limbs, or is loaded with still greater burdens than the mere 
weight of the body itself. 
The thigh-bone is one of the most regular of the cylindrical bones. 
Its body is very thick and strong, of a rounded form, swelling out at 
either end into two heads. Tn its middle it bends a little outwards, 
with its circle or convex side turned towards the fore part of the 
thigh. This bending of the thigh-bone lias been a subject of specu- 
lation abundantly ridiculous, viz. whether this be an accidental or a 
natural arch. There are authors who have ascribed it to the nurse 
carrying the child by the thighs, and its soft bones bending under the 
weight. There is another author, very justly celebrated who im- 
putes it to the weight of the body, and the stronger action of the 
flexor muscles, affirming, that it is straight in the child, and grows 
convex by age. This could not be, else we should find this curve 
less in some, and greatest in those who had walked most, or whose 
muscles had the greatest strength; and if the muscles did produce 
this curve, a little accident giving the balance to the flexor muscles, 
should put the thigh-bone in their power to bend it in any degree, 
and to cause distortion. But the end of all such speculations is this, 
that we find it bended in the foetus, not yet delivered from the mo- 
ther’s womb, or in a chicken, while still enclosed in the' shell ; it is 
a uniform and regular bending, designed and marked in the very first 
formation of the bone, and intended perhaps, for the advantage of 
the strong muscles in the back of the thigh, to give them greater 
power or more room. 
The head of the thigh bone is likewise the most perfect of any in 
the human body, for its circumference is a very regular circle, of 
which the head contains nearly two-thirds : it is small, neat, and com- 
pletely received into its socket, which is not only deep in itself, and 
very secure, but is further deepened by the cartilage which borders it, 
so that this is naturally, and without the help of ligaments, the 
strongest joint m all the body: but among other securities which 
are superadded, is the round ligament, the mark of which is easily 
seen, being a broad dimple in the centre of its cavity. In the sur 
Femur; 
general 
(form cy- 
lindrical, 
curved. 
Head 
being more 
than half a 
circle. BONES OF THE THIGH, &C. 
79 
face of the head or ball we observe a small pit for the attachment of 
the round ligament of the hip-joint. 
The neck of this bone is the truest in the skeleton ; and indeed it 
is from this neck of the thigh-bone, that we transfer the name to 
other bones, which have hardly any other mark of neck than that 
which is made by their purse-like ligament being fixed behind the 
head of the bone, and leaving a roughness there. But the neck of 
the thigh-bone is more than an inch in length, thick, and strong, yet 
hardly proportioned to the great weights which it has to bear ; long, 
that it may allow the head to be set deeper in its socket; and stand- 
ing wide up from the shoulders of the bone, to keep its motions wide 
and free, and unembarrassed by the pelvis ; for without this great 
length of the neck, its motions had been checked even by the edges 
of its own socket. 
The trochanters are the longest processes in the human body 
for the attachment of muscles, and they are named trochanter (or 
processes for turning the thigh), from their office, which is the re- 
ceiving those great muscles which not only bend and extend the thigh, 
but turn it upon its axis ; or these processes are oblique, so as to bend 
and turn the thigh at once. 
The trochanter major, the outermost and longer of the two, is 
that great bump which represents the direct end of the thigh-bone, 
while the neck stands off from it at one side; therefore the great 
trochanter stands above the neck, and is easily distinguished out- 
wardly, being that great bump which we feel so plainly in laying the 
hand upon the haunch. On the upper and fore part of this great 
process, are two surfaces for the insertion of the gluteus medius and 
minimus. 
The extremity of the great trochanter hangs over a pit into which 
principally the small rotator muscles of the thigh are inserted, viz. 
the pyriformis, thegemini, the obturator internus and externus. On 
the lower part there is a very strong marked ridge, which is for the 
insertion of the gluteus maximus. 
The trochanter minor, or lesser trochanter, is a smaller and 
more pointed rising on the inner side of the bone, lower than the 
trochanter major, and placed under the root of the neck, as the greater 
one is placed above it. It is directed backwards, so that the mus- 
cles inserted into it turn the toe outwards at the same time that 
they raise the femur. It is deeper in the thigh, and never to be felt, 
not even in luxations. Its muscles, also, viz. the flexors of the thigh, 
by the obliquity of their insertion into it, turn the thigh, and bend it 
towards the body, such as the psoas and iliacus internus, which 
passing out from the pelvis, sink deep into the groin, and are im- 
planted into this point. On the neck of the thigh bone there is a 
very conspicuous roughness, which marks the place of the capsule 
or ligamentary bag of the joint; for it encloses the whole length of 
the neck of the thigh bone. 
Betwixt the greater and lesser trochanters, there runs a rough 
line, the inter-trochantral line, to which the capsular ligament is 
attached, and into which the quadratus femoris is inserted. 
The line \ aspeba is a rising or prominent line, very rugged and 
Pit. 
Neck. 
Trochan- 
ter. 
Major. 
Tr. minor. 
Inter-tro- 
chantral 
line. 
Linen 
a»pera, 80 
BONES OF THE 
unequal, which runs all down the back part of the thigh : it begins 
at the roots of the two trochanters, and the rough lines from each 
trochanter meet about four inches down the bone ; thence the linea 
aspera runs down the back of the bone a single line, and forks 
again into two lines, one going towards each condyle, and ending 
in the tubercles at the lower end of the bone, so that the linea 
aspera is single in tiie middle, and forked at either end. 
The condyles are the two tubers, into which the thigh-bone 
swells out at its lower part. There is first a gentle and gradual 
swelling of the bone, then an enlargement into two broad and flat 
surfaces, which are to unite with the next bone in forming the great 
joint of the knee. The two tuberosities, which, by their flat faces, 
form the joint, swell out above the joint, and are called the con- 
dyles. The inner condyle is larger, to compensate for the 
oblique position of the thigh-bone ; for the bones are separated at 
their heads, by the whole width of the pelvis, but are drawn towards 
a point below, so as to touch each other at the knees. On the fore 
part of the bone, betwixt the condyles, there is a broad smooth 
surface, upon which the rotula, or pulley-like bone glides. The 
outer side of this trochlea is the largest and most prominent. On 
the back part of the .high bone, in the middle betwixt the condyles, 
there is a deep notch, which gives passage to the great artery, vein, 
and nerve, of the leg. 
The great nutritious artery enters below the middle of this bone, 
and smaller arteries enter through its porous extremities; as may 
be known by many small holes, near the head of the bone. 
The iie\d of the thigh-bone is round, and set down deeply in its 
socket, to give greater security to a joint so important, and so much 
exposed as the hip is. The neck stands off from the rest of the 
bone, so that by its length it allows a free play to the joint, but is 
itself much exposed by its transverse position, as if nature had not 
formed in the human body any joint at once free, moving, and 
strong. The neck is not formed in the boy, because the socket is 
not yet deep, nor hinders the motions of the thigh, and the head is 
formed apart from the bone, and is not firmly united with it till adult 
years, so that falls luxate or separate the head in young people, but 
they break the neck of the bone in those that are advanced in years. 
The trochanters, or shoulders, are large, to receive the great 
muscles which are implanted in them, and oblique, that they may 
at once bend and turn the thigh. The shaft or kody is very strong, 
that it may bear our whole weight, and the action of such powerful 
muscles ; and it is marked with the rough line behind, from which 
a mass of flesh takes its rise, which warps completely round the 
lower part of the thigh-bone, and forms what are called the vasti 
muscles, the greatest muscles for extending the leg. The condyles 
swell out to give a broad surface, and a firm joining for the knee. 
But of all its parts, the great trochanter should be most particularly 
observed, as it is the chief mark in luxations or fractures of this 
bone: for when the greater trochanter is pushed downwards, we 
find the thigh luxated inward; when the trochanter is higher than 
its true place, and so fixed that it cannot roll, we are assured that 
Double 
above, and 
below. 
Condyles. 
The inner 
largest. 
Trochlea. 
Notch. 
Nutritious 
artery. 
Review of 
the princi- 
pal points 
of demon- 
stration. THIGH, LEG, AJSD FOOT. 
81 
it is luxated : but when the trochanter is upwards, with the thigh 
rolling freely, we are assured its neck is broken, the trochanter 
being displaced, and the broken head remaining in its socket; but 
when the trochanter remains in its place, we should conclude that 
the joint is but little injured, or that it is only a bruise of those 
glands or mucous follicles, which are lodged within the socket, for 
lubricating the joint. 
The tibia is named from its resemblance to a pipe ; the upper 
part of the tibia, representing the expanded or trumpet-like end, 
the lower part representing the flute end of the pipe. The tibia, 
on its upper end, is flat and broad, making a most singular articula- 
tion with the thigh-bone ; for it is not a ball and socket like the 
shoulder or hip, nor a hinge-joint guarded on either side with pro- 
jecting points, like the ancle. There is no security for the knee- 
joint, by the form of its bones, for they have plain flat heads ; they 
are broad indeed, but they are merely laid upon each other. It is 
only by its ligaments that this joint is strong ; and by the number of 
its ligaments it is a complex and delicate joint, peculiarly liable to 
disease. 
The upper head of the tibia is thick and spongy, and we find 
there two broad and superficial hollows, as if impressed, while soft, 
with the marks of the condyles of the thigh-bone ; and these slight 
hollows are all the cavity that it has for receiving the thigh-bone. 
A pretty high ridge rises betwixt these two hollows, so as to be re- 
ceived into the interstice betwixt the condyles, on the back part, 
which is the highest point ol the ridge. There is a pit on the fore 
and on the back part for the attachment of the crucial ligaments. 
The spongy head has also a rough margin, to which the capsular 
ligament is tied. On the fore part of this bone, just below the knee, 
there is a bump for receiving the great ligament of the patella, or, 
in other words, the great tendon of all the extensor muscles of th » 
leg: and lastly, there is upon the outer side of this spongy head, 
just under the margin of the joint, a smooth articulating surface, 
(like a dimple impressed with the finger,) for receiving the head of 
the fibula. It is under the margin of the joint, for the fibula does 
not enter at all into the knee-joint; it is only laid upon the side of 
the tibia, fixed to it by ligaments, but not received into any thing 
like a cavity. 
The body of the bone is of a prismatic or triangular form, and 
its three edges or acute angles are very high lines running along its 
whole lengtli. The whole bone s a little twisted to give a proper 
position to the foot. One line, the anterior angle, a little waved, 
and turned directly forwards, is what is called the shin. At the top 
of this ridge, is that bump into which the ligament of the rotula or 
patella is implanted ; and the whole length of this acute line is so 
easily traced through the skin, that we can never be mistaken about 
fractures of this bone. Another line less acute than this, is turned 
directly backwards ; and the third acute line, which completes the 
triangular form, is turned towards the fibula, to receive a broad liga- 
ment, or interosseous membrane, which ties the two bones together- 
Tibia. 
Form, 
Upper 
head. 
Two arti- 
culating 
surfaces. 
Ridge. 
Pits. 
Margin. 
Tubercle. 
Articulat- 
’ ing surface 
for the 
fibula. 
Body tri- 
angular. 
Shin. 
Posterior 
angle. 
Lateral 
angle. 82 
BONES OE THE 
The middle of the posterior surface of the bone is hollowed tor 
the lodgment of the muscles, which extend the foot, and bend the 
toes ; and the anterior and outer surface is hollowed by the lodg- 
ment of that muscle, which is called tibialis anticus, and the long 
extensors of the toes. 
On the back part of the bone, near its head, there is a flat surface 
made by the insertion of the popliteus muscle, which is bounded on 
the lower part by a ridge giving origin to one of the flexors. 
The lower head of the tibia composes the chief parts of the ancle- 
joint. The lower head of the tibia is smaller than the upper, in the 
same proportion that the ancle is smaller than the knee. The 
pointed part of this head of the tibia represents the mouth-piece, or 
flat part of the pipe, and constitutes the bump of the inner ancle. 
The lower end of the fibula lies so upon the lower end of the tibia, 
as to form the outer ancle ; and there is on the one side of the tibia 
a deep hollow, like an impression made with the point of the thumb, 
which receives the lower end of the fibula. The acute point of the 
tibia, named the process of the inner ancle, passes beyond the bone 
of the foot, and, by lying upon the side of the joint, guards the ancle, 
so that it cannot be luxated outward, without this pointed process of 
the malleolus internus, or inner ancle, being broken. The lower 
extremity of the tibia has that sort of excavation to correspond with 
the astragalus, to which anatomists give the name of scaphoid 
cavity. 
On the back of the lower head of the bone there is a groove 
which transmits the tendon of the tibialis posticus muscle, and at its 
apex a pit giving origin to the deltoid ligament. 
On the back part of the tibia, and a little below its head, we have 
to observe the hole for the transmission of the nutritious artery, to 
the centre of the bone. In amputation of the leg, this artery is some- 
times cut across just where it has entered the bone, and the bleeding 
proves troublesome. 
The tibia is a bone of great size, and needs to be so, for it supports 
fhe whole weight of the body. It is not at all assisted by the fibula, 
in bearing the weight, the fibula, or slender bone, being merely laid 
upon the side of the tibia, for uses which shall be explained pre- 
sently. The tibia is thick, with much caucelli, or spongy substance 
within ; has pretty firm plates without; is much strengthened by its 
ridges, and by its triangular form : its ridges are regular with regard 
to each other, but the whole bone is twisted as if it had been turned 
betwixt the hands when soft: this distortion makes the process of the 
inner ancle lie not regularly upon the side of that joint, but a little 
obliquely forward, which determined the obliquity of the foot, and 
this must be of much consequence, since there are many provisions 
for securing this turning of the foot, viz. the oblique position of the 
trochanters; the oblique insertion of all the muscles, and this obli- 
quity of the ancles; the inner ancle advancing a little before the 
joint, and the outer ancle receding in the same degree behind it. 
The fieula, which is named so from its resemblance to the 
Roman clasp, is a long slender bone, which is useful partly in- 
strengthening the leg, but chiefly in forming the ancle joint and in af- 
Tower 
head. 
Malleolus 
internus. 
Impression 
of the 
.fibula. 
Scaphoid 
cavity. 
Groove for 
the tibialis 
posticus. 
Fibulj*'. THIGH, LEG, ANB FOOT. 
83 
fording attachment to muscles. The tibia only is connected with 
the knee, while the fibula, which has no place in the knee-joint, goes 
down below the lower end of the tibia, forming the long process of 
the outer ancle. 
The fibula is a long and slender bone, the longest and slenderest 
in the body. It lies by the side of the tibia like a splint, so that when 
at any time the tibia is broken without the fibula, or when the tibia 
having spoiled, becomes carious, and a piece of it is lost, the fibula 
maintains the form of the limb till the last piece be replaced, or till 
the fracture be firmly re-united. It is, like the tibia, triangular in the 
middle part, but square towards the lower end, and has two heads, 
which are knots, very large, and disproportioned to so slender a bone. 
The sharpest line of the fibula is turned to the sharp line of the tibia, 
and the interosseous membrane passes betwixt them. The other 
lines or spines are in the interstices of the attachment of muscle, of 
which no fewer than six take their origin here, making the bone irre- 
gular with spines and grooves. There arise from the fibula, I. The 
soleus from the back part of the head ; 2. The tibialis posticus 
from the back and lower part of the bone; 3. The flexor longus 
pollicis all down the back part of the bone ; 4. The peroneus longus 
from nearly the whole length of the bone; 5. The peroneus brevis 
from the middle and lower part; 6. The peroneus tertius from the 
fore-part of the bone. The bone lies in a line with the tibia, on the 
outer side of it, and a little behind it. The upper head of the fibula 
is rough on the outer surface, for the insertion of the lateral ligament, 
and of the biceps cruris; smooth, and with cartilage within ; and is 
laid upon a plain smooth surface, on the side of the tibia, a little 
below the knee: and though the fibula is not received deep into the 
tibia, this want is compensated for by the strong ligaments by which 
this little joint is tied ; by the knee being completely wrapped round 
with the expanded tendons of those great muscles which make up 
the thigh; by the knee being still farther embraced closely by the 
fascia, or tendinous expansion of the thigh ; but above all, by the 
tendons of the outer hamstrings being fixed into this knot of the 
fibula, and expanding from that over the fore part of the tibia. 
The lower head of the fibula, is broad and flat, and is let pretty 
deep into a socket on the side of the tibia ; together, they form the 
ancle-joint for receiving the bones of the foot. The extreme point 
of the thin extremity gives attachment to the outer ligament of the 
joint, and is sometimes called the coronoid process. On the back 
part of this lower head there is a furrow which lodges the tendons 
of the peronei muscles. The ancle-joint is one of the purest hinge- 
joints, and is very secure ; for there is the tibia, at the process of' 
the inner ancle, guarding the joint within, there is the fibula passing 
the joint still further, and making the outer ancle still a stronger 
guard without. These two points, projecting so as to enclose the 
bones of the foot, making a pure hinge, prevent all lateral motion ; 
make the joint firm and strong, and will not allow of luxations, till 
one or both ancles be broken. We know that there is little motion 
betwixt the tibia and fibula ; none that is sensible outwardly, and no 
more in truth than just to give a sort of elasticity, yielding to slightf, 
Spines. 
Upper* 
head. 
Firmly 
united to 
the tibia. 
Lower 
head. 
Malleolus 
ext er no 3. 
Ankle- 
joint. 84 
BONES OP THE 
strains. But we are well assured, that this motion, though slight and 
imperceptible, is very constant; for these joinings of the fibula with 
the tibia are always found smooth and lubricated; and there are no 
two bones in the body so closely connected as the tibia and fibula 
are, and which are so seldom anchylosed, i. e. joined into one by 
disease. 
The fibula may be thus defined ; it is a long slender bone, which 
answers to the double bone of the fore-arm, completes the form, and 
adds somewhat to the strength of the leg ; it gives a broader origin 
for its strong muscles, lies by the side of the tibia like a splint; and, 
being a little arched towards the tibia, supports it against those acci- 
dents which would break it across, and maintains the form of the 
leg when the tibia is carious or broken ; the fibula, though it has 
little connection with the knee, passes beyond the ancle-joint, and is 
its chief guard and strength in that direction in which the joint should 
be most apt to yield ; and in this office of guarding the ancle, it is 
so true, that the ancle cannot yield till this guard of the fibula be 
broken. This fracture of the lower part of the fibula, attended with 
more or less injury of the inner ligament of the ancle-joint, is by far 
the most frequent accident received into a London hospital. 
Rotula, or patella, or knee-pan, is a small thick bone, of an 
oval, or rather triangular form. The basis of this rounded triangle 
is turned upwards to receive the four great muscles which extend 
the leg ; the pointed part of this triangle is turned downwards, and 
is tied by a very strong ligament to the bump or tubercle of the 
tibia, just under the knee. The convex surface is rough, the concave 
smooth, and divided by a ridge into two unequal parts : round the 
margin of the bone there is a slight depression for the attachment of 
the capsular ligament. This ligament is called the ligament of the 
patella, or of the tibia, connecting the patella so closely, that some 
anatomists of the first name choose to speak of the patella as a mere 
process of the tibia, (as the olecranon is a process of the ulna,) only 
flexible and loose ; an arrangement which I think so far right and 
useful, as the fractures of the olecranon and of the patella are so 
much alike, especially in the method of cure, that they may be 
spoken of as one case ; for these two arc exceptions to the common 
rules and methods of setting broken bones. 
The patella is manifestly useful, chiefly as a lever ; for it is a 
pully, which is a species of lever, gliding upon the fore part of the 
thigh bone, upon the smooth surface which is betwixt the condyles. 
The projection of this bone upon the knee removes the acting force 
from the centre of motion, so as to increase the power ; and it is 
beautifully contrived, that while the knee is bent, and the muscles 
at rest, as in sitting, the patella sinks down, concealed into a hollow 
of the knee. When the muscles begin to act, the patella begins to 
rise from this hollow; in proportion as they contract, they lose of 
their strength, but the patella, gradually rising, increases the power ; 
and when the contraction is nearly perfect, the patella has risen to 
the summit of the knee, so that the rising of the patella raises the 
mechanical power of the joint in exact proportion as the contraction 
expends the living contractible power of the muscles. What is cu- 
General 
descrip- 
tion oi the 
fibula. 
Patella. 
Basis. 
Apex. 
Ridge. THIGH, LEG, AND FOOT. 
85 
nous beyond almost any other fact concerning the fractures of bones, 
the patella is seldom broken by a fall or blow ; in nine of ten cases, 
it is raiiier torn, if we may use the expression, by the force of its own 
muscles, while it stands upon the top of the knee, so as to rest upon 
one single point; for while the knee is half bended, and the patella 
in this dangerous situation, the leg fixed, and the muscles contract- 
ing strongly to support the weight of the body, or to raise it as in 
mounting the steps of a stair, the force of the muscles is equivalent at 
least to the weight of the man’s body ; and often, by a sudden vio- 
lent exertion, their power is so much increased, that they snap the 
patella across, as we would break a stick across the knee. 
The tarsus, or instep, is composed of seven large bones, which 
form a firm and elastic arch for supporting the body ; which arch 
has its strength from the strong ligaments with which these bones are 
joined, and its elasticity from the small movements of these bones 
with each other ; for each bone and each joint has its cartilage, its 
capsule or bag, its lubricating fluid, and all the apparatus of a regu- 
lar joint; each moves, since the cartilages are always lubricated, 
and the bones are never joined by anchylosis with each other ; but 
the effect is rather a diffused elasticity than a marked and percepti- 
ble motion in any one joint. 
The seven bones of which the tarsus is composed are, 1. The 
astragalus, which, united with the tibia and fibula, forms the 
ancle-joint. 2. The os calcis, or heel-bone, which forms the end or 
back point of that arch upon which the body stands. 3. The os na- 
viculare, or boat-like bone, which joins three smaller bones of the 
fore part of the tarsus to the astragalus. 4. The os cuboides, which 
joins the fore part of the os calcis to the external cuneiform bone. 
The 5th, 6th, and 7th, are the smaller bones making the fore part of 
the tarsus ; they lie immediately under the place of the shoe-buckle, 
and are named the three cuneiform bones, from their wedge-like 
shape ; and it is upon these and the anterior surface of the cuboides 
that the metatarsal bones, forming the next division of the foot, are 
implanted. 
These bones of the tarsus form, along with the metatarsal bones, 
a double arch : first, from the lowest point of the heel to the ball of 
the great toe, is one arch, the arch of the sole of the foot which sup- 
ports the body; then there is a transverse arch formed by the cu- 
boides and the cuneiform bones; and again, there is another arch 
within this, formed among the tarsal bones themselves, one within 
another, and laid horizontally, i. e. betwixt the astragalus, os calcis, 
cuboides, cuneiform bones, and naviculare. Ft is these arches which 
give so perfect an elasticity to the foot, and must prevent the bad 
effects of leaping, falls, and other shocks, which would have broken 
a part less curiously adapted to its office. 
(1.) The astragalus is the greatest and most remarkable bone 
of the tarsus, and w'hich the surgeon is most concerned in knowing. 
The semicircular head of thi3 bone forms a curious and perfect pully. 
The circle of this pully is large; its cartilage is smooth and lubri- 
cated ; it is received deep betwixt the tibia and fibula, and rolls under 
the smooth articular surface of the latter, which, being suited to this 
Of the 
tarsus. 
Astraga- 
luSl 
General 86 
BONES OF THE 
pully of the astragalus, with something of a boat-like shape, is often 
named the scaphoid cavity of the tibia. 1. We remark in the astra- 
galus its articulating surface, which is arched, high, smooth, covered 
with cartilage, lubricated, and in all respects a complete joint Its 
form is that of a pully, which, of course, admits of but one direct 
motion, viz. forwards and backwards. 2. We observe its sides, 
which are plain, smooth, and flat, covered with the same cartilage, 
forming a part of the joint, and closely locked in by the inner and 
outer ancles, so as to prevent luxations, or awkward motions to 
either side. 3. We observe two large irregular articulating surfaces, 
backwards and downwards, by which it is pined to the os calcis. 4. 
There is on the fore part, or rather the fore end, of the astragalus, a 
large round head, as regular as the head of the shoulder-bone, by 
which it is articulated with the scaphoid bone. 
l. Superior surface corresponding with the scaphoid cavity of the 
tibia. 2. Internal articulating surface for the malleolus internus. 3. 
External articulating surface for the extremity of the fibula. 4. In- 
er*or a,)d posterior articulating surface joining with the body of the 
os calcis. 5. Inferior and anterior surface articulating also with a 
corresponding surface of the os calcis. 6. Deep fossa, dividing 
these two inferior articulating surfaces, for the lodgment of a Jiga- 
merit which unites this hone to the os calcis. 7. The ball or ante- 
rjor articulating surface which enters into the socket of the navicu- 
~ . . 
lare. 8. A smooth part, which is like a continuation of this last, but 
which rests upon a cord of ligament, which is stretched betw ixt the 
os calcis and naviculare. 9. Furrow for attachment of the capsular 
ligament. On the inside of the bone we see a hollow and a rough 
Protul)erance f,,r the attachment of the deltoid ligament, which comes 
down from the tibia ; a point of the anatomy of the first conse- 
quence to the surgeon. 
(2.) The os calcis is the large irregular bone of the heel ; it is 
the tip or end of the arch formed by the tarsal and metatarsal l>ones. 
There is an irregular surface on the highest part of the projection 
backwards, to which the tendo Achillis is inserted. The lower and 
back part of the bone is rough, but peculiar in its texture, for the 
attachment of the cartilaginous and cellular substance on which ii 
rests. We next notice an irregular articular surface, or rather two 
surfaces covered with cartilage, by which this bone is joined with 
the astragalus. Another articulating surface by which it is joined 
vvith the os cuboides. A sort of arch or excavation, on the inside, 
under which the vessels and nerves, and the tendons also, pass on 
safely into the sole of the foot. On the outer surface of this bone we 
observe a groove, which transmits the tendon of the peroneus 
longus. 
On the upper surface of the bone, and betwixt the surfaces which 
articulate with the astragalus, there is an irregular rough fossa, 
which is opposite to a corresponding depression in the astragalus, 
and which gives attachment to powerful ligaments which unite the 
bones, and, on the lower and outer part, the sinuosity. 
We further notice the tubercle which stands internally, and gives 
Points of 
stration. 
Trochlea. 
artici'iat 
ing sur- 
face. 
surface?1 
Inferior 
posterior. 
Interior 
anterior, 
Fossa. 
®al1' 
Attach- 
ligament, 
Os calcis. 
Great pro- 
E7rs"t 
Second, 
Third 
articulat- 
face*Ur 
Arch. 
roove. 
Fossa. 
Tubercle. THIGH, LEG, AND FOOT. 
87 
attachment to the ligamentum inter os calcis et naviculare, and which 
supports the lower part of the ball of the astragalus. 
(3.) The next bone is named os naviculare, or os scathoides, 
from a fanciful resemblance to a boat. But this is a name to which 
anatomists have been very partial, and which they have used with 
very little discretion or reserve : the student will hardly find any such 
resemblance. That concave side which looks backwards is pretty 
deep, and receives the head of the astragalus : that flat side which 
looks forward has not so deep a socket, but receives the three cunei- 
form bones upon a surface rather plain and irregular. From the 
inner and lower part of this bone a tubercle stands out for the at- 
tachment of a powerful ligament, already described, running be- 
twixt. this and the os calcis. • 
(4,5, 6.) The cuneiform bones are so named, because they re- 
semble wedges, being laid to each other like the stones of an arch. 
The most simple and proper arrangement is t, and 3. ; counting 
from the side of the great toe towards the middle of the foot; but 
they are commonly named thus : the first cuneiform bone, on which 
the great toe stands has its cutting edge turned upwards ; it is much 
larger than the others, and so is called os cuneiforme magnum. The 
second cuneiform bone, or that which stands in the middle of the 
three cuneiform bones, is much smaller, and is therefore named os 
Cuneiforms minimum. The third in order, of the cuneiform bones, 
is named os cuneiforme medium.* These cuneiform bones re- 
ceive the great toe and the two next to it. The fourth and fifth 
toes are implanted upon the os cuboides. 
(7.) Os cuboides.—The os cuboides is named from its cubical' 
figure, and is next to the astragalus in size, and greater than the os 
naviculare. The three cuneiform bones are laid regularly by the : 
side of each other ; and this os cuboides is again laid on the outer | 
side of the third cuneiform bone, and joins it to the os calcis. Its i 
anterior point is divided into two surfaces, for two metatarsal bones: - 
the lower surface of the bone is a groove for transmitting the tendon ' 
of the long peroneus muscle. The place and effect of the cuboid < 
bone is very curious ; for as it is jammed in betwixt the third cunei- 
form bone and the os calcis, it forms a complete arch within an 
arch, which gives at once a degree of elasticity and of strength 
which no human contrivance could have equalled. 
Metatarsus.—The metatarsus, so named from its being placed 
upon the tarsus, consists of five bones ; they extend betwixt the 1 
tarsus and the proper bones of the toes. 
The metatarsal bone of the great toe is the shortest, and is other- 
wise distinguished by its strength and the great size of its extremi- 
ties. The metatarsal of the second toe is the longest, its nearer 
head being wedged betwixt the cuneiform magnum and minime, 
while it has a surface of contact with the medium and the head of 
Navicu- 
lare. 
Concave 
surface. 
Convex 
surface. 
Tubercle. 
Cuneiform 
bones. 
Os cunei- 
form e 
magnum. 
Minimum. 
Medium. 
Cuboides. 
Surface for 
the third 
cuneiform 
bone. 
Articulat- 
ed with 
os calcis. 
Groove. 
Place and 
use. 
Distinc- 
tions. 
* The confusion in these names arises from sometimes counting them by their 
place, aud sometimes reckoning according to their size. It is only in relation to its 
size that we call one of these bones os enneiforme medium; for the os cuneiforme 
medium is not in the middle of the three ; it is the middle bone with respect to size: 
it is the smallest of the enneiform bones that stands in the middle between the 
other two. 88 
BONES OF THE THIGH, &C. 
the extremity of the metatarsal bone of the third toe. The meta- 
tarsal bone of the little toe is also peculiar in the size of its nearer 
head, and the manner in which that head projects upon the out- 
side of the foot to receive the tendons of the peroneus secundus 
and tertius. The metatarsal bones generally have these peculiari- 
ties. They are rather flattened, especially on their lower sides, 
where the tendons of the toes lie ; they have a ridge on their upper 
or arched surface ; they are very large at their ends next the tarsus, 
where they have broad square heads, that they may be implanted 
with great security ; they grow smaller forwards, where again they 
terminate, in neat small round heads, which receive the first bones 
of the toes, and permit of a very free and easy motion in them, and 
a greater degree of rotation than our dress allows us to avail our- 
selves of, the toes being cramped together, in a degree that fixes 
them all in their places, huddles one above another, and is quite the 
reverse of that free and strong like spreading of the toes, which 
the painter always represents. 
The further extremities of these bones terminate in round balls, 
which correspond with the sockets in the first bones of the toes, 
and a distinct groove runs round the upper part of the extremity of 
ti>e bone for the attachment of the capsule. Processes stand out 
laterally from the anterior extremities, which give attachment to 
the lateral ligaments of the joint. These bones, by the connection 
of their nearer extremities, form an arch corresponding with the 
lateral arch of the tarsus : owing to this the metatarsal of the 
great toe is placed on a lower level, so that its great extremity 
projects into the sole of the foot, and into it are inserted part of 
the tendon of the tibialis posticus, and the peroneus longus, whilst 
the tibialis anticus is inserted into its upper surface. 
The marks of the metatarsal bones are chiefly useful as direct- 
ing us where to cut in amputating these bones; and the surgeon 
will save the patient much pain, and himself the shame of a slow 
and confused operation, by marking the places of the joints, and 
the form of the extremities of the bones. 
THE TOES.—The last division of the foot consists of three 
distinct bones ; and as these bones are disposed in row's, they are 
named the first, second, and third phalanges or ranks of the toes. 
The great toe has but two phalanges; the other toes have three 
ranks of bones : these bones are a little flattened on their lower 
side, or rather, they have a flattened groove which lodges the ten- 
dons of the last joint of the toes. The articulating surfaces of 
the nearer extremities of the first bones are deep sockets for the 
extremities of the metatarsal bones, and the motions are free. 
But the articulations of the second and third joints are proper 
hinge joints, the further extremities of the first and second bones 
being a flattened trochlea. It is particularly to be noticed, that the 
heads of these bones are large, and that they send out a lateral pro- 
jection for the attachment of the lateral ligament. The consider- 
ation of the size and form of the extremities of these bones, and 
the nature and attachment of their ligaments, is of the first impor- 
General 
form. 
Ball. 
Groove. 
Condyles. 
Tiieir ex- 
tremities 
large. BOSSES OK THE SHOULDER, &C. 
89 
lance, as explaining the peculiarity in the dislocation of these 
bones, and the manner of reduction. 
The sesamoid bones are more regularly found about the toes 
than any where else. They are small bones, like flattened peas, 
found in tendons, at the points where they suffer much friction ; 
or rather they are like the seeds of the sesamum, whence their 
name. They are found at the roots the great toe, and of the 
thumb. We find two small sesamoid bones, one on each side of 
the ball of the great toe ; and grooves may be observed on the 
lower part of the articulating surface of that bone, for their lodg- 
ment and play: they are within the substance of the tendons ; 
perhaps, like the patella, they remove the acting force from the 
centre of motion, and so, by acting like pullies, they increase the 
power; perhaps, also, by lying at the sides of the joint in the ten- 
dons of the shorter muscles of the toes, they make a safe gutter for 
the long tendons to pass in. They are not restricted to the balls 
of the great toe and thumb, but sometimes are also found under 
the other toes and fingers, and sometimes behind the condyles of 
the knee ; or in the peronei tendons, urhich run under the sole of 
the foot. 
BONES OF THE SHOULDER, ARM, AND HAND. 
OF THE SCAPULA, OR SHOULDER-BLADE. 
This is the great peculiarity of the superior extremity, that it is 
connected not directly with the trunk, like the thigh-bone with the 
haunch, but is hung by a moveable intermediate bone, which not 
only is not immediately joined to the trunk by ligaments, nor any 
other form of connexion, but is parted from it by several layers of 
muscular flesh, so that it lies flat, and glides upon the trunk. 
The scapula is a thin bone, which has originally, like the skull, j 
two tables, and an intermediate diploe ; but by pressure, and the ( 
action of its own muscles, it grows gradually thinner, its tables are i 
more and more condensed, till in old age it has become in some 
parts transparent, and is supported only by its processes, and by its 
thicker edges ; for its spine is a ridge of firm and strong bone, 
which rises very high, and gives a broad origin and support for its 
muscles. The acromion, in which the spine terminates, is a broad 
and flat process, a sure guard for the joint of the shoulder. The 
coracoid process is a strong but shorter process, which stands out 
from the neck of the bone; and the costa, or borders of the bone, 
are also rounded, firm, and strong, so that the processes and borders 
support the flat part of the bone, which is as thin as a sheet of 
paper. 
Scapula. 
General 
descrip- 
tion. 90 
BONES OF THE 
There is no part nor process of the scapula which does not re- 
quire to be very carefully marked ; for no accidents are more fre- 
quent than luxations of the shoulder ; and the various luxations 
are explained best by studying in the skeleton, and being able to 
recognise on the living body all the processes and projecting points. 
The flat side of the scapula is smooth, somewhat concave, and 
suited to the convexity of the ribs : it is sometimes called venter. 
The scapula is connected with no bone of the trunk, tied by no 
ligaments, is merely laid upon the chest, with a large mass of mus- 
cular flesh under it, upon which it glides; for there are below it two 
layers of muscles, by one of which the shoulder-bone is moved upon 
the scapula, while by the other, the scapula itself is moved upon the 
ribs. The subscapularis muscle, lying in the hollow of the scapula, 
marks it with many smooth hollows, and wave-like risings, which 
are merely the marks of the several divisions of this muscle, but 
which were mistaken even by the great Vesalius for the impressions 
of the ribs. 
The upper or exterior flat surfaco is slightly convex; it is tra- 
versed by the spine, which is a very acute and high ridge of bone ; it 
is called the dorsum scapula. Now the spine thus traversing the 
bone from behind forwards, divides its upper surface into two un- 
equal parts, of which the part above the spine is smaller, and that 
below the spine is larger. Each of these spaces has its name, one 
supra spinatus, and the other infra spinatus; and each of them 
lodges a muscle, named, the one the musculus supra spinatus sca- 
pulae, as being above the spine ; the other musculus infra spinatus 
scapulae, as being below the spine. A third muscle is named sub- 
scapularis, as lying under the shoulder-blade, upon that concave 
surface which is towards the ribs ; so that the whole scapula is co- 
vered with broad flat muscles, whose offices are to move the hu- 
merus in various directions, and which impress the scapula with 
gentle risings and hollows on its upper as well as on its lower 
surface. 
The triangular form of the scapula must be next observed. 
The upper line of the triangle is the shortest; it is named the supe- 
rior costa or border ; here the omo-hvoideus has its origin. On 
this superior edge is seen the notch, through which a nerve, and 
sometimes an artery passes. The lower edge, which is named the 
costa inferior, or the lower border of the scapula, receives no 
muscles; because it must be quite free, to move and glide as the 
scapula turns upon its axis, which is, indeed, its ordinary movement. 
But it gives rise to two smaller muscles, which, from being a little 
rounded, are named the musculi teretes; they leave their impressions 
on this lower costa. 
The long side of the scapula, which bounds its triangular form 
backwards, is named the basis of the scapula, as it represents the 
base of the triangle. This line is also like the two borders, a little 
thicker or swelled out; and this edge receives powerful muscles, 
which lie flat upon the back, and coming to the scapula, in a variety 
of directions, can turn it upon its axis : sometimes raising, some- 
times depressing the scapula: sometimes drawing it backwards; and 
Surfaces. 
Venter or 
faceCrSUr' 
Exterior 
surface or 
dorsum. 
Divided 
into fossa 
supra, and 
infra spi- 
nata. 
Scapttla 
triangular. 
Superior 
costa. 
Notch. 
Inferior 
costa. 
Basis. shoulder, arm, and hand. 
91 
sometimes fixing it in its place ; according to the various sets of 
fibres which are put into action. These are the larger and lesser 
rhomboid muscles, and the great serrated muscle of the fore part of 
the chest, which runs under the scapula to be inserted into the inner 
edge of the base of the bone. 
The angles of the scapula are two, the superior more obtuse, and 
the inferior more acute. From the inferior angle the teres major 
takes its origin, and the outer surface of the bone is made smooth by 
the passage of the latissimus dorsi muscle. To the superior angle 
the levator scapula) is inserted. 
The glenoid or articulating cavity of the scapula is on the 
point or apex of this triangle. The scapula is more strictly triangular 
in a child, for it terminates almost in a point or apex ; and this arti- 
culating surface is a separate ossification, and is joined to it in the 
adult. The scapula towards this point terminates in a flat surface, 
not more than an inch in diameter, very little hollowed, and scarcely 
receiving the head of the shoulder-bone, which is rather laid upon it 
than sunk into it: it is indeed deepened a little by a circular gristle, 
which tips the edges or lips of this articulating surface, but so little, 
that it is still very shallow and plain, and luxations of the shoulder 
are infinitely more frequent than of any other bone. 
This head, or glenoid cavity of the scapula, is planted upon a nar- 
rower part, which tends towards a point, but is finished by this flat 
head; this narrower part is what is named the neck of the scapula, 
which no doubt sometimes gives way, and breaks.* A rough line 
bordering the glenoid cavity receives the capsular ligament, or rather 
the capsule arises from that bordering gristle, which I have said tips 
this circle. 
The spine of the scapula is that high ridge of bone which runs the 
whole length of its upper surface, and divides it into two spaces for 
the origin of the supra and infraspinatus muscles. It is high and very 
sharp, standing up at one place to the height of two inches. It is 
flattened upon the top, and with edges, which, turning a little towards 
either side, give rise to two Strong fascia), i. e. tendinous membranes, 
which go from the spine, the one upwards to the upper border of the 
scapula, the other downwards to the lower border : so that by these 
strong membranes, the scapula is formed into two triangular cavities, 
and the supra and infra spinatus muscles rise not only from the back 
of the scapula, and from the sides of its spine, but also from the inner 
surface of this tense membrane. The spine traverses the whole dor- 
sum, or back of the scapula ; it receives the trapezius muscle, that 
beautiful triangular muscle which covers the neck like a tippet, into 
its upper edge ; whilst from its lower edge a part of the deltoid 
muscle departs. The spine beginning low at the basis of the sca- 
pula, where a certain triangular space may be observed, gradually 
rises as it advances forwards, till it terminates in that high point or 
promontory which forms the tip of the shoulder, and overhangs and 
defends the joint. 
Angles. 
Superior. 
Interior. 
Glenoid 
cavity. 
Neck. 
Spine. 
Triangular 
space. 
+ I have met with the accident in practice, and have preparations of the fractured 
bone, so that there can be no doubt of this accident sometimes occurring, yet it is 
very rare. 92 
BONES OF THE 
Termi- 
nates in 
the acro- 
mion. 
This high point is named the acromion process. It is the conti- 
nuation and ending of the spine, which at first rises perpendicularly 
from the bone, but, by a sort of turn or distortion, it lays its flat side 
towards the head of the shoulder-bone: here it is hollow, to transmit 
the supra and infra spinati muscles. At this place, it is thickened, 
flat, and strong, overhangs and defends the joint, and is not merely 
a defence, but almost makes a part of the joint itself; for, without 
this process, the shoulder-bone could not remain a moment in its 
socket; every slight accident would displace it. The acromion 
prevents luxation upwards, and is so far a part of the joint, that 
when it is full under the acromion, the joint is safe; but when we 
feel a hollow, so that we can push the points of the fingers under the 
acromion process, the shoulder is luxated, and the socket empty. 
The point of the acromion forming the apex of the shoulder, a 
greater projection of this point, and a fulness of the deltoid muscle 
which arises from it, is a chief cause, and of course a chief mark of 
superior strength. 
But there is still another security for the joint; for there arises from 
the neck of the scapula, almost from the border of the socket, and 
its inner side, a thick, short, and crooked process, which stands di- 
rectly forwards, and is very conspicuous; and which, turning for- 
wards with a crooked and sharp point, somewhat like the beak of a 
crow, is thence named the coracoid process. This also guards and 
strengthens the joint; though it cannot prevent luxations, it makes 
them less frequent, and most probably when the arm is luxated in- 
w'ards, it is by starting over the point of this defending process. This 
process has three surfaces for the attachment of muscles, and these 
muscles are, the pectoralis minor, the coraco brachialis, and the short 
head of the biceps. 
Now the glenoid surface, and these twro processes, form the cavity 
for receiving the shoulder bone. But still, as if nature could not 
form a joint at once strong and free, this joint, which performs 
quick, free, and easy motions, is too superficial to be strong. Yet 
there is this compensation, that the shoulder-joint, which could not 
resist, if fairly exposed to shocks and falls, "belongs to the scapula, 
which, sliding easily upon the ribs, yields, and so eludes the force. 
Falls upon the shoulder do not dislocate the shoulder ; that accident 
almost always happens to us in putting out the hand to save ourselves 
from falls : it is luxated by a twisting of the arm, not by the force of 
a direct blow. This bone is subject to be fractured; and then the 
muscles pull asunder the fractured portions. The acromion is very 
apt to be broken off by falls on the shoulder, and if the accident be 
not treated with due attention to the action of the deltoid muscle, 
permanent lameness is the consequence. 
Coracoid 
process. 
Three sur- 
faces on it. 
THE CLAVICLE. 
Clavicle. 
The clavicle, or collar-bone, named clavicle from its resemblance 
to an old-fashioned key, is to the scapula a kind of hinge or axis on 
which it moves and rolls ; so that the free motion of the shoulder is 
made still freer by the manner of its connexion with the breast. SHOULDER, ARM, AND HANS). 
93 
The clavicle is placed at the root of the neck, and at the upper 
part of the breast: it extends across from the tip of the shoulder to 
the upper part of the sternum ; it is a round bone, a little flattened 
towards the end which joins the scapula ; it is curved like an Italic f , 
having one curve turned out towards the breast; it is useful as an 
arch supporting the shoulders, preventing them from falling forwards 
upon the breast, and making the hands strong antagonists to each 
other, which, without this steadying, they could not have been. 
It is described by authors in three divisions or parts, viz. the sca- 
pular, sternal extremities, and middle portion. The end next the 
sternum is round and flat, or button-like; the articulating surface is 
triangular, and is received into a suitable hollow on the upper piece 
of the sternum. It is not only, like other joints, surrounded by a 
capsule or purse ; it is further provided with a small moveable carti- 
lage, which (like a friction-wheel in machinery) saves the parts, and 
facilitates the motion, and moves continually as the clavicle rolls. 
From this inner head there stands out an angle, which, when the cla- 
vicles are in their places, gives attachment to the interelavicular liga- 
ment ; it ties them to the sternum and to each other. The lower 
surface has a groove in it for the subclavius muscle ; the upper sur- 
face is marked by the attachment of the clavicular portion of the mas- 
toid muscle, and the insertion of trapezius. 
But the outer end of the clavicle is flattened as it approaches the 
scapula, and the edge of that flatness is turned to the edge of the 
flattened acromion, so that they touch but in one single point; Nthis 
outer end of the clavicle, and the corresponding point of the acro- 
mion, are flattened and covered with a crust of cartilage ; and on 
the under surface of it, there is a groove corresponding to the groove 
under the acromion : there is also a small tubercle for a ligament; 
but the motion here is very slight and quite insensible : they are tied 
firmly bv strong ligaments ; and we may“ cortkider this as almost a 
fixed point, for there is little motion of the scapula upon the clavicle; 
but there is much motion of the clavicle upon the breast bone, for 
the clavicle serves as a shaft or axis, firmlydied to the scapula, upon 
which the scapula moves and turns, being connected with the trunk 
only by this single point, viz. the articulation of the clavicle with 
the breast-bone. 
The use of the clavicle being to keep the shoulders apart, it is 
very obvious that fracture of this bone must be the consequence of 
falling, as from horse-back, so as to pitch upon the prominence of 
the shoulder. It is a very common accident, and requires consider- 
able care and management in setting the bone. 
Curve. 
Par* acro- 
mialis, 
sternalis, 
and media. 
Sternal 
head 
round. 
Groove. 
Scapular 
heatl flati 
Scapular 
head flat. 
HUMERUS. 
The os iiijmeri is one of the truest of the cylindrical bones : it is 
round in the middle ; but it appears twisted and flattened towards 
the lower end ; and this flatness makes the elbow-joint a mere hinge, 
moving only in one direction. It is again regular and round towards 
the upper end, dilating into a large round head, where the round- 
Humerus, 94 
BOKES OF THE 
ness iorms a very free and moveable joint, turning easily in al) 
directions. 
The head of this bone is very large: it is a neat and regular cir- 
cle ; but it is a very small portion of a large circle, so that it is flat; 
and this flatness of the head, with the shallowness of the glenoid ca- 
vity of the scapula, makes it a very weak joint, easily displaced, and 
nothing equal to the hip-joint for security and strength. 
The neck of this bone cannot fairly be reckoned such; for, as I 
have explained in speaking of the neck of the thigh-bone, this neck 
of the humerus, and the necks of most bones (the thigh-bone still 
excepted), are merely a rough line close upon the head of the bone, 
without any straitening or intermediate narrowness, which we can 
properly call a neck. The roughness round the head of the shoul- 
der-bone is the line into which tiie capsular ligament is implanted. 
The tuberosities of the os humeri are two small bumps of un- 
equal size, (the one called the greater, the other the smaller, tubero- 
sity of the os humeri,) which stand up at the upper end of the bone, 
just behind the head : they are not very remarkable. Though infi- 
nitely smaller than the trochanter of the thigh-bones, they serve simi- 
lar uses, viz. receiving the great muscles which move the limb. 
The greater tuberosity is higher towards the outer side of the 
arm, and receives the supra-spinatus muscle ; while the infra-spinatus 
and teres minor muscles, which come from the lower part of the 
scapula, are implanted into the same protuberance, but a little 
lower. The lesser tuberosity has a single muscle fixed into it, 
the sub-scapularis muscle. 
The two tuberosities form betwixt them a groove, which is pretty 
deep ; and in it the long tendon of the biceps muscle of the arm 
runs : and as it runs continually, like a rope in the groove of a pully, 
this groove is covered in the fresh bones with a thin cartilage, 
smooth, and like the cartilages of joints. On the outside of this 
groove there is a long ridge for the insertion of the pectoralis, on 
the inside one for the latissiinus dorsi. On the body of the bone, 
about one third part of its length from the head, there is an irregu- 
larity for the attachment of the deltoid muscle; and on the inside of 
the bone near its middle, is the hole for the nutritious artery. 
The os humeri at its lower part changes its form, is flattened and 
compressed below, and is spread out into a great breadth of two 
inches or more ; where there is formed on each side a sharp pro- 
jecting point, (named condyle,) for the origin of great muscles ; 
and in the middle, betwixt the two condyles, there is a grooved arti- 
culating surface, which forms the hinge of the elbow. At the lower 
extremity, the bone is somewhat twisted. 
At the lower end of the bone, there are two ridges, one leading 
to either condyle, which it is of some consequence to observe; for 
the articulation of the humerus and ulna is a mere hinge, the most 
strictly so of any joint in Ihe body : it lias, of course, but two mo- 
tions, viz. flexion and extension: and there are two muscles, chiefly 
one for extending, the other for bending the arm : the flexor muscle 
lies on the fore part, and the extensor on the back part of the arm , 
and so the whole thickness of the arm is composed at this place of 
Head. 
Keck. 
Line for 
the cap- 
sule. 
Greater 
tuberosity. 
Lesser tu- 
berosity. 
Groove. 
Ridges. 
toid. 
Foramen, 
Ridges in- 
temal and SHOULDER, ARM, AND HAND. 
95 
these two muscles and of the bone : but that the fore and back parts 
of the arm might be thoroughly divided, the bone is flattened betwixt 
them ; and that the division might extend beyond the mere edges of 
the bone, there are two fascia? or tendinous webs, which go off 
from either edge of the humerus, and which continue to divide the 
fore from the back muscles, giving these muscles a broader origin ; 
they are named, from their office, intermuscular membranes ; and 
this is the meaning of the two ridges which lead to the two condyles. 
The two projections in which these edges end, are named con- 
dyles. The condyles of the thigh-bone are the broad articulating 
surfaces by which that bone is joined with the tibia ; while the con- 
dyles of the shoulder-bone are merely two sharp projecting points for 
the origin of muscles, which stand out from either side of the joint, 
but which have no connection with the joint. The chief use of the 
condyles of the shoulder-bone is to give a favourable origin, and 
longer fulcrum for the muscles of the fore-arm, which arise from 
these points. The outer tubercle being the smaller one, gives origin 
to the extensor muscles*, where less strength is required. But the 
inner tubercle is much longer, to give origin to the flexor muscles 
with which we grasp, which require a bolder and more prominent 
process to arise from ; for greater power is needed to perform such 
strong actions as grasping, bending, pulling, while the muscles 
which extend the fingers need no more power than just to antagonise 
or oppose the flexors ; their only business being to unfold or open 
the hand, when we are to renew the grasp. 
It is further curious to observe, that the inner tubercle is also 
lower than the other, so that the articulating surface for the elbow- 
joint is oblique, which makes the hand fall naturally towards the face 
and breast, so that by being folded merely without any turning of the 
os humeri, the. hands are laid across. 
The articulating surface which stands betwixt these condyles, 
forms a more strict and limited hinge than can be easily conceived, 
before we explain the other parts of the joint. The joint consists of 
two surfaces ; first, a smooth surface, upon which the ulna moves 
as on a hinge ; and secondly, of a small knob upon the outside of the 
trochlea, which has a neat round surface, upon which the face or 
socket belonging to the button-like end of the radius rolls. These 
two surfaces are called, the one the small head, and the other the 
cartilaginous pully, or trochlea, of the humerus. 
Belonging to the joint, and within its capsular ligament, there are 
two deep hollows, which receive certain processes of the bones of 
the fore arm. One deep hollow on the fore part of the humerus, 
and just above its articulating pully, receives the horn-like or coro- 
noid process of the ulna, viz. fossa coronoidea ; the other receives 
the olecranon, or that process of the ulna which forms the point of 
the elbow, viz. fossa olecranalis. 
Condyles. 
The inner 
longest, 
and why. 
Trochlea. 
Knob for 
the head of 
the radius. 
Fossa for 
the coro- 
noid pro- 
cess. 
' Fossa for 
the olecra- 
non. 
RADIUS AND ULNA. 
The radius and ulna are the two bones of the fore-arm. The 
radius, named from its resemblance to the ray or spoke of a wheel; 96 
BONES OF THE 
the ulna, from its being often used as a measure. The radius be- 
longs more peculiarly to the wrist, being the bone which is chiefly 
connected with the hand, and which turns along with it in all its 
rotatory motions : the ulna, again, belongs more strictly to the elbow- 
joint, for by it we perform all the actions of bending or extending 
the arm. 
The ulna is in general of a triangular or prismatic form, like the 
tibia, and the elbow is formed by the ulna alone ; for there is a very 
deep notch or hinge-like surface, which seems as if it had been 
moulded upon the lower end of the humerus, embraces it very closely, 
and takes so sure a hold upon the humerus, that it allows not the 
smallest degree of lateral motion, and almost keeps its place in the 
dry skeleton, without the help of ligaments or muscles ; it presents, 
in profile, somewhat of the shape of the letter y, or f of the Greek, 
and therefore is named the sigmoid cavity of the ulna. But this 
sigmoid cavity were a very imperfect lunge without the two pro- 
cesses by which it is guarded before and behind ; the chief of these 
is the olecranon, or large bump, which forms the extreme point 
upon which we rest the elbow. It is a big and strong process, 
which, fitting into a deep hollow on the back of the humerus, serves 
two curious purposes; it serves as a long lever for the muscles which 
extend or make straight the fore-arm; and when by the arm being 
extended, it checks into its place, it takes so firm a hold upon the 
hinge or joint of the os humeri, as to secure the joint in pulling, and 
such other actions as might cause a luxation forwards. The other 
process which guards the elbow-joint is named the coronoid pro- 
cess, from its horn or pointed form : it stands up perpendicularly 
from the upper or fore part of the bone ; it forms the fore part of 
the sigmoid cavity, and completes the hinge. On the root of the 
cQronoid process there is a rough tubercle for the attachment of the 
brachialis interims. The coronoid process is useful, like the olecra- 
non, in giving a fair hold and larger lever to the muscles, and to 
secure the joint; for the arm being extended, as in pulling, the ole- 
cranon checks into its place, and prevents luxation forwards: and the 
arm again being bent, as in striking, pushing, or saving ourselves 
from falls, the coronoid process prevents luxation backwards ; so 
the joint consists of the olecranon and the coroniod process as the 
two guards, and of the sigmoid cavity or hollow of articulation be- 
twixt them. But the smaller or upper head of the radius also enters 
into the joint, and lying upon the inner side of the coronoid process, 
it makes a small hollow there in which it rolls ; and this second 
hollow, touching the edge of the sigmoid cavity, forms a double sig- 
moid cavity, of which the first, or greater sigmoid cavity, is for re- 
ceiving the lower end of the humerus ; and the second or lesser 
sigmoid cavity, for receiving the upper head of the radius. Betwixt 
these there is a pit for receiving the glandular apparatus of the joint. 
The form of the bone being prismatic, or triangular, it has, like the 
tibia, three ridges, one of which is turned towards a corresponding 
ridge in the radius, and betwixt them the interosseous ligament is 
stretched ; and this interosseous ligament fills all the arch or open 
space betwixt the radius and ulna, and saves the necessity of much 
Ulna. 
Sigmoid 
cavity. 
Olecra- 
non. 
Coronoid 
process. 
Tubercle. 
Greater 
sigmoid. 
Lesser 
sigmoid 
cavity. 
Pit. 
Form pris- 
matic. 
Ligament. 97 
SHOULDER, arm, and hand. 
bon§; gives as firm an origin to the muscles as bone could have 
done, and binds the bones of the fore-arm together so strongly, that 
though the ulna belongs entirely to the elbow-joint, and the radius 
as entirely to the wrist, they have never been known to depart from 
each other. On the outside of the greater extremity of the ulna, 
there is a triangular surface for the attachment of the anconeus mus- 
cle. The ulna, bigger at the elbow, grows gradually smaller down- 
wards, till it terminates almost in a point. It ends below in a small 
found head, which is named the lower head of the ulna, which 
scarcely enters into the joint of the wrist; but being received into a 
hollow on the side of the radius, the radius turns upon the lower head 
of the ulna, like an axis or spoke. 
Below this little head, the bone ends towards the side of the little 
finger, in a small rounded point, which is named the styloid process 
of the ulna; it is chiefly useful in giving a strong adhesion to the 
ligament which secures the wrist there. And as the styloid process 
and the olecranon, the two extremities of the ulna, are easily and dis- 
tinctly felt, the length of this bone has been used as a measure; 
and so it was named cubitus by the ancients, and is named ulna 
by us. 
Triangular 
surface. 
Lower 
head. 
Styloid 
Proce3S* 
RADIUS. 
The radius is the second bone of the fore-arm, and has its position 
exactly reversed with that of the ulna: for the ulna, belonging to 
the elbow, has its greater end upwards ; the radius, belonging to 
the wrist, has its greater end downwards ; and while the ulna only 
bends the arm, the radius carries the wrist with a rotatory motion, and 
so entirely belongs to the wrist, that it is called the manubrium ma- 
nus, as if the handle of the hand. 
The body of the radius is larger than that of the ulna. The trans- 
verse strength of the arm depends more upon the radius, which has 
more body and thickness, is more squared, and is arched in some 
degree so as to stand off' from the ulna, without approaching it, or 
compressing the other parts. The radius lies along the outer edge 
of the fore-arm, next to the thumb ; and being, like the ulna, of a 
prismatic or triangular form, it has one of its angles or edges turned 
towards the ulna to receive the interosseous ligament. 
The upper head of the radius is smaller, of a round, flattish, and 
button-like shape, and lies so upon the lower end of the humerus, and 
upon the coronoid process of the ulna, that it is articulated with 
both bones ; for, 1st, The hollow of its head is directly opposed to 
the little head of the os humeri; and, 2dly, The flat side of its 
button-like head rubs and turns upon the side of the coronoid pro- 
cess, making a socket there, which is called the lesser sigmoid cavity 
of the ulna. 
Immediately below the round flat head, is a narrowness or strait- 
ening, called the neck of the radius; round this neck there is a 
collar or circular ligament, (named the coronary ligament of the ra- 
dius,) which keeps the bone securely in its place, turning in this liga- 
mentous band like a spindle in its bush or socket; for the radius has 
Radius. 
Positiou. 
Form of 
the body. 
Upper 
head 
smaller. 
Hollow. 
Neck. 98 
BONES OF THE 
two motions, first, accompanying the ulna in its movements of Hexiorr 
and extension ; and, secondly, its own peculiar rotation, in which it 
is not accompanied in return by the ulna ; but the ulna continuing 
steady, the radius moves and turns the wrist. 
Immediately under this neck, and just below the collar of the 
bone, there is a prominent bump, like a flat button, soldered upon 
the side of the bone, which is the point into which the biceps flexor 
cubiti, the most powerful flexor muscle of the fore-arm, is inserted. 
On the outside of the bone, and near the middle, there is a roughness 
for the insertion of the pronator teres. Where the face of the radius 
is towards the ulna, there is a long sharp spine for the attachment of 
the interosseous ligament. 
The upper head is exceedingly small and round ; while the lower 
head swells out, broad and flat, to receive the bones of the wrist. 
There are two greater bones in the wrist, the scaphoides and lunare, 
which form a large ball, and this ball is received into the lower end 
of tli© radius: the impression which these two bones make there is 
pretty deep, and somewhat of a boat-like shape; whence it is called 
(like the articulating surface of the tibia) the scaphoid cavity of the 
radius : it is sometimes partially divided by a ridge; and on the edgo 
of the radius, next to the thumb, the bone ends in a sort of peak or 
sharper point, which is named, (though with very little meaning,) the 
stvloid process of the radius. 
So the scaphoid cavity of the radius forms the joint with the wrist; 
but there is another small cavity, on the side of the radius, near to 
the little head of the ulna, into which the lesser head of the ulna is 
received, and this is enclosed in a proper and distinct capsule. The 
little head of the ulna does not descend so low as to have any share 
in forming the wrist. There are properly two distinct joints: the great 
joint of the wrist, moving upon the radius; the other a little joint 
within this of the radius, rolling upon the ulna, and carrying the wrist 
along with it. On the outside of the extremity of the radius, we 
find a ridge, in the grooves on the sides of this ridge the extensor 
tendons run. The extensors of the thumb also make impressions. 
On the inside of the head of the bone, there is a flattened surface for 
the lodgment of the pronator quadratus muscle ; and a sharp line 
lor its insertion. 
Tubercle. 
Rough- 
ness. 
Spine. 
Lower 
head. 
Scaphoid 
cavity. 
Styloid 
process. 
ttidge and 
grooves. 
OF THE HAND AND FINGERS/ 
The wrist is the most complex part of all the bony system, and is 
best explained in a general way, by marking the three divisions ol 
the hand, into—the carpus, or wrist bones; the metacarpus, or 
bones that stand upon the wrist; and the lingers, consisting each of 
its three joints. 1. The carpus, or wrist, is a congeries of eight small 
bones, grouped together, into a very narrow space, very firmly tied 
together by cross ligaments, making a sort of ball or nucleus, a solid 
foundation, or centre, for the rest of the hand. 2. The metacarpus 
is formed of five long bones, founded upon the carpal bones, and 
which, departing from that centre in somewhat of a radiated form, 
give, bv their size and strength, a firm support to each individual 
Carpus; 
Metacar- 
pus. SHOULDER, ARM, AND HAND. 
99 
linger, and by their radiated or spoke-like form, allow the lingers 
free play, 3. The fingers, consisting each of three very moveable 
joints, are set free upon the metacarpus, so as to show a curious 
gradation of moving in all these parts; for the carpal bones are 
grouped together into a small nucleus, firm, almost immoveable, and 
like the nave of a wheel; then the metacarpal bones founded upon 
this are placed like the spokes of the wheel, and having a freer mo- 
tion ; and, lastly, the fingers, by the advantage of this radiated form 
in the bones upon which they are placed, move very nimbly, and 
have a rotatory as well as a hinge-like motion : so that the motion is 
graduated and proportioned in each division of the hand ; and even 
where there is no motion, as in the carpus, there is an elasticity, 
which, by gentle bendings, accommodates itself to the more movea- 
ble parts. 
The CARPUS, or wrist.—Looking upon the external surface of 
the carpus, we count eight small bones disposed in two rows, with 
one bone only a little removed from its rank ; and we observe that 
the whole is arched outwards, to resist injuries, and to give strength ; 
and that the bones lie like a pavement, or like the stones of an arch, 
with their broader ends turned outwards. On the internal surface, 
again, we find the number of bones not so easily counted ; for their 
smaller ends are turned towards the palm of the hand, which being 
a concave surface, the narrow ends of the wedges are seen huddled 
together in a less regular form, crowded, and lapped over each 
other ; but in this hollow, the four corner bones are more remarka- 
ble, projecting towards the palm of the hand, so as to be named 
processes: and they do indeed perform the office of processes; for 
there arises from the four corner points a strong cross ligament, 
which binds the tendons down, and makes under it a smooth floor or 
gutter for them to run in. 
The individual bones of the carpus are small, cornered, and very 
irregular bones, so that their names do but very poorly represent 
their form. To describe them without some help of drawing, or 
demonstration, is so very absurd, that a description of each of them 
seems more like a riddle, than like a serious lesson : it cannot be un- 
derstood, and indeed it need hardly be remembered ; for all that is 
useful, is but to remember the connection and place, and the particular 
uses of each bone : in reading of which, the student should continu- 
ally return to the plates, or he must have the bones always ip his 
hand, 
Fingers. 
Carpus, 
Form, 
1, ROW FORMING THE WRIST : viz. 
OS SCAPIIOIDES, LUNA RE, CUNEIFQRME, PISIFORM E, 
Os scapiioides.—The boat-like bone. This name of boat-like 1 
bone, or boat-like cavity, has been always a favourite name, though 1 
a very unmeaning one. The scaphoid bone is worthy of notice not 
merely from its being the largest bone, but also as it forms a chief 
part of the joint of the wrist; for it is this bone which is received - 
Os sea, 
phoidcs. 
Receive*} 
ipto the' 100 
BONES OF THE 
scaphoid 
cavity of 
the radius. 
into the scaphoid cavity of the radius : it is a very irregular bone, 
in which we need remember only these points,—the large round 
surface covered with cartilage, smooth, and answering to the cavity 
in the head of the radius ; the hook-like or projecting process, which 
forms one of the corner points of the carpus, and gives a hold to one 
corner of the ligament which binds down the tendons of the wrist. 
There is also a furrow for the capsular ligament, the concavity from 
which this bone takes its name, and by which it is articulated with 
the trapezium andtrapezoides ; and on its inner surface an oval cavity 
for the os magnum. 
The os lunare is named from one of its sides being somewhat of 
the shape of a half moon ; it is next in size to the scaphoid bone, 
and is ecpial to it in importance : for they are joined together, to be 
articulated with the radius. This bone takes an equal share in the 
joint with the scaphoid bone ; and, together, they form a great ball, 
fitting the socket of the radius, and of a long form : so that the wrist 
is a proper hinge. The chief marks of this bone are, its greater size, 
its lunated edge, and its round head forming the ball of the wrist- 
joint These are its surfaces : 
1. The surface of a semilunar shape, and, on the radial side, at- 
tached to the last bone. 2. The convex surface for articulation with 
the radius. 3. The ulnar surface for articulation with the os cunei- 
forme. 4. The hollow surface for articulation with the os magnum, 
the central bone of the second row . 
The os cuneiforme, or wedge-like bone, is named rather perhaps 
from its situation, locked in among the other bones, than strictly 
from its form. Its side forming the convex of the hand is broader ; 
its point towards the palm of the hand is narrower: and so far, we 
may say, it is a wedge-like bone; but it is chiefly so from its situa- 
tion, closely wedged in betwixt the lunare and pisiform bones. 
1. We may readily distinguish the surface articulated with the os 
lunare. 2. Opposite to this the surface of attachment of the os pisi- 
forme. 3. The further surface, that is, the side most remote from 
the fore-arm, is articulated with the unciforme ; a loose cartilage is 
interposed betwixt this bone and the end of the ulna. 
The os pisiFOUME is a small, neat, and round bone, named some- 
times orbicular, or round bone, but oftener pisiform, from its re- 
semblance to a pea. It is placed upon the cuneiform bone, and it 
■ stands off from the rest into the palm of the hand, so as to be the 
most prominent of all the corner bones ; of course, it forms one of 
the corner points or pillars of that arch under which the tendons 
pass. The pisiform bone is a little out of its rank, is very moveable, 
and projects so into the palm as to be felt outwardly, just at the end 
of the styloid process of the ulna ; it can be easily moved and rolled 
about, and is the point into which the ligament of the wrist is im- 
planted ; t he flexor carpi ulnaris, one of the strong muscles for bend- 
ing the wrist, is inserted into it. 
The pro- 
cess. 
Concavi- 
ty. 
Os lunare. 
Surfaces. 
Os cunei- 
forme. 
Surfaces. 
One sur- 
face of ar- 
ticulation. 101 
SHOULDER, ARM, AND HAND. 
2. ROW SUPPORTING THE METACARPAL BONES : VIZ. 
OS TRAPEZIUM, TRAPEZOIDES, MAGNUM, ET UNCIFORME. 
The second row begins with the trapezium, a pretty large bone, 
which, from its name, we should expect to find of a regular squared 
form ; while it has, in fact, the most irregular form of all, especially 
when detached from the other bones. The chief parts to be remark- 
ed in the bone, are the great socket, or rather the trochlea for the 
thumb ; and as the thumb stands off from one side of the hand, this 
socket is rather on one side. There is also a little process which 
makes one of the cornerNpoints, and stands opposite to the hook of 
the unciforme. 
Opposite to the surface of articulation with the thumb, and to- 
wards the first row, there is a semilunar surface which touches the 
convexity of the scaphoides, and another which articulates with the 
trapezoides. The fourth articulating surface of this bone is opposed 
tq the head of the metacarpal bone of the finger. 
The trapezoides is next to the trapezium, is somewhat like the 
trapezium, from which it has its name. It also resembles the cunei- 
form bone of the first row in its shape and size, and in its being jam- 
med in betwixt the two adjoining bones. 
It is articulated by its nearer surface to the scaphoides ; on its 
further surface, by two planes, to the metacarpal bone of the fore 
finger ; on the radial surface, to the trapezium ; and on the ulnar 
surface, to the os magnum ; having thus five planes or surfaces. 
The os magnum is named from its great size ; not that it is the 
largest of all, nor even the largest bone of the second row, for the 
unciform bone is as big ; but there is no other circumstance by 
which it is well distinguished. It is placed in the centre of the 
upper row ; has a long round head, which is jointed with the socket 
formed of the os lunare and scaphoides ; on the radial surface the 
magnum is articulated with the trapezoides; on the ulnar surface 
with the unciform; on the further surface it has three planes, and 
receives the whole head of the metacarpal of the middle finger, and 
part of the metacarpal of the fore finger and of the ring finger. 
The os unciforme, or hook-like bone, is named from a flat hook- 
like process, which projects towards the palm of the hand. This is 
one of the corner bones ; and standing in the end of the row, it is 
wedged betwixt the os magnum of its own row, and the os lunare 
and cuneiforme of the first row. It is large and squared; but the 
thing chiefly remarkable is that process from which it takes its name ; 
a long and flat process of firm bone, unciforme, or hook-like, and 
projecting far into the palm of the hand, which being the last and 
highest of the corner points, gives a very firm origin to the great liga- 
ment by which the tendons of the wrist are bound down. On its 
further surface, it has two articulating surfaces corresponding with 
the metacarpal bones of the ring and middle fingers. 
All these bones of the carpus when they are joined to each other, 
are covered with a smooth articulating cartilage, are bound to each 
other by all forms of cross ligaments, and are consolidated, as it 
Irregular. 
Surfaces 
of articu- 
lation. 
Trapezoi- 
des. 
Fire 
planes or 
articulat- 
ing sur- 
faces. 
Os mag- 
num. 
Os unci- 
forme. 
Its situa- 
tion and its 
process. 
Their con- 
nections. 102 
BONES OF THE 
were, into one great joint. They arc in general so firm as to be 
scarcely liable to luxation ; and although one only is called cuneiform, 
they are all somew hat of the wedge-like form, with their broader 
ends outwards, and their smaller ends turned towards the palm of 
the hand ; they are like stones in an arch, so that no weight nor 
force can beat them in ; if any force do prevail, it can beat others in 
only by forcing one out. A bone starting outwards, and projecting 
upon the back of the hand, is the only form of luxation among these 
bones, and is extremely rare.* 
METACARPUS.—The metacarpus is composed of four bones, 
upon which the fingers are founded. They are big, strong bones, 
brought close together at the root, but wider above; for the lower 
heads are small and flat, and grouped very closely together, to meet 
the carpal bones. But they swell out at their upper ends into big 
round heads, which keep the bones much apart from each other. 
Nothing of importance can be said concerning the individual bones. 
To speak of them individually is a mere waste of time. We may 
observe of the metacarpal bones in general : 1. That their nearer 
heads, being flat and squared, gives them a firm implantation upon 
their centre or nucleus, the carpus; and they have scarcely any 
freer motion upon the carpal bones, than the carpal bones have upon 
each other. 2. Their further heads are broader, whereby the arti- 
culating parts of the bone are kept apart, which gives freedom to 
the lateral motions of the bones of the fingers. 3. Each metacarpal 
bone is slightly bent; 4. and being smaller in the middle, there is a 
. space left betwixt the bones for the lodgment of the interossei mus- 
cles, and they have ridges which mark the place of attachment of 
the interossei muscles. 3. These bones taken collectively still pre- 
serve the arched form of the carpal bones, being, with the carpal 
bones, convex outwardly, and concave inwardly, to form the hollow 
of the hand ; and though they have littlb motion of flexion or exten- 
sion, they bend towards a centre, so as to approach each other, in- 
creasing the hollowness of the hand, to form what is called l)io- 
gene’s cup. 6. The articulating heads of the further extremities of 
these bones arc flattened, or somewhat grooved, for the play of the 
, tendons of the interossei muscles : and small processes stand out 
laterally for the attachment of ligaments, like little condyles. It is 
farther necessary to observe, into how small a space the carpal bones 
are compressed, how great a share of the hand the metacarpal bones 
form, and how far down they go into the hollow of the hand ; for I 
have seen a surgeon, who, not having the smallest suspicion that 
their lower ends were so near the wrist as they really are, has, in 
place of cutting the bone neatly in its articulation with the carpus, 
broken it, or tried to cut it across in the middle. 
Pour me- 
tacarpal 
pones. 
Their 
nearer 
head 
square. 
Their fur- 
ther head 
round and 
free. 
They 
diverge 
somewhat. 
Ridges. 
They are 
arched. 
Pondyles. 
* Late years have presented to me a subluxation of the centre bones of the first 
row, which generally ends in considerable obliquity of the hand, or distortion of the 
wrist. The boy that played the, dragon in the pantomime in Covent-Garden, fell 
upon his hands, owing to the breaking of the wire that suspended him in his flight, 
and he suffered this accident in both his wrists. These bones, and their ligaments, 
are subject to scrofulous inflammation. SHOULDER, AKM, AND HAND. 
103 
i’Ii\GERS.—We commonly say, that there are five metacarpal 
bones ; in which reckoning we count the thumb with the rest: but 
what is called the metacarpal of the thumb is properly the first pha- 
lanx, or the first proper bone ot the thumb, so that the thumb, regu- 
larly described, has, like the other fingers, three joints, and no meta- 
carpal bone. 
Thumb.—The first bone of the thumb resembles the metacarpal 
bones in size and strength, but it differs widely in being set upon the 
carpus, with a large and round head ; in being set off from the line 
of the other fingers, standing out on one side, and directly opposed 
to them; it rolls widely and freely : it is opposed to the other fingers 
in grasping, and, from its very superior strength, the thumb is named 
pollex, from poliere ; and the peculiar shape of the articulating ex- 
tremities, and the lateral processes or condyles are, as it were, better 
characterized than in the bones of the fingers. 
The fingers have each of them three bones:—The bones are 
gently arched, uniform, and convex upon their outer surface, grooved 
within for the lodgment of the stronger flexor tendons. l.The 
first bone is articulated with the metacarpal bones by a ball and 
socket; the socket, or hollow on the lower part of the first finger- 
bone, being set down upon the large round head of the metacarpal 
bone. 2. The second and third joints of the fingers are gradually 
smaller, and though their forms do a good deal resemble the first 
joint, they are quite limited in their motions; and are strictly hing6 
joints. 3. Here, as in other hinge joints, there are strong lateral 
ligaments, and lateral processes or condyles, for their attachment. 
When these lateral ligaments are burst or cut, the finger turns in 
any direction ; so that the motions of the fingers are limited rather 
by their lateral ligaments, than by any thing peculiar in the forms 
of the bones. 4. The face of each finger-bone is grooved, so that 
the tendons, passing in the pahn of the hand, run upwards along 
this groove or flatness of the fingers ; and from either edge of this 
flatness there rises a ligament of a bridge-like form, which covers 
the tendons like a sheath, and converts the grove into a complete 
canal. 5. '['he last joint or phalanx of each finger is flattened, rough, 
and drawn smaller gradually towards the point of the finger ; and it 
is to this roughness that the skin and nail adhere at the point. 104 
OF THE SKULL IN GENERAL: 
THE BONES OF WHICH IT IS COMPOSED—THEIR TABLES DIPLOE 
SUTURES THEIR ORIGINAL CONDITION, AND THEIR PERFECT 
FORM, REPRESENTED AND EXPLAINED. 
While the bones in general serve as a basis for the soft parts, of 
supporting and directing the motions of the body, certain bones 
have a higher use in containing those organs whose offices are the 
most essential to life. The skull defends the brain ; the ribs and 
sternum defend the heart and lungs; the spine contains that prolon- 
gation of the brain which gives out nerves to all the body : and the 
injuries of each of these are important in proportion to the value of 
those parts which they contain. 
IIow much the student is interested in obtaining a correct and 
perfect knowledge of the skull he must learn by slow degrees. For 
the anatomy of the skull is not important in itself only ; it provides 
for a more accurate knowledge of the brain ; explains, in some de- 
gree, the organs of sense; instructs us in all those accidents of the 
head which are so often fatal, and so often require the boldest of all 
our operations. The marks which we take of the skull, record the 
entrance of arteries ; the exit of veins and nerves ; the places and 
uses of those muscles which move the jaws, the throat, the spine. 
Indeed, in all the human body, there is not found so complicated and 
difficult a study as this anatomy of the head; and if this fatiguing 
study can he at all relieved, it must be by first establishing a very 
regular and orderly demonstration of the skull. 
For this end, wre distinguish the face, where the irregular surface 
is composed of many small bones, from the cranium or skull-cap, 
where a few broad and flat-shaped hones form the covering of the 
brain. It is these chiefly which enclose and defend the brain, which 
are exposed to injuries, and are the subject of operation. It is these 
also that transmit the nerves : so that the cranium is equally the ob- 
ject of attention with the anatomist and with the surgeon. 
All the bones of the cranium, are of a flattened form, consisting 
Of two tables, and an intermediate diploe, which answers tothecan- 
celli of other bones. The tables of the skull are two flat and even 
plates of bone : the external is thought to be thicker, more spongy, 
less easily broken ; the inner table, again, is dense, thin, and brittle, 
very easily broken, and is sometimes fractured, while the external 
table remains entire: thence it is named tabula vitrea, or the glassy 
table. These tables are parted from each other by the distance of 
a few lines ;* and this space is filled up with the diploe, or cancelli. 
* In anatomy, there is occasion, in almost every description, for a scale of smaller 
parts. The French divided their inch into twelve parts, each of which is a line. 
The French line, or twelfth of an inch, is a measure which 1 shall often have occa- 
sion to use. OF THE SKULL IN GENKKAL. 
105 
The cancelli, or lattice-work, is a net of membranes, covered with 
vessels, partly for secreting marrow, and partly for nourishing the 
bone ; and by the dura mater adhering to the internal surface, and 
sending in arteries, which enter into the cancelli by passing through 
the substance of the bone, and by the pericranium covering the exter- 
nal plate, and giving vessels from without, which also enter into the 
bone, the whole is connected into one system of vessels. The peri- 
cranium, dura mater, and skull depend so entirely, one upon the 
other, and are so fairly parts of the same system of vessels, that an 
injury of the pericranium spoils the bone, separates the dura mater, 
and causes effusion upon the brain : a separation of the dura mater 
is, in like manner, followed by separation of the pericranium, which 
had been sound and unhurt; and every disease of the cancelli, or 
substance of the bone, is communicated both ways ; inward to the 
brain, so a3 to occasion very imminent danger ; outwards towards the 
integuments, so as to warn us that there is disease. The general 
thickness of the skull, and the natural order of two tables, and an 
intermediate diploe, is very regular, in all the upper parts of the head. 
In perforating with the trepan, we first cut with more labour, 
through the external table ; wherr we arrive at the cancelli, there is 
less resistance, the instrument moves with ease, there is a change of 
sound, and blood comes from the tearing of these vessels, which run 
in the cancelli, betwixt the tables of the skull. Surgeons thought 
themselves so well assured of these marks, that it became a rule to 
cut freely and quickly through the outer table, to expect the change 
of sound, and the flow of blood, as marks of having reached the can- 
celli, and then to cut more deliberately and slowly through the inner 
table of the skull. But this shows an indiscreet hurry, and unpar- 
donable rashness in operation. The patient, during this sawing of 
the skull, is suffering neither danger nor pain, unless when the bone 
is inflamed ; and many additional reasons lead us to refuse altogether 
this rule of practice : for the skull of a child consists properly of one 
table only; or tables are not yet distinguished, nor the cancelli 
formed: in youth, the skull has its proper arrangement of can- 
celli and tables; but still, with such irregularities and exceptions, 
as make a hurried operation unsafe : in old age, the skull declines 
towards its original condition, the cancelli are obliterated, the tables 
approach each other, or are closed &nd condensed into one ; the 
skull becomes irregularly thick at some points, and at others thin, or 
almost transparent; so that there can hardly be named any period of 
life in which this operation may be performed quickly and safely at 
once. But, besides this gradual progress of a bone increasing in 
thickness and regularity, as life advances, and growing irregular and 
thinner in the decline of life, we find dangerous irregularities in skulls 
of all ages. There are specimens in the Museum of Windmill Street, 
where the thickness of the skull-cap varies from half an inch to the 
thinness of common paper. There are often at uncertain distances, 
upon the internal surface of the skull, hollows and defects of the in- 
ternal table, deep pits, or foveas, as they are called. These fovefe in- 
crease in size and in number as we decline in life : they are more 
frequent on the inner surfaces of the parietal and frontal hones : so 106 
OF THE SKULL IN GENERAL. 
that in those places where the skull should be most regular, we are 
never sure, and must, even in places considered to be the safest, per- 
forate gradually and slowly. Let the reader pursue this subject 
under the title of the formation and growth of bones. 
The BONES of the skull are divided into those of the cranium ; 
the bones of the face ; and common, or intermediate bones.* 
The following is the usual division of the bones of the head:— 
In the adult head there are thirty bones and thirty-two teeth. 
Of the Cranium, 
Six Bones. 
1 OsFrontis 
2 Ossa Pariatalia or 
Bregmatis 
2 Ossa Temporalia 
1 Os Occipitis 
Intermediate or 
Common Bones, Two. 
1 Os Spbenoides 
1 Os .dSthraoides 
Bones of the Face, 
Fourteen. 
2 Ossa Maxiliaria Supra. 
2 Ossa Malarum 
2 Ossa Nasi 
2 Ossa Palati 
2 Ossa Unguis vel La- 
chryraalia 
2 Ossa Turbinata Infr*. 
1 Vomer 
1 Maxilla Inferior 
Bones of the Ear, 
Four on each Side, viz. 
Malleus 
Incus 
Os Orbiculare 
Stapes 
Teeth. 
In the child twenty. 
In the adult thirty-two, viz. 
8 Incisores 
4 Cuspidati 
8 Bicuspides 
12 Molares. 
We see, therefore, that the bones of which the cranium, or skull, is 
formed, by which the brain is surrounded and protected, are in all 
eight in number. 1. The frontal bone, or bone of the forehead, 
forms the upper and fore part of the head,—extends a little towards 
the temples, and forms also the upper part of the socket for the eye. 
2. The parietal bones are the two large and flat bones which form 
all the sides and upper part of the head: and are named parietalia, 
as they are the walls or sides of the cranium. 3. The os occipitis 
is named from its forming all the occiput or back of the head, though 
much of this bone lies in the neck, and is hidden in the basis of the 
skull. 4. The ossa temporum form the lower parts of the sides of 
the cranium: they are called temporal, from the hair that covers 
them being the first to turn gray, marking the time of life. 5. The 
os J3THM.OIDES and 6. the os sphenoides are quite hidden in the basis 
of the skull: they are very irregular, and very difficultly described or 
explained. The os asthmoides is a small square bone, hollow, and 
with many cells in it: it hangs over the nose, and constitutes a great 
and important part of that organ, and at the same time supports the 
brain. The olfactory nerves, by passing through it at many points, 
* The head is divided into the cranium and face. For the cranium we find in 
old authors the words calva or calvaria, from calvus, bald, or sometimes cerebri 
galea, as being like a helmet to protect the brain. 
We find some terms distinguishing certain parts of the cranium, as glabella, the 
smooth part in the centre and lower part of the forehead; occiput, the utmost con- 
vexity of the head backward; vertex, the crown of the head where the hairs turn ; 
bregma, or fontanelle, which are terms derived from very false notions, but which 
mean the interstices left in a child’s skull betwixt the cranial bones. 
The student ought to know these terms, but good taste rejects them even from me« 
dieal language, when the description can be given in plain English. OF THE SKULL IN GENERAL. 
107 
perforate it like a sieve ; and it takes its name from this perforated 
or aethmoid plate. The os sphenoides is larger and more irregular 
still; placed further back ; locked in betwixt the occipital and aeth- 
moidal bones ; lies over the lop of the throat, so that its processes 
form the back of the nostrils, and roof of the mouth : and it is so 
placed, as to support the very centre of the brain, and transmit almost 
all its nerves.* 
OP THE SUTURES OP THE SKULL. 
The joinings of the bones being indented and irregular, and like 
seams, they are called sutures. 
1. The coronal suture is that which joins the frontal to the pa- 
rietal bones ; extends almost directly across the head, from ear to 
ear; descends behind the eye, into the deep part of the temple ; and 
there, losing its serrated appearance, becomes like the squamous or 
scaly suture, which joins the temporal bones. It is named coronal, 
because the ancients wore their garlands on this part of the head. 
But the suture had been better entitled to this name, had it surround- 
ed the head, than as it crosses it. 
2. The lambdoidal suture is that one which joins the parietals 
to the occipital bone. It begins behind one ear, ascends and arches 
over the occiput, descends behind the other ear. It thus strides 
over the occiput, in a form somewhat resembling the letter lambda 
(A) of the Greeks, whence its name. 
3. The sagittal suture joins the parietal bones to each other ; 
runs on the very top of the head ; extends forwards from the lamb- 
doid suture till it touches, or sometimes passes, the coronal suture ; 
and from lying betwixt these two sutures, like an arrow betwixt the 
string and the bow, it has been named sagittal. 
4. The temporal sutures join the temporal bones to the parietal, 
occipital, and frontal bones ; the sphenoid bone also enters into the 
temporal suture, just behind the eye. The temporal suture makes 
an arch corresponding almost with the arch of the external ear ; it 
meets the coronal suture an inch before the ear, and the lambdoidal 
an inch behind it. This back part belongs as much to the occipital 
as to the temporal bone ; and so has been named, sometimes addita- 
mentum suturre lambdoidalis, sometimes additamentum suturae squa- 
moste : for this temporal suture is, on account of the edge of the 
temporal and occipital bones being thin, and like scales of armour 
laid over each other, often named the squamous or scaly suture. 
5. The sphenoidal and .ethmoidal sutures are those which sur- 
round the many irregular processes of these two bones, and join them 
to each other, and to the rest. 
6. The transverse suture is one which, running across the 
face, and sinking down into the orbits, joins the bones of the skull 
to the bones of the face ; but with so many irregularities and inter- 
ruptions, that the student will hardly recognise this as a suture. 
* Some foreign authors, as if it were to make a complex piece of anatomj still 
more complicated, describe the sphenoid and occipital bone as one, calling it os 
spheno-occipitale, or os basUare. 108 
Ob' THE SKILL IN GENERAL. 
7. The zygomatic suture is one which joins a brancii of tiie 
temporal bone, to a process of the cheek bone ; forming an arch, 
zygoma, or yoke : but this suture has not extent; it has a serrated 
appearance at one single point only. 
To mark and know these sutures, and to be able to trace them in 
imagination upon the naked head, to foresee where a suture willpre* 
sent, and how far it runs, may be a matter of great importance to 
the surgeon. Hippocrates, who has had more to praise his honesty 
than to follow his example, acknowledges bis having mistaken a su- 
ture for a fracture of the skull; and since this warning, various con- 
trivances and marks have been thought of, for preventing the like 
mistake, it may be useful to remember, that the suture has its 
serrae or indentations, ia firmly covered by the pericranium, is close, 
and does not bleed : but that a fissure, or fracture of the skull, runs 
in one direct line, is larger and broader at the place of the injury, 
and grows smaller, as you recede from that, till it vanishes by its 
smallness; and that it always bleeds. Indeed the older surgeons, 
observing this, poured ink upon the suspected part, which, if the 
skull was hurt, sunk into the fissure, and made it black and visible ; 
but left the suture untouched.* The old surgeons, or rather the 
ancient doctors, directed to make the patient take a wire betwixt 
his teeth, which being struck like the spring of an instrument, he 
would feel the twang produce a painful and particular sensation in 
the fractured part of the head. But after all these observations, 
in place of any true and certain marks, we find a number of accidents 
which may lead us into a mistake. 
Sutures cannot be distinguished by their serrse or teeth ; for the 
temporal sutures want this common character, and rather resemble 
capillary fractures of the skull nor even by their places, for we 
know that there are often insulated bones (ossa Wormiana) sur- 
rounded with peculiar joinings, which so derange the course of the 
common sutures, that the joinings may he mistaken for fractures of 
the skull, and the ossa Wormiana for broken parts. Sometimes the 
squamous suture is double, with a large arch of bone intercepted 
betwixt the true and the false suture ; or the sagittal suture, de- 
scending beyond its usual extent, and quite to the nose, has been 
mistaken for a fracture, and trepanned ; and oftener in older skulls, 
the sutures are entirely obliterated, all over the head. If the sur- 
geon should pour ink upon the skull, he would have reason to he 
ashamed of an experiment so awkward and unsuccessful: and for 
the old contrivance of a wire or cord held in the mouth, it cannot 
he done, since the patient is commonly insensible ; and even, though 
less hurt, his feelings, after such an accident, must be very confused : 
he must be too liable to he deceived : and we cannot on such slen- 
der evidence as this, perform so cruel an operation as cutting up the 
scalp, or so dangerous a one as the trepan. 
For various reasons, we are careful to trace the hones from their 
* In matter of fact, the blood serves this purpose by its sinking into the fissure, 
and giving it a dark appearance. There is a roughness on the edge of the Assure, 
which, being felt by means of the yrobe, will distinguish the fissure from the suture 
t Vir, Fractures as small as a hair, thence named capillary. OF THE SKULL IN GENERAL, 
109 
original soft and gristly or membranous state, to their perfect condi- 
tion of hard bone: and most of all, we are concerned to do so in the 
head, where, in childhood, the appearances are not singular and 
curious only, but have always been supposed to indicate some wise 
and useful purpose. It is in this original condition of the soft and 
growing bones, that anatomists have sought to find a theory of the 
sutures, how they are formed, and for what uses. It has been re- 
marked, that the number of pieces in the skull is infinitely greater in 
the child than in the man. These bones, ossifying from their cen- 
tre towards their circumference, it happens, of course, that the fibres 
are close at the centre of ossification, and are more scattered at the 
extremities of the bone; when these scattered fibres of opposite 
bones meet, the growing fibres of one bone shoot into the interstices 
of that which is opposed : the fibres still push onwards, till they are 
stopped at last, and the perfect suture, or serrated line of union is 
formed. 
In dilating this proposition, we should observe, that in the boy all 
the bones in the head are membranous and imperfect. The mem- 
branous interstices begin to be obliterated ; the sutures are begin- 
ning to close ; the distinction of two tables is not yet established ; 
the cancelli are not yet interposed between the plates ; the sinuses 
or caverns of the bones, as in the forehead, the nose, and the jaw, 
are not formed ; and each bone is not only incomplete towards its 
edges and sutures, but consists often of many parts. The os frontis 
is formed of two pieces, which meet by a membranous union in the 
middle of the bone. The ossa pari et alia have one great and pro- 
minent point of ossification in the very centre of each, from which 
diverging rays of ossification extend towards the edges of the bone. 
The os occipitis is formed in four distinct pieces: and the tempo- 
ral bones are so fairly divided into two, that their parts retain in 
the adult the distinct names of petrous and squamous bones. Al- 
though these are all the regular points of ossification, yet sometimes 
there occur small and distinct points, which form irregular bones, 
uncertain in number or size, found chiefly in the lambdoid suture, 
sometimes numerous and small, more commonly they are few in 
number, and sometimes of the full size of a crown, always distorting 
more or less the course of the suture, and being thus a subject of 
caution to the surgeon ; these are named ossa triquetra or trian- 
gularia, from their angular shape, or wormiana, from Olaus Wor- 
mius, w'ho remarked them first. Now the os frontis being formed 
into two larger pieces, their edges meet early in life, and they form 
a suture ; but the bones continuing to grow, their opposite points 
force deeper and deeper into each other, till at last the suture is en- 
tirely obliterated, and the bones unite ; and so this suture is found 
always in the child, seldom in the adult, almost never in old age. 
The occipital bone having four points, they are closer upon eacli 
other, they meet early, are soon united ; and, although very distinct 
in the child, no middle suture has ever been found in the adult, but 
always the four pieces are united into one firm and perfect bone. 
The parietal bones have their rays most of all scattered ; the rays of 
ossification run out. to a great distance, and diverge from one single 110 
OP THE SKULL IN GENERAL. 
point, so that at their edges they are extremely loose, and they never 
fail to form sutures by admitting into their interstices the points and 
edges of the adjoining bones. The surest and most constant sutures 
are those formed by the edges of the parietal bones ; the sagittal in 
the middle, the coronal over the forehead, the lambdoidal behind, 
and the squamous suture, formed by their lower edges. But another 
phenomenon results at the same time, from this meeting and oppo- 
sition of the fibres and interstices of the growing bones : that when 
the opposite fibres meet, they are not admitted into the open spaces 
of the opposite bone ; but the fibres of each bone both turn inwards, 
and form a ridge or spine, such as is seen on the inner surfaces of the 
frontal and occipital bones.* 
* NOTE BY CHARLES BELL. 
It would be, indeed, an idle mode of proceeding on such a subject, to suppose that 
the spinous processes and sutures of the skull arc accidentally produced, when de- 
sign, and the most curious adaptation of parts to their office, is so apparent. To 
suppose these things produced by chance, is at once to end all inquiry, and to leave 
a blank in our minus. 
To comprehend the nature of sutures, we must reflect on the difference of the 
tables of the skull. Why are there two tables and a meditulium ? To stop vibra- 
tion ; that one layer of bonf- might not correspond with another in its vibratory mo- 
tion ; that the motion of the one might not be communicated to the other, and the 
brain ultimately suffer by the concussion. 
If we see that the outer table is tough like wood, and the inner table brittle like 
glass, for sufficient reason, we may see also how the joinings of the bone are dif- 
ferent ; the outer edge of each true suture is dovetailed or joined by teeth, while the 
inner edge of the same suture is merely laid in contact. If you have a fine piece of 
foreign wood, and desire to have it formed into a box, you give it to the cabinet- 
maker, and he joins it curiously by minute carvings of corresponding edges. But if 
you had slabs of marble or alabaster, you would not give it to the cabinet-maker, but 
to the marble-cutter, to join it, and form a trough or sarcophagus ; and you would 
expect him to lay its smooth edges together, and join it with cement; for if he cut it 
into dovetailing, it would chip off, and fail to give security. Would you then have a 
negligence exhibited in the structure of an animal body of that which is so evident to 
a villain workman'! The outer table of the skull has its suture ; but the inner table 
is laid in simple contact, by joining called harmonia. By such proofs, convinced 
that there is perfect design in every thing that regards these bones, we now observe, 
that it is only the thick and strong cranial bones which are joined by means of the 
sutura vera; for why join bones which are weak in their texture, with forms of 
strength ? The thin bones, accordingly, are merely laid in contact. But if the 
bones of tlie face require strength, as in animals which have deep-socketted tusks or 
horns, then, with increased thickness, they have sutures conforming. Nor has it 
been noticed, that the sutures are so formed, that while one part of a cranial bone is 
within, another is without, by which they are held firmly together, even when yon 
replace them in their dry state. 
Nothing can better prove the stupid indifference to the beauty of animal struc- 
ture, than the continual repetition of the observation, that the squamous suture is 
formed by the pressure of the temporal muscles. If the bones were thus accident- 
ally crushed into this shape, would it not sometimes happen in a thousand specimens, 
that the parietal bone should overhang the temporal bone ? yet such an appearance 
was never seen: besides that, the temporal muscle extends further than the squamous 
suture. To believe that this form of the bones on the side of the cranium proceeds 
from the accidental pressure of the muscle, is to lose sight of one of the most inte- 
resting provisions in the whole structure of the skeleton. The temporal and sphenoid 
bones lock in the lower part of the parietal bone, to prevent the abutment of the 
arch starting. Another lolly is the supposing the spines visible on the inner surface 
of the cranium accidentally produced by the superabundant ossification of the bones 
in forming the suture ; whereas they are groining obviously intended to strengthen 
the bones. 
It has been supposed, and, with much appearance of truth, that the sutures limit 
the extent of fractures, leave a free communication of the internal with the external 
parts ; that they must serve as drains from the brain; that they are even capable of 
opening at times so as to give relief and ease in the most dreadful diseases of the head: 
but these use9 of them arc far from being proved. 
The sutures tvere not intended by nature for limiting the extent of fractures: for 111 
DESCRIPTION OP THE INDIVIDUAL BONES OF THE SKULL. 
OS FRONTIS.—This bone is compared with a clam-shell. It 
is of a semicircular shape, hollowed like a shell. It is divided into 
the frontal, nasal, and orbitary portions, and it has within it the cavi- 
ties which are named the sinuses of the frontal bone. The frontal 
bone is connected by sutures with the parietal bones, &,c. 
fractures traverse the skull in all directions ; cross the sutures with ease ; and very 
often, passing all the sutures, they descend quite to the basis of the skull, where wc dare 
not follow them with the knife, nor apply the trepan. Indeed we do not even know that 
limiting the extent of fractures could be a gracious provision of nature, since it would 
rather appear by the common accidents, that the more easily the bone yields, the 
less is the injury to the brain. If a certain violence and shock be committed, and 
the bone does not yield, and is not fractured, yet the vibration is propagated through 
it, and concussion is even more dangerous than fracture, because it is a general injury 
to the brain. 
Neither were they intended as drains ; for surely it is a bold position to assume, 
that nature has carefully provided for our making issues upon the sutures. When 
the original openness of the head and the membranous condition of the sutures were 
first observed, it was thought to be an observation of no small importance. The an- 
cients believed that the membranes of the brain came out by the sutures, to form the 
pericranium, and going from that over the several joints, formed the periosteum for 
all the bones. They saw a close connexion between the external and internal mem- 
branes of the skull, and they thought that nature had intended there a freer commu- 
nication, and an occasional drain. They found the sutures particularly wide and 
membranous in a child, which they attributed to the watery state of its brain, re- 
quiring a freer outlet than in the adult; and accordingly they named the opening of 
the child’s head the bregma, fons, fontanclle, the fountain, by which they believed 
there was a continual exudation of moisture from the brain. 
We might have expected these notions to have vanished with the doctrines of hu- 
mours and revulsions which gave rise to them ; but both the doctrines, and the prac- 
tice, have been revived of late years ; and a surgeon of some eminence has been at 
pains to examine various skulls, trying to find which of all the sutures remains longest 
open, and which should form the readiest and surest drain ; and after a curious ex- 
amination of each, he decidedly condemns the fontanelle ; finds the additamentum of 
the squamous suture always open, and expects this superior advantage from placing 
his issues there, that he will command at once a drain both from the cerebellum and 
from the brain. But these notions of derivation and revulsion, of serous humours 
falling upon the brain, of drains of pituita by the nose, and through the sutures, were 
much cherished by the ancients, had been long forgotten, and have not been effec- 
tually revived by this attempt. It cannot be denied, that, in some instances, the su- 
tures have continued quite open in those grown in years, or have opened after a most 
wonderful manner, in some diseases of the head. 
The fontanelle, or opening at the meeting of the coronal and sagittal sutures, was 
once thought to be a sure mark for the accoucheur to judge by, both of the life of the 
child, and of the direction in which its head presents. It is large and soft in a child, 
and the good women lay a piece of firm cloth upon it, and defend it with particular 
care. It begins to contract from the time of birth ; and in the second and third year, 
K is entirely closed. Its closing is delayed by weakness, scrophulous complaints, 
and indeed by any lingering disease; it closes very late in rickets, and in hydro- 
cephalic children the bones never close, but continue soft, yield to the watery swell- 
ing of the brain, and separate in a wonderful degree, so as to hold ten or twelve 
pounds. As the sutures continue open in a hydrocephalic child they are said to open 
again in a few instances where adults are seized with the same disease. 
We cannot pass unnoticed their looseness and flexibility in the new born child ; 
how wonderfully the head of the child is increased in length, and reduced in breadth 
in the time of delivery, and how much this conduces to an easy and happy labour. 
Were I to assign a reason for the flexible bones, and wide sutures, and the yielding 
condition of the bend of the child, I should say that it were meant by nature to stand 
in the place of that separation of the bones of the pelvis which fas been supposed, 
but which cannot exist; for the child’s head is moulded with little injury, is evolved 
again without help; and it seems a provision of nature, since the child scarcely feels 
the change : but no woman has been known to have the joinings of the pelvis relaxed 
or dissolved without pain and danger, confinement for many months, a temporary 
lameness, and sometimes she is rendered unable to walk for life. 112 
DESCRIPTION OF THE 
Its con- 
nections. 
Its rela- 
tions. 
The frontal bone stands connected with the parietal bones by the 
coronal suture; it is connected to the great ala of the sphenoid bone 
by the satura spheuo-frontalis; while its orbitary plates are united to 
the iesser ala; by the tinea spheno-frontalis. The nasal bones are 
attached to it by part of the transverse suture of the face. The cri- 
briform plate of the aethmoid bone is united to the orbitary plates by 
the linea aethmoidea frontalis, and looking into the orbits the same 
orbitary plates are seen to he contiguous to the ossa plana arid ossa 
unguis; and, lastly, the ossa malarum are attached to the frontal 
bone by the extremities of the transverse suture of the face. Its orbi- 
tary plates are two thin and diaphanous lamelhe that depart from the 
part of the bone which forms the forehead in a horizontal direction, 
so as to form a part of the socket of the eye, and a door for sup- 
porting the anterior lobes of the cerebrum. These two orbitary 
plates leave an open space, into which part of the .ethmoid bone is 
received. 
The first point to be remarked is the superciliary ridge, on 
which the eye-brows are placed : it is a prominent arched line, cor- 
responding jn size and length with the eye-brow which it supports : 
over this line the integuments are loose : here many arteries perfo- 
rate the bone, which are properly the nutritious arteries of this part 
of the bone ; and- we find all over the superciliary ridge many small 
holes through which these arteries had passed. Among these, there 
is one hole which is larger, and which is distinguished from the rest; 
for its use is not like the others, to transmit arteries to the bone, but 
to give passage to the frontal nerve and a small artery which come 
out from the orbit, to mount over the forehead. Sometimes tho 
nerve turns freely over the border of the orbit, and makes no mark, 
or but a slight one : often lying closer upon the bone, it forms a 
notch ; but most commonly, in place of turning fairly over the edge 
of the orbit, it passes obliquely through the superciliary ridge, and 
by perforating the bone, makes a hole. It is accompanied by the 
superciliary branch of the ophthalmic artery. This hole is named 
the SUPERCILIARY HOLE. 
The second foramen is the foramen orbitale internum. It is 
within the orbit, near the junction of the orbital plate with the mth- 
moid. It transmits a branch of the ophthalmic division of the fifth 
nerve from the orbit into the cranium, from which the same nerve 
immediately passes through the aethmoid into the nose. Sometimes 
there are two, when they are distinguished by the terms anterior 
and posterior orbitary foramina ; but occasionally there is only a 
groove, or one side of the foramen, the other being formed by the 
JEthmoid. 
The orbitary, or superciliary ridge, ends by two processes, which, 
forming the angles of the eye, are named the angular processes. 
The frontal bone has, therefore, four angular processes : 1. The 
two internal angular processes, forming the internal angles of the 
eyes ; and 2. The two external angular processes which form the 
external angles of each eye. 
Betwixt the two internal angular processes there is the nasal 
point or process. This nasal process is a «mall sharp projecting 
Points of 
demon- 
stration. 
1. Orbi- 
tary 
plates. 
2. Fissura 
aethmoi- 
dea. 
3- Super- 
ciliary 
ridge. 
4. Pores, 
or minute 
foramina. 
5. Super- 
ciliary 
hole. 
6. Fora- 
men orbi- 
tale. 
7. Angular 
processes. 
8. Nasal 
process. INDIVIDUAL BONES OF THE SKULL. 
113 
point, occupying that space which is exactly in the middle of' the 
hone, and is betwixt the two internal angular processes. It is very 
irregular and rough all round its root, for supporting the two small 
nasal bones ; and this a firm seat, and such a hold upon 
the root of the forehead, that they oftener are broken than dis- 
placed. 
From the external angular process there extends backwards and 
upwards the temporal ridge or spine. 
At the inner end of the superciliary ridge, is that bump which 
marks the place of the frontal sinus, which also indicates their size ; 
for where this rising is not found, the sinuses are wanting, or are very 
small; but this is no sure nor absolute mark of the presence of 
these sinuses, which often, in the flattest foreheads, are not entirely 
wanting. a 
The sinuses* of the olftontis are two in number, one on either 
side above the root of the nose : they are formed by a receding of 
the two tables of the skull from each other : they are formed at first 
with the common cancelli, and at first they resemble the common 
cancelli, as if they were only larger cells : gradually they enlarge into 
two distinct cavities, often of very considerable size, going backwards 
into the orbitary plate, or sideways into the orbitary ridge, or upwards 
through one half of the frontal bone ; and Ruysch had, in a giantess 
(puella gigantica), seen them pass the coronal suture, and extend 
some way into the parietal bones. 
The two sinuses of either side are divided by a partition ; hut still 
they communicate by a small hole: sometimes the partition is almost 
wanting, and there are only crossings of the common lamellated sub- 
stance ; and though the communication with one another i« not 
always found, they never fail to with the nose : this in- 
deed seems to be their chief use ; for the Wontal sinuses are the be- 
ginning of a great train of cells, which, commencing thus in the 
frontal bone, extend through the aethmoidal, sphenoidal, and max- 
illary bones, so as to form cavities of great extent and use belonging 
to the nose. These cavities extend and give form to the face, en- 
large the cavities which receive effluvia, and allow them to circulate 
and pass over the proper organ of smelling; and they give perfection 
and strength to the voice. The membrane which lines these cavities 
is thin, exquisitely sensible, and is a continuation of the common 
membrane of the throat and nose. A thin humour is poured out 
upon its surface to moisten it and keep it right. This the ancients did 
not consider as a mere lubricating fluid, but as a purgation of the 
brain, drawn from the pituitary gland, which could not be diminished 
without danger, and which it was often of consequence to promote. 
These cells, or thin membranes, are subject to inflammation and 
abscess. They are also subject to the accidental nestling of insects, 
which nestle there, and produce inconceivable distress; and it is 
a n ge’ 
®ne"r 
diiares. 
10. Sinus- 
es. 
n. parti- 
[|°ens- 
esie smus" 
* The word sinus is used in two senses : we call the cavities or cells, within the 
substance of a bone, the sinuses of that bone ; as the sinuses of the forehead, of the 
sphenoid, tethmoid, or maxillary bones ; we call also certain great veins by the same 
name of sinuses ; thus the great veins being enlarged where they approach the heart, 
and the veins being particularly large in the brain and the womb, we call them the 
sinuses of the heart, of the brain, and of the womb. 114 
DESCRIPTION OF TI1E 
particular, that they more frequently lodge in the frontal sinuses, 
than in the cavities of any of the other bones. In sheep and dogs 
such insects are very frequent, as in seeking their food, they carry 
their nose upon the ground; and it has been proved, or almost 
proved, that in man they arise from alike cause. Indeed, what can 
we suppose, but that they get there by chance ; thus, a man having 
slept in barns, was afflicted with dreadful disorders in the forehead, 
which were relieved upon discharging from the nose a worm of that 
kind which is peculiar to spoiling corn ; while others have had the 
complaint by sleeping upon the grass. The patient might be re- 
lieved on easier terms than by the operation of trepan, which has 
been proposed, by the injection of aloes, assafcetida, myrrh, the use 
of snuff or smoking, and pressing the fumes upwards into the nose. 
Much should be tried, before undertakinJfc dangerous operation on 
slender proofs. 
It may be right in cases of fractures, to decline applying the trepan 
above the sinuses, unless a fracture cannot be raised in any easier 
way; and we must be especially careful to distinguish a fracture of 
the outer table only, from entire fractures of this bone. For Palfin 
says, that the outer table being broken, and the natural mucus of the 
sinus being corrupted and flowing out, has been mistaken for the 
substance of the brain itself. And Paree, who first gives this cau- 
tion, affirms, u that he had seen surgeons guilty of this mistake, ap- 
plying the trepan, and so killing their unhappy patients.”* 
The spine or ridge which runs upon the internal surface of the 
frontal bone, is to be observed, as it gives a firm hold to the falx, or 
that perpendicular membrane, which, running in the middle of the 
head, divides and supports the brain. This is more or less prominent 
in different skulls, and to the age. The spine is more 
prominent at its root; but as it advances up the forehead, it de- 
creases, and often ends in a groove. The spine gives firm hold for 
the falx, and the groove lodges the great longitudinal sinus, or in 
other words, the great vein of the brain, which runs along the head, 
in the course of the perpendicular partition, or falx. At the root of 
this spine, there is a small blind hole ; it is named blind, because it 
does not pass quite through the bone, and the beginning of the falx, 
dipping down into this hole, gets a firmer hold. The ancients, 
thinking that the hole descended through both tables into the nose, 
ignorantly believed, that the dangerous and ungovernable bleedings 
at the nose must be through this hole, and from the fore-end, or be- 
ginning of the longitudinal sinus. 
Upon the orbitary plate, and just under the superciliary ridge, 
there are two depressions in the socket of each eye : the one is very 
small, and deeper at the inner corner of the eye, under the superci- 
liary hole, which is the mark of the small cartilaginous pully, in which 
the tendon of one of the muscles of the eye plays ; the other a more 
gentle and diffused hollow, lies under the external angular process, 
is not deep, but is wide enough to receive the point of a finger, and 
12. Inter- 
nal spine. 
13.Groove 
14. Fora- 
men cae- 
cum. 
15. Pit of 
the troch- 
lea. 
16. Pit for 
the lachry- 
mal gland. 
* For a more perfect account of the pathology of the sinuses, see Mr. John Hell's 
Principles of Surgery. INDIVIDUAL BONES OP THE SKULL. 
115 
is Me place where the lachrymal gland lies, that gland winch secretes 
the tears, and keeps the eye moist.* 
On the whole, this bone affords a very important subject of study 
to the surgeon, and he is especially called to attend to the sinuses, 
the internal spine, and to the orbitary processes of this bone. These 
orbitary processes are the most remarkable points of this bone. 
They are often fractured by a blow on the forehead, and being ex- 
tremely brittle, the splinters are beat up, and enter the brain. They 
are no defence to the brain when a weapon enters the orbit. We 
have known a young man killed by the push of a foil which had lost 
its guard, and which passed through this plate into the brain. 
PARIETAL BONE.—The parietal bones form much the greater 
share of the cranium : they are more exposed than any others, are the 
most frequently broken, and the most easily trepanned ; for the 
parietal bones are more uniform in their thickness, and more regular 
in their two tables and diploe, than any others. But the accidental 
varieties of pits and depression are very frequent in them, and the 
sinus or great vein, and the artery which belongs to the membranes 
of the brain, both make their chief impressions upon this bone. It 
enters into the formation of the coronal, the sagittal, the lambdoidal, 
and the squamous sutures. 
The square form of the bone produces four angles ; and in surgery, 
we speak of the frontal, the occipital, the mastoidean, and temporal 
angles of the parietal bone. It has deeply serrated edges which 
unite the two bones with each other, and with the occipital and 
frontal bones. All the corners of this bone*are obtuse, except that 
one which lies in the temple, and which, running out to a greater 
length than the other corners, is sometimes named the spinous or 
temporal process of the parietal bone, though there can be no 
true process in a bone so regular and flat. The lower edge of the 
bone is a neat semi-circle, which joins the parietal to the temporal 
bone ; and the edge of each is so slanted off, that the edge of the 
temporal overlaps the edge of the parietal, with a thin scale, forming 
the squamous suture. About an inch above the squamous suture, 
there is a semicircular ridge, where the bone is particularly white 
and hard ; and rays extend downwards from this, converging towards 
the jugum. The white semicircular line represents the origin of the 
temporal muscle ; and the converging lines express the manner in 
which the fibres of the muscles are gathered into a smaller compass, 
to pass under the jugum, or arch of the temple. The sagittal suture, 
or meeting of the two parietals, is marked with a groove as big as 
the finger, which holds the longitudinal sinus, or great vein of the 
brain ; but the groove is not so distinctly seen, unless the two bones 
are put together ; for one half of this flat groove belongs to each 
bone. 
Points of 
demon- 
stration. 
1. The 
four an- 
gles. 
2. Spinous 
process or 
sphenoidal 
angle. 
S. Squa- 
mous 
edge. 
4. Tempo- 
ral ridge. 
5. Groove 
for the 
sinus. 
The great artery of the dura mater touches the bone at that angle 
of it which lies in the temple. It traverses the bone from corner to 
6. Groove 
of the me- 
ningeal 
artery. 
* In addition, ag points of demonstration, we may add the eminentia: frontal?*' 
See general review of the skeleton. 116 
DESCRIPTION OF TIIL 
comer, spreading from the first point, like the branches of a tree: 
it beats deep into the bone where it first touches it; but where it 
expands into branches, its impressions are very slight; commonly it 
makes a groove only, but sometimes it is entirely buried in the bone ; 
so that at the lower corner of the parietal, we cannot escape cutting 
this vessel, if we arc forced to operate with the trepan. 
There is but one hole in the parietal bone: it is small and round, 
is within one inch of the meeting of the lambdoidal and sagittal 
sutures, and gives passage to a small external vein, which goes in- 
wards to the sinus, and to a small artery which goes also inwards to 
the dura mater, or rather to the falx. 
On the inner surface of the bone, and near the sagittal edge, we 
very often see a pit or fovea, which receives one of those bodies 
which are called glands, of the dura mater. 
The lateral sinus makes a depression on the inside of the mas- 
toidean angle. 
The meeting of the frontal and parietal bones, being imperfect in 
the child, leaves that membranous interstice which, by some, is 
named folium or folliolum, from its resembling a trefoil leaf, and was 
named by the ancients, hypothetically, bregma, fons,* or fountain ; 
they thinking it a drain of moisture from the brain : and so the 
parietal bones are named ossa bregmatis. The parts of these bones 
which form the upper portion of the skull, are equable in their thick- 
ness, and there the surgeon would apply his trephine, if he had it in 
his power to choose ; but towards the temporal angle he would 
apply it unwillingly, because of the meningeal artery, which is apt 
to be opened, and to bb at least troublesome. Formerly, surgeons 
were forbid to trepan over the longitudinal sinus : now the fashion is 
altered, and some surgeons would persuade us to prefer it! We do 
it when necessary, but always with due consideration of the great 
vein or sinus. 
OS OCCIPITIS has also the names of os memoriae, and os ner- 
vosum. It is the thickest of the cranial bones, but is the least 
regular in its thickness, being transparent in some places, and in 
others swelling into ridges of very firm bone. It gives origin or 
insertion to many of the great muscles, which move the head and 
neck ; it supports the back part of the brain, contains the cerebellum 
or lesser brain, transmits the spinal marrow, and is marked with the 
conflux of the chief sinuses, or great veins of the brain. 
This bone is united to the parietal bones by the lambdoid suture, 
to the mastoidean portions of the temporal bone by the additamentum 
suturae lambdoidalis, laterally and forward it is attached to the 
petrous portion of the temporal bone, and at its lower and most 
anterior part, it is attached to the sphenoid bone, by that peculiar 
bond of union called synostosis. 
In beginning the demonstration, we point out its divisions: 1. Pars 
occipitalis. 2. Pars lateralis or condvloidea. 3. Pars basilaris or 
7. Fora- 
men pa- 
rietale. 
8. Fovea. 
9. Fossa 
of the 
sinus. 
Points of 
demon- 
stration. 
* The word pulsatilis, or fons pulsatilis, or beating fountain, was added, because 
we feel the beatin<r of the arteries of the brain there- individual bones of the skull. 
117 
cuneiformis; which, at birth are distinct bones divided by cartilage. 
It is also necessary to name its angles, viz. the superior or parietal 
angle, and the mastoidean angle. 
The external surface is exceedingly irregular, by the impres- 
sions of the great muscles of the neck : betwixt the insertions of the 
muscles, projecting lines are on the bone. In the middle of the 
bone, and betwixt the muscles of opposite sides, there runs a ridge 
from above downward ; at the upper margin of the insertion of the 
trapezius, there is formed a superior transverse spine or ridge, and 
in the same way, directly above the insertion of the recti, which make 
two irregular depressions, there is an inferior transverse spine. In 
a strong man, advanced in years, where the ridges and hollows are 
strongly marked, at the point where the superior transverse crosses 
the perpendicular one, it is so very prominent as to be named the 
posterior tuberosity of the occipital bone. 
The internal surface.—Opposite to these ridges there are 
similar crucial ridges within ; but larger, more regular, smooth, and 
equal, and making only one transverse line, and one perpendicular 
line. The tentorium cerebcllo super-extensum is a diaphragm or 
transverse partition, which crosses the skull at its back part; cuts 
off from the rest of the cranium the hollow of the occipital bone, 
appropriates that cavity for the cerebellum, and defends the cere- 
bellum from the weight and pressure of the brain. This tentorium, 
or transverse membrane, is attached to the great internal ridge 
of the occipital bone. In the angle where this membrane is fixed 
to the ridge, lies the great sinus or vein, which is called the longitudinal 
sinus, while it is running along the head ; but-the same sinus, dividing 
in the back of the head, into two great branches, changes its name 
with its direction ; and the forkings of the vessel are named the right 
and left lateral sinuses, which go down through the basis of the skull; 
and being continued down the neck, are there named the great or 
internal jugular veins. This forking of the longitudinal, into the 
lateral sinuses, makes a triangular or tripod-like groove, which 
follows the internal ridges of the occipital bone : and above and 
below the transverse ridge there are formed four plain and smooth 
hollows. The two upper ones, are above the tentorium, and con- 
tain the posterior lobes of the brain ; the two lower ones are under 
the tentorium, and hold the lobes of the cerebellum or little brain. 
Processes.—The processes or projections of the occipital bone 
are few and simple. 1. There is a part of the bone which runs 
forward from the place of the foramen magnum, lies in the very 
centre of the base of the skull, joins the occipital to the sphenoidal 
bone, and which, both on account of its place, (wedged in the basis 
of the skull,) and of its shape, which is rather small, and somewhat of 
the form of a wedge, is named the Cuneiform, or wedge-like 
process of the occipital bone. On the inside of this part of the 
bone is a slight hollow, to which the name of fossa basilaris is given, 
and lateral to this the groove of the lower petrous sinus may be ob- 
served. And there arc two small oval processes, or button-like 
projections, which stand off from the side, or rather from the fore- 
part of the foramen magnum, or great, bole, and which, being lodcred 
1. Perpen- 
dicular 
external 
spine. 
2. Supe- 
rior trans- 
verse 
spine. 
3. Inferior. 
4. Tuber- 
osity. 
5. Internal 
crucial 
ridges. 
6. Grooves 
for the 
sinuses. 
7. Fossa 
cere belli, 
and fossa 
cerebri. 
8. Cunei- 
form pro- 
cess. 
9. Fossa 
basilaris. 
Lateral 
groove. 
10. Con' 
dyles. 118 
DESCRIPTION OF THE 
in joints belonging to the upper bone of the neck, form the hinge on 
which the head moves. These two processes are named the con- 
dyles of the occipital bone. They are not very prominent, but 
rather flattened ; are of an oval form, and have their fore-ends turned 
a little towards each other ; so that by this joint the head moves 
directly backwards or forwards, but cannot turn or roll. The turn- 
ing motions are performed chiefly by the first bones of the neck. 
Round the root of each condyle, there is a roughness, which shows 
where the ligament ties this small joint to the corresponding bone of 
the neck. 
On the lower part of the cuneiform process, there are two tuber- 
cles for the attachment of the recti capitis anteriores. Near the con- 
dyle, and immediately behind the foramen lacerum, there is a tuber- 
cle for the rectus capitis lateralis. 
Holes.—These condyles stand just on the edge of the foramen 
magnum, or great hole of the head, which transmits the spinal mar- 
row, or continuation of the brain ; and the edges of this hole 
(which is almost a regular circle) are turned and smoothed ; a little 
thicker at the lip, and having a roughness behind that, giving a firm 
hold to a ligament, which, departing from this hole, goes down 
through the whole cavity of the spine, forming at once a sheath for 
the spinal marrow, and a ligament for each individual bone. There 
pass down through this great hole the spinal marrow, and the verte- 
bral vein, there come up through it the vertebral arteries, which are 
of great importance and size ; and a nerve, which, from its coming 
backwards from the spine to assist certain nerves of the brain, is 
named the spinal accessory nerve. 
The second hole is placed a little behind the ring of the foramen 
magnum, and, just at the root of either condyle, is round and large, 
easily found, and sometimes it is double ; it transmits the ninth pair, 
or great lingual nerve. 
There is another hole smaller, and less regular than this last. It 
is exactly behind the condyle, while the lingual hole is before it. 
It is for permitting a small vein of the neck to enter and drop its 
blood into the great lateral sinus ; sometimes it is a hole common 
to the temporal and occipital bones, but often it is not found, and 
this trifling vein gets in by the great occipital hole. 
VVe shall describe with the temporal bone that wide hole which is 
common to the temporal and occipital bones, and which transmits 
the great lateral sinus, and the nerves of the eighth pair. 
The surgeon would do well to study, with great care, the place of 
the posterior tubercle, and to teach himself to calculate the place of 
the sutures from their protuberance, and as it were from the same 
land-mark, to estimate the place of the internal spines, and the 
fossa cerebrales ; for these inequalities in the thickness of this bone 
become of the first consequence in applying the trephine to the 
back of the head. 
11. Tuber- 
cles of the 
cuneiform 
process. 
12. Small 
lateral tu- 
bercles. 
13. Fora- 
men mag- 
num. 
14. Fora- 
men con- 
dyloidetim 
anterius. 
15. Poste- 
riua. 
16. Part 
of the 
foramen 
lacerum. 
TEMPORAL BONE.—The temporal bone is, in the child, two 
bones ; which retain their original names of pars petrosa and pars 
squamosa. The whole bone is very irregular in its thickness, and INDIVIDUAL BONES OE THE SKL'LL. 
119 
hollows, and processes. 1 he pars squamosa is a thin or scaly 
part ; rises like a shell over the lower part of the parietal bone, and 
is smoothed and flattened by the rubbing of the temporal muscle. 
The pars petrosa, often named os lapidosum, or stony bone, is 
hard, irregular, rocky ; juts inwards towards the basis of the skull: 
contains the organ of hearing, and of course, receives and trans- 
mits all the nerves which are connected with the ear.* There is a 
third portion of this bone, viz. the mastoidean angle, which is thick 
and hard, is divided into cells, and forms those caverns which are 
supposed to be chiefly useful in reverberating the sound. 
The squamous part is grooved, to make the squamous suture ; is 
scolloped or fringed ; and exceedingly thin on its edge ; it is ra- 
diated, in consequence of its original ossification shooting out in 
rays. The petrous part again is triangular, unequal by the cavities 
of the ear ; it has a very hard, shining, polished-like surface ; ex- 
ceeded in hardness by nothing but the enamel of the teeth. Where 
it projects into the base, it has several open points, which are filled 
up with cartilaginous or ligamentous substance; and its occipital 
angle is connected with the other bones by the additamentum 
suturae squamosoe. 
The temporal bone closes the cranium, upon the lower and 
lateral part; backwards it is connected by the additamentum 
suturae lambdoidalis to the occipital bone ; by the squamous suture 
and the additamentum suturae squamosae, it is joined to the parietal 
bone ; whilst anteriorly it is united to the sphenoid bone by the 
spheno-temporal suture, the spinous process of the sphenoid bone 
being deeply wedged betwixt the petrous and squamous portions of 
the temporal bone. 
Processes.—The zygomatic process rises broad and flat before 
the ear ; grows gradually smaller as it stretches forward to reach 
the cheek-bone : it forms with it a zygoma, yoke, or arch of the 
temple, under which the temporal muscle plays. The temporal 
muscle is strengthened by a firm covering of tendon, which stretches 
from the upper edge of this zygoma to the white line on the parietal 
bone ; and several muscles of the face arise l orn the lower edge of 
the zygoma, particularly one named masseter, which moves the jaw ; 
and one named zygomaticus, or distortor oris, because it draws the 
angle of the mouth. The zygomatic process is united by a short 
suture to the cheek-bone. 
The styloid process is so named from a slight resemblance to 
the stylus, or point with which the ancients engraved their writings 
on tables of wax. It is cartilaginous long after birth ; even in the 
adult, it is not completely formed ; it is exceedingly delicate and 
small; and when its cartilaginous point is fairly ossified, as in old 
men, it is sometimes two inches long. It stands obliquely cut from 
the basis of the head, and is behind the jaws ; so that it gives con- 
venient origin to a ligament which goes downwards to support the 
os hyoides, or bone of the tongue ; and it is the origin of many 
curious muscles, chiefly of the throat and jaws. One slender 
Pars 
squamosa. 
Pars pe- 
trosa. 
Mastoi- 
dean an- 
gle. 
1. Zygo- 
matic pro- 
cess. 
2. Styloid 
process. 
* The interior and posterior semicircular canals are protuberant upon its surfaces. 120 
DESCRIPTION OF THE 
muscle going downwards from the styloid .process, and expanding 
over the pharynx, is called stylo-pharyngeus ; one going to the os 
hyoides, is the stylo-hyoideus ; one going to the tongue, is the' 
stylo-glossus : and since the process is above and behind these 
parts, the muscles must all puli backwards and upwards, raising ac- 
cording to their insertions, one the pharynx, another the os hyoides, 
another the tongue. 
Processus vaginalis will not be easily found, nor acknowledged 
as a process ; for it is only a small rising of a ridge of the bone, 
with a rough and broken-like edge, on the middle of which the sty- 
loid process stands: it is, in short, the root of the styloid process 
which anatomists have chosen to observe, though it gives origin to 
no particular part; and which they have named vaginalis, as if it. 
resembled a sheath for the styloid process. 
Mastoideus, or mammillakis, is a conical nipple-like bump, like 
the point of the thumb ; it projects from under the ear, and is easily 
felt with the finger without; it is hollow, with many cells which en- 
large the tympanum, or middle cavity of the ear, arid are thought to 
reverberate and strengthen the sound. Under its root there is a 
deep and rough rut which gives a firm hold to the first belly of the 
digastric muscle : and the point or nipple of this process is the point 
into w hich the mastoid muscle is inserted from before ; and the corn- 
plexus obliquus and trachclomastoideus muscles from behind. 
The auditory process is just the outer margin of the hole of 
the ear. It is in a child a distinct ring, which is laid upon the rest 
of the bone.* The membrane of the ear is extended upon this 
ring, like the head of a tambour upon its hoop, whence this is 
named the circle of the tambour by the French, and by us the drum 
of the ear. In the adult, this ring is fairly united to the bone, and 
is named the processus auditorius ; and may be defined a circle, or 
ring of bone, with a rough irregular edge ; the drum or membrane 
of the ear is extended upon it, and the cartilaginous tube of the ear 
is fixed to it; and this ring occupies the space from the root of the 
mammillary to the root of the zygomatic process. 
Betwixt this and the mastoid process there is a kind of fissure, 
the rima mastoidea. 
The lower jaw is articulated with this bone by a shallow/ fossa, 
which is anterior to the auditory process, and at the root of the 
zygomatic process. A tubercle immediately before this articulating 
surface deepens it. A fissure may be observed in nearly the middle 
of the cavity, which is for the attachment of the ligament which 
unites the intermediate cartilage of this articulation. This fissure 
divides the proper articular or glenoid cavity from that fossa which 
gives lodgment to a deep portion of the parotid gland. 
Holes.—The temporal bone is perforated with many holes ; 
some for permitting nerves to enter ; others to let them out; others 
for the free passage of air to the internal ear. 
The m catus auditorius externus (the circle of which has been 
described) is that deep tube which in the dry bones leads to thq 
3. Vaginal 
process. 
4. Mastoid 
process. 
Groove 
for the di- 
gas tricus. 
5. Audi- 
cess. 
6. Articu- 
lar fossa. 
7. Articu- 
lar tuber- 
cle. 
8. Fissure. 
9. Meatus 
extern™*.3 
* In brutes it is, indeed, a process standing out. INDIVIDUAL BONES OF THE SKULL. 
121 
interior cavity, the but which is closed at the bottom by 
the membrane of the tympanum in the living body. 
The meatus auditohius internus is that hole by which the 
auditory nerves have access to the ear. It is a very large hole 
seated upon the back of the pars petrosa. The hole is at first 
large, smooth, almost a regular circle, with a sort of round lip. 
Within this are seen many small holes, the meaning of which is 
this: the nerve of the 7th pair is double from its very origin in the 
brain : it consists, in fact, of two distinct nerves, the portio dura, 
and the portio mollis. The portio mollis is a large soft and delicate 
nerve, which constitutes the true organ of hearing ; and when it is 
admitted into the ear, it is expanded into a thin web which spreads 
into all the cavities of the ear, as the cochlea, semi-circular canals, 
&c. The portio dura, the smaller part of the*nerve, passes indeed 
through the ear, but it is quite a foreign nerve ; it is not distributed 
within the ear ; it keeps the form of a distinct cord, and, passing 
through the temporal bone, it comes out upon the cheek, where it 
is expanded ; so that the portio dura is a nerve of the face, passing 
through the ear, but forming no part of that organ. Thus the two 
nerves, the portio dura and mollis, enter together ; they fill the 
greater hole, and then they part : the portio dura, entering by one 
distinct hole, takes its course along a distinct canal, the aqueduct of 
Fallopius, from which it comes out upon the cheek ; while the por- 
tio mollis, entering by many smaller holes into the cochlea, semi- 
circular canals, and cavity of the vestibule, is expanded in these 
cavities to form the proper organ of hearing. 
There is a small hole which will admit the point of a pin upon 
the fore-part of the petrous bone. This hole receives a small twig 
reflected from the fifth pair of nerves : the nerve is as small as a 
sewing thread ; it can be traced along the petrous bone by a small 
groove, which conducts it to the hole ; and when it enters the ear 
it goes into the same canal with the portio dura, and joins itself 
to it. 
The hole by which the portio dura passes out upon the cheek, is 
found just before the mastoid, and behind the styloid process ; and 
being betwixt the two, it is named the stylo-mastoid hole. 
The hole for the Eustachian tube is very irregular. No air can 
pass through the membrane of the drum ; and as air is necessary 
within the ear, it is conveyed upwards from the palate by the iter 
a PAiiATo ad aurem, or as it is commonly called, the Eustachian 
tube. This tube is long, and of a trumpet form ; its mouth, by 
which it opens behind the nostril, is wide enough to receive the 
point of the finger, it grows gradually smaller as it advances towards 
the ear : it is Cartilaginous in almost its whole length ; very little of 
it consists of firm bone ; so that the student, in examining the skull, 
will hardly find the Eustachian tube ; for the cartilage being rotted 
away, nothing is left but that end of the canal that is next the ear, 
and which opens both above and below, ragged, irregular, and 
broken. 
Above and to the outside of the Eustachian tube there is a nar- 
row canal which conveys the nerve called corda tympani. This 
10. Inter- 
nus. 
Il.Videan 
foramen. 
12. Stylo- 
mastoid 
foramen. 
13. Eusta- 
chian 
tube. 
14. Canal 
of the 
cor da 
tyropani.  122 
DESCRIPTION OF THE 
nerve, traversing the tympanum, enters aqueduct of FalTo-' 
pius, and unites with the facial nerve. 
On the inside of the Eustachian tube we may observe a canal 
which, leading backwards, opens into the cavity of the tympanum 
with a mouth like a spoon, it gives lodgment to the long muscle of 
the malleus. 
The other holes do not relate to the ear, and are chiefly for trans- 
mitting the great blood-vessels of the brain. 
The carotid artery, the chief artery of the brain, enters into the 
skull near the point of the petrous bone, and just before the root of 
the styloid process. The artery goes first directly upwards, then ob- 
liquely forwards through the bone, and then again upwards, to 
emerge upon the inside of the skull; so that the carotid makes the 
form of an italic S, when it is passing through the substance of the 
bone; and, in place of a mere hole, we find a sort of short canal, 
wide, a little crooked, and very smooth within. It is at this particu- 
lar point that we are sensible in our own body of the beating of these 
two great arteries; and Haller informs us, that, during a fever, he 
felt this beating in a very distressing degree. The sympathetic nerve 
accompanying the carotid artory, ia uleo transmitted through this 
canal. 
The great lateral sinus comes out in part through the tem- 
poral bone, to form the internal jugular vein. The course of the 
sinus may be easily traced by the groove of the occipital bone down- 
wards, behind the pars petrosa: there also it makes a deep groove, 
and ends with a large intestine-like turn, which makes a large cavity 
in the temporal bone, big enough to receive the point of the finger. 
The sinus passes out, not by any particular hole in the temporal 
bone, but by what is called a common hole, viz. formed one half 
by the temporal and one half by the occipital bone. This hole is very 
large; is lacerated or ragged-like. It is sometimes divided into 
two openings, by a small point, or spine of bone. The larger open- 
ing on one side of that point transmits the great sinus, where it be- 
gins to form the jugular vein ; and the smaller opening transmits the 
eighth nerve of the skull, or par vagum, which goes down to the 
heart, lungs, and stomach. 
There is a small hole on the outside of this bone, in the occipital 
angle ; or rather the hole is oftener found in the line of the suture 
(the additamentum suturae squamosae). Sometimes it is in the occi- 
pital bone ; or sometimes it is wanting : it transmits a trifling vein 
from without, into the great sinus, or a small artery going to the 
dura mater. 
There are two very small canals, which carry blood-vessels and 
lymphatics from the inner cavities of the ear ; they have been called 
aqueductus vestibuli, and aqueductus cochleae; they open on the 
posterior surface of the petrous bone, near the internal auditory 
foramen. 
Among the irregular depressions on the different faces of this 
bone are sometimes enumerated these: the groove already men- 
tioned on the mastoid process for the lodgment of the head of the 
digastricus ; certain cerebral fossae, which are the impressions of the 
15. Canal 
of the long 
muscle of 
the mal- 
leus. 
16. Caro- 
tid fora- 
men, 
for the 
passage of 
the great 
artery, 
and for the 
sympa- 
thetic 
nerve. 
17. Fora- 
men com- 
mune lace • 
rum trans- 
mits the 
internal 
jugular, 
and the 
nerves of 
the eighth 
pair. 
18. Mas- 
toidean 
foramen. 
19. Ducts 
of Cotun- 
nius. INDIVIDUAL BONES OP THE SKULL. 
123 
convolutions of the brain upon the inside of the squamous portion ; 
the jugular fossa, or thimble-like depression, made by the first turn 
of the great jugular vein ; the temporal sinuosity for the lodgment 
of the temporal muscle ; and, lastly, we observe in a well-marked 
bone, the sulci for the artery of the dura mater, and the groove for 
the petrous sinus on the ridge which divides the surfaces of the pe- 
trous bone. 
The temporal bone is important as a bone of the cranium, and 
lying in contact with the membranes of the brain. It is subject to 
scrofulous disease, from containing the complicated organ of hearing. 
Its diseases not only affect the brain, but in a particular manner in- 
fluence the muscles of the face, from the nerves transmitted being 
those of expression. 
The BONE is perhaps one of the most curious bones 
of the human body. It appears almost a cube, not of solid bone, 
but exceedingly light, spongy, and consisting of many convoluted 
plates which form a net-work like honey-comb. It is curiously en- 
closed in the os frontis, betwixt the orbitary processes of that bone. 
One horizontal plate receives the olfactory nerves, which perforate 
that plate with such a number of small holes, that it resembles a 
sieve, whence the bone is named cribriform, or aethmoid bone. 
Other plates, dropping perpendicularly from this one, receive the 
divided nerves, and give them an opportunity of expanding into the 
organ of smelling; and these bones, upon which the olfactory nerves 
are spread out, are so much convoluted as to extend the surface of 
this sense very greatly, and arc named spongy bones. Another flat 
plate lies in the orbit of the eye, which being very smooth, for the 
rolling of the eye, is named the os planum, or smooth bone ; so that 
the aethmoid bone supports the fore-part of the brain, receives the 
olfactory nerves, forms the organ of smelling, and makes a chief part 
of the orbit of the eye ; and the spongy bones, and the os planum, 
are neither of them distinct bones, but parts of this aethmoid bone. 
Thus the aethmoid is united to the frontal bone, by the linea aeth- 
moidea frontalis, and to the sphenoid bone by a similar line of con- 
tact, visible on theinside of the base of the cranium. Looking into 
the orbit, we again see a union with the frontal, and with the sphe- 
noidal and palate bones. Its perpendicular plate stands connected 
to the back part of the nasal process of the frontal bone ; the vomer 
is attached to the back part of this plate. The ossa unguis close 
the cells of this bone anteriorly. In the foetus the aethmoid bone is 
divided into two by a cartilaginous partition, which becomes after- 
wards the perpendicular plate and crista galli. 
The cribriform PLATE is exceedingly delicate and thin, lies hori- 
zontally over the root of the nose, and fills up neatly the space be- 
tween the two orbitary plates of the frontal bone. The olfactory 
nerves, like two small flat lobes, lie out upon this plate, and, ad- 
hering to it, shoot down like many roots through this bone, so as to 
perforate it with numerous small holes, as if it had been dotted with 
the point of a pin, or like a nutmeg-grater. 
This plate is horizontal; but its processes are perpendicular, one 
above, and three below. 
Connec- 
tions. 
Processes. 
1. Cribri- 
form plate. 124 
DESCRIPTION OF Till. 
2. Crista 
galli. 
The first perpendicular process is what is called crista galli, a 
small perpendicular projection somewhat like a cock’s comb, but 
exceedingly small, standing directly upwards from the middle of the 
cribriform plate, and dividing that plate into two ; so that one olfac- 
tory nerve lies upon each side of the crista galli; and the root of the 
falx, or septum, betwixt the two hemispheres of the brain, begins 
from this process. The foramen caecum, or blind hole of the frontal 
bone, is formed partly by the root of the crista galli, which is very 
smooth, and sometimes, it is said, hollow or cellular. 
Exactly opposite to this, and in the same direction with it; i. e. 
perpendicular to the sethmoid plate, stands out the nasal plate of 
the sethmoid bone. It is sometimes called the azygous, or single 
process of the aethmoid, and forms the beginning of that septum or 
partition which divides the two nostrils. This process is thin, but 
firm, and composed of solid bone ; it is commonly inclined a little 
to one or other side, so as to make the nostrils of unequal size. The 
azygous process is united with the vomer, which forms the chief part 
of the partition ; so that the septum, or partition of the nose, con- 
sists of this azygous process of the aethmoid bone above, of the vomer 
below, and of the cartilage in the fore or projecting part of the nose; 
but the cartilage rots away, so that whatever is seen of this septum 
in the skull, must be either of the aethmoid bone or the vomer. 
The lateral parts of the aethmoid bone consist of a series of cells 
communicating with each other, and which are called the labyrinths. 
The cells of the labyrinth are closed by the external plate called os 
planum. These cells belong to the organ of smelling, and are use- 
ful by detaining the effluvia of odorous bodies, and by reverberating 
the voice. 
From each of these labyrinths there hangs down a spongy bone, 
one hanging in each nostril. They are each rolled up like a scroll 
of parchment; they are very spongy; are covered with a delicate 
and sensible membrane, and when the olfactory nerves depart from 
the cribriform plate of the aethmoid bone, they attach themselves to 
the septum, and to these upper spongy bones, and expand upon 
them so, that the convolutions of these bones are of material use in 
expanding the organ of smelling, and detaining the odorous effluvia 
till the impression be perfect. Their convolutions are more nume- 
rous in the lower animals, in proportion as they need a more acute 
sense. They are named spongy, or turbinated bones, from their 
convolutions, resembling the many folds of a turban. 
The orbitar plate of the aethmoid bone is a large surface, 
consisting of a very firm plate of bone, of a regular quadrangular 
form, exceedingly smooth and polished : it forms a great part of the 
socket for the eye, lying on its inner side. When we see it in the 
detached bone, we know it to be just the flat side of the .-ethmoid 
bone; but while it is incased in the socket of the eye, we should be- 
lieve it to be a small square bone; and from this, and from its 
smoothness, it has got the distinct name of os planum. 
The os unguis should also, perhaps, be counted as a part of the 
bone; for though when observed in the orbit, it seems to be a small 
detached bone, thin, like a scale, and of the size of the finger nail 
3. Nasal 
plate. 
4. The la- 
byrinth. 
5. Process- 
superior 
spongy 
bones. 
6. Os pi a- 
num. 
The os 
unguis. INDIVIDUAL BONES OF THE SKULL. 
125 
(whence it has its name), yet in the adult the os unguis is firmly at- 
tached to the acthmoid bone, comes along with it when we separate 
the pieces of the skull, and when the os unguis is pared off from the 
{ethmoid bone, it exposes the cells. This os unguis, is a small 
scaly-like plate, in the inner corner of the orbit just over the nose, 
which closes the cells of the aethmoid bone ; however, it will be de- 
scribed hereafter as a distinct bone. 
The cells of the aethmoid bone, which form so important a share 
of the organ of smelling, are arranged in great numbers, along the 
spongy bone. They are small neat cells, much like a honey-comb, 
and regularly arranged in two rows, parted from each other by a 
thin partition ; so that the os planum seems to have one set of cells 
attached to it, while another regular set of cells belongs in like man- 
ner to the spongy bones. The cells are thus (commonly but not 
regularly) twelve in number, opening into each other, and into the 
nose. 
These cells are frequently the seat of venereal ulcers, and the 
spongy bones are the surface where polypi often sprout up ; and 
from the general connections and forms of the bone, vve can easily 
understand how the venereal ulcer, when deep in the nose, having 
got to these cells, cannot be cured, but undermines all the face ; how 
the venereal disease, having affected the nose, soon spreads to the 
eye, and how even the brain itself is not safe. We see the danger 
of a blow upon the nose, which, by a force upon the septum, or 
middle partition, might depress the delicate cribriform plate, so as to 
oppress the brain with all the effects of a fractured skull, and where 
no operation could give relief. We also see much danger in pulling 
away polypi, which are firmly attached to the upper spongy bone.* 
* In the year 1814, Wistar read a paper before the American Philosophical So- 
ciety, in which he showed that the triangular plates of bone which were described by 
Bertin as forming the sphenoidal comets, were continued from the cribriform plate 
of the aethmoid bone, in the form of two hollow triangular pyramids, which, when in 
their proper position, receive between them the azygous process of the sphenoid bone. 
“ The internal side of each of these pyramids applies to the aforesaid azygous process ; 
the lower side of each forms part of the upper surface of the posterior nares; the exter- 
nal side at its basis is in contact with the orbitar process of the os palati. The base of 
each pyramid forms also a part of the surface of the posterior nares, and contains a 
foramen which is ultimately the opening into the sphenoidal sinus of that side. 
“In the sphenoidal bones, which belong to such xthmoids as are above described, 
there are no cells or sinuses ; for the pyramids of the aethmoid bones occupy their 
places. The azygous process, which is to become the future septum between the 
sinuses, is remarkably thick, but there are no cavities or sinuses in it. 
“ The sides of the pyramids which are in contact with this process are extremely 
thin, and sometimes have irregular foramina in them, as if their osseous substance had 
been partially absorbed. That part of the external side of the pyramid, which is in 
contact with the orbitar process of the os palati, is also thin, and sometimes has an 
irregular foramen, which communicates with the cells of the aforesaid orbitar process. 
“Upon comparing these perfect specimens of the aethmoid and sphenoidal bones of 
the subject about two years of age, with the os sphenoides of a young subject, which 
was more advanced in years, it appears probable, that the azygous process and the 
sides of the pyramids applied to it, are so changed in the progress of life, that they simply 
constitute the septum between the sinuses ; that the external side ot the pyramid 
is also done away, and that the front side and basis of the pyramid only remain, con- 
stituting the ‘ cornets sphenoidaux of M. Bertin.’ ” Wistar. Anat. vol. i. p. 35. 
Notwithstanding the ease with which the accuracy of VVistar’s observations on 
this structure may be demonstrated, European anatomists still continue to describe 
the sphenoidal cornets, without reference to the true condition ot this arrangement; 
a circumstance, which, whether originating in prejudice or ignorance, is far from 
creditable to those who desire to be considered lovers of scientific improvement. 
—T. D, G, 126 
DESCRIPTION OF THE 
SPHENOIDAL RONE.—The sphenoidal bone completes tho 
cranium, and closes it below. It is named sphenoid, cuneiform, 
or wedge-like bone, from its being incased in the very basis of the 
skull; or it is named os multiforme, from its irregular shape. It 
is united to fourteen distinct bones. It is much of the shape of a 
bat, whence it is often named the pterygoid hone : its temporal 
processes being like extended wings ; its proper pterygoid processes 
like feet; its middle like the body and head of a bat. Its wing-like 
processes are in the hollow of the temple, forming a part of the squa- 
mous suture, and also composing a part of the orbit of the eye : its 
pterygoid processes hang over the roof of the mouth, forming the 
back of the nostrils : the body is in the very centre of the skull, and 
transmits five of the nerves from the brain, besides a reflected nerve ; 
but still the body bears so small a proportion to the bone, that we 
have not a regular centre to which all the processes can be referred ; 
so that we are always, in describing this bone, moving forwards from 
point to point, from one process or hole to the next. 
Processes.—The ala:, or wings, often named temporal pro- 
cesses, rise up in the temple, to form a part of the hollow of the 
temple ; and the wings of the sphenoid meeting the frontal, 
parietal, and temporal bones, by a thin scaly edge, they make part 
of the squamous suture, and give a smooth surface for the temporal 
muscle to play upon. 
The other side of this same process looks towards the socket of 
the eye, and has a very regular and smooth surface; it is opposite to 
the os planum. As the sethmoid bone forms part of the inside of 
the orbit, the wing of the sphenoid bone forms part of the outside of 
the orbit; and so the surface turned towards the eye is named the 
oKBiTAR process of the sphenoid bone, or orbitar plate of the 
great aloe. 
The surface of the great wing which looks backward receives the 
middle lobe of the cerebrum, and is called the cerebral fossa ; and 
that which is external and receiving the temporal muscle, is called 
the TEMPORAL FOSSA. 
The lower, or back part of this bone runs out into a narrow 
point, which sinks in under the petrous portion of the temporal bone, 
and being sharp pointed, it is named the spinous process. It is very 
remarkable for a small hole which permits the great artery of the 
dura mater to enter. 
The point of this spinous process projects in the form of a very 
small peak, which will hardly be found by the student. It projects 
from the basis of the skull, just within the condyle of the lower jaw, 
and being a small point, like the point of the stylus, or iron pen, it 
also is named styloid process. 
The lesser wing of Ingrasias next attracts the eye. It is that 
part of the bone which unites (by harmonia) with the orbitar plate 
of the frontal bone, and with the aethmoid bone.. 
This lesser wing projects laterally into the transverse spinous 
PROCESS. 
The pterygoid processes* are four in number, two on either 
* There is some confusion in this name, since pterygoid signifies aliform or wing- 
like processes. 
Points of 
demon- 
alae. 
Its sur- 
laces. 
2. Orbital. 
3. Cere- 
Temporal 
fossae. 
5. Spinous 
process, 
6. Styloid 
process. 
7. Win® 
of Ingra- 
sias' 
8. Trans- 
verse spi- 
nous pro- 
cess. 
Pterygoid 
processes. 127 
individual bones of the skull. 
side. They are those processes, upon which (with the spinous pro- 
cess) the bone naturally stands, and which, when we compare it 
with a bat, represent the legs; one of each side, is named external 
pterygoid, the other is named the internal pterygoid process. 
Each external pterygoid PROCESS is thin and broad, and ex- 
tends farther backwards. Each internal pterygoid process is 
taller and more slender, and not so broad. It has its end rising 
higher than the other, and tipped with a small neat hook, named 
the hook of the pterygoid process (viz. the hamular process). The 
inner pterygoid processes, form the back of the nostrils. The hook 
of the pterygoid process, is called the hook of the palate, of which it 
forms the backmost point. The musculus circumflexus vel tensor 
palati, rising from the mouth of the Eustachian tube, turns with a 
small tendon round this hook, like a rope over its pulley ; and the 
great muscles of the lower jaw, the only ones for moving it sideways, 
or for its grinding motions, arise from the pterygoid processes. 
Between the two processes there is a hollow which is called the fossa 
pterygoidea, and at the root of the internal pterygoid process there is 
a groove which leads to the mouth of the Eustachian tube. 
The azygous process,* is so named, from its being single, be- 
cause it is seated in the centre of the bone, so that it can have no 
fellow. It stands perpendicularly downwards and forwards, over 
the centre of the nose, and its chief use is to give a firm seat or in- 
sertion for the vomer or bone, which forms the septum. The vomer, 
or proper bone of the partition, stands with a split edge, astride 
over this process, so as to have a very firm seat. A kind of union 
which has been called gomphosis. 
The clinoid processes have, like many parts of the human body, 
a very whimsical name, very ill-suited to express their form ; for it is 
not easy, in this instance, to acknowledge the likeness of four little 
knobs to bed-posts ; yet the clintnd processes are very remarkable. 
The two anterior clinoid processes are small bumps, rather sharp, 
projecting backwards, and terminating in two flat projecting points. 
The posterior clinoid processes rise about an inch farther back- 
wards, and are, as it were, opposed to the others. They rise in one 
broad and flat process, which divides above into two points, small 
and round, or knobby at their points; and they look forwards towards 
the anterior clinoid processes. 
The tuberculum olivare is an eminence between the anterior 
clinoid process and before the sella turcica. 
The sella turcica ephippium, or Turkish saddle, is the space 
enclosed by these four processes, and is well named. The sella tur- 
cica supports the pituitary gland, an appendage of the brain, the 
use of which is unknown. The carotid arteries rise up by the sides 
of the sella turcica, and mark its sides with a broad groove. The 
9. Exter- 
nal. 
10. Inter- 
nal. 
11. Hanau- 
lar pro- 
cess. 
12. Fossa 
pterygoi- 
ilea. 
13. Azy- 
gous pro- 
cess. 
14. Ante- 
rior cli- 
noid pro- 
cesses. 
15. Poste- 
rior. 
16. Tuber- 
culuru. 
17. Sella 
turcica. 
* Azygous is a term which is applied to such parts as have no fellow ; because 
almost always the parts on one side of the body are balanced by similar and corres- 
ponding parts on the other side. When they stand in the centre of the body, or are 
otherwise single, we call them azygous, and so the azygous process of the .ethmoid 
and sphenoid, and other bones; or the azygous vein, which runs in the centre of the 
♦horax, and is single. 128 
DESCRIPTION OF THE 
optic nerves lie upon a groove at the fore-part of the sella turcica* 
between the two anterior clinoid processes ; and sometimes the two 
anterior processes stretch backwards, till they meet the posterior 
ones, and form an arch, under which the carotid artery lies. Often 
the posterior clinoid knobs cannot be fairly distinguished ; since, in 
many skulls, they form but one broad process. 
On the side of the posterior clinoid process, the carotid artery as 
it rises impresses its form upon the bone. 
The cone, or triangular process, is singularly placed in obscurity, 
when the bones are in union, and in separating the sphenoid bone it 
is very apt to be broken off. This process closes the cell, and pro- 
jects laterally towards the deepest part of the orbit, but so as to be 
concealed by the palate bone. 
This bone has also its cells, for all that part which we call the 
body of the bone, all the sella turcica, that space which is between 
the clinoid processes within and the azygous process without, is hol- 
lowed into one large cell, divided with a middle partition. It is, in- 
deed, less regular than the other cells ; it is sometimes very large, 
sometimes it is not to be found ; it has other trifling varieties which 
it were idle to describe. As it communicates with the ethmoid 
cells, it probably performs one office with them, is almost a conti- 
nuation of them, so that when any one is less or wanting, the others 
are proportionably larger. 
In the foetus there is no sphenoid cell; and the great alae can be 
separated by maceration. 
HOLES.—The sphenoid bone is so placed in the very centre of 
the skull, that its holes transmit the principal nerves of the skull, and 
it bears the marks of the chief arteries. 
The optic holes are large round holes, just under each anterior 
clinoid process. We trace the optic nerves by a large groove into 
each optic hole ; and an artery goes along with them, named the oph- 
thalmic artery, nearly the size of a crow-quill, twisting round the 
optic nerve, and giving arteries to the eye-lids, muscles, and lachry- 
mal gland, but most especially to the ball and humours of the eye 
itself. This ocular or ophthalmic artery comes off from the great 
carotid, while it lies by the side of the sella turcica: and it is a 
branch again of this ocular artery, which goes out upon the fore- 
head, through the superciliary notch, or hole. 
The foramen lacerum antekius is next in order, and is so 
named, because it is a wide slit. It is also called superior orbitarv 
fissure. The foramen lacerum is wide near the sella turcica, grows 
gradually narrower, as it goes out towards the temple, till it termi- 
nates almost in a slit. The upper line of the foramen lacerum is 
formed by the transverse spinous process, extending outwards sharp 
and flat. 
The nerves of the skull are counted from before backwards. 
There are nine nerves, proper to the skull; the first, or olfactory 
nerve, perforates the cribriform bone; the second, or optic nerve, 
passes through the optic hole ; the third, fourth, part of the fifth, and 
sixth pairs of the nerves, pass through this foramen lacerum, or wide 
18. De- 
pression 
l'or the 
carotid. 
19. Trian- 
gular pro- 
cess. 
20. Sphe- 
noid cell. 
21. Optic 
foramen. 
22. Fora- 
men lace- 
rum. INDIVIDUAL BONES OF THE SKULL. 
129 
iiole, to go also into the orbit. The optic nerve forms the proper 
organ of vision. The smaller nerves of the third, fourth,, fifth, and 
sixth pairs, go to animate its muscles, and, passing through the 
orbit, to mount upon the forehead, or go downwards into the nose. 
The fobamen rotundum i3 named from its round shape. The 
foramen opticum is indeed round, but it has already got an appro- 
priated name. Now to give the young anatomist a regular notion 
of this, and of the next hole, we must enumerate the branches of the 
fifth pair. The fifth nerve of the brain is as broad as the little finger, 
and lies by the side of the sella turcica, where it divides into three 
lesser nerves, which are called branches of the fifth pair. The first 
branch of the fifth pair is destined for the eye; the second branch 
of the fifth pair for the upper jaw; the third branch of this fifth pair 
for the lower jaw : so the first branch of the fifth pair passes through 
the foramen lacerum to the eye ; the second branch of the fifth pair 
passes through the foramen rotundum to the upper jawr; the third 
branch of this great nerve passes through the foramen ovale to the 
lower jaw\ 
The foramen rotundum, then, is a hole exactly round, pretty large, 
opening immediately under the inner end of the foramen lacerum, 
and transmitting the second branch of the fifth pair of nerves to the 
upper jaw. 
The fobamen ovale is an oval hole, larger than the foramen ro- 
tundum ; about half an inch behind it: and transmitting the third 
branch of the fifth pair to the lower jaw. 
The foramen siunale, or spinous hole, is a very small round 
hole, as if made with a large pin ; is in the very point of the spinous 
process; is one third of an inch behind the oval hole, and transmits 
the small artery, less than a crow-quill, which constitutes the chief 
artery of the dura mater, viz. that artery which makes its impression 
upon the parietal bone. 
There is still another hole, which transmits a nerve curious in this ■ 
respect, that it is not going out from the skull, but returning into it: j 
for the second branch of the fifth pair, or the superior maxillary' 
nerve, sends a small branch backwards, which, having come within 
the skull, enters the temporal bone, and goes to join itself to the 
portio dura of the seventh pair, and in its way gives a small branch, 
to help out the slender beginning of the great sympathetic nerve. 
This retrograde branch of the maxillary nerve gets back again into 
the skull, by a hole which is found just under the root of each ptery- 
goid process, whence it is named pterygoid hole :* or, by many, 
is named after its discoverer, the Vidian hole.! This hole is almost 
hidden under the point of the petrous bone ; is not to be seen unless 
in the separated bones, and is nearly of the size of the spinous hole. 
If there are found some minute holes about the sella turcica, they 
are the marks of some blood-vessels entering the bone to nourish it. 
When the bones of the cranium are united, there is apparent an 
irregular hole, which corresponds well with the name foramen la- 
* This retrograde twig is the little nerve which perforates the os petrosum on its 
fore part. 
t Vidus Vidius, a professor of Paris, and physician to Francis the First. 
23. Fora- 
men ro- 
tundum. 
24. Fora- 
men orale. 
25. Fora- 
men spi- 
nale. 
26. Fora- 
men 
pterygoid- 
eum. 
27. Irregu- 
lar fora- 
mina. 
Common 
foramina. 
28. Fora- 
men lace- 
rum me- 
dium. 130 
OF THE BONES 
cerum medium. It is the continuation of the carotid foramen, but 
belongs equally to the sphenoid, temporal, and occipital hones. The 
petrous portion of the temporal bone points to it.* 
There is a second common hole formed betwixt the sphenoid, the 
maxillary, and cheek-bone. It is called the spheno-maxillary fissure. 
There is a third common hole betwixt the cell of the palate-bone 
(in the separate bone a groove may be noticed on the back part of 
this cell) and the root of the pterygoid process. This hole transmits 
an artery, and a twig of the fifth pair of nerves, into the membrane 
of the nose. 
29. Sphe- 
no-maxil- 
lary As- 
sure. 
30. Pala- 
tfoecanal. 
OF TIIE BONES OF TIIE FACE AND JAWS. 
The face is composed of a great number of small bones, which 
are grouped together, under the common name of upper and lower 
jaw. There are bones on either side of the face, and a central or 
azygous bone; but as their names could convey no distinct notion 
of the uses, forms, or places of these bones, to enumerate them were 
but waste of time : they have indeed sutures, and their sutures have 
been very regularly enumerated; but these bones meet each other 
by such thin edges, that no indentation nor proper suture is formed. 
None of these sutures run for any length, or are of any note, there- 
fore I have only this to say, concerning the sutures of the face, that 
they are acknowledged to be purely a consequence of the ossifica- 
tion having begun in* many points: no particular design of nature 
has been supposed. The sutures, if they require names, are to be 
named after the bones which they unite together. 
OSSA NASI.—The ossa nasi are small bones, rather thin, having 
no cancelli, being merely firm and condensed plates. They are 
convex outwardly, so that the two together form nearly an arch. 
They are opposed to each other by a pretty broad surface, so that 
their thin arch is firm. They have a flat rough surface, by which 
they are laid upon the rough surface of the frontal bone; so that 
there also their connection is strong. They are enclosed by a branch 
of the upper jaw-bone, which, stretching upwards, is named its nasal 
process: and they lie with their edges under it in one part, and 
above it in another, in such a way that they cannot easily be forced 
in. Lastly, their lower edge is rough, for the firm attachment of 
the cartilages of the nose ; and their lowest point, or that where the 
bone3 of the nose and the gristles of the nose are joined, is the most 
prominent point (or, as it is vulgarly called, the bridge) of the nose ; 
from which connection, notwithstanding its firmness, the cartilages 
are sometimes luxated. 
The only point like a process in these bones is, that rough ridge 
* It is called medium because there is a foramen lacenlm between the tempora 
and occipital bones which make three of that name OP THE PACE ASP JAWS. 
131 
(brined by their union which projects towards the cavity to give at- 
tachment to the nasal plate of the aethmoid bone. 
Os unguis, so named from its being of the size and shape of the 
nail of the finger ; or sometimes named the os lachrymale from 
its holding the duct which conveys the tears, is that thin scale of 
bone which l have described as belonging to the os aethmoides. It 
is commonly described as a distinct bone; it is a thin flat bone, a 
single scale, without any cancelli, having only one sharp ridge upon 
it; it forms a groove for lodging the lachrymal sac, and is of course 
found in the inner angle of the eye at its fore-part, and just touching 
the top of the nose. One half of this bone is behind the groove, 
and there the eye rolls upon it. One half of it is occupied by the 
groove for the nasal duct; and the other side of the groove is formed 
by the rising branch or nasal process, as it is called, of the upper 
jaw-bone. The os unguis is delicate, and easily broken, being as 
thin as a sheet of paper. It is this bone which is pierced in the 
operation for the fistula lachrymalis, which is easily done, almost 
with a blunt steel or probe ; and the chief caution is to perforate in 
the place of the groove, as that will lead into the nose, and not be- 
hind it, which would carry the perforating instrument into the aetli- 
inoidal sinuses, and perhaps wound the spongy bone; nor more 
forward, as that would be ineffectual from the strength of the nasal 
process of the maxillary bone. 
This bone seems peculiarly liable to caries, which is perhaps the 
nature of all these thin bones; for as they have no marrow, they 
must depend entirely on their periosteum for their blood-vessels, 
which they are no sooner robbed of than they die. 
Ossa maxillaria superiora.—The upper jaw-bones are par- 
ticularly worthy of notice ; for here we find all that is curious in 
the face, even to its size and shape. The upper jaw-bones are of 
a very great size, forming, as it were, the foundation or basis of the 
face. * They send a large branch upwards, which forms the sides of 
the nose ; a broad plate goes backwards, which forms the roof of 
the palate. There is a circular projection below, which forms the 
alveoli, or sockets of the teeth. The upper jaw-bones are quite hol- 
low within, forming a very large cavity, which is capable of con- 
taining an ounce of fluid, or more ; and the size of this cavity seems 
to determine the height of the cheek-bone and the form of the face ; 
and the diseased enlargement of this cavity raises the cheek-bone, 
lessens the eye, and deforms the face in a very extraordinary degree. 
These processes, and this cavity of the bone, are what deserve 
most particular notice. 
The surfaces or plates of the bone are these : external or malar: 
the superior or orbital: the internal or nasal ; the inferior or palatine 
surface. 
From this description we shall understand the connections of the 
bone. It is attached forward and upward to the nasal and frontal 
bones; laterally to the cheek-bone, and in the orbit it is connected 
with the lachrymal and aethmoid bones; towards the nasal cavities 
it has the vomer palate-bone and lower spongy bones attached to it; 
and at the back part it touches the sphenoid bone. 
1. Ridge. 
2. Groove. 
Surfaces. 
Connec- 
tions. 132 
OF THE BUNEs 
1. Nasal 
process. 
The first process is the nasal process, which extends upwards to 
form the side of the nose. It is arched outwards, to give the nostrils 
shape. Its sides support the nasal bones; and the cartilages of the 
ala; nasi, or wings of the nose, are fixed to the edges of this process. 
On the inside and root of the nasal process there is a rough horizon- 
tal ridge, which gives attachment to the fore-part of the inferior 
spongy bone. 
A plate of this bone is called the orbitary process. This thin 
plate is the roof of the great cavity, which occupies this bone entirely. 
It is at once as a roof to the antrum maxillare, and as a floor for the 
eye to roll upon. There is a wide groove along the upper surface 
of this plate, in which the chief branch of the upper maxillary nerve 
lies : and this nerve, named infra-orbitary nerve, from its lying thus 
under the eye, comes out by a bole of the jaw-bone under the eye, 
which is named infra-orbitary hole. And thus the nerve appearing 
upon the cheek, becomes a nerve of the face. 
This great bone is the basis upon which the cheek-bone stands; 
and that it may have a firm place, there is a rough and (as anato- 
mists call it) scabrous surface, of a triangular shape, which makes a 
very firm suture with the cheek-bone ; and as this surface rises a 
little, it is named the malar process. 
From the lower circle of the upper bone, there projects a semi- 
circle of bone, which is for lodging the teeth of the upper jaw. 
This circle of bone is as deep as the fangs of the teeth are long. 
And it may be very truly named a process (processus alveolaris,) 
since it does not exist in the foetus, nor till the teeth begin to bo 
formed; since it grows along with the teeth, and is absorbed and 
carried clean away when in old age the teeth fall out. The sides of 
the sockets in which the teeth are lodged are extremely thin, and 
surround them closely. The teeth arc so closely embraced by their 
sockets, and we are so far from being possessed of any instrument 
by which they can be pulled perpendicularly out, that the sockets 
can seldom escape ; they are broken or splintered in perhaps one of 
four extractions, even by the most dexterous artists in that line. 
The palate process is a plate of bone which divides the nose 
from the mouth, constituting the roof of the palate, and the floor or 
bottom of the nostrils. This plate is thinner in its middle, and thicker 
at either edge: thus, it is thick where it first comes off from the al- 
veolar process; it is thin in its middle ; and it is again thick where 
it meets its fellow of the opposite side. For at the place where the 
two upper jaw-bones meet, the palate-plate is turned upwards, so 
that the two bones are opposed to each other in the middle of the 
palate by a broad flat surface, which cannot be seen but by separa- 
* ting the bones. This surface is so very rough, that the middle palate- 
suture almost resembles the sutures of the skull; and the maxil- 
lary bones are neither easily separated, nor easily joined again. 
This meeting of the palate-plates by a broad surface, makes a rising 
spine, or sharp ridge, towards the nostrils, so that the broadness of 
the surface by which these bones meet serves a double purpose ; it 
joins the bones securely, and it forms a small ridge upon which the 
split edge of the vomer* or partition of the nose, is planted. Thus 
2. Internal 
ridge. 
3. Orbita- 
ry plate. 
Infra-or- 
bitary 
canal. 
4. Malar 
process. 
5. Alveo- 
lar pro- 
cess. 
6. Palate 
process. 
Its suture. 
7. Nasal 
spine. OF THE FACE AND JAWS. 
133 
We rind the palate-plate of the maxillary bones conjoined, forming 
almost the whole of the palate, while what are properly called the 
palate-bones form a very small share of the back part of the roof of 
the mouth. As these thinner bones of the face have no marrow, 
they are nourished by their periosteum only ; they are of course per- 
forated with many small holes. A great many minute holes are 
found along the palate-plate, about the place of the sockets, and in- 
deed all over the maxillary bones ; and this is particular in the palate, 
that the hard membrane, or covering of it, is fixed to the bony plate 
by many rough tubercles, and even by small hooks, which are easily 
found in the dried bone. 
Since we are describing the plates of the bone as processes, we i 
ought to enumerate the facies interna nasalis as an internal j 
nasal-plate. This is the side of the bone which is towards the 
cavity of the nose, on which the lower spongy bone hangs, and 
which is perforated to allow a communication between the great cell 
and the nose. 
The antrum maxillare, or cavity of the jaw-bone, is commonly 
named antrum iiigiimorianum, after its discoverer, Highmore. 
We have gone round the antrum on all its sides, in describing these 
processes of the bone ; the palate-plate makes the floor of the 
antrum ; the orbitary process makes its roof; the cheek quite up 
from the sockets of the teeth to the lower part of the eye, forms its 
walls or sides : so that when the antrum enlarges, it is the cheek 
that becomes deformed ; and when we design to open the antrum, 
we either perforate its anterior surface within the cheek, or pull one 
of the teeth. The antrum is round towards the cheek, but it has a 
flat side towards the nose ; it is divided from the cavity of the nos- 
tril by a flat and very thin plate of bone ; it seems in the naked 
skull, to have a very wide opening; but in the skull, covered with 
its soft parts, we find the antrum almost closed by a membrane 
which stretches over the opening, and leaves but one or two very 
small holes, of the size of the smallest pea, by which, perhaps, the 
reverberation of sound in the antrum is more effectual in raising the 
voice, and by which small hole, the mucus, which is secreted in the 
antrum, drops out into the nose. The cavity of the antrum, like 
the inner surfaces of the nostrils, is covered with a membrane, and 
is bedewed with mucus ; and the mucus drops more or less freely in 
various positions of the head. Sometimes by cold or other ac- 
cidents, inflammations and swellings of the membrane come on ; 
the holes are closed ; the drain of matter is suppressed and confined 
within, and the cheek swells. Perhaps there may be some particular 
disease of the membrane with which the cavity is lined, or of the 
bone itself: in one way or other, diseases of this cavity, and col- 
lections of matter, dreadful pain and caries of the bone, are very 
frequent : then the cheek rises : the face is irrecoverably deformed. 
Sometimes the matter makes its way by the sides of the teeth, or at 
last it bursts through the bones, makes an ulcer in the cheek ; and 
then there is a natural cure, but slow and uncertain. There is no 
very sure mark of this disease ; it may be known by an attentive re- 
trospect of all the circumstances. The disease is not to be easily 
8. Internal 
nasal 
plate. 
9. Antrum 
maxillare. 
Its mem- 
brane. 134 
OE THE BONES 
nor certainly discovered ; but a very long continued tooth-ache, an 
uncommon degree of pain or greater aflection of the eye, with a 
swelling and- redness and gradual rising of the cheek, are very sus- 
picious signs. The pulling of the second or third of the grinding 
1 teeth, often brings a splinter away with it, which opens a road for 
the matter to flow ; or though there be no breach of the socket, 
often the confined matter follows the tooth, because not unfrequently 
the longer fangs of the grinders naturally penetrate quite into this 
cavity of the jaw : if the matter should not flow, the floor of the 
antrum is easily perforated, by introducing a sharp stillet by the 
socket of the tooth that is pulled. The flow of the matter gives 
relief, and injections complete the cure. But as this opening is 
sometimes a cure, it is sometimes also a disease ; for the breaking 
of a socket, sometimes opening a way into this antrum, there fol- 
lows inflammation of its internal surface, a running of matter, and 
sometimes caries of the bone. 
Holes.—There is only one perfect hole in this bone ; but, by its 
union with other bones, it forms four more: the infra-orbit ary 
hole, for transmitting the infra-orbitary nerve from the bottom of 
the eye, is the opening of the canal which comes along under the 
eye/ ft is just under the margin of the orbit, or sometimes the 
nerve which it transmits, divides, and makes two smaller holes in its 
passage upon the cheek. A hole in the palate-plate, which belongs 
equally to each of the maxillary bones, may be counted the second 
foramen ; for it is between the two bones in the fore-part, or begin- 
ning of the palate-suture behind the two first cutting teeth. This 
hole is named foramen incisivum, as opening just behind the in- 
cisive or cutting teeth ; or it is named anterior palatine hole, 
to distinguish it from one in the back of the palate. This hole is 
large enough to receive the point of a quill; it is single towards the 
mouth ; but towards the nose it has two large openings, one open- 
ing distinctly into each nostril. 
But it will be well to explain here a third hole, which is common 
to the maxillary with the proper palate-bones. It is formed on the 
back part of the palate (one on either side), in the suture which 
■ joins the palate-bones to the jaw-bones: it is named posterior 
palatine hole : it is as large as the anterior palatine hole, but it 
serves a much more important purpose ; for the upper maxillary 
nerve sends a large branch to the palate, which branch comes down 
behind the back of the nostril, perforates the back of the palate by 
the posterior palatine hole, and then goes forward in two great 
branches along the palate. Thus the chief nerves of the palate 
come down to it through these posterior palatine holes. The use 
of the anterior palatine hole has long been a problem. It looks 
almost as if it were merely designed for giving the soft palate a 
surer hold upon the bone ; but Scarpa, the Italian anatomist, de- 
scribes a nerve from the firth pair, taking its course in this way to 
the soft palate. 
The fourth foramen is formed by the union of the lower spongy 
bone, to the internal nasal plate of the bone ; and is for the trans- 
Root of 
the second 
molaris 
projects 
into it. 
Foramina. 
10. Infra- 
orbitary 
hole. 
11. Fora- 
men incisi- 
vuia. 
12. Poste- 
rior pala- 
tine hole. 
it La- 
chrymal 
groove. OP THE FACE AND JAWS. 
135 
mission of the lachrymal duct: the groove will be observed just 
behind the upright nasal process. 
The LATERAL ORBITARY FISSURE, Called also SPIIENO-MAXILLARY 
fissure, has been already noticed : it is a slit formed by this bone 
and the sphenoid bone ; it is a communication between the orbit and 
temple. 
The whole surface of the bone which forms the antrum is per- 
forated with frequent small holes, especially towards its back part, 
transmitting small arteries and nerves to the teeth ; and the back 
part of the antrum forms with the orbitary part of the sphenoid 
bone a second foramen lacerum for the orbit, which is an irregular 
opening towards the bottom of the socket, and is for the accumu- 
lation of fat, rather than for the transmission of nerves; and it is 
from the wasting of this fat, taken back into the system, that the eye 
sinks so remarkably in fevers, consumptions, and such other diseases 
as waste the body. At the termination of the alveolar circle, back- 
wards, there are two or three holes, into which the branches of the 
internal maxillary artery enter, which go to supply the teeth of the 
upper jaw. There is a trifling hole for the transmission of an artery 
on the nasal plate of this bone. 
The OSSA PALATI, or PALATE-BONES, are very small, 
but have such a number of parts, and such curious connections, as 
are not easily explained. They seem to eke out the superior max- 
illary bones, so as to lengthen the palate, and complete the nostrils 
behind : they even extend upwards into the socket, so as to form a 
part of its circle ; although, in looking for them upon the entire 
skull, all these parts are so hidden, that we should suppose the 
palate-bones to be of no greater use nor extent than to lengthen the 
palate a little backwards. 
The parts of the palate-bone are these : 
The palatal plate, or process of the palate-bone, whence it 
has its name, lies horizontal in the same level with the palatal pro- 
cess of the jaw-bone, which it resembles in its rough and spinous 
surface, in its thinness, in its being thinner in the middle, and thicker 
at either end ; in its being opposed to its fellow by a broad surface, 
which completes the middle palate suture ; and it is connected 
with the palate process of the jaw, by a suture resembling that by 
which the opposite bones are joined ; but this suture, going across 
the back part of the palate, is named the transverse palate 
suture. Where the two palate-bones are joined, they run back- 
wards, into an acute point; on either side of that middle point, 
they make a semi-circular line, and again run out into two points 
behind the grinding teeth of each side. By this figure of the bones, 
the back line of the palate has a scalloped or waved form. The 
velum palati, or curtain of the palate, is a little arched, following the 
general line of the bones ; the uvula, or pap, hangs exactly from the 
middle of the velum, taking its origin from the middle projecting point 
of the two bones ; and a small muscle, the azygos uvulae, runs down 
in the middle of the velum, taking its origin from this middle part of 
the bones. 
14. Late- 
ral orbita- 
ry fissure. 
15. Alveo- 
lar fora- 
mina. 
1. Palatal 
plate. 136 
OF THE BONES 
2. Ptery- 
goid pro- 
cess. 
The small projecting point of the palate-bone, just behind the 
last grinding tooth, touches the pterygoid process of the sphenoid 
bone ; it is, therefore, named the pterygoid process of the palate- 
bone ; but it is so joined with the pterygoid process of the sphe- 
noidal bone, that they are not to be distinguished in the entire skull. 
The posterior pterygoid hole, or third hole of the palate, is just 
before this poiut. 
The nasal plate, or process, is a thin and single plate ; rises 
perpendicularly upwards from the palate; lies upon the side and 
back part of the nostrils, so as to form their opening backwards 
into the throat; it is so joined to the upper jaw-bone, that it lies there 
like a sounding-board upon the side of the antrum Highrnorianum, 
and completes that cavity forming the thin partition between it and the 
nose. On the inside of the nasal plate there is a rough projection 
which runs horizontally, and is the continuation of a spine of the 
maxillary bone, for the attachment of the lower spongy bone. On 
the outside of the nasal process is the groove for the palatine nerve. 
This nasal process extends thus up from the back arcb of the 
palate to the back part of the orbit; and, though the nasal plate is 
very thin and delicate in its whole length, yet, where it enters into 
the orbit, it is enlarged into an irregular kind of knob of a triangular 
form. This knob is named its orbitary process ; or, as the knob 
has two faces looking two ways in the orbit, it is divided sometimes 
(as by Monro the father) into two orbitary processes, the anterior and 
posterior ; the anterior one is the chief. This orbitary process, or 
point of the palate bone, being triangular, very small, and very deep 
in the socket, is not easily discovered in the entire skull. 
This orbitary process is most commonly hollow or cellular, and 
its cells are so joined to those of the sphenoid bone, that it is the 
palate-bone that shuts the sphenoid cells, and the sphenoid and pala- 
tine cells of each side constitute but one general cavity. 
The OSSA SPONGIOSA, or TURBINATA INFERIORA, 
are so named, to distinguish them from the upper spongy bones, 
which belong to the os aethmoides ; but these lower spongy bones are 
quite distinct, formed apart, and connected in a very slight way with 
the upper jaw-bones. 
The ossa spongiosa inferiora are two bones, much rolled or 
convoluted, very spongy, much resembling puff-paste, having exactly 
such holes, cavities, and net-work, as we see in raised paste, so that 
they are exceedingly light. They lie rolled up, in the lower part of 
the nose ; are particularly large in sheep; are easily seen either in the 
entire subject or in the naked skull. Their point forms that projec- 
tion which wre touch with the finger in picking the nose; and from 
that indecent practice, very often serious consequences arise ; for in 
many instances, polypi of the lower spongy bones, which can be 
fairly traced to hurts of this kind, grow so as to extend down the 
throat, causing suffocation and death. 
One membrane constitutes the universal lining of the cavities of 
the nose, and the coverings of all the spongy bones. This continuity 
of the membrane prevents our seeing in the subject how slightly the 
S. Nasal 
plate. 
4. Ridge. 
5. Groove. 
6. Orbita- 
plate and 
cell. 
7. Its cell. OF THE FACE AND JAWS. 
137 
spongy bones are hung ; but in the bare and dissected skull we find 
a neat small iiook upon the spongy bone, by which it is hung upon 
the edge of the antrum maxillare ; for this lower spongy bone is laid 
upon the side of the antrum, so as to help the palate-bone in closing 
or covering that cavity from within. One end of the spongy bone, 
rather more acute, is turned towards the opening of the nostril, and 
covers the end of the lachrymal duct: the other end of the same bone 
points backwards towards the throat. The curling plate hangs down 
into the cavity of the nostril, with its arched side towards the nose. 
This spongy bone differs from the spongy process of the aethmoid 
bone, in being less turbinated or complex, in having no cells con- 
nected with it, and perhaps it is less directly related to the organ of 
smell. If polypi arise from the upper spongy bone, we can use less 
freedom, and dare hardly pull them away, for fear of injuring the 
cribriform plate of the aethmoid bone. We arc indeed not absolutely 
prohibited from pulling the polypi from the upper spongy bone ; but 
we are more at ease in pulling them from the lower one, since it is 
quite an insulated bone. When peas, or any such foreign bodies, 
are detained in the nose, it must he from sw elling, and being detained 
among the spongy bones. 
The spongy bones are not absolutely limited in their number : 
there is sometimes found betwixt these two a third set of small tur- 
binated bones, commonly belonging to the aethmoid bone. 
VOMER.—The nose is completed hy the vomer, which is named 
from its resemblance to a plough-share, and which divides the two 
nostrils from each other: it is a thin and slender bone, consisting 
evidently of two plates, much compressed together, very dense and 
strong, but still so thin as to be transparent. The two plates of 
which the vomer is composed split or part from each other at every 
edge of it, so as to form a groove on every side. 1. On its upper 
part, or, as we may call it, its base, by which it is fixed to the skull, 
the vomer has a wide gkoove, receiving the projecting point of the 
aethmoid and sphenoid bones : thus it stands very firm and secure, 
and capable of resisting very violent blows. 2. Upon its lower part 
its groove is narrower, and receives the rising line in the middle of the 
palate-plate, where the bones meet to form the palate-suture. At 
its fore-part it is united by a ragged surface, and by something like a 
groove to the middle cartilage of the nose ; and, as the vomer re- 
ceives the other bones into its grooves, it is in a manner locked in 
on all sides : it receives support and strength from each ; and if the 
vomer and its cartilage should seem too slender a support for the 
fabric of the nose, let it be remembered, that they are all firmly con- 
nected, and covered by one continuous membrane, which is thick 
and strong, and that this is as a periosteum, or rather like a con- 
tinued ligament, which increases greatly the thickness and the 
strength of every one of these thin plates. The vomer, in almost 
every subject, bends much towards one or other nostril, so as some- 
times to occasion no small apprehension, when it happens to be first 
observed. 
Plates, 
United 
with the 
aethmoid. 
The sphe- 
noid. 
The pa- 
late bone, 138 
OF THF. BONES 
OS MALJS, or the bone of the cheek, is easily known. It is that 
large square bone which forms the cheek: it has four distinct points, 
which anatomists have chosen to demonstrate with a very superfluous 
accuracy. The upper orbitary process stands highest, running 
upwards to form part of the socket, the outer corner of the eye, and 
the sharp edge of the temple. The inferior orbitary process, 
jU3t opposite to this, forming the lower part of the orbit, 
and the edge of the cheek. The maxillary process is that broad 
and rough surface, by which it is joined to the upper jaw-bone. The 
one the best entitled to the name of process, because it stands out 
quite insulated, and goes outwards and backwards to unite with the 
temporal bone, forming the zygoma or temporal arch, is named 
the zygomatic process. That plate, which goes backward* to form 
a part of the orbit, is named the internal orbitary process. A 
9mall hole is observed on the outer surface of the bone which trans- 
mits an artery, and sometimes a very small nerve from the orbit, 
OS MAXILLiE INFERIORIS.—The lower jaw-bone is 
likened to a horse-shoe, or to a crescent, or to the letter U, though 
we need be under no anxiety about resemblances for a form so 
generally known. There is such an infinite complication of parts 
surrounding the jaw, of glands, muscles, blood-vessels, and nerves, 
that it were endless to give even the slighest account of these. 
They shall be reserved each for its proper place, while I explain the 
form of the lower jaw, in the most simple and easy way. The lower 
jaw is divided into the chin, viz. the space betwixt the two mental 
foramina ; the base, properly the sides, extending backward to the 
angle; and the upright portion of the bone. 
The f°re parti or chin, is in a handsome and manly face, very 
square ; and this portion is marked out by this squareness, and by 
two small holes, one on either side, by which the nerves of the 
lower jaw come out upon the face. 
The base of the jaw is a straight and even line, terminating the 
outline of the face. It is distinctly traced all along, from the first 
point of the chin, backwards to the angle of the jaw. Fractures of 
this bone are always more or less transverse, and are easily known 
by the falling down of one part of this even line, and by feeling the 
crashing bones when the fallen part is raised. Such fractures happen 
from blows or falls, but not by pulling teeth, for the sockets of the 
teeth bear but a small proportion to the rest of the jaw ; even in chil- 
dren, this cannot happen ; for in them the teeth have shorter roots, 
and have no hold nor dangerous power over the jaw : though (as 1 
have said) the sockets often suffer, the jaw itself never yields. 
The angle of the jaw is that corner where the base of the jaw ends, 
where the bone rises upwards, at right angles, to be articulated with 
the head. Here we see the impressions of the inasseter muscle. 
This part, also, is easily felt, and by it we judge well of the situation 
of veins, arteries, and glands, which might be in danger of being cut, 
in wounds or in operations. There are two processes of the jaw of 
particular importance, the coronoid or horn-like process, for the 
insertion of its strong muscles, especially of the temporal muscle, and 
1. Upper 
process! 
2. inferior 
orbitnry 
3. Maxi’l- 
lary pro- 
4. Zygo- 
matic pro- 
5?Internal 
orbitary 
process. 
Fora- 
men. 
Chin. 
Base. 
Angle. OP THE PACE AND JAWS. 
139 
the condyloid or hinge-process, by which it is jointed with the tem- 
poral-bone. X i , 
The coronoid process, named from its resemblance to a horn, is, 
like the rest of the jaw-bone, flat on its sides, and turned up with an 
acute angle, very sharp at its point, and when the bone is in its place 
lying exactly under the zygoma or temporal arch. The temporal 
muscle runs under this arch, and lays hold on the coronary process, 
not touching it on one point only, but grasping it on every side, and 
all round. And the process is set so far before the articulation of 
the jaw, that it gives the muscle great power. This process is so 
defended by the temporal arch, and so covered by muscles, that it 
cannot be felt from without. 
The condyloid process, or the articulating process of the jaw, is 
behind this. This also is of the same flat form with the rest of the 
jaw. The condyle, or joint of the jaw-bone, is placed upon the top 
of the rising branch, and has a lengthened neck. The condyle, or 
articulating head, is not round, but flat, of a long form, and set 
across the branch of the jaw. This articulating process is received 
into a long hollow of the temporal bone, just under the root of the 
zygomatic process ; so that by the long form of the condyles, and 
of the cavity into which it is received, this joint is a mere hinge, not 
admitting of lateral nor rotatory motions, at least of no wider lateral 
motions than those which are necessary in grinding the food ; but 
the hinge of the jaw is a complex and very curious one, which shall 
be explained in its proper place. The line of continuation between 
these two last processes forms what is called the semi-lunar notch. 
The alveolar process, or the long range of sockets for the 
teeth, resembles that of the upper jaw. The jaw, as the body grows, 
is slowly increasing in length, and the teeth are added in proportion 
to the growth of the jaws. When the jaws have acquired their full 
size, the sockets are completely filled ; the lips are extended, and 
the mouth is truly formed. In the decline of life the teeth fall out, 
and the sockets are re-absorbed, and carried clean away, as if they 
had never been ; so that the chin projects, the cheeks become hollow, 
and the lips fall in, the surest marks of old age. 
The spina interna, or internal tubercle of the lower jaw, is just 
behind the symphysis, or on the inside of the circle of the chin. It 
gives origin to muscles which move the tongue and larynx. On the 
inside of the lateral portion of the jaw, wo observe an oblique ridge 
for the attachment of the rnylo-hyoideus. On the inside of the angle, 
the bone is rough for the attachment of the pterygoid muscle. 
The successive changes of the form of the jaw are worthy of being 
mentioned once more; first, that in the child the jaw consists of two 
bones, which are joined slightly together in the chin. This joining, 
or symphysis, as it is called, is easily hurt, so that in preternatural 
labours it is, according to the common method of pulling by the chin, 
always in danger, and often broken. During childhood the pro- 
cesses are blunt and short, do not turn upwards with a bold and 
acute angle, but go off obliquely from the body of the bone. The 
teeth are not rooted, but sticking superficially in the alveolar pro- 
cess ; and another set lies under them, ready to push them from the 
jaws. 
1. Coro- 
noldPro* 
“ s' 
cess.1*™ 
Cervix, 
Semi-lu- 
nar noteh. 
3. Alveo- 
lar pro- 
cess. 
4. Spina 
interna. 
5. Line* 
interna. 
6. Rough- 
ness for 
the attach- 
ment of 
the ptery- 
goid mus- 
cles. 
Symphy- 
sis. 140 
BONKS OK THE FACE AND JAWS. 
, Secondly, That in youtli the alveolar process is extending, the teeth 
are increasing in number. The coronoid and articulating processes 
are growing acute and large, and are set off at right angles from the 
bone. The teeth arc now firmly rooted ; for the second set has 
come up from the body of the jaw. 
Thirdly, In manhood the alveolar process is still more elongated. 
The dentes sapientiae are added to the number of the teeth; but 
often, by this, the jaw is too full, and this last tooth coming up from 
the backmost point of the alveolar process in either jaw, it sometimes 
happens, that the jaw cannot easily close; the new tooth gives pain; 
it either corrupts, or it needs to be drawn. 
Fourthly, In old age the jaw once more falls flat; it shrinks ac- 
cording to the judgment of the eye, to half its size ; the sockets are 
absorbed, and conveyed away ; and in old age the coronoid process 
rises at a more acute angle from the jaw-bone, and by the falling 
down of the alveolar process, the coronoid process seems increased 
in length. 
HOLES.—The holes of the jaw are chiefly two : 
A large hole on the inner side, and above the angle of the jaw, 
just at the point where these two branches, the condyloid and the 
coronoid processes, part. A wide groove, from above downwards, 
leads to the hole ; and the hole is, as it were, defended by a small 
point, or pike of bone, rising up from its margin. This is the great 
hole for admitting the lower maxillary nerve into the hollow of 
the jaw, where it goes round within the circle of the jaw, distributing 
its nerves to all the teeth. But at the point where this chief branch 
of the nerve goes down into the jaw, another branch of the nerve 
goes forward to the tongue. And as nerves make an impression as 
deep as that of arteries in a bone, we find here two grooves, first, 
one marking the great nerve, as it advances towards its hole; and 
secondly, a smaller groove, marking the course of the lesser branch, 
as it leaves the trunk, and passes this hole to go forward to the tongue. 
Along with this nerve the lower maxillary artery, a large branch, 
enters also by the hole; and both the nerve and the artery, after 
having gone round the canal of the jaw, emerge again upon the chin. 
The second hole of the lower jaw is that on the side of the chin, 
which permits the remains of the great nerve and artery (almost ex- 
pended upon the teeth) to come out upon the chin: it is named the 
MENTAL HOLE. 
7. Internal 
maxillary, 
hole. 
8. Impres- 
sion of 
nerves. 
9. Mental 
hole. OF THE TEETH. 
The structure, and growth, and decay of tile teeth, are subjects' 
of considerable interest. 
Considering the teeth generally, as belonging to man and brutes, 
they are for masticating the food ; they are for retaining the prey ; 
they are weapons of defence ; in some classes they are for digging 
and searching for food * and in some animals we can see no other 
use than for defending the eyes, as in the sus JEthiopicus. Nor are 
we to consider them as exclusively belonging to the jaws, for they 
are sometimes seated in the back part of the mouth ; and in fishes, 
we find them in the beginning of the oesophagus, or at its termina- 
tion, as in the crab and lobster. 
The teeth differ from common hone: they are not only harder, 
but they are covered with a peculiar substance, the enamel, which 
is not found elsewhere in the body : though they stand exposed, they 
do not suffer as bone would do in the same circumstances ; though 
worn by friction, they are not excited to diseased action; their 
mode of formation is peculiar, and so is the manner of their decay : 
and all these instances of their being different from common bone, 
are so many reasons for instituting a distinct inquiry into their 
structure. 
These peculiarities impose the necessity of a double set of teeth, 
since they cannot accommodate themselves by growth, to the in- 
creasing size and strength of the jaws; it follows, that they must 
yield in succession, and that a double set be provided. The first set 
are called the milk teeth, or deciduous set of teeth ; the second, the 
adult teeth. We shall begin this description with the perfect adult 
teeth. 
DESCRIPTION OF THE HUMAN ADULT TEETH. 
There are thirty-two teeth in the adult skull. These are divided 
into/classes, according to their form and use. There are eight 
incisores; four cuspidati, or canine teeth; eight bicuspides; and 
twelve molares, or grinding teeth. 
Every tooth has three parts; the crown, neck, and fang or root. 
Incisores.—The crown of the incisor tooth is a wedge, having 
its anterior and posterior surface inclined and meeting in a sharp 
edge. On the fore-part the surface is convex; on the inside the 
surface is concave ; and viewing the tooth laterally, it is broader 
and flat'near the neck, and rising pyramidal towards the cutting 
edge. The cortex or enamel covers the crown of the tooth ; it 
descends on the back and anterior surface further than on the side. 
The fangs of the incisores are long and straight, and of a pyra- 
midal form, so that they are deeply socketed in the jaw. 142 
OP THE TEETH. 
From their position in the jaw, the upper incisor teeth project 
more than the lower, and in chewing their edges do not meet. 
They pass each other so as to cut, and yet do not meet, and this 
prevents the rapid wasting of the edge which would otherwise take 
place, as we see in the horse.* 
The incisor teeth of the horse, being subject to attrition, have a 
provision against this, in the cavity lined with enamel, which is 
observed in their centre ; nevertheless, we see them worn down 
even below the bottom of that cavity ; thus the surface of the tooth 
becomes smooth, and the horse has lost the mark. 
In some animals, as in the rodentia, the front teeth are still better 
formed for cutting, but as they suffer attrition, in order to preserve 
the outer edge sharp, they have a peculiar structure. They are 
so deeply socketed, that they reach the whole length of the jaw, 
and they are provided with a continual growth from behind, which 
pushes the tooth out in proportion as it is worn away on the fore 
part. The enamel in these animals is more accumulated on the 
anterior edge of the tooth, so that the edge stands up fine and sharp. 
The cuspidati, or canine teeth, are next in order, counting 
backwards. They are two in number in each jaw. They have a 
general resemblance to the incisor teeth, for when their points are 
worn off, they are hardly distinguishable. Their fangs are longer, 
and being the corner teeth of the jaw, and deep socketed, they form 
the strength of the front teeth. Their principal distinction is in the 
form of the upper part of the crown, which is like a spear, having a 
point with two lateral shoulders. 
In the larger carnivorous mammalia, this order of teeth is of 
terrific length, whilst the front teeth are small and carved. The 
spiral tusk of the narwhal and the tusks of the walrus belong to this 
division of the teeth : so do the tusks of the babyroussa, which 
turn up in a spiral direction. The use of these teeth Blumenbach 
cannot comprehend, but Sir Evcrard Home conceives, that they are 
provided to defend the eyes of the animal as it rushes through the 
underwood. There is a small imperfect tooth, called the tush, in a 
horse, which belongs to this order of teeth, as it is placed between 
the incisors and the grinding teeth. 
The bicuspides are four in each jaw : they stand between the 
canine teeth and the grinding teeth, and in form are intermediate 
between these two orders. They are sometimes called the lesser 
molares, being in truth grinding teeth. The crown of the bicuspis 
rises in two sharp points, so that they are like two cuspidati incor- 
porated, and their fangs prove this to be the case ; for whilst they 
are always flatter and shorter than those of the cuspidati, they have 
often a division, and sometimes there are distinctly two fangs : their 
roots are oftener curved than those of the other teeth. The second 
bicuspis is sometimes wanting. 
Molares or grinding teetii, are six in each jaw. The form of 
the crown is an oblong square. They have four or more projec- 
* And as indeed we sometimes see in the human teeth. See specimens in ror Col- 
lection. OF THE TEETH. 
143 
tions on their upper surface, and they are covered with enamel to a 
uniform level, and form indeed an approximation to the graminivo- 
rous tooth, since these regular projections being covered with 
enamel, a portion of the enamel remains in the depressions when 
the projections have been worn down ; and this is sufficient in a 
certain degree to save the remaining part of the tooth from wasting 
rapidly under attrition. The lower grinders have two separate 
fangs, and those of the upper jaw three. 
The molares are best considered as cuspidati united, in which 
idea four cuspidati are incorporated to form one grinder. The pro- 
jections on the grinding surface correspond with the points of the 
cuspidati, and the fangs correspond with the projections of the 
crown; for although there are only two or three roots to each 
grinding tooth, yet we may discover that there would be always 
four fangs if they were disjoined. 
The term grinder is not good in comparative anatomy, for in 
brutes of prey they are compressed, and terminate in three sharp 
processes, and these in the closing of the jaw intersect each other 
like the blades of scissors. 
These four orders make the full number of thirty-two teeth in the 
adult jaws. . 
On the whole the teeth of man arc peculiar, in being on a level, 
and being more nearly of one length than any instance which wo 
observe in brutes. In all other animals the teeth differ remarkably 
in the length and size of their different classes ; and they arc 
separated by wider intervals : another peculiarity is the upright 
position of the incisors, and the regular inclination of the whole 
lateral phalanx, in proportion as they are distant from the centre of 
motion in the condyle of the jaw. It is indeed quite obvious that 
the front teeth have a use in speech, and therefore are different in 
man from those of animals. But there is a peculiarity in tho 
molares also, in their obtuse tubercles, which exhibits a correspon- 
dence between the teeth, taken collectively, and the variety of food 
and the mixed diet which i§ natural to man. 
OP THE FIRST SET OF THE TEETH, THE MILK OR DECIDUOUS TEETH. 
The first set of teeth are twenty in number: these are divided 
into three classes ; the iiscisores, four in each jaw; the cuspidati, 
two in each jaw ; and the molares, four in each jaw. 
The teeth of a child generally appear in this order : first the cen- 
tral incisores of the lower jaw pierce the gum. In a month after, 
perhaps, their counterparts appear in the upper jaw. These in a 
few weeks are succeeded by the lateral incisores of the lower jaw ; 
then the lateral incisores of the upper jaw, though sometimes the 
lateral.incisores of the upper jaw appear before those of the lower 
jaw. The growth of the teeth is not after this in a regular progres- 
sion backwards ; for now, instead of the cuspidati, which are im- 
mediately lateral to the incisores, the anterior molares of the lower 
jaw show their white surface above the gum about the fourteenth or 
fifteenth month. Then the cuspidati pierce the gum ; and. lastly, 144 
OF THE TEETH. 
the larger molares make their appearance, the teeth of the lower 
jaw preceding those above. The last tooth does not rise till the 
beginning of the third year.* 
The teeth do not always cut the gums in this order ; but it is the 
more regular and common order. When the teeth appear in irregular 
succession, more irritation and pain, and more of those symptoms 
which are usually attributed to teething, are said to accompany 
them. 
The deciduous set of teeth are perfected with the rising of the 
second molaris ; for the third molaris being formed about the eighth 
year, when the jaw is advanced towards its perfect form, is not shed, 
but is truly the first permanent tooth.. The molares of the adult are 
properly the permanent teeth (immutabiles,) for they alone arise in 
this part of the jaw, and remain in their original places ; yet we must 
recollect that, in opposition to Albinus, in this arrangement, it is 
more common to speak of the whole set of the adult teeth as the 
immutabiles. 
In the sixth and seventh years the jaws have so much enlarged, 
that the first set of teeth seems too small, spaces are left between 
them, and they begin to fall out, giving place to the adult teeth. But 
the shedding of the teeth is by no means regular in regard to time ; 
the child is already no longer in a state of nature, and a thousand 
circumstances have secretly affected the health and growth. The 
teeth even fall out three years earlier in one child than in another ; 
nay, so frequently are some of them retained altogether, that it would 
appear necessary to be assured of the forward state of the adult 
tooth before the tooth of the first set should be thoughtlessly drawn, 
The jaw-bones are still so small, that the second set of teeth must 
rise slowly and in succession, else they would be crowded into too 
small a circle, and of course turned from their proper direction. 
The incisores of the under jaw are loose commonly when the 
anterior of the permanent molares are thrusting up the gum. The 
permanent central incisores soon after appear, and in two or three 
months more those of the upper jaw appear. In three or four 
months the lateral incisores of the lower jaw are loose, and the per- 
manent teeth appear at the same time with the anterior molares. 
The lateral incisores of the upper jaw follow next; and in from six 
* The figure exhibits a section of the lower jaw, at that period when the milk teeth 
hare all risen, and when the permanent teeth are preparing in the jaw. OF THE TEETH. 
145 
to twelve months more, the temporary molares loosen, the long 
fangs of the cu3pidati retaining their hold some time longer. 
The anterior molares and tho cuspidati falling, are succeeded 
about the ninth year by the second of the bicuspides and the cuspi- 
dati. The posterior of the bicuspides take place of the anterior of 
the molares about the tenth or eleventh year ; the second permanent 
molaris does not appear for five or six years from the commence- 
ment of the appearance of the permanent teeth. The jaw acquires 
its full proportion about the age of eighteen or twenty, when the 
third molaris, or the dens sapient ice, makes its appearance. This 
tooth is shorter and smaller, and is inclined more inward than the 
others. Its fangs are less regular and distinct, being often squeezed 
together. From the cuspidati to the last grinder, the fangs are be- 
coming much shorter, and from the first incisor to the last grinder, 
the teeth stand less out from the sockets and gums. 
OF THE STRUCTURE OF THE TEETH. 
A tooth consists of these parts :—The enamel (A), a peculiarly 
hard layer of matter composing the surface of the 
body of the tooth. The internal part, or bone of 
the tooth (B), is less stony and hard than tho enamel, 
but of a firmer structure and more compact than 
common bone. In regard to the form of the tooth, 
we may observe, that it is divided into the crown, 
the neck, and the fangs, or roots of the tooth, which 
go deep into the jaw. There is a cavity in the body of the tooth 
(C), and the tube of the fangs communicates with it. This cavity 
receives vessels for supplying the remains of that substance upon 
which the tooth was originally formed. The roots of the teeth are 
received into the jaw by that kind of articulation which was called 
gomphosis. They are not firmly wedged into the bone, for in con- 
sequence of maceration, and the destruction of the soft parts, the 
teeth drop from the skull. There is between the tooth and its 
socket in the jaw a common periosteum. 
Of tiie enamel.—The surface of a tooth, that which appears 
above the gum, is covered with a very dense hard layer of matter, 
which has been called the enamel.* In this term there is some de- 
gree of impropriety, as assimilating an animal production with a 
vitreous substance, although the enamel very widely differs from the 
glassy fracture when broken. This matter bestows the most essen- 
tial quality of hardness on the teeth ; and when the enamel is broken 
off, and the body of the tooth exposed, the bony part quickly 
decays. 
The enamel is the hardest production of the animal body ; it 
strikes fire with steel. In church-yard skulls it is observed to remain 
* This section of the tooth is a plan ; for in our preparations we make the bone 
black by burning to exhibit the enamel contrasted with it. In this figure the bone is 
white, and the enamel black. 
In brutes there is a considerable variety in the relative form of the enamel and 
bone of the tooth; but it is always laid with reference to the friction against the 
tooth, and so as to protect it from the effects of attrition. 146 
OF THE TEETH. 
undecayed when the centre of the tooth has fallen into dust. It ha* 
been found that the component parts of the enamel are nearly the 
same with those of bone. In bone, the phosphate of lime is depo- 
sited on the membranes, or cartilage, but this hardening matter of 
bones is a secretion from the vessels of the part, and is accumulated 
around the vessels themselves : it is still within the control of their 
action, and is suffering that succession of changes peculiar to a living 
part. In the enamel, the phosphate of lime has been deposited in 
union with a portion of animal gluten, and has no vascularity, nor 
does it suffer any change from the influence of the living system. 
Although the hardening matter be principally phosphate of lime, a 
small proportion ef the carbonate of lime enters into the composition 
both of bone and of enamel. But in enamel, according to Morichini 
and Gay Lussac, there is fluat of lime, to which ingredient these 
chemists attribute the hardness of this crust.* 
Although we call the earthy deposite the hardening matter, yet it 
is the union of the glutinous matter which bestows the extreme hard- 
ness : for, when the tooth is as yet within the jaw, and in an earlier 
stage of its formation, the deposition is soft, and its surface rough; but, 
by a change of action in the secreting surface, which throws out this 
fluid, the first deposition is penetrated with a secretion, which either 
by this penetration simply, or by causing a new apposition of its 
parts, (its structure indeed looks like crystallization,) bestows the 
density and extreme hardness on the crust or enamel. 
When an animal is fed with madder, the colouring matter coming, 
in the course of the circulation, in contact with the earth of bone, is- 
attracted by it, and i3 deposited upon it in a beautiful red colour. 
This colouring matter penetrates more than injection can be made to 
do in the dead body ; and, as by this process of feeding, the enamel 
is not tinged, we have a convincing proof that the vascular system 
has no operation on the enamel after it is formed. 
In the marmot, beaver, and squirrel, the enamel is of a nut-brown 
colour, on the anterior surface of the incisor teeth. The molares of 
some of the cloven-hoofed animals are covered with a black vitreous 
matter, and sometimes they have a crust of a shining substance like 
bronze. In the grinding teeth of the graminivorous animals, the 
arrangement of the enamel is quite peculiar. 
* By Mr. Hatchett’s Experiments, (Philos. Transact. 1799,) we learn that bone 
consists of phosphate of lime, with a small proportion of carbonate of lime. The 
shell of the crab and lobster consists of phosphate of lime and carbonate of lime, 
the latter being; in the greatest quantity. The testaceous shells consist entirely of 
carbonate of lime. The matter of bone and teeth consists of phosphate of lime and 
a small portion of carbonate deposited in the interstices of an animal substance, 
which is of the nature of cartilage, and proves to be gelatine. The bones of fish differ 
from those of man and brutes, in the larger proportion of animal substance. These 
chemical facts are, however, of little import to the anatomist: he is desirous of 
knowing what property of life these parts are endowed with; whether they are 
formed by a final deposition, or are still under the influence of the circulating vessels, 
whether they possess a principle of self-preservation independent of vascularity, or 
are like common dead matter altogether ont of the system. 
The formation of bone has been very fully described. The formation of shell is 
more like that of teeth- The testaceous shell consists of layers ; the layers are 
formed successively by secretion from the animal body, and each successive layer is 
broader than the preceding, answering to the increased circumference of the animal. 
Reaumur broke the shell of a snail, and he found that when he corered the surface 
of the creature and prevented the exudation, no shell was formed. OF THE TEETH. 
147 
From the composition of the enamel, we must be aware of the 
bad effect of acidulated washes and powders to the teeth : they dis- 
solve the surface, and give a deceitful whiteness to the teeth ; they 
erode the surface, which it is not in the constitution of the part to 
restore. 
OP THE CENTRAL BONY PART OF THE TOOTH. 
The chemical composition, and the manner of combination of the 
matter forming the central part of the tooth, and of the fangs, is simi- 
lar to other bones of the body; but when we examine the hardness 
and the density of the tooth, and see that it is not even porous, or ap- 
parently capable of giving passage to vessels, we conclude that it ig 
not vascular, and are apt to suppose that it holds its connection with 
the living jaw-bone by some other tenor than that of vessels, or the 
circulation of the blood through it. The body and fangs of a tooth 
are covered with a periosteum like other bones. The vascularity of 
the periosteum, which surrounds the tooth, and the vessels which 
enter by the fangs to the cavity of the tooth, seem to be a provi- 
sion for supplying them plentifully with blood ; but on further 
examination, it will prove to be a means only of fixing the tooth in 
the socket, and of preserving the sensibility of the nerve in the cavity 
of the tooth. As the bony part of the tooth has often been co- 
loured by feeding young animals with madder, it might deceive some 
to suppose that there is blood circulating through the body of the 
tooth, and that the tooth undergoes the same changes by absorption 
which the other bone3 are proved to do. But these experiments may 
have been made while the teeth were forming by a secretion from 
the pulp, and of course they might be coloured without the experi- 
ment affording a fair proof that the circulation continues in the tooth 
after it is formed. 
OF THE VASCULARITY AND CONSTITUTION OF THE BONY TART OF 
THE TOOTH. 
The teeth undergo changes of colour in the living body, to which 
it would appear they could not be liable as dead matter. They be- 
come yellow, transparent, and brittle with old age; and when a tooth 
has been knocked from its socket, and replaced, dentists have ob- 
served that it loses its whiteness, and assumes a darker hue. 
The absorption of the roots in consequence of the caries of the 
body of the tooth, and the absorption of the fangs of the deciduous 
teeth, are further alleged in proof of their vascularity ; not only the 
pressure of the rising tooth on the fangs of the temporary teeth will 
cause an absorption of the latter, but the fangs of the temporary teeth 
will waste and be absorbed, so as to drop out without the mechanical 
pressure of the permanent teeth, and before they have advanced to 
be in contact with the former. Of what nature is this absorption of 
the fangs of the deciduous teeth ? Is it an influence commencing in 
the tooth, or is it the agency of the vascular substance around the 
tooth ? 
The teeth seem acutely sensible; but a little consideration teaches 148 
OF THE TEETH. 
us that the hard substance of the teeth is not endowed with sensibility, 
and that it must be the remains of the vascular pulp, presently to be 
described, occupying the centre of the tooth, which being supplied 
with nerves, gives the acute pain in tooth-ache. It Is as a medium 
communicating or abstracting heat, that the condition of the tooth is 
attended with pain. When wrought upon by the dentist’s file, no sen- 
sation is produced unless the tremor be communicated to the centre 
or unless the abrading, or cutting instruments, be so plied as to heat 
the tooth; then an acute pain is produced from the heat communi- 
cated to the centre; and so ice or extremely cold liquids, taken into 
the mouth, produce pain, from the cold affecting the pulp through 
the body of the tooth. 
As living parts, the teeth have adhesion to the periosteum, and are 
connected with their internal pulp; but when they spoil, and are 
eroded, the disease spreads inwardly, probably destroying the life of 
the bony part of the tooth, the progress of which disease is marked 
by a change of colour penetrating beyond the caries towards the 
centre of the tooth. When this discoloration has reached the 
internal surface, the pain of tooth-ache is excited ; the pulp, vascular 
and supplied with nerves, inflames, from a want of accordance with 
the altered state of the tooth, just as the dead surface of a bone will 
inflame the central periosteum and marrow'. The extreme pain pro- 
duced by this state of the tooth probably proceeds from the delicate 
and sensible pulp swelling in the confinement of the cavity of the 
tooth. 
In caries of the teeth, the body of the tooth is discoloured deep 
in its substance long before the pulp of the central cavity is exposed 
by the progress of the caries. No exfoliation, or exostosis, takes place 
upon that part of the tooth which is above the gum, which, how'ever, 
some say, may be owing to the mere compactness of the ossific de- 
positions. 
in the further consideration of this subject, there are circumstances 
which will make us conclude that there is no vascular action in the 
teeth, and incline us to believe that they possessalow degree of life, in- 
dependent of vascular action. Supposing the bony part of the tooth 
to be vascular, and to possess the principle of life, is not the firm ad- 
hesion and contact of the enamel to the body of the tooth a curious 
instance of a part destitute of life adhering to the surface of a living 
part, without producing the common effects of excitement and ex- 
foliation, or inflammation in the latter ? 
In rickets, and mollifies ossium, and other diseases of debility in 
which the body wastes, or the growth is retarded, the growm teeth 
are not altered in their form or properties. The effects which we 
perceive in the bony system under these diseases, are produced by 
the activity of the absorbents prevailing over the action of the red 
vessels; while in the teeth no such effect can take place, if they are 
formed by a deposition of bony matter w'hich is not re-absorbed, 
nor subject to the revolution of deposition and re-absorption, which 
takes place in other parts of the body. Accordingly, we find in 
rickets, where the hardest bone yields, and where the jaw-bone itself 
is distorted or altered in its form by the actions of its muscles, that OF THE TEETII. 
149 
the teeth remain distinguished for their size and beauty. In molli- 
ties ossium, I have found the teeth loose, but hard in their sub- 
stance. In rickets the teeth are large, and perfectly formed, while 
the jaws are stinted and interrupted in their growth. The conse- 
quence of this is, that the teeth form a larger range than the jaw, 
and give a characteristic protuberance to the mouth. 
I must here observe, however, that if a child is in bad health 
during the formation of the teeth, they are often deficient in form, or 
the crust of enamel which covers them, is irregular, and which cir- 
cumstances continue through life. 
When an adult tooth of one jaw is lost, there appears to be a 
growth of the tooth of the opposite jaw ; but I believe the tooth only 
projects from its socket a little further, in consequence of the want 
of that pressure to which it is naturally accommodated. The teeth 
of the rodentia are wasted by attrition and seem to grow. This is 
indeed a growth, but it is of the nature of the first formation of the 
tooth proceeding from the pulp ;* for while the tooth wastes by at- 
trition on its anterior edge, it continues to grow by addition from the 
pulp, and to be pushed forwards. 
Much has been said of balls being found in elephants’ teeth, as 
they are found in bones, the bony matter accumulated around the 
ball, and considered to be a proof of the inflammation of the tooth, 
and of course of its vascularity. The specimens in the collections 
of Haller, Blumenbach and Monro, are quoted. I possess a great 
variety of these specimens, of both iron and leaden balls immersed in 
the ivory of the elephant’s tusk, but they prove that the pulp continu- 
ing to secrete bony matter, has enveloped the ball after it has 
pierced the shell of the tooth. 
The roots of the teeth are sometimes found enlarged, distorted, or 
with exostosis formed upon them. Again the cavity of the tooth is 
found filled up with what appears to be new matter, or around the 
fangs we often find a small sac of pus, which is drawn out in extract- 
ing the tooth. Nevertheless, in these examples of disease, there are 
no unequivocal marks of vascular action in the tooth; the unusual 
form, or exostosis of the roots, is produced by an original defect in 
the formation. The filling up of the cavity of the tooth is caused in 
the same way, or by the resumed ossific action of the pulp, in con- 
sequence of the disease and destruction of the body of the tooth ; 
and the abscesses which surround the fangs are caused by the death 
of the tooth, in consequence of which it has lost its sympathy with 
the surrounding living parts, and becomes a source of irritation like 
a foreign body. 
The transplanting of teeth presents another very interesting phe- 
nomenon. A tooth recently drawn, and placed accurately into a 
socket from which one has been taken, will adhere there: nay, it will 
even adhere to any living part, as in the comb of a cock. This, 
however, proves only that the tooth possesses vitality ; for after it is 
taken from the natural socket, if it be kept any time it will not ad; 
♦ See the inhesions Inaugural Dissertation of Dr. Blake. 150 
OF THE TEETH. 
here; it lias become a dead part, and the living substance refuses to 
unite with it. Again, and in opposition to this, is it not very extra- 
ordinary that a tooth may be burnt by chemical agents, or the actual 
cautery, down to the centre, and yet retain its hold; or that the 
body of the tooth may be cut off, and a new tooth fixed into it by a 
pivot? Had the teeth any vascular action, this torturing would 
cause re-action and disease in them. No doubt sometimes very dis- 
tressing effects are produced by these operations, as tetanus, ab- 
scess in the jaws, &c. ; but this happens in consequence of the 
central nerve being bruised by the wedgingof the pivot in the cavity 
of the tooth, or by the roots of the tooth becoming, as dead bodies, 
a source of irritation to the surrounding sockets. 
Of the gums.—The necks of the teeth are surrounded by the 
gums, a red, vascular, but firm substance, which covers the alveolar 
processes. To the bone and to the teeth the gums adhere very 
strongly, but the edge touching the tooth is loose. The gums have 
little sensibility in their healthy and sound state ; and by mastica- 
tion, when the teeth are lost, they gain a degree of hardness which 
proves almost a substitute for the teeth. The use of the gum is 
chiefly to give firmness to the teeth, and at the same time, to give 
them that kind of support which breaks the jar of bony contact. 
Like the alveolar process, the gums have a secret connection with 
the state of the teeth. Before the milk-teeth appear, there is a firm 
ridge which runs along the but this is thrown off, or wastes 
with the rising of the teeth : and as the teeth rise, the proper gum? 
grow, and embrace them firmly. The gum is firm, and in close ad- 
hesion, when the teeth are healthy ; loose, spongy, or shrunk, when 
they are diseased. The only means of operating upon the general 
state of the teeth is through the gum'; and by keeping them in a 
state of healthy action, by the brush and tinctures, the dentist fixes 
the teeth, and preserves them healthy ; but when they are allowed 
to be loose and spongy, and subject to frequent bleeding, (which is 
improperly called a scorbutic state,) the teeth become loose, and the 
gums too sensible. If a healthy t»oth be implanted in the jaw, the 
gum grows up around it, and adheres to it; but if it be dead or 
diseased, the gum ulcerates, loosens, and shrinks from it; and this 
shrinking of the gums is soon followed by the absorption of the 
socket. 
We must conclude, that the whole of the phenomena displayed 
in the formation, adhesion, and diseases of the teeth, show them to 
be possessed of life, and that they have a correspondence or sym- 
pathy with the surrounding parts. But are we prepared to acqui- 
esce in the opinion of Mr. Hunter, that they possess vitality w'hile 
yet they have no vascular action within them ? We naturally say, 
how can such vitality exist independently of a circulation ? In 
answer to this, there are not wanting examples of an obscure and 
low degree of life existing in animals, ova, or seeds, for seasons, 
without a circulation ; and if for seasons, why not for a term of 
life ? We never observe the animal economy providing superfluously; 
and since there is no instance to be observed in which the teeth OF THE TEETH. 
151 
have shown a power of renovation, why should they be possessed 
of vascularity and action to no useful purpose ? All that seems ne- 
cessary to them is, that they should firmly adhere without acting as 
a foreign and extraneous body to the surrounding parts, and this, 
vitality, without vascular action, seems calculated to provide. 
OF THE FORMATION AND GROWTH OF THE TEETH. 
In ibis figure we see the milk-teeth of one side of the lower jaw 
prepared to rise above 
the gum. They are 
.in their distinct bony 
'cells, and also sur- 
rounded with their 
membranous sacs.— 
The first of the per - 
manent teeth is also 
seen in a state of ad- 
vancement. 
In the jaws of a child newly born, there are contained two sets 
of teeth as it were in embryo : the deciduous, temporary, or milk- 
teeth : and the permanent teeth. The necessity for this double set 
of teeth evidently is to be found in the incapacity of alteration of 
shape or size in the teeth, as in other parts of the body ; the smaller 
teeth, which rise first, and are adapted to the curve and size of the 
jaw-bone of an infant, require to be succeeded by others, larger, 
stronger, and carrying their roots 
deeper in the jaw. 
Each tooth is formed in a little 
sac, which lies between the plates 
of bone that form the jaw-bone 
of the foetus, or child, under the 
vascular gum, and connected 
with it. A. is the sac containing 
the milk-tooth : B. the sac of the 
permanent tooth attached to the 
sac of the milk-tooth. 
When we open one of these sacs at an early period of the for- 
mation of the tooth, a very curious appearance presents itself: a 
little shell of bone is seen within the sac, but no enamel is yet 
formed. Upon raising the shell of bone, which is of the shape of 
the tooth, and is the outer layer of the bony substance of the tooth, 
a soft vascular stool, or pulp,* is found to have been the mould on 
which this outer layer of ossific matter has been formed ; and a fur- 
ther observation will lead us to conclude, that this bony part of the 
tooth is in the progress of being formed by successive layers of 
matter thrown out from the surface of this vascular pulp ; though 
* L« noyau, la coque, or le germe de la dent, by the French author.*. 152 
OF THE TEETH. 
many have explained' the formation of the tooth, by 
supposing that the layers of this pulp were succes- 
sively ossified. A. is the pulp on which the tooth is 
formed : B. the sac opened, which surrounds the 
pulp and new tooth, and which secrets the enamel: 
C. the shell of the new tooth taken off the pulp A. 
to which of course it corresponds accurately in 
shape. 
If we now turn our attention to the state of those 
teeth which we know to be later of rising above the 
gum, we shall find the ossification still less advanced, 
and a mere point, or perhaps several points of the deposited matter 
on the top of the pulp. 
The pulp, or vascular papilla on which the tooth is formed, has 
not only this peculiar property of ossification, or rather secretion of 
ossific matter, but, as the period of revolution advances, where it 
forms the rudiments of the molares for example, its base splits so as 
to form the mould of two, three, or four fangs, or roots ; for around 
these divisions of the pulp the ossific matter is thrown out so as to 
form a tube, continued downwards from the body of the tooth. 
Gradually, and by successive layers of matter on the inside of this 
tube, it becomes a strong root, or fang, and the bony matter has so 
encroached on the cavity, that only a small canal remains, and the 
appearance of the pulp is quite altered, having shrunk in this nar- 
row space. 
We have said that the tooth forming on its pulp, or vascular bed, 
is surrounded with a membrane, giving the whole the appearance of 
a little sac. This membrane has also an important use. It is vascu- 
lar also as the pulp is, but it is more connected with the gums, and 
receives its vessels from the surface, while the pulp, lying under the 
shell of the tooth, receives its blood-vessels from that branch of the 
internal maxillary artery which takes its course in the jaw. 
The enamel is formed after the body of the tooth has considerably 
advanced towards its perfect form. It is formed by a secretion from 
the capsule, or membrane, which invests the teeth,* and which is 
originally continuous with the lower part of the pulp. The enamel 
is thicker at the point, and on the body of the tooth, than at its neck. 
Mr. Hunter supposed that the capsule always secreting, and the 
upper part of the tooth being formed first, it would follow of course, 
that the point and body of the tooth would be covered with a thicker 
deposition ; but it rather appears that that part of the sac opposite 
to the upper part, and body of the tooth, has a greater power of 
secreting, being in truth more vascular and spongy ; for the whole of 
the body of the bony part of the tooth is formed before the enamel 
invests the tooth. 
We arc indebted to M. Herissant for much of the explanation of 
the manner in which the enamel is formed. He describes the sac, 
its attachment to the pulp and to the neck of the teeth,—as the tooth 
* This outer sac has been called chorion, from the numerous vessels distributed 
upon it. OF THE TEETH. 
153 
advances to its perfect form, the sac also changes. At first it is 
delicate and thin, hut it thickens apace. And he asserts, that if after 
this progress is begun you examine the inner surface of it with a 
glass, you will perceive it to be composed of little vesicles in regular 
order, and which sometimes have a limpid fluid contained in them. 
This liquid exuded upon the surface of the teeth he supposes to form 
the enamel. He explains also how this sac, originally investing the 
body and neck of the tooth, being pierced by the edge of the tooth, 
and the tooth rising through it, is inverted, and by still keeping its 
connection with the circle of the crown of the tooth, rises up in con- 
nection with the gum, and in some degree formaAfie new gum which 
surrounds the tooth. 
The sac which encloses the rudiments of the tooth consists of a 
double membrane. The outer membrane is of a looser texture, and 
vascular; the inner is vascular also, but delicate and soft. Mr. 
Hunter said, that while the tooth is within the gum, there is always 
a mucilaginous fluid like the sinovia in the joints between this mem- 
brane and the pulp of the tooth. I do not imagine that the enamel 
is produced by the concretion of this humour, which we may find at 
any period of the growth of the body of the tooth ; but that the 
secreting surface changes the nature of its action, when the bone of 
the tooth is perfected in its outer layer, and that it then throws out 
the matter which consolidates into enamel. 
This subject of the formation of teeth would be incomplete if we 
left unexplained the peculiar structure of the teeth of graminivorous 
animals. 
Mr. Corse, in a curious paper in the Philosophical Transactions 
of London for the year 1799, describes the grinding tooth of an 
elephant in the following terms :—In describing the structure of the 
grinders, it must be observed, that a grinder is composed of several 
distinct laminae or teeth, each covered with its proper enamel; and 
that these teeth are merely joined to each other by an intermediate 
softer substance, acting like cement. 
The structure of the grinders, even from the first glance, must 
appear very curious, being composed of a number of perpendicular 
laminae, which may be considered as so many teeth, each covered 
with a strong enamel, and joined to one another by the common 
osseous matter. This being much softer than the enamel, wears 
away faster, by the mastication of the food ; and, in a few months 
after some of these teeth cut the gum, the enamel remains consider- 
ably higher, so that the surface of each grinder soon acquires a 
ribbed appearance, as if originally formed with ridges. 
The pulp of graminivorous animals is not shaped like that which 
forms the human tooth ; it consists of several processes united at 
their base. The capsule has also processes which hang into the 
interstices of the pulp ; the pulp forms a shell of bone which in time 
covers it. The processes of the which of course hang into 
the interstices of this layer of bone, (which has taken the exact form 
of the pulp,) form over the bone layers of enamel. The tooth now 
consists of conical processes of bone, united at their roots, and the 
surfaces of these processes have deposited on them the enamel. The 154 
OF THE TF.ETH. 
membranous productions of the capsule having completed the 
enamel, change the nature of their secretion somewhat, and throw 
out a bony matter which Dr. Blake has called the crusta, petrosa. 
By the formation of this last matter of the tooth, the processes which 
secrete are encroached upon so much, that they shrink altogether, 
and into the place left by them, after they have lost their power of 
secreting, foreign matter is sometimes introduced by mastication.* 
The effect of this formation is to make the layers of the enamel 
pervade the whole substance of the tooth, the better to make it stand 
against the continued attrition necessary in the grinding and rumina- 
tion of the herbivorous and graminivorous animals. The grinding 
teeth of the purely carnivorous animals, as of the lion and tiger, 
close like the blades of scissors : they are prevented by the long 
canine teeth from moving laterally; and as they are not subject to 
attrition, the enamel only covers their surfaces. 
OF THE GROWTH OF THE SECOND SET OF TEETH, AND THE SHEDDING 
OF THE FIRST. 
The teeth of the first, or deciduous set, are twenty in number. 
They are small, being adapted for the jaws of a child ; they are 
destined to be shed, and to give place to the adult, or permanent 
set of teeth. Accordingly, in observing the progress of the forma- 
tion of this first set of teeth, the rudiments of the second may also 
be seen so early as in the foetus of the seventh or eighth month ; 
and in the fifth and sixth month after birth, the ossification begins in 
them. The rudiment of the permanent tooth may be observed even 
when the sac which contains it is very small, and appears like a 
filament stretching up to the neck of the sac of the deciduous tooth.t 
These sacs lie on the inner side of the jaw-bone, and when further 
advanced, the necks of the two sacs (both as yet under the gum) 
are united ; but when the first teeth are fully formed, and have risen 
above the gum, the alveolar processes have been at the same time 
formed around them, and now the sacs of the permanent teeth have 
a connection with the gums through a small foramen in the jaw- 
bone, behind the space through which the first teeth have risen. 
The opinion entertained, that the second set of teeth push out the 
first, is erroneous, for the change on the deciduous and the growing 
teeth seems to be influenced by laws of coincidence, indeed, but not 
of mechanical action. Sometimes we observe the falling tooth 
wrasted at the root, or on the side of the fang, by the pressure of the 
rising tooth. Now here we should suppose that the newly formed 
tooth should be the most apt to be absorbed by the pressure of the 
root of the deciduous tooth, did we not recollect that the new tooth 
is invested with the hard enamel, while the pressure on the other is 
upon the bony root. But there is more than this necessary to the 
explanation of the shedding-of the teeth, for often the fang is wasted, 
and the tooth adheres only by the gum, and the permanent tooth has 
made little progress in its elevation, and has not pressed upon it. 
* See a paper of Mr. Home’s in the Philosophical Transactions, and Dr. Blake’s 
Inaugural Dissertation. 
t Sec the tiro figures in page 151. OF THE TEETH. 
155 
This decay and wasting of the tangs of the teetii looks more like 
a satisfactory proof of their vascularity, than any other change to 
which they are subject. Yet there seems to be no reason why we 
should not suppose, that as the rudiments of the teeth rise into action 
at a particular time, and form the bony centre of the tooth, the de- 
composition should be effected by similar laws; than at a particular 
period the tooth should decay, and that the decay of the tooth should 
begin with the destruction of the fangs. Has the bony part of the 
tooth a tendency to dissolution independently of a circulation of blood 
through it ? and as the roots wTaste, dp the surrounding vascular parts 
absorb its substance ? or, does the surrounding vascular substance 
operate on the tooth dissolving, and absorbing it, as it is said a dead 
bone is absorbed, when placed upon an ulcer ? 
When the internal vascular substance of a tooth is destroyed, it 
does not waste : when teeth are pivoted, their roots remain twenty 
years without wasting or being absorbed ; and when the vascular 
centre of the milk-teeth is destroyed, their roots waste no more, and 
they continue adhering to the gum. This seems to point to the 
internal membrane of the tooth as the means of its absorption. 
It is no proof of the first set being pushed out by the second set of 
teeth, that if the permanent teeth do not rise, the first will remain, 
their roots unwasted and firm, even to old age ; for still 1 contend, 
that there is an agreement and coincidence between the two sets of 
teeth in their changes, and also in the alveoli by which they are 
surrounded ; but this is not produced by the pressure of the rising 
teeth. When a dentist sees a tooth seated out of the proper line, 
and draws it, and finds that he has made the mistake of extracting 
the adult tooth, letting the milk-tooth remain, he must not expect 
that the milk-tooth will keep its place, for the contrary will happen ; 
it will in general fall out. 
The old and the new teeth are lodged in distinct compartments of 
the jaw-bone, and, what is more curious, their alveoli are distinct; for as 
the roots of the first teeth decay, their alveolar processes are absorbed, 
while again, as the new teeth rise from their deep seat in the jaw-bone, 
they are accompanied with new alveoli; and the chief art of the 
dentist in shifting the seat of the teeth, is gradually to push them 
along the jaw, nQtwithstanding the bony partitions or alveoli and 
processes, so as to bring them into equal and seemly lines. It is 
curious to observe, that the alveoli will by the falling out of one 
tooth, or the operation of wedging between the teeth, change their 
place in the jaw. 
When a tooth is lost, it appears as if the space it occupied were 
partly filled up by an increased thickness of the adjacent teeth, and 
partly by the lengthening of that which is opposite: indeed, this 
appearance has been brought as a proof of the continual growth of 
teeth. But there is a fallacy in the observation ; for when the space 
appears to have become narrow by the approximation of the two 
adjacent teeth, it is not owing to any increase of their breadth, but 
to their moving from that side where they are well supported to the 
other side where they are not. For this reason they get an inclined 
direction ; and this inclination may be observed in several of the ad- 
joining teeth. 156 
REVIEW OF THE SKELETON. 
No circumstance can better illustrate how perfect the dependence 
of the alveoli is upon the teeth, than that of their being thrown off 
with them in extensive exfoliations. I have a specimen of this in 
my Collection, where the whole circle of the alveolar processes and 
teeth is thrown off. This happened after the confluent small-pox. 
I think I recollect a similar case occurring to Dr. Blake. In those 
tumours which arise from the alveoli and gums, filling the mouth 
with a cancerous mass, and softening the upper part of the jaw, 
there is no eradicating the disease but by taking away the whole 
adventitious part of the jaw which belongs to the teeth, and leaving 
only the firmer base. But even this operation will be too often 
unsuccessful. 
REVIEW OF THE SKELETON. 
Although we are obliged to study the parts of the human body 
separately, in what we choose to call systems, as the bones, the mus- 
cles, the blood-vessels, yet these in nature form one system, and 
have the most intimate correspondence. The bones correspond 
with the muscular parts ; and as the strength of the muscular frame 
distinguishes the male, so the male skeleton is marked by stronger 
and heavier bones, where all the processes and tubercles are more 
distinctly marked. It is for the same reason that the skeleton of an 
athletic man is valuable, because, corresponding with the fulness 
and symmetry of the muscular frame, that activity which has per- 
fected the moving parts, has added distinctness to all the points of 
demonstration of the bones. It is a correspondence of the same 
kind which accounts for the bones of a man suddenly cut off in the 
vigour of health and exercise, being hard as ivory, compared with 
the bones of one who has lived an indolent life, or has long lain in 
sickness. 
The skeleton of woman is further distinguished from that of man : 
1. By the depth of the vertebrae ; 2. The narrowness of the lower 
part of the thorax ; 3. The sternum shorter, and more projecting ; 
4. The diameters of the pelvis greater; the sacrum more hollow, 
as well as broader ; the os coccygis slender and more flexible at its 
articulation; 5. The acetabula more distant; 6. The thigh bones 
more oblique in their position under the body ; 7. The feet small, 
and the toes more pointed outward ; 8. The bones of the face 
smaller, and the cavities less developed. To these are added a 
peculiarity in the sagittal sutures, since the lateral divisions of the 
os frontis are later of being joined than in man. 
As to the height of the human skeleton, we have, in the collec- 
tions in London, skeletons of the natural form, varying, from eight 
feet two inches, to thirty-five inches in height. However we may 
account for the giant height, the dwarf is undoubtedly disease, a dis- 
eased limitation of the growth of the whole body, as we sometimes 
see of individual parts of the body. 
In reviewing the general form of the skeleton, we are naturally REVIEW OF THE SKELETON. 
157 
called to observe the spine. We see that it has three oflices com- 
bined : to support the head and trunk as a column under the weight; 
to lodge and give passage to the spinal marrow ; and to afford at- 
tachment to the muscles of trunk. And these uses both ex- 
plain and give importance to the accidents and diseases to which it 
is subjected. The incumbent pressure explains why it sinks down 
distorted by defect of the earth of bone, in rickets, and mollities 
ossium ; why being fractured, the accident is fatal, from the injury 
to the marrow ; and why, in dislocation of the vertebrae from the 
same complication, the membranes of the spinal marrow become 
inflamed, and the unfortunate patient drags his extremities, feeble 
through paralysis, and like a wounded snake. 
But the natural curves, or forms of the spine, are subjects of 
interest. And, first, we may observe, that the spine of an infant 
is not so pyramidal as in the adult. It is some time before the ver- 
tebrae of the loins assume their just form. The spine of an infant 
is straight, compared with the column of the adult; by which we 
see that there is a growth and gradual change in the conformation 
of the chain of bones, fitting them for the erect posture. We must 
never lose sight of the grand purpose of this chain of bones ; that 
it is to support the head on an elastic column. This explains the 
curves which are given to it. Had all the bones been joined in a 
right line, a fatal shock might have been given to the brain before 
the spine had bent or inclined at all. By the curves of the column 
this is rendered impossible ; the direction is already given, and it is 
prepared to sink or yield on the slightest pressure. In the adult, 
the direction of the lumbar vertebrae, forward from the sacrum, pro- 158 
REVIEW OF THE SKELETON. 
tecls the spine in the motion of the body ; for if the spine stood 
perpendicularly, its base would be jarred in the forward motions of 
the body. The motions of the trunk following the propelling 
power of the lower extremities, it is of much consequence that the 
line in which the force is applied, should not be lateral to the 
column ; but in the direction of the bodies of vertebrae, that is in 
the line A. B. By this inclination forward the pressure falls per- 
pendicularly on the bodies of the vertebrae. Instead of the jar 
coming on the [joint C, the force is distributed over several verte- 
brae. The motion of the body forward, instead of tending to dis- 
join the first lumbar vertebra from the sacrum, and to make it go by 
the board, like a mast of a ship, tends to press the surface of the 
one bone against the other. The receding of the spine in the 
thorax is to expand that cavity, but it again inclines forward, that 
the head may be sustained perpendicularly over the centre of 
motion in the pelvis. In reviewing the building up of the column, 
there are three points which possess more, extensive motion, and 
which, on that very account, are more subject to accident and to 
disease. The first is the junction of the vertebrae of the back to 
those of the loins ; for as the vertebrae of the back constitute the 
most unyielding part of the chain ; where they terminate below, the 
flexibility of the adjoining piece must be the greater, and propor- 
tionally weaker—a fishing-rod breaks close to the joining, because 
the part joined is inflexible. 
As some introduction to the study of the deformities of this 
column, we may observe the necessary consequence of grow th and 
stature. We cannot fail to observe, that a little fat man carries 
himself perpendicularly, throwing the body backward, as it were, 
briskly, for which he is accused of conceit; when it is no more than 
balancing the anterior weight of his belly, by throwing back the 
trunk and shoulders. And so the inccssus of a pregnant woman 
is stately, and she is accused of carrying her burden proudly, when, 
it may be, there is more shame than pride ; yet she must throw the 
body back, to poise the increased weight of her condition. It is 
upon the same principle, that parents have so much trouble with a 
tall and thin young person, who naturally stoops, since the spine 
and head are always brought to bear perpendicularly over the 
sacrum and the wrant of filling up, and consequent comparative de- 
ficiency of weight in front, makes the head and shoulders project 
forward. The spine being a flexible column, produces that consent 
through the whole body, to which the eye is familiar, without our 
seeking to account for it. The stiff knee, and the erect position of 
the head, correspond, just as the relaxed knees, and the pelvis pro- 
jecting backwards in old age, is accompanied with the curve in the 
back and the stoop of the neck and shoulders. These natural con- 
sequences should be well considered by those who append weights 
to young people to correct their carriage, when they should be at- 
tending to the conformation and the natural exercise of the trunk 
and limbs. 
It has been explained how the pelvis stands, as an arch between 
the spine and the lower extremities. From the term pelvis, and 
from the manner in which the student has these collected bones de- 159 
REVIEW OF THE SKELETOiY. 
monstrated to him, he is apt to forget how they stand in relation to 
the body. If aline were drawn perpendicularly from the centre of 
the brim of the pelvis, that line would come through the umbilicus. 
If that line were carried through the cavity of the pelvis, equidistant 
from the sacrum and pubis in all its course, it would form a curve 
D. E.; and this curved line, passing through the pelvis, is properly 
the axis of the pelvis. It is the line in which the child’s head de- 
scends ; it is the line in which instruments are used: the forceps in 
midwifery, the gorget in lithotomy ; the trocar in puncturing the 
bladder, must also be used with due regard to this line. And now 
that the bones are contemplated in their natural relation, we see into 
what form the pelvis will be distorted, by the combined influence of 
rickets, pressure, and the progress of growth in the bones. The 
arch receives the pressure in three points ; on the acetabula, where 
they rest on the thigh-bones, and on the sacrum, which, like the 
key-stone of an arch, closes the bones of the pelvis, and supports 
the column of the spine and the incumbent weight of the body. The 
consequence of this is, that the distorted pelvis assumes, most fre- 
quently, a triangular form. Sometimes, however, the ossa pubis are 
pressed in so uniformly as to give the pelvis a flattened form; and 
the accoucheur would do well to consider the form of the distorted 
pelvis, before he gives out his absolute rule, regarding what is to be 
done in certain degrees of diminished diameter in the brim and outlet 
of the pelvis. 
The size and strength of the lower extremities, at once declare 
the provision of the human skeleton, for the upright position, and 
that there is no true biped but man. The admirable adaptation of 
all creatures to their condition, and the provision of monkeys and 
apes to climb and spring among the branches of trees, has given rise 
to long and useless speculations, not very creditable to philosophy. 
These creatures are of the class quadrumanus ; their hind feet are 
as perfect instruments of prehension as their paws, which shows the 
limited object of their structure. 
The human feet have a combination of bones, of greater strength, 
solidity, and breadth than those of any animal: no other animal rests 
upon the os calcis ; the cloven-hoofed animals touch the ground with 
the third phalanges only, and even the simia? and the bears have 
their os calcis raised. The size, form, and position of the os calcis 
is, therefore, a remarkable peculiarity in the human skeleton. Then 
we must admire the arches of the foot, so curiously calculated to 
unite elasticity with strength ; the foundations of the Eddystone 
being not more obviously intended for security ; nor should we for- 
get the provision in the early ossification of the os calcis and the bones 
of the tarsus, while yet the bones of the hand are imperfectly formed. 
A silly observation is copied through many books, that we owe the 
position of the toe to the dancing-master ; every thing in the shape 
of the bones of the lower extremity, and the insertion of the muscles, 
conform to this object; and it is not unimportant, being that which 
gives elasticity, freedom, and, consequently, elegance to the motion 
of the body. How awkward is that man’s gait who walks directly 
over his toes : and if a woman have one foot placed straight for- 160 
REVIEW OP T1IE BONES OF THE HEAD. 
ward and the other pointed, you perceive the effect in the awkward 
motion of the whole of one side of the body compared with the 
other. 
The thorax of the human skeleton is remarkable for its transverse 
diameter, its elevation and shortness,* and, consequently, for the 
large space betwixt the pelvis and margin of the chest, which gives 
a remarkable facility and extent to the motion of the human body. 
Quadrupeds have the thorax compressed laterally, with a projecting 
and lengthened sternum, so that the scapulae rest on the sides of the 
thorax, and the fore legs, stand perpendicularly under the chest. 
There are a class of philosophers who conjoin, as necessary parts 
of the same plan, man’s reason and the perfection of the hand, the 
one for council, the other for action. The peculiarity of the upper 
extremity, as distinguishing it from the lower extremity, is the small- 
ness of the bones, the freedom of their articulations, and the great 
variety of motions attainable through the combination of the whole. 
As distinguished from the anterior extremity of brutes, we find its 
peculiarity principally in the perfect clavicle, in the great mobility of 
the scapula, and the lateral projection of the glenoid cavity : in the 
provision of the joint of the elbow for the co-operation of the hands: 
and in the perfect articulation of the twenty-nine bones of the carpus, 
metacarpus, and fingers: in the position of the bones, and in the 
strength of the muscles of the thumb. There is a sort of resemblance 
in the arrangement of the bones of the lower and upper extremities: 
but the solid junction of the bones of the leg, the firm building of the 
bones of the tarsus, and the strength and size and firmly wedged 
position of the metatarsal of the great toe, are in remarkable con- 
trast with the free rotatory motions of the radius, and the mobility of 
the thumb, and the freedom and extent of motion of the fingers. 
REVIEW OF THE BONES OF THE HEAD. 
Wf. possess a very remarkable power of discriminating minute 
differences in the human countenance, and slight variations of ex- 
pression, although we are so familiar with the exercise of this faculty, 
that it ceases to be surprising. There are varieties in the propor- 
tions of the head too, but we should be sadly puzzled to discover 
our best friends, bv the most careful inspection of their crania. 
While the design of producing a variety in the faces of men, and a 
power of expression is obvious, it would be a useless provision, if wc 
did not also possess a corresponding capacity of minute observation 
of the human face. One source of this capacity is, that our sympa- 
thies are alive to every change of countenance ; we are naturally or 
instinctively led to peruse those features, where every sentiment of 
the heart has a corresponding character displayed, which differ from 
the character of a language only in being transient. But if nature 
* The horse has thirty-six ribs; there are thirty-two in the hyena ; forty in the 
elephant. REVIEW OF THE BONES OF THE HEAD. 
161 
had intended that we should estimate the capacities or affections of 
our friends by a measurement of the skull, it is probable that she 
would not have covered the head with hair, nor have left our hearts 
so little susceptible of impression from a bald one. 
Whilst there is a never failing source of interest in the human 
countenance, it is probably conducive to our happiness that our 
opinions of men, drawn from this source, are not infallible. Yet dis- 
appointment and unrequited affection or friendship, cannot erase 
that which is so deeply impressed on our natures : we nevertheless 
do not cease to scan the human features. Certain expressions go 
to our hearts, and we love not merely the expression of qualities, but 
the appropriate fitness of the countenance to express those qualities 
of mind which we love. 
Whilst there is so much instinctive feeling, and such a mingling 
of accidental associations in the formation of our opinions on the 
beauty and fitness of the human countenance, we must be liable to 
continual delusion : and this is the source of the popularity of works, 
in which the authors, like Lavater, have sought to connect the intel- 
lectual endowments with the features ; or, like Gall, sought to dis- 
cover the propensities of our natures in the lesser irregularities of 
our skulls. We have a natural propensity to examine the human 
countenance, and we do, in fact, possess a certain natural power of 
discrimination : we comprehend a part without the aid of teaching, 
and we yield ourselves to the delusion that by the lights of phy- 
siology, the sphere of our knowledge may be extended. But 1 ap- 
prehend that, this faculty is of the nature of those instinctive powers 
that are matured early, and do not admit of unlimited improvement. 
I may be permitted to touch upon a subject, which has too much 
interested my countrymen. T mean the opinion of Dr. Gall, that 
the propensities of our nature may be ascertained by the protuber- 
ance of certain parts of the skull. I shall confine myself to the ex- 
amination of the skull. 
How far are the lesser convexities and irregularities of the human 
skull to he attributed to the peculiar form of the brain ? 
In my lectures it is necessary to give a severe or minute demon- 
stration, of the bones of the head ; and for this purpose, I first exhi- 
bit the membrane, or little vesicle that surrounds the brain in the 
foetus, before any bone is formed. I then demonstrate, that the 
several bones of the cranium are formed between layers ot that 
membrane; and that they are necessarily adapted to the form of the 
brain previously existing ; but when on that subject I take occasion 
to remark that a pregnant error has grown out of this demonstra- 
tion, and one which, though blown out to the extent of a splendid 
folio, is only a more monstrous misconception. Some have con- 
templated this matter, as if the brain and skull were pieced together 
after the manner of a cunning artificer, and not formed as a perfect 
whole. Has not the skull those forms which best resist violence 
from without ? Are not all the exposed parts strengthened, and is 
not the substance and the internal texture of the skull calculated to 162 
REVIEW OE TIIE BONES OF THE HEAD. 
stop the vibrations that would be conveyed through a helmet diller- 
ently constructed ? This much I shall prove. I may then ask, is the 
brain while it is yet exposed, and has no bony covering, formed with 
a relation to the case which is destined to cover it, or not ? Look to 
the whole skeleton, and we shall find the answer ; observe how the 
bones are formed in their just proportions to bear the weight, and to 
move in certain directions, long before they can be exposed to pres- 
sure, or put to use. How they are strengthened with spines where- 
ever the force is destined to be applied ; how curiously fashioned at 
their extremities to permit motion in the direction proper to the 
joint, and consistent with the movement of the whole limb. These 
provisions arc made while the bones of the extremities are soft and 
transparent cartilages, and have not yet been put to their proper 
offices; and shall the skull, which is intended to protect the noblest 
organ, be merely an accidental cast of the brain ; and can it be sup- 
posed that Its forms bear no relation to its proper office ? This can- 
not be admitted ; it must be granted, that the skull bears relation to 
•external circumstances ; and if this be so, must not the brain be 
formed with relation to the skull, and to such forms of the skull as 
are capable of protecting it ? It follows, therefore, that although the 
skull be in close contact w ith the surface of the brain, and formed 
over it; yet if the external shape be obviously that which is best 
calculated to resist injury from without, we must conclude that the 
brain conforms to what is necessary in the shape of the skull; and 
although first formed, that it is bound up in that manner which shall 
best secure its protection by bone.* 
But I shall prove further, that the lesser prominences of the skull, 
which are adding strength to it, result from circumstances quite in- 
dependent of the brain, and ought not, therefore, to be brought for- 
ward as indications of propensities of the mind. 
In contemplating the forms of the skull, the eye fixes naturally on 
the frontal bone, and on the slightest, as on the most careful inspec- 
tion, it appears that the form of the bone on its lower part, has relation 
to the orbits of the eyes, and the organ of smelling. It is evident, 
that but for the eyes there would be no orbits, no lateral ridge of the 
frontal bone, and no relative flatness of the temples ; and but for the 
developement of the cavities of the nose, there would be nothing of 
that manly form which is so necessary to the perfection of the coun- 
tenance ; no support for the eyebrows, and no space for the muscles 
which move them ; the flat insipidity of the child’s forehead would 
be continued in after age. 
Higher on the frontal bone, and on the upper division of the fore- 
head, are two eminences, the eminentiee frontales of anatomists. 
When natural, they give a fine variety of surface to the full and 
polished forehead ; when not visible, there is a defect; when too 
prominent, there is a deformity. What are these ? Are they indica- 
tions of a corresponding prominence of the brain ? by no means: 
they are obviously intended to give strength to these parts of the 
skull, which are much exposed ; the bone is more raised and arched 
* All the viscera conform to a system of packing. REVJEW OF THE HOKES OF THE HEAO. 
163 
ut these two parts ; and that this is to afford protection, is demon- 
strated on making a section of the bone, for the frontal bone is 
thicker at these parts, and there is no concavity on the inside, to 
correspond with the external convexities. Let my reader here dis- 
tinguish between that opinion so long and generally acknowledged 
to have a foundation in nature ;—that a full and high forehead indi- 
cates the perfection of the organ of the intellect; and these new 
opinions, that the lesser irregularities are produced by the greater 
developernent of distinct organs in the brain. To the former opinion, 
I shall by experiments afford some support; the latter has no foun- 
dation. 
Let us now direct our attention to the prominence of the parietal 
bone. If a man were to fall on the side of the head, the injury 
would be inflicted on the point of the utmost convexity, the lateral 
projection : and here, where the bone assumes the arched form of 
strength, we find that it is also increased in thickness. In this 
instance, as in the forehead, the outward convexity, or the elevation 
of the surface of the bone into a higher arch, bears no relation to 
the surface of the brain beneath. 
Suppose, again, that we were to place a weight, accurately 
balanced, upon the top of the head ; when the head was adjusted, 
so as to bear the weight with most ease, we should find that it was 
placed on the utmost convexity near the meeting of the coronal and 
sagittal sutures, where the bone rises into a fuller r4ch, I may say, 
the better to sustain the weight. We shall also find, on sawing the 
bone across here, that it is thicker, we must presume for the same 
purpose that its convexity is increased to give strength. I can have 
no doubt that this is a provision for bearing burdens on the head ; 
and certainly the outer convexity has no relation to the form of the 
brain. 
When we come round, in this examination, to the back of the 
head, we cannot fail to observe, that the occiput is least of all pro- 
tected by the hands, and therefore we may presume that it is best 
protected by its form and thickness. The occipital bone is crossed 
with spines, which centre in a remarkable protuberance, which pro- 
jects so as to meet the ground when we fall backwards. Besides, 
within, the occipital bone is in a manner groined, with crossing 
arches of bone, which add much to the strength of the skull at this 
part. 
In short, after a general and unprejudiced inspection of the shape 
of the skull, we must believe that it is formed with reference to the 
pressure it has to sustain from without, or of resistance to external 
violence. If it be so, and the brain and skull are close in contact, 
the former must be constituted with reference to the latter. That 
the size and general dimensions of the cranium do correspond with 
the volume of the brain, there can be no doubt; but the lesser con- 
vexities have no such relation to the internal organ. 
It is a strange delusion that would lead some men to believe, that, 
in the outward configuration of the skull, by which I mean the 
forms which have relation to the organs of sight, smell, and voiee, 
and those spines and prominences-which have respect to the strength 164 
liKVIEW OF THE BOWES OF THE HEAD. 
of the skull, or to the attachment of muscles, they see the indication* 
of particular properties of the mind, or the organs of certain propen- 
sities. 
That the size of the brain-case, or the prevailing form of the whole 
head, may not have some relation to the perfection of the intellect, 
it would be bold to affirm. Most anatomists have believed that they 
have ; hut we must distinguish this question from the speculations of 
Drs. Gall and Spurzheim, opinions which they have attempted to 
engraft upon the acknowledgment of men every way worthy of 
credit.* 
* The tyranny of inveterate prejudice is very distinctly manifested in the foregoing 
remarks of the author, relative to the views of Gall and Spurzheim, which, we are 
sorry to find, as little understood by him as the generality of those who consider 
themselves bound to oppose, what they are pleased to denounce as “ delusions” and 
speculations. The canons of inductive philosophy demand an accurate examination 
of the facts upon which judgments are to be formed, or from which principles are to 
be deduced. Instead of setting forth, as our author and others'do, to ov erturn the 
observations of Gall and Spurzheim by force of argument, and play of words, these 
opponents should examine the previous question, of the degree to which the doctrine 
is supported by fact, or nature, and the extent of evidence to be adduced in its favour, 
independent ot all theory or system. If it be true, that certain protuberances of the 
skull are found in numerous individuals, and each of these individuals are remarkable 
for the possession of given qualities or dispositions of mind—and, if it be true, that 
a number of persons are found wanting in the same qualities of mind, and, at the 
same time, destitute of the first mentioned protuberances of the skull—it is perfectly 
justifiable, after a sufficiently extensive examination has been made to decide upon 
the general declare that the protuberance is a correct indication of the mental 
quality ; or that *he manifestation of the mental qualities indicates the presence of 
certain protuberances upon the skull. This is the foundation upon which the doc- 
trines of Gall and Spurzheim rest—purely upon observation—and this is the reason 
why these doctrines have bo triumphantly outlived all the misrepresentation and 
violence of opposition. 
In this view of the case, it is altogether unessential whether the protuberance be 
caused by the brain within, or the membranes or bone without. The lact of the rela- 
tion between the natural protuberance and the intellectual character, is not in the 
slightest degree altered by our being unable to account for it. It is because We com- 
mence with a determination to see and believe, in a certain way, that our improvement 
is so much impeded, and our advances are so slow. We appear afraid to discover a 
truth, lest we be obliged to relihquish some cherished notion, and wc find as much 
fault with those who attempt to arrive at a better knowledge, as if they' were doing 
so with a view to our injury. If we remain unwilling to submit to the evidence of 
our own senses, we certainly are under no necessity of denouncing those who do : 
yet such is the perverseness of our nature, that nothing is more common than this 
preposterous conduct. 
Let it be granted for a moment, that the facts observed by Gall and Spnrzheim are 
supported by general observation, and then let it be fully admitted, that the develop- 
ment of the brain is not always indicated by protuberance; we are driven to the 
necessity—not of denying the (acts, nor of showing their incompatibility with com- 
monly received opinions, but of allowing that we are not able to explain the connexion 
between the outward and visible sign of the inward and intelligent principle. This 
supposed case is the actual one: Gall and Spnrzbeim’s observations, as a general 
rule, are supported and confirmed by the observations of all competent investigators. 
The natural protuberances of the skull are correct indications of the existence of 
certain mental qualities—the development of the brain docs not uniformly corres- 
pond to the protuberances—and this fact is not of the slightest importance in the de- 
cision, although it may be entirely contrary to our preconceived views. We may 
explain the case according to the best of our abilities, but none of our explanations 
can possibly alfect the state of the fact, which must rest upon unbiassed observation 
alone. 
As a general rule, it is perfectly safe to infer, that the opponents of Gall and Spurz- 
heim do not understand the exact nature of the case against which they dispute. At 
least, no man who has ever set himself honestly to work to examine the subject fairly, 
has remained in opposition. A great degree of ingenuity has been wasted in discus- 
sion on both sides. The opposition, taking it for granted, that the whole doctriue is 
one supported, merely by plausible arguments, and, therefore, to be overthrown by 
argumentation—-and the defenders ot Gall and Spnrzheim nnavailinglv endeavouring; REVIEW OF THE BONES OF THE HEAD. 
165 
Varieties in the forms of the Head indicative of national 
peculiarities. 
It is impossible to conceal from ourselves, that much theory, and 
a great deal of misplaced enthusiasm, has had an influence on the 
opinions of physiologists, regarding the varieties of mankind. It 
is, however, allowable to take as a principle, that there will be a 
relation between vigour of intellect and perfection of form ; and 
that, therefore, history will direct us to the original and chief family 
of mankind. We therefore ask, which are the nations that have 
excelled and figured in history, not only as conquerors, but as for- 
warding, by their improvements in arts and sciences, the progress of 
human knowledge ? 
It i3 not to be denied, that there are national peculiarities in form 
of the skull, as there are of features, of colour, and of general form. 
These, in their extremes, are very distinct; hut they are joined, as 
it were, by intermediate degrees of difference ; and there are dis- 
tinctions to be observed in the individuals of any one people, as 
great at least as those which mark national peculiarity. There are 
as great varieties among individuals of the tribes of America, or of 
Africa, as among the nations of Asia or of Europe. 
Among the ancient nations, one great character seems to have 
prevailed: the Assyrians, Chaldeans, Medes, Persians, Jews, the 
Greeks, and Romans, appear to have had their origin and centre in 
the Western part of Asia, perhaps between the mountains of Cau- 
casus and the Caspian Sea. To this day there is in the people 
seated there, Circassians and Georgians, a degree of beauty and 
perfection of form, that at least agrees with this hypothesis'; and 
from this, as the centre of the old Continent and of ancient nations, 
departure from a common form of the head and features is to be ob- 
served in all directions over the face of the globe. It is noticed as 
we depart eastward through Tartary, and to the extreme north- 
eastern parts of Asia even to America. Again, departing from the 
centre, we may descend south-east to the Peninsula of India, and 
the Asiatic Islands, and to those of the great Pacific Ocean. Or, 
on the other hand, we may trace a change towards Egypt and the 
African varieties; or lastly, towards the western extremities of 
Europe"; where in the extreme islands of the west, there is a perfec- 
tion of manly form and feminine beauty, happily combined with quali- 
ties still more to be esteemed, and which are now spread to the New 
Continent, and destined to characterize the larger portion of the 
inhabitants of our globe. 
to induce those to reason from facts, who bare determined previously to be solely 
influenced by prejudice. The rational student has only to examine candidly for him- 
self, without reference to any predetermination, and the result will be perfectly satis- 
factory. 
But a few years hare elapsed since the writer of this note was filled with zeal 
against the views of Gall and Spurzheim, and even deemed it his duty to join the 
hue and cry against then) ; so much was his mind imbued with the prejudices derived 
from the fulmioations of a public teacher, whose “zeal,” unequivocally, on this 
subject, at least, was not “according to knowledge.” An investigation of the evi- 
dences on which Gall and Snurzheiin’s views rely for support, fully dissipated the 
clouds in which the subject had been involved by misguided ignorance, and taught 
with force, the valuable lesson, that no judgment should be formed in matters of 
science, without a careful examination of the facts connected therewith.—J. D. G 166 
KEVlEtV OF THE BONES dF THE HEAI>. 
These varieties are distinguishable into five grand families : 1. In 
the people seated between Mount Caucasus and the Caspian, there 
is observed a due balance between the cranium and bones of the 
face, that is a full development of the cranium or brain-case, and, 
as we may suppose, a perfection in the organ of intellect ; a due pro- 
portion between the bones of the face, both in comparison with the 
cranium and among each other ; so that the face is small, the outline 
smooth, the contour of the features regular, and there is no harsh- 
ness from their undue prominence. With this there is combined 
beauty of the frame generally : long hair and fair skin, and blooming 
complexion, varying with emotion, and an index of the mind not to 
be neglected in estimating the perfection of the human body. This 
is the white variety of mankind, which spreads over Western Asia 
and Europe. The form of the skull is considered as the medium 
and more perfect form, between the Mongolian races, in which the 
face is compressed, so as to he extended laterally, and the Ethiopian, 
which exhibits the jaws lengthened, and the face projecting from a 
receding forehead. 
II. The Mongolian variety extends to the Calmucks, the Tun- 
gooses of China, and round by Siberia to the transition forms of the 
Esquimaux, and the Greenla ider. i he cranium is globular, the 
bones of the face broad and flattened, the os frontis broad and flat, 
the malar bones projecting laterally, the orbits large and open, the 
superciliary ridges elevated, corresponding with the Calmuc counte- 
nance ; the face is broad, the eyes are apart, and the space between 
them flat, the aperture of the eyelids is narrow, and the nose round. 
III. The third variety is the Ethiopian, and comprehends the 
well-known African skull. The head is the reverse of the globular 
form. The great peculiarity is not, as has been supposed, in the 
comparative size of the hones of the face, over the cranium, hut 
merely in the size of the teeth and jaws, and the forms of the hones 
connected with the teeth in office, as giving origin to the muscles 
which move the jaws; and here l may observe, that whatever pecu- 
liarity of form may distinguish the teeth and jaws of any nation, there 
is always a correspondence in the soft parts placed over them, and 
hence the thick and fleshy lips, and the heavy cheeks of the African, 
are combined with their protuberant jaws and teeth.* 
IV. The fourth variety includes the native Americans ; and a race 
arriving from the eastern extremity of Asia, may be traced down the 
North American continent, until it meets the native of the South, 
the Caribbees, or Caribs, who have the bones of the face broad, but 
not flat, prominent cheek hones, a short forehead, the eyes deep, 
and the bones of the nose developed, but the nose flattened. 
V. The fifth is the Malay variety, which is intermediate between 
the Asiatic and the Negro. It would appear as if mankind had 
spread more easily by the influence of the winds and the currents of 
the ocean, than by the regular progress of wandering tribes. The 
* Some years ago I made a comparison between the extreme forms of the European 
and Negro skull. This I did by suspending them on a rod introduced through the 
foramen magnum. 1 then compared their position and the inclination of the facial 
line. See the Philosophy of Expression. Second edition. OP THE MUSCLES. 
167 
peculiarities under this head may be traced from the Red Sea, along 
the coasts of Hindoostan ; through the straits of Malacca, to the 
islands of Sumatra, Java, and the Celebes, to New Guinea, to New 
Holland, and Van Dieman’s Land. The skull of a Huggess, from the 
island of Celebes, has the low forehead and the prominent jaws of 
the Negro, with the lateral projection of the face of the Mongolian 
variety, a combination which we might expect on looking to the map 
of Eastern Asia. Captain Cook has informed us, that among the 
Friendly Islanders, he met with hundreds of European faces, and 
“genuine Roman noses.” In the islands of the Pacific Ocean, 
there is scope for the re-union of the families of mankind ; arrivals 
from the North of the American Continent: men sprung from the 
natives of the Southern Continent of America: the Ethiopian 
extreme, floating through the Eastern Archipelago, and meeting the 
descending current of the maritime people of China, Corea, and 
Japan, from varieties and transitions. In the Marquesan, Society, 
Friendly, and Sandwich islands, the Caucasian variety prevails, and 
it meets in the New Hebrides and New Zealand, with the tribes of 
New Guinea and New Holland. 
OF THE MUSCLES. 
l’HEIK TEXTURE, AND THE VARIETIES IN THE ARRANGEMENT OF 
THEIR FIBRES. 
The muscles are the appropriate organs of motion. They are 
distinguished, by their peculiar texture, and by their singular vital 
property of contraction.* 
The muscle is the only proper fibrous texture in the human frame. 
These fibres have the power of contracting, and are the active 
agents, in contradistinction to the bones and tendons, and ligaments, 
which are passive instruments under the influence of the muscles. 
The muscular fibres are formed into packets, or fasciculi: these 
fasciculi are variously ordered or arranged in the several muscles, 
and adapted to the action to be performed. 
The proper muscular fibres are every where enveloped by the 
common cellular substance. Towards the extremities of the'mus- 
cle, the proper fibres become fewer, and begin successively to ter- 
minate ; by which the cellular membrane, being freed from the in- 
terposition of the fibres, the divisions of it approach-, and become 
more firmly combined, so as to form a tendon or rope. This ten- 
don holds relation to each fibre of the proper muscle ; and when 
these fibres contract, they concentrate and unite their power upon 
the tendon. The tendons, then, are not the continuations of the 
fibres of the proper muscle, but of the interstitial cellular membrane. 
Every muscle is supplied with arteries, veins, lymphatics, and 
* At the end of the history of the muscles, the subject of muscular poxocr is 
treated of. 168 
OF THE MHSCLES. 
nerves. W ithout nerves they would be insulated parts, contracting 
perhaps spasmodically and irregularly; but through the nerves 
these contractions are regulated so as to be efficient in the economy 
of the system, or the motions of the body. 
The muscles are divided into simple and compound ; the simple 
muscles are those which have their fibres in a similar direction and 
disposition. The most common being the ventriform, so called 
because the middle is large, and they diminish gradually towards 
their tendons or extremities. 
I have given here the example of the ventriform muscle in the 
biceps, which, as it has two heads or tendinous origins running into 
one belly, is so named. Another simple muscle is when the fibres 
are laid flat and parallel: these do not terminate in a round tendon, 
but in a broad web of the same material. The muscles are radiated; 
that is, their fibres are laid diverging, or like the radii of a circle. 
This is the pectoralis 
major, which is an 
example of the fibres 
converging to their 
tendinous insertion. 
Or they are penni- 
form; that is, re- 
sembling the fea- 
thers of a quill, the 
fibres running paral- 
lel, but all of them 
oblique to their tendons. There is a double penniform muscle, which, 
indeed, is the form most like a quill or feather ; for a double range of 
parallel fibres are obliquely inserted or attached to the tendon, the 
tendon running up between them. There are muscles, which are 
called ’complicated, from their having two or more tendons, and a 
variety in the insertion of oblique fibresinto these tendons. From 
the different disposition of the fibres results the absolute force of the 
muscles ; but the mode of the attachment, or, as it is termed, the 
insertion of their tendons, determines their real effect. 
The muscles accomplish very different purposes. Their first, or 
most important purpose, is to move the fluids through the intestines 
and hollow tubes, thus performing the mQtions necessary to the 
vital functions.* Besides these, they conform themselves, com- 
monly, to the apparatus of the frame. 1. They envelope and com- 
* They embrace and contract on the hollow viscera, as the bladder and nterus. OF THE MUSCLES. 
169 
press, and sustain the viscera, as the abdominal muscles. 2. They 
lengthen, shorten, or compress some organ, as the tongue. 3. They 
widen or contract some aperture, as the sphincter muscles. 4. They 
relax, or draw up, or render rigid some valve, or septum, or curtain, 
as the velvum of tli$ palate. 5. They roll or move, and are thus 
subservient to the organs of the senses, as the eye and ear. 6. They 
are inserted or attached to the bones, and thus perform the voluntary 
motions. It is principally in this last office that we have now to 
study them. The human body is estimated to have 450 muscles, 
differing, however, in the sexes, and according to individual pecu- 
liarities. In these examples, with little exception, the fibres run 
obliquely to their insertions; by which they lose force, but gain 
velocity, in the motion communicated to their point of insertion. 
For the purpose of dissection, it is as necessary to understand 
the varieties in the forms of the tendons, as of the muscles. The 
tendons are textures of great strength and firmness, which are in- 
termediate between the irritable fibres, forming a muscle, and the 
points of attachment. The ligaments are of the same texture, but 
they want this part of the definition; they are stretched from one 
fixed point to another, not intermediate between muscular fibres 
and bone. 
Very often the tendon of a muscle assumes a round form, and 
resembles a rope ; but they are also of a flat form, or extended1 
into a web, or they are radiated, and spreading in digitations. It 
is difficult actually to distinguish the expanded tendons from the 
fascre and aponeuroses, which are sheets of a tendinous inter- 
texture, to which very often muscles are attached, but which have 
other offices, besides affording attachment of muscles. 
The fascle cover and embrace the limbs like bandages. Their 
under surfaces have, generally, divisions and subdivisions, which 
sink down between the muscles, and serve to class them, and some- 
times to direct their action, and to hold them as in a sheath. The 
aponeurosis is a term somewhat loosely applied : we shall consider 
it as expressive of those sheets of tendinous texture, which are 
continued from the tendons or ligaments, without, fairly embracing 
the limb. They differ in density and firmness from the shining, 
silvery, expanded tendon to the layer of the common, soft, cellular 
texture. 
Another variety of the tendon, or ligament, i3 the ring of firm 
ligamentous substance, which is in the neighbourhood of the joints, 
and which ties down the tendons, which would otherwise start from 
their places : and which, furnishing sheaths to the tendons, directs 
their course, and, as. it were, appropriates the action of the muscle. 
See further of these subjects under the title of twe oeIt.uuaiu 
SUBSTANCE. 170 
OF THE MUSCLES OF THE F£€E, EYE, 
AND EAR. 
1. MUSCLES OF THE FACE. 
Gccipito- 
Frontalis. 
The occipito-frontalis is abroad and thin muscular expansion, 
which covers all the upper part of the cranium. It consists of 
two bellies, with an intermediate sheet of flat tendon. The one 
belly covers the occiput, the other covers the forehead, and the ten- 
dinous expansion covers all the upper part of the head ; by which 
it has happened that the most eminent anatomists, as Cowper, 
(p. 29.) have misnamed its tendon, pericranium; many have 
reckoned it two distinct muscles, viz. the occipital and frontal, 
while others (because of a sort of rapha, or line of division in the 
middle of each belly,) have described four muscles, viz. two frontal, 
and two occipital muscles. But it is truly a double-bellied muscle ; 
and the broad thin tendon, which belongs equally to both bellies, 
lies above the true pericranium, and slides upon it. The muscle is 
therefore named, with strict propriety, occipito-frontalis, sometimes 
epicranius* sometimes biventer, or digastricus capitis. 
Origin.—The occipital portion is the fixed point of this muscle, 
arising from the superior transverse ridge of the occipital bone, and 
covering the back part of the head, from the mastoid process of 
one side, round to that on the opposite side of the head. And by 
the perpendicular ridge of the occiput, it is marked with a slight 
division in the middle. 
Insertion.—The fore belly of the muscle which covers the fore- 
head, is fixed more into the skin and eye-brows than into the bone : 
it is slightly attached to the bone, near the inner end of the orbitary 
ridge, and especially about the inner corner of the eye, and the 
root of the nose, by a smaller and acute pointed process called the 
descending slip of the occipito-frontalis ; but still its chief attach- 
ment is to the skin under the eye-brows. 
The tendon or thin membranous expansion which joins the two 
bellies, is exceedingly thin: it has on its inner side much loose cel- 
lular substance, by which, though attached to the true pericranium, 
it slides easily and smoothly upon it; but its outer surface is so firmly 
attached to the skin, and its fore belly adheres so firmly to the eye- 
brows, that it is very difficult to dissect it clean and fair. 
I consider the occipital belly as the fixed point, having a firm 
origin from the ridge of the bone ; its frontal belly has the loose end 
attached, not to the os frontis, but to the eye-brow and skin, and its 
office, that of raising the eye-brows, wrinkling the forehead, and 
corrugating the whole of the hairy scalp. It is a muscle expressive 
of and it is sometimes so thin as hardly to be perceived. 
Or. sup. 
transverse 
ridge of 1 
the occipi- 
tal bone, 
and from 
hack part 
of the 
mastoid 
pro. of 
temporal 
bone. 
1. In. or- 
bicularis 
palpebr® 
skin of the 
eyebrow. 
2. Super- 
ciliary 
ridge ; 
3. by a dis- 
tinct slip 
to the in- 
tern. nng. 
process. MUSCLES OF THE FACE, &C. 
171 
There is a small, neat, and pointed slip of the occipito-frontalis, 
which goes down with a peak towards the nose, and is inserted into 
the small nasal bone. This process being much below the end of 
the eye-brow, must pull it down wards ; so that while the great mus- 
cle raises the eye-brow and skin of the forehead, this small nasal slip 
pulls the eye-brow downwards again, restoring it to its place, and 
smoothing the skin. 
II. The corrugator supercilii is a small muscle which lies along 
the upper margin of the orbit, under the last. Its origin is from the 
internal angular process of the frontal bone. Thence it runs out- 
ward, and a little upward, to be inserted into the skin under the eye- 
brow. Its action is to knit and corrugate the eye-brows. 
III. Orbicularis palpebrarum, is a neat and regular muscle, 
surrounding the eye, and covering the eye-lids in a circular form. It 
should be considered as two muscles, for there are a set of pale 
fibres running on the eye-lids, which move in the rapid and involun- 
tary motion of the eye-lids. There are other stronger and redder 
fibres, which run round the orbit, and these are only used in passion, 
or in spasmodic closing of the eye-lids, as when something irritates 
the organ, and forces out the tears. It has one small tendon in the 
inner corner of the eye, which is both its origin and insertion : for it 
begins and ends in it. This small tendon is easily felt through the 
skin in the inner corner of the eye. It arises by a little white knot 
from the nasal process of the upper jaw-bone. Its fibres immedi- 
ately become muscular, and spread out thin over the upper eye-lid. 
They pass over it to the outer corner of the eye, where they cross a 
little, and having covered just the edge of the temple with their thin 
expanded fibres, they return in a circular form round by the lower 
eye-lid to the point from whence they had set out. It is rather a 
little broader over the lower eye-lid, extends itself a little upon the 
face beyond the brim of the socket, both at the temple, and upon the 
cheek ; and its fibres cross each other a little at the outer angle ; so 
that some understanding this crossing as a meeting of fibres from 
the upper and from the lower muscle, have described it as two semi- 
circular muscles. And those fibres which are next to the tarsus or 
cartilaginous circle of the eye-lids, were distinguished by Riolan, 
under the title of musculus ciliaris. Our name expresses the com- 
mon opinion, that it is a circular muscle, whose chief point or ful- 
crum is in the inner corner of the eye, and which serves as a sphincter 
for closing the eye. It squeezes with spasmodic violence, when the 
eye is injured, as by dust. And by its drawing down the eye-lid so 
firmly, it presses up the ball of the eye hard into the socket, and 
forces the lachrymal gland that is within the socket, so as to procure 
a flow of tears. 
IV. Levator palpebrje superioris.—This small muscle arises 
deep within the socket, from the margin of that hole which gives 
passage to the optic nerve. It begins by a small flat tendon in the 
bottom of the optic cavity, becomes gradually broader as it goes 
over the eye-ball; it ends in the eye-lid, by a broad expansion of 
muscular fibres, which finally terminate in a short flat tendon. It 
Descend- 
ing slip nf 
the last 
muscle. 
Or. intern, 
angular 
process. 
In. skin of 
the eye- 
brow. 
Orbicula. 
ris octili. 
Or. Qr,l»ir 
tary pro. 
of the sup. 
maxillary 
bone. 
/(i. the 
same. 
Musculo* 
ciliarn. 
Levator 
palpebrns 
superior!*. 
Or. upper 
part of 
.margin of 
foramen 
optfenm. 172 
MUSCLES OF TIIE 
in. whole 
Buperk>rf 
ciliary 
Actionof 
time mus- 
cics. 
]ifis under the orbicularis palpebra, is inserted into the whole length 
the cartilage of the tarsus, and raises and opens the upper eye-lid. 
The occipito-frontalis, but especially its occipital belly, raises the 
eye*ftrows ; the pointed slip of the same muscle pulls them down- 
wards; the corrugator pulls them directly inwards, and knits the 
brows: the levator palpebrae opens the eye-lid, and the orbicularis 
oculi closes the eye. Whether certain fibres from the platysma- 
myoides, (a thin flat muscle which mounts from the neck over the 
-cheek,) may not pull down the lower eye-lid, or whether some strag- 
gling fibres, arising from the zygoma, may not have the appearance 
of a depressor of the lower eye-lid, it is not necessary to determine, 
since there is no regularly appointed muscle, and the lower eye-lid 
)s almost immoveable, at least in man. 
MUSCLES OF THE :\’OSE A!VD MOUTH. 
Levator 
labii supe- 
riors alse 
<)tic nasi. 
Or. Nasal 
pro. of 
sup. max. 
bone. 
V. Levator labii superiors and alje nasi.—Cowpcr do- 
scribes the levator labii superioris as an irregular production of the 
frontalis, extending along the nostrils. But it is a neat and delicate 
muscle, which arises, by a small double tendon, from the nasal pro- 
cess of the upper jaw-bone, close by the tendon of the orbicularis 
oculi. It is one little fasciculus of muscular fibres above ; but as it 
approaches the nose, it spreads out broader, dividing into two small 
fasciculi, one of which is implanted into the wing or cartilage of the 
nose, and the other passing the angle of the nose, goes to the upper 
lip : thus it is pyramidal with its base downwards, and was named 
pyramidalis by Casserius, Winslow, and others. It is called by 
Cowper dilator al® nasi; it raises the upper lip, and spreads the 
nostrils wide, as is observed in a paroxysm of rage, or in asthmatics. 
VI. The levator labii superioris proprius is distinguished by 
the name of levator proprius, because there are two others: one be- 
longing to the angle of the mouth, and consequently to both lips ; 
and one common to the lip and nostril. 
The levator proprius is often named musculus incisivus, because 
it arises from the upper jaw, just above the incisores, or cutting 
teeth, and consequently just under the edge of the orbit; it is broad 
at its origin ; it lies fiat and runs downwards, and obliquely inwards, 
to the middle of the lip till it meets its fellow just in the filtrum.* It 
pulls the upper lip and the septum of the nose directly upwards. 
It generally receives a slip from the orbicularis oculi. 
VII. The levator anguli oris, is called also levator commu- 
nis labiorum, because it operates equally on both lips. It is named 
caninus ; for as the last-named muscle rises from the upper jaw- 
bone above the incisors or cutting teeth, this arises above the canini 
or dog-teeth, or above the first ‘grinder, by a very short double ten- 
don. The exact place of its origin is half way betwixt the first 
grinder and the infra orbitary hole : it is mixed with the orbicularis 
oris, at the corner of the mouth, so that it raises the angle of the 
mouth upwards. 
In. upper 
lip and ala 
itasi. 
Levator 
labii supe- 
riors pro- 
prius. 
Or. Orbit, 
pro. of 
sup. max. 
b. above 
the infra 
orbit, fora- 
men. 
In. upper 
lip and 
orbicularis 
muscle. 
Levator 
anguli 
oris. 
Or. super, 
maxillary 
b. between 
the first 
molaris 
and the 
inf. orb. 
for. 
In. angle 
of the 
mouth. 
♦ The filtrum is the superficial gutter along the upper lip from the partition of the 
nose to the tip of the lip. 173 
PACE, EYE, AND EAR. 
VIII. The zygomaticus major arises from the cheek-bone near 
the zygomatic suture; it runs downwards and inwards to the corner 
of the mouth ; is a long and slender muscle, which ends by mixing 
its fibres with the orbicularis oris and tire depressor of the lip. 
IX. The zygomaticus minor arises a little higher upon the cheek- 
bone, but nearer the nose ; it is much slenderer than the last, and is 
often wanting. In negroes we frequently find three zygomatic 
muscles. 
It is the zygomatic muscle that marks the face with that line which 
extends from the cheek-bone to the corner of the mouth, and which 
is so strong in many. The zygomatic muscles pull the angles of the 
mouth upwards as in laughter ; or one of them distorts the mouth, 
whence the zygomatic muscle has got the name of distortor oris ; 
the strong action of the muscle is particularly seen in laughter, rage, 
grinning. 
X. Buccinator.—The buccinator was long thought to be a 
muscle of the lower jaw, arising from the upper alveoli, and inserted 
into the lower alveoli to pull the jaw upwards ; but its origin and in- 
sertion, and the direction of its fibres, are quite the reverse of this. 
For this large flat muscle, which forms, in a manner, the walls of 
the cheek, arises chiefly from the coronoid process of the lower jaw- 
bone, and partly also from the end of the alveoli or socket process of 
the upper-jaw, close by the pterygoid process of the sphenoid bone; 
it arises also from the upper jaw ; it goes forwards with direct fibres 
to be implanted into the corner of the mouth, within the orbicularis. 
It is thin and flat, and forms the walls of the cheek ; it is perforated 
in the middle of the cheek by the duct of the parotid gland. Albinus 
describes two irregular sets of fibres besides mentioning those which 
are running directly to the angle of the mouth : 1. One narrow slip 
which runs in a semicircular direction, and joins the inner surface of 
the upper lip ; 2. Another considerable slip which runs much in the 
direction of the orbicularis towards the middle of the lip, this he calls 
the appendix of the buccinator. These are its principal uses; that 
it flattens the cheek, and so assists in swallowing liquids : that it 
turn3, or helps to turn, the morsel in the mouth while chewing, and 
prevents its getting without the line of the teeth : in blowing wind 
instruments, it both receives and expels the wind : it dilates like a 
bag, so as to receive the wind in the cheeks ; and it contracts upon 
the wind so as to expel the wind, and to swell the note : In blowing 
the stronff wind instruments, we cannot blow from the lungs, for it 
stresses tne breathing, but reserve the air in the mouth, which we 
keep continually full; and from this it is named, from blowing the 
trumpet, the buccinator. 
XI. Depressor anguli oris.—The depressor anguli oris is a neat 
small triangular muscle, and is indeed very commonly named muscu- 
lus triangularis labiorum, from its shape. The base of the trian 
gle is at the line of the lower jaw, where the muscle rises with a fat 
fleshy edge, more than an inch in breadth. It grows smaller gradually 
as it rises towards the corner of the mouth, where it is implanted, 
small almost in a point, and directly opposite to the zygomatic and 
levator muscles : and as the zysromatic rnusrle makes a line from 
Zygomati- 
cus major. 
Or. os 
mal® near 
the zygo- 
matic su- 
ture. 
In. angle 
of the 
mouth. 
Zygomati- 
cus minor. 
Or. os 
malae 
higher and 
nearer the 
nose than 
the last. 
In. the lip 
between 
the lev. 
prop, and 
zygo. ma- 
jor. 
Buccina- 
tor. 
. Or. 1. al- 
veolar pro. 
of lower 
jaw. 
2. the cor- 
onoid pro. 
3. the 
space be- 
tween the 
last mola- 
ris of 
upper jaw 
and ptery- 
goid pro. 
, of sphe- 
noid bone. 
4. the 
point of 
the ptery. 
pro. 
In. into 
the angle 
of the 
mouth. 
Use. 
Depressor 
annuli 
oris. 
Or. the 
base of 
the lower 
jaw near 
the chin. 
In. the 
angle of 
the noouth. 174 
MUSCLES OF THE 
the cheek down to the angle of the mouth, this makes a lme from 
the chin up to the corner of the mouth. It is chiefly active in ex- 
pressing the passions, and gives form to the chin and mouth. In 
cheerful motions, as laughter, smiling, &c. the zygomatics and 
levators pull the angles of the mouth upwards. In fear, hatred, re- 
venge, contempt, and the angry passions, the triangulars pull the 
corners of the mouth downwards ; and at the place where these 
meet, there is formed a sort of rising at the angle of the mouth : for 
a great many tendons are crowded into this one point; the zygoma- 
tic, levator, depressor, and orbicularis oris muscles meeting and 
crossing each other at this place. 
XII. The depressor labii inferioris is a small muscle, the dis- 
covery of which Cowper claims for himself. It is a small muscle, 
lying on each side of the chin, which, with its fellow, resembles very 
much the levators of the upper lip. The depressor labii inferioris 
arises on each side of the chin, from the lower jaw-bone, under the 
line of the triangular muscle. It grows obliquely upwards and 
inwards, till it meets its fellow in the middle of the lip ; and where 
the muscles of the opposite side meet, there is a little filtrum or 
furrow on the lower lip, as on the upper one. It mixes its fibres 
with the orbicularis, and its use is to pull the lip downwards; each 
muscle is of a square form, and thence has been often named quad- 
ratus gena:, the square muscle of the chin. 
XIII. The orbicularis oris, or muscle round the mouth, is often 
named constrictor oris, sphincter, or osculator. It is very 
regular ; it is an inch in breadth, and constitutes the thickness of 
the lips : it lies in the red part of the lips, and is of a circular form, 
surrounding the mouth after the same manner that the orbicularis 
oculi encircles the eye. We see a degree of crossing in the fibres 
at the angles of the mouth, whence it has been considered by many 
not as a circular muscle, but as one consisting of two semicircular 
muscles, the semi orbicularis superior, and semi orbicularis 
inferior. Its fixed points are the two angles of the mouth ; at 
that swelling which is formed by the union of the zygomatic, triangu- 
lar, and other muscles, part of it takes origin from the alveolar pro- 
cess of the canine teeth. The chief use of this muscle is to contract 
the mouth, and antagonize the other muscles which I have just de- 
scribed. Often a small slip runs up from the middle of the upper 
lip, to the tip of the nose; it is the nasalis labii superioris of 
' Albinus ; it lies exactly in the furrow of the filtrum, and is occa- 
sionally a levator of the upper lip, or a depressor of the tip of the 
nose. 
These muscles of the nose and lips are not useful merely in ex- 
pressing the passions ; their great office is to perform those continual 
movements, which breathing, speaking, chewing, swallowing, re- 
quire. There are muscles for opening the mouth in various direc- 
tions, which are all antagonized by this one, the orbicularis oris. 
The levator labii superioris, and the depressor labii inferioris, sepa- 
rate the lips and open the mouth. The levator anguli oris, along 
with the zygomatic muscles, raises the cheek, and dilates the corners 
of the mouth. The buccinator pulls the corner of the mouth 
Depressor 
labii infe- 
rioris. 
Or. base 
of lower 
jaw. 
In. middle 
of lower 
lip. 
Orbicu- 
laris oris. 
Semi or- 
bicularis. 
Attached 
to the 
alveolar 
process. 
Nasalis 
labii supe- 
rioris. 
Their ac- 
tion. FACE, EYE, AND EAK. 
175 
directly backwards, opening the mouth. The angularis oris also 
dilates the mouth, pulls the angles of the mouth downwards and 
backwards, and forms it into a circle, if the others act at the same 
time; but the orbicularis oris is the largest and strongest (formed, 
as it were, by the fibres of all these, taking a new direction, and 
turning round the lips,) shuts the mouth, and antagonizes them all, 
and from an opening as wide as the mouth can require, shuts the 
mouth at pleasure, so closely, as to retain the very breath against all 
the force of the lungs. It is the true antagonist of all the other 
muscles, and they and the orbicularis mutually re-act on each other, 
in alternately opening and closing the mouth. This phenomenon 
of the orbicularis muscle, dilating to such a wideness, and in an 
instant closing the mouth again, with such perfect accuracy, as to 
retain the breath, puts to naught all the vain calculations about the 
contraction of muscles, as that they can contract no more than one 
third of their length ; for here is an infinite contraction, such as no 
process can measure. It is u paralysis of these muscles that SO 
often occasions a hideous distortion of the face ; for when one side 
of the body falls into palsy, the muscles of one cheek cease to act; 
the muscles of the other cheek continue to act with their usual de- 
gree of power. This contraction of the muscles of one cheek ex- 
cites also the orbicularis oris to act, and so the mouth is pursed up, 
and the lips and angles of the mouth are drawn towards one side. 
There are some smaller muscles, which, lying under these, could 
not be described without danger of confusion ; as 
XIV. The depressor labii superioris and alj3 nasi, which is 
very small, and lies concealed under the other muscles. It rises from 
the gum or socket of the fore teeth, and thence is named, by 
Winslow, incisivus medius. It goes into the root of the nostril, and 
pulls it, and, of course, the upper lip down, and is named, by Albi- 
nus, depressor alae nasi. 
XV, The constrictor nasi, or compressor of the nose, is a small 
scattered bundle of muscular fibres, which crosses the wings, and 
goes to the very point of the nose ; for one arises from the wing of 
the nose on each side, and meets its fellow in the middle ridge, 
where both are fixed into the middle cartilage, or into the lower 
point of the nasal bones meeting with the peak of the frontal mus- 
cle, or its scattered fibres. But this muscle is so difficultly found, 
that when Cowper saw it distinctly marked in Bidloo’s 12th table, 
he considered it as a fiction, having sought for it very carefully, but 
in vain. 
And XVI. The levator menti, which arises from the lower 
jaw, at the root of the cutting tooth, has been named incisivus in- 
ferior. It is inserted into the skin, on the very centre of the chin : 
by its contraction it draws the centre of the chin into a dimple ; and 
from its moving the under lip at the same time, it is named levator 
labii inferiors ; sometimes the superbus. 
Depressor 
alae nasi. 
Or. alveo- 
lar pro. of 
the inci- 
sores and 
canine 
teeth. 
In. cor- 
ner of the 
ala of the 
nose, and 
part of the 
uper lip. 
Compres- 
sor naris. 
Or. ant. 
point of 
os. nasi, 
and nasa! 
pro. of 
sup. max. 
bone. 
In. root 
of the ala 
nasi. 
Levator 
labii infe- 
rioris. 
Or. alveoli 
of the inci -- 
sores and 
caninus. 
In. chin, 
MUSCLES OF THE EXTERNAL EAR. 
Though perhaps not one often thousand has the power of moving 176 
MUSCLE3 OF THE 
the outward ear, yet there are many thin and scattered fibres of 
muscles about the root of the cartilage of the ear, to which we can- 
not refuse the name and distinction of muscles; and which serve, 
indeed, to indicate, that nature had intended a degree of motion, 
which, perhaps by the manner of covering the heads of children, we 
may have lost. But in a few, these fasciculi of fibres, have not the 
form only, but the uses of muscles. The celebrated Mr. Mery, was 
wont, when lecturing on this subject, to amuse his pupils, saying, 
pleasantly, “ that in one thing, he 6urely belonged to the long ear'd 
tribe upon which, he moved his ears very rapidly backwards and 
forwards.* 
XVII. Superior auris is named attollens because it lifts the 
ear upwards : it is a very thin, flat expansion, which can hardly be 
distinguished from the fascia of the temporal muscle, upon which it 
lies : it arises broad and circular, from the expanded tendon of the 
occipito-frontalis, and is inserted into the back part of the antihelix. 
XVIII. Anterior auris is a very delicato, thin, and narrow ex- 
pansion, arising about the zygoma, or rather from the fascia, with 
which the zygoma is covered; it is inserted by a tendon into that 
eminence of the helix which divides the concha. 
XIX. The posterior auris is also a small muscle, very delicate 
and thin; but the anterior rises in one small and narrow slip only, 
while this, the posterior, rises commonly, in three narrow and distinct 
slips, from about the place of the mastoid process ;t whence it is 
often named triceps auris. These fibres are often described as 
two distinct muscles, retrahentes: it goes directly forwards to be in- 
serted into the back part of the concha, opposite the septum that 
divides the concha, by tw'o slips. 
But there are still other muscles enumerated, which are not for 
moving the outward ear upon the head, but for moving, or rather 
giving tension to the cartilages of the outward ear. They in all 
probability prepare the cartilages of the ear for receiving and pro- 
pagating the vibrations of sound, inwards along the tube of the ear. 
The ring and other bendings of the outward ear are called helix 
and antihelix, tragus and antitragus ; and this determines the 
names of these ambiguous fibres, which are sometimes found lying 
upon these circles of the outward cartilage, just under the skin. 
XX. The musculus helicis major lies upon the upper, or sharp 
point of the helix or outward ring ; rising from the upper and acute 
point of the helix, and inserted into the same cartilage a little above 
the tragus. 
XXI. Helicis minor rises lower than the former, upon the fore 
part of the helix, and runs across the notch which is in that part of 
the helix that projects into the concha, the muscle having its origin 
above the notch, and its insertion below it. 
XXII. The tragicus lying upon the concha, and stretching to 
the tragus ; takes its origin from the middle of the concha to the 
root of the tragus, and is inserted into the tip of the tragus. 
Superior 
auris. 
Or. ten- 
don of 
occipito- 
frontalis. 
In. back 
part of the 
antihelix. 
Anterior 
auris. 
Or. zygo- 
matic pro. 
In. the 
point of 
the helix 
that di- 
vides the 
concha. 
Posterior 
auris. 
Or. mas- 
toid pro- 
cess. 
In. back 
part of the 
concha. 
* Vide Paliin, who was his pupil. The celebrated Albinus could'more his ear* 
t Fibrae came® transverse, a nobis descriptor,—Valsalva. FACE, EYE, AND EAK. 
177 
XXIII. The antitragi4us lies on the antitragus, running up 
from this cartilage to be inserted into the edge of the concha, at 
the notch on the termination of the helix. 
XXIV. And, lastly, There is the tranversus auris of Albinus, 
which runs in scattered fibres on the back part of the ear from the 
prominent part of the concha to the outer side of the antihelix. 
MUSCLES OF TIIE EYE-BALL. 
The eye-ball is entirely surrounded by muscles, which turn it in 
all directions. There is one muscle on either side, one above and 
one below ; these arise from the very bottom of the socket, spread 
out upon the ball of the eye, and are implanted into its fore part, 
where the expansions of their colourless tendons form what is called 
the white of the eye. Now these four muscles, coming in a straight 
course from the optic foramen to the anterior part of the eye-ball, 
are called the recti, or straight muscles : for their pulling is from 
the bottom of the socket. But there are two other muscles which 
are named the oblique muscles, because they pull from the edges 
of the socket, and turn the eye obliquely ; for they go in a direction 
exactly opposite to the recti. The recti come directly forwards, 
from the bottom of the orbit; these go obliquely backwards, from 
the edge of the orbit; one rises from the lower edge of the socket 
and goes backwards under the eye-ball ; the other rises, indeed, 
along with the recti, in the bottom of the socket, but it has a car- 
tilaginous pulley on the very edge of the socket, at its upper part; 
and its small round tendon first runs through this pulley, and then 
turns down upon the eye, and goes backwards ; so that the straight 
muscles press down the eye-ball deep into the socket, while the ob- 
lique muscles bring the eye-ball forwards, pulling it outwards from 
the socket. 
The truest description of the recti is as of one muscle, since their 
only variety is that difference of place, which is expressed by the 
name of each. 
They all agree in these chief circumstances, that they arise by flat, 
but small tendons, round the margin of the optic hole, arising from 
the circle of that hole, or rather from the periosteum there; and 
there being one above, one below, and one on either side, they com- 
pletely surround the optic nerve, and adhere to it. They are neat 
and delicate which gradually expand each into a fleshy 
belly, which surrounds and covers the middle of the ball of the eye. 
They still go on expanding, till they at last terminate, each in a 
broad, flat, and very wide tendon, which covers all the fore part of 
the eye, up to the circle of the lucid cornea or window ; and their 
white and shining tendons form that enamelled-like part, which lies 
without the coloured circle, and which is named the white of the 
eye, or the tunica albuginea, as if it were absolutely a distinct 
coat. 
Now, the only difference in these straight muscles is in respect of 
length ; for the optic rierve enters the eye, not regularly in the 
centre, but a little towards the inner side, so that the rectus internus. 178 
MUSCLES* OF TtJE 
or muscle nearest the nose, is a little shorter. The rectus externus, 
or muscle nearest to the temple, is a little longer : but the rectus 
superior and the rectus inferior are of equal length. The uses o4' 
these muscles are exceedingly plain. 
XXV*. The kectus superior, lifting the eye directly upwards, 
is named the Museums attollens, the levator oculi or supekbus, 
as expressive of haughtiness and pride. 
XXVI. And the kectus inferior, which is directly opposite to 
it, is named depbimkns oculi or humilis, as expressing modesty and 
submission. 
XXVII. The hectus inteknus is called adducens, as carrying 
the eye towards the nose, or bibitorius, because it directs the eye 
to the cup. 
And (XXVIII.) the rectus externus, the outer straight mus- 
cle, as it turns the eye away, is named abductor oculi, or indig- 
nabundus, expressing anger or scorn. Such is the effect of these 
muscles,that when they act in succession, they roll the eye; but if 
they act all at once, the power of each is balanced by the action of 
its opposite muscle, and the eye is immoveably fixed. So that 
sometimes in our operations, when the couching needle approaches 
the eye, fear comes upon the patient, and the eye is fixed by a con- 
vulsive action, more firmly than it could be by the instruments, or 
by the finger; so that the speculum oculi is after such an accident 
of no use. The eye continues fixed during all the operation, but it 
is fixed in a most dangerous way, by a power which we cannot 
control, and which sometimes, when our operation is for extract- 
ing one of the humours only, squeezes out the whole. 
XXIX. The obliques superior or trochlearis arises along 
with the recti in the bottom of the eye above, and towards the inner 
side, directing its long tendon towards the inner angle of the eye ; 
and there it passes its tendon through that pulley, whose hollow I 
have marked in describing the os frontis, as under the superciliary 
ridge, and near to the inner corner of the eye. It arises by a small 
tendon like one of the recti; it goes over the upper part of the 
eye-ball, a long and slender muscle, whence it is often named lon* 
gissimus oculi, the longest muscle of the eye. It forms a small 
smooth round tendon, which passes through the ring of the cartila- 
ginous pulley, which is in the margin of the socket. The pulley is 
above the eye, and projects farther than the most prominent part of 
the eye-ball, so that the tendon returns at an acute angle, and bends 
downwards before it can touch the eye-ball. And it not only returns 
backwards in a direction opposite to the recti muscles, but it slips 
flat under the body of the rectus superior, and is spread out under 
it upon the middle or behind the middle of the eye, viz. about half- 
way between the insertion of the rectus, and the entrance of the 
optic nerve. 
XXX. The obliquus inferior is, with equal propriety, named 
the musculus brevissimus oculi. It is directly opposite to the obli- 
quus superior, in form, place, office, &c. for it arises from the orbi- 
tary process of the superior maxillary bone, near its union with the 
os unguis: it is short, flat, and broad, with a strong fleshy belly: it 
Obliquus 
superior. 
Or. edge 
of the 
for am. 
opticum. 
In. the 
sclerotic, 
half way 
between 
the inser- 
tion of 
rect. sup. 
and entry 
of the 
optic 
nerve. 
Obliquus 
inferior. 
Or. outer 
edge of 
orb. pro. LOWER JAW, THROAT, AND TONGUE. 
179 
goes obliquely backwards and outwards, lying under the ball of the 
eye ; and it is inserted broad and flat into the ball, exactly opposite 
to the insertion of the obliquus superior muscle. 
These two muscles are said to roll the eye, whence they are 
named musculi circumagentes, or amatorii. It was Winslow’s 
opinion that they had another office, viz. supporting the eye-ball, for 
the operation ofiits straight muscles : for when the obliqui act, they 
pull the eye forwards, the straight muscles resist, and the insertion 
of the oblique muscles at the middle of the eye-ball becomes, as it 
were, a fixed point, a centre or axis round which the eye-ball turns 
under the operation of the recti muscles. The conjoined effect of 
the oblique muscles is to bring the eye-ball forv/ards from the socket. 
The particular effect of the upper oblique muscle is not to bring the 
eye forward, but to roll the eye so as to turn the pupil downwards, 
and towards the nose. And the particular effect of the lower oblique 
muscle is to reverse this action, to turn the eye again upon its axis, 
and to direct the pupil upwards and outwards ; but still there is 
some difficulty here, for if the question be put,—nloes not the eye- 
ball roll in all directions ? we must answer that it does : which, ifit 
were in any measure accomplished through the operation of the 
oblique, there should be four, and not two.* 
of sup. 
/na*'ciero- 
ties oppe- 
Sl*f.the 
superior, 
MUSCLES OF THE LOWER JAW, THROAT, AND 
TONGUE. 
MUSCLES OF THE LOWER JAW. 
The lower jaw requires muscles of great power to grind the food ; 
and accordingly it is pulled upwards by the strong temporal, massc- 
ter, and pterygoid muscles ? but, in moving downwards, the jaw 
almost falls by its own weight, and having little resistance to over- 
come, any regular appointment of muscles for pulling down the jaw 
is so little needed, that it is pulled downwards by muscles of such 
ambiguous office, that they are equally employed in raising the 
throat, or pulling down the jaw, so that we hardly can determine to 
which they belong ; for the chief muscles of the throat, coming 
from the lower jaw, must, when the jaw is fixed, pull up the throat, 
or when the throat is fixed, depress the jaw. 
XXX. The temporal muscle is the great muscle of the jaw.t 
Tempo- 
ral^. 
* The subject of the action of these muscles is taken up again, when discussing the 
physiology of the eye. See Vol. II. 
f Temporal Fascia.—Before dissecting these muscles of the jaw, the student must 
make himself acquainted with the strong fascia which covers the side of the head, 
and covers the temporal muscle. This strong (tndinons web is continued from the 
periosteum of the temporal ridge of the os frontis, and from the jugum ; it extends 
over the temporal muscle, and is attached to the ridge of the parietal bone, where it 
may be again traced into the pericranium. The surgeon has to take particular notice 
of this fascia, for in wounds of the head, when matter gets under it, the fluid sink' 
deep, and perhaps appears at the angle of the jaw. 180 
MUSCLES OP THE 
Or. l. sc- 
ridge of 
parietal 
2. 
squamosa 
ra/h™1*0* 
5. ex. ang. 
pro. of 
bone.31 
4. tempo- 
ofViietC 
sphenoid, 
5- zyg°- 
cess.0 l'r° 
6. from a 
rcriLgOie 
muscle. 
coronoid 
pro. of in- 
feriormax. 
Masse ter 
Or. l. sup. 
“a*-kone. 
mal®, and 
3. the zy- 
fts'whole 
length. 
side of the 
an?le and 
the base 
maxMainf 
jt arises from all the flat side of the parietal bone, and from the 
sphenoid, temporal, and frontal bones, in that hollow behind the 
eye, where they meet to form the squamous suture. It arises also 
fr°m 'nner surface of that strong tendinous membrane which is 
extended from the jugum to the semicircular ridge of the parietal 
k°ne‘ The fibres are bundled together and pressed into a small 
compass, so that they may pass under the jugum : there they take 
a new hold upon the inner surface of the jugum ; the muscle is of 
course pyramidal, its rays converging towards the jugum ; its mus- 
cular fibres are intermixed with strong tendinous ones ; it is particu- 
larly tendinous, where it passes under the jugum ; and it has both 
strength and protection from that tendinous plate which covers it in 
the temple. Its insertion is into the coronoid process of the lower 
jaw-bone ; not merely into the tip of the horn, but embracing it all 
round, and down the w7holc length of the process, so as to take the 
firmest holtl- 
XXXI. The masseter is a short, thick, and fleshy muscle, 
g*ves the rounding of the cheek at its back part. It arises 
from the upper jaw-bone, at the back of the antrum, and under the 
cheek-bone, and from the lower edge of the zygoma. It lies upon 
*be outside °f the coronoid process, covering the branch of the 
lower jaw quite down to its angle. It is particularly strong, has 
many massy bundles of flesh, interspersed with tendinous strings, 
Indeed, in dissection, this muscle may be divided into two portions, 
which cross each other obliquely ; which reminds us that the action 
ie musc^ei's not simply to close the teeth, but also to pro- 
duce the lateral or grinding motions of the jaw. The jaw is very 
Mrmly pulled up by these two, ivhich are its most powerful muscles : 
aRd when we bite, we can feel the temporal muscle swelling on the 
flat part of the temple, and this, the masseter, upon the back part of 
cheek. The parotid gland lies on its upper part, and the duct 
of the gland (as it crosses the cheek) lies over this muscle. 
XXXII. XXXIll. The two pterygoid muscles (of which there 
are f°ur in tilU two on each side,) are named from their origin to 
the pterygoid processes of the sphenoid bone. The pterygoideus 
IXTKRNUS *s that one which rises from the internal or flatter pterv- 
goid process, and which goes downwards and outwards to the angle 
0f the jaw on its inside, it fills up the fossa pterygoidea. 
The pterygoideus externus arises from the outside of the ex- 
ternal plate of the pterygoid process of the sphenoid bone, and from 
part °f the upper maxillary bone. It is inserted into 
the neck of the condyle of the lower jaw-bone, the upright part of 
bone, and to the capsule of the joint. 
The jaw is moved chiefly by these muscles ; the temporalis acting 
upon the coronoid process like a lever, the masseter acting upon the 
angl0i and before it, and the pterygoideus internus balancing it 
within, like an internal masseter fixed on the inside of the angle. 
AM these pull strongly up wards for biting, holding, and tearing with 
the teeth ; and the external or lesser pterygoid muscle going from 
within outwards, pulls the jaw from side to side, and performs the 
motion of grinding. f 
the neck and upright part of maxilla. 
Pterygoi- 
nus!n t r 
Or. 1. In- 
upperpart 
of internal 
pterygoid 
t'he'pala- 
tine bone. 
of the Je 
angle 
inf* max 
bone. * 
Pterygoi- 
ternus*' 
Or. l. ex- 
teiate of 
pterygoid 
process, 
maxillary 
hone. In. LOWER JAW, THROAT, AND TONGUE. 
181 
MUSCLES LYING ON THE FORE-PART OF THE NECK, AND MOVING 
THE HEAD. 
Although we might now, following the order of functions, be di- 
rectly led to treat of the muscles of the tongue and throat, yet we 
shall, in the lirst place, dismiss those, which in dissection, must be 
first exposed upon the fore-part of the neck, 
Platysma myoides.—This is a very thin muscular expansion, 
which is spread over the other muscles of the neck and throat, 
which extends upwards, upon the lower part of the face. It arises 
by scattered fibres, which are attached to the celiular membrane, 
between the pectoral and deltoid muscles and the skin of the chest. 
It extends upwards and forwards, over the clavicle and the mastoid 
muscle, going like a thin integument over the neck. It terminates 
on the face ami jaw. Some of its fibres mounting over the bone of 
the jaw, are inserted near the depressor anguli oris. 
This muscle supports the parts in the neck, as fasciae do else- 
where ; it compresses veins, and forces the blood down into the 
chest, when there is difficult respiration. It is, in truth, more a mus- 
cle of respiration and circulation, than for the motion of parts, or 
even for expression ; yet it is very active in the expression of the 
stronger passions. In dissecting this muscle the surgical student 
will have a regard to a very important part of the surgical anatomy 
of the neck. Although there be no proper fascia investing the neck, 
for very obvious reasons, yet the fibres of this muscle interlacing 
with the common cellular membrane, form a pretty dense and firm 
covering. It will be noticed in dissection, that this compound web 
is very particularly connected to the transverse processes of the ver- 
tebrae, to the mastoid process, and to the angle of thejatv. It will 
be found, also, to be connected to the clavicle and first rib, and to 
make a sort of septum between the region of the neck and the thorax. 
The reason of the difference in the texture of this web in com- 
parison with the fascia of the extremities, is to provide for the free- 
dom of the trachea, and to permit its easy motion. 
Mastoipeus.—This is the most conspicuous and finest muscle of 
the body, giving the fleshy roundness of the neck, and when in 
action rising to produce the most beautiful contour of the neck, both 
in man and woman. Its origin and insertion are shortly described 
in its name, sterno-cleido mastoideus. It arises from the triangular 
portion of the sternum, by a strong round tendon, and from the 
sternal portion of the clavicle, by a broader and more fleshy origin. 
It ascends upon the neck, and in such a manner, that the dissector 
can separate the two portions with the handle of his scalpel, to their 
termination. It is inserted into the mastoid angle of the temporal 
bone, and extends its attachment backwards upon the mastoid angle 
of that bone. 
When the muscles of both sides act together, they pull the head 
downwards, and bring the chin to the breast; but when one muscle 
acts, it pulls down the ear to the shoulder, and so twists the neck, 
as to throw the chin a little up, and to the other side This effect 
of the single muscle, it is important to notice, because this muscle is 
Platysma 
uiyeides. 
Or. super- 
ficially on 
the upper 
part of the 
chest. 
In. the in- 
, teguments 
covering 
the jaw 
and lace. 
Use. 
'Mastoi- 
deus. 
Or. 1. 
sternum. 
2. the 
clavicle. 
In. the 
mastoid 
process, 
and angle 
of the 
temporal 
bone. 
Action. 182 
MUSCLES OF THE 
subject to a disease which produces wry neck ; and it requires a 
knowledge of anatomy to distinguish the different causes of this dis- 
tortion, whether arising from paralysis or disease of muscle, or 
affection of the spine, &c. 
MUSCLES OF THE THROAT AM) TONGUE. 
The muscles of the throat and tongue cannot be understood 
without a previous acquaintance with certain cartilages and bones, 
which form the basis of the throat and tongue, and the centre of 
those motions which we have next to desciibe. 
The os hvoides is a small bone resembling in shape at least the 
lower jaw bone. It has a middle thicker part, named its basis, 
which is easily felt outwardly; it corresponds in place with the chin, 
and during life it is distinguished about an inch below the chin, the 
uppermost of the hard points which are felt in the fore-part of the 
throat. Next, it has two long horn-like processes, which go back- 
wards along the sides of the throat, called the cornua, or horns of 
the os hyoides, and winch are tied by a long ligament to the styloid 
process of the temporal bone. And, lastly, it has small cartilaginous 
pieces or joinings, by which the horns are united to the basis; and 
often in the adult this joining is converted into bone. At this point, 
where the two horns go backwards, like the legs of the letter U, 
there are commonly, at the gristly part of the os hyoides, two small 
perpendicular processes which stand up from the joining of the horns 
to the body, and these are named the appendices of the os hyoides, 
or the iesser cornua. 
Now, this os hyoides forms by its basis the root of the tongue, 
thence it is often named the bone of the tongue. It forms at the 
same time a part of the larynx, which is the collection of cartilages 
forming the top of the trachea, or windpipe ; and it carries upon it 
that cartilage named epiglottis, which, like a valve, prevents any 
thing getting down into the windpipe. Its horns extend along the 
sides of the throat, keeping the openings of the windpipe and gullet 
extended, as we would keep a bag extended by two fingers. The 
chief muscles of the tongue and of the windpipe arise from its body ; 
the chief muscles of the gullet arise from its horns, and especially 
from their points ; it receives the chief muscles which either raise 
or depress the throat; and it is the point d’appui, or fulcrum, for all 
the muscles of the throat and tongue, and the centre of all their 
motions. It is the centre of the motions of the tongue, for it is the 
origin of these muscles which compose chiefly the bulk of the 
tongue ; of the motions of the trachea or windpipe, for it forms at 
once the top of the windpipe, and the root of the tongue, and joins 
them together ; of the motions of the pharynx or gullet, for its horns 
surround the upper part of the gullet, and join it to the windpipe; 
and it forms the centre for all the motions of the throat in general: 
for muscles come down from the chin to the os hyoides, to moye the 
whole throat upwards ; others come up from the sternum, to move 
the throat downwards; others come obliquely from the coracoid LOWER JAW, THROAT, AND TONGUE. 
183 
process of the scapula, to move the throat backwards, w hile the os 
hyoides still continues the centre of all these motions. 
The trachea, or windpipe, is that tube which conveys the air 
to the lungs ; and the larynx is the head or figured part of that tube 
which is formed like a flute for the modulation of the voice, and con- 
sists of cartilages, that it may stand firm and uncompressed, either 
by the passage of the food, or by the weight of the outward air; and 
that it might resist the contraction of the surrounding parts, serving 
as a fulcrum for them in the motions of the jaw, tongue, and gullet. 
Its cartilages are, first, the scutiform, or thyroid cartilage, which 
is named from its resemblance to a shield, or rather it ts like the 
flood-gates or folding doors of a canal, the meeting of the two sides 
being in the middle line of the throat. This prominent line of the 
thyroid cartilage is easily felt in the middle of the throat, is about an 
inch in length, and makes that tumour which is called the pomum 
Adami. The flat part3 of the thyroid cartilage form the sides of the 
larynx. And there are two long horns at its two upper corners, 
which rise like hooks above the line of the cartilage, and are joined 
to the horns of the os hyoides, and two similar but shorter hooks 
below, by which it embraces the cricoid cartilage. 
The cricoid cartilage is next to the thyroid, and below it; it is 
named from its resemblance to a ring.* It is indeed like a ring or 
hoop, but it is not a hoop equally deep in all its parts, it is shallow 
before, where it ekes out the length of the thyroid cartilage, and is 
deeper behind, where it forms the back of this flute-like top of the 
trachea; it is the top ringofHhe trachea, and the lower ring of the 
larynx or flute-part of the windpipe. And upon its back, or deeper 
part, are seated those two stnall cartilages, which, with their liga- 
ments, form the opening for the breath. 
The arytenoid cartilages! are two small triangular bodies, 
seated within the protection of the thyroid cartilage. They are 
foolishly described with cornua, ridges and surfaces, when they are 
so small that nothing further can be observed of their forms, than that 
they are somewhat conical; that the base or broad part of each sits 
down upon the upper edge of the cricoid cartilage at its back ; that 
the point of each stands directly upwards, and is a very little crooked, 
or hook-hke; that standing, as they do, a little apart from each 
other, they form together an opening something like the spout of a 
ewer, or strouped basin, whence their names. And these cartilages 
being covered with the common membrane of the throat, which is 
thick, and full of mucous glands, the opening gets a regular appear- 
ance with rounded lips. From these cartilages to the buck part of 
the thyroid cartilages, ligaments are extended; over these liga- 
ments the lining membrane of the larynx is laid, and between the 
arytenoid ligaments is formed the chink or rima glottidis ; viz the 
opening of the windpipe. The voice is, in a considerable degree, 
formed by the motion of these cartilages and their ligaments, and the 
action of the muscles of the arytenoid cartilages are so exquisitely 
minute, that for every changing of the note (and there are some 
* From *pt*o{, a rin^. 
t From apvratva, an ewer, and cito<, like. 184 
MUSCLES OP THE 
thousand gradations in the compass of the voice) they move in a 
proportioned degree. 
The epiglottis is a fifth cartilage of the trachea, belonging to it 
both by connection and by office. It is a broad triangular cartilage, 
not so hard as the others, very elastic, and so exactly like an arti- 
choke leaf, that no other figure can represent it so well. Its office 
is to defend the opening of the glottis. It is fixed at once to the os 
hyoides, to the thyroid cartilage, and to the root of the tongue, and 
it hangs obliquely backwards over the opening of the rima, or chink 
of the glottis ; it is suspended by little peaks of the membrane, 
which we call ligaments of the glottis, and it is said to be raised or 
depressed by muscles, which-yet are not very fairly described. But 
the rolling of the mor«el which is swallowed, and the motion of the 
tongue, are sufficient to lay it flat over the rima, so that it is a perfect 
guard upon the windpipe. 
Then this is the constitution of the larynx. It is of hard cartila- 
ges to resist compression, and of a flute form at its opening, to regu- 
late the voice. The thyroid cartilage is the great one, the chief 
defence before, and which has edges slanting far backwards, to de- 
fend the opening of the larynx. The cricoid cartilage, which forms 
the upper ring of the trachea, supports the arytenoid cartilages, and 
by its deepness behind raises them so, that the opening of the glottis 
is behind the middle of the great thyroid cartilage, and in the deepest 
part of it, well defended by its projecting wings. The arytenoid 
cartilages form the rima glottidis, the chink by which we breathe; 
which, as it is narrower or wider, modulates and tunes the voice ; 
the opening of which is so exquisitely moved by it' muscles in sing- 
ing, widening or contracting in most delicate degrees, and which is 
so spasmodically shut by the same muscles when it is touched by a 
drop of water, or by a crumb of bread ; but the valve of the glottis, 
the epiglottis standing over it, flaps down like the key of a wind 
instrument, so that the rareness of such accidents is wonderful, when 
we consider that the least attempt to draw the breath, while we are 
swallowing, will produce the accident. 
The muscles which move the tongue and throat, must be far too 
complicated to be explained at all, without some previous know- 
ledge of these parts ; and still, I fear, not easily to be explained with 
every help of regularity and order. 
MUSCLES OF THE THROAT. 
By this arrangement, I mean to include under one class, all those 
muscles which move the os hyoides, or the larynx ; and through 
these, as centrical points, move the jaws, gullet, and tongue, and 
which, though they are inserted into the larynx, have more relation 
to swallowing, or the motions of the gullet, than to breathing, or to 
the motions of the windpipe. 
The muscles which pull the throat down are these: 
XXXIV. The sterno-hyoideus, which passes from the sternum 
os hyoides, & flat, broad, ribbon-like muscle, arises from the 
upper piece of the sternum, rather within the breast, and partly also 
Stemo- 
Or0,!decar- 
til. of first LOWER JAW, THROAT, AND TONGUE. 
185 
from the clavicle and cartilage of the first rib, goes flat and smooth 
along the fore-part of the throat, mounts nearly of the same breadth 
to the os hyoides, and is implanted into its basis, or that part (which 
in comparing the os hyoides to the jaw) we should compare with 
the chin. 
XXXV. The sterno-thyroideus, which passes in like manner 
from the sternum to the thyroid cartilage, is like the last, a flat, 
smooth, ribbon-like muscle, rather thicker and more fleshy, but very 
uniform in its thickness. As the thyroid cartilage is below the os 
hyoides, the sterno-thyroid muscle must lie under the sterno-hvoideus 
muscle. It arises under the sterno-hyoideus muscle from tire ster- 
num and cartilage of the rib, and is implanted into the rough line of 
the lower edge of the thyroid cartilage, and a little to one side, but. 
not so much as is represented in Cowper’s drawings. It immedi- 
ately covers the thyroid gland. 
XXXVI. The omo-hyoideus, which was once named coraco- 
jiyoideus, being thought to arise from the coracoid process, is a 
muscle of great length, and very slender ; reaches from the shoulder 
to the os hyoides ; it is, like these last mentioned, a long, flat, 
strap-like muscle, as flat and as fleshy, but not so broad as either of 
the former, ft lies along the side of the neck ; is pinched in a little 
in the middle, where it is divided by a tendinous cross line, which 
separates the fleshy belly into two heads, whence it has fretjuently 
the name of digastricus inferior. It arises from the upper edge of 
the scapula, which is called costa, near its notch, and from the liga- 
ment that crosses the notch, and is implanted into the side of the os 
hyoides, where the horn goes off from the body of the bone. 
These three muscles pull down the throat. The sterno-hyoideus, 
and sterno-thyroideus pull it directly downwards : one of the omo- 
hyoidei acting, pulls it to one side ; but if both act, they assist in 
pulling directly down, and brace the trachea at the same time a 
little down to the back. These muscles are in almost constant 
action, and are perfectly relaxed only during the action of deglutition, 
when they yield to let the throat be drawn up, and the mouth thrust 
back. 
The muscles which move the throat upward are : 
XXXVII. The mylo-iiyoideus, a flat and broad muscle, which 
arises from the whole semicircle of the lower jaw, i. e. from the 
alveoli of the backmost grinders to the point of the chin. It rises 
from a line on the inner surface of the lower jaw-bone, goes down 
to the basis of the os hyoides, proceeds with very regular, straight, 
distinct, and orderly fibres, from the jaw to the os hyoides, is plainly 
divided in the middle from the symphysis of the jaw to the middle 
of the os hyoides, by a middle tendinous and white line. And though 
Cowper denies the authority of Vesalius, who divides it thus, it is 
plainly two distinct muscles one belonging to either side. 
XXXVlfl. The genio-iiyoideus is a small neat pair of muscles, 
arising from the chin at a rough point, which is easily distinguished 
within the circle of the jaw. The mylo-hyoideus is named from the 
whole jaw. The genio-hyoideus is named from the chin, arising 
from a small tubercle behind the chin ; its beginning is exceedingly 
i rib. 2. up- 
per and 
inner part 
of ster- 
num, 
3. the 
clavicle 
near the 
sternum. 
In. base 
of the os 
hyoides. 
Sterno- 
thyroideus 
Or. 1. the 
■ sternum, 
2. the car- 
tilage of 
first rib. 
In. lower 
edge of 
thyroid 
cartilage. 
Omo- 
hyoideus. 
■ Or. sup 
costa near 
the notch 
of the 
scapula. 
In. base 
of os 
hyoides 
opposite 
the lesser 
cornu. 
[ Mylo- 
liyoideus. 
Or. from 
the line or 
ridge on 
the inside 
of the iaw. 
In. 1. low- 
er edge of 
the body 
of the os 
hyoides, 
2. Its fel- 
low, by a 
white line, 
Genio- 
hyoideus. 
Or. tuber- 
cle on the 
inside of 186 
MUSCLES OK THE 
the sytu- 
pjiysis of 
the lower 
jaw. 
In. the 
body of 
the os hy- 
oidcs un- 
der the 
mylo- 
tyoideus. 
narrow : as it proceeds downwards, it grows flat and broad ; it is 
implanted into the basis of the os hyoides, by a broad edge, and is a 
beautiful and radiated muscle. The submaxillary gland lies flat be- 
tween this mtascle and the last, and in the middle the submaxillary 
duct pierces the membrane of the mouth, to open under the root of 
the tongue. The two muscles move the os hyoides forwards and 
upwards when the jaw is fixed ; but when the os-hyoides is fixed by 
the muscles coming from the sternum, these muscles of the os hyoides 
pull down the jaw. 
XXXIX. The stylo-hyoideus is one of three beautiful and 
slender muscles which come from round the styloid process, which 
all begin and end with slender tendons, and with small fleshy bellies ; 
and one going to the pharynx or gullet, another to the os-hyoides, 
and a third to the tongue, they coincide in one common action of 
drawing back the tongue, and pulling the throat upwards. 
This one, the stylo-hyoideus, ariecs from about the middle of the 
styloid process, and going obliquely downwards and forwards, is fixed 
into the side of the os hyoides, where the basis and horn are joined. 
Above its insertion, its fibres are split, so as to make a neat small 
loop, through which the tendon of the digastric muscle runs. This 
stylo-hyoideus is sometimes accompanied with another small fleshy 
muscle like it, and of the same name, which was first, perhaps, ob- 
served by Cowper, and has been lamed by Innes stylo-hyoideus 
alter ; but it is not regular, nor has it ever been acknowledged as 
a distinct muscle. 
XL. The digastricus or biventer maxilla: inferioris muscle, 
is named from its having two bellies. One belly arises from a rugged 
notch along the root of the mastoid process, where the flesh is thick 
and strong; going obliquely forwards and downwards, it lorms a 
long slender tendon, which passes by the side of the os hyoides; and 
as it passes, it first slips through the loop or noose of the stylo-hyoi- 
deus, and then is fixed by a tendinous bridle to the side of the os- 
hyoides ; and then turning upwards towards the chin, it ends in a 
second fleshy belly, which, like the first, is flat and of a pyramidal 
shape, lying above the mylo-hyoideus ; and is inserted into a rough 
part of the lower jaw, on the inside of the circle. 
Though this muscle is often called biventer maxillae inferioris, as 
belonging to the lower jaw, perhaps it does more regularly belong 
to the throat. No doubt, when the os hyoides is fixed by its own 
muscles, from the shoulder and sternum, the digastricus must act 
on the jaw ; an office which we cannot doubt, since we often feel it 
taking a sudden spasm, pulling down the chin with severe pain, and 
distortion of the neck. But its chief office is raising the os-hyoides ; 
for when the jaw is fixed, as in swallowing, the os hyoides pulls up 
the throat; and this is the true meaning of its passing through the 
noose of the stylo-hyoideus, and of its connection with the side of 
the os hyoides. Then the digastric and stylo-hyoideus muscles pull 
the throat upwards and backwards. 
The muscles which move the parts of the larynx upon each other 
are much smaller, and many of them very minute. 
XLI. The hyo-thyroideus goes down, fleshy and short, from 
Stylo-hy- 
oiaeus. 
Or. the 
lower half 
of the 
styloid 
Jrocess. 
n. the os 
hyoides at 
tne union 
of the base 
and horn> 
Digastri- 
Or roove 
inraastoid 
pro. of 
bone.°ia 
In. fixed 
oides, and 
turning 
•ertedinto 
a rough 
under the 
chin. 
Hy°-t!iy- LOWER JAW, THROAT, AND TONGUE. 
187 
tbe os hyoides to the thyroid cartilage. It arises from the lower 
border of the thyroid cartilage, where the sterno-thyroideus termi- 
nates, and goes up along the side of the thyroid cartilage, like a con- 
tinuation of the sterno-thyroideu3 muscle. It passes the upper 
border of the thyroid cartilage, and is fixed to the lower edge of the 
os hyoides, along both its base and part of its horn. 
XLII. The crico-thyroideus is a very short muscle, passing 
from the upper edge of the cricoid to the lower margin of the thyroid 
cartilage, chiefly at its side, and partly attached to its lower horn, 
which comes down clasping the side of the cricoid ring, so that it 
is broader above, and a little pointed below. 
These two small muscles must have their use, and they bring the 
thyroid cartilage nearer to the os hyoides, and the cricoid nearer to 
the thyroid cartilage ; and by thus shortening the trachea, or com- 
pressing it slightly, they may perhaps afiect the voice; but the mus- 
cles on which the voice chiefly depends are those of the rima glot- 
tidis ; for there are many small muscles which have their attach- 
ment to the arytenoid cartilages, and which by their operation on the 
thyro-arytenoid ligament, govern the rima glottidis. 
XLIII. The MI7SCULUS arytenoideus transvbrsus is that deli- 
cate muscle which contracts the glottis by drawing the arytenoid 
cartilages towards each other. It lies across, between them at their 
back-part; it arises from nearly the whole length of one arytenoid 
cartilage to go across, and be inserted into the same extent of the 
opposite one. 
XLIV. \rytexoideus obliquus is one which crosses in a more 
oblique direction, arising at the root of each arytenoid cartilage, and 
going obliquely upwards to the point of the opposite one. These 
two muscles draw the arytenoid cartilages together, and close the 
rima : frequently we find only one oblique muscle. 
XLV. The crico-arytenoideus posticus is a small pyramidal 
muscle, which arises broader from the back-part of the cricoid car- 
tilage, where the ring is broad and deep; and going directly up- 
wards, is implanted with a narrow point, into the back of the 
arytenoid cartilage. This pair of muscles pulls the arytenoid carti- 
lages directly backwards, and lengthens the slit of the glottis: per- 
haps they assist the former, in closing it. more neatly and in pro- 
ducing more delicate modulations of the voice. 
XLVI. The crico-arytenoideus lateralis is one which 
comes from the sides of the cricoid cartilage w here it lies under the 
wing of the thyroid, and being implanted into the sides of the ary- 
tenoid cartilages, near their roots, must pull these cartilages asunder, 
and (as the origin of the cricoid lies rather before their insertion in 
the arytenoid cartilages) it must also slacken the lips of the slit; for 
the lips of the slit are formed by two cords, which go within the 
covering membrane, from the tip of each cartilage to the back of the 
thyroid cartilage, and the crico-arytenoideus posticus must stretch , 
these cords, and the crico-arytenoideus lateralis must relax them. 
XLVII. The thykeo-arytenoideus is a muscle very like the 
last one, and assists it. It arises not from the cricoid cartilage, but 
from the back surface of the wing of the thyroid, from the hollow of 
Or. lower 
edge of 
thyroid 
cartilage. 
In. part of 
base and 
almost all 
the cornu 
of os hy- 
oides. 
Crico-thy- 
roideus. 
Or. side 
and fore 
part of 
cricoid 
cartilage. 
In. 1. the 
base. 
2. inferior 
cornu of 
the thy- 
roid'] carti- 
lage. 
Arytenoi- 
deus trans* 
versos. 
Or. side of 
one aryte- 
noid carti- 
lage. 
In. side of 
the other 
ary. cart* 
Arytenoi- 
deus ob- 
iiquus. 
Or. base 
of the one 
ary. carti- 
lage. 
In.apex of 
the other 
ary. cart. 
Crico-ary- 
tenoidens 
posticus. 
Or. broad 
part of 
cricoid 
cart. 
n. back 
and outer 
point of 
arytenoid 
cart. 
Crico* 
arytenoi- 
deus late- 
ralis. 
Or. side 
of cricoid 
cart. 
In. side of 
the base of 
the aryte- 
noid carti- 
lage. 
ThjWP- 188 
MUSCLES OF THE 
arytenoi- 
deus. 
Or. back 
and under 
part of 
thyroid 
cart. 
In. nearly 
the midde 
of the ary. 
cartilage. 
its wing, or where it covers the cricoid ; is implanted into the fore-part 
of the arytenoid cartilage, and by pulling the cartilage forward and 
sideways, directly slackens the ligaments, and widens the glottis. 
There is another muscle, the tuyreo-epiulottideus. ft is com- 
posed of a number of fibres, which run from the concavity of the 
thyroid cartilage to the side of the epiglottis; it has been divided by 
Albinus into major and minor, but this we cannot expect to find 
always, as it is only in particular bodies that we see fibres running 
from the thyroid cartilage to the epiglottis. Along with this muscle 
may be classed the set of fibres which are seen sometimes running 
from the arytenoid cartilage to the epiglottis, and called aryteno- 
cpiglottideus.* 
These are all the muscles which belong to the larynx ; and in our 
arrangement the muscles of the palate and pharynx come next in 
order, 
When a morsel is to be thrown down into the cesophagus, or tubo 
which leads to the stomach, the velum palati, or curtain of the 
palate, is draw n upwards ; the opening of the throat is dilated ; the 
morsel is received; then the curtain of the palate falls down again.. 
The arch of the throat is contracted, the bag of the pharynx is com- 
pressed by its own muscles ; and the food is forced downwards into 
the stomach. 
XLVIII. The azygos uvulas.—The velum pendulum palati is 
that pendulous curtain which we see hanging in the back-part of 
the mouth, in a line writh the side circles of the throat; and the 
uvula is a small pap, or point of flesh, in the centre of that curtain. 
The azygos uvulas, or single muscle of the uvula, is a small slip of 
straight fibres, which goes directly down to the uvula in the centre 
of the curtain. It arises from the peak, oi backmost sharp point of 
the palate bones, and pulls the uvula, or pap of the throat, directly 
upwards, removing it out of the way of the morsel which is to pass. 
XLIX. Levator palati mollis arises from the point of the os 
petrosum, and from the Eustachian tube, and also from the sphenoid 
bone.f These parts hang over the roof of the velum, and are much 
higher than it ; so this muscle descends to the velum, and spreads 
out in it; and its office is to pull up the velum, to remove it from 
being in the way of the morsel, which is about to pass, and to lay 
the curtain back at the same time, so as to be a valve for the nostrils, 
and for the mouth of the Eustachian tube, hindering the food or 
drink from entering into these passages. 
L. The circumflexes palati,| and the constrictor isthmi 
Azygos 
uvulae. 
Or. poste- 
rior ex- 
tremity of 
palatine 
suture. 
In. point 
of the 
uvula. 
Levator 
palati. 
Or. extre- 
mity of 
pars pe- 
trosa, and 
Eusta- 
chian 
tube. 
In. the 
velum 
palati. 
Circum- 
flexus 
palati. 
* There is in Albinus a second set of fibres, which he calls- thyreo-arytenoideus 
alter, arising from the inner and upper part of the thyroid cartilage, and inserted 
into the arytenoid cartilage just above the insertion of the crico-arytenoideus lateralis 
this muscle must have much the same action as the other. 
t From the Eustachian tube, it was named salmngo-staphilinus ; from the 
sphenoid bone, spheno-staphilinus ; from the pterygoid process, pterygo-sta- 
philinus ; from the petrous process it was named petko-salpingo-staphilinus ; 
as if there were no science but where there were hard names, and as if the chief mark 
of genius were enriching the hardest names with* all possible combinations and con- 
tortions of them. 
f This also has got a tolerable assortment of hard names, as circumflexcs 
PALATI, TENSOR PALATI, PALATO-SALPINGEUS, STAPHILINUS EXTERNUS, SPHF.NO- 
SALPIN GO-STAPH I LIN US, MU8C0LUS TUBiE, VIZ, EUSTACHIAN.E NONUS. PTE- 
RYGO STAPHILINUS of Cowper, &c. LOWER JAW, THROAT, AND TONGUE. 
189 
faucium, have a very different use. The circumflexus palati is named 
from its fibres passing over, or rather under the hook of the ptery- 
goid process ; the muscle arises along with the levator palati, (i. e.) 
from the sphenoid bone at its spinous process ; and from the begin- 
ning oft he Eustachian tube, it runs down along the tube in the hollow 
between the pterygoid processes ; it then becomes tendinous, turns 
under the hook of the internal pterygoid process, and mounts again 
to the side of the velum. Now the levator and circumflexus arise 
from the same points; but the ievator goes directly downwards into 
the velum-, and so is useful in lifting it up. The circumflexus goes 
round the hook, runs on it as on a pulley, turns upwards again, and 
so it pulls down the palate and stretches it, and thence is very com- 
monly named the tensor palati mollis, or stretcher of the palate.* 
LI. The constrictor isturn faucium arises from the very root of 
the tongue on each side, goes round the middle of the velum, and 
ends near the uvula.| This semicircle forms that first arch which 
presents itself, upon looking into the mouth. 
LII. The palato-phakvnoicusJ again forms a second arch behind 
the first; for it begins in the middle of the soft palate, goes round 
the entry of the fauces, ends in the wing or edge of the thyroid car- 
tilage ; and as the first arched line (that formed by the constrictor) 
belonged to the root of the tongue, the second arched line belongs 
to the pharynx or gullet.§ The circumflexus palati makes the 
curtain of the palate tense, and pulls it downwards: the constrictor 
faucium helps to pull down the curtain, and raises the root of the 
tongue to meet it : the palato-pharyngeus farther contracts the arch 
of the fauces, which is almost shut upon the morsel now ready to be 
forced down into the stomach, by those muscles which compress the 
pharynx itself. . 
lhe pharynx, which is the opening of the gullet, that it may 
receive freely the morsel of the food, is expanded into a large and 
capacious bag, which hangs from the basis of the skull, is chiefly 
attached to the occipital hone, the pterygoid processes, and the 
back parts of either jaw-bone. The oesophagus again is the tube 
which conveys the food down into the stomach, and this bag of the 
pharynx is the expanded or trumpet-like end of it; or it may be com- 
pared with the mouth of a funnel. Towards the mouth, the pha- 
rynx is bounded by the root of the tongue, and by the arches of the 
throat; behind, it lies flat and smooth along the bodies of the ver- 
tebra) ; before, it is protected, and in some degree surrounded by the 
great cartilages of the larynx ; the horns of the os hyoides embrace 
its sides, and it is covered with flat muscular fibres, which, arising 
from the os hyoides and cartilages of the throat, go round the pha- 
rynx in fair and regular orders, and are named its constrictors, be- 
Or. 1. 
®^“,(Pro“ 
sphenoid, 
py^’*ta* 
tu 
3. root of 
|“teerynl^i(| 
procoss. 
runs 
the°hook 
inserted 
palati. 
Constric- 
faucium. 
Or. side 
the 
near its 
r°ot*, 
0f tbe"" * 
velum at 
aot 
Palato- 
ph«uryn- 
f/r.middle 
of the 
the uvula, 
part of the 
thytr?“L 
* Some of its posterior fibres mix with the constrictor pharyngis superior and 
palato-pharyngeus. 
t Named glosso-staphilinus, from its origin in the tongue, and insertion into 
the TJVTJLA. 
I The salpingo-pharyngeus of Albinus is no more than that part of the palnte- 
pharyngeus which arises from the mouth of the Eustachian tube. 
§ In its passage down its fibres are fixed with the stylo-pharyngeus, and in its in- 
sertion they are mingled with the inferior constrictors. 190 
MUSCLES OF THE 
cause they embrace it closely, and their contractions force down the 
food. 
LIII. The stylo-pharyngeus arises from the root of the styloid 
process. It is a long, slender, and beautiful muscle; it expands 
fleshy upon the side of the pharynx ; extends so far as to take a hold 
upon the edge of the thyroid cartilage ; it lifts the pharynx up to 
receive the morsel, and then straightens and compresses the bag, to 
push the morsel down, and by its hold upon the thyroid cartilage it 
commands the larynx also, and the whole throat. 
The pharynx being surrounded by many irregular points of bone, 
its circular fibres or constrictors have many irregular origins. The 
constrictor might fairly enough be explained as one muscle, but the 
irregular origins split the fibres of the muscle, and give occasion of 
dividing the constrictor into distinct parts; for one bundle arising 
from the occipital bone and os petrosum, from the tongue, the ptery- 
goid process, and the two jaw-bones, is distinguished as one muscle, 
the constrictor superior.* Another bundle arising from the os hyoides 
is named the constrictor medius.t A third bundle, the lowest of 
the three, arising from the thyroid and cricoid cartilages, is named 
the constrictor inferior. J And it is remarkable that the lower edges 
of the superior divisions are clasped and covered by the upper edges 
of that which is inferior; so that these muscles are like three funnels, 
one within the other. 
LIV. The constrictor superior arising from the basis of the 
skull, from the jaws, from the palate, and from the root of the 
tongue, surrounds the upper part of the pharynx; and it is not one 
circular muscle, but two muscles divided in the middle line behind, 
by a distinct rapha, or meeting of the opposite fibres.§ 
LV. The constrictor menus rises chiefly from the round point in 
which the os hyoides terminates ; it also arises from the cartilage of 
the os hyoides (*. e.) where the horns are joined to the body. The 
tip of the horn being the most prominent point, and the centre of this 
muscle, it goes upwards and downwards, so as to have something of 
the lozenge-like shape; it lies over the upper constrictor like a se- 
cond layer, its uppermost peak, or pointed part, touches the occipi- 
tal bone, and its lower point is hidden by the next muscle. 
LVI. The constrictor inferior arises partly from the thyroid 
and partly from the cricoid cartilage; and it again goes also obliquely, 
so as to overlap or cover the lower part of the constrictor medius. 
This, like the other two constrictors, meets its fellow in a tendinous 
middle line ; and so the morsel admitted into the pharynx by the 
dilatation of its arches, is pushed down into the oesophagus by the 
fQrces of these constrictores pharyngis, assisted by its styloid muscles. 
LVII. The (esophagus is merely the continuation of the same 
tube. It lies flat upon the back-bone, and it is covered in its whole 
Stylo-pha- 
ryngeus. 
Or. root 
of the 
styloid 
process. 
In. side of 
pharynx 
and back 
part of 
thyroid 
cartilage. 
Constric- 
tor supe- 
rior. 
Or. 1. cu- 
neiform 
process of 
the occi- 
pital b. 
2. ptery- 
goid pro- 
cess of the 
sphenoid, 
3. alveolar 
processes. 
In. into 
its fellow. 
Constric- 
tor me- 
dins. 
Or. ap- 
pendix, 
cornu, and 
lig. of os 
hyoides. 
In. 1. cu- 
neiform 
process of 
occip. 
bone, 
2. into its 
fellow. 
Constric- 
tor infe- 
rior. 
Or. sides 
of thyroid 
and cri- 
coid cart. 
In. into 
its fellow. 
* These good opportunities of names have not been disregarded : this muscle has 
been named cephalo-tiiaryngeus, pterygo-pharyngeus, mylo-pharyngkcs, 
GLOSSO-PHARYNGEUS. 
t This one is named hyo-pharyngeus, or SYNDesmo-piiaryngeus, from its 
origin in the cartilage also of the os hyoides. 
I This, of is named thyro-fharyngeus, and crico-pharykgetts. 
§ It is connected with the buccinator, the root of the tongue, and palate. LOWER JAW, THROAT, AND TONGUE. 
191 
length by a muscular coat, which is formed, not like this of the pha- 
rynx, or circular fibres, but of fibres running according to its length 
chiefly. And this muscle, surrounding the membranous tube of the 
oesophagus like a sheath, is named (LVIII.) vaginalis gul^e. 
MUSCLES OF THE TOjNGUE. 
The muscles of the tongue are bundles of fibres, which come from 
the os hyoides, the chin, and the styloid process. Their thickness 
constitutes the chief bulk of the tongue. Their actions perforin all 
its motions. 
LIX. The hyo-glossus is a comprehensive name for all those 
which arise from the os hyoides. The muscles from the os hyoides 
go off in three fasciculi, and were once reckoned as distinct muscles. 
That portion which arises from the basis of the os hyoides was called 
basio-glossus : that which arises from the cartilaginous joining of 
the body and horn was called chonuro-glossus ; and that which 
arises from the horn itself wras named cerato-glossus j or the 
terms were all bundled together in the perplexed names of basio- 
CHONDRO-CERATO-GIiOSSUS. 
The hyo-glossus, then, is all that muscular flesh which arises from 
the whole length of the os hyoides, and which, by the changing form 
of the bone in its basis, cartilage, and horn, has a slight mark oi 
division, but w hich lie all in one plain, and need not have distinct 
names. 
LX. The genio-hyo-glossus arises from the rough tubercle be- 
hind the symphysis of the chin. It has a very narrow or pointed 
origin ; it spreads out fan-like, as it goes towards the tongue and base 
of the os hyoides; and it spreads with radii, upwards and backwards, 
making the chief part of the substance of the tongue. 
LXI. The likgualis is an irregular bundle of fibres, which runs 
according to the length of the tongue ; it lies between the genio-hyo- 
glossusand the hyo-glossus, and as it is in the centre, and unconnected 
with any bone, it is named lingualis, as arising in the tongue itself. 
The genio-hyo-glossi muscles form by far the larger part of the 
tongue, and lie in the very centre. They go through the whole 
length (i. e.) from the root of the tip of the tongue, and from the 
radiated form of their fibres they perform every possible motion ; 
whence this was named by Winslow, musculus polyciirestus, for 
its rays proceed from one point or centre, and those which go to the 
point of the tongue, pull the tongue backwards into the mouth. Those 
which go backwards thrust the tongue out of the mouth. The middle 
fibres acting, make the back of the tongue hollow, while the tip and 
the root of the tongue both rise. 
The hyo-glossi muscles lie on either side of the genio-hyoidei, and 
make up the sides of the tongue ; and their chief action would seem 
to be this, that the hyo-glossus muscle of either side acting, the 
edges of the tongue would be pulled downwards, and the back 
rounded, the opposite of which motion is the genio-hyodei acting, 
by which the middle of the tongue is made into a groove, the edges 
rising, and the centre being depressed. Lastly, The stylo-glossus is 
plainly intended for drawing the tongue deep into the mouth, particu- 
larly affecting the point; of the tongue. 
Hyo-glos- 
sua. 
Or. 1. 
base, 
2. cornu, 
3. appen- 
dix of os 
byoides. 
Genio- 
hyo-glos- 
SU8. 
Or. pro- 
cess be- 
hind the 
symph. of 
lower jaw. 
In. 1. tip, 
middle, 
and root 
of the 
tongue. 
2. base of 
osbyoides, 
Lingualis. 
Or. root 
of the 
tongue. 
In. tip 
of the 
tongue. 192 
OF THE MUSCLES OF THE ARM, 
INCLUDING TIIE MUSCLES OF THE SCAPULA, ARM, FORE ARM, AND HAND. 
MUSCLES OE THE SCAPULA. 
The great peculiarity of the arm is the manner of its connection 
with the breast, to which it is fixed by the slight ligaments of the cla- 
vicle only : but its union to the body is secured by its strong and 
numerous muscles, by which indeed it may be said both to be fixed 
and moved. Though it were perhaps more regular to describe first 
the muscles of the trunk, it will be more easy and natural to describe 
first the broad muscles belonging to the scapula, which cover almost 
the whole trunk, and hide its proper muscles, viz. those which move 
the ribs and spine. For the muscles which move the scapula lie 
upon the trunk; those which move the arm lie upon the scapula; 
those which move the fore arm lie upon the arm ; and those for 
moving the hand and fingers lie upon the fore arm. The leg requires 
but one chief motion, viz. backwards and forwards, flexion and exten- 
sion. It has no other motions than those of the thigh and of the 
knee; but the arm requires an easy and circular motion, and its 
joints are multiplied : for it has the wrist turning round ; it has the 
elbow for hinge-like motions ; it has the shoulder-joint upon which 
the arm rolls ; and to assist all these, the scapula, which is the centre 
of all these motions, is itself moveable ; after a certain point of ele- 
vation, all the motion in raising the arm is performed, not by the mo- 
tions of the shoulder-bone upon the scapula, but by the scapula upon 
the trunk. For whenever the shoulder-bone rises to the horizontal 
direction, it is checked by the acromion, which hangs over it ; and 
if the arm is to be raised higher still, the scapula must roll; it turns 
upon the point of the clavicle, and in turning, it glides upon those 
muscles, which are like a cushion between it and the trunk. 
The muscles which move the scapula come from the breast to move 
it forwards ; from the neck, to move it upwards ; from the spines of 
the vertebrae, to move it backwards ; and from the side, that is, from 
the ribs, to move it downwards. 
LXII. The trapezius is named from its lozenge form ; or is often 
named cucularis, from its resembling the monk’s cowl, hanging 
back upon the neck. It is one of the most beautiful muscles in the 
body; and the two muscles together cover all the shoulders and neck, 
with a lozenge-like form, with neat and sharp points, extending from 
the tip of one shoulder to the tip of the other, and from the nape of 
the neck quite down to the loins. It arises from the most pointed part 
of the occipital bone, and along the transverse spine quite to the mas-, 
toid process, by a thin membranous tendon $ from this point, all down 
Trapezius. 
Or. l. 
transverse 
ridge of 
occip. b. MUSCLES OF THE ARM, 6iC. 
193 
the neck, it has no hold of the vertebrae, but arises from its fellow in 
a strong tendon, which, extending like a bow-string down the neck, 
over the arch of the neck, and not touching the vertebrae, till it 
comes down to the top of the back, is naineii ligamentijm nuchal 
The tendon begins again to take hold of the spines of the two last 
vertebrae of the neck, and arises from all the spinous processes of the 
back, downwards; from this long origin its fibres converge towards 
the tip of the shoulder : it also comes a little forward over the side of 
the neck. 
It is implanted into more than one-third of the clavicle nearest the 
shoulder ; into the tip of the acromion ; into the whole length of the 
spine, from which the acromion rises ; and its fibres arising from along 
the neck and back, and converging almost into a point, must have 
various effects, according to the different fibres which act: for those 
which come downwards must raise the scapula ; those which come 
from the middle of the back must carry it directly backwards ; those 
which come from the lower part of the back must depress it; and 
those different fibres acting in succession, must make the scapula 
roll. The trapezius is a muscle which moves the scapula, but it 
must be also occasionally a muscle of the head, pulling the head back- 
wards, and bending the neck. It is also a powerful muscle of respira- 
tion, as may be seen under the head of Inspiration. 
LXI1I. Levator scapulae, named also levator froprius angu- 
laris, is a small thin slip of flesh, which arises from the four or five 
uppermost vertebrae of the neck, at their transverse processes, by 
three or four and sometimes five distinct heads. The heads join to 
form a thin and flat stripe of muscle, about three inches in breadth, 
which is fixed by a flat thin tendon to the upper corner of the scapula, 
to pull it upwards, as in shrugging the shoulders; whence it is named 
MUSCULUS PATIENTIJE. 
LX IV. and LXV. The rhomboid muscle stretches flat, neat, 
and of a square form, between the spine and the whole line of the 
base of the scapula. One part arises from the three lower spinous 
processes of the neck, and is implanted into the base of the scapula 
higher than the rising of the spine of the scapula ; another portion 
arises from the spinous processes of the first four vertebrae of the 
back, runs exactly in the same plane with the other into the base of 
the scapula below the spine.* The part arising from the three ver- 
tebrae of the neck is slightly divided from that which arises from the 
four vertebrae of the back, though not distinctly, and often not at all. 
I would reckon this but one muscle, but it has been commonly dis- 
tinguished into (LXIV.) the riiomroideus minor, the uppermosl 
portion, and (LXV.) the rhomboideus major, the lower portion. 
These are seen after raising the trapezius ; and the uses of the trape- 
zius, levator scapulae, and rhomboideus, are to raise the scapula or 
to carry it backwards. The muscles which move the scapula down- 
wards and forwards, viz. the pectoralis minor and the serratus major 
anticus, lie upon the fore part of the breast. 
2. liga- 
ment, 
nuchse. 
S. the two 
last vert, 
of neck. 
4. all the 
spin, pro- 
cesses of 
dorsal 
vert. 
In. 1. the 
clavicle. 
2. Acro- 
mion. 
3. spine 
of scapula. 
Levator 
scapulae. 
Or. trans. 
pro. of 4 
or 5 upper 
cervical 
vert. 
In. upper 
angle of 
scapula. 
Rhomboi- 
deus ma- 
jor. 
Or. spin- 
ous pro. of 
4 sup. dor- 
sal vert. 
In. nearly 
' the whole 
of base of 
scap. be- 
low the 
spine. 
: Rhomboi- 
deus mi- 
nor. 
Or. spin- 
ous pro. 
of 3 last 
cervical 
vert. 
In. base 
of scap. 
opposite 
the spine. 
* We frequently indeed almost find that the rhomboideus major takes also an origin 
from the seventh cervical vertebra: it is so expressed in Albinos. 194 
MUSCLES OF THE ARM, &C. 
Serratus 
SST BD* 
LXVI. The serratus major anticus lies upon the side ol’ the 
chest arising from the ribs; and as the ribs have interstices between 
them, every muscle arising from the ribs arises by distinct portions 
from each rib : all sucb distinct and pointed slips arc named digita- 
tions, tongues, or sometimes serrae, from their resembling the teeth 
of a saw ; and every muscle arising from the ribs must be a serrated 
muscle. The serratus major anticus is that great and broad muscle, 
the chief part of which lies under the scapula ; and nothing of which 
is seen but the fleshy tongues, by which it arises from the sides of 
the ribs. It is all fleshy, and is of a considerable breadth and 
strength: it arises from all the true ribs, (it sometimes misses the 
first rib) and from three of the false ribs : its indigitations, of course, 
spread all over the side of the thorax like a fan; its upper indigita- 
tions lie under the pectoralis major, and its lower indigitations arc 
mixed with the beginning of the external oblique muscle of the 
abdomen; its middle indigitations are seen spreading upon the sides 
of the thorax : it lies thick and fleshy under the scapula, and is a 
part of that cushion on which the scapula glides : its fibres converge 
towards a narrower insertion; and the muscle ends thick and fleshy 
in the whole length of that, line which we call the basis of the sca- 
pula, and is as it were folded round it; so that this muscle, which 
comes from before, is implanted along with the rhomboideus, which 
comes from behind. 
One operation of this muscle is upon the scapula, when the whole 
acts, it pulls the scapula downwards and forwards. When only the 
lower portions act, it pulls the lower angle of the scapula forwards, 
by which the scapula rolls, and the tip of the shoulder is raised ; 
when the upper part acts in conjunction with the little pectoral 
muscle, the tip of the shoulder is fixed and pulled towards the chest, 
and the lower corner of the scapula rolls backwards. But its most 
important action is in excited respiration, when its insertion is con- 
verted into its origin, and the scapula being fixed, it expands the 
ribs, and performs respiration. 
LXVII. The pectoralis minor lies under the pectoralis major, 
close upon the ribs ; and as it arises upon the third, fourth, and filth 
ribs, it sometimes takes its origin from the second, third, and fourth 
ribs, and sometimes only from the third and fourth ; it also is a ser- 
rated muscle, and was named serratus minor anticus : its three digi- 
tations are very thick and fleshy ; and soon converge so as to form 
a small, but thick and fleshy muscle which, terminating in a point, 
is inserted into the very apex of the coracoid process: by pulling 
the coracoid process forwards and downwards, it will roll the 
shoulder. 
LXVIII. The subclavian muscle is another concealed muscle of 
the scapula ; for the clavicle is just the hinge upon which the sca- 
pula moves, and the subclavian muscle arises by a flat tendon from 
the cartilage of the first rib; it becomes flat and fleshy, and lies along 
between the clavicle and the first rib ; it arises at a single point of 
the rib, flat and tendinous ; but it is inserted into a great length of 
the clavicle, beginning about two inches from the sternum, and beimr 
Or. from 
Fromthe 
2d to the 
9th' 
base of the 
scapula. 
Pectoralis 
Orn°3d 
4th, and 
5th nb. 
In. Cora- 
£f°* 
scapula, 
Subcla- 
lage<ofthe 
1st rih. 
the lower 
edge of the 
clavicle. MUSCLES OF TIIE ARM, &C. 
195 
inserted all along the clavifcle, quite out to where it is joined to the 
acromion process : its chief use (since the rib is immoveable) must 
surely be to pull the clavicle, and consequently the shoulder down- 
wards, and so to fix them. 
The scapula is thus moved in every possible direction : upwards, 
by the levator scapulae and the trapezius; backwards by the rhom- 
boideus, assisted by the middle portions of the trapezius ; down- 
wards and backwards by the lowest order of fibres in the trapezius ; 
downwards and forwards by the serratus major anticus; directly 
downwards by the serratus, balanced by the trapezius, and assisted 
by the subclavius; and directly forwards by the pectoralis minor. 
MUSCLES OF THE ARM ; 
VIZ. THOSE MOVING TIIE OS HUMERI, OR ARM-BONE. 
LXIX. The pectoralis major is a large, thick, and fleshy muscle 
which covers all the breast. It arises from the half of the clavicle 
next the sternum ; from all the edge of the sternum, the cartilagi- 
nous endings of the three lower true ribs.* Where it arises from the 
sternum, it is tendinous, and the fibres from the opposite muscle 
cross and mix, so as to make a sort of fascia covering the bone. It 
is fleshy where it arises from the ribs, and there it mixes with the 
external abdominal muscle. The fibres approach each other till 
they form a flat tendon about an inch in breadth ; and as the fibres 
approach each other, they cross in such a way, that the lower edge 
of the muscle forms the upper edge of the tendon, which is still flat, 
but twisted ; its implantation is into the edge, if I may call it so, of 
the groove or rut of the biceps tendon. That part which arises 
from the clavicle is a little separated from that which arises from the 
sternum; a fatty line makes the distinction ; and they are sometimes 
described as two parts : it is those two bundles chiefly which cross 
each other to make the plaited appearance. The pectoralis, among 
others, has been made a muscle of respiration.! 
LXX. The latissimus dorsi is the broadest, not only of the 
back, but perhaps of the whole body. It is a beautiful muscle, 
covering all the lower part of the back and loins, and reaching to 
the arm, to be the antagonist to the pectoral muscle. It arises 
by a broad, flat, and glistening tendon, which covers all the loins, 
Pectoralu 
“aJ?r’ 
nal half of 
the clavi- 
2lea'n tbe 
edge of 
lages of 
5th, 6th, 
“bds-7tl1 
in. out- 
s,.d® °.f bi' 
gro0ve of 
humerus, 
Latissi- 
raU8 ‘,orsi* 
* We frequently find slips running as distinct muscles from the 7th and 8th rib to 
the humerus ; they have been remarked, in the Windmill-street dissecting room, 
more frequently ill Lascars and Negroes than in Europeans. In December 1814, a 
body was dissected, in which there was found on both sides a slip of fibres 18 inches 
long, extending from the 4th and oth rib to the fascia, between the triceps and bra- 
chialis internus, and a distinct slip of tendon might be traced even to the inner condyle. 
t Haller tells us, that when, at any time, he had rheumatism in this muscle, his 
breathing was checked : and when he had difficult breathing, he found great relief 
by fixing his hands, raising the shoulders, and acting with the pectoral muscles. It 
seems confirmed by these facts, that asthmatics take this posture ; women in labour 
fix their arms, by resting upon the arms of their chair; those who play on wind in- 
struments raise the shoulders in straining. 196 
MUSCLES OP THE ARM, &C. 
and which is in some degree the root of other muscles, especially of 
the longissimus dorsi. This broad silvery tendon begins exactly in 
the middle of the back; it arises from the lower vertebrae of the 
loins, from the spines and knobs of the back of the sacrum, and 
from the back part of the circle of the os ilium ; this last is the only 
part that is fleshy. The flat tendon gradually passes into a flat and 
regular muscle, which wraps round the side of the body, and as it 
lies over the corner of the scapula, it sometimes receives a small 
fleshy bundle from it; and as it passes over the four lower ribs, it 
has some tendinous slips sent into it, by which it is attached to the 
ribs. Its fibres converge : for the lower ones ascend ; the upper 
ones go directly across. And these different. orders not only meet 
to form this flat tendon, but they cross each other, like those of the 
pectoral muscle : here also the tendon is twisted, and the upper 
edge ol the muscle forms the lower edge of the flat tendon ; which, 
passing into the axilla, turns under the arm-bone, and is implanted 
into it, on the inner edge of the bicipital groove ; so the tendons of 
the pectoralis and latissimus meet each other ; they, in fact, join 
face to face, as if the one tendon ended directly in the other; and 
both united, make a sort of lining for the groove, or a tendinous 
sheath, for the long tendon of the biceps to run on. 
These two muscles form the axilla or arm-pit; and although 
each has its peculiar offices, their chief operation is when they coin- 
cide in one action ; and that action is exceedingly powerful, both 
by the great strength of either muscle, and by their being implanted 
into the arm-bone, four inches below its head. The pectoralis 
major is for pulling the arm forwards, as in laying the arms across 
the breast, or in carrying loads in the arms ; and it forms the bor- 
der of the axilla before. The latissimus dorsi has a wider range ; 
when the arm is raised, it brings it downwards as in striking with a 
hammer, or downwards and backwards, as in striking with the elbow, 
or in rolling the arm inwards and backwards, as in turning the palm 
of the hand behind the back, whence it has the obscene name of 
musculus scalptor ani, or tersor ani ; and it forms the back 
edfe of the axilla. The edges of these two muscles receive the 
pressure of crutches, and defend the vessels and nerves ; when 
both muscles act, the arm is pressed directly downwards, as in rising 
from our seat, or in holding a bundle under the arm ; or when the 
arm is fixed, these muscles raise the body as in the example just 
mentioned, of rising from our seat, or in walking with a short stick, 
or in raising ourselves by our hands over a high beam. 
LXXI. The deltoides is the first of those muscles which arise 
from the scapula, to be inserted into the shoulder-bone. It is named 
deltoid muscle, from its resembling the letter A of the Greeks ; it 
is thick and fleshy, and covers the top of the shoulder, filling up 
the space between the acromion process and the shoulder-bone ; it 
arises from all that part of the clavicle, which is not occupied by 
the pectoralis muscle, and is separated from it only by a fatty line ; 
it arises again iu another bundle, from the point of the acromion 
process, and this middle bundle is also insulated by a fatty line on 
either side of it. The third bundle arises from the spine of the 
Or. 1. 
poster.part 
of the os 
ilii, 2. all 
the spin- 
ous pro. 
of sacrum 
and lum- 
bar. vert. 
3. spines 
of six or 
seven inf. 
dorsal 
vert. 
4. three 
inf. ribs; 
sometimes 
5. angle 
of the 
scapula. 
In. inner 
of 
bicipital 
groove of 
the hume- 
rus. 
Deltoides. 
Or. 1. ant- 
clavicle °f 
2. aero- 
3. spine 
and pai't MUSCLES OF THE ARM, <Lc. 
197 
scapula, behind the acromion process, and which is also attached to 
the base by a strong ligamentous fascia, which covers the infra 
spinatus muscle. And thus the muscle has three converging heads, 
viz. a head from the outer end of the clavicle, a head from the 
acromion, or tip of the shoulder, a head from the ridge of the spine, 
each divided from the other by a fatty line.-* These heads or bun- 
dles of fibres, meeting about one-third down the humerus, form a 
short, flat, and strong tendon, which grasps or almost surrounds the 
shoulder-bone. 
These three distinct heads must be observed in speaking of the 
use of the muscle ; for though the chief use of the muscle be to 
raise the arm, this is not the use of it in all circumstances; for the 
outer and inner heads, lying by the side of the shoulder-bone, and 
below the joint, do, when the arm is lying flat by the side, assist the 
pectoral and latissimus dorsi muscles in drawing it close to the side. 
But when the middle bundle raises the arm, in proportion as the 
middle bundle raises the arm, it loses its power ; and in proportion 
as it loses of its power, the side portions, having come into a new 
direction, begin to help ; nay, when the arm is raised to a certain 
point, more power is still required, and the clavicular part of the 
pectoral muscle also comes to assist. It is in this succession, that 
the several bundles of fibres act; for if they began all at once to 
act, the arm should rather be bound down by the lateral portions, 
than raised by the middle one. It is still more surprising that 
authors have neglected the great and obvious use of these lateral 
portions, since they are the most powerful rotators of the arm, e. g. 
the guards in fencing are performed chiefly through the operation 
of these portions of the deltoid muscle. 
LXXII. Cokaco-brachialis.—The coraco-brachialis, so named 
from its origin and insertion, is a long and rather slender muscle. 
It arises from the coracoid process of the scapula, along with the 
short head of the biceps muscle, and it is closely connected with 
this head, almost its whole length : it is small at its beginning : it 
grows gradually thicker as it descends; it is all fleshy, and is in- 
serted by a very short tendon into the os humeri, nearly about its 
middle, between the brachialis and the third head of the triceps. 
It is perforated by the external cutaneous nerve. This was observed 
by Casserius, an Italian anatomist; and the muscle is often named 
MUSCULUS PERFORATUS CASSF.RII. 
Its action is very simple, to raise the arm obliquely forwards and 
upwards, and consequently to give a degree of rotation. It will 
also have a chief effect in pulling the arm towards the side of the 
body. 
LXXI1I. The supra spinatus is so named from its occupying 
the hollow of the scapula above the spine. 
It arises from the back of the scapula reaching to the base, from 
the spine, and from the superior edge or costa ; it is exceedingly 
thick and fleshy, filling up all the hollow between the spine and 
superior costa ; and it is firmly enclosed in this triangular hollow, 
of the base 
of scapula. 
In. rough 
ridge on 
the fore 
part of the 
humerus. 
Coraco 
brachialis- 
Or. fore 
part of 
coracoid 
process. 
In. inner 
ridge of 
liumerns 
near the 
middle. 
Supra 
Spinatus, 
Or. dor- 
sum, 
•pine, 
base, and 
superior 
costa of 
the sca- 
pula. 
* Albinus has distinguished it into se-ren fasciculi or bundles ; a very superfluous 
accuracy. 198 
.MUSCLES OK THE ARM, &.C. 
In. upper 
part of the 
great tube- 
rosity flf 
humerus. 
by a strong tendinous expansion which passes from the superior 
edge of the scapula, to the ridge of the spine : it is consequently 
a muscle of a triangular figure, thick and strong ; it passes under 
the acromion, and degenerates into a tendon there, and going under 
the acromion, as under an arch, and over the ball of the humerus, 
it adheres to the capsule of the shoulder-joint, and is at last im- 
planted by a broad strong tendon into the upper part of the great 
tuberosity on the head of the bone. 
It is evidently designed for raising the humerus directly upwards, 
and by its attachment to the capsule, the capsule is drawn up when 
the arm is raised, so that though lax, it cannot be caught in the 
joint. It exactly performs the same motion with the middle part of 
the deltoides, lies in the same direction with it, and assists it. 
LXXiV. Infra spinatus, is like the former in all respects, of 
the same use, and assisting it. 
This also is of a triangular shape, and is fully one half larger than 
the supra spinatus ; and the supra spinatus arises from all the tri- 
angular cavity above the spine: this arises from almost all the tri- 
angular cavity below it. 
It arises fleshy from all the back of the scapula below the spine, 
except that part giving origin to the teres major and minor, from 
the spine itself, and from all the base of the scapula, below the 
beginning of the spine, and also from the greater part of the lower 
costa of the scapula. It is very thick and strong, almost filling up 
the triangular cavity, and it is closed in, like the former, by a strong 
tendinous expansion ; it begins to grow tendinous about its middle, 
but it continues also fleshy till it passes over the socket of the- 
shoulder-joint : it also is connected with the capsular ligament, is 
inserted into the middle of the same tuberosity with the former, and 
has exactly the same uses, viz. preventing the capsule from being 
caught in the joint, and raising the arm upwards, and inclining it a 
little outwards, by a slight degree of rotation. And I do believe, 
that one great use of these two muscles is, when the arm is much 
extended backwards, to prevent the head of the humerus from 
starting out of its superficial socket. 
LXXV. The teres minor is a third muscle which co-operates 
with these. This and another are so named from their appearance, 
not from their shape, for they seem round when superficially dis- 
sected, because then their edges only are seen ; but when fully dis- 
sected from the other muscles, they are rather flat. The teres 
minor is a small, fleshy muscle ; it arises from the angle and all the 
lower edge of the scapula : it is like the infra spinatus ; it becomes 
early tendinous; but the tendon is accompanied with fleshy fibres 
from below ; its flat tendon, in passing over the joint, is attached 
to the capsule, and is finally inserted into the great tuberosity of the 
shoulder-bone, so that it must have exactly the same uses as the 
two former muscles. It is separated from the infra spinatus by that 
tendinous expansion with which the latter is covered ; it looks like 
a part of the same muscle in its origin, where it lies upon the sca- 
pula ; but is very distinct in its tendon. The supra spinatus, infra 
spinatus, and teres minor, raise and roll the arm outwards. 
Infra spi- 
natus. 
Or. dor- 
sum, 
spine, 
base, and 
inf. costa 
of scapula. 
In. middle 
part of the 
large tu- 
bercle of 
the hume- 
rus. 
Teres 
minor. 
Or. edge 
of the in- 
ferior 
costa sca- 
pulae. 
In. large 
tubercle of 
the hume- 
rus infe- 
rior to the 
last. MUSCLES OF THE ARM, &C. 
199 
LXXVI. The teres major is in shape like the former, lies 
lower upon the edge of the scapula than the teres minor, and is 
thicker and longer than it. 
It arises chiefly from the angle of the scapula; partly from the 
lower edge of the scapula at its back part; it is connected with the 
teres minor, and infra spinatus. It is a large, thick, and flat 
muscle and forms a flat strong tendon, which passes under the long 
head of the triceps ; it passes under the os humeri ; turns round it, 
and is inserted into the ridge, on the inner side of the groove, and 
gives some tendinous fibres to line the groove. In short, it accom- 
panies the tendon of the latissimus dorsi, is inserted along with it, 
and may be considered as the congener of the latissimus dorsi ; 
and the two tendons are enclosed in one common capsule, or sheath 
of cellular substance. 
Its use, then, is evidently to draw the humerus downwards and 
backwards, and to perform the same rotation of the arms, which 
the latissimus dorsi does. 
LXXVII. The subscapttlaris lines all the concavity of the 
scapula like a cushion. It is like the surface of the scapula on 
which it lies, of a triangular shape ; and from the convergence of 
all the fibres it is completely radiated or fan-like ; it is very fleshy, 
thick, and strong ; the radii are each minutely described by Albums ; 
but Sabatier says, with good sense, that he cannot distinguish them, 
so as to describe them accurately ; and he might have added, that 
there was not the shadow of a motive for wasting time in so trivial 
an employment as counting the bundles. 
It arises from the two costae, the base, and all the internal sur- 
face of the scapula. And indeed it is to favour this origin that the 
inner surface of the scapula is full of little risings and hollows, to 
every one of which the muscle adheres closely. Just under the 
coracoid process, is the only part from whence it does not arise. 
That little space is filled up with cellular substance. 
Its alternately tendinous and fleshy fibres are so rooted in the 
scapula, and so attached to its risings and depressions, that it is 
difficultly cleaned away from the bone. 
The tendon and upper edge of the muscle is almost continuous 
with the supra spinatus ; but from the manner of its insertion, its 
effect is very opposite from that of the supra spinatus, for it goes 
round the os humeri to its insertion, and it is fixed to the lesser 
tuberosity, therefore it both pulls the arm backwards and down- 
wards, and performs the rotation like the teres major, and latissimus 
dorsi. It is also like all the other tendons, attached to the capsule, 
so as to prevent its being caught; and it is particularly useful by 
strengthening the shoulder-joint. 
Teres 
major. 
Or. infe- 
rior angle, 
and part 
of the infe- 
rior costa 
of the 
scapula. 
In. the in- 
side of the 
groove for 
the long 
tendon of 
the biceps. 
Subscapu- 
laris. 
Or. 1. the 
concave 
surface of 
the scapu- 
la. 2. the 
base, 3. in- 
terior cos- 
ta. 4. sup. 
costa. 
In. intern- 
;il tubercle 
of the 
humerus. 
OF THE MOTIONS OF THE HUMERUS. 
Having thus described all the muscles which move this bone, J 
shall review the order in which they are arranged, and mark their 
place and effects. 200 
MUSCLES OF THE ARM, &C. 
To distinguish clearly the function of each muscle, we have but 
to mark the point to which it is attached. 
1. Those implanted above the head of the bone must raise the 
arm. Now the supra spinatus, infra spinatus, and teres minor, are 
implanted into the great tubercle, and raise the arm ; and the del- 
toides is implanted in the same direction, and still lower, so that it 
performs the same action with a still greater degree of power. 
2. There is implanted into the opposite or lower part of the 
head, the subscapularis, which, of course, draws the arm directly 
downwards and backwards. 
3. There is implanted into the outer edge of the bicipital groove, 
the pectoralis major, and also the coraco-brachialis, which comes 
in the same direction ; and these two pull the arm inwards, towards 
the side and forwards. 
4. There are inserted into the inside, or lower side of the groove, 
the latissimus dorsi, and teres major, both of which pull the arm 
directly backwards, as they bend under the arm, to reach their in- 
sertion. They also roll the palm inwards and backwards. And it 
is easy to observe in what succession those muscles must act, to 
describe the circular and rotatory motions of the arm. 
Joints are more strengthened by the origin and insertion of 
muscles around them, than by elastic ligaments, which yield or 
tear; whereas the muscles, having a living power, re-act against 
any separating force. They contract, or, in other words, they are 
strong in proportion to the violence that the joint suffers. Thus, in 
the shoulder the capsule is so lax, that there is a mechanical con- 
trivance to prevent its being cheeked in the joint, and it is moreover 
so weak, that, independent of its yielding easily, it is also very easily 
torn ; but these muscles surround the joint so fairly, that their 
strength and their tendinous connexions with the head of the bone 
are more than a compensation for the looseness of its capsular liga- 
ment. Were not the muscles thus closely attached, the shoulders 
would be very often displaced, the glenoid cavity is so superficial, 
and the bursa so lax; and surely it is for some such purpose, that 
the muscles are planted so closely round the head ; for when they 
are implanted at a distance from the centre, as one muscle, the del- 
toid is, or as the biceps and triceps of the arm, or the hamstrings, 
or tendo Achillis, the power is much increased. Here, in the mus- 
cles arising from the scapula, power is sacrificed to the firmness of 
the joint, and they are all implanted closely round the head of the 
bone. 
The connection of the bones in this joint is in a manner formed 
by these muscles, for the supra spinatus, infra spinatus, teres major 
and minor, and the subscapularis, surround the joint very closely, 
cover the joint with their fiat tendons, and so thicken the capsule, 
and increase its strength. 
The muscles of the fore-arm are only four, the biceps and 
brachialis for bending, and the triceps and anconeus for ex- 
tending. 
LXXVIII. Biceps brachii flexor is universally named biceps, 
from its having two very distinct heads. It is an exceedinglv thick 
Bicep*. MUSCLES OF THE AKM, &C. 
201 
and strong muscle, for when it contracts, we feel it almost like a 
hard firm ball upon the fore part of the arm, and at the upper and 
most conspicuous part of this ball is the union of the two heads. 
The larger and thicker head arises from the coracoid process, by 
a tendon which extends three inches along the fore part of the 
muscle, in the form of an aponeurosis, but at the back part the 
tendon is short, and the muscle is attached there to the fleshy belly 
of the coraco-brachialis. 
The second, or long head, arises from the edge of the glenoid 1 
cavity, at its upper part; it is exceedingly small and tendinous, and 
this long tendon runs down in its proper groove, till about the third 
part down the humerus the two heads meet. And though below 
this it is but one fleshy belly, yet here, as in other muscles, the 
common division between its two origins may be still observed.* 
It is earlier tendinous at the fore part and outer side ; the tendon 
here sends off that aponeurotic expansion which covers all the arm 
below, and encloses the muscles as in a sheath. The tendon, at 
first flat and large, becomes gradually smaller and rounder ; and 
turns a little in its descent, so as to lay one flat edge to the radius, 
and another to the ulna ; and it is at last implanted into that round 
tubercle, which is on the fore part of the radius, a little below its 
neck ; but it has also an insertion into the fasciae of the fore arm. 
The great use of the biceps is to bend the fore arm with great 
strength. But as it is inserted into the tubercle of the radius, 
when the arm and hand are turned downwards, it, by acting, will 
pull them upwards, i. e. it will assist the supinators. Since both its 
heads are from the scapula, it will occasionally move the humerus, 
as well as the fore arm. 
LXX1X. The brachialis intf.rnus lies immediately under the 
biceps, and is a very strong, fleshy muscle, for assisting the biceps 
in bending the arm. It is called brachialis, from its origin in the 
fore arm, and internus, from its being within the biceps. 
It arises from two-thirds of the os humeri at its fore part, by a 
sort of forked head ; for it comes down from each side of the del- 
toid. It continues its attachment all the way down the fore part of 
the humerus to within an inch of the joint. It is very thick, fleshy, 
and strong ; it is tendinous for about two inches in its fore part; 
and is inserted by a flat strong tendon into the coronoid process of 
the ulna. 
Other uses are ascribed to it, as the lifting up the capsule to 
prevent its being pinched. But the chief use of it is to bend the 
fore arm. In a strong man, it is exceedingly thick, and its edge 
projects from under the edge of the biceps, and is seen in the 
lateral view. 
liXXX. Triceps extensor.—Upon the back part of the arm 
three muscles have been described : the extensor longus, the ex- 
tensor brevis, and the brachialis externus ; but there is, in fact, 
only one three-headed muscle. 
The longest head of this muscle is in the middle. It arises by a 
* It is not uncommon to find a third head to this muscle, which takes an origin 
from the fore part of the humerns. 
Or. 1. co- 
racoid 
process, 
2. glenoid 
cavity. 
In. 1. fas- 
cia of the 
fore arm, 
2. tubercle 
of the ra- 
dius. 
Brachialis 
internus. 
Or. the 
anterior 
flat sur- 
face of 
humerus. 
In. coro- 
noid pro- 
cess of 
ulna. 
Triceps 
extensor. 
Or. 1st 
head,neck 
of the 
scapnlit. 202 
MUSCLES OF THE ARM, &C. 
flat tendon; from an inch of the edge of the scapula under the 
neck, and a little way from the origin of the long head of the 
biceps ; and it is under this head that the tendon of the teres major 
passes to its insertion. 
The second head is on the outside of the arm, next in length to 
this. It arises from the arm-bone under the great tuber, and just 
below the insertion of the teres minor. The long and second heads 
meet about the middle of the humerus. 
The third, or internal head, is the shortest of all. It begins at 
the inner side of the humerus, just under the insertion of the teres 
major ; and it arises from the inner part of the humerus, all the way 
down, and joins just where the second head joins (*. e. about the 
middle). All these heads still continue adhering to the humerus (as 
the brachialis does on the fore side), quite down to within an inch 
of the joint, and then a strong thick tendon is formed, by which it 
is implanted strongly in the projecting heel of the ulna, named 
olecranon, by which projection of the bone the muscle has great 
power, and the power is increased by an increased length of the 
process in dogs, and other animals which run or bound. 
The whole forms a very thick and powerful muscle, which covers 
and embraces all the back part of the arm ; and its use is too sim- 
ple to admit of any farther explanation, than just to say that it ex- 
tends the hinge-joint of the elbow with great power; and that by 
its long head it may assist also to bend the arm-bone outwards and 
backwards. 
LXXXI- The anconeus is a small triangular muscle, placed on 
the back part of the elbow. It arises from the ridge and from the 
external condyle of the humerus, by a thick, strong, and short 
tendon. From this it becomes fleshy, and after running about three 
inches obliquely backwards, it is inserted by its oblique fleshy fibres 
into the outer part of the ridge of the ulna. 
It is manifestly designed for the extension of the fore arm, and 
has only that one simple action. 
2d head, 
ridgTof 
the hume- 
rus. 
3d head, 
internal 
the hume- 
rus. 
In. Ole- 
cranon. 
Anco- 
OrUSrid e 
and ouier 
condyle of 
rus.hUme 
In. flat 
the^back>" 
of the 
ulna. 
THE FASCIA OF THE ARM. 
Besides bones, there is also another source of attachment for 
muscles, that is, the tendinous expansions; for the expansions, 
which go on the surface like sheaths, also dive between the muscles, 
and form septa, or partitions, from which their fibres arise. 
One tendinous expansion begins from the clavicle and acromion 
process, or rather comes down from the neck : it is then strength- 
ened by the tendon of the deltoid muscle ; it descends, covering all 
the arm ; and before it goes down over the fore arm, it is again 
reinforced chiefly by the biceps, but also by the tendon of the triceps 
extensor. One remarkable process, or partition of this general 
fascia, is sent in from the sheath to be fixed to the outside of the 
humerus, all the way down to the ridge of the outer condyle. 
Another partition goes down, in like manner, to the inner condyle, 
along the ridge which leads to it; then the fascia, taking a firm 
hold on the condyles, is greatly strengthened about the elbow, and MUSCLES OF THE ARM, &C. 
203 
goes over the fore arm, enclosing its muscles in a very firm and 
close sheath ; and it sends partitions down among the several layers 
of muscles in the fore arm, which gives each of them a firm hold. 
The fore arm is covered with this fascia, or strong tendinous web, 
which, like that which covers the temporal muscle, gives both origin 
and strength to the muscles which lie under it, which divides the 
several layers one from another. This fascia is said to proceed from 
the strong tendon of the biceps muscle, though that were but a 
slender origin for so great a web of tendon, which not only covers 
the surface of the muscles, but enters among their layers. This 
fascia really begins in the shoulder, and has an addition and an in- 
crease of strength from every point of bone: it is assisted by each 
tendon, because the tendons and fascia are of one nature over all 
the body, and its connection with the tendon of the biceps is quite 
of another kind from that which has been supposed. L would not 
allow that the biceps tendon expands into the fascia, but rather that 
the web receives the biceps tendon, which is implanted into it, and 
for this wise purpose, that when the fore arm is to strike, or the 
hand to grasp, the biceps first moves, and by making the fascia 
tense, prepares the fore arm for those violent actions which are to 
ensue. Thus, it may be defined, a web of thin but strong tendon, 
which covers all the muscles of the fore arm, makes the surface 
before dissection firm and smooth, sends down partitions which are 
fixed into the ridges of the radius and ulna, enabling those bones to 
give a broader origin to the muscles, establishing a strong connec- 
tion among the several layers, and making the dissection more 
difficult. 
The fascia of the fore arm is continued to the wrist, where it is 
strengthened by the annular ligament, and passes over the back of 
the hand even to the fingers. 
The fascia of the fore arm, and its relation to the tendon of the 
biceps flexor, is of much importance as a piece of surgical anatomy. 
It has to be particularly considered in very many cases, as in wounds 
of the fore arm, abscesses forming under it; as in the inflammation 
which follows bleeding, and in the aneurism which is consequent on 
the wound of the brachial artery. 
MUSCLES or THE FORE ARM, CARPUS, AND FINGERS. 
The motions to be performed by the muscles which lie upon the 
fore arm are these three ; to roll the hand, to bend the wrist, to 
bend the fingers. 
1. The turning of the hand, which is performed by rolling the 
radius on the ulna, is named pronation and supination. When we 
turn the palm down, it is said to be prone ; when we turn the palm 
upwards, it is supine. This is pronation and supination. The muscles 
which perform these motions are the pronators and the supinators, 
and the motion itself is best exemplified in the turning a key in a lock, 
or in the guards of fencing, which are formed by a continual play 
of the radius upon the ulna, carrying the wrist round- in the half 
circle. Now. all musclfes which are inserted into the radius, tufn 204 
MUSCLES OF THE ARM, &C. 
it or roll it. We have just seen that even the biceps does so. 
Therefore, when the student finds a muscle inserted into this bone, 
he knows by that mark that it is either a pronator or supinator. 
2. The wrist is called the carpus, and, therefore, those muscles 
which serve for bending or extending the wrist are the flexors and 
extensors of the carpus. 
. 3. The bending and extending of the fingers cannot be mistaken, 
and therefore the flexors and extensors of the fingers need not be 
explained. 
These muscles are denominated from their uses chiefly ; but if 
two muscles perform one motion, they may be distinguished by some 
accident of their situation or form. And thus, if there be two 
benders of the fingers, one above the other, they are named flexor 
sublimis, and flexor profundus, i. e. the superficial and deep 
flexors. If there be two flexors of the carpus, one is named 
flexor radialis carpi, by its running along the radius, the other 
flexor ulnaris carpi, from passing in the course of the ulna. 
And if there be two pronators, one may be distinguished pronator 
teres, from its round shape, the other pronator quaduatus, from 
its square form. And this, I trust, will serve as a key to what is 
found to be a source of inextricable confusion. 
It will be easy to make the origins and insertions still more sim- 
ple than the names ; for all the muscles arise from two points, and 
have but two uses. 
This assertion shall be afterwards qualified with a few exceptions : 
but at present it shall stand for the rule of our demonstration ; for 
all the muscles arise from two points, the external and internal 
condyle. The internal condyle is the longer one, and gives most 
power : more power is required for bending, grasping, and turning 
the hand inwards ; therefore all the muscles which bend the hand, 
all the muscles which bend the fingers, and the principal pronator, 
or that muscle which turns the palm downwards, arise from the in- 
ternal condyle. 
The external condyle is shorter ; it gives less power ; there is 
little resistance to opening the hand, and little power is required in 
extending the fingers ; and so all the muscles which extend the wrist 
or the fingers, or roll the hand outwards to turn it supine, arise from 
the external condyle. So that when we hear a pronator or a flexor 
named, we know that the origin must be the internal condyle, and 
the insertion is expressed by the name. Thus a pronator radii goes 
to the radius ; a flexor carpi goes ,to the wrist: a flexor digitorum 
goes to the fingers ; and a flexor pollicis goes to the thumb : and 
they all issue from the inner condyle as from a centre. 
And, again, when a supinator or extensor is named, we know 
where to look for it; for they also go out from one common point, 
the external condyle ; and the supinator radii goes to the radius : 
the extensor carpi goes to the wrist; the extensor pollicis goes to 
the thumb ; and the extensor indicis to the fore finger. 
A kind of artificial memory of the muscles of the fore arm may 
be had by arranging them in numbers; for example, if we take the 
biceps flexor as supinator in this instance, which it truly is. and the MUSCLES OF THE ARM, &C. 
205 
mass of the flexor muscles as one great pronator, for such is their 
conjoint operation, then the muscles go in threes—thus : 
For the motion of the wrist, three flexors, the ulnaris, radialis, 
and medius, commonly called palmans longus.— Three extensors, 
ulnaris, radialis longior, and brevior.— Three pronators, the teres, 
quadratus, and the mass of flexor muscles.—Three supinators, the 
supinator longus, brevis, and biceps cubiti. There are three exten- 
sors of the fingers, extensor communis digitorum, extensor primi 
digiti, extensor minimi digiti.— Three extensors of the thumb, exten- 
sor primus, secundus, and tertius.— Three flexors of the fingers and 
thumb, flexor digitorum sublimis, flexor digitorum profundus, flexor 
pollicis longus. In the arrangement of the muscles of the fore 
arm, it is correct to say that the flexors arise from the inner con- 
dyle, and the extensors from the outer condyle ; but the supinators 
and pronators are better distinguished by their insertion :—thus, all 
muscles inserted into the radius turn the wrist, and thus the supina- 
tor longus, the supinator brevis, the pronator teres, the pronator 
quadratus, and the biceps, are employed in turning the hand. 
MUSCLES INSERTED INTO THE RADIUS. 
LXXXII. Supinator radii longus. This muscle forms the 
very edge of the fore arm : it arises by many short tendinous fibres, 
from the ridge of the humerus, above the external condyle, which 
origin is fully two inches in length above the condyle. It also arises 
from the intermuscular membrane ; and, as it lies on the very edge 
of the fore arm, it runs between the flexor and extensor radialis. 
It becomes thicker as it passes the joint of the humerus, and there 
gives a very peculiar form to the arm ; it then becomes smaller, and 
forms a flat tendon, which is quite naked of flesh from the middle of 
the radius, or a little below, down to the wrist. This tendon becomes 
gradually smaller, till it reaches the wrist, where expanding a little, 
it is inserted into the lower head of the radius on its outer side. 
Its use is, perhaps, chiefly as a supinator, but it is placed just 
upon the edge of the arm ; it stands as a sort of intermedium be- 
tween the two sets of muscles; it is fixed, indeed, rather upon the 
internal surface of the radius ; but yet, when the supination is com- 
plete, when the hand is rolled very much outward it will become a 
pronator. 
It is at once supinator and pronator, and for a most evident rea- 
son, a flexor also of the fore arm, since its origin is at least two 
inches up the humerus, above the joint of the elbow. 
LXXXIII. The supinator brevis is an internal muscle, which 
forms, with the muscles of the thumb and of the fore finger a kind of 
second layer; and this one lies concealed, as much as the pronator 
quadratus does, on the inner side of the fore arm. It is a short 
muscle, but very thick and fleshy, and of great power. 
It arises from the outer condyle of the os humeri, and from the 
edge of the ulna, and from the interosseous ligament: it is then 
lapped over the radius, and is inserted into its ridge ; so that this 
supinator brevis is very directly opposed to the pronator teres, the 
Supinator 
r“^u Ion' 
<>. ridge 
and outer 
the hume°-f 
rus. 
tower 
[he radius, 
Supinator 
brevis. 
Or. 1. ext. 
condyle of 
the hume- 
rus, 
2. back of 
the ulna. 206 
MUSCLES OF THE ARM, &C. 
In. ridge 
Of the ra- 
dius. 
insertion of the two muscles, almost meeting on the edge of the 
radius. It is almost circumscribed to one use, that of performing 
the rotation of the radius outwards ; but, perhaps, it may also have 
some little effect in extending the ulna, and of assisting the anco- 
nasus. 
LXXX1V. The pronator teres radii is of the outermost layer 
of muscles, is small and round; named pronator from its office of 
turning the radius, and teres from its shape, or rather to distinguish 
it from the pronator quadratus, which is a short square muscle, and 
which lies deep, being laid flat upon the naked bones. 
The pronator teres arises chiefly from the internal condyle of the 
humerus, at its lower and fore part. It has a second origin from 
the coronoid process of the ulna ; these form two portions, between 
which passes the radial nerve. The muscle thus formed is conical, 
is gradually smaller from above downwards, is chiefly fleshy, but is 
also a little tendinous, both at its origin and at its insertion; and 
stretches obliquely across the fore arm, passing over the other mus- 
cles to be inserted in the outer ridge of the radius, about the middle 
of its length. 
Its use is to turn the hand downwards, by turning the radius ; and 
it will also, in strong actions, be brought to bend the fore arm on 
the arm, or the reverse, when the fore arm is fixed, and we are to 
raise the trunk by holding with the hands. 
LXXXV. The pronator quadrates, so named from its shape 
and form, is one of the most simple in its action, since it serves but 
one direct purpose, viz. turning the radius upon the ulna. 
It lies flat upon the interosseous ligament upon the fore part of 
the arm, about two inches above the wrist; it is nearly square, and 
is about three inches in length and breadth. Its fibres go obliquely 
across, between the radius and ulna. It arises from the edge of the 
ulna, adheres to the interosseous ligament, and goes to be implanted 
into the edge of the radius ; it turns the radius upon the ulna. This 
muscle, and in some degree also the flexor pollicis, are the only 
muscles which do not come fairly under that arrangement, by which 
I have endeavoured to explain the muscles of the fore arm. 
LXXXVI. The palmaris longus flexor carpi medius, is a long 
thin muscle, which, although it seems to have another use in its 
expansion into the aponeurosis, yet is truly, by insertion into the 
annular ligament of the wrist, a flexor of the wrist, and, in some 
degree, a pronator of the radius. 
It arises from the internal condyle of the os humeri, and is the 
first of five muscles w hich have one common tendon going out, like 
radii, from one common centre, viz. the palmaris; the flexor 
radialis ; the flexor ulnaris ; the flexor digitorum sublimis ; the flexor 
digitorum profundus. 
The palmaris longus arises from the inner condyle of the os humeri, 
and also from the intermuscular tendon, which joins it with the 
flexor radialis and flexor digitorum sublimis, and from the internal 
surface of the common sheath. Its fleshy belly is but two inches 
and a half or three inches in length ; and its long slender tendon 
descends along the middle of the fore arm to be inserted into the 
Pronator 
teres. 
Or. inner 
condyle 
and ridge 
of the 
Ulna. 
In. near 
the middle 
of the ra- 
dius. 
Pronator 
quadratus. 
Or. edge 
of the 
nlna. 
In. edge 
of the ra- 
dios. 
Palmaris 
longus. 
Or. inner 
condyle 
and fascia 
of the fore 
arm. 
in. annu- 
lar He. MUSCLES OF THE ARM, &C. 
207 
tore part of the annular ligament of the wrist, just under the root of 
the thumb. This tendon seems to give rise to the very strong thick 
aponeurosis of the palm of the hand, (under which all the muscles 
of the hand run, and which conceals the arch of blood-vessels, and 
protects them,) thence the muscle has its name. But it is a very 
common mistake to think, that because tendons are fixed to the 
sheaths, the sheaths are only productions of the tendons ; whereas 
the sheaths do truly arise from bones. The fascia, which the del- 
toides is thought to form, arises from the acromion and clavicle ; 
and the fascia, which the biceps is thought to produce, arises from 
the condyles of the hpmerus ; and that great sheath of tendon which 
is made tense by the musculus fascialis of the thigh, does not arise 
from that muscle, but comes down from the spine of the ilium, 
strengthened by expansions from the oblique muscles of the abdo- 
men ; in the present instance, we have the clearest proof of fascia 
being derived from some other source than the tendons, for some- 
times the palmaris muscle is wanting, when still the tendinous ex- 
pansion is found, and some pretend to say, that the expansion is 
wanting when the muscle is found. The aponeurosis, which covers 
the palm, is like the palm itself, of a triangular figure ; it begins from 
the small tendon of the palmaris longus, and gradually expands, 
covering the palm down to the small ends of the metacarpal bones. 
Its fibres expand in form of rays ; and towards the end there are 
cross bands which hold them together, and make them stronger; 
but it does not cover the two outer metacarpal bones, (the meta- 
carpal of the fore finger, or of the little finger,) or it only covers 
them with a very thin expansion. 
Now this palmar expansion also sends down perpendicular divi- 
sions, which take hold on the edges of the metacarpal bones : and 
thus there being a perpendicular division to each edge of each meta- 
carpal bone, there are eight in all, which form canals for the ten- 
dons of the fingers, and for the lumbricales muscles.* 
LXXXVIT. The palmaris brevis is a thin flat cutaneous muscle, 
which arises properly from the edge of the palmar aponeurosis, near 
to the ligament of the wrist; whence it stretches across the hand in 
thin fasciculi of fibres, which are at last inserted into the os pisi- 
forme, and into the skin and fat on the ulnar edge of the palm. 
This is the palmaris cetaneus of some authors, for which we can 
find no use, except of drawing in the skin of the hand, and perhaps 
making the palmar expansion tense. 
LXXXVIII. The flexor carpi radialis is a long thin muscle 
arising from the inner condyle, stretching along the middle of the 
fore arm somewhat in the course of the radius, and is one of the 
five muscles which rise by one common tendon, and which are, for 
some way, tied together. 
It arises tendinous from the inner condyle ; the tendon very short 
and thick. This tendon at its origin is split into many (seven) 
and fascia 
palmaris. 
Palmaris 
brevis. 
Or. fascia 
palmaris. 
In- ospisio 
forme and 
the skin 
and fat of 
the palm. 
Flexor 
carpi radi« 
alis. 
Or. inner 
condyle 
and fascia 
of the fore 
arm. 
* There is great irregularity in this mnscle ; it is frequently wanting, and it is not 
uncommon to find two. We have found more than once, that the tendinous part of 
the muscle was next to the condyle, and the fleshy part connected with the (asm 
palmaris. 208 
MUSCLES OF THE ARM, &C. 
heads, which are interlaced with the heads of the sublimis, profun- 
dus, palrnaris, &c. ; consequently this muscle not only arises from 
the internal condyle, but also from the inter-muscular partitions (as 
from that between it and the sublimis): it forms a long tendon, 
which, becoming at last very small and round, runs under the annu- 
lar ligament : it runs in a gutter peculiar to itself; but in this canal 
it is moveable, not fixed : it then expands a very little, and is 
inserted into the metacarpal bone of the fore finger, also touching 
that which supports the thumb. 
Its use is chiefly to bend the wrist upon the radius. But when 
we consider its oblique direction, it will also be very evident that it 
must have some effect in pronation ; and this, like many of the mus- 
cles of the fore arm, although designed for a different purpose, will 
also have some effect in bending the fore arm at the elbow-joint. 
LXXXIX. The plexor carpi ulnaris is a long muscle, much 
like the former ; but as its course is along the radius, or upper edge 
of the fore arm, this runs along the ulna or lower edge. 
It comes off tendinous from the inner condyle of the os humeri, 
by the common tendon of all the muscles ; it has also, like the pro- 
nator teres, a second head, viz. from the olecranon process of the 
ulna, which arises fleshy, and the ulna nerve perforates between these 
heads. The flexor ulnaris passes all along the flat side of the ulna, 
between the edge of the sublimis and the ridge of the bone ; and 
here it has a third origin of oblique fibres, which come from the 
edge of the ulna, two thirds of its length. Its tendon begins early 
on its upper part, by which it has somewhat the form of a penniform 
muscle. It has still a fourth origin from the inter-muscular partition, 
which stands between it and the flexor sublimis ; and is also attached 
to the internal surface of the common fascia of the arm. Its long 
tendon is at last inserted into the os pisiforme at its fore part, where 
it sends off a thin tendinous expansion to cover and strengthen the 
annular ligament; and also a thin expansion towards the side of the 
little finger to cover its muscles. 
This is to balance the flexor radialis : acting together, they bend 
the wrist with great strength ; and when this muscle combines in 
action with the extensor carpi ulnaris, they pull the edge of the hand 
sideways. 
XC. The flexor digitorum ooMMUivis sublimis, is named SUB- 
LIMIS from being the more superficial of the two muscles; perfo- 
ratus, from its tendon being perforated by the tendon of that which 
lies immediately below. It lies between the palrnaris longus and 
flexor ulnaris: it is a large fleshy muscle ; and not only its tendons, 
but its belly also, is divided into four fasciculi, corresponding with 
the fingers which it is to serve. 
It arises from the internal condyle, along with the other four mus- 
cles ; from the ligament of the elbow-joint; from the coronoid pro- 
cess of the ulna ; and from the upper part of the radius, at the sharp 
ridge. By these origins, it becomes very fleshy and thick ; and, a 
little above the middle of the fore arm, divides into four fleshy por- 
tions, each of which ends in a slender tendon. The tendons begin 
at, the middle of the fore arm. or near the division, but they continue 
In. meta- 
carpal 
bone of 
the fore 
finger and 
first of the 
thumb. 
Flexor 
carpi ul- 
naris. 
Or. 1. in- 
ner con- 
dyle, 
2. olecra- 
non, 
3. the 
ridge of 
the ulna. 
4. the in- 
terosseous 
lig, and 
5. the 
fascia. 
In. os pisi- 
forme. 
Flexor di- 
gitorum 
snblitnis. 
Or. 1. in- 
ternal con- 
dyle, 2. 
coronoid 
pro. of the 
ulna, and 
3. sharp 
ridge of 
the radios. AiUSO’LES OF TtlE AKM, &C. 
209 
to be joined to each other by fleshy fibres some way down: and 
indeed the fleshy fibres cease only when it is about to pass under 
the annular ligament of the wrist. At this place, a cellular stringy 
tissue connects the tendons with each other, and with the tendons 
of the profundus ; but after they have passed under the ligament, they 
expand towards the fingers which they are to serve. They each 
begin to be extended and flattened, and to appear cleft; they pass 
by the edge of the metacarpal bones, and escape from under the 
palmar aponeurosis ; and where it ends, viz. at the root of the fingers, 
a tendinous sheath begins, in which these tendons continue to be 
enclosed. 
The tendons are fairly split just opposite to the top of the first 
phalanx : and it is at this point that the tendons of the deeper mus- 
cle pass through this splitting. The flattened tendon parts into two, 
and its opposite edges diverge ; the back edges meet behind the 
tendons of the profundus, and form a kind of sheath for them to pass 
in ; and then they proceed forward along the second phalanx, into 
the fore part of which they are implanted. 
This muscle is exceedingly strong: its chief office is to bend the 
second joint of the fingers upon the first, and the first upon the meta- 
carpal bone. And in proportion to the number of joints that a mus- 
cle passes over, its offices must be more numerous ; for this one not 
only moves the fingers on the metacarpus, but the hand upon the 
wrist, and even the fore-arm upon the arm. 
XCI. The flexoh digitorum puofuwdus vel perfobans, has so 
nearly the same origin, insertion, and use, that the description of the 
last is applicable to this rtiuscle in almost eveiy point. This is of a 
lower stratum of muscles ; it lies deeper, and under the former, 
whence its name : and by this deeper situation it is excluded from 
any hold upon the tubercle of the humerus. 
It arises from the ulna beginning at the coronoid process, and ex- 
tending all along its internal surface, from the whole surface of the 
Interosseous ligament, from the inner edge of the radius, and, also, 
in some degree, from the inter-muscular membrane, which separates 
this from the sublimis. 
This muscle is small, we may say compressed above ; but it grows 
pretty strong and fleshy, near the middle of the arm ; it divides above 
the middle of the arm into four portions, corresponding with the four 
fingers ; and it is about the middle of the arm that the tendons begin, 
and continue to receive muscular fibres from behind, all down to the 
ligament of the wrist: at the wrist these tendons are tied to each 
other, and to the tendons of the sublimis, by loose tendinous and cel- 
lular fibres. They diverge from each other, after passing under the 
annular ligament; and going along in the hollow of the bones, under 
the tendons of the sublimis, they first pass through the bridges formed 
by the palmar aponeurosis, then enter the sheaths of the fingers, and 
finally pass through the perforations of the sublimis, a little below 
the second joint of the fingers : at this place the perforating tendons 
are smaller and rounder for their easy passage, and after passing they 
again expand and become flat. They also, above this, appear them- 
selves split in the middle without anv evident purpose; they pa%s tire 
In.second 
phalanx of 
all the im 
gera. 
Flexor di- 
g»to»>um 
pr0 1,11 '‘ 
Or. 1. co- 
ronoid 
pro. and 2. 
the ridet 
of the ulna, 
3. inter- 
rosseou.s 
ligament, 
and 4. 
edge of Che 
radius. 210 
MUSCLES OF THE ARM, Ac. 
Phalanx of 
alUhefin- 
gers. 
cates!*1" 
second phalanx, and are fixed into the root of the third. And every 
thing that is said of the use of the sublirnis may be applied to this, 
only that its tendons go to the furthest joint. 
XCII. Lumbricales.—I shall here describe, as a natural appen- 
dage of the profundus, the lumbricales muscles, which are four small 
and round muscles, resembling the earth-worm, in form and size ; 
whence they have their name. They arise in the palm of the hand, 
from the tendons of the profundus, and are therefore under the sub- 
limis, and under the palmar aponeurosis. They are small muscles, 
with long and very delicate tendons. Their fleshy bellies are about 
the length of the metacarpal bones, and their small tendons stretch 
over two joints, to reach the middle of the second phalanx. The first 
lumbricalis is larger than the second, and the two first larger than the 
two last. * 
The first arises from the side of the tendon of the fore finger, 
which is next to the radius ; the others arise in the forks of the ten- 
dons ; and though they rise more from that tendon which is next the 
ulna, yet they have attachments to both. Their tendons begin below 
the first joint of each finger ; they run very slender along the first 
phalanx, and they gradually wind around the bone, so that though 
the muscles are in the palm of the hand, the tendons are implanted in 
the back parts of the fingers, and their final connection is not with 
the bending tendons of the sublirnis and profundus, but with tendons 
of the extensor digitorum, and with the tendons of the external inter- 
ossei muscles, with which they are united by tendinous threads. 
Hence their use is very evident; they bend the first joint, and ex- 
tend the second ; they perform alternately either office ; when the 
extensors act, they assist them by extending the second phalanx or 
joint: when the flexors act, and keep the first and second joint 
bended, the extending effect of these smaller muscles is prevented, 
and all their contraction must be directed so as to affect the first 
joint only, which they then bend. 
They are chiefly useful, in performing the quick short motions, and 
so they are named by Cowper, the musculi fidicinales, as chiefly 
useful, in playing upon musical instruments. 
XCIII. The flexor longus pollicis is placed by the side of the 
sublirnis, or perforatus, and lies under the supinator and flexor carpi 
radialis. It runs along the inner side of the radius whence chiefly 
it arises. 
Its origin is from all the internal face of the radius downwards, 
from the place where the biceps is inserted, and from the interosseous 
ligament, all the length down to the origin of the pronator quadratus: 
nor does it even stop here ; for the tendon continues to receive fleshy 
slips all the way down to the passage under the ligament of the 
wrist. It has also another head, which arises from the condyle of 
the humerus, and the fore part of the ulna ; which head is tendinous, 
and joins that origin which comes from the radius. 
The muscle becomes again tendinous, very high, i. e. above the 
middle of the arm ; and its small tendon passes under the annular 
ligament, glides in the hollow of the os metacarpi pollicis, and sepa- 
rates the short flexor into two heads, passes between the two sesa- 
don ofThe 
flexor pro- 
fundus. 
of theddle 
cond pha- 
Ianx. 
Flexor 
lo"£.u? 
p0 1 ' 
Or. inner 
surface of 
the radius, 
and inner 
condyle of 
the hu- 
merus. 
Jn. the 
last pha- 
lanx of 
the thumb. MUSCLES OP THE AlOl, &C. 
211 
moid bones in the first joint of tho thumb, and running in the tendi- 
nous sheath, it reaches at last the end of the farthest bone of the 
thumb, to be inserted into the very point of it. 
There is sometimes sent off from the lower part of the muscle a 
small fleshy slip, which joins its tendons to the indicator tendon of 
the sublimis. 
Its uses, we conjecture, are exactly as of those of the other flexors, 
to bend the last phalanx on the first, the first on the metacarpal bones, 
and occasionally the wrist upon the radius and ulna. 
EXTENSORS. 
The muscles which lie upon the outer side of the fore arm, the su- 
pinators, and the extensors of the fingers and wrist, all arise from 
one point, the external condyle of the humerus, and are all delivered 
in this list : 
The extensor carpi radialis longior, 
The extensor carpi radialis brevior, 
The EXTENSOR CARPI ULNARIS, 
all extend the wrist. 
The supinator longus,—turns the palm upwards. 
The extensor communis digitorum,—extends all the fingers, and 
unfolds the hand. 
The extensor primi internodii pollicis, 
The EXTENSOR SECUNDI INTERNODII POLLICIS, 
The EXTENSOR TERTII INTERNODII POLLICIS, 
extend the several 
joints of the thumb. 
The extensor I’Rimi dioiti vel indicator,—extends the fore finger. 
The extensor minimi digiti vel auricijlaris,—extends the little 
finger. 
All these muscles arise from one point, the external condyle. 
They all roll the radius outwards, or extend the wrist, or extend the 
fingers. As the muscles which are flexors, need more fibres, and 
greater strength, they arise from the internal condyle, which is the 
larger ; they lie in a deep hollow, for the bones of the fore-arm are 
bent to receive them, and they form a very thick fleshy cushion : but 
the extensors requiring less power, arise from the shorter process of 
the outer condyle, are on the convex side of the arm, and are thin, 
having few fibres ; for though there is a large mass of flesh on the inner 
side of the arm, forming two big flexors of the fingers, there is 
only a thin layer on the outer side of the arm, forming one flat and 
weak extensor. 
XCIV. The extensor carpi radialis LONGioE, has the additional 
name of longior or primus, to distinguish it from the next. It is almost 
entirely covered with the last muscle, the supinator. 
It arises frop the ridge of the humerus above the external con- 
dyle, and just under the origin of the supinator ; it descends all along 
the back of the radius ; and after having become a thick fleshy belly, 
it degenerates a little lower than the middle of the radius, into a 
thin flat tendon, which becomes slender and smaller as it descends ; 
and turning a little more towards the back of the radius, it then 
I Extensor 
carpi radi- 
' alis lon- 
ger. 
Or. ridge 
and outer 
condyle of 
the hume- 
rus. 212 
MUSCLES OF THE ARM, AtC. 
passes over the wrist, and goes along with the tendon of the exten* 
sor, under the annular ligament, passing in a groove of the radius; 
at last it is inserted into the root of the metacarpal bone of the fore 
finger, in that edge next the thumb. 
It is chiefly an extensor of the wrist: in pronation, it pulls the 
wrist directly backwards ; in supination, it moves the hand sideways. 
It is also a pronator, when the hand is turned back to the greatest 
degree ; and from its origin, high upon the arm bone : it is also a 
flexor of the fore-arm. 
XCV. Extensor carpi radialis brevior.—This muscle is almost 
the same in description, name, and use, with the former. It arises 
from the external condyle; and here a common tendon for many 
muscles is formed, just as in the internal condyle ; for from this 
point arise the extensor carpi radialis brevior, extensor digitorum, 
extensor minimi digiti, extensor carpi ulnaris. 
The extensor carpi radialis brevior arises from the outer condyle 
of the humerus, by the common tendon ; it also arises from the apo- 
neurosis, which lies between the extensor digitorum and this; it 
grows a pretty large, fleshy body, and begins, like the last, to be 
tendinous below the middle of the radius ; so that this muscle con- 
tinues fleshy lower than the last one, and its tendon is also much 
larger and thicker; it runs under the annular ligament, in the same 
channel with the extensor longior ; it expands a little before its inser- 
tion, which is into the back part of the metacarpal bone of the mid- 
dle finger, a little towards that edge which is next the radius : some 
little fibres pass from this tendon to tfte metacarpal bone of the fore- 
finger. 
All that was said concerning the extensor longus, may be said of 
this ; for all the three last muscles lie so ambiguously on the edge of 
the arm, that though they are regularly supinators and extensors, 
they become pronators and flexors, in certain positions of the hand. 
XCVI. Extensor carpi ulnaris.—By the name merely of this 
muscle, we know its extent and course, its origin, insertion, and use. 
It is one of the muscles which belong to the common tendon, 
arising from the external tubercle of the os humeri: it lies along the 
ulnar edge of the arm ; it also arises from the intermuscular mem- 
brane, which separates this from the extensor digitorum and the ex- 
tensor digiti minimi ; and chitefly it is attached to the internal surface 
of the common sheath ; it arises also from the face and edge of the 
ulna, the whole way down. Its tendon begins in the middle of its 
length, and is accompanied all down to the wrist with feather-like 
fleshy fibres. 
It is fixed into the outside of the head of the metacarpal bone of 
the little finger. 
Its use is to extend the carpus. And it may be now observed, that 
when the two extensors of the wrist, the radialis and ulnaris act, the 
hand is bent directly backwards; that when the flexflr radialis and 
extensor radialis act together, they bend the thumb towards the 
radius; and that when the flexor ulnaris and extensor ulnaris act, 
they draw down the ulnar edge of the hand. 
XCVII. Extensor digitorum: communis.—This muscle corres- 
In. meta- 
carpal 
bone of 
the fore 
finger. 
Extensor 
carpi radi- 
alis bre- 
vior. 
Or. outer 
condyle of 
the hume- 
rus, and 
fascia of 
the fore 
arm. 
Jn. meta- 
carpal 
hone of 
the middle 
finger. 
Extensor 
carpi ulna- 
ris. 
Or. 1. 
outer con- 
dyle, 2. 
fascia of 
the fore 
arm, 3. 
hack of 
the radius, 
and 4. of 
the ulna. 
In, head 
of the 
metacar- 
pal bone 
ofthe little 
finger. 
{Sxtensor MUSCLES OF THE ARM, &C. 
213 
ponds with the sublimis and profundus, and antagonizes them, and 
resembles them in shape as in use. It covers the middle of the fore 
arm at its back, and lies between the extensor radialis brevior and the 
extensor minimi digiti. 
Its origin is chiefly from the outer condyle, by a tendon common 
to it, with the extensor carpi radialis brevior; it comes also from the 
intermuscular membrane, which separates it on one side from the ex- 
tensor minimi digiti, and on the other from the extensor carpi radialis 
brevior, and lastly, from the back part of the common sheath. It 
grows very fleshy and thick, as it descends, and about the middle of 
the fore-arm it divides itself into three slips of very equal size. But 
though the tendons begin so high, they continue like those of the 
flexors, to receive fleshy penniform fibres all down, almost to the an- 
nular hgamenU These tendons are tied together by a loose web of 
fibres, and being gathered together they pass under the ligament in 
one common and appropriated channel. Having passed this ligament 
they diverge and grow flat and large. And they all have the ap- 
pearance of being split by a perpendicular line. They are quite dif- 
ferent from the flexor tendons in this, that they are all tied to each 
other by cross bands ; for a little above the knuckles, or first joint of 
the fingers, all the tendons are joined on the back of the hand by slips 
from the little finger to the ring-finger, from the ring-finger to the 
mid-finger, and from that to the fore finger. So that it seems to be 
one ligament running quite across the back of the hand. It would 
be foolish to describe them more minutely : for the cross bands 
change their places, and vary in every subject, and in some they are 
not found. 
After this, the tendons pass over the heads of the metacarpal bones, 
along the first phalanx of the fingers, and being there joined by the 
tendons of the interossei and lumbricales, they all together form a 
strong tendinous sheath, which surrounds the back of the fingers. 
l\ow it is to be remembered, that this muscle serves only for the 
fore, middle, and ring fingers : that if it moves the little finger, it is 
only by a small slip of tendinous fibres, which it often gives off at 
the general divergence, but sometimes not ; sometimes it gives one 
slip, sometimes two, often none at all. And so the little finger has 
its proper extensor quite distinct from this. 
The use of the muscle is to extend all the fingers ; and when they 
are fixed, it will assist the extensors of the wrist, as in striking back- 
wards with the knuckles. 
XCV1II. The extensor minimi digiti, named also auricularis, 
from its turning up the little finger, as in picking the ear, should 
really be described with the last muscle; if we see the origin, course, 
and use of this muscle exactly the same with it, why should we not 
reckon it as a slip of the common extensor, appropriated to the little 
finger ? 
Its origin is from the outer condyle, along with the other tendons. 
If also adheres so closely both to the tendinous partitions, and to 
the internal surface of the common fascia, that it is not easily sepa- 
rated in dissection. It begins small, with a conical kind of head ; 
k gradually increases in size ; it is pretty thick near the wrist; it ad- 
digitoram 
Or. 1. 
*[utj®r£on* 
fascia, "3. 
interos- 
tbe radius, 
&>«> 
andrin*. 
fingers.” 
Extensor 
minimi 
digiti. 
Or. 1. 
outer con- 
dyle, 2. 
fascia, 3. 
inteross. 
ligament, 
4. back of 
the ulna. 214 
MUSCLES OF THE ARM, &C. 
heres all along1 to the common extensor of the fingers ; it begins to 
be tendinous about an inch above, the head of the ulna : it continues 
to receive fleshy fibres down to the annular ligament, and it passes 
under the annular ligament, in a channel peculiar to itself, which is 
indeed the best reason for making this a distinct muscle. 
This channel has a very oblique direction, and the tendon, like 
all the others, expands greatly in escaping from the ligament of 
the wrist. It is connected with the other tendons, in the manner I 
have described. Close to the wrist, it is connected with the tendon 
of the ring finger, by a slip which comes from it; and at the 
knuckle, and below it, it is again connected with the tendons both 
of the ring finger, and of all the others, by the cross bands or ex- 
pansions. 
Whatever has been said of the use of the last muscle, is to be 
understood of this ; as its extending its proper finger, assisting the 
others by its communicating band, and in its extending the wrist, 
when the first is clenched. Its insertion is into the back of tlip 
second joint of the little finger, along with the interossei and lum- 
bricales. Its tendon has also a small slit; for the head of the 
proper extensor of the little finger, and the heads of the common 
extensors of the others, are inserted into the top of the second 
phalanx, just under the first joint. They send oft’ at the sides ten- 
dinous slips, which, passing along the edges of the bones, do, in 
conjunction with the tendons of the interossei and lumbricales, form 
a split tendon, which meets by two curves at the foot of the last 
bone of the fingers, to move the last joint. 
XCIX. The extensor primus pollicis is the shortest of the 
three. It is named by Albinus and others, abductor longus ; but 
since every muscle that extends the thumb must pull it away from 
the hand, every one of them might be, with equal propriety, named 
abductors. 
The extensor primus lies just on the fore edge of the radius, 
crossing it obliquely. 
It arises about the middle of the fore arm, from the edge of the 
ulna, which gives rise to the interosseous membrane itself, and also 
from the convex surface of the radius. 
The fleshy belly commonly divides itself into two or three, some- 
times four fleshy slips, with distinct tendons, which, crossing the 
radius obliquely, slip under the external ligament of the carpus, 
and are implanted into the trapezium and the root of the first 
metacarpal bone, or rather of the first phalanx of the thumb, 
towards the radial edge, so that its chief use is to extend the thumb, 
and to incline it a little outwards towards the radius. It has also 
frequently a tendon inserted into the abductor pollicis. It must 
also, like the extensors of the fingers, be an extensor of the wrist: 
and it evidently must, from its oblique direction, assist in supination. 
C. The extensor secundus pollicis is longer than the first. It 
is named by Douglas, tbe extensor secundi internodii pollicis ; by 
Albinus, the extensor minor pollicis. 
This muscle lies close by the former. It arises just below it, 
from the same edcre of the radius, and from the same surface of 
In. last 
phalanx of 
the little 
finger. 
Extensor 
primus 
pollicis. 
Or. 1. 
ufna °andC 
2. convex 
surface of 
the radius. 
In. 1. tra- 
and'lTme 
tacarpal 
boneofthe 
mm * 
Extensor 
SEE- 
Or. l. 
«!na,°2. 6 MUSCLES OF T1IE ARM, «k,C. 
215 
the interosseous membrane, it runs along with it in the same bend- 
ing .course; and, in short, it resembles it so much, that Winslow 
has reckoned it as part of the same muscle. 
Its origin is from the edge of the ulna, the interosseous ligament, 
and the radius. Its small round tendon passes sometimes in a 
peculiar channel, sometimes with the extensor primus. It goes 
over the metacarpal bone of the thumb ; it expands upon the bone 
of the first phalanx ; and it is inserted just under the second joint. 
It extends the second bone of the thumb upon the first; it ex- 
tends the first bone also ; and it extends the wrist, and, by its 
oblique direction, contributes to supination. 
Cl. Extensor tektius pollicis.—This which bends the third 
joint is called in common the extensor longus pollicis. And here 
is a third muscle, which, in form, and place, and function, corres- 
ponds with the two former ones. 
Its origin is from the ridge of the ulna, and from the upper face 
of the interosseous membrane; and it is a longer muscle than the 
others, for it begins high, near the top of the ulna, and continues 
the whole way down that bone, and is very fleshy and thick. It is 
penniform all the way down to the ligament of the wrist; and its 
small tendon passes the ligament in a peculiar ring. This tendon 
appears split, like those of the fingers ; it goes along the ulnar side 
of the first bone of the thumb, reaches the second, and is implanted 
there by a small slip of tendon ; and being expanded, it still goes 
forward to be inserted once more into the third bone of the thumb 
at its root. 
Its use is evident, after describing the others : for we have only to 
add another joint for motion. It moves the last joint of the thumb, 
then the second, then its metacarpal bone upon the carpus ; and if 
that be held firm, it will extend the carpus ; and it will, in its turn, 
contribute to supination, though in a less degree than the others, 
ClI. Indicator.—The extensor indicis proprius has very 
nearly the same origin, and exactly the same course with the last, 
and lies by the side of it. * 
Its origin is from the ulna, by the side of the extensor longus 
pollicis. It has also some little attachments to the interosseous 
membrane. It, like the others, is feathered with fibres in an oblique 
direction down to the ligament of the wrist. 
This muscle lies under the extensor communis digitorum : its 
tendon passes along with the common tendon, through the annular 
ligament; and near the top of the metacarpal bone, or about the 
place of the common junctions of all these tendons, this one joins 
with the indicator tendon of the common extensor. 
Its use is in extending all the three joints of the fore finger ; 
assisting the common extensor in pointing with that finger ; in 
acting independently of the common extensor ; and in helping to 
extend the wrist, when the fingers are closed. 
inteross. 
lig. and 3, 
the radius. 
In. 1st and 
2d phalan- 
ges of the 
thumb. 
Extensor 
tertins 
pollicis. 
Or. 1. 
ridge of 
the ulna, 
and 2. in- 
terros- 
seous lig. 
In. last 
phalanx of 
the thumb. 
Indicator. 
Or. 1. 
ridse of 
the ulna, 
last 2. in- 
ter oss. lig, 
last , 
the fore ° 
finger, 
MUSCLES SEATED ON THE HAND. 
Besides these muscles which bend and extend the fingers, there 216 
Muscles of the arm, &c. 
are other smaller ones seated on the hand itself, which are chief!) 
for assisting the former, and for quicker motions ; but most espeJ 
cially for the lateral motions of the fingers, and which are named 
adductors, abductors, and flexors, when they belong to the 
thumb and to the little finger. 
That they are chiefly useful in assisting and strengthening the 
larger muscles, is evident from this, that much power being required 
for flexion, wo find many of these smaller muscles added in the 
palm of the hand ; but as there is little power of extension needed, 
ho more almost than to balance the power of the flexors, there are 
no small muscles on the back of the hand, the interossei externi 
excepted, which are chiefly useful in spreading the fingers. 
The short muscles in the palm of the hand are for bending the 
thumb, the fore finger and the little finger ; and the little finger and 
the thumb, have each of them three distinct muscles ; one to pull 
the thumb away from the hand, one to bend it, and one to pull it 
towards the hand, opposing it to the rest of the fingers, and so of 
the little finger, which has also three muscles. 
All the muscles of the thumb are seated on the inside, to form 
the great ball of the thumb ; and it is not easy at first to conceive 
how muscles having so much the same place should perform such 
opposite motions ; yet it is easily explained, by the slight variations 
of their places ; for the abductor arises from the annular ligament 
near the radius, and goes towards the back of the thumb. 
The flexors arise deeper, from bones of the carpus, and from the 
inside of the ligament, and go to the inside of the thumb. The 
adductor arises from the metacarpal of the mid finger, and goes to 
the inner edge of the thumb. 
CIII. The abductor pollicis is only covered by the common 
integuments. It begins a little tendinous from the outside of the 
annular ligament, just under the thumb, and by some little fibres 
from the trapezium ; and, from the tendon of the long abductor or 
extensor primus, it bends gradually round the thumb, and is at last 
inserted in the back of the first joint, just above the head of tire 
metacarpal bone. But it does not stop here ; for this flat tendon is 
now expanded into the form of a fascia, which, surrounding the first 
bone of the thumb, goes forward upon its back part, quite to the 
end, along with the common tendon of the extensor. This muscle, 
like the others, is covered by a thin expansion from the tendon of 
the palmaris, as well as by the common integuments. 
Its only use is to pull the thumb from the fingers, and to extend 
the second bone upon the first. 
Albinus describes a second muscle of the same name, having the 
same' course, origin, insertion, and use : it also arises from the 
outer side of the ligament of the wrist, and is fixed into the side of 
the thumb, and lies upon the inside of the former muscle. 
These two are inserted into the first bone of the thumb ; but the 
next is inserted into the metacarpal bone. 
CIV. The opponens pollicis is often called the flexor of the 
metacarpal bone of the thumb. It is placed on the inside, and im- 
planted into the side of the thumb : its office is to draw the thumb 
Abductor 
pollicis. 
Or. 1. an- 
nular lig. 
3. trape- 
zium. 
In. back 
part of se- 
cond bone 
of the 
thumb. 
Opponens 
nollicis. MUSCLES OF THE ARM, &C. 
217 
across the other fingers, as in clenching the fist; and from its thus 
opposing the fingers it has its name of opponens. 
it lies immediately under the last described muscle, and is like it 
in all but its insertion. 
it arises from the trapezium, and from the ligament of the wrist. 
It is inserted into the edge and fore part of the metacarpal bone of 
the thumb : and its use is to turn the metacarpal bone upon its axis, 
and to oppose the fingers ; or, in other words, to bend the thumb : 
for I can make no distinction. Therefore, this muscle and the next, 
which lies close upon it, may be fairly considered as but two differ- 
ent heads of one thick short muscle. 
CV. The flexor brevis tollicis is a two-headed muscle, placed 
quite on the inside of the thumb, between the fore finger and the 
thumb, and extends obliquely across the two first metacarpal bones. 
It is divided into two heads by the long flexor of the thumb. 
The edge of this muscle lies in close contact with the edge of 
the last, or opponens ; and indeed they may fairly be considered as 
one large muscle surrounding the basis of the thumb. 
One head arises from the os trapezium, or base of the thumb, 
and from the ligament of the wrist. The other head comes from 
the os magnum and unciforme, and from the ligaments which unite 
the bones of the carpus. \ 
The first head is the smaller one : it terminates by a pretty con- 
siderable tendon in the first sesamoid bone. The second head runs 
the same course: it is implanted chiefly in the second sesamoid 
bone, and also into the edge of the first bone of the thumb close by 
it. The second head is exceedingly muscular and strong : the heads 
are completely separated from each other by the tendon of the flexor 
longus passing between them. 
The office of this muscle is to bend the first joint upon the second, 
and the metacarpal bone upon the carpus: and indeed the office of 
this, and of the opponens, is the same. It is in the tendons of this 
double-headed muscle that the sesamoid bones are found. 
CVI. The adductor pollicrs arises from the metacarpal bone o 
the middle finger, where it has a flat extended base. It goes from 
this directly across the metacarpal bone of the fore finger to meet 
the thumb. It is of a triangular shape, and flat: its base is at the 
metacarpal bone ; its apex is at the thumb : it is inserted into the 
lower part or root of the first phalanx: its edge ranges with the edge 
of the flexor brevis : it concurs with it in office; and its more pecu- 
liar use is .to draw the thumb towards the fore finger, as in pinching. 
Thus do these muscles, covering the root of the thumb, form that 
large ball of flesh which acts so strongly in almost every thing wo 
do with the hand. 
The ball of the thumb is fairly surrounded ; it is almost one mass, 
having one office : but as the deltoides will, in some circumstances, 
pull the arm downwards, some portions of this fleshy mass pull the 
thumb outwards obliquely ; some directly inwards: but the great 
mass of muscle bends the thumb, and opposes it to the hand: and 
as this one muscle is to oppose the whole hand, the bail of fldsh is 
cry powerful and thick 
Or. 1. an- 
nular lig. 
and 2. tra- 
pezium. 
In. meta- 
carpal 
bone of 
the thumb. 
Flexor 
brevis pol- 
licis. 
Or. I. tra- 
pezium, 
2. mag- 
num, and 
3. unci- 
forme. 
In. ossa 
sesamoi- 
dea. 
Adductor 
pollicis. 
Or. meta- 
carpal 
bone of 
the middle 
finger. 
In. root of 
the second 
hone of the 
thumb. 218 
MUSCLES OF THE ARM, &C. 
The short muscles of the little linger surround its root, just us 
those of its thumb surround its ball. 
CVII. The abductor minimi digiti is a thin fleshy muscle, which 
forms the cushion on the lower edge of the hand, just under the 
little finger. It is an external muscle : it arises from the os pisi- 
forme, and metacarpal bone of the little finger, and from, the outer 
end of the annular ligament. It is inserted laterally imo the first 
bone of the little finger ; but a production of it still goes forward to 
the second bone of the little finger. 
Its use is to spread the little finger sideways, and perhaps to assist 
the flexors. 
C VIII. The flexor parvus minimi digiti is a small thin muscle 
which rises by the side of the last, and runs the same course, with 
nearly the same insertion. 
Its origin is from the ligament of the wrist, and in part from the 
crooked process of the unciform bone. Its use is to bend the little 
finger. And indeed the office and place of both is so much the 
same, that I have marked the last as a flexor ; the little difference 
there is, is only that this performs a more direct .flexion. 
CIX. The adductor minimi digiti is sometimes called the meta- 
carpal of the little finger. It lies immediately under the former 
muscle. Its origin is from the hook of the unciform bone, and the 
adjoining part of the carpal ligament. 
It is inserted into the outside of the metacarpal bone, which it 
reaches by turning round it. Its use is to put the little finger anta- 
gonist to the others : it is to this finger what the opponens is to the 
thumb. It also, by thus bending one bone of the metacarpus, affects 
the whole, increases the hollow and external convexity of the car- 
pus, and forms what is called Diogenes’s cup. 
CX. The abductor indicts is a flat muscle of considerable 
breadth, lying behind the adductor pollicis, and exactly resembling 
it, being like the second layer. It arises from the os trapezium, and 
from the first bone of the thumb; and it is inserted into the back 
part of the first bone of the fore finger, and pulls it towards the 
thumb. 
The interossei are situated between the metacarpal bones. 
They are small, round, and neat, something like the lumbricales in 
shape and size, and in office resemble the adductors and abductors. 
Four are found in the palm which bend the fingers, and draw their 
edges a little towards the thumb ; three are found on the back of 
the hand, for extending the fingers ; they at the same-time perform 
the lateral motions of the fingers. 
CXI. The interossei intehni arise from between the metacar- 
pal bones. They are also attached to the sides of these bones. They 
send their tendons twisting round the sides to the backs of these 
bones. And they are inserted along with the tendons of the lumbri- 
cales and extensors, into the back of the finger. They are thus 
flexors of the first joint, and extensors of the second joint, as the 
lumbricales are. 
CXII. The interossei externi are three in number. They 
arise, like the interni, from the metacarpal bones and their inter* 
Abductor 
minimi 
digit). 
Or. 1. os 
pisiforme, 
2. meta- 
carpal 
bone, and 
3. annular 
I'g- 
In. root 
and out- 
side of the 
third pha- 
lanx. 
Flexor 
parvus 
minimi 
digiti. 
Or. 1. an- 
nular lig. 
and 2. os 
unciforme. 
In. root 
and side 
of the first 
phalanx. 
Adductor 
minimi 
digiti. 
Or. 1. an- 
nular lig. 
and 2. os 
unciforme. 
In. out- 
side of the 
metacar- 
pal bone. 
Abductor 
indicis. 
Or. 1. tra- 
pezium, 
and 2. me- 
tacarpal 
bone of the 
thumb. 
In. back 
of the first 
bene. 
Interossei 
interni. 
Or. sides 
of the me- 
tacarpal 
bones. 
In. with 
the lum- 
bricales. 
Interossei 
externi. 
Oi\ rtrbts MUSCLES OF RESPIRATION. 
219 
sUces, and from the ligaments of the carpal bones. They are pecu- 
liar in having each two heads, therefore named interossei bicipites. 
They join their tendons to those of the extensor and lumbricales ; 
they have therefore one common office with them, that is, extending 
all the joints of the fingers. Many have chosen to describe the 
origin and insertion with most particular care, marking the degree of 
obliquity, and ascertaining precisely their office, and giving particular 
names to each, as prior indicis for the first external ; all which I 
forbear mentioning, because they must be more liable to perplex 
than assist: if we but remember their common place and office, it is 
enough. The tendons of the flexor muscles bend round the finger, 
along with the interossei and lumbricales, for a surer hold : conse- 
quently the tendons of the lumbricales, of the interossei interni, of 
the extensors, and of the interossei externi, meet upon the backs of 
the fingers, which are by them covered with a very strong web of 
tendinous fibres. 
of the me- 
tacarpal 
bones, 
having 
two heads. 
In. tendi- 
nous ex- 
' pansion of 
the exten- 
sor com- 
munis. 
MUSCLES OF RESPIRATION, OR, OF THE RIBS. 
The whole back is clothed with strong muscles, and all its holes, 
irregularities, and spines, are crossed with many smaller ones. These 
muscles are related either to the arm, to the ribs, or to the spine 
i. e. the vertebras, whose motions they perform ; and from this we 
obtain an arrangement not inconsistent with the regular order of 
their office, and yet corresponding with the best order of dissection. 
The first, or uppermost layer of muscles, viz. the trapezius, the 
musculus patientiae, the rhomboideus, the latissimus dorsi, belong 
principally to the arm. The serrated muscles which lie‘next under 
these are muscles of respiration, and belong to the ribs; while the 
splenius and complexus, the muscles of the neck, the longissimus 
dorsi, sacro-lumbalis, and the quadratus lumborum, which are mus- 
cles of the back, and the innumerable smaller muscles which lie 
between the vertebrae, belong entirely to the spine. 
The muscles of respiration properly which are appropriated to the 
ribs, performing no other motion, are, 
1. The SERRATUS posticus supe- 
rior, 
which comes from the neck, 
and lies fleshy over the ribs, 
to pull them upwards. 
2. The serratus inferior pos- 
ticus, 
which comes from the lumbar 
vertebrae, and lies flat on the 
lower part of the back, to pull 
the ribs downwards. 
which are twelve flat muscles 
arising from the transverse 
process of each vertebra, and 
going down to the rib below, 
they raise the ribs. 
3. The LF.VATORES COSTARUM, 220 
MUSCLES OF RESPIRATION, 
which lie between the ribs, 
and fill up all the space be- 
tween rib and rib ; they also 
raise the ribs. 
4. The INTERCOSTAL MUSCLES, 
And there may be added to these, that muscle, which, lying under 
the sternum, and within the thorax, is called triangularis sterni, and 
pulls the ribs downwards. 
CXII1. The seiiratus superior posticus lies flat upon the side 
of the neck, under the trapezius and rhomboideus, and over the 
splenitis, and complexus muscles. It arises by a flat and shining 
tendon from the spines of the three lower vertebrae of the neck, and 
the two uppermost of the back. It goes obliquely downwards under 
the upper corner of the scapula, and is inserted into the second, 
third, fourth, and fifth ribs, by three or four neat fleshy tongues. 
The ligamentum nuchae is chiefly formed by the meeting of the 
trapezii muscles; but the flat tendons of these upper serrated mus- 
cles help to form it. 
They are purely levators of the ribs ; their effect upon the verte- 
brae, if they have any, must be very slight. 
CXIV. The serratus inferior posticus is a very broad thin 
muscle, situated at the lower part of the back, under the latissimus 
dorsi, or over the longissimus dorsi muscle. 
It arises in common with the latissimus dorsi, from the spines of 
the two lower vertebrae of the back, and the three uppermost verte- 
brae of the loins. Their origin, like that of the latissimus, is by a 
thin tendinous expansion ; it soon becomes fleshy, and, dividing into 
three, sometimes four fleshy strips or tongues, each of them is 
inserted separately into the ninth, tenth, eleventh, twelfth lower ribs, 
near their cartilages. So that this muscle, spreading so wide out 
from the centre of motion, has vast power; for it has the whole 
length of the rib as a lever. 
The office of ij; is to pull the ribs downwards and backwards, the 
effect of which must be to compress the chest, and in certain cir- 
cumstances to turn the spine. 
CXV. The levatores costarum are twelve muscles on each 
side, for the direct purpose of raising the ribs ; they lie above or upon 
the ribs, at their angles, and are thence named, by some, supra 
COSTALES. 
They are almost a portion of the external intercostal muscles. 
Tho first of the levators arises from the transverse process of the last 
vertebra of the neck, and goes down to be inserted into the first rib, 
near its tuberosity ; and so all that follow arise from a transverse 
process, and go to the rib below, being very small and tendinous at 
either end ; but the three last levators arise from the second process 
above the rib to which they belong: they pass one rib to go into 
the one below it; they are consequently twice as long as the nine 
first are, and are therefore named levatores costarum longiores, 
from the ninth downwards. 
Thus, the levatores costarum are a succession of small muscles, 
arising from the transverse processes of the vertebrae, and going to 
the angles of the ribs, beginning from the last vertebra of the neck, 
Serratus 
sup. post. 
Or. 3 inf. 
spines of 
the neck. 
2 of the 
sup. of the 
back. 
In. 2d, 3d, 
4th, 5th, 
ribs. 
Serrat. 
inf. post. 
Or. 2 low- 
er vert, of 
the back, 
S sup. of 
the loins. 
In.4 in- 
ferior ribs. 
Levatores 
costarum. 
Or. trans- 
verse pro- 
cess of the 
vertebrae. 
In. sup. 
margin of 
the rib. 
Longiores. OR, OF THE RIBS. 
221 
and ending with the last but one of the back. They lie under the 
longissimus dorsi, and sacro-lumbalis ; and often they have connec- 
tions with these muscles,►sometimes very close. 
The iNTEKcoaxALEs extf.rni run obliquely from the lower edge 
of one rib, downward and forward, or in a direction from behind 
forward, to be inserted into the upper edge of the rib below ; the 
muscle is not continued into the space between the cartilages of the 
ribs. The internal again are perfect between the cartilages of the 
ribs, but they proceed no further bhck than the angles of the ribs. 
They are further different from the internal muscles, inasmuch as 
they pass obliquely backward and downward from the margin of the 
one rib to the other. 
These two rows were thought to antagonise each other : the one 
to pull tiie ribs downwards, the other to raise them ; but I shall not 
stop to explain this, nor to refute it; it is sufficient to declare their 
true use, which is (both external and internal) to raise the ribs and 
assist inspiration.* 
The ninth, tenth, eleventh, and twelfth ribs, have a freer motion ; 
and it appears to me that this is the true reason of the levatores 
longiores; and for the same reason, we find, that from the sixth rib 
and downwards, there are certain slips of the internal intercostals, 
which pass over one rib, and go to the second below ; and as the 
levatores longiores were called supra-costales, these have been 
named infra costales, and costarum depressores proprii. They 
were discovered by Verhein, and bear his name ; they were explain- 
ed as depressors of the ribs by Haller ; but they are little different 
from the intercostals in form, and not at all in office, for they raise 
the ribs, along with the intercostal muscles. 
CXVII. The TRIANGULARIS STERNI, Or STEIINO-COSTALIS, is a 
depressor of the ribs; an internal muscle lying chiefly on the inner 
face of the sternum, and the cartilages of the ribs. It is very gene- 
rally considered as a triangular muscle on each side, but some con- 
sider it as three or four muscles, under the title of sterno-costales. 
There are generally four slips lying on the cartilages of the third, 
fourth, fifth, and sixth ribs. The lower portion of the triangularis 
arises from the ensiform cartilage, and is inserted into the third or 
fourth rib ; the third arises from the middle of the sternum, and goes 
off from the edges of that bone, to be inserted into the third rib. 
The fourth or uppermost portion is often w anting; it goes off in 
part, also, from the inner surface of the sternum, but more com- 
monly from the third rib, and goes to the second rib. 
In a dog they are much larger than in a man. Their office is to 
depress the ribs; and these portions are all conjoined at their roots, 
which gives the whole muscle the triangular shape. 
The true uses of the intercostales, subcostales, and triangularis 
sterni, have been disputed ; but if the first rib be more fixed than the 
other ribs, then the intercostals proceeding downwards, from the first 
rib, must raise all the thorax ; and if the sternum be more fixed than 
Iutercos- 
tales ex- 
tend. 
Or. lower 
edge of 
the rib. 
In. sup. 
edge of 
next rib. 
Intercost, 
interni. 
Or. sup. 
margin of 
the rib. 
In. inf. 
margin of 
next rib. 
Triangu- 
laris 
stcrni. 
Or. edge 
and body 
of ster- 
num. 
In. 3d, 
4th, 5tta, 
and 6th 
rib. 
* I remember many years ago, to hare heard Dr. JVlonro explain the office of the 
intercostal muscles by a diagram, deducing from that argument the more powerful 
effect of all muscles having the oblique fibres. 222 
the ribs, then the sterno-costales muscles going upwards from the 
sternum, must pull down the ribs. 
These muscles of the ribs are the appropriate muscles of respira- 
tion, and are united in office with the diaphragm and abdominal 
muscles. But it must bo observed that there are many other mus- 
cles brought into action when the respiration is excited, as well as 
when the organs of respiration are brought to be subservient to other 
offices, as in coughing, sneezing, speaking, smelling, &,c. 
Such is the usual arrangement of the muscles of the thorax ; and 
it may serve the purposes of dissection, or to aid the memory of the 
student. But if we were fully to enter into this subject, it would be 
necessary to consider the various conditions of the respiratory mus- 
cles. There is common, equable, and gentle breathing, as when we 
are at rest or asleep. This is sufficient for the oxygenating of the 
blood, in the ordinary state of the circulation. But when the respi- 
ration is excited, the thorax rises higher, and subsides lower ; and 
the action is not limited to the chest; for then the shoulders arc 
elevated, the neck and throat violently drawn, and even the nostrils 
and face are affected. 
And this excited state of the organs of respiration is not only 
attendant on exercise or bodily activity, but also on excitement of 
the mind, as in passion. Moreover, when the act of inspiration or 
expiration has become a part of another function, as smelling, 
sneezing, coughing, yawning, &,c. this more universal excitement 
takes place. 
The principal agents in this high and excited state of respiration 
are the sterno-oleido-mastoideus, the trapezius, and the ser- 
ratus magnus anticus. These powerful muscles cover the others ; 
and although in the common exercise of the arms they are volun- 
tary muscles, in the excited condition of the respiratory organs they 
become powerful agents of inspiration. 
MUSCLES OP TIIE 
MUSCLES OF THE HEAD, NECK, AND TRUNK. 
The serratus superior posticus being raised, the splenii come 
into view, and the splenii being also lifted, the complexus is fully 
exposed. 
CXVIII. Splenius.—The two splenii are so named from their 
lying like surgical splints, along the side of the neck ; both together 
they have the appearance of the letter Y ; the complexus being 
seen between them in the upper part of the angle. They lie im- 
mediately under the trapezii, and above the complexi. 
Each splenius is a flat and broad muscle, which arises from the 
spinous processes of the neck and back, and is implanted into the 
back part of the head. It arises from the four upper spines of the 
back, and the five lower of the neck ; it parts from its fellow at 
the fifth vertebra of the neck, so as to show in the interstice two or 
three of the uppermost spines of the neck, with the upper part of 
tSplenius. 
Or. 4 sup. 
spines of 
the back, 
and 5 inf. 
of the 
Beck. 223 
HEAL) AND NECK. 
the complexus muscle; each splenius goes obliquely outwards to 
be inserted into the occipital ridge, and all along to the root of the 
mastoid process. At the third vertebra of the neck, where the 
two splenii muscles part from each other, the tendons of the oppo- 
site splenii are closely connected both with each other and with 
the common tendon, which is called ligamentum nuchae. 
This is the splenius capitis ; but there is a portion of this same 
muscle which lies under this, and which has the same common 
origin, but which terminates by fo.ur or five distinct tendons in the 
transverse processes of the upper vertebrae of the neck. This 
portion may be dissected apart, and has been considered by many 
as a muscle, the splenius colli of Albinus ; who has distinguished 
as splenius capitis all that part arising from the spines of the neck, 
and implanted into the head ; and as the splenius colli, all that part 
which arises from the vertebrae of the back, and is implanted into 
the transverse processes of the neck. 
These splenii are the right antagonists of the mastoid muscles ; 
both the splenii acting, pull the head directly backwards ; one 
acting turns the head and neck obliquely to one side ; one acting 
along with the corresponding mastoid muscle, lays the ear down 
upon the shoulder. 
CXIX. The complexus is named from the intricacy of its mus- 
cular and tendinous parts, which are mixed ; from the irregularity 
of its origins, which are very wide, it has the names of complexus 
implicatus trigeminus, by which the student is warned of the 
difficulty of understanding this muscle. 
It lies immediately under the splenius ; arises by distinct tendons, 
with ten or more tendinous feet from the four lower transverse pro- 
cesses of the vertebrae of the neck, and from the seven uppermost 
of the back ; having also some less regular origins, as from two 
spines of the back and from four oblique processes in the neck. 
It grows into a large muscle, which is not like the splenius, flat 
and regular, but thick, fleshy, composed of tendon and flesh mixed, 
filling up the hollow, by the sides of the spines of the neck, and 
terminating in a broad fleshy head, which is fixed under the ridge 
of the occipital bone ; and this is the part which is seen in the 
angle or forking of the splenii. 
This may stand as the general description of the muscle consi- 
dered as one. But Albinus has chosen to describe it as two mus- 
cles, under two different names, with a minuteness which, far from 
clearing the demonstration of any difficulties, makes it less distinct; 
and if any thing could complete the confusion, it was his humour of 
calling that biventer, which had been hitherto named complexus, 
and naming the lower part of the muscle complexus, though it 
never had been distinguished from the rest. 
The biventer of Albinus is the upper layer of the muscle, that 
part which appears in the fork of the splenii: and if we have 
hitherto named it complexus, from its mixtifre of tendons and flesh, 
it was particularly improper to transfer that name to another part 
of the muscle which is less complicated. This upper layer, the 
biventer cervicus, if attached by a large broad head to the occi- 
In. 5 sup. 
traus. pro- 
cesses of 
the virt.of 
the neck, 
the mas- 
toid pro- 
cess, the 
os occipi- 
tis. 
Complex- 
us, 
Or. 7 sup. 
traus. pro- 
cesses of 
dorsal 
vert. 4 inf, 
of the 
neck ; spi- 
nous pro- 
cess of the 
1st of the 
back. 
In. the oc- 
cipital 
bone in the 
line from 
the tuber 
to the 
mastoid 
process. 224 
MUSCLES OE T1IE HEAD AND NECK 
pital bone; in the centre of this belly there is a contusion of ten- 
don ; then there is a middle tendon about the middle of the arch 
of the neck, and the lower part of the biventer arises from two 
parts ; first, by one slip of fiesh from the two uppermost spines of 
the back; and, secondly, by a larger fleshy portion which comes 
from the fourth, fifth, sixth, and seventh transverse processes of the 
back. And it is from the upper and lower fleshy heads and the 
confused middle tendon that it is called biventer. 
The complexus of Albinus lies below this one. It arises by 
three tendinous and fleshy slips, from the three upper transverse 
processes of the back. Then it has four other slips from four 
oblique or articulating processes of the neck ; which various origins 
are gathered into one thick irregular fleshy belly, which is implanted 
into the occiput under the great head of the biventer, and mixed 
with it. This I have chosen to explain, lest the student should be 
embarrassed by false names : referring him to the first paragraph 
for the true and simple description of this muscle. 
CXX. Trachelo-mastoideus.*—The last muscle is often named 
complexus major, and this complexus minor ; but a fitter name is 
the trachelo-mastoideus, from its origin in the neck, and its in- 
sertion in the mastoid process. 
Its origin is from the three first vertebrae of the back, and from 
the five lowest of the neck at their transverse processes. Its origins 
are by distinct tendons, and its belly is in some degree mixed of 
tendon and flesh, whence its name of complexus minor. It is in- 
serted into the mastoid process, just under the insertion of the 
occipital part of the splenius ; and indeed its long and flat belly lies 
all along under that muscle, so that the order of dissection is this : 
1. The trapezius. 2. The splenius capitis. 3. The splenius 
cervicis. 4. The trachelo-mastoideus. 
It is needless to speak of its use, since the use of all these mus- 
cles is to draw the head backwards directly, when both act; ob- 
liquely, when one acts alone. 
The recti muscles are two deep-seated muscles, which go im- 
mediately from the vertebrae to the occiput, to be inserted into its 
lower ridge. They are called major and minor. 
CXXI. The rectus minor is the shorter of the two, arising 
from the first vertebra of the neck. Its place of origin is a small 
tuber which stands in the place of the spinous process of the first 
vertebra, and from that point, where it is tendinous, it goes up to 
the occipital ridge, and is inserted fleshy. 
CXXII. The rectus major is larger. It arises, in like manner, 
tendinous, from the second vertebra of the neck at its spinous pro- 
cess, and mounting from that, is inserted fleshy into the lower ridge 
of the occiput without the former. These are so placed that the 
recti minores appear in the interstice of the recti majores. And 
though we call them both recti, yet they cannot truly be so ; for the 
recti minores must be, ‘in some degree, oblique, and the recti 
Trachelo- 
mastoid- 
eus. 
Or. the 3 
uppermost 
transverse 
processes 
of the ver- 
teb. of the 
back, and 
the 6 low- 
est of the 
neck. 
In. back 
of the 
mastoid 
process. 
Rectus 
minor. 
Or. tuber 
of the 
atlas. 
In. edge 
of os occi- 
pitis. 
Rectus 
major. 
Or. spin- 
ous pro. 
of the den- 
tatus. 
In. os oc- 
cipitis. 
* It is the TR ACIIEI.O-M ASTOIDEUS, tile MASTOIDEUS LATERALIS, the CAPITIS 
par-tertios, the complexus minor ; by some it is considered as a part of the 
COMPLEXES, MUSCLES OF THE TRUNK. 
225 
Jiiajores still more so ; and, consequently, although their chief use 
be conjointly to draw the head directly backwards, yet one acting 
must turn the head to its side. And indeed the same may be said 
of all the muscles of the neck. 
The ohliquus superior and obliques inferior, correspond very 
closely in all tilings with the recti; but, in their oblique direction 
the uppermost, as being much shorter, has been named obliquus 
minor, the lower one obliquus major. 
CXXIII. The obliquus superior arises from the transverse 
process of the atlas, and is inserted into the end of the lower occi- 
pital ridge. Its use, notwithstanding its oblique position, is not to 
turn, but to bend the head backwards, for the occipital condyles 
standing obliquely, do not permit the rotatory motion of the head 
on the first vertebra. Its insertion into the occiput is under the 
splenius and complexus : but one edge of it is above the insertion 
of the rectus major. 
CXXIV. The obliquus inferior arises from one vertebra and 
goes to another. It arises from the spine of the second vertebra : 
it goes to the transverse process of the first, and it meets the supe- 
rior oblique muscle ; and this one obtains great power, by the 
lateral projection of the atlas giving it a lever power. The first 
vertebra or atlas rolls on the tooth-like process of the dentatus; 
and while the great and slow motions of the neck in general are 
performed by other muscles, there is a presumption, that the short 
and quick turnings of the head are performed by these oblique 
muscles. 
Obliquus 
superior. 
Or. trans. 
pro. of the 
atlas. 
In. end of 
the lower 
occip. 
ridge. 
Obliquus 
inferior. 
Or. spin- 
ous pro. 
of the 
dentatus. 
In. trans. 
pro. of the 
atlas. 
MUSCLES OF THE TKUIN'K. 
The great muscles which move the back and loms are the 
QUADRATIC LUMBORUM, SACRO-LUMBALIS, and LONGISSIMUS DORSI. 
The sacro lumbalis and longissimus dorsi run by the side of the 
spine, and lie immediately under the latissimus dorsi, whicji is the 
outer layer; the quadratus lumborum lies again under these, and 
nex< to the abdominal cavity. Although the quadratus lumborum 
lies deep under the longissimus dorsi muscle, I shall describe it first 
for the sake of a connection which will be presently understood. 
CXXV. The quadratus lumborum is a flat squared muscle, 
named quadratus from its square, or rather oblong form. It arises 
fleshy from two or three inches of the back part of the os ilium, 
and from the ligaments of the pelvis which tie the back part of the 
ilium to the side of the sacrum, and to the transverse processes of 
the loins. As it goes upwards along the side of the lumbar ver- 
tebral, it takes hold of the points of the transverse processes of 
each, by small tendinous slips ; so that we are almost at a loss 
whether to consider these as new origins or as insertions : but its 
chief insertion is into the lower edge of the last rib, and a small 
production of it. slips under the arch of the diaphragm, to be im- 
planted into the body or fore part of the last vertebra of the back. 
The longissimus dorsi and sacro-lumbalis have their origin 
in one common and broad tendon coming from the sacrum, ilium, 
Quadrates. 
lumbo- 
rurn. 
Or. 1. 
spine of 
ilium, 2. 
trans. pro. 
of lumbar 
vert. 
In. last 
rib,, and 
last dorsal 
vert. 226 
MUSCLES OF THE TRUNK. 
and loins; the two muscles lie alongside of each other ; the longi.-'- 
simus dorsi is nearer the spine, and keeps its tendons closer by the 
spine. The sacro-lumbalis is farther from the spine, and spreads its 
tendinous feet broader upon the sides of the thorax: and if one be a 
little under the other, it is the outer edge of the longissimus dorsi, 
which is a little under the edge of the lumbar muscle. 
The common tendon and muscle (for there is for some way but 
one muscle) begins thus: it may be said to have two kinds of adhe- 
sion ; for, first, externally it appears a broad, flat, and shining tendon, 
which arises tendinous from all the spines of the lumbar vertebra); 
from the spines of the sacrum, and from the back part of the os 
ilium. But the inner surface of this broad tendon is strongly fleshy; 
for it arises fleshy from the back part of the ilium ; from the deep 
hollow between the ilium and sacrum ; from the sides of the long 
spines of the lumbar vertebrae; and from their articulating processes, 
and the roots of their transverse processes. In short, its origin is 
all tendinous without, and all fleshy within ; and its flesh arises from 
all that irregular surface which is on either side of the spine between 
tire os ilium and the vertebrae of the loins; and thus it continues one 
strong tendinous and fleshy muscle, filling up all the hollow of the 
loins. There is an appearance of separation, something like a split 
in the tendon, which shows in the loins what part of the tendon 
belongs to each muscle ; but it is only in the back that they are 
fairly divided. 
Just opposite to the lowest rib, the longissimus dorsi and sacro- 
lumbalis break off from the common tendon; and the longissimus 
keeps close by the vertebrae, while the sacro-lumbalis is implanted 
into the ribs. 
CXXYI. The longissimus dorsi is a muscle of the spine. It is 
not a flat muscle, but round, thick, and firm, filling up all the hollow 
between the spine and the angle of the ribs. It is of a long form,, 
as its name implies, terminating towards its top almost in a point. 
It has two distinct sets of feet by which it is inserted ; one set of 
feet more fleshy, but small and neat, go outwards from the side, as 
it were, of the muscle, to be implanted near the heads of the ribs; 
the lower ones farther out than the heads of the ribs; the upper ones 
close to the head, and consequently closer to the spine. These 
heads are nine or ten in number, corresponding with the nine or ten 
uppermost ribs. Another set of heads, which are not so well seen 
as this set, because they lie more under the muscle, are small, neat, 
and tendinous ; they go in an opposite direction, viz. inwards and 
upwards ; keep closer by the spine, and are inserted into the trans- 
verse processes of the vertebrae of the back. This set of heads is 
thirteen in number, implanted into the transverse processes of all 
the back, and of one vertebra of the neck. 
CXXVII. The sacro-lumbalis separates from the longissimus 
dorsi at the last rib, and is a flatter and less fleshy muscle: its twelve 
tendons are flatter than those of the longissimus dorsi, and go out 
wider from the spine. The tendons next to the longissimus dorsi 
run highest up, and are the longest; those farthest from the spine, 
i. e, farthest out upon the chest, are the shortest. It has a flat tendon 
i,ongiss. 
dorsi. 
Or. 1. the 
os sacrum, 
2. spine of 
the os ilii, 
3, spinous 
and trans- 
verse pro- 
cesses of 
the loins. 
In. 1. the 
transverse 
processes 
of the 
vert, of 
the back. 
2. the 
lower edge 
of all the 
ribs ex- 
cept the 
two low- 
est. 
Sacro- 
lumbalis. 
Or. in 
common 
with the 
last. 
/a, all the MUSCLES OF THE TRUNK. 
227 
.or each rib, which takes hold upon the lower edge of the rib. But 
it has another order of small muscles which mix with it; for as the 
longissimusdorsi has a double row of insertions, this has another set 
of attachments, for there arises from the surface of each rib, at least 
of the six or seven lowest ribs, a small slip of flesh, which runs into 
the substance of the sacro-lumbalis, and mixes with it \ and these 
fleshy slips go by the name of the addit amentum ad sacro-lumba- 
LEM, or MUSCULI ACOESSOKII. 
Both these muscles, viz. the longissirnus and sacro-lumbalis, ter- 
minate in points which reach towards the neck, and under the point 
of each there lie the roots of two small muscles, which go up to move 
the neck. Many have referred these slips going up into the neck 
entirely to the muscles 1 am now describing, calling one an ascending 
slip of the longissirnus dorsi, and the other a slip of the sacro-lum- 
balis, while others have described them as distinct muscles, having 
but slight connexions with the longissirnus and sacro-lumbalis. 
Their proper names are cervicauis descendens, and transver- 
SALIS COLLI. 
CXXVII1. The cervicalis descendens is Connected with the 
sacro-lumbalis muscle ; it cannot be entirely referred to it, for the 
cervicalis descendens arises as a distinct muscle from the five lower 
vertebrae of the neck, at their transverse processes, goes downwards 
very small and slender to be inserted into the six uppermost ribs, to 
get at which it slips under the longest tendons of the sacro-lumbalis; 
but that the cervicalis descendens does not belong to the sacro- 
lumbalis may be inferred from its having distinct tendons from six 
ribs, and from five transverse processes of the neck, and from these 
tendons being in a direction which does not at all correspond with 
the heads of the sacro-lumbalis. Indeed the longissirnus dorsi has a 
better claim to this muscle ; for a long slip, partly tendinous and 
partly fleshy, runs upwards from the longest tendon of the longis- 
simus dorsi, to join itself to the cervicalis descendens. Perhaps it 
would be better to consider it a continuation of the accessorii ad 
sacro-lumbalem.* 
CXXIX. The transversalis colli is that which Sabatier refers 
to the longissirnus dorsi; but it is a distinct muscle, arising partly 
tendinous, and partly fleshy, from the five upper transverse processes 
of the back ; lies between the tracheio-mastoideus and the cervicalis 
descendens ; goes from the transverse processes of the back to the 
transverse processes of the neck, and has no more than a confused 
and irregular connexion with any other muscle. 
The ouadratus lumborum keeps the trunk erect, by the action 
of both muscles at once ; inclines it to one side, or turns it upon its 
axis, when one only acts ; and by its insertion into the ribs, must 
assist in high breathing, by pulling down the ribs. The longis- 
ribs at 
matures!1' 
N. B. The 
8Sforil 
the six or 
eight low- 
into its 
descen- 
]0^est 
trans. pro- 
of 
neck. 
In.sixuyt- 
permost 
{.^5, 
Transver- 
or Strans- 
verse pro- 
cesses of 5 
safvert?1* 
/«• trans. 
ofaUt*h* 
cervic. 
vert' 
* Hence it is plain that the sacro-iumbalis and longissimus dorsi have nearly an 
equal claim to this cervicalis descendens. For, first, the longissimus dorsi sends its 
longest tendons fairly up into the cervicalis descendens so lar, that the slip is implanted 
into the transverse processes of the neck. And, secondly, the feet of the cervicalis 
descendens begin under the last tendons of the sacro-iumbalis, so as to have the ap- 
pearance of arising from its supplementary muscle, the additamentum, and being a part 
«f it; and indeed Sabatier has described it according to this view. 228 
MUSCLES OF THE THUNK. 
Simus dorsi has no power but over the spine, whicli it bends back 
wards, acting continually in keeping the trunk erect. This is also 
the chief use of the sacro-lumbalis ; but the sacro-lumbalis going 
out further upon the ribs, takes such hold upon them, that besides 
its common action of raising the trunk, it may, on occasions, pull 
them down, assisting the quadratus and the lower serrated muscle. 
And it will have greater power in turning the trunk of the body upon 
its axis than the longissimus dorsi, which pulls almost directly back- 
wards. The cervicalis descenders co-operates with the trachelo- 
mastoideus, and others, which turn the head to one side; and the 
eervicalis descendens bends the neck to one side, both the one and 
the other being independent muscles. 
These two muscles bring us to mention that intricate set of mus- 
cles which fills up all the hollows and interstices among the spines 
and irregular processes of the vertebra?, which might be fairly 
reckoned as one muscle, since they are one in place and in office, 
but which the anatomist may separate into an infinite number, with 
various and perplexing names ; an opportunity which anatomists 
have been careful not to lose. 
The surface of the back, from the bulge of the ribs on one side, to 
the bulge of the ribs on the opposite side of the thorax, is one confused 
surface, consisting of innumerable hollows, processes, and points of 
bone ; and it is tied from point to point with innumerable small 
muscles or unequal bundles of mixed tendon and flesh. There arc 
many points, as the spinous, transverse, and oblique processes of the 
vertebrae, and the bulging heads and angles of the ribs ; and each 
process, or . at least each set of processes, has its distinct sets of 
muscles and tendons. 
1. There is one long continuity of muscular and tendinous fibres 
going from spine to spine, and lying on the side of the spinous pro- 
cesses along the whole length of the back and neck. This is 
divided into the spinalis cervicis, and the spinalis dorsi. 
2. There is a similar continuation of fibres, with less tendon and 
more flesh, belonging one half to the spinous, and the other half to 
the transverse processes, whence it is named semi-spinalis dorsi. 
3. There is a great mass lying' all along the hollow of the back, 
on each side of the spinous processes, which passing alternately from 
the transverse process of one vertebra to the spinous process of tho 
next above, is of course split into many heads, but yet having such 
connexion as to give it the form and name of a single muscle, the 
MULTIF1DUS SPINjE. 
4. and 5. There are yet smaller muscular fasciculi which stand 
perpendicularly between every two transverse and every two spi- 
nous processes; thence they are named inter-transveksarii and 
INTER-SPINALES. 
CXXX. The spinalis cervicis is that which is implanted into 
the spines of the cervical vertebra;; but because it does not go from 
spine to spine, like the spinalis dorsi, but from transverse processes 
to spines, it has been named by Winslow, semi-spinalis, or thans- 
. veuso-spinalis colli. It arises from the transverse processes of 
the six upper vertebrie of the back, and is inserted into all the spi 
Semi-spi- 
lialis cer- 
vicis. 
Or. trans. 
process of 
the 6 np- MUSCLES OF THE TRUNK. 
229 
nous processes of the vertebra) of the neck, except the first and last; 
and it extends the neck, or by its obliquity may contribute to the 
turnings of the neck, or to bending it to one side.* 
CXXXI. The spinalis doksi arises from two spinous processes 
of the loins, and from the three lower spines of the back, and passing 
two spines untouched, it is implanted into all the spines of the back, 
except the uppermost. This muscle is very slender and long, and 
consists fully more of tendon than of flesh : it has five feet below, 
rising from the lower spines of the back and loins ; and nine feet 
above, implanted into the upper spines of the back. Its action 
must raise the spine, but perhaps it may be equally useful, as a mus- 
cular and tendinous ligament. 
CXXXIL The semi-spinalis porsi arises from the transverse 
processes of the seventh, eighth, ninth, and tenth vertebrae of the 
back, and is implanted into the six or seven upper dorsal spinous 
processes and into the two last of the neck.t 
CXXXIII. The multifidus spina: runs from the sacrum along 
all the spine to the vertebra of the neck ; and is a comprehensive 
and true way of describing many irregular portions of flesh, which 
authors have divided into distinct muscles, j It is a continued fleshy 
indentation, from transverse process to spine, through all the verte- 
bra of the back, neck, and loins. 
It begins both tendinous and fleshy, from the upper convex surface 
of the os sacrum, which is rough with spines, from the adjoining part 
of the ilium ; and in the loins, it arises from oblique processes : in 
the back, from transverse processes ; and again from oblique pro- 
cesses, among the cervical vertebra. 
Its origin in the loins is close to the spine, being from the oblique 
processes, and from the root of the transverse processes. In the back 
it arises from the transverse processes, and therefore arises there by 
more distinct heads. In the neck again, it arises from the lower ob- 
lique processes, more confusedly. 
Its bundles or fasciculi are inserted into the spinous processes, 
sometimes into the second, or even into the third or fourth spine, 
above that from which the bundle arises ; for the tendons do not 
stop at that spinous process which they first touch, but go upwards, 
taking attachments to other two or three, and mixing their tendons 
with those of the fasciculi, above and below ; and these tendons 
reach from the first of the loins to all the vertebra up to the atlas, 
which is the only one not included. 
The use of the multifidus spin®, is to retain the spline from being 
too much bent forward ; for these muscles serve (as I have observed) 
the purpose of a ligament, and the bfcst of all ligaments ; having a 
degree of strength, exactly proportioned to the necessity for strength. 
Per dorsal 
the 
spinous 
Cept the 
an'1 
gpinalis 
dorsi. 
vert. 3 
jn- 8 or 9 
sup.dorsal 
cept the 
1st. 
Sennspi- 
or. transl 
process of 
gj1® 
vert, of , 
’he ba?k- 
of 6 or 7 
upper dor- 
two lowest 
cervical, 
* The transversalis colli (vide p. 227.) is that which goes from the trans- 
verse processes of the back tr the transverse processes of the neck ; while this, the 
spinalis cervicis, goes from the transverse processes of the back to the spines of 
the neck. 
t This is of course the transverso-spinalis dorsi of Winslow. 
J Transverso-spinalis lcmborum, sacer, semi-spinalis intermits, sive 
TRANS VERSO-SPIN AL19 DORSI, SE.MI-SPINAL1S, give TRANS VERSO-9PINALIS COLLI, 
pars interna.—-Winslow. Transversalis lumborum, vtilgo sacer, trans- 
VERSALIS DORSI. TRANSVERSALIS COLLI. 230 
MUSCLES OF THE TRUNK. 
It also moves the spine backwards, though perhaps it is less useful 
in this than as a ligament; for we find it as strong in the vertebrae of 
the back, which have little motion between the individual bones, and 
what little there is, must consequently be general. It seems rather 
intended to moderate the lateral motions of the vertebrae than to 
produce them : when it acts, its chief use is either to resist the spine 
being bent forward by a weight, or to erect the spine. 
CXXX1V. The inter-spinalis colli, oorsi, and lumborum, 
have varieties, so little interesting that they need hardly be described. 
The inter-spinales colli are stronger, because the neck has many 
and quick motions, and the bifurcated spines of the neck give broader 
surfaces for these muscles. The inter-spinales oorsi are almost 
entirely wanting, because the spines of the back are close upon each 
other, and the vertebras are almost fixed. The inter-spinales in the 
Loins, are rather tendons or ligaments, than proper muscles. 
CXXXV. The inter-transversales are again stronger and fuller 
in the neck, because of the lateral motions of the neck being free, 
and its transverse processes forked. They are in more numerous 
bundles, where the motion is greatest, viz. between the atlas and 
dentatqs ; and it is there, that Albinus counts his inter-transver- 
sales servicis, PRiORES-LATERALES, &c. The inter-transversales 
are wanting in the back, giving place to'the ligaments, by which they 
are tied to each other, and to the ribs ; but in the loins, the inter- 
transversales are again strong, for the lateral or twisting motions of 
the loins. 
The muscles on the fore part of the head and neck will complete 
the catalogue of those belonging to the spine, and they are the chief 
antagonists to the muscles which I have been describing. 
CXXXVI. Rectus iNternus capitis major.—There are thtee 
muscles on each side, lying under the oesophagus, trachea, and great 
vessels, flat upon the fore part of the vertebrae ; anc( this is the first 
and longest. 
Although this be called rectus, it is oblique, and running rather on 
one side ; for it arises from the transverse processes of the five lower 
vertebrae of the neck, and it is inserted into the cuneiform process of 
the occipital bone, just before the foramen magnum. 
CXXXV1I. Rectus internus minor.—This is an exceedingly 
small muscle. It lies immediately under the rectus major : it 
arises from the fore part of the body of the first vertebrae, the atlas, 
and going (like the other rectus) obliquely inwards it is inserted into 
the occipital bone, near the condyle. 
CXXXVII1. And the rectus capitis lateralis is another small 
muscle like the former, which arises from the transverse processes of 
the first vertebras, and is inserted into the side of the cuneiform pro- 
cess of the occipital bone. It lies immediately under the exit of the 
great jugular vein. 
CXXXIX. Longus colli.—This is the chief of those muscles 
which lie upon the fore part of the neck ; it is very long, arising from 
the flat internal surface of the vertebrae of the back, to go up along 
those of the neck. 
Its origin is first within the thorax, from the three uppermost ver- 
Inter-spi- 
nales. 
Inter- 
transver- 
sales. 
Rectus 
major. 
Or. 4 or 5 
lower 
trans. pro- 
cesses of 
eervic. 
vert. 
In. cunei- 1 
form pro- 
cess. 
Rectus 
minor 
internus. 
Or. fore 
part of the 
atlas. 
In. occipi- 
tal bone 
near the 
condyle. 
Rectus 
cap. late- 
ralis. 
Or. trans. 
process of 
the atlas. MUSCLES OF THE TRUNK. 
231 
tebrse of the back, from the flat part of their bodies, and then from all 
the transverse processes and bodies of the neck, except the three 
upper ones. It is inserted tendinous into the fore part of the second 
vertebrae of the neck, where the opposite large muscles meet in one 
point almost.* 
All these muscles, which lie thus flat- upon the plain surface of the 
vertebrae of the neck, pull the head and neck directly forwards ; or 
when one acts, they are of use in pulling it towards one side ; though 
I rather suppose this motion is performed by the external muscles 
chiefly. 
CXL. The scalenus I consider as one muscle ; for it is one in 
origin, insertion, and office. Its origin is from the whole upper sur- 
face of the first rib, from its cartilage backwards, and also from the 
second rib; and its insertion is into the transverse processes of the 
vertebrae of the neck. But by its broad origin, and its very long in- 
sertion, it gives opportunity for dividing it into several fasciculi; and 
accordingly it has been so divided ; but these divisions are entirely 
modern, artificial, and unnatural. The ancients considered it as one 
triangular muscle : Winslow divided it into two, the primus and se- 
cundus; Cowper into three ; Douglas into four ; and Albinus 
divides it into five muscles. The ancients called it scalenus, from 
its resemblance to the scalene triangle ; and the true anatomy is, to 
consider it as one great triangular muscle, flat, and stretching from 
the ribs to the neck, closing the thorax above, and giving passage to 
the nerves and vessels of the arm. 
If it were to be described in distinct portions, it would be in three 
parts. The anterior portion arises from the transverse processes of 
the fourth, fifth, and sixth vertebrae of the neck, and is inserted into 
the flat part of the first rib hard by its cartilage. The middle portion 
from the transverse processes of all the vertebrae of the neck goes to 
the outer edge of the rib, and extends along all its length. The pos- 
terior portion arises from the transverse processes of the fourth, fifth, 
and sixth vertebrae. It is inserted into the upper edge of the second 
rib, about an inch or more from its articulation with the spine. 
The first head is tendinous and fleshy at its insertion into the rib ; 
but the second and third heads are tendinous, both in their origins 
and insertions. 
The subclavian artery and the nerves pass in the interstice between 
the first and second portions. 
The office of the scalenus muscle is to pull the neck to one side, 
or to bend the head and neck forward, when both act; and when 
the neck is fixed backwards, they may perhaps raise the ribs ; for 
asthmatics are observed to throw the head backwards, in order to 
raise the chest with greater power. 
In. side of 
the cunei- 
form pro. 
Longus 
colli. 
Or. 1st, 
bodies of 
3 upper 
dorsal 
vert, and 
2d, bodies 
and trans. 
pro. of all 
the cerv. 
vert, ex- 
cepting 
the 3 up- 
per. 
In. body 
of dentata. 
Scalenus 
' anticus. 
Or. trans. 
pro. of 
4th, 5th, 
and 8th 
cerv. vert. 
In. 1st rib 
near its 
cartilage. 
Scalenus 
medius. 
Or. trans. 
pro. of all 
the cerr. 
vert. 
In. large 
portions of 
1st rib. 
Scalenus 
posticus. 
Or. trans. 
process of 
4th, 5th, 
and 6th 
cerv. vert. 
In. 2d rib. 
* The fongus colli muscle is in part covered by the rectus major. 232 
OF THE MUSCLES OF THE ABDOMEN AND 01 
THE DIAPHRAGM. 
The abdominal muscles cover in the belly, contain the bowels* 
and take a firm hold upon the pelvis aiid the trunk. The diaphragm, 
again, is a moving partition between the thorax and the abdomen, 
and the diaphragm pressing down the bowels upon the abdominal 
muscles, enlarges the thorax, and the abdominal muscles re-acting 
push the bowels back upon the diaphragm, and compress the thorax. 
Thus, the alternate yielding and re-action of the abdominal muscles 
and diaphragm perform breathing, agitate the bowels, promote the 
circulation, expel the faeces and urine, assist the womb in the 
delivery of the child. And, with all these important uses, the 
abdominal muscles bend and turn the trunk, and fix it for the 
stronger actions of the limbs. They steady the body in lifting 
weights, in bearing loads, in all our more violent exertions. They 
often give way under this double office of breathing and of strain- 
ing, along with the rest of the body ; and the bowels coming out 
through their natural openings, or by bursting through the inter- 
stices of their fibres, form herniae of various kinds. Whence the 
anatomy of these muscles is most interesting to the surgeon. 
The muscles of the abdomen are five on each side. 1. The 
outer oblique muscle, to which the names of descendens, declivis, 
and major, are added, because it is the outermost of all the ab- 
domihal muscles, because it is the largest, covering all the side of 
the abdomen with its fleshy belly, and all the fore part of the ab- 
domen with its broad expanded tendon; and it is called declivis, 
or descendens, because its fleshy belly begins above, upon the 
borders of the thorax ; and because both its muscular and tendinous 
fibres, which lie parallel to each other, run obliquely from above 
downwards and inwards. 
2. The obliquus internus is named from its being within the 
first, and has the names of ascendens vel minor superadded, be- 
cause its fleshy belly is smaller than that of the first, arises below 
chiefly in the haunch-bone, and all its fibres go from below upwards. 
3. The transversalis lies under all the others, and next to the 
cavity of the abdomen, and has but one name, wdiich also is de- 
rived from the direction of its fibres running across, or round the 
abdomen. 
4. The rectus, so named, because of its running on the fore 
part of the abdomen, in one straight line from the os pubis to the 
sternum. 
5. The pyramidal muscle is the only one named from its shape. 
It is a small, neat, conical muscle, which arises from the os pubis, 
by a broad basis, and has its apex turned upwards; but it is not 
always found, for is only as a supplement to the recti muscles, 
and as a part of them, whence it has been named Museums suc- 
oenturiatus. or supplementary muscle. 233 
MUSCLES Ob' THE ABDOMEN' AMJ HATIlKACM. 
(JXLI. The external oblique muscle arises from the ribs, and, 
like all the others which arise from ribs, is a serrated muscle. It 
comes from the eight lower ribs, by distinct fleshy tongues, one 
from each rib. These serras are mixed with the indentations of 
the serratus major anticus muscle, which goes off in an opposite 
direction, and with the origin of the pectoralis major and latissimus 
dorsi; indeed sometimes there is a mixing of the fibres of this 
muscle with those of the pectoralis major. The origin of the 
muscle lying broad upon the border of the chest, is its thickest and 
most fleshy part, whence its fibres go down ail in one direction, 
parallel with each other, but oblique with respect to the abdomen. 
Its fleshy belly ceases about the middle of the side. Its flat sheet 
of tendon goes over the fore part of the belly, till it meets its fellow 
exactly in the middle, so that one half, or the back part of the ab- 
domen, is covered by its fleshy belly, and the fore part by its tendi- 
nous expansion. 
The muscle meets its fellow in the middle of the belly ; and this 
meeting forms (along with the other tendons) a white line from the 
pubes to the sternum, which is named linea alba. It also, before 
it reaches the middle, adheres to the flat tendon of the internal 
oblique. This meeting is about four inches on either side of the 
linea alba, and is a little inclined to the circular, whence it is named 
linea semilunaris. And, finally, this muscle is implanted into the 
spine of the ilium, fleshy about the middle of the ilium, tendinous 
at the fore part, or spinous process of the ilium, and still tendinous 
into the whole length of that ligament, which extends from the spine 
of the ilium to the crest of the pubes. 
This is the whole of its insertions, viz. all the length of the linea 
alba, from the pubes to the sternum, the fore part of the spine of 
the ilium, and the ligament of Poupart, which, though it is com- 
monly thought to be but the tendon of the external oblique stretch- 
ing from point to point, is, in truth, a distinct ligament, independent 
of the tendon, and stronger than it.* 
CXLI1. Obliquus internes abdominis.—The chief part of this 
muscle arises thick and fleshy from all the circle of the spine of the 
ilium, with its fibres directed upwards. But, to be accurate, we 
must describe it as arising from the whole length of the spine of 
the ilium, from the joining of the ilium and sacrum, from the spines 
of the sacrum itself, and from the three lower spinous processes of 
the loins ;t and, lastly, it arises from nearly half of the ligament of 
the thigh, at its end next to the ilium; but still the chief belly is at 
the iliac spine. From that it spreads upwards in a radiated form ; 
the central fibres only are direct, going across the abdomen to the 
linea alba; the higher fibres ascend and go towards the sternum, 
and the lower ones go obliquely downwards to the pubes. Its flat 
ten’don is like that of the external oblique, and it is inserted into 
the cartilages of the seventh and all the false ribs, into the ensiforrn 
Obliquus 
extemus. 
Or. 8 inf. 
ribs. 
In. 11 
linea alba, 
2. spine of 
the ilium. 
S. Poupart 
lig. 4. os 
pubis. 
Obliquus 
internus. 
Or. 1. 
•spine of 
tne ilium, 
2. spine of 
’the sa- 
. crmn, and 
S. the 3’ 
lowest 
lumb.vert. 
4. half of 
Poupart’s 
Hg- 
In. 1. cat-' 
tilago en- 
sif. 2. car~‘ 
tilagcs of 
7th and all 
the false 
ribs, 3. 
linea alba, 
4.0/p'uW'r’ 
* Of.which see below, at page 237. 
t This origin from the spinous processes’of the loins is a thin tendon, common with 
fhe serratus posticus inferior and lafissimns dorsi mmscle*. 234 
MUSCLES OE THE ABDOMEN 
cartilage of the sternum, and into the linea alba, through its whole 
length, and the os pubis.* 
CXL11I. The transversalis abdominis forms the internal layer, 
it runs directly across the belly. It arises fleshy from the inner 
surface of the seven lower ribs, where its digitations mix with 
those by which the diaphragm arises ; tendinous from the transverse 
processes of the four lower lumbar vertebrae, and last of the back ; 
from the whole spine of the os ilium internally, and from a part of 
the Poupart ligament. Upon the whole, its origin is like that of 
the inner oblique muscle ; its fibres go across the abdomen, and its 
tendon is inserted into the whole length of the linea alba, cartilago 
ensiformis, and os pubis. 
The succession in which these three muscles arise from the chest, 
is this : the external oblique muscle lies broad upon the outside of 
the chest, and so its tongues mix with the tongues of the serratus 
anticus major. The internal oblique muscle again rises lower 
down the thorax, from its edge, from the cartilages of the ribs. 
The transverse muscle arises within the thorax, from the internal 
surface of the ribs, opposite to where the tongues of the external 
oblique lie ; and the diaphragm arising from the same ribs, mixes 
its indigitations with the transversalis, so that Gaspar Bartholin, 
observing this indigitation to be very curious in the larger animals, 
believed the diaphragm and transverse muscles to be but one great 
trigastric, or three-bellied' muscle, surrounding all the abdomen. 
But the transversalis, with the other abdominal muscles, are the 
antagonists of the diaphragm. 
CXLIV. The recti muscles cover the abdomen on its fore part, 
in a line from the pubes to the sternum, and they belong so equally 
to the sternum, and to the os pubis, that it is indifferent which we 
call their origin, and which their insertion. The origin (as I should 
call it) of each rectus muscle is in the sternum, is broad and fleshy, 
lies upon the outside of the sternum, covering part of it, and all 
the xiphoid cartilage, and touching and mixing its fibres with the 
great pectoral muscle, and likewise taking part of its origin from 
the cartilages of three of the ribs. It is about four inches broad 
all down the abdomen, and terminates at the side of the symphysis 
pubis, with a flat and pointed tendon about an inch in length, and 
about an inch broad. This muscle is crossed at intervals by four 
tendinous intersections, which divide it into five distinct bellies. 
Commonly there are three bellies above the umbilicus, and two 
below ; but the recti muscles are the least regular of all the muscles 
of the abdomen. Vesalius, Albinus, and Sabatier, were thought to 
have found the recti abdominis extending up to the throat. But it 
is now found that Vesalius had only represented the muscles of a 
monkey, or of a dog, which are very long, upon the thorax of a 
human subject. Sabatier, upon revising his notes, retracts what 
he had said: and Albinus also is supposed to have seen only a pro- 
duction of the mastoid muscle extending down the breast; for ir- 
regularities of this kind have been found. 
Transver- 
salis abdo- 
minis. 
Or. 1st, 
the 7 
lower ribs, 
2d, trans. 
process of 
last dorsal 
vert. 3d, 
the four 
trans. 
processes 
of the 
lumbar 
vert. 
In. 1. car- 
tilago en* 
sif. 2.linea 
alba, and 
3. os pubis. 
Rectus. 
Or. first, 
from 8 inf. 
cart, of 
sternum. 
In. sym- 
jihyswpu* 
* See further at the description of the sheath of the rectus muscle aivd o» the diaphragm. 
235 
CX-LV. The ptramidal muscles are as a supplement to tlie 
recti. There is a small neat pyramidal muscle on each side, or 
rather a triangular muscle, fleshy through its whole extent and 
length, with its base turned towards the pubes, and its apex towards 
the umbilicus; so that its origin is in the crest of the pubes, and 
its pointed insertion in the linea alba : and though the recti muscles 
have been supposed by Massa to relate to the penis, or by Fallopius 
to belong to the urinary bladder, their true use is only to assist the 
rectus to draw down the sternum, and tighten the linea alba, and so 
to give greater power to the oblique and transverse muscles. The 
pyramidalis is so irregular a muscle, that sometimes two are found 
on one side, and none at all on the other. Sometimes two on each 
other; sometimes there is but one, and very often they are wanting, 
the belly of the rectus coming quite down to the pubes. 
The effects of the abdominal muscles in moving the trunk cannot 
be mistaken. The recti pull the ribs downwards in breathing, 
flattening the belly, and bending the body forwards. The two 
oblique muscles of.orle side acting, turn the trunk upon its axis; 
but the oblique muscles of the opposite side acting, co-operate with 
the rectus in flattening the belly and bending the body; and tho 
transverse muscles tighten the linea alba, so as to give effect to 
all the others ; and particularly they brace the sheath of the recti 
muscles, so as to give them their true effect. 
1. The linea alba is the common meeting of all the thin flat 
tendons, and therefore we call it their insertion, being the common 
point towards which they.all act ; it is white, by the gathering of 
all the colourless tendons. 
2. The linea semilunaris is a line of the same white appear- 
ance, of a circular form, and produced by the meeting of all the 
tendons, on the edge of the rectus muscle, to form a sheath for it. 
3. The sheatii for the rectus muscle does not admit of so 
brief a definition as this : it has been commonly supposed to be 
formed in a very curious manner, chiefly by the broad tendon of 
the obiiquus internus, which being the central muscle, between the 
two other layers, is supposed to have its tendon split into two thin 
sheets ; that the outermost sheet adheres to the outer oblique 
muscle, forming the outer part of the sheath, while its inner sheath 
adheres to the tendon of the transverse muscle, forming the inner 
part of the sheath ; but this is too intricate, and can hardly be 
proved by dissection. Cowper expresses his doubts about this 
doctrine of the tendon of the inner oblique muscle being split into 
two layers ; and 1 think the truest description is this, that all the 
tendons meet, and adhere to the semilunar line ; that they im- 
mediately part and form this sheath ; that the flat tendons of both 
the oblique muscles go upon the outer surface of the rectus to form 
that side of the sheath ; that the tendon of the transverse muscle 
only lies under the rectus, forming the lower part of the sheath, 
and that it is unassisted by any lamella of the inner oblique muscle ; 
that the sheath is complete at the fore part, or over the muscle ; 
but that under the muscle the sheath stops about five or six inches 
above the pubes, and that there the recti muscles (or in their place 
J°yrarai- 
dalls‘ 
Or. crest 
of *he os 
/n. Tinea 
alba< 236 
MUSCLES OF THE A8DOMES 
the pyramidal muscles) lie bare upon the viscera, lined only by 
some scattered fibres of the fascia transversalis and the perito- 
naeum.* And that this back layer of the sheath is thinner and 
more delicate, and but little attached to the back part of the rectus 
muscles, which is easily raised in dissection, while the fore part of 
the sheath adheres firmly to the fore part of the muscle, forming 
those cross bands, or tendinous intersections which divide the rectus 
into bellies, and the sheath where it lies over the muscle cannot be 
dissected without a degree of violence, either to the sheath, or to 
these tendinous intersections. 
4. The umbilicus is that opening in the centre of the abdomen, 
in the middle of the linea alba, through which the nutritious vessels 
of the foetus pass. The vessels have degenerated into ligaments in 
the adult, and the umbilicus is closed in the form of a ring ; but. 
sometimes it is forced by violent action, and the viscera come out 
by it, forming umbilical hernia. 
5. The kiis'g of the aiidomixa.l muscles is that opening near 
the lower part of the abdomen, just over the pubes, through which 
the spermatic cord passes in men, and the round ligament of the 
womb in women. 
Cowper (p. 5.) says that the spermatic cord passes through 
separate rings, in each of the three abdominal muscles ; and, like 
older authors, he makes nature exceedingly wise, in placing the 
rings not opposite to each other, but one high, and another lower, 
and a third lower still, so as to prevent the bowels falling out. But 
the truth is, that neither the internal oblique nor the transverse 
muscles have any share at all in the ring, which belongs entirely to 
the external oblique muscle, and is formed in this way : all the ten- 
dinous fibres of the external oblique are, like the muscle itself, 
oblique, running from above downwards ; and the tendinous fasciculi 
are in some places wider, a little disjoined from each other, and 
resembling stripes, crossed by small threads of tendon, as if the 
long fibres w ere in danger of parting from each other, so as to leave 
a gap, and were held together by these cross threads ; and it is, in 
fact, a wider and perfect separation of two fibres that forms tho 
ring, and a stronger interlacement of cross fibres, that secures it 
from splitting farther up. But the chief security of the ring is by 
the form of the opening ; for it is not a ring, as we cal] it, but a 
mere split in the tendon, which begins about an inch and a half 
above the pubes, is oblique, and looking towards the pubes, like the 
fibres which form it, and consists of twro legs, or pillars of the ring, 
as they are called ; for the upper slip which forms the upper part of 
the opening, goes directly towards the crest, or highest point of the 
pubes; the lowrer pillar, or the slip which forms the lower line of 
the slit, turns in behind, gets under the upper one, and is implanted 
into the pubes, within and behind the upper pillar ; this lower slip 
forms at once the lower pillar of the ring and the edge of the fe- 
* Cowper had never observed this but once, that the lower part of the rectus was 
pot lined by the tendon of the transversalis. He concluded, that in this instance it 
was a sporting of nature: “so much a lusus natirrse, that accidents like this might 
be the cause of certain ruptures.’1 AM) OF THK JUAtHKAUM. 
237 
moral ligament. But Cowper was not far from the truth, when he 
said the bowels were prevented from falling down by the obliquity 
of the spermatic passage. The spermatic cord is flat and spread 
out when it begins to pass down through the abdominal walls, and 
it is only when it has emerged from this proper ring that it assumes 
the round and cord-like form. Besides, it conies out under the 
transversalis muscle considerably higher up and more towards the 
ilium than the ring, and in its further descent it splits the fasciculi of 
the internal oblique muscle, and carries one of these fasciculi along 
with it, which constitutes the cremaster muscle. First its veins and 
arteries are gathered together, then it is joined by the vas deferens, 
and finally, it is embraced by the cremaster muscle; and thus per- 
fected, as it were, it glides obliquely through the ring of the external 
oblique muscle. Where it comes out it is covered by the fascia 
superficialis, a process of which goes down upon the cord. When 
the cord is passing under the transversalis muscle it passe the fascia 
transversalis, the fibres of which are strong upon one side: the cel- 
lular membrane too here is dense, and, although there be in the 
natural condition of the parts no proper ring, yet when a rupture 
takes place, a portion of the peritonaeum is thrust through the sper- 
matic passage, and presses the cellular membrane and fascia so 
together, that a ring is formed: this is what is meant by the IN- 
TERNAL KINO. 
CXLVf. 'fhe cremaster muscle of the testicle, which is a 
thin slip of fibres from the internal oblique muscle of the abdomen, 
which is designed for suspending the testicle, and for drawing it up, 
is very thick and strong in the lower animals, as in bulls, dogs, &c.; 
is easily found in man, but not always, being sometimes thin and 
pale, and hardly to be known from the coats upon which it lies. It 
appears to grow more fleshy in old age and to be thickened in en- 
largements of the testicle, the better to support the weight. 
6. The ligament of the thigh* is a distinct ligament, and not 
merely the tendon of the external oblique, rounded and turned in. 
It passes from the ilium obliquely across to the pubis. It re- 
ceives the external oblique muscle, for the tendon is implanted into 
it. Part of the flesh of the internal oblique muscle and trans- 
versalis arise from the outer end of the ligament. It forms an arch 
over the psoas and iliacus internus muscles, where the crural artery 
vein and nerve pass out, and it is tied down at both sides of the 
passage for the vessels by the fascia of the thigh. But this liga- 
ment requires a more particular description. It appears outwardly 
to have a round edge, but in fact it is here turned in, and spreads hori- 
zontally upon the os pubis. The angle where in turns inwards is 
attached to the fascia of the thigh, while the edge, which is turned 
in, is continued imvards in the form of a fascia, and through that, is 
connected with the linea ilio-pectinea. This attachment of the 
ligament to the fascia of the thigh demands a little more attention. 
When the glands and fat are taken away, the connection of the 
Cremas- 
ter. 
Or. 1. 
lower edge 
of intern, 
obliq. 
2. the os 
pubis. 
In. tunica 
vaginalis. 
Crural 
arch. 
* This ligament of the thigh is named also the inguinal ligament ; the crura* 
ARCH : the LIGAMENT of POURART ; the LIGAMENT of FaT.I.OFUJS, &C. 238 
MUSCLES OK THE ABDOMEN 
fascia of the thigh and the Poupart ligament, presents the form of a 
funnel : and if an attempt be made to pass the finger to the bottom 
of it, it is stopped by a strong net-work of fibres : the meshes of 
this net-work permit the lymphatics of the thigh to pass upwards, 
whilst the stronger processes of the fascia take the form of an arch. 
Thus, besides the proper strong Poupart or inguinal ligament, there 
is an arch or crescent formed of less dense and shining substance, 
which goes down from the edge of the ligament, and terminates on 
each extremity in the fascia of the thigh. This is the part under 
which the crural hernia comes out; round which, indeed, the tumour 
turns, and it is the sharp edge of this crescent which nips, and 
causes the strangulation of this kind of hernia. 
It often happens, that in vomiting, in violent coughing, in strain- 
ing at stool, or in lifting heavy weights, the natural openings are 
forced, and the bowels descend. The umbilicus is very seldom 
forced by sudden exertion, for it is a very firm ring ; but it is slowly 
dilated in pregnancy, and hernia of the navel is infinitely more fre- 
quent with women than with men. The opening of the ring is 
often kept dilated by the bowels following the testicle when it de- 
scends ; forming the congenital hernia ; most frequently of all, the 
ring is forced in strong young men by hard and continued labour, 
or by sudden straining ; but women are safer from this kind of 
hernia, because the round ligament-of the womb is smaller than the 
spermatic cord, and the ring in them is very close.—Abdominal 
ventral iiernue are those which come not through any natural 
opening, but through the interstices of the muscles, or their tendons ; 
sometimes hernia follows a w'ound to the abdomen; for a wound of the 
abdominal muscles may not heal so neatly as not to leave some small 
interstice, through which the bowels protrude. Thus, any point 
may be forced by violence ; any of the openings, or all of them, may 
be relaxed by weakness, as in dropsical or other lingering diseases : 
for it is from this cause that hernias are more frequent in childhood 
and in old age, by the laxity which is natural to childhood, or by 
the weakness natural to the decline of life. Often there seems to 
be a hereditary disposition to hernias in certain houses, the form of 
the openings of the abdomen being wider in a whole family, just as 
the features of the face are peculiar. And 1 have seen a child with 
all these openings so particularly wide, that upon the slightest 
coughing or crying, hernias carne down at every possible point, at 
the navel, the scrotum, the thigh, and in the sides of the abdomen, 
all at once ; or as one tumour was reduced another arose. 
CXLVII. The diapiiragma is a Greek word, translated inter- 
septum, the transverse partition between the abdomen and the thorax, 
the midriff; but it is not merely a transverse partition, it is a vaulted 
division between the thorax and abdomen; and not only is the 
middle raised into a vaulted from, but its obliquity is such, that 
though its fore part be as high as the sternum, its lower and back 
part arises near the pelvis from the lowest vertebra of the loins. 
It is a circular muscle, which is fleshy towards its borders, and 
tendinous in the centre ; which is convex towards the thorax, and 
concave towards the abdomen : becoming plain, or almost so. when 
Dia- 
phragm. 239 
AXD OF THE DmiRAGAf. 
it presses against the abdominal muscles in drawing the breath ; and 
returning to its convex form, when the abdominal muscles re-act in 
pushing it back into the thorax. 
* The diaphragm arises, by one broad lleshy attachment, from all 
the borders of the chest, forming the upper or greater muscle of the 
diaphragm ; and it arises below, by many small tendinous feet from 
the fore part of the loins, which meeting, form what is called the 
lesser muscle of the diaphragm. 1st, The great or upper muscle 
arises, first, from under the xiphoid cartilage, and from the lower 
surface of the sternum. 2dly, From all the false ribs ; from the 
cartilage of the seventh, eighth, and ninth ribs ; and from the bony 
parts of the tenth and eleventh ribs, and from the tip of the twelfth 
rib. All these origins are, of course, fleshy digitations or tongues 
which intermix with those of the transverse muscles of the abdomen. 
3dly, From the tip of the twelfth rib to the lumbar vertebrae, there 
is a ligament extended, which, going like an arch over the psoas 
and quadratus lumborum muscles, is named ligamentum arcuatum ; 
and from this another part still of the great muscle of the dia- 
phragm arises. Thus, the upper muscle of the diaphragm has four 
chief origins, viz. from under the sternum and xiphoid cartilage; 
from all the false ribs; from the ligamentum arcuatum ; and, in 
short, from all the borders of the chest, from the xiphoid cartilage 
quite round to the vertebra) of the loins. 
2. The lesser muscle of the diaphragm, which arises from the 
spine, begins by four small slender tendinous feet on each side. 
The first of these, the longest one, arises from the second vertebra 
above the pelvis: it goes from the flat fore part of its body, and 
adheres to the fore part of all the lumbar vertebrae as it mounts 
upwards. The second rises from the third vertebra, but farther out 
towards the side of the vertebra. The third arises from the side of 
the fourth vertebra. And the fourth tendon of the diaphragm arises 
from the transverse process of the same fourth vertebra of the loins. 
But indeed we ought, in place of this minute demonstration, to say, 
that it arises from the four uppermost lumbar vertebrae by four 
tendinous feet, flat and glistening, and adhering closely to the shi- 
ning ligament with which the bodies of the vertebrae are strength- 
ened ; that these tendons soon join to form two strong round fleshy 
legs, which are called the crura diaphragmatis ; of which crura, the 
left, is the smaller one: and these crura having opened to admit 
the aorta between them, and then joining, mixing, and crossing their, 
fibres, form a fleshy belly, the lesser muscle of the diaphragm. 
3. The tendon in the centre of the diaphragm is determined 
in its shape by the extent of these fleshy bellies ; for the muscle 
above almost surrounds the central tendon. The smaller muscle 
below meeting it, the two divisions give it a pointed form behind ; 
the tendon has the figure of a trefoil leaf, or of the heart painted 
upon playing cards. The middle line of this tendinous centre is 
fixed by the membrane which divides the thorax into two ; the two 
sides go upwards into the two sides of the chest, each with a form 
like the bottom of an inverted basin : their convexity reaching 
within the thorax, quite up to the level of the fourth true rib : the 
propet centre of the diaphrasrm is fixed by this connection with the 
Greater 
muscle. 
Or. 1. xi- 
phoid 
cart. 
2. seventh 
and all the 
false ribs, 
3. the lig. 
arcuatum. 
In. cordi- 
form ten- 
don. 
Lesser 
muscle. 
Or. 2d, 3d, 
and 4th 
lumb.vert. 
In. back 
part of 
cordiforco 
tendon. 240 
MUSCLES OF THE ABDOMEN, &.C. 
mediastinum, that its motion might not disorder the actions of the 
heart, which rests upon this point, and whose pericardium is fixed 
to the tendon : but the convexity of either side descends and ascends 
alternately as the diaphragm contracts, or is relaxed : so that it is 
chiefly these convexities on either side which are moved in breathing. 
Thus is the diaphragm composed of one great and circular 
muscle before ; of one smaller circular muscle behind ; and of the 
triangular tendon, as the centre between them ; and, both in its 
fleshy and tendinous parts, it is perforled by several vessels passing 
reciprocally between the thorax and the abdomen. 
First, The aorta, or great artery of the trunk, passes between 
the crura or legs of the diaphragm, which, like an arch, strides 
over it to defend it from pressure. The thoracic duct passes up 
here also. 
Secondly, The (esotiiagus passes through the diaphragm, a little 
above this, and to the left side : its passage is through the lower 
fleshy belly, and through the most fleshy part of the diaphragm : 
and the muscular fibres of the crura diaphragmatis first cross 
under the hole for the oesophagus; then surround it; then cross 
again above the hole ; so that they form the figure of 8 : and the 
oesophagus is so apparently compressed by these surrounding fibres, 
that some anatomists have reckoned this a sort of sphincter for the 
upper orifice of the stomach. 
Thirdly, The great vena cava goes up from the abdomen to the 
heart, through the right side of the diaphragm ; and this hole being 
in the firm tendon, there is no danger of strangulation, or of the blood 
being impeded in the vein. 
The tendon is composed of fibres which come from the various 
fasciculi of this muscle, meeting and crossing each other with a 
confused interlacement, which Albinus has been at much pains to 
trace, but which Haller reports much more sensibly : “ Intricationes 
variae et vix dicendae irregular and confused, crossing chiefly at 
the openings, and especially at the vena cava, the triangular form 
of which seems to be guarded in a most particular way. 
The lower surface of the diaphragm is lined with the peritonaeum, 
or membrane of the abdomen ; and the upper surface is covered 
with the pleura, or membrane of the chest. The hole for the vena 
cava is so large that the peritonaeum and pleura meet, and nearly 
touch each other through this opening, all round the vein. 
The chief use of the diaphragm is in breathing, and in this office it 
is so perfect, that though there be a complete anchylosis of the ribs 
(as has often happened), the person lives and breathes, and never 
feels the loss. The diaphragm is in its natural state, convex towards 
the thorax ; when in acts, it becomes plain, the thorax is enlarged, 
and, by the mere weight of the air, the lungs are unfolded, and 
follow the diaphragm. No vacuum is ever found between the dia- 
phragm and the lungs ; but the lungs follow the ribs and diaphragm 
as closely as if they adhered to them : and indeed when they do 
adhere, it is not known by any distress. So we draw in the breath, 
and when the abdominal muscles re-act, the diaphragm yields, goes 
back into the thorax, and grows convex again, bv which we blow PARTS OF GENERATION, ANUS, AAp PEKIN.EUM. 
241 
Out the breath ; and while the diaphragm is acting, the abdominal 
muscles are relaxed, yield, and are pushed out, and leave the ribs 
free, to be raised by their levator muscles. And again, when the 
abdominal muscles re-act, the diaphragm in its turn yields so, that 
they at once force up the diaphragm, and pull down the borders 
of the thorax, assisting the serrated muscles which depress the ribs. 
There is also in every great function, such a wonderful combina- 
tion of actions conspiring to one end, as cannot be even enumerated 
here. But the alternate action and re-action of the abdominal mus- 
cles draw in and expel the breath, promote the circulation, and 
gently agitate the bowels, while their more violent actions discharge 
the faeces and urine, and assist the womb; and vomiting, yawning, 
coughing, laughing, crying, hiccup, and the rest, are its stronger and 
irregular actions. The diaphragm might well be named by Haller, 
Nobilissimus post cor musculus.” And Buffon, who affected the 
character of anatomist with but little knowledge of the human body, 
might mistake its central tendon for a nervous centre, the place of 
all motions, and almost the seat of the soul. For the ancients con- 
founded the names and ideas of tendon and nerve. And, in sick- 
ness and oppression, lowness and sighing, in weeping or laughing, 
in joy or in fear, all our feelings seem to concentrate in this part. 
THE MUSCLES OF THE PARTS OF GENERA- 
TION, AND OF THE ANUS, AND PERINEUM. 
Thb muscles of the perinaeum and parts of generation follow the 
division of the abdominal muscles more naturally than any other. 
On looking to the skeleton, we see that the viscera of the abdomen 
and pelvis would fall out from the lower opening, if this space was 
not guarded in a particular manner. It is therefore closed, 1. by 
fascia ; 2. by muscles, now to be enumerated ; and 3dly, by fat and 
cellular texture ; the nature and quantity of which is a matter of 
no mean interest to the surgeon. 
Before reading the account of the muscles of the perinaeum, the 
reader should peruse that part of the last volume which treats of 
the structure of the penis, &c. 
Fascia, or aponeurosis.—Before dissecting the muscles of the 
perimeum, the student should examine that web of membrane which 
covers them. It comes across from the tuberosity and ramus of the 
ischia, and running forward, terminates at the scrotum. It is a sub- 
ject very important to the operating surgeon. 
CXLVIII. The erector penis is a delicate and slender muscle, 
about two inches in length. It lie3 along the face of the crus penis 
on each side. And when the crura penis are inflated, the erectors 
are seen of their proper length and form. The erector of each side 
rises by a slender tendon from the tuberosity of the os ischium. It 
Erector 
penis. 
Or. tuber, 
of the 
ischium. 242 
MUSCLES OP THE PART if OP 
goes fleshy, thin, and flat, over the crus penis, like a thin covering. 
1 ft ends in a delicate and flat tendon, upon the crus penis, about two 
inches up ; and the- tendon is so thin> and delicate, that it is hardly 
to be distinguished from the membrane of the cavernous body. 
The erectors lying thus on the sides of the penis, have been called 
cor. later ales penis, or isciiio-cavernosi, from their origin in the 
ischium, and their insertion into the cavernous bodies. 
CXLIX. The transversalis is often named transver- 
sals penis ; but its origin being in the tuberosity of the os ischium, 
by a delicate tendon, and its insertion into the very backmost point 
of the bulb of the urethra, where it nearly touches the anus, and 
where there is a meeting of several muscles, its course is directly 
across the perinaeum, and its relation to the perinaeum and anus is 
very direct and evident, while its relation to the penis is rather doubt- 
ful. Often there is a second muscle of the same origin and inser- 
tion, running like this, across the perinaeum, named transversalis 
rERIN.EI ALTER.* 
This transverse muscle may, by bracing up the bulb to the arch 
of the pubis, have some effect in stopping the vein on the back of 
the penis, and so producing erection ; but its chief use must be in 
preventing the anus from being too much protruded in discharging 
the faeces, and in retracting it when it is already protruded. 
CL. The ejaculator muscle is not a single muscle, as it is often 
described. It is manifestly a pair of muscles surrounding the whole 
of the bulb of the urethra. They arise on each side from the side 
of the bulb, and crus of the penis, and from the triangular ligament 
of the urethra. From their arising from this ligament, they have 
been frequently described as arising from the ramus of the pubes. 
There is along the lower face of the bulb a white and tendinous line, 
corresponding with the outward line or seam of the perinaeum. 
This line distinguishes the bellies of the two muscles, and is formed 
by their tendinous insertions ; or sometimes this central line is con- 
sidered as the origin of the muscle : in that case, the fibres of each 
side surround their proper half of the bulb with circular fibres, 
winding obliquely round the bulb ; and each muscle ends in its sepa- 
rate tendon, which is delicate and small, and which, leaving the bulb 
of the urethra, turns oft’ obliquely to the side, so that the tendon of 
each side goes out flat and thin upon the crus penis of its own side, 
a little higher than the insertion of the erector penis. We know 
and feel its convulsive, involuntary action in throwing out the seed ; 
and we are conscious that we use it as a voluntary muscle in empty- 
ing the urethra of the last drops of urine. 
CLI. The sphincter ani muscle is a broad circular band of 
In. sheath 
perris.°1US 
Transver- 
of the 
ischium, 
moreen- 
tre of 
union. 
. 
tor. 
Or side 
of the 
Jody and 
trian’g. 
fascia. 
bulb, and 
spongy 
Sphincter 
ani, 
* There is a great irregularity in this muscle. There is very frequently a slip 
called transversalis alter, which, however, would be better named ubliquns. In some 
bodies the transversalis is hardly perceptible, while in others it is very strong : there 
is also a great variety in the size of it, on comparing the two sides of the same body; 
thus we see frequently in Lascars and Negroes, that on one side there is a very large 
muscle, while on the other there is a small transversalis. and a large obliquus. 
We may also frequently see a muscle, the transversalis profundus; it has exactly 
the same origin and insertion with the other, but lies deeper. At first view it ap- 
pears to be part of the levator ani, but the fibres run directly across, while those of 
t-hc levator run in a descending direction. GENERATION, ANUS, AND FERINJEUM.’ 
243 
fibres, which surrounds the anus. It arises from the point of the os 
coccygis behind. It sends a neat small slip forwards, by which it 
is attached to the back part of\the ejaculator muscle ; but the great 
mass of the muscle is inserted into the common angle of union of 
the ejaculator, transversales, and this muscle. It is of a regular 
oval form, and is, for a very obvious reason, stronger in man than in 
animals. Some choose to enumerate two sphincter muscles, of 
which this is the external, or cutaneous; ami what they describe as 
the internal one, is merely the circular fibres, or muscular coat of 
the intestine, strengthened a little towards the anus, but not a dis- 
tinct muscle. Its effect is to shut the anus. 
CLI1. The levator am muscle is described as a pair of mus- 
cles, one from each side ; but it is properly one broad and thin mus- 
cle, which arises from the internal surface of all the fore part of the 
pelvis, and, from its breadth, it has been named musculus am laths. 
It continues its origin from the internal surface of the pubes, from 
the edge of the foramen thyroideurn, from the thin tendinous sheath 
that covers the obturator internus and coccygeus muscles, and from 
the body and spine of the os ischium. It grows gradually smaller, 
as it goes downward to surround the anus. So it is inserted into 
the circle of the anus, into the point of the os coccygis, and is mixed 
with the sphincter ani muscle. The whole pelvis is lined with it 
like a funnel, or inverted cone, the wider part representing its origin 
from the pelvis, the narrower part its insertion into the anus. The 
whole bladder is surrounded, and covered by this muscle; the ure- 
thra passes through a split in its fibres, and no operation of lithoto- 
my can reach the bladder from below, without cutting through this 
muscle. It raises the anus, and at the same time dilates it, opening 
the anus for the passage of the faeees, and supporting it, so as to 
prevent its being protruded. Thus, it is not for shutting the anus, 
as some have supposed, but is the direct antagonist of the sphincter 
ani muscle. By enclosing the bladder, the levator ani acts upon it 
also ; for the neck of the bladder passing through a slit in its fibres, 
while the levator ani is acting, this slit is drawn, as it were, round 
the neck of the bladder, and so the urine is for the time prevented 
from flowing. It is as a sphincter to the bladder, which prevents our 
passing the urine and faeces at the same moment. By surrounding 
the lower part of the bladder, and enclosing the prostate gland, and 
the vesiculae seminales, which lie upon the back of the bladder, this 
muscle affects these parts also, and is, perhaps, the only muscle 
which may be supposed to empty the vesiculae, or to compress the 
gland, pulling upwards at the same time, so as to press the back of 
the penis against the pubes, to maintain the erection, and to assist 
the accelerator muscles. By enclosing the bladder, vesiculae, pros- 
tate, and anus, this muscle produces that sympathy among the parts, 
which is often very distressing, as in gonorrhoea, the stone in the 
bladder, constipation, piles, and other diseases of these parts; for 
piles, constipation, or any cause which may excite the action of the 
levator muscles, will cause erections, a desire to pass the urine, and 
an obstruction in the discharge of it.* 
Or. os 
coccygis. 
In. 1. 
round the 
anus, 
2. spongy 
body of 
the ure- 
thra, and 
S. com- 
mon angle 
• of union. 
Levator 
aui. 
Or. 1. os 
pubis, 
thyroid 
hole, 2. 
the spine 
and body 
of the 
ischium. 
In. 1. 
verge of 
the anus, 
and 2. the 
two last 
bones of 
the os 
coccygis.’ 
* There is a muscle described by Mr. Wilson, as a levator, or compressor nrt- 244 
MUSCLES OF THE 
Coccy- 
gcus. 
Or. spine 
of the 
ischium 
and the 
ligament. 
In. side of 
the os coc- 
eygis. 
CLIII. Tlic muscuhjs coccyoeus is a thin, flat muscle, which 
arises by a narrow point, from the inside of the pelvis, at the spine 
of the os ischium; is implanted, expanded and fleshy, into the whole 
length of the os coccygis; can be useful only by pulling up the point 
of the os coccygis ; which is just equivalent to raising the circle of 
the anus ; so that from every circumstance of its form and use, it 
might be fairly enough described as being merely the back part of 
the levator ani muscle. 
The perinseum, where the bulb begins, is the point into which all 
the muscles are united ; for the ejaculator muscle, and the sphincter 
ani muscle, touch at the beginning or point of the bulb; and a 
small pointed slip of the sphincter ani, going upon the bulb, con- 
nects them firmly together. The transversales perinaei come across 
the perinseum from either side ; and the levator ani muscle comes 
dow'n to meet the sphincter, so that the sphincter ani, the levator 
ani, the transversalis perinoei, and the ejaculator muscles, all meet in 
one point, viz. the back of the bulb. They secure the perinteum, 
and support the heavy viscera of the abdomen; if they be unskil- 
fully cut in performing lithotomy, it will be difficult to extract the 
stone. In that operation, the incision passes by the side of the anus, 
and on the inside of the tuber ischii j and our knife accordingly 
cuts clean across the transverse muscles, which stand as a bar across 
the perinamm ; it passes by the side of the erector muscle, need not 
touch it, or touches it slightly, and by a sort of chance : it must not 
touch the ejaculator muscle ; for whoever says he cuts the ejacula- 
tor, cuts too high, and performs his operation ill.* After the first 
incision we get deep into the pelvis, and cut the levator ani. The 
surgeon does not observe these muscles, on account of any danger 
which may attend wounds of them, but takes them as marks for the 
true place of his incision ; and a good operator will be careful to 
have them fairly cut, that they may be no hindrance to the extraction 
of the stone.t 
We find, of course, a difference in the muscles in the female pe- 
rinaeum. There is an erector clitoridis, which has the same origin 
as in the male, and it is inserted into the crura clitoridis, in the same 
manner that the erector penis is inserted into the crura penis. The 
next muscle is the sphincter vagina?, wffiich is a large muscle, taking 
an origin from the sphincter ani and posterior side of the perinmum ; 
it is inserted into the union of the crura clitoridis. We find, like- 
wise, a transversalis, which, though taking the same origin as in the 
male, is a very small muscle ; its insertion is into the union betwreen 
thrse. The origin of this muscle is from the arch of the pubes, and its fibres run 
round the membranous part of the urethra, being inserted on the lower part into 
each other: it is situated between the Cowper’s gland and the levator ani, being 
separated from the last muscle bj a thin fascia, and some small veins. In order to 
make out this muscle distinctly, and with as large a tendon as Mr. Wilson describes 
it, it is necessary to sacrifice several of the fasciae. 
* Those anatomists who describe the origin of the ejaculator to be from the ramus 
ischii object to this. 
t The detrusor urin* is but the muscular coat of the bladder ; the sphincter 
vesicae is but a denser fasciculus of this common coat of the bladder. I should no 
more think of describing them here than of describing the coats of the intestines or 
stomach. These muscles of internal parts, with the muscles of tlie internal ear, &c. 
I reserve for that part of the system whjrh describes Ihe organs and viscera THIGII, LEG, AND FOOT. 
245 
rhe sphincter vaginas and sphincter ani: in the two next muscles, 
viz. sphincter ani and levator ani, there is no difference, except that 
they are attached to the vagina instead of the penis. 
The muscles of the female perineum, are, 
Erector clitoridis.-—Or. From the ramus of the os ischium : 
in its ascent it covers the crus of the clitoris, as far up as the os 
pubis. 
In. Into the upper part of the crus, and body of the clitoris. 
Use. To erect the clitoris, by pushing the blood into its cavernous 
substance. 
Sphincter vaginjb.—Or. From the sphincter ani and from the 
posterior side of the vagina, near its external orifice, opposite to the 
nymphae, and covers the corpus cavernosum vaginae. 
In. Into the body, or union of the crura clitoridis. 
Use. Contracts the mouth of the vagina, and by compressing the 
corpus cavernosum, pushes the blood into the clitoris and nymphae. 
Tkansversalis perinju. —Or. As in the male, from the fatty cel- 
lular membrane which covers the tuberosity of the os ischium. 
In. The upper part pff the sphincter ani, and into a white tough 
substance in the perinaeum, between the lower part of the pudendum 
and anus. 
Use. To sustain the perinaeum. 
Sphincter ani.—Or. As in the male, from the skin and fat sur- 
rounding the extremity of the rectum. 
In. Into the white tough substance in the perinaeum, and below, 
into the front of the os coccygis. 
Levator ani.—Or. As in the male, within the pelvis. It de- 
scends along the inferior part of the vagina and rectum. 
In. Into the perinaeum and sphincter ani. 
MUSCLES OF THE THIGH, LEG, AND FOOT. 
iviuscx.es moving the thigh bone. 
The muscles'belonging to the thigh-bone arise all from the pelvis 
or trunk. The psoas magnus, and iliacus internes, come from 
within the pelvis, at its fore part, and passing under the femoral 
ligament, go down to be implanted into the trochanter minor ; and 
by this obliquity of their insertion, they turn the toes outwards, and 
bend the thigh. Other muscles corne from the lower and fore part 
of the pelvis, as the pectinalis, triceps, and obturator externus, 
which arise from the arch of the os pubis, and go down to be 
implanted into the linea aspera and lesser trochanter; and, they 
pulling the thigh towards the body, are called the adductors. 
Others arise from the sacrum and back part of the pelvis, as the 246 
MUSCLES MOVING THE THIGH-BONE. 
glutei, which coming directly forwards to be implanted into the 
greater trochanter, pull back the thigh ; and a fourth set coming 
also from the internal surface of the pelvis; viz. the obturator 
internus and the pyramidalis come out through the back opening, 
turn round the pelvis, as round a pulley, and roll the thigh, and draw 
it back. Thi completes the catalogue of those muscles which 
move the thign 
1. The PSOAS MAGNUS, ILIACUS INTERNUS, PECTINEUS, TRICEPS, 
obturator externus, which, coming from before, are inserted into 
the line of the minor trochanter, and bend the thigh. 
2. The GLUTA3I, GEMINI, PYHIFORMIS, OBTURATOR INTERNUS, and 
quadratus, which come from behind, are implanted into the line 
of the great trochanter, and extend the thigh ; and it hardly need be 
remembered, that as, when the arms being fixed, their muscles raise 
the weight of the body, as in climbing or in turning over a bar, by 
grasping with the hands, so the muscles of the thigh move that thigh 
only which is loose, and free from the weight of the body, while the 
muscles of the other thigh, which is fixed by the weight of the body, 
move not the thigh, but the trunk upon the#thigh ; so that our walk- 
ing is performed not so much by the muscles of the thigh moving 
the limb, as by their moving the pelvis, i. e. rolling the trunk upon 
the limb. 
MUSCLES MOVING THE THIGH. 
1. The thigh is moved backwards and outwards, 
By the glutseus maximus, 
medius, 
minimus, 
which are 
implanted 
into the 
linea aspera, 
trochanter major, 
top of trochanter. 
2. The thigh is moved backwards, and rolled upon its axis, 
Bv the pvriformis, 
gemini, 
obturator cxtemus, 
internus, 
quadratus, 
which are 
implant- 
ed into 
the 
== 
L between the trochanters. 
3. The thigh is moved forwards, and the toe pointed outwards. 
By the psoas magnus, 
iliacus internus, 
pectinalis, 
triceps, 
which are 
inserted 
into the 
trochanter minor, 
linea aspera. 
In the dissection of these muscles, a sort of artificial arrangement 
may be made of the muscles of the thigh, by taking off the fascia, the 
fascialis muscle, the sartorius, and the gracilis, and then dividing 
the remaining twelve muscles into groups of four ; as, four inserted 
into the patella, to extend the leg ; four to bend the leg : and four 
adductors to bring the thighs together. 
OF THE FASCIA 0F THE THIGH. 
The thigh is enclosed in a very strong sheath, which, like that of 
the arm, sends down among the muscles strong tendinous septa or MUSCLES MOVING THE THIGH-BONE. 
247 
partitions, and the muscles are enclosed in these septa, and support- 
ed by them.* The tendinous fascia of the thigh arises chiefly from 
the spine of the ilium, and from the Poupart ligament. Every fascia 
has something added by each muscle, and takes a new increase and 
adhesion at each bone which it passes. It is always strengthened 
by adhesion to joints, and comes down from them thicker upon the 
muscles below ; and so this fascia of the thigh, which arises chiefly 
from the spine of the ilium, descends, covering all the muscles of 
the thigh : it sends partitions down to the linea aspera and trochan- 
ters ; it has a new adhesion, and a new source of tendinous fibres 
at the knee ; it adheres most remarkably at the inner side of the 
tibia, and then descends to the calf; it covers all the leg, and is again 
reinforced at the ancle ; and this is a juster history than the common 
idea of making it an expansion of the small tendon of the small 
muscle, which I am now to describe ; for the fascia is too essential 
to the strength of the leg, and would be found there, though this 
muscle were away, as is the case with the palmar expansion. 
This fascia rightly consists of two plates ; one is that which comes 
down from the crest of the ilium, and from the muscles of the belly • 
the other, that which arises purely from the tendon of the musculus 
fascialis, and which is at the same time connected with the capsular 
ligament of the femur, and with the trochanter; and so the muscle 
called fascialis lies between the two plates of the fascia ; and as 
the fascia, at this part, takes at least a reinforcement from the cap- 
sular ligament and from about the trochanter major, the fascialis 
muscle may be said to be inserted into the trochanter. 
So this great tendinous fascia has these connections : the crest of 
the ilium ; the ligament of Poupart, at the rim of the belly ; the crest 
and arch of the os pubis; the tuber ischii, and so back along the 
coccyx, to the ridge and processes of the sacrum ; the ligament of 
the joint, the great trochanter: and the linea aspera, all the way 
down to the knee, where its last adhesion is very strong, and from 
whence it comes off again, much strengthened. It is thicker on the 
outer side, and back part, and very thin on the inner side of the 
thigh ; it splits to embrace the sartorius, and it drives with perpen- 
dicular divisions among the muscles of the thigh, and is even con- 
nected with the sheath of the great vessels. 
The use of this tendinous membrane has been quite overlooked. 
While it gives attachment to muscles, and embraces them like the 
* The peculiar connexion of the fascia femoris with the muscles of the thigh and 
with the capsular ligament of the hip-joint, is very interesting and worthy of the spe- 
cial attention of the student of anatomy. Each muscle is included by two processes 
of the fascia, and the sheaths thus formed are successively united to the capsular 
ligament, so that in raising them therefrom, we gradually thin this ligament until we 
arrive at the synovial membrane. This has induced us to consider the capsular liga- 
ment as formed by successive additions from the processes of the fascia lata; being 
thickest where the greatest number of these layers are united, and thinnest where 
fewer muscular sheaths are attached. It is certain, that these attachments of the 
muscular sheaths to the capsular ligament, have considerable influence upon them, 
and enable the muscular contractions to affect the joint in a manner advantageous to 
its free motion and strength, whatever opinion may be entertained relative to the 
formation of the capsule. For the opinions and observations of the editor on this 
and some similar subjects, see his “ Anatomical Investigations, &c.” Philad. 1824; 
J. D. G. 248 
MUSCLES MOVING THE THIGH-EONE. 
other fascia, it performs a much more important office. Its con 
nections enable us to throw the weight of the body on one limb, and, 
as it were, to hang the weight of the body on the pelvis, indepen- 
dent of muscular exertion. When a soldidr, from a constrained and 
stiff position in the ranks, is standing equally on both legs, his joints 
are kept straight by muscular exertion ; but when at the words, stand 
at ease, he throws himself on one leg, and relaxes the other, the 
body, supported by the spine, and the spine by the pelvis, weighs 
behind the centre of the acetabulum ; then the fore part of the ilium 
rises; the fascia is stretched; the muscles of the thigh become 
braced ; the patella is drawn up ; the knee grasped by the mem- 
branes, and the leg extended. The whole limb is thus embraced 
and extended by the weight of the body thus operating on the fascia, 
to the relief of muscular exertion.* 
This is a very beautiful mechanical provision for saving muscular 
power ; and while the body rests alternately on one leg or the other, 
it throws the whole body into a position of ease and grace. But 
when there is weakness, as in young people, or when there comes 
to be a habit of standing on one foot, the necessary obliquity of the 
pelvis produces an obliquity of the spine, and at last permanent dis- 
tortion of the spine. 
In a surgical point of view the fascia of the thigh is a subject of 
the utmost consequence, as it regards hernia, aneurism, and abscess. 
CLIV. The fascialis muscle.—The muscle is named tensor 
vaginm femoris. It arises from the upper spinous process of the 
ilium, i. e. from the fore part, or very point of its spine, by a tendon 
of about an inch in length. It is very small at its origin, and at its 
termination. It is thick and fleshy in the middle, swelling out; it 
extends downwards, and obliquely backwards, almost to the middle 
of the thigh, and there it terminates obliquely, between the two 
lamellae of the membrane to which it belongs. 
Its use is chiefly as an abductor, and to make the fascia tense, to 
prepare the muscles for strong action ; and, perhaps, by its adhesions 
about the trochanter, it may have some little effect in rolling the" 
thigh, so as to turn the toes inwards, and oppose the Gemini. 
CLV. Psoas magnus.—This and the following muscle come from 
within the body to move the thigh forwards. This is a very long 
and fleshy muscle, of considerable strength, of constant use, per- 
petually employed in moving the thigh forward, or in supporting the 
pelvis upon the thigh-bone, so as to preserve the equilibrium of the 
body. 
The psoas is a large round muscle, very strong, of great length, 
filling up all the space upon either side of the spine, and bounding 
the pelvis at its side. It comes from under the ligamentum arcua- 
tum of the diaphragm ; for it arises first by its uppermost head from 
the last vertebra of the back, then successively from each of the ver- 
tebras of the loins. It sticks close to the lumbar vertebrae ; for it 
arises not only from the transverse processes, but from the sides of 
fascialis. 
Or. sup. 
ant. spine 
of the 
ilium. 
In. fascia] 
fata. 
Tsoas 
magnus. 
Or. 1. 
body of 
last dorsal 
vert. 
2. bodies 
and trans. 
process, 
of all the 
lumbar 
fert. 
* The consequences of this obliquity of the pelvis in yoong people is verv fu!'y 
treated of in Mr. Shaw’s folio work on the spine. MUSCLES MOVING THE 1 HICH-BOiNE. 
249 
the bodies. These heads do not appear, for they are covered by the 
body of the muscle, which goes down thick and round, till it reaches 
the sacro iliac symphysis, and then being united to the internal iliac 
muscle, they descend through Poupart’s ligament. It is inserted into 
the lesser trochanter of the thigh-bone, and into the body of the 
bone, a little below the root of the process. 
CLVI. The psoas i>arvus docs not, like this, belong to the thigh, 
but is a muscle of the loins, which arises along with this one from the 
last vertebra of the back, and the first of the loins. 
It is a small and delicate muscle, ends in a slender tendon, which 
goes down by the inner side of the great psoas, but does not go out 
of the pelvis along with it: it stops short, and is implanted into the 
brim of the pelvis, into the os ilium near the place of the aceta- 
bulum : it bends the spine upon the pelvis. This muscle is more 
regular in the monkey : in the dog it is seldom wanting. It is said 
to be more frequently found in women than in men ; in both, it often 
is not to be found : but sometimes, in strong and big men, three 
psoas muscles have been found. This muscle is so small, and so 
powerless, in regard to the motion of the trunk, that looking to tho 
connection of ks tendon with the Poupart ligament, I regard it rather 
as closing the opening to the thigh, and strengthening the abdominal 
tendons in their insertion into the os pubis. 
CLVII. The iliacus internus is a thick, very fleshy, and fan- 
like muscle, which occupies the whole concavity of the os ilium. 
Its origin is from the internal lip of the crista ilii and transverse 
process of the last lumbar vertebrae : it adheres to all the concave 
surface of that bone, down to the brim of the pelvis ; to the fore part 
of the bone under the spinous process ; and to a part also of the cap- 
sular ligament of the joint: all its radiated fibres are gathered to- 
gether into a tendon at the ligament of Poupart. This tendon is 
longer on the lower than on the upper surface : for below, it slides 
on the pubes as upon a pulley, and continues tendinous that it may 
bear the friction ; but above it is unconnected, or it is connected 
only by loose cellular substance; and there it is quite fleshy. Just 
under the ligament the two tendons are joined, whence they bend ob- 
liquely round, to be implanted into the lesser trochanter. 
The psoas magnus and iliacus internus are two very powerful mus- 
cles. Their chief use is to bend the thigh, while the psoas, as arising 
from the vertebrae, is more particularly for supporting the body. 
We must not pass from the study of these muscles, without paying 
attention to the iliac fascia, which is very important in a surgical 
point of view. ' 
Although the term origin of the fascia is used in description, it is 
incorrect; for there is no resemblance between the connections of 
fascia with the spines of bone, and the origin of muscles from bone. 
From the inside lip of the spine of the ilium, a strong tendinous mem- 
brane or fascia stretches over the iliacus internus muscle. This fas- 
cia continues upwards over the psoas magnus, and may be traced 
over the lateral parts of the lumbar vertebra1. Downwards and for- 
wards it connects itself with the inner edge of the Poupart ligament. 
In. tro- 
Psoas 
or7ias’t 
dors. vert. 
“<jJ^)sr 2 
In. brim 
Iliacus 
“»ternus. 
Or. 1. in- 
ternal lip 
of the 
crista ilii. 
2. the hol- 
low and 
fore part 
of the 
same, 3. 
trans. pro. 
of the last 
1 limb. vert. 
In. tro- 
chanter 
minor. 250 
muscles moving the thigh-bone. 
iroui which it may be traced into the aponeurosis, which lines the 
inside of the muscles of the abdomen. 
This fascia extends between the iliac and psoas muscles and the 
peritoneum ; and by its connections to the os ilii and os pubis, and to 
the tendon of the abdominal muscles, at the part called Poupart liga- 
ment, it completes and secures the walls of the abdomen. But if 
matter should be formed by the side of the vertebrae, or in the cellu- 
lar membrane, which is around the psoas muscle, it has an easy de- 
scent behind this fascia, and under the Poupart ligament, into the 
thigh, by a canal posterior to that which admits the descent of hernia. 
We return to the muscles of the thigh. 
CLVIII. The pectineus or pectinalis, so named from its arising 
at the pecten or os pubis, is a broad, flat, square muscle : it lies 
along-side of the last described muscles, and is inserted with their 
common tendon. It arises flat and fleshy from that part of the os 
pubis which is bounded on the upper part by the linea ileo pectinea, 
and on the lower by a ridge running from the tuberous angle of the 
pubes to the upper part of the acetabulum, and is implanted into the 
linea aspera, immediately belovV the trochanter minor, by a tendon 
flat and long, pretty nearly of the same extent and shape with its 
origin. 
This muscle lies immediately under the skin and fascia lata : and 
by its bending round under the thigh-bone, it has three actions ; to 
close the knees together ; to pull the thigh forward; to perform 
rotation, turning out the toe; and, in certain positions of the limb, 
it will pull the thigh back, assisting the extensor muscles. 
CLIX. The triceps femoris is a broad flat muscle, with three 
heads, arising from the os pubis, also in part from the ischium, and 
inserted into the whole length of the linea aspera down to the con- 
dyle, and serving for pressing the knees together ; when the thigh 
is behind, they must assist in bringing it forward ; when the thigh 
is forward, they must carry the body perpendicularly over the thigh- 
bone, so that, besides being adductors, these muscles are in incessant 
operation in walking. 
The triceps consists of three heads, which lie in different layers, 
one above the other ; and have so little connection among them- 
selves, that they have been more commonly, and I think properly, 
described as three muscles. These three parts of the muscle are, 
indeed, for one common use : but they are of very different forms ; 
for they do not even lie on the same plane : one is long, another 
shorter by one half, a third larger than both the other two ; so that 
they have been commonly described under the names of adductor 
PRIMUS or LONGUS ; ADDUCTOR SECUNDUS or BREVIS ; ADDUCTOR 
TERTIUS Or MAGNUS. 
1. The adductor eongus is the uppermost layer ; its border 
(for it, like the pectinalis, is a flat muscle,) ranges with the border 
of the pectinalis. It arises from the upper and fore part of the os 
pubis and the ligament of the symphysis by a short roundish tendon, 
very strong : it swells into a thick fleshy belly, not round, but flat- 
tened ; the belly grows flatter as it goes down towards the thigh- 
bone : it ends in a flat and short tendon, which is inserted into the 
Pcctincus. 
Or. upper 
mrt of th 
os pubis, 
above the 
JnTunea 
aspera be- 
minor. 
Adducts 
ongus. 
Or. upper 
part of the 
os pubis 
ment18*’” 
jn, nritffite muscles Moving the thigh-bone 
251 
hnea aspera in all its middle part, viz. about four inches. Thus, 
the muscle is of a triangular form, with its base in the linea aspera, 
and its apex on the os pubis. Its head or origin lies between the 
pectinalis and the gracilis : its upper edge ranges with the pecti- 
nalis ; its lower edge lies upon the triceps magnus. It is called 
longus, because it is longer than the next muscle. 
2. The adductor brevis lies under tho adductor longus, and is 
of another layer of muscles ; for as the first layer consists of the 
pectinalis, adductor longus, and gracilis, this layer consists of the 
obturator externus, adductor brevis, and adductor mangus. The 
adductor brevis is exceedingly like the former, in rising near the 
symphysis pubis, by a thick and flattened tendon, swelling like it 
into a strong fleshy belly ; like it, it grows flat, and is inserted by a 
short flat tendon into the inner trochanter and upper part of the 
linea aspera. But it differs in these points : that it is less oblique, 
for this muscle being shorter, goes more directly across between the 
pelvis and the thigh ; that it is placed higher than the last, so that 
whereas the layers are inserted into the middle of the thigh-bone, 
this one is inserted into the lesser trochanter, and only the upper 
part of the linea aspera ; and the triceps longus is a superficial 
muscle, while this is hidden under it, and behind it. The longus 
takes its rise from the very crest of the os pubis ; this takes its ori- 
gin from the fore part of the os pubis, from the limb just under the 
crest, so as to be immediately under the head of the longus. 
3. The adductor magnus, the third head of the triceps, is a 
very long and flat muscle, lying behind the other heads. It arises 
by a short tendon, just under the tendon of the adductor brevis ; it 
continues to have a fleshy origin all down the ramus, and the ramus 
ischii to the tuber, i. e. from the flat edge of the thyroid hole. 
From this broad origin, it goes to be implanted into the thigh-bone 
the whole length of the linea aspera, its fibres having various degrees 
of obliquity, according to their insertion, for the uppermost fasciculi 
go almost directly across, to be inserted flat into the upper part of 
the linea aspera ; the succeeding fasciculi go more and more ob- 
jiquely as they descend, the lower part of the muscle following that 
rough line which leads to the condyle, and the last fibres of all are 
implanted, by a tendon of considerable length, into the condyle 
itself. This adductor magnus makes as it were a flat partition be- 
tween the fore and the back parts of the thigh ; and it is about 
three inches above the condyle that the great artery passes between 
this tendon and the bone perforating the triceps, to get from the 
fore to the back part of the thigh, and down into the ham. 
The use of all these muscles is entirely the same, making allow- 
ance for their various degrees of oblique insertion ; and they must 
be very powerful, by the great distance of their origins from the 
centre of that bone which they move, so that while other muscles 
pull in a direction very oblique, these three heads of the triceps must 
pull more at right angles, and, therefore, at a more favourable 
direction. 
CLX. The obturator externus is named after the obturator 
ligament, from which it arises. The ligament and the muscles shut- 
and back 
part of the 
linea 
aspera. 
Adductor 
brevis. 
Or. os lat- 
his below 
the last. 
In. linea 
aspera, 
from the 
root of the 
lesser tro- 
chanter to 
the com- 
mence- 
ment of 
the inser- 
tion of the 
next. 
Adductor 
magnus. 
Or. the 
ramus pu- 
bis, and 
ramus 
ischii. 
In. linea 
aspera, 
and inner 
condyle of 
the femur. 
Obturator 
exfcmufr* 252 
MUSCLES MOVING THE THIGH-BONE. 
ting up the foramen tliyroideum are named obturators, and it 1s 
sometimes named rotator femoris extroksum, from its turning 
the thigh outwards. It arises from the ramus of the ischium and os 
pubis, where they form the margins of the thyroid hole ; and from 
the outer surface of the ligament, which it occupies entirely, leaving 
only room for the obturator vessels and nerves. It is a short muscle ; 
its origin is broad, and its insertion narrow, so that it is of a conical 
form ; for the flesh of its muscles is gathered very soon into a round 
short tendon, which twists under the thigh-bone between it and the 
pelvis ; so that it is in a manner rolled round the thigh-bone, being 
inserted into the root of the great trochanter. It pulls the thigh for- 
wards, but is more peculiarly a rotator of the thigh. This muscle is 
of the second layer, and the succession of all the muscles is this ; 
the upper layer consists of the psoas and iliacus, where they come 
out from the abdomen, of the pectinalis, and of the long head of 
the triceps; the second layer consists of the short • head of the tri- 
ceps ; and the third layer consists of the obturator externus at the 
upper part, and the triceps magnus, or third head of the triceps, all 
down to the condyle. 
Glutaii.—There are three glutasi muscles, each under the other, 
and each smaller than the muscle which covers it. The first, 
arising from the back part of the ilium, the back of the sacrum, and 
the sacro-sciatic ligament, forms the whole hip, and descends so 
low as to be inserted into one-third of the length of the linea aspera, 
and into the root of the great trochanter. 
The second arises from all that portion of the ilium which is 
before this one, and from the back of the bone, and goes down to 
be inserted into the very top of the great trochanter. 
The third arises from the back of the bone below the last; and 
it is inserted into the root between the apex of the great trochanter 
and the neck of the bone. 
CLXI. The GLUTJ3US maximus arises from the back of the ilium 
nearly one half its length ; from the joining of the ilium and sacrum; 
from all the spines and irregularities of the sacrum ; and from the 
sacro-sciatic ligament and os coccygis. Its thick fleshy fasciculae 
come in a winding and oblique direction down to the thigh bone ; 
and, being gathered into a flat and pretty broad tendon, it is inserted 
into the root of the trochanter major, and down three inches of the 
outside of the linea aspera. This is one of the largest and most 
fleshy muscles of the body; covers all the other muscles of the hip ; 
forms the contour of the hip ; pulls the thigh backwards, or the 
body forwards upon the thigh, when the thigh is fixed : and being a 
wide-spreading muscle, which, in a manner, surrounds its joints, its 
different portions act with different effects ; not only according to 
their natural direction, but according to the accidental position of 
the pelvis with regard to the thigh-bone. A large bursa lies under 
the broad tendon of this muscle. 
CLXII. The glutjeus medius or minor is smaller than the 
former, but like it. It arises from all the outside of the ilium not 
occupied by the glutaeus major. It, like the other, is a fan-formed 
muscle; for its fibres converge from its broad origin in all the back 
Or. crus 
pubis, and 
ischii, 
membrana 
obturato- 
ria. 
In. cavity 
under the 
trochanter 
major. 
Glutseus 
maximus. 
back part 
-ft* 
XeUium• 
2. os sa- 
sciatic 
ligament, 
cyds?00 
In. linea 
theT*’ er 
part/ 
Glutseus 
rior sup. 
spinous 
process*, 253 
MUSCLES MOVING THE THIGH-BONE. 
of the ilium, to form a short flat tendon which is inserted into the 
back, or into the very top of the great trochanter. It lies in part 
under the glutaeus maxirnus; but its chief part lies before the glutaeus 
maximus ; and as certain portions of the muscle are before the 
thigh-bone, there are positions of the pelvis and thigh-bone in which 
it will pull the thigh forwards, although its proper office is to assist 
the glutaeus magnus in pulling the thigh backwards, and moving it 
outwards from the body. 
CLXIIL The glutaeus minimus is a small radiated muscle, 
which lies deep, and quite under the former. It has, compared 
with the former, a very narrow origin ; for it arises chiefly from 
the lowest part of the back of the ilium, viz. that part which forms 
the socket for the thigh-bone, and a little higher up, and from the 
border of the sciatic notch. Its origin from the dorsum ilii is 
bounded by a ridge, which extends from the upper part of the ace- 
tabulum to the notch. It forms a short, flat, and strong tendon, 
which is fixed to the fore part of the trochanter major, between the 
trochanter and the neck of the bone; so that these muscles are 
inserted in this succession ; first, the great glutaeus, below the root 
of the trochanter, and into the linea aspera ; the middle glutmus 
into the back and top of the trochanter ; and the smallest of the 
glutaei is implanted into the roughness on the fore and upper part of 
the trochanter. 
Gemini.—The gemini are two muscles, or rather one biceps 
muscle ; but the heads are so distinct, that they are reckoned two, 
and so much alike, that they are named gemini. 
CLXIV. The uppermost, the larger, and stronger muscle, arises 
from the spinous process of the os ischium. 
CLXV. The second or smaller head arises in like manner from 
the tuber ischii, upon its ball or outer end. They are fleshy in their 
whole length. They meet, and unite their tendons at the great 
trochanter. They are inserted firmly along with the tendon of the 
obturator interims, at the root of that process. 
CLXVI. The pyriformis, or pyramidalis, comes from the hollow 
of the sacrum, runs in the same line with the lesser glutaeus, and is 
inserted with the two last named muscles in the root of the great 
trochanter. 
Its origin is from the hollow of the sacrum, rising from the verte- 
brae of that bone, by three or four small fleshy digits; and from the 
sacro-sciatic notch, it runs between the glutaeus minor and the 
gemellus superior, and its round tendon is inserted between them, 
somewhat connected with each.* 
The pyriformis, gemini, obturator internus, and quadratus, form 
what some anatomists have called musculi quadrigemini : and they 
are so much alike in insertion and use, that it would be waste of 
time to repeat what has been said of the gemini and obturator. 
This muscle, the pyriformis, like the others, rolls the thigh out- 
wards. Its name is from its shape. 
CLXVII. The obturator internus, once named marsupialis, 
spine and 
dorsum of 
os ilii. 
In. tro- 
chanter 
major. 
■Glutreus 
minimus. 
Or. 1. 
dorsum 
ilii, 2. 
the ridge, 
and 3. the 
edge of 
the great 
notch. 
In. fore 
part of 
trochanter 
major. 
Gemellus 
sup. 
Or. spin- 
ous pro- 
cess of the 
ischium. 
Gemellus 
inferior. 
Or. tuber 
ischii. 
In. root of 
the tro- 
chanter. 
Pyrifor- 
mls. 
Or. from 
3 bones of 
os sacrum, 
from the 
os ilii. 
In. cavity 
under the 
great tro- 
chanter. 
Obturator 
intern. 
* This muscle is frequently divided by the great sacro-sciatic nerve. 254 
MUSCLE? MOVING THE THIGH-BONE. 
Or. all the 
thyroid 6 
hole and 
obturator 
or bttrsalis, arises from all the internal surface of the obturator liga- 
ment, and from all the edges of the thyroid hole, from the ilium, 
ischium, and pubis. Its origin is therefore circular and fleshy. It 
runs along the inside of the os ischium, turns round that bone between 
the spinous process and the tuber. The hollow there is guarded 
with cartilage, and this tendon runs in the hollow, like a rope round 
a pulley ; passing this, it runs between the two legs of the gemini, 
and its tendon is united to theirs ; and the three appearing almost 
like one tendon, are insertedjtogether in the root of the trochanter 
major. These, then, might with some propriety be named one 
muscle; all the three, viz. the two gemini muscles, and the obtura- 
tor muscle passing between them, were once accounted as one 
muscle, and then it seemed to be a muscle with two bellies, and an 
intermediate t'epdon : and this intermediate tendon, with two fleshy 
ends, gives it the appearance of a purse, thence named marsupiauis, 
or BURSALIS. 
CLXVI1I. The quadratus femoris is a thin flat muscle, passing 
in a transverse direction between the tuber ischii and the thigh-bone. 
It arises from the lower and flattened surface of the tuber ischii 
by a short tendinous beginning. It goes a little obliquely upwards 
and outwards, and is inserted into the back of the great trochanter, 
in that roughness which is found just where the trochanter is joined 
to the bone, and goes obliquely between the trochanter major and 
the trochanter minor. 
It rolls the thigh-bone, so as to turn the toe outwards, and pulls it 
almost directly backwards. 
The motions of the thigh must be performed by many very strong 
muscles, as it moves under the weight of the whole body ; and it 
seems to be curiously contrived, that the muscles fit for moving the 
thigh forward, should in certain positions of the thigh, move it back- 
wards ; also giving an increase of strength to that motion of the 
thigh in which most strength is required. 
There are but two, or chiefly two points for insertion ; the tro- 
chanter major and trochanter minor. These two points are so 
oblique, that no one muscle, nor set of muscles, performs any direct 
motions; for they all twist round the bone’s axis, to get at their 
insertion. The glutaei, the pyriformis, the gemini, the quadratus, 
the obturator internus, and obturator externus, all bend round the 
axis of the thigh-bone, to reach the trochanter major. These 
now may be called the abductors of the thigh, to pull it outwards; 
but we should conclude from this direction, that they could not pull 
the thigh backwards, for the thigh-bone would turn on its axis and 
elude their action. 
The psoas magnus, the iliacus internus, the pectinalis, and the tri- 
ceps, do in the same manner go round the inner side of the bone : 
the two first to be implanted into the trochanter minor, the two 
latter into the linea aspera, just below it. These are justly named 
adductors of the thigh ; their chief use is to draw the thighs together, 
and this is their combined effect: when the adductors act by them- 
selves, they pull the thigh forwards, moving the leg, rolling the 
thigh-bone, and turning the toe out in a graceful step: which is; 
In. root of 
chanter 
Quadratus 
femoris. 
Or. tube- 
rosity of 
the ischi- 
um. 
In. inter- 
trochan- 
tcral line. MUSCLES MOVING THE LEG. 
255 
most peculiarly the effect of the pectinalis and triceps. But when 
we are to finish the motion, by pulling forward the body, which is 
the same with pulling back the thigh, it is not merely the antagonists 
of these muscles, as the glutaei, the gemini, &-c. which must act. 
Were the glutaei to act alone, they would rather turn the thigh upon 
its axis outwards than pull it back ; but the triceps, &c. act again 
in conjunction with the glutaei, &c. and by the action of the triceps, 
the inner trochanter is fixed : the further rolling of the thigh is pre- 
vented ; the full effect is given to the glutaei muscles. When the 
glutaei act, they pull the thigh directly backwards, assisted by the 
triceps, pectinalis, and others: for now the thigh-bone is so far ad- 
vanced before the body, that those muscles, as the triceps which 
were benders of the thigh in its first position, are extensors when it 
is advanced a step before the body ; or, pm;haps, it will be more ex- 
plicit to say, that when the thigh is movedone step before the body, 
the iliacus internus, psoas magnus, and triceps muscles, agree with 
the glutaei muscles in bringing the trunk forwards to follow the limb, 
and then in fixing and stiffening the trunk upon that limb, till the 
other thigh is advanced again a step before the body. 
The consideration of the uses and actions of the muscles, are 
very necessary to the surgeon. If we suspect that the lameness 
we perceive in a patient is arising from the hip-joint, we make him 
throw out the thigh in abduction, because the glutaei are abductors, 
and they press the hip-joint in that operation, and give pain, and 
thus prove the seat of the complaint. In the same manner, when 
there i3 disease in the course of the psoas magnus, the patient 
stoops, and he cannot extend his thigh, because that stretches the 
psoas muscle. 
The muscles moving the leg, are the most simple of all; for 
the knee is a mere hinge, at least it is so in all our ordinary motions, 
so that there is no action to be performed, but those of mere flexion 
and extension, and there are only two classes of muscles to be de- 
scribed, the extensors and the flexors of the leg. 
1. The extensors of the leg.—The only muscles which ex- 
tend the leg are those four, which may be very fairly reckoned a 
quadriceps extensor cruris. Indeed the French anatomists arrange 
them so. Sabatier calls them the triceps femoris. These muscles, 
which all converge to the patella, and are inserted in it, are, rectus 
FEM0RI3, CRUK.EUS, Or FEMORvEUS,—VASTUS EXTERNUS, VASTUS 
INTERNUS. 
And these are all implanted by one tendon; because the joint 
being a hinge, bending only in one direction, its muscles could 
have given but one motion, however oblique their origin and course 
had been. 
2. The flexors of the leg are one on the outside, and four on 
the inside of the leg ; the tendons of the outside being implanted 
into the upper knob of the fibula, and those in the inside into the 
rough head of the tibia, forming the ham-strings, and extending 
their tendons or aponeurotic expansions downwards upon the leer. 256 
MUSCLES MOVIiN'U THE LEO. 
INSIDE FLEXORS. 
S'artorius, 
Semitendinosus, 
Gracilis, 
Semimembranosus, 
OUTSIDE FLEXOR. 
Biceps. 
EXTENSORS OF THE LEG. 
Hectus 
Or'Tnfer 
ant. spin, 
pro. of the 
upperedee 
of the ace- 
tabulum. 
CLXIX. The rectus femoris, sometimes rectus cruris, is so 
named from its direction; it arises by two heads. The first or 
greater head arises from the lower spinous process of the ilium by 
a short round tendon ; its second head is in a different, and 
somewhat of a curved direction ; for it comes from the edge of 
the acetabulum, and from the capsular ligament. These join to- 
gether, and form a flat tendon of four inches in length, which 
becomes gradually fleshy and larger down to its middle, and then 
again contracts towards the patella. There is a middle tendinous 
line, running the whole length of the muscle, especially conspicuous 
on its back part, and towards that central line all the muscular fibres 
converge. 
The rectus is united at the sides to the vasti, at the back part to 
the cruraeus ; and its tendon, along with that of the cruraeus, goes 
to be directly implanted into the rotula or patella. 
The rectus cruris is the first of those muscles which Sabatier 
calls the triceps femoris ; they may be more properly named the 
QUADRICEPS CRURIS. 
This large mass of muscle or flesh enwraps the whole of the 
thigh-bone behind as well as before ; for, first, the crura:us arises 
fleshy from all the fore part of the bone. The vastus externus 
from the great trochanter, and all the back part and outer side of 
the bone ; and the vastus internus arises, in like manner, from 
the lesser trochanter, and all the inner side of the bone, from the 
trochanter major all round to the origin of the cruraeus. 
CLXX. The cruraeus arises from the fore part of the femur, 
between the two trochanters, and it continues its origin from the 
fore part of the femur, the whole way down to within two inches, 
or little more, of the patella. About three inches from its origin 
it is joined by the vastus externus, which unites with it at the outer 
edge and fore part; and the vastus internus comes into it about 
five inches below its origin, and it joins it at the inner edge and 
fore part. At. its lower part it is joined to the tendon of the rectus, 
to form but one large tendon, which is inserted into the rotula. By 
Albinus, the plate of this muscle is given in union with the two 
vasti, which is the best method of describing the muscle, as it is 
very seldom to be made out distinct from these two muscles. 
Under the cruraeus are sometimes found two little muscles, or 
rather two little slips of this muscle, which are quite distinct. They 
In- upper 
patella/ 
Cruraeus. 
oartofthe 
lemur. 
In. the 
under*hc 
rectus. MUSCLES MOVING THE LEG. 
257 
arise on tiie lore part of the thigh-bone, two or three inches above 
the capsule of the joint ;»and they are inserted into the capsule on 
each side of the patella, evidently for the purpose of pulling it up 
to prevent its being caught; and when these two (subcrurau) are 
not lound as distinct muscles, some fibres of the cruraeus supply 
their place. 
CLXXI. The vastus externus is the largest of these three 
muscles. 
Its origin is, by a pretty thick and strong tendon, from the lower 
and fore part of the trochanter major ; and it continues its origin 
from the root of the trochanter all down the linea aspera, to that 
rough line which goes to the outer tuberosity of the thigh-bone. 
It touches the end of the cruraeus about four inches below its 
origin, and continues attached to it the whole way down ; and then 
it forms a flat tendon which connects itself with the tendon of the 
rectus femoris, and then embraces, in a semi-circular manner, the 
outside of the patella. And several of the fibres of this aponeurosis 
not only cross over the rotula, but go down over its opposite side to 
glide along the head of the tibia, and to be inserted into the inner 
side of the knee. 
CLXXII. The vastus internus is neither so large nor so fleshy 
as the vastus externus ; but it is exceedingly like it in all other 
respects. 
It arises from the fore part of the trochanter minor, just under 
the insertion of the psoas magnus, and from the fore part of the 
thigh-bone ; it continues its origin from the linea aspera the whole 
way down to the inner condyle, exactly opposite to the origin of the 
vastus externus ; they leave merely a channel between them. The 
vastus internus, very soon after its origin, joins itself to the cruraeus, 
or middle portion, and accompanies it in all its length ; and, at the 
distance of two inches from the rotula, it unites itself with the ten- 
don of the cruraeus at its internal edge; and this tendon completes 
that junction which unites the four muscles into a quadriceps cruris. 
This vastus internus descends much lower, in a fleshy form, than the 
external vastus does, and forms that fleshy cushion which covers 
the inner side of the knee-joint. Its tendon embraces the rotula, 
somewhat in the same circular form with the vastus externus ; and, 
like the externus, it sends some fibres across the knee-pan, to be 
inserted in the outer part of the head of the tibia. 
The rectus, and the vastus externus, internus, and crur.eus, 
form one large mass of flesh, which embraces and encloses all the 
thigh-bone; and they are so connected, that the cruraius cannot be 
separated, and cannot be neatly distinguished. 
The use of these four muscles is evident; to extend the leg, and 
1o bend the thigh on the trunk, or reciprocally to bend the trunk on 
the thigh. This, or these two motions alternately, is the common 
use of these muscles, as in walking; and they are most peculiarly 
useful in running and leaping. 
After describing a large mass, conjoined in one tendon, and con- 
curring in one simple action, it is superfluous to say that its power 
must be great. This power must be still farther increased by the 
Vastus ex* 
ternus. 
Or. root of 
the troch. 
major, 
and the 
linea 
aspera. 
In. the 
patella 
laterally, 
and the 
fascia of 
the knee- 
joint. 
Vastus 
internus. 
Or.l. root 
of troch. 
minor. 
2. linea 
aspera. 
3. fore 
part of the 
bone. 
In. inside 
of the pa- 
tella, and 
into the 
fascia. 258 
MUSCLES MOVING TIIE LEG. 
rotuia, which removes the force from the centre, find gives the ad- 
vantage of a pulley, which it really and truly is : without this pulley, 
these muscles could be of no use in certain situations ; for instance, 
in the recumbent posture : for then the extending muscles, being in 
the same line with their bones, could have no further power ; but 
the rectus, by the pulley of the rotuia, and by its attachment to the 
pelvis, raises the trunk, or at least helps the psoas, the iliacus, and 
the muscles of the belly. 
The rotuia is again attached to the tibia by a strong ligament, to 
sustain the pulling of these great muscles.*' 
The surgeon would do well to remember the attachment of the 
rectus to the pelvis in the case of fractured patella, and to see the 
necessity of raising the body of the patient, to keep the broken parts 
of the bone in contact."!- 
FLEXORS OF THE LEG. 
SarWrius. 
CLXXIII. The sartorius or tailor’s muscle, is so named from 
its bending the knees, and drawing the legs across. It is the longest 
muscle, and a very beautiful one; extends obliquely across the whole 
length of the thigh, crossing it like a fillet or garter, about two 
inches in breadth. 
It arises from the upper spinous process of the os ilium, by a 
tendon about half an inch in length ; its thin flat belly extends ob- 
liquely across the thigh, like a strap, and is inserted in the same 
oblique form into the inner tubercle of the head of the tibia; its 
aponeurosis spreads widely, going over the whole joint of the knee, 
a thin sheet of tendon. 
From the oblique position of the muscle, it might in action change 
its place ; but it is so far embraced by the fascia lata, and is tied by 
such adhesions, as to form something like a peculiar sheath of 
itself. 
It turns the thigh like the quadratus, gemini and obturator muscles. 
It also bends the leg upon the knee ; and when the leg does not 
yield, it bends the thigh upon the pubes ; or where the thigh is also 
fixed, it bends the body forwards; but in performing that action, 
whence it has its name, it does all these ; for first the leg and thigh 
are rolled, then the thigh is raised, then the leg is bent to draw it 
across. Though a small muscle, yet it is of great power from its 
origin, and in some degree, its insertion also, being much removed 
from the centre of motion. 
Or. sup. 
ant. 
the'ilium. 
In. inner 
ofthe*6 
bead of 
the tibia. 
* These muscles are in continual action ; for their office is to resist the bending 
of the knee, which would happen by this incumbent weight of the body ; so that 
the continual support of the body depends wholly on these muscles ; and they are 
the great agents in running, leaping, walking, &c. Since by extending the knee 
they raise the weight of the pelvis aud trunk, and of all the body, they must be very 
powerful; and accordingly, when they are weighed against their antagonist muscles, 
we find them greatly to exceed, for the quadriceps, i. e. the rectus cruneus, and 
vasti, weigh four pounds, while the biceps, &c. their antagonists, weigh but two 
pounds. This experiment was often repeated by the great Cowper, for ftlr. Brown, 
who was delivering lectures on muscular motion. 
t The action of the muscles and the position of the limb in fractures of the Femur 
are considered in my Observations on Injuries of the Spine and Thigh-bone, MUSCLES MOVING THE LEG. 
259 
CLXX1V. The gracilis, sometimes called rectus internes 
femoris,* is a small, Hat, thin muscle, in its general shape somewhat 
like the sartorius. 
It arises by a flat tendon of two inches in length from the ramus of 
the os pubis, and near the symphysis; and it passes immediately 
under the integuments down to the knee ; it -passes by the inner 
condyle of the knee, in the form of a short round tendon; and, as it 
bends behind the head of the tibia, it is bound down by a bundle of 
tendinous fibres, which, crossing it, go to the back part of the leg. 
After passing the head of the tibia, it turns obliquely forwards and 
downwards; it here runs behind the tendon of the sartorius, and 
before that of the semitendinosus. It is inserted with the sartorius 
into the side of the tuberosity, at the top of the tibia. 
This muscle runs also in a line so wide from the centre of motion, 
that its power is very great. It serves chiefly as flexor of the leg : 
when the leg is fixed, it must by its origin from the pubes be a flexor 
of the thigh, and an adductor in nearly the same direction with the 
pectineus and triceps ; and it is worth observing, that while the 
knee is straight, the sartorius and the gracilis cannot bend the knee : 
they, on the contrary, keep it steady and firm ; but when the knee 
is bent, they come into action; for, in proportion as the muscles 
which have made the flexion are contracted, they are less able to 
contract farther, and therefore it is desirable, that more muscles 
should come into play. 
CLXXV. The semitendinosus is so named from its lower half 
being composed of a small round tendon ; and as tendon was once 
misnamed nerve, this is the seminekvosus of Winslow, Douglas, 
and others. 
Its origin is from the tuberosity of the ischium, (along with the 
semimembranosus, and touching the biceps,) by a short thick tendon. 
It also arises by many oblique fasciculi of fibres, from the posterior 
portion of its opposite muscle the biceps cruris. This cross con- 
nexion between the two muscles continues for three inches down 
from the tuber ischii; it then departs from the biceps, goes obliquely 
inwards, and is flattened and contracted into a tendon, six inches 
from the knee, and getting round the head of the tibia, it comes 
forward to be inserted into the tuber, at the head of that bone. At 
this place, the tendon grows broad and flat; it is expanded and as 
it were grasps the inner side of the knee ; its upper edge is joined to 
the lower edge of the tendon of the gracilis, so that the sartorius, 
gracilis, and semitendinosus are implanted like one muscle; and 
this tendinous expansion seems like a capsule, for enclosing the 
heads of the tibia and femur, and for strengthening the knee-joint. 
The semitendinosus bends the leg. 
CLXXVJ. The semimembranosus has its name from the muscle, 
which is flat, thick, and fleshy, beginning and ending with a flattened 
tendon, somewhat like a membrane, but infinitely thicker and massier 
than such name should imply. 
Gracilis. 
Or. ramus 
pubis. 
In. below 
the sarto- 
rius. 
Semiten- 
dinosus. 
Or. tuber 
ischii. 
In. into 
the tibia 
below the 
gracilis. 
Semimem- 
branosus. 
* Gracilis, is from its smallness; rectus jvternus, is from its straight fli* 
rectirm. 260 
MUSCLES MOVING THE LEG. 
Sti!nber 
,s ' 
It arises from the tuber iscliii, before the semitendinosus and 
biceps. It arises a broad, thin, and flat tendon, of about three 
inches in length. It becomes fleshy and thick in its middle, but it 
soon becomes thinner again, and terminates in a short tendon, 
which, gliding behind the head of the tibia, is inserted there.* 
This muscle has little connexion with any other. It lies under, 
or more particularly speaking, on the inside of the semitendinosus, 
and the two together form the inner hamstrings. The hamstring 
muscles contribute also to another motion. Though when extended 
the tibia cannot roll, yet when we sit with our knees bent, it can 
roll slightly and such rolling is accomplished by these muscles. 
All these muscles which bend the leg, and which consequently ex- 
tend tiie thigh at the same time, are muscles of great power, because 
they arise in one common point, the tuber iscliii and that point is 
very far distant from the centre of motion. 
There is still one small muscle, a flexor of the leg, which performs 
this rotation during the bent state of the knee, with most particular 
power. 
CLXXVII. The musculus poplitjEus, which is so named from 
its lying in the ham, is a small triangular muscle, lying across the 
back part of the knee-joint, very deep under the hamstrings, and 
under the muscles of the leg. 
Its origin is from the outer condyle of the thigh-bone, and from 
the back part of the capsule of the joint. Its tendon is short and 
thick, but of no great extent. It passes fleshy behind the knee- 
joint ; and it is inserted broad into a ridge on the back part of the 
tibia ; so that by its small origin and broad insertion, it is a fan-like 
muscle, its upper fibres being almost transverse, and its lower fibres 
nearly perpendicular. Besides bending the leg, it is useful by pulling 
aside the capsule to prevent its being caught. 
CLXXVIII. The biceps cruris, so named from having two 
heads, a long and short one, lies immediately under the skin, in the 
back part of the leg, running down from the pelvis to the knee, to 
form the outer hamstring. 
It is the single flexor on the outside of the thigh. Its origin is 
from the outer part of the tuber iscliii, by a tendon of an inch and 
a half in length. And this tendon is, in its origin, closely united 
with that of the semitendinosus for two inches, or at least the whole 
length of the tendon. After a short, but very thick fleshy belly, it 
degenerates into a tendon, especially on its back part; and this 
tendon, which begins above the middle of the tliigh, is continued the 
whole way down. 
About one-third down the bone is the beginning of the second, or 
short head, which has its origin all the way down the linea aspera, 
to the line above the outer condyle of the thigh-bone; and here it is 
somewhat connected with the origin of the vastus externus muscle, 
In.head of 
the tibia. 
Popli- 
**us‘ 
Or. ext. 
condyle. 
in. trian- 
the back 
of the 
tibm. 
Biceps 
cruris. 
Or. tuber 
Ischu. 
2. linea 
aspera. 
* The two tendons ot this muscle, the membranous ‘tendon at the head, and this 
smaller one by which it is inserted, stand so obliquely, that the muscular fibres be- 
tween them must be very oblique ; for the membranous tendon descends low upon 
the back part or edge, and the tendon of insertion begins high upon the fore edge of 
the muscle. MUSCLES MOVING THE LEG 
261 
and the insertion of the glutieus maximus. The tendons of the two 
heads are joined a little above the inner condyle, and go outwards 
to be inserted into the outer part of the head of the fibula forming 
the outer hamstring. t 
Its insertion surrounds the head of the fibula, and a small portion 
also sinks between the bump of the fibula and the inner Head of the 
tibia, to be implanted into it also. 
This muscle, Tike the opposite ones, serves for bending the leg. 
The short head simply bends the leg. The long head assists the 
short one in bending the leg, and is also a muscle of the thigh. 
Fascia. We must not relieve our attention from these posterior 
muscles of the thigh without considering the manner in which the 
great fascia comes down on the back part of the thigh to cover them, 
and to form the popliteal cavity. The fascia, strengthened as it 
were by its connexion with the linea aspera, stretches down over 
the hamstring muscles and their tendons, embraces them and holds 
them together; and between the flat part of the femur before, the 
hamstring tendons laterally and the fascia behind, there is a cavity, 
(if we may call that a cavity which is filled with loose cellular mem- 
brane and fat,) which transmits the popliteal artery and vein and 
nerve. This cavity is particularly important to the surgeon, because 
the artery here is subject to disease or rupture ; anti then the popli- 
teal aneurism is formed. 
The muscles of the foot are six extensors and two flexor 
muscles. 
In. bead 
of the 
fibula. 
EXTENSORS. 
Gastrocnemius vel gemellus, 
Plantaris, 
Gastrocnemius internus, vel soleus, 
Tibialis posticus, 
lying on the back part of 
the leg. 
Peronjeus LONGUS, 
BREVIS, 
on the outside 
of the leg. 
FLEXORS 
The tibialis anticus, 
The PEItONAXS TERTIUS, 
lying on the fore part 
of the leg. 
CLXX1X. The gastrocnemius is often divided into three mus- 
cles, named gasthocnemii or gemelu. But, far from counting 
thus, we should rather favour the arrangement of Douglas, who 
couples this with the next muscle, as forming a quadriceps, or two 
muscles joined with two heads each ; and he calls it the extensor 
SURALISj. 
The gastrocnemius is the great muscle of the calf of the leg; 
its two heads are two very large and fleshy bellies, which arise from 
the tubercles of the thigh-bone. The inner head is the larger, and 
arises by a strong tendon from the back of the inner condyle, and a 
Gastroc- 
mius. 
Or. the 
condyles 
of the fe- 
mur. 
In. os 
c&lcis. 262 
MUSCLES MOVING THE LEG. 
little way up the rough line ; and it has also a strong adhesion to 
the capsular ligament of the knee. 
The outer head is shorter than this: it arises in the same way, 
from the outer tubercle of the thigh-bone ; and the two muscles 
meet and run down together, forming the appearance of a rapha, by 
the direction of their fibres ; but the two bellies continue distinct till 
they meet in the middle of the leg. They are distinct at their back 
part, but, at their fore part, they are connected by a tendinous apo- 
neurosis, or strong but flat tendon ; and the two bellies being about 
the middle of the leg, united firmly, they form a large flat tendon, 
very broad at its beginning, which unites with that of the soleus a 
little above the ancle. 
CLXXX. Soleus.—This name is from its resemblance to the 
soal fish ; and it is often named gastrocnemius internus. This, 
like the last muscle, has two heads, which arise from either bone. 
One head arises from the head of the fibula, and continues to ad- 
here to one-third of the upper part of the bone ; another head arises 
from about three inches of the part of the tibia, immediately below 
the insertion of the poplitams. The first of these heads is large and 
round ; the second is smaller and round : they unite immediately ; 
and a large fleshy belly is formed, with still a conspicuous division 
between the flesh of the two heads. The great tendon begins about 
half-way down the leg, but still is intermixed with fleshy fibres till it 
approach the heel. A little below the middle of the leg, this tendon 
is united with the tendon of the gastrocnemius, to form the great 
back tendon, named tendo Achillis ; and sometimes, though very 
rarely, chorda magna. 
The tendon is large; it grows smaller as it approaches the heel; 
when it touches the extremity of the heel-bone, it expands to take a 
firmer hold. 
In running, walking, leaping, &c. this muscle, with the extensors 
of the leg, are the principal agents. The external gastrocnemius has 
double power ; for, arising from the tubercles of the thigh-bone, it 
is both an extensor of the foot and a flexor of the leg ; but the gas- 
trocnemius internus is a mere extensor of the foot, and both together 
have such strength as often to break the tendo Achillis. 
CLXXXI. Plantaris.—This muscle is named from a mistaken 
notion of its going to the planta pedis, or sole of the foot, to form 
the plantar aponeurosis, like the palmaris of the hand ; but, in fact, 
it does not go to the sole, but is a mere extensor of the foot, inserted 
along with the tendo Achillis. 
This long and slender muscle is situated under the gastrocnemius 
externus. It arises from the external condyle of the femur wholly 
fleshy; it also has an attachment to the capsular ligament of the 
joint; after an oblique fleshy belly, of about three inches, it forms 
its small flat tendon. The tendon runs between the inner head of 
the gastrocnemius and the soleus; and when the tendo Achillis 
begins, the tendon of the plantaris attaches itself to the inner edge, 
and fore part of the Achillis tendon ; it accompanies it down to the 
heel, running in a groove which seems made to receive it; and it 
Sole ns. 
Or. head 
of the fi- 
bula, and 
hack part 
of the 
tibia. 
in. os 
calcis. 
JPlantaris. 
Or. ex- 
tern. con- 
dyle. 263 
MUSCLES MOVING THE LEG. 
is implanted with the tendo Achillis, into the inner side of the heel- 
bone. It is often wanting. 
The use of this muscle is to tuck up the capsule, in the great 
bendings of the knee-joint, and to assist the gastrocnemii muscles. 
The peronjsi muscles are those which arise from the fibula. 
They are named from their length being different; the peron.eus 
longus being as long again as the brevis, for it is one-half longer 
in its origin, the one rising at the head, the other at the middle of 
the bone ; and again, it is one-half longer at its insertion, going 
fully round under the foot to the opposite side, while the shorter 
peronaeus stops at the side of the foot to be inserted. 
CLXXXII. The peron.eus longus is so named from its lying 
along the fibula. It arises partly tendinous, chiefly fleshy, from the 
upper knob of the fibula, and from the ridge of the bone down to 
within three inches of the ancle. It has another small slip of a 
head from the upper part of the tibia, above where the fibula joins ; 
it has also adhesions to the tendinous partition, which separates this 
from the extensor digitohum communis and the soleus. 
Its tendon begins very high above the middle of the leg, and it 
continues to receive the fleshy fibres, almost at right angles in the 
penniform manner. The tendon is concealed down to about or 
below the middle of the leg. Then it is seen immediately under 
the integuments, and we can easily distinguish it through the skin, 
being that acute line or string which runs down behind the outer 
ancle, and which gives shape to that part. 
In passing the outer ancle it runs down through a cartilaginous 
pulley, or annular ligament, which also transmits the peronseus bre- 
vis : it leaves the peronaeus brevis on the side of the foot; and pass- 
ing by itself in a groove of the heel-bone, it bends obliquely across 
the arch of the foot, goes quite down to the opposite side, and is 
inserted into the metatarsal bone of the great toe, and the great 
cuneiform bone on which it is founded. Under the eminence of the 
os cuboides, it suffers great friction, so as to be thickened to a de- 
gree of ossification, and to resemble a sesamoid bone. It is also 
thickened in a lesser degree, as it passes the outer ancle ; and in all 
this length, it is tied down by a strong ligamentous expansion. 
It is a powerful extensor of the leg ; it also gives that obliquity 
to the. foot, which is so handsome and natural, and useful in walk- 
ing. This muscle particularly turns down to the ground, the inner 
edge of the foot; so it presses to the ground the ball of the great 
toe, and that is the part which touches the ground, and which feels 
sore after long walking, or violent leaping or running : it is by that 
part we push, in making a step ; so that this muscle is perceived to 
be continually active in all motions of walking, leaping, running, 
and more particularly in dancing. 
CLXXXIII. The peronaeus brevis is like its fellow, except 
in length and insertion. Its origin is from the ridge of the fibula, 
beginning about one-third down the bone, and continuing its adhe- 
sion the whole way to the ancle. It also has adhesions to the ten- 
dinous partition which is between it, and the common extensor ; so 
that these two muscles are, by such adhesions, very difficult, to dis- 
In. inside 
of the oa 
calcis. 
Peronseus 
Q“g“s* 
head and 
almost all 
the tibia, 
jn. cunei- 
in- 
themeta- 
tarsal 
g°eaf 
toe. 
Peronams 
orJrklge 
of the 
half. 264 
MUSCLES MOVING TIIE LEG. 
sect. It is smaller at its origin, but increases in its fleshy belly as it 
descends ; and it is fleshy lower down than the peronaeus longus. 
It is, like it, a penniform muscle. The tendons of the two peronaei 
pass together, by the outer ancle, in the same ring ; but the tendons 
cross each other ; for the peronaeus longus is in its belly more for- 
ward. The brevis lies under and behind it, quite covered by it, and 
yet the tendon of the brevis, by creeping under the longus, gets 
before it, just under the outer ancle: and from that it runs in a 
separate groove, superficially upon the outer edge of the foot, to be 
inserted into the metatarsal bone of the little toe. In both muscles 
the tendon is upon the outer edge, and begins almost as high as the 
upper head of each muscle. This tendon of the peronaeus brevis, 
the shorter one, is small where it passes through the pulley, and ex- 
pands when it reaches its insertion, that it may grasp the metatarsal 
bone firmly. The tendon of the longer muscle also expands a little, 
and somewhat in the form of a hand and fingers, taking hold of two 
bones by three little heads. 
This muscle assists the former in extending the fopt, and coin- 
cides well in its oblique action with the last; for, as the last turned 
down the inner edge of the foot, this turns the outer edge upwards, 
which is exactly the same motion. 
CLXXXIV. The peroxasus tertius is a third muscle, having 
its origin from the fibula; but as its tendon passes before the mal- 
leolus externus, and as it is inserted into the outside of the foot, it 
has a contrary action to the peronaeus longus and peronaeus brevis. 
The peronaeus tertius lies on the fore part of the fibula, and rises 
from the middle of that bone, and down to near its lower head. Its 
tendon does not pass into the same sheath with the peronaeus longus 
and brevis, but goes under the annular ligament on the fore part of 
the ancle-joint, to be inserted into the root of the metatarsal bone, 
which sustains the little toe. It is so much connected with the ex- 
tensor communis digitorum, that there is often great difficulty in 
dividing the two. The action of this muscle balances the connection 
of the tibialis anticus, and the two together bend the foot, that is, 
bring it to an angle with the leg. 
CLXXXV. The tibialis posticus is a penniform muscle ; its 
tendon goes round the cartilaginous pulley of the inner ancle. 
It is named tibialis from its origin, and posticus from its.place. 
It arises from the back part and ridge of the tibia, from the oppo- 
site part of the fibula, and from the interosseous membrane below 
these. Some fibres pass between the bones at the upper part, and 
take an origin from the fore part of the tibia ; and it continues its 
attachment to the interosseous ligament, quite down to the ancle. 
It has also strong attachments to the surrounding tendinous par- 
titions. Its fibres are all oblique, and go to the middle tendon, 
which is in the heart of the muscle. About the middle of the tibia, 
this tendon begins to emerge from the fleshy belly; it grows gra- 
dually smaller, but still continues to receive flesh quite down to the 
ancle. It passes in the groove of the inner ancle, and is retained 
there by such a ligament as holds the peronaei. After passing the 
ligament, it expands in the hand-like form, to grasp the bones of the 
in. meta- 
bone of 
the little 
toe, and 
boidesCU* 
Peronseus 
tertius. 
Or. lower 
fbula*thC 
1 ' 
in. met a- 
bone of 
tke little 
toe. 
Tibialis 
posticus. 
Or, i. 
back of 
5 
fibula, 
the 
tibia, and 
4. interos- 
ment.llSa* 
in. almost 
bonesof MUSCLES MOVING THE TOES. 
265 
tarsus; and it is expanded much more than the peronaeus, for it 
sends roots down among the bones both of the tarsus and metatar- 
sus, so as to take hold first on the lower rough part of the navicu- 
lare in passing over it. Then it is implanted into the two first 
metatarsal bones, then into the calcaneum, and lastly, into the os 
cuboides; and where it passes over the os naviculare, it is hardened 
into a sort of sesamoid bone. In short, it is implanted in the sole 
of the foot by a tendon like a hand, which sends down its fingers 
among the tarsal and metatarsal bones, to take the surest hold. 
This muscle pulls the foot in, so as to put the toes together, and, 
when balanced by the peronaei, it directly extends the foot. 
CLXXXVI. The tibialis anticus crosses obliquely the fore 
part of the leg. It arises from the fore part and outside of the tibia, 
part of the fibula, and interosseous ligament. It begins just under 
the outer tuber, and continues its adhesion down two-thirds of the 
bone; then the tendon begins to be formed : and this muscle, like 
almost all the smaller ones of the leg, adheres to the tendinous 
partitions, and to the with which they are covered. The 
tendon begins almost with tne origin of the muscle, but continues 
covered by the flesh, and not appearing till within four inches or so 
of the ancle, when it begins to pass obliquely over the leg, and 
having completed the crossing above the ancle, it goes under the 
annular ligament in a peculiar ring, it runs along the side of the 
foot, and is implanted into the os cuneiforme internum, and a small 
production of the tendon goes forwards to be inserted into the meta- 
tarsal bone of the great toe. 
This muscle turns the great toe towards the leg, and when as- 
sisted by the peronaeus tertius directly bends the foot. 
the tarsus. 
1. os cal- 
cis, 2. 
cuboides, 
3. cunei- 
forme in- 
ternum, 
4. meta- 
tarsal of 
the middle 
toe. 
Tibialis 
anticus. 
Or. 1. 
head and 
fore part 
of the 
tibia, 
2. interop 
seous lig. 
3. head of 
the fibula. 
In. cimci- 
forme in- 
ternum 
and meta- 
tarsal 
bone of 
the great 
toe. 
MUSCLES OF THE TOES. 
The long muscles of the toes are just four, two plexors, and 
two extensor muscles. The flexor muscles lie upon the tibialis 
posticus, or behind, between it and the soleus. The extensor mus- 
cles again lie under the tibialis anticus, or at least their heads are 
under it, and their bellies only appear from under it, about the 
middle of the leg. 
The flexor tendons follow the tendon of the tibialis posticus, 
over the pulley of the inner ancle into the hollow of the foot. 
The tendons of the extensor muscles keep with that of the tibialis 
anticus, and cross over the fore part, or prominence of the ancle, 
where the tibia is united with the astragalus. And in dissection 
we must follow these in an opposite order’ to that in which they are 
described, for next to the fore part of the soleus is, 1st, the flexor 
tollicis ; 2dly, the flexor digitorum ; and 3dly, the tibialis 
posticus. 
CLXXXVII. The flexor longus pollicis is small and pointed 
at its origin, and arises fleshy from three-fourths of the fibula, to 
within an inch of the outer ancle, and interosseous ligament. It 
grows thicker and larger as it descends, and adheres to the tendinous 
partitions of the tibialis posticus, and of the peromei. Jts tendon 
Flexor 
longus 
poliicis. 
Or. three- 
fourths of, 
the fibula 
in teross. 
Ifr- ' 266 
muscles moving the toes. 
can be seen only about an inch above the joint of the anple. It 
passes down behind the inner ancle, where it is bound in a sort of 
annular ligament, it there passes under the heel-bone, in an arch 
of the foot, between the bones and the abductor pollicis ; it then 
glides into the channel made by the two heads of the flexor pollicis 
brevis ; it then passes between the two sesamoid bones at the root 
of the great toe; it then goes forward in a sheath, to be inserted 
into the last bone of the great toe, at which implantation it is en- 
larged. Sometimes it sends a small tendinous insertion into the os 
calcis. 
Its office is to bend the great toe ; but it is also continually useful 
at every step in extending the foot, or in keeping the toe firm to the 
ground, while the gastrocnemii raise the heel; and, therefore, we 
should not be rash in cutting away the great toe, for in it consists 
not the strength of the foot only, but of the leg. 
CLXXXV11I. The flexor longus digitorum pedis is named 
in addition the perforans, because, like the perforans of the hand, 
it runs its tendons through the split tendon of a smaller muscle, 
which is lodged in the sole of the foot. It is named also flexor 
communis, although there be less reason here, where there are no 
flexors for the individual toes, than in the hand, where there are 
separate flexors for the individual fingers. 
It arises from the back and inner part of the tibia, its whole 
length, that is, from the end of the popliteal muscle, and from the 
septum tendinosum, by which it is divided from the tibialis posticus, 
which lies immediately before it; and it continues this origin from 
the tibia down to. within three inches or so of the ancle. About 
the middle of the muscle we find fibres coming across to join it 
from the outer edge of the tibia, and between these two sets of 
fibres the tibialis posticus passes. Its origin is not easily separated 
before from the tibialis posticus, nor behind from the flexor pollicis. 
The tendon is not formed till near the ancle, (within two inches 
of it,) and the flesh still accompanies it quite down to the joint. 
It Crosses the tendon of the tibialis posticus behind the ancle-joint, 
and goes forward in the groove of the-os calcis, tied down by a sort 
of capsule, or annular ligament. In the arch of the foot, it crosses 
the tendon of the flexor pollicis, from which it receives a slip of 
tendon ; and thus the office of either is assisted by the other, and 
could be wholly supplied by it ; it then passes over to the middle of 
the sole, and growing flatter and thicker, divides into four flat ten- 
dons. These go forward, diverging till they arrive at the ends of 
their metatarsal bones ; % then they emerge from the aponeurosis 
plantaris, along with the common short flexor. Now both these 
tendons run under a ligamentous sheath, and are included in it 
under the first and second bones of the toes ; and having perforated 
the short flexor opposite to the second joint, they are finally inserted 
into the root of the third or last bone of each toe. These tendons, 
like the corresponding ones of the hand, seem to be slit with a sort 
of longitudinal fissure. 
The proper use of this muscle is to bend the four lesser toes, to 
bend all their joints, but more peculiarly the last bone ; and also to 
In. last 
phalanx of 
the great 
toe. 
Flexor 
Htonun^1" 
' 
Or. 1. 
back part 
of the 
tibia, 
2, septum. 
In. the 
base «f the 
third pha- 
lanx of 
four toes. 31 LSCLES AlOVIINu THE TOES. 
267 
extend the foot, keeping the point of the toes to the ground, conse- 
quently assisting the gastrocnemii, and all the muscles used in walk- 
ing, &c. ' 
CLXXXIX. The massa carnea Jacobi Sylvii, or plants 
pedis, flexor accessorius, lies in the sole of the foot; it is a small 
body of flesh, naturally connected with the flexor longus. The 
massa carnea arises from the lower part of the heel-hone, in two 
divisions, one (the external one) tendinous, the other fleshy. It is, 
upon tiie whole, pretty nearly of a square form ; it joins the tendon 
of the flexor longus, before its division into tendons for each toe, 
and by the advantage with which it acts in consequence of its origin 
from the heel-bone, it must be of great assistance to the flexor. It 
is more generally considered in the light of a supplementary muscle ; 
by some, it is considered as a distinct muscle, and by others, as the 
origin and first beginning of the lumbricales pedis. 
Thus Cowper considers tire massa carnea, and the lumbricales, 
as one and the same: that the massa carnea joins the tendon, covers 
it with its flesh, continues fleshy along the common tendon, till at 
the bifurcation it also parts along with the four tendons, into four 
small fleshy muscles, which are called lumbricales. 
Albinus, again, paints the massa carnea distinctly, terminating at 
the common tendon, and the lumbricales as arising distinct from each 
of the divided tendons. 
CXC. The flexor brevis- digitoritji is also named the flexor 
sublimis or perforatus. It arises from the lower part of the heel- 
bone, or the bump upon which we stand. It arises by very short 
tendinous fibres, and being placed immediately under the plantar 
aponeurosis, it takes hold of it, and also of the tendinous partitions 
between it and the two abductors of the small and of the great toe, 
which are on either side of it. Under the metatarsal bones, it 
divides itself into four heads ; their tendons begin earlier upon the 
side next the foot; they grow round, emerge from between the 
dentations of the plantar aponeurosis ; they then pass into the 
vagina, or sheath of each toe; and on this, the first phalanx, they 
lie over the tendons of the long extensors. About the root of the 
first bone, they divide into two little bands, which form a split (like 
the perforatus of the fingers) for the passage of the long tendon. 
The long tendon passes through it upon the second joint of the 
toe, and immediately after, the perforated tendon fixes itself by the 
two forks to each side of the second bone, or phalanx of the toe. 
Its use is to bend the first and second joints of the toes, but most 
peculiarly the second. The obliquity of the long flexor is exactly 
balanced by a corresponding obliquity of the short flexor ; for the 
tendon of the long flexor coming round the inner circle, runs ob- 
liquely outwards to reach the toes, while the short flexor coming from 
the heel, which is towards the outer edge of the foot, runs in a like 
degree obliquely inwards, and meets the other at an acute angle 
near the toes. 
CXCI. The lumbricales must be dissected after the short 
flexor. They need no description, since they exactly correspond 
with those of the hand. They rise, like them, in the forks of the 
Fiexomc- 
cessorius. 
Or. sinuo- 
8U 
0i> ca c,s' 
In. tendon 
Jon 
gUS. 
Flexor 
brevis di- 
gitorum. 
Or. lower 
part of the 
os calcis, 
and the 
plantar 
aponeuro 
sis. 
In. the 
second 
bones of 
four toes. 
Lumbri - 
cales. 
Or.tendoir 268 
MUSCLES MOVING THE TOES. 
of the 
flexor lon- 
gus. 
flexor tendons. They, like them, pass through the digitations of 
the aponeurosis. They pass on to the first bone of the toes, and, 
like the lumbricales of the hand, creep over the convexity of the 
bone, to be united along with the tendons of the extensors. Their 
insertion is always at the side of the toe next the great toe, and 
their use is to bend the first joint of the toes, and to draw them 
towards the great one, making an arch in the foot, and assisting 
the transversalis pedis. The flexor brevis lies most superficially 
upon the sole of the foot, having its origin from the inner surface of 
the aponeurosis. The massa carnea lies deeper, having no origin 
but from the tip of the heel-bone, and being soon implanted into 
the tendon of the long flexor. The lumbricales again rise from 
the tendons of the long flexor, beginning just where the massa carnea 
ends in it; and the lumbricales are the flexores primi internodii; 
the short flexor muscle, the flexor secundi internodii; the long 
flexor, the flexor tertii internodii digitorum. 
In. side 
of the first 
phalanges. 
EXTENSORS OF THE TOES. 
Extensor 
longus di- 
gitorum. 
Or. 1. up- 
per and 
outer part 
of the 
head of 
the tibia, 
2. almost 
the whole 
length of 
the fibula, 
3. interos- 
seous liga- 
ment, 4. 
the fascia. 
CXCir. The extensor long us uigitorum fedis is very difficult 
to dissect, from its numerous adhesions. 
It arises properly from the head of the tibia, at its outer and fore 
part, just under the knee; but it has also strong adhesions to the 
inner surface of the fascia, to the tendinous partitions between it, 
and the tibialis anticus before and between it, and the peronaei be- 
hind, and also to the interosseous ligament, and to the edge of the 
fibula. Its small origin soon becomes thick, and is divided even 
from the beginning very perceptibly into three distinct portions. 
These soon form three round tendons, which go obliquely inwards:, 
pass under the annular ligament of the ancle, and run in a ring of 
it, peculiar to them and the peronseus tertius. They then traverse 
the two bands of the annular ligament, upon the fore part of the 
foot, and now they change their direction a little, and go from 
within outwards, and diverge towards their proper toes. There are 
three portions of muscle, and four toes to be moved ; the first por- 
tion divides its tendon into two, at the joint, so that the first portion 
serves both the first and second toe, the second the third toe, and 
the third serves the fourth toe. Here the tendon of the long ex- 
tensor receives four other tendons ; first of the interossei externi; 
secondly, of the interossei interni ; thirdly, of the long flexor; 
fourthly, of the lumbricales ; and these form a very large sheath, 
quite surrounding the toe. 
CXCIII. The extensor digitorum brevis is so connected with 
the extensor longus, that it is natural to describe them together. It 
is placed just where the buckle lies, upon the rising of the foot, 
having its origin from the heel-bone, and running obliquely inwards. 
Its origin is from the outer side, and fore part of the heel-bone, 
and also from part of the annular ligament. It is smaller where it 
arises by a short tendon from the heel-bone, but it gradually in- 
creases in size : it divides early into four heads, which are muscular, 
and very distinct -f the two inner of which arc larger, the two outer- 
In. base 
of the first 
phalanx of 
four toes, 
continued 
over the 
toes. 
Extensor 
digitorum 
brevis. 
Or. i. 
outer and 
fore part 
of the os 
calcis. 
2. annular 
lijjnoectT MUSCLES MOVING THE TOES. 
269 
more slender: each head has already formed an oblique tendon 
under its flesh, which begins to appear naked about half way down 
the metatarsal bones. These tendons cross those of the long ex- 
tensor, and pass under them nearly about the end of the metatarsal 
bones. Then one is implanted into the first bone of the great toe, 
on the inside of the long tendon under which it had turned. The 
second, third, and fourth tendons are inserted into their respective 
next toes, and the little toe is left without one. The three last of 
these tendons form a sort of slit, the two sides of which pass along 
the sides of the toes, surrounding the long tendon, something like 
a perforatus ; so that the three last tendons are inserted along with 
the long tendons into the last bone of the toes. 
The obliquity of this short muscle counteracts the obliquity of 
the long and it serves to extend and to spread the toes, and to pull 
them away from the great toe. 
CXC1V. The extensor pollicis prophius is a very slender 
muscle running from the top of the leg to the second joint of the 
great toe. It arises from the fibula, a little below its head, takes 
fibres from the interosseous ligament, grows tendinous as it ap- 
proaches the foot, then passing under the annular ligament, and the 
cross ligament of the foot, it goes onwards to the second joint of 
the toe over the first. 
The succession in which these muscles lie, under and behind 
each other, is this: first, the tibialis anticus, the outermost muscle, 
arises from the fore part of the tibia, nearest the fore part of the 
leg, at the ridge of the tibia: secondly, the extensor pollicis lies 
immediately behind, and under the tibialis anticus : thirdly, the ex- 
tensor digitorum communis lies behind that: and fourthly, the 
peronaeus tertius lies behind the common extensor, like a part of 
that muscle. 
These extensor tendons are bound down by cross bands, re- 
sembling the annular ligaments of the wrists. The general fascia 
of the thigh is continued over the knee, and down the leg : it is 
much strengthened at the knee, where it adheres to each point of 
bone ; it descends very thick and strong over the leg, binding down 
and strengthening the tibialis anticus and extensor muscles. The 
sheath grows thinner towards the ancle, but where it passes over 
the joint it is so remarkably strengthened by its adhesions to the 
outer and inner ancles, that it seems to form two distinct cross 
bands, which, going from the point of the outer ancle, across the 
extensor tendons, to the point of the inner ancle, forms a strong 
crucial ligament, resembling the annular ligament of the wrist; so 
that this, which is called the crucial ligament of the ancle or 
foot, is plainly but a strengthening of the common sheath. 
The remaining muscles in the foot are the interossei, which, in 
the foot, are found single on the lower surface or sole, but double, 
and two-headed, upon the upper part of the foot. The abductor, 
flexor, and adductor pollicis, which surround the great toe, 
something like those of the thumb; and the abductor and flexor 
minimi digiti, surrounding the little toe; and there is a small slip 
In. pha - 
langes of 
all except 
the little 
toe. 
Extensor 
pollicis. 
Or. from 
the two- 
thirds of 
the spine 
of the 
fibula, and 
inteross. 
!ig- 
In. last 
phalanx of 
the great 
toe, 270 
-MUSCLES MOVING THE TOES. 
of muscle, the transveksalis pedis, which goes across the sole ol 
the foot. 
CXCV. The abductor pollicis arises by very short tendinous 
fibres, from the knob of the os calcis, and also from a ligament 
which stretches from this knob to the sheath which belongs to the 
tibialis posticus ; and it arises also from the tendinous partition 
between it and the short flexor of the toes ; and although it forms 
a tendon beginning opposite to the cuneiform bone, the tendon is 
not naked, till it has reached the middle of the long metatarsal 
bone. It unites with the short flexor of the same toe, and is inserted 
into the first bone or phalanx of the toe at its root, and os sesamoi- 
deum. Its use is to pull aside the toe, and at the same time to bend 
it a little ; it also curves the foot itself, for a joint, or any loaded 
part, is much better supported by muscles than by ligaments ; and 
this arch requires support more than almost any other part. 
CXCVI. Flexor brevis pollicis. This muscle is much shorter 
than the last, and lies between the abductor and the adductor ; 
it lies immediately upon the metatarsal bone. 
Its origin is by a pretty long tendon from the heel-bone, and from 
the os cuneiforme externum, by two separate slips from the heel- 
bone, being a full inch in length ; it also adheres to the membranous 
partitions on either side of it. It is soon divided into two heads ; 
one goes to the abductor, and the other goes to the adductor, to 
have the tendons inserted with theirs, into the root of the first bone or 
phalanx. These tendons contain the sesamoid bones; and the 
parting of the two heads makes a channel for the tendon of the long 
flexor to run in. 
Its use is to bend the first joint of the great toe. 
CXCVII. The adductor pollicis is the third and last portion 
of the muscle which encircles the great, toe. 
It arises from the heel-bone, by a tendon as long almost as that 
which it gives the abductor : it does not immediately arise from the 
heel-bone ; but there is a ligament extended from the heel-bone to 
the os cuboides, and it arises from that ligament: this is the ligament, 
under which the tendon of the peronaeus longus glides. It takes 
likewise an origin from the cuneiforme externum. The adductor is 
divided into two fleshy fasciculi or heads ; these unite, and going 
obliquely inwards, are inserted either into the sesamoid-bone, or 
directly into the first bone of the great toe. 
CXC V111. The transversalis pedis extends transversely across 
the sole of the foot, at the head of the metatarsal bones ; it is a very 
small muscle, and resembles a good deal the paimaris brevis. 
It arises from the fore part of the metatarsal bone of the great toe, 
and the sesamoideuin internum, and is inserted into the under and 
outer part of the anterior extremity of the metatarsal bone of the little 
toe and ligament of the next toe. 
Its use is said to be, to make a sort of gutter in the foot, by draw- 
ing the heads of the metatarsal bones together ; but is it not evident, 
that this is one of many instances of muscles being a more perfect 
support than ligaments ?—It is a support, having a sort of intelligence, 
contracting or relaxing, accordingto the necessity or degree offorce • 
Abductor 
pollicis. 
Or. os 
calcis and 
Iig. of the 
navicu- 
lare, 
In. sesa- 
moideum 
intern, 
and 1st. 
phalanx. 
Flexor 
brevis pol- 
liois. 
Or. os 
calcis and 
cunei- 
form e 
extern. 
In. ossa 
sesamoida. 
Adductor 
pollicis. 
Or. os 
calcis, cu- 
boides, 
and cunei- 
forme ex- 
ternum. 
In. sesa- 
moideum 
externum. 
Transver- 
Salis. 
Or. meta- 
tarsal 
bone, and 
os sesa- 
raoideum 
of the 
freat toe. 
n. meta- 
tarsal 
bone of 
the little 
toe, and MUSCLES MOVING THE TOES. 
271 
indeed, except this use, it is not easy to assign any, for there is very 
little occasion for hollowing the foot in this direction. 
CXCIX. The abductor minimi digiti, like the abductor pol- 
licis, is a pretty long muscle, but very slender, lying on the outer side 
of the foot. 
Its origin is from the knob of the heel-bone, and from the ten- 
dinous septum, which covers the flexor brevis : it forms two small 
tendons in the same direction : one small and shorter tendon is fix'ed 
in the metatarsal bone, at its root: the other goes forward, to be 
inserted into the root of the first bone of the toe, so that this muscle 
clearly performs both the offices ascribed to the other flexors. It 
bends the toe to which it belongs, and it extends and supports the 
tarsus in walking ; and it carries the toe a little outwards, from 
which it has its name. 
CC. The flexor brevis minimi digiti is next, and is almost 
the same muscle in place and office: it is an exceedingly small 
muscle ; it just measures the length of the metatarsal bone, and arises 
from it. Its origin is from the root of the metatarsal bone of the little 
toe, and from the ligament by which that bone is connected with the os 
cuboides ; its small belly runs the length of that bone, and it is im- 
planted by a short tendon, into the root of the first bone of the little toe. 
Its use is to bend the toe. 
CCI. The interossei interni are three small muscles seated in 
the planta pedis, as the interossei manus are in the palm of the hand. 
Their slender tendons pass through the openings of the aponeurosis 
plantaris, and, going on the inside of the toes, are, like the lumbri- 
cales, inserted along with the extensor tendons. 
These pull the toes towards the great toe, bend the first joint, and 
extend the second and third. 
CCII. The interossei externi are, like the corresponding 
muscle of the hand, four in number, and double headed, and have 
been named bicipites. They rise from the metatarsal bones, on 
each side of them : each has some little variety in its origin or 
course ; but it is far from being worth our while to describe each 
individually, as many do: it is sufficient to observe their origin, and 
that their tendons all meet the tendons of the long and short extensors 
of the lumbricales, and of the intbrossei interni, upon the backs 
of the toes ; so that the whole forms a web, aponeurosis, or sheath, 
which covers the upper part of the toe, and adheres to its point. 
The office of these muscles is to extend the toes. 
Fascia of the leg.—The dissection of these muscles on the 
fore part of the leg and foot is somewhat difficult from the relations of 
the fascia. This fascia is a continuation of that of the thigh, for we 
trace that membrane over the knee-joint, as I have said, into the 
tibia. But from the spine of the tibia it takes a new origin, and, as 
it were, renews its strength. It not only covers the tibialis anticus 
and extensor muscles, but sends strong septa between them. Its 
obvious use at this point is to give attachment to the muscles, and 
to afford that origin which the bone cannot do, but through its in- 
tervention. Here, during the dissection, it will be seen, that the 
fascia is verv erroneously described as a covering to the limb, since 
ligament 
ot the tar- 
sus. 
Abductor 
min. dig. 
Or. os 
calcis and 
1!g- 
in. root of 
the little 
toe. 
Flexor 
nvl® v 
’ ° 
Or.l. me- 
tatarsal 
bone of 
the little 
toe. 
2. os cu- 
boides. 
In. root of 
the first 
boneof the 
litUe toe. 
Interossei 
interni. 
Same as in 
the hand. 
Interossei 
gamers 
in the 
han(,‘ 272 
MUSCLES MOVING THE TOES. 
it dives between the muscles, and gives off connections to the bones 
and deeper membranes. While a superficial fascia covers the gas- 
trocnemius and the tendo Achillis on the back of the leg, another 
layer slips under these, and, having connection with the bones, covers 
the tibialis posticus and flexors. 
Towards the ancle on the fore part, the fascia is strengthened by 
strong tendinous fibres, so as to form the annular ligament at this 
point; and from this it is stretched over the dorsum of the foot to 
the toes. 
Plantar aponeurosis.—The palm and the sole are much ex- 
posed, and are especially defended by a thick tendinous aponeurosis. 
In the palm, there is the more reason to suspect expansion to pro- 
ceed from the tendon of one muscle, because the tendon of the pal- 
maris is inserted into it; yet that is not probable ; for the tendon is 
very slender, and quite unfit for the generation of so broad a sheet 
of aponeurosis. In the foot, such an origin is still less probable ; 
for the plantaris tendon does not terminate in the plantar aponeu- 
rosis, but is inserted into the heel-bone. 
The plantar aponeurosis arises most distinctly from that part of 
the tuber of the heel bone upon which we stand : it is divided into 
three sheaths. Sabbatier makes a middle, external, and internal 
portion of the same aponeurosis. Albinus also describes it as three 
distinct aponeuroses ; one for the middle of the foot; one for the ab- 
ductor of the great toe : and one the aponeurosis of the abductor of 
the little toe ; all connected together only by their edges. Cowper 
considers it as a general expansion from the plantaris ; and it is from 
this prejudice that the muscle has its name. 
But its true origin is from that part of the knob of the heel-bone 
on which we stand. The middle and more pointed tendon arises 
from the very point of the knob. The inner fascia arises from the 
inside of this ; and the outer one from the outside. And though 
thus divided into three heads, yet the whole origin is from the heel- 
bone. From this point the aponeurosis goes forward expanding till 
it is as broad as the roots of the toes ; so that the whole has the shape 
of a sandal; and as it expands, its fibres are scattered, so as to have 
a radiated appearance. Accordingly, the part nearest the heel is 
thicker, while the broader part is thinner. 
It goes forward like the sole of a shoe, till having approached the 
heads of the metatarsal bones, it is divided into five heads, corres- 
ponding with the five knobs ; and each of these heads again sub- 
divides itself into two bands, which, passing on each side of the heads 
of the metatarsal bones, is fixed into the sides, so as to leave room 
for the passing of the tendons, and nerves, and arteries. 
Now this middle aponeurosis sends down a deep strong partition 
on each side of it; which is the best reason that 1 know for making 
these three distinct aponeuroses ; for by these perpendicular partitions 
the hollow of the foot is separated into three distinct chambers : 
under the middle one are concealed the tendons of the long flexors, 
with the lumbricales and short flexor muscles: under the outer one 
the flexor and abductor of the little toe: and under the inner one 
the abductor, flexor, and the abductors of the great toe. OF THE MUSCLLAR POWKK, 
273 
Tpe uses of this great and very strong aponeurosis are : that it pro- 
tects all the parts, the blood vessels, muscles, and nerves that lie 
under it: that it supports the arch of the foot, both in standing and 
in motion, passing from heel to toe like a bow-string across its arch : 
that it binds down the muscles, and consequently supports and 
assists them in their strong actions : that it gives origin, or part of 
their origin, to many of the muscles ; which, by their frequent and 
irregular adhesion to it, are very difficult to dissect: that it forms 
openings or rings, in which the tendons of the other muscle pass-. 
OF THE MUSCULAR POWER. 
That contractile power which resides in the muscular or living fibre, 
is a phenomenon the most wonderful and perplexing of all. When we 
cannot reach the true point, the mind too often condescends to the 
most trifling pursuits ; and so, when the older physiologists could not 
understand the intrinsic nature of this muscular power, they endeavoured 
to discover the size, the colour, and other external properties of the 
fibre: foolishly desiring to know what, if known, could be of no avail. 
Colour was believed to be essential to the constitution of a muscle: 
but in fowls, in amphibious animals, in fishes, in worms, and insects, 
through all the gradations of animals, of different species or different 
sizes, the colours of the muscular fibre change. In fishes and in 
insects, it is entirely white; even in the human body, it is not essen- 
tially red : the blood which makes the fibre red may be washed away. 
Then why should we define a muscle by that accidental property which 
it so often wants, and of which it may be so easily deprived, while we 
may define it more truly by its contractile power, the only evidence of 
its nature, and its chief distinction in the system ? for the contraction 
of the iris constitutes its nature; it is a muscle by truer marks than by 
its colour: and, by the same rule, the muscles of the least insect are 
as perfect as the muscles of a man. 
Philosophers of the last age had been at infinite pains to find the 
ultimate fibre of muscles, thinking to discover its properties in its form ; 
but they saw just in proportion to the glasses which they used,-or to 
their practice and skill in that art, which is now almost forsaken. Some 
found the fibres to be of one equal size in all creatures, however 
various: others found them proportioned to the size, or age, or strength 
of their subject; but even such discrepancies are trivial to those which, 
in one of the greatest of these minute philosophers, are found almost in 
the same page ; sometimes affirming the ultimate fibre to be greater 
or smaller, according to the strength of the subject, and again making 
them of equal size, in the whale and in the insect. 
Others, less troubled about the size of these ultimate fibres, had con- 
ceived notions of their form, which, in the credulity of the times, rose 
into the importance of doctrines, and, from the first raw conceptions 
of their authors, were finally proved by the microscope, forsooth ; and 274 
OF THE MUSCULAR POWER. 
while one author was drawing his rhomboidal fibres, all conjoined in 
regular succession ; and another describing them also from the micro- 
scope, as consisting of six cylindrical fibres, involved in a spiral one, a 
third was reckoning the fibres, as a succession of spherical bodies : and 
Cowper thought that he was injecting with quicksilver, chains of bells 
jointed with each other. For the honour of the age, these vanities 
are forgotten now. 
Physiologists have, by a late sense of their own weakness, been at 
last humbled to this becoming, but unwilling acknowledgment, that 
this contractility of the muscles is an original endowment of this living 
matter, derived from the Creator, imparted in a way which we cannot 
know, and so attached to the organization of the muscular fibre, that 
where its organization is destroyed, this power is lost. We have 
resigned the search after a mechanical or physical cause, and seek only 
to learn the properties of this living power, and the excitements by 
which it is moved. To this end it is necessary to define this power, 
distinguishing it from these feelings nr motions which result from the 
nerves. The vis insita is that power which belongs to muscles, and is 
the source of motion. The vis nervea is that property which is pecu- 
liar to nerves, is the source of feeling, and the cause of voluntary 
motion, relating chiefly to the enjoyments and consciousness of life ; 
for life and motion exist even in plants, and in many creatures, which 
not having nerves, have neither consciousness nor enjoyment, and in 
which the place of feeling i6 supplied by some analogous inherent 
power. 
This irritable power residing in muscles, may be defined to be the 
property by which muscles feel and re-act, upon certain stimuli being 
applied ; and that, while certain orders of muscles are obedient to their 
own stimuli only, as the heart to the blood, the bladder to the urine, 
other orders of the muscles are ready to receive the commands of the 
will. And above all, so little dependent is this action upon the brain, 
that it is as perfect in animals which have no brain, and is for a time 
very perfect in the parts which have been severed from the systems to 
which they belonged. This power, inherent in the muscular fibre, 
belonging to its constitution, and not derived from without, is the vis 
insita, or irritability of Haller,* the vis vitalis of Goerter, the oscillation 
of Boerhaave, and the tonic power of Stahl. It is seen in the spontaneous 
and tremulous contractions of muscles when lacerated, as in wounds, 
when cut in operations, when entirely separated from the body ; as in 
experiments upon animals, like that tremulous motion which we often feel 
in various parts of the body, without any evident cause, and independent 
of the will. Even when the body is dead to all appearance, and the ner- 
vous power gone, this contractile power remains ; so that if a body be 
placed in certain attitudes, before it be cold, its muscles will contract, 
and it will be fixed in that posture till the organization yields and begins 
* The irritability of a muscle is, perhaps, more properly the vis insita, or inherent 
power called into immediate action, by the presence of stimuli; and as for the names of 
Tonic Power, Vital Power, and the rest, the terms are quite undefined, and may, per- 
haps, have referred rather to the combined effect of all the powers of life, and of all 
the properties of inaniiqatb matter, of nervous sympathy, elasticity, and of mn»cnl«r 
ptiweTr combined. OF THE MUSCULAR FOVVER. 
275 
xo be dissolved; it is the same inherent power by which a cut muscle con- 
tracts andleavesa gap. This is but a faint indication of that latent power, 
which can be easily excited to the most violent motions, and on which all 
the strength of the muscles depends : for the ligaments, tendons, bursae 
of joints, and all those parts which have no such power, are capable of 
bearing the same weight when dead as when alive. But such is the 
dependence of the muscle on this vital endowment, that the moment 
it dies its power is gone ; and the muscle which could lift a hundred 
pounds while alive, cannot bear the weight of a few pounds when dead. 
This latent power may be brought into full action by various stimuli. 
The latent power itself is called vis insita, the acting power put into 
action, or the proof of the vis insita, upon applying stimuli, is called the 
irritability of muscles. This irritability is so far independent of nerves, 
and so little connected with feeling, which is the province of the nerves, 
that upon stimulating any muscle by touching it with a caustic, or 
irritating with a sharp, point, or driving the electric spark through it, or 
exciting with the metallic conductors, as of silver and zinc, the muscle 
instantly contracts ; although tlie nerve of that muscle be tied, although 
the nerve be cut su as to separate the muscle entirely from all con- 
nection with the system, alilmugh the muscle itself be separated front 
the body, although the creature upon which the experiment is perform- 
ed may have lost all sense of feeling, and have been long apparently 
dead. Thus, a muscle cut from the limb, trembles and palpitates long 
after ; the heart separated from the body contracts when irritated ; the 
bowels when torn from the body continue their peristaltic motion, so as 
to roll upon the table, ceasing to answer to stimuli only when they 
become stiff and cold ; and too often in the human body the vis insita 
loses the exciting power of the nerves, and then palsy ensues; or, 
losing all the governance of the nerves, the vis insita, acting without 
this regulating power, falls into partial and general convulsions. 
Thence comes the distinction between the irritability of muscles and 
the sensibility of nerves ; for the irritability of muscles survives the 
animal, as when it is active after death ; survives the life of the part, 
or the feelings of the whole system, as in universal palsy, where the 
vital motions continue entire and perfect, and where the muscles, 
though not obedient to the will, are subject to irregular and violent 
actions; and it survives the connection with the rest of the system, as 
where animals very tenacious of life are cut into parts ; but sensibility, 
the property of the nerves and of the scusorium, gives the various 
modifications of sense, as vision, hearing, and the rest; gives also the 
general sense of pleasure or pain, and makes the system, according to 
its various conditions, feel vigorous and healthy, or weary and low. 
And thus the eye is sensible, and the skin is sensible ; but their ap- 
pointed stimuli produce no motions in these parts ; they are sensible, 
but not irritable. The heart, the intestines, the urinary bladder, and 
all the muscles of voluntary motion, answer to stimuli with a quick and 
forcible contraction ; and yet they hardly feel the stimuli by which these 
contractions are produced, or at least they do not convey that feeling 
to the brain. The muscular parts have p.11 the irritability of the sys- 
tem ; while nerves have all the sensibility of the system, and have the 
power of excnmg motion without tire power of motion. 276 
OF THE MUSCULAR POWER. 
The vfs insita is a power that is in continual force, preserving the 
parts ready for their proper stimuli, whatever these may be: one set 
obeying their own peculiar stimuli, while others are obedient to the 
influence of the will. The heart is stimulated by the quantity or quality 
of its blood ; the stomach by the presence of food ; the intestines by 
their contents : the urine stimulates the bladder; the venereal appetite 
stimulates the genital system ; the foetus stimulates the womb ; and the 
voluntary muscles (if we may be allowed to guess at a thing so little 
known,) are excited by the nerves, and so are obedient to the will; 
for, to our limited view, the nerves seem to be the sole messengers of 
these commands, and any stimulus to the nerves moves the muscles 
like the commands of the will. The absence of the due stimulus to 
each, or the presence of the ordinary stimuli in too great power, will 
excite irregular motions, as fulness of blood in the heart, poisons in the 
stomach, acrimonies in the intestinal canal, or the passions of anger 
or fear in the system of the voluntary muscles. * The due stimuli pre- 
serve their right tone and action ; but these violent stimuli hurt their 
irritability, or moving power; the heart acts weakly after fevers ; the 
appetite is languid after debauch ; the limbs are weakened by labour ; 
and the whole system is ruined by excess. Thus, the functions by 
which the system lives, the heart, the stomach, the bowels, and the 
womb, the various sorts of vessels by which the fluids are conveyed, are 
providently removed from the influence of the will; for these are the 
machines of the system, whose motions could not stop, must not be 
interrupted, nor lowered, nor raised, but must move and act according 
to the needs of the system. Not left to the irregularities or careless- 
ness of voluntary motions, they are governed each by its own peculiar 
stimulus, and act in a continued and equal course. 
Thus, there are in the body two living powers, which are as cause 
and effect in all the motions of our system. The nerves stand as an 
intermedium between all external objects and our general sense ; by the 
impressions through these come pleasure and pain, and all the motives 
to action ; by the will, returned through other nerves, all voluntary 
motions ensue. Thus are the nerves, as internuncii, between the ex- 
ternal impression and the moving power. But nerves were never 
known to move under the influence of stimuli; the moving power is 
another property of a distinct part of our body, having its own arrange- 
ment of particles, and its own peculiar form. All motion, then, pro- 
ceeds from the joint operation of either power ; the nerves convey the 
impressions, while the muscles contain the power ; and it is here, as in 
other natural effects, the external cause changes, while the inherent 
property, the subject of its operation, remains the same. Some have, 
with reason, supposed that the nervous power is the regulator of the 
system; it is the prqperty suited to all the supports of life, upon which 
they act, and by which they maintain their power over our body ; but 
is subject to continual changing : it rises and it falls, is perfect or low ; 
but the energy of the muscle, which is to answer to this power, remains 
ever the same, while its organization remains : the nervous power is 
exhausted and languid ; but the muscular power is always perfect, 
always ready for the excitement of stimuli, or for the commands of 
the will. OP THE MUSCULAR POWER. 
277 
The irritability, or inherent power, not only keeps the muscles ready., 
each for its peculiar stimulus, but preserves a balance over the whole 
system of the muscles. We know that muscles maintain a constant 
action. The muscles of one side balance the opposite muscles ; and 
if the muscles of one side be relaxed by palsy, the action of the oppo- 
site muscles instantly appears ; or if a limb be luxated, and its muscles 
displaced, they persevere in a violent and spasmodic action, till they 
be restored each to its place. Have we not reason to believe, that if 
muscles were absolutely and entirely quiescent, they could not be so 
instantaneously called into action ; but that by this continual tension 
or tone, they more readily follow the commands of the will. 
The nervous influence, again, is as a mere stimulus to the volun- 
tary muscles. It loses its influence over the system faster than the 
ordinary powers of life do ; and the irritable state of the muscles con- 
tinues long after the voluntary motion, or the power of excitement from 
the nerves is gone : for when a man dies slowly, this inherent power is 
exhausted in the struggles for life. If, while in perfect health, he is 
killed by a sudden blow, the irritable power of the muscles survives the 
nervous system many hours or days, and we can, by operating upon 
this poor remains of life, restore the circulation, re-animate the nervous 
system, and recover that life, which seemed to have entirely left the 
body ; and thus, the nervous influence, which seemed to animate the 
system, and to be the prime mover and source of life, owes its resto- 
ration to that which was thought to be but a secondary power. We 
naturally revert in this place to the sound opinions of Mr. Hunter, who, 
speaking of life, distinguishes the properties or actions of parts into 
two, those which regard their own preservation, and those which regard 
the general economy. These latter may be interrupted as by suffo- 
cation ; but if the powers of the separate parts remain, we may produce 
resuscitation and reanimation, by restoring the corresponding sympa- 
thies. It is the remains of contractile power which fixes the dead body 
in whatever posture it is placed : it is this remains of irritability, which 
preserves freshness in the animal which seemed dead ; but which is 
really dying still: for the moment this lingering portion of life is gone, 
the body dissolves, and falls down ; and so we judge of freshness, by 
the rigidity of the flesh, and foresee approaching putrefaction, by its 
becoming soft. The fish, which is allowed to struggle till it be dead ; 
the ox, over-driven before it be brought to the slaughter; the animal 
killed by lightning, which suddenly explodes (if we may be allowed the 
expression) all the powers of life ; in these the contractile power is 
effectually destroyed or lost by the entire death. The life stopped all 
chemical decomposition, but now putrefaction comes quickly on. Jq 
those who die of the plague, of poison, of fevers, or of any sudden and 
violent disease, which at once extinguishes life in the vulgar sense, and 
robs the system of that remnant of life, .which the physiologist could 
produce to view ; in all these cases, the body becomes putrid in a few 
hours. 
And here we are led to observe a fact of great consequence to the 
Pathologist; the muscles are not equally under the influence of the 
sensorium ; some are prompt and exact, under the guidance of the will, 
whilst over others we have no command at all; and there are not a few 278 
OB THE MUSCULAR POWER. 
which we command indirectly, that is, we put a certain class of muscle* 
into operation, which are followed by the combination of others, over 
which we have no direct power. And as the muscular system is thus 
connected with the sensorium in different degrees, so we might be led 
to expect that these muscles might be differently influenced when the 
mind is oppressed. In fact, in proportion as the muscles are more or 
less immediately under the guidance of the will, so they are affected 
when the brain is oppressed. This we may see in the approach of 
natural sleep, or in the effects of intoxication. The influence steals 
over the eyes, the countenance, and the limbs, until the vital operations 
of respiration and circulation are all that remain apparent. 
But, before dismissing this subject, we must present the muscular 
system in a different view from what has hitherto been taken of it. 
The voluntary nerves, which control the muscular system, are sensible 
of the degree of activity assumed by these muscles, and there is thus a 
universal sense spread over the body, which ministers to the proper 
organs of sense, and is, itself, more important than them all. It is by 
this property in the voluntary nerves and muscles, that we are enabled 
to balance the body in standing, walking, or running; adjusting the 
muscular action, and the state of tension of the limb, to the gravitation 
of the body, and so sustaining it in every variety of posture. We see 
with what pains, and after repeated efforts, the child acquires this 
power ; and we see how a man is deprived of it in sickness or inebriety: 
whilst the utmost perfection of the same power is exhibited in the 
rope-dancer. And what we are thus led to contemplate in the whole 
body, may be noticed in the hand, in subserviency to the sense of 
touch ; in the tongue, as subservient to mastication; in the eye, in aid 
of vision. It is this faculty which gives us the impression of resistance, 
and consequently of weight, of solidity, of fluidity, roughness, smooth- 
ness, angularity, &c. Thus, a man deprived of his sense of touch in 
his arm and hand, has continued in possession of the muscular power, 
and of the sense of muscular exertion, and, therefore, he could form an 
estimate of the weight of what he held in his hand. Here then is truly 
that power which gives us the most accurate perception of things ex- 
ternal to the body, and of all those qualities which would induce us to 
call this the geometrical sense ; a term which has hitherto been given 
with little propriety to the sense of touch.* 
As for the mechanical powers, by which the contractions of the 
muscular fibre is forwarded or retarded, they are not what they have 
been believed ; for we find few circumstances in the origin, insertion, 
or forms of muscles, to favour their power, but many by which their 
power is abridged. There are certain points, where the length of 
lever gives an increase of power. The mastoid process, and the occiput 
are as levers for the head ; the spines of the vertebrae for the back ; 
the olecranon for the arm ; and the pisiform bone for the hand. The 
pelvis, and the jutting trochanters are as the levers for the thigh ; the 
patella is a lever for the leg; the heel-bone is a lever for the whole 
foot; and the arch of the foot is as a lever for the toes. These are 
not the whole, but they are, perhaps, the chief levers in the human 
* Sec the organs of the senses. OF THE MUSCULAR POWER. 
279 
body. In all the other implantations the muscle is fixed, not behind 
the joint, but between the joint and the weight that is to be moved. 
There is a greater loss of power, when inserted near to the joint: there 
is less loss of power, when the tendon is inserted far from the joint, 
and though we call such insertion a longer or shorter lever, there 
is always some loss of power, and the true levers in the body are very 
few ; far from providing mechanical forms to increase the power, nature 
has provided such a quantity of contractile power as to compensate 
for any loss of effect: so, in place of increasing the effect of muscles 
by levers, pulleys and hinges, there is in almost every muscle a great 
abatement of its force, by the form of the bones which it is destined to 
move; for muscles lose of their effect, by their being implanted, not 
behind the joint, but between the joint and the body to be moved; by 
the insertion of almost all muscles being very oblique, with respect to 
the motions which they are to perform, so that half their force is lost 
upon the immoveable end of the bone. Much force is lost by a mus- 
cle passing over many joints ; one set of fibres in a muscle hinders the 
action of adjoining fibres, and every degree of contraction takes from 
that muscle an equal proportion of its power. Thus, every where in 
the human body ; is power sacrificed to the form and fitness of the 
parts that the joints may be smaller than the limbs ; that the limbs may 
be proportioned to the body : and beauty, conveniency, and velocity 
of movement are gained by the sacrifice of that power, which is not 
needed in the system, since the wisdom and goodness of the Creator 
has appointed a degree of force in the muscles, more than proportioned 
to all this loss of the mechanical power. Those who will admire the 
ways of Providence, should know how to admire ! Nature is not seek- 
ing to compensate for want of power, by the advantages of pulleys, and 
levers, and mechanical helps; nor is it in the forms of the parts, that 
the Infinite Wisdom is to be found : for among other gifts, such a por- 
tion of this spirit is given to man, that he has used the pulleys, and 
levers, accelerations of motion, and all the mechanical powers that 
result from it; he has invented valves of infinite variety, each perfect 
and true, to its particular office ; he has anticipated all that be has 
found in the mechanism of the human body ; but the living power 
which compensates for the want of levers, which allows every where 
power to be sacrificed to the beauty of form, which has strength in 
convulsive and violent actions, to break the very bones; this is the act 
of Infinite Wisdom, on which our admiration should chiefly dwell. It 
is but the very elements of so deep a subject that can be delivered here. 280 
OF THE CELLULAR SUBSTANCE, 
AND OF THE 
TENDONS, LIGAMENTS, AND FAS CUE, 
AND ALL THE PARTS WHICH BELONG TO THE BONES OR MUSCLES, OR 
WHICH ENTER INTO THE CONSTITUTION OF A JOINT. 
The bones and muscles themselves are but the smallest part of that 
beautiful mechanism by which the motions of the human body are per- 
formed ; for the parts by which the bones are joined to each other, or 
the muscles fixed into the bones, are so changed, and varied in their 
forms, and according to the uses of each part, as to give a natural and 
easy shape to the limbs, security and firmness to their motions, and 
lubricity and smoothness to the joints by which these motions are per- 
formed ; and this apparatus deserves our attention, not merely that we 
may know the forms of these joinings, but that we may learn some- 
thing of the nature and uses of each part, and the various degrees of 
sensibility with which each is endowed; for, from this kind of study, 
conclusions will arise, which may lead us to the knowledge of their 
diseases, suggesting the means of their prevention and cure. 
There is a difference in the parts of the human body, according to the 
several uses for which they are designed ; some are vascular and soft, 
others bony and hard; some sensible, and very prone to inflammation 
and disease, others callous and insensible, having little action in their 
natural state, and little proneness to disease. 
The active parts of the system, as we have stated in the introduc- 
tion, are the muscles and nerves; the muscles to move the body, and 
perform its offices, each muscle answering to its particular stimuli, and 
most of them obeying the commands of the will; the nerves to feel, 
to suffer, and to enjoy, to issue the commands of the will, and to move 
the muscles to action ; but there is a substance which joins these parts 
and connects arteries, veins, nerves, and muscles, and performs for 
them every subservient office, forms coverings for the brain, coats for 
the nerves, sheaths for the muscles and tendons, ligaments and bursa:, 
and all the apparatus for the joints ; unites them by a continued tissue 
of cellular substance. The tendons, ligaments, periosteum, and bursae, 
may be considered as composed of this cellular substance. 
OF THE FORMS OF THE CELLULAR SUBSTANCE. 
Under various modifications and shapes, the cellular substance per- 
forms most important offices among the living parts:—1. It forms 
cells over all the body, which allow the parts to glide and move easily, 
which contain the fluid that makes all the motion of parts more easy 
and free. This cellular substance is peculiarly useful to the muscles, 
dives in among them, keeps their fibres at such due distance, that. OF THE TENDONS, &C. 
281 
each may have its action, supports and lubricates them ; so that per- 
haps the difference of strength, in health and disease, depends, at least, 
in some degree, upon this support. The interstitial cellular substance 
surrounds the fat cells also. This structure, which is called the adi- 
pose membrane, consists of small bags which do not communicate with 
each other,, but are for the deposite of oil or fat. The fat is lodged 
between the muscles and fills up every interstice \ a want of it is a 
defect, while a superabundance of it encumbers the body and limbs. 
And Haller seems to have believed, that a diseased increase of it might 
not only oppress, but almost annihilate the muscular fibre. 
2. But it is still further essential to a muscle, that while it moves, it 
should neither be hurt itself, nor harm the surrounding parts. There- 
fore, where one muscle moves over another muscle, soft flesh upon soft 
flesh like itself, there can be no hurtful friction, and the cellular sub- 
stance is loose and natural, preserving its common form. But where 
tendons rub upon tendons, or bones upon bones, or where tendons rub 
upon muscles, or upon each other, some defence is needed, and the 
cellular substance assumes a new form. The cells are run together into 
one large cell, with thicker coats, and a more copious exudation, so 
that, being more liberally bedewed with a gelatinous mucus, it pre- 
vents the bad effects of friction, and is called a bursa mucosa, or 
mucous bag. These mucous bags are placed under rubbing tendons, and 
chiefly about the greater joints ; some are large, and others small; 
their glairy liquor is the same with that which bedews the cellular sub- 
stance, or the cavities of the joints ; and the provision of nature is so 
perfect, that the occasions which require burs* seem to lorm them by 
friction, out of the common cellular substance. 
3. It is often useful that an individual muscle should be enclosed in 
a tendinous sheath, to give it strength and firmness, and to preserve it 
in its shape, or to direct its force. All muscles, or almost all muscles, 
form for themselves individual sheaths, such as are seen enclosing the 
supra-spinatus and infra-spinatus of the scapula, the biceps humeri, the 
sartorius, and most of the muscles of the leg and thigh ; but it is 
especially necessary that the whole muscles of the limb should be en- 
closed in some stronger membrane than the common skin, both to give 
form to the limb, and strength to its muscles, and to keep the indi- 
vidual muscles in their proper places, which otherwise might be lux- 
ated and displaced. And so some parts of the trunk of the body, the 
arm, the thigh, the leg, are bound each with a strong, smooth, and 
glistening sheath, formed out of the cellular substance, condensed 
and thickened by continual pressure. It is hardly to be distinguished 
in the child ; grows thicker and stronger as we advance in years and 
in strength, and in the arms of workmen it grows particularly thick and 
strong, increasing in the back, shoulder or limbs, according to the par- 
ticular kind of labour. These arc the membranes, which by enclosing 
the muscles like sheaths, are called the vagina, or fascia of the 
arm, the leg, the thigh, &c. 
4. Tendons or ropes were needed, for the muscles could not bo 
implanted thick and fleshy into each bone, without a deformity of the 
limbs, and especially of the joints, which wrould have been not un- 
shapely only, but which must have abridged them of their motions and 282 
OF THE TENDONS, 
uses. Where a muscle is not implanted directly into a bone, tendons 
are seldom required; and so there are no tendons in the heart, the 
tongue, the oesophagus, the stomach, intestines, or bladder. But where 
tendons pass over bones, or traverse the joints, their force is con- 
centrated into narrower bounds : and long tendons are fixed to the 
ends of the muscles, to pull the bones. These tendons were once 
believed to be but the collected fibres of muscles, gathered into a 
more condensed form ; by which condensation, their properties of 
feeling and motion were lost, while they became hard, white and 
glistening; and it was believed, that parts which were fleshy in the 
child became tendinous in the adult. But we know by the microscope, 
that the tendon is not truly continued from the flesh ; that the fibres of 
the tendon, and of the flesh, are not in the same line, the fibres of all 
penniform muscles running into their tendon, in a direction more or 
less oblique : and good anatomists have been able to separate the 
tendon from the flesh, without any violence, and with the bluntest 
knives.—Muscles are irritable, and have nerves; tendons have no 
visible nerves, have neither feeling nor self-motion, nor any endow- 
ment by which we should believe them to be allied to the muscles or 
nerves ; and many tendons as the expansion of the palmaris, may be 
unravelled into mere cellular substance.* 
The texdon then, is nothing more than the cellular membrane* 
which is in the interstices of the muscular fibres condensed together. 
The tendinous origin of a muscle for example, may be traced through 
the muscle from one extremity to the other till it is again gathered and 
twisted into the tendinous insertion. They may be resolved into loose 
cellular membranes by maceration, and many tendons may be stretched 
Out into a web even without maceration. 
5. The Periosteum is merely a condensation of the common cellular 
substance, formed in successive layers : and the tendons are of the 
substance of the periosteum ; they rnix with the periosteum, and are 
implanted into it. In dissecting a child, we tear up the periosteum 
along with tendons and without hurting the bones; but in process 
of time, the periosteum, and consequently, the tendons are inseparably 
fixed to the bones. The periosteum, tendons, fasciae, and bursae mu- 
cosae:, are all of one substance, and of one common nature ; they are 
various modifications of that dead matter, which having but little 
vascularity, and no feeling, and hardly any disposition to disease, is the 
fittest for its office, and bears the roughest usage in our experiments, 
and the most violent shocks in the motions of the body, without any 
signs of feeling, and without falling into disease. 
6. These tendons must be bound firmly down, for if they were to 
rise from the bones, during the actions of the muscles to which they 
belong, the effect of contraction would be lost, and they would dis- 
order the joint, starting out in a straight line from bone to bone, like 
a bow-string over the arch of a bow. The same substance still per- 
forms this office also; for the tendons of one muscle often split to 
form a sheath or ring for the next, or their tendons, after taking hold 
of the bone, spread their expaiision out over all the bone, so as to 
* The tendons are the continuation of the intersticial cellular membrane of the mus- 
cle ; and I have succeeded in unravelling them into a web. LIGAMENTS, BURS&C. 
283 
form an entire sheath for the finger and toe ; or there is a wide groove 
in the bone which receives the tendons, and it is lined with a cartilage, 
and with a lubricated membrane; the membrane comes off from the 
lips of the groove, or from corners-or edges of the bone, passes over 
the tendons, so as to form a bridge, or often it forms a longer sheath, 
as in the fingers, or where the peronaei muscles pass behind the ancle, 
and thus the vagina or sheaths of the tendons are connected with 
the tendons, periosteum, and other modifications of the common 
cellular membrane. 
7. The periosteum which has run along one bone, leaves it at the 
head, and forming a bag lor the joint, goes onwards to the next bone. 
Thus, the periosteum of all the hones is one continued membrane, 
passing from point to point; each bone is tied to the next by its own 
periosteum, and this membrane, between the end of one bone and the 
beginning of the next, is so thickened into a strong and hard bag, as 
to form the capsule of the joint; and the periosteum is assisted in per- 
forming this office, by the tendons, fascia), bursae, and all that confusion 
of cellular substance which surrounds the joint. The capsule of the 
joint is then a firm and thick bag, which, like a ligament, binds the 
bones together, keeps their heads and processes in their right places, 
contains that glairy liquor with which the heads of moving bones are 
bedewed, and prevents the adjacent parts falling inwards, or being 
caught between the bones in the bendings of the joints. The capsule 
of every joint proceeds from the periosteum, and is strengthened by 
the tendons ; it is formed like these parts out of the cellular membrane ; 
and when a bone is broken, or its periosteum destroyed by any acci- 
dent or disease, when a tendon snaps across, when a joint is luxated, 
and the capsule tom, the injury is soon repaired by a thickening of 
the cellular substance round the breach ; and wherever a bone being 
luxated, is left unreduced, a new sooket, new periosteum, newr liga- 
ments, and new bursae, are formed out of the common cellular sub- 
stance : and though the tendons may have been torn away from the 
head of the bone, they are fixed again, taking a new hold upon the 
bone. 
8. There are other ligaments of a joint which prevent its luxa- 
tion, guarding it at its sides, or round all its circle, according to its 
degree of motion ; and those ligaments are of the same nature with 
the first, or bursal ligaments, arise like them, from the periosteum 
chiefly, or indeed are truly but a thickening of the bursal ligament at 
certain points. 
The universal connection of these parts is now sufficiently explained, 
since we have followed the several forms of cellular substance ; 1st. 
Clothing the bone3 with a thick membrane, which, though insensible, 
as contrasted with the skin, conveys blood-vessels, the means of life, 
to the bones, and is named periosteum : 2dly, The same periosteum, 
thickened and strengthened by the adhesion of surrounding parts, so 
as to form the capsules for the joints : 3dly, The tendon also continued 
from the periosteum, and not growing from the muscle, but formed of 
the cellular membrane : 4thly, We see that smaller tendon, expanded 
into a thinner tendinous sheet, as in the brawn of the leg where the 
ham-strings (whose expansion strengthens the knee-joint) go down 284 
OF THE TENDONS, 
over the muscles of the leg : Sthly, We see the perpendicular partitions 
of this fascia going down among the muscles, and dividing them from 
eacli other ; and the cellular substance which lies under the fascia, and 
immediately surrounds the muscle, cannot be distinguished from the 
inner surface of the fascia itself: 6thly, And as for the bursae we see 
that they are formed wherever a tendon rubs over a bone. The upper 
surface of the bursa i$ formed by the tendon which rubs over the bone : 
the lower surface of the same bursa is formed by the periosteum of the 
bone which it defends ; the sides are formed by the common cellular 
substance. Its cavity appears to be merely an enlarged cell: and the 
bursae and the mucosae and capsular ligaments are plainly of one and 
the same nature : their liquors are the same, they often open into one 
another naturally, or if not naturally, at least it is no disease, since no 
bad effects ensue. 
I must now explain more fully the constitution and nature of all 
the less feeling parts : for what I have said might he thought to imply 
absolute insensibility and total exemption from disease or pain : whereas, 
the sensibility of tendons, ligaments, burs®, and joints, stand on the 
same footing with the feeling of bones : they are insensible in health ; 
not easily injured ; entering slowly into disease ; but their diseases are 
equally dreadful from their duration and from their pain : for by in- 
flammation, their organization is deranged, their healthy consistence 
destroyed, and their sensibility excited in a dreadful degree. 
The tendons of animals have been cut or pierced with embowelling 
needles ; they have been cauterised, they have been burnt with a lighted 
stick, while the creatures neither struggled nor shrunk from the irritation, 
nor ever gave the smallest sign of pain. Oil of vitriol has been poured 
upon eacli of the parts belonging to a joint, and a piece of caustic has 
been dropped into its cavity, but still no pain ensued ; nay, some have 
been so bold, may I not say so vicious, as to repeat these experiments 
upon the human body. Without such cruel and inhuman practices, 
avo do not want opportunities of knowing, that, in the human body 
also, the tendons and burs® have no acute feeling. When we cut 
open a fascia or tendinous membrane, there is little pain : when (as in 
amputation) we cut the ragged tendons even and neat, there is no pain : 
when we snip with our scissors the ragged tendons of a bruised linger 
to cut it off, the patient does not feel: when we see tendons of sup- 
purating fingers lying flat in their sheaths, we draw them out with our 
forceps, or touch them with probes, Avithout exciting pain. In the old 
practice of sewing tendons, there was some danger, but no immediate 
pain : Avhen Ave cut down into the cavity of a joint, still the pain is but 
slight. There is very little pain when the ligament of the patella is 
broken away from the tibia, nor when the great Achillis tendon is torn. 
There is but little pain in the moments of those accidents which appear 
slight in the time, but which turn out to be the most dreadful sprains. 
Yet, after rupture of the patella, the knee inflames and swells : after 
rupture of the Achillis tendon, there is swelling and inflammation, Avith 
such adhesion of the parts as makes the patient lame : after the 
slightest sprain, such inflammation sometimes comes on as destroys the 
joint. There is but little pain Avhen Ave lirst make an opening into 
any joint; yet it often brings On such pain and fever, that the patient LIGAMENTS, BUHS.E, &C. 
285 
<lica. in short, every thing conspires to prove, that though in wounds 
of the less feeling parts, there is indeed future danger, there is no im- 
mediate pain. Still there are many accidents which prove to us, that 
even in health, the joints are not entirely exempted from pain : a smart 
stroke cn the knuckles, or a biow on the elbow, or a fall upon the knee, 
are not perhaps the purest instances of feeling in joints : for such blow 
may have hurt some external nerve ; but when a small moveable car- 
tilage forms Within the joint of the knee, though it be small and very 
smooth, and iodged fairly within the cavity of the joint, it often gets 
between the bones, causing instant lameness; the moment it causes 
this lameness, it brings dreadful pains : the pain, the lameness, and all 
the feeling of inconveniency subside the instant that this cartilage is 
moved away lirom between the bones ; and the joint continues easy till 
this moving cartilage chances again to fall in between the heads of the 
bones. Even the pain from a blow upon the knee, for example, is 
plainly within the joint, and is caused by the force with which the patella 
is struck down against the ends of the bones ; what indeed is a sprain, 
but a general violence and twisting of all the parts which compose the 
joint ? These parts are of one common nature, and may be arranged 
and enumerated thus : a joint is composed of the heads of the bones 
swelling out into a broader articulating surface, and of a thin, plate of 
cartilage, which covers and defends the head of each bone ; sometimes 
of small and moveable cartilages which roll upon the bones, and follow 
all the motions of the joint, and, like friction wheels in machines of 
human invention, abate the bad effects of motion. There is a secre- 
ting apparatus within every joint, which pours out a lubricating fluid 
called synovia; and there is a bursal membrane reflected from the 
cartilages that tip the head of one bone to the edges of the cartilages 
of the opposite bone : this membrane confines the lubricating fluid, 
and serves at the same time to separate what is properly called the joint 
from the surrounding parts. This fine bursal or synovial membrane is 
surrounded and strengthened by a membrane of a more ligamentous 
character, which serves to bind the bones together. Sometimes this is 
called membrana capsularis, and sometimes more appropriately liga- 
mentvm cafsulare : there are lesser ligaments on the outside of this, 
going along the sides of the joint, and passing from point to point: 
there are great tendons moving over the joint, and bursae, or mucous 
bags, which accompany these tendons, and prevent the violence which 
their continual rubbing might do to the bones. It is remarkable how 
slowly physiologists have come to the right knowledge of this matter. 
The fact is that all the apparatus of the joint i3 sensible cartilage liga- 
ment and tendon ; but they do not possess the same kind or degree of 
sensibility with the skin and some other parts. They have just the 
degree and the kind of sensibility which is suited to their function ; 
that is to say, which permits the performance of their office, yet gives 
us token of violence by pain. Their sensibility, like the sensibility of 
other parts, being obviously designed as a guard upon them that we 
may be careful of such accidents ; and avoid such exertions as would 
be injurious to their texture. 
Though seemingly insensible to the common modes of inflicting 
pain, yet are the ligaments and tendons and sheaths sensible to sprains 286 
OF THE JOINTS. 
and bruises, and such kind of injury as they are naturally exposed to. 
And when once the process of inflammation is set up in them, they 
become the seat of excruciating agony. The inflammation of joints, 
and of all the parts belonging to them, breaks up the organization of 
the part, evolves the feeling, and then in them also comes disease 
and violent pain. They are slow in entering into action, but once 
excited, they continue to act with a perseverance quite unknown in 
any other part of the system. Their mode of action, whatever it 
may be at the time, is not easily changed: if at rest, they are not 
easily moved to action, and their excessive action once begun is not 
easily allayed. The diseases are infinite to which these parts are sub- 
ject. They are subject to dropsical effusions ; they are subject to 
gelatinous concretions ; they are subject to slight inflammation, to 
suppuration, to erosions of their cartilages, and to exfoliation corres- 
ponding with the dropsies, suppurations, and mortifications of the 
softer and more feeling parts. Rheumatism is an rnflammation round 
the joints, with a slighter effusion, which is soon absorbed : chronic 
rheumatism is a tedious and slow inflammation, with gelatinous effu- 
sions round the tendons, and permanent swelling and lameness of the 
joints, (jiout, in a joint, is a high inflammation with a secretion of 
earthy matter into its cavity. The inflammation of tendons attends 
sprain: effusion of gelatinous matter round them forms ganglion : 
suppurations in the tendinous sheaths is whitloe : the inflammation of 
bursas is false white swelling, not easily distinguished from the true : 
the disease of the joint itself is either a dropsy, where the joint, though 
emptied by the lancet, is filled up again in a few hours, showing how 
continual, and how profuse, both the exhalation and absorption of 
joints naturally are : or it is white swelling, which, next to consump- 
tion, is the most dreadful of all scrophulous diseases, which begins by 
inflammation in the joint itself, is marked by stiffness, weakness, loss 
of motion, and pain ; which goes on through all the stages of high 
inflammation, dreadful pain, destruction of cartilages, suppurations 
and spontaneous openings of the joints ; which sometimes stops by 
an effusion of callus and concretion of the bones, forming a stiff'joint, 
but wdiich oftener ends in hectic fever, diarrhoea, morning sweats, and 
extreme weakness ; so that the patient dies, exhausted with fever and 
pain. 
OF THE JOINTS. 
Almost every thing relating to the heads and processes of the bones, 
and every proposition concerning the motions which they have to per- 
form, has been already explained, anticipating much of the anatomy 
of the joints : and the principles of motion mentioned in describing 
the bones, shall form the chief propositions on which my descriptions 
of joints shall be arranged, seeking that method chiefly by which the JOINTS OP THE HEAD AND SPINE. 
287 
joints may be easily and rapidly explained ; for it is a subject on which 
volumes might be bestowed, and not in vain. 
1 should not wish the readers of this book, to be ignorant of terms, 
which it is, however, bad taste to introduce into our discourse, as 
they are useless and pedantic, viz. 
Diarthrosis is the free articulation, or proper joint. 
When the globular head of a bone rolls in a socket, it is Enar- 
throsis. 
When plain surfaces meet, as in the bones of the tarsus, we have 
the term Arthrodia. 
The hinge joint is called Gin^limus. 
When a bone turns by rotation it is termed Trochoides. 
When there is a firm union by cartilage, admitting no motion, or 
verv little, the term Synchondrosis is appropriate. 
LIGAMENTS #F THE HEAD AND SPINE. 
We may compare, in the following order, the chief motions of the 
head and trunk. The head is so placed upon the oblique surfaces of 
the atlas, that it cannot turn in circles ; but at that joint all the nod- 
ding motions are performed. The atlas rests so upon the vertebra 
dentata, that there all the turning motions are performed. The neck 
and loins have their vertebra so loosely framed, with such perpendicu- 
lar processes and easy joints,'that there all the bending motions are 
performed, while the back is fixed, or almost fixed, by its connexion 
with the ribs, and by the obliquity and length of its spines ; and 
though, upon the whole, the spine turns many degrees, yet it is with a 
limited and elastic motion where the whole turning is great, but the 
movement of each individual bone is small. 
To secure these motions, we find, the occipital condyles received into 
hollows of the atlas, where the oblique position of the condyles secures 
the joint, the occipital condyles looking outwards, the articulating 
surfaces of the atlas looking towards each other, the occiput set down 
between them, so as to be secured towards either side, and the 
obliquity of the joint being such withal as to prevent the head from 
turning round. These joints of the occiput withi the atlas, are, like 
the greater joints of the body, secured with regular capsules, or bag- 
like ligaments, for each condyle, each rising from a rough surface on 
the vertebra}, and being fixed into a roughness at the root of the con- 
dyle. We find a flat membranous ligament, which extends from the 
ring of the atlas to the ring of the occipital hole, closing the interstice 
between the occiput and the atlas : it is confounded at the sides with 
the capsules of the articulating processes ; is very strong before ; and 
at the middle short point of the atlas it seems a distinct ligament,* 
which is strong only at this point, and very lax and membranous 
behind. We find the atlas tied to the dentata, by a more complete 
order of ligaments. These are, 1st, (as between the atlas and dentata,) 
regular capsules, or bags, fixing the condyles of one vertebra to the 
* This is part of what Winslow called ligamemtum infundibiliforme, a 
funnel-like ligament, joining the. first vertebra*, to the occiput. 288 
JOINTS OF THE HEAD AND SPINE. 
cotulylcs of the other. 2dly, A cross ligament* which, crossing the 
ring of the first vertebra, makes a bridge, embraces the neck of the 
tooth-like process, and ties it down in its place. 3dly, A smooth and 
cartilaginous surface all round the root of the tooth-like process, 
where this tooth of the dentata turns in the ring of the atlas, and is 
bound by the ligament; and this rolling of the atlas upon the axis of 
the dentata is so fair and proper a joint, that it also is all included in a 
capsular ligament. 4thly, The point of the tooth-like process having 
threaded the ring of the atlas, almost touches the occipital hole ; and 
there another ligament ties it by its point to the occipital hole.t 
All the other vertebras have another kind of articulation ; to which 
the occiput, atlas, and dentata are the only exceptions, for their 
motions are particular, and quite different from the rest. The atlas 
and dentata bend, turn, and roll by connections resembling the com- 
mon joints of the body ; but the other'”vertebrae are united, each by 
its intervertebral substance, to the b»nes above and below ; they 
are also united by their articulating processes to each other ; each 
articulating process is held to another by a distinct capsule ; each 
intervertebral substance is secured, bound down, and strengthened by 
strong ligaments ; for the intervertebral substance, which of itself ad- 
heres very strongly to the periosteum, and to the rough socket-like 
surface upon the body of each vertebra, is further secured by a sort of 
cross ligaments, which go from the rim .or edge of one vertebra to the 
edge of the next, over the intervertebral substance ; and so, by ad- 
hering to the intervertebral substance, they strengthen it. These 
ligaments cross each other over the interstice between each vertebra, 
and are very strong in the lumbar portion. They are regular and 
shining, and are named intervertebral crucial ligaments. 
r spine is further secured by a general ligamentous or tendinous 
expansion, which goes over the fore parts of all the vertebra?, from 
top to bottom of the spine. It begins at the fore part of the atlas ; 
it almost passes the body of the dentata, or is but very slightly 
attached to it. It is at first pointed, small, and round ; it begins to 
expand upon the third vertebra of the neck, so as to cover almost all 
its body. It goes down along the bones, chiefly on their fore parts, 
and is but little on their sides. It is weaker in the neck, 
where there is much motion : stronger in the back, where there is 
none ; weaker again in the loins, where the vertebrae move ; but still 
on the bodies of all the vertebra? it is seen white, shining, and ten- 
dinous. We can distinguish all along the spine interruptions and 
fasciculi, or firmer bundles going from piece to piece of the spine; 
which fasciculi are indeed very seldom continued without interruption, 
further than the length of two or three vertebra?; yet the whole is so 
* Viz. Ligamrnttjm transversale, or transvf.rsgm ; and what arc called the 
appendices of the transverse ligament, are merely its edges, extending upwards 
and downwards, to be fixed into the dentata, and into the occipital hole, so as to enclose 
the tooth-like process of the dentata in a capsule. 
t There are two flat ligaments which come from about the neck or root of the tooth- 
like process, and which go obliquely upwards, to be fixed into the groove just behind 
the lip of the occipital hole ; but the ligament from the point of the tooth-like process is 
not what it has been supposed, a fair round ligament of some strength ; there is nothing 
more than a few straggling fibres of ligament going from the point to the occiput, though 
.Knstachius has drawn it rrtind and strong. 289 
JOINTS OF THE UEAJJ ANL> SPJiVE. 
much continued, that it is considered as one uninterrupted sheath,- 
and is called the external br anterior vagina, or ligament of the 
SPINE.* 
But still the canal of the spine were left open and undefended, 
rough and dangerous to the spinal marrow, if internal ligaments were 
not added to these. The rings of the vertebrae are held at a consider- 
able distance from each other by the thickness of the intervertebral 
substance, and by the corresponding length of the oblique processes ; 
but this space is fdled up by a strong flat ligament, which goes from 
the edge of one ring to the edge of another, and so extending from 
the articulating processes, backwards to the spinous processes, they 
fill up all the interstice, complete the canal of the spinal marrow, and- 
bind the bones together with great strength :f these are assisted in 
their office of holding the vertebrae together, bv a continuation of the 
same ligament, or of a ligamentous membrane connected with it, 
which runs all the way onwards to the ends of the spinous processes, 
where they are strengthened by accidental fasciculi :J and in the middle 
vertebrae of the back, but not of those of the loins or neck, similar 
ligaments are found also between the transverse processcs.§ 
Next there is another internal ligament, which is not interrupted 
from bone to bone, but runs along all the length of the spine, within 
the medullary canal; and it corresponds so with the external vagina, 
or anterior ligament of the spine, that it is called the posterior or 
internal ligament.il It begins at the occiput, lies flat upqn the back 
part of the bodies of the vertebra; ; at the interstice of every vertebra 
it spreads out broad upon the intervertebral substance, doing the same 
office within that the intervertebral ligaments do without. It is broader 
above; it grows gradually narrower towards the loins. Although it. 
is called a vagina, or sheath, it does by no means surround nor enclose 
the spinal marrow, but is entirely confined to the covering of the 
bodies of the vertebra;, never going beyond the setting off of the arti- 
culating surfaces, or the place where the nerves go out. It adheres 
firmly to the bones, and does not belong at all to the spinal marrow. 
It should rather be called a ligament for the bones, than a sheath for 
the medulla. The anterior ligament prevents straining of the spine 
backwards : this one prevents the bending of the spine too much for- 
wards, and they enclose between them the bodies of the vertebra;, and 
their intervertebral substances. 
There is yet a third internal ligament, which belongs entirely to the 
neck ; it is called apparatus ligamentosus colli : it begins from the 
edge of the occipital bone, descends into the canal of the vertebrae, is 
* The LIO AMENTUM COMMUNE ARTERIU9, FASCIA LONGITUDIN AUS ANTERIOR, 
Fascia ligamentosa, &c. It is from this ligament in the loin>f that the crnra ilia- 
phragmatis arise, with tendons flat and glistening like the ligament itself, and hardly to 
he distinguished from it. 
t They are named the ligamenta subflava crurum frocessuum spinosorum. 
J These are named the membran.® intersimnales, and ligamenta apices spi- 
2t arum comitantes, or funiculi ligamentosi. The ligaments which tie the points 
of the spines, running from point to point, making a long ligament which stretches 
down all the spine. 
§ Called ligamenta processuum transversorum, and fonnd only from the fifth 
to the tenth vertebra of the back. 
|| Fascia ligamentosa fostica, fascia lonoitudinalis postica, liOameN' 
TUM COMMUNE POSTERlU?. 290 
JOINTS OP THE HEAD ANJ) SPINE. 
thin and flat, and adheres firmly to the body of each vertebra, covering 
the tooth-like process. The irregular fasciculi, or bundles of this liga- 
ment, stretch from bone to bone ; and the whole of the apparatus 
ligamentosus extends from the edge of the occipital hole to the fourth 
vertebra of the neck, where it ends. Its chief use is also as a liga- 
ment, merely fixing the head to the neck. The dura mater is within 
these, immediately enclosing the spinal marrow. The ligaments which 
I have just named, may be well enough allowed to be u at once liga- 
ments for the bones, and a sheath for the medulla.” But there is no 
such sheath as that called ligamentum infundibiliforme by Winslow; 
for either they are peculiar and distinct ligaments for the bones, such 
as I have described, or they belong exclusively to the medulla, as the 
dura mater, which is indeed strengthened at certain points, into the 
thickness of a ligament; but the only close connection of the spinal 
marrow with the ligaments of the spine, is just at the hole of the occi- 
pital bone ; and for a little way down through all the rest of the spine, 
the connection is by the loosest cellular substance. 
OP THE LOWER JAW. 
Tlie lower jaw is, by its natural form, almost a strict hinge, and 
the lateral motion in grinding is but very slight. The joint is formed 
by a deep hollow or socket in the temporal bone, by a ridge which 
stands just before the proper socket, at the root of the zygomatic pro- 
cess, and by along small head, or condyle, which is placed across the 
long branch, or condyloid process of the jaw. These form the joint, 
and the condyle, the hollow of the temporal bone, and the root of the 
zygomatic process, are all covered with articulating cartilage. The 
joint is completed by a capsule of the common form, which arises from 
the neck of the condyle, and which is so fixed into the temporal bone 
as to include both the proper socket and the root of the zygomatic pro- 
cess. Thence it is manifest, that in the motions of the jaw, this trans- 
verse ridge is required as a part of its articulating surface; that the 
common and lesser motions are performed by the condyle moving in 
the deepest part of its socket; that the larger and wider openings of 
the mouth are performed by such depression of the jaw as makes its 
condyle mount upon the root of the zygomatic process. While the 
luxation of the jaw is a starting forwards of the condyle, till it is lodged 
quite before and under the zygomatic process, and the condyle stand- 
ing upon the highest ridge, is the dangerous position in which luxation 
is most easily produced. 
To render these motions very easy and free, a moveable cartilage is 
interposed. We find such cartilages in the joints of the clavicle, wrist, 
knee, and jaw, because the motions are continual and rapid. The 
moveable cartilage is thin in its centre, and thicker towards its edges, 
by which it. rather deepens than fills up the hollow of the joint. It 
corresponds in shape with the head or condyle of the jaw, and with 
the hollow of the temporal bone. It moves with every motion of the 
jaw, facilitates the common motions, and prevents luxation; but the 
joint is still more strongly secured by the strength of its pterygoid and 
temporal muscles, which are inserted close round the joint, than by anv JOINTS OF THE IIEAD AND SPINE. 
291 
strength of its capsule. It is the muscles which prevent luxation ; 
and it is their action also that makes luxation, when it has happened, 
so difficult to reduce. 
The Ligaments of the jaw are these : 
1. Membrana Articularis. 
2. Ligamentum Cartilaginis Intermcdise. 
3. Ligamentum Maxillae Laterale Internum. 
4. Ligamentum Maxilloe Laterale Externum. 
5. Ligamentum inter Maxillam et Processum Styloideum. 
After these descriptions of the ligamentous connections of the spine, 
the student may require some more precise table; for example : 
LIGAMENTS OF THE VERTEBRAL COLUMN, 
SEEN EXTERNALLY. 
First, as standing by itself jrcculiar, the intervertebral substance. 
1. Ligaments Capsularia. 
2. Ligamenta Crucialia. 
3. Ligamentum Commune Anterius, or Fascia Longitudinals Anterior. 
4. Ligamenta Apicium Processuum Spinosorum, or Funiculi Ligamentosi. 
5. Ligamentosoe Interspinales membrane. 
G. Ligamenta Processuum Spinosorum. 
1. Ligamentum Commune Posterius, or Fascia Longitudinalis Posterior. 
2. Ligamenta subflava Crurum Processuum Spinosorum. 
LIGAMENTS SEEN ON MAKING THE SECTION OF TIIE SPINE. 
1. Apparatus Lieamentosus. 
2. Ligamentum InfumiibJiforme. 
3. Ligaments Capsularia. 
4. Ligamentum Perpendiculare. 
5. Ligamentum Transversale—Appendices ejtfs. 
6. Ligaments Lateralia Moderatoria. 
LIGAMENTS BETWEEN TIIE IIEAD AND UPPER VERTEBRA. 
These ligaments of the spine, which strengthen and support bones 
of very delicate and spongy texture, are very subject to scrofulous 
inflammation. 
The transverse ligament has been burst, and the tooth-like process 
of the second vertebra has crushed the spinal marrow, with instant 
death ensuing. 
A diastasis, or partial separation of the vertebrae of the neck, with 
laceration of ligaments, is no unfrequent effect of falling from a height 
on soft ground. 
A subluxation of the atlas from the vertebra dentata, has occurred 
from suddenly turning the head, and death has attended the attempts at 
reduction. 
Subluxation of the lumbar vertebrae, that is, displacement of the 
articulating process, I have often seen. 
Total dislocation of the bodies of the vertebra?, is a very rare acci- 
dent ; yet there is an instance in my collection, where the child lived 
more than a year, and died at last of croup. 
After all twists and injuries of the ligaments of the spine, although 
there may be no dislocation, we have reason to be apprehensive of 
inflammation of the ligaments or general sltoath of tire spinal marrow. 292 
,501 MS OF THE HEAD AND SPINF., 
KIM. 
The ribs have two joints, anti a lhnge-like motion, rising and falling 
alternately, as we draw in or let out the breath. The two joints of 
the ribs are thus secured ; First, the proper head of the ribs being 
hinged upon the intervertebral substance, and touching two vertebrae, 
it is tied to the bodies of each by a regular capsule ; the bag is regu- 
lar, is lubricated within, and is as perfect as any joint in the body ; it 
is radiated without, so as to expand pretty broad upon the sides of the 
-Vertebrae, and has a sort of division, as if into two fasciculi, the one 
belonging to the vertebra above, the other to the vertebra below : 
they gradually vanish, and mix with the periosteum upon the bodies of 
the vertebrae ; these are named ligamenta caiutellorum costarum, 
as belonging to the little heads of the ribs. 
The back of the rib touches the fore part of the transverse process, 
and is articulated there; consequently there is a small capsular liga- 
ment belonging to this joint also ; but this joint is further secured, by 
two small ligaments, which come from the transverse process of the 
vertebra, and take hold on the neck of the rib : one short ligament 
coining from the point of the transverse process, is behind the rib, and 
thence named ligamf.ntum transversarium externum ; another, 
rather longer, comes from the inner face of the transverse process, 
goes a little round the neck of the rib, is implanted into the lower edge 
of the rib, and is named ligamentum transversarium internum : 
another small ligament exactly opposite to this, going, into the neck 
of the rib, upon its back part, is also very regular ; and other sub- 
sidiary ligaments from different points assist these or supply either 
place. 
The ribs are fixed into the sternum by their cartilages, each of 
which has a round head, a distinct socket, a regular capsule, and liga- 
ments which expand upon the surface of the sternum, much in the 
same way that the ligamenta capitelli expand upon the bodies of the 
vertebras : a tendinous membrane also binds the cartilages of the ribs, 
one to another, crosses over the interstice, and so covers the intercos- 
tal muscles with a sort of faseia ; and the whole surface of the sternum 
and that of the cartilages is covered with this tendinous expansion, 
which belongs confusedly to the origins of the pectoral muscles, to the 
ligaments of the ribs and sternum, and to the periosteum of that bone. 
LIGAMENTS BETWEEN THE RIB AND THE SPINE. 
1. Ligamentum Capitelii Costae Anterius. 
2. Ligamenta Capsularia Capitelii. 
3. Ligamentum Capsulare (of the union with the transverse process). 
4. Ligaiuentmn Externum Transversale. 
5. Ligamentum Cervicis Internum. 
,6. Ligamentum Cervicis Externum. 
ANTERIOR EXTREMITY OF THE RIBS AND STERNUM. 
1. Ligamenta Radiatim Disjecta. 
2. Ligamenta Transversa fvi/.. on the inner surface, i 
3. MembrUna Sternalfs, 293 
JOINTS OF TIIE SHOULDER, ARM, AND HAND. 
CLAVICLE. 
The joining of the clavicle with the sternum is the hinge upon 
which the whole arm moves, and is the only point by which the arm is 
connected with the trunk: the round button-like head of the clavicle 
rolls upon the articulating surface of the upper bone of the sternum; 
it is in such continual motion, that some particular provision is re- 
quired ; and accordingly it has, like the condyle of the jaw, a small 
moving cartilage, which rolls between this head and the sternum. 
The cartilage is thin, and of a mucous nature ; it is moveable in some 
degree, yet it is fixed by one edge to the head of the clavicle. This 
joint is enclosed in a strong capsule, consisting first of a bag, and then 
of an outer order of fibres, which go out in a radiated form, upon the 
surface of the sternum, like the ligaments of the ribs ; and they cross 
and cover the sternum, so that the ligaments of the opposite sides 
meet: and this meeting forms a cord across the upper part of the ster- 
num, which is named interclavicular ligament. Thus is the cla- 
vicle fixed to the sternum, and another broad ligament also ties it to 
the first rib, viz. the ligamentum rhomboides. 
The joining of the clavicle with the scapula is by the edge of the 
fiat clavicle, touching the edge of the acromion process with a narrow 
but flat articulating surface : both surfaces, viz. of the acromion and 
of the clavicle, are covered with a thin articulating cartilage : in some 
subjects a moveable cartilage is also found here : it is a regular joint, 
and is very seldom obliterated ; yet its motion, though continual, is 
not very free ; it is rather a shuffling and bending of the scapula upon 
this bone, favouring the play of the other joints: it is secured first by 
a capsular ligament, which is in itself delicate and thin, but which is 
strengthened by many ligamentous bands, which pass (over the cap- 
sule) between the clavicle and the acromion process; the clavicle, as 
it passes over the point of the coracoid process, is tied down to it by 
ligaments of considerable strength ; one comes from the root of the 
coracoid process to the clavicle, and is called ligamentum commune 
conoides ; another from the point of the coracoid process, is implanted 
into the lower or inner edge of the clavicle, and is named ligamentum 
commune trapezoides—trapezoid, on account of its square form, and 
commune, because it goes from the scapula to the clavicle; while 
other ligaments, going from one process of the scapula to another, are 
named proper or peculiar ligaments of the scapula. The ligamentum 
proprium triangulare stretches from the coracoid process to the 
acromion process of the scapula. The ligamentum scapulas ijro- 
puiUM posteriU3 is of less importance, being that which completes the 
notch of the scapula into a hole, and gives attachment to the omo- 
hyoideus muscle. 
The acromion scapuhe is sometimes separated from the end of the 
clavicle, and the accident may be mistaken for a dislocation of the 
Jiumerus. 
The sternal extremitv of the clavicle is sometimes dislocated, A 294 
JOINTS OF TIIF 
case presents to me while this is going to press. It is an accident very 
easily distinguished, for the great tubercle on the end of the bone 
rises like a tumour, and the part of the mastoid muscle arising from 
it is also raised, and seems as if, by its contraction, it pulled up the 
bone. 
SH0T7LDER-J0IKT. 
The shoulder is one of the most beautiful joints, loose and moveable, 
very free in its motions, but very liable to be displaced. To form this 
joint, the humerus has a large round and flattened head ; the cavity of 
the scapula,* which receives this head, is oval, or triangular, small and 
very shallow ; it is eked out with a thick cartilaginous border, which 
increases the hollow of the socket, but still it is so shallow, that the 
humerus cannot be so truly said to be lodged in the glenoid cavity as 
to be laid upon it. Its capsule or bag is very loose and wide, coming 
from the edges of the glenoid cavity, and implanted round the neck of 
the bone ; the joint is richly bedewed with synovia, which is partly 
secreted by a fimbriated organ, the common organ for this secretion 
through all the joints, and by a thinner exudation from those extreme 
arteries, which terminate with open mouths, upon the internal surface 
of the capsule. 
By the shallowness of its socket, and the largeness of its head, by 
the looseness of its capsule, by all the forms and circumstances of its 
structure, the shoulder is exceedingly loose, and very liable to be dis- 
placed : it has this loose structure, and superficial socket, that its 
motions may be free, but seldom is there any great advantage gained in 
the human body, without a counterbalance of weakness and danger; 
and every where in the limbs we observe that a joint is weak and liable 
to luxation in proportion as its motions are free and large. Yet the 
shoulder-joint is not without some kind of defence ; its socket is shallow, 
but it is guarded by the largest projecting processes in all the body, by 
the acromion projecting and strengthening it above, and by the coracoid 
process within; its ligament is lax, easily torn, and useful rather for 
confining the synovia, and keeping the head of the humerus opposite 
to its proper cavity, than in securing the joint by any strength it has : 
therefore a ligament extends from the coracoid to the acromion pro- 
cess (ligamf.ntum proprium triaingulare scapulas), which com- 
pletes the defences of the joint above, and at its inner side. The cap- 
sule is perforated by the long tendon of the biceps muscle,! to arrive 
at which it takes a long course through a sheath which passes over the 
groove in the bone which lodges the tendon; and there comes also 
from the point of the acromion process an additional ligament, which 
adheres to the capsule: but the circumstance from which the chief 
strength of the shoulder-joint is derived, is the insertion of the four 
muscles which come from the scapula close round the head of the 
bone, so that they adhere to the capsular ligament, pull it up to pre- 
* It is called a glenoid cavity, from the Greek name of a joint, and the name is not 
absolutely appropriated to the scapula. 
t The capsular membrane is perforated, while the thin synovial membrane is reflect- 
ed upon the tendon. SHOULDER, ARM, A Up HAi\IJ, 
295 
vent its being checked in the motions of the joint, strengthen it by 
their thickness, for they are spread upon it: and the contraction of the 
muscles holds the humerus in its place : their total relaxation (as in 
certain cases of weakness) suffers the humerus to drop away from the 
scapula, without any fall or accident, forming what we are accustomed 
to call a luxation of the humerus, from an internal cause ; and the 
shoulder cannot be luxated by a fall, without such violence as tears up 
the tendons of these muscles. We must add to this anatomy of the 
joint, that it is surrounded by numbers of bursas or mucous bags : one 
under the tendon of the subscapularis ; one under the short head of 
the biceps muscle ; one between the coracoid process and the shoul- 
der-bone ; and one under the acromion process of the scapula, ex- 
ceedingly large : and these are so fairly parts of the joint, that very 
commonly they open into it with communications, either perfectly 
natural or at least not hurtful, either originally existing, or formed by 
continual friction. It should also be remembered, that the long ten- 
dinous head of the biceps muscle comes from the margin of the socket, 
directly over the ball of the os humeri, and through the capsule, and 
answers the purpose of a ligament. 
1. Ligament urn Interclaviculare. 
2. Ligamentum Rhomboides, [between clavicle and rib.] 
3. Ligamenta Radiata, [on the point of the acromion.] 
4. Ligamentum Scapulse Proprium Triangulare. 
3. Ligamentum Scapulae Proprium Posterius. 
6. Ligamentum Scapulae Commune Trapezoidea.- 
7. Ligamentum Scapulse Commune Conoides. 
8. Membrana Capsularis. 
RECAPITULATION OF THE LIGAMENTS AB03T THE SHOULDER’. 
The' most frequent dislocation is that of the humerus from the 
glenoid cavity of the scapula. 
ELBOW. 
The elbow-joist is formed by threo bones; the humerus, radius, 
and ulna : the ulna bends backwards and forwards upon the 
bone ; the radius bends upon the shoulder-bone along with the ulna ; 
it always must accompany the ulna, but it also has a motion of its own, 
rolling in circles ; its round button-like head rolling continually with 
its edge upon a socket in the ulna, and with its flat face upon the tuber- 
cle of the humerus. The whole composes one joint, and is enclosed 
in one capsule ; the bones accompany each other in their luxations, as 
well as in their natural motions ; the ulna is never dislocated without 
the radius being also displaced ; a circumstance which is but too little 
noticed, and, so far as I remember, hardly considered or known. 
The radius and ulna are united principally by the interosseous liga* 
>ient, which, as it extends in the whole length of the bones, has great 
strength. Towards the elbow this ligament is deficient for a space, 
and it is perforated by vessels. The chorda transversalis cubiti 
is an oblique slip of ligament which passes from the tubercle of the 
ulna obliquely downwards and across to the tubercle of the radius. 296 
JOINTS OF THE 
The general capsule arises from the humerus, from both the tuber- 
cles, and all round the two hollows which receive the olecranon and 
coronoid processes of the ulna ; it is implanted again into the tip of the 
olecranon, and all round that sigmoid cavity of the ulna which receives 
the lower end of the humerus, and all round the edge of the coronary 
process. It is also fixed round the neck of the radius ; it comprehends, 
in one bag, the humerus, radius, and ulna ; and unites them into one 
joint, performing two motions, viz. flexion and extension by the ulna, 
and rolling by the radius ; the joint is lubricated by synovia and by fat,* 
which is found chiefly about the olecranon : and that the bones may be 
further secured, additional ligaments are spread out upon them, which 
are all without the common capsule of the joint lying upon it, and 
strengthening it at the necessary points. 
1. There is the common capsule enclosing the whole. 2- It is the 
form of every hinge-joint (and this is one of the purest) to have its cap- 
sule strengthened at the sides : and the sides of this, the elbow-joint, 
are strengthened by two fasciculi, or ligamentous heads, which, coming 
from the tubercles of the humerus, spread a little upon the capsule, 
and adhere to it like part of its substance. One, from the outer con- 
dyle, spreads upon the neck of the radius, and sends a strong division 
to be attached to the rough spine of the ulna, which is near the lesser 
sigmoid cavity df the ulna. This is of course the external lateral 
ligament. Another ligament, from the inner condyle of the humerus, 
goes upon the inside of the capsule and strengthens it there : it is im- 
planted in the prominence on the inner edge of the coronoid process 
of the ulna, and is named the internal lateral ligament.! The 
continual rolling motion of the radius requires a peculiar ligament, and 
this peculiar ligament of the radius is named ligamentum. coronarium, 
or annulare, because it encircles the neck of the radius ; annulare 
or orbiculare, from its hoop or ring-like form ; it is a very strong and 
narrow stripe or band, which arises from that part of the ulna where 
the radius rolls upon it, and surrounds the radius, making at least two 
thirds of a circle ; and so having turned over the neck of the radius, is 
inserted into the opposite side of the ulna. This is commonly described 
as a distinct ligament surrounding the neck of the radius, and having 
the common capsule implanted into its upper edge ; but, in truth, it is 
like the others, a thicker band of the common capsule, but with a dis- 
tinction much more particular here by the contrast of the great thick- 
ness of the coronary ligament, and the extreme thinness of the capsule 
at the fore part: for the capsule of every hinge-joint is strong only at its 
sides ; other bands from the outer condyle, and from the coronary pro- 
cess of the ulna, strengthen this ligament of the radius, and arc known 
LIGAMENTS OF THE ELBOW-JOINT. 
* The oil contained in the adipose membrane never exudes in the living body, and 
cannot lubricate. 
t I sec another ligament behind the internal lateral ligament, viz. arising from the 
external condyle, and inserted into the side of the olecranon. There are in truth two 
internal lateral ligaments, and their operation is not merely to confine the motion of 
the joint laterally, but to check the flexion and extension of the arm; the one being 
made tense by the flexion, the other by the extension of the fore-arm SHOULDER, ARM, AND HAND. 
297 
by the general name of accessory ligaments of the coronoid ligament, 
as the lateral ones are known by the name of accessory ligaments to 
the capsule.* 
RECAPITULATION. 
1. Membrana Capsularis. 
2. Ligamentum Laterale Internum. 
3. Ligamentum Laterale Externum. 
4. Ligamentum Orbiculare. 
5. Ligamenta Accessoria. 
The ulna is sometimes dislocated from the trochlea of the humerus. 
The head of the radius may be separated from the lesser sigmoid cavity 
of the ulna. But this part of the ligamentous apparatus of the joint is 
more apt to be sprained, to swell, and thence be mistaken for disloca- 
tion of the head of the radius. 
wrist. 
The whist is one of the most moveable joints in the body, having' 
the strength of a mere hinge-joint: (because it is almost a strict hinge, 
by the connection of the long ball of the carpus with the long hollow 
of the radius,) and having, at the same time, all the properties of the 
most moveable joint by the free turning of the radius, without the weak- 
ness which is peculiar to the circular and free moving joints. These 
distinctions divide the wrist-joint into its two parts. 
1. The articulation formed by the scaphoid and lunated bones, 
which form an oval ball of articulation, and the great scaphoid cavity 
of the radius which receives this ball: the end of the ulna does not 
properly enter into the cavity of the wrist, but its end, or little round 
head, is covered with a moveable cartilage, ami that cartilage represents 
the end of the ulna. It is called cartilago intermedia triangu- 
laris. Now, this first joint, viz. of the scaphoid and lunated bones, 
the head of the radius, and the moveable cartilage which represents 
the head of the ulna, are surrounded by the general capsule or bag of 
the joint. The capsule arises from the ends of the radius and of the 
ulna ; from the styloid point of the one, round to the same point of the 
other; and is implanted near the lower rank of the carpal bones : 
though it adheres first to the scaphoid and lunated bones, it passes them 
going over all the bones of the carpus, especially in the palm, so as to 
add strength to their peculiar ligaments ; and in the palm, the tendons 
for the fingers run over it: so it forms on one side an additional liga- 
ment for the carpus ; on the other, it forms the floor of the tendinous 
sheath, a smooth and lubricated surface for the tendons to run upon. 
This general ligament is strengthened by particular ones coming from 
the styloid processes of the radius and of the ulna, which spread upon 
* But the capsule ought to he called membrana capsularis ; it is not a ligament, and 
these which are called accessory are proper ligaments. The ligament which is on the 
fore part of the joint, and which runs towards the Ligamentum Annulare is properly 
called Accessorium Annuli Anticum; it crosses from the ulna to the external condyle ; 
and another coming round from the olecranon, and being on the back of the joint Ac- 
cessorium Annulare Posticum, 
VoL I.—O O 298 
JOINTS OF THL 
the bones of the carpus, and may be described as lateral ligaments ; tor 
although the wrist-joint is not accurately a hinge, yet it partakes most 
of that character, and the ligaments are strongest at the radial and 
ulnar edges of the wrist. But there are so many irregular points of 
bone about the wrist, that the little fasciculi, with which this capsule is 
covered and strengthened, are innumerable. Within this joint, and 
stretching from the groove between the scaphoid and lunated bones, 
there is an internal ligament of a soft and pulpy nature ; it is named 
ligamentum mucosuji ; but the very name shows, that it is less valu- 
able as a ligament, (since the joint is already well enough secured,) 
than as a conductor for the lacunae or ducts which separate the synovia. 
2. The articulation by which the hand performs all its turning 
motions is that of the radius with the ulna : this is set apart altogether 
from the general articulation of the joint. The lateral cavity of the 
radius receives the little round head of the ulna ; they are enclosed 
in their own peculiar capsule, which is so loose about the bones, that 
although it is a regular capsule of the common form, it has the name 
of membuana capsularis sacciformis. Thus there is one joint within 
another ; a moveable cartilage between them, and the capsule of the 
one, the more moveable joint, peculiarly wide, and not so strong ; 
all which should be considered in thinking about luxations of the 
wrist. 
The carpal bones are connected with each other so very closely, 
that the name of joint can hardly be used. They are rather fixed than 
jointed together. Each bone has four smooth articulating surfaces, by 
which it is united to the adjoining bones. The first two bones form 
the great ball of the wrist; the second row again is united with the 
first, by a sort of ball and socket; for the os magnum, which is the 
central bone of the second row, has a large round head, which is re- 
ceived into the lunated hollow of the os lunare, which is the central 
bone of the first row. The first row is thus united to the second, by a 
distinct and general capsule, in addition to which each single bone is 
tied to the next adjoining, by a regular capsular ligament within, and by 
flat cross ligaments without, or rather by many bundles of ligaments, 
which cross each other in a very complicated manner, and the little flat 
and shining fasciculi give the whole a radiated, or star-like form.* 
But there is a very particular ligament which descends from the styloid 
process of the ulna to the carpus, the use of which will be understood, 
if we rest upon our hands, for then the whole weight of the body is 
sustained by it. 
The metacarpal bones are also joined to the carpal in one row, by a 
line of joints, which are as one joint: besides their common capsule, 
the metacarpal of each finger has its peculiar ligaments proceeding in 
a radiated or star-like form from the carpal bones, and going out broad 
upon the metacarpal bones, and so numerous, that each metacarpal 
bone is securely tied by ligaments to one or two of the bones of the 
* These are the ligaments which are. really so unimportant to the anatomist, or to 
the surgeon, but which are so laboriously described under the titles of ligamenta, bre- 
via, obljqua, trans vers aria, and fropria ossium carpi; for they do in fact cross 
and transverse the carpus in every possible direction. SHOULDER, ARM, AND HAND. 
299 
-carpus ;* and at their heads, where the fingers are implanted upon 
them, forming the knuckles, they are again tied by flat ligaments, which 
go from head to head of the metacarpal bones,! binding them together, 
permitting a slight bending towards each other, so as to make a hollow 
in the hand, but no such wide motion as might assist the fingers ; 
they are but as a foundation upon which the fingers stand and move. 
1. Funiculus Ligamentosua Ulnle.' 
2. Membrana Capsularis. 
3. Membrana Sacciformis. 
4. Ligamentum Mucosuna. 
5. Ligamentum Cartilaginis Intermedia. 
6. Ligamentum Transversale Carpi Pronritim. 
7. Ligamentum Commune Carpi Dorsale. 
8. Ligamentum Rhomboides. 
9. Ligamenta Brevia. 
RECAPITULATION. 
FINGERS. 
The joints of the fingers are formed by round heads in the upper 
end of one row of bones, and by hollow sockets on the lower ends of 
the next row ; each joint is qualified by the round form of its head, to 
be a circular and free moving joint; but it is restricted by the forms of 
its ligaments, to the nature of a hinge-joint; for each finger-joint is 
included first in a fair round capsule, or bag, of the ordinary form, but 
that capsule is strengthened by very distinct lateral ligaments upon its 
sides, which lateral ligaments form the chief strength of the joints; 
above these lateral ligaments the joint is strengthened by abroad fascia, 
or sheath, which comes from the tendons of the interossei muscles, 
covers the backs of all the fingers, which is especially strong over the 
joints. One part of the apparatus of the wrist-joint is the smooth and 
lubricated sheath, in which the tendons of the fingers run. It is 
formed in part by the outer side of the capsule of the wrist, and in part 
by that bridge of ligament which proceeds from the four corner points 
of the carpal bones. This sheath is lined with a delicate and softer 
modification of the common tendinous membrane, is fully bedewed 
with mucus, and is fairly to be ranked with the bursae mucosae, as it is 
indeed, like them, a shut sac. But it is farther crossed in such a 
manner by partitions belonging to each flexor tendon, that each of 
them may be said to have its appropriated bursa mucosa. And these 
bursae, to prevent the bad consequences of friction, are put both 
between the cross ligament and the tendons, and also between the 
tendons of the uppermost muscle, and of the deeper one, and again 
between the tendons of the fingers and of the thumb. 
In the same way the sheaths of the tendons, as they run along the 
fingers, may be considered as part of the apparatus of their joints; for 
the first set of bursae, viz. those which lie in the palm of the hand, stop 
before they reach the first joints of the fingers, and then other longitu- 
* And these also are named according to their several directions, LIGamenta AR- 
TICULAR1A, LATERAL!A, RECTA, PERPENDICULAR!A, &C. 
t These are named the no amenta intebossea. 300 
JOINTS 0F THE 
dinal bursae begin from the first joint of the fingers, and go all along 
them to the last joint, forming a sheath for the tendons to run in, which 
does at once the office of a strong ligament, binding them down in 
their places, and which is so lubricated on its internal surface, as to 
save the necessity of other bursae. These sheaths are thicker in cer- 
tain points, so as to form cross rings of strong ligament; but the 
common sheath, and these thicker rings, still form one continued 
canal; these are named the sheaths and annular ligaments, or 
cross ligaments* of the lingers, and are of the same nature with the 
bursas. Besides these, there are no distinct bursae on the fingers, but 
there is one of considerable size at the root of the thumb.t 
JOINTS OF THE THIGH, LEG, AND ANCLE. 
OF THE HIP-JOIST. 
The acetabulum, which is rough in the naked bone, is naturally 
lined with a thick and very smooth cartilage. The head of the thigh- 
bone is covered with a similar cartilage, also very thick and smooth; 
and these cartilages almost fill up that deep dimple which is seen in 
the centre of the head of the thigh-bone, and smooth that hole which 
is formed in the centre of the socket, by the meeting of the several 
pieces of which it is composed. The socket is not only deep in its 
bones, but is further deepened by the cartilage which tips the edge of 
the socket, and which stands up to a considerable height. The socket 
is imperfect at that side which looks towards the thyroid hole; the 
bony edge is entirely wanting there, and the space is filled up by a 
strong cartilaginous ligament, which goes across this gap, from the 
one point to the other, and from its going across is named the liga- 
mentum labri cartilaginei transversale.| The capsular ligament 
of the hip-joint is the thickest and strongest of all the body. It is, like 
other capsules, h reflection and thickening of the periosteum; the 
periosteum coming along the outside of the bone, leaves it at the edge 
of the socket. The periosteum, or rather perichondrium from the 
inside of the socket, comes up to the edge, and meets the outer layer. 
They unite together, so as to form the general capsule enclosing the 
ring-like cartilage which tips the edge of the socket between them. 
This ligament encloses all the bones from the edges of the socket to 
the roots of the trochanters, embracing not only the head, but the neck 
of the thigh-bone. The outer plate, continuous with the periosteum, 
is thick and strong, and is assisted by much cellular substance con 
* LlGAMENTA V AGIN ALIA, LIGAMENTA CRtTCIATA, PH ALANGUM, &C. 
t Vide Monro’s Bursae Mucosae. 
| This ligament is double, that is, there is one on the inside of the edge, and one on 
the outside ; thence it is often reckoned as two ligaments, viz. ligamentum trans- 
verSale internum et externum. THIGH, LEG, AND ANCLE. 
301 
densed round it, and it is further thickened by slips which come from 
the iliacus, glutaeus, and other muscles which pass over the joint, while 
the external plate of the ligament lines the whole with a soft and well 
lubricated coat. 
In addition to this general capsule, there are two internal ligaments, 
1st, the round ligament, as it is called, which comes from the centre of 
the socket to be fixed into the centre of the ball of the thigh-bone. It 
is not round, but flat or triangular. It has a broad triangular basis, 
rooted in the socket exactly at that place where the several bones of 
the socket meet, forming a triangular ridge, which gives this triangular 
form to the central ligament. It has three angles, and three flat sides. 
It is broad where it arises from the bottom of the socket, is about an 
inch and a half in length, grows narrower as it goes outwards towards 
the head of the bone, and is almost round where it is implanted into the 
dimple in the head of the thigh-bone, at which point it is so fixed as to 
leave a very remarkable roughness in the naked bone. But round the 
roots of this ligament, and in the bottom of the socket, there is left a 
pretty deep hollow, which is said to be filled up with the synovial gland. 
It is wonderful how easily authors talk of the synovial gland, as if they 
had seen it; they describe very formally its affections and diseases, as 
when hurt by a blow upon the trochanter ; yet there is no distinct gland 
to be found. There is a fringed and ragged mass lodged in the bottom 
of the socket., hanging out into the hollow, and continually rubbed by 
the ball of the thigh-bone in its motions: the fringes and points cer- 
tainly are ducts from which we can squeeze out mucus ; but it is by no 
means proved that they belong to a synovial gland, and it looks rather 
as if the ducts were themselves the secreting organ, like the lacunas, or 
mucous bags in the tongue, or in the urethra, vagina, oesophagus, and 
other hollow tubes. Such a structure is fitter for suffering the strong 
pressure and continual action of the thigh-bone, than any determined 
gland. We see, then, nothing but mucous ducts of a fringed form, 
hanging down from this hollow in the cavity of the joint, a quantity of 
fat accompanying these fringes, and a pappy mucous membrane, which 
keeps these fringes and fatty membranes orderly, and in their places, 
and which ties them so to the angles of the triangular ligament, that, 
they must move with the motions of the joint. This mucous mem- 
brane, which keeps these fatty fringes orderly, has two or three small 
bridles in different directions, whence they are named the ligament A 
mucosa, or ligamentula mass® adiposae glandulosa ; and this may be 
considered as the continued inflection of the softer internal lamella of 
the capsule, which not only lines the socket, but is reflected over the 
central ligament, and over the globe of the thigh-bone, covering them 
also with a delicate synovial coat. Other fringes of the same kind are 
found at the lower part of the joint, lying round the neck of the thigh- 
bone, near the angle where the capsular ligament is implanted into the 
root of the great trochanter : the liquor from these mucous fimbriae, 
with the general serous exudations, are mixed and blended for lubri- 
cating the joint. 
This capsule, which is naturally the thickest and strongest in the 
body, almost a quarter of an inch in thickness, is further strengthened 
by many additions ; for a slip of very strong tendinous or ligamentous 302 
JOINTS OF THE 
substance condensed, comes down from the lower spinous process of 
the os ilium, and spreads out over the capsule, and strengthens it very 
much on its fore part; the smallest of the glutafi muscles adheres to 
the capsule, and strengthens it behind ; the psoas magnus and iliacus 
internus pass by the inner side of the capsule, and though they do 
not absolutely adhere to it, they deposite much cellular substance, 
which is condensed so as to strengthen the capsule, forming at the 
same time a large bursa mucosa, between their tendinous fibres and 
the joint. That tendon of the rectus muscle which comes from the 
margin of the socket, lies upon the outer side of the capsule, adheres 
to it, and strengthens it. The security of the hip-joint seems to 
depend more upon the strength of its capsular ligament, than that of 
almost any other joint. 
1. Ligamentum Capsulare. 
2. Ligamentum Accessorium Anti cum. 
3. Ligamentum Teres. 
4. Ligaments Labri Cartilaginei. 
5. Ligamentula Massas Adiposse. 
RECAPITULATION OP THESE LIGAMENTS. 
The head of the thigh-bone is subject to dislocation upward and 
outward, and also to displacement downward and forward. 
THE KNEE-JOINT. 
The knee-joint is one of the most superficial joints, and one of the 
weakest so far as relates to the bones, for the flat condyles of the thigh- 
bone are merely laid upon the flat head of the tibia. There is here 
no fair cavity, receiving a large head, as in the joint of the hip ; no 
slighter ball and socket, as in the fingers ; no strong overhanging 
bones, as in the shoulder ; no hook-like process, as in the ulna. This 
is not a hinge-joint, like the ancle, secured between two points of 
bone. We do not find the means of strength in its bones, but in the 
number, size, and disposition of the great ligaments with which its 
bones are joined ; by virtue of these ligaments it is the strongest joint 
of the human body, the most oppressed by great loads, the most exer- 
cised in continual motions, yet less frequently displaced than any 
other. But this complication of ligaments, which gives it mechanical 
strength, is the very cause of its constitutional weakness, makes it 
very delicate, and very liable to disease. 
The bones which compose this joint are the tibia, thigh-bone, and 
patella ; and they are united by many ligaments, both within and with- 
out the joint. 
1. The capsule of the knee is naturally very thin and delicate, 
transparent as a cobweb. This thin capsule comes from the fore 
part of the thigh-bone, all round the articulating surfaces, whence it 
goes downwards by the sides of the condyles; from this origin it is 
inserted into all the edge of the rotula, and in such a way as to keep 
the rotula properly without the cavity of the joint, the capsular liga- 
ment going over its inner surface, and lining it with a smooth and 
delicate coat. It is fixed below into all the circle of the head of the 303 
THIGH, LEG, AND ANCLE. 
;ibia, and thus completes its circle, embracing all the bones. This 
Capsule, naturally so thin and delicate, is made up from all the sur- 
rounding parts to a considerable thickness ; first, it is covered behind 
by the heads of the gastrocnemii; at the sides, by the biceps, and 
other muscles of the hamstrings ; on its fore part, it is strengthened 
by the general fascia of the thigh, which goes down over the knee, 
and being there reinforced both by its adhesion to the bones, and by 
the broad expansion of the vastus interims, sartorius, biceps, and 
other muscles, which go out over the patella, it adheres to the capsule, 
and makes the whole very strong; besides which, there is a ligament, 
which, lying in the ham, upon the back part of the capsule, is named, 
in compliment to Winslow, ligamentum posticum Winslowii. It is 
a ligament somewhat resembling the lateral ligaments of the elbow. 
It arises from the outer condyle, goes obliquely across the back part 
of the joint, adheres to it, and strengthens it; but often it is not found 
at all, or in such straggling fibres as cannot be accounted a ligament.* 
It is manifest that the knee requires some such additional ligaments 
behind, to serve as a check, and to prevent its yielding too far. 
2. The knee, as being a hinge-joint, has strong ligaments at the 
sides, and here the lateral ligaments are particularly distinct, and can 
be raised from the capsule ; on the inner side of the joint, there comes 
down from the internal condyle of the thigh-bone, a broad flat liga- 
ment, which is fixed into the inner head of the tibia, and is named 
the internal lateral ligament ; on the outside of the knee, there de- 
scends from the tip of the outer condyle a much stronger ligament, 
not quite so flat, rather round : it extends from the condyle of the 
thigh-bone to the bump of the fibula which it embraces. It is a little 
conical from above downwards ; it is from two to three inches in length, 
and is named ligamentum laterale externum longius, to dis- 
tinguish it from the next; for behind this first external ligament, there 
arises a little lower from the same condyle, along the outer head of 
the gastrocnemius muscle, a ligament which is called the ligamentum 
i,aterale externum EREVius, and it is not shorter only, but so spare 
as not to be easily distinguished, not having the true form of a lateral 
ligament coming down from the condyle, but of a mere strengthening 
of the capsule, coming upwards from the knob of the fibula.! 
3. The joint is still further secured by internal ligaments which are 
within the cavity of the joint; they are named the crucial ligaments 
of the knee. 'I'hey arise between the hollow of the condyles of the 
thigh-bone, and are implanted into the back part of the middle rising 
of the tibia : they lie in the back part of the joint, flat upon the back 
of the capsule, and the one crossing a little before the other (but yet 
in contact with each other, at the place of crossing); they are dis- 
tinguished by the names of anterior and posterior crucial liga- 
ments. 
The posterior crucial ligament is more perpendicular ; it arises 
from the hollow between the condyles of the thigh-bone, and is im- 
planted into a roughness on the back of the tibia, betiveen its two 
* Often it is irregular* or in straggling fibres ; but I bare never found it wanting, 
t Some strong, but irregular accessory ligaments go down to that part of the head of 
ibe tibia which is before the head of the fibula. 304 
JOINTS OF THE 
cup-like hollows, and behind the tubercle which divides these hollows 
from each other. While the posterior arises rather from the internal 
condyle, the anterior ligament arises properly from the external 
condyle, passes obliquely over the tuber, in the articulating surface of 
the tibia, and terminates in the cup-like hollow. The effect of these 
two ligaments is more particular than is commonly observed; for the 
one goes obliquely out over the articulating surface of the tibia, while 
the other goes directly down behind the joint; and of course when 
the knee is bended, the posterior ligament is extended ; when the leg 
is stretched out, the anterior ligament is extended ; they both are 
checks upon the motions of the joint: the anterior ligament prevents 
the leg going too far forwards, the posterior ligament prevents it 
being too much bent back upon the thigh.* 
4. The most admirable part of the mechanism of this joint, is the 
two semilunar cautilages. They are so named from their semi- 
lunar form; they lie upon the top of the tibia, so as to fill up each of 
them one of the hollows on the top of that bone. They are thicker 
towards their convex edges, thinner towards their concave edges ; 
they end by two very acute and long iiorns, named the cornua of the 
lunated cartilages. In short, they resemble the shape of the label 
which we put round a wine decanter ; and the two horns are tied to 
the tubercle, or ridge that stands in the middle of the articular surface 
of the tibia, and consequently they are turned towards each other, so 
as to touch in their points. There are here, as in the other joints, 
masses of fat enclosing the fimbriated ends of the mucous ducts. 
These fimbriae, and fatty bundles, are formed chiefly round the cir- 
cumference of the patella, commonly surrounding it with a complete 
fringe ; they are also found at the hack of the cavity, about the crucial 
ligaments, and in all the interstices of the joint; the fatty bundles 
filling up the interstices, protecting the mucous ducts from more vio- 
lence than what is just necessary to empty them, and perhaps mixing 
their exudation with the mucus of the ducts. 
These masses of fat lie covered by the delicate internal surface of 
the capsule, and the mucous fimbriae project from it. 
The inner surface of the capsule is so much larger than the joint 
which it lines, that it makes many folds or lurks, and Several of these 
are distinguished by particular names. Thus, at each side of the 
patella there are two such folds, the one larger than the other, whence 
they are named ligamentum alare majus, and ligamentum alare 
minus. These two folds are like two legs, which join and form one 
middle fold, which runs across in the very centre of the joint, viz. from 
the lower end of the patella to the point of the thigh-bone, in the 
middle between the condyles. It keeps the looser fatty bundles and 
fimbriated ducts in their place (viz. the hollow between the condyles, 
where they are least exposed to harm); thence it has been long 
* There is not attention enough paid to the origins of these ligaments from the femur ; 
for it is the origin from he thigh-bone which determines their operation. The poste- 
rior ligament comes from the root of the internal condyle, and depth of the semilunar 
notch, anterior to the centre of motion of the lower head of the femur on the tibia ; it 
is consequently stretched in extending the leg. The anterior ligament arises from the 
root of the external condyle, posterior to the centre of motion; it is consequently stretched 
in the flexion of the knee-joint. 305 
THIGH, LEG, AND ANCLE. 
named the ligamentum mucosum. The internal membrane of the 
joint covers also the semilunar ligaments, as a perichondrium; it 
comes off from the ridge of the tibia, touches the horns of the semi- 
lunar cartilages, moves over the cartilage, so as to give them their 
coat and at the point where it first touches the horns, it forms four little 
ligaments, two for the horns of each cartilage. These tags by which 
the four points of the lunated cartilages are tied, are named the liga- 
menta cahtilaginum lunatarum, or more simply named the four 
adhesions of the lunated cartilages. There is a little slip of ligament, 
which goes round upon the fore part of the knob of the tibia, and ties 
the fore parts of these two cartilages to each other. It is named 
ligamentum transversale gommune, because it goes across from 
the fore edge of the one cartilage to the fore edge of the other, and 
because it belongs equally to each ; but for their further security, these 
cartilages also adhere to their outer circle, or thick edge, to the in- 
ternal surface of the general capsule of the joint by the ligamentum 
coronarium, and that again adheres to the lateral ligaments which are 
without it; so that there is every security for these cartilages being 
firm enough in their places, to bear the motions of the joint, and yet 
loose enough to follow them easily. 
This joint has the largest bursae mucosae of all, and these perhaps the 
most frequently diseased. There is one bursa above the patella, be- 
tween the common tendon of the extensor muscles and the fore part 
of the thigh-bone, which is no less than three inches in length. There 
is a smaller bursa about an inch below the patella, and under the liga- 
ment of the patella, protecting it from friction, upon the head of the 
tibia. These bursae, I am persuaded, arc often the seat of disease, 
when it is judged to be in the joint itself. But the truth is very easily 
known ; for if a swelling appear under the patella, projecting at the 
sides, and raising the patella from the other bones, we are sure that it 
must be in the main cavity of the joint: but if swellings appear above 
and below the patella, then there is reason to believe that these belong 
to the great bursae, which are placed above and below the patella, a 
complaint which is far less formidable than a swelling of the joint itself: 
I would almost say, easily cured ; for openings into these bursae, though 
they should be avoided, are less dangerous than openings into the joint. 
It is from mistaking such tumours for collections in the capsule itself, 
that authors speak of openings into the joint as a familiar or easy thing, 
or think that they have done such operations safely, when probably 
they were puncturing the bursae only.* 
These bursae mucosae lie under the tendon of the extensor muscles, 
and under the ligament of the patella : they are of the same substance 
with the capsule of the joint itself; they lie over the capsule, united to it 
by cellular substance, and the bundles of fat which are disposed irregu- 
larly about the joint, belong partly to the bursa? and partly to the cap- 
sule ; one end projecting into the cavity of the bursas, while the other 
end of the same fatty bundles projects into the cavity of the joint. 
Thus the knee-joint, which is the most important in all the body ; 
* I believe that the great burs® and the joint always communicate largely ; and that 
being consequently one continuous surface, the opening of the burs® would be highlv 
improper. 306 
JOINTS OF THE 
the most oppressed by the weight of the trunk, and by the accidental 
loads which vvc carry ; the most exercised in the common motions of 
the body, and the most liable to shocks and blows, which is the most 
superficial and the weakest in all that respects its bones, is the strong- 
est in its ligaments, and the most perfect in all the provisions for easy 
motion. 
1. The great capsule of the joint encloses the heads of the bone, 
secretes (in part) and contains the synovia ; lines the joint with a 
smooth and delicate membrane, and, by turning over all the parts, and 
adhering to them, it forms the perichondrium for the cartilaginous 
heads of the bones, and the covering and ligaments for the moving 
cartilages of the joint. 
2. This capsule, which is exquisitely thin, and which was formed 
for other uses than for giving strength to the joint, is surrounded on 
all sides with such continuations of the common fascia, and such par- 
ticular expansions of the hain-string and other muscles, as by adding 
outwardly successive layers to the capsule, brings it to a considerable 
degree of strength. 
3. The capsule having no stress upon its fore part, is very thin upon 
its fore part, viz., at the sides of the patella, but is strengthened at the 
sides by fair and distinct ligaments, going from point to point of the 
three great bones, and so large and particular as to deserve, more than 
any others in the body, the name of lateral ligaments ; at the back 
part of the joint, the same strength is not required as at the sides ; yet 
it must be stronger than at its fore part, wherefore it is strengthened 
by the additional bands which are sometimes general and confused, 
but often so perfect and distinct, as to be known by the name of the 
posterior ligament of winslow ; and as the lateral ligaments pre- 
vent all lateral motions, this strengthening of the capsule serves as a 
check-band behind. 
4. It is only in the greatest joints that we find the additional security 
of internal ligaments, and the only joints where they are perfect, are 
the joints of the hip and of the knee ; the former having its round, or 
rather triangular ligament, which secures the great ball of the thigh- 
bone, and fixes it in its place ; the latter having its crucial ligaments, 
which, coming both from one point nearly, and going the one over the 
face of the tibia, and the other down the back of that bone, serve the 
double purpose of binding the bones firmly together, and of check- 
ing the larger and dangerous motions of the joint, the fore ligament, 
preventing it going too far forwards, and the back ligament preventing 
it bending too much. 
5. A Moving cartilage for facilitating motion and lessening fric- 
tion is not common, but is peculiar to those joints whose motions are 
very frequent, or which move under a great weight; such are the inner 
head of the clavicle, the articulation of the jaw, and the joints of the 
wrist and of the knee ; and it is in the knee that the moveable carti- 
lages have their most perfect forms and use, are large and flat semi- 
lunar, to correspond with the forms on the head of the tibia ; thicker at 
their outer edges to deepen the socket; and though moveable, yet so 
tied with ligaments, as never to go out from their right place. 
And, 6. The mucous foficular bundles of fat,and the bursas mucosae. THIGH, LEG, AND ANCLE. 
307 
which complete the lubricating apparatus of the joint, and the mucous 
frenulae or ligaments, which both conduct the mucous fringes and keep 
them in their place, are more perfect in the knee, and greater in num- 
ber and size, than in any other joint. 
I may well call this the most complicated, and (by daily and melan- 
choly proofs) it is known to be the most delicate joint of the body. 
LIST OF THE LIGAMENTS OF THE KNEE-JOINT. 
External to the capsule these : 
1. Ligamentum Patellae. 
2. Ligamentum Laterale Internum. 
3. Ligamentum Laterale Externum Longum. 
4. Ligamentum Laterale Externum Breve. 
5. Ligamentum Posticum Winslowii. 
Within the capsule these: 
6. Ligamentum Mucosum. 
7. Ligamentum Alare Majus. 
8. Ligamentum Alare Minus. 
9. 10. Ligamenta Crucialia. 
11. Ligamentum Coronarium. 
12. Ligamentum Transversals. 
13. 14, 15. Ligamenta Cornuum Cartilaginum Femilunanum. 
The most frequent accident to this joint is the sprain of the internal 
lateral ligament. 
FIBULA. 
The fibula is a support to the tibia in its various accidents ; it gives 
a broader origin to the muscles, and it is the chief defence of the ancle- 
joint. It has no motion upon the tibia ; the best authors speak of it 
as a symphysis, which classes it with the joinings of the pelvis, and ex- 
cludes it from the list of true and moveable joints. It is united with 
the tibia by a sort of flat cartilaginous surface* upon either bone ; 
it is merely laid upon the tibia, not sunk into it. It 14 tied by a close 
capsule : it has no particular ligament for itself; but is strengthened 
by the external lateral ligament of the knee, which adheres to this 
knob, and by the insertion of the biceps tendon, which is implanted 
into this point, and which spreads its expanded tendon over the fore 
part of the tibia, and holds the bones together; and the firmness of 
the fibula is further secured by the great interosseous ligament, which 
goes from bone to bone. Towards the head of the bone the interos- 
seous ligament is deficient. 
AiYCLE. 
The ANCLE-joint owes less of its strength to ligaments than to the 
particular forms of its bones ; for while the strong lateral ligaments ol 
the knee guard it so that it cannot be dislocated till they are torn, the 
lower heads of the tibia and fibula so guard the foot, that when luxated 
these bones are often broken. First, the fibula is so connected with 
the tibia, at its lower end, that they form together one cavity for re- 
ceiving the astragalus, with two projecting points, the fibula forming the 
outer ancle, and the tibia forming the process of the inner ancle ; the 308 
JOINTS OP THL 
joining of the iibuia to the tibia here, is like that of its upper end, tow 
close to admit of the smallest motion, and it is thoroughly secured by 
particular ligaments, one of which passing from the fibula to the tibia 
on the fore part, is named the ligamentum superius anticum, con- 
sisting, iu general, of one or two distinct flat bands. Another more 
continued and broader ligamentous membrane goes from the fibula to 
the tibia across the back part, and is named ligamentum posticum 
stjperius ; the ligamentum posticum inferius, being but a slip of the 
same. Next comes the capsule of the joint, which joins the astragalus 
to the lower heads of the tibia and fibula; it is thinner both before 
and behind, than we should expect from the strength of a joint which 
bears all the weight, and the most violent motions of the body. But, 
in fact, the capsule every where serves other purposes than giving 
strength to the joint, and never is strong, except by additional ligaments 
from without; so it is with the ancle-joint, the capsule of which is 
exceedingly thin before; but it is strengthened at the back part, and espe- 
cially at the sides, by supplementary ligaments ; First, a strong ligament 
comes down from the acute point of the inner ancle, expands in a 
radiated form upon the general capsule; adheres to it,4and strengthens 
it, and is fixed all along the sides of the astragalus, to the os calcis and 
naviculare. This ligament, coming from one point, and expanding to 
be inserted into a long line, has a triangular form, whence it is named 
ligamentum deltoides ; and while the general ligament secures the 
joint towards that side, the oblique fibres of its fore edge prevent the 
loot being too much extended, as in leaping, and its oblique fibres on 
the back edge prevent its being too much bended, as in climbing. But 
the ligaments of the outer ancle, tying it to the outer side of the astra- 
galus, are indeed distinct, one going forwards, one going backwards, 
and one running directly downwards ; one goes from the point or knob 
of the fibula, obliquely downwards and forwards to be inserted into 
the side of the astragalus ; it is square and flat, of considerable 
breadth and Strength, and is called liuamentum fibulas anterius. 
Another ligament goes perpendicularly downwards, from the acute 
point of the outer ancle, to spread upon the side of the astragalus, 
and of the capsule, and is finally inserted into the heel-bone ; this is 
named the ligamentum fibulae perpendiculare. A third ligament 
goes out still from the same point, to go backwards over the back pari 
of the capsule, adheres to the back of the capsule and strengthens it. 
and is named ligamentum inter fibulam et astragalum posterius. 
There is nothing very particularly worthy of notice jn the ancle-joint, 
for it is covered with cartilages, lined with a soft and Mufcous mem- 
brane, and lubricated with mucous fimbriae and masses of fat, such as 
are found in all the joints. It is stronger than the other joints ; it can 
hardly be luxated, without a laceration of its ligaments, and breaking 
of the bones which guard it at either side ; and it is the great violence 
which is required for completing this dislocation, and the terrible com- 
plication of dislocation, fracture, and laceration of the skin, which 
makes this accident so dangerous beyond any other luxation. THIGH, LEG, AND ANGLE. 
309 
RECAPITULATION'. 
From the hbula to the tarsus: 
1. Lin amentum Fibulae Perpendicular e, 
2. Ligamentum Fibulae Anterius. 
3. Ligamentum Fibulae Posterius. 
From the tibia to the tarsus : 
4. Ligamentum Ueltoides. 
5. Ligamentum Capsulare. 
Accidents to this joint are very frequent: the sprain of the deltoid 
ligament is very frequent; so is the partial laceration of the perpendicular 
ligament of the fibula. We have to distinguish this last case from 
the sprain of the tendons of the peronaei rnucles, which is a very 
frequent accident. 
UNION BETWEEN THE BONES OF THE TARSUS. 
The astragalus, os calcis, os naviculare, and all the bones of 
the tarsus, are united to each other by large heads, and have distinct 
and peculiar joints; besides which, the bones are cross-tied to one 
another by ligaments, so numerous and complicated, that they cannot 
nor need not be explained. They pass across from bone to bone, in 
an infinite variety of directions, some longitudinal, some transverse, 
and some oblique. There is a curious complication, which we may 
call a web of ligaments, covering either side of the foot with shining 
and star-like bundles ; each bone has its capsular ligaments for joining 
it to the next; each joint of each bone has its articulating cartilages 
always fresh and lubricated ; each joint has, besides its capsule, flat 
strips of oblique, longitudinal, and transverse ligaments joining it to 
the nearest hones, and the greater bones have larger and more im- 
portant ligaments ; as from the astragalus to the os calcis, from the 
os calcis to the os naviculare, and from that again to the scaphoid 
bone, &c. 
The metatarsal bones have their capsular ligaments joining them to 
the tarsal bones ; and they have ligaments strengthening their capsules, 
and tying them more strongly to the tarsal bones ; and as in the me- 
tacarpal bones, the several ranks are tied one to another by cross liga- 
ments which pass from the root of one bone to the root of the next; 
so we have ligaments of the same description and U3e, holding the 
metatarsal bones together, both on the upper and on the lower surface 
of the foot; and all the ligaments of the foot are of great strength 
and thickness. The lower ends of the metatarsal bones have also 
transverse ligaments by which they are tied to each other. The toes 
have hinge-joints formed by capsules, and secured by lateral ligaments, 
as those of the fingers are ; and, except in the strength or number 
of ligaments, the joinings of the carpus, metacarpus, and fingers, 
exactly resemble the joinings of the tarsus, metatarsus, and toes. 
But these ligaments, though helping to join the individual bones, 
could not have much effect in supporting the whole arch of the foot 
I t is further secured by a great ligament, which extends in one triangu- 
lar and flat plate, from the point of the heel to the roots of each toe. 
This is named the AroNEnRosrs flantaris rrvois. which is not. morel v 310 
joints of the 
an aponeurosis i'or covering, defending, and supporting the muscles of 
the foot ; that might have been done on easier terms with a fascia very 
slight, compared with this ; but the chief use of the plantar aponeuro- 
sis is in supporting the arch of the foot. It passes from point to point, 
like the bow-string between the two horns of a bow, and after leaping, 
or hard walking, it is in the sole of the foot, that we feel the straining 
and pain ; so that, like the palmar aponeurosis, it supports the arch, 
gives origin to the short muscles of the toes, braces them in their action, 
and makes bridges under which the long tendons are allowed to pass: 
it comes off from the heel in one point: it grows broader in the same 
proportion as the sole of the foot grows broad. It is divided into 
*hree narrow heads, which make forks, and are inserted into the 
roots of the second, third, and fourth toes ; and the great toe and the 
little toe have two smaller or lateral aponeuroses, which cover their 
own particular muscles, and are implanted into the roots of the great 
toe and of the little toe. 
The bursa) mucosae surround the ancle and foot in great numbers. 
None of them having any very direct connection with the joint, and 
most of them accompanying the long tendons as they pass behind the 
ancle, or in the sole of the foot, are of that kind which we call ten- 
dinous sheaths. First, there are sheaths of two or three inches long, 
which surround the tendons of the tibialis posticus, and of the peronaei 
muscles, as they pass down behind the ancle. The sheaths of the 
peronaei begin from that point where the tendons first begin to rub 
against the bone, and are continued quite down into the sole of the 
foot; making first a common sheath for both tendons, and then a 
bursa peculiar to the tendons of the peronaeus brevis muscle, and about 
an inch in length. When the peronaeus longus begins to pass under 
the sole of the foot, the sheath which enclosed it behind the ancle is 
shut, and a new bursa begins : in the same manner where the tendons 
of the flexor pollicis, and flexor digitorum pedis, pass behind the inner 
ancle, a bursa of three inches in length surrounds them, and facilitates 
the motion. As the tendons of the flexor muscles go under the arch 
of the foot, they lie among soft parts, and rub chiefly against the flesh 
of the massa carnea, and the belly of the short flexor muscle : but 
whenever they touch the first joints of their toes, they once more rub 
against a hard bone. New bursae are formed for the tendons ; each 
bursa is a distinct bag, running along the flat face of the toe, and is of 
a long shape, and the tendon is carried through the centre of the 
lubricated bag, so that we sec once more, that there is no true distinc- 
tion between bursae mucosae and tendinous sheaths ; nor between the 
tendinous sheaths and the capsules of joints. 
Joints have been arranged under various forms, as shown in the 
beginning of this chapter, but not with much success; and 1 do not. 
know that enumerating the joints in any particular order will either 
explain the motions of individual joints, or assist in recording their 
various forms ; some joints are loose and free, capable of easy motions, 
but weak in proportion, and liable to be displaced ; such is the joint 
of the shoulder, which rolls in every direction ; other rolling joints, 
more limited in their motions, are better secured with ligaments oi 
peculiar strength ; such is the joint of the hip, where the ligaments 
are of great strength both within and without : some wanting all oir THIGH, LEG, AND ANCLE. 
311 
cular motions, are hinge-joints, by the mere form of their bones j 
such are the lower jaw, the vertebrae, the elbow, and the ancle- 
joints ; some are hinges by their ligaments, which are then disposed 
only along the sides of the bones; such are the knee, the ribs, the 
fingers, and the toes. Some joints partake of either motion, with 
all the freedom of a ball and socket-joint, yet with the strength and 
security of the strictest hinge : thus the wrist having one joint by 
which its turning motions are performed, and another joint by which 
it rolls, has the two great endowments so rarely combined in any joint 
of the freest motion, and of great strength ; so also has the head, by 
the combination of two joints of opposite uses and forms ; for its own 
condyles play like a mere hinge upon the atlas, and the axis of the 
dentata secures all the properties of a circular joint; this combination 
gives it all the motions of either joint, without their peculiar defects. 
But there is still a third order of joints, which have such an obscure 
and shuffling motion, that it cannot be observed. The carpus and 
metacarpus, the tarsus and metatarsus, the tibia, with the fibula, 
have these shuffling and almost immoveable joints; they are not in- 
tended for much motion among themselves, but are appointed by a 
diffused and gradual yielding, to facilitate the motions of other joints. 
OF Tin; BURSAS MUCOSA',. 
The bursa; mucosa; are little bags or sacs, placed between the ten- 
dons and bones, where there is much friction. By the smoothness of 
their inner surfaces, and the lubrication of their surfaces, by a fluid 
similar to the synovia, they act the office of friction-wheels in ma- 
chinery, and take oft’ the too severe pressure or friction from the bone 
or tendon. As they are of a structure similar to the apparatus of joints, 
they are subject to similar diseases. This most common disease is a 
kind of dropsy, which produces a puffiness or compressible swelling 
around the joint. Although we have mentioned the principal bursae, 
in treating of the joints and the muscles, yet we consider it right to 
enumerate them here. 
In connection with the shoulder-joint, these : 
1. A very large bursa under the acromion, and between it and the 
head of the humerus. 
2. Between the head of the clavicle, and the coracoid process of the 
scapula. 
3. Upon the capsule of the shoulder-joint, under the tendon of the 
subscapularis muscle. 
4. Under the deltoid muscle. 
5. Under the tendon of the latissimus dorsi. 
The principal bursae around the elbow-joint, are these : 
1. Between the tendon of the biceps flexor cubiti, and the radius. 
2. Over the round head of the radius, and the extensor muscles. 
3. On the olecranon, under the triceps tendon. 
About the wrist, these : 
1. A large bursa between the flexor tendons, and the carpus. 
2. Qn,tlm trapezium. 
3. Onjjrc pisiforme. 
4. On tno back of the carpus, and under the extensor carpi radiajis. 312 
JOINTS OF THL 
5. Between the ligament of the wrist, and the tendon of the extern 
sor carpi ulnaris. 
Besides these sacs or proper bursae, sheaths surround the tendons of 
almost all the muscles about the wrist-joint. 
On the pelvis, these : 
1. A large bursa between the glutaeus maximus, and the vastus es- 
ter nus. 
2. Between the capsule of the hip-joint, and the psoas and iliacus 
internus. 
3. Under the pectinalis. 
4. A large one on the surface of the trochanter major, under the 
glutaeus maximus.— Also, under the glutaeus minimus. 
5. On the os ischii, under the origin of the biceps. 
6 Under the tendons of the rotators of the thigh-bone. 
In the thioh, and around the knee-joint, these : 
1. Under the tendon of the quadriceps, and communicating with the 
knee-joint. 
2. Under the ligament of the patella. 
3. Between the insertion of the semimembranosus, and the origin 
of the gastrocnemius. 
4. Over the internal lateral ligament of the knee-joint. 
5. Under the popliteus. 
N.B. Several irregular bursae around the tendons inserted into the 
tibia and fibula. 
Around the ancle-joint. 
All the principal tendons which cross the ancle-joint, have bursae 
under or around them, as the tendon of the tibialis anticus, the exten- 
sor proprius, the extensor digitorum, the peronaeus longus and brevis. 
There is also a proper bursa between the tendo achillis, and os calcis. 
Another under the flexor longus pollicis ; and also under the flexor 
longus digitorum, and the tibialis posticus. 
These bursae it is necessary for the surgeon to know, because after 
sprain and injuries, effusion takes place in them, and they present a 
puffy swelling over the joint, not easily understood, without the recol- 
lection of the natural anatomy. 
OF THE CIRCULATING SYSTEM. 
Wf. have understood that a continual revolution or change of the 
material of the animal frame is necessarily connected with life. The 
living principle may he joined to the animal or vegetable matter, and 
remain in a latent state but when its presence is betrayed by action, 
it has begun a course of existence through certain defined stages, and 
during this active condition, all the material of the frame undergoes a 
continual revolution. 
* Mr. Hunter, in his lecture, illustrated the condition of life in the seed before vegeta- 
tion, or in the egg before incubation, by the discoveries of Black, of the presence ofhent 
tn bodies in an insensible state. OF THE BLOOD. 
313 
While solids are necessary to the constitution of the frame, fluids are 
necessary to these internal changes. From the fluids the solids are 
formed, and the solids are again broken down and change their con- 
dition of aggregation, and become fluid, and circulate in the vessels. 
The fluid blood and the blood vessels are therefore necessary to all the 
operations of life, since without them the revolution of solids into fluids, 
and fluids into solids, could not take place ; the body would he stag- 
nant and fixed, and no better than a machine, which being broken or 
wasted, possesses no power of reparation. 
The Hunters began their demonstration of the system by exhibiting 
the condition of the blood, and the splendid consequences which attend- 
ed this mode, should incline us to follow their example. 
QUALITIES OF THE BLOOD. 
Blood is a fluid of a rich and beautiful colour : it is vermilion- 
coloured in the arteries, strong purple in the veins, and black, or al- 
most so, at the right side of the heart ; it feels thick and unctuous 
between the fingers, is of a slightly saline taste, and varies somewhat 
in the depth of its colour, in certain parts of the body. In various 
individuals, but much more in different animals, it varies with their 
functions and manner of life ; it is different in birds, in fishes, in in- 
sects ; it is red or pale, warm or cold, in different classes of animals: 
and from this last variety comes our division of animals into those of 
warm and cold blood. 
It is by ibe most simple and natural methods that we examine the 
blood ; since almost spontaneously it resolves itself into the ckassa- 
mentum, the serum, and the red globules, suspended in the crassa- 
mentuin, and forming a part of it. In a cup of flood, the crassamen- 
tum, or clot, the hepar sanguineum, as it was called lot g ago, Hoats 
in the serum ; the red globules are engaged in this clot, and give it 
colour ; the serum may be poured off; the coagulum may be washed 
till it is freed of the red parts of the blood, and then the red particles 
are found in the water with which the coagulum was washed, and the 
coagulum remains upon the strainer, little reduced in size, pure and 
white, the fibrin or gluten. Or wo may separate this part bv a method 
which Ruyseh first taught us ; we may, while the blood is congealing, 
stir it with a bunch of rods, when the pure and colourless fibrin gathers 
upon the rods, and the serum with the red particles suspended in it, 
remains behind. The coagulable part was called fibrin, from the 
fibrous appearance it assumes in this experiment, a name it has 
retained. 
The red globules, as we have observed, are not universal; yet in 
all creatures, even in colourless insects, there seems to be formal par- 
ticles in the blood. 
The red globules of the human blood are easily seen ; they are 
best examined with a simple lens, the globules being diluted in serum 
and laid upon an inclined plane, not in water, which dissolves them 
quickly, but in serum, which has the property of preserving their glo- 
bular form. The watery solution of this part of the blood turns the 
syrup of violets green, and contains soda and albumen.—The size of 314 
OF THF. BLOOD. 
the particles of the blood varies in various creatures: it is asserted 
that, in the foetus, they are bigger than in a grown animal; and al- 
though Leeuwenhoek thought it essential to his doctrine to say that 
they were alike in all creatures, there are, in respect to the size of the 
animals, the strangest reverses. The skate has red globules much 
larger, and the ox has globules much smaller than those of a man. 
Fish have large globules, serpents smaller ones, and man smaller 
still. In man the diameter of each globule has been estimated not to 
exceed the two hundred thousandth part ol an inch. 
There is in the effect of lenses, or in the nature of these globules, 
some strange refraction, by which there seems a darkness in the centre 
of each globule, and thence a deception which has been universal: so 
that no single description has tallied with that which went before. 
Leeuwrenhoek believed, that he saw them consisting each of six well 
compacted smaller globules. Ilewson believed that they were blad- 
ders, which had within them some central body, loose and moveable ; 
that often the central part might be seen rolling in its bag; and that 
sometimes the bladder was shrunk and shrivelled around the central 
body, and could by putting a drop of water upon it, be plumped up 
again. The Abbe Torre examined them with simple lenses too ; but 
they magnified so highly, that from this cause all his noisy mistake has 
arisen ; for he used not ground lenses but small sphericles of glass 
formed by dropping melted glass into water ; they magnified so much, 
that to him the central spot appeared much darker; he said that these 
were not globules, but rings. He sent his sphericles of glass and his 
observations from Italy, his own country, to our Royal Society ; and 
.for a long while, though nobody could see them, still the public w ere 
annoyed by Abbe Torre’s rings. Falconer, with all the zeal of a 
friend, published Hewson’s discoveries after he wras dead ; lamenting, 
as we all must do, the loss of a promising young man. Falconer 
thought he saw these globules, not as spheres, but as flattened spheres; 
he thought he saw them often as they rolled down the inclined plane 
upon which he placed them, turning their edges, their sides, their faces, 
towards the eye ; he even compared their flatness with that of a coin. 
Many authors have conjectured that these globules are compressed 
when they come into narrow passages, and expand again when they 
get into wider arteries. This Reichell says he has seen, and Blumen- 
bach believes; but Blumenbach, less easy of belief with regard to all 
these strange forms ascribed to the particles of the blood, pronounces 
his dissent in plain terms. “ They appear,” says he, “ to my eye no 
other than simple globules apparently of mucus : that lenticular or 
oval form which authors speak of, I have not seen.” 
The following are their chief properties with regard to the rest of 
the blood. When blood stands, the red globules fall to the bottom, be- 
cause they are heavier than the other parts of the blood ; and although 
the fibrin entangles them while it is forming, still it is to be noticed 
that the cake is always redder at the bottom ; and when by weakness 
or disease this coagulation is very slow, some globules escape the 
grasp of the coagulum, and the serum is tinged with red, and the 
cake, though coloured at the bottom, is white at the top, or has the 
huffy coat. Their form they preserve only while in the blood, and OF THE BLOOU. 
315 
to be supported more by the qualities of the serum than by their 
own properties ; for if mixed with water, they mix easily, and totally 
dissolve ; the water is red, but the globules are gone ; when we mean 
to preserve their forms for experiment, we must keep them in serum. 
Their quantity, in regard to the whole mass, varies so, that the appear- 
ance of the blood is an index of health or disease: in disease and 
weakness, the blood is poor and colourless; in health and strength, 
it is rich and florid; by labour, red particles may be accumulated ; in 
hard working men they abound ; they may be accumulated by exercise 
into particular parts, as in the wings of Moorfowl or Pigeons, and in 
the legs of common Hens. In short, the red globules are numerous 
in health ; in large and strong creatures ; and in the centre of the 
system. In fishes the flesh is colourless; in such a system, particular 
glands only, or viscera, as the liver, stomach, or spleen, are coloured 
with blood, and but a small proportion circulates in the other parts. 
The redness of these particles is a peculiarity. The chemical phy- 
siologists have ascribed it to iron contained in the blood. 
COAGt'LABLE LYMPH. 
The self-coagulating part of the blood, the cake which is left when 
we wash away the red globules, that which has been called the gluten, 
and now the fibrin, is by far the most important part of the blood, the 
most universally diffused in the animal system, the most necessary for 
the supply and growth of parts. It spontaneously concretes, and 
neither heat nor cold, nor dilution, will prevent its coagulation. Cir- 
culating in the vessels, it furnishes the solids of the body ; when 
washed, it is white, insipid, extremely tenacious, and very fibrous, and 
can be drawn out; and it is the coagulation of this part that makes the 
long fibrous strings which we find in the tub when bleeding a patient 
in the foot in very hot water. Being slightly dried, it shrinks into a 
substance like parchment; being hardened by heat, it becomes like 
a piece of horn or bone; when burnt, it shrinks and crackles, with a 
very fetid smell, like the burning of feathers, wool, flesh, or any other 
animal substance ; by which we know it to be the part of the blood 
which is the most perfectly animalized, and the most ready to be assi- 
milated with the living solids. When distilled, it gives ammoniacal 
salt and alkaline water, and a very thick heavy fetid oil, and much me- 
phitis, which are the marks of the most perfect animal nature; and 
after burning it, the residuum is a phosphate of lime, or, in other words, 
the earth of bones. 
W'hat takes place within the living and active blood vessels cannot 
be made matter of demonstration ; but there is no reason to doubt 
that an important change is brought upon the contained fluid in the 
moment of secretion, during that change, when from a fluid it becomes 
a component solid of the body, we see how the greater part of the 
body is composed of fibrine, and the analysis of any single part con- 
firms this. A muscle being squeezed, and thoroughly cleansed of 
blood, washed in spirits of wine, and again cleansed, is seen plainly 
to be but a peculiar form of coagulable lymph or fibrine. A bone 
being infused in any mineral acid, or in vinegar, its earthy parts are 316 
OF THE BLOOD. 
dissolved even to its centre ; it becomes soil and flexible, still retains 
the form of a bone ; but what remains consists principally of coagu- 
lable lymph. Fourcroy has said that coagulable lymph is that part 
upon which nature fixes irritability, or the contractile power, he should 
have added ; u but this substance is moreover in the animal body, the 
basis of every part which possesses life.” The membranes, ligaments, 
tendons, periosteum, and all the white parts of the animal body, con- 
sist chiefly of this. It is this fibrous part, then, which is secreted by 
the vessels for repairing the waste, and the accidents of the body. 
THE SERUM. 
The serum is the thinnest and most fluid of the parts of the blood, 
into which it spontaneously separates. And it contains those sub- 
stances which one is almost tempted to call extraneous. It is a fluid 
like whey, of a yellowish, or rather greenish colour, of an unctuous 
or slippery feeling among the fingers ; it is slightly saline, and contains 
various salts in solution, and turns vegetable reds to green. It coagu- 
lates with a heat much lower than that which makes it boil; being 
dropped into hot water it coagulates as it falls; by 150 degrees of 
heat it coagulates into the albumen, and does not again return to its 
soluble state like gelatin. 
But by this influence of heat the whole serum does not coagulate, 
but only the albumen, a substance like the white of an egg ; what 
remains fluid is the serosity. On cooling, the serosity coagulates like 
size or jelly. This coagulation is owing to the gelatin dissolved in 
the water ; and the water being evaporated it leaves the gelatin in the 
form of size or glue, or the gelatin may be precipitated from the water 
by various re-agents, but especially by tanin, and by alcohol. After 
the separation of the gelatin, there remains only the salts in watery 
solution : these are muriate of soda, phosphate of soda, and phos- 
phate of lime. 
This analysis of the blood contains the analysis of almost all the 
humours or secretions of the body. We perceive that the materials, 
of which the body is constructed, are contained in the blood, or 
formed from that fluid. It is true that we find in the body various sub- 
stances, which do not exist formally in the blood, but which are new 
compounds out of the materials, which, by the imperfect acids of 
ehemistry, we discover in it. 
LIFE OF TIIE BLOOD. 
Mr. Hunter, in forming his suite of preparations of the incubated 
egg, was led to reflect on the freshness of the yolk and the white of 
the eggs which are fit for incubation, while placed in circumstances 
which should quickly have produced putrefaction. What can it be, he 
said, which thus counteracts the chemical decomposition and prevents 
putrefaction, but the principle of life ? He was thus led to make expe- 
riments, which ascertained that the same principle which in the egg 
prevented putrefaction, resisted cold. Life, according to these sug- 
gestions. was not a result of organization, but a principle added to the OF THE BLOOD. 
317 
material, which might be either fluid or solid. Philosophically consi- 
dered it is equally intelligible, that life shall be united to a fluid as to a 
solid ; but we are more familiar with the latter, though we do not un- 
derstand the mode of union more perfectly. It will however reconcile 
us to the fact to remember, that, in regard to the animal frame, solidity 
and fluidity are terms referrible to different conditions of aggregation of 
the same substances ; all parts of the body being in that state of revolu- 
tion whilst there is life, that they are at one tune fluid and at another 
solid. A particular and permanent figure of parts in the animal body, 
is necessary to mechanical action, but not required for the mere pre- 
sence of life; though the blood may have no motion in itself, and yet 
it may have the principle of life added to it. Thus Mr. Hunter argued, 
and then he said, can we deny life to this fluid which becomes the 
means of life, conveying it to the other parts of the body, even to the 
nerves themselves ? For nerves do not convey life, but only direct the 
motions of parts, and without the blood the nerves themselves cease to 
be alive. Health, Mr. Hunter conceived, to consist in the harmony 
existing between the solids and fluids, and between the blood and its 
containing vessels, and in disease there is also a consent between them; 
if solids are disordered, the blood also puts on a diseased appearance; 
if it circulates in inflamed solids, it acquires an inflammatory disposition, 
and the condition is marked by signs ; its parts separate more easily, 
and it coagulates more slowly. 
I have said, “that the blood is a fluid of a rich and beautiful colour; 
vermilion-coloured in the arteries, dark purple in the veins, and black, 
or almost so, at the right side of the heart.” When we open the 
thorax of a living dog, the lungs collapse, the heart soon ceases to play, 
the dog languishes, expires, is revived again when we blow up its lungs: 
—then begins again the motion of the heart, the black blood of the 
right auricle is driven into the lungs ; the blood goes round to the left 
aide of the heart of a florid red ; and this purple blood of the veins, the 
vermilion blood of the arteries, the change happening so plainly from 
access of air, is a phenomenon of the most interesting nature, and binds 
us to look into the doctrines of chemistry for the solution of a pheno- 
menon to which there is in all the animal economy nothing equal. 
It is the study of air and aerial fluids that has brought to light all the 
beautiful discoveries of which modern chemistry can boast. The sim- 
plicity of the facts in chemistry, the correctness of the reasoning, the 
grandeur which now the whole science assumes, is very pleasing ; and 
leaves us not without hope, that by this science, all others, and ours in 
an especial manner, may be improved. 
The older chemists were coarse in their methods, bold in their con- 
jectures, in theory easily satisfied with any thing which others would 
receive. They condescended to repeat incessantly the same unvarying 
process over each article of the materia medica ; and among hundreds 
of medicinal plants which they had thus analyzed, they could find no 
variety of principles, nor any other variety of parts and names than 
those of phlegm, and oil, and alkali, and acid, and sulphur, and coal. 
By this they disburdened their consciences of all they knew, pleased 
their scholars, and set the physicians to work, forming magnificent, 
theories of salt, sulphurs, and oils; for such has ever been the connexion 318 
of THE BLOOD. 
of chemistry with physiology, that, good or bad, they have still gone 
hand in hand. 
The older chemists thought that they had arrived at the pure ele- 
ments, while they were working grossly among the grosser parts of 
bodies. They could know nothing of the aerial forms of bodies, for 
they allowed these parts to escape. When their subjects, by extreme 
force of heat, rose upwards in the form of air, no further investigation 
was attempted : it was supposed that the subject of their operation 
was consumed, annihilated, wasted into air, and quite gone. When 
they thus stopped at airs, they stopped where only their analysis became 
interesting or simple ; stopping where they stopped, among their oils 
and sulphurs, they made their science a mere rhapsody of words. Phi- 
losophy they consniered so little, as not to know that the lightest air is 
really a heavy body, and that with weight and substance other proper- 
ties must be presumed. 
Modern chemistry begins by assuring us, that these airs are often 
the densest bodies in the rarest forms ; that airs are as material, as ma- 
nifest to the senses, as fairly subject to our operations, as the dense 
bodies from which they are produced: that it is heat alone (a substance 
which irresistibly forces its way into all bodies) that converts any sub- 
stance into the aerial form : that some bodies require for their fluidity 
merely the heat of the atmosphere, and so cannot appear on this planet 
in any solid form : that others require some new principle to be added, 
in order to give them the gaseous or aerial form : that others require 
very intense heat to force them into this state ; but that all aerial fluids 
arise, or must be presumed to arise, from some solid body or basis, 
which solid basis is dilated by heat into an air. The solid basis of 
some airs can be made apparent, as of fixed air, which proceeds from 
charcoal; others, as iiure air, or azotic air, (the great constituents of 
our atmosphere,) cannot be produced to view in any solid form. But 
those airs which cannot be exhibited in any solid form, can yet be so 
combined with other bodies as to increase their weight and give them 
qualities of a very peculiar nature ; ami these airs can be alternately 
combined with a body and abstracted again, adding or abstracting from 
its weight and chemical properties, not oidy in a perceptible, but in a 
wonderful degree ; so that these abstractions and combinations con- 
stitute some of the most general and important facts. When the old 
chemists, then, neglected to examine these airs, they refrained from 
examining the first elements of bodies at the very moment in which 
they came within their power. 
That these must be the most, material and important facts in all the 
science, it is easy to explain ; for chemistry, ever since it has been a 
science, has rested upon one single point. There are certain great 
operations in chemistry which we perceive to have the strictest analogy 
with each other, or rather to be the same ; the operations are the com- 
bustion of inflammable bodies, the respiration of animals, the calcination 
of metals; and whatever theory explains one explains the whole. The 
older chemists observed, that when they burnt an inflammable body, 
the surrounding air was contaminated, the substance itself was anni- 
hilated, nothing remained of its former existence but the foul air ; and 
they supposed that this inflammable body consisted of a pure inflam- 319 
OK THE BLOOM. 
mable principle, which was the substance which spoiled the air, les- 
sening its bulk, and making it unfit for supporting any longer either 
combustion or animal life. When an animal breathed in confined air, 
they found the phenomenon still the same ; the animal contaminated 
the air, and expired itself; left the air unfit for burning or breathing, 
loaded, as they supposed, with the inflammable principle. When they 
calcined a metal, (which is done merely by heating the metal and ex- 
posing it to air,) they found, as in these other operations, the air con- 
taminated, the metal losing its metallic lustre, ductility, and all the 
marks of a metal,—acquiring (in certain examples) new qualities, like 
those of some mineral acid, and becoming, of course, a most caustic 
drug; but above all, they uniformly observed the metal to increase in 
weight. 
To account for all these discordant changes was the most difficult 
part of all : it was indeed easy to say, that combustion was the giving 
out of an inflammable principle to the air ; and to say concerning res- 
piration, that it was the business of the air to take away continually 
the superabundant phlogiston of the blood ; but how a metal should 
pass from a mild to a most acrimonious and caustic state ; and above 
all, how by the loss of its inflammable principle it should not lose in 
weight, but increase in weight! This was the Gordian knot which they 
had to untie, and which they cut lustily, betaking themselves, in de- 
fiance of all philosophy, to the absurd project of a principle of absolute 
lightness. They all agreed to call the phlogistic principle, a principle 
of absolute levity ; and thus their doctrine stood for many years, viz. 
that when phlogiston, or inflammable principle, was added to the calx 
of any metal, as to red lead, by roasting it with any inflammable body 
—the metallic lustre, tenacity, ductility, were restored, and the metal 
became lighter withal, because it now had within it the principle of 
levity. But that when by heat and air it was calcined, this principle 
was driven out, and then the metallic lustre, tenacity, ductility, &c. 
were lost by the absence of the inflammable principle upon which they 
all depended ; but the weight of it was increased, for the principle of 
levity was gone. 'Phis is the brief abstract of the theory to which 
the very best chemists have addicted themselves down to the present 
times. 
But the chief perfection of modern chemistry is, that its apparatus is 
so perfect, that it can employ exactly a certain quantity of air in cal- 
cining a metal ; it can collect that air again to the twentieth part of a 
grain ; it can prove whether the metal has really been giving out any 
inflammable principle to the air, or whether it has received matter from 
the air, and how much expressly it has gained or lost. Modern che- 
mistry proves to us, that it is not the loss of any principle that endows 
a metal, for example, with negative powers ; but the direct acquisition 
of a new principle, which endows it with positive powers. 
Upon our atmosphere and its surprising harmony with all parts of 
nature ; with animal and vegetable life ; with water, metals, acids, and 
all the solid bodies into which it enters—much more depends than it is 
easy to conceive. Could we have supposed that it was the cause, not 
merely of life in all living creatures, but almost the cause of all the pro- 
perties that reside in the most solid forms ? Could we have supposed 320 
OF THE BLOOD. 
that air rendered heavy bodies heavier, changed metals into the most 
caustic substances, converted many bodies into acids, changed inflam- 
mable air into the pure element of water, which at least we have hitherto 
conceived to be pure ? Yet if there be one word of truth in chemistry, 
all th is is true. 
The atmosphere contains various gases or airs ; but one only, viz. 
vital air or oxygen gas, is useful to respiration, combustion, and animal 
life ; that purer air must, like every other, arise from some solid basis : 
that basis cannot be shown in any substantial form, but it can be com- 
bined with many various bodies, so as to give them an increased weight 
and new qualities ; and thence we presume to say, whenever we see 
a body, by such a process, acquiring such qualities, that it acquires them 
by absorbing the basis of pure air ; for pure air is nothing but this 
presumed basis dilated into the form of air by heat; and when it com- 
bines with any body, it gives out its heat ; so that in all these pro- 
cesses heat is produced. And although inflammable bodies, metals, 
acids, &c. seem very distinct from each other; although combustion, 
calcination, and the forming of ar-ids, are processes seemingly very 
unlike ; yet they are all in their essential points the same, viz. a change 
of qualities and a production of heat in consequence of the absorption 
of pure air ; and there is a certain analogy between breathing and these 
chemical processes, which, however, the chemists have cariied too far. 
First, when an inflammable body is burnt, or consumed by fire, the 
basis of pure air is combining with the combustible body ; the air is 
entering into a new combination, and therefore must give out its beat; 
it combines rapidly, gives out its heat rapidly, is wasted ; the inflam- 
mable body burns and seems to be consumed ; but if we catch that 
air which escapes from the inflammable body, we find it to be equal 
exactly to the whole weight of the air and of the burning body that 
have been consumed ; and this air consists of two parts, viz. of the 
substance which was burnt, and of the basis of pure air. Thus, for 
example, when we burn charcoal or carbon, the whole substance of 
it, weight for weight, is converted into an air, which is called fixed or 
carbonic acid gas ; the same which is discharged from stoves, the same 
also which is found in pits, the same which oozes through the ground 
in the Grotto del Cane, the same which floats upon the surface of fer- 
menting vats, and which is so much heavier than common air that it 
ean be taken out from a vat in basins, and poured from dish to dish. 
Combustion then, is a process which consists in the rapid assumption 
ot the basis of pure air, and a consequent conversion of the burning 
body into an air or gas endowed with peculiar qualities and powers. 
So chemists have supposed that the function of respiration differs 
from these only in the rapidity of the process. So far it is true, that 
the carbon of the blood, secreted and thrown off from the lungs, 
unites to the oxygen of the atmosphere. But it is a mistake to sup- 
pose, as they have done, that the blood becomes oxydated like a metal; 
there is no proof that oxygen unites to the blood. It appears only to 
be the means of involving and extricating the carbon of the blood, and 
converting it into carbonic acid gas. No doubt there is a balance 
preserved between the function of the lungs in producing carbon and 
the condition of the atmosphere to receive it; for our atmosphere is OF THE BLOOD. 
321 
so tempered that no more than twenty-seven parts of a hundred con- 
sists of pure air, as we term it, that is of oxygen. This is the reason 
that even burning as well as breathing are slow processes, and that an 
animal, if made to breathe pure air, or vital air, as it is called, gets 
oxygen too rapidly supplied, is inflamed quickly, and dies. 
As there are various marks of the influence of oxygen on the blood, 
there are terrible proofs of its importance in the system, and how 
miserable the person is who has imperfect organs, or an ill oxygenated 
blood. It signifies not to our present purpose, whether any thing is 
actually given to the circulating blood during respiration, or if only 
the carbonaceous matter be separated and carried away ; the contact 
of blood with a certain portion of pure air or oxygen is absolutely ne- 
cessary to the continuance of life. 
Nature, disregarding all occasional supplies, as by the absorption of 
the skin, the assimilation of aliments, &c. has appointed one great 
organ for the oxygenation ot the blood, viz. the lungs. In opening 
the breast of a living creature we best see the connection of respira- 
tion with the great system ; but it is out of the body that we can best 
understand its particular effects upon the blood. 
The most obvious effect of air is its heightening the colour of the 
blood. If we expose blood to fixed air, or azotic air, it continues 
dark ; these fluids communicate nothing, they have no effect on the 
colour of the blood : when we expose blood to atmospheric air, it as- 
sumes a florid colour; for in the atmosphere there is a large propor- 
tion of oxygen gas ; if, lastly, we expose it to oxygen gas, the purest 
of all air, as chemists would formerly have expressed themselves, it 
grows extremely florid : and it must either be that the carbon in the 
blood is attracted, and floated off, and united to the oxygen, or oxygen 
is absorbed into the blood, and the former opinion prevails. 
Blood, when exposed to the air, becomes red chiefly on the surface; 
it remains black beneath, but by turning up the clot to the air all the 
surfaces become red. If air be blown into a tied vein, the blood 
which was black in the vein becomes florid ; and when the air is pressed 
out again, it becomes black If the air-pump be exhausted over a 
dish of blood, the blood becomes dark in the vacuum ; and it becomes 
florid when the air is allowed to rush in again. If you expose blood 
in a moist bladder, the blood is oxygenated through the walls of the 
bladder ; which brings this experiment as close as may be to the phe- 
nomenon of blood oxygenated through the cells of the air vesicles of 
the lungs, and through the coats of the blood-vessels which circulate 
the blood upon those air vesicles. 
When we open a Frog, or Newt, or other amphibious creature, we 
see a long and slender artery accompanied by a slender vein, running 
from top to bottom along the whole surface of their lungs; and whiste 
their heart continues to beat, we see this pulmonic artery black, the 
vein red, the lungs themselves most delicate and pellucid, like the swim- 
ming bladder of a fish : even in the extremities of the human system, 
the blood of a vein is dark, of an artery red ; so that surgeons distin- 
guish venous and arterial hemorrhages in this way. 
From these facts we may understand whv the blood of the womb. 322 
OF THE BLOOD. 
of sinuses, of varices, and of all stagnant veins, is so dark ; and why 
that blood is so very pure and florid which is coughed up from the 
lungs. Is not the face livid in apoplexies or strangulations, in hang- 
ing or drowning, in fits of passion or of coughing, or in any accident 
which interrupts the lungs ? The face of a child during a paroxysm of 
the hooping-cough, is it not black ? Is not the hand livid when the arm 
is compressed or tied up, and its blood prevented from returning to the 
lungs .and heart ? Are not tumours dark coloured from dilated veins 
which return their blood too slowly ? The first effect of oxygenation 
is a reddening of the blood. The menstrual blood, the blood of ec- 
chymosis, the blood of aneurismal bags, are all black ; and the blood 
of varices is so very black, that the ancients said they were filled with 
atrabilis, or black bile. The stripes, inflicted on a soldier as a pun- 
ishment, are at first of the most lively red, but soon become black. 
If we open the breast of a Frog and stop its breathing, we observe, 
first, its pulmonic blood florid, and the heart beating strongly ; secondly, 
in half an hour the pulmonic blood has become dark, and the heart’s 
motion has grown languid ; in a little tvhile the pulmonic blood be- 
comes black, and the pulsation of the heart ceases : and, lastly, the 
trachea of the Frog being untied, and the creature allowed to breathe 
again, the blood becomes florid, and the heart acts. 
We have stated the facts regarding this matter, as they have been 
brought forward, and as they appear. But a closer inspection of the 
phenomena will probably show that the oxygen is not in these instances 
the stimulus. But that the change produced upon the blood in respi- 
ration, makes that fluid more capable of supplying the irritability of 
the muscular fibre, and, consequently, of adding power to the heart. 
The load of carbon which the venous blood carries back from the cir- 
culation of the body, makes it incapable of adding to the irritability or 
contractile power of muscles. But when by purification in the lungs 
that carbon is carried off in form of carbonic acid gas, the colour of 
the blood is restored, and with it new powers. 
By these views the facts stated above have a new light thrown on 
them, the heart does not become weak, because the black blood is not 
stimulant, but because being black, and loaded with carbon, it is in- 
capable of supporting the irritability of the muscular fibres of the 
heart. 
OF THE HEAT OF THE BLOOD. 
The next effect of respiration is the communicating of heat to the 
body. There are some who pretend to say, that when they draw in 
vital air, they feel a genial warmth in the breast, diffusing itself over all 
tliw! body ; but it is easy to feel in this way, or any way, when a favour- 
ite doctrine is at stake, while those who know nothing about doctrines 
breathe the vital air without any peculiar feeling which they can 
explain. 
To suppose, but for a moment, that all the heat which warms the 
whole body, emanates from the lungs, were a gross error in philoso- 
phy : it were to suppose, an accumulation of heat in the lungs equal OF THE BLOOD. 
323 
to this vast effect of heating the whole body. But, were it so, we 
should feel a burning heat in the centre, a mortal coldness at the ex- 
tremities, and marked differences in the heat of each part in propor- 
tion to its distance from the lungs. In fevers, we should feel only the 
intense heat of the centre ; we should be distressed, not with the heat, 
in the soles of the feet or palms of the hands, or in the mouth and 
tongue ; we should feel only the heat of the lungs. When the limbs 
alone were cold, would the lungs warm them ? How could it warm 
them up to the right temperature without overheating the whole body ? 
When a part were inflamed, how could the heat go from the lungs, 
particularly to that point, and rest there ? 
It is a law of nature, to which, as far as we know, no exception is 
found, that a body, while it passes from an aerial to a fluid form, or 
from a fluid to a solid form, gives out heat. So it might be said, what 
is the whole business of the living system but a continual assimilation 
of new parts, making them continually pass from fluid into a solid 
form ? but this would be an erroneous view of the matter. 
It were easy to say, that the gases were consumed in breathing, and 
the fluids in circulation became solids, and, therefore, heat was gene- 
rated in the animal body. But, unfortunately for this hypothesis, these 
solids are again melted into fluids, and the fluids are giving out gases; 
and then as much heat as we might suppose was generated in building 
up the fabric of the body, would be lost in its decomposition. 
This is a subject of much difficulty, as may be readily conceived, 
when we consider, that for its elucidation, we require to measure the 
air, and estimate, not the temperature of that air, but the degree of 
heat it is capable of producing: we are consequently engaged with 
chemical processes of great delicacy. The received opinion is this ; 
bodies and even gases have different capacities for heat, and the heat 
may take a part of their compound, without being in a state to raise 
their actual temperature ; this property of latent heat was the great 
discovery.of Black. Now it is said that the blood when going out 
from the heart to the lungs, differs in its capacity of absorbing and re- 
taining the heat from the same blood on its return : that the arterial 
blood, returning in the veins, contains more absolute heat, though it 
be not of a higher temperature than the blood of the veins. It is fur- 
ther alleged, that when the arterial blood is conveyed along the tubes 
and vessels to the body, and generally diffused, it is not heating the 
body, because the latent heat is not disengaged, and is not in a state to 
raise the temperature. But when that arterial blood is converted into 
venous blood, a process which takes place in the extremities of the 
arteries and veins of the body, then the latent heat is disengaged, be- 
cause the venous blood has not the same capacity for retaining it as 
the arterial blood had ; and thus heat is uniformly diffused in proportion 
to the activity of the arterial circulation, in proportion to the conver- 
sion of arterial into venous blood. 324 
OF THE 
HEART, ARTERIES, AND VEINS. 
OF TIIE HEART. 
OF THE MECHANISM OF THE HEART. 
The heart is placed nearly in the centre of the human body, and l.-f 
itself the centre of the circulating system. The system of vessels 
which it excites and moves, consists of arteries and of veins ;—the ar- 
teries act with great strength, with a pulsation like that of the heart 
itself, and convey the blood over all the body ; the veins are in greater 
number, exceedingly large, pellucid almost in their coats, incapable of 
that energetic action with which all the functions of the arteries are 
performed ; they return the blood to the heart with a slow, equable, 
and gentle motion, and deposite at the right side a quantity of blood 
equal to that which is at each pulsation driven out from the left. The 
heart is placed between the arteries and the veins, to regulate and en- 
force their action ; to receive the blood from the veins by a slow dila- 
tation, and to restore, by a sudden contraction, that force which the 
blood loses in passing round the circle of the body. But the heart 
lias also another and more important office to perform; for by having 
four great cavities and two orders of arteries, it performs in the same 
instant two circulations, one for the lungs and one for the body ; it 
receives from the lungs nothing but pure blood, it delivers out to the 
body nothing but what is fit for its uses: and this purifying of the 
blood, and this excitement of the arteries, are two chief points of 
modern physiology, which every step of the following demonstration 
will tend to explain. 
It will be most easy to conceive at first the idea of a more simple 
heart, of one circle of actions, of one simple circulation ; 
of one bag for receiving, and another joined to it for 
propelling the blood. Indeed a heart consists merely of 
these essential parts; a great vein, an auricle, a 
ventricle, and a great artery : of a vein which re- 
turns the blood from all the body ; of an auricle or 
smaller bag, which receives that blood and retains it till 
the action of the heart is relaxed ; of a ventricle (which 
is the proper heart), strong, muscular, very irritable, and 
easily excited, into which the auricle pours its blood ; of 
an artery which is allied to the ventricle in strength and 
action, (as the auricle is to the vein in the delicacy of its 
coats,) and which carries on the blood to the extremities 
of the body ;—and the vein and artery meeting at their 
extremities in the body, and uniting, the whole is a cir- 
cle, and the heart is the central power. OF THE MECHANISM OF THE HEAKT. 
325 
If an animal were not to breathe, its system might be exactly what is 
now described ; it would have but one vein, one auricle, one ventricle, 
one artery ; it would have one simple heart: but with us, and other 
breathing animals, it is not so; and 1 am now to describe a more complex 
and curious circulation. For suppose this blood, so essential to our exist- 
ence, to have in it some principle ot life, which is continually lost, or in 
its passage through the body, to be impregnated with something which 
should be thrown off, that principle must be continually renewed, or 
an opportunity given to send off' what is offensive to life : the heart 
which fills the arterial system, must not be taken from its appointed 
office, nor disturbed ; nature appoints a second heart, which belongs 
entirely to this most important of all functions, viz. renewing the blood; 
and it may be renewed in many various ways. It might, for example, 
circulate in some peculiar viscus ; in the fcetus it does circulate in such 
a mass, for the placenta is a thick and flat cake, whose office we know 
to be equivalent to that of the lungs, but whose structure we imperfectly 
comprehend : in the chick we see its blood circulating over the yolk, 
(for the yolk is enclosed within the membranes of the unhatched Chick,) 
and we perceive the blood redder as it returns to the heart, and plainly 
changed : in fish we find the blood circulated over the gills, exposed 
thoroughly to the water in which they swim, and thus the gills perform 
to them the function of lungs. Hut in all breathing creatures, the lungs 
do this office ; the lungs are, next to the heart itself, essential to life ; 
in those who die from bleeding, we can perceive from the livor of the 
face, from the sobbing and struggles of the chest, from the regular con- 
vulsive sighs of those creatures which are butchered, rather a desire for 
air than a want of blood. It is for the purpose of this second circula- 
tion that nature has appointed in all the warm-blooded animals two 
hearts, a heart for the lungs and a heart for the body. 
There are other varieties which distinguish animals into creatures of 
cold or of warm blood ; for there are certain constitutions which do 
not require that the blood should be thus continually renewed. It is 
not because animals are amphibious, or go into the water, that they 
have peculiar lungs; for the land tortoise, the newt, the cameleon. 
never go into the water; yet they have membranous lungs ; nor indeed 
can the amphibia?, as the seal, the porpoise, the sea-lion,&c. dive and 
exist under water more than a man can do, though for whole days 
they lie in herds basking upon the shore : it is their peculiar constitu- 
tion to need less than other creatures the office of the lungs. The 
cold-blooded animals are generally creeping animals, sluggish, languid, 
cold, inert, difficultly moved, and tenacious of life to a wonderful de- 
gree. They can bear all kinds of stimuli; they can bear to have their 
heads, legs, bowels, cut away ; and among other peculiarities of this 
constitution, they can live long without air : they will rise from time 
to time above water, if you allow them ; they can bear again to be kept 
under water, if you force them : but if they can live long under water, 
they can also live at least as long after you have cut off their heads, or 
cut out their hearts. By all which it is clear that they cannot live with- 
out breathing. That this function is necessary to their existence : but 
iliat they are tenacious of life. 
Of those cold-blooded creatures alwavs either the heart or the uric- 326 
Ob' THE MECHANISM 
ries are peculiar; the heart is so in many amphibia?, as in the turtle, where 
the heart seems to consist of three ventricles, but with partitions so 
imperfect between them that they are absolutely as one : this one ven- 
tricle gives out both the great arteries ; the blood of the lungs and the 
blood of the body are both mixed in the heart: and since there are 
two arteries conveying this mixed blood, if the two arteries be nearly 
equal in size, then it is just one half of the blood thrown out by the 
heart, at each stroke that receives the benefit of the lungs. In many 
others, as the frog, the newt, the toad, the peculiarity is in the arte- 
ries alone ; they have one single and beautiful heart; there is one 
large auricle as a reservoir for all the blood both of the body and of 
the lungs ; there is one neat, small, and very powerful ventricle placed 
below the reservoir, having strength quite sufficient for moving both 
the blood of the lungs and'the blood of the body ; and this ventricle 
gives off* an aorta, which soon divides into two branches, one for the 
body and one for the lungs; and these of course have but half the 
blood of this heart exposed to the air: these also are cold-blooded 
animals, of which take this as an example. 
But all breathing creatures, such as are called animals of hot blood, 
have two hearts; the one heart is sending blood through the lungs, 
while the other heart is pushing its blood over the body ; not the half 
only, but the whole blood which is sent by each stroke of the heart 
over the body must have first passed through the lungs ; no blood can 
reach the heart for the body which has not been sent to it through the 
lungs, or, in other words, the veins of the lungs ; and they alone, feed 
the left side of the heart. 
Words alone will never explain any of the endless difficulties which 
concern the mechanism of the heart; but at every point, in every kind 
of difficulty, in explaining the form, the parts, the posture, even the 
coats or coverings of the heart, I shall have recourse to plans, such as 
cannot fail to make all this intricate mechanism be easily conceived. 
The most simple form of the heart, which is represented in the 
plan, on page 323. has a vein marked (aV—an auricle (b).—a ventri OF THE HEART. 
327 
ole (c),—an artery (d);—it has no provision for purifying the blood ; 
it has no resemblance to that kind of heart which is connected with 
lungs; but the blood is received by the veins, falls into the auricle, is 
driven by its force into the ventricle, by the ventricle it is thrown into 
the artery, and courses round all the body, till at length, reaching the 
extremities of the veins, it passes by the veins to the auricle a second 
time, and so this single circle is perfect. 
The heart of the amphibious creature is represented in page 325 ; 
it is a frog’s heart: it has the most simple form, and the fewest parts; 
it has the same vein, auricle, ventricle, and artery : but its great artery 
divides into two chief branches, of which (d)—the aorta, goes to the 
body,—(e) the pulmonic artery goes to each side of the lungs. 
The heart of a breath- 
ing creature is repre- 
sented here in its most 
intelligible form ; and 
the double circulation of 
the human body may be 
traced easily in the fol- 
lowing way.—Here the 
heart of the lungs is set 
off from the heart of the 
body, being as distinct 
in office as in form and 
parts ; on the right side 
is the heart of the lungs, 
on the left side is the 
heart of the body.—(a) 
Is the great vein called 
vena cava from its im- 
mense size ;—there is 
an ascending and a de- 
scending cava; the one brings the blood from the head and arms, the 
other brings the blood from all the lower parts of the body : they meet 
and form by their dilatation a chief part of that bag which is called 
the auricle,—in it they deposite all the returning blood of the body, 
and thus present it at the right side of the heart to be moved through 
the lungs.—(b) Is the right sinus, or right auricle ; it is in part, 
formed by a dilatation of these veins, but it puts on a strong and mus- 
cular nature as it approaches the heart; it is the first cavity of the 
heart, and, like all its parts, is strong and irritable ; it is filled by the 
returning blood of the cavae ; it receives, dilates, is oppressed by this 
great quantity of blood; it is strongly excited to act; in its action 
the blood goes down into the ventricle or lower cavity of the heart.— 
(c) Is the right ventricle, thick and strong in its walls, and of great 
muscular power ; it is filled by the auricle, and is strongly stimulated 
both by the stroke of the auricle and by the weight and quantity, and 
also, in some degree, by the qualities of the blood ; its action is sudden 
and violent, and it drives the blood through all the system of the lungs. 
—(d) Is the pulmonic artery,—the artery of the lungs which receives 
all the blood of the right, side of the heart.; it. is fdled bv the stroke of 328 
OP THE MECHANISM 
the right ventricle, from whose cavity it arises ; it carries the blood in 
many branches through all the substance of the lungs ; and thus that 
blood which had returned imperfect and robbed of its vital quality to 
the right auricle of the heart, is by this circulation through the pulmonic, 
artery ventilated and renewed, and made fit for the uses of the sys- 
tem ; and thus the lesser circulation, or the circulation of the lungs, 
the circulation of the right side of the heart, is completed, and the 
purified blood is brought round to the left side of the heart to un- 
dergo the greater circulation or the circulation of the body. 
Thus it is from the extremities of this first circle that the second 
circle begins : it consists of like moving powers, of an auricle, ventri- 
cle, vein, and artery ; for as the right heart receives the contaminated 
blood of the body from the veins of the body, the left heart receives the 
purified blood of the lungs from the veins of the lungs. — (e) Repre- 
sents the veins of the lungs, which are sometimes three, sometimes 
four in number ; two enter from each side of the lungs, and return the 
blood purified in the lungs to the left auricle of the heart. — {/) Is the 
ieft auricle, smaller, but more muscular, and stronger than the 
right; it receives easily whatever quantity of blood the lungs convey 
to it ; it is irritated, contracts, forces the mouth of the ventricle, and 
fills it with this purified and redder blood.—(g) Is the left ventricle, 
whose form is longer, its fleshy w'alls thicker, its cavity smaller, its power 
greater far than that of the right side ; this ventricle is thus small that 
it may be easily filled and stimulated, and thus strong that it may pro- 
pel all the blood of the body. — (h.) Is the aorta or great artery of tho 
body, arising from this left ventricle, just as the pulmonic artery arises 
from the right : the left ventricle, by its strong and sudden stroke, not 
only delivers itself of its own blood, but propels all the blood of the 
body, communicates its vibratory stroke to the extremest vessels, and 
excites the whole ; this is the greater circle or circulation of the body, 
as opposed to the shorter circulation or lesser circle of the lungs. 
That there are strictly two hearts, is now clearly made out; they 
are different in office : there are two distinct hearts, two systems of 
vessels, two kinds of blood, and two circulations. These tw'o hearts 
might have done their offices, though placed in the opposite sides of 
the breast; it is in order to strengthen mutually the effect of each other 
that they are joined ; for the fibres of the two hearts intermix ; they are 
both enclosed in one membranous capsule, viz. the pericardium ; the 
veins, auricles, ventricles, and arteries correspond in time and action 
with each other, and harmonize in a very beautiful manner. But this, 
I believe, will be more easily explained by marking the succession of 
motions, by a suite of figures placed upon the several parts of the heart, 
by which the successive motions are performed. 
Here l have joined the right and the left hearts ; both that it may 
be seen how the left heart locks in behind the right heart, how7 the right 
heart comes to be the anterior one. and how the aorta seems to arise 
from the centre of the heart, while its root is covered by the great 
artery of the lungs ; and also that the synchronous parts, i. e. the parts 
which beat time with each other may be correctly seen.—(1) The 
cava3 arc receiving the blood from all parts of the body, and in the 
same instant the pulmonic veins are receiving blood from the lungs. (2V> OF THE HEART. 
329 
The bight auricle is gradu- 
ally filling with the contami- 
nated blood of the body ; the 
left auricle, marked also with 
a second figure, is filling with 
purified blood from the lungs. 
(3) The EIGHT VENTRICLE is 
stimulated by its auricle, and 
throws its contaminated blood 
into the lungs ; and in the same 
moment the left ventricle throws 
its purified blood over the body. 
(4) The pulmonic artery re- 
acts upon the blood driven into 
it by the heart; and in the same 
moment the aorta re-acts upon 
the blood thrown into it, and that re-action works it through all this great 
system of vessels from this the centre to all the extremities of the body. 
Thus it is easy to perceive how the successive actions accompany 
each other in the opposite sides of the heart: (1) The two veins swell; 
(2) The two auricles are excited ; (3) The two ventricles are filled 
with blood ; (4) The two arteries take up and continue this pulsating 
action of the heart. It is thus that the two hearts assist and support 
the actions of each other, and there seems almost a physical necessity 
for their being joined ; yet on the very best authority, and after delibe- 
rate dissection, we are entitled to affirm, that the heart is found, not 
with its apex sharp and conical, but cleft ; the two ventricles plainly 
distinct from each other, and divided by a great space* 
OF THE PARTS OF THE HEART. 
* Lati’O, quas pcenas scelerum luebat quarnlo excnteraretur a carnifice, cor iiabuji 
singular!* figur®, mucrone non acuto, ut fieri solet, scd bifkto; ut. distinct! ventriculi 
manifestos externa facie apparuerint, dexter nempc ei sinister, interjecto magno hiatn.— 330 
OF THE MECHANISM 
As yet I have explained only the general plan of the circulations 
without having described those curious parts which are within the 
cavities of the heart, and which support the actions in this beautifii! 
harmony and perfect order, each part subordinate to some other part, 
and each action succeeding some other action with perfect correctness, 
often without one unsteady motion or alarming pause, during the course 
of a long irregular life. 
1. The venjj cavjs are two in number ;* they are named venae 
cavae from their very great size: the one brings the blood from the 
upper, and the other from the lower part of the body, and they are 
formed of these branches: the upper vena cava (a) is properly termed 
the descending cava, because it carries the blood of the head and arms 
downwards to the heart: this great vein is properly a continuation of 
the right jugular vein, which joins with the right axillary vein, and then 
descends into the chest a great trunk : and in the upper part of the 
chest it is joined at (b)—by a great branch, containing the axillary 
and jugular veins of the left side, which, in order to reach the cava 
crosses the upper part of the chest, and lies over the carotid arteries. 
The lower vena cava, or cava ascendens, brings in like manner all 
the blood from the belly and lower parts of the body by two great, 
branches. One, marked (c),—is the vein which lies in the belly along 
the right side of the spine, and brings the blood from the legs, the 
pelvis, and parts of generation, the kidneys, &c. ; it is named the 
vena cava audominalis, because of its lying in the abdomen. Another 
marked fddd),—arises in three or four great branches from the liver ; 
it is named the branches of the vena cava in the liver, or the vena 
cava hbfatica ; and these two make up the lower cava : and the 
lower and the upper cavse now join themselves at (e),—to form the 
right sinus of the heart. 
2. The right sinus of the heart, marked (e),is of considerable 
extent; it is just the gradual dilatation of the two veins forming the 
auricle or reservoir which is incessantly to supply the heart; the veins 
grow stronger as they approach the sinus, and the sinus still stronger 
as it approaches the auricle or notched and pendulous part (f), and 
the auricle again approaches in it3 nature to the ventricle of the 
heart: for it is crossed with very strong muscular fibres, which make 
very deep risings and furrows upon its inner part. To say that these 
veins, or the sinus which they form, are not muscular, merely because 
they are not red nor fleshy, is very ignorant; for the uterus, arteries, 
intestines, the iris, and many other parts of the human body, are, at 
the same time, perfectly muscular and perfectly pale ; and the heart 
of a fish is as transparent as a bubble of water, and yet so irritable that 
after it is brought from market, if you lay open the breast, and stimu- 
late the heart with any sharp point, it will renew its contractions, and 
in some degree the circulation. 
Bartbolini Epist. p. 170. There are examples in the lower animals, of the hearts being 
actually in distinct parts of the System. 
♦ Let the reader observe, that the whole of this description of the various parts of the 
heart is, as it were, an explanation of the plans : of which the lirst shows the right side 
of the heart, or the heart of the lungs opened ; while the second shows only the left 
heart, or the heart of the body opened. OK THE HEART. 
331 
3. The tuberculum Loweri should he looked lor in this point, if 
it were not really an imagination merely of that celebrated anatomist. 
The whole matter is this ; the two veins meet, not directly, but at a 
considerable angle within the vein, as at (g). Lower conceived a 
projection of the inner coats of the vein at this point much more con- 
siderable than what I have here represented. It was thought to do 
the office of a valve, to break the force of the descending blood, to de- 
fend from pressure that blood which is ascending from the lower cava, 
and to direct the blood of the upper cava into the right auricle of the 
heart; and in the place appointed for finding this tuberculum Loweri 
we can find nothing but on the inside the natural angle of the two veins, 
and on the outside some fat cushioned up in that angle in the line (h). 
Though generally wanting, I have found the tuberculum Loweri very 
distinct in the human heart. If we must assign a use for this angle 
and this inclination of the veins, it is certainly to direct the two streams 
of blood which meet here towards the opening of the ventricle. 
4. The auricle is, as I have said, a small appendix to the great 
bag or sinus, and is marked (f). It is small, semicircular, notched or 
scolloped, and somewhat like a dog’s ear; whence its name. In 
general, we name the whole of this bag auricle ; but by this plan the 
names of sinus and auricle must be easily understood. The point 
chiefly to be noted is this, that the veins, as they approach the auricle, 
are thin, delicate, transparent; that where they expand into the sinus 
they become fleshy, thick, and strong ; that in the auricle itself the 
muscular fibres at (f) are very strong, have deep sulci like those of the 
ventricle ; these strong fibres (f) are what are named the musculi pecti- 
nati auriculae. Where these muscles run, as in cords, across the 
auricle, they are very thick and opaque ; but in the interstice of each 
stripe or muscular fibre, the auricle is transparent, like the membranes 
of the veins ; and when you look on the inner surface of the auricle, 
they stand out so distinct, and get so regular, that they have a resemblance 
to the teeth of a comb ; and thus they are named husculi pectinati, 
5. The valves of the auricle are placed at the circle (i), where the 
auricle enters into the ventricle, and the valves are marked (k); and 
how necessary these are for regulating the movements of the heart 
will be easily understood by considering the conditions in which the auri- 
cle and ventricle act. First, the cavae pour in a floor! of blood 
upon the sinus and auricle, with a continual pressure ; the moment 
the auricle has contracted, it dilates, and it is full again; the 
pressure from behind excites it to act, and while it is acting, there 
is no occasion for valves to guard those veins whose blood is pressing 
forwards continually, because they are continually full, and have behind 
them the whole pressure of the circulating blood. But when the auri- 
cle acts, it throws its blood into the ventricle, fills it, and stimulates it; 
the auricle then lies quiescent for a moment, while it is gradually fill- 
ing from behind with blood ; but during this quiescent state the whole 
blood from the ventricle would rush back into it, were it not guarded 
by valves. The valves, then, which rise whenever the ventricle 
begins to act, are of this kind : there is, first, a tedinous circle or hole. 332 
OF THE MECHANISM 
by which the auricle communicates with 
the ventricle. I. It is called the annu- 
lus venosus, being that tendinous ring 
of the ventricle which is towards the 
venous system. The opening, 2. os- 
teum venosum,* is large enough to ad- 
mit two or three fingers to pass through 
it; it is smooth, seems tendinous, is 
plainly the place of union between the 
auricle and ventricle, which are in the 
fcetus (in the chick for example,) distinct 
bags; and from all the circle of this hole 
arises a membrane, thin, and apparently delicate, but really very strong; 
not divided into particular valves at this root or basis, but as the mem- 
brane hangs down into the ventricle, it grows thinner and is divided 
into fringes. How these 
fringes can do the office of 
valves is next to be explain- 
ed. The tags and fringes of 
this membrane are actually 
tied to the inside of the ven- 
tricle by many strings, which 
being like the valves, of a 
tendinous nature, are called 
cordjE tendineje, or tendi- 
nous cords; and these cords 
being attached to little pro- 
cesses projecting from the muscular substance of the heart, these pro- 
cesses are named column.® carjve.e, or fleshy columns. Of these 
tyings of the valves there are three chief points; the whole circle 
seems to be divided into three sharp-pointed valves : they are named 
valvul.e tricuspides, or three pointed, or they are still sometimes call- 
ed Triglochine Valves. The valves fall down easily when the blood 
goes down through them, and they rise readily and quickly whenever 
the blood gets behind them : when the ventricle is full, the valves arc 
still open ; but when the ventricle contracts, the blood throws up the 
valves, and closes the opening into the auricle; and now the tendinous 
cords and fleshy columns support the margins of the valves, so that 
they give them strength to support the heart’s action. 
6. The ventricle of the right side (11) is, like its auricle, larger 
than the same parts on the left side ; for this auricle and ventricle of 
the right side have the weight of the whole blood of the body pressing 
upon them. They are subject to occasional fulness, for they must be 
dilated by many accidents, as labour, violent struggles, &.C., which 
send the blood too quickly upon the heart; while the left auricle and 
ventricle, on the other hand, can never be overloaded, as long as the 
pulmonic artery preserves its natural size, for that artery continues al- 
* The figure represents the osteuru venosum and tricusped valve cut out. The stringy 
appearance is foriued by the cord® tendinex, and the pendulous portions are the column* 
earpese, which in their natural place are connected with the substance of the ventricle. OF THE HEART. 
333 
ways the measure of the quantity of blood which they receive. The 
ventricle is thick, strong, fleshy. Its inner surface is extremely irregu- 
lar ; it puts out from every part of its surface very strong fleshy columns. 
These fleshy columns are irregular in size, big, strong, running along 
the length of the ventricle ; some cross the ventricle, so as to connect 
its opposite walls together ; some have the tendons of the valves fixed 
to them: all of them have perfect contractile power, and are, indeed, 
the strongest muscles of the heart. Between the fleshy columns, there 
are, of course, very deep and irregular grooves ; and among the con- 
fused roots of these fleshy columns the blood often coagulates, after 
death, into the form of what are called polypi of the heart. Yet still 
the walls of the right ventricle are thinner, the fleshy columns smaller, 
the cavity greater, than those of the left side ; the right ventricle of the 
heart has also a peculiar form for the septum cordis,—a partition 
between the right and left heart, is not, as generally supposed, a part 
common to both ; but the left ventricle is longer and more conical than 
the right one; the septum belongs almost entirely to the left ventricle; 
the right ventricle, which is much bigger, laxer, flatter, and thinner, in 
the walls, is, as it were, wrapped round the left; and thus the left ven- 
tricle alone forms the acute apex of the heart, and the left ventricle 
of necessity bulges very much into the cavity of the right, since the 
right ventricle is so much larger, and in a manner wrapped round it. 
In both ventricles, it is very remarkable, that towards the opening of 
the auricle, the surface of the ventricle is very rugged, irregular, and 
crossed with columnas carneae, while a smooth and even lubricated 
channel leads towards the artery. 
7. The pulmonic artery arises from the right ventricle, to carrv 
out the blood close by the great opening at which the auricle pours it 
in ; the artery arises at its root in a very bulging triangular shape. It 
is the valve within the mouth of the artery that gives it this very pe- 
culiar shape without; for the bulging root is divided into three knobs, 
indicating the places of the three valves, the artery dilating behind 
each valve into a little bag, which, when it is described, is called its 
sinus. 
8. This valve of the pulmonic artery has a more perfect and 
simple form than that of the auricle. The valves in the mouth of each 
of the great arteries are three in number; they are thin but strong 
membranes, arising from the circle of the artery, where it come3 oft* 
from the heart: each valve is semilunar; its larger and looser edge 
hangs free into the cavity of the artery ; the edge is a little thicker 
than the rest of the valve ; the three valves together form one perfect 
circle, which closes the mouth of the artery so that no grosser fluid, 
nor hardly air, can pass. When they are filled till they become very 
tense, each valve forms a kind of bag ; so that when you look at the 
mouth of a dried artery, they appear like neat round bags ; and when 
they are likely to be forced, the little horns or tags by which each valve 
is fixed into the coats of its artery, becomes so tense as to do the office 
of a ligament; these are called the semilunar or sigmoid valves. 
Now, the condition of the ventricle while it is contracting is well 
understood : the auricle by its action lays down the tricuspid or au- 
ricular valve, and fills the ventricle : the ventricle cannot feel the 334 
OF THE JIECirANXSM 
stimulus of fulness till its valves rise, and its cord.-e tendincce begin to 
pull; and the ventricle could not be close for acting, nor its walls 
perfect, it could not in short be an entire cavity, till the tricuspid or 
auricular valves were completely raised. But there is another open- 
ing of the ventricle, viz. that into the artery, which must be also shut: 
this is one of the several instances of the subordination of these actions 
one to another ; for, first, the auricle acts, then the ventricle, then the 
artery ; so that the auricle and the artery are acting in the same 
moment of time ; the artery by acting throws down its valve, and closes 
that opening of the ventricle, while the auricle is filling it with blood : 
and again, the moment that the ventricle is filled, both the auricle and 
artery are in a state of relaxation ; the auricular valve rises so as to 
close the ventricle on that side, and the arterial valve falls down, both 
because the artery has ceased acting, and because the valve is laid flat 
by the whole blood of the ventricle rushing through it. Hence it is 
very obvious, that the right ventricle could neither be filled or stimu- 
lated, unless the opening toward the artery were closed during the time 
of its filling ; and again, it is obvious that this valve cannot be laid down 
by any other power than that of the artery itself: who then can doubt 
that the artery has in itself (like the ventricle) a strong contractile 
power ? That it is the stroke of the artery succeeding that of the heart, 
that lays down this valve so closely, is proved by this, that in many 
animals, in fishes, for example, the aorta is as plainly muscular as the 
heart itself, — it is like a second heart; and in fishes the vessel return- 
ing from the gills, and often in human monsters, the artery alone, by 
its own muscular power, moves the whole circulation without any com- 
munication with the heart. In fishes there is no second heart for the 
circulation of the body; and in monsters the heart is sometimes wanting, 
and there is found nothing but a strong aorta to supply its place. This 
stroke of the pulmonic artery, then, (which the heart excites,) pushes 
the blood through the lesser circle or circulation of the lungs, and by 
the pulmonic veins it is poured into the left side of the heart. 
9. The LEFT aukicle of the heart is unlike the right auricle in these 
respects : the sinus, or that part which consists of the dilatation of the OP THE HEART. 
335 
pulmonic veins, is smaller; while the auricula, which is the more 
muscular part, is larger ; the pulmonic veins come in four great trunks 
from the lungs, two from the right side and two from the left; two 
great veins then enter at each side of the left auricle, by whicli it gets 
a more square form ; the whole of the left sinus, which forms the chief 
bulk of this part, is turned directly backwards towards the spine, and 
is not to be seen in any common view of the heart; but [ have here 
added a plan of the back part of the heart,* showing 1, How the left. 
ventricle lies behind ; 2. How the left auricle is turned still more 
directly backwards ; 3. How the pulmonic veins enter into it in four 
great branches, so as to give a square or box-like form, compared 
with the gliding, gentle shape of the right auricle; 4. How the pul- 
monic artery comes out from under the arch of the aorta, dividing into 
its two great branches for each side of the lungs; and, 5. How the 
aorta arches over it, towers above all the other vessels, and is known 
always among the vessels of the heart by the carotid and subclavian 
arteries which come off from its arch. On the plan, (p. 334.) are 
seen—(oo) the two pulmonic veins entering from each side of the lungs 
—(pp) the opening of these into the auricle—(qq) the sinus formed in 
part by the dilatation of these veins, and,—(rjthe auricula or little 
ear, from which the whole bag is named auricle. 
10. The valves which guard the left auricle arc seen heret (ss) - 
Now, it is to bo remembered that the left auricle is smaller than the 
right; that the circle or opening of the left auricle is of course smaller 
than that of the right; that while it requires a valve divided into three 
points to fill the opening of the right auricle, a valve divided only into 
* Explanation of the back view of the heart. 
1. The left Ventricle—2. The left Auricle—3 3 33. The four Pulmonic Veins— 
4 4. The two great branches of the Pulmonic Artery—5. The Aorta—6. The Carotids 
and Subclavians—7. The Cava Descendens—8. The Cava Aacendens, with all its 
branches from the Liver—9. The great Coronary Vein running along the back of the 
Heart between the Auricle and Ventricle in a groove surrounded by fat. 
t This begins the description of the left side of the heart, and the description follows 
the plan, p. 334. 336 
of tub Mechanism 
two poults suffices for the opening of the left auricle: this is the 
reason of this slight variety of shape between the two auricular valves, 
and is also the reason of the valve of the right side being called tri- 
cuspid or three-pointed, while this of the left side, from some very 
slight resemblance to a mitre, is named valvula mitralis, the mitral 
valve, fn all other points this valve is the same with that of the 
right side ; it has the same apparent thinness, for it is even transparent; 
the same real strength ; the same columns carneje and tendinous 
strings to support it; the same rough irregular surface towards the 
opening of the auricle ; the same smooth gutter leading towards the 
artery. The constitution of all these parts, in short, is expressly the 
same; so that even concerning the left ventricle there is nothing 
further to be observed, but that while it is much longer than the right 
ventricle, it is much smaller in its whole cavity, is much stronger in its 
columns carneje, and much thicker in its fleshy walls; as at (tt) 
where it is seen to be thicker than the right ventricle, it is indeed 
nearly three times as thick. 
11. The semilunar valves of the aorta are also seen in this general 
plan at(u)—where manifestly the general structure and general inten- 
tion of the valves are the same as in those of the puimomc artery ; but 
still we find at every point marks of superior strength and more violent 
action in the left side of the heart; for though this valve be expressly 
like that of the pulmonic artery, and named like it, semilunar, yet it is 
thicker and stronger in its substance, and is peculiarly guarded by three 
small hard tubercles, which being placed one in the apex or point of 
each valve, meet together when the valve is close, and give a more 
perfect resistance to the blood, and prevent the valve being forced 
open. These are to be seen chiefly in the marginal drawing, (p. 337) 
and from their being of the size of sesamum seeds, they have the 
name of corpora sesamoidea ; sometimes they are named Corpuscula 
Arantii. 
12. The aorta arises from its ventricle very large and strong; it 
swells still more at its root than the pulmonic artery does ; the three 
subdivisions of this swelling, which mark the places of the semilunar 
valves, are very remarkable ; the curvature at the arch of the aorta is 
called its great sinus, and these three smaller bags are called the three 
lesser sinuses of the aorta. 
But there still remains to be explained that peculiar circulation by 
which the heart itself is nourished ; and yet there is nothing in it very 
different from the usual form of arteries and veins : it is a part of the 
general circulation of the body ; 
for the heart is nourished by the 
two first branches which the aorta 
gives off. The circulation des- 
tined for the nourishment of the 
heart is peculiar in this chiefly, 
that the forms of the arteries and 
veins of the heart are beautiful, 
and that the arteries rise just un- 
der the valves of the aorta, while 
the veins end writh one greaf 
OF THE CORONARY VESSELS. OP THE HEART. 
337 
mouth m the right auricle. The coronary arteries are two in number, 
of the size of crow-quills; we see from the inside of the artery their 
mouths opening above the sigmoid valves. One artery comes from 
the lower side of the aorta; it lies towards the right; it belongs 
chiefly to the right ventricle ; it comes out first between the roots of 
the aorta and pulmonic arteries ; it passes in the furrow between the 
right ventricle and auricle, and turning round arrives at the back part 
of the heart, and runs down along the middle of that flat surface which 
lies upon the diaphragm ; and when it arrives at the apex of the heart, 
its extreme arteries turn round the point and inosculate with the op- 
posite coronary. The other coronary belongs in like manner to the 
left side of the heart, and arises from the upper side of the aorta ; it 
first goes out between the pulmonic artery and the left auricle, and 
then turning downwards upon the heart, it runs along that groove 
which is between the ventricles, and marks the place of the partition 
or septum ventricolorum ; its chief branches turn towards the left 
ventricle, and branch out upon it; it belongs as peculiarly to the left 
side of the heart as the other does to the right side : after supplying 
the left ventricle, &c. it turns over the point of the heart to meet the 
extremity of the first, and inosculate with it. Both these arteries give 
branches not only to the flesh of the ventricles, but to the auricles, 
and also to the roots of the great arteries, constituting the vasa vaso- 
kum, as such minute branches sent to vessels are called. 
The great coronary vein which collects the blood of these 
ries, arises in small branches all over the heart; these meet so as to 
form a trunk upon the fore part of the heart, where the septum or 
union of the ventricles is. While small, the veins accompany their 
respective arteries ; but after the great trunk is formed, the vein takes 
its own peculiar route. When the trunk of the great coronary vein 
(accompanied by several lesser veins) arrives at the auricle, it runs in 
between the left auricle and left ventricle ; it turns all round the back 
of the auricle till it gets to the right side of the heart; it lies in the 
deep groove between the auricle and ventricle, surrounded with much 
fat; and having almost entirely encircled the heart, it discharges its 338 
OV THE NEC HA'S ISM 
blood into the right auricle, close by the entrance of the lower cava. * 
The opening is very large ; it lies just above the tendinous circle of 
the auricle, and it is guarded with a strong semilunar valve. This is 
the great coronary vein ; all the veins which appear upon the heart 
are but branches of it; what are called the middle vein of the heart, 
the vein of the right auricle, the vena innominata, &c. are all but 
branches of the great coronary vein running along the right side or 
lower surface of the heart; if there were to be any marked distinction, 
it should be into the great coronary vein belonging to the left side 
of the heart, and the vena innominata belonging to the right side. 
But one thing more is to be observed, viz. that upon the inner surface 
of the right auricle may be seen many small oblique and very curious 
openings, which serve for the mouths of veins, while their obliquity 
performs the office of a valve. This name of coronary vessels is a 
very favourite one with anatomists, and is applied wherever vessels 
surround the parts which they belong to, however little this encircling 
may be like a crown ; and it is thus that we have the coronary arteries 
of the stomach, coronary arteries of the lips, and coronary arteries 
of the heart. But these vessels of the heart are really very beautiful, 
and have some things very peculiar in their circulation : first, with 
regard to the coronary arteries, they lie with their mouths under the 
sigmoid valves ; or at least, in so equivocal a manner that their pecu- 
liar posture has given rise to violent disputes; viz. whether they be 
filled, like all other arteries, by the stroke of the heart, or whether 
they he covered by the valve so as to let the blood rush pass them 
during the action of the heart. 
We see the opening of the coronary arteries! rather, as 1 imagine, 
under the valve; though Haller says they are above the valve, and 
* This is the aorta inverted, so as to show the semilunar valves.—(a) One of the 
valves—(b) Corpus scsamoideum—(c) Opening of the coronary artery, 
t Sketch of the arch of the aorta with the coronary arteries-. OF THE irEARi. 
339 
that the highest point to which the margin of the valve reaches in very 
old men is below the opening of the coronary artery, and half way 
between it and the bottom of the sinus or little bag behind the valve. 
But let this be as it will, if the condition of the aorta be considered, 
it will be found to make no difference ; for though the valves rise and 
fall, are at one time fully opened, and at another time closely shut, 
still in both these conditions of the valve, the aorta is as full as it can 
hold ; its contraction instantaneously follows that of the heart, but its 
contraction is not, like that of the heart, such as to bring its sides 
together ; on the contrary, the aorta is full when the heart strikes, the 
action of the heart distends it to the greatest degree, the aorta re-acts 
so as to free itself of this distension, but still it remains in some degree 
full of blood; else how could this, like every other artery, preserve 
always its form and apparent size ? In this condition of matters, it is 
obvious that the coronary branches are on the same footing with all 
the other branches of the aortic system ; that, like all the other arteries, 
they first feel the stimulus of fulness from the push of the heart, and 
along with it the stroke of the aorta. 
Secondly, with re- 
gard to the coronary 
veins a dispute has ari- 
sen more violent than 
this : for it has been 
doubted whether the 
coronary veins, large 
as they are, do actually 
convey the whole of the 
blood which the coronary artery gives out.* Veussens believed that 
some of the coronary arteries opened directly into the cavities of the 
heart, without the interposition of veins. Thebesius, after him, be- 
lieved that there were some shorter ways by which the blood was 
returned; not by a long circle into the right auricle, but directly into 
the ventricles of the heart. Veussens, Thebesius, and others who 
belonged to their party, pretended to prove this fact by injections : 
but what doctrine is there which such clumsy anatomy and awkward 
injections may not be made to prove ? They used mercury, tepid 
water, and air; and they forced these, the most penetrating of all in- 
jections, till they exuded upon the inner surface of the heart; but if 
they had fixed their tubes, not into the coronary artery, but into the 
aorta, and had proceeded to inspect, not the heart, but all the viscera 
of the body, they would have found their injections exuding from 
every surface ; of the pleura and lungs ; of the peritoneum and in- 
testines ; of the brain and dura mater; of the mouth and tongue ; 
and universally through the cellular membrane of the whole body; 
but if any coarse injection, as tallow or wax, be used, following this 
natural course, it keeps within the arteries and veins, and if thin and 
well prepared, finds its way back to the auricle of the heart; but 
* In this cut the aorta is opened at its origin, and the semilunar valves exhibited-. 
The openings of the mronarv arteries are seen above the margins of the valve's. 340 
OF THE MECHANISM 
this injection also is extravasated, and is found in the cavities of the 
heart. 
Du Verney was so far engaged in this question, that having an op- 
portunity of dissecting the heart of an elephant, he tied up the coro- 
nary arteries and veins, washed and cleaned very thoroughly the cavi- 
ties of the heart; and then tried, by squeezing, and all kinds of 
methods, to make that blood which was tied up in the coronary 
arteries and veins exude upon the inner surfade of the heart, but with 
no effect. 
On the present occasion, a theoretical answer happens to be as 
satisfactory as the most correct experiments : and it is this. If there 
really wTere to be formed (by disease, for example,) those numerous 
openings which Thebesius and Yeussens describe, then the blood 
flowing all by these shorter afid easier passages, none could come to 
the great coronary vein ; its office would be annihilated ; and itself, 
contracting gradually, would soon cease to exist. 
OF THE EUSTACHIAN VALVE. 
There remains to be explained in the mechanism of the heart one 
point; and which I have separated from the others ; not because it is 
the least important, but because it is the most dillicult, and, if I may 
be allowed to say so, not yet thoroughly understood ; I mean the ana- 
tomy of the Eustachian valve ; which, if it had been easily de- 
scribed, should have been first described ; for it is a valve which lies 
in the mouth of the lower cava, just where that vein enters the right 
auricle of the heart. How imperfect a valve this is, how difficult to 
dissect or to explain, may easily be known from this, that Winslow 
was first incited to look for the valve by some hints in Sylvius : he 
was soon after fairly directed to it by finding it in the tables of Eusta- 
chius, which were then first found and published by Lancisi, after tho 
author had been dead 150 years ; and yet with all this assistance, 
Winslow sought for it continually in vain, till at last he reflected, that by 
cutting the heart in its fore part, he must have always in his dissections 
destroyed any such valve ; by opening the back part of the cava, he 
at last saw the valve, and dem onstrated it to the Academy of Sciences 
in France ; and having just ri 'eivcd from Lancisi his edition of the 
Eustachian Table, so lo.ig hidden, and since so outrageously praised, 
he called it valvula Eustachiana, a name which it has retained to 
this day, and he added reticularis, to express its lace-like netted 
appearance at its upper edge. 1 rom Winslow's time to this present, 
day, that is, for eighty years, there has been no good drawing, nor 
even any perfect description of the valve ; and in the confusion of 
opinions upon the subject, what its use may be no one knows. 
The Eustachian valve lies in the mouth of the ascending cava, just 
where that great vein is joined to the auricle of the heart. It looks as 
if formed merely by the vein entering at an acute angle, and by the 
inner edge of the vein, or that which is joined to the auricle, rising 
high, so as to do the office of a valve. The very first appearance of 
the valve, and its place just over the mouth of the cava, seems to point 
out that use which Lancisi has assigned it, viz. to support the blood of OF THE HEART 
341 
the upper cava, and prevent that column of blood which descends 
from the cava gravitating upon the opposite column which comes 
from the liver and lower parts of the body ; and yet this, most likely, 
is not its use. The valve somewhat resembles a crescent, or the 
membrane called hymen. It occupies just that half of the cava which 
is nearest the auricle. Its deepest part hangs over the mouth of the 
cava, and is nearly half an inch in breadth, seldom more, often less, 
sometimes a mere line. Its two horns extend up along the sides of the 
auricle ; the posterior horn arises from the left of the isthmus, as it is 
called, or edge of the oval hole ; its anterior horn arises from the vena 
cava, where it joins the auricle. Behind the valve the remains of the 
foramen ovale may be seen, now shut by its thin membrane, but still very 
easily distinguished ; for its arch-like edges are so thick, strong, and mus- 
cular, that they look like two pillars, and thence are called the columns 
for am ims oval is : these two pillars were called isthmus Vieussemi, 
and by Haller are named anxulus fossjg ovalis, while the remains 
of the hole itself is so deep that it is named the fossa ovalis. Before 
the Eustachian valve, lies the great opening into the ventricle ; but 
between that and the valve there is a fossa or hollow, in which lies the 
opening of the great coronary vein ; and the valve which covers the 
coronary vein is a neat small slip of white and very delicate mem- 
brane, the one end of which connects itself with the fore part of the 
Eustachian valve ; so that both valves are moved and made tense at 
once. 
The Eustachian valve is sometimes reticulated or net-like even in 
the foetus, but by no means so often as to vindicate Winslow, in adding 
reticulare to the name; it grows reticulated chiefly in the adult. The 
only beautiful drawing that we have of a reticular Eustachian valve 
is in Cowper ; and that was from a man of eighty years of- age. 
Perhaps in eight or ten hearts, you will not find one that is reticulated 
in the least degree ; in old men it is reticulated, just as all the other 
valves of the heart are, not by any thing peculiar to the constitution 
of this valve ; not by the pressure of the blood and continual force 
of the vessels, as Haller represents ; but by the gradual absorption 
which goes on in old age, and which spares not the very bones ; for 
even they grow thin, and in many places transparent. 
This is the simple description of a valve, which has been the occa- 
sion of more controversy than the circulation of the foetus and the use 
of the oval hole. Winslow first began about eighty years ago to ob- 
serve the connections and uses of this valve ; he laid it down as an 
absolute fact, that this valve was almost peculiar to the foetus ; that it 
was perfect only while the foramen ovale was open ; that it vanished 
gradually as the foramen ovale closed ; that in the adult it was seldom 
seen, unless the foramen ovale was also open by chance. It is incre- 
dible what numbers of anatomists followed this opinion ; for the diffi- 
culty of dissecting the valve made it always easier to say that it was 
only in the foetus that it could be found: it is also incredible what ab- 
surd consequences arose from this doctrine, which, after all, is but a 
dream ; for in fact the valve is more easily shown in the adult heart.* 
* One author, I find in the Acta Vindohonensia, is exceedingly ans;ry indeed with all 342 
Of THE MECHANISM 
The foundation being now laid for connecting this valve with the 
peculiar circulation of the foetus, they conceived the following theory, 
which has come down to this very day ; viz. that in the child the great 
object of nature, in arranging its vessels, was to convey the blood 
which came fresh from the mother’s system directly into the carotids, 
and so plump into the head at once. The pure blood from the mother 
comes through the liver by the ductus venosus ; it is deposited in the 
lower cava at the right side of the heart; and these anatomists sup- 
posed that this current of fresh blood was directed by the Eustachian 
valve into the oval hole, through that into the left auricle and ven- 
tricle, and from these directly into the aorta and carotids ; while the 
foul blood of the upper cava went down into the right auricle and 
ventricle, and from that into the ductus arteriosus, and so away down 
to the lower and less noble parts of the body, and to the umbilical 
arteries, and so out of the system ; for the ductus arteriosus, which 
comes from the right ventricle in the foetus, joins the aorta only as it 
goes down the back, and none of its blood can pass upwards into 
the head. 
This is the theory which, modified in various ways, has amused the 
French Academy, or, rather, been the cause of a perpetual civil war 
in it, for a hundred years. This doctrine began with Winslow, it is 
still acknowledged by Sabbatier ; and Haller, after announcing a 
theory not at all differing from this, challenges it as his own theory ; 
“ hanc meam conjecturam etiam a Nichols video proponi.” Ol' the 
truth of this theory Haller was so entirely satisfied, that he not only 
published it as peculiarly his own, but reclaimed it when he thought it 
in danger of being thus appropriated by another. Sabbatier is the last 
in this train of authors ; and in order that there might remain no am- 
biguity in what they had said or meant, he pronounces plainly that the 
Eustachian valve is useful only in the fetus, and that there are two op- 
posite currents in the right auricle of the heart; that the one goes 
from the lower cava upwards to the foramen ovale, while the other 
from the upper cava descends right into the opening of the ventricle. 
What shall we say to anatomists who in the narrow circle of the auricle 
conceive two currents to cross each other directly, and to keep as 
clear of each other as the arrows by which such currents are usually 
represented ? This error in reasoning is below all criticism ; it car- 
ries us backwards a hundred years in anatomy and in pin sics; and 
yet this is all that Winslow, Ilallcr, Sabbatier, and many others, have 
been able to say in proof of the connection of the Eustachian valve 
with the circulation of the fetus. 
the great anatomists, for not connecting more strictly with each other the anatomy and 
accidents of the foramen ovale and Eustachian valve; with Morgagni, Alhinus, and 
Wietbrecht, he is offended for saying that they had seen the foramen ovale open, without 
saying one word concerning the state of this valve; and with Lieutaud, Portal, and 
others again, he is equally offended that they should have had opportunities of seeing 
the Eustachian valve entire without inquiring into the condition of the oval hole. The 
reason of all this is very plain : the oval hole had not been open, neither in the one 
situation nor in the other, else it is very unlikely that sueh correct and anxious anato- 
mists should have described that valve which arises Irnm one of the borders of the oval 
hole, without observing it if it was so ; especially as the ovale hole, being open, 
is by no means an usual occurrence. OP THE HEART. 
343 
Lancisi, again, believed that it was chiefly useful by supporting the 
blood of the lower cava, defending it from the weight of that column 
of blood which is continually descending from above ; and Winslow 
and others approved of this, as being, perhaps, one use of the valve. 
But they have all of them forgotteu a little circumstance, which must 
affect the office of the valve, and which should have been regarded 
especially by those who said it was useful chiefly before birth ; they 
have forgotten a little circumstance, which John Hunter also forgot, 
when theorizing about the gubernaculum testis, viz. that the child lies 
with its head downmost for nine months in the mother’s womb.* 
Nothing is more certain than that the Eustachian valve is not pecu- 
liar to the foetus; that it has no connection with the oval hole; that 
the valve is often particularly large after the foramen ovale is closed ; 
that the valve is often obliterated where yet the foramen ovale remains 
open ; that in adults it is more easily demonstrated than in children ; 
that in old age it is often reticulated as the other valves are. Its use 
relates neither to the foramen ovale, nor to the ascending cava ; it re- 
lates to the auricle itself, and, therefore, it is found in all the stages of 
life, smaller or larger, according to the size or form of the heart. 
The auricle on the side towards the venae cavae is imperfect; the 
anterior part of the auricle chiefly is muscular, and when it contracts, 
the laxity of the cavae and the great width of the sinus venosus, i. e. 
of almost the whole auricle, would take away from its contraction all 
effect ; but to prevent this, and to make the auricle perfect, the vena 
cava and auricle meet so obliquely, that the side of the cava makes a 
sort of wall for the auricle on that side. This wall has entirely and 
distinctly the reticulated structure of the auricle itself, with fleshy bands 
of muscular fibres in it : this wall falls loosely backwards when the 
auricle is quite relaxed, as, for example, when we lay it open ; and thus 
it has got the appearance and name without the uses of a valve ; but 
when the heart is entire, tense, and filled with blood, this valve repre- 
sents truly a part of the side of the auricle : and that this part of the 
wall of the auricle should be occasionally a little higher or lower, looser 
or tenser, we need not be surprised. This further may be observed, 
that wherever, as in a child, this valve is very thin and delicate, the 
anterior part of the fossa ovalis goes round that side of the auricle par- 
ticularly deep and strong. Let it also be remembered, that in certain 
animals this valve is particularly large and strong; now, in a creature 
which goes chiefly in a horizontal posture, it may strengthen and make 
up the walls of the auricle (the chief use which I have assigned for it 
in man) ; but surely it cannot protect the blood of the lower cava from 
the weight of blood coming from above, since the body of an animal lies 
horizontally, and there is no such weight. The Parisian academicians 
describe the heart of the Castor in the following terms : “ Under the vena 
coronariawe find the valve called nobilis (viz. the Eustachian valve*), 
* I hare left these opinions as originally expressed by Mr. John Bell, because I think 
it right that the reader should have the opinions fairly before him. In what follows he 
gives his own opinion of the function of this membrane. Notwithstanding all that is 
•here delivered, I believe that the principal use of this membrane is to direct the blood 
during the fetal circulation, and that it remains as a mere ligamentous bond, strength- 
ening the auricle in the adult. 344 
OF THE ACTION 
which fills the whole trunk of the vena cava, and which is so disposed 
that the blood may be easily carried from the liver to the heart by the 
vena cava, but which is hindered from descending from the heart towards 
the liver through the same vein.” 
OF THE IRRITABILITY AND ACTION OF THE HEART. 
But even this curious mechanism of’ the heart is not more wonderful 
than its incessant action, which is supported by the continual influx of 
stimulant blood, and by its high irritability and muscular power ; for 
though we cannot directly trace the various courses of its muscular 
fibres, there is not in the human body any part in which the muscular 
substance is so dense and strong. In the heart there can be no direct 
or straight fibres; for let them go off from the basis of the heart in 
what direction tfiey may, still as they belong to the one or the other 
ventricle, they must, by following the course and shape of that ven- 
tricle, form an oblique line. Vesalius has, indeed, not represented them 
so, he has drawn straight fibres only; because in the latter end of his 
great work he was without human subjects, and betook himself to 
drawing from beasts. 
The fibres of the heart re all oblique, or spiral, some lying almost 
transverse ; they all arise from a sort of tendinous line which unites the 
auricle to the ventricle ; they wind spirally down the surface till the 
fibres of the opposite ventricles meet in the septum and in the apex of 
the heart. The fibres of each ventricle pass over the convex or upper 
surface of the heart, then over the apex, and then ascend along the fiat, 
side of the heart, which lies upon the diaphragm, till they again reach 
the basis of the heart. The second layer or stratum of fibres is also 
oblique ; yet many of the fibres run almost transversely, uniting the 
oblique fibres; but when wre go down into the thick substance of the 
heart, we find its fibres all mixed, crossed, and reticulated in a most 
surprising manner; so that we at once perceive both that it is the 
strongest muscle in the body, and that the attempt to extricate its 
fibres is quite absurd * Their desire of giving more correct and 
regular descriptions has been the cause why those who have particularly 
studied this point have been fatigued and disappointed ; the most sen- 
sible of them have acknowledged with Vesalius, Albinos, and Haller, 
that the thing could not be done ; while those, again, who pretended 
to particular accuracy, and who have drawn the fibres of the heart, 
have represented to us such extravagant, gross, and preposterous things, 
as have satisfied us more than their most ingenuous acknowledgments 
could have done, that they also could accomplish nothing. 
There is no question that irritability is variously bestowed in various 
creatures, that it is variously appointed in various parts of the body, 
that this property rises and falls in disease and health : without hesita- 
tion we also may pronounce that the heart is in all creatures the most 
irritable part ; it is the part first to live and the last to die: “ Pulsus et 
vita pari ambulant passu.” When we see the punctual saliens in the 
* Thickening the walls of the heart by vinegar, strong acids, alum, or boiling tbe 
heart, have assisted us in unravelling its structure but very little. OF Tilt HEART. 
345 
chick, we know that there is life ; and when we open the body of an 
animal soon after death, still the heart is irritable and contracts. 
In the very first days in which the heart appears in the chick, while 
yet its parts are not distinguished, and the punctual saliens is the only 
name we can give it, the heart, even in this state, feels the slightest 
change of heat or cold; it is roused by heat, it languishes when cold, 
it is excited when heated again. It is stimulated by sharp points or 
acids, it works under such stimuli with a violent and perturbed motion, 
in all creatures it survives for a long while the death of the body ; for 
when the creature has died, and the breathing and pulse have long 
ceased, and the body is cold, when the other muscles of the body are 
rigid, when the stomach has ceased to feel, when the bowels, which 
preserve their contractile power the longest, have ceased to roll, and 
they also feel stimuli no more, still the heart preserves its irritability ; 
it preserves it when torn from the body and laid out upon the table : 
heat, caustics, sharp points, excite it to move again. 
We know also another thing very peculiar concerning the irritability 
of this organ, viz. that it is more irritable on its internal than on its 
external surface ; for if instead of cutting out the heart we leave it con- 
nected with the body, seek out (as the old anatomists were wont to do) 
the thoracic duct, or pierce any great vein, and blow a bubble of air 
into the heart, it pursues it from auricle to ventricle, and from ventricle 
to auricle again, till, wearied and exhausted with this alternate action, 
it ceases at last, but still new stimuli will renew its force. 
Thus it is long after apparent drowning or other suffocation before 
the principle of life is gone, and long after the death of the body before 
the heart be dead ; and just as in this peculiar part of the system irrita- 
bility is in high proportion, there are in the scale of existence certain 
animals endowed in a wonderful degree with this principle of life. 
They are chiefly the amphibious creatures, as they are called, needing 
little air, which have this power of retaining life ; no stimuli seem to 
exhaust them, there seems especially to be no end to the action of their 
heart; a Newt’s or a Toad’s heart beats for days after the creature 
dies ; a Frog, while used in experiments, is often neglected and forgot- 
ten, its limbs mangled, and its head gone, perhaps its spinal marrow cut 
across, and yet for a whole night and a day its heart does not cease beat- 
ing, and continues obedient to stimuli for a still longer time. It seems 
as if nothing but the loss of organization could make this irritable 
muscle cease to act; or rather it seems as if even some degree of 
deranged organization could be restored : breathe upon a heart which 
has ceased to act, and even that gentle degree of heat and moisture 
will restore its action. Dr. Gardiner having left a turtle’s heart 
neglected in a handkerchief, he found it quite dry and shrivelled, but 
by soaking it in tepid water its plumpness and contractility were 
restored. 
Since then this irritable power supports itself in parts long after they 
are severed from the body, what doubt should we have that there is in 
the muscular fibre some innate contractile power.or vis insita indepen- 
dent of nerves ? And when we talk on a subject so difficult and so 
abstruse, what other proof can we expect or wish for than the power 346 
OK THE ACTION 
of one peculiar and insulated muscle surviving the separation oi the 
head and brain, the destruction of its nerves, or its total separation 
from that living system to which it belongs ? If the heart be the most 
irritable muscle of the body, if all this irritability arises from the nerves, 
how can it be that this muscle, which is thus announced as the most 
dependent on its nerves, is really the most independent? that the mus- 
cle which of all the body needs this nervous supply oftenest should 
want it the least, and should survive the loss of its nerves so much 
longer than the other muscles of the same body ? 
Although the ancients knew how irritable the heart was, although 
they often opened living creatures, and saw the heart struggling to 
relieve itself, because it was oppressed with blood, yet they continued 
entirely ignorant of the cause: and why the heart should alternately 
contract and relax without stop or interruption, seemed to them the 
most inexplicable thing in nature. Hippocrates ascribed it to the 
innate fire that is in the heart; Sylvius said, that the old and alkaline 
blood in the heart mixing with the new and acid chyle, and with the 
pancreatic lymph, produced a ferment there; Swammerdam, Pitcairn, 
and Freind, thought that the heart, and every muscle which had no 
antagonist muscle, was moved by a less proportion of the vital spirit 
than other muscles required. Others believed that each contraction 
of a muscle compressed the nerves of that muscle, and each relaxation 
relieved it; and that this alternate compression and relief of the nerve 
was the cause of the alternate movements of the heart: another phy- 
sician of our own country, a great mechanic, and a profound scholar 
in mathematics, and all those parts of science which have nothing to do 
with the philosophy of the human body, refined upon this theory most 
elegantly ; for observing that the nerves of the heart turned around the 
aorta, and passed down between it and the pulmonic artery, he ex- 
plained the matter thus: “ These great arteries, every time they are 
full, will compress the nerves of the heart, and so stop this nervous 
fluid, and every time they are emptied (a thing which he chose to take 
for granted, for in truth they never are emptied,) they must leave the 
nerves free, and let the nervous fluid pass down to move the heart.” 
Descartes, who studied every thing like a right philosopher of the 
old breed, viz. by conjecture alone, supposed that a small quantity of 
blood remained in the ventricle after each stroke of the heart; which 
drop of blood fermented, became a sort of leaven, and operated upon 
the next blood that came into the heart, “ like vitriol upon tartar ; so 
that every successive drop of blood which fell into the ventricle swelled 
and puffed up so suddenly as to distend the heart, and then burst out by 
the aorta. Philosophers have been so bewitched with the desire of 
explaining the phenomena of the human body, but without diligence 
enough to study its structure, that from Aristotle to Buffon, it is all the 
same, great ignorance and great presumption. But on this subject of 
the pulse of the heart, physicians almost surpassed the philosophers in 
the absurdity of their theories, till at last they were reduced to the sad 
dilemma of either giving up speaking upon this favourite subject, or of 
contenting themselves with saying, “ that the heart beat by its fbcults' 
pulsifica, its pulsatjve faculty.” OF THE HEART. 
347 
The ancients, I have said, often opened living creatures, and saw 
the heart struggling to relieve itself because it was oppressed with 
blood : this blood is itself the stimulus which moves the whole ; for 
important as this function is, it is equally simple with all the others : 
and as urine is the stimulus to the bladder, food an excitement to the 
intestines, and the full grown ftetus a stimulus to the womb;—so is 
blood the true stimulus to the heart. When the blood rushes into the 
heart, the heart is excited and acts; when it has expelled that blood, 
it lies quiescent for a time ; when blood rushes in anew, it is roused 
again : so natural is both the incessant action and regular alternation 
of contraction and relaxation in the heart. 
It is when we are so cruel as to open a living creature that we see 
best both the operation of the blood as a stimulus, and tire manner in 
which the heart re-acts upon it. When we tie the two venae cavae so 
as to prevent the blood from arriving at the heart, the heart stops ; 
when we slacken our ligatures and let in the blood, it moves again ; 
when we tie the aorta, the left ventricle being full of blood will con- 
tinue struggling, bending, turning up its apex, and contracting inces- 
santly and strongly, and will continue this struggle long after the other 
parts have lost their powers. One author, whether from his awkward- 
ness, or the -delicacy of the subject, or really from the strength of the 
ventricle, assures us, that often while he has held the aorta of a frog 
close with pincers, it has burst by the mere force of the heart. If, 
after violent struggles of this kind, you cut the aorta, even of so small 
a creature as an eel, it will throw its blood to the distance of three or 
four inches. 
Thus we not only know that we can excite the heart by accumula- 
ting blood in it, but that by confining the blood in it we can carry that 
excitement to a very high degree ; and, in short, by keeping the one 
or the other ventricle incessantly full of blood, we can make the one 
heart work continually, while the other lies quiet, or is only slightly 
drawn by the other’s motion, showing the true distinction between the 
heart of the body and the heart of the lungs. And this is a memora- 
ble fact, that it is not merely the stimulus of the blood, but the sense 
of fulness that makes the heart contract; for the auricle often beats 
twice or thrice, sometimes it makes its push four or five times, before 
it can force the ventricle to contract. 
When we empty the heart, and tie all its veins, all its parts cease to 
act; stimuli applied outwardly make it contract partially ; it trembles 
in particular fibres : but it is only letting in the blood, or blowing it 
up with air, that can bring it into full action again. When we look 
with cruel deliberation upon the strokes of the heart in any living 
creature, we observe that at first, during the full and rapid action of 
the heart, there is hardly any perceptible interval among the several 
parts ; but towards the end of each experiment, when the pulse flags, 
and the creature falls low, the swelling of the great veins, and the 
successive strokes of auricle and ventricle, are distinctly told. The 
dilatation and contraction of each part is what we cannot observe, 
they are so quick ; but these things we distinctly observe—the auricle 
contracts and dilates the ventricle: the ventricle contracts, subsides- 348 
OF THE ACTION 
anti fills the aorta; the aorta turns an<l twists with the lbrce of the 
blood driven into it, and by its own re-action, and the ventricle, every 
time that it contracts, assumes a form slightly curved, the point turn- 
ing up like a tongue towards the basis, and the basis in some degree 
bending towards the point. The basis, indeed, is in some degree fixed 
to the diaphragm and spine, but the heart in its contraction always 
moves upon its basis as upon a centre ; its ventricles, and especially 
its apex, are free ; the point rises and curves so as to strike against the 
ribs ; and the dilation of the heart is such (together with the posture 
and relation of its several parts), that during the dilation the heart 
turns upon its axis one way ; the contraction of the heart reverses 
this, and makes it turn the other way, so that it seems to work per- 
petually with the turning motions of a screw. All this is most stri- 
king, while we are looking upon the motion of the heart in a living 
creature. 
The posture of the human heart is very singular, and will illustrate 
this turning motion extremely well; for in the human heart the pos 
ture is so distorted, that no one part has that relation to another 
which we should beforehand expect. In the general system, the human 
heart is placed nearly in the centre, but not for those reasons which 
Dionis has assigned ; it is not in order that by being in the centre, it 
may feel less the difficulty of driving the blood to any particular limb 
or part of the body ; it is the place of the lungs that regulates the 
posture of the heart; and wherever they are, it is. Except the Oyster, 
I hardly know of any creature in which the heart lies expressly in the 
centre of the body. In Frogs, Toads, Newts, and Snakes, the lungs 
are not moved by any diaphragm : they are filled only by the working 
of the bag attached to the lower jaw, the lungs in them being under 
tiie jaws, and the heart is lodged at the root of the jaws, leaving, as in 
a Newt or Cameleon, Crocodile, Adder, Serpent, &c. the whole length 
of their trailing body behind. In a fish, the gills serve the creature 
for lungs : the gills are lodged under the jaws, and the heart is placed 
between them. In insects, as in the common Caterpillar, (the aurelia 
of our common Butterfly,) the air enters by many pores on its sides ; 
and accordingly its heart is not a small round bag, but may be easily 
seen running all down its back, working like a long aorta, but having 
regular pulsations, denoting it to be the heart: and this you easily see 
through the insect’s skin, for it is more transparent along the back 
where the heart is. 
The breast in man is divided into two cavities by a membrane named 
the mediastinum. This membrane passes directly across the breast 
from the sternum before till it fixes itself into the spine behind. It is 
on the left side of this membrane, in the left cavity of the breast, that 
the heart is placed, lying out flat upon the diaphragm, as upon a floor, 
by which it is supported : and that surface (a), which lies thus upon 
the diaphragm, is perfectly flat, while the upper surface (6), or what 
we usually call the fore part of the heart, is remarkably round. The 
whole heart lies out flat upon the diaphragm ; its basis (c), where the 
auricles arc, is turned towards the spine and towards the right side ; 
ihe apex (rf), or acute point, is turned forwards and a little obliquclv OF THE HEART. 
349 
towards the left side, where it strikes the ribs ; the vena cava (c) enters 
in such a manner through a tendinous ring of the diaphragm,* that it 
ties down the right auricle to that floor (as f may term it) of the tho- 
rax. The aorta (f) does not rise in that towering fashion in which 
it is seen when we take a dried-up heart, which naturally we hold by 
its apex, instead of laying it out flat upon the palm of our hand ; nor 
in that perpendicular direction in which hitherto, for the sake of dis- 
tinctness, I have represented it in these plans ; but the aorta goes out 
from its ventricle towards the right side of the thorax ; it then turns in 
form of an arch, not directly upwards, but rather backwards towards 
the spine ; then it makes a third twist to turn downwards; where it 
turns downwards it hooks round the pulmonic artery (g), just as we 
hook the fore fingers of our two hands within one another. The right 
heart (A) stands so before the other, that we see chiefly the right auri- 
cle and ventricle before, so that it might be named the anterior heart; 
the pulmonic artery (g) covers the root of the aorta ; the left ventricle 
(i), from which the aorta rises, shows little more than its point at the 
apex of the heart; the left auricle (fc) is seen only in its very tip or 
extremity, where it lies just behind the pulmonic artery ; and the aorta 
(_/) arises from the very centre of the heart. From this view any man 
may understand these vessels by other marks than the mere colours of 
an injection ; and he will also easily understand why the heart twists 
so in its actions, and how it comes to pass that its posture is difficult 
for us to conceive, no one part, having that relation to any other part 
which we should beforehand suppose. 
Let it be observed, that (e) in this drawing marks (he point where the lower cava 
was tied close upon the diaphragm, to prevent the injection going down into the veins 
of the liver and abdominal cavae. 350 
OF THU PERICARDIUM. 
OF THE PERICARDIUM.* 
But the pericardium, purse, or capsule, in which the heart is con- 
tained, affects and regulates its posture, and makes the last important 
point concerning the anatomy of the heart. It is a bag of considera- 
ble size and great strength, which seems to us to go very loosely round 
the heart, because when we open the pericardium, the heart is quite 
empty and relaxed ; but I believe it to surround the heart so closely 
as to support it in its palpitations, and more violent and irregular ac- 
tions ; for when we inject the heart, its pericardium remaining entire, 
that bag is filled so full that we can hardly lay it open with a probe 
and lancet without wounding the heart; and still further, when we open 
the pericardium before we inject the heart, the heart receives much 
more injection, swells to an unnatural bulk for the thorax that it is 
contained in, and loses its right shape. The pericardium is formed 
like the pleura and mediastinum, of the cellular substance ; it is rough 
and irregular without and fleecy, with the threads of cellular substance, 
by which it is connected with all the surrounding parts; within it is 
smooth, white, tendinous, and glistening, and exceedingly strong. As 
the heart lies upon the floor of the diaphragm, the pericardium, which 
lies under the heart, is connected with the diaphragm a little to the 
left of its tendinous centre, and so verv strongly that they are abso- 
lutely inseparable. The pericardium surrounds the whole heart, but 
it is loose every where except at the root of the heart, where it is con- 
nected with the great vessels : for the pericardium is not fixed into the 
heart itself, but rises a considerable way upon the great vessels, and 
gives to the roots of the vessels, which are seen on opening the peri- 
* Plan of the pericardium.— (a) Outside of the pericardium—(b\ part where 
the membrane is reflected on the heart— (e) the same membrane covering the substance 
of the ventricle. N. B.—The membrane, which is extremely thin, is represented thick 
and coarse, for the sake of illustration. Oi> THE VEttlCAKDIUM. 
351 
eardium, an outward coat, and surrounds each vessel with a sort of 
ring. For, 1st, It surrounds the pulmonic veins where they are enter- 
ing the heart; there the pericardium is short : 2dly, It mounts higher 
upon the vena cava than upon any other vessel; the cava of course is 
longer within the pericardium, and it also is surrounded with a sort of 
ring: 3dly, It then passes round the aorta and pulmonic artery, sur- 
rounding these in one greater loop : 4thly, The cava inferior is the 
vessel which is the shortest within the pericardium ; for the heart in- 
clines towards the horizontal direction ; it lies in a manner flat upon 
the upper surface of the diaphragm, while the lower surface of the 
diaphragm adheres to the upper surface of the liver. Thus it happens 
that the liver and the right auricle of the heart are almost in contact, 
the diaphragm only intervening ; thence the lower cava which passes 
from the liver into the right auricle of the heart cannot have any length. 
While the pericardium thus passes round the great vessels, it must leave 
tucks and corners; and these have been named the coknua, or horns 
of the pericardium. 
But there is another peculiarity in the form of the pericardium, 
which I have explained in this second plan ;* viz. that the pericar- 
dium constitutes also the immediate coat of the heart ; for the peri- 
cardium having gone up beyond the basis of the heart so as to sur- 
round the great vessels, it descends again along the same vessels, and 
from the vessels goes over the heart itself. I have marked the man- 
ner of this more delicate inflection of the pericardium at (aa), w here 
the pericardium is loose : at (&&), the angle where it is reflected ; and 
at (cc), where it forms the proper coat of the heart, and where it is 
intimately united to its substance. The pericardium, where it forms 
this coat, becomes extremely thin and delicate, almost cuticular, but 
strong ; under this coat the coronary arteries pass along in the cellular 
substance ; under it the fat is gathered sometimes in a wonderful de- 
gree, so as to leave very little to be seen of the dark or muscular colour 
of the heart. 
The pericardium, then, is a dense and very strong membrane, which 
I would compare with the capsule of any great joint, both in office 
and in form ; for it is rough and cellular without, shining and tendi- 
nous within ; bedewed with a sort of lialitus like the great joints : its 
uses are to keep the heart easy and lubricated by that exhalation which 
proceeds from its exhalant arteries (and which can be imitated so 
easily by injecting tepid water into its arteries); to suspend the heart 
in some degree by its connections with other parts, especially by its 
connections with the mediastinum and diaphragm. The pericardium 
limits the distention of the heart, and checks its too violent actions ; 
just as we see it prevent too much of our injections from entering the 
heart. How strong the pericardium is, and how capable of support- 
ing the action of the heart, even after the most terrible accidents, we 
know from this, that the heart or coronary arteries have actually burst, 
but with a hole so small as not to occasion immediate loss of life ; 
then the pericardium, receiving the blood which came from the rup- 
* Tf>- 352 
OP THE PERICARDIUM. 
ture, has dilated in such a manner as to receive nine or ten pounds of 
blood, but has yielded so slowly as to support the heart in some kind of 
action, and so preserved life for two or three days. But while, accord- 
ing to authors, we have been following the inflection of the pericar- 
dium, we should not omit noticing that the membrane is double, and 
that, while the finer layer of the membrane is reflected over the heart, 
a stronger texture of fibres is sent off into the sheaths of the great 
vessels which ascend from the heart. 
If I have not mentioned any fluid under the direct name of aqua 
pericardii, or the water of the pericardium, it is because I consider 
the accident of water being found as belonging not to the healthy 
structure, but to disease. Yet this same water occupied the attention 
of the older authors in a most ludicrous degree. Hippocrates be- 
lieved that this water of the pericardium came chiefly from the drink 
we swallow, which found some way or other (as it passed by the 
pericardium) to insinuate itself into this bag. Some after him said, 
it. was the fat of the heart melted down by incessant motion and the 
heat of the heart; some said it was from humours exuding through 
the heart itself, and retained by the density of the pericardium, that 
this water came ; and it is but a few years since this clear and distinct 
account of it was given, viz. “• that it proceeds from the aqueous ex- 
crementitious humour of the third concoction.” The same men,* 
u viri graves ct docti,” declare to us that the uses of the aqua peri- 
cardii are to cool the heart, for it is the very hottest thing in the 
body ; or by its acrimony to irritate the heart, and support its motions ; 
or to make the heart by swimming in it seem lighter. By this it is 
pretty obvious what absurd notions they had of the quantity of water 
that may be found in the pericardium. But of all the outrages against 
common sense and common decorum, the most singular was the dis- 
pute maintained among them, whether it was or was not the water of 
the pericardium which rushed out when our Saviour’s side was pierced 
with a spear ? The celebrated Bardius, in a learned letter to Bartho- 
line, shows how it was the water of the pericardium that flowed out; 
but Bartholine, in his replication thereunto, demonstrates, that it must 
have been the water of the pleura alone. This abominable and ludi- 
crous question, I say, they bandied about like boys rather than men: 
Bartholinus, Arius, Montanus, Bertinus Nicelius, Fardovius, Lauren- 
bergius, Chiprianus, with numberless other Doctors and Saints, rvere 
all busy in the dispute ; for which they must have been burnt every 
soul of them, at the stake, had they done this in ridicule ; but they 
proceeded in this matter with the most serious intentions in the world, 
and with the utmost gravity. The whole truth concerning water in 
the pericardium is, that you find water there whenever at any time 
you find it in any of the other cavities of the body. If a person have 
laboured under a continued weakness, or have been long diseased ; if 
a person have lain long on his death-bed, then you find water in the 
pericardium. But if you open any living animal, as a dog, or if you 
open the body of a suicide, not a drop of water will be found in the 
* They are thus denominated in all the charters of the College of Physicians from 
die time of Henry VIII. downwards. OF THE PERICARDIUM. 
353 
pericardium. When such fluid is to be found, it is of the same nature 
with the dropsical fluids of other cavities: in the child, and in young- 
people, it is reddish, especially if the pericardium be inflamed ; in 
older peopie, it is pellucid, or of a light straw colour ; in old age, and 
in the larger animals, it is thicker, and more directly resembles the 
liquor of a joint. 
Thus does the pericardium contribute in some degree to settle the 
posture of the heart; but still the heart is to a certain degree loose 
and free. It is fixed by nothing but its great vessels as they run up 
towards the neck, or are connected with the spine; but how slight 
this hold is, how much the heart must be moved, and these vessels en- 
dangered, by shocks and falls, it is awful to think. The pericardium 
is no doubt some restraint; its connexions with the diaphragm and 
with the mediastinum, make it a provision, in some degree, against any 
violent, shock ; its internal lubricity is, at the same time, a means of 
making the heart’s motions more free : yet the heart rolls about in the 
thorax ; we turn to our left side in bed, and it beats there ; we turn 
over to our right side, and the heart falls back into the chest, so that 
its pulse is nowhere to be perceived ; we incline to our left side again, 
and it beats quick and strong. The heart is raised by a full stomach, 
and is pushed upwards in dropsy : and during pregnancy its posture is 
remarkably changed; it is suddenly depressed again when the child is 
delivered, or the waters of a dropsy drawn off. It is shaken by cough- 
ing, laughing, sneezing, and every violent effort of the thorax. By 
matter collected within the thorax it may be displaced to any degree. 
Dr. Farquharson cured a fine boy, about eight years old, of a great 
collection of matter in the che3t, whose heart was so displaced by a 
vast quantity (no less than four pounds) of pus, that it beat strongly on 
the right side of the breast while his disease continued, and as soon as 
the pus was evacuated, the beating of the heart returned naturally to 
the leftside. Who could have believed that, without material injury, 
the heart could be so long and so violently displaced ? Felix Platerus 
tells us a thing not so easily believed, that a young boy, the son of a 
printer, having practised too much that trick which boys have of going 
upon their hands with their bead to the ground, began to feel terrible 
palpitations in the left breast: these gradually increased till he fell into 
a dropsy from weakness, and died; and upon dissecting his body, the 
situation of his heart was found to have been remarkably changed by 
this irregular posture. Now, we are not to argue that such change of 
posture of the heart could not happen merely from this cause, because 
professed tumblers have not these diseases of the heart; it were as 
silly to argue thus against the authority of Platerus, as to say that 
every post-boy has not aneurisms of the ham, or that every chimney- 
sweeper has not a cancer of the scrotum. 
We may now close this account of the mechanism of the heart; 
in which all the parts have been successively explained. We know 
how the heart is suspended by the mediastinum, and by its great ves- 
sels ; how it is lubricated, supported, and regulated in its motions, by 
the pericardium: its nerves, which remain to be explained at a fitter 354 
OF THE HEART. 
time, arc extremely small; while its vis insita, or irritability, is great 
beyond that of all the other parts. We can easily follow the circle 
of the blood, which, as it arrives from all the extremities, irritates the 
auricle, is driven down into the ventricle, is forced thence into the pul- 
monic artery, pervades the lungs, and then conies round to the left side 
of the heart, or to that heart which supplies the body; and there be- 
gins a new circulation, called the greater circulation, viz. of the body, 
as the other is called the lesser circulation of the lungs. Thus we re- 
cognise distinctly the functions of the double heart, u ith all its me- 
chanism ; the stronger heart to serve the body, the weaker heart to 
serve the lungs; and we see in the plainest manner two distinct func- 
tions performed by one compound heart: the right heart circulates the 
blood in the lungs, where it is purified and renewed ; the Jett delivers 
out a quantity of blood, not such as to fill all the vessels, nor such as 
to move onwards by this single stroke of the heart to the very ex- 
tremities of the body, but such merely as to give a sense of fulness 
and tension to the vessels: the force is merely such as to excite and 
support that action which the arteries every where perform in the va- 
rious organs of the body, each artery for its appropriated purposes, 
and each in its peculiar degree. 
By understanding thus the true mechanism and uses of the heart, 
we can conceive how the ancients were led into strange mistakes by 
Very simple and natural appearances. We understand why Galen 
called the right auricle the “ ultimum moriens,” or the part which 
died last; for, upon opening the body soon after death, he found the 
right auricle filled with blood, and still palpitating with the remains of 
life, when all the other parts seemed absolutely dead ; and if the blood 
always accumulates on the right side of the heart before death, it is 
plain that the stimulus of that blood will preserve the remains of life 
in the right side, after all appearance of life on the left side is gone. 
But the cause of this accumulation of blood in the right side is very ill 
explained by Haller, though it seems to have employed his thoughts 
during half his life. He says, that in our last moments we breathe 
with difficulty ; the lungs at last collapse, and cease to act; and when 
they are collapsed, no blood can pass through them, but must accu- 
mulate in the right side of the heart. That there is really no such 
collapse of the lungs, I propose hereafter to show ; but, in the mean- 
while, this is the true reason, viz. that when the ventricles of the heart 
cease to act, and the beating of the heart subsides, the two auricles 
lie equally quiet, but in very different conditions ; the right auricle has 
behind it all the blood of the body pouring in from all parts during the 
last struggles ; but the left auricle has behind it nothing but the empty 
veins of the lungs ; nothing can fill it but what fills the vessels of the 
lungs ; or, in other terms, nothing can fill the left auricle but the 
Stroke of the heart itself: but instead of acting the heart falls into a 
quiescent state ; the left auricle remains empty, while the blood oozes 
into the right auricle from all the extremities of the body till it fills it up. 
Nothing is more agreeable than to find such phenomena described 
faithfully long before the reason of them is understood. In the Pa- 
risian dissections I find the following description : u When the breast OF THE HEART. 
355 
Of a living Dog is opened by taking away the sternum, with the car- 
tilaginous appendices of the ribs, the lungs are observed suddenly to 
sink, and afterwards the circulation of the blood and the motion of 
the heart to cease. In a little time after the right ventricle of the 
heart and the vena cava are swelled, as it they were ready to burst.”* 
This was what deceived the ancients, and was the cause of all their 
mistakes. When they found the right ventricle thus full of blood, 
they conceived that it alone conveyed the blood ; they found the left 
ventricle empty, and believed that it contained nothing but vital spirits 
and air; and so far were they from having any notions of a circula- 
tion, that they thought the air and vital spirits went continually for- 
wards in the arteries ; that the gross blood which was prepared in the 
liver came up to the heart to be perfected, and went continually for- 
wards in the veins; or, if they provided any way of return for these 
two fluids, it was by supposing that the blood and spirits moved for- 
wards during the day-time, and backwards in the same vessels during 
the night. 
These things next explain to us why they called the right ventricle 
ventrictjlus sanguineus ; they found it full of blood, and thought 
its walls were thinner, because it had only to contain the very grossest 
parts of the blood : and why they called the left ventricle ventricu- 
xtjs spirituosus and nobilis because they saw it empty, and con- 
cluded that it contained the animal spirits and aerial parts of the 
blood, and its walls were thicker, they said, to contain these subtile 
spirits. They explain to us their names of arteria venosa ; and 
vena arteriosa ; for they would have veins only on the right side of 
the heart, and arteries only on the left; and although they saw plainly 
that the pulmonic artery was an artery, they called it Arteria Venosa : 
and although, on the left side again, they saw plainly that the pulmonic 
vein was merely a vein, they would still cheat themselves with a name, 
and call it Vena Arteriosa : the veins, they said, were quiet, because 
they contained nothing but mere blood ; the arteries leaped, they said, 
because they were full of the animal spirits and vital air. 
The very name and distinction of arteries which we now use, arise 
from this foolish doctrine about air ami animal spirits. To the oldest 
physicians there was no vessel known by the name of artery, except 
the aspera arteria ; and it was named Artery because it contained 
air ; so that Hippocrates, when he speaks of the carotids, never names 
them arteries, but calls them the Leaping Veins of the neck. But. 
when Eristratus had established his doctrine about the vessels which 
go out from the heart, carrying vital spirits and air, the name of ar- 
tery was transferred to them ; and then it was that the ancients began 
to call the vessels going out from the left side of the heart arteries, 
naming the aorta the arteria magna, and the pulmonic vein the ae~ 
teria venosa. 
When a vein was cut, they saw nothing but gross blood, and of a 
darker colour ; but when an artery was cut, they observed that the blood 
was red ; that it was full of air bubbles ; that it spurted out, and wac' 
* Paare 26*. 356 
OF THE BLOOD. 
full of animal spirits ; and thus it became easy for them to show how 
safe it was to open a vein where nothing was lost but gross blood, how 
terribly dangerous it was to open an artery, which was beating with 
the spirit of life ; ami this they considered as such an awful difference, 
that when arteriotomy in the temple was first proposed, they pro- 
nounced it murderous, and on this reasoning it was absolutely forsaken 
for many ages. 
OF THE RESPIRATION OF ANIMALS. 
The effects of oxydation then are, to redden the blood, to renew its 
stimulant power, and to communicate heat, not so much to the blood, 
as to the whole body through the medium of the blood, and to assist 
in the secretions and chemical changes which are incessantly going on 
in all parts of the system. This is accomplished by the perpetual and 
rapid motion of the blood through the lungs ; and there it is exposed 
to our atmosphere, which is a mixed fluid very different from what we 
at first conceive, or what our ignorant wishes might desire to have it; 
not consisting merely of air fit to be breathed, but for the greatest 
part formed of an air which is most fatal to animal life, whence it has 
the name of Azotic Gas. Of an hundred measures of atmospheric 
air, we find twenty-one only to consist of vital or pure air, that is oxy- 
gen ; seventy-eight consist of azotic air, or nitrogen, as it is called, 
fatal to animal life; and one measure only is fixed air, or carbonic 
acid, which is also an unrespirable air. But of these twenty-one parts 
of pure air, seventeen parts only are affected by respiration, so that in 
respiration we use much less than a fifth part, even of the small quan- 
tity of air which we take in at each breath. 
Within these few years, the following opinions prevailed on this 
subject. The air in respiration is diminished by the abstraction of a 
part of the oxygen; there is formed a quantity of carbonic acid gas 
by the union of the carbon of the blood with the oxygen respired ; and 
there is discharged along with these a quantity of watery halitus. 
Therefore atmospheric air, after it has been breathed, is found to have 
suffered these changes; First, It contains now a considerable pro- 
portion of carbonic acid, which is easily discovered, and even weighed: 
because when a caustic alkali is exposed to it, the alkali absorbs 
the fixed air and becomes mild. Secondly, It has less of the 
vital air, as is easily ascertained by the eudiometer which mea- 
sures the purity of the whole: And, thirdly, All that remains 
is merely azotic air, unfit for animal life, or for supporting flame. 
The oxygen, then, in part unites itself with the blood; in part 
it forms fixed air by combining with the carbon of the lungs ; in 
part it forms water by combining with the hydrogen of the blood. 
Respiration frees the blood of two noxious principles, the hydrogen 
and carbon; and it insinuates a new principle, viz. the oxygen into 
the blood. 
Such has been the opinion of chemists up almost to the present day; 
but the rapid changes of opinion, and, indeed, of whole systems, and 
the confusion into which the discoveries of the day throw the result of OF THE MEMBRANES OF CAVITIES. 
357 
ail preceding labours, would almost provoke an anatomist to put out of 
his system the chemical discussion altogether, until the masters of that 
science have arrived at acknowledged principles. More careful expe- 
riments have proved that the volume of air expired is the same with 
that inspired,—the respired air differing only in the variable proportion 
of carbonic acid gas, and aqueous vapour; that all the oxygen taken 
from the atmosphere by respiration, is consumed in the formation of 
the carbonic acid gas found in the respired air ; and that the heat 
evolved by respiration is not the heat of the body, but the heat of the 
air respired, latent before, and now become sensible, owing to a 
change of capacity in the gases. 
The change produced in the blood during the circulation in the lungs, 
is simply to free it of the superabundance of carbon with which it is 
loaded by the circulation through the body. 
As to the heat of the body, chemists seem to have agreed, that full 
confidence is to be put in the experiments and opinions of Dr. Crau- 
ford, whose theories have been criticised in former editions of this 
work. The brief abstract of which doctrine we have already given. 
When the blood of the arteries of the body is converted into purple 
blood, and enters the small veins, heat is let loose and becomes sensible, 
giving warmth and a stimulus to the operations of the animal economy. 
When this venous blood is, in the round of the circulation, brought 
back to the lungs, it throws out its superabundant carbon, and when 
this carbon unites with oxygen of the air respired, it forms carbonic 
acid, and heat is evolved. While this action of respiration is pro- 
ducing heat, it is also forming of venous blood arterial blood. And as 
the arterial blood, in its conversion into venous blood, gave out heat, 
so now, being re-converted into arterial blood, it takes up heat, and 
that heat is not sensible heat, but latent. There is, therefore, no cen- 
tral fire, as it were in the breast, and yet there is a source of heat to 
the whole body from the operation of the lungs. And that proportion 
of heat more than is necessary for the conversion of the blood, and 
which might be injurious, is expended in forming the vapour exhaled 
from the lungs. 
In short, it is concluded that the expenditure of heat in an animal, is 
proportioned to the loss of oxygen, or, which is the same thing, the 
production of carbonic acid; and that it is the same in degree, that 
would be given out in the combustion of charcoal, in a quantity suffi- 
cient to produce the same proportion of acid. 
OP THE MEMBRANES OP CAVITIES, AND PARTICULARLY OF THE MEM- 
BRANES OF THE THORAX, 
Every part of an animal body, with the exception of the fluids, the 
matter of the nerves, of the muscles, and of the bones, is resolvable 
into membrane by maceration, and the contrivances of the anatomist. 
The fine web which supports the retina in the eye, and the strong cord 
on which the gastrocnemius acts, are formed of the same kind of tissue{ 
the same cellular texture. Another remarkable circumstance is, that 
this cellular texture no where terminates, and that the membranes of 358 
OP THE MEMBRANES OP CAVITIES'. 
the body are every where in continuity. If, for example, we begin ouf 
investigation with the tendon of a muscle, we shall find that it is 
resolvable into a twisted membrane, we may trace this membrane into 
the muscle, and we shall find it enveloping the muscular fibres, and 
extending through the muscle, and uniting again to form the tendinous 
insertion of the muscle into the bone. From the tendon the conti- 
nuation is direct to the periosteum ; the periosteum is continued into 
the ligaments and capsule of the joint ; from this again we may trace 
the fascia, and intermuscular septa. These firmer structures we shall 
find loosening into the common cellular texture, and that texture, as 
has been already explained, may be traced over the whole animal frame. 
But we have now particularly to consider the structure and connec- 
tions of the membranes of the great cavities of the body ; and, in the 
first place, the membranes of the thorax. 
A membrane is an expansion or web of animal matter, having 
extension with a scarcely measurable thickness : it has one surface, 
free or disunited, and smooth, and lubricated with a secreted fluid. It 
has the other surface rough and attached, being more like the common 
cellular texture, of which, in fact, the whole membrane is a compo- 
sition. 
The membranes of the viscera are arranged in two grand divisions, 
viz. the mucous membranes, and the serous membranes ; all of which 
are remarkable for their extent of surface, but especially the former. 
The difference of the two great classes of membranes is referrible to 
the nature of their secretions. The object of the secretions is to pre- 
vent adhesion of contiguous surfaces, which is most effectually done 
by the mucous secretion. But as the mucous secretion is not readily 
soluble, nor prepared for absorption ; as when secreted it must be 
thrown off from the surface, and urged out of the body altogether ; it 
is obvious that this is a secretion calculated solely for the membranes 
which are open, and from which it may be discharged. 
The serous fluid is finer, more watery, and very readily absorbed ; 
so that it is supplied to moisten the surfaces of shut sacs, and mem- 
branes which are continuous and have no outlet, such as those lining 
the great cavities. But if there be any tendency to inflammation on 
these surfaces, they are more prone to adhesion than the mucous 
membranes, because the inflammatory action will more quickly convert 
serum to coagulable lymph (which is the medium of adhesion) than it 
will the mucous secretion. 
The mucous membrane is the continuation of the skin ; it is every 
where continuous, but it admits of a natural division, viz. 1. The mucous 
lining of the lungs ; 2. The mucous lining of the alimentary canal, and 
the ducts which open into it; and, 3. The mucous lining of the urinary 
organs. 
We may trace the first from the nostrils up into the cavities of the 
nose, and from that into the lining membrane of the cells of the face. 
We may then trace it backwards into the throat, into the larynx, the 
trachea, the bronchia, and finally, into the bronchial cells, an extent 
perhaps equal to the whole surface of the body. 
To trace these continuous surfaces is not an idle minuteness; for wr OF THE PLEURA 
359 
require to know, that inflammation will creep along the surface by a 
prevailing action, which has got the name of continuous sympathy. 
Thus we are sensible in catarrh of a sense of pain and weight in the 
forehead, commencing with a dryness of the cavities of the nose ; then 
we have increase of secretion, and tickling in the larynx; this is fol- 
lowed by pain and a sense of rawness in the throat; lastly, we have 
pain in the chest, or an uneasy tickling sensation in the very margin of 
the lungs, and thus the inflammatory action terminates only within the 
extremity of this long line of connection. 
The second division of the mucous membrane is the lining mem- 
brane of the mouth, which we trace into the oesophagus, into the 
stomach, into the intestines ; and, after a course of full seven times the 
length of the body, it appears on the verge of the anus, terminating, as 
it began, in the skin ; and along the whole of this mucous lining we 
may sometimes trace the course of inflammatory action. An erysipe- 
latous blush, visible in the throat, will sometimes take its course in a 
very dangerous manner, over the whole extent of the canal, even to 
the anus. 
The third division of this membrane is where the fore-skin is re- 
flected over the extremity of the penis into the urethra: here the 
mucous secretion commences, and it characterizes the whole extent of 
the canal, tracing it through the bladder to the pelvis of the kidneys. 
Thus we shall find, that the mucous membranes form the internal 
surface of all the hollow viscera, and now we shall also perceive that, 
the serous membranes lbrm the outward surface of the same viscera, 
investing both the solid and membranous viscera with a common 
covering. The course of the serous membranes, are, however, by no 
means so simple nor so easily comprehended by the student, as that of 
the mucous membrane: at the same time that they are reflected from 
one viscus to another, they lbrm a shut pouch or sac. I shall at pre- 
sent confine myself to the anatomy of the membranes of the thorax or 
chest. 
OF THE PLEURA. 
The thorax is the superior cavity of the trunk, and contains the heart 
and great blood vessels, the lungs, and the thymus gland : it transmits 
into the abdomen the oesophagus and nerves ; and these parts are in- 
volved and supported by the processes of the pleura. 
By this it will be understood that there are two pleurae; that which 
lines the central cavity has another name. 'Faking the membrane of 
one side we may thus describe it. The pleura is the fine serous mem- 
brane forming a bag which lines the cavities of the chest, and is reflect- 
ed upon the lungs. We shall consider the pleura first as it lines the 
ribs (and where it is called pleura costalis) ; secondly, where it is 
reflected on the diaphragm ; thirdly, as it forms the septum dividing the 
chest; fourthly, as it is reflected to cover the lui.gs (where it is the 
PLEURA PUI.MONALis). 
The pleura costalis is the lining of the lateral walls of the chest. 
These walls consist of the ribs, their cartilages, and the sternum, their 360 
OK THE PLEURA. 
interstices being filled up with the intercostal muscles. The lining 
membrane of course is attached in part to the inside of the ribs, in part 
to the muscular texture which intervenes. It is a simple membrane ; 
for so we call it, although, like every other membrane, it may be di- 
vided into layers of cellular membrane. On its outer surface it is more 
loose and cellular in its texture ; on the surface towards the cavity it is 
smooth and bedewed with secretion, and is unattached or free. The 
pleura lining the ribs is very thin, and is immediately attached to the 
periosteum. 
As the ribs and sternum form the walls of the chest on the lateral 
and fore parts, the diaphragm forms the floor of division between the 
cavity of the chest and the lower cavity, or abdomen. From the ribs, 
the membrane is reflected upon the diaphragm, to which it adheres ; 
and from the diaphragm and lateral parts of the chest, it is reflected 
to form the partition of the chest which is called mediastinum ; which 
completes the circle of connexions, as far as relates to the lateral 
cavity of the chest. 
To understand whether or not we should speak of one or more 
membranes under the name of pleura, we must understand what is 
meant by cavity, and how many cavities there are. 
We speak continually of the cavities, when correctly there are none 
in the animal body ; for there is no empty space : the heart and lungs, 
with their membranes, lie in close contact. But when the anatomist 
exposes these viscera, the air rushes in, and there are then cavities. 
Or if, in the living body, air should escape from the lungs, or blood or 
secretion should be deposited between the membranes, then, correctly 
speaking, such fluid lies in the cavity. It would, therefore, be affecta- 
tion to use any other term, and with this explanation no false concep- 
tion can be formed. 
Of such cavities there are three in the thorax, the cavity for the 
heart, nearly in the centre, and the two lateral cavities for the lungs. 
For although the lungs form one organ, yet being extended in two 
grand divisions laterally, and these divisions contained in different 
cavities, and embraced by distinct membranes, we speak of them as 
double, and call them the lungs. 
The 1st Plan shows the two cavities of the thorax formed by the pleura costalis, and 
the septum or mediastinum formed by the meeting of the membranes. 
The 2d Plan shows, by the continuation of the dotted lines, how the pleura east nils 
is continued into the pleura pul man arh. OP THE MEDIASTINUM. 
361 
In the first plan here, the dotted line represents the course of the 
pleura, in a supposed section of the chest. Two lateral cavities are 
seen with a partition ; that partition or septum is the mediastinum, 
and passes from the spine to the sternum, dividing the chest into two 
lateral cavities. The second plan shows the manner in which the 
pleura is reflected to cover the lungs and form the pleura pulmonalis : 
a dotted line still marks the course of the membrane ; and here we 
may observe, that when the pleura has formed the septum, called 
mediastinum, it is there again reflected over the vessels going to the 
lungs, and, covering the vessels, protects them, and forms what is 
called the ligament of the lungs. Tracing the membrane in its course, 
we do not find that it terminates any where ; we find that it is every 
where continuous, and that the pleura pulmonalis and pleura costalis 
are the same continued surface of membrane. So that were it pos- 
sible to dissect it all out, without a hole in it, it might be blown up 
like a bladder. It is unnecessary to say that such a dissection will not 
be attempted. 
But in these plans a liberty is taken to represent the lungs shrunk, 
and leaving the sides of the chest, a thing which never takes place in 
nature. This is done that my reader may follow the line distinctly ; 
properly the surface of the lungs (that is, the pleura pulmonalis) anti 
the inner surface of the ribs (the pleura costalis) should have been in 
contact; for although we continually speak of the cavity of the chest, 
yet there is no cavity but in disease, or when by wounds the air is per- 
mitted to escape from the lungs, and then, indeed, the circumstances 
are as represented in this plan ; for the lungs leaving the side of the 
chest, there is a cavity which is then filled with air. 
When we trace the membrane of the ribs over the lungs, we com- 
prehend how the smooth and proper surface of the one is internal, and 
the other external ; and yet that these surfaces are continuous and the 
same. We understand too how the surface of the pleura pulmonalis 
and costalis are in close contact, and yet do not adhere, and that con- 
sequently freedom is given to the motion of the lungs. At least, if in 
respiration the lungs do not move from the sides of the chest, they are 
not prevented by the adhesion of the pleura, when in a healthy and 
natural state; but by a circumstance already in part explained. The 
lungs cannot recede from the pleura covering the ribs, because no air 
can he admitted to fill the space which would he then necessarily 
formed between the lungs and ribs. 
The ligaments of the lungs are understood when my reader com- 
prehends the manner in which the pleura is reflected from the ribs 
over the spine, and from the spine over the great vessels and over the 
lungs. Where this reflection of the pleura takes place, embracing 
the tubes and vessels going to the substance of the lungs, it. forms 
ligamentous roots, the only natural connection of the lungs to the 
chest. 
The mediastinum is a partition dividing the great cavity of the 
chest into two lateral parts : it is stretched from the spine to the ster- 
num. This is a common, and it may be a true description of the 
mediastinum as far as it. goes, yet it is a most imperfect, one. This 362 
OF THE MEDIASTINUM. 
partition of the thorax is esteemed a provision for our safety worthy 
of all admiration; and so, indeed, it is. But when it is said, that, 
this partition provides that a man, being diseased in the lungs of one 
side, or wounded between the ribs of one side, may still breathe with 
the other, I would venture to say, that it is a wrong reading in that 
volume which it ought to be our pride to preserve pure. Every motion 
of the natural system has its proper cheek; every delicate part has 
its guard against, the violent motions of the natural system ; and is 
constituted with a due provision against the injuries we are liable to 
in a state of nature. But nature had it not in contemplation that we 
should be exposed to the gun and bayonet, nor can I think with a cele- 
brated anatomist that she has provided for sustaining the prolonged 
existence of him who is slowly wasted by pulmonary consumption. 
I cannot believe that thore is either in the foramina of the heart, or 
the mechanism of the chest, a provision against the effects of disease. 
I have therefore to show that the mediastinum has a reference to the 
support of the heart and great vessels, against the unequal pressure to 
which, without this guard, they would be exposed in the necessary 
and natural changes to which the body is subject in health. But I 
have said that the description of the mediastinum is imperfect; and 
really, though seemingly simple, it is difficult to represent by words 
the connection of the membranes of the thorax. 
The two distinct sacs of the pleura, each forming a lining mem- 
brane to the two sides of the thorax, approach towards the centre of 
the cavity, and would absolutely unite but for the intervention of the 
heart and its appendages. And so, indeed, it is, that anterior to the 
heart and posterior to it, these membranes nearly touch. Where the 
sacs of the pleura approach each other anterior to the heart, they 
form the anterior mediastinum ; and in the same manner, behind 
the heart and near the spine, they form the posterior mediastinum. 
The anterior, or pectoral, mediastinum has, in the embrace of the 
membranes, much cellular membrane; and when in dissection we 
raise the sternum, this loose cellular membrane allows the pleura to 
be drawn separate so as to form a cavity, which cavity did not pre- 
viously exist. The anterior mediastinum contains the thymus gland, 
some absorbent glands, a considerable trunk of the lymphatic system, 
which has been called the ductus thokacicus anterior. 
The posterior mediastinum, called sometimes dorsale, contains 
the extremity of the trachea and part of its branches called bronchi, 
and part of the pulmonic artery and veins; the oesophagus, for the 
greater extent of its course, the descending aorta, and the great trunk 
of the absorbents, the thoracic duct, the eighth pair of nerves, the 
vena azygos and the dorsal lymphatic glands. 
Both the mediastina are a little towards the left side, and the pos- 
terior one is much the longest. 
I now leave authority, and proceed to describe the more important 
connections of the membranes of the chest with the heart and great 
vessels. The pleura, which is a very thin and weak membrane, where 
it invests the lungs, or adheres to the inside of the ribs, is particularly 
strong, where it is reflected from the diaphragm. And from tho dia- OJv' THE VKDt A.STIXL JJ. 
363 
) iiragm to the upper and more contracted part of the chest, all along 
the tract of the cava, it is of a ligamentous firmness, and is moro like 
a fascia or tendon than those layers of cellular tissue, which have of 
late got that name in connection with the subject of hernia. Towards 
the upper part of the chest, the pleura, or rather the mediastinum, 
covers and embraces the branches of the cava, and posteriorly it covers 
and protects the aorta and thoracic duct; in short, were it not the 
fear of confounding the ideas of the younger student, I would say, 
that this structure of membranes excludes all but the lungs from the 
cavity of the chest; and consequently from the effect of the chest’s 
motion in respiration. How the respiration does not affect the veins 
and cavities of the heart will now, l trust, be easily conceived, and 
consequently the use of the mediastinum be understood. 
But before 1 proceed further, I must here observe, that the pleura 
where it is reflected to form the mediastinum is double ; that is, the 
cellular texture acquires a different structure, has a ligamentous firm- 
ness, and performs the office of a fascia around the vessels, an office 
which could not have been done by the mere reflection of the lining 
membrane of the chest. 
The enlarged capacity of the thorax in every direction, the raising 
of the ribs, the thrusting out of the sternum, is attended with the 
contraction and sinking of the arch of the diaphragm. But this 
motion which expands the cavities of the chest, and consequently the 
cells of the lungs, and draws the air into them, would disorder the 
heart’s motion, would cause a lodgment of the blood and distension 
of the great veins and sinuses, were they under the influence of the 
motion of respiration, as the lungs are. But the diaphragm moves 
chiefly on its lateral parts ; it is checked and interrupted at the middle 
part by the connections of the mediastinum. In proportion as the 
lateral cavities of the chest, and the lungs consequently, suffer the 
influence of this expansion of the chest, and have the pressure taken 
from them, the parts contained in the mediastinum, on the contrary, 
suffer pressure by the action of the diaphragm and rising of the ster- 
num. If the veins near the heart were exposed to the same influence 
that the lungs are, they would be subject to the same change of quan- 
tity of what they contain ; that is, the blood would be accumulated in 
inspiration, and forced out from them in expiration, as the air is in the 
lungs, and the regular action of the heart would Jt>e thus interrupted 
or disturbed. 
There is a further use in these connections of the membranes surround- 
ing the great vessels with the diaphragm, viz. to support or produce an 
equal pressure upon the great vessels of the trunk during the violent 
action of the body. Thus in leaping, pulling, or straining, there is a 
sudden and great pressure on the viscera and veins of the abdomen, 
and at the same time there is a powerful acceleration of the blood from 
every remote part towards the great veins and right sinus of the heart 
These vessels would be overpowered and burst but for the protection 
of the mediastinum. It is then that we perceive the happy influence 
of the diaphragm, in drawing down the mediastinum, and consequejitty 
restraining and supporting the heart and great vessels. 364 
OF THE GLAND. 
The pericardium, or heart-purse, is the third cavity of the thorax ; 
but here again I must caution my readers on the use of the term cavity. 
The pericardium closely embraces the heart, retains the lubricating 
fluid, and restrains and limits the heart’s motion. But this being 
already explained, I have only to add a circumstance slightly noticed 
under the former head. The pericardium is a double membrane : the 
inner layer of membrane belongs to the class of serous membranes ; the 
outer is quite of a different character, being a tissue of strong fibres 
which form a web as strong as a fascia, ft is this external layer of the 
pericardium which is continued upon the great vessels as they arise 
from the heart, and which forms their supporting sheath ; and what the 
closer texture of the sheath does to restrain and support the arteries 
and veins, is done by this outward layer of the pericardium of the heart. 
The next point left unexplained is the manner in which the heart 
and pericardium are embraced by the pleura. 
OF THE PERICARDIUM. 
In this plan* we see how the heart, surrounded by the pericardium, 
is further embraced by the mediastinum, by which it is not only sup- 
ported, but the great vessels are surrounded and led securely out of 
the thorax, until they reach their proper sheaths in ascending upon the 
neck, or passing out into the axilla. 
GP THE THYMITS GLAND. 
The thymus is a gland of a pale colour and soft consistence, having 
many divisions or lobuli. It lies immersed in the cellular membrane 
of the anterior mediastinum, but stretches upwards on the neck, and 
its extremities are between the trachea and carotid arteries, but it lies 
principally on the pericardium. It has two superior cornua, and two 
inferior, the right of which is the longest. On puncturing this gland 
* A, The heart. B, the pericardium. CC, the pleura of the right and of the left 
nide, embracing the pericardium betwixt them. OP THE LUNGS. 
365 
a white fluid may be expressed, and when we blow into this puncture 
the air pervades the whole gland, giving the appearance of a cellular 
texture : but no ducts have been discovered. The thymus occupies 
a very considerable space in the chest of the foetus, while it diminishes 
rapidly during childhood ; therefore it is presumed, that it has a func- 
tion adapted to some peculiarity of the foetal circulation : but not even 
a probable conjecture has been offered further. It has been supposed 
a kind of diverticulum chyli; it has been supposed to secrete a fluid 
to attenuate the blood; it has been supposed to separate a peculiar 
fluid which was again thrown into the blood through the small veins ; 
it has been supposed useful to fill up the thorax during the contracted 
state of the lungs in the foetus ; forgetting altogether that it is large in 
the foetus, and diminishes after birth ; it has been supposed to protect 
the lungs from the pressure of the sternum; all which are suppositions 
merely, that have not the most distant proof to support them, and yet 
possess not sufficient absurdity to make them worthy to be recollected 
on that account. 
OF THE LUNGS. 
Thk lungs are the soft compressible bodies which fill the two lateral 
cavities of the chest; and their use is to convey the atmospheric air 
into contact with the circulating blood. They consist principally of a 
cellular texture, and air tubes communicating with the atmosphere 
through the trachea. The degree of fleshy consistence and solidity 
which they have, is owing to the many vessels which carry blood 
through them, and the firm texture of membrane necessary to support 
them. Their function is respiration. 
It is through the larynx, trachea, and lungs, that we respire ; and 
respiration is a complicated as well as an important function. It car- 
ries away the superfluous carbon of the blood ; bestows heat, and 
stimulates the system : endows us with the power of speech ; affords 
us the sense of smelling, or greatly contributes to the perfection of 
the sense, while the lungs bestow due buoyancy to the bodies of man 
and animals. 
In form, the lungs correspond to the cavity which contains them. 
When taken from their place and extended, they are wide below, 
forming a base, and rise conically upward ; they are concave where 
they lie on the arch of the diaphragm, obtuse above, convex forward, 
and more slightly so on the sides ; their borders, behind, are obtuse, 
while they are pointed, and thin before. The lungs have a deep sul- 
cus behind, left for the spine, and within the projecting lobes, there is 
a place of lodgment for the pericardium and heart. 
Attending to this general form, we see why the lungs are spoken of 
as double, for unless by the connection of the common wind-pipe 
there are two great lateral portions, each of which belongs to a dis- 366 
OP THE TRACHEA, OR ASPERA ARTERIA. 
tinct cavity. And when we look to the lungs of the two sides, we 
discover that they are not perfectly alike. On each lung a fissure 
begins a little above the apex, and runs obliquely forward and down- 
ward to the base. This fissure on the left side divides the lung into two 
lobes. On the right side there is a lesser fissure, which consequently 
forms a lesser intermediate triangular lobe. 
OF THE TRACHEA, OR ASFERA ARTERIA. 
The trachea is that extent of the wind-pipe which is between the 
larynx (already described) and the forking or division of this tube 
where it is about to enter the lungs. It is seated on the fore part of 
the neck, and anterior to the oesophagus or gullet. Anteriorly it is 
covered by the thyroid gland, and the flat muscles, which go from the 
sternum to the os hyoides and the thyroid cartilage, and all around it 
has a very loose and elastic cellular membrane to permit it to move 
in breathing, swallowing, &c. 
The trachea is not a perfect cylinder, it is quite flat on the back 
part and membranous; it is rigid to admit of the easy passage of the 
air through it, and this rigidity is derived from the cartilaginous hoops 
of which it is principally formed. These hoops are not perfect circles. 
They are deficient on the back part, and this deficiency is not only 
calculated to permit the tube to be flat on the back part, and to give 
place to the oesophagus, but to allow a more perfect elasticity ; for the 
extremities of the cartilaginous hoops being free, their elasticity is thereby 
increased. The hoops of cartilage are not perfectly regular : above 
they are most so, and are broader ; but they are more irregular, and 
have weaker cornua the nearer the bifurcation ; the cornua have trans- 
verse fibres uniting them, which appear to be muscular. 
The membrane lining the trachea, and continued from the larynx 
into the cells of the lungs, is, as we have already said, a mucous mem- 
brane ; it is soft, elastic, and vascular ; but it has many pores or 
foramina opening upon it, especially about the larynx and epiglottis. 
These are the openings of the ducts of the bronchial glands, and on 
the outside of the membrane round and oval glands are visible. These 
glands are often diseased, inflamed, and ulcerated.* The moisture 
which bedews the trachea is a limpid, bland mucus, which subsides in 
water, unless air-bubbles be in it. The thinner part of this secretion 
is carried off by the air which passes through the trachea, and the 
thick matter is expectorated. 
This secretion, which in the healthy state is of the consistence of 
thin jelly, transparent and of a bluish colour, becomes from inflamma- 
tion of the catarrhal kind, thinner and more transparent, and is co- 
piously expectorated. In more chronic inflammation the matter 
becomes thick, opaque, and of the colour of straw. And in a still 
later stage it may become purulent, without implying lesion of surface. 
* Glandules bronchioles conglobata, mentioned by different authors, are no more 
than the conglobate lymphatic glands, seated around the bronchi* at the root of thr 
lungs and in the mediastinum, and which belong to the lymphatics of the Jnngs, OP THE BRONCHIAL CELLS. 
367 
The firmer nodules of viscid secretion which are brought up, are pro- 
bably from the sacculi laryngis. 
From its exposed situation, its sensibility and vascularity, the mem- 
brane of the trachea is very subject to disease. I have now before me 
examples of general inflammation, of inflammatory crust, of suppura- 
tion and deep ulcer in the inside of the trachea. Often lesser degrees 
of inflammation change the nature of the bland secretion, making it 
more saline, acrid, and stimulating. Sometimes the inflammatory 
action will mix a portion of coagulable lymph with the mucus secreted, 
and which, by this addition, will take a tubular form as in the croup. 
But let it be remembered, that coagulable lymph in the form of tubes 
or vessels, may be coughed up from the lungs, a consequence of blood 
poured into the bronchi® without the presence of inflammation. 
BHONCHIjC. 
On entering the thorax the trachea inclines backward, and passeB 
into the posterior mediastinum, and behind the arch of the aorta, and 
before the oesophagus ; opposite to the third vertebra of the back it 
divides into two branches, passing to the right and left; these and their 
Subdivisions are the bronchi*. 
When we follow one of these tubes, we find it entering the substance 
of the lungs, accompanied by blood-vessels, branches of the pulmo- 
nary artery with their corresponding veins ; and lesser arterial branches 
enter here, which are derived from the aorta, and are called the bron- 
chial arteries. 
The bronchi* divide and subdivide in regular order, branching like 
a tree through all the substance of the lungs, until their tender ex- 
tremities terminate in the air-cells ; for the cartilaginous rings of the 
bronchi*, which near the trachea resemble those of the trunk, become 
weaker, more oblique and irregular, and further removed from each 
other, until the extremities are little more than membranous tubes. 
BBONCHIAL CELLS. 
The bronchial cells, into which the air is admitted in respiration, 
have been represented as very regular sphericles attached to the 
branches of the bronchi®, and having no communication with each 
other. Malpighi described them as round vesicles, as if the branches 
of the bronchia were dilated into bags. Willis described them like 
myrtle-berries on the stalk. Hales estimated that those cells were in 
diameter the hundredth part of an inch, and the extended surfaces of 
them 1035 square inches. Keil estimates their whole number to be 
1,744,186,015.* 
On these cells the ultimate branches of the pulmonary arteries and 
veins ramify and inosculate, and the thin membrane of the cell and 
the coats of these minute vessels do not prevent the influence of the 
air upon the circulating blood. My reader must well distinguisli 
* I tales, Keil, and Leiberkuhn, differ greatly in estimating the conjoint extent of the 
vesicular surface. 368 
OF THE BLOOD IN THE LUNGS'. 
between this regular cellular structure, for the admission of air which 
is drawn through the trachea and bronchiac, and that cellular texture 
of the lungs which is common to them and every part of the body ; 
this tissue which supports the air-cells, the bronchi*, and the three 
several kinds of blood-vessels, and the lymphatics which collectively 
constitute the substance of the lungs. This common cellular sub- 
stance supports the air-cells, and unites the lobules, and conveys the 
vessels to their destination. 
Some have contended that there was a muscular tissue around the 
bronchial cells; but it is impossible to demonstrate this, and I must 
presume physicians have allowed themselves to be misled by symptoms 
during life. 
Sometimes the air escapes from the proper bronchial cells into the 
cellular texture; then there is emphysema of the lungs; then the 
lungs are distended with air ; but that air does not minister to the 
oxygenation of the blood, on the contrary the patient dies suffocated. 
And still more frequently it happens that the lungs being over exerted, 
as by long-continued difficult respiration, a watery or mucous effusion 
takes place into the common cellular texture of the lungs, which ef- 
fectually compresses the proper air-cells, and after much oppression 
suffocates. 
OTHER TUBES OR VESSELS WHICH ENTER INTO THE TEXTURE OF THE 
LUNGS. 
Although the blood-vessels which enter into the composition of the 
lungs are described elsewhere, yet, as they really constitute the more 
solid substance of the lungs, we may shortly review them here. 
The blood-vessels which cling to the bronchia; are called the vasa 
bronchi alia. There are two, sometimes three arteries of that name. 
There are one or two branches from the anterior part of the descending 
thoracic aorta, sometimes a branch from the superior intercostal artery, 
sometimes one from the subclavian artery ; these, taking a serpentine 
course, cling to the air-tubes within the lungs. They at the same time 
send branches to the mediastinum, bronchial glands, oesophagus, and 
pericardium. 
These are arteries to supply and nourish the membranes, glands, 
bronchi®, and the other blood-vessels themselves. 
The bronchial veins which correspond with the arteries. These 
are two, distinguished as right and left. The first commonly joins 
the vena azygos. The latter goes into the superior intercostal vein. 
The next is the pulmonary artery, that which arises from the 
right side of the heart to carry the dark blood into the lungsthe 
other great artery of the system, as distinguished from the aorta. 
This artery, bending towards the lungs, divides and sends its grand 
right division behind the aorta and the superior cava, and before the 
right bronchia. The left branch is shorter and straighter, and diverges 
to its destination. Both of these dive into the substance of the lungs, 
and can be traced to great minuteness. These arteries terminate like 
die branches of the aortic svstem in veins. This was the first part, of OF THE BLOOD IN THE LUNGS. 
369 
the great circulation discovered, and it was an ancient experiment to 
push coloured fluids from the artery into the veins of the lungs. On 
the vesicular lungs of the cold-blooded animals, by the assistance of 
the microscope, the blood can be seen moving directly from the ar- 
teries into the veins. The pulmonic veins receiving this blood, and 
gathering together their branches from the whole substance of the 
lungs, form trunks, and terminate in the left auricle. 
The lymphatics of the lungs form yet another set of vessels, con- 
stituting the substance of the lungs. They come out superficially in 
great profusion, and run their course along the ligaments of the lungs 
to the thoracic duct. Most of them run into the conglobate or lym- 
phatic glands in the posterior mediastinum, called glandulte Vesalii. 
The nerves of the lungs are the branches of the par vagum, and of 
tl e great sympathetic nerve. 
These parts combined constitute the soft spongy substance of the 
lungs, which the ancients, without much inquiry, called the parenchy- 
matous substance. 
COURSE OP THE BLOOD IK THE LUNGS 
Coloured water, or size, or oil of turpentine, being injected into 
the pulmonary artery, comes back by the pulmonic veins, running ill 
what is called the lesser circulation. The same fluids being injected 
into the vein, return by the artery.* The fluid being more forcibly 
propelled into the pulmonary artery, flows by the trachea, and the 
exudation of the fluid is facilitated, if the action of respiration be 
imitated by blowing into the trachea at the time of the injection. 
These coarse experiments in the dead body prove little ; but the 
course of the blood from the extreme pulmonic arteries into the veins, 
having been seen in the membranous lungs of the lacert«%‘, the chy- 
mical phenomena exhibited by respiration, leave little for us to wish 
further in explanation of the functions of the lungs.t 
There are some reflections which naturally occur in taking leave of 
this subject of respiration, which may have the further effect of con- 
flrming in my reader the accurate knowledge of the anatomy. 
Although the lungs are very often found adhering to the inside of 
the chest, and although this union occurs where we cannot discover 
that the person during life was subject to any inflammation of the 
chest, yet it is a preternatural appearance. The lungs (covered with 
the pleura) lie in contact with the sides of the chest, and consequently 
with the pleura costalis, but without adhesion. They are passive in 
the motion of respiration. The muscles of respiration clothing the 
thorax are the agents in this function. The bony and cartilaginous 
texture of the thorax is the machinery put in motion, and the effect is 
the dilatation of the lungs ; for as the sides of the chest rise, the 
lungs being in close contact, they must follow this rising; and as the 
* In an experiment which was made by a pupil of mine, the mercury, which was 
1 brown into the crural vein of a live ass, was found at the end of a month to be lodged 
in the cells of the lungs : it bad not been forced into the pulmonary veins. 
t For the consent or sympathy of the lungs with other parts, see the observations 
under the head of Par vagum, in the description of the nerves. 370 
OP THE BLOOD IN THE LUNGS. 
dilatation of the lungs is freely permitted by the entrance of the at- 
mosphere through the trachea into their cells, the effect of the action 
of the muscles of inspiration is the drawing of the atmospheric air 
into the bronchial cells, and the contact of that air with the blood cir- 
culating in the lungs. In expiration the lungs are equally passive as 
in inspiration. The muscles which contract the diameters of the 
thorax, force the compages of bones and cartilages upon the lungs, 
and compressing them throw out the air by the trachea. 
That any other idea should arise in the student’s mind is owing to 
two circumstances ; first, the not comprehending the principles of 
natural philosophy, and puzzling himself with the expression that the 
Hir fills the lungs by its weight; which is true, but it is as true that 
the milk enters the mouth of a sucking infant by the weight of the at- 
mosphere, or that in using a syringe, it is the weight of air which 
forces the fluid into the syringe. The air enters the lungs by suction ; 
the motion of the thorax produces that suction ; or, in other words, 
the operation of the weight of the air is permitted to take effect by 
the tendency to a vacuum which the rising of the sides of the thorax 
produces ; the pressure of the atmosphere then causes the air to 
descend into the bronchial cells. 
The second circumstance which gives occasion to misconception, 
is the lungs seeming to have a motion independent of the chest. 
Thus, when a man is wounded between the ribs, the lungs protrude, 
and this rising of the lungs appears to be owing to a power inherent 
in them : but attention to the true circumstance will explain the oc- 
casion of this. When the wound is received the air enters the chest, 
and the lungs fall collapsed ; the cavity is therefore full of air, and the 
lobes of the lungs hang loose. The air plays freely out and in through 
the hole in the chest. But when by change of posture the flapping 
edge of the lungs falls against the hole in the side, the air which is in 
the chest can no longer make its exit, without forcing the lungs through 
the wound. Accordingly, in the act of expiration, the same compres- 
sion which forces the air out in breathing pushes out the lungs from 
the side. We may have the proof from anatomy that the lungs lie in 
close contact with the pleura costalis. 
When the intercostal muscles are dissected off, and the pleura cos- 
talis exposed, the surface of the lungs is seen in contact with that 
transparent membrane, and when the pleura is punctured with the 
lancet, the air rushes in, and visibly the lungs retire in proportion as 
the air is admitted. This proximity of the lungs to the ribs explains 
the effect of fracture of these bones in producing the tumour called 
emphysema, for thus it happens. The broken end of the rib piercing 
the pleura costalis, tears also the pleura pulmonalis, and breaks the 
surface of the lungs, and opens the bronchial cells. Now when the 
chest is expanded, a little air is drawn through the rugged opening, 
and lodges in the cavity of the chest (now truly a cavity, the air oc- 
cupying the space between the lungs and chest). By little and little 
the small portion of air which is drawn into the cavity of the chest 
at each inspiration, accumulates until a distressing quantity fills tlw 
whole of that side of the chest. 371 
r>K THE BLOOD IN THE LUNGS. 
The chest being now' full of air, the action of expiration, compres- 
sing the air in the chest, it insinuates itself by the side of the fractured 
ribs into the cellular texture, consequently a crepitating tumour of air 
is formed over the part hurt, and this quickly extends over the whole 
body, until the skin is blown up like a sack, and the man is in danger 
of suffocation. The suffocation is not a consequence of this disten- 
tion of the cellular substance of the body, but of the fulness of the 
cavity of the chest on that side wounded. For, at length, the chest 
being kept distended, and the diaphragm pushed down, and the 
mediastinum pressed to the opposite side, both sides of the chest are 
oppressed, and the breathing is so checked, that if not quickly re- 
lieved, the patient would die. 
These plans will explain the common case of emphysema: 
Fiff.l. 
Fig. 2. 
The emphysema of the body may take place in a different way.* 
The lungs may be diseased; air may be drawn through the abscess, 
and collect in the cavity of the chest; or the bronchial and true air 
cells may be hurt by exertion, so that the air gets access into the 
common cellular texture of the lungs ; and from the lungs it may find 
its way between the ligaments of the lungs into the cellular texture 
of the mediastinum, and hence up into the neck and over the body. 
These last instances are rare compared with that proceeding from 
fractured rib. 
* The first plan exhibits a section of the thorax, with the rib broken A, and entering 
the lungs D. Air has already begun to accumulate in the cavity of the chest B. The 
air insinuating itself by the side of the broken rib forms the tumour on the side C. 
I he second plan exhibits the extent of the evil The lungs D are compressed. The 
cavity ot the chest left by the retraction ot the lungs is lull of air. The emphysema- 
tous tumour C is extended over the body. The right side of the diaphragm E is pushed 
down, the heart and mediastinum F are forced towards the opposite side, encroachin"- 
on the lungs of the left side. INTRODUCTION 
TO 
THE STUDY OF TIIE CIRCULATORY SYSTEM, 
The discovery of the circulation of the blood has been always re- 
garded as one of the most important, and has been ranked rather with 
the great doctrines of philosophy, than with the discoveries in our 
peculiar science : it has been boasted of by our countrymen, and much 
coveted, and often claimed, by strangers; it is indeed a discovery the 
most ingenious and beautiful. 
How the well-proved doctrines of Harvey were perverted ; what 
new, strange, monstrous, and impossible circles his antagonists con- 
trived for the blood, it were tedious to relate: but it is most natural 
to mention why his doctrines were opposed. It was the universal 
opinion, in those days, that the blood was formed in the liver, and sent 
out from it by all the veins to nourish the body, proceeding outw ards 
during the day, and returning by night. The old physicians had thus 
entered into a train of thinking which it was not easy to change : 
these notions about the blood were become great and important doc- 
trines, and had descended to them from their oldest teachers, with 
many weighty dependencies, conclusions, and rules of practice issuing 
from them : they were as articles of faith which it was a heresy to 
forsake ; and it was easy to foresee that should the Harveian doctrine 
prevail; should it be once completely proved that the blood moved 
outwards along the arteries, and returned by the veins ; then all the 
reasonings of the physicians would be confounded ; their theories em- 
bracing the whole body of physic disturbed ; their system of practice 
entirely overthrown ; and all they had written themselves, and all the 
ancient books which they had read with so much diligence (for they 
were really learned) ; all that they had ever been proud of was to be 
wiped out from the thoughts of that and all succeeding ages! 
But the doctrine of Harvey did at last prevail, dispelled those idle 
dreams of humours, and temperaments, and spirits, and blood !—of 
the blood concocted in the liver, and moving outwards along the veins 
to nourish the body ; of the blood moving outwards during all the 
day, and returning by night; of the arteries carrying air only or vital 
spirits, to animate the system by mixing with the blood, while the veins 
alone conveyed the proper blood. Yet this theory of the illustrious 
Harvey introduced general doctrines more mischievous in all their 
consequences than those which had just vanished; as, that the blood 
was composed of particular globules, the larger globules of smaller 
«nes. and these again of globules of a third series; and that, the arte- 374 
rsr'fHODlTCTIOPf. 
ries were so proportioned to the diameters of those globules, and de» 
scended by steps so regular and uniform, that each kind of artery had 
its peculiar globule which it received with ease, while others were re- 
jected ; or, if unhappily driven by a too violent action into vessels 
which they did not suit, were arrested in their progress, and produced 
either some local inflammation or some universal disease. These are 
the once famous doctrines of Malpighi, Boerhaave, and all the great 
men of their day ; and which they dilated into various forms, and 
adorned with the fine words of Hmtor, remora, error loci. 
To these succeeded the mechanical physicians, who, by unintelli- 
gible problems of mathematics and algebra, (reasonings which were 
ill-founded in their principles, even had the calculations been correct,) 
pretended to estimate the force of the heart, the velocity of the blood, 
the power of the arteries, the strength of the veins, and the shape and 
size of each secreting orifice, according to the secretion which it had 
to perform. These were the doctrines, these the discoveries, which 
rendered famous the names of Bellini, Pitcairn, Keil, Hales, and other 
mechanical physicians, whose books are no longer of authority, and 
are consulted only for the history of opinions. 
The chemists next soon turned their thoughts, from the vain search 
after the universal solvent, and the philosopher’s stone, to pharmacy 
and the useful arts. By the abilities and industry of Newman, this 
branch began to assume the more respectable appearance of a useful 
art: it began to be allied to science, and its connexion with medicine 
was found to be of the most direct and important nature. 
Having analysed the materials of the druggist, the chemists pro- 
ceeded to analyse the parts of the human body to which those medi- 
cines were to be applied : but from this rational commencement fol- 
lowed one of the most trivial of all the miserable doctrines with which 
our science has been disgraced ; for as the chemists had already ex- 
plained the properties of the salts, metals, earths, and of all active 
substances, by the angles, cubes, or other forms which they saw their 
particles assume, they soon persuaded themselves that such forms as 
cubes, wedges, spiculac, &,c. existed in the blood ; and acid and alka- 
line humours, sharp, corrosive, irritating, and pointed particles, were 
the terms in which they expressed their most admired theories; and 
acids, alkalies, and metals, and medicines for rounding the pointed 
particles, or obtunding, (as they termed it,) or sheathing, or covering 
the acrimonious humours, were their chief preventives and cures. 
Until the present day, this fault has pervaded all the great theories, 
that in describing our vessels physicians have continued to use the lan- 
guage of hydraulics and hydrostatics ; of a philosophy applicable only 
to rigid tubes : in short, in describing the living system, they have for- 
gotten that it was endowed with life. 
YVe also may have erred in our turn : but with whatever degree of 
contempt we may view the doctrines of these older authors, or how- 
ever succeeding generations may be amused with ours—still this is 
plain, that the most important facts in all anatomy, and the chief doc- 
trines of the human body, must always accompany the explanation of 
two Great functions of the heart and lungs. Of course, the con INTRODUCTION. 
375 
sutution of the blood ; the chemistry of airs ; our dependence, so in- 
cessant and immediate, upon the atmosphere in which we live ; the 
various and singular ways by which the fetuses of different creatures, 
or the creatures themselves, according to their peculiar modes of life, 
draw their existence from the atmosphere ; the various kinds of circu- 
lation by which this air is distributed through the system of each ; the 
effects of air particularly upon our body ; and the effects also of acci- 
dents, deformities, and diseases, in those prime organs—all this wide 
circle of physiology belongs, in the strictest and clearest sense, to the 
anatomy of the heart. For one chief purpose in studying the anatomy 
of the human body is to understand its functions, and to compare them 
with those of other creatures, till we arrive at last at some distinct 
conception of the whole; of the various structures of animals and 
vegetables ; and of the various functions which in each of these classes 
support life, and action, and through it the principle of life. 
There is no occasion on which this desire of knowledge, this willing 
admiration of the wonders of nature is so strong as on first studying 
the functions of the lungs and heart; for upon the conjoined offices 
of the heart and lungs all perfect life seems to depend And how' 
universal these two functions are ; how necessary to the support of 
the greater animals ; how essential also to the constitution of the 
meanest insect—it shall be my business to explain. 
The knowledge of the arteries again bears along with it the whole 
anatomy of the human body. The nerves accompany the arteries; 
the lymphatics and veins twine round them ; the glands and various 
organs are composed of them. The intimate structure of parts is 
known only by understanding the forms of their vessels ; and as each 
individual part is nourished by arteries, he who has studied the arteries 
thoroughly knows the whole. 
But to the surgeon the knowledge of the arterial system is valuable 
beyond all calculation or belief. He performs no operation in which 
arteries are not engaged ; he cures no great wound in which arteries 
are not first to be tied ; he enters into no consultation in which the 
arteries are not first spoken of. Without a knowledge of the arteries, 
he can neither think sensibly nor act safely. 
Most unhappily all this comes to be known at that period of life 
when the deepest conviction can produce only fear and perplexity, 
sorrow and regret. Yet, strange to tell, there is no such conviction ; 
no regret, no irresolution, no perplexity is ever seen. 
If the negligence with which anatomy is studied may stand excused 
on any account, it is on this only, that anatomists have been accus- 
tomed to write, not for the public, in plain and simple language, but 
for each other, in an unknown tongue. By this I mean not a foreign 
or a dead language, but a peculiar style and phrase which no one can 
understand unless he be initiated ; unless he have studied the science 
itself so intensely, that he has also learned the jargon in which it 
is conveyed : in short, no one but a thorough anatomist can under- 
stand the language of anatomy, nor can even he understand it without 
some labour. Anatomists have buried their science under the rubbish 
of names : there is not a difficult or hard-sounding word upon which 376 
INTRODUCTION. 
they have any claim that they have not retained: they have choked 
their subject with useless minutiae; they have polluted their language, 
by transferring to it from Latin many words, which, by their continual 
inflections, in that language were beautiful; while their unvaried, un- 
couth termination in ours, is barbarous in the utterance, while it tends 
but to interrupt and puzzle the sense. 
This is the scholastic jargon which has so long been the pride of 
anatomists and the disgrace of their science ; which has given young 
men a dislike for the most useful of all their studies ; and which it is 
now full time to banish from our schools. These are the authors who 
avoid plainness as if it were meanness ; who are studious of hard 
words as if they constituted the perfection of science : “ it is their 
trade, it is their mystery to write obscurely and full sorely does the 
student feel it. 
Want of arrangement, again, has still worse effects. Confusion is 
a monster in science. 
If I should tell my reader that there are very nearly one thousand 
arteries in the body, going promiscuously to bones, ligaments, bowels 
and glands, muscles, and nerves, to a thousand unconnected and diffi- 
cult parts, all of which he must know by name, how would he be 
affected! But when I observe that these go to the neck, the head, 
the arm, the leg, he begins to see this confusion of muscles, and 
glands, and bowels, vanish, and to perceive that all these arteries may 
be usefully and very simply arranged. When he is next taught to 
know the course of each greater artery, and the parts in which each 
division and branch of it lies, he perceives clearly that the parts through 
which it runs, as the arm-pit, neck, or groin, must limit and regulate 
the number of its branches, and give to each twig even an appropriate 
place and name : when, next, the whole arterial system is marked and 
chalked out for him in different portions; when there are points of 
peculiar importance set apart which he is charged to learn with parti- 
cular care—he sees a good end in all this toil; he begins with courage, 
and gets forward easily ; it becomes an interesting, and of course a 
pleasing task ; but still it is a task : and I entreat the young student, 
as he values his own honour, or the safety of his friends, not to bate 
himself one iota of the whole. Let him not take an indolent advan- 
tage of those arrangements which are meant to promote his industry, 
not to prevent it. Let him not read only concerning the greater arte- 
ries, neglecting the smaller ones, but go through the whole piece of 
anatomy honestly and fairly. He will no doubt forget in time the 
smaller arteries; but by having studied even them with diligence, he 
must remember the great and important arteries with a clearness of 
comprehension and arrangement, which those who have not gone thus 
honestly through the whole study can never attain. Let him also re- 
member that studies like these, well performed during his early years, 
do, like past dangers, or the remembrance of good deeds, give an ease 
and pleasure to his after-life. 
The arteries, 1 will now venture to say, should be with the surgeon 
as familiar as his name ; and there is no argument which proves it 
more strongly than this, that a man of real learning, of sterling good lxNTKODLCTIOxN. 
377 
sense, of a clear head and steady hand, a man accomplished in all 
other respects, and fitted by nature and genius for performing the most 
difficult operations, if yet he want this part of knowledge, may, in one 
unhappy moment, do things which he must think of with horror during 
all his life. I know well how such little accidents are thought of, when 
at last the evil day comes. A surgeon hardly believes this strict know- 
ledge of the arteries to be so great a point. In the midst of an opera- 
tion, or in a common wound, it gives him no concern to see arteries 
bleed which he did not look for ; nor has he great reluctance to drive 
his needle among parts which he does not know. An artery bleeds, 
and he looks for it; he calls out at last to screw the tourniquet, and it 
stops ; the tourniquet is loosened again, and again it bleeds ; again the 
screw is tightened on account of the loss of blood; he expects to 
strike the artery ; he is accustomed to strike it, not by knowing where 
it lies, but by seeing it bleed : at last some lucky dab of the needle 
succeeds, or perhaps from faintness of the patient the bleeding ceases: 
the surgeon is relieved from his present anxiety ; but in a few hours 
he is called back to this scene of confusion and dismay ; yet at last 
the bleeding is somehow or other mastered ; and thus he gets on 
through all his difficulties, accident after accident, operation after ope- 
ration, till at last he almost forgets that anatomy was a branch of his 
education, or the knowledge of blood-vessels necessary in operations 
or wounds. 
I will not say that a man cannot suppress a bleeding from a wound 
in the arm, because he is not acquainted with the anatomy of the arm; 
but this surely 1 may be allowed to say, that it is a piece of know- 
ledge which at all times, but especially in those circumstances, can do 
no harm ; and that if you leave a patient to choose between two sur- 
geons, one skilled in the knowledge of arteries, another knowing them 
only by seeing them spout out blood, it is easy to foretell where his 
choice will fall. 
Perhaps some will be so hardened as to say, “ and yet we seldom 
hear that patients die of bleeding.” Is it then a merit that your pa- 
tient is not plainly killed ; that he does not expire under your hands ? 
Is it nothing to lose blood from day to day ? Is it nothing that your 
patient is reduced to extreme weakness, suffering every thing but actual 
death ? Is it nothing that he lies with tourniquets round the limbs in 
fear and anxiety, attended by young surgeons appointed to watch that 
bleeding, which may burst out while the patient turns in bed, and de- 
stroy him in one moment ? Is it nothing to have fresh incisions and 
new searchings for the artery to endure ? These are real difficulties 
and dangers, and they should be provided for; our honour as well as 
our duty requires it. Bleeding from a great artery is to the patient the 
greatest danger; the very report of an ill accident is to the surgeon 
(though God knows he may be blameless,) the greatest disgrace ; and, 
lastly, though it should not be so, his taking up a bleeding artery dex- 
terously and quickly, when others have failed, is a great honour. 
When we think of all the important consequences of being tho- 
roughly versed in this part, of anatomy, they crowd upon our imagina- 
tion more in number than can be even named. The surgeon mav. 378 
INTRODUCTION, 
indeed, provide tor the arteries to be cut in a regular operation, L>y 
consulting books ; but when he is called to a patient bleeding and 
faint, perhaps expiring, that person must live or die by his immediate 
skill! By his skill he will obtain the good opinion, not of ignorant at- 
tendants only, but of the profession : and by a bold and sensible con- 
duct in any difficult situation he may give him a lesson of real use. 
Let us but for a moment think of the chances of those wounded in 
war ; the alarming, unthought-of accidents which overtake us daily in 
private life ; the wounds and hurts which workmen receive; let us 
reflect on all the kinds of aneurism both in the heart and arteries, from 
wounds, from blows, from inward diseases; let us think of all the 
various operations in which arteries are concerned—and then declare 
whether, of all his studies, the young man should not value that most 
which makes Mm so immediately and eminently useful. OF THE HEART, 
AND OF THE 
ARTERIES, VEINS, AND LYMPHATICS 
RESPIRATION continued. 
RESPIRATION, OR THE MANNER IN WHICH THE OXVRATION OP THE 
BLOOD IS ACCOMPLISHED IN VARIOUS ANIMALS. 
Those who are the best acquainted with the comparative anatomy 
will best know how natural it is for me to illustrate this function, by 
comparing various animals with man : how pleasant, how useful, it is 
to know these analogies, every student must feel ; and it is now full 
time to correct many mistakes into which modern as well.as ancient 
authors have wandered, from want of general principles, and from 
want of anatomical knowledge. I shall endeavour to make this 
chapter interesting and short. 
At one time all authors believed that the lungs were moved, not by 
any external agent, but by some internal power residing in the lungs. 
When in their first essays to investigate this subject they opened 
the thorax, or rather the body, of amphibious animals, they observed 
that the creature lay out upon the table with expanded lungs ; that 
the lungs continued for hours to appear like inflated bladders ; the 
lungs expanded, the heart playing, the creature quite alive. When 
they emptied their lungs from them by thrusting tubes down the tra- 
chea, or pressing the lungs, the lungs entirely subsided : but in a little 
while the lungs, at the creature’s will, rose again into complete infla- 
tion ; again they appeared like two tense bladders. Surely, said they, 
there resides some expansile power in the lungs themselves ; but when 
a few of them began to pursue this mistake with serious experiments, 
they committed absurdities which should be noticed, for they serve to 
illustrate the true doctrine concerning the expansion of the lungs. 
Mr. Houston, in our Philosophical Transactions, undertook to prove 
the following thing, which, to use the words of a learned author, 
“ are so improbable as to be incredible first, that the breathing of 
a dog is nothing affected bv any wound of the thorax, if only the 380 
OF RESPIRATION. 
lungs themselves be not hurt: secondly, that the lungs never collapse, 
though the thorax be laid open ; thirdly, that when the breast is en- 
tirely laid open, the lungs continue to move, and the thorax also con- 
tinues to move, hut that the motion of the thorax never keeps time 
with the motions of the lungs. But, to do Houston justice, he en- 
deavoured to explain away the inconsistencies of his own experi- 
ments ; and the world would never have been troubled any more with 
them, had it not been for a Mr. Bremond, a great academician, philo- 
sopher, and experiment-maker, who published the following suite of 
experiments in the academy of Paris. 
His first mistake is this. “ 1 found (says he) that having stabbed a 
dog in one side only, it could run about the house and howl.” This 
is what nobody will doubt. “ But also (says he) the air which the 
dog took in by the wound when it expired, was pressed out again by 
the wound when it inspired.” This is one cunning stroke of Mr. 
Bremond ; for had the air entered the chest during inspiration, that 
must have proceeded from the rising of the thorax, which is not the 
kind of respiration which he wanted to prove : but as the air entered 
the chest during expiration, it proceeds clearly, according to his prin- 
ciples, that the lungs in squeezing out their air have a contractile 
power ; that they contract by their own motion, and leave the ribs, 
and so make room for the air. 
u Next (says Mr. Bremond) I opened the thorax of a living dog, 
and there I saw, that when the lungs contracted the thorax dilated, 
and when the thorax contracted the lungs dilated.”—But in fact, it 
means no more than this, that often in these agonies produced by such 
cruel experiments upon animals, or by actual wounds in the human 
body, the diaphragm, chest, every thing which contributes to breathing, 
is so closely contracted, and the pressure is so great, that the lungs 
are actually compressed and protruded : so that his seeing, as he says, 
the lungs dilated, that is, squeezed out, when the thorax contracted, is 
like the ignorance of a child looking from a carriage-window, who 
believes and wonders at the trees and houses running backwards. 
But as no experiment-maker ever allows his experiments to remain 
incomplete, Mr. Bremond finishes his by the following daring asser- 
tion, “ that always when he made his incision no more than three 
inches long, the lungs dilated themselves with so much violence that 
they drove out the air before them, protruded themselves through the 
opening, and made the blood jerk out at all points.” In short, he re- 
peats this mistake in every possible form, viz. that the motions of the 
lungs and thorax are directly opposite to each other ; that the lungs 
are contracting while the thorax dilates, and the thorax contracting 
again when the lungs dilate. When l open a frog, it fills its lungs 
with perfect ease after both its breast and belly have been entirely cut 
away. “ If admitting air into the thorax could really make the lungs 
collapse, why do not those of the frog collapse?” This is such gross 
ignorance as should not have been endured in one reading papers 
before the Royal Academy of France. He is farther back in physi- 
ology than Oligerius, Jacobaius, or Malpighi.—The frog has a res 
piratron peculiar to itself, or at. least to its kind. OF RESPIRATION. 
381 
FIRST SPECIES OF RESPIRATION, VIZ. BY A DIAPHRAGM. 
Under this title I shall explain the respiration of Man, and of 
animals like Man ; which have heavy lungs, of a strong fleshy texture, 
a prodigious number of blood-vessels passing through them, their 
lungs lodged entirely in the chest, and their respiration performed by a 
diaphragm.—I mean to arrange respiration according to the mechan- 
ism of those organs by which it is performed; and place in the first 
order that of Man, and animals which in this point resemble Man ; 
and I say respiration by a diaphragm, for this is indeed the only use of 
a diaphragm. The support of the great blood-vessels, the compres- 
sion of the viscera, the expulsion of the urine and fceces, the ridding 
the womb of its burden ; all could have been performed by the pres- 
sure of the abdominal muscles alone ! the diaphragm is added merely 
for breathing. 
Forsaking, for a moment, authority and minute anatomy, let us ex- 
plain it in the shortest and most intelligible way.—The diaphragm 
divides the thorax from the abdomen ; it is strong, muscular, and acts 
with great power, enlarging the thorax; it is convex towards the 
breast, and concave towards the belly ; when it acts the belly is pro- 
truded, the diaphragm becomes flat, the thorax is enlarged, and a 
vacuum would be formed, but that instantly the lungs follow it and 
prevent a vacuum ; for the lungs are free in the thorax, the air has free 
access to go down into the vesicles of the lungs ; and so when the 
diaphragm retires, the lungs follow it, being dilated by the pressure of 
the air which enters by the trachea. 
But this protrusion of the belly excites the abdominal muscles to 
re-act; their pressure restores the diaphragm to its natural form ; when 
pressed back again by the abdominal viscera, it rises in the thorax, 
becomes again convex towards the lungs, the thorax is reduced in size, 
the lungs are compressed, and that air is driven out again which they 
have just received. The thorax also moves in concert with the dia- 
phragm : and this motion is most curiously arranged; for, first, the 
intercostal muscles lift the thorax for respiration, in the very moment in 
which the diaphragm is pressing down, and consequently at the instant 
when the abdominal muscles, which are attached to the lower borders 
of the thorax, are relaxed, so that they suffer it to rise. Next, the 
thorax is to be compressed and pulled down by the abdominal muscles: 
and this happens at the very instant in which the abdominal muscles 
re-act against the diaphragm ; so that the abdominal muscles, while 
they thrust back the diaphragm, pull the lower edges of the thorax 
down with great power. 
Thus in Man, and almost all animals, the respiration is performed by 
a diaphragm. 382 
OF RESPIRATION. 
SECOND SPECIES OF RESPIRATION, VIZ. THAT OF BIRDS. 
This figure represents the apparatus of respiration in a bird, a is the solid lungs, 
which are not moveable; b, c, the boues of the body, the breast-bone c extending the 
whole length of the body ; 1,2, 3, 4, 5, 6, the air-cells occupying the thorax and abdo- 
men, which are here one cavity, or rather series of cavities. These are dilated when 
the chest rises to the line It. 
Birds are supposed to breathe like Man, but have in fact no dia- 
phragm to divide their body ; they have vesicles, or air bags extending 
through the whole body, and connected with the true lungs ; their ster- 
num and ribs expand over the whole, and by their motion move the air 
vesicles, which blow the air through the true lungs ; while the true 
lungs, far from having any thing to do with a diaphragm, never move. 
Every one skilled either in anatomy or physiology, must know, that 
one of the greatest physiologists of our times has written a paper about 
the respiration of birds, little understood, and in proportion much ad- 
mired ; of which function he is so thoroughly ignorant, as to explain 
how they breathe with a diaplrragm ; and until 1 set this point right, my 
arrangement is good for nothing. 
“The diaphragm of fowls (says Mr. Hunter) is thin, transparent, 
and membranous, and runs across the abdomen.” But if thin, mem- 
branous, and transparent, it can perform none of the functions of a 
diaphragm, and must be merely such a membranous interseptum as 
some Amphibia and Reptiles have, supporting the viscera, or con- 
fining them in their place. But he thinks to make good his point by 
acknowledging the imperfection of this diaphragm ; and adding, that 
it is moved by certain small muscles, which arise from the inner surface 
of the ribs, and pull the diaphragm and lungs down. He still persists 
in calling it a diaphragm, in the very sentence in which he informs us 
that “it is perforated in many places with holes of a considerable 
siize.” Since Mr. Hunter is so bold as to say of other authors, that 
they have too limited notions of a diaphragm, we may be allowed to 
say, that his notions of it are as much too liberal as theirs are too con- 
fined. But descriptions and arguments of this kind, where the author 
is entirely wrong, should not be tediously refuted, nor answered in any 
other way than by a simple statement of the case.* 
* For the respiration of birds, i. e. for raising and depressing the thorax, I see many 
muscles having a very strong analogy with those of M«n. The pectoral musrles are OF RESPIRATION, 
383 
The anatomy of a fowl’s respiratory organs is plainly this :—The 
trachea having descended into the thorax, divides into two branches ; 
of which one goes in a simple and ordinary manner into each side of 
the lungs. The heart, winch lies immediately upon this division of the 
trachea, sends into the lungs two great pulmonic arteries, and receives 
in return two veins. The lungs themselves are very small, dense, and 
bloody ; they are somewhat of the shape of the human lungs ; they arc 
seated in the very uppermost part of the chest, are closely braced down 
to the back, and are indeed in part niched in among the ribs, which in 
birds have their edges very deep. These are the true lungs for oxy- 
dating the blood ; they never move ; the air passes through them in the 
following way. 
These lungs cannot move, because they are braced down by a mem- 
brane very thin, and cobweb-like, yet very strong. This membrane is 
a peritonaeum, lining at once the whole thorax and abdomen, (which 
still are not parted from each other,) and it is a covering to the lungs, 
liver, and other viscera; but also the same cobweb-like membrane forms 
cells, which fill the whole cavity from tiie neck down to the anus, and 
from the breast-bone to the back ; and which are so attached to all the 
surfaces, being, as I have said, the lining membrane, that as the breasl 
moves these cells must move. 
These cells appear at first sight quite irregular ; but I hold it as a 
principle, that, although we may not see it, yet all is orderly in the 
animal body ; in fact, the order of these cells is extremely regular. 
First, there is a membrane which comes down from the breast-bone in 
a perpendicular direction till it touches the viscera ; it runs the whole 
length of this common cavity of breast and abdomen ; it enters into the 
great cleft of the liver, and so divides the liver into two lobes, serving 
as a ligament for the liver, as a mediastinum to divide the great cavity 
into two, and also as a sort of root or basis for the cells of either side ; 
though beautifully transparent, it is very strong. At the upper end 
this mediastinum touches the heart, and there expands into a very large 
bag exquisitely transparent, which is at once an air-cell and a large 
pericardium. Next, at its lower end, it touches the gizzard or stomach, 
and forms a large cell surrounding it. Behind the liver which fills all 
the upper part of this great cavity, and the gizzard which fills all the 
lower part, lie all the intestines, which are also surrounded with many 
cells ; at the sides the cavity is occupied by three or four large cells 
extending from the middle membrane to the flanks of the bird. And, 
lastly, when we look into those greater cells which are nearest the 
lungs, we see clearly many openings, very large, oblique, running flat 
under that part of the membrane which braces down the lungs, so as 
to communicate the air from the lungs to all the cells very freely. 
amazingly strong, and their scapulae absolutely fixed, so that these could raise the breast 
with great power ; but I suspect that no such power is needed, that the elasticity merely 
of the sternum and ribs raises them. There lies under these, upon the back, a very 
strong muscle like our serratns posticus. There lies on the inside of the ribs a set of 
three beautiful muscles like large intercostals : they are quite insolated from all other 
parts, are seen instantly upon opening the belly: these are what Mr. Hunter calls Mus- 
cles of the Diaphragm ; but in truth the breast of a bird is pulled down strongly by its 
short, yet strong abdominal muscles, and rises again by its own elasticity with little 
help 5 and these are merely intercostal muscles. 384 
OF RESPIRATION. 
Now let me add, in one word, that the essential part9 of respiration 
are these : First, There is no diaphragm, no division of breast and belly, 
the stomach lying upon the rectum in the pelvis ; a true and muscular 
diaphragm could not exist in birds, having nothing to do in their scheme 
of respiration. Secondly, The true lungs are small, high in the back, 
quite immoveable, so that no diaphragm nor no power of vacuum could 
unfold, them ; and these lungs are perforated at every point, so that 
they could not expand by air. Thirdly, What has been confounded 
with the true lungs is the vast congeries of abdominal cells, which arc 
of use only in lightening the creature that it may fly, and in forcing the 
air through the true lungs. Fourthly, There is in the [dace of a divided 
abdomen and thorax, with long abdominal muscles, no proper abdo- 
men, a long thorax, a high sternum, and very elastic ribs, extending 
along the whole body till they almost meet the pelvis, making the ab- 
dominal muscles very short; and the air cells all along adhere to the 
inner surface of these bones. 
With these points clearly before us, we cannot mistake the mode of 
respiration in birds. The thorax does the whole ; the thorax is raised, 
and immediately the cells are expanded, by which two functions are. 
performed ; for the air which comes into the cells, passing through the 
lungs, oxydates the blood, and the cells become full at the same time 
so as to make the body specifically lighter. The thorax is depressed 
again, and the air, which passes now a second time through the lungs, 
may a second time oxydate the blood, for it is not thoroughly spoiled ; 
and what is spoiled is diluted with the air of many cells, which re- 
spiration cannot empty at one stroke. 
The final cause also is plain ; had the lungs in a fowl been solid and 
fleshy, (as they are in fowls, or even in any other creature,) and at the 
same time sufficiently large to perform, without the help of those air 
bags, all the functions of lungs, they must have been large and heavy 
in proportion to the body of the fowl; they must have occupied much 
room, and added much to the weight. But the lungs of a fowl are 
very dense, very small in proportion to its system, very full of blood, 
quite fixed, and undilatable ; the rapid course of the air through them 
backwards and forwards enabling them in their business of oxygena- 
tion to do much with little. In short, there are two functions to be 
performed in birds : first, the oxydation of the blood, which is per- 
formed by the small, fleshy, contracted lungs, which lie immoveable in 
the upper part of the thorax, and through which the air blows con- 
tinually as through a furnace, while they are quite passive ; and, se- 
condly, the lightening of their bodies for flying, which is performed by 
the abdominal cells. It was also necessary that the sternum and bony 
compages should be large, in order to afford space for the origin and 
lodgment of the muscles of the wings, and to enable them to raise the 
whole weight of the body in flying. The describing of a diaphragm, 
and the confounding of the abdominal cells with the true lungs, where 
none can be. was like to have put us all wrong. OF HESl'IRATIOIV. 
385 
THIRD SPECIES OF RESPIRATION, VIZ. THAT OF AMPHIBIA. 
This species of respiration differs from the two first in these re> 
spects ; it differs from the respiration of Man, because there is no 
diaphragm ; it differs from that of birds, for there is no chest covering 
the lungs. There is a short sternum, no chest, no ribs by which the 
lungs may be moved, there is no vacuum formed in their respiration; 
they fill the lungs by the working of their pharynx, that is to say, in- 
stead of the air being drawn in by the action of the thorax, it is forced 
down by the action of the muscles under the jaw. By the swallowing 
of the air, as it were, the membranous air cells are inflated ; and when 
inflated, they are emptied by the contractions of the abdominal 
muscles. 
The Frog, the Newt, the Camelion, the Tortoise, and many other 
creatures, breathe in this way ; and as one of the most curious me- 
chanisms for respiration, 1 shall represent that of the Frog. As 1 have 
just explained, their organs for moving the lungs are not in the chest, 
nor in the lungs themselves, but in the throat. Behind the root of the 
tongue, is the slit-like opening of the trachea ; this is what is called 
the glottis in the human subject. We see this rima opening and gasp- 
ing for air when we keep the mouth distended ; it has no epiglottis or 
valve to defend it; its own contraction is sufficient, for when closed 
you cannot even guess at its place ; besides, the jaws force down the 
air into it, and the long tongue carries the food over it into the gullet. 
The small nostril is a very important part of the apparatus of 
breathing. The Frog never opens its mouth in breathing. Looking 
carelessly upon this creature, we do not perceive that it ever breathes, 
for it lies plunged over the mouth in water. It is never seen to open 
its mouth ; there is no motion in its sides like breathing; in short, it 
docs not seem to breathe; and when it is provoked, (or rather through 
fear,) though it still keeps its mouth closely shut, its sides and back 
rise, and it blows itself up apparently by some internal power. But 
when we observe the creature more narrowly, we perceive that there 
is a frequent motion of its jaws, or rather of that skinny and bag-like 
part of its mouth which is under the lower jaw. We are apt now to 
fall into a worse mistake, for this bag under the jaw is alternately di- 
lated and contracted ; the mouth is never opened to take in new air ; 
the creature seems to live all the while upon one mouthful of air, and 
seems to be playing it backwards and forwards between its mouth and 
its lungs. 
But, lastly, when we observe its nostrils, we find that there is in the 
nostrils a twirling motion for each movement of the jawrs, which makes 
the whole process perfectly simple to our comprehension ; for a Frog 
breathes by the nostril alone, it cannot breathe by the mouth ; it never 
raises its mouth above water, nor opens it but to catch flies or other 
food. If you keep its mouth open, you see it presently struggling for 
breath; for its respiration goes on in the following way: its broad 
jaws are continually shut; they lock into each other by grooves ; the 
mouth is completely close, and forms n sort of bellows, of which the 386 
OF RESPIRATION. 
nostrils are the air-holes, and the muscles of the jaws which come 
from the os hyoides draw the draught by their alternate contraction 
and relaxation ; and the nostrils lie so obliquely over the hole in the 
skull, that the least motion of them enables them to perform the office 
of a valve. First, there is a twirl of the nostril which lets in the air ; 
then a dilatation of the bag under the jaws, by which the mouth is 
greatly enlarged and filled with air ; then a second motion of that bag, 
by which the mouth is emptied and the lungs filled ; then there is a 
slight motion of the sides of the creature, by which the muscles of the 
abdomen expel the air again ; and then the twirl of the nostril and the 
motion of the jaw succeeds again ; so that with these creatures in- 
spiration is the swallowing of the air (but not into the stomach) by 
their broad expanded jaws, with their coverings driving it down into 
the lungs; and expiration is the contraction of the abdominal muscles 
driving it out again : and these two motions, when we observe a Frog 
attentively, are as perfectly regular as respiration in a Man. Their 
muscles of respiration are not the muscles of the belly, but the mus- 
cles of the jaws; and this causes the uncouth broadness of the jaws ; 
in Frogs, Newts, Lizards, Serpents, Turtles. 
Now we shall no 
longer wonder why the 
Frog never opens its 
mouth; why it never 
seems to breathe ; why, 
after opening its belly, 
the lungs still project; 
why, after emptying its 
lungs, it can fill them 
again at will, not by any 
peculiar power in the 
lungs, but by blowing 
them up with its jaws. 
If you gag the Frog 
and keep its mouth open, 
it cannot fill them, because it cannot breathe ; if you plug its nostrils, 
it suffocates, though not soon ; if you keep its mouth open by force, 
you soon find it struggling for breath ; and looking into its throat, 
you see the glottis opening from time to time. 
The Newt, (or as it is called in Scotland, the Ask) breathes with 
the jaws and nostril like the Frog; it has, like the Frog, a constant 
motion by short strokes of the bag under the jaw, (which bag is formed 
by the membranes of the mouth, covered and moved by the genio- 
hyoidei and mylo-hyoidei muscles,) but we observe that every minute, 
or less, it stops as if intending some particular motion ; then gradu- 
ally the bag swells out under the lower jaw to a great size ; then the 
air contained in it is puffed down into the lungs with a sudden flap of 
the bag ; and in proportion as the jaw's are emptied, the long sides of 
ffie creature are heaved up. 
(o) The nostrils—(6) The tongue. QF RESPIRATION. 
387 
(aa) The liver of the Newt— 
{b) the stomach—(c) the intes- 
tines—(d) the ovaria—(e) the 
heart—(jff) the vesicular lungs, 
which are long like intestines, 
and transparent like the swim- 
ming bladders of a fish—(g) the 
bag of the jaws by which the 
lungs are blown up. 
The Toad, the Carnelion, the Green Lizard, breathe exactly in the 
same way. The Carnelion has the flat broad jaws of the Frog; they 
lock into each other, and it does not open its mouth in respiration ; it 
swallows its air in mouthfuls, drives it downwards into its lungs ; its 
lungs are of a vast extent, stretching from the jaws all along the ab- 
domen : it is the vast size of its lungs, almost concealing the abdomi- 
nal viscera, that makes Gesner say, “ that of the entrails of a Came- 
lion the lungs pnly are visible.” The air it swallows in greater or 
smaller quantity as its needs or fears prompt it. When you alarm this 
timorous animal, it fills its sides just as a Frog swells out its back ; 
and either in this greater respiration, or in its ordinary breathing, we 
see it pressing the air onwards from cell to cell; and we see the mo- 
tion proceeding from its jaws to its breast, and all along its sides, till 
its lank form is quite puffed up almost to bursting. 
All these creatures have in addition to their peculiar respiration, a 
peculiar kind of lungs, thin, membranous, and extremely delicate : the 
lungs even of so great an animal as the Crocodile are, when in- 
flated, very delicate and transparent, of a rose colour or slight red, 
consisting of delicate vesicles, and exactly like the Frog’s lungs. The 
lungs of the Frog are in shape like a fir-cone, with the stalk of 
the cone on each side fixed to the side of the heart. But these conical 
lungs of each side are delicate, silvery, perfectly transparent, divided 
within into innumerable cells like a honey-comb ; and these also are 
so extremely delicate, that though the outside membrane is as trans- 
parent as a soap-bubhle, the divisions can hardly be seen, except by in- 
flating and drying the lungs, and then cutting them. The lungs of the 388 
OF RESPIRATION. 
Ask are still more beautiful, as a specimen of what are called mem- 
branous lungs ; for the creature is very long in the body, its lungs run 
down along its sides; they are about the size of a common earth- 
worm or writing-quill; they end like a blind gut; they are of a bluish 
white, exquisitely transparent, like the swimming bladder of a fish. 
It is the nature of membranous lungs to oxygenate but a very small 
quantity of blood; they are membranous, only because there is not 
that vast profusion of arteries, veins, and strong vesicles, which there 
is in the human lungs. The pulmonic artery and vein are always, in 
the membranous lungs, extremely small in proportion to the system 
which they serve. 
From these peculiarities of the membranous lungs, it is plain that 
the oxydation of the blood is a process of less immediate necessity in 
their system ; and thus they are the better enabled to go into the water, 
and to want breath for a time. But chiefly it appears, that the mean- 
ing of this peculiarity is not so much to give them the privilege of 
Amphibia, in allowing them to go into the water ; for many creatures, 
as the Camelion, all the tribe of Lizards, Newts, Toads, Serpents, 
&,c. have these lungs, and yet never approach the water : but that the 
chief use of it is to establish in this class of animals a peculiar con- 
stitution, a permanent, almost inexhaustible, irritability, and a tena- 
ciousness of life ; which, 1 believe, no creature, whether of the land 
or the water, wants, which has membranous lungs. And when we 
are told that these creatures can be kept two days under water, as a 
proof of their being Amphibia, i cannot but consider it as a very 
childish proof; for, in the first place, we see them breathing with 
wonderful regularity when out of the water ; when plunged into the 
water, we see them very soon struggling for breath, and if they can 
live for two days without air, it is only because they could bear any 
other kind of injury with equal ease, and could live two days without 
their heart or their head. Circulation is necessary, respiration is ne- 
cessary to their life, but the irritability and properties of the living 
parts are sustained longer without new supply thaft in the warm 
blooded animals. 
FOURTH SPECIES OF RESPIRATION, VIZ. THAT OF FISHES. 
In this species of respiration the creature breathes neither water 
nor air, but water mixed with air, and this office is performed by gills 
in place of lungs. 
The reason why I have called this a species of respiration, needs 
to be very fully explained ; for, though little observed, it is a certain 
fact, that a creature, without any apparent change upon its system, 
can do well, having its blood oxygenated at one time by gills, at ano- 
ther time by lungs. The Frog, for example, lives long in the water ; 
while it does so, it may be considered as a foetus which cannot breathe : 
the young Frog which has not yet acquired its proper and natural 
respiration, breathes like a fish. For the first fourteen days after 
hatching from the egg, and while the Tadpole is very small, it has 
gills, wliich are two long, projecting, fimbriated appendages like fins : 07 RESPIRATION. 
389 
by the thirty-sixth day these appendages are taken into the jaws, and 
form four rows of gills on each side, regular, and like those of a fish ; 
but at the same time, this fcetus has its lungs within the body, not to 
be used till it come out into the air, when the lungs assume their 
function and the gills shrink. The same system in this instance, which 
was at first served by gills, is in the end oxygenated by lungs. 
The motion of the gills in fishes is a true and perfect respiration ; 
for, in the first place, if there be no air in the water, or not enough of 
air, they cannot breathe ; distilled water is to a fish what the vacuum 
of an air-pump is to a breathing creature : if you exhaust water with 
an air pump, if you boil it, if you distil it, if in any way you deprive 
it of its air, fishes cannot breathe in it, but come up to the surface and 
gasp for air. If you take a fish out into the air, it is the same with 
plunging any breathing creature into water, it gasps and dies. Fishes 
cannot breathe in air wanting water, for that element is not accommo- 
dated to their species of lungs; nor in water wanting air, for then 
there is no oxygen ; and we find, upon extracting the air from water 
which fishes have breathed, that it is contaminated, exactly in the same 
way with air which had been breathed by any breathing animal, and 
that it differs very little from that in which a candle has burnt out. 
This is the reason that when many small fishes are enclosed in a narrow 
glass, they all struggle for the uppermost place, and that when in 
winter a fish-pond is entirely frozen over, you must break holes for the 
fishes, not that they may come and feed, but that they may come and 
breathe ; without this, if the pond be small, they must die. Fishes 
according to their kind require water differently impregnated with air. 
The shallow water that runs over a pebbly bottom is by its agitation 
more thoroughly mixed with the atmosphere, and there the trout and 
salmon breed. 
In the respiration of fishes, there are two curious points to be con- 
sidered : first, the manner in which their respiration is performed ; and, 
secondly, the manner in which their blood, when thus oxydated, is distri- 
buted over the body. 
In the osseous fishes the apparatus of respiration is more like the 
texture of the ribs than would seem at first view. The operculum, or 
large flap which covers the gills, consists of arched bones, over which a 
membrane is stretched, and they have a very beautiful and somewhat 
complex system of muscles operating upon them. The margin of the 
operculum has a soft pliant fringe, which, in the motion of respiration, 
accurately shuts the slit or opening. When the creature breathes, it 
is by the operation of the muscles upon this covering : it is rendered con- 
vex, and the cavity under it is dilated without the margin rising; the 
consequence of which is, that the water is drawn from the mouth 
through the branchiae, and is for a moment lodged behind them. At 
length the elevation of the operculum is so great that the fringed margin 
is raised, and then the water rushes out and is discharged backward. 
By this we understand why the fish keeps the head continually up the 
stream, and why it is the art of the fly-fisher to keep his head down the 
3tream, or tQ, suspend him in such a manner as to keep his mouth out of 
the u'ater: for the fish cannot breathe if the water is rushing' into the gills 390 
OF RESPIRATION. 
from behind, and he cannot make use of air as he does of water, but is 
exhausted and suffocated. 
Having explained this first point, viz. the mechanism of their gills, I 
proceed next to explain the circulation of their blood, how their blood 
is oxydated, and how it is distributed over the body. 
A fish and an amphibious animal have both of them the simple heart, 
consisting of one auricle and ventricle, but with this singular variety, 
that the Frog, for example, wants the heart belonging to the lungs, a 
small artery only from the common system performing the office; 
while the fish again wants the heart which should circulate the blood 
through the body, and has that heart only which belongs to the lungs. 
The whole blood of the fish passes through this single heart, and there- 
fore the whole mass circulates parcel by parcel through the gills, for 
every time that it circulates through the body. We shall begin its 
circulation, then, at the heart. First, The whole blood of the body is 
returned into the heart of a skate, by two great veins. These two 
great veins deliver it into a vast auricle, or reservoir rather, which lies 
over the heart. The auricle delivers it into a strong ventricle, whose 
action is further strengthened by the action of its aorta, which from the 
heart up to where the valves are, is very muscular and powerful, and 
constitutes, in a manner, a part of the heart. But this great vessel 
must in this species of circulation change its name, for it really is not 
an aorta, has nothing to do with the body; both the heart of a fish, 
and this its only vessel, belong entirely to the lungs or gills, and as these 
are called bronchi®, this is the bronchial artery. The gills of this fish 
are five in number on each side, and on each side the bronchial artery 
gives out two branches which serve the five gills : the lower branch is 
large, and serves the three lower gills ; the higher branch, which goes 
off like one of the arms of a cross, serves the two upper gills. 
Secondly, these arteries being distributed along tbe gills, divide into 
exquisitely small branches producing that feathery appearance which 
is so beautiful. Those minute subdivisions of the bronchial vessels 
expose the blood to the air. This may explain to us how in the human 
lungs the exposing of the blood, even with the interposition of mem- 
branes and of the arterial coats, may be sufficient for the oxydation of 
the blood. All the blood thus oxygenated is returned by veins, cor- 
responding exactly in number and arrangement with their arteries : 
and the heart being turned aside, and all the other viscera taken out, 
the veins are seen accompanying their arteries and emerging from the 
gills to form the aorta. 
Thirdly, The aorta is formed by the veins of the gills, and the veins 
of the gills lie close upon the skull of the fish, and the aorta upon the 
back-bone ; and this vessel is in one sense a vein, since it is a continu- 
ation of those veins which return the blood of the gills ; but both in 
office and form it is a true aorta ; in office, because it distributes blood 
to the whole body ; and in form, because it no sooner swells out into 
the shape of an aorta than its coats grow hard, strong, muscular, fit 
for its office, while those of the veins from which it is formed are pel- 
lucid, delicate, and very tender. The aorta is full of the oxydated 
blood of the "ills; and although, by the delicate circulation of the OF RESPIRATION. 
391 
gills, it has lost all communication with the heart, it circulates this 
oxydated blood through the body to all the muscles, glands, viscera, 
&.c. without the intervention of a new heart. 
The veins which return the blood of this aorta are the ordinary 
veins ; they arrive in two great branches at the heart, and need not be 
further explained. 
I will not be at the trouble to repeat the tedious calculations of au- 
thors concerning the immense surface which the gills expose; let the 
student look to the gills, and he will presently, with the help of this short 
sketch, understand how the whole function goes on. 
FIFTH SPECIES OF RESPIRATION, VIZ. THAT OF INSECTS. 
There is in this kind of respira- 
tion no breathing organ like the 
lungs, but tracheae or air tubes by 
which air enters into all parts of 
their body. 
What is most perplexing in this species of respiration is the prodi- 
gious quantity of air which these creatures receive ; the little connec- 
tion between the air tubes and the heart; the impossibility of tracing 
blood vessels from the heart to the various parts to nourish them ; and 
the clearness with which we see their air tubes branching over all parts 
of their body. The stomach, bowels, and other viscera, the legs and 
wings, even the very scales of insects, have branches of the air tubes 
dividing over their surfaces like the delicate vessels of leaves and 
flowers. In short, the magnitude of these air tubes is quite surprising ; 
and their branchings are so minute, delicate, universal over all the body, 
that it looks almost as if the air tube had exchanged functions with the 
heart and arteries. 
It is plain by these expressions of admiration that I do not mean to 
attempt so difficult a subject as this at present: I only mention diffi- 
culties which it is surprising that others have not declared and inves- 
tigated, for nothing can be more interesting. The little that we do 
know shall be simply and plainly told. 
The dorms of insects are often very strange, their lives very irregular, 
sometimes in water, sometime? in air ; many of them begin in worms, 
and end their lives as flies and moths; and according to these varieties 
of their tbrm, or life, or generation, their air tubes are various. 
Sometimes, as in the common bee, they have nearly the form of lungs: 
they begin like two bags, resembling those of the Alga Marina or sea- 
weed, in shape ; and these bags distribute pulmonary tubes, with occa- 
sional bag-like dilatations in the course of the tubes, through all the 
body. More commonly the air tubes of insects are direct tubes, mere 
tracheae, of a- very singular construction ; they have rings like the 
tracheae of animals ; they have a delicate membrane covering these 
rings, and forming them into a tube : the tube continues always rigid 
like a flexible catheter, or other tube of twisted wire not liable to col- 
lapse : they begin by many open mouths opening along the sides of 
the insect, and they terminate in mvriads of vessels, which in their 392 
OF RESPIRATION. 
forms and progress over the various parts of the body, resemble blood 
vessels more than it is easy to conceive. These air tubes being thus 
rigid, are always full of air, and by their refractions through the trans- 
parent parts of the insect’s body, they give it in the microscope a 
great degree of brilliancy ; as, for example, in the louse, whose air 
tubes make the brilliant lines and points which are contrasted like a 
silvery colour with the dark and opaque parts ; or in the mite, which 
is as beautiful in the microscope as the louse ; and when the larger 
insects are prepared by drying and varnishing, and preserved in turpen- 
tine, the air tubes are beautiful. Of these curious particulars, the 
openings of the air tubes are best seen in the worm, from which the 
common butterfly is produced ; we count these holes down the sides, 
we name them puncta respiratoria, spiracula, or most commonly stig- 
mata. That particular form in which they resemble more the lungs of 
animals is seen in the pulmonic bags and the tracheae or air tubes of 
the common bee. Their exquisite branchings through the various parts 
are well seen in the air tubes which run along the wings of a bee, or 
those which twist and ramify round the intestines and stomach of a 
worm ; and it is not to be forgotten, that though the begii nings of 
these tubes in their great tracheae and near the puncta respiratoria or 
stigmata are quite transparent, their extreme branches are beautifully 
white like vessels filled with chyle, or rather one might be apt to mis- 
take them for nerves. 
Of the way in which this function is performed, there must be more 
varieties than we can know or comprehend : this we may safely con- 
clude from the little that we do know, finding the varieties so very 
great. 
Almost all insects, with the exception of dipterous larvas, have 
their puncta like those of the Caterpillar, ranged along the side, and 
inosculating from branch to branch : often the puncta open along the 
sides 5 but in place of inosculating from branch to branch, all round 
one side, they inosculate across the belly, the one side communicating 
with the other. This is best observed in the small larva from which 
the Bee proceeds. And here it must be observed, that, as in insects, 
with the exception of dipterous, always the stigmata or breathing 
points correspond neatly with the folds or rings while it continues a 
larva, and with the segments or divisions of the body when it becomes 
a Fly ; in the Bee-worin also the inosculations answer to the joint of 
the body. 
Sometimes when an insect lives in water, it has only two puncta 
respiratoria : these puncta begin either in the snout or in the tail ; 
they are the openings of two great air tubes which run down each 
side of the insect like two aortas, and the insect has means of rising 
to the surface, takes down a bubble of air along with it, and discharges 
a bubble of air before it rises again : of this nature are the air tubes of 
that Worm from which the Ephemeris proceeds. The two great air 
tubes are seen like two aortas running all along the body, and their 
minute branches are seen ramifying beautifully upon the abdominal 
muscles and other parts. Many insects are aquatic when first they 
are hatched from the egg. They have little gills which serve them OF KESPIRATlW\. 
393 
while they continue in the water, as, for example, the larva of the 
Ephemeris Fly. These little gills are fringed with microscopic ma- 
inilhe, which communicates with the great tracheal branches ; so that 
along with the gills they have the ordinary structure of air-tubes, and 
the day on which they emerge from the water, the gills shrink, and 
the air-tubes begin their function ; and these changes succeed each 
other very rapidly in all insects, but most especially in the Ephemeris, 
which is destined to live but one day. 
It is most of all singular, that in some insects the number of respi- 
ratory points, or puncta, changes according to the various conditions 
or stages of their existence. For example, a larva which crawls 
among the dust, since it must breathe less easily, has more puncta. 
than when it has changed its state to that of a Fly, and has its puncta 
very freely exposed to the air : in the Rhinoceros Beetle the larva has 
more puncta respiratoria, and closer, because it crawls on the ground 
amidst mud or dust; they are less numerous in the Fly, as its air-holes 
are always more freely exposed ; and when the Beetle is actually 
flying, those puncta, which were closed by the cases of the wings are 
fully opened ; so that the insect breathes more freely, and perhaps its 
body is lightened, so that it flies more easily : it is also particular 
that in the full-grown Beetle, though the puncta be less in number, 
the lungs are enlarged, they both change their form and become 
more capacious ; for the tubes are mere trachea or straight lines, with 
direct branches in the larva, but in the Beetle they are dilated from 
point to point into air-bags. 
Insects in general are bred in eggs, transformed into larvae, and of 
these the greater number assume the form of aureliae ; an aurelia is a 
Fly, small but full formed, with its legs drawn up, it wings plaited and 
folded, ready at all points to burst from the covering which surrounds 
it; for both in posture and in the membranes which surround it, it 
resembles a foetus. In these three stages it still is supplied with air by 
air-tubes : they open by puncta respiratoria while it remains a larva ; 
the same puncta still serve it while it is wrapped up in an aurelia or 
concealed Fly ; when the Fly bursts out, the same puncta, the same 
tubes, which have served in its former stages, serve it still; only this 
is most curious, that when from a larva it proceeds to be a Fly, the 
skin which it rids itself of (by crawling out of it and pushing with its 
feet) carries off along with it many of the internal parts; the mouth, 
the anus, and especially all the respiratory tubes, lose an internal skin 
at the same time that the old skin or slough is pushed off from the out- 
ward surface of the body ; and when the puncta are thus changed, 
they are left more open than before, and often their number is changed. 
These are the various ways by which insects are supplied with air; 
and nothing can be more interesting than to observe the vast propor- 
tion of air which they draw in, which is certainly a provision for their 
living in places where oxygen cannot be plentifully supplied. And 
the fact is well known, that insects can live on air much less pure than 
what is necessary to breathing creatures, and that they exhaust the 
oxygen of the atmosphere much more completely than any other living 
creature. The variety in the manner of conducting the air to the 394 
OF RESPIRATION. 
tem of insects, is changed, and suited, as I have observed, to their 
various ways of life, and to the various conditions and stages of their 
life; while they are Worms, when they are involved foetuses, and 
when they have burst their shell, and are full grown. In short, Worms, 
Aureliae, Flies, Beetles, Bees, and all forms of insects, have all of them 
their tracheae by which they breathe a wonderfully large proportion 
of air. 
There can be no mistake concerning the function of their air-tubes 
and of their circulation ; it is ignorance or inattention only that can 
cause confusion ; the heart of a Caterpillar, of a Snail, of the larva? 
from which various Flies are produced, is seen distinctly through their 
transparent body, running down their back in form of a tube, some- 
times slightly oval, sometimes having frequent dilatations, and throbbing, 
though with less equable and distinct pulses than in the more perfect 
animals : or, perhaps, we should say rather exhibiting oscillations. 
Nor can there be any mistake that it is air they breathe; for before we 
dissect an insect, we must kill it; the contortions of a live Caterpillar 
prevent all deliberate dissection, or even a view of the parts; we may 
poison the insect as with turpentine or spirits: we commonly drown 
it; this is done by immersing it in a little tepid water. Nay, we find 
a thing which is at first inconceivable to be really true, that notwith- 
standing the inosculations of the air-tubes with each other, which seem 
to provide against all such effects, when we close up the stigmata of 
an insect one by one, the parts become in the same proportion paralytic; 
if we varnish over the stigmata of one side, that side becomes paralytic; 
if we varnish over the stigmata of both sides up to the last holes, the 
insect lives, but in a very languid condition, it survives in a kind of 
lethargic state for two days, without any pulsation in its heart; if we 
also stop the two highest holes, it dies. 
Of all the examples of respiration, that which is reported by Spal- 
lanzani is what I most wonder at, and cannot but doubt. In acescent 
liquors, or the juices of animal bodies, animalcules are seen plainly 
with simple glasses, moving sometimes rapidly, sometimes slowly ; but 
never hitherto has any author pretended to see their lungs or heart. 
Mr. Spallanzani says, “ that these animalcules are elliptic bodies ; that 
in the centre of each ellipsis he sees two stars, which are in constant 
alternate and regular motion, whether the creature rests or moves. 
Each star-like body has in its centre a small globe, and every three or 
four seconds the globules are blown up slowly to three or four times their 
natural size, and as slowly compressed again ; and every time that the 
radii are inflated the central globule subsides. On one side of these 
star-like bodies there is an ova’ part, whicli is continually agitated 
with a trembling motion ; lie calls the star-like bodies, lungs, and the 
oval body he thinks is the heart."’ Spallanzani surely has forgotten 
that he is speaking of lungs in an aquatic insect; if these star-like 
bodies have any such use, they must be gills. 
These are the animalcules which Buflon called organic germs, and 
from which, as materials and pieces, he built up the animal body. But 
if all this be true, then the day has come which he little expected, 
when the organic particles, on the faith of which he built all his system 
of generation, are proved to be living and moving animalcules, vnra- 395 
OF RESPIRATION. 
clous of food, devouring each other, breathing air, and having a visible 
pulsating heart; animalcules deposited from the atmosphere, and 
generating like other insects of their kind. 
Thus we are convinced of the importance of respiration, and the 
absorption of air in all living creatures, from Man even to the meanest 
reptile ; and not least needful in the last and lower order, which receive 
in proportion a’fuller supply of air than fishes, anlphibia, or Man. 
or THE MOTIONS OF THE THORAX, AND OF RESPIRATION IN MAN. 
We have understood by our studies of the skeleton, and of the 
muscular system, how admirably adapted, the thorax is to dilatation 
and contraction ; and how the muscles act upon the bony and cartila- 
ginous apparatus for this purpose. We have seen also that the car- 
tilages are added to the ribs and sternum, to give them elasticity, and 
consequently strength, or at least a principle of resistance. This 
elasticity of the texture of the thorax serves another purpose ; it pre- 
serves the chest in a middle condition, between its utmost state of con- 
traction and of dilatation, and tends to preserve life. 
Let us now understand what takes place in the drawing of the breath. 
This figure represents a 
section of the body—(a) the 
thorax—(6) the abdomen. 
These two cavities are divided 
by the diaphragm which is re- 
presented by the arched line 
(c) ; for the diaphragm as- 
sumes this arched form espe- 
cially in expiration. When 
the effort is made to inspire, 
the diaphragm descends, and 
then its state may be repre- 
sented by the dotted line (d). 
As the diaphragm descends, 
it of course compresses the 
viscera in the abdomen (A), 
and this pushes out the abdo- 
minal muscles in the form of 
the dotted line (f) ; at the 
same time that the diaphragm 
and the abdominal muscles 
have changed their condition, 
the ribs are expanding, and 
the breast-bone (e) is rising, 
30 that the thorax is enlarging 
in all its diameters. This 
being the act of inspiration, 
we easily understand expira- 396 
OF HE SPIIl ATI Off. 
tion to be the return of these parts to their original condition, i. e. the 
descent of, (e) ; the falling in of (f) ; and the rising of (d) to (c). 
Let us now take a front view of the thorax, so that we may have our 
notions of the action confirmed and corrected. We have the cavities 
of the thorax divided by a dotted line ; and the floor of these cavities 
formed by the arch of the diaphragm (art). When the diaphragm con- 
tracts and descends,*it can not uniformly descend as represented in the 
lateral plan; for we have understood that it is tied up by the medias- 
tinum. The perpendicular dark line represents the mediastinum. 
Thus the arch (aa) instead of descending in a single arch, acts on its 
lateral parts principally, and assumes the form (bb). As it was formerly 
explained, it acts on the lungs more than on the heart and vessels. 
The student who has attended to the anatomy and relations ot the 
lungs, must perceive that the rising and falling of the chest, and the pro- 
pulsion upwards of the diaphragm (by the abdominal muscles.) and its 
descent, must influence the lungs, alternately drawing the atmospheric 
air into them and expelling it; and thus the act of respiration is per- 
formed, the lungs being passive. He must perceive that by this me- 
chanism, in which the whole muscles of the neck, chest, and abdomen 
and back are concerned, there is a continual exercise, and an incessant 
motion or agitation of all the viscera. No doubt this is conducive to 
their proper function and health. We will, no doubt, also observe, 
that this extensive apparatus of bones, cartilages, and muscles, serve 
other purposes than mere breathing, that they assist the circulation of CIRCULATION OF THE FfcETCb. 
397 
the blood, that they are agitated in speaking, coughing, laughing, 
crying, smelling, vomiting, the expulsion of the fceces, &-c. He must 
perceive this importance in the economy, and must surely be desirous 
of knowing how they are combined and animated—for which see the 
nervous system. The action of the diaphragm on the circulating ves- 
sels is a subject which for the present, 1 must reserve. 
OF THE PECULIARITIES IN THE CIRCULATION OF THE FCETUK. 
The peculiarities of the fetus relate principally to the circulation of 
the blood, and are such chiefly as fulfil the circulation without any need 
of its passing through the lungs, enabling the fetus to live without 
that function in its mother’s womb. 
The system of the fetus is attached to the maternal system, through 
the placenta, as we shall afterwards find. The placenta is a sort of 
cake, consisting of numerous convoluted vessels, belonging in part to 
the fetus, in part to the mother, and fixed to the interior surface of the 
uterus. The umbilical cord, or funis, consists of one large vein, and 
two arteries : and these vessels go out from the umbilicus of the fetus 
to the placenta, and circulate the blood in that body, by which, of 
consequence, the blood of the fetus is exposed in vessels of inde- 
scribable minuteness, to the corresponding vessels of the maternal 
system. 
We are assured that the blood which comes to the fetus through the 
umbilical vein is pure, or of greater value than that which the fetus 
returns to the mother’s system. Either this blood is restored to all its 
properties merely by passing through theinother’s system, and what is 
thus drained off* from the extremities of$he mother's system is more 
than sufficient for the life of the child ; or, without such direct com- 
munication, the placenta performs to the fetus a function equivalent 
to that of the lungs. 
The blood returning from the placenta to the fetus, by the great 
vein, is of the arterial colour, as we have said, and fit for the uses of 
the fetal body, and capable of nourishing it. The umbilical vein en- 
tering the body of the fetus, by the umbilicus, runs, directed by the 
broad ligament of the liver, under that viscus. Here, within the liver, 
it forms a large and direct inosculation with the vena portae. To com- 
prehend this subject at all, we must so far anticipate, as to say, that 
the vena portae is a vein which collects the blood of the stomach, 
spleen, and intestines, and carries it into the liver. 
The blood thus, as it were, conveyed by the umbilical vein into the 
system, does not circulate there, but finds a direct passage into the 
heart. This passage is called ductus venosus, it runs direct from the 
extremity of the umbilical vein into the cava ascendens, and conse- 
quently it conveys its blood into the right auricle of the heart. 
This blood does not pass through the circulation of the lungs ; 
perhaps it ought not to pass: for there being no respiration, no air 398 
eiKCULATION Ol 
admitted to the lungs, the blood might rather be contaminated ; per- 
haps it cannot pass, the lungs never having been expanded with air: 
but, however that be, there is a side passage for conveying it from the 
right to the left side of the heart clear of the lungs. For this use is 
the foramen ovale, which is an opening of no inconsiderable size 
between the right and left auricle of the heart; its area is as large as 
that of the vena cava; and it is sufficient to convey the blood freely 
from right to left. 
The dlctus arteriosus serves quite another purpose ; for though 
the circulation of the aorta is well maintained in the adult body by the 
force of one ventricle only, yet in the foetus one ventricle will not suf- 
fice. In the foetus, the heart must push its blood not only through that 
system of vessels which is within the body, but also it must push it 
onwards through a second circle of vessels, viz. those of the placenta; 
for we might be tempted to say that the iliac arteries do not descend 
into the thigh and pelvis of the foetus, but the iliac artery itself, with 
little diminution, (very small branches only being given downwards 
into the pelvis and thigh,) turns upwards along the side of the bladder ; 
and these two arteries going out from the navel, form with the great 
vein the umbilical cord ; and the heart of the foetus has to give life 
and action not only to the internal system of the body of the foetus, 
but to these two arteries, which run out to the distance nearly of three 
feet along the umbilical cord, and which make wonderful convolutions 
in the placenta, and terminate with extreme minuteness, as we have 
said, in the extremities of the umbilical vein. It is this which occa- 
sions the necessity of the ductus arteriosus, which is merely a union 
or inosculation of the pulmonic artery with the aorta. This union is 
formed by a great branch of the pulmonic artery in the foetus, joining 
the aorta below its curve. This great branch (for it is greater than 
the two branches which go to the lungs,) is named the ductus arte- 
riosus, and may be defined iiwnosculation between the pulmonic artery' 
and the aorta, so very large, that it gives the aorta of the foetus twice 
its natural size and proportion, and enables the blood of that artery to 
receive the full force of both ventricles. 
The contaminated or venous blood of the foetus must be returned 
to the mother, or at least to the placenta ; for which purpose the two 
iliac arteries are reflected along the side of the bladder as I have just 
explained. I say the iliac arteries without reserve, because the hypo- 
gastric and femoral arteries, that is, the arteries of the pelvis and thigh, 
though they are the largest branches of all the body in the adult, are 
in the foetus extremely small; and thence that smallness of the lower 
extremities compared with the largeness of the head, which charac- 
terizes the child, and which it takes years to redress. 
Thus have I defined these parts and their uses, in order that their 
strict anatomy may be the more easily explained ; and the part first 
mentioned, viz. the ductus venosus, is the part the most difficult to be 
understood, and never without the help of a plan. In the plan I have 
endeavoured to elucidate these points: 
First, the mere anatomy, connexions, and inosculations of the ves- 
sels ; showing how the umbilical vein brings in the blood of the mo- THE FCBTUS. 
399 
tuer ; how that vein spreads in the liver, and feeds all Its left side with 
blood ; and how the ductus venosus carries part of that blood away 
from the circulation of the liver, conducting it directly onwards to the 
right side of the heart. 
Secondly, I have endeavoured to explain what parts of the liver 
each branch supplies, and how these vessels lie in the liver of a new- 
born child. 
The blood from the maternal system transmitted through the pla- 
centa, and oxydated, or having undergone some change equivalent to 
what takes place in the lungs of the adult, comes down along the um- 
bilical vein :—the vein enters by the navel, adheres to the inner surface 
of the abdomen, enters into the liver at the top of that great trans- 
verse cleft which divides the liver into two lobes ; and after entering 
the liver, it begins, as if it were the regular and peculiar vessel of the 
liver, to distribute branches through its substance from right to left. 
In the Plan,—(a) shows the umbilical vein, (6) branches given to 
the substance of the liver, (c. c. c.) three great veins from the spleen, 
stomach, and intestines, which run together, and forms (rf) the vena 
porte. (e) The cylinder of the portae being its great right branch 
where it lies in the transverse fissure ;—(f) the great right branch of 
the vena portae in the liver. Next comes (A) the ductus venosus, 
whose office is important, but the size of which is not quite what we 
should suppose. It comes off' direct from the umbilical vein (a) ; 
its course is short, and a little curved ; it joins at (») the largest of the 
hepatic veins, i. e. of those great veins which return the blood from the 
liver, and along with it goes directly into the right auricle of the heart; 
(*) the cava abdominalis; (& k) the cava) hepaticac. This, perhaps, 
might suffice as a description of the ductus venosus ; but it. is e-onve- 400 
CIRGFBATJGN GF 
nicnt, and will make a clear subject, to finish that circulation of which 
this ductus venosus is one of the chief difficulties. 
The ductus venosus (h) I consider as the end of the umbilical vein 
(a), for here its circulation ends ; or, if it sends blood into the right 
branch of the vena portae (&), its proportion is but small. But the 
vena portae, (which is just the collection of all the abdominal veins 
(c. c. c.) into one trunk,—of the splenic vein, of the mesenteric vein, 
of the hemorrhoidal vein, i e. the vein from the pelvis)—the vena 
portae (d), 1 say, composed of all these veins, is the true vein of the 
liver. 
The branches of the vena portae are gathered into a trunk, that 
trunk enters the liver ; it divides into two great transverse branches, 
the one serving the right side of the liver and the other the left; but 
in the foetus this left branch is not known as the limb or left branch 
of the vena portae, but looks rather like the right branch of the umbili- 
cal vein ; indeed it is named so by Mr. Bertin. 
Those peculiar veins which we find in the foetus, are accommoda- 
tions for its circulation, are ranked among the peculiarities of the 
foetus, and are, when the child is born, obliterated by a new circula- 
tion ; and what is very curious, by a circulation which goes through 
the same vessels in a retrograde course. 
The liver of the foetus has blood circulating in two directions ; the 
right side of the liver is filled from the vena portae, the left side by the 
umbilical vein. The liver of the foetus having two veins has a large 
quantity of blood, a growth larger than that of any of the viscera ; 
and indeed the liver alone seems to fill all the upper region of the ab- 
domen. This is changed when the child is born ; the umbilical cir- 
culation is cut off, and the liver of the child ceases to grow but in 
proportion to the other parts. 
But what is most extraordinary, is this, that the proper function of 
the liver is not performed, while the foetal circulation continues, and 
it is only when the blood of the umbilical vein is cut off by the tying 
of the cord, and when the venous blood comes slowly up from the 
vein of the membranous viscera of the abdomen, to fill this extensive 
system, that the true and stimulating bile is formed in the liver. 
FORAMEN OVALE. 
(a) The ascending cava, with its hepatic 
branches (bb),—(c) the descending cava,—(d) 
the right auricle, where it lies against the roots 
of the aorta and of the pulmonic artery,—(i) the 
isthmus Veussenii, as it is called, or circle which 
surrounds the oval hole,—(m) the valve of the 
foramen ovale,—(n) a small opening, which we 
always find towards its upper part,—(o) the 
opening towards the ventricle. This plan is in- 
tended chiefly for showing the true place of the 
foramen ovale ; its anatomy and just form is bet- 
ter represented in the true drawing which ends 
this subject. 
The foramen ovale, which we have mentioned as one ot the clnel pe- 
culiarities of the foetus, is a hole of no inconsiderable size, transmitting THE FOSTUS. 
401 
the blood Ireely from the right to the left side of the heart. Its use is 
obvious, even from a general view of the system ; and when we look 
more closely into its mechanism, its uses are completely explained. 
Its valve being placed on the side of the left auricle, perfectly settles 
(and that by the only authentic proof) the course of its blood ; and, 
satisfied with the description which I am now to give, 1 decline all dis- 
putes about the nature of this opening, or its valve. This is a subject 
which disputes may perplex, but cannot explain. Another reason 
which I have for declining such controversies is this: It is an easy 
matter to impose upon a whole academy, easier by far than upon one 
ingenious man ; and thus it came to pass that in the French Academy 
each theorist brought dissections of the heart, and foramen ovale suited 
to his own doctrines ; each, when convenient, changed his ground a 
little, and brought new dissections ; and thus valves and auricles, foetal 
and adult hearts, double cats and human monsters, made their annual 
exhibitions in the halls of the French Academy: the Society never 
sickened nor tired, and the raree-show lasted exactly one hundred years. 
What kind of doctrines were current at such a time it is almost su- 
perflous to explain ; yet I think it not amiss to remark two examples, 
of obduracy on the one hand, and of ingenuity on the other, in two of 
the greatest men. Mr. Mery had conceived notions about the circula- 
tion of blood in the foetus, which can hardly be explained ;* but it was 
one point essential to his doctrine, that, the blood in the foetus moved 
directly from the left auricle to the right. He was forced to deny that 
the foramen ovale had a valve ; and this doctrine he continued, with 
many quirks and tricks, to maintain to his dying day. Mr. Winslow 
agreed with Mery ; he said, that the foramen ovale had no valve ; that 
though it had a membrane, that membrane performed nothing of the 
office of a valve ; that the blood passed freely from.right to left, or from 
left to right, as occasion required ; that thus the two auricles were 
as one. He forgot for a time that there is but little circulation in the 
foetal lungs ; that the right auricle is filled with all the blood of the 
body, while the left is filled very sparingly by the pulmonic veins. 
From these data it is plain, that the balance must always be in favour 
of the right auricle ; that it always must be more full of blood ; that 
without some valve the blood must rush with a continual pressure from 
right to left ; while, again, the place of the valve istlself a demonstra- 
tion that the blood cannot pass ftoM left to right. Winslow, when he 
some years after perceived that he had spoken idly upon this subject, 
left Mr. Mery among his foolish arguments and dissections, and re- 
tracted all that he had written, with a manliness of spirit which de- 
serves to be recorded. 
The foramen ovale is not strictly b*it is* rather round. In the 
plan it appears oval, because there l Have endeavoured to represent the 
condition of the vessels when the heart is dilated and the vessels full; 
but when we lay it out for demonstration or for drawing, it appears as 
in the drawing, of a rounded shape. 
* All that can be done towards the explaining it in one word is this : He “ fancied 
that the right cavity of the heart was so large and the left so small, that always the left 
side was obliged to disgorge again upon the right side ; and this was the meaning of the 
blood rushing through the foramen ovale from the left side to the risht,’’ 402 
CIRCULATION OF 
The oval hole is in the partition between the two auricles at its vefjr 
backmost point; for, in fact, the auricles touch each otherjonly be- 
hind ; at their forepart they are separated by the roots of the aorta 
and pulmonic artery, as may be seen in any of the plans. We look, 
then, for the foramen ovale at the very backmost partofTtTC right 
auricle ; or rather it is placed so high in the auricle as to seem to be- 
long rather to the root of the cava descendens. A ring rises round the 
bordets or the hole, very prominent. This was named isthmus vecs- 
senii ; but this conceited name of isthmus, Veussens gave it, is quite 
unintelligible, and it must be changed for that of the ctrculus foha- 
rnxis ovalis, the ring or circle of the oval hole. This circle is thick 
at its edges ; very strongly muscular, like the musculi pectinati of the 
auricle ; in so much that authors of some character have' thought this 
a sphincter for the oval hole. There is no doubt a kind of decussation 
of the fibres at each end of the oval hole ; so that these fibres, forming 
a sort of pillar on each side or edge ofvthe foramen, the name of Pil- 
lars of the Ring, or columnje,foramini^*evalis, is lc§»exceptionable -7 
though these pillars, or any thing des<jflring such a name,\will not be 
easily found by one beginning anatomy. 
The valve of the oval hole lies entirely on the left side, as the round 
edges of the right side may demonstrate. By taking the blunt probe, 
we find we can lift it towards the left side ; but being pushed towards- 
the right side, it rises into a sort of bag, and opposes the probe. The 
valve is perfectly transparent; it seems delicate, like all the other mem- 
branous valves, hut is really strong. There is often left, after the clo- 
sing of the valve,small opening at ifcs upper part.v The 
soon after birth : ’the hole is ’so large, that this membrarie a 
very large share of the partition between the auricles ; its transparency 
is such, compared with the rest of the walls, that it is as distinct in a 
hoy, or in an adult, as in a feetus. 
This is the anatomy of the oval hole, and of its valve ; and tins 
proves, and any one who examines it will entirely he convinced, that 
the blood of fhe fn?tus passes through it from right to left. 
This heart ot a Unfits had all its pubs 
* ut away, except the ventricles (a)— 
the vena cava, with a hlow-pipe in it 
{b)—and the wall or partition between 
the auricles (c c), which is here unfold- 
ed to show the foramen ovale. The 
musculi pcctinati, or mupcular fibres of 
the auricle, arc well seen at (ltk)L((| 
is the annulus foraminis ovalis,—(e) is 
the valve itself,—(i) is the small open- 
ing in the upper part of the valve, 
where the valve falls slack, and ready 
to open. THE KCETlfs. 
403 
DUCTUS ARTERIOSUS. 
The ductus arteriosus I Jiave defined a great inosculation between 
the pulmonic artery and the aorta; not for the purpose of conveying 
away that blood which should pass through the lungs, but for giving to 
the blood of the aorta the propelling power of both ventricles ; and 
how well it is able to perform this office, will be easily seen from the 
drawing on the margin. 
The pulmonic artery of the adult divides, as has been marked in all 
my former plans, into two great arteries, one going to the right side, 
another to the left; but in the ftetus there arises a middle branch he- 
This sketch is taken from a little pre- 
paration made on purpose, where a quill 
was thrust in so strongly between the 
ductus arteriosus and aorta, as to separate 
them unnaturally, aud leave a space (a) 
between them, (bb) Marks the two ven- 
tricles—(c c) the place from which the 
two auricles were cut away to make every- 
thing clear,— (d) the root of the porta, 
known by(ee)its carotids,—(g) is the 
root of the pulmonic artery, (i) the right 
and (k) the left pulmonic arteries,—(m) 
the ductus arteriosus, or middle branch, 
running into the aorta,—(n) the place 
where they join,—(o o)the aorta inert ased 
in size by this addition. 
TV. B. This heart is but a very little 
under the natural size in a new-born child. 
tween these two. Tt is larger than both put together; it is in the 
middle, and so comes most directly from the heart; it goes in a straight 
line towards the aorta, and joins with it immediately below the arch. 
This is the ductus arteriosus, the centre branch of the three branches 
into which the pulmonic artery of the foetus is divided. It is bigger 
than the aorta in the foetus ; it gives the full force of the right ventri- 
cle to the blood of the aorta, in addition to that of the left. In the 
adult it is so thoroughly obliterated, that by the most careful dissec- 
tion we can show no other vestige of it than a cord-like adhesion of 
the aorta and pulmonic artery.* 
These, then, are the chief peculiarities of the circulation in the 
fcetustt hut the conclusions which have been drawn from this me- 
chanism are, as I suspect, very far wrong. But this I can in no shape 
prove, till I shall have first represented the real condition of the foetal 
heart. First, then, let it be observed, that every drop of blood which 
comes into the system is, either by the powers of the placenta, or by 
* For the other peculiarities of the foetus, see the description of the intestines, of the 
kidney, of the thymns, and of the membrana pupilaris of the eye. 
t The umbilical arteries must be explained in another place. 404 
CIRCULATION OK 
communion with the mother's system, oxydated blood.—One part ot 
this blood, indeed, passes through the circulation of the liver before it 
reaches the heart, while another passes more directly through the duc- 
tus venosus ; but both are mixed, and the blood is all of one quality 
when it arrives ai the auricle, in order to fill the heart, and to begin its 
course round the body. Now, since the blood is all of one quality, 
Nature could have no cause for dividing such blood into two portions ; 
one to pass through the lungs, the other to pass over the body. She 
could have no motive for employing, as in the adult, two hearts. The 
design of Nature plainly is, to prepare a double heart, and kept it in 
reserve for the circulation of the adult, but to use it as a single heart 
in the foetus. And see how simply this is accomplished. The two 
auricles communicate so freely by the foramen ovale, that they are as 
one: the two ventricles both deliver their blood into one vessel, the 
aorta ; and they are also as one. The blood arrives by the cavae, fills 
the right auricle, and in the same moment fills, through the foramen 
ovale, the left auricle; so that the auricles are as one, and filled by 
one stroke; the two auricles act at once, and so the ventricles also 
are filled by one stroke ; the aorta receives the blood of both ventricles 
at one stroke. So that, in the strictest sense of the word, the foetus 
has but one single heart, the heart of the body (the function of the 
lungs being performed by the placenta, far from its proper system) ; 
and when the function of its own lungs begins, then Nature, by the 
simplest of all mechanisms, divides the two hearts, that they may per- 
form each its peculiar function. First, the flow of blood into the lungs 
deprives the ductus arteriosus of blood ; and, secondly, this flow of 
blood coming round to the left auricle of the heart restores the balance, 
presses down the valve of the foramen ovale, and makes the partition 
between the auricle entire. In short, while the oval hole and ductus 
arteriosus are open, it is a single heart; and when they close, as they 
do the moment the child is born, it becomes the double or perfect 
heart. 
Now the mistake which all physiologists have fallen into is this :— 
They have not observed that no creature can live with a single heart, 
which has the oxydation of its blood performed by lungs. A fish lives 
by a single heart, because its blood is oxydated by gills, not by lungs: 
insects live with a single heart, as their lungs, or the branches of their 
lungs, are distributed like arteries over all their body ; the foetus can 
live with a single heart, because its blood is oxydated by the placenta. 
And that this idea may make a more determined impression, it will be 
good to prove, that the function of the placenta actually is equivalent to 
the function of the lungs ; and that it is the placenta itself that produces 
this change upon the blood, I am the rather inclined to believe, be- 
cause we see the veins and arteries of the chick spreading over the 
membranes of the egg, and we can observe the artery sending dark- 
coloured blood into these membranes, while the vein brings back 
florid or oxydated blood. 
If, during child-labour, the umbilical cord falls dowrn before the 
head of the child, at first it is not pressed but beats strongly, and the 
ftetiis is felt struggling in the womb : but when, after a fpw pains, the THE ECETUS. 
405 
Head descends into the pelvis, the cord is pressed between the head 
and pelvis, the pulse falters, ceases ; the child ceases to stir in the 
womb; and if not born in a few minutes is irrecoverably dead, and is 
black in the face like one strangled or drowned. When a child comes 
with its feet or other parts of the body first, the head being last 
delivered, is difficultly delivered; the accoucheur struggles long in 
bringing out the head ; the umbilical cord is compressed all the 
while, between the child’s head and the brim of the pelvis, and 
the child dies. Neither the ductus arteriosus, nor the oval hole can 
save the child, for it dies because it is deprived of the function of the 
placenta, which is the foetal lungs ; and this is the cause why it appears, 
when born, like one suffocated or drowned. 
When the child is born, the nurse lays it on her knee, the cord 
being uncut, you will observe that the one function declines exactly 
as the other strengthens. That if the child do not breathe freely, the 
cord will continue to beat steadily, the placenta still attached to the 
uterus continuing to perform the function of the lungs : that when the 
child begins to cry freely the pulse of the cord and the function of the 
placenta cease at once. If the child breathe freely, but yet do not 
cry, and you tie the cord, it is instantly forced to cry for a fuller breath ; 
and if a rash person tie the cord prematurely, when the child neither 
cries nor breathes, he cuts off’ the function of the placenta before the 
function of the lungs is established, and often the child is lost: this, 
in the hurry and officiousness of ignorant women happens every day. 
If even after two days the child’s breathing be much interrupted by 
coughing, crying, or any spasmodic affection of the lungs, Nature seeks 
again the function of the placenta, and the pulse returns into the cord 
so as to raise it from the belly of the child. These things prove what the 
best physiologists have sometimes forgotten, that the fetus has, in the 
function of the placenta, something equivalent to the function of the 
lungs. 
One great mistake then runs through the whole of physiology. It 
has been universally believed that the free and easy transmission of the 
blood was the chief use of the lungs, as if they had acted like fanners 
to flap on the blood from the right to the left, side of the heart. They 
affirmed, that either continued distension or continued collapse, hindered 
the progress of the blood ; and they also believed universally, that if but 
the ductus arteriosus or foramen ovale, or any thing, in short, were left 
open to let the blood pass, that person may live in spite of hanging, 
drowning, or suffocation of any kind. 
This will be found to be the most perfect of all absurdities ; and to 
allege such a thing against authors, requires some kind of proof; it 
will suffice, if I prove it against a few of the most eminent. So much 
were the older authors wedded to this misapprehension of the dilatation 
of the lungs being useful only by driving forwards the blood, that, in 
the Parisian dissections, we find the following experiment made on 
purpose to prove the fact. “ We have also made another experiment 
(say the Parisian dissectors) to know more distinctly the necessity of 
the motion of the lungs for the entire circulation of the blood. An 
injection being made by the right ventricle of the heart into the artery 406 
CIRCULATION OF 
of the lungs of a dead dog, it happens, that if one continue to make 
the lungs rise and sink alternately bv means of bellows put into his 
trachea, the liquor pushed into the artery does easily pass and go 
through the vein into the left auricle ; but when one ceases to blow, it 
passes not but with a great deal of difficulty,” (page 262.)—Which 
doctrine is dilated into its full absurdity in the next paragraph. 
“ Having viewed the difference of structure, in a tortoise and in a dog, it 
is easy to give some probable reason of the phenomena of these expe- 
riments ; and the reason is, that it is necessary that these vessels shall 
be dilated for the receiving of the blood of the right ventricle of the 
heart, and that they may be afterwards compressed in expiration to 
press out the blood, and make it pass into the left ventricle.” Swam- 
merdam indeed says, concerning the Frog’s lungs, that an artery goes 
over them, which has no other purpose but to nourish the lungs ; and 
that it is of the nature of those called bronchial arteries in Man. But 
the College of Dissectors have plunged still deeper into this remarkable 
blunder ; for they say, (page 261) in speaking of the lungs of Newts, 
Frogs, and other creatures, which I have represented as having a pul- 
monic artery extremely small in proportion to their system, u that in 
such creatures the lungs have merely that quantity of blood passing 
through their substance which is necessary tor their own particular 
nourishmentwhich is saying in the plainest terms, that they have 
lungs (only, I suppose that they may be like other creatures) ; but 
their lungs are of no manner of use, except to nourish themselves. 
One should have thought-that the folly of this opinion would have 
appeared more striking in proportion to the earnestness of these argu- 
ments, and that no subsequent author would have deigned to honour 
such an opinion so Far even as to notice it: but the celebrated Haller 
not only adopts this notion very fully, but enriches it with further expla- 
nations, saying, “ that the vessels are all, during the contraction of 
the lungs, forced into numerous angles and joint-like folds ; that the 
angles are made even, and the passages of the blood more direct upon 
the expansion of the lungs.” As if the lungs, folded and closed upon 
each other like the wings of a Butterfly or Beetle. Santorini also 
represents the vessels of the lungs as thus collapsed, plaited, and folded 
a thousand various w\ays, &,c. “ One effect of expiration (says Haller) 
is so to compress all the arteries of the lungs, that they cannot receive 
the blood from the ventricle of the heart so freely as they are wont to do. 
“ It must seem very strange for me, alter saying that inflating the 
lungs restores an animal after apparent death, and recovers the drowned, 
to affirm that long continued respiration is fatal: and yet we need not 
look long for the cause of this ; for during this long continued respi- 
ration, much blood must be gathered in the lungs, but none can get 
out.” Nothing is attributed, in his explanation, to the want of air, 
but all is attributed to the obstruction of the blood : yet if this were all, 
Amphibia would need no lungs, fishes would need no gills, insects 
could need no air-tubes ; for none of these assist the motions of the 
heart. Monro, who puts Haller to rights in every thing else, follows 
him in this. u In all amphibious animals, therefore,” says Monro, 
“ every part of the body may receive a considerable portion of blood. THE FOETUS. 
407 
although the respiration and free passage of the blood through their 
lungs be interrupted,” (p. 21) &<c. And the celebrated Blumenbach, 
the man most admired on the continent for his Physiology, says, at 
p. 80, “ After the last respiration, the usual course of the blood is pre- 
cluded through the venae cavae to the now collapsed lungs.”* 
Thus it has been the opinion down to the present day, that the col- 
lapse or over distension of the lungs are both equally opposite to the 
easy passage of the blood : but instead of going round about the 
matter as some lesser authors have done, I like ratheF the manner of 
the Reverend Dr. Hales, who says, plumply, “ that suffocation con- 
sists in the falling flat of the lungs.” (p. 271.) 
Now, the condition of the human lungs is quite opposite to all this ; 
and also (in respect of distention) is less different from the lungs of 
reptiles than it is easy for any one bred up in the old doctrines to 
conceive. 
In expiration the lungs do not collapse in any sensible degree. Let 
us take for our data the common calculations concerning the quantity 
of air in the lungs, and let us see what they will do towards proving 
this opinion. The lungs are supposed to contain at the time of their 
utmost fulness about 220 cubic inches of air. When we continue 
breathing in a natural and easy way, we draw in and expel alternately 
about 40 cubic inches of air ; but when we choose to force respiration, 
we find that we can expel without danger or harm 70 inches more ; 
we can expel 110 inches of air, leaving only 110 inches remaining in 
the lungs. Now, let us for a moment, observe how little danger or 
distress it occasions when a forced respiration is made—such as is used 
in coughing, laughing, speaking, crying, expelling the child, urine, or 
faeces, bracing up the body for the lifting of heavy weights, or other 
violent occasions, for which such forced respirations are by nature 
reserved. Let us notice how much forced respiration exceeds the 
ordinary respiration, and how small a proportion the quantity of an 
ordinary breathing, viz. 40 bears to 220, the whole quantity of air 
within the lungs. Reflecting thus what large inspirations of air we 
may take, and how very little we do take, we begin to perceive how 
gentle the motion of the lungs must be. 
There remains always within the lungs a great mass of air, which I 
will call the permanent dilatation of the lungs, which, from the first 
movements of the child, from the hour of birth till death, and even 
after death, must remain in the lungs. This mass, equal to 220, can- 
not be entirely breathed out; even the utmost force of respiration ex- 
pels but the half: this is never done but on extraordinary and most 
urgent occasions, which do indeed disturb the circulation ; as cough- 
ing, laughing, crying, or running do. And here we may stop an 
instant to admire one happy effect of this provision; if in ordinary 
breathing we had emptied the lungs, we should have been continually 
* Mr. Keate, one of the latest writers on the recorcry of drowned persons, has the 
same notion. “We inflate and empty the lungs (says he,) in order by their expansion 
and contraction to force the blood across from the right to the left side of the heart.” 
'Vnd he expresses himself as perfectly indifferent what kind of air be used, foul or pure 
i» all one. 408 
MALCONFORMATION of 
subject to suffocation ; whereas when any thing irritates to cause 
coughing, we can by extraordinary effort expel an additional quantity 
of air, and, by coughing or sneezing remove the cause of irritation. 
If there had not been at all times of ordinary breathing a large portion 
of air in the lungs, we must have inspired, and have drawn in the irri- 
tating body instead of expelling it. But this great mass of air in the 
lungs is seldom so moved ; it is regularly and gently agitated by the 
change of 40 parts of the 220, which we expire and draw in again at 
each breath; we do not empty and fill the lungs at each breath : there 
is, on the contrary, a permanent expansion of the lungs, and a mass 
of air always in them ; there is along with this a gentle and regular 
agitation ; and there is changed at each respiration a small proportion 
of this mass of air. Our lungs are little different (in respect of dis- 
tension) from those of Amphibia : for their lungs also, as 1 have de- 
scribed in the Frog, are permanently expanded, and at each respiration 
a little dilated and contracted ; the air a little changed, a little moved, 
a little renewed ; the change is in both cases placid and gentle, and 
hardly to be perceived. 
With these opinions concerning the state of our lungs, nothing can 
appear to me more coarse than the notion of their being entirely filled 
and emptied at each breath ; nothing more ignorant than the sup- 
posing them to fall flat, as Hales expresses it, so as to hinder the 
motion of the blood ; and the grossness of this opinion appears in its 
true light when I put down this last proof, viz. that for each act of 
respiration there are four pulses of the artery, or four strokes of the 
heart. Is it not plain, then, to the meanest apprehension, that if the 
blood moves twice through the lungs in expiration, and twice during 
inspiration ; or, in other words, if there be four strokes of the artery 
for each respiration, and if each of the four pulses be equally strong, 
that the blood passes through the lungs in all states and conditions 
with equal ease 1* 
OF MALCONFORMATIONS OF THE HEART, AND OTHER CAUSES, PREVENT- 
ING THE DUE OXYDATION OF THE ULOOD. 
We are at no period of life, from the cradle to the grave, exempted 
from those diseases which prevent the due oxydation of the blood. 
They often are born with us ; they often overtake us when advanced 
in life ; they cause an anxiety and misery, which exceeds all other dis- 
tress : pain and suffering of every other kind humanity can bear, but the 
feeling of instant dissolution is what the noblest mind sinks under. We 
know by the pale and subsiding countenance how awful the inward 
feelings are, and wo be to him who has not feeling enough to sympa- 
thize with this distress, and an anxious desire to understand the cause, 
and to alleviate the misery of inward diseases which he cannot cure. 
* Their old and favourite experiment, so often repeated by Hooke, Croone, and 
others, before our Royal Society, viz. of blowing up the lungs of a dog, and then com- 
pressing them, is good for nothing: for there the thorax is cut clean away ; the perma- 
nent distension of the lungs is entirely lost; and then, no doubt, there is such a collapse 
of the lungs, as may, or rather must, hinder respiration; for tb« lungs are alternately 
distended to the greatest degree, and then emptied as completely. THE HEAKT. 
409 
These are seducing motives, and might of themselves have drawn 
me on to give this slight sketch of the inalconformations and diseases 
of the heart: but I feel also the stronger motives of duty and necessity ; 
for truly, without some knowledge of the ill organized, irregular, and 
diseased heart, the structure and functions of the heart in its sounder 
state would be but poorly understood. This sketch, then, is the last 
part of this anatomy of the heart. 
While the following history serves to correct our notions of the me- 
chanism of the heart, we must also observe how it explains and illus- 
trates up to a much higher point the combined functions of the heart 
and lungs, viz. the oxydation of the blood. Perhaps nothing can 
better explain the effects of a full and healthy oxydation, than a sparing 
oxydation of the blood, such as produces disease. 
The fcetus alone can live with its single heart ; it lives in the womb 
by its having a heart different from that of an adult. A foetus, then, 
being born, cannot live with that heart which served it in the womb ; 
and Nature, as I have explained already, divides the single heart, that 
is to say, closes the communication between the right and the left side, 
and there is then a heart for the lungs and a heart for the body. But 
if any fault in the organization prevent this separation of the heart; if 
the foramen ovale be preserved open ; or if there should be any hole 
in the septum between the ventricles of the heart; if the pulmonic ar- 
tery do not admit the blood, now that the child is born, and should 
breathe the air ; if the aorta arise from the right ventricle, so as to carry 
off all the blood from the lungs ; or if the aorta be so displaced, that 
its mouth stands in part over both ventricles, so as to receive the blood 
of both—then the organization, movements, and functions of the heart 
are all wrong ; no blood passes into the lungs, the child cannot live ; 
it either dies immediately in convulsive struggles, or lives in misery but 
a few years. 
It is not in this rapid enumeration that these varieties of malcon- 
formation can be understood, nor yet do they deserve to be minutely 
detailed. I shall keep the middle path ; and those of my readers will 
easily follow me who have studied the mechanism of the heart; con- 
cerning which this subject will recal to their memory all the important 
facts. 
The most usual of all these disorders of the heart is some fault in 
the pulmonic artery, or some defect in the state of the great vessels 
in their origin from the cavities of the heart; and that disorder again is 
fruitful of others; for if the pulmonic artery cannot receive its blood, 
the foramen ovale cannot close : then the blood cannot circulate nor 
pass into the lungs when they first expand ; then the office of the right 
heart is taken away, it has no power but to drive the blood with strug- 
gles through the foramen ovale into the left heart ; the left heart then 
drives this blood, unoxydated as it is, into the aorta : the heart is now 
a single heart; it is the left heart, alone that receives or circulates the 
blood : either it labours but for a few pulses, and then the child, after 
a convulsive struggle, expires ; or there is some degree of opening in 
the pulmonic artery, a little blood passes through it into thcJungs ; the 410 
MALCONFOKMATIOiS OF 
child is4>y that enabled to struggle with its convulsive pangs tor eight 
or ten days, and then expires. 
Such a scene the celebrated Dr. Hunter once witnessed ; and there 
was, I perceive, in that heart a peculiarity very much to be admired. 
The chief fault was in the pulmonic artery, which was contracted into 
a solid substance or cord absolutely and completely impervious, so 
that the lungs had never received one drop of blood by the pulmonic 
artery. And here 1 must stop to notice one thing which 1 have always 
suspected, and which this dissection proves, viz. that though it is 
natural to believe, and the best physiologists suppose it, that some 
blood, as much at least as to support the form of the pulmonic vessels, 
passes through the foetal lungs ; yet here is direct proof that a well- 
nourished child may be born capable of breathing, and in which the 
pulmonic vessels arc all free except at the heart, in which not one 
drop of blood ever passed into the pulmonic circulation. But chiefly 
it is to be observed, that this child, with its pulmonic artery, quite im- 
pervious, could not have struggled a single day, far less ten days, with- 
out some proportion of oxydated blood ! and accordingly we find that 
it had a small portion, just such as supported life for a few days ; 
which small proportion it obtained thus : The blood went to be oxy- 
dated, not from the right ventricle into the pulmonic artery, but from 
the left ventricle into the aorta ; from thence into the ductus arteriosus ; 
and then, by a retrograde course, backwards through the lungs; and 
then by the pulmonic veins it was returned oxydated into the left side 
of the heart, from whence it came. 'I'his child accordingly lived a few 
days, and could not live longer ; because this difficult circulation was 
continually accumulating a quantity of black blood in the right side of 
the heart. 
This child, then, had a heart resembling that of the Newt or Frog; 
for the pulmonic artery was closed, and the right heart of no value ; 
the left heart pushed its blood into the aorta, and the aorta, as we may 
express it, sent a side branch into the lungs In this first instance, 
then of malconformation, the child could not live, because it wanted 
the pulmonary artery, and of course the office of the right ventricle ; it 
had but a single heart. 
Next to this disorder of the pulmonic artery, viz. being obliterated 
or being closed, is this : That the aorta, in place of arising distinctly 
either from the right or from the left ventricle, is so placed, that its 
root stands directly over the septum ventriculorum, or partition of the 
ventricles ; that the partition is perforated with a large hole, opening 
a very free passage from side to side : and that the heart being cut up, 
we find, upon thrusting down the finger into the aorta, that it passes 
with equal ease into the right or into the left side of the heart.* 
In this conformation of the heart, the single heart appears again in 
a new form, and the office of the right or pulmonic- side of the heart is 
well nigh annihilated. First, The pulmonic artery is small, sometimes 
almost close: Secondly, The aorta, arising as well from the right as from 
the left ventricle, carries oft'one half of that blood which should be cir- 
* This is bv far the most common defect, or malformation of the heart THE HEART. 
411 
oulated through the lungs : And, lastly, That blood, small as it is in 
quantity, which has passed through the lungs, is brought round to the 
left side of the heart; but the left side is not as it should be, close, to 
keep this purer blood lor the circulation of the body, but it is mixed 
with the blood of the right side, through the perforated septum ; so 
that its virtues, as oxydated blood, are diluted or almost lost. 
If the pulmonic artery were unaffected, and the aorta placed equally 
over both ventricles, then the one half exactly of that blood which 
should be oxydated would undergo the change. But in all these mal- 
conformations, the root of the pulmonic artery also is in fault; it is 
narrow ; it is so small, that at first opening such a body it alone attracts 
the eye ; its mouth is sometimes so beset with a sort of fleshy granu- 
lous papillae, that there is hardly left opening enough to pass a silver 
probe. The degree of contraction io the pulmonic artery is the true 
measure of all the oxydated blood which that system can receive ; but 
in such a system the quantity is still farther reduced by various acci- 
dents of the organization. Thus, for example,—The pulmonic artery, 
is, we shall suppose, but one-third of its natural size, and the original 
quantity of oxydated blood is proportionably small ;—next, the fora- 
men ovale, being open, carries off much blood towards the left auricle ; 
the aorta, planted over the right ventricle, carries off' also much blood. 
But let us suppose, that still as much remains as to fill the pulmonic 
artery to its full: when the pure blood comes round to the left side, it is 
mixed through the foramen ovale, and through the breach of the septum, 
with a quantity of black blood, which is continually accumulating upon 
it; and the small quantity of oxydated blood is, if I may use the ex- 
pression, drowned in the general mass. 
That I may explain the point of its accumulating a little farther, let 
me repeat, that even in a child which has died on the tenth day of such 
a disorder, the heart is crammed with dark-coloured blood : that in those 
children which have lived two or.three years under such a distress, 
the heart has been greatly enlarged : that in a boy dissected by Sandi- 
fort, who died at fifteen, the thing that was first seen upon opening 
the body was, not the lungs covering the heart and lapping over it, but 
a large mass, lying between the lungs oppressing them and pushing 
them aside in every direction. This was the pericardium covering a 
heart of enormous size, filling the thorax, and reaching almost to the 
first rib : very little of the right lobe of the lungs, and none almost of 
the left, was to be seen ; the veins in the upper part of the thorax, viz. 
the subclavian and jugulars, were choked by the pressure, and much 
distended ; the heart itself was full of blood, and the coronary veins so 
turgid, that it resembled a most minute and beautiful injection of the 
heart. 
But it is most of all singular, that this heart was so enlarged, that 
the great veins, (which are indeed as reservoirs for the right side of the 
heart,) and especially the upper cava, dilated along with it in such a 
degree that there was felt distinctly a pulsation in the neck by a sort 
of back stroke every time the heart beat. 
Still a child, even with a heart so ill organized, may struggle through 412 
MALCOKFORMATI&N OF 
all the weakness and all the diseases of childhood* for a few years, but 
they are years of complete misery; and still, as is proved by much 
sad experience, the boy cannot live, but must die. 
Another conformation, the strangest of all, is that in which new 
parts are added to the circulating system, as if with design to make it 
resemble the heart of an amphibious creature ; for it happens, some- 
times, that there is as it were a third heart interposed. For example, 
the two venae cavae end in the right auricle, the pulmonic veins enter 
into the left auricle, and the right and left ventricles receive their blood 
from their auricles in the usual way ; yet the right ventricle sends out 
no pulmonary artery, the left ventricle sends out no aorta: but both 
of them pour their blood into a middle ventricle, and the arteries go 
out from it: and here, as the blood is fairly delivered by both ventricles 
into this third ventricle, and as the pulmonic artery and aorta both 
arise from it, there is, of course, a fair division of the blood; and of 
the quantity which should be oxydated, exactly one half undergoes 
that change. This is somewhat like the heart of the turtle : it is 
plainly the structure of an amphibious heart, a single heart; for though 
there be three cavities, yet are they single in their function ; it is a 
single heart with half oxydated blood. Such a heart is sufficient for 
amphibia, or for the foetus; but not for a child, which must breathe 
and have a double heart. 
These are a few of the varieties of the imperfect heart; but the 
sufferings of children who are born with these imperfections, the marks 
of imperfect oxydation, and the manner of their life and death, was a 
chief motive for entering on this subject. 
When the heart is so imperfect that the child lives but a few days, 
its sufferings are slight, and not lingering, so that we cannot mark them : 
They arc not explained to us by any account of its inward feelings : 
They are all accumulated into one terrible struggle, in which we sec 
the worst marks of ill oxydated blood. 
The child is born well and healthy, it cries and draws its breath, it 
is removed from the mother; the function of the placenta ceases, but 
there is no other to succeed it; the child turns black in the face, strug- 
gles for breath, and is convulsed ; and without any apparent cause 
it seems in the agonies of death : but yet it lives, it becomes black 
all over the body ; the blackness never goes oft’ except when it changes 
sometimes into a deadly ash colour. The child continues for a few 
days labouring under almost unceasing convulsions, which growing 
gradually weaker, it at last expires ; and while it lives, the heart pal- 
pitates ; sometimes it throbs so, that it can be distinguished at a dis- 
tance by the eye. Dr. Hunter, in the child which I have already 
mentioned, laid his hand upon the breast, and the throbbing which he 
felt there was terrible to him. 
When the child has the heart so formed as to admit into the lungs 
even a very small proportion of blood, it struggles through the first 
years of life, and its protracted sufferings can be more easily observed. 
Then no mark of ill oxydated blood is wanting ; every thing is the re- 
* Sandifort attended a pucr cceruleus, who, in addition to his chief disease, passed 
through the small-pox ami measles safely, and attained the age of fifteen. THE HEART. 
413 
Verse of healtii, or the natural appearance flushed and florid of a 
growing child ; its colour is always dark, its motions languid and 
powerless ; it is cold, so that the parents must keep it carefully wrapped 
in flannels and furs to preserve any thing of vital heat; its breathing 
is difficult and distressed ; fits come upon it at times ; and if the child 
has begun to walk, the least hurry, or fear, or quick step, even w«Iking 
across the room, brings a return of the fit: in which the extremities 
are deadly cold, the face black, the breathing one continued struggle, 
and the end of the fit is the obtaining of a degree of relief, which 
happens in a most singular way. 
The coldness, the livor, the languor, the fainting, the struggle for 
free breathing, are all marks of ill oxydated blood. The convulsive 
paroxysm is a sure consequence of the want of stimulus and force, 
and of blood accumulating on the right side of the heart. If, then, 
the child fall down in this paroxysm, it is the very surest proof that or- 
dinary respiration will not save him from the struggle : if during the 
fit he breathe so that he recovers, and that presently his strength, co- 
lour, spirits, every thing, is in a degree restored ; then it is plain that 
the respiration during the fit, imperfect as it appears to us, is really 
more effectual than ordinary respiration. 
When we observe which is the most natural way of obtaining relief, 
and notice the very peculiar manner in which these children breathe, 
we shall understand why they are breathing best w hen we believe they 
are hardly getting breath, and how they are recovering slowly when 
we think them labouring in the greatest danger. 'I he child, feeling 
the growing oppression at its breast, if it be young, signifes a desire 
to be turned upon its face ; if not indulged, it contrives to turn itself 
that way before its hard struggle begins. When the child begins to 
breathe hard, it drives out the air with a sudden exertion, and apparent 
pain ; he remains longer without respiration than an adult could do ; 
his expirations are attended with a sort of scream. What can this 
way of breathing mean ? To my apprehension it implies that kind of 
breathing which I have called forced respiration, and no other plainly 
can serve. 
The ordinary respiration, by which we draw- in 40 cubic inches of 
air, has failed ; the fit is approaching, because that quantity of air will 
not suffice. However rapidly the child breathes, however rapidly the 
heart palpitates, it will not do, because there are but 40 inches of pure 
air mixed with the whole of that great mass which remains always in 
the lungs. Then the child, driven by instinct, provides for the fullest 
respiration : it turns upon its face, that the weight may help to com- 
press the thorax ; it forces with all its power, and seems to cease from 
breathing, and refrains a long while in that state because it is empty- 
ing and compressing the lungs. Then its purpose is accomplished ; 
the lungs are more emptied than in ordinary respiration ; it draws in 
the largest draught of air, utters a sort of scream, seems quiet again : 
and again, by pressing its breast, and by contortions (convulsive like) 
of its body it empties its lungs at a distant interval, and receives again 
the fullest draught of air. It is this forced respiration that brings into 
the lungs 70 cubic inches of air, (if we were speaking of the adult,) 414 
MALCONFORMATION OK 
more than the usual respiration does, This, then, is three times more 
effectual than ordinary breathing ; and when a boy grown up to those 
years in which he knows the warnings of his disorder, and has found 
out this relief; when such a boy by pressing upon the corner of a table, 
or by throwing himself upon the ground, prevents or alleviates his 
paroxysms,—in what way can it be but by practising for a time this 
deeper respiration ; pressing the chest, forcing and compressing the 
lungs beyond their usual degree of collapse, and so obtaining a fuller 
draught, a draught of 110 inches of air, to be mixed with the 110 inches 
which must always remain in the lungs ? 
After half an hour of a kind of breathing most awful to behold, but 
much more effectual than common breathing, the child recovers slowly. 
The boy, when advanced a few years, knows how to prevent the fit; 
but the child of two or three years old knows only how to struggle 
with it: yet this struggle being a more effectual breathing, the child 
is relieved at once from an anxiety, and oppression, and throbbing, 
which precedes the fit for many days ; the languor goes off, the heat 
in some degree returns, and the lips acquire a vermilion colour, and 
the skin a higher tint, which last for many hours after the fit is gone. 
In those children, again, which have the heart so formed that they 
may live, not two or three years only, but to the age of 15 years, it 
naturally happens that the symptoms follow each other in their course 
very slowly ; and the ill oxydation of the blood in this its slower pro- 
gress it is very curious to observe. 
There is one thing in the economy of the foetus very singular—the 
child, the cluck, the foetus of every kind, need less of this principle of 
oxygen : the foetus lives (if this be so) like an amphibious creature ; 
perhaps it has little oxydated blood ; yet being totally deprived of that 
little, it soon dies. Perhaps the foetus, living the life of an amphibi- 
ous creature, is not without some of that peculiar tenacity of life 
which characterizes that class ; for the struggles and sufferings which 
a weakly infant endures, before it parts with life, are matter of ob- 
servation even among the vulgar. Another circumstance is obvious 
from our preceding account of respiration. The office of the heart, 
lungs, and circulation, has among other functions to produce heat. 
But the foetus still in the mother’s womb cannot expend heat, and 
therefore cannot require its generation. Independent of other offices 
requiring a more perfect circulation (and when 1 say circulation, T 
include respiration, which is in a manner a part of it), the child visit- 
ing the light, and living, in an atmosphere colder than its body, requires 
to generate heat. Here is one cause of the violence of these paroxysms, 
when the apparatus of circulation and respiration are imperfect. And 
this is the reason that immersing the child in warm water is one of the 
most effectual ways of relieving the fit. 
But. to return to our first' position, it would appear that children 
have a greater degree of tenacity of life, or arc capable of struggling 
against the defects of respiration. For this reason, 1 believe, it is that 
children, having a heart so ill arranged, that absolutely they cannot 
live beyond the years of puberty, yet during the first year feel no com- 
plaint. and seem thriving and healthy ; the vesretating life of a sucking THE HEART. 
415 
child saves it trom all dangers of hurried respiration and rapid pulse. 
—But when it leaves the breast; when it begins to stir and move ; 
when its blood moving languidly, begins slowly to accumulate at its 
heart; when the properties of its living fibres change so as to require 
a fuller supply of oxygen from the blood—then the unhealthy colour, 
languor, palpitations, slighter fits, and all the marks of its disease, 
begin ; and often its colour gradually changes, and it becomes the 
puer cceruleus, or livid child, before we can perceive by any other 
marks how dangerous a condition it is in. 
In one child* the first year had elapsed before the very slightest of 
those complaints came on, which ended in death at a very distant pe- 
riod of fifteen years. At first, its finger nails were observed to be livid, 
yet not continually ; the colour varied, but still the nails were unnatu- 
rally livid, so as to alarm and surprise the parents : but there was as 
yet no reason to desire advice. The child seemed healthy, began to 
use its legs, and in the second year it walked alone.—Next it happened 
that one day, after being forced to take a medicine, not without some 
resistance, his face was on the following day freckled with red spots, 
which soon changed to a livid hue. Now the lassitude and chillness 
came on ; motion or exercise was more and more oppressive to the 
boy ; till at last, when he fatigued or hurried himself the hands and feet 
became livid, the mouth and tongue became almost black, and last of 
all, those fits came on in which the whole body becomes livid or black. 
This is the progress of this darker colour of the body ; but his other 
complaints also advanced with a very slow and regular pace. He in- 
creased in stature ; his appetite was good ; he complained of great, 
lassitude ; of head-ach, with a sort of gravitating pain ; of anxieties, 
especially during the winter months ; and of such extreme coldness, that 
neither fire in winter nor summer’s sun could warpi him : he never felt 
heat except when just wrapped up and newly laid in bed. 
Now the blood began to accumulate ; the struggles of the heart 
began ; and so terrible were the throbbings of his heart at times, that 
they might be seen, or even heard. Actual faintings succeeded ; the 
poor boy, now eleven years of age, knew that he was to die ; he said, 
that “ no one could know or cure his illness, and that no one could 
imagine what feelings he had here at his heart.” 
Motion was now quite impossible ; upon the slightest effort saliva 
flowed from his mouth, a fainting fit ensued, and he continued for a 
little while blind. All that he was wont to delight in was now indif- 
ferent to him ; he could not move ; his face was turgid, his eyes promi- 
nent, his feet were swelled with an oedema, his eyes dead and heavy, 
expressive of some inward distress ; when he wras put to bed his anxie- 
ties were very great, and thus he died a slow and miserable death. A 
case nearly similar to this occurred very lately, and the preparation was 
added to the collection in Windmill-street. The whole sufferings ot 
the child had been attributed to the effects arising from the sudden 
death of its grandmother, while the child was asleep in the same bed ; 
yet the condition of the heart showed evidently that the cause was of 
* Vi,!* Sandifort 416 
MALCONFORMATION OF 
u permanent nature, and must have been from birth. And here we 
have another instance, that as the constitution advances, it is more 
influenced by the privation arising from malformations. 
Sometimes a child wants spirit or strength to strive against the lassi- 
tude of this disease. A girl under Vasalva’s care lived to her fifteenth 
year; but from her infancy, from her very birth, she had lain in bed, 
partly on account of sickness, but chiefly on account of extreme weak- 
ness. She had a short and difficult breathing, and her skin was tinged 
all over with a livid colour; her quiet state saved her from the suffo- 
cating paroxysms ; but her heart was just like all the others, the fora- 
men ovale open, and the pulmonic artery closed. 
These, then, are the marks of imperfectly oxydated blood: a livid 
colour, coldness which nothing can remove, oppression and anxiety of 
the breast, palpitations and difficult breathing; and when the blood is 
by passion or motion hurried too fast towards the right side of the 
heart, then come fits, which last a longer or a shorter time in proportion 
as they have been long delayed, and which end in death. And, last 
of all, I would rank among these consequences an imperfect nourish- 
ment : for all the boys have been small, most of them particularly 
slender ; and one boy especially, of fifteen years of age, is mentioned 
by Dr. Hunter, who, in respect of tallness, was just what you should 
expect at his years, but slender to a wonderful degree ; not as if wasted 
by consumption but as if by natural habit. His form was quite sur- 
prising, so that Hunter could give no idea of his shape, otherwise 
than by comparing his body with that of a grey-hound ; and his legs, 
he says, put him in mind of those of a crane, or some tall water-fowl. 
When we see the effect of this insufficient supply of that for which 
the lungs are provided, we cannot but reflect on the idea of Mr. Cline, 
that in animals the capacity of the chest is the measure of their strength, 
and their power of receiving nourishment. A fact illustrated by the 
opinion of the grazier or the horse-jockey. 
SIMILAR CONSEQUENCES FROM MALCONFORMATION OF THE LUNGS, 
AND FROM THEIR DISEASED CONDITION. 
The consequences must be alike, whether it be that the heart sends 
no blood towards the lungs, or that the lungs cannot receive that blood ; 
and the malconformations of the heart are hardly more frequent than 
those of the lungs ; and both, we may be well .assured, are infinitely 
more frequent than we suppose ; especially when we observe how 
many children die suddenly, discoloured, and in convulsions ; and how- 
many of those advanced in years have lived very miserable with com- 
plaints in the breast. 
A young man of twenty-four years of age, by birth a Pole, and at the 
time of his death a soldier in the German service, had been continually 
oppressed from his cradle upwards with difficult breathing and anxie- 
ties at his breast. lie had been three or four times relieved from 
slighter complaints of the breast; but at last the bleedings and demul- 
cent medicines failed : he lay ill in the military hospital two months, 
where of course his complaints were correctly known. He had none THE HEAR*. 
417 
but the slighter degrees of difficult breathing ; when one day sitting 
up in bed he suddenly expired. Being opened, the right side of tho 
lungs was found to be totally wanting ; not destroyed by disease, as 
we have often seen, not oppressed by wafer, nor eroded by pus, but 
entirely wanting : a peculiarity Which he had from his mother’s womb, 
for it was attended with a peculiar arrangement of the Vessels. On 
the right skle there was no vestige of the lungs, not even the smallest 
button to mark where they might have been ; there was no branch of 
the tracheae for the right lobe intended by Mature, but both the legs of 
the tracheae plunged into the left Jung, which was large : there was 
no forking of the pulmonary artery to give a branch to the right side, 
but the whole trunk of the pulmonic artery plunged into the left lung. 
But if one should suspect that there might have been once a right 
b-anch, the lungs destroyed, and the mouths curiously united by that 
coagulable lymph which the membranes of the viscera, and the pleura 
especially throw out when inflamed ; there are still other cases which 
must remove all our doubts, especially that of a young man,* who died 
in a very lingering way, and in whom, before his death, there was plainly 
perceived, along with his slight anxieties, a pulsation in the right side 
of the breast. Upon opening his body, there was found in the left 
side neither lungs nor heart; nor, upon the most careful Examination 
(seeking for the wasted lung), could there be found the smallest re- 
mains of lungs, bronchi®, pulmonic arteries, or the slightest evidence 
that any such parts had ever been. But the surest proof of this re- 
mains behind, for the heart stood in the right side of the chest; it 
stood perpendicularly, quite upright like a dog’s; it gave out a right 
pulmonic artery, but there was not even the smallest vestige of any 
artery having been appointed for the left lobe. We must not say, but 
that his chest may have been full enough of lungs and heart, and he 
may have had a well oxydated blood ; in which case, it was no very 
dangerous derangement that his lungs were all on the right side, more 
than if his liver had been on the left. But let us notice that the aorta 
was extremely small; the diameter of the aorta is the true measure 
of the blood which is received from the lungs. Where the aorta is 
small, surely the lungs are not good, nor the system fully supplied with 
oxydated blood. 
We also know, that though the vessels of the lungs themselves may 
be natural and well arranged, the lungs may still be amiss; they may 
Want the proper structure of cells in which the blood should be ex- 
posed ; they may be encumbered with tumours arising out of their 
substance, by which they will be prevented from dilating. One is 
pleased to find in old authors good descriptions of diseases which have 
remained for ages unknown ; and among these I reckon that of the 
celebrated Spindler ; whose description I admire as much as that of 
any succeeding author. 
The child of a certain prince having died after a few days of great 
suffering, Spindler opened the body, and found all sound and right, 
except that there was seated upon the two lungs two tubercles of a 
* Under tiie care of Pr. Heberden 418 
MALCONFORMATION OF THE LUNGs. 
variegated rod colour, as were the lungs themselves ; “ which tumours, 
no doubt, hindered the passage of the blood,” which he expresses with 
a correctness in respect of physiology quite unknown in those times. 
His description of the disease so long before it was properly understood 
is curious : u During the eight days in which the child lived, it had 
never cried strongly nor clearly, had never sucked, had never been 
regular in its bowels, breathed as if its sides had been blown up ; it 
was suddently seized with a fit, which seemed epileptic, soon went off, 
but soon returned ; the whole face and body became first red, then of 
a copper colour ; the breathing was interrupted, the eyes immoveable, 
the feet and hands lay almost lifeless ; it suffered at least a hundred of 
these fits before it expired.” 
To enumerate those cases where a defect of the lungs was the 
consequence, not of malconformation, but of disease, were a business 
quite inconsistent with my design ; yet I wish to record these two.— 
First, It has been long observed, that by long continued suppuration, 
the lungs are so often wasted that not a bud or particle of them re- 
mains : sometimes these patients survive, dragging on a languid and 
miserable existence, enjoying no freedom, life, nor spirits; and the 
cause of their frequent ailments is discovered at their death. The 
lungs also may be thus compressed even by the mere pressure of 
water within the chest, which has caused such a subsiding, or rather 
absorption, of the lungs, without any ulcer of their surface, that one 
lung has been oppressed till it became no more than three lines in 
thickness ; and indeed it was not easily found : so Ilaller says in his 
Commentary upon Boerhaave. But of all the strange things which 
Haller, or any other man has ever related, what he tells in the following 
words is the most incredible ; at least it is so improbable as to be in- 
credible : “ A man having died of a lingering disease occasioned by 
a fall, the left lobe of the lungs was not to be found ; that side of the 
chest was full of coagulable serum ; but the aspera arteria and large 
arteries and veins (a thing which I never could have believed, had I 
not seen it myself,) opened with gaping orifices into the cavity of the 
thorax, as if they had been cut across; so that it was very hard to 
conceive what had prevented the blood from pouring out.” Haller, 
p. 34. 
The truth is, that the vessels appear open when they are not; for 
within their gaping mouths there is a secretion of coagulable lymph, 
and the formation of a clot of blood which stops them. 
Secondly, in the peripneumonia notha there is not merely an in- 
flammation of the pleura, as the name expresses, but of the lungs 
themselves; and it is not from inflammation, pain, fever, or acute 
suffering, that the patients die ; but because the lungs are entirely 
crammed with blood, the heart can no longer move ; they are not 
sensible of their dangerous state, but are suffocated in a moment, and 
die without a groan. It seems more frequent in other countries, than 
in this, though no country is exempted. When this disease conies 
upon a place, it comes with all the frequency and destruction of an 
epidemic disease ; and the sudden unexpected deaths are terrible. 
Valsalva found an old gentleman going abroad in the morning, and OF THE ARTERIES. 
419 
prevented him, questioning him about his complaints, which he him- 
self thought very slight: but Valsalva gave notice privately to the 
servants to expect nothing better than their master’s deatli; and not- 
withstanding all assistance, he was that very evening dead. 
The pulse is weak, the cough si ght, the difficulty of breathing more 
anxious than painful; the face sunk in the features and flushed, or 
rather of a lurid colour, except when it is cadaverous, pale, and sallow ; 
the suffocation is sudden; the lungs have, as Morgagni expresses it, 
a liver-like, solid consistence; they have no longer the cellular ap- 
pearance of lungs, for their bronchiae are crammed with blood ; their 
common cellular texture is also full of exuded blood ; they are dense, 
solid, very heavy, and black, and they sink in water like the lungs of 
a foetus. The heart is so curbed in its actions, that it gives but a 
small, feeble, and trembling pulse ; and even in a few days (as in the 
foetus having an imperfect organization) the heart is wonderfully 
dilated and enlarged, and filled with fluid and grumous blood. Haller 
laments the death of friends by this terrible disease, and especially of 
his own son, “ whose body he gave to be opened by those skilled in 
dissections.” A long continued difficulty of breathing, proceeding 
from disorder of the larynx, will much in the same manner deprive the 
lungs of their power of oxygenating the blood. Effusion takes place 
into the texture of the lungs, so as to compress the air-cells ; and 
sometimes the natural mucous secretion of the bronchiae is so in- 
creased as to impede the entrance of the air.—By which the cells are 
choked, and the lungs become incapable of oxygenating the blood. 
I have here confined the disquisition to the illustration of the natural 
functions of the heart and lungs ; and therefore I have struck out of 
the present edition some observations very curious in themselves, on 
the diseases of the heart, which however, were I to admit, and were 
I to follow up by the introduction of other divisions of the pathology, 
would lead us too far. 
OF THE ARTERIES. 
THEIR STRUCTURE. 
The membranes which form the coats of the arteries, may be sepa- 
rated into many piles or layers ; but properly there are three coats, 
distinguishable by structure and use. Besides these proper coats, the 
arteries, and indeed all vessels, have a surrounding sheath of condensed 
cellular texture. I shall begin my description with this exterior 
covering. 
OF THE SHEATH OF THE ARTERY'. 
The sheath of the artery is a coat of loose cellular texture, which 
surrounds it. It may be traced from the exterior layer of the pericar* 420 
OP THF. ARTERIES. 
dium, along the aorta and all its branches, till it escapes the eye, from 
the delicacy and minuteness of the ramifications which it surrounds. It 
has connection with the common cellular membrane in the interstices 
of the muscles, and with the fascia ; so that it forms the bond of union 
between the vessels and the surrounding substance of the limb : as in 
general, an artery is accompanied with its veins (the venae comites), 
and with n nerve, and generally with lymphatics, the cellular texture 
forming the sheath is common to all these, envelops them, and binds 
them together. But, again, it is important to the surgeon to observe 
that the artery has, appropriated to it, a division of this sheath. For 
the sheath of the artery is strengthened by ligamentous filaments, so 
as to form a sort of vagina in which the artery lies, and to which it is 
attached by very loose and elastic filaments of cellular texture. 
External coat.—The exterior proper coat of an artery, sometimes 
called the tendinous coat of the artery, is dense, strong, tough, and 
elastic.* The power of resisting the force of the heart, that is, of 
resisting over distension, is very principally seated in this coat. When 
a ligature is tied about an artery, it is this coat which, by its tough- 
ness, withstands the operation of the cord, when the internal coats 
are cut and give way. It may be dissected into several layers, espe- 
cially in an old subject. 
Muscular coat.—The middle or muscular coat of an artery is of 
a very distinct structure ; for although some (trusting to chemical 
tests, and neglecting the finest suite of experiments by Mr. Hunter, 
\vhich go to prove the muscularity of the arteries,) have denied that 
this coat consists of muscular fibres ; yet there is not the slightest 
doubt that it is fibrous, that these fibres contract, and that they lose 
their contractile power on death. This coat consists of fine muscular 
fibres, which run in a course around the artery: none go in the length 
of the artery, nor run obliquely in the human subject. It is a mistake 
to suppose that these are not visible in the greater arteries, although 
it be in the smaller branches that they bear the largest proportion to 
the other coats. 
Indeed, it is well known that the arteries possess two distinct pro- 
perties : 1. Elasticity; 2. Muscularity. The former quality is pos- 
sessed, in the greatest degree, by the arteries near the heart: the 
latter quality is possessed, in a larger proportion, by the arteries more 
remote from the heart. The elastic property is well calculated to 
resist the shock of the heart’s action, but in the extremities this is not 
necessary, for there the violence of the heart's motion is subdued or 
diminished, and then, consequently, there is a necessity for a second 
power, similar to that of the heart, viz. the muscular power of the ar- 
terial coats. 
Internal coat.—The inner coat of an artery, sometimes, but very 
improperly called cuticular coat, is very thin and smooth, and yery 
easily torn, especially in its transverse direction. The density and 
fineness of its texture is for the purpose of retaining the blood, and 
its smoothness for permitting the blood to flow with the least possible 
* Tunica rellulosa propria. Haller. Cartilaginca. Vesalius. Tendinca. Heister. OF THE ARTERIES. 
421 
interruption. But there is another property, more difficult to com- 
prehend fully : an endowment of life, and a mutual influence which 
exists between this coat and the contained fluid, without which, as it 
appears to me, the circulation could not proceed at all. 
The vasa vasorum are those small arteries and veins which enter 
into the coats of the artery, to nourish them, and to support their living 
properties. For the blood within the cavity of the artery, though it 
be arterial, is not capable of giving a supply, neither of nourishment 
nor of power of any kind to the coats ; by which we see that it is not 
the contact of arterial blood that suffices to the supply of living parts, 
the blood must be sent through the small arteries, and must suffer the 
agency of these small arteries. 
The vasa vasorum pass to the proper coats of the arteries, by per- 
forating the sheath, and are carried through, as it were, by the support 
and connexion of the cellular membrane. It is this circumstance 
which makes the surrounding cellular substance of the artery a matter 
of vast importance in operations on the arteries, for if it be destroyed, 
so also are the nourishing vessels, and then the artery is a dead tube, 
and sloughs under the ligature. 
Cellular coats.—There is acellular coat between the sheath and 
the outer tendinous coat; another layer of cellular membrane inter- 
venes between the outer and muscular coat; and, again, a third layer 
of cellular substance, (which, however, is very fine,) is interposed be- 
tween the muscular and inner coat of the artery. 
OF THE MOTION OF THE BLOOD THROUGH THE ATERIES. 
There is no subject of physiology more important than the consi- 
deration of the causes which accelerate or retard the blood in the ar- 
teries, and none on which it appears to me that more extraordinary 
mistakes have been entertained. 
The increasing muscularity of an artery, as it extends from the 
heart, is a provision for giving increase of arterial power in propor- 
tion to the diminution of the power of the heart. By the due distri- 
bution of these two powers the blood is made to circulate with an 
equal velocity in parts near and in parts remote from the heart; yet 
the length of an artery has been considered as a means of subduing 
the velocity of the blood, and the tortuous form of an artery has been 
considered as the most effectual check to the force of circulation. 
Exactly the reverse of this is the case. A few examples will prove it. 
The blood mounts against the power of gravity to the head ; an in- 
creasing tortuosity distinguishes the arteries of the head. And so the 
arteries of the temple and the occiput increase in their tortuosity as 
they advance upwards. The arteries of the mamma go in a straight 
course while the woman is not suckling, but if she should die while 
nursing, then the tortuous form of the arteries may be demonstrated 
by injections, and is very remarkable. If a tumour grows upon any 
part of the body requiring or exciting a greater flow of blood to the 
part, then we find that the vessels of the part which in their natural 
state are nearly straight, assume a tortuous form at the same time that 422 
OF THE MOTION OF THE BLOOfc 
they are enlarged. The surgeon knows well that if he cuts a tortuous 
vessel in an operation, the blood flows from it with a force much 
greater than from a vessel in its natural state. If the muscles of ani- 
mals require much and long exertion, they require also more blood to 
preserve an increased irritability or power of action, and therefore they 
require tortuous arteries. Thus the muscles of ihe jaws of the lion, 
the muscles of such animals as cling and hang to branches of trees, 
possess tortuous arteries to carry on the circulation with more than 
common power during their long and powerful contractions. More 
numerous proofs might be given to show that the tortuous artery, being 
an artery with an increased muscularity, is ever a more powerful artery. 
Another circumstance may be demonstrated, and that is, that a tor- 
tuous artery is one which impedes the blood while it is passive, and 
lias an unusual power of accelerating the blood when its muscular 
coat is excited. 
It appears to me, that the nature of the forces circulating the blood 
have been much overrated by experimenters, from the neglect of a 
principle which more than any other should raise our admiration, and 
is important in the practice of surgery. They have calculated the 
power of the heart by the difficulties to be overcome in the circulation. 
They have made a fluid of the exact degree of viscidity of the cir- 
culating blood ; they have put this into a glass tube, the extremity of 
which was drawn into a capillary vessel; they have raised the fluid in 
the tube until it flowed through the capillary extremity, and by the 
height of the column they have calculated the force necessary to push 
the fluid onward. But the operations of nature in a living body can- 
not thus be calculated, for there must come a living property into the 
estimate. The Creator has not contrived means of overcoming an 
obstruction, but through the influence of life has removed that obstruc- 
tion altogether, which exists in dead parts. These experimenters are 
contriving means to measure the cohesion which takes place between 
the fluid and the solid parts, but it would have been well to have in- 
quired whether in the living frame such attraction takes place as exists 
between the particles of dead matter, or whether or not that attraction 
was modified by the influence of life. In fact, in the living body, the 
cohesion or attraction between the fluids and the vessels is destroyed ; 
there is no such cause of retardation as we witness in dead tubes in 
inert matter. A weak impetus propels the blood, because it has not 
the force of attraction to overcome ; but if by injury, inflammation, 
or any other derangement, the peculiar influence existing between the 
vessels and their fluids is deranged, attraction takes place, then the 
blood adheres to the sides of the vessels, coagulates and stops ; w hich 
is the occasion of the spontaneous stopping of the blood in cut vessels ; 
and, I must add, that this is a principle most strangely overlooked in 
many ingenious books, which offer an explanation of this circumstance. 
When we have persuaded ourselves that we have arrived at some 
just notions of the pow'er circulating our blood, and have in imagina- 
tion placed the frame of the human body before us, and contemplated 
riie various results from the circulation of a living fluid, our concep- 
tion of these wonders is imperfect, until we see the body in activity, THROUGH THE ARTERIES. 
423 
and witness the effects upon the blood, of the change from repose to 
exertion. 
The instant that a man becomes animated, or starts into exertion, 
the motion of the blood is thrown into disorder. There is no longer 
the measured activity of the heart, and the gentle and equable motion 
of the lungs. The whole vital organs suffer the nature of a revolution. 
Is this an error or an imperfection in the frame work ? Far otherwise ; 
out of this agitation, and seeming irregular violence, come additional 
means for sustaining the activity of the body. It is like those changes 
in nature, storms and tempests, and extremes of heat and cold, which 
seem the forerunners of misfortune, but which remove whatever is 
stagnant and noxious; preserving all nature in healthful activity. 
The valves of the veins are provided for the exercise of the body ; 
through them the pressure of the muscular frame-work, w’hen em- 
ployed in walking, running, leaping, or any sort of exertion, becomes 
a power additional to that of the heart and arteries in circulating the 
blood. While the veins are tubes, conveying back the blood which 
was sent out by the arteries from the heart, they are, from their capa- 
cities and their numbers, also reservoirs of the blood which moves 
through them languidly. The veins are compressible by the muscles : 
this compressibility is so far from being an imperfection in the appa- 
ratus of the circulation (an opinion too hastily received), that it is at- 
tended with the most happy result; since through this effect solely, 
there is ever preserved an equality between the force and rapidity of 
circulation and the muscular exertions. 
Without the valves of the veins, which hinder the blood from moving 
retrograde, the pressure of the muscles would not effect this purpose of 
throwing the blood in increased quantity upon the heart; the blood 
would be forced by exertion to the extremities, instead of towards the 
centre of the circulation. The observations of those who preceded 
Harvey went thus far, and Fabricius distinctly says, that the valves of 
the veins were to prevent the blood from being forced outwards upon 
the extremities during exertion. They can bestow no additional ac- 
tivity, they only direct the impulse received from the muscles of the 
extremities towards the heart. 
The heart assumes an activity proportioned to the blood which it 
receives ; and the lungs, always in sympathy with the heart, partake 
of this activity, and the respiration is increased. The office of the 
lungs is to render the blood capable of supporting the life of the body, 
and in an especial manner the irritability of the muscles ; now the 
motions of respiration are in proportion to the quantity of blood 
which has been compressed from the veins, and placed under the 
more active operations of the heart and arteries. It is thus that an 
activity is given to the circulation, and consequently the means of 
supporting the irritability of the muscles, in the proportion to its ex- 
penditure in exertions. 
The circle of operations is in this succession ; the muscles com- 
press the veins ; the heart, is distended with blood; the lungs are ex- 
cited by the state of the heart, the activity of the circulation and the 424 
OF THE MOTION -OF THE ULOOD. 
respiration is thus promoted : and the effect is, that the circulation in 
the muscles is increased, and their irritability thereby supported.* 
The action of the muscles has not only an influence in sending 
back the blood to the heart, but also in accelerating the flow of blood 
outwardly through the arteries. In performing an operation on 
an infant, or trying to suppress a hemorrhage from a drunk man, I 
have witnessed, with surprise, the additional force given to the jet of 
blood from an artery during the moment of exertion. 
It is fortunate that we can have recourse to' the account of experi- 
ments made by a man of veracity, instead of repeating hateful experi- 
ments on dying animals. When Hales was attempting to estimate 
the power of the heart by attaching glass tubes to the arteries of a 
horse, and admitting the blood to rise into the tube, he observed that 
an occasional variation took place in the length of the column of 
blood; and this not attributable to the force of the heart, but to the 
exertions of the creature. He saw, even in the moment of its ex- 
piring, that the blood rose remarkably in the tube ; and that on stop- 
ping the nostrils of the animal, the blood rose five inches; that it rose 
considerably and suddenly on the animal drawing a deep inspiration. 
Hales observed accurately, but he drew a wrong conclusion. He 
thought this additional rise in the column of blood was owing to the 
dilatation of the lungs, and the greater freedom with which the blood 
passed from the right to the left side of the heart. On the contrary, 
we know that, during a struggle, there is a greater difficulty in the 
circulation through the lungs. The true explanation of this effect 
must be derived from the observation of the manner in which the heart 
and great vessels are guarded, by the tension of the membranes which 
are around them; and which tension is increased in a remarkable 
manner during the violence of corporeal action; without which, in- 
deed, the heart would be overpowered by the blood sent in upon it ; 
and by which the additional force of the abdominal muscle and dia- 
phragm is still employed in accelerating the blood in the course in 
which it ought to flow. 
In this review of the forces circulating the blood, by giving to the 
vessels, and to the membranes surrounding the heart, their due impor- 
tance, l have somewhat diminished the value of the heart’s action, 
and reduced it to the regulation of the general current of the fluids, 
and the action of the lungs in connection with the circulating system. 
When we reflect that the blood of some creatures circulates without 
a heart, and see acephali born without a heart, yet fully nourished,— 
and when we see the aortic system of fishes removed almost out of the 
influence of the heart,—and when we see that the heart of all animals 
is placed in juxtaposition, and in accurate sympathy with the lungs,— 
it is impossible to refuse assent to the proposition, that the arteries 
possess the chief power in circulating the blood through the corporeal 
system ; and that the heart is rather the regulator than the prime and 
* A very interesting memoir on the influence of the atmosphere on the circulation of 
the blood was presented to the French Institute, in 1826, by Dr. Barry. The reader 
may refer with great advantage to the report of Messrs. Cuvier and Dumeril, published 
in the Philadelphia Medical ami Physical Journal, for July, 1826.—J. D. G. general flan of the arteries. 
425 
efficient cause of the circulation. And by this it is not only meant 
that its state of excitement and activity commands and draws after it 
the motion of the blood generally, but that it regulates the actions of 
the lungs, in exactly according with the state of the blood and the 
necessities of the system. 
I have shown that the irregularity in the demand of remote parts for 
blood cannot be answered by the acceleration or diminution of the 
heart’s action ; that the principal organs of the system have a provision 
for that partial increase of activity in their vessels which does not dis- 
turb the general economy, nor call for the action of the heart. I think 
I have shown that the object could not be effected by the increase or 
diminution of the heart’s activity : and that if the endowment and vital 
properties of the organs were entirely dependent upon the general force 
of circulation, and not on the capacity of their own system of vessels, 
to increase or diminish the force of the blood, life would be held by a 
still more precarious tenure than it is : the vital action would interrupt 
the general system, and the agency of passion, and mental, and eve*n 
corporeal activity, would disturb the economy of the organs essential 
to life. 
For entering on this subject I have offered the apology, that I felt 
myself obliged to do so by the nature of my daily occupations. But 
surely there is another and better reason in the nature of the subject 
itself. To ascertain the difference between fluids moving in pipes, and 
according to the law s of extended nature, and the circulation of fluids 
in the vessels of living beings, must be an important part of science. 
It is interesting to him who loves to take an extensive survey of nature, 
and very important to the student who is about to devote himself to 
the survey of animated nature, to perceive by these proofs, that there 
are new principles and new laws to be studied. By the novelty of this 
inquiry, to some it may prove the occasion of opening those sensi- 
bilities to the works of nature which, by habit of inattention, have been 
lost to things seen in the more familiar path of existence. To con- 
template with the microscope the circulation of the blood in minute 
vessels, makes the head giddy, so surprising is the rapidity of the glo- 
bules of blood ; and on raising the head, and calmly considering the 
matter, the surprise does not cease ; we have surveyed a new world, 
where the velocity and seeming impetus have no sufficient cause, and 
to which the laws of things hitherto familiar do not extend. 
GENERAL PLAN OF TIIE ARTERIES. 
The arteries of all the body (excepting only those of the lungs em- 
ployed merely in oxygenating the blood) arise from one trunk, the 
aorta ; which we must describe as of great size, since we compare it 
with other arteries, but which is wonderfully small, considering that it 
is of its branches only that the whole arterial system is composed. 
Those will have the truest notion of the distorted form of the aorta 
who have studied the anatomy of the heart. Its root is deep buried 
in the flesh of the heart. In the Tortoise we sec the flesh of the heart 
AORTA. 426 
GENERAL PLAN OF 
rising round the root of the aorta, and endowing it yvitli the power of a 
second ventricle : in the Frog we find its internal surface beset with a 
triple row of valves, and its coats are like those of a ventricle, they are 
so exceedingly strong : in Man we find it plainly muscular, surrounded 
in circles yvitli great fibres, and having much muscular poyver. 
The beginning of the aorta, then, lies deep in the flesh of the heart; 
it is there that it gives off its coronary arteries: it bulges at its root 
into three great knobs, which mark the place of its three valves, and 
are called the lesser sinuses of the aorta ; it is large at the root, it 
grows smaller as it rises, it mounts upyvards and backwards from the 
heart, till it begins to form its arch or curvature ; its direction is first 
towards the right side of the thorax ; looking backwards, it turns in 
a very distorted manner, yvherc it forms the arch ; it strides over the 
root of the lungs, going now to the left side and backwards, till ii 
touches the spine ; its arch lies so upon the forking of the trachea, 
that its aneurisms often burst into the lungs : it then applies itself close 
to the spine, so that in aneurisms the pressure of the aorta often 
destroys the vertebra); and now lying along the left side of the spine, 
and yvitli the oesophagus running close by it, it passes down through 
the thorax, and from that to the belly under the crura of the diaphragm. 
This, then, may serve as a short description of the aorta, which is 
the root of all those arteries which we proceed noyv to explain. It is 
the trunk from which the general tree of the arteries is to be traced. 
From the arch of the aorta go oft three great arteries, which rise to 
the head, or bend sidewise towards the arms, and so nourish all the. 
upper parts of the body. Of these three arteries, the first is a great 
one, named Arteria Innominata, which contains, if I may so express 
it, the right carotid and the right subclavian, and divides so as to 
form those two arteries, about one inch after it arises from the arch ; 
the next is the left carotid artery going to the head : the third is 
the left subclavian, going to the left arm. The roots of these three 
branches occupy a great part of the arch of the aorta. 
AKTK1UA I3NJ0MINATA. 
The right carotid and right subclavian arteries arise from the inno- 
minata. The right subclavian goes otT in a more direct course than the 
left ; it is thought to receive the blood more fully ; perhaps, also, it is 
rather larger than the left subclavian : but, at all events, there is some- 
thing peculiar in the mechanism of the right arm ; most probably it is 
the peculiar form or direction of this artery that gives to the right arm 
a superior dexterity and strength. When Horses are to be broken, we 
find the chief difficulty to consist in teaching them to move equally 
with both feet, for they prefer the right; when a Dog trots, or when 
he digs the ground, he goes with his right side foremost, and digs 
chiefly with his right foot; and in these creatures we find the same 
arrangement of these arteries as in ourselves. But in Birds, where an 
equal balance of strength is required for the wings, both subclavian 
arteries arc distinct branches of the aorta. When yve lose our arm. 
the left hand acquires by use all the strength and dexterity of the right im.' AKTttRlKS 
427 
ciince, then, either arm can acquire this dexterity, and since the right 
leg is stronger by its dependence upon the motions ol‘ the right hand, 
we have every reason to believe, that the preference given to the right 
hand has some physical cause, and that it is the peculiar form of this 
arterv, viz. going off more directly on the right side, and that those 
who are ambidexter must have the right as well as the left subclavian 
going off as one independent branch. 
There is another peculiarity which has occurred. This arch some- 
times gives out four branches, and the left subclavian, arising first from 
the arch, has passed behind the trachea, between the trachea and the 
cesophagus. In a subject dying of difficult deglutition, which had sub- 
sisted from childhood, it was attributed to the pressure of this preter- 
natural artery, an effect which I cannot easily believe ; and it has been 
proposed to rank it as a new and certainly incurable species of disease, 
under the title of dysphagia lusoria, as arising from a lusus nature of 
this artery. 
LEFT CAROTID. 
The next branch of the arch is the left carotid. The two-caro- 
tids mount along the sides of the neck, are felt beating strongly, and 
seem much exposed. They retire for protection behind the promi- 
nence of the thyroid cartilage. They divide into external and internal 
carotids under the angle of the jaw. The external carotid supplies 
the neck, the face, the inside of the throat; and the reader will have 
chiefly to observe its course all along the neck, its branching at the 
angle of the jaw, and the operations and wounds about the throat, 
neck, face, and especially about the root of the ear. 
LEFT SUBCLAVIAN. 
The left subclavian is the third branch of the aorta. Each subcla- 
vian artery varies its name according to the parts through which it 
goes. This great artery of the arm is named subclavian under the 
clavicle, where it gives branches to the neck ; axillary in the arm- 
pit, where it gives branches on the one hand to the scapula, on the 
other to the breast. It is named brachial where it runs down the 
arm, and where there are few important branches ; and, finally, its 
branches, into which it divides at the bend of the arm, are named 
radial, ulnar, and interosseous, because they respectively run along 
these parts, the radius, the ulna, and the interosseous membrane.* 
* The arch of the aorta, like all parts of the system belonging to the organic life, is 
subject to irregularities ; among which the most common departure from the usual dis- 
tribution, is the origin of the left vertebral artery immediately from the arch, between 
the left carotid and left subclavian ; the latter vessel being at the same time situated 
very near to the posterior part of the arch. 
The following are the most remarkable deviations from the general rule that we hare 
yet met with, and we cannot believe them to be very uncommon, although not very frequent- 
ly observed. In the aorta of an adult male subject, an anomalous branch was given off 
from the arch immediately between the root of the innominata and right carotid. This 
branch ascended almost perpendicularly to the inferior edge of the sternal end of the 
clavicle, and then inclined towards the centre of the body. It terminated in two branches 
of considerable size, which ramified on the inferior part of the thyroid gland, in thi* 428 
GENERAL PLAN oF THE ARTERIES. 
THORACIC AND ABDOMINAL AORTA. 
The aorta, after completing its arch, passes through the thorax, 
giving but few branches, and those very slender. Hut the abdominal 
aorta, as soon as it has emerged from under the crura of the dia- 
phragm, gives three great abdominal arteries : first, the cjeliac, going 
in three branches to the liver, the stomach, and the spleen ; secondly, 
the superior mesepweric, which furnishes all the small intestines; 
and thirdlyvthe lower mesenteric, which supplies most of the great 
intestines down to the rectum. The arteries of the kidneys and of the 
testicles follow these, and then the aorta divides into two great branches 
for the pelvis and legs. 
The iliac arteries are the two great branches into which the aorta 
divides within the abdomen, and these again are each subdivided into 
two great arteries ; the internal iliacs to supply the pelvis, the 
external iliacs to go to the thigh. 
INTERNAL I LI ACS. 
The internal iliac supplies the bladder, the rectum, the womb, 
with lesser arteries ; but its great arteries go out by the openings of 
the pelvis to supply the very large muscles of the hip and thigh. Thus 
the OLUTA5AL, a very great artery, turns round the bone, goes out by 
the sciatic notch, and goes to the glutaeal muscles. The sciatic, 
almost equally large, turns down along the hip opposite to the glutaeal, 
which turns tip. The pudic, of great size, also turns out of the pelvis, 
turns inwards again towards the root of the penis, and belongs entirely 
to the private parts, as its name implies. 
subject so enlarged and elongated on both sides, as to descend very nearly to the edge 
of the sternum. The regidar thyroid arteries, from the external carotid and subclavian, 
were distributed as usual in this gland. The left lobe was as much elongated as the 
right, but was without any additional artery, which precludes the possibility of attri- 
buting the state of enlargement to the distribution of this vessel immediately from the 
aortic arch. The origin of the left subclavian was very peculiar and uncommon ; it 
arose from the most posterior part of the superior surface of the arch, full two inches 
distant from the left carotid. 
In the second case, we have the aorta of a female, we find a branch similar to the 
irregularity, above described, taking origin from the innominata, a short distance from 
the aorta. This branch was distributed upon the inferior part of the right lobe of the 
thyroid gland, exactly as in the first observed subject; but the gland was in no other 
respect extraordinary. 
This branch from the innominata has not been noted by any one, except Allan Borns, 
who, in his surgical anatomy of the head and neck, makes the following remarks :— 
“ The thyroid gland generally receives its supply o( blood from four vessels, but we 
sometimes find a fifth, sent to it by the arteria innominata. Where this anomalous vessel 
exists, it will usually be found entering the cross flip of the gland, just on the fore-part 
of the trachea. This artery sometimes supplies the place of one of the regular thyroid 
branches. In extirpating the thyroid gland, these facts must be recollected.’’ p. 266. 
In both instances observed by us, the irregular artery was distributed on the 
inferior part of the right lobe. As far as wre know at present, no one has hitherto re- 
corded an instance of the origin of this anomalous thyroid branch, directly from the 
aorta.—See The Philadelphia Journal of the Med. and Phys. Sciences, Vol. xiv. p. 
118. [For an account of the irregular muscle, frequently to be found arising from the 
os-hyoides and inserted into the left side of the thyroid gland, See Soemmering de cor- 
poris humani fabrica, Vof. i. p. 117. Caldani tab. anat. xii.j—.T. P. G. OF THE CAROTID ARTERIES. 
429 
EXTF.RNAI. 1LIACS. 
The external iliac, when it passes out of the abdomen, takes the 
name of femoral artery: it divides into two large arteries a little 
below the ligament of the thigh: the one goes deep, belongs to the 
muscles, and is called profunda ; it furnishes all the thigh, and it 
might with the strictest propriety be named the femoral artery. The 
femoral artery, as we call it, is the other great branch, which con- 
tinues superficial, runs obliquely down the fore part of the thigh, gives 
few and but trivial branches to the thigh, and is really destined for the 
leg. When the artery turns inwards towards the ham, it is named 
popliteal artery ; and, like the artery at the bend of the arm, this 
one at the bending of the knee divides into three great branches, which, 
like those of the arm, take their names from the bones along which 
they run ; the anterior tibiae artery lies on the fore part of the 
tibia; the posterior tibial artery runs along the back part of the 
tibia ; the fibular artery funs along the fibula; and these great 
arteries terminate by making arches with each other in the sole of the 
foot, in the same manner that the radial and ulnar arteries join in 
great archqs in the palm of the hand. 
This slight plan I have chosen to throw out before my reader, that 
the succeeding parts may seem more methodical, and that he may 
have at a slight glance the chief .parts of his task before him ; and 
knowing all his duty, he cannot be inattentive to that on which the lives 
of his fellow-creatures must so often depend. 
OF THE ARTERIES OF THE HEAD. 
OF TIIE CAROTID ARTERIES IN GENERAL. 
The carotid arteries are also named the Arterial Cerebri, as if they 
were the sole arteries of the brain ; and the ancients, either ignorant 
or forgetful of there being any other arteries for the brain, or not ob- 
serving that the vertebral arteries might convey blood enough for the 
functions of the brain, did actually name the carotids the Arteriae Sopo- 
riferre ; believing that, if they were tied, the person must fall asleep.* 
How a person might die from having the great arteries of the head 
tied, I can most readily conceive ; but how he shouM rather fall asleep, 
and not die, is quite beyond my comprehension : and yet many of the 
best anatomists, in the best age of anatomy, have abused their time 
repeating these experiments.! 
Galen has explained it well, saying, “ that physicians and philoso- 
* The name which we use, viz. that of carotids, is synonymous in Greek with Arteri;e 
Soporales. 
[ Valsalva, Van Swieten, Pechlinus, Lower, and especially Drelincurtins in his 
Experiments Canicidia, and many jthers, spent days and weeks in tyinsf up the carotids 
of Does. 430 
OV THE CAROTID ARTERIES. 
phers, tying the carotid arteries, tie in along with them the recurrent 
nerves which serve for the voice ; and if they will have silence to be 
sleep, no doubt the creature is mute after their awkward operation ; 
but no other function is hurt neither then nor afterwards.” 
This is probably the whole truih ; for if but one Dog lives after 
both carotids are tied, nothing can be more certain than that those 
which die must have suffered by some awkwardness or disease. Is it 
wonderful that, after such a cruel tedious operation as this is, the Dog 
should be exhausted, should be weakened by loss of blood, should feel 
sore, and hang his head and droop, and let the slaver fall from his 
jaws ? that he should skulk in corners, look side long, be jealous, and 
not easily moved from his hole ? These are what they have thought fit 
to call drowsiness and signs of sleep ; but it is such drowsiness and 
such sleep as would have followed such a cutting up of the creature’s 
neck, whether the experiment-maker had touched the carotids or not. 
The creature lolls its tongue, hangs its head, closes its watery and heavy 
eyes, is drowsy, or, in other words, feverish for many days : it eats 
with all the voracity of a Dog, but with difficulty, and slowly, owing 
to the swelling of its throat; and if it dies, it dies from the same 
cause. Nothing is more certain than that these are the only particular 
effects, and that the carotids of a Dog may be tied without any other 
danger than that of the wound. 
If what Dr. Parry says be true, than in lean people, in women at 
least, we can, by reclining the head backwards, compress the carotids 
entirely against the fore part of the neck, wit!) the finger and thumb ; 
why, then, we need have no fear of hemorrhages of the nose, wounds 
about the jaw, cutting the parotid gland, or operations about the ton- 
sils or tongue ! But there is a dangerous mistake here ; for there is 
(as I know by much experience) a wide difference between preventing 
the pulse of an artery and suppressing the How of blood through it. 
In the case of a Man fainting during any great operation, if you are 
holding in the blood with the point of your finger upon some great 
artery, you feel the pulse there, while the face is deadly pale, the ex- 
tremities cold, and the pulse of the wrist and of all but the largest 
arteries, gone. In fainting, even the heart itself is not felt to move ; 
and yet it moves, and the blood circulates : how else could a person 
lie in a hysterical faint for hours, 1 had almost said days ? 
The carotid artery, having emerged from the chest, runs up 
along the neck by the side of the trachea, a single undivided artery, 
without twig, or branch, till it is opposite the jaw. The length of this 
artery gives us a fair opportunity of observing, of proving, if we 
choose, that arteries are cylinders, and not as they once were supposed, 
of a conical form. But the cylindrical form of this artery should not 
occupy our attention so much, as that peculiarity of direction, which, 
though apparently exposed, keeps it safe ; or those important con- 
nections and relations which are so necessary to know before tying it 
in the operation of aneurism, or when wounds have been received 
high in the neck and under the jaw. 
The carotid artery, from the place where it emerges from the chest 
up to the angle of the jaw. is continually receding from the fore part of OE THE CAROTID ARTERIES 
431 
the throat, is getting deeper and deeper by the side of the trachea, 
at last the strong projection of the larynx or cartilaginous part of the 
tube defends it; and when it has got to the angle of the jaw, it lies 
there so deep under the ear, between the ear and the jaw, in a sort 
of axilla, as we may call it, filled with fat and glands, that it is almost 
out of reach of danger.. 
The artery lies nearly parallel to the spine, though seeming to retreat 
from the projection of the throat. It lies deep, invested with its 
sheath. The omo-hyoideus crosses it. The sterno-cleido-mastoideus 
covers it. 
To stop the growth of an aneurism, to allow the extirpation of other 
tumours about the jaw, to save a patient from dreadful bleedings of 
the throat, or from the hemorrhages of deep wounds, when, for ex- 
ample, a patient is stabbed in the neck, or a ball passes through the 
mouth and under the angle of the jaw ; may present themselves as 
motives for tying the trunk of this artery, when its great branches arc 
torn. But always the observation of Galen is to be remembered, that 
the nerves accompanying these arteries are liable to be tied together 
with them.* 
Let us recollect how the carotid artery, jugular vein, and eighth pair 
of nerves, come out from the skull, for it is almost at one single point. 
The internal carotid artery enters by a hole in the temporal hone ; 
the jugular vein comes out by a larger hole, between the same bone 
and the occipital bone, the foramen lacerum ; immediately behind it 
the eighth pair of nerves or the par vagum, goes out through a division 
of the same foramen lacerum, separated from the vein only by a little 
cross slip of the dura mater ; and so the carotid artery, jugular vein, 
and eighth pair, touch each other at the basis of the skull. Through 
the whole length of the neck they continue the connection which is 
thus early begun, and are included in the same sheath. The par vagum 
being the great nerve of the viscera, at least of the heart, lungs, and 
stomach, strictures upon it or wounds are certainly fatal. It is there- 
fore to be avoided with the utmost care in all operations performed in 
the neck, and especially in tying the carotid artery.—It lies in a division 
of the general sheath proper to it, rather under the artery, and be- 
tween the artery and vein. 
When the common carotid has risen to the angle of the jaw, it 
divides into two great arteries, one going to the outside of the head, 
the other to the brain ; the one of course named the external, the 
other the internal carotid. Some of the most eminent anatomists 
are incorrect when they say, that the carotid artery gives no branches 
till it arrives at the larynx. They say so because the first branch goes 
* The common carotid artery has been within a few years past taken up frequently 
and successfully both in America and Europe. The advantage obtaiued from having 
secured the common carotid artery a day previous to the removal of a huge morbid 
growth requiring the excision of nearly two-thirds of the lower jaw, led professor Mott 
of New-York, to the establishment of the important rule of securing the great trunks of 
arteries leading to diseased parts, a short time previous to their extirpation. The value 
of this improvement is acknowledged by all practical surgeons to be great, and wc hope 
that Dr. Mott will shortly favour the profession with a history of the operations about 
the lower jaw especially, in which he has derived much of his success from the practice 
referred to.—T. D. O. 432 
OF THE EXTERNAL CAkOTIi*. 
to the larynx; but, in fact, the carotid passes much beyond the place 
to which it is to give its first branch, for instead of branching at the 
larynx, it does not do so till it arrives at the corner of the jaw ; there, 
as I have observed, it can, as in an axilla, lie deep and safe; and the 
laryngeal artery, which is the first branch* of the carotid, turns down- 
wards again to touch the larynx. 
The first division, then, of the carotid artery is into the external 
and internal carotids; and1 the external carotid gives branches so in- 
teresting to the surgeon, yet so numerous, that it is at once very de- 
sirable and very difficult to get a knowledge of each : arrangement is 
here of more importance than in any of arteries, though ex- 
tremely useful in all. 
arrangement of the branches of the EXTERNAL carotid 
ARTERY. 
The external carotid gives three sets of arteries; each of which, 
having a plain and distinct character, cannot be forgotten, nor their 
direction, nor their uses, nor their relative importance, misconceived ; 
for if we consider but the parts along which the carotid artery passes, 
as 1. The thyroid gland; 2. The tongue; 3. The face; 4. The 
pharynx ; 5. The occiput; 6. The ear ; 7. The inside of the jaws ; 
8. The temple:—if we remember thus the order of these parts, we 
shall not forget the order in which the branches go off. 
j 1. Arteria Thyroidca Superior. 
j 2. Arteria Idngualis. 
3. Arteria Facialis. 
! 4. Arteria Pharyngea. 
| 5. Arteria Occipitalis. 
6. Arteria Auricularis posterior. 
j 7. Arteria Temporalis. 
I 8. Arteria Maxillaris Interna. 
BRANCHES OP THE COMMON 
CAROTID ARTERY. 
1. The branches which go oft' from the carotid forwards arc pecu- 
liarly important; one of them goes to the thyroid gland, another to t,he 
tongue, and a third to the face; parts which, to say no more, are pecu- 
liarly exposed ; but they are, besides, the subject of many particular 
operations. 
2. Those branches which go, backwards and inwards, as the pha- 
ryngeal, the auricular, and the occipital arteries going to the car, the 
pharynx and the occiput are both extremely small, and also run so 
deep, that wounds of them are rare and of less importance, and fortu- 
* An American Surgeon, Mott, has the honour of having first successfully applied 
the ligature upon the common iliac artery for the cure of aneurism. The artery was 
tied just below the bifurcation of the aorta, opposite the promontory of the sacrum. 
The peritoneum was not injured, and the patient speedily recovered, and is at present 
entirely well. For a detailed account of this operation, see the first number of the 
American Journal of the Medical Sciences, for Nov. 1827, the London Medical Re- 
pository, &c. 
The internal iliac artery has recently been successfully taken for the cure of gluteal 
aneurism, by Dr. White, of Hudson, N. Y. An account of this operation will be seen 
in the 2d No. of the American Journal of the Medical Sciences, a periodical, which bids 
fairtd contribute largely totho advancement of the American medical character.—J.D.G. OF THE EXTERNAL CAROTID. 
433 
uately those branches are the only ones which it is difficult to 
remember. 
3. The great, artery which passes behind the lower jaw, named 
maxillary artery, and the temporal artery which lies behind the jaw, 
imbedded in the parotid gland, must be studied with particular care ; 
the difficulty of cutting out tumours here, the course of the temporal 
artery in which we bleed, and which, lying imbedded in the parotid 
gland demonstrates the absurdity of talking about cutting out the pa- 
rotid gland, since plainly it cannot be done, without first tying the 
carotid itself, and then probably the operation would be fruitless, since 
a disease which had pervaded parts so deep would certainly return ; 
and, lastly, the terrible hemorrhages which often happen from the 
throat, nose, tonsils, &lc. give an importance to these two branches 
above almost any other. They should be very familiarly known to the 
surgeon. 
1. ARTERIA THYROIDKA. 
The thyroid artery, often also named the upper laryngeal artery, 
comes off from the external carotid almost in the very moment in 
which it separates from the internal carotid. Its place is behind the 
angle of the jaw ; it goes downwards and forwards in a very tortuous 
form, till it arrives at the thyroid gland, upon which it is almost entirely 
expended ; but yet it gives some branches, or rather twigs, of which 
the following are the chief: 
1. One superficial branch goes upwards to the os liyoidcs, and sends 
its twigs sometimes under, sometimes over the os hyoides ; it belongs 
chiefly to that muscle and to that piece of membrane which joins the 
os hyoides with the thyroid cartilage, named musculus hyo-thyroideus. 
This branch is both long and beautiful; it meets its fellow of the oppo- 
site side with free inosculations; it supplies cutaneous twigs, and twigs 
to the platysma myoides. 
2. A second superficial twig goes downwards to the lower part of 
the thyroid cartilage, where it meets the cricoid, and there gives little 
arteries to the mastoid muscle, jugular vein, and skin. 
3. There is another branch which proceeds frequently enough from 
this second one : it belongs entirely to the larynx, for which reason the 
thyroid is often named the superior laryngeal artery : it dives imme- 
diately between the cartilages of the larynx; it enters between the thy- 
roid and cricoid cartilages, carries in along with it a twig from the 
eighth pair of nerves; it gives its twigs to the epiglottis, and to all the 
small muscles which lie under cover of the thyroid cartilage, and which 
move the little arytenoid cartilages ; and then passes outward emer- 
ging from the larynx, and appears again supplying the crico-thyroideus 
muscle. 
The fourth branch of the thyroid is properly the main artery, or con- 
tinuation of this branch into the substance of the thyroid gland ; it ap- 
plies itself to the side of the gland, nourishes its substance by a great 
many small branches into which it is divided. These branches are all 
oblique, tending downwards and forwards. Their course is upon the 434 
Ob' THE EXTERNAL CAROTID, 
side of the gland, because, indeed, the gland consists chiefly of two 
lateral lobes, and hardly any of the gland, or only a small portion crosses 
the trachea; consequently this artery does not inosculate so much 
with its fellow of the opposite side as with the lower thyroid, which 
comes from the subclavian artery, and whose branches, mounting upon 
the lower part of the gland, have pretty nearly the same degree of obli- 
quity with those of the upper thyroid. 
S. A branch of this runs across, and inosculates with the artery of 
the other-side. 
RECAPITULATION OB THE BRANCHES OF THE 
Arteiua 
Thtroi»ea. 
1. Rami Mvsculares. 
1 2. Arteria Laryngea. 
I 8. Ramus Anattomoticus. 
v 4. Arteria Thyroidea Propria 
2”. ARTUR la LINGUALIS, 
The lingual artery is one of which the four branches are nearly 
of on equal size, and which of course require all of them to be equally 
well remembered. It is next to the thyroid, comes off immediately 
above it, goes forward towards the os hyoides, runs directly above the 
extremity of the cornu of that bone, and towards the tongue ; it lies 
flat upon the side of the tongue upon its flesh or muscles, and gives the 
following branches: 
1. Upon passing the horn of the os hyoides, it gives first one twig of 
less note backwards to the constrictor pharyngis, at the place where 
that constrictor arises from the horn of the os hyoides (viz. the con- 
strictor medius) ; and it gives another branch forwards round the basis 
of the os hyoides, where it meets its fellow, viz. ramus anastomoticus: 
and to those who are acquainted with the muscles which arise from the 
os hyoides, it is needless to say what muscles it supplies.* This, 
which is named the ramus hyoideus, seems to be very necessary, as 
it- is a very constant branch ; and when it does not come from the 
lingual, it infallibly arises from some other, commonly from the facial 
artery. 
2. Dorsalis linguai is a branch which goes off from the lingual at 
the insertion of the stylo-glossus muscle into the tongue: it turns first 
outwards a little, and then inwards over the root of the tongue, where 
the arteries of the opposite sides meet, and form a sort of net-work. 
Its chief branches are directed backwards towards the epiglottis and 
mouth of the pharynx, amygdalae, &c. 
About the middle of the tongue, or about half way to the chin, mea- 
suring along the jaw, the lingual artery forks into tw'o branches ; the 
one below the tongue, the sublingualis, belongs to the sublingual gland 
and surrounding parts; the other remaining at the root of the tongue, 
belongs to the tongue itself. 
3. Sublingualis then arises next; it comes from the side of the 
artery next the tongue ; it runs under the sublingual gland, covered 
* Viz. the hyo-gloafstis, digastricus, mylo-hyoideuS, the genio-hyoidens, the genie 
hve-gljtssus, sterno-Rvoideus, and hyo-thyroideus. OF THE EXTERNAL CA&OTIP. 
435 
like it by the genio-hyoideus muscle, and emerges only when it arrives 
at the chin, where it terminates in the skin. Its branches are chiefly 
to the sublingual gland, which lies over it, and to the genio-hyoidei and 
mylo-hyoidei muscles and skin, for these are the parts wluch imme- 
diately cover it. 
4. The arteria ranina is the larger branch of these two ; it runs 
along the root of the tongue quite to the tip of it. In this course it is 
accompanied by its vein, which appears on the inside of the mouth 
when we turn up the tip of the tongue. This is the vein which the 
older physicians were so fond of having opened in sore throats; 
the artery is that which we are so apt to cut in dividing the frenulum 
lingua); an awkwardness from which a great many children have died. 
RECAPITULATION OF THE BRANCHES OF THE 
' 1. Rami Pharyngei. 
2. Ramus Huoidens Anaslomoliciis. 
S. Arteria Dorsalis fAnguce. 
4. Arteria Sublingualis. 
5. Arteria Ranina. 
_ 6. Rami Irregulares JNuecularr*. 
Arteria Linguaus 
3. ABTERIA LABIALIS, OR FACIALIS. 
The labial artery is named occasionally the external maxillakv 
artery, to distinguish it from one which goes off at a higher point, and 
goes to the inside of the jaw ; or angularis, because it goes to the 
corner of the mouth and there divides ; or facialis, implying, that it 
supplies the face, as indeed it does as far as the angle of the eye and 
forehead, where there are other small arteries. Haller adheres to 
this name of labialis, and in compliment to him we adhere to it. 
This artery is still carefully kept down in the deep angle; although 
it is to come out upon the jaw, yet it is not exposed till it actually 
makes its turn: it lies under the stylo-hyoideus and the tendon of the 
digastric muscle : it is very tortuous, that it may move along with the 
jaw, and lies still so deep, even when it approaches the jaw-bone, that 
it is forced to make a very violent and sudden angle when turning over 
it. This sudden turn, which is sometimes almost a circle, is made, as 
it wrere, in the heart of the great sub-maxillary gland, the artery being 
buried under it. The labialis is a very large artery, very tortuous; 
sometimes one great trunk gives off two important arteries at once, die 
lingual and the facial; in which case they separate just at the angle of 
the jaw, where the artery, dividing the substance of the gland, is quite 
imbedded in fat. When we consider how deep this artery lies ac- 
cording to this general description, and the parts which it passes along, 
it becomes easy to foresee what branches it will give, and to trace them 
in imagination. 
1. Where it lies the deepest upon the side of the pharynx, it sends a 
branch directly upwards, which goes straight to the arch of the palate, 
spreading its small twigs upon the arch of the palate, upon the velum 
palati, and upon the uvula : it usually has two small branches for sup- 
plying these parts, one superficial and one deep; and thus the labial 
gives a particular artery to the palate, named artjtkta 
inferior. 436 
OP THE EXTERNAL CAROTID. 
2. It gives a particular artery to the tonsil, which arises at that 
point where the stylo-glossus begins to mix with the other muscles of 
the tongue. This little artery penetrates the walls of the pharynx 
upon which it lies, and spreads its many twigs upon the tonsil and 
tongue. 
3. While passing through the sub-maxillary gland, dividing it, as it 
were, into two parts, the labial artery gives a great many small twigs 
into the substance of the gland itself; and after these it gives many 
twigs to the tongue, the skin, the muscles, &c. Of these, two chiefly 
are remarkable ; one, which goes to the pterygoid muscle chiefly, 
though it also gives branches to the constrictors of the fauces and 
palate, and to the root of the tongue ; and another artery, more con- 
stant and regular, which breaks off at the place where the labial artery 
curls and bends to turn upwards; it runs superficially, and goes straight 
forwards to the root of the chin, where it is named akteria submen- 
talis : it turns upwards over the chin to the face at the middle of the 
chin, and often inosculates with some of the arteries of the face: it 
sometimes comes from the sublingual artery. 
But the artery having emerged from between the lobes of the 
sub-maxillary gland, (for this artery in a manner divides it into lobes,) 
and from among the fat with which it is surrounded, makes a sudden 
turn over the angle of the jaw at that point where we feel it beating 
strongly ; and then mounting upon the face, begins to give a new set 
of arteries. 
1. A branch to the masseter muscle ; for the labial artery passes 
over the jaw, and up the face, just at the fore edge of the masseter 
muscle; and this branch inosculates with a twig descending over the 
surface of the masseter .from the temporal artery. 
2. The labial artery ascending in the hollo west part of the cheek, 
and lying flat upon the buccinator muscle, gives out small branches to 
it, which inosculate chiefly with the transversalis faciei, another branch, 
and a considerable one coming from the temporal artery across the face. 
Here also the main artery has still a very serpentine line, on account 
of the continual motions of the part. 
3. Before the artery comes to that point where it is to give off the 
coronary artery of the lower lip, it gives a branch named labialis infe- 
rior ; w7hich artery belongs to the lower part of the lower lip : its 
branches go to the triangularis and quadratus muscles, which lie on the 
chin and on the side of the chin, and also to the lower part of the 
orbicularis oris. This branch inosculates particularly with a twig, 
which comes from within the lower jaw through the mental hole, and 
with its fellow, and of course with the coronary arteries which run 
immediately above it, viz. in the red part of the lip. 
The artery now divides into two branches, one for each lip, named 
the coronary arteries, because they always surround the lips entirely, 
though their manner of going off is not perfectly regular. The lower 
coronary artery is usually smaller, and is to be named the branch, while 
the upper one not only surrounds the lip, but mounts along the side of 
the nose ; it is larger; and is therefore to be considered as the continued 
trunk. We frequently observe the upper coronary larger on one side 
of the face, and the lower coronary larger on the other. OF THE EXTERNAL CAROTID. 
437 
4. The lower coronary comes ofT about an inch or more from the 
angle of the mouth, at that point where the triangularis oris and many 
other muscles meet. It goes directly forwards to the angle of the 
mouth, enters into the lower part of the lip, and runs along the red 
pulpy part of it, where with the finger and thumb it can be felt beating. 
It inosculates with all the arteries formerly mentioned ; as the sub- 
mental, the twig which comes through the hole near the chin, the infe- 
rior labial artery, and with its fellow. With all these it inosculates so 
freely, that it signifies little from which side your injection is driven : it 
goes freely all round the lips, and the arteries are every where equally 
filled. 
5. The upper coronary artery we are to consider as the con- 
tinued trunk. The labial artery is still rising, and still tortuous, when 
it arrives at the angle of the mouth ; runs into the border or fleshy part 
of the upper lip, and runs along it till at the middle of the lip it meets 
its fellow of the opposite side, with a very free inosculation : yet the 
two arteries do not terminate here, but usually two very delicate arte- 
ries ascend towards the point of the nose, along that little ridge from 
the nose to the lip which we call the filtrum ; and almost always a 
considerable artery runs up from the superior labial artery by the side of 
the nose. From this is given off a branch to the nose, viz. the nasalis 
lateralis, and now the artery still ascending, (under the name of 
angularis,) gives oft’ branches to the cheek and eyelids, and growing 
gradually smaller, it arrives at last near the angle of the eye, and inos- 
culates pretty freely with the branch of the internal carotid artery, 
which is named ophthalmic, because it first nourishes the parts of the 
eye with many branches, and then comes out of the orbit at the corner 
of the eye, where, though small, it may be felt beating distinctly. 
ARRANGEMENT OF THE BRANCHES OF THE 
Ramus Palatinus Superficialis. 
Ramus Palatinus Profundus. 
1. Pulatina Ascendens. 
2. Ramu3 Muscularis. 
3. Ramus Tonsillaris. 
4. Ramus Pterygoideus. 
5. Arteria Submentalis. 
Ramus Superficialis. 
Ramus Profundus. 
Arteria 
Facialis. 
6. Ramus Massetericus. 
7. Arteria Coronaria habit Jnferioris. 
8. Arteria Coronaria Labii Superioris. 
9. Arteria Angular is. —from which Nasalis Lateralis. 
10. Ramus Anastomoticus Cerebralis. 
11 Ramus Frontalis. 
The second set of arteries, which go backwards from the external 
carotid, comprehend the pharyngeal, the occipital, the auricular. 
4. PHARYNGEA INFERIOR. 
The lower pharyngeal* is a small slender artery, which gives no 
branches deserving to be numbered ; it stands alone, and should be 
* It is named lower pharyngeal, to distinguish it from one which comes downwards 
from the internal maxillarv. 438 
OP THF. EXTERNAL CAROTID. 
described as one simple artery, whose small branches spread all about 
the throat in the following manner. 
This artery is smaller than any other branch of the carotid yet enu- 
merated. It arises opposite to the lingual artery ; and as it arises from 
the inner side, it comes out in a manner from the fork between the ex- 
ternal and internal carotid arteries ; it rises upwards very slender and 
delicate : it lies deep in the neck, upon the fore part of the flat verte- 
bral, or rather lies upon the flat face of the longus colli muscle.* 
After rising in one slender artery, single, without branches or connec- 
tions, it begins all at once to give twigs. 
First, It gives branches inwards to the throat; for one twig surrounds 
the lower part of the pharynx about the root of the tongue, and some- 
times goes forwards along with the glosso-pharvngeal nerve into the 
tongue. Another twig goes to the middle of the pharynx, and wan- 
ders towards the velum palati, giving branches to the amygdalae. And 
still another goes higher towards the basis of the skull; it also gives 
twigs to the velum palati, to the back of the nostrils, to the upper part 
of the pharynx where the upper constrictor lies, (viz. that which comes 
from the basis of the skull,) and it gives small arteries to nourish the 
basis of the skull; as, to the os sphenoides, to the cuneiform process of 
the occiput, to the point of the temporal bone, and to the cartilage of 
the Eustachian tube. 
Secondly, It sends branches outwards to the mastoid muscle, to the 
jugular vein, to the ganglion of the intercostal nerve, and to the eighth 
pair; and one particular branch, very small and delicate, goes along 
conducted by the great jugular vein, enters together with it into the 
skull, and makes one of the arteries of the dura mater, but it is a very 
delicate twig. 
In general, one artery only of the dura mater is known or mentioned ; 
but we shall see, besides the great artery of the dura mater, lesser 
arteries entering to it by ail the perforations at the basis of the skull. 
The pharyngeal actually terminates in the dura mater, passing through 
the foramen lacerum posterius, and sending also a branch in together 
with the jugular vein. The occipital artery also sends one with the 
jugular vein, one by the foramen mastoideiun, and one by a small hole 
in the occiput. The temporal often sends one through by the hole in 
the back part of the parietal bone. 
5. AKTERIA OCCIPITALIS. 
The occipital artery is also a simple artery, distributing its twigs 
about the ear, over the occiput, and down the back of the neck, and 
having no branches of sufficient importance to be particularly marked. 
It arises next to the pharyngeal from the back part of the carotid ; 
and lying particularly deep, it not only is covered at its root by the other 
branches of the carotid, but is covered in all its course by the thick 
* When dissected, it must be taken out in a manner from behind the oesophagus. 
The carotids must be raised outwards before it can be seen ; for it lies under them, 
between them and the throat. OF THE EXTERNAL CAROTID. 
439 
muscles of the neck, except just where it is passing behind the mastoid 
process. 
At first the occipital artery lies close in among the bones, passing 
over the transverse process of the atlas, crossing the root of the great 
jugular vein, and passing under the root of the mastoid process so as 
to lie at this place under the belly of the digastric muscle. Still as it 
encircles the occiput, it passes along very deep under the bellies, first 
of the trachelo-mastokleus, and then of the splenius and complexus, 
and emerges only when it arrives at or near the middle ridge of the 
occiput; and, lastly, it rises with many beautiful branches over the 
back of the head, to meet the branches of the temporal artery. 
In this course the occipital artery sends out the following branches : 
1. Branches to the biventer, which lies over it, and to the stylo- 
hyoideus muscle ; and there is one longer artery which attaches itself 
to the root of the mastoid muscle, and passes along that muscle to 
inosculate with the thyroid arteries or with the lower cervical arteries 
which mount upwards as this descends. 
2. Next it gives like the pharyngeal, a small artery, which goes 
backwards along the jugular vein; and having entered by the foramen 
lacerum, attaches itself within the skull to that part of the dura mater 
which lies under the lobes of the cerebellum. 
3. The occipital artery, as it passes under the ear, sends out to it a 
small posterior artery, which goes to the little lobe of the ear, and 
creeps up along its postesior border. 
4. At this point the occipital often gives another artery, which passes 
upwards behind the ear, and is named the posterior temporal 
ARTERV. 
5. The occipital artery, as it passes under the trachelo-mastoideus 
and splenius, gives branches to these two muscles; and it sends out 
from between the trachelo-mastoideus and complexus a long branch, 
(the cervicalis) which descends along the neck a considerable way ; 
and after having further supplied the splenius, complexus, and also the 
deeper muscles of the neck, it terminates by inosculating wuth a branch 
from the axillary artery, which as it crosses the neck is named trans- 
versalis colli. This descending branch of the occipital inosculates 
also with the vertebral arteries through the insterstices of the vertebrae. 
Having pierced the belly of the complexus, the artery now rises over 
the occiput in small and beautiful arteries; the chief of which belong 
to the occipital belly of the occipitofrontalis muscle and to the skin: 
it finally ends in inosculations with the backmost branches of the tem- 
poral artery. But of these extreme twigs of the occipital, two are 
remarkable, because they pass through the skull to the dura mater ; 
one through a small hole in the occipital spine, and one through that 
small hole, which is behind the mastoid process. Sometimes the hole 
is in the temporal bone, but more frequently in the suture which sur- 
rounds the back part of the temporal bone.* 
* Viz. the additamentnm sntnra squamosa*. 440 
OF THE EXTERNAL CAROTID. 
RECAPITULATION OF THE BRANCHES 
f 1. To the Styloid Muscles and Jugular Glands. 
2. Through the Foramen Lacerum to the Dura 
Mater. 
OF THE 
Arteria Occipitalis. 
W 
3. Ramus Auricularis. 
Ramus Temporalis poste- 
rior. 
4. Ramus Cervicalis. ■ 
5. Arteria Occipitalis 
Ramus Superficialis. 
Ramus Profundus. 
Propria Ascendent. 
6. ARTERIA POSTERIOR AURIS. 
The posterior artery op the ear is the smallest and least con- 
stant of all the arteries which go oft’ from the carotid ; for it is often 
wanting, or often comes from some branch, and not from the carotid 
itself; often from the occipital, sometimes from the pharyngeal artery ; 
it can scarcely be reckoned as a regular branch of the carotid. This 
artery, also, like the pharyngeal and occipital gives out no distinguished 
branches which we need to mark ; it chiefly belongs to the ear, it gives 
branches to the cartilage of the external ear, it sends a larger branch 
through the stylo-mastoid hole to the internal ear, and the rest of its 
twigs go to the integuments, or to the bones. 
The posterior auris arises much higher than any of those arteries 
which have been just described ; it does not come off from the external 
carotid till it reaches the parotid gland ; or rather it arises where tho 
carotid is plunged into the substance of that gland ; it passes directly 
across under the styloid process, and over the belly of the digastric mus- 
cle, and then goes up behind the ear: in this passage it gives branches 
to the parotid gland, and to the biventer muscle, the parts on which it 
lies; next it gives a twig, which furnishes the root of the cartilage of 
the ear, and perforates the lowest part of the cartilage, so as to spread 
itself upon the drum of the ear ; this branch is named arteria 
TYMPANI. 
Its next branch, the arteria stylo-mastoidea, is the most remark- 
able, for it is of considerable size, enters the mastoid hole, while the 
portio dura, or great nerve of the face, comes out: it is a chief artery 
of the internal ear ; for it gives branches, l. to the tympanum, one of 
which beautifully surrounds the bony circle, and then spreads upon the 
membrane itself; 2. to the muscles of the stapes, to the semicircular 
canals, to the cells of the mastoid process and its delicate vessels ; which 
arteries, when well injected with size, paint the walls of the cavity of 
the tympanum, and of the semicircular canals. 
The main artery having given oft' the arteria tympani and this stylo- 
mastoid artery, and having passed the stylo-mastoid hole, becomes 
properly the arteria posterior auris, rising behind the ear, and giving 
its branches to the skin and mastoid muscle, and to the muscle behind 
the ear, (posterior auris,) and to the bone and periosteum, chiefly about 
the mastoid process ; then its small branches play round the back part 
of the concha or shell of the ear ; and, lastly, the artery, still mounting 
behind the ear, ends in small twigs, which go to the fascia of the tem- 
poral muscle, and which, of course, inosculate above the ear with the 
temporal artery. OF THE EXTERNAL CAROTID. 
441 
The third order of arteries includes the termination of the external 
carotid artery in the temporal and maxillary arteries, which is after the 
following manner : 
external carotid artery—continued 
The artery having entered into the parotid gland, lies there absolutely 
imbedded in its substance ; and of the two arteries in which it termi- 
nates, one passes directly through the substance of the parotid gland, 
emerges before the ear, mounts upon the temple, and is named of course 
the temporal artery ; it performs here in the temple the same office 
which the occipital does behind, viz. it supplies the pericranium mus- 
cles, and skin : all this is very simpjg. But the other branch, in which 
(since it is exceedingly large) one would say the carotid terminates, 
goes off' from the temporal with a sudden bend, sinks very deep under 
the articulation of the lower jaw, terminates in a leash of branches at 
the back of the antrum Highmorianum, and there gives branches to the 
lower jaw, the upper jaw, the inside of the cheeks, to the temple, (deep 
arteries which lie under the temporal muscle,) to the upper part of the 
pharynx, to the nostrils, and to various other parts : it is this artery too 
which gives off the chief artery of the dura mater. The description of 
so great an. artery, so widely distributed, becomes both difficult and 
important. 
7. arteria maxillaris interna. 
The internal maxillary arteuy turns off from the temporal 
artery while imbedded in the substance of the parotid gland, and 
aboui the middle of the upright branch or process of the lower jaw- 
bone. It passes between the lower jaw-bone and the outer pterygoid 
muscle ; it then goes forward till it touches the back part of the 
antrum maxillare, and terminates in a leash of vessels between the 
back of the antrum and the pterygoid process ; and, finally, it ends at 
the spheno-maxillary fissure, or, in other terms, at the bottom of the 
socket of the eye, where it gives the infra-orbitary artery, and a branch 
to the back of the nostrils. 
In all this course the internal maxillary artery is extremely tortuous : 
first, it rises with a high and round turn at that point where it goes off 
from the temporal artery ; then it bends suddenly downwards, where it 
passes between the pterygoid muscle and the jaw-bone ; then, as it ap- 
proaches the back of the antrum, it rises with a third bending, and 
continues rising with very great contortions, till it ends in small vessels 
at the back of the eye and nostrils. 
Before this artery gives out its greater branches, which require to 
be marked with numbers, it very generally gives some small twigs, 
nameless, and of less note ; as a small twig to the ear, and the glands 
around it, another which gets into the tympanum to the muscle of the 
malleus, and a branch of it sometimes goes into the skull by that hole 
named foramen ovale, by which a division of the fifth pair of nerves 442 
OF TtlL EXTERNAL CAROTID. 
comes out, and goes to that part of the dura mater which covers tne 
sides of the sella turcica. 
Of the larger branches which the internal maxillary gives out, the 
first is the arteria meningea, the great or middle artery of the 
dura mater. It goes off from the maxillary just where it leaves the 
temporal artery. Sometimes before entering the skull it gives small 
branches to the pterygoid muscles, to the mouth of the Eustachian 
tube, to the os sphenoides, and sometimes through that bone to the 
dura mater; but the main artery passes through what is called the 
spinous hole, which is in the very extreme point or spine of the sphe- 
noid bone : it is this artery of which the surgeon should be particularly 
aware, and which touches the parietal bone at its lowest corner in the 
temple, and spreads from that pojgt all over the dura mater like the 
branches of a tree. But besides these, its chief branches, which 
spread thus upon the parietal bone, on its inner surface, it gives smaller 
ones, which go into the substance of the bone, or into the ear, and 
sometimes through the orbit into the eye. Thus first several smaller 
twigs go into the substance of the os petrosum to nourish it; the holes 
may be seen about the rough part, where the os squamosum and os 
petrosum are united ; next two twigs enter into the aqueduct by the 
small hole on the fore part of the petrous bone, one keeping to the 
canal itself, the other going to the cavity of the tympanum, and to the 
inner muscle of the malleus ; and, lastly, one or two small twigs pass 
through the outer end of the foramen lacerum into the orbit, and go 
to the lachrymal gland.* 
The lower maxillary artery is a slender and curious artery, 
which belongs chiefly to the teeth of the lower jaws, and which runs 
all along in a canal within the jaw-bone. The internal maxillary pro- 
ceeds nearly an inch before it gives oft’ this branch ; and then, while 
lying under the pterygoid muscle, it gives oft' a long and slender artery, 
which enters the jaw-bone at that great hole which is between the con- 
dyloid and coronary processes ; then runs all along within the jaw- 
bone, surrounding each of the teeth with arteries at the bottom of 
each socket. About the middle of the jaw-bone it divides into two 
branches, which proceed together in the bony canal, till one of them 
emerges upon the chin at the mental hole, inosculating there with the 
arteries of the face, viz. the labial and submental arteries, while the 
other goes onwards to supply the roots of the fore teeth also, and to 
meet its fellow within the jaw-bone at the chin. The nerve for the 
lower jaw enters along with this artery ; the vein of this artery accom- 
panies it, but lies under it in a separate canal, though still in the same 
line. The artery itself, before it enters into the hole of the lower 
jaw, commonly gives twigs to the inner pterygoid muscle which covers 
the hole. Considering the size of this artery, w7e cannot wonder at 
profuse bleedings from the teeth, or rather from their sockets. 
The pterygoid arteries.—While the artery is thus crossing be- 
tween the jaw and the pterygoid muscle, it gives branches to the exter- 
* Sometimes the great and proper artery of the lachrymal gland, instead of arising 
from the ophthalmic or proper artery of the eye. arises thus from the artery of the dm* 
mater. OF THE EXTERNAL CAROTID. 
443 
rial pterygoid muscle, both into its substance and over its surfaces. 
The number of these pterygoid arteries is variable and unimportant. 
Next, while the maxillary artery is passing in a contorted form under 
the zygoma, where the temporal muscle is lodged, it gives off’ two 
arteries, which are called the deep temporal arteries to distinguish 
them from the proper temporal artery, the only one which we feel out- 
wardly, and which is superficial. Of these two deep temporal arteries, 
one runs more outwards, viz. towards the ear, the other runs more 
inwards, viz. closer upon the bone ; whence the one is called the deep 
external, the other tire deep internal temporal artery. . 
The deep external temporal artery arises where the maxillary 
is passing under or near the jugum ; it is of course near the coronary 
process of the jaw-bone. This branch then passes along the tendon 
of the temporal muscle, and ends in that muscle, giving branches also 
to the external pterygoid muscle ; it is a short artery, and not very im- 
portant by its size. 
The deep internal temporal artery arises further forwards, viz. 
where the artery is close upon the back of the antrum ; from which 
point, mounting directly upwards, it passes in the very deepest part of 
the temporal arch, viz. that which is formed by the cheek-bone. It is 
longer and more important than the outward branch, supplies the 
deepest and thickest part, of the temporal muscle, mounts pretty high 
upon the temple between the muscle and the bone, and often, where 
it lies behind the cheek-bone, it sends a branch through that bone into 
the orbit which supplies the fat and periosteum of the socket, and in 
some degree also the lachrymal gland. 
The artery op the cheek is a very regular artery, in so far as re- 
gards its destination, viz. for the cheek ; but in its origin it is extremely 
irregular. It has not often the importance of coming off as a distinct 
branch from the maxillary ; but comes off rather more frequently from 
some of its branches, as from the deep temporal artery just described, 
or from the alveolar, or infra-orbital arteries, which are presently to be 
described. This artery perforates the buccinator muscle, and is spent 
upon it, and upon the other muscles of the cheek, as the zygomaticus 
and levator labii; it ends, of course, by inosculations with the arteries 
of the face. 
The artery of the upper jaw serves much the same office with 
that of the lower jaw, viz. supplying chiefly the sockets of the teeth ; 
whence it is named arteria alveolahis. It is an artery fully as large 
as that of the lower jaw ; it begins upon the back of the antrum High- 
morianum, and runs round that tuberosity towards the face and cheek 
with very tortuous branches. Its branches are distributed first to the 
buccinator and fat, which fills up the great hollow under the cheek-bone, 
and also to the cheek-bone itself, where it is connected with the jaw- 
bone. Secondly, Other branches perforate into the antrum Highmo- 
rianum by small holes, which are easily seen upon its back part, and 
some of these branches go into the sockets of the backmost teeth. 
Thirdly, A more important branch than any of these, the branch in- 
deed from which it has its name of alveolar artery, enters by a hole 
into the substance of the jaw-bone, and goes round into the canal of 444 
OF THE EXTERNAL CAllOTID. 
the teeth, just as the artery of the lower jaw does, giving branches to 
each socket. The curlings of this artery upon the back of the antrum 
are very curious ; and while its deeper artery furnishes the teeth, some 
of the superficial branches go to the gums. 
The infra-orbital is so named from the hole or groove by which 
it passes all along under the eye from the back of the nostril till it 
emerges upon the face. The infra-orbital, and the branch last de- 
scribed, viz. the alveolar artery, generally come off from the maxil- 
lary by one common trunk ; the alveolar goes forwards and down- 
wards by the back of the'antrum : the infra-orbital mounts upwards, 
and enters the spheno-maxillary hole, or rather it comes off just at the 
spheno-maxillary hole, which is the great slit at the bottom of the eye. 
As the artery enters its proper canal at the bottom of the eye, it gives 
some twigs to the periosteum and to the fat of the socket; as it passes 
along its canal in the bone, one branch dives down into the antrum 
through the bone ; for this plate of bone in which its groove runs, is at 
once the floor of die eye and the roof of the antrum ; within the socket 
it gives twigs also to the deprimens oculi, and to the lower oblique 
muscle, to the lachrymal sac, or even to the nostrils ; when it emerges 
from the socket by the infra-orbitary hole, it terminates in the levator 
labii and levalor anguli oris, and in inosculations with the arteria buc- 
calis, labialis, and especially with the nasal branch of the ocular artery. 
This infra-orbitary artery is accompanied through the canal, and out 
upon the face, witli a small nerve of the same name, viz. the infra- 
orbitary nerve. 
After this, the maxillary, though nearly exhausted, still sends out 
three small arteries, in which it terminates irregularly, sometimes one, 
sometimes another twig being larger. Of these three, one goes to 
the palate, one to the pharynx, one to the nostrils. 
The upper palatine ARTERY arises near the infra-orbital; and from 
that point, viz. the spheno-maxillary slit, it descends along the groove, 
which is formed between the pterygoid process and the palate-bone ; 
and when it has gone down to the palate, one lesser branch turns 
backwards through the posterior.palatine hole, and expands upon the 
velum palati; the other larger branch is the great palatine artery, for 
it comes through the anterior or larger palatine-hole ; the artery itself 
is large, it runs all along the roof of the mouth between the pulpy sub- 
stance of the palate and the bone ; in this progress it gives little arte- 
ries to the sockets of the teeth, and it frequently terminates, not merely 
in the palate itself, but in a small artery which runs up through the 
foramen incisivum, or hole under the fore teeth, into the cavity of the 
nose. This artery is also accompanied with a corresponding palatine 
nerve. 
The upper pharyngeal artery is the highest of all the branches 
of the internal maxillary; it goes off at the back of the orbit, opposite 
the spheno-maxillary fissure ; it ascends along the sphenoid bone to 
the place of the sphenoidal sinus, and along the upper part or arch of 
the pharynx, where that bag adheres to the basis of the skull; it also 
goes along the sides of the pharynx : its twigs are of very diminutive 
size : some go into the substance of the sphenoid bone to nourish it by OF THE EXTERNAL CAROTID. 
445 
imaii holes both over the cells and in the alas; a branch goes towards 
the pterygoidean or vidian hole,* where it inosculates usually with a 
branch from the internal carotid artery, sometimes with the lower pha- 
ryngeal, or with the meningeal arteries. 
This artery ends in small branches which play round the mouth of 
the Eustachian tube. 
The nasal artery is the last branch of the internal maxillary. It 
passes through the spheno-palatine hole ;t by this opening it comes 
into the nostril at its upper and back part; the twigs go, one shorter 
to the backmost of the aethmoid cells, another to the cells of the 
sphenoid bone ; one longer branch goes to the back part of the sep- 
tum narium ; and one branch, the longest of all, often passes both 
the upper and lower spongy bones, (along the lining membrane of 
the nose, giving twigs to the antrum as it passes,) till it inosculates 
with that twig of the palatine artery which rises through the foramen 
incisivum into the nose. This nasal artery often has two branches. 
These branches are so numerous, and so small, that they require 
recapitulation. 
1. Ramus Auricularis. 
2. Arteria Meningea Media. 
3. Arteria Parvee. 
4. Arteria Maxillaris Inferior. 
5. Arteria Temporales Profunda, 
6. Arteria Alveolaris. 
7. Arteria Infra- Orbitalis. 
8. Arteria Palatina Maxillaris. 
9. Arteria Pharyngea. 
10. Arteria Nasalis. 
Maxillaris Interna. 
8. ARTERIA TEMPORALIS. 
The temporal artery, if we consider its straight direction, may 
be regarded as the termination of the external carotid artery. When 
the maxillary artery bends away from it to go under the jaw, this goes 
directly forwards through the substance of the parotid gland, mounts 
before the ear; and as it passes alternately the parotid gland, the face, 
the ear, it gives its three chief branches to these parts, and ends in 
that temporal artery-which runs along the side of the head under the 
skin, which we feel, and even see distinctly, beating, and which we 
open when bleeding in the temples is required. 
The temporal artery is named superficial, because of its lying 
under the skin only, above the fascia of the temporal muscle, while the 
deep branches from the maxillary artery lie under the muscle.—The 
temporal artery passes just before the meatus auditorius, and behind 
the branch of the jaw-bone ; it pushes its way through the substance 
of the parotid gland, and there it gives its first branches, commonly 
* This is the hole by which the recurrent of the 5th pair goes backwards from the 
nose into the skull. 
t Observe, this is not the spheno-maxillary slit so often mentioned, which is a slit- 
like opening lying between the wing of the sphenoid bone and the upper jaw-bone ; and, 
as it is at the bottom of the socket, whatever parts enter it go to the eye. The spheno- 
palatine hole is between the sphenoid and palate bones j it is at the bark of the nostrils, 
artd the branch which enters it belongs to the nostril. 446 
OR THE EXTERNAL CAROTID. 
seven or eight in number, but quite irregular, into the substance ol the 
gland itself; next it gives off to the face an artery of very consider- 
able size ; which arises from the same part of the artery with these 
parotideal branches, viz. under the zygoma and within the gland : like 
them it goes off almost at a right angle, and is like one of them, but 
larger, nearly of the size of a crow-quill; it pushes sideways through 
the substance of the parotid, emerges from it upon the face just below 
the cheek-bone ; runs across the cheek in the same direction with the 
parotid duct; it is named from this direction transversalis faciei. 
Its branches go to the joint of the jaw-bone, the inasseter, buccinator, 
parotid gland, &lc. and terminate in inosculations with all the arteries 
of the face. 
Next the temporal artery, as it rises towards the zygoma, and of 
course approaches the angle of the jaw, gives an artery which is pro- 
per to the articulation of the jaw. This artery belonging to the joint 
of the jaw, is often named artekia articularis. After having sent 
its two branches to the articulation of the jaw, it sends another artery 
to the ear, which divides into two twigs ; one of them going round 
the back part of the ear, assists the branch of the stylo-mastoid artery 
in forming the little circular artery of the tympanum ; while another 
branch, penetrating through the slit which is in the articulation of the 
lower jaw, goes to the muscle of the malleus. 
But before it reaches the zygoma, the temporal artery gives another 
branch, which is named the middle temporal artery, to distinguish 
it from the deep temporal arteries which lie under the whole thickness 
of the temporal muscles, and the superficial temporal, which lies above 
the fascia ; for this middle temporal artery lies under the fascia ; but 
on the outside of the muscle it arises from the mam artery just under 
the zygoma, rises over the zygoma, and then pierces its way under the 
fascia of the temporal muscle, and under that covering gives branches 
to the temporal muscle, the artery itself still rising and passing ob- 
liquely forward towards the outer corner of the eye, where one of its 
twigs often goes to the orbicularis oculi, and inosculates with the 
ophthalmic artery. 
About this point, or rather above the zygoma, the temporal gives off 
those small arteries, irregular in number, which are named ante- 
riores auris, the anterior arteries of the ear, and which play all round 
the fore part of the ear. 
The temporal artery having now emerged from the parotid gland, 
and from the thick fascia which covers it, makes a sudden serpentine 
turn before the ear ; and then rising about half an inch perpendicu- 
larly, it forks with a pretty wide angle into two arteries, which are 
named the anterior and posterior temporal arteries. These lie quite 
superficial under the skin, above the fascia, and are distributed in this 
manner: First, the anterior temporal arterv goes directly forwards 
to the naked part of the temple, runs up the side of the forehead with 
a very serpentine course ; it is here that in old men we see its contor- 
tions and pulsations very distinctly ; it goes round arching forwards, 
and upwards from the temple towards the top of the head. It belongs 
chiefly to the skin and frontal muscle, and that tendinous kind of OF THE EXTERNAL CAROTID. 
447 
sneath which covers the cranium ; it gives some branches to the orbi- 
cular and corrugator muscles ; it forms often a superciliary arch with 
the proper frontal artery ; it often sends off'a branch very early towards 
the outer corner of the eye, which is entirely destined for the orbicu- 
laris oculi. 
The posterior temporal arterx is the last branch of all. It 
arches backwards over the top of the ear; it turns thus backwards till 
it meets the branches of the occipital artery ; it deals its branches 
from either side upwards and downwards, i. e. towards the ear, and 
towards the top of the head in great profusion, till it is quite exhausted. 
These branches belong to the skin chiefly and to the pericranium ; 
and the smaller twigs pierce the outer tables of the skull, and go into 
the bone in great profusion for its nourishment. 
RECAPITULATION OF THE BRANCHES OF THE 
1. Ramus Massetericus. 
2. Arteria Trarutversalis faciei. 
3. Arteria Temporalis Subfascialis. 
4. Rami Auriculares. 
6. Arteria Temporalis Anterior. 
6. Temporalis Posterior. 
Temporalis. 
Comes Ductus 
Salivtp.. 
It would surely be wrong to conclude the description of a system oi 
arteries so important as this, without attempting to interest my reader 
in this piece of anatomy, by observing a few anatomical and surgical 
facts. 
It is natural to observe, as a thing which may prevent confusion in 
the student’s mind, how irregular (after all our attempts at arrange- 
ment) the smaller arteries unavoidably must be ; how natural it is that 
each particular part should draw its blood from all the arteries which 
are near or round it. The ear has its posterior artery peculiar to 
itself; but it has also an anterior artery from the temporal, where it 
lies under the parotid gland ; and it has even a superior auris from 
that branch of the temporal artery which bends round towards the 
occiput, and arches over the ear. The dura mater has its great middle 
artery appropriated to itself, a peculiar branch, the first of the maxil- 
lary artery ; but it has besides small assisting arteries, entering by 
almost every point at the basis of the skull ; and especially it has 
arteries from the maxillary, by the mouth of the Eustachian tube, from 
the pharyngeal, running in by the hole for the great jugular vein ; and 
from the occipital both by the hole of the jugular vein in the basis of 
the skull, and also by the small occipital hole in the back part of the 
skull, close by the temporal bone. The throat also, though it has 
many peculiar arteries, derives its branches from a great many sources ; 
as from the lingual artery by twigs, which cross the root of the tongue ; 
from the labial artery by branches, which go to the tonsil, tongue, and 
palate ; from the pharyngeal artery, many branches not confining 
themselves to the pharynx, stretch forwards to the palate, tongue, and 
tonsils ; and, lastly, the maxillary artery gives a profusion of branches 
CONCLUSION. 448 
OF THE ARTERIES 
to all parts of the throat. These may serve as hints by which the 
student, if he wishes to become a correct anatomist, may ttace the in- 
osculations ; or for the surgeon, if he wishes to separate the study of 
this minute anatomy from that of the greater arteries. 
But there is a circumstance which may guide the student in the 
study of the arteries, the confusion or intricacy of branches arises from 
our manner of counting them off from the trunks ; now the manner 
of the branching varies, whilst there is no variety in the place of any 
artery, or the manner of its final distribution. 
The thyroid artery, or the lingual artery, may come off separately, 
or together, but they never vary in their exact place ; their relation to 
the thyroid cartilage, or to the cornu of the os hyoides, or to the mus- 
cle or the nerve, is invariably the same ; some advantages might be 
had, by arranging the arteries according to their destination, instead of 
their departure in succession from the trunk ; but the latter mode 
gives so great a facility to the learner, that we shall not depart from it. 
OF THE ARTERIES OF THE BRAIN, SPINAL 
MARROW, AND EYE. 
OF THE ARTEEIES OF THE BRAIN. 
The internal carotid arteries are named the arterle 
cerebri, as being the chief arteries of the brain ; while, in truth, the 
brain is also supplied by two other arteries nearly equal in size, viz. 
the vertebral arteries, which though they do indeed arise from a differ- 
ent trunk, viz. the subclavian artery, yet are so entirely destined for 
the brain, give so few branches before they reach the skull, are so im- 
portant when they arrive there, and above all make so large a com- 
munication with the carotid arteries, that without a description of the 
vertebral arteries, any description of the carotids must be defective ; 
they unite so with the carotids as to form but one great system of ves- 
sels for supplying the brain. 
The two greatest functions of the animal body, those of the womb 
and of the brain, the one for the life of the individual, the other for the 
continuation of the species, are the most liberally supplied with blood. 
The womb has on each side two arteries ; it has two spermatics, and 
two hypogastrics, and the inosculations of these vessels are very large 
and free. The brain has two great arteries on each side ; it has two 
carotids, and two vertebral arteries ; they are infinitely larger than 
those of the womb ; their inosculations are so particular, that there 
arc no others like them in all the body ; the injection of any one 
artery easily fills the whole; the preservation of but one artery saves 
the life of the creature, when the others are stopped. 
These four arteries alone convey to the brain the fifth part of the 
whole mass of blood. This is the calculation made by Haller ; and 
even those who would settle it at the lowest point still acknowledge, 
that the carotid and vertebral arteries receive at least the tenth part of 
all the blood of the body. The brain then which weighs not. a fortieth OF THE BRAIN. 
449 
putt of the whole body, receives one tenth of all the blood ; a pro- 
portion which must occasion surprise. 
Besides the profusion of blood which thus rushes into the brain, 
the impetus with which it forces its way seems dangerous; and Nature 
also seems to have provided against the danger. We cannot be but 
sensible of this danger ; for the slightest increase of velocity occasions 
strange feelings, if not absolute pain. We cannot run for any length 
of way, nor ascend a stair rapidly, nor suffer a paroxysm of fever, 
nor, in short, have the circulation quickened by violent exertions, by 
emotions of the mind, or by disease, without feeling an alarming 
beating within the head ; we feel it particularly in the carotid canal 
where the artery passes through the bone. If it continue from dis- 
ease, or if we persist in our exertions, giddiness, blindness, ringing of 
the ears, come on. Ilaller remembers, that while he was lying in a 
bad fever, he suffered so much from the pulsations of the carotid artery 
within the skull, that his head was lifted from his pillow at every stroke. 
I wish he had said, “ seemed to be lifted from his pillow at every 
stroke for it was rather a sickly feeling than what could actually 
happen. 
Did this vast column of blood rush directly into the brain, we do 
not know what might be its effects; but surely they could not be 
harmless, since Nature has provided against it in man, and in the 
lower animals which hang their heads, with a peculiar care. In Man, 
this blood is retarded chiefly by the tortuous course which the artery is 
obliged to follow,* and by that long bony canal which, by holding the 
carotid as in a sheath, must suppress its violent action, and at least 
prevent its being dilated by force of the blood, when, as often happens, 
the lower part of the artery is more full and tense. Perhaps also it 
may have some effect, that the carotid, as it lies by the side of the 
sella turcica, is not naked and free, but is enclosed in a venous sinus, 
which consists of cells like those of the male penis, and in the heart 
of which the carotid lies. 
It is also peculiar in all the arteries of the brain that they do not 
enter in trunks into its substance. This seems to be a violence which 
the soft texture of the brain could not bear; but all the arteries having 
perforated the dura mater, attach themselves to the pia mater, a deli- 
cate membrane, which is the immediate covering of the brain ; which 
follows all its divisions, lobes, and convolutions; which enters all its 
cavities, and lines its internal surfaces as it covers the external. To 
this membrane of the brain the arteries attach themselves : it conducts 
them every where along the surface of the brain, and into its cavities ; 
and when the arteries are to enter into the substance of the brain, they 
have already branched so minutely upon the pia mater, that they enter 
into the pulpy substance in the most delicate twigs; so that having 
injected the brain, at whatever level you cut into it, you find its white 
surface dotted with red points regularly, and like the dots of a pin. 
* Although this be true, still the subject is pursued further when speakiflg of the cir- 
culation of the blood through the arteries.—C. if. 450 
OP THE AItT£EIEfc> 
But ill the lower animals, especially in the Call', the Deer, the 
Sheep, which hang their heads in feeding, there is a provision of so 
singular a nature, that we can have no doubt that these contortions of 
the great trunks and minute divisions of the smaller arteries in man 
have the same final cause; for in those creatures the carotid, before 
it enters the brain, first divides into innumerable smaller arteries. Not 
one of these is sent off for any particular function ; they are imme- 
diately reunited again, and gathered together into one trunk ; and then 
the force of the blood being thus broken, the artery divides a second 
time into branches of the ordinary form, which enter safely into the 
substance of the brain. 
It is still further supposed, that the arteries of the brain have this 
peculiarity, distinct from all others in the body, that as they enter tho 
skull they lay asido one of their coats, and that of course the arteries 
of the brain are peculiarly weak. That the arteries of the brain want 
that outward coat of cellular substance which all arteries passing 
through other cavities or along the limbs have, is no doubt true, and 
so far they are thinner : but how much they are weakened by this loss, 
it is not easy to say ; for they want none of the coats which are es- 
sential to the constitution of an artery and this cellular coat, though 
it constitutes much of the thickness of an artery, has, I believe, but 
little to do with its strength. Yet true it is, that the arteries of the 
brain, either from being weaker in themselves, being less supported, 
lying upon the soft and pulpy substance of the brain, are more fre- 
quently burst by falls, or even by the slightest accidents, than the ar- 
teries of any other part, even tho limbs, however much exposed. Our 
injections burst them very often; the slightest blow or fall upon the 
head often produces an internal effusion of blood, which occasions 
death ; but that the arteries of the brain are so delicate as to be burst 
by a false step so as to produce a fatal aneurism within the brain, is a 
truth perhaps not commonly known. 
The quantity of blood ascending to the head is exceedingly great; 
its free circulation in all tho arteries is perfectly secured ; and the 
plan of its distribution is extremely simple, for the carotid entering by 
the os petrosum, gives three branches. First, a branch which unites 
the two carotids with the two vertebrals, and forms the fore part of 
the circle of Willis. Secondly, it gives an artery to the great middle 
lobe, whence it is named the great middle artery of the brain. 
Thirdly, an artery which is named anterior cerebri, as belonging to 
the fore part of the brain. But the vertebral, as it arises through the 
occipital hole, lies upon the cerebellum, and supplies all the cere- 
bellum, and also the back part of the cerebrum. One branch goes 
to the back part of the cerebellum, another to the fore part of the 
cerebellum, a third branch goes to the back part of the brain ; and 
thus there is formed between the carotid and the vertebral, by means 
of the great inosculation of the circle of Willis, one great set of 
vessels; which should first of all be described free from all the inter- 
ruptions of trivial arteries, which go off from point to point, but of 
which the destinations cannot be important, which are hardly known, 
which do not go in any two subjects the same way. OF TUB BRAIN. 
451 
OF THE INTERNAL CAROTID ARTERY. 
The internal carotid artery leaves the external carotid at the angle 
of the jaw : it is so inclined to contortions, that at this point it 
bulges, and even seems the outermost of the two. In mounting along 
the neck, it is tied by cellular substance to the fore part of the rectus 
or straight muscle of the neck, and it is also connected with the par 
vagum and intercostal nerve : the ganglion of the intercostal, or sym- 
pathetic nerve, lies by its side; the nerve, before it forms this ganglion, 
comes down small and thread-like through the same canal by which 
the carotid passes into the skull. 
The contortions of the carotid are great, both before and after its 
passage through the bony canal; but within the canal it is forced to 
particular and successive bendings, such as indicate plainly some design 
of Nature ; for the canal for the artery is long and tortuous, while the 
nerves and veins pass through plain and simple holes. When the 
carotid first presents itself to enter the skull, it is curved, and is a 
little behind its hole; it bends forwards and inwards a little, and so 
enters the canal; in entering the canal it rises almost perpendicularly 
upwards, but soon bends forwards again, lying, as it were, upon the 
floor of the canal; then it bends again upwards and forwards, to 
emerge from the canal; by which turn the portion of the artery which 
is engaged in the canal has the form of an Italic f. Even after it gets 
into the skull, it must still bend once more sideways and forwards, as 
if to meet its fellow, and to get to the side of the sella turcica; then 
it goes directly forwards till it touches the anterior clynoid process ; 
and then doubling back, or returning upon itself, it rises perpendicu- 
larly ; and so perpendicular is this last turn, that when cut across, the 
mouth of the artery gapes perpendicularly upwards: here it begins 
to give its branches to the brain. 
It is by the side of the sella turcica that the cavernous sinus sur- 
rounds the artery. This sinus is formed by the two plates or lamelke 
of the dura mater, parting from each other, and leaving an interstice 
full of cells, like those of the penis or of the placenta. It is filled 
with blood, by communication with several of the smaller sinuses or 
veins about the basis of the brain ; the ophthalmic veins bring into it 
the blood from the eye ; four or five small veins descending from the 
fossa Sylvii bring blood into it from the middle parts of the brain ; 
the sinuses of the os petrosum (both on its upper and lower grooves) 
open into it, one high, another lower down, and that circular sinus or 
vein which surrounds the root of the optic nerves, opens into it from 
cither side. All this blood is poured into the cells ; the internal caro- 
tid artery rises through these; and by the side of the carotid artery 
lies also that small nerve of the sixth pair which is connected with 
the great intercostal nerve. 
Veussens first discovered this curious structure ; Ridley denied it, 
and Haller at last in his turn confirmed it. Veussens believed that 
the sinus which deposited this blood conveyed it away again. Haller 
s<? vs that this is the neculiar office of that vein which accompanies the 452 
OF TflE ARTERIES* 
carotid artery, and which is named the vena sodalis arteriae carotidis. 
It was once supposed that certain small arteries opened also into the 
sinus; but it has neither arteries nor pulsation. 
Thus we trace the carotid through its canal, through the cavernous 
sinus, up to the side of the sella turcica, and about to enter the brain, 
to give off the arteries of the brain. But before we describe these, 
it will be easy to count shortly those little twigs which it gives ofT in 
the canal and in the sinus. 
The carotid artery seldom gives out arteries before it enters the 
skull; it is a lusus naturae, when it does happen that the occipital or 
pharyngeal arteries come off from it. 
The first twig, which in any case it gives off, is sometimes a small 
artery, which returns downwards along with the upper maxillary 
nerve ;* next, a small twig, accompanied by a branch from the me- 
ningeal artery, goes into the tympanum by way of the aquaeductus 
Fallopii; and next, while the artery is within the sinus cavernosus, it 
gives out two little branches, the one forwards, the other backwards, 
named arteries of the repeptaculum. 
1. The little artery which goes backwards from the sinus or recep- 
taculum goes chiefly to that part of the dura mater which covers the 
posterior clynoid process, and which covers the cuneiform process of 
the occipital bone ; it gives twigs to the 4th, 5th, and 6th pair of 
nerves, and to the pituitary gland; in short, to all the parts at the 
back of the sella turcica ; it ends in inosculations with those twigs of 
the vertebral artery which come oil' from the vertebral before it enters 
the skull. 
2. The little artery which comes out from the receptaculum to go 
forwards, arises where the carotid is crossed by the 6th pair, and has 
been confounded with a delicate nerve which joins the intercostal nerve 
to a branch of the 5th pair. The distribution of this little artery is 
nearly the same w ith that of the first, for it belongs to the 3d, 4th, and 
5th pair of nerves, and to the pituitary gland. 
The carotid having risen to the anterior clynoid process, gives out 
there a small artery, less than a crow-quill, which enters directly into 
the orbitary hole, accompanies the optic nerve into the eye, furnishes 
the eye, the eye-lids, the muscles, and the lachrymal gland, and 
sends out branches upon the forehead, viz. the frontal arteries in which 
it ends. This is a short history of the ophthalmic artery ; which, 
as it furnishes all the arteries of the eye, must be described apart. 
The carotid, now about to enter into the brain, divides at the sella 
turcica into three arteries; one to the tore lobe, another to the middle 
lobe, and a third to form the circle of Willis. These arteries arc 
usually so numbered that the communicating branch is first described ; 
next, the anterior artery of the brain ; and, lastly, the middle artery 
of the brain. But of this arrangement no one who is accustomed 
to observe the course of this artery can entirely approve: for when 
DIVISION OF THE INTERNAL CAROTID. 
* The second branch of the 5th pair. OF THE BRAIN. 
453 
the carotid rises from the side of the sella turcica, it divides into its 
three branches all at once, in a tripod-like form : the middle branch of 
the tripod is largest; the next, which goes forwards to the fore lobe 
of the brain, is smaller; the third, which is the communicating branch, 
going backwards to unite with the vertebral artery and form the circle 
of Willis, is the smallest of all. The middle artery of the brain then 
is, from its great size, to be regarded as the trunk. 
1. ARTERIA MEDIA CEREBRI. 
The middle lobe of the brain is separated trom the anterior lobe by 
a very deep sulcus or furrow, which is named fissura sylvii. This 
fissura Sylvii is formed by the transverse process of the sphenoid bone, 
or, in other words, by that very sharp line which runs out laterally 
from each of the anterior clynoid processes, and which parts the fore 
lobe, which lies in the shallow part of the skull upon the orbitary pro- 
cesses of the frontal bone, from the middle lobe, which lies in the 
deepest part of the skull behind the clynoid processes. The middle 
artery of the brain having risen from the side of the sella turcica, 
runs straight along this fossa Sylvii, and is really the continued trunk 
of the carotid ; it is larger than the artery at the wrist; it goes di- 
rectly outwards, viz. towards the temple; it runs along the fossa 
Sylvii, and is lodged deep in that cleft ; where it lies deep, it divides 
into two great branches, one deep and one superficial : it gives some 
branches to the anterior lobe, but it is chiefly limited to the middle 
lobe of the brain ; its branches to the posterior lobe, or inosculations 
with any branches of the basilar artery, are comparatively few. 
Thus the artery ends by pas ng into the substance of the brain. 
Cut nearer the sella turcica, and before it enters into the fossa Sylvii, 
it gives some small and delicate arteries ; the consideration of which 
seems to be unimportant at first view, but which is really useful in ex- 
plaining the anatomy of the brain. It gives small twigs to the pitui- 
tary gland, to the optic nerve, to the tentorium, and especially to the 
pia mater covering the basis of the brain. Among these small twigs 
certain sets of arteries make a very distinguished figure. 
1. There is one small artery which runs up into the anterior horn 
of the lateral ventricle, and forms that great plexus which lies along 
the floor of the ventricle, named plexus choroides. This, then, is 
the artery of the choroid plexus. 
2. There is a set of arteries, of considerable number, but varying in 
respect of number, small as sewing threads, which inosculate repeat- 
edly with each other, and which are scattered widely and beautifully 
over the crura cerebri and basis of the brain, forming in the pia mater 
a plexus or web of vessels. This part of the pia mater is named velum 
from its beauty and delicacy ; and this is what Wepfer, among other 
older authors, considered as a species at least of the rete mirabile; 
but that name implies a peculiar office, as in beasts, which this deli- 
cate net-work of vessels cannot have. 454 
OF TJIE ARTERIES OF THE BRAIJ'j. 
2. ARTERIA ANTERIOR CEREBRI. 
The fore artery of the braix comes off from the middle artery 
at right angles nearly ; for the great or middle artery runs directly out- 
wards towards the temple, while this second artery runs directly for- 
wards along the fore lobe of the brain. It is named sometimes the 
artery of the corpus callosum, because of two great branches into which 
it is divided one goes to that part of the brain. The corpus callosum 
(a most absurd name for any part of the brain) is the white and medul- 
lary substance where the two hemispheres of the brain are joined ; and 
upon separating the two hemispheres with the fingers, the corpus cal- 
losum is seen like a large white arch, and the artery of the corpus cal- 
losum is seen also arching over its surface. 
The anatomy of the arteria anterior cerebri may therefore be ex- 
plained thus : first, it goes oft' at right angles from the middle artery of 
the brain, which is to be considered as the trunk, and there it often 
gives small twigs to the olfactory and optic nerves; next, the two 
anterior arteries of each side, while they go forwards as if towards the 
crista galli, bend a little towards each other ; they almost meet, but do 
not absolutely touch ; they form a communication with each other, 
which of course is exceedingly short, but pretty large, It is this short 
communication which completes the circle >of Willis at its fore part. 
This cross communication between the arteries of the opposite sides 
passes just before the sella turcica and pituitary gland, and exactly in 
the middle it sends off an artery, which goes down into the third ven- 
tricle, and gives branches to the fore part of the fornix and to the sep- 
tum lucidum. 
After this communication, both arteries rise, with a large sweep 
along the flat surface of that deep division which the falx makes between 
the two hemispheres of the brain : there each divides into its two 
great branches ; one attaches itself to the corpus callosum, or that 
arch which we see upon holding apart the two hemispheres; it arches 
along with the corpus callosum so as to describe a semicircle; it is 
the larger of the two branches ; it is named arteria corporis cal- 
xosi : the other branch keeps upon the flat surface of the brain, where 
the one hemisphere lies flat upon the other, and it rises in a beautiful 
arch within the pia mater, dividing into beautiful and very minute rami- 
fications before it enters actually into the substance of the brain. 
These two great branches of the anterior artery are well distin- 
guished by Wepfer by the names of arteria profunda and arteria sub- 
lirnis, (the deep and superficial of the anterior artery,) as there is a 
deep and a superficial branch of the middle artery. The arch of the 
arteria anterior cerebri overhangs in a manner that of the artery of 
the corpus callosum, and both of them inosculate under the falx with 
the arteries of the opposite side. 
3. ARTERIA C03IMUNICANS. 
The communicating artery goes as directlv backward* from <ho OR THE VERTEBRAL ARfEKT; 
455 
middle artery as the anterior artery goes forwards. It is small, pro- 
ceeds backwards, and a little inwards ; it goes round the sides of the 
corpora mamillaria, and is about a quarter of an inch in length before 
it meets the branch of the vertebral artery} and though it does give 
off small twigs, as to the infundibulum, to the optic nerve, to the crura 
cerebri, and especially one of greater size, to the choroid plexus; yet 
all these are trivial arteries, such as every trunk at the basis of the 
brain gives off. It is not its twigs that are to be observed, but itself 
only that is important, as forming one of the largest and most impor- 
tant inosculations of the body. It unites the middle artery of the brain, 
which is the trunk of the carotid, with the posterior artery of the brain, 
which is the first and greatest branch of the vertebral artery. 
This anastomosis is the circle of Willis, too remarkable not to have 
been very long observed ; it was drawn by Veslingius and by Casse- 
rius ; it is but ill represented by Bidloo and by Cowper ; it is not a 
circle, but is right lined, and of course angular: it is of very un- 
equal size; in one body it is large, in another smaller, often even in the 
same body it is irregular, the one side being large and the other small. 
This inosculation brings us round to the first branch of the vertebral 
a-tcries, viz. the arteria posterior cerebri ; for the vertebral artery 
gives two arteries to the cerebellum, and one to the back part of the 
brain, 
OF THE VERTEBRAL ARTERY. 
The vertebral artery, thougli but the secondary artery of the head, is 
a principal one of the brain, and conveys a very great proportion of 
blood ; and its turnings and windings before it enters the skull arc 
almost as particular as those of the carotid itself. The vertebral is 
among the first branches of the subclavian artery, and comes off from 
it where it lies across the root of the neck. The two lower ganglions 
of the sympathetic nerve lie over it, and their threads surround its 
trunk, making curious net-works round it. The artery then enters 
into the canal prepared for it in the transverse processes of the verte- 
bra, commonly getting in by the 6th vertebra: but in this it is irre- 
gular, sometimes entering into the 7th or lowest; and it has been 
seen entering into the uppermost hole but one. In this canal it 
ascends in a direct line from the bottom of the neck to the top ; but, 
like the carotid, it makes great contortions before it enters the skull; 
for when it has reached the second vertebra, its transverse process 
being rather longer than those of the lower vertebras, the artery is 
forced to incline outwards ; and the transverse process of the atlas or 
first vertebra being still much longer, the artery in passing through it 
is carried still farther outwards; it is forced to take a very sudden turn, 
and is visible without cutting the bones. When the artery has passed 
through the transverse process of the atlas, it makes another very sud- 
den turn, lies flat upon the circle of that vertebra, so as to make a 
large hollowness or groove upon the bone, and then it enters the fora- 
men magnum by rising in a perpendicular direction ; and then again 
it bends and inclines forwards, lying flat along the cuneiform process 456 
OF THE VERTEBRAL ARTERY. 
of the occipital bone, where it soon meets its fellow, and the two 
uniting form the basilar artery. 
This basilar artery lies, with regard to the bone, upon the cuneiform 
process of the os occipitis, and runs along it from the foramen magnum 
to the sella turcica ; with regard to the brain, it lies upon that great 
tubercle which is named the tuber annulare or pons Varolii; and as 
the artery goes along in one great trunk, it gives out from each sido 
little arteries, which belong to this tuber annulare. 
The brain has three arteries derived from the vertebral artery as it 
has from the internal carotid ; two are given to the cerebellum and 
one to the cerebrum. 
1. arteria cerebelli posterior. 
The POSTERIOR ARTERY, Or LOWER ARTERY of the CEREBELLUM, 
is small and not regular. It comes oft' from the basilar artery either 
immediately after the union of the vertebrals, or from the vertebral 
artery immediately before the union. It is often smaller on one side 
than on the other, and sometimes it is wanting on one side. It moves 
downwards in a sort of retrograde course between the accessory nerve 
of Willis and the group of fibres which form the eighth pair, and dives 
in between the cerebellum and the medulla oblongata. Its larger 
branches spread out upon the pia mater, and then enter into the medul- 
lary substance. They belong to the cerebellum, to the spinal mar- 
row, and some of them to the pons Varolii. But there are also smaller 
and particular twigs, as twigs to the eighth and ninth pair of nerves: 
one also which enters into the fourth ventricle, to form a sort of velum 
or choroid plexus there ; and as this posterior artery winds downwards 
under the cerebellum, it gives many branches about the vermis, and 
small twigs which run between the lower point of the pons Varolii and 
the pyramidal bodies. 
Next, the arteria basilaris proceeds forwards along the pons Va- 
rolii in one great trunk : now the pons Varolii is just the tuberosity 
produced by the crura cerebri and cerebelli, meeting and uniting to 
form the spinal marrow. The corpora olivaria and pyramidalia arc 
just two bulgings at the root of the spinal marrow ; and as every great 
artery, whatever its destination may be, gives twigs to those parts 
which it passes over, so does the basilar artery ; giving twigs first to 
the corpora olivaria and pyramidalia, next to the crura cerebelli and 
to the crura cerebri; and as it runs along the pons Varolii it distributes 
little arteries to it from right to left. These little arteries also mark 
the sides of the pons with small furrows, which are seen when the 
arteries are dissected away. One of these transverse arteries, longer 
than the rest, looks like another posterior cerebri. It goes to the 
seventh pair, or auditory nerve, in the following way : The seventh 
pair of nerves proceeds from the back part of the pons Varolii; and 
as it goes forwards, the two nerves which it consists of, viz. the portio 
dura and the portio mollis, arc separated from each other by a small 
and very beautiful artery which shoots in between them, and enters 
along with them into the car. The basilar artery also gives twigs to OF THE VERTEBRAL ARTERY. 
457 
thehtth and sixth pair of nerves, which arise from the fore part of the 
pons, as the seventh pair arises from behind. • 
Arrived at the fore part of the pons Varolii, the basilar artery gives 
off almost at one point tour great arteries, two to the right hand and 
two to the left. These are the anterior cerebelli and the posterior 
cerebri. 
2. ANTERIOR CEHEEELLI. 
The axterior artery of the cekebelujm, or the upper artery, as 
it is called, goes off'at right angles from the basilar artery, and bends 
round the crura cerebri to get to the cerebellum. It gives its branches 
first to the crura cerebelli, to the cerebellum, and to the processus ver- 
miformis. S&ondly, There is a greater artery going over all the upper 
part of the cerebellum, (where it lies under the brain,) and also an- 
other which keeps closer to the brain than to the cerebellum, branches 
over that velum or delicate part of the pia mater which is interposed 
between the cerebellum and brain ; and going along it supplies the 
crura cerebri, and arrives at last at the place of the nates, testes, and 
pineal gland, and attaches itself to them. Some of the tw igs go down 
into the fourth ventricle. 
3. ARTERIA POSTERIOR CEREBRI. 
The posterior artery of the brain goes off immediately after this, 
is like it, runs parallel with it, is larger, goes to the po;terior lobe of the 
brain, and receives near its root the communicating artery from the 
carotid, which forms the circle of Willis. Where this posterior cere- 
bri and the anterior cerebelli run parallel with each other, the third 
pair of nerves rises between them. The posterior cerebri first gives a 
small twig on either side to the bottom of the third ventricle, which 
runs so far forwards as to give branches to the thalami, infundibulum, 
and to the crura fornicis. Then the main artery, bending like that last 
described round the crura cerebri, and passing deep into the great divi- 
sion between the cerebellum and brain, arches upwards towards the back 
lobes of the'brain; but before it arrives there, it gives first small twigs 
to the crura cerebri, and then another notable artery (though small) 
destined for the internal surfaces of the ventricle. This is a chief artery 
of the choroid plexus ; it enters the lateral ventricle by the inferior 
horn ; goes along with the cornu ammonis ; helps to form the choroid 
plexus ; inosculates, of course, with the choroid arteries from the caro- 
tid ; and twigs also go from this artery to the nates, testes, and pineal 
gland, or in other words, to the velum which separates the cerebellum 
from the brain, which closes the ventricle behind, and which covers the 
pineal gland, and is a membrane or velum to it also ; the pineal gland, 
nates, and testes, being situated neither in any of the ventricles, nor on 
the surface of the brain, but between the surfaces of the cerebrum and 
cerebellum, where the one lies upon the other. 
After this second branch to the internal surfaces, the great trunk 
of the posterior cerebri branches profusely like a tree all over the back 458 
ARTERIES of the 
part of the brain, inosculating forwards with the middle artery of the 
brain, and also with the artery of the corpus callosum. 
Thus is the whole brain supplied with blood: and next in order 
come the arteries of the spinal marrow. 
PLAN, OR RECAPITULATION OF THE ARTERIES OF THE DRAIN. 
1. Rami Pterygoidei. 
2. Rami to the Origin of Nei'ves and 
the Cavernous Sinus. 
3. Arteria ophtiialmica. 
4. Rami to the Pituitary Gland, 
Nerves, Infundibulum, and 
membranes. 
5. Arteriacerebralis anterior. 
6. Arteria cerebralis media. 
1. Rami Musculares, before entering 
the Canal. 
2. Rami Spinales. 
3. Rami Musculares, under the Oc- 
ciput. 
4. Mcningeec Posteriores. 
5. Arteria inferior cerebelli. 
V. Arteria Centralis Retina- 
2. Arteria Lacrymalis. 
3. Arteria Supra-orbitalis. 
4. Arteria Ctiiares. 
5. Arteria AEthmoidalis. 
6. Artei ia Nasalis. 
7. Arteria Frontalis. 
8. Arteria Anastomoica 
CEREBRAL 
ARTERT. 
INTERNAL 
CAROTID. 
vertebral 
ARTERY. 
6. Rami Spinales. 
7. Union to form the ar- 
teria BASILAR1S. 
1. Arteria Anterior Cerebelli. 
2. Arteria Cerebralis Posterior 
3. Arteria Communicans. 
OF THE ARTERIES OF THE SPINAL MARROW. 
I have mentioned none of those smaller arteries which the vertebral 
gives off before entering the skull, because, being destined chiefly for 
the spinal marrow, they belong to this second class. 
The vertebral artery, as it mounts along its canal towards the head, 
gives at each step, or as it passes each vertebra, a delicate twig; these 
little arteries pass through the intervertebral spaces, go to the deeper 
muscles of the neck, and inosculate with the thyroid and cervical arte- 
ries. In like manner, other small arteries go inwards to the spinal 
marrow at the place where each nerve comes out. They enter into 
the sheath of the spinal marrow, and inosculate with the chief arteries 
of the medulla spinalis. 
As the vertebral passes through the atlas, both above and below that 
bone it gives out much larger arteries to the muscles, as to the recti, 
trachelo-mastoideus, and complexus, inosculating largely with the oc- 
cipital artery; often there is at this point one large and particular 
artery going out to the back of the neck. 
Again, as the vertebral passes through the occipital hole, it gives 
Out a little artery, which accompanies the trunk itself up through the 
foramen magnum, and goes to that part of the dura mater which covers 
the cuneiform process, and there it inosculates with the twig of the 
carotid, which enters along with the jugular vein. This is the poste- 
rior artery of the dura mater. 
Next come the arteries of the spinal marrow, the anterior of which SPINAL MARROW. 
459 
comes out from the trunk of the vertebral artery ; the posterior (though 
k also sometimes comes olf from the vertebral before the basilar is 
formed) more commonly comes off from the posterior cerebelli. 
1. ARTERTA ANTERIOR MEDVLLA2 SPINALIS. 
The anterior artery of the spinal marrow is the larger of the 
two. It was discovered first by Willis ; it had been looked upon, till 
the time of Veussens, as a nerve accompanying the spinal marrow ; 
because, when empty of blood and uninjected, it is white, and not un- 
like a nerve. This spinal artery begins within the skull by two branches, 
which unite as they proceed down the spine. These two branches 
arise one from each vertebral artery, at the very point where the ver- 
tebrals are about to unite to form the basilar trunk : each artery passes 
down its own side of the spinal marrow, between the corpora olivaria 
and the corpora pyrainidalia; each artery, before it leaves the skull, 
gives twigs to the tuber annulare, and to the pyramidal and oval bodies, 
for they are the beginnings of the spinal marrow ; and soon after 
emerging from the skull,* the two spinal arteries join so as to form one 
anterior spinal artery. This joining is usually at the top of the neck, 
or rather within the skull, but sometimes so low as the last vertebra 
of the back. Almost always they join within the head or near it; and 
the anterior spinal artery which they form descends along the spinal 
marrow in a furrow which it forms for itself. The peculiar office 
of this artery is to supply the spinal marrow and its sheath, which 
it does by sending continual branches into the substance of the spinal 
marrow ; while other branches go into the sheath itself, and pass out 
from the spiral canal along with those nerves which go out from the 
spinal marrow, accompanied by little processes of the sheath, which 
are named processus denticulati. 
But this artery, being extremely small, would be soon exhausted, 
were it not reinforced with small arteries coming into the sheath : 
these pass through the vertebral interstices into the spinal canal, and 
are derived from every artery that passes near the spine. Thus in the 
neck, the spinal artery receives twigs from the vertebral arteries, and 
from the thyroid and cervical arteries ; in the back it receives twigs 
very regularly from each of the intercostal arteries, and it receives its 
twigs from the lumbar arteries when it has got down as low as the 
loins. 
But thl? spinal artery, which is continually diminishing, at last fails 
in the loins ; and where the cauda equina is, that is, principally in the 
canal of the os sacrum, the medulla is no longer supplied by a spinal 
artery, but by the small branches of the sacral arteries, which enter by 
the ten holes of the sacrum. 
Of those adventitious branches which reinforce the artery of the spinal 
marrow as it descends through the spine, each gives several other 
branches ; they give twigs to the muscles of the spine, twigs to the 
* The artery which accompanies the ninth pair or linsmal nerve, often comes from 
th« anterior spinal artery. 460 
ARTERIES OF THE EYE. 
substance of the vertebra? themselves, twigs to the sheath of the spinal 
marrow 5 and, finally, twigs which inosculate with the spinal artery, 
and which sink into the nervous substance to nourish it. 
2. A,RTERIA SPINALIS POSTERIOR. 
The posterior spinal artery differs in all essential points from 
the anterior : first, there are two posterior spinal arteries which arise, 
not from the basilar or vertebral arteries like the anterior, but usually 
from the arteria anterior cerebri; and they are smaller than the anterior 
spinal artery. Secondly, these two arteries give small twigs to the 
bottom of the fourth ventricle, and then go round from the fore to the 
back part of the medulla oblongata ; but there, instead of uniting like 
the beginnings of the anterior artery, they continue separate, run down 
the spinal marrow as two distinct arteries, with very frequent inoscu- 
lations between them. This artery is also unlike the other in respect 
of its termination, for it disappears at the second vertebra of the loins 
Its inosculations w ith the arteries from without are very free. 
OP THE ARTERIES OF THE EYE. 
The arteries of the eye, as we have seen in the plan, come from one 
branch only, the ophthalmic artery, the branch which the carotid, when 
it touches the anterior clynoid process, sends into the Orlrtt along with 
the optic nerve. But small as this original artery is, (not so big as a 
crow-quill,) the system of arteries which arises from it is very great; 
whether wo consider their number, the irregular parts which they supply, 
or the great inosculations which they form even with the outward arte- 
ries of the nose and face. 
These are reasons for setting this order of arteries apart; and even 
with all possible care in the arrangement, it is not easy to deliver an 
orderly intelligible history of this artery. The ophthalmic artery sup- 
plies not only the eye itself, i. e. the globe, but it supplies also all the 
apparatus, if I may so call it, of the eye, i. e. the muscles, the lachry- 
mal gland, the eye-lids, and even the forehead and nose. 
1st, It sends a great branch, which leaves the ophthalmic artery, and 
takes its course outwards and upwards along the eye, to supply the 
lachrymal gland where it is exhausted. Sdly, The ophthalmic supplies 
the eye itself, both by that artery which enters into the centre of the 
optic nerve, called arteria centralis retina?, and also by other arteries 
which are named the ciliary arteries ; because they go onwards to the 
fore part of the eye, where the ciliary circle is. 3dly, The muscles 
are supplied by an artery which comes from the same place nearly with 
those ciliary arteries. 4thly, There are two arteries which go down 
through holes in the socket into the bones and cavities of the nose ; 
and these, as they perforate chiefly the .ethmoid bone, are named reth- ARTERIES OF THE EYE. 
461 
moid arteries. Sthly, and lastly, Those arteries which go out upon 
the forehead and nose are so directly from the trunk of the ophthalmic 
artery, that they must be regarded as the termination of it. This is the 
system of vessels which comes now to be described, and this is, perhaps, 
the best order for the description. 
ARTE REV LACHRY MAXIS. 
The lachrymal artery is the first branch of the ophthalmic; but 
in order to know its place correctly, we must first observe how the 
ophthalmic artery enters the orbit. It comes off from the carotid, 
where that artery touches the clynoid process ; and is so close upon 
the process, that the setting off of the ophthalmic is almost covered by 
that projection. It then dives under the optic nerve, and appears on 
the outer side of it; and as the artery goes along through the orbit, it 
makes a spiral turn till it completely surrounds the nerve. 
The lachrymal artery goes off from the ophthalmic immediately after 
entering the orbit,* though sometimes it arises from the artery of the 
dura mater ; and then it enters by the foramen lacerum, which is the 
next opening to the optic hole. It goes off from the ophthalmic about 
two or three lines after it has entered the socket. It goes all along 
the outer side of the orbit, because the lachrymal gland lies in the 
outer corner of the eye. When it reaches the gland, it is branched out 
and entirely expended upon it, except that it sends some small twigs 
forwards to the eye-lid. Of these vagrant branches, one twig goes to 
the periosteum of the orbit, perforates the cheek-bone, and so gets into 
the hollow of the temple, inosculating with the deep temporal artery ; 
while another little branch goes to the tarsus of the upper eye-lid, and 
another to the tarsus of the lower eye-lid, and thus ends the lachrymal 
arterv. 
ARTERIA CENTRALIS RETINA}. 
This branch of the ophthalmic artery is so named because it perfo- 
rates the optic nerve, runs up through its very centre or axis, enters into 
the cavity of the eye through the very centre of the optic nerve, and 
spreads its branches all over the retina. It usually arises from the 
ophthalmic artery, where it turns in the middle of the orbit over tho 
upper part of the optic nerve ;t it plunges into the nerve ; and this 
artery, or rather the artery and vein both (for the vein accompanies it) 
make so large a canal in the centre of the optic nerve, that their 
sheath stands quite open and gaping when the nerve is cut across ; 
and was long known to the older anatomists by the name of porus 
opticus, before the meaning of this orifice or hole was understood. 
When this artery arrives within the eye it branches out most beauti- 
fully upon the outer delicate membrane of the retina. The angles 
and meshes which this artery makes give the name of retina or net- 
* Sometimes it goes off one or two lines before the ophthalmic enters the optic hole, 
sometimes from the middle of the artery. 
t It may be fonnd arising from the ciliary arterirs, or sometimes from the muscular. 462 
ARTERfES OP THE EVE. 
like to the whole; for the pulpy part of the optic nerve expands into 
a very thin and delicate web which resembles, mucus. This web has 
its strength from these branches of the central artery. The branches 
of the artery, and the mucus-like expansion of the nerve, lie in two 
separate layers ; and hence some anatomists reckon the retina a double 
membrane. 
The arteria centralis having given off sideways these innumerable 
branches to the retina, still goes forwards, plunges through the sub- 
stance of the vitreous humour, does not stop till it arrives at the back 
part of the lens, and is of course the arteria centralis oculi, the 
central artery of the eye itself. This central artery cannot be seen 
in the adult, and therefore there may be a question as to their ex- 
istence at all; but by injecting the arteries of the eye of a foetus, of 
a slink Calf, or of any young animal, the arteria centralis oculi is found 
to distribute its branches in the following way : As it goes forwards 
through the centre of the eye-ball, it gives off its delicate arteries from 
side to side, which go along the partitions of the vitreous humour (for 
the vitreous humour is divided every where by membranes into small 
honey-comb-like cells). These cross arteries inosculate with those of 
the retina, and are plainly the arteries which secrete and support the 
virtreous humour.* The central artery stops when it comes to the 
back of the lens : it is scattered in a radiated form, as if by the resist- 
ance, into many great branches. These branches go round all the 
capsule of the lens, and meet again on its fore part; where, uniting 
into one or more small arteries, they pass onwards into the opening 
of the pupil, and help to form that membrane which in the foetus passes 
from the margin of the iris, and shuts the pupil. 
So the arteria centralis retina? passes first through the centre of the 
optic nerve ; next through the centre of the vitreous humour ; next, 
after going round the capsule of the lens, it passes through the poste- 
rior chamber of the aqueous humour, and terminates in the centre of 
the pupil. But as these last arteries, viz. of the pupil, vanish soon 
after birth, we may consider the central artery as ending in inosculations 
with those arteries, which coming upwards along the sides of the eye 
along with the retina, form a strong circle of arteries at the root of 
the ciliary process. 
ARTERLE CILIARES. 
The ciliary circle is known, upon looking outwardly at the eye, by 
that white line which borders the iris, and separates the iris or colour- 
ed part of the eye from the white or colourless part. That circle 
marks the place where there is a great concourse of arteries. The 
corpus ciliare, or ciliary body, is the part within the eye which lies flat 
upon the fore part of the vitreous and crystalline humours, which is like 
a second iris behind the first, which is extremely vascular, and corres- 
ponds with the ciliary circle without. This corpus ciliare is radiated 
* I have observed the artery branching in the midst of the vitreous humour, but these 
branches I have seen terminating on the back of the capsule of the lens.—C.B. A Ilf ERICS OP THE EYE. 
463 
(that is a consequence of the peculiar order and arrangement of its 
vessels, which run in rays from the ciliary circle, i. e. from the circum- 
ference towards the centre). These radii coining from the ciliary 
circle are called the ciliary processes ; so that the ciliary circle, 
corpus ciliare, and ciliary processes, are all parts of the same vascular 
organ. This is the part of the eye to which all those arteries go which 
are next to be described. 
1. Two arteries of considerable size gooff from the sides of the 
ophthalmic artery : these go along the sides of the optic nerve ; they 
go towards the ball of the eye; and the one on the outer side of the 
eye is named external ciliary artery, that on the inner side of the 
optic nerve is named the internal ciliary. 
2. These two divide themselves again into two subordinate branches : 
one of them as soon as it touches the eye, that is, just beyond the 
implantation of the optic nerve, enters its substance, and is spread out 
on its choroid coat in a great number of branches, which are named 
ciliares breves, the short ciliary arteries : the other goes further for- 
ward upon the eye before it enters, and even after it enters, it still goes 
forwards to the very fore part of the eye before it divides ; hence named 
CILIARES LONGUE. 
3. The anterior ciliary arteries are some small and uncertain 
branches, which come sometimes from one source, sometimes from 
another, but most commonly from the muscular branches ; and they go 
along with the muscles, and consequently enter the eye at its fore part 
just where the recti muscles are inserted. But, though small, these 
anterior ciliary arteries are of considerable number. 
From the places at which these several arteries enter the ball, one 
might guess a priori how they will be distributed through its coats. 
The ciliary arteries do not all of them arise from the ophthalmic 
artery ; many arise from the muscular branches. As soon as they 
touch the eye-ball, they enter into it near the insertion of the optic 
nerve, pass through the sclerotic coat (leaving for its nourishment a few 
twigs); they divide so, that just after they have entered, we can count 
twenty-five or thirty all round the root of the optic nerve which go for- 
wards in a radiated form, and are completely diffused upon the choroid 
coat; these are the posterior ciliary arteries. This coat of 
vessels lines the choroid all the way forward to the lens, goes still 
onwards to the fore part of the lens ; and then turning down upon the 
lens at right angles, it meets with the anterior vessels, and forms the 
ciliary circle, and the ciliary processes or radii; a few twigs go still 
forward upon the uvea arid iris, so as to make a very important con- 
nection of all the vascular parts of the eye. 
Secondly, The longer ciliary" arteries enter the sclerotic a little 
further forward, and penetrate at a greater distance from the optic 
nerve. They are two arteries thus distinguished ; they pass forward 
between the sclerotic and choroid coats, and on approaching the ciliary 
circle, they each divide and make a circle of inosculation. Their 
branches meet each other, and are now joined both by the shorter 
ciliary arteries and by the anterior ciliary arteries; by which conjunc- 
tion an anterior circle is formed, which corresponds with the outer 464 
ARTERIES OF THE EVE. 
circle of the uvea, and is called the outer ciliary circle : this agam 
sends radii of vessels, perhaps 30, inwards, which meeting, form a 
second circle, the inner ciliary circle. 
Thirdly, The anterior ciliary arteries enter the eye at its fore part, 
and immediately unite with these, as has just been explained ; they help 
to form the ciliary circle, which is the great conjunction of all the in- 
ternal vessels of the eye. 
The muscular arteries are the least regular of all the branches of 
the ophthalmic artery. From one or other branch of the ophthalmic 
there generally arise two muscular arteries ; the one for the upper, the 
other for the lower muscles. 
ARTERIA MUSCULARIS SUPERIOR. 
The upper muscular artery consists of small twigs, which go 
chiefly to the levator palpebrae and rectus superior ; and these, though 
they sometimes arise as two small twigs from the ophthalmic artery 
itself, yet in general come off rather from that artery which, as it goes 
out by the supra-orbitary hole, is named the supra-orbitary artery. 
These muscular branches of the supra-orbitary, then, supply the upper 
muscles of the eye, as the levator palpebrse, the obliquus major, the 
rectus superior, and the sclerotic or outer coat of the eye. 
ARTEKIA MUSCULARIS INFERIOR. 
The lower muscular artery is very generally an independent 
artery, and pretty large. It comes off from that part of the ophthalmic 
artery where it is giving off the ciliary arteries. This muscular branch 
is large enough to give off sometimes the arteria centralis retinae, and 
often some of the short ciliary arteries arise from it; it is so long as 
even to reach the lower eyelid. The muscles which it supplies are all 
those which lie on the lower part of the eye, as the deprimens oculi, 
abducens oculi, obliquus minor. It also gives variable twigs to the 
sclerotica, the optic nerve, the periosteum of the orbit, and sometimes 
to the adnata and lower eye-lid. 
ft 
The set of arteries which stand next in order are those which go 
down into the nose through the aethmoidal bone, whence they are 
named aethmoidal arteries. The aethmoidal arteries are, like the other 
branches of the ophthalmic, pretty regular in their destination, but far 
from being regular in the manner in which they arise. 
ARTERIA .ETHMOIDALIS POSTERIOR. 
The posterior .ethmoidal artery is so named, because it passes 
through the posterior of two holes which are in the orbit at the joining 
of the aethmoidal with the frontal bone.* It is an artery by no means 
regular in its place, coming sometimes from the ophthalmic trunk. 
* In describing the skull, these arc named the interna! orbitary holes AftTEKlES OF THE EVE. 
465 
sometimes trom the lachrymal artery, very rarely from tiie supra-orbi- 
tary artery. It is of no note : it is the smaller of the two rethmoidal 
arteries ; it gqes through its hole, and is scattered upon the bones and 
membranes of the nose. While it is circulating its twigs among the 
aethmoidal cells, it inosculates, of course, with the nasal arteries of the 
external carotid. 
ARTERIA .ETIIMOIDALIS ANTERIOR. 
Tiie anterior mthmoidal artery is rather more regular and more im- 
portant ; it passes through a larger hole, and is itself larger ; it comes 
off more regularly from the ophthalmic trunk, and it goes not down 
into the nose, but upwards into the skull. 
The ophthalmic artery, much exhausted by giving off many branches, 
has risen over the optic nerve, has completed its spiral turn, and has 
just got to the inner corner of the eye, where the aethmoid hole is when 
the anterior aethmoid artery arises from it. It arises just behind the 
pulley of the upper oblique muscle, plunges immediately into its pecu- 
culiar hole, and, passing along a canal within the aethmoid bone, it 
merely gives twigs to the frontal and aethmoidal sinuses, and passes up 
by one of the largest holes in the cribriform plate of the aethmoid bone. 
When within the skull, it is under the dura mater, between it and the 
bone; it goes to the dura mater and to the root of the falx, and some 
of its delicate twigs turn downwards again into the nose, through the 
small holes of the cribriform plate accompanying the branches of the 
olfactory nerves. 
The fifth order of arteries is very numerous, including all those 
which send their twigs outwards upon the face. They are the supra- 
orbitary artery, the artery of the upper eye-lid, the artery of the lower 
eyelid, the artery of the forehead, and the artery of the nose. 
ARTERIA SUI’EA-ORBITALIS. 
The supra-orbitary artery is so named from its emerging from the 
socket by that notch in the superciliary ridge which we call the supra- 
orbitary hole. It comes off from- the ophthalmic artery at the place 
where it gives off the ciliary and lower muscular arteries : it so often 
gives off the arteries which go to the upper muscles of the eye, that 
some have named it the superior muscular artery. It passes onwards, 
giving twigs to the levators of the eye and of the eyelid, and to the 
upper oblique muscles, and to the periosteum : and before it arrives at 
the supra-orbitary hole, it divides into two twigs; of which one lies 
deep, and supplies the periosteum of the forehead, inosculating with 
the temporal artery ; the other lies more superficial, but still is covered 
by the orbicularis and corrugator supercilii, on which muscles it be- 
stow's all its branches. 466 
ARTERIES OF THE Elk. 
ARTEKLE PALPEBRALES. 
TJie two palpebral arteries arise from the ophthalmic after it 
has passed the tendon of the obliquus superior, when it has in a manner 
emerged from the socket, and is lying at the inner angle of the eye ; 
there it commonly gives off two small arteries, one to the upper and 
one to the lower eye-lid : and often the two arise by one trunk. 
Arteria palpebralis inferior.—The artery of the lower eye- 
lid is the branch of the two which goes off the first; but it is the smaller 
and less regular of the two. Its twigs go, one to the union of the two 
tarsal cartilages, to the caruncula lachrymalis, and to the adjoining 
part of the adnata ; another goes deeper, viz. to the lachrymal sac, 
and even into the sethrnoid cells; and a third twig runs along the 
margin of the tarsus, named tarsal artery, supplying the JVfeibomean 
glands. 
Arteria palpebralis superior.—The artery of the upper eye- 
lid arises along with the lower palpebral, or near it; it gives few 
branches ; one keeps to the angle of the eye, and supplies the orbicu- 
laris oculi, the caruncula, and the tunica conjunctiva ; another having 
pierced the fibres of the oblique muscle, runs along the borders of the 
tarsus, inosculating with a similar branch of the lachrymal artery, and 
forming an arch along the upper tarsus as the other does below. 
ARTERIA NASALIS. 
The nasal artery goes off at the edge of the orbit, rises over the 
lachrymal sac, and over the ligament of the eyelids ; it first gives a twig 
upwards to the root of the frontal muscle; then another goes down 
over the lachrymal sac, and after giving branches to the sac, goes to 
the orbicularis muscle, and inosculates with the infra-orbitary artery ; 
and lastly, the most remarkable branch of this artery, from which 
indeed it has its name, runs down upon the side of the nose, making 
a beautiful net-work, and inosculating with the last branch of the labial 
artery, called angularis, which runs up to meet it.* This is quite a 
cutaneous artery ; many of its twigs go to the skin ; it is felt beating 
strongly; it was often opened when arteriotomy was more regarded 
than it is now. 
ARTERIA FRONTALIS. 
The frontal artery is now to be distinguished from the supra-or- 
bital; for the supra-orbital rises deep in the socket, emerges by the 
supra-orbitary hole, passes along chiefly between the bone and muscles, 
and makes no remarkable figure upon the face : while this frontal 
artery keeps chiefly upon the surface of the muscles, is quite subcuta- 
neous, has nothing to do with the supra-orbitary hole, and rises beauti- 
* Some of its branches absolutely penetrate the cartilages of the nose, and so get ac- 
cess to the Schneiderian membrane, and supply it With blood. ARTERIES OP THE ARM. 
467 
fully upon the forehead. It is a delicate and slender artery, not so 
large as the nasal, and looks like one of its branches; it gives off first 
a branch to the eyelids, named superciliary artery, which supplies the 
root of the frontal and the upper part of the orbicularis muscles ; it 
sends an ascending branch which dives under the frontal muscle, and 
belongs chiefly to the os frontis and pericranium. This is the little 
artery which often makes a perpendicular groove in the os frontis. 
The chief branch of the artery continues subcutaneous, is felt beating 
along the forehead, belongs chiefly to the skin of the forehead and to 
the hairy scalp, and mounts to the top of the head, to the place of the 
fontanelle, where it has free inosculations with the temporal artery. 
This last branch is the end of the ocular or ophthalmic artery, of 
which the branches are so irregular in their origin, that the most dili- 
gent anatomists have declined that part of the description, and yet 
have arranged the branches upon that scheme, viz. the points from 
which the several twigs arise: whereas I have thought it more prudent, 
since the branches are regular in respect of the parts which they sup- 
ply, to arrange them according to those parts, viz. the lachrymal 
gland, the eyeball, the muscles, the aethmoid cells, the face ; an order 
which also very nearly corresponds with the order in which the arteries 
arise. The learning and remembering these arteries, it is right to 
acknowledge, is a task more difficult than useful; more suiting the 
severe anatomist, than the practical surgeon ; ye, who, if he do his 
duty, will learn all; and as he learns much, must expect to forget 
much. 
OF THE ARTERIES OF THE ARM. 
The subclavian arteries arise from the arch of the aorta. The left 
subclavian arises from the extremity of the arch, and just where the 
aorta is turning down towards the spine. It is longer within the tho- 
rax, runs more obliquely to pass out of the chest, receives in a less 
favourable direction the current of the blood. But the right subclavian 
arises from the aorta by that artery which is called the arteria inno- 
minata ; for it is an artery which can have no name, being neither the 
carotid nor the subclavian, but a trunk common to both. It is large, 
rises from the top of the aortic arch, receives the blood in the most 
direct manner ; from which physiologists have deduced those conse- 
quences which have been already explained.* 
1. The artery of the arm, as it proceeds, changes its name according 
to the parts through which it passes. It is named subclavian within the 
breast, axillary in the arm-pit, brachial as it goes down the arm, and 
when it divides at the bending of the arm its two branches are named 
* Douglas says the left is shorter, which I can hy no means understand. 468 
ARTERIES OF THE ARM. 
the radial and ulnar arteries, after the radius and ulna, along which 
they run, until at last they join to form vascular arches in the palm of 
the hand. 
Nature has thus arranged and divided the parts of this artery ; and 
the study of its branches becomes easy to those who will first conde- 
scend to observe t his simple arrangement and the parts through which 
it goes. 1st, While the artery is within the breast, it lies transversely 
across the root of the neck ; it supplies the neck, the breast, the 
shoulder; it gives all its branches upwards into the neck, or down- 
wards into the breast: upwards it gives the vertebral to the inside of 
the neck (if I may use an expression which cannot now be misunder- 
stood) ; the cervical, which goes to the outside of the muscles of the 
neck ; the thyroid, which goes to the thyroid gland. While it gives 
off from its opposite side downwards, and into the chest, the mammary, 
which goes to the inner surface of the breast; the upper intercostal 
artery, which serves the space between the uppermost ribs ; the medi- 
astinum and pericardium, and even the diaphragm, though far distant, 
receive branches from this mammary artery. 
2. When the artery, having turned over the sloping part of the chest, 
glides into the axilla, and lies deep there between the scapula and the 
thorax, what parts can it supply, or what vessels can it give off, but 
scapular and thoracic arteries ? Its branches accordingly are three or 
four slender arteries to the thorax on one hand, named the four thora- 
cic arteries, which give twigs to the glands, the pectoral muscles, and 
the breast or mamma ; and on the other hand it gives off first great 
articular arteries which surround the joint, and still great scapular 
arteries which surround the scapula, and nourish all that great mass of 
flesh which lies upon it. 
3. But when this artery takes the name of the humeral artery, and 
passes along the arm, it must be simple, as the arm is simple ; for it 
consists of a bone, of one mass of muscles before, and another behind : 
the artery of course runs along the bone undivided, except that it gives 
oft' one branch, which runs parallel with the main artery, and running 
deeper among the flesh, is named muscularis or profunda. 
4. It divides at the bend of the arm, in order to pass into the fore 
arm in three great branches. In wounds thus low, all danger of losing 
the arm from wmmds of the artery, unless by the gross ignorance or 
fault of the surgeon, is over : we do not attend so much to the parts 
which it supplies, or,/in other words, to its inosculations, as to the parts 
against which the great branches lie. We observe here, as on all 
occasions, the artery seeking protection, and running upon the firmest 
parts : its three branches now pass ; one along the radius, another along 
the ulna, a third along the interosseous membrane. 
5. In the palm of the hand we find the artery still following the 
order of the bones ; and as the carpal bones are as a centre or nucleus, 
upon which the metacarpal and finger bones stand like radii, the pal- 
mar artery forms a complete arch, from which all the fingers are sup- 
plied by arteries, issuing in a radiated form. 
Of all these subdivisions the subclavian artery is that which seems the 
least important to know ; and yet, without a perfect knowledge of it. ARTERIES 07 THE ARM. 
469 
how shall we understand many important arteries of the neck or shoul- 
der ? How shall we understand the anatomy of the greatest of all the 
nerves, viz. the sympathetic nerve which twists round it ? How shall 
we judge rightly of tumours near it, or of aneurisms which so often 
mount along this artery from the arch of the aorta until they are felt 
here ? Of the second division of the aitery, viz. where it lies in the 
axilla, the importance is most unequivocal ; since every attempt to stop 
hemorrhages, by compressing this artery, requires a knowledge of it; 
since every full bleeding wound near this place alarms us, and requires 
all our knowledge; since every tumour that is to be extirpated opens 
some of its branches ; since we cannot cut off a cancerous breast, or 
the glands which should be taken along with it, without cutting the 
thoracic arteries.—Next the artery of the arm, simple as it is, in- 
terests us greatly. It is this simple artery which is hurt in aneurisms; 
it is its delicate, I had almost said capillary, branches, which are to es- 
tablish a new circulation, and to save the limb. We have indeed no 
apprehensions of losing the limb for want of blood (the continual suc- 
cess of our operations having established this point;) yet it is most inter- 
esting to observe the extreme smallness of these branches, as an as- 
surance to us in other cases of danger ; though 1 do indeed believe, 
that there cannot in any simple wound in any limb be the smallest 
danger from this much dreaded obstruction of the blood. 
The arteries of the fore arm are more interesting still; for if we 
will be so selfish as to consider the difficulties of the surgeon merely, 
wounds of the arteries in the fore arm are very distressing. These 
arteries lie deep among the muscles, driving their blood (when 
wounded) through the whole arm, and either occasion a difficult and 
most painful dissection, or cause a deep and gangrenous suppuration ; 
so that whether the surgeon be so dexterous as to secure the arteries, 
or so timid as to leave the arm in this woful condition, the patient is 
to undergo such sufferings by pain or by a long disease, as must interest 
us greatly. 
The arteries even of the wrist and hand, though small, are important. 
The difficulty of managing wounds of these arteries stands but too 
often recorded in all kinds of books for us to doubt the fact. >If many 
have died after frequent bleedings from these arteries, though under 
skilful hands, what ought we not to submit to in the way of study and 
labour to acquire and to retain a knowledge of these arteries ; since by 
that alone every thing that is surgical in tumours, aneurisms, amputa- 
tions, is well or ill performed, according to our degree of knowledge ; 
and since, according to our degree of knowledge, we are disengaged 
in our minds, and have free possession of our judgment, to do any 
thing which may be required ? In short, as we proceed along this 
artery, we shall perceive that each division of it rises in importance ; 
or at least that if wounds about the axilla be more dangerous, they are 
proportionably rare ; that if accidents about the wrist or hand be less 
dangerous, they are, however, more frequent, so as to deserve every 
degree of attention. 470 
OF THE SUBCLAVIAN ARTERY'. 
I. OF THE SUBCLAVIAN ARTERY. 
This artery is so named from its passing under the clavicle by winch 
it is protected ; and wTe include under this division all that part of the 
artery which lies between the arch of the aorta and the outside of the 
clavicle, where the artery comes out upon the chest. Here the artery 
is of a very great size ; it lies directly across at the top of the chest 
and root of the neck ; and like a cylinder or axis, it gives its branches 
directly upwards and directly downwards to the throat, to the neck, 
and the parts within the chest. Upwards it sends the vertebral, the 
thyroid, the cervical, and all the humeral arteries ; downwards it sends 
the upper intercostal artery, and also the internal mammary, which, 
besides its going along the inner surfaces of the chest, gives branches 
to the pericardium, mediastinum, thymus, and other parts. 
1. ARTERIA mammaria interna. 
The internal mammary artery is the first which the subclavian 
gives off; it is of the size of a crow-quill, long, slender, its ramifica- 
tions very beautiful. On each side of the chest the mammary artery 
passes down along all the inner surface of the sternum, and ends at 
the cartilago ensiformis, in numerous inosculations with the epigastric 
artery ; for the epigastric arises from the femoral at the groin, just as 
this does from the subclavian at the top of the chest, and runs upwards 
along the belly, as the mammary runs downwards along the breast till 
they meet each other midway. This is an inosculation which fifty 
years ago was much noticed. Physiologists deduced the most im- 
portant consequences from it, ascribing the connection of the breast 
and womb to the flux and reflux, to the alternate stoppage and ac- 
celeration of the blood in these vessels ; although the sympathy of the 
breasts and womb is plainly a connection which Nature has established 
upon other laws, upon a kind of sympathy such as we see every where 
in the system, but can in no instance explain. 
The course of the mammary artery, and the order of its branches, 
is this : It goes off from the low er and fore part of the subclavian 
artery ; it lies on the outside of the membranous bag of the pleura ; 
and considering the pleura as ending in an obtuse and rising apex, the 
mammary artery lies at first a little behind the pleura, its first movement 
is to rise and turn with an arch over the top of the pleura or bag which 
encloses the cavity of the chest; there it descends again, and passes 
between the ribs and pleura; the artery runs along the inside of the 
thorax under the middle of the cartilages. At the seventh or eighth 
rib the mammary itself emerges from the thorax, and becomes an ex- 
ternal artery ; it first sends a branch towards the ensiform cartilage, 
which plays round it, and then it goes to the upper part of the ab- 
dominal muscles by two distinct branches, the one of which is internal, 
the other external. The internal branch goes into the belly or sub- 
stance of the rectus muscle, descends nearly as far as the navel, and 
inosculates with the epigastric arterv. The external branch turns off UF THE SUBCLAVIAN ARTERY. 
471 
to one side, goes rather to the lateral muscles of the abdomen, espe- 
cially to the two oblique muscles, and inosculates more with the lumbar 
arteries ; and so the mammary ends. But as it passes down along 
the chest, it gives the following branches :— 
First, Where it is passing the clavicle, bending to go downwards, it 
gives a small retrogade branch which follows the course of the clavicle, 
and goes to the muscles and skin of the neck.* 
Secondly, It gives an artery, or rather arteries, to the thymus, ar- 
terle thymI0j£. These are in the adult extremely small, because 
the gland itself is so; but in the child the gland is large, the upper 
part lies before the trachea, the lower part lies upon the heart, or rather 
upon the pericardium between the two lobes of the lungs: the upper 
end then is supplied by the thyroid arteries ; the middle part is often 
supplied by a distinct and particular branch, viz. by the arteria thy- 
mica coming from the mammary, but this is far from being always so ; 
the lowest part of the gland has twigs from those arteries which 
properly belong to the mediastinum, upon which it lies, or to the peri- 
cardium, or to the diaphragm. 
Thirdly, The mammary gives also the upper artery of the diaphragm, 
its lower artery being the first branch of the aorta within the abdomen. 
This upper artery of the diaphragm is named arteria comes nervi 
phrenici, because it accompanies the phrenic nerve. The phrenic 
nerve is passing from the neck (where it arises) into the chest, by the 
side of the axillary artery, when it receives from the mammary this 
small artery which goes along with it; and this artery (which is so 
extremely small that nothing but its regularity can give it any import- 
ance) goes down through the whole chest, accompanying the phrenic 
nerve over the pericardium till they arrive together on the upper surface 
of the diaphragm, and spread out there. This artery, small as it is, 
gives twigs as it passes along to almost all the parts within the chest. 
Fourthly, The mammary gives an artery to the pericardium, which 
may be called the upper pericardiac artery ; and which is of such 
importance, that generally when it does not come off from the mam- 
mary, it comes from the subclavian itself, or even from the aorta. It 
belongs to the upper and back part of the pericardium. 
Fifthly, The pericardium has another artery from the mammary, 
which belongs to that part of it which is united to the diaphragm : it 
is thence named by some arteria phuenicu-pericardiaca. 
Sixthly, The mammary gives many small arteries to the mediasti- 
num ; for the mammary is covered only by the sterno-costalis muscle, 
which is often hardly visible in Man, so that the artery may be said to 
lie upon the pleura, between it and the ribs. The mediastinum is just 
that doubling of the pleura? which descends from the sternum to the 
spine, and of course many small arteries go down from the lower sur- 
face of the sternum along the pleura? into the mediastinum, and by 
that to the pericardium, or even to the membrane of the lungs. 
The mammary, as it goes downwards, sends branches through the 
* Sabbatier is so confused, and copies Haller so ill, that he mistakes this for the trane- 
versalis humeri, which is really an important arterv. 472 
OF THE SUBCLAVIAN ARTERY. 
interstices of the ribs ; two twigs pass through each interstice, going 
to the intercostal muscles, and to the muscles which lie upon the 
thorax, as the pectoral muscles ; also to the mamma, to the obliquus 
externus abdominis : they form loops of inosculations round the ribs 
with the proper intercostal and thoracic arteries. These twigs pass 
through the interstices of the six or seven upper ribs, but at the seventh 
the artery itself cornes out. They are too numerous and too small to 
be either counted or named. 
Seventh, The mammary, before it terminates in the two branches, 
of which one keeps the middle and goes to the rectus muscle, while 
the other goes outwards to the oblique muscle, as already described, 
gives about the place of the sixth rib a branch, which in place of 
passing out of the thorax, keeps to its inner surface, goes downwards 
along the seventh, eighth, and ninth ribs, makes its inosculations there 
with the intercostal and other arteries, and ends in the side of the dia- 
phragm, and in the transverse or innermost muscle of the abdomen, 
which indigitates, as we call it, with the diaphragm. From this des- 
tination it is sometimes named the ramus musculo-phrexicus. 
PLAN, OR RECAPITULATION OF THE BRANCHES OF THE 
1. Rami Mammaria intercostales. 
2. Arteria Thymica. 
3. Arteria Comes Nervi Phrenici. 
4. Arteria Pericardiaca. 
5. Arteria Mediastina. 
6. Arteria Diaphragmatica. 
7. Arteria Epigustrica Communicans. 
Mammaria Interna. 
2. arteria thyroidea inferior. 
The lower thyroid arteuy, whose branches go to the neck, the 
shoulder, and the thyroid gland, arises from the fore part of the sub- 
clavian artery, close upon the origin of the internal mammary. It is 
there covered by the root of the mastoid muscle. It buds out from 
the root of the great axillary artery, in the form of a short thick stump, 
which immediately divides whip-like into four small and slender 
arteries. 
1. The main branch of this artery is again named the ramus thy- 
roidcus arterial thyroideai. This thyroid artery is the first great branch ; 
it does not ascend directly, but moves a little inwards towards the tra- 
chea, from which the root is a good deal removed ; it bends behind 
the carotid artery, is tortuous, ascends by the side of the trachea till it 
touches the lower lobe of the thyroid gland ; it spreads upon it like a 
hand, inosculates very freely with the upper thyroid artery, and 
nourishes the gland. This branch moreover gives some twigs up- 
wards to the lower constrictors of the pharnyx and to the oesophagus ; 
but its chief arteries, beside those which plunge into the gland, are its 
tracheal arteries. These tracheal arteries, two or three in number, 
are reflected along the trachea, turn down with it into the chest, and 
reach even to the bifurcation of the trachea, where, inosculating with 
the intercostal arteries. they form a most beautiful net-work. Oi’ THE SUBCLAVIAN ARTERY. 
473 
2. The ascending thyroid artery, or thyroidea ascendens, is a small 
and delicate branch, which lies pretty deep, going off rather from the 
back part of the artery; it supplies all the deep parts of the neck, 
and even penetrates the vertebrae ; it soon divides into an irregular 
number of branches; the artery keeps almost close to the naked 
vertebrae, lying under most of the muscles ; its general tendency is 
upwards, surrounding the neck in a spiral form. Its chief twigs are, 
first, some which go towards the surface, i. e. to the muscles which 
lie over the artery, as to the scalenus, the mastoid muscle, the levator 
scapulae, and the splenius: and twigs of this artery play over the 
rectus capitis and the anterior surface of the vertebrae, and attach 
themselves to the eighth pair of nerves, and to the ganglion of the 
sympathetic nerve. Its deeper arteries again go to the inner-trans- 
versarii, and other muscles which lie closer upon the neck; and these 
are the branches which pass in through the intervertebral holes, and 
penetrating the sheath of the spinal marrow, and following its nerves, 
inosculate with the spinal arteries. 
3. The transverse artery of the neck, or transversalis colli, is an 
artery of the same kind with the last, viz. chiefly destined for the 
muscles, but more superficial. It passes obliquely round the neck 
outwards and upwards, goes under the trapezius muscle, and covered 
by it sends branches as far as the occiput. Its twigs are distributed 
thus : First, to the mastoid muscle and to the skin ; next, to the 
trapezius, levator scapulas, and splenius ; then, a long branch passing 
obliquely upwards over the splenius, and under cover of the trapezius, 
gives twigs to those muscles, and ends in inosculations with the lower 
branches of the occipital artery ; and, lastly, another branch goes 
downwards towards the scapula and shoulder. 
4. The last branch of this artery is the transversalis humeri ; 
an artery so important in its destination, and so irregular in its origin, 
and so frequently arising as a distinct arid particular branch, and having 
so little relation to these trivial branches of the thyroid artery, that I 
shall describe it by itself. 
3. ARTERIA VERTEBRALIS 
The vertebral artery arises next from the upper part of the subcla- 
vian artery; and running upwards and backwards but a little way, 
it plunges into the hole destined for it in the vertebrae ; and it has 
been already described through all its course both within the bony 
canal and within the brain. 
4. AKTERIA CERVICALIS PROFUNDA. 
The deep cervical artery comes next in order; it is generally the 
least important of all the branches from, the subclavian artery, and the 
least regular in its place, ft often comes from some other branch, 
and often it is entirely wanting ; its course resembles a good deal 
that of the transversalis colli, i. e. it goes to the deepest muscles of 
the neck, and to the vertebrae, and ends about the occiput; it usually 
arises from that part of the subclavian artery where it is just going to 
pass, or has already passed, betwixt, the scaleni muscles. Its branches 474 
OF THE SUBCLAVIAN ARTERY. 
are few in number, it gives branches to all the scaleni muscles ; others 
also which play over the anterior surface of the vertebrae and the deep 
muscles of the neck, as the spinalis colli, inter-transversarii, the root of 
the splenius and trachelo-mastoideus ; the complexus also receives a 
branch, which usually inosculates with the occipital artery. 
5. ARTERIA CERVICALIS SUPERFICIALIS. 
The superficial cervical artery is still less regular, being very of- 
ten supplied by the thyroid. Its course is directly the reverse of the last, 
running rather outwards and downwards, or in other words, belonging 
rather to the shoulder than to the neck. The subclavian artery has got 
from under the muscles, and has passed the splenii a little way before it 
gives off this superficial cervical. This artery immediately attaches it- 
self to the plexus of the brachial nerve, and is indeed hidden in the plex- 
us : its first branch is given to the plexus, but its next and chief branch 
goes across to the top of the shoulder; it sends branches to the levator 
scapulae, trapezius, and even to the skin ; while a deeper branch goes to 
the splenius and complexus, where these muscles arise in the neck ; and 
when this artery is large, it sends branches along the margin of the sca- 
pula, which go even to the seratus major, rhomboidei, latissimus dorsi, 
&c. 
After enumerating these jarring names, I perceive the necessity of ar- 
ranging once more those arteries which go to the neck. Let the stu- 
dent then observe, 1. That the vertebral artery goes to the brain, that 
the cervical arteries belong to the muscles of the neck. 2. That the 
thyroid gives two arteries to the neck, the thyroidea ascendens and the 
transversalis colli. 3. That when a second set of arteries for the neck 
begins to be enumerated, the name is changed ; that of colli is dropped, 
and that of cervicis adopted. 4. That as there are two branches of the 
thyroid going to the neck, viz. the ascending thyroid and the transversa- 
lis colli, there are also two entire arteries going to the neck, qnd which 
come off immediately after the thyroid, viz. the cervicalis profunda more 
constant, and the cervicalis superficialis which is less regular. 
6. ARTERIA INTERCOSTALIS SUPERIOR. 
The upper intercostal is given to supply the intercostal space be- 
twixt the two uppermost ribs, because the aorta which gives out all the 
other intercostals, regularly one for each rib, does not begin to give them 
off till after it has made its turn downwards ; of course it leaves the two 
upper ribs without arteries. To supply this, then, is the office of the 
superior intercostal artery, which is about the size of a crow-quill, and 
goes off from the subclavian generally next after the vertebral and thy- 
roid arteries. It comes from the upper and back surface of the subcla- 
vian trunk; it turns downwards and backwards, and lodges itself by the 
side of the spine in the hollow where the spine and the first rib are join- 
ed, and where the first thoracic ganglion of the great intercostal nerve 
lies. Before it takes its place betwixt the ribs, as the intercostal of the 
two upper spaces, it sends a branch upwards upon the face of the lower 
vertebra; of the neck, which is given to the scaleni, to the longus colli 
muscle, and to tke nerves : next it gives off the highest intercostal arte- 475 
OF THE SUBCLAVIAN ARTERY. 
ry for the space betwixt the first and second ribs, which artery divides 
into two branches ; one perforates the thorax, and goes outupon the back, 
and supplies the muscles which lie flat upon the back of the chest; while 
another branch, the proper intercostal branch, runs along betwixt the ribs. 
Next it gives off a second intercostal artery, which also has its exter- 
nal and internal branches, and of which a branch inosculates over the 
third rib with the uppermost intercostal of the aorta. Besides these, it 
gives also small branches to the oesophagus, which inosculate with the 
tracheal arteries ; and it gives branches to the spinal marrow, which pass 
into the canal along the holes for the nerves ; and which not only sup- 
ply the sheath, but also inosculate with the arteries of the spinal marrow 
itself. 
7. ARTERIA SUPRA-SCAPULARIS. 
The supra-scapular artery, or the superior scapular artery, is one 
of such magnitude, and is so different in size and destination from the 
cervical and other small arteries of the neck, that it ought to be des- 
cribed apart: though of great size and importance, it is yet so little 
known, that Sabbatier does not even describe nor name it. 
The supra-scapular artery very often comes off*from the thyroid 
artery; in which case it is the last in order of all the branches of the 
thyroid, that is to say, the nearest to the shoulder, and then it is named 
transversalis humeri, Decause of its going across the root of the neck 
of the shoulder. Sometimes it arises from the cervicalis superficialis ; 
but then it is a small artery, and in such cases it reaches no further than 
the tip of the shoulder, and does not descend to the scapula. Often I 
see it arising as a distinct artery, large, very long, and tortuous ; run- 
ning across the root of the neck, till at the top of the shoulder it dives 
under the acromion process ; and then passing over the notch of the 
scapula, supplies all the flesh of its upper surface. 
The reason of my naming it supra scapular artery, is its passing thus 
over the scapula, while another, the largest branch of all those proceed- 
ing from the axillary artery, is named the sub-scapularis, from passing 
under the scapula. 
To repeat the origin then of this supra-scapular artery ; it arises 
sometimes as an independent artery, and is so great, that we wonder 
that it does not always do so : often it arises from the thyroid, is its last 
branch, and is named transversalis humeri, authors not observing 
that it belongs absolutely to the scapula; it rarely arises from the cervi- 
calis superficialis ; and when it does so, it is small: often in a strong 
man it arises apart; and when it does arise from the thyroid or cervical 
arteries, it is often so large as to annihilate as it were all the other 
branches of the artery from which it arises. 
Where this artery passes out of the chest it is covered only by the 
root of the mastoid muscle ; and it gives twigs to the mastoid, to the 
muscles which ascend to the throat, to the subclavian muscle, to the 
fat, jugular vein, and skin. 
Next it gives a superficial branch to the skin, trapezius, and other su- 
perficial parts about the shoulder. 
Next it turns over the acromion process, passes through the supra- 
scapular notch, with many windings and contortions ; spreads itself over 
all the outer surface of the scapula, both above and below the spine, 476 
OP THE SUBCLAVIAN ARTERY. 
and is the sole supra-scapular artery. The manner of its spreading is 
this: having passed over the ligamentum proprium posterius scapula;, 
for it very seldom passes through the notch, and near the supra-scapular 
nerve, it lies flat upon the scapula, it sends off two branches, one on 
cither hand at right angles; and of these one goes along the upper bor- 
der of the scapula towards its basis, the other goes in the other direction 
towards the shoulder-joint, and circles round the upper side of the spine 
or ridge of the scapula. 
The main artery having first passed the scapular notch, and given 
these two small branches, next makes a second perforation, viz. by pass- 
ing under the root of the acromion process; and then it again divides 
into large branches in which it ends. The one branch runs all along 
the root or base of the spine or high ridge ; the other branch runs nearly 
in the same direction, but lower down, viz. nearer that edge where the 
great sub-scapular artery runs ; and with which, of course, it makes 
many free inosculations. 
This artery lies so across the neck that it may be cut, especially in 
wounds with the sabre; and in a big man it is of such size as to pour 
out a great quantity of blood. It is necessary for the surgeon to re- 
member the great size of this supra-scapular artery, its long course over 
the shoulder, at what place it arises within the chest, and how it may be 
compressed. But in another sense also it is peculiarly important; for 
the supra-scapular artery makes inosculations with the lower scapular 
artery, freer, and fuller, than in almost any other part of any limb. 
One can hardly force tepid water through those small arteries which sup- 
port the arm after the operation for aneurism ; but the inosculations of 
this supra-scapular artery are so free, that often, though I have tied the 
arteries with great care, the very coarsest injection has gone round by it; 
and when I desired only to inject the head, I have found the arteries of 
the arm entirely filled. The conclusion which this leads to in wounds 
of the axillary artery is too obvious to need any further explanation. 
RECAPITULATION AND PLAN OF THE BRANCHES OF THE 
1. Transversalis Humeri 
or Supra-Scapularis* 
2. Transversalis Colli. 
3. Thyroidea Asctndens. 
4. Ramus Thyroidea Thy- 
[_ roideus. or Proprius. 
Thyroidea Inferior. 
GENERAL PI,AN OF THE PRIMARY BRANCHES OF THE 
1. Arteria Mammaria Interna. 
2. Arteria Thyroidea Inferior. 
3. Arteria Intercoslalis Superior. 
4. Arteria Vertebralis. 
5. Arteria Cemcalis Profunda. 
_6. Arteria Cervicalis Superjieialis. 
Subclavian Arteiit. 
* A? my reader has seen, this artery comes off sometimes from the subclavian as a dis- 
tinct branch; and then its size in a manner deranges the relative magnitude of the other 
branches. OF THE AXILLARY ARTERY. 
477 
II. OF THE AXILLARY ARTERY. 
This artery assumes the name of axillary, where it lies in the arm-pit 
or axilla. The scaleni muscles being attached to the ribs, the artery 
passes first through betwixt the first and second scalenus ; next it passes 
out trom under the arch of the clavicle, where it was protected : then it 
falls over the breast in a very oblique direction ; it inclines outwards to 
wards the axilla, lies flat upon the slanting convexity of the chest, is co- 
vered by the pectoral muscles, and the great pectoral muscle arises from 
the clavicle, under which the artery passes ; but far from being protect- 
ed, it is so far exposed as to be easily felt beating, and it is at this point 
only that it can be rightly compressed. It declines still outwards and 
downwards, till at last it gets so deep into the arm-pit, and so much un- 
der the scapula, as to lie betwixt the serratus anticus and sub scapular 
muscles. There it is rightly called the axillary artery. In this hollow 
it lies safe, protected by the deep borders of the pectoral muscle before, 
and of the latissimus dorsi behind, surrounded with fat and glands, in- 
closed within the meshes of the plexus, or great conjunction of nerves, 
which go to the arm, surrounded also by all the veins of the arm, which 
twine round it in a wonderful manner. Here it gives off the thoracic 
arteries to >he thorax, and the scapular arteries to the shoulder. In short, 
the axilla itself is a complicated study ; but in all that respects the arte- 
ries it may be made very easy and plain. But let the surgeon remember 
that it is only by a perfect knowledge of the arteries, a bold stroke of 
the knife, and a masterly use of the needle, that the patient is to be saved 
from bleedings after wounds hereabouts : for the old story of compressing 
the axillary artery above the clavicle is now of no credit with any surgeon 
of knowledge or good sense. 
As the artery turns over the borders of the chest, it gives one or two 
twigs to the adjacent parts, as to the scaleni, and to the great nerves 
which lie over the artery, and to the serrated muscle, where it lies under 
the scapula : but these branches are so small that it is unnecessary either 
to number or describe them. The thoracic or external mammary arte- 
ries are the first important branches ; they are four in number, and they 
are named after their place or office. 
1. ARTERIA THORACICA SUPERIOR. 
The upper thoracic artery, being the first, lies of course deep in 
the axilla. It comes off about the place of the first or second rib ; it 
lies betwixt the lesser pectoral and the great serrated muscle ; it gives 
its chief branches to these muscles, and it also gives other branches to 
the intercostal muscles and the spaces betwixt the ribs. But, upon the 
whole, it lies very deep, is small, and is so short that the next is entitled 
thoracica longior : it is an artery of little note. 
2. ARTERIA THORACICA LONGIOR. 
The long thoracic artery is more important, supplying all the 
great pectoral muscles and the mamma. It was named the external 478 
OF THE AXILLARY ARTERY. 
mammary artery ; but we are the more willing to change the name, since 
it has no likeness to the internal mammary artery, is in no respect fca 
counterpart to it; it might be named the pectoral artery. It is long, not 
tortuous, but straight and slender, and about the size of a crow-quill. It 
is needless to describe an artery so variable in its branches as this is ; it 
is sufficient to say, that after giving small twigs to the axillary glands, it 
term nates with all its larger branches in the pectoral muscle, mamma, 
and skin, and in inosculations with the intercostals and internal mam- 
mary : it is very long, descending sometimes so low as to gives branches 
to the oblique muscles of the belly. 
3. ARTERIA THORACICA HUMERARIA. 
The thoracic artery of the shoulder goes off from the upper and 
fore part of the axillary artery. Its place is exactly opposite to that of 
the mammaria externa, viz. under the point of the coracoid process, 
insomuch that Haller has named it thoracica acromialis. It is a short, 
thick artery ; it bursts through the interstice between the pectoral and 
deltoid muscles, and appears upon the shoulder almost as soon as it 
comes off from the main artery ; it resembles the thyroid in shape, be- 
ing a short thick artery, terminating all at once in a leash of slender 
branches, which go over the shoulder in various directions ; but I never 
could observe any order worth describing. One deeper branch goes to 
the serratus major, a branch goes along the clavicle, gives it the nutri- 
tious artery, and then goes on to the pectoral muscle, and to the skin of 
the breast : it gives small branches to the axillary glands, and larger 
ones to the deltoid and pectoral muscles and skin of the shoulder, for 
this is very much a cutaneous artery. The chief branch is that which 
is last named, running down betwixt the deltoid and pectoral muscles ; 
and the most curious branch is a small artery which accompanies the ce- 
phalic vein, and runs backwards along the course of the vein, a small 
and beautiful branch. 
4. arteria thoracica alaris. 
Sometimes, though not always, there is a fourth thoracic artery. 
When it exists, we find it close by the last artery ; its branches, which 
are sometimes numerous, belong entirely to the cup or hollow of the 
axilla ; it goes to the glands and fat, and thence its name of alaris or 
axillaris. This is the deepest or backmost of these mammary arte- 
ries ; it attaches itself to the lower border of the scapula, and we often 
see it running along the lower border a considerable length, and giving 
branches chiefly to the sub-scapularis muscle. 
These are the four mammary arteries which go to the breast. The 
arteries which go to the scapula follow next, and are only three in num- 
ber ; one, which is the counterpart of the supra-scapular artery is the 
greatest branch from the axillary artery, supplies the lower surface of 
the scapula, and thence is named sub-scapular artery ; one, which, 
as it is reflected round the joint by the outside, is named the external 
circumflex artery ; and one, which, as it turns round the inner side 
of the joint, is named the internal circumflex artery. OP THE AXILLARY ARTERY. 
479 
5. ARTERIA SUB-SCAPULARIS. 
The sub-scapular artery is of a great size ; it is hardly described 
in books. I might say was hardly known to the older anatomists. 
Douglas, and most especially Sabbatier, have scarcely named it, though 
it is in fact one of the largest arteries in the body, being nearly as large 
as the axillary artery, from which it takes its rise.* 
The greatest mass of flesh in almost any part of the body is that which 
lies under and around the scapula in a strong man ; and this artery sup- 
plies almost all that mass. It goes off from the axillary opposite to the 
neck of the scapula, just under the short head of the biceps brachii: it 
no sooner comes off from the axillary artery, than it attaches itself to the 
lower border of the scapula; and as soon as it comes to the edge of the 
scapula (but sometimes lower down the edge, viz. where the head of the 
triceps comes off,) it splits into two great branches ; one of which goes 
to the upper, and one to the lower surface. But to describe each little 
artery among such a mass of flesh, or to expect to find them regular, 
would be very thoughtless ; the general course of them only can be de- 
scribed. First, The greater branch, which goes to the lower surface of 
the scapula, is the proper trunk of the sub-scapular artery ; it divides into 
two great branches, which course all over the lower or hollow surface of the 
scapula: one of these is deeper, runs downwards along the naked border 
of the scapula, lies under the muscles upon the flat bone, and supplies 
the inner surface of the sub-scapular muscle with many branches. It 
sends a branch upwards, which runs along the inner surface of the neck 
of the scapula, runs still forwards under the root of the coracoid process, 
and its extreme branch goes round by the basis of the scapula to make an 
inosculation with the larger branch. 
Secondly, The larger branch keeps nearer the surface, and supplies 
all the outer side of the sub-scapular muscle. Its general course is 
round the scapula, down the fore edge, then round by the lower angle, 
then up by the line of the basis scapula), encircling it with what might be 
named a coronary artery. It first gives branches to the teres major ; then 
passes down along that muscle to the angle of the scapula ; then turning 
along the angle of the scapula (which it does not do without leaving many 
branches behind,) it runs in a waving line all round the basis scapula), till 
it arrives at the upper corner, where it ends in free inosculations, both 
with its own deeper branch, and also with the supra-scapular artery which 
comes along the shoulder. 
Now this great branch, with all its arteries, belongs entirely to the lower 
surface of the scapula ; but the branch which leaves it at the neck of the 
scapula turns round under its lower edge, gets to the upper surface of the 
scapula, runs in under the infra-spinatus and teres minor muscles, be- 
twixt them and the bone ; and although the supra-scapular artery from 
the shoulder supplies chiefly the upper part of the scapula, yet it is chiefly 
above the spine that that artery circulates, while the lower parts of the 
* It is named often scapularis inferior or infra-scapularis ; it is better named sub-scapular, 
both to harmonize with the name sub-scapular muscle, to which it belongs, and also to con- 
trast with its counterpart, the sopra-scapular artery, which comes from the subclavian ar- 
te, rv. 480 
OF THE AXILLARY ARTERY. 
infra-spinatus and the teres minor muscles are left to be supplied by this 
reflected branch of the sub-scapular artery : thus this reflected branch 
gives its arteries, first to the teres, then it enters into the hollow under 
the spine, and besides supplying the infra-spinatus and the bone itself, it 
also makes a circle, though a shorter one, and inosculates with the supra- 
scapularis, just as the other branch of this same artery does on its lower 
surface. This branch descends nearly to the corner of the scapula before 
it begins this inosculating circle ; but it sends also another chief branch 
round the neck of the scapula, which advancing towards the supra-sca- 
pular notch, inosculates very largely with the supra-scapular artery. 
Thus is the scapula encircled, and supplied with a wonderful profusion 
of blood by two great arteries ; one, the supka-scapular artery, com- 
ing across the neck, over the shoulder, and through the scapular notch ; 
another, the sub-scapular artery, which comes from the axilla to the 
lower flat surface of the scapula, and divides at the edge of the scapula in- 
to two great branches ; one of which keeps still to the flat surface, while 
the ther turns over the edge of the scapula, and supplies in part its up- 
per or outer surface. 
If instead of attending to the branches of this artery, in the order of 
their size and importance, but according to their most common succes- 
sion ; then this will be the plan. 
SlJB-SCA PU LARIS. 
Scapularis Inferior. 
' 1. Ramus Muscularis Irregularis. 
2 Ramus Circumflexus Scapularis. 
3. Ramus Dorsalis Scapula Superior. 
4. Ramus Dorsalis Scapulae Inferior. 
6. Ramus Sub-scapularis. 
6. ARTERIA CIRCUMFLEXA POSTERIOR. 
The posterior circumflex ARTi ry is a very large one. It arises 
either along with, or immediately after, the great sub- capular artery ; the 
place of it is of course settled by -he place of the shoulder-joint, for it be- 
longs so peculiarly to it that it is sometimes named the Humeralis, some- 
times the Articularis, sometimes the Reflexa Humeri. It goes offbe- 
tvveen the sub-scapularis and teres major muscles ; it passes in between 
them to get to the joint; it th< n turns round the shoulder-bone, accom- 
panied by the circumflex nerves, just as the supra-scapular artery is ac- 
companied by the supra-scapular nerve ; it ends, after having made near- 
ly a perfect circle, upon the inner surface of the deltoid muscle. 
Its branches are, first, Twigs to the nerve which accompanies it, and 
to the capsule of the shoulder-joint. Secondly, Branches to the coraco- 
brachialis and short head of the biceps, and to the triceps, and a twig to 
that groove in which the tendon of the long head of the biceps lies. Third- 
ly, It sends large branches to the sub-scapularis, to the long head of the 
triceps, &c. And lastly, The artery, far from being exhausted by these 
branches, goes round the bone, turns over the joint under the deltoid 
muscle, and ends in a great number of branches, still accompanied by 
branches of the nerve, which are distributed in part to the capsule, but 
chiefly to the lower surface of the deltoid muscle, where it lies upon the 
joint. OF THE AXILLARY ARTERY. 
481 
7. ARTERIA CIRCUMFLEXA ANTERIOR. 
The anterior circumflex artery, which goes round the fore part 
of the joint, bears no kind of proportion to that great artery which passes 
round the back. The anterior goes off'from the same point nearly with 
the posterior, or sometimes arises from the posterior itself; it takes a direc- 
tion exactly opposite ; it keeps close to the shoulder-bone, passes under 
the heads of the coraco-brachialis and biceps ; encircles the head of the 
os humeri just at the root of the capsular ligament, and goes round till it 
meets and inosculates with the posterior circumflex artery. I never 
could find those muscular branches which are said to go to the scapula, 
or have found them very trivial ; the whole artery belongs to the bone 
and its parts ; it encircles the root of the capsule with a sort of coronary 
artery; it gives twigs to the capsule, the periosteum, and the tendons, 
which are implanted into the head of the bone ; and having given twigs 
to the heads of the biceps and coraco-brachialis, it gives off its only re- 
markable branch, which is indeed regular and curious; it is a small branch 
which runs down along the bone in the groove in which the tendon of the 
biceps lies. 
PLAN OF THE 
fl. Arleria Thoracica Superior. 
2. Arteria Thoracica Longior. 
3. Arteria Thoracica Humeraria. 
4. Arteria Thoracica Axillaris. 
5. Arleria Sub-scapularis. 
6. Arteria Circumjiexa Posterior. 
7. Arteria Circumjiexa Anterior. 
Arteria Axillaris.* 
* Concerning the axillary artery in general, there is more to be observed than this occasion 
will allow. But these things must not be passed over in total silence. In the first place, the 
artery, as it passes over the border of the chest, and after leaving the arch of the clavicle, is 
felt beating, and there it can be compressed. 
The connexion of the artery with the axillary nerves, though it must be more fully describ- 
ed in another place, must yet be observed here as a relation too important to be omitted. 
The artery passes along with the nerves through the interstice of the scaleni muscles; the 
nerves, which consist of no less than nine, make by their mutual connexions a sort of net, 
which is called the plexus of the axillary nerves. This plexus has its meshes formed, not by 
small divisions, but chiefly by the seven great cords. This broad plexus lies over the artery 
as it comes out from the chest; the artery perforates the plexus, or passes through one of the 
largest meshes in the cavity of the axilla ; and when we extend the arm, for example, to cut 
out an axillary gland, the great veins lie nearest the knife, or lowest in the axilla : the plexus 
of nerves next; and list of all the artery which has just perforated the plexus of these great 
nervous cords; three nerves are below the artery and two above; and when the arm is lux- 
ated, and the shoulder-bone pushed downwards, the head of it is so pressed against the net of 
nerves, and the artery is so compressed betwixt the head of the bone and the mesh of nerves, 
that I have very seldom failed to find the pulse almost entirely suppressed in luxations of this 
kind. 
This connexion, viz. with the nerves, is a very interesting one. It is plainly such that the 
artery cannot be hurt without a wound of the nerves; it has never been known that the artery 
has been cut in the axilla without the arm being lamed by this wound of the nerves : also the 
nerves cannot be hurt without the artery being in danger ; but it does escape sometimes; of 
which, among other examples, this is one. of the most singular.— I have seen the artery escape 
in wounds when the nerves were hurt; but how it could escape the stroke of a blockhead’s 
needle in the following case, I am at a loss to couceive. A woman came tome with a great 
string hanging in her axilla, and along with her came her surgeon. He had about three 
months before cut off her breast for a cancer, and moreover some glands from the axilla, front 
which there was a bleedingand of course, as bis fingers could not go deep enough, he took a 482 
OF THE BRACHIAL ARTERY. 
III. OF THE BRACHIAL ARTERY 
The brachial artery is that division of the artery which is marked by 
the tendon of the great"pectoral muscle : for as that is the fore border of 
the axilla, all above that is axillary, and all below it brachial artery, down 
to the bend of the arm, where it divides into the radial and ulnar arte- 
ries. The brachial artery runs on the inner side of the os humeri, here 
the bone is most naked ; and this is the line in which we feel the artery 
beating, and apply the cushion of the tourniquet. 
To describe, as some authors have done, each insignificant and name- 
less branch which this artery gives off, were to make a simple matter in- 
tricate beyond all enduring. The whole matter is this : As the artery 
goes downwards, lying exactly on the inner side of the arm-bone, and 
directly in the middle betwixt the biceps on the fore part and the triceps 
behind, it gives frequent branches to each. Those going to the biceps 
are short, small, pretty regular, and exceedingly like each other all the 
way down the arm ; and they are thus frequent, and very short, in con- 
sequence of the artery adhering closer to the sides of the biceps. Not 
one of them can be distinguished, or is worth naming. Those which it 
sends downwards to the triceps are (in consequence of that being a large 
muscle, with several thick and fleshy origins) both longer and more tor- 
tuous, and more important; and they accordingly have some of them ap- 
propriate names. Of these arteries going down towards the back part 
of the arm, and working their way among the muscles, three chiefly are 
to be observed. First, The arteria profunda superior, which goes round 
the back of the arm to the exterior muscles, and is often named the up- 
per muscular artery. Secondly, Another like it, called arteria profunda 
inferior, or the lower muscular artery. Thirdly, The ramus anastomo- 
ticus major, which anastomoses round the elbow with the branches of 
the ulnar artery. These three chiefly deserve notice. 
ARTERIA PROFUNDA HUMERI SUPERIOR. 
Those arteries, which in the limbs go deep among the fleshy parts, as 
in the arm or thigh, have always one of two names, either profunda or 
muscularis, and often both. The upper deep muscular artery of the arm 
is about the size of a crow-quill, or larger ; it goes off from the inner 
side of the brachial artery, just where the tendons of the latissimus dor- 
si and teres are inserted ; and very ofteq, it arises from the great artery 
needle proporlionably large, struck it down into the arm-pit, and tied all up. When he 
brought his patient to me, there hung from the arm-pit, not a surgical ligature, but a good 
large tape ; the axilla was a large gaping and terribly fetid ulcer ; i passed my finger into it, 
and felt the arteries beating around it, and the tape firm about some cord of nerves, whether 
one or more 1 could not tell; the woman’s fingers were as crooked as a bird’s talon, and her 
arm hung by her side quite useless and lame. I made the surgeon feel the nerve with his 
finger, ottered to cut out the ligature safely ; but he carried away his patient, that he might, 
though at a long interval, finish the operation himself. 
The breast had been long healed, and the cord acted as an issue in the axilla. Mow near 
the edges of this needle must have been to the great artery, it is terrible to think ; and it is 
most providential that such accidents do not happen daily, considering how much this crooked 
needle is used in deep places, where it is least fit to be used. or THE BRACHIAL ARTERY. 
483 
of the scapula, or that of the joint, viz. the sub-scapularis, or reflexa hu- 
meri. 
The profunda turns downwards and backwards round the bone ; it 
glides in betwixt the first and second head of the triceps; there it divides 
within the thick flesh of that muscle into two chief branches, or the two 
branches sometimes part immediately after their common origin, or some- 
times they go off apart from the humeral artery. One of these, perfo- 
rating the biceps muscle, turns quite round the bone ; and Monro the Fa- 
ther, who gave us the name of spiral nerve, named this also, very 
properly, the muscular spiral artery : so this artery also, as well as the 
supra-scapular and circumflex arteries, has its accompanying nerve. 
This long artery runs down the back and outside of the arm ; it descends 
quite to the outer condyle of the os humeri, and by branches round the 
olecranon, and over the outer condyle, it inosculates very freely with the 
radial artery. 
The other branch of the profunda superior runs down the inner side 
of the arm, gives many branches to the triceps, and coraco-brachialis ; 
gives a few also to the biceps and deltoid muscle : its longest branch, 
the proper termination of the artery, runs downwards till it touches the 
inner condyle, as the posterior branch does the outer condyle ; and this 
inner artery communicates with the outer branch round the olecranon, 
making small but frequent and beautiful inosculations ; and it also in- 
osculates over the condyle with the reflected branch of the ulnar artery. 
In short, the pr@funda superior turns down towards the back part of the 
arm, buries itself under the triceps muscle, supplies all the flesh of the 
triceps, and divides in the heart of that muscle into two branches, both 
of which go down to the elbow-joint, and inosculate; the one, round 
the outer condyle with the radial artery ; the other, round the inner con- 
dyle with the ulnar artery. 
2. ARTERIA PROFUNDA HUMERI INFERIOR VEL MINOR. 
The lesser profunda, or the lower muscular artery, is so named be- 
cause it resembles the former in almost all points. It is smaller, being 
not half the size (viz. of a crow-quill), and goes oft', in general, about 
two inches lower down the arm. Its course, also, is exactly similar, 
except in this, that it is single, does not divide into two branches ; it 
gives twigs to the muscles of the arm ; runs down to the inner condyle, 
and after touching it, makes a sudden and serpentine turn, by which it 
gets upon the back part of the elbow-joint. Its chief inosculations are 
with the upper profunda, and with the rccurrens interossea upon the 
back part of the joint. 
Betwixt the upper and lower profunda there generally is sent oft' that 
artery which is to nourish the bone. It is named arteria nutritia 
humeri ; but is not of sufficient importance to be numbered among the 
main branches of the artery. The nutritious artery sends ofT small 
branches, or rather small twigs, to the brachialis, or that muscle which 
lies under the biceps and to the triceps; and it perforates the bone about 
its middle in one larger artery, and sometimes there are also one or two 
smaller ones. 484 
OF THE BRACHIAL ARTERV. 
3. rames anastomoticus major. 
The greater anastomosing artf.ry is one of three or four which 
anastomose round the elbow-joint; for as the humeral artery advances 
towards the bend of the arm, it begins about three inches above it, to 
give off sideways, and almost at right angles with the trunk, three or 
four small arteries, more or fewer according to the size of the arm. Each 
of these sends its little twigs round the condyle, to inosculate with the 
arteries of the fore-arm both radial and ulnar. Among these, one is 
distinguished for its size and importance ; it is one of the-largest of these 
arteries, and thence named anastomoticus Magnus ; it arises from the 
humeral artery ab< >ut three inches above the joint; it lies close by the 
side of the brachialis internus, and gives many branches to it and to the 
triceps ; but it is chiefly expended in three branches, one of which turns 
backwards, and running up the arm, gives branches to the muscles, and 
inosculates with the profunda: another goes downwards towards the 
middle of the bend of the arm, and gives branches to the pronator teres 
and the flexor digitorum; and then going deeper, it touches the capsule, 
and makes a beautiful inosculation over the fore part of the joint with 
the radial recurrent or inosculating artery ; another branch, the most im- 
portant, and the chief termination of the artery, runs down betwixt the 
olecranon and the condyle, in the hollow where the ulnar nerve lies. It 
first contributes to that net-work of inosculations which covers the back 
of the joint over the olecranon ; it inosculates very freely with the re- 
currens ulnaris : and it is this inosculation that gives the artery its im- 
portance and its name. This is the channel through which the blood goes 
after the operation for the aneurism, as we know from preparations ; 
and I have several times felt for it, and found it after the operation, while 
the arm was still very small, having been wasted by the disease and by 
the suppuration. 
I have not, in describing these arteries of the arm, once mentioned 
the name of collateral artery; for it is a name which must be entirely 
dropped, because it has been much abused. Sabatier, Murray, Haller, 
and all the French and German anatomists, have named the arteriae pro- 
fundae collateral arteries ; because they lie alongside of the great 
artery, running along with it down the arm. Douglas, and the English 
anatomists and surgeons, have called the three or four short anastomosing 
branches near the elbow the collateral arteries ; because, though they 
run off at right angles or obliquely from the trunk, yet they run parallel 
with each other. Dropping this name, then, we find no more than three 
arteries in the arm, of any note: the upper or greater profunda, with its 
two branches; the lower or lesser profunda; and the great anastomosing 
artery. 
We are obliged to add, however, that the branches of the humeral or 
brachial artery are exceedingly irregular. 
RECAPITULATION AND PLAN OF THE 
It Rami Musculares Irregulares. 
1 2. Arteria Profunda Humeri Superior. 
( 3. Arltria Profunda Humeri Inferior- 
4. Anattomotica Magna-. 
Arteria Brachialis. OF THE FORE-ARM. 
485 
OF THE ARTERIES OF THE FORE-ARM, VIZ. OF THE RADIAL, ULNAR, AND 
INTEROSSEOUS ARTERY. 
The place and condition of this artery at the bend of the arm, is as 
interesting as where it lies in the axilla; for while bleeding is allowed, 
or is practised by low and ignorant people, operations at this point must 
be more frequent than at any other, and must be easy or successful only 
in proportion as the artery and all its relations are well understood. 
The humeral artery still continues an undivided trunk, lower than the 
bend of the arm; though we are accustomed to name that as the place 
at which it divides. The whole arm, it must be remembered, is covered 
with a fascia, and that fascia lies over the artery ; but at the bend of the 
arm there is a peculiar fascia, or at least the round tendon of the biceps 
so strengthens the general fascia, by sending a broad expansion obliquely 
across the bend of the arm (which fascia is fixed into the condyle and down 
the edge of the ulna,) that we call this expansion peculiarly the tendon 
of the biceps, and say that the artery is at the bend of the arm covered 
and protected by the tendon of the biceps muscle. The condition, then, 
of the artery is shortly this ; it comes from the inside of the arm, in- 
clining all along towards the middle of the bend or folding of the fore- 
arm ; there, without any particular ring or aperture for its admission, it 
passes under the aponeurosis of the biceps muscle; for the aponeurosis 
of the biceps and of the arm in general are one continued sheath. When 
thus lodged behind the tendon, it lies in a deep hollow betwixt the flexors 
and extensors of the arm, or, in other words, betwixt the muscles of the 
upper and of the lower edge ; the tendon of the biceps covers this tri- 
angular hollow ; the floor or bottom of it is the coronary process of the 
ulna, and the fore part of the elbow-joint, and there the artery lies im- 
bedded in cellular substance, encircled by those veins which accompany 
the artery particularly, and which are thence named venae cornices ; and 
it carries along with it a nerve in diameter equal to itself, and this nerve 
is named the great radial nerve. 
The artery does not divide immediately, even after it has thus passed 
the bend of the arm, but goes down deep among the flesh of the fore-arm, 
and there divides ; the ulnar artery being lodged under the thick flesh of 
the pronator and flexor sublimis muscles, and the radial artery under the 
strong fleshy belly of the flexor radial is and of the supinators, not abso- 
lutely within their substance, nor passing below them, but under cover of 
their fleshy bellies, which swell out into a great thickness at this part of 
the arm, and in a manner enclose the artery. The only part of the arte- 
ry which is exposed, the point which we feel beating, is that where the 
single and undivided trunk first begins to pass under the thicker fascia of 
the biceps muscle; and there the artery is pushed forwards, raised, and 
made to appear superficial by the projection of the coronoid process and 486 
OF THE ARTERIES 
brachialis muscle, or, properly speaking, by the protrusion of the fore part 
of the elbow-joint. This is just before it sinks into the triangular hollow 
betwixt the muscles. 
This artery is singular in one kind of lusus naturae, which never hap- 
pens, nor any thing similar to it in the lower extremity, viz. that the 
trunk of the artery forks into two great branches high in the arm ; some- 
times in the axilla, but often in the middle of the arm or opposite to the 
pectoral muscle ; when this happens the radial artery is, as it were, the 
accidental branch, and passes across the arm near the bend of the elbow, 
so as to traverse the ulnar or main artery; and that the radial artery some- 
times passes quite on the outside of the fascia, which binds down the ul- 
nar or main branch of the artery.* 
* This short description involves many points which the surgeon should think of, and more 
than can be touched upon in this place. The following consequences certainly follow from 
this arrangement of parts. 
First, The artery lying thus deep under the biceps, cannot be hurt by anv skilful surgeon, 
though bleeding the very vein under which it beats, and at the most critical point; it is hurt, 
as far as I have observed, only by the rudest stroke of very ignorant fellows ; I have seen in 
six cases a wound in it little less than a quarter of an inch in length. In one of the operations 
I found it absolutely transfixed ; the blood had been poured out from the orifice behind ; I felt 
with surprise the artery running over the tumour, not under it; and having opened the sac, I 
passed a prope through (he artery from side to side. 
Secondly, Since the artery divides only after it has gone deep, where its great branches are 
protected by the muscles of the fore-arm, the trunk only is wounded in bleeding; the branch 
is never wounded ; and we cannot but be surprised that Hunter, Haller, Sharp, and others, 
who ought to have studied this point, believed it to be sometimes at least wounded in one of 
its branches ; nor can we think, without surprise, of the. arteries being so little understood in 
the time of Dr. Monro the Father, that he is forced to argue the propriety of doing the opera- 
tion of aneurism from this fact, “ That though it were dangerous to trust to the common anas- 
tomosis round the elbow, yet it sometimes happens, that the two branches of the radial and ul- 
nar are set olfin the axilla.” This surely must have been but a cold assurance to the surgeon 
in those days, viz. that he was to trust chiefly to the chance of a lusus naturae for the success of 
one of his greatest operations. 
Thirdly, It must follow, since the artery lies behind the fascia, and is wounded through it, 
that the blood, being poured out behind the fascia, must raise it into a hard, firm, and (in time) 
inelastic tumour, growing every day firmer and harder. Ifsurgeons will but think of this, they' 
will go through their operation more correctly. It makes a point of vast importance in the 
description of aneurism, since it gives outwardly the true character, and inwardly the true 
shape and appearance of the tumour, when the operation is begun, the outward incision being 
performed. I lad it been but attended to rightly, what noise and wrangling might it not have 
saved about the nature and names of the disease (yet still the older surgeons knew and describ- 
ed this piece of anatomy, though they made but a poor use of it) ? and what idle and stupid de- 
scriptions might it not have prevented, such as we have never seen in surgical books till now, 
of diffused aneurism, and the operation for diffused aneurism ; when in truth the first stroke of 
the knife shows it to he a tumour very different from that which such names, and such formal 
divisions, and old-fashioned descriptions must convey ? The cup of an aneurism is the trian-' 
gular hollow which I have d-scribed, and the hag of the tumour is the extended fascia, with 
the cellular membrane extended, and bent into a firm capsule. 
Fourthly, the course of this double artery tempts me to believe, that in those few cases 
where the blood of an aneurism was truly diffused, where it was an ecchymosis, where the 
blood was not confined bv the fascia, but poured out under the skin, and driven upwards to the 
shoulder, and downwards to the fingers, giving the whole arm the appearance of mortification ; 
that in such rare cases, there must have lieen a high division, and that the preternatural artery 
had been wounded, for it lies above the fascia, it is lodged in no hollow, such as might receive 
its blood, nor covered by any membrane which might confine it: but at all events, I am per- 
suaded that Hunter is wrong in suspecting that, since the pulse so seldom returns instantly, 
this preternatural artery and the true one must be often tied together ; for if the preternatural 
artery were wounded, it would be a very diffused aneurism, under the skin and above the fas- 
cia; but the main artery would be found in its place, under the fascia, quite safe ; whereas, if 
the true artery where wounded, the tumour would be under the true fascia, the preternatural 
artery would cross by the side of the tumour, over it, and the wounded artery being at the bot- 
tom of its own-tumour, the two arteries would be a great way apart. Besides, the necessity of 
supposing this is not so strong as Hunter believed; I have seen the pulse return during the 
dressing of the arm, when the dissection was so wide aud free that I am sure there could be no 
hisus naturae, but one artery dividing in the common place. OS' TUK FORE-ARM. 
487 
The humeral artery having left the bend of the arm, divides into three 
great branches, the radial, ulnar, and interosseous arteries ; at least the 
ulnar gives off the interosseus so soon, and the interosseus is so large, and 
has so pointed a destination, that I take the privilege of describing the 
three branches apart. The ulnar artery, which we may regard as the 
continuation of the main artery, makes its way through the thickest flesh 
of the fore-arm, under the pronator teres, and the flexor digitorum 
sublimis, goes along the ulnar edge of the arm, appears again from under 
the edge of the flexor carpi radialis muscle, about three or four inches 
above the wrist; it goes down by the side of the pisiform bone into the 
palm'Of* the hand, and root of the little finger, and gives the chief 
arches in the palm of the hand, and all the arteries of the fingers, saving 
only the side of the fore-fing6r. Tfye Radial artery goes off like a 
branch from the ulnar, or, in other weirds,Vhe ulnar seems to continue in 
the course of the main artery, while tne radial goes off to one side; it 
makes its appearance as a superficial artery much higher in the fore-arm 
than the ulnar does ; it turns backwards over the wrist, or root of the thumb, 
and it gives all the arteries of the thumb and fore-finger, as the ulnar does 
of the other fingers. The interosseus, again, is truly a branch from 
the ulnar ; it comes off where the ulnar lies deepest; it runs along the 
interosseous membrane, whence its name : it belongs to the deep muscles 
of the arm. 
These are the great divisions of the artery ; but before entering upon 
these, it will be well to set apart and describe one particular set of arte- 
tries, vfz. the recurrent; both because they belong in a peculiar manner 
to the joint, and because the recurrents, from whichsoever of the great 
arteries they come, still serve the same office, viz. of inosculating with those 
from the above joint; though, after all, this part of their office attracts 
our attention, chiefly because we depend upon these inosculations for our 
success in operations for aneurism, though unquestionably the chief use 
of these arteries is to supply the joint and adjacent parts ; and there inos- 
culations are but a secondary office. 
ARTER1JE RECURRENTES. 
The recurrent arteries are small arteries corresponding with the anas- 
tomosing arteries from above. They turn quickly backwards, almost, as 
soon as they are clear of the main arteries from which they arise ; they 
encircle the whole joint, for they are no less than four, or sometimes five 
in number: one from the radial, two from the ulnar, and one from the in- 
terosseous artery. 
Fifthly, The close connexion of the artery with the great radial nerve must always be con- 
sidered in all wounds at the bend of the arm ; and especially it constitutes a difficulty in the 
operation of aneurism, of which authors of great eminence have spoken far too lightly ; and 
surgeons of character have tied it in with their great ligatures, as if for amusement, or that they 
might see what would ensue- 488 
OP THE ARTERIES 
recurrens radialis anterior. 
The anterior recurrent of the radial artery'is the first branch 
which it sends off*, excepting a small branch to the supinator and skin. 
The place where the radial recurrent is to be found, is deep in the hol- 
low betwixt the brachialis internus muscle of the arm, and the extensor 
radialis or first muscle of the fore-arm, viz that which constitutes its out- 
er edge. The recurrent lies upon the fore of the joint, where the 
outer condyle is; the muscles which lie over this recurrent artery,' or 
near it, are the two flexors of the wrist, the supinator longus, and the bi- 
ceps, and these receive its first branches ; and one of its branches runs 
down along the tendon of the supinator. Its next branches go less regu- 
larly to the other muscles of the fore-arm, as to the pronator teres, and to 
the flexors of the fingers; it has one superficial anastomosing artery, 
whose anastomoses are not upon the naked joint; but, on the contrary, 
the branch mounts along the fore part of the brachialis internus muscle, 
and inosculates under the biceps with the lesser or lower profunda. A 
second anastomosing branch goes deeper; it passes through the flesh 
or belly of the brachialis, and anastomoses with the ramus anastomoticus 
major from above. A third anastomosing branch is the chief branch ; it 
lies deeper still upon the fore part of the joint, in the hollow which 1 have 
lately mentioned ; it runs up under the belly of the supinator, along the 
fore part of the shoulder-bone, where it inosculates with the upper profun- 
da humeri, and chiefly with its greater branch called spiral artery, which 
turns round the bone, and ends here over the outer condyle. 
This is the recurrens anterior of the radial artery; but none of these 
branches have I ever seen or felt to be enlarged after operations for 
aneurism. The success of that operation depends entirely upon the ar- 
teries next to be described, viz. the ulnar recurrents, which are always 
two in number; but sometimes these two recurrents go off* in one branch 
from the ulnar: in which case, viz. of a single recurrent coming oflffrom 
the ulnar, it divides immediately into two branches, and the one takes 
the fore and the other the back part of the joint. 
nECURRENS ULNARIS ANTERIOR. 
The anterior recurrent of the ulnar artery goes off the first of 
the branches, immediately before it gives off the interosseous, and where 
the artery lies deep in its triangular hollow. This anterior artery passes 
up under cover of the pronator teres, lies close upon the fore part of 
the inner condyle, and is of importance, not only by its own size, but 
also by its anastomosing with the ramus anastomoticus major, which is 
the largest of the arteries from above. 
RECURUENS ULNARIS POSTERIOP.. 
The posterior recurrent of the ulnar artery is often a branch of 
the anterior one, coining off with it in one common trunk. When it 
comes off apart, it arises a little lower; it is a larger and stronger arte* 489 
OF THE FORE-ARM. 
ry, t. e. it makes as full inosculations, goes farther, and gives more 
branches to the muscles. This posterior recurrent arises from the ul- 
nar at that place where it perforates the bellies of the flexor muscles ; it 
also dives through betwixt the two bellies of the flexor muscles of the 
fingers ; it thus gets round the condyle, for these two muscles arise to- 
gether, from the condyle; the artery gives many branches both to the 
pronator and flexor muscles, and to the periosteum, and capsule of the 
joint; it then lodges itself in that deep hollow which is betwixt the ole- 
cranon and the condyle, where the ulnar nerve lies (that nerve which 
we feel so benumbed when we strike the inner side of the elbow). The 
artery stretching upwards along the bone meets a similar descending 
branch from the upper profunda, and inosculates with it. As far as we 
yet know, the whole weight of the business in saving the arm after aneu- 
risms depends upon these two arteries. In Mr. White’s preparation it 
is the anterior branch which is enlarged, inosculating with the anasto- 
moticus major over the fore part of the inner condyle. In a prepara- 
tion which I have, it is the posterior artery which runs tortuous and en- 
larged behind the inner condyle : but I must add to the authenticity of 
this preparation, by noticing, that I have several times felt distinctly, 
after successful operations for the aneurism, that it was this posterior ar- 
tery that was enlarged. 
RECURRENS INTER03SEA. 
The recurrent of the interosseous artery is x the first of its 
branches, though sometimes this recurrent rises from the ulnar a little 
above the interosseous. This artery going to the middle and back part 
of the joint, is very constant; it first sends one smaller branch for- 
wards towards the root of the brachialis internus muscle, which inos- 
culates over the fore part of the joint with the ramus anastomoticus 
magnus, and with the ulnar and the radial recurrents,‘ but these inos- 
culations and this anterior branch are of small importance. The chief 
branch goes through that lacerated-like hole which is in the upper end 
of the interosseous ligament; and the artery having passed through this 
hole, and got to the back of the joint, it runs for two inches upwards 
along the back of the olecranon, contributing greatly to form, by its in- 
osculations with both branches of the profunda superior, that net-work 
of arteries which covers all the back part of the joint, and which be- 
longs chiefly to the joint, to the capsule, and to the bones which form 
the joint. 
From these anastomosing branches which belong to all the three ar- 
teries, we now return to describe the general course of the three great 
arteries; and first, of the radial. 
ARTERIA RADIALIS* 
The radial artery is properly the first branch of the ulnar ; it goes 
off from it at a pretty obtuse angle in the bend of the arm ; it passes 
over the insertion of the pronator radii teres and under the edge of the 
supinator longus. It then takes its course to the wrist, parallel to the 
tendon of the flexor carpi radialis, and about a quarter of an inch to the 490 
OF THE ARTERIES. 
outside of that tendon. It is here covered with a regular tascia. it is 
at the root of the thumb only that it divides into its great branches : and 
a clear proof that in its course down the fore-arm it gives off none but 
small and irregular muscular branches, is this, that it preserves almost an 
equal diameter in all its progress from the elbow to the wrist. 
This is the artery which lies naked upon the radius at the wrist, where 
we feel the pulse. It lies more superficial, less imbedded in muscles, 
than the ulnar artery ; for six inches above the wrist there is to be felt 
nothing but the naked artery, the sharp tendon of the supinator, and the 
bone. The radial artery, as to its course down towards the wrist, is di- 
rect ; but with regard to itself, it is tortuous, with short and gentle wav- 
ings. Of its branches, as it moves down the fore-arm, there is not one 
that is worthy to be named. First, it gives a branch to the supinator, 
and to the extensors of the carpus; then it gives the radial recurrent, 
already described ; then, having gone a little deeper among the muscles, 
it repeats its branches to the supinator and extensors; but being deep, it 
gives also twigs to the pronator and to the flexor radialis, inosculating 
with the interosseous arteries. Next, the radial artery, emerging from 
among the thickest of the muscles of the fore-arm, becomes superficial, 
touches the naked radius, and runs along it, with the belly of the flexor 
pollicis below it, and the long tendon of the supinator above it. Here 
are no muscles lying on the outside of it, nothing but the tendon ; and 
therefore all its twigs are downwards to the flexor pollicis, upon which it 
lies ; to the flexor digitorum, which lies next to that; and to the flexor 
radialis and the palmaris longus. Next it gives deeper branches, viz. to 
the pronator quadratus ; and also it gives small twigs, which accompany 
the several tendons along the naked bone. Arrived at the wrist, it does 
not divide, as authors have represented, into two branches, viz. a palmar 
and a dorsal artery ; this is indeed a very rare occurrence : the radial 
artery passes on undivided to the root of the thumb, and there divides 
into three great branches ; one to the thumb, one to the fore-finger, and 
one to the palm of the hand : it does, indeed, while it is passing the 
wrist, give two considerable branches, one to the palm, and one to the 
back of the hand ; yet they are but branches. 
arteria superficialjs vol.e. 
The first branch, then, of the radial artery, after arriving at the wrist, 
is that which goes across the palm of the hand, and may be named the 
superficial artery of the palm. It goes off just where the main artery 
is about to turn over to the back of the hand ; it passes in general through 
the flesh of the thumb, going under the root of the abductor brevis 
POLLicis. This artery we generally find dividing into three branches : 
The first is tv-more superficial branch, which crosses the palm of the 
hand, and gives its twigs to the skin, palmar aponeuroMs, annular liga- 
ment, and all the tendinous parts about the joint : The second is a larger 
and more important branch : it is the middle branch of these three ; it 
goes deep ; and having given several branches to the muscles about the 
root of the thumb, and to one or two of the interossei muscles, it makes 
a large inosculation with the great palmar arch, which seems to be in- 
deed the chief tendency of the whole artery : The third branch is less OP THE PORE-ARM. 
491 
regular than the others ; it mounts along the root of the thumb, and 
belongs to its outer edge. * 
The next branches of the radial artery are very small and nameless 
twigs, which go to the naked part of the wrist, to the tendons, liga- 
ments, and the bones; and then comes the artery opposite to this artery 
of the palm, viz. the artery of the back of the hand. 
ARTERIA DORSALIS CARPI. 
The artery of the back of the hand comes off from the radial, just 
after it has turned over the radial edge of the wrist. It takes its course 
directly across the back of the hand, over the carpal bones ; and by its 
frequent inosculations with branches from the ulnar artery, and with the 
dorsalis raetacarpi or dorsalis manus, it makes beautiful net-works across 
all the naked part of the back of the hand. 
DORSALIS METACARPI. 
The radial arterv, continuing its course under the extensor ten- 
dons of the thumb, sends off the dorsalis metacarpi, which is an artery 
generally larger than the last: it takes its course across the back of the 
hand and over the metacarpal bones, and from this artery are given off 
the interosseous arteries. 
The first interosseous artery of the hand is large, long, goes up in a 
direct course to the fork betwixt the fore and mid-fingers, and plunges 
into the cleft of the digital artery at right angles with it. A second twig 
like this, and then a third, are given off; named the first, second, and 
third interosseous arteries : but they are all smaller than the first, and 
all the three communicate with the arteries from the palm. 
Before the final division of the radial artery j* into its three branches, 
it gives a third artery; or, as often happens, two arteries, to the back of 
the thumb. 
ARTERIA DORSALIS POLLICIS. 
The small artery, or the two small arteries, which, from going along 
the back of the thumb* named arterise dorsalis pollicis, come off 
either along with, or immediately after, the dorsalis carpi. When there 
are two, they run both along the back of the thumb, one on one side, the 
other on the opposite side ; that which runs along the outer edge of the 
thumb passes through under the tendons, and is rather shorter ; that 
which inclines to the inner side of the thumb is rather longer. These 
small arteries on the back inosculate round the edges of the thumb 
with the great artery on the inner side ; which is next to be described. 
* This branch, anatomists have thought fit to call artkria ulnaris radialis pollicis, 
which involves such a complication of contradictions, that, upon reading it, one would na- 
turally turn to the table of errata. The artery is called radialis, because it comes from the 
radial artery; and ulnaris pollicis, because it goes upon the ulnar side of the thumb. 
f Notwithstanding the inconsistency of retaining the name of radial artery, after the ar- 
tery has passed the wrist, and begun to run along the thumb, I venture to sacrifice verbal ac- 
curacy, and would make much greater sacrifices to obtain a clear arrangement. 492 
OF THE ARTERIES 
Thus we have seen that the radial artery, having advanced to the wrist, 
turns quick round the wrist, over the head of the radius, and under the 
tendons of the thumb: it gives immediately before it passes, the artery 
of the palm ; it gives immediately after it passes, the artery of the back ol 
the wrist: it gives immediately after that, the artery to the back ol the 
hand ; and then the little arteries for the back of the thumb; it then mounts 
along the thumb in that hollow which is by the side of the metacarpal bone 
of the hand : and then the little arteries for the back of the thumb, till it 
arrives at the cleft betwixt the thumb and fore finger. Here it divides in- 
to three arteries ; one to the inner side of the thumb, very large; another 
to that side of the fore finger which is next the thumb, which branch is 
much smaller; and one which exceeds these in importance, for it dives 
down into the palm of the hand, forms what is called the deep arch ol the 
palm ; and which, having crossed the palm, forms on the side next the 
little finger, that inosculation betwixt the upper and lower arches which is 
so much celebrated. 
ARTERIA RADIALIS INDICIS. 
The artery of the fore finger proceeding from the radial artery is the 
first and smallest of these three branches. It goes off at the root of the 
metacarpal bone of the fore finger, goes up along its interosseous muscle, 
and runs along all the edge of the fore finger next the thumb, inosculating 
with the artery of the opposite edge, which comes from the ulnar arch ; 
it sends off twigs at its root, which inosculate with the small dorsal arte- 
ries of the thumb; and it gives a branch to the abductor indicis. 
ARTERIA MAGNA POLLICIS. 
The chief artery of the thumb rises along its metacarpal bone, a 
single artery, and there splits commonly, I think, into three smaller branch- 
es. Two of these run along the fore part of the thumb up to its extremi- 
ty, and inosculates there; the one running along the radial, the other along 
the ulnar side, till they meet at the point. These are, as it were, coun- 
terparts of the dorsal arteries, but greatly larger; the thumb being naked 
on the back, but fleshy where it looks towards ,tl» palm. Another branch 
of the arteria pollicis is one which turns to the palm of the hand and runs 
towards the fore finger. 
ARTERIA PALMARI3 PROFUNDA. 
The third branch of the radial artery and that by which it ends, imme- 
diately succeeds the artery of the thumb. It crosses the palm of the hand 
so as to form the deep arterial arch, or the radial arch of the palm ; it lies 
under the aponeurosis, and all the tendons and muscles, close upon the 
metacarpal bones. Having gone its circle so as to complete the arch, 
and having arrived at the root of the little finger, or rather lower, near the 
pisiform bone, it turns backwards with a sudden serpentine turn, and 
enters into the side of the ulnar arch, so as to make a complete inoscula- 
tion. OP THE PORE-ARM. 
493 
This deep palmar arch gives out many arteries ; but as it lies close up- 
on the bones, they are all of the smallest order of arteries, and go only to 
the bones, and to the joints of the carpus and metacarpus. Those branch- 
es, again, which run upwards, give little arteries to the interossei muscles, 
to the lumbricales, to the long tendons, and to the interstice of each bone. 
Small twigs are sent through to the back of the hand, which are named 
arteriae perforantes, and which inosculate with the dorsalis carpi, or artery 
of the back of the wrist; they also inosculate with the arteries of the 
fingers. 
PLAN OP THE 
1. Ramus ad Musculum Supinatorem. 
2 Arteria Recurrens Radialis, 
3. Rami Musculares Irrtgularcs. 
4. Arteria Superficialis Pola. 
5. Arteria Dorsalis Pollicis. 
Arteria 
Radialis. 
6. Arteria Dorsalis Carpi. 
7. Arteria Magna Pollicis. 
Dorsalis Metacar pi. 
8. Arteria Radialis Indicts. 
9. Ramus Anastomoticus Ulnaris Superficialis. 
10. Ramus Anastomoticus Profundus. 
Ramus ad Indicem. 
ARTERIA ULNARIS. 
The ulnar artery, both from its size and its direction, is to be con- 
sidered as the continued trunk of the humeral artery. It dives down- 
wards and backwards into the triangular hollow which has been described, 
till it touches the interosfeeous membrane: it first gives off a small branch 
to the pronator teres and common origin of the flexor muscles, before 
it passes through them: sometimes it gives off here the recurrent 
which should come from the interosseous artery, in which case that 
branch, as it passes backwards through the interosseous membrane, is 
named interossea posterior suprema. Next the ulnar gives off the pro- 
per interosseous artery, which is named interossea communis, because 
both the anterior and posterior arteries are branches of it. Then the 
ulnar artery is lodged deep under the muscles which go off from the in- 
ner condyle, as the palmaris, pronator teres, flexor ulnaris, and flexor 
digitorurn sublimis. But though it passes betwixt the upper and lower 
flexor, it does not, like the radial, appear immediately as a superficial 
artery ; it shows itself only about three inches above the wrist. The 
ulnar artery, running along by the tendon of the flexor carpi ulnaris, 
passes forward from the wrist to the palm of the hand, by the side of 
the pisiform bone ; it then forms the superficial arch of the palmar arte- 
ries, and supplies all the fingers, as the radial supplies the thumb. 
The arteries which the ulnar gives out after it passes through the mus- 
cles, and before it arrives at the wrist, are merely muscular branches, ex- 
tremely variable in size and number. To enumerate these, would be 
but to repeat the names of all the muscles which lie upon the flat part 
of the fore arm. 
As the radial sends a branch over the back of the hand, named dor- 
salis radialis ; so does this send a branch round the back of the little 
finger, named dorsalis ulnaris. 494 
OF THE ARTERIES 
artf.ria dorsalis ulnaris. 
The dorsalis ramus ulnaris is a small branch which goes off from 
the ulnar artery as it advances towards the wrist. The ulnar artery goes 
forwards towards the pisiform bone ; while this little artery turns off 
about two inches below, passes under the tendon of the flexor ulnaris, 
and round the head of the ulna, to the back of the hand ; it then goes 
upwards along the back of the little finger, where it ends. It gives 
branches as it passes along to the pronator quadratus, to the extensor ul- 
naris, to the joints about the lower part of the wrist, and especially to 
the joining of the radius with the ulna ; and it finishes on the back of 
the hand by arteries given to the tendons and capsule, by inosculations 
with the rete which is formed upon the back of the wrist, by the radial 
artery, and by giving the dorsal artery of the little finger. 
Next, the ulnar artery, before it begins its arch, gives small branches 
to the flexor tendons and fore part of the wrist; others to the pisiform 
bone, to the annular ligament, and the palmaris cutaneus ; and then 
branches to the flexor, abductor, and adductor of the little finger ; or, 
in other words, to all that mass of muscular flesh which surrounds the 
root of the little finger; and still, before it begins to bend into an arch, 
and just beyond the pisiform bone, it gives of that branch which may be 
called arteria palmaris profunda. 
arteria palmaris profunda. 
The description of this artery is shortly this : It is but a small arte- 
ry ; it comes off a little lower than the pisiform bone; it often gives 
the last lateral artery of the little finger; it then turns downwards and 
backwards with a large circle, passes through betwixt the two heads of 
the flexor digiti minimi; by this it gets into the deepest part of the 
palm, and there joins itself with that palmar branch of the radial artery 
which comes off at the root of the thumb ; and by this inosculation the 
the deep palmar arch is completed. 
The ulnar artery having now arrived at the root of the metacarpal 
bones, but above the tendons of the fingers, forms a great arterial arch 
across the palm of the hand, which is named the superficial palmar 
arch ; and this arch gives out the arteries for the fingers after the fol- 
lowing order: it does not give off twro arteries to each finger, one for 
each side, because it does not lie at the root of the fingers; but instead 
of this it sends out three single arteries ; each of these goes to the cleft 
betwixt two of the fingers ; and when arrived at the roots of the fin- 
gers, these branches. divide uniformly and regularly into two branches ; 
of which one goes up along the side of one finger, while the other goes 
up the opposite side of the next finger; and thus all the fingers are sup- 
plied each with two arteries, one running along either edge of each 
finger. To number them according to the fingers, one, two, three, 
were mere drudgery and waste of time; and to name and describe 
them were an absolute abuse, since they are so uniform in all points : 
it is sufficient to observe, that a long and slender artery runs along each OP THE FORE-ARM. 
495 
edge of each finger; that generally at each joint or division of the fin- 
ger the two arteries make arches to meet each other across the hollow 
where the tendons lie, supplying the tendons and ligaments at the same 
time; and that the fork of each digital artery receives a branch from 
the deeper arch of the palm. That the arteries are each accompanied 
with corresponding nerves, one for each side of each finger ; for the 
ulnar nerve accompanies the ulnar artery down the fore-arm, and 
branches along with it in the palm into the form of an arch, with three 
branches; which three branches are afterwards divided like the arte- 
ries, each into two twigs at the roots of the fingers. 
The superficial palmar arch finishes with a small branch which makes 
another inosculation at the root of the thumb with that superficial pal- 
mar branch which comes off from the artery of the thumb, near the 
place where the artery of the fore finger also comes off 
1. Ramus ad Musculum Pronatorem Teretem. 
2■ Arteria R>currens Anterior, 
3. Arteria Recurrent Posterior. 
4. Arteria Inlerossea. 
5. Arteria Dorsalis Ulnaris. 
6. Ramus ad Musculos Minimi Digiti. 
7. Arteria Palmaris Profunda. 
Arteria 
Ulnaris. 
8. Arcus Superjicialis Palmaris. 
1. Ulnar is Minimi Digiti. 
2. Digitales Tres. 
3. Ramus Anastomoticus. 
ARTERIA INTEROSSEA. 
The interosseous artery is, after the radial and ulnar, the last of 
the arteries of the fore-arm. It is but a branch of the ulnar; it arises 
from the ulnar just where it lies in the very deepest part of the arm, 
and touches the interosseous ligament. This artery is named interos- 
sea communis, because of two lesser interosseous arteries into which 
it divides. First, the interossea communis divides about an inch be- 
low the elbow into the interossea anterior and interossea posterior ; next, 
the interossea posterior gives off the posterior or interosseus recurrent. 
That artery is already described ; and I proceed to describe now the 
course of the two interosseous arteries. 
First, the anterior interosseous artery is the continued trunk, for it 
goes straight forwards, and is larger ; while the posterior interosseous is 
smaller, turns out of the straight course to perforate the membrane, and 
is exhausted before it reaches the wrist. 
The anterior interosseous artery lies flat upon the fore part of the in- 
terosseous membrane ; is larger than a crow-quill, or about half the dia- 
meter of the radial artery. As it goes down the fore arm, it gives 
branches to all the muscles ; it gives the nutritious arteries to the radius 
and ulna; it goes forwards ; and, ending in small branches under the 
annular ligament of the wrist, it makes beautiful net-works and anasto- 
moses over the capsular joints of the carpus. 
Secondly, the posterior interosseous artery turns through the interos- 
seous ligament about two inches below the elbow-joint. It instantly 
gives off the interosseous recurrent; which being very large, the artery 496 
OF THE ARTERIES 
seems to be divided into two equal branches, of which one is the recur- 
rent, turning upwards towards the elbow-joint; the other is the posterior 
interosseus itself, running downwards, and distributing its branches 
among all the great bellies of the extensor muscles which lie on the out- 
side of the fore-arm. 
Thirdly, there is something like a second interossea posterior ; for 
the anterior interosseous artery sends off, about four inches above the 
wrist, another artery, but much smaller, which perforates the interosse- 
ous membrane : might be called a second posterior interosseus ; though 
it is rather to be reckoned among those smaller twigs which, coming off 
from the anterior interosseus, and perforating the ligament, go through 
it to the extensor muscles, and are named perforating arteries, be- 
ing from about four to seven in number. 
Arteria 
Interossea 
COMMON18. 
' 1. Ramus Muscular is. 
2. Arteria Perforans Superior. 
3. Ramus Muscularis, 
4. Arteria Perforans Inferior. 
5. Arteria Carpi Anterior. 
OF THE ARTERIES OF THE THORAX, ABDOMEN, 
AND PELVIS. 
ARTERIES OF THE THORAX. 
AORTA THORACICA. 
The aorta from the arch (after the subclavians and carotids go off) 
bends downwards and backwards, and touches the left side of the spine. 
The two membranes called pleura, of the right and left side, meet in 
the middle to form the mediastinum ; but as they do not meet imme- 
diately, they leave a triangular space, the basis of which triangle is 
the spine : the sides are the two menbranes or pleurae, inclining towards 
each other; and there, in the interstice betwixt them, the aorta is lodg- 
ed, and along with it lies the oesophagus, which runs downwards to- 
wards the stomach. The thoracic duct, which is passing upwards to 
the subclavian vein, and the vena azygos, which returns the blood of 
the thorax, and brings it into the descending cava; these parts are all in- 
volved in cellular substance, and inclosed in this triangular space be- 
twixt the two membranes. 
The aorta, as it goes thus downwards beside the spine, gives the 
following branches : First, as it lies immediately behind the root of the 
lungs, it gives small arteries which nourish the proper substance of the 
lungs, the bronchial arteries: Secondly, as it lies by the side of 
the oesophagus, it supplies it with small twigs, the (esophageal arte- 
ries : Thirdly, the aorta, as it moves downwards through the thorax, 
gives off a small and regular artery to the interstice of each rib as it 
passes it; and these are the intercostal arteries. 
The bronchial arteries are always three, and sometimes four, in 
number. Their office is not to contribute to the oxydation of the OF THE THORAX. 
497 
blood; that office belongs peculiarly to the pulmonic artery ; while the 
small bronchial arteries are for nourishing the proper substance of the 
lungs; for which end they attach themselves immediately to the tra- 
chea, and follow its branches, twisting round them through all the sub- 
stance of the lungs. 
1. ARTERIA BRONCHIALIS COMMUNIS. 
The common bronchial artery, so named because it gives branches 
to both sides of the lungs, arises highest from the fore part of the aorta ; 
it gives two branches, one to the right side of the lungs, and one to the 
left ; the right branch gives an artery to the oesophagus, and sometimes 
the whole of the right branch goes to that part. 
2. ARTERIA BRONCHIALIS DEXTRA. 
The right bronchial artery sometimes like the common bron- 
chial, comes off from the aorta ; but very often it comes off from the 
upper intercostal artery. It goes round the right branch of the trachea, 
and belongs to that side of the lungs alone : but it gives, notwithstanding, 
some branches to other parts, especially to the oesophagus, to the back 
of the pericardium, and to the posterior mediastinum, or membrane which 
strides across the aorta. 
3. ARTERIA BRONCHIALIS SINI9TRA. 
The left bronchial artery comes off along with the bronchiahs 
communis from the fore part of the aorta ; it goes to the left side of the 
lungs, and also affords small branches to the oesophagus and neighbour- 
ing parts. 
4. ARTERIA BRONCHIALIS INFERIOR. 
Often there is a fourth bronchial artery, which we would call bro.v- 
chialis inferior, or the lower bronchiai. ARTERY, because it comes 
off lower than these, commonly about the place of the fifth rib. It goes 
to the back of the heart, where the pulmonic vein of the left side ex* 
pands into the auricle, and taking the pulmonic vein as a conductor, creeps 
backwards along it into the substance of the lungs. 
These bronchial arteries arc the least regular in all the body, coming off* 
usually from the aorta, but sometimes from the mammary, and often trom 
the upper intercostal artery ; sometimes also they arise from the inter- 
costals of the aorta. But from one or other of these sources we usu- 
ally have three or four bronchial arteries, which are so named from their 
belonging to the branches of the trachea or bronchiae. 
Ruysch, who first discovered this artery, and Sylvius de la Boe and 
others, who followed Ruysch and used his words in describing the ar- 
tery, explained its office truly : they said it was for nourishing the sub- 
stance of the lungs. But this sensible opinion was disputed by many 
physicians of very great reputation ; who maintained that it was quite 
disproportioned to the size of the lungs, and that it nourished the trachea 498 
OF THE ARTERIES 
only ; and they gave a most whimsical reason for believing all this. The 
lungs they consider as made of very coarse stuff, which the half elabo- 
rated blood of the right ventricle and pulmonic artery might serve ; 
while the harder and more perfect substance. of the trachea required a 
more perfect and finer blood. 
5. ARTERIiE (ESOPHAGEjE. 
The (esophageal arteries are generally five or six in number. They 
are small twigs which come off from the aorta below the bronchial ar- 
teries ; they encircle the oesophagus, and make anastomoses with each 
other ; and very generally they pass off’ from the (esophagus to the pos- 
terior mediastinum, or that double membrane under the interstice of 
which the aorta lies. These secondary arteries, along with very small 
twigs which come off from the aorta itself, some anatomists choose to 
describe apart under the title of posterior mediastinal arteries. 
6. INTERCOSTALKS INFERIORES. 
The lower intercostal arteries are nine or ten in number, accord- 
ing to tho number of ribs which are not supplied by the upper intercostal 
artery, (for the upper intercostal, which comes downwards from the sub- 
clavian artery, supplies usually the intercostal spaces of the two first ribs, 
but sometimes of three, and sometimes of one only.) The aorta, in its 
course down the back, gives out, as it passes each vertebra, one artery 
for each rib ; as it goes down along the loins it still gives off an artery at 
the interval of each vertebra ; in the thorax they are named intercostal, 
and in the loins the lumbar arteries. 
The right intercostals are longer, because they have to mount over 
the ridge of the vertebrae ; the left ones are shorter, because the aorta 
lies on that side of the spine : the intercostals often give small twigs to 
the oesophagus and mediastinum ; but besides these, each intercostal ar- 
tery gives three principal branches. 
1. By the head of each rib it gives a small artery, which belongs en- 
tirely to the spine, and this artery sends one twig to the substance of each 
vertebra ; another twig goes to the sheath or dura mater of the spinal 
marrow ; the third, following each intercostal nerve backwards, enters 
into the substance of the spinal marrow itself. 
2. Each intercostal gives next a larger artery, which perforates near 
the head of each rib, and passes through to the back, and supplies the 
longissimus dorsi, latissimus dorsi, sacro-lumbalis, and all the great mus- 
cles of the back, which have indeed no other source whence they can de- 
rive arteries ; and though these are apparently small for so great a mass 
of muscular flesh, the smallness of the branches is compensated for by 
their frequency. 
3. The intercostal artery proceeds, after giving these branches, along 
its proper intercostal space, where it gives an immense number of small 
arteries to the intercostal muscles ; and as each artery passes round the 
thorax along the ribs, it splits into two branches ; one attaches itself to 
the lower edge of the rib above it, where there is a sort of groove to re- 
ceive it, i. e. the larger artery, and the artery which is to be feared in 
wounds or operations : the other attaches itself to the upper sharp edge OF THE ABDOMEN. 
499 
of the lower rib, where there is no groove ; this of course is the smaller 
branch, much less important in all respects. These two, accompanying 
each rib, run round the circle of the thorax to its fore part, and inosculate 
with the mammary and epigastric arteries. 
1. Arlerire Ptricardiactt. 
2. Arttria Brouchialis Dexlra. 
3. Arttria Bronchinlis Sinistra. 
4. Arterue (Esophagea. 
5. Arttria Inlercostales Aorlictz. 
6. Rami Irregulares. 
Aorta Thoracica 
Descended. 
ARTERIES OF THE ABDOMEN. 
The aorta descends into the belly under that arch which is formed by 
the legs of the diaphragm. It passes along the left side of the spine ; 
but now upon emerging into the abdomen, it inclines nearer to the mid- 
dle of that ridge which is formed by the vertebrae. The flat and tendi- 
nous legs of the diaphragm not only stride over the aorta, so as to form 
an arch, apparently for its protection, but the uppermost part of the crura 
turns flat under it, so as to embrace it. No vein goes along with the 
aorta ; for the cava, which returns all its blood, leaves it a little above 
the pelvis, and inclines towards the right side, that it may enter into the 
right side of the heart, which it does by passing under the liver. 
But the aorta has other very important connexions : for as one of its 
first arteries is the great artery of the intestines, of course the root of the 
mesentery (the membrane which conducts the arteries of the intestines) lies 
over the aorta ; and as the mesentery conducts the lactcals from the in- 
testines, of course, the meeting of the lactcals and of the lymphatics, or, 
in other words, the beginning of the thoracic duct, is at the side of the 
aorta. Again, as the great nerves which come down from the breast into 
the abdomen, are destined chiefly for the viscera, they have no other way 
of reaching the viscera than by taking the direction of the several branches 
which the abdominal aorta gives out. There are three great branches : 
the coeliac, the superior mesenteric, and the inferior mesenteric arteries. 
Of course there are three great plexuses of nerves ; the coeliac plexus, 
the superior mesenteric plexus, and the inferior mesenteric plexus. As 
these net-works all come from the greater net-work which covers the 
aorta itself, that plexus is named, from its great size and from its many 
radiated nerves, the solar plexus ; and the semilunar form of the two 
great nerves which supply the whole gives them the name of semilunar 
ganglions. 
These connexions of the aorta, deduced in this general way, will be 
easily understood ; will show the importance of studying this point, where 
there are so many intricate parts ; and will explain also the necessity of 
mentioning this group of difficult parts at once. 
The aorta then passes from the thorax into the abdomen, through be- 
twixt the legs of the diaphragm ; the beginning of the thoracic duct lies a 
little below this point, and the duct itself runs up by the side of the aorta. 
The aorta, having come out into the abdomen, the first branch which 
it gives off is a small one to the diaphragm as it passes under it. The 
AORTA ABDOMISALIS. 500 
OP THE ARTERIES OF THE 
rttjxt branch which it gives off is the most important of all, viz. the coe- 
liac artery; and it supplies the stomach, the liver, and the spleen, because 
they lie in the upper part of the abdomen. Next it gives a great artery 
to the intestines, which is named the superior mesenteric artery, for it 
goes to the intestines which lie within the abdomen. Then it gives the 
arteries to the kiddies and the spermatic vessels. And, lastly ; it gives off 
a great artery, which is named lower mesenteric; because it supplies 
chiefly the lower part of the great intestines, and most especially the rec- 
tum, where it goes down into the pelvis. 
Then the aorta divides into the two iliac arteries, and of course has no 
1 onger the name of abdominal aorta. 
The diaphragm has in nine of ten bodies two arteries named the phre- 
nic arteries ; one going to the right side, the other to the left. The 
varieties of this artery are too great almost to be mentioned ; but, how- 
ever, these are the chief: generally the phrenic arteries are two small ar- 
teries arising from the aorta, one going to the right side, another to the 
left; often there is one artery going off from the fore part of the aorta, 
and dividing immediately into two arteries, right and left; sometimes 
one arises from the aorta itself, another from the cceliac artery ; some- 
times the coeliac artery, which has properly but three branches, has a 
fourth added, which is the phrenic artery : sometimes there are three 
phrenic arteries ; sometimes even four; and the diaphragm, it is always 
to be remembered, receives often smaller branches from the intercostal 
and lumbar arteries, or from the capsular arteries, besides those which 
it gets from the thorax accompanying its nerves and coming along the 
pericardium. 
These varieties being mentioned, the history of the regular phrenic ar- 
teries may be very short. One goes round the right side of the dia- 
phragm, and the other round the left, with very little variety. First, the 
phrenic artery crosses what is called the fleshy part of the crus dia- 
phragmatis of its own side, and goes bending along to what is called 
the ala or wing of the diaphragm, and gives a great many arteries in all 
directions into these fleshy sides of the diaphragm ; the artery then 
turns round, and encircles the great central tendon, where the two 
phrenic arteries begin to turn round ; they give one branch particularly 
large to the fleshy sides of the diaphragm, which arise from the ribs; 
then bending round the central tendon, they spread all their remaining 
branches forwards upon the central tendon, and upon that part of the 
muscle which arises from the sternum, and meet in large inosculations 
with each other. One branch often pierces the diaphragm, goes into 
the pericardium where it is attached to the diaphragm, and unites with 
that artery which comes down along with the phrenic nerve, the comes 
nervi phrenici. 
But still it is to be remembered, that the phrenic arteries, before they 
enter into the diaphragm, give small arteries to the capsulce renales, and 
to the oesophagus and neighbouring parts ; the oesophageal branch run- 
ning upwards into the thorax, to inosculate with the upper arteries of 
the oesophagus. 
ARTERTiE PHRENICjE. STOMACH, LIVER, AND SPLEEN. 
501 
OF THE ARTERIES OF THE STOMACH, LIVER. AND SPLEEN. 
The upper part of the abdomen is occupied entirely by the stomach, 
liver, and spleen; the stomach in the middle, the liver on the right hand, 
and the spleen on the left. The cceliac artery supplies all these parts ; 
it rises up from the fore part of the aorta a short thick artery encircled 
by the lesser arch of the stomach ; and immediately splits into three 
branches, of which the middle branch goes to the stomach, the left goes 
to the spleen, the right goes to the liver; and thus we have all the 
branches of the cceliac artery neatly and simply arranged. 
ARTERIA CtEUACA. 
The cceliac artery is so important, that its place and connexions 
must be more minutely described. It arises from the fore part of the 
aorta, just at that place where the aorta is closely embraced by the 
crura diaphragmatis, and over the eleventh vertebra of the back ; it 
juts directly forwards, almost at right angles from the aorta, and is en- 
circled by the lesser arch of the stomach ; the artery standing up be- 
twixt it and the diaphragm. The cceliac trunk, then, is so placed as to 
be surrounded by these parts : it has the oesophagus on the left hand ; 
the lobulus Spigelii, or lobulus papillaris of the liver, on the right hand; 
it has the lesser arch of the stomach making its turn under it; and it 
has the diaphragm above and the pancreas running across below ; it is 
covered by the delicate web of the omentum, named omentum mi- 
nus, which goes from the lesser arch of the stomach to the liver and 
to the spine. 
Now this short jutting out or stump we call the trunk of the cceliac 
artery; or we call it axis arterise cceliacae, for there is no other artery of 
the body that divides like it: the stump, which is less than half an inch 
in length, serving as an axis, from which the three great branches, viz. 
to the stomach, liver, and spleen, go off all at once, in a tfipod-like 
form { one upwards, one to the and one to the left. The hepatic, 
which goes to the right, is largest in the child, because of the great 
bulk of its liver; the splenic, which goes to the left, is larger in the 
adult; the gastric is almost always the smallest of the three. 
1. ARTERIA CORONARIA VENTRICULI. 
The coronary artery of the stomach is the central artery of the 
tripod. When it belongs entirely to the stomach, it is smaller than the 
splenic or hepatic arteries : but when it gives (as often it does) a branch 
to the liver, it is the largest of the three. This gastric artery, or coro- 
nary artery of the stomach, is generally the smallest, not very much larg- 
er than a crow-quill; it rises upwards, and turns a little towards the 
left side, because the cardiac orifice of the stomach is there. 
Before it reaches the cardiac orifice of the stomach, it divides itself 
into two great branches; one going round the cardiac orifice of the sto- 
mach. and the other returning along the lesser arch. 502 
OF THE ARTERIES OF THE 
CORONAR1A SUPERIOR VENTR1CUL1. 
The branch which belongs to the cardiac orifice of the stomach at- 
taches itself to the oesophagus, just where it emerges from the diaphragm, 
and is joined to the stomach : the artery turns round the oesophagus, 
passes first under and behind it, and then turns round and appears on 
the fore part, or rather on the left side, of the stomach to spread over 
it. In the middle of this turn it gives off an artery which runs back- 
wards along the oesophagus, takes directly the line of the oesophagus, 
runs up with it into the thorax a considerable way, inosculates with the 
upper oesophageal arteries, and though a small branch, it is long, and 
seldom wanting. The second branch is a continuation of the same 
artery encircling the cardiac orifice, sending its arteries down over the 
large and bulging part of the stomach, somewhat in the form of a crown. 
As the spleen is attached to this end of the stomach, this artery inos- 
culates with what are called the vasa brevia, or short vessels coming 
from the artery of the spleen ; and so it ends, having the name of co- 
RONAR1A SUPERIOR VENTRICULI. 
The second branch of the coronary returns along the lesser arch of 
the stomach ; it is so connected with the last that it may be called ra- 
mus coronarke dexter, though properly it is not a branch, but the con- 
tinued trunk of the gastric artery. As the first branch turns round be- 
hind the oesophagus, this stops and turns to the lesser arch of the sto- 
mach touches it just at the cardiac orifice, i. e. at the root of the oeso- 
phagus ; turns with a gentle turn round the lesser arch of the stomach, 
bending as the arch bends, giving its branches down both forwards and 
backwards over each side of the stomach. As it runs along the sto- 
mach it is sensibly exhausted by these arteries, so that it arrives very 
small at the lower or pyloric orifice of the stomach ; there it turns over 
from the stomach upon the small gut in such a way as to belong to the 
pylorus or union of the gut with the stomach ; and though small and 
trivial, it has an appropriated name, artekia tylorica superior, and 
thus the gastric artery ends. 
But sometimes, as has been mentioned in the general description, this 
gastric artery sends a branch to the liver; yet, in that case the order of 
these arteries already enumerated is in no degree disturbed; the ar- 
tery running along the oesophagus, the artery running round the cardia 
and in form of a crown, the artery returning along the lesser arch, are 
still the same ; only, after giving off this last artery, the trunk of the 
gastric goes off from the stomach, continues its course towards the li- 
ver, and passes into it. 
2. ARTERIA IIEPATICA. 
The hepatic artery goes off from the Cceliac axis, where it almost 
touches the point of the Spigelian lobe. The pancreas covers the root 
of the hepatic artery ; it then turns a little forwards, and rising some- 
what upwards at the same time, it passes under the pylorus, i. e. un- 
der the stomach and duodenum; it passes behind the omentum minus STOMACH, LIVER, AND SPLEEN. 
503 
and biliary ducts; it arrives at the porta where the great vena port® enters 
the liver, and where the great biliary ducts come out; it passes the vein, 
and to the left of the biliary ducts; and having a little before divided in- 
to two great branches, these now enter into the right and left lobes of the 
liver. In this place it is inclosed along with all the other vessels in that 
sheath of cellular substance which is called the capsule of Glisson. 
Thus the artery finally terminates near the liver in two great branches, 
right and left; but before it does so, it gives, as it passes the stomach, 
duodenum, and pancreas, very important branches to these parts. Be- 
fore it gives these more important branches, it gives small twigs to the 
vena port® and to the head of the pancreas ; then it gives off the great 
artery which is the source of these lesser arteries, (to the pylorus, pan- 
creas, and duodenum,) viz. the arteru duodeno-gastrica, which, soon 
after it goes off from the hepatic artery, divides into two chief branches. 
One turns backwards along the duodenum to the stomach, and from 
supplying the stomach and epiploon, is named gastro-epiploic artery. 
The other, turning downwards along the duodenum, gives at the same 
time arteries to the pancreas, and so is named arteria pancreatico- 
duodenalis. The trunk which divides into these two arteries may be 
described thus : The duodenum begins from the pylorus ; the pancreas 
pours its liquor into the duodenum ; and therefore the head of the pan- 
creas is attached to the duodenum : this marks the point at which the 
trunk of the arteria duodeno-gastrica goes off; for it rises at right 
angles from the hepatic ; it lies behind the lower end of the stomach, 
just between the pylorus and pancreas ; there it splits into its two 
great branches, viz. to the duodenum and to the stomach. But besides 
these two great branches there are subordinate arteries, which must 
be enumerated together with them. 
One artery goes off to the upper and back part of the duodenum over 
the biliary ducts ; next go off small arteries to the duodenum of’ still less 
importance, and nameless ; and at the same place small twigs are often 
given to the pancreas. 
The first which is distinguished or regular, or has a name, is the py- 
lorica inferior, the lower pyloric artery. It goes off from the pancre- 
atico-duodenalis almost as soon as it touches the duodenum ; there 
are sometimes two or more pyloric arteries going off at this point; they 
encircle the pylorus with delicate branches; and at the same time turn 
obliquely upwards, to receive inosculations from the upper pyloric, which 
comes from the artery of the stomach. 
The next artery to be distinguished by a peculiar name is one which 
gogs off directly opposite to this, belongs to the pancreas, and is named 
from its running transversely across the pancreas, the transverse pan- 
creatic artery. It is a neat small branch, which passes under the pan- 
creas, runs along its back part, gives its arteries into the substance of the 
pancreas from side to side ; and yet is not exhausted till it has run along 
more than two-thirds of the length of this long gland. 
The next branch is that from which the whole artery has its name : 
for the artery having given off the lower pyloric artery, and the trans- 
verse artery of the duodenum, turns downwards, bending according to 
the circle which the duodenum makes, lying in the hollow side of that 
circle just as other mesenteric arteries lie along their proper intestines. 
In all this circle it gives continual arteries outwards to the duodenum : 
it gives also frequent arteries inwards to the pancreas. From these two 504 
OF THE ARTERIES OF THE 
connexions this branch is peculiarly named arteria pancreatico-duo- 
denalis. It ends in inosculation with the mesenteric artery. 
At the place where this pancreatico-duodenalis turns downwards, the 
other great branch turns backwards and upwards to reach the stomach. 
It is so great that it must be considered as the continuation and ultimate 
part of the artery. It goes to the stomach and epiploon, and thence is 
named gastro-epiploic artery. 
The course of the gastro-epiploic artery is along the lower part of the 
Stomach, and is most beautiful; it makes a broad sweep round all the 
greater arch of the stomach : it lies in that line where the great omen- 
tum comes off from the stomach : it sends many and large branches up- 
wards upon the stomach, both on its fore and on its back surfaces ; it 
sends opposite branches, very frequent and considerable, down into the 
web of the omentum or epiploon ; it runs along the stomach till it meets 
with a similar branch from the splenic artery ; and the inosculation be- 
tween them is so large and perfect, that we cannot tell where the one ar- 
tery ends or the other begins. This branch from the hepatic artery is 
named the right artery of the stomach, or the right gastro-epiploic 
artery, while that from the splenic artery is the left. 
Besides this great artery to the duodenum and stomach, the hepatic 
artery, before it plunges into the liver, gives another branch, but small: 
it is named pylorica superior hepatica. 
PYLORICA SUPERIOR HEPATICA. 
The pylorica superior hepatica is so named to distinguish it from 
that upper pyloric artery which comes down from the stomach, and 
sometimes it is called gastrica vel coronaria minor. It comes oft' 
from the hepatic artery just before it divides, or immediately after from 
the left hepatic. It turns backwards at an acute angle to the lesser arch 
of the stomach, and, having given small twigs to the omentum minus, 
it goes directly to the pylorus, inosculating with its upper and lower ar- 
teries. 
HEPATICA SINISTRA. 
The hepatic artery, now advanced to within about two inches of the 
liver, divides into its two great arteries. Both go to the porta of the 
liver; but the one belongs to the right lobe, the other belongs to the 
left. The artery which belongs to the left lobe of the liver is smaller, 
and when there is a hepatic artery from the stomach it is very small 
it mounts over the vena portae, and enters into the liver at the fossa um- 
bilicalis ; its branches within the liver go chiefly to the left lobe, lobulus 
•Spigelii, and anonymous lobe. 
HEFATICA DEXTKA. 
The right branch of the hepatic artery passes under the biliary ducts, 
enters along with them into the right lobe of the liver, and before it 
does so it gives oft' the arteria cystica, or artery of the gall-bladder, one 
of the most beautiful little arteries in the body. The cystic artery STO>JACil, LIVER, AND SPLEEN. 
505 
branches over the gall-bladder, between its coats, in the form of a 
coronary artery, and having made a beautiful tree of branches over 
the gall-bladder, it passes off from it, and goes to the substance of the 
liver. 
AHTERIA SPLENICA. 
The splenic artery is one of the most remarkable in the human 
body. The spleen is tied down to the left side of the diaphragm by a 
proper ligament; it is also connected with the greater or bulging end 
of the stomach by processes of the omentum and by vessels. The 
splenic artery, the largest branch of the cceliac, as large as a goose- 
quill, turns off from the cceliac trunk almost at right angles, and runs 
across the abdomen to get to the spleen. It is in all this course ex- 
ceedingly tortuous ; it runs along the upper edge of the pancreas, 
(which also lies across the abdomen,) and gives arteries to it; when it 
approaches the spleen, it gives off that great artery which returns along 
the lower border of the stomach, and when it actually arrives at the 
spleen, it divides into a great many branches, which enter by the con- 
cave surface of the spleen, and plunge into its substance. 
The branches, then, of the splenic artery, are these: 1. It gives a 
great artery to the pancreas, named fancreatica magna, which passes 
to the right under the pancreas, and belongs chiefly to the head of the 
pancreas, or that rounded end which is next to the duodenum. Though 
named magna, it is a variable artery, and of little importance. 2. All 
along, as the splenic artery is passing to the left by the border of the 
pancreas, it sends short branches into it. They are named pancre- 
parvas, or small pancreatic arteries. 3. It often sends small 
arteries upwards to the back part of the stomach, named posterior 
gastric arteries. 4. The gastro-epiploica sinistra, or the left 
gastro-epiploic artery, is a very large and principal branch of the 
splenic artery. It arises under the stomach, a little beyond the left or 
larger head of the pancreas ; it makes a large arch, and then turns 
with a serpentine turn towards the stomach, returns along the lower 
border of the stomach, within the doubling of the omentum, and gives 
its arteries upwards to the stomach and downwards upon the omentum, 
so much like those of the right gastro-epiploic artery, that when they 
meet in the middle of the great arch of the stomach, and inosculate, 
w'e cannot distinguish where either of them ends ; the chief difference 
is, that some of the epiploic branches of this artery are particularly 
large. 5. The vasa brevia are a set of three or four arteries which 
the splenic gives off just before it enters the spleen ; and as the artery 
lies close to the stomach, these arteries which go to the great bulging 
of the stomach are exceedingly short, and are thence named vasa brevia. 
The artery ends by eight or ten branches, which plunge into the 
spleen. Sometimes we see the artery pass, almost undivided, or 
divided into one or two branches only, into the bosom or sinus of 
the spleen. 
These are all the arteries of the stomach, liver, and spleen, the vis- 
cera which fill the upper region of the abdomen. 506 
OF THE AKTEHiE-S 
RECAHTULATION OF THE BRANCHES OF THE 
cr> 
B $ 
P* H 
r n 
o 2 
► ► 
1. Arteria Coronari* 
Ventricidi. 
2. Arteria Hepatica. • 
S. Arteri'a Splenic*?. 
. 1. Panereatica. 
2. Vasa brevia. 
[ S> Artnia Gastro-epiplmia Sinistra. 
r 1. Arteria Hepatica Dextra—Arteria Cgsticu. 
1. Ramus to the Stamaeh. 
2. Ramus ascending to the (Esophagus. 
3. Ramus to the Diaphragm and Omentum 
Minus. 
4 Ramus to the lesser Curvature of the 
Stomach. 
5. Arteria Pylorica Suptriw. 
2. Arteria Hepatica Sinistra. 
1. Coronaria Deztra. 
2. Dnodeno Gtastrica, 
C1. Pylericu Inferior. 
2 2. Pancreutica Duodenalis. 
C, calm.Epiploim-. OB THE INTESTINES. 
507 
OF THE ARTERIES OF THE INTESTINES. 
OF THE UPPER AKT) LOWER MESENTERIC ARTERIES. 
The bowels are so disposed within the abdomen, that the largest of 
them, viz. the colon, the great intestine, encircles all the others. It 
begins on the right side in a blind sac called the caput coli, or head of 
the colon : it goes upwards and crosses the belly, so as to support the 
stomach, and separate the stomach, liver, and spleen, from the small 
intestines : it descends again into the pelvis at the left side, forming 
the rectum ; and all the small intestines hang by their mesentery in the 
central part of the abdomen, surrounded by this great intestine; and 
the arteries lie within the two lamellae of the mesentery or supporting 
membrane of the intestines, so that they are called mesenteric arteries; 
and they follow the intestines in the order in which I have named 
them. 
The great or superior mesenteric artery gives its first branches 
to the caput coli; its next branch to the middle of the colon under the 
stomach ; the thousand turn9 of the small intestines next absorb all 
its other branches. The lower mesenteric artery, which gives no 
branches to the small intestines, attaches itself to the left side, and es- 
pecially to the lowest part of the colon, and goes down with the rec- 
tum into the pelvis, and ends there. This, then, may serve as a gene- 
ral plan or arrangement for the intestines and for the two mesenteric 
arteries. 
1. MESENTERICA SUPERIOR. 
It is not surprising that the upper mesenteric is the largest of all 
the abdominal arteries, ft arises from the aorta, where it is still be- 
tween the legs of the diaphragm, and not more than half an inch below 
the coeliac artery. The cceliac and mesenteric arteries lie close upon 
each other; only we are less sensible of their nearness by the axis 
cceliacm jutting perpendicularly forwards, and by the trunk of the 
mesenteric running very obliquely downwards, and by the head of 
the pancreas lying immediately over the mesenteric and hiding its 
root. The trunk of the mesenteric artery passes under the pancreas, 
then through the mesocolon or mesentery of the colon, then into the 
proper mesentery of the small intestines. It turns first to the left ; 
and then, by a second gentle bending, it turns again towards the right 
side of the abdomen. It runs very low into the abdomen before it 
gives out any branches ; and then it gives them off in the following 
order. 
From the right side it gives branches to the great intestines, of 
which there are three chief arteries; but from the left side, where it 
gives arteries to the small intestines, it gives innumerable branches, very 
large, and so inosculated with each other, that they form a sort of mesh 
or immense plexus in the mesentery before they go onward to the guts. 
The undivided trunk of the artery is verv large and long: the gentle 508 
OK THE ARTERIES 
curvature of it from left to right, gives it the form of an Italic/; the 
prodigious size of that mesh or plexus of vessels which goes to the 
great intestines is such as to carry the artery down to the left ilium or 
flank, where the caput coli or conjunction of the ilium with the colon 
lies. 
It is from the convex of this gently bending arch, and from the right 
or outer side of the artery, that the following arteries to the great in- 
testines go off.* The colica media to the middle of the great intes- 
tine, the colica dextra to the right side of the great intestine, the 
iLEO-eoLicA to the joining of the ilium with the caput coli or beginning 
of the great intestine. 
COLICA MEDIA. 
1. The middle colic artery passes along in the doubling, i. e. 
between the two lamellae of the mesocolon. J t goes with a circular sweep 
upwards towards that part or corner (as we may call it) of the colon 
which lurks under the liver ; but before it touches the intestine, and 
generally at the distance of about three or four inches from it, this ar- 
tery divides into two great branches ; one turning backwards, along 
the right side of the colon, inosculates with the colic arteries ; the 
other, more like the continued trunk, turns upwards, bending accord- 
ing to the curvature of the arch of the colon, which supports the 
stomach ; and having rounded the concave of this arch, and arrived 
at the left side, it there makes a great inosculation with the left colic 
artery, which is a chief branch of the lower mesenteric ; and so com- 
pletes the great mesenteric arch, one of the most celebrated inoscula- 
tions in the whole body, that of the circle of Willis hardly excepted. 
COLICA DBXTRA. 
2. The right colic artery is enumerated as a distinct artery chiefly 
for the sake of plainness ; for though sometimes it arises apart from 
the general mesenteric trunk, yet in ninety-nine of one hundred bodies 
it proceeds from the upper or middle colic artery. It is a very large 
branch ; it is set oft' from the colica media at a very acute angle ; it 
moves along the right side of the colon, inclining also a little upwards 
towards the liver ; it also splits when it approaches the gut into two 
branches ; one turning towards the upper side to inosculate with the 
middle colic artery, the other turning downwards towards the ilium or 
flank to inosculate with the ileo-colic artery. 
ARTERIA ILEO COLIC A. 
3. The ileo-colic artery arises about an inch lower than the last. 
It is a long, small, and slender artery, compared with the two last; 
which are short, stumpy, and with contorted angles. This artery goes 
* Often before giving off its greater arteries, the mesenteric gives to the pancreas 
several small arteries ; and to the duodenum two or three, which are sometimes named 
under the title of dnodennles inferiores. OP THE INTESTINES. 
509 
to the place where the small intestines end, and the great ones begin ; 
of course, the membrane which holds the intestines at this corner (I 
mean in the right haunch) changes its name from meso-colon (in the 
middle of the colon) to mesentery, or meso-enteron (in the middle 
of the intestines) ; and of course the ileo-colic artery runs down, not 
along the mesocolon, but along the mesentery. It goes directly down 
towards the joining of the ilium with the colon ; it ends in three regular 
branches ; one passes straight onwards to the junction of the ilium and 
colon, splits into two branches, one going over the fore and the other 
over the back part of the caput coli, and having a very curious corres- 
pondence with the valve within, so that it might be called arteiua 
valvule coli. While this branch goes straight forwards over both 
sides of the caput coli, another branch runs backwards along the 
colon, and inosculates with the right colic artery ; and another runs 
downwards along the ilium, and inosculates with the common branches 
of the mesenteric artery. It is from these two branches, which diverge 
like the rest of the colic arteries, that this is called ileo-colioa. Even 
the appendix vermiforrnis has its little mesentery tying it down to the 
caput coli, and from the back of the caput coli a little artery runs 
down upon that mesentery to the appendix, passing along the whole 
length of that process. 
From this point all the remaining arteries of the mesenterica supe- 
rior go to the small intestines ; and they are so undistinguished, and 
so prodigiously numerous, that no branches can be described or named; 
there is nothing but a great net-work of arteries to describe. The 
first or radical branches which go to the small intestines, are thick, 
large, short, and vary from twelve to fifteen or twenty in number. But 
it is not these that make this vast appearance of a network; these 
twelve branches are first joined to each other, as it were mouth to 
mouth, forming one great confluence of arterial arches : from these, 
secondary branches arise, and they unite again in like manner, and 
make a second row of arches ; from the union of these still other ar- 
teries arise, and make a third, or fourth, and even a fifth row of arches, 
before any arteries go to the intestines ; till at last the proper arteries 
of the intestines go out in straight lines from the last arch, and spread 
upon the coats of the intestine. In short, the mesentery has a very 
intricate and matted appearance from the redoubling of these arches, 
which are more and more numerous as the artery proceeds lower. 
The last of the twelve radical branches makes an arch, which serves 
the ileon or lowest of the small intestines, and inosculates with the 
ILEO-COLIC ARTERY. 
2. MESENTERICA INFERIOR. 
The lower mesenteric artery is that which is named by Haller 
the left colic artery, because it goes only to the left side of the colon. 
It arises from the fore part of the aorta, below the two emulgent arte- 
ries, i. e. pretty low down. It goes off rather from the left side of the 
aorta ; it goes off very obliquely, and keeps close to the left side of 
the aorta for a great way ; and when it has descended as low as the 510 
OF THE ARTERIES 
l)ifurcation of the aorta, it gives off its great branch to the left side of 
the colon, viz. the left colic artery ; and then turning down over 
the iliac artery of the left side it descends into the pelvis, along with 
the rectum, and ends there. 
1. Its first branch is the arteria colica sinistra. The lower 
mesenteric has run a considerable length, has passed as low as the 
bifurcation of the aorta, before this branch is given off. This artery 
soon divides into three large branches ; the trunk itself is short and 
stumpy, the branches go off like those of the other side, at very acute 
angles : First, One branch ascends towards the angle of the colon, 
under which the spleen lies, and there divides itself into two branches ; 
one keeping closer to the intestine, nourishes it; the other keeping 
more to the middle of the meso-colon, or broad membrane of the 
colon, meets the branch of the upper mesenteric, and completes with 
it the mesenteric arch, being indeed the larger and more important 
artery of the two. Secondly, Another branch goes directly across to 
the right side of the colon, and when it approaches the gut, splits (as 
usual with the colic arteries) into two lesser branches, one turning 
upwards and the other dowmwards. Thirdly, The third branch of 
this left colic artery goes obliquely downwards to that part of the gut 
which lies in the hollow of the left haunch-bone, and which forms the 
turn named sigmoid flexure of the colon ; and the membrane of the 
colon is here so fast braced down to the loins that this artery gives 
twigs to the loins inosculating with the lumbar arteries. 
ARTERI.E IIJEMORRIIOIDALES. 
The internal h.emorriioidal artery is one of considerable size : 
it is just the trunk of the lower mesenteric artery, descending into the 
pelvis ; it is often as large as a writing quill; it applies itself closely 
to the back part of the rectum ; it arrives at it by turning obliquely 
over the pelvis, and under the rectum, and passes down its whole 
length quite to the anus. It encircles the rectum completely on each 
side with its large branches, which meet again upon the fore part of 
the gut, and its branches lower down in the pelvis, inosculate with the 
middle hamiorrhoidal artery, and sometimes with those of the bladder 
and womb. This is the artery which prevents us from operating when 
a fistula in ano has gone deep by the back of the rectum ; and which 
has given occasion to the establishing of something like a general rule 
in surgery, that one should not operate when the fistula is more than 
two or three inches deep. It is the last of the arteries belonging to 
the loose and floating viscera. OP THE FIXED VISCERA. 
511 
OF THE REMAINING ARTERIES OF THE ABDOMEN, 
VIZ. TO THE KIDNEYS, TESTICLES, &c. 
artekie capsulares. 
The capsulae atrabiliares are two small bodies of a triangular form, 
of thick walls and small cavities, filled in general with a black and 
bilious-looking liquor. The ancients thought this the atrabilis, and 
named them the capsulae artrabiliares: the moderns, from seeing them 
placed immediately above the kidney, and observing no apparent con- 
nection but with that gland, have named them capsulae renales. They 
lie, then, above the kidney, are, like the kidney, surrounded with fat, 
have straggling arteries from various sources, but none regular or im- 
portant. 
First, They have, very generally, some small branches from the 
phrenic arteries. These are the highest of the capsular arteries ; they 
touch the uppermost point of this glandular body. They are named 
the upper capsular arteries. Secondly, They often have small 
arteries from the aorta peculiar to themselves, which come off about 
the root of the upper mesenteric artery, go to the fat and glands, and 
play over the vena cava, (at least those of the right side do,) and go 
to the middle parts of the gland, whence they are named capsulares 
mediae. Thirdly, They have their last arteries sent upwards to them 
from the emulgent artery, or artery of the kidney. They are named 
the lower capsular arteries. 
The two renal or emulgent arteries, the two arteries ot* the 
kidneys, go off from the sides of the aorta, midway between the upper 
and lower mesenteric arteries. Each goes to its kidney almost at a 
right angle, arching a little over the bulging belly of the psoas muscle. 
The aorta is still a little inclined to the left side, and so the left emul- 
gent is shorter, and mounts over its accompanying vein ; while the 
right kidney, being further off from the aorta, and somewhat lower, on 
account of the liver being on that side, the right artery is longer, and 
is covered by its emulgent vein. When the emulgent artery, which is 
short and very thick, arrives at the concave edge of the kidney, it is 
divided into three or four large branches, which surround the pelvis, or 
beginning of the ureter, plunge into the substance of the kidney, and 
inosculate and make arches with each other. Thus, in supplying the 
kidney within its substance, they form circles and arches over the roots 
of the papillae uriniferae. 
Before the emulgent arteries enter into the substance of the kidney, 
they usually give off small arteries, as has been already mentioned, to 
the lower part of the capsulae renales, to the upper part of the ureters, 
and to the fat surrounding the kidneys. 
ARTERLE BEN ALES. 512 
OF THE ARTERIES 
ARTERIA SPERMATICA. 
The spermatic artery, or artery of the testicle, is one of the 
most singular, both for its extreme smallness and great length, and for 
its important office. 'It arises on each side from the lateral parts of 
the aorta, a little above the lower mesenteric artery. The left sper- 
matic artery rises somewhat higher, and often comes from the emul- 
gent artery ; it descends from the aorta almost in the same line with 
itself; it crosses the vena cava, and meets its accompanying vein upon 
the surface of the psoas muscle ; it then forms the spermatic cord, and 
passes obliquely through the spermatic passage and abdominal ring; 
before it goes down into the testicle, it gives out many very small 
twigs. First, It gives small twigs to the fat of the kidneys ; secondly, 
It gives small branches to the ureters ; thirdly, Small twigs to the 
peritonaeum ; and lastly, Small twigs to nourish the spermatic cord 
itself. When it has passed through the ring, it soon after divides into 
many small arteries for the several parts of the testicle, four or five in 
number ; two of which go to the epidydimis, and two others, particu- 
larly large, go to the testicle ; the largest of these branches turns round 
the testicle in a beautiful and serpentine form, waving along the upper 
part of the testicle, viz. just under the epidydimis, and sending beauti- 
ful coronary branches downwards all over tlie semicircle or convex 
surface of the testis. 
These are the chief arteries, viz. those of the kidney and testicle. 
Those of the renal capulse 1 hold to be so irregular, that they hardly 
deserve the short description which I have given of them. The follow- 
ing classes of small and irregular arteries are equally insignificant; 
for few authors have been at the pains to enumerate the arteries going 
to the fat of the kidney ; and none (except Murray) have been at the 
pains to gather together into one class or description the trifling arte- 
ries of the ureter. 
ARTERIA3 ADIPOSA3. 
The arteries of the fat of the kidney are extremely small but 
numerous. The upper arteries come from the capsular and diaphrag- 
matic arteries which are above the kidney ; the middle arteries of the 
fat come from the renal artery itself, from the spermatic, or even from 
the aorta ; the lower arteries come from the colic arteries, and one 
from the spermatic, which comes off below the kidney, and turns up 
towards its lower end. 
ARTERLE URETERIC^. 
As the ureter is a long canal, its arteries come oil' from various 
parts which it passes. Its upper arteries are from the renal artery 
itself, before it enters the kidney ; and also from the capsulars and 
spermatics. The middle arteries of the ureter are more particular and 
more important: they arise either from the aorta itself, or from the 
iliac artery, where the ureter crosses it: and they run far both upwards UF THE PELVIS. 
513 
and downwards, along the canal. The lowest arteries of the ureter 
arise from those of the bladder itself. 
AKTEBI.E LUMBALES. 
The lumbar arteries are those which succeed to the intercostal 
arteries, and which run parallel with them ; performing the same office 
in the loins which the intercostals do in the thorax, viz. nourishing the 
spine and the muscles. 
The lumbar arteries arise from the sides of the abdominal aorta. The 
first arteries go off at right angles; the lower ones are a little inclined 
downwards. The right ones are longer, because they have to rise over 
the spine. The arteries of both sides, as soon as they have left the 
spine, sink under the psoas muscle, and go onwards behind it, round 
the side, till they terminate in the lateral muscles of the abdomen. The 
uppermost lumbar artery is large ; and as it runs along the lowest rib 
but one, it of course gives arteries both to the transverse or innermost 
muscle of the belly, and also to the diaphragm, which indigitates with 
it in consequence of their both taking their origin from the same ribs. 
The two lower lumbar arteries are small, and begin to inosculate with 
the lesser arteries about the top of the pelvis. 
Each lumbar artery gives out, like the intercostals, two chief 
arteries : 1. One which goes to the spine, and which, splitting into 
two, gives a larger twig to the vertebra itself; and a smaller one, which 
enters the sheath, lies by the nerve, and passes into the spinal marrow. 
2. A muscular branch, which is also divided ; for one branch of it sup- 
plies the psoas muscle, and then runs round within the muscles of the 
abdomen; while the other pierces the back, and supplies the sacro- 
lumbalis, longissimus dorsi, and other muscles of the loins. 
RECAPITULATION AND PLAN OF TIIE BRANCHES OF THE 
1. Arteria Phrenica Dextra. 
2. Arteria Phrenica Sinistra. 
3. Arteria Cceliaca. 
4. Arteria Mesenterica Superior. 
5. Arleria Mesenterica Inferior. 
6. Arteria Capsulares. 
7. Arteria Renalis Dextra. 
Aorta 
Abdominalis. 
8. Arteria Renalis Sinistra 
Arteria Spermatica 
Sinistra. 
9. Arteria Spermatica Dextra. 
10. Arteria Lumbales. 
11. Arteria Sacro- Media. 
12. Rami Irregulares—to the ureter, perilonaum, 4 c. 
ARTERIES OF THE PELVIS. 
The aorta divides into two great arteries, named iliac arteries. The 
two iliac arteries move downwards to the brim of the pelvis, where 
they meet the veins of the lower extremity ascending to form the cava, 
and also a vast plexus of lymphatics from the legs and pelvis, which 
twist round the arteries and veins. The two iliac veins lie upon the 
inner sides of the two arteries; and since these veins meet on the right 514 
OK THE ARTERIES 
side of the aorta to form the cava, of course the right iliac artery 
crosses the trunk of the cava. This bifurcation of the aorta is much 
higher than the pelvis; it begins upon the fourth vertebra of the loins, 
so that the abdominal aorta is short, notwithstanding the great number 
of its branches, and the iliac arteries go off at such an angle, that they 
diverge very gradually ; so that when they arrive at the top of the pelvis, 
they are just over the joining of the haunch-bone with the sacrum ; 
and it is but a very little below this again that they divide into their two 
great branches ; the one, named the external iliac, which passes 
straight forwards into the thigh ; the other, the internal iliac, which 
dives immediately down into the pelvis to supply the internal parts. 
A ETERI A SACRO MEDIA. 
The bifurcation of the aorta gives off only one artery, which pro- 
ceeds exactly from the fork; and being in the middle, it is a single or 
azygous artery, which has not a fellow. It is small, long, very regular, 
and passes down so correctly in the middle of the bone, that it is named 
the middle sacral artery. It is about the size of a crow-quill; 
passes directly over the middle of that projecting point which is named 
the promontory of the sacrum ; it descends expressly in the middle of 
the bone, quite to the point of the os coccygis. At the place of each 
vertebra, (for the sacrum consists of vertebras now united together,) it 
gives off cross branches, which go across the body of the sacrum to 
inosculate with the lateral sacral arteries. Besides these, it gives 
arteries to the substance of the bone, and not unfrequently small arteries 
to the rectum. * This artery ends near the point of the os coccygis in 
a forked or double inosculation with the lateral sacral arteries of 
each side. 
ILI AC A INTERNA. 
The internal iliac artery is of vast size ; it not only supplies air 
the parts within the pelvis, but sends out by the several openings of the 
pelvis those great arteries which supply both the private parts, and the 
immense mass of muscle which surrounds the haunch. Thence the 
necessity and the usefulness of arranging them under two classes; first, 
of the lesser arteries which go to parts within the pelvis, as to the loins, 
to the sacrum, to the bladder, and to the womb ; and, secondly, those 
larger arteries which go out through the several openings of the pelvis, 
the hips, the haunch, and the private parts. 
This artery we cannot describe in the adult, without attending to its 
condition and function in the child ; for it is that indeed which gives it 
the peculiar form which we have to describe ; and which especially 
gives it that arch downwards, from the convexity of which all the great 
branches go off. For in the child, the internal iliac or hypogastric 
artery is extremely large : first, it turns down into the pelvis with a 
large circle ; then it goes close to the side of the bladder very low into 
the pelvis; then it begins to rise again by the side of the bladder, out 
of the pelvis, and going along bv the urachus (w'hich is a tube or liga OF THE PELVIS. 
515 
ment rather leading upwards from the bottom of the bladder,) it goes 
out by the navel, forming the umbilical artery. Now this sudden turn 
by the side of the bladder makes the artery convex downwards, i. e. 
towards the parts which it has to supply. The artery keeps this same 
form in the adult; both in the child and in the adult all the great 
branches come off from the back of this arch. 
ORDER FIRST. 
THE BRANCHES OF THE HYPOGASTRIC OR INTERNAL ILIAC ARTERY. 
WHICH REMAIN WITHIN THE PELVIS- 
This artery is so named, because it so resembles the lumbar arteries 
that it might be mistaken for the last of them ; and because it belongs 
equally to the haunch-bone and to the loins. It goes off from the 
outer side of the iliac artery, about an inch below the bifurcation ; it 
is about the size of the lumbar arteries, or a little larger ; it turns in 
behind the iliac artery, and passes under the psoas muscle ; its trunk 
is short, for it splits immediately into its iliac and lumbar branches. 
The lumbar branch goes off between the last vertebra of the loins 
and the inner end of the ilium, and goes directly upwards ; it gives its 
branches about the psoas muscle. The iliaG branch setting off from 
the same point, runs straight outwards, lodges itself under the edge or 
crista ilii, and supplies the iliacus intcrnus muscle by a superficial 
branch ; and it nourishes the bone by a deeper branch, which lies 
close in the hollow of the haunch. 
I, ILEO-LUMBAI.IS. 
2. ABTERIiE SACRjE LATERALES. 
The lateral arteries of the sacrum are very generally three or 
four in number. Sometimes we find one general artery coming off from 
the iliac, or from the ileo-lumbar artery, running down all the side of 
the sacrum, and giving off the lateral sacral arteries ; but much more 
frequently we find three distinct arteries coming off from the side of 
the iliac artery, which run across the sacrum in the following manner, 
to inosculate with the middle sacral artery : First, each lateral sacral 
artery has one large branch, which runs along the fore part of the 
sacrum, runs along the naked bone, and inosculates with the middle 
sacral artery: Secondly, another branch, still larger, dives into each 
of the sacral holes, which not only nourishes the nerves, and the sheath 
of the cauda equina, and the bone itself by one branch, but penetrates 
by another branch through the posterior sacral hole, and supplies the 
periosteum, the great ligaments which join the ilium to the sacrum, 
and the root also of the sacro-lumbalis, and glutaeal muscles. From 
these two branches, (viz. to the spine and to the posterior muscles,) 
and from the regularity of these five arteries, (going from some artery 
or other into each sacral hole,) they resemble the intercostal and lum- 
bar arteries, to whose office and place they have succeeded. 516 
OF THE ARTERIES 
ARTERIA HYPOGASTRIC A. 
The hypogastric artery, or the umbilical artery, is of great size 
and importance in the child ; and even in the adult it still remains, in 
this sense at least, that though the fore part of it (where it turns up 
by the side of the bladder) is closed, even that part is still known by 
a round ligamentous substance, into which it is converted, and which 
we easily trace up to the navel, where the artery meets its fellow of 
the other side. 
This artery is even in the adult body pervious down to the side of 
the bladder, where in Man it gives one long and slender artery, some- 
times two, which go to the sides of the bladder; and in Women, 
small arteries to the womb, sometimes to the rectum ; but these 
branches are quite irregular in number and size. 
ARTERI.E VESICALES, 
The arteries of the bladder are extremely irregular both in num- 
ber and size ; for it is to be considered, that the bladdei being a round 
body placed amidst great arteries, and being itself membranous, and 
needing but few or but small branches, it gets them from various 
sources. Very generally the hypogastric, just before it closes into a 
ligament, sends one or more small arteries downwards and forwards to 
the neck of the bladder, at that part where the vesiculae seminales lie; 
and of course the vesiculae and the prostrate gland get small twigs 
from this artery of the bladder ; sometimes also the bulb of the urethra 
has a small artery from it. 
ARTERLE HA2MORRHOIDALES. 
The arteries of the rectum are all named haemorrhoidal arteries. 
The upper haemorrhoidal artery is the great branch of the lower me- 
senteric continued to the pelvis. The middle haemorrhoidal artery is 
one which sometimes comes from the hypogastric artery, but very 
often from the pudic artery, insomuch as to be reckoned among its 
regular branches. The lower, or the external haemorrhoidal artery, 
almost always is a branch of the pudic artery, or that artery which 
goes to the penis. Two great arteries, one going to the rectum and 
another to the womb, are the last which the’hypogastric gives off before 
it degenerates into a ligament. 
ARTERIA IU3MORRHOIDEA MEDIA. 
The middle haemorrhoidal artery is not a large branch. Often we 
do not find it, but other arteries supplying its place : sometimes again 
it is so large as to give off both the uterine and the lateral sacral arte- 
ries ; but in general it is small. It comes off from the hypogastric 
opposite to the glutaeal artery (presently to be described); it touches 
the rectum below its middle, and descends curling and winding chiefly OF THE PELVIS. 
517 
along its fore part quite to the anus ; and often it gives, as it runs be- 
tween the rectum and bladder, arteries to the bladder, prostrate gland, 
and vesiculae seminales. It is this artery also which in women gives 
small branches to the vagina. 
ARTERIA- UTERITVA. 
The womb has four arteries, two from each side; the uppermost 
that which enters by the upper corners of the womb, comes from the 
aorta, corresponds with the spermatic in Man, runs along the broad 
ligament towards the ovaria. The lower artery of the womb, and the 
largest, comes from the hypogastric, enters the womb, where it is con- 
nected with the vagina, and runs upwards along the sides of the womb 
to meet the spermatic; and it sends also at the same time branches 
downwards into the vagina, and forwards upon the bladder, where it 
adheres to this part of the womb. 
This uterine artery arises from the hypogastric near the origin of 
the haemorrhoidal artery ; and when it enters the womb it becomes 
very tortuous. 
These, then, are the chief arteries of the rectum, bladder, womb, 
vesiculae seminales, and other parts within the pelvis. 
ORDER SECOND. 
OF THE ARTERIES WHICH OO OUT FROM THE PELVIS TO THE HAUNCHES, 
HIPS, AND PRIVATE PARTS. 
In this second class or order there are just four great arteries; one 
which goes over the back of the haunch-bone to the glutaeal muscle, 
named Glutseal artery ; one going downwards over the tuber ischii to 
the hip, named the Ischiatic artery ; one which goes out of the pelvis, 
returns into it again, and passes out a second time by the root of the 
penis, named the Pudic artery ; and one which passes out through the 
thyroid hole into the deep muscles at the top of the thigh, named 
Obturator artery. All these larger arteries go off from the convex of 
that arch which the hypogastric forms, and move backwards and 
downwards, in order to escape from the pelvis. 
Let it be remembered, that the iliac artery forks just at the meeting 
of the ilium and sacrum; that the great sacro-sciatic notch is formed 
by this joining of the ilium and sacrum, and is just under the junction 
of these two bones : that the glutaeal artery passes out by this sacro- 
sciatic hole ; and that of course it is the first, as well as the greatest, 
of those three arteries which turn backwards out of the pelvis. 
ARTERIA GtCTjBA. 
The glutjeal artery goes off from the internal iliac immediately 
after the lateral sacral arteries. It is exceedingly large, thick, and 
short, within the pelvis, for it immediately turns over the bone : the 
turn which it makes over the naked bone is backwards and upwards ; 518 
OF THF. ARTERIES 
it instantly divides itself into a great leash of vessels, which spread in 
every direction, supply the two glutaeal muscles, and turn and ramify 
upon the back of the haunch-bone, just as the great scapular arteries 
play over the surface of the scapula. 
The pyriform muscle goes out from the pelvis at the same great 
opening with the glutaeal artery, and the artery is accompanied by some 
of the roots of the great sciatic nerve : the artery passes out over the 
pyriform muscle, between it and the bone; and when the glutaeal artery 
is to give out its branches, it splits into two great branches at the edge 
of the glutaeus medius muscle. By this splitting, the glutaeal artery 
is arranged thus: First, one great branch passes under the glutaeus 
medius, of consequence it is naked upon the back of the ilium; it 
sends one large and beautiful artery, which courses round the bone ac- 
cording to the line of the crista ilii, which supplies all the upper half 
of the haunch bone with its nutritious arteries, and supplies of course 
all the upper half of the great or outermost glutaeal muscle where it 
arises from the spine and dorsum of the ilium. Another large bunch, 
still belonging to this deeper artery, passes under the thickest part of 
the belly of the glutaeus medius, lies upon the small fan-like muscle 
named glutaeus minimus, and gives innumerable great branches to the 
middle and lesser glutaei muscles, and to the joint of the thigh-bone. 
The other great branch of the glutaeal artery slips in between the 
glutaeus major and the glutaeus medius ; and as it lies between these 
two great muscles, it gives a prodigious number of branches to each, 
but chiefly to the great glutaeal muscle. 
ARTERIA ISCHIATICA. 
The sciatic artery is so named, because, instead of going up- 
wards with this crooked turn towards the haunch, it goes obliquely 
downwards to the hip, in the direction of the main artery from which 
it comes. It comes off from the iliac about an inch lower than the 
glutaeal, and is next to it in size, almost equal, when (as it often hap- 
pens) the pudic artery is derived from it. The glutaeal artery should 
be contrasted with it thus : the glutaeal goes out above the pyriform 
muscle ; the sciatic goes out below it; the glutaeal turns upwards over 
the haunch-bone, the sciatic turns downwards along the hip ; the 
glutaeal spreads its arteries wide with sudden and crooked angles; the 
sciatic sends its arteries downwards in a gentle waving form, or almost 
straight, and so numerous as to be compared with a lash of many thongs 
proceeding from one shaft. 
Often the glutaeal artery, before it passes out of the pelvis, gives 
small twigs to the rectum, to the bone, and to the pyriform muscle ; 
and in like manner the ischiatic, before it escapes from the pelvis, gives 
also trivial branches to the rectum, and to the pyramidal muscle. 
The branches of so great an artery, ramifying merely among muscles, 
and among such a vast variety of muscles, can neither be named, nor are 
worth naming. All that is to be desired is, to know the trunk, and the 
general direction in which its greater branches go. Among these 
branches there are few remarkable. OF THE PELVIS. 
519 
Virst, The coccygeal artery turns quick backwards upon the 
sciatic ligaments, and lying under the glutseus magnus ; and passing 
along by the direction of the ligament, it arises at that part of the 
sacrum whence the ligament takes its rise; and turning downwards 
upon the coccyx, and upwards upon the back of the sacrum, it inoscu- 
lates with the sacral arteries through the posterior holes. Secondly, 
Another branch, more remarkable for its office than its size, runs down- 
wards along the sciatic nerve, supplying its coats and substance. But 
the great branch of this artery sends a confused lash of arteries down- 
wards, which give arteries, first to the glutasal muscles and pyriformis, 
and then downwards to all those muscles of the back of the thigh which 
arise about the knob or tuber of the ischium. In short, all its chief 
branches are muscular ; and the artery is remarkable for no other 
peculiarity than this, that its inosculations downwards with the reflected 
arteries of the thigh are so frequent, that those alone may save the 
limb in wounds of the femoral artery above its profunda, or that great 
branch which belongs to the thigh. 
The common pudic artery,* or the artery of the external parts of 
generation, is the third great artery which goes out from the pelvis back- 
wards. And there is in the course of this artery a peculiarity which is never 
fully explained ; and being unexplained, makes the succeeding descrip- 
tion quite defective and lame : and it is this. The pudic artery (which is 
nearly of the size of a writing quill) usually comes off as a branch 
from the sciatic artery : it goes out from the pelvis along with the 
sciatic artery through the lower part of the sciatic notch, under the 
lower edge of the pyriform muscles, over the upper sacro-sciatic liga- 
ment. But no sooner has it made its appearance along with the sciatic 
artery, and emerged from the pelvis, than it returns into the pelvis 
again : it does not go over the outside of the tuber ischii, and so down 
to the perinajum; but it just appears out of the pelvis, rises over the 
upper sacro-sciatic ligament, gives out a few branches, turns in again 
under the lower sacro-sciatic ligament, or rather under the spine or 
sharp ridge of the tuber ischii, whence that ligament arises : it is now 
within the pelvis again ; it lies flat against the inner surface of the 
ischium ; it runs along by the direction of that bone till it approaches 
the symphysis pubis, where the root of the penis is. It there dives 
into the root of the penis, having just before given off that branch 
which goes to the perinaeum. It is this long artery running naked 
and unprotected along the whole inner side of the ischium, bending 
as the arch of the ischium and pubis bends, that is cut by ignorant 
lithotomists, which a broad gorget is sure to wound, and which can be 
safe only by our exchanging the gorget for the knife. 
The branches of the pudic artery are chiefly these : First, Before it 
proceeds out of the pelvis, it usually sends branches inwards to the 
neck of the bladder, vesiculae seminales, and prostate gland. Secondly, 
When it emerges from the pelvis, and while bending over the sacro- 
ARTERIA PUDICA COMMXTNIS. 
* It is named often the circumflex pudic artery, the internal pudic artery, the middle 
p»idlc artery, the spreat pudic artery. 520 
OF THE ARTERIES 
sciatic ligament, it gives, like the sciatic artery, chielly muscular 
branches : it gives twigs to the sacro-sciatic ligament and pyriform 
muscle : others go to the gemini muscles, and turn oyer them to the 
great trochanter, and to the hip-joint, reaching as far as the acetabulum; 
others spread over the tuber ischii, to which they give arteries, which 
go outwards along the three muscles of the thigh which arise from tliis 
point; and it sends inwards from this part an artery which encircles the 
verge of the anus, and belongs to the sphincter and levator ani mus- 
cles. This branch is named the lower or external hemorrhoidal 
artery ; and other branches it sends forwards into the perinaeum ; 
but these are smaller and less regular arteries : they are not what are 
distinguished by the peculiar name of perinaeal arteries. This artery, 
like the ischiatic, ends every where in inosculations with the reflected 
arteries of the thigh. 
Thirdly, The artery returning again into the pelvis, and running along 
under the flat internal surface of the ischium, gives off many small 
branches to the bladder, prostate gland, vesiculae seminales, and rec- 
tum. But when it has reached the perinaeum, and is about to emerge 
from the pelvis a second time, and go into the root of the penis, it 
gives out three chief arteries ; one to the perinaeum, one to the body 
of the penis, one to the back of the penis, thus : 
When the artery has approached nearly to the musculus transversalis 
perinsei, it splits into two branches; one of which is the artery of the 
perineum, the other is the proper artery of the penis. 
The artery of the perineum passes under the tranversalis perinaei 
and between the accelerator and erector penis ; in short, it comes out 
from that triangular cavity which we cut into in lithotomy ; in which 
operation of course this branch cannot escape. The artery having 
escaped from this triangular cavity, runs forward along the perinaeum 
for two or three inches, according to the size of the subject, growing 
very sensibly smaller as it goes along. It is chiefly for supplying the 
skin and muscles of the perinaeum; and gives these branches : 1. When 
it has just come out from the triangular hollow, it gives off from its 
root one branch at right angles, which goes directly across the peri- 
nasum; it keeps the course of the transverse muscle ; it may be named 
arteria transversalis ferinei, and ends about the sphincter ani. 
2. It gives branches to the accelerator and erector muscles. 3. It 
gives branches to the scrotum ; and being continued along the corpus 
cavernosum of each side, it ends upon the tendinous sheath, which 
binds the corpora cavernosa. Thus ends the perinaeal artery. 
ARTEUIA PERINEI. 
The proper arterv of the penis is the continued trunk of the 
pudic artery. It is much larger than this perinaeal branch ; is as 
big as a crow-quill; it keeps still close to the bone, while the perinaeal 
artery goes outwards; it at last touches the symphysis pubis, and of 
course pierces the corpus cavernosum. just where it takes its rise from 
ARTERIA PENIS. OF THE PELVIS. 
521 
the leg of the pubis : and here it splits into two great branches ; one 
to the corpus cavernosum, and one to the back of the penis, or rather 
into three, since there is one also for the bulb of the urethra. 
The bulb of the urethra is quite insulated in the perinaeum, while 
the corpora cavernosa arise from the bone. Now, first, as the artery 
of the penis is passing by the side of the bulb, it gives off an artery to 
the bulb sidewise, which in part plunges into the bulbous substance, 
and in part is scattered upon the accelerator, prost i e gland, &,c. 
Secondly, the artery having risen to the place where the root of the 
corpus cavernosum is, gives off that artery, which runs small and deli- 
cate along all the back of the penis, till it ends at last in a branch 
which encircles the corona glandis. This is named the arteria dor- 
salis penis. 
Thirdly, The artery now plunges deep into the proper substance of 
the penis; the artery of each side goes into each corpus cavernosum 
at its root, and splits into two branches ; these run chiefly along the 
septum, or partition between the corpora cavernosa, of each side. It 
is this artery which pours out blood so freely into the cells of the 
penis, and causes erection. 
These three, the glutaeal, the sciatic, and the pudic arteries, are the 
only ones whieh go out from the pelvis behind, and one only goes out 
by an opening on its fore part, or rather its lower part, viz. the obtu- 
rator artery. 
ARTEKIA OBTURATORIA. 
The obturator artery is so named from its passing through the 
thyroid hole. No artery is less regular in its origin ; arising some- 
times from the iliac, sometimes from the hypogastric, and not unfre- 
quently from the root of the epigastric artery : in which case it turns 
back again over the pubis, coming into the pelvis behind the ring. 
But no artery is more regular in its destination ; a considerable artery 
always passes through the thyroid hole, to supply the muscles which 
take their origin from the membrane, and from the ramus of the os 
pubis. 
The obturator artery, arising from the iliac or hypogastric, runs 
along the upper edge of the pelvis, by the lower edge of the psoas 
muscle, accompanied with the obturator nerve, which is to go through 
the hole along with it. Having arrived at the fore part of the pelvis, 
it slips through the oval hole by a very smad opening, which is in the 
upper part of the tendinous membrane, which closes that hole, and 
which is consequently at the upper edge of the obturator internus 
muscle. The artery, before it passes out of the pelvis, often gives 
branches of considerable size downwards to the neck of the bladder, 
prostate gland, and vesiculae ; to the iliacus internus, and psoas mus- 
cles, and to the lymphatic glands which lie upon them ; and there is 
always a branch, which encircles the upper part of the foramen thy- 
roideum, lies close upon the bone, and gives its twigs upwards into the 
muscles of the belly. 
After the artery has passed along with its nerve through the thyroid 522 
OF THE ARTERIES 
hole, it comes into the very heart or central part of the thigh. Almost 
all its branches are muscular ; none are worth distinguishing by name ; 
it is only the general tendency of the artery that needs to be explained. 
It divides into two chief branches, taking opposite directions. The 
first is deeper ; it turns downwards and outwards towards the hip-joint. 
It performs three services here ; it gives, first, arteries to the perios- 
teum, to the capsule, and to the gland within the acetabulum ; it gives 
also large branches to the obturator, quadratus femoris, and all the 
great muscles which immediately surround the joint; it also forms very 
large and important anastomoses round the joint, with the sciatic and 
pudic arteries, from the pelvis, and with the reflected arteries from the 
thigh. 
The more superficial branch of the thyroid sends all its branches 
into the great muscles upon the inner side of the thigh coming from 
the pubis. Its chief branches are to the upper part of the triceps 
muscle; it sometimes gives branches even to the superficial muscles, 
as the gracilis and sartorius; always, at least, small twigs pass through 
these muscles to the skin of the thigh and to the scrotum. Of these 
two arteries, this superficial one encircles the inner edge of the thyroid 
hole, or that which is next to the pubis, with one of its branches; 
while the deeper artery encircles the outer edge, or that which is next 
to the hip-joint; so that they meet upon the bone inosculating with 
each other. 
The following is a very common order of the branches of the 
1. Arleria Ilio-lumbalis. 
2. Arteria Sacra Laterales. 
3. Arteria Hypogastrica. 
4. Arteria Obturatoria. 
5. Arteria Glutcea. 
6. Arteria Ischiatica. 
7. Arteria Pvdica Communis. 
Arteria Imaca 
Interna. 
ARTERIES OF THE LOWER EXTREMITY . 
ILIACA EXTERNA. 
The external iliac artery is that branch of the common iliac 
which descends under Poupart’s ligament into the thigh. The internal 
iliac or artery of the pelvis parts from this within the pelvis at the 
joining of the ilium and sacrum. The external iliac passes down into 
the thigh, not bending aV>ng the upper edge or brim of the pelvis, 
directed by the lower edge of the psoas muscle, which also descends 
into the thigh. This great artory is accompanied by the anterior cru- 
ral nerve ; its corresponding vein lies by the side of it; the lymphatics 
of the thigh creep upwards along this artery into the pelvis ; and when 
the artery descends into the thigh, it passes so over the bulging part 
of the acetabulum and head of the thigh-bone, that it is felt projecting 
♦here and beating with amazing force. OF THF. LOWER EXTREMITY 
523 
AKTERIA EPIGASTRIC-!. 
The epigastric artery, so named from its running up along the 
belly, goes off from the inner side of the external iliac artery about an 
inch before it passes out into the thigh. 
The epigastric, when first given off, turns downwards with a full 
round turn till it touches Poupart’s ligament. The peculiarity of its 
course here must be very carefully attended to. The femoral artery 
lies at the very outer margin* of the opening, called the crural arch. 
The Fallopian ligament forms the upper line of the crural arch. The 
epigastric artery moves inwards and downwards with the Fallopian 
ligament, running along its lower edge ; then it crosses the open- 
ing called the abdominal ring, behind the ring, and also behind the 
spermatic cord which passes through the ring; then it mounts by the 
border of the transverse muscle, and gets to the rectus muscle of the 
belly ; but it is pretty high before it touches the side of the rectus, and 
lying on the outside of the peritonaeum, and on the inner surface of the 
rectus muscle, and keeping in the direct line of the rectus muscle near 
its centre, or rather nearer the outer edge of the muscle, and inclining 
inwards, it mounts from the groin to a little below the borders of the 
thorax, where it inosculates very freely with the internal mammary 
artery. These are the inosculations which were mentioned in speaking 
of the internal mammary artery. Through its whole course this artery 
is so large as to make its wounds important; we should know where 
to stop it in wounds ; we should remember to avoid it in opening or 
extirpating tumours. I have seen some confusion and much loss of 
time during an operation, from not attending to this. The main artery 
must be remembered : its branches are of little value. The only 
branches which it is at all necessary to mention are, first, one small 
twig, which it sends downwards along the spermatic cord ; soon after 
entering under the abdominal muscle, it gives off a large branch almost 
equal to the artery itself, which goes directly towards the navel, and 
ends there. This branch goes obliquely across the muscle, while the 
main artery follows the general line of the muscle, and gives branches 
on every side to the rectus, transversalis, obliquus; in short, to all the 
muscles of the abdomen, and spreads its last branches very freely about 
the lower border of the chest. 
ARTERIA CTRCUMI'LEXA ILII. 
The cikgtmelex arterv of the haunch is named circumflexa 
from its turning directly backwards, and ilium from its passing along 
the hollow of the haunch-bone. 
It is smaller than a crow-quill; it goes off from the outside of tho 
external iliac artery opposite to the epigastric, or rather a little lower; 
exactly at that point where the outer end of the Fallopian ligament 
begins in the haunch-bone. It runs backwards in a curved line along 
the hollow of the haunch-bone, curving along the crista ilii, or ridge 
* Viz. that end of the slit or arch which is nearest to the haunch-bone. 524 
CRURAL ARTERY. 
of the ilium, under which it lies. Its line is along the most naked part 
of the bone, where the internal iliac muscle begins on one hand, and 
the transverse muscle of the belly on the other: in short, it runs along 
all the upper edge of the internal iliac muscle, quite round almost to 
the lumbar spine, where it joins the ileo-lumbar artery by small inoscu- 
lations ; for at this place the reflected iliac artery, which grows gradu- 
ally and sensibly smaller, is almost spent. There are no remarkable 
branches which deserve to be described, or even to be named, unless it 
be one which goes off early, near the head of Poupart’s ligament, and 
gives branches to the ligament, to the sartorious muscle which arises 
at the same point of the haunch-bone, and to the edge of the iliac 
muscle. And as it runs along between the iliac muscle on the one 
hand, and the transverse of the belly on the other, it gives many 
branches downwards to the internal iliac anti psoas muscles, and to the 
substance of the bone ; and upwards it gives three or four branches 
into the abdominal muscles, which go so far along the belly as to inos- 
culate with all its other arteries. 
THE CRURAL ARTERY. 
The projection of that part, of the great artery which is very often called 
the femoral artery, hut with more propriety the crural artery, is occa- 
sioned not merely by the naked pelvis and the head of the femur ; 
these parts are covered by the flesh and tendons of the psoas magnus 
and iliacus internus, which also come out from the pelvis to the thigh. 
The artery lies cushioned upon these muscles ; the muscles dive very 
deep to get at the trochanter minor or inner trochanter of the thigh- 
bone. The artery follows them ; and thus it is plunged as it were into 
a deep cavity, assumes a new position, and this constitutes a second 
point of description. 
The hollow in which the artery now lies may be compared with 
that of the bend of the arm. The artery now takes the name of 
femoral, lies deep in a hollow surrounded by much fat and many glands ; 
the cavity is covered with a very strong fascia, or tendinous sheath, 
which descends from the muscles of the belly over Poupart’s ligament, 
and which is greatly strengthened at this point bv the general fascia 
of the thigh. Here the femoral artery, instead of sending off less 
effectual branches from point to point as it moves downwards, and 
which could not have conveniently penetrated through all the thickness 
of the thigh, sends off one great branch, which furnishes the thigh, 
whence it is named the muscular artery of the thigh. This great 
artery goes off from the femoral artery just like the ulnar from the 
artery at the bend of the arm, i. e. very deep among the muscles, in 
the triangular cavity above described. Thence it is oftener named 
profunda than muscular artery. 
The artery having sent down this great branch, equal almost to 
itself in size, is now properly the femoral artery (arteria superficialis 
femoris) : and now it inclines outwards again, meets the inclined line 
of the sartorius, and passes obliquely under it, and is covered by it and 
by the fascia. It is felt beating along the line of the sartorious muscle : CRURAL ARTERi. 
525 
and by that line wq apply the cushion of our tourniquet, it retires 
from our feeling only about two hands’ breadth, or a little more, above 
the joint of the knee ; at which place it perforates the triceps or great 
muscle of the thigh, gets from the fore to the back part, or, in other 
words, forsakes the thigh to go down behind into the ham, where it 
exchanges its name for that ot popliteal artery 
The popliteal artery, when it has got into the ham, meets with its 
corresponding nerve, which is of vast size ; and the artery lies now flat 
upon the back part of the thigh-bone, passes down in a hollow formed 
between its great condyles, lies flat upon all the back of the knee- 
joint, is enclosed by the two great ham-string muscles from above, 
and by the two great heads of the gastrocnemii muscles below. But 
although we say it is protected, yet in truth it is not tightly bound 
down by a fascia embracing it, but lies on the contrary so loose and 
unsupported among the cellular substance, that we have the most 
certain evidence of its being often racked and strained in sudden or 
awkward motions of the joint. 
From the ham, the artery descends into the leg, under the heads of 
the gastrocnemii muscles ; and being lodged behind the great bulging, 
or head of the tibia, below the joint, it there divides into three great 
arteries. One passing down behind the tibia is named posterior tibial 
artery ; one perforating the interosseous membrane goes down along 
the fore part of the tibia, is named tibialis antica; the third artery, 
passing down behind the fibula, is named the fibuiar or peronseal artery. 
These may be justly compared with the three arteries of the fore-arm ; 
and as those meet in arches upon the palm of the hand, these meet 
and form similar arches on the sole of the foot. 
In short, to enumerate the variety of accidents which may affect 
this artery, would be impossible; but surely, from the little that 1 dare 
venture to say in this place, it must seem one of the largest, the most 
exposed, and most dangerous, and by all this the most important artery 
in the body; and from these previous hints and general descriptions, the 
value of the several branches which are now to be enumerated will 
be more easily felt and understood. 
BRANCHES OF THE CRURAL ARTERY. 
The great crural artery, until it gets down into the hollow which I 
have described, gives no branches, or none with which I would choose 
to confound the description of the profunda or great artery of the 
thigh. The crural artery between the point where it comes out from 
under the Poupart ligament, and where it sends off the profunda ferno- 
ris, gives out several small arteries : 
1. Rami Inguinales. 
2. Ramus Major. 
3. Arteria Pudenda Externa. 
4 Arteria Circumflexa Externa. 
5. Arteria Profunda. 
Arteria 
Cruralis. 
First, Twigs go out along the femoral ligament, and terminate in the 
skin. Secondly, Twigs go to the fat., and lymphatic glands of the 526 
BRANCHES OF THE 
groin. Thirdly, There ascends a small branch, sometimes towards 
the origin of the sartorius, to the middle glutasal muscles, and to the 
beginning of the fascia lata. Fourthly, Of those branches which go 
across the upper part of the thigh to the genitals, and which are named 
pumCiE extern.®, to distinguish their branches from fliose of the 
pudica communis, there are usually three. The uppermost is scattered 
about the fat of the pubis. The middle one goes across the heads of 
the triceps ; it is longer and larger than the others ; it goes to the side 
of the scrotum and penis in Men ; in. Women it is large, and runs 
into the labium pudendi. The lower one of the three goes to the 
lower parts of the scrotum, and to the skin of the thigh near it. 
ARTERIA frofunda femokis. 
Then conies off the profunda femoris, the deep or muscular ar- 
tery of the thigh. It arises from the femoral artery about four 
inches below the groin, more or less, according to the size of the sub- 
ject. It turns off from the femoral artery with a bulging, which looks 
backwards and towards the outside of the thigh. It lies deep in the 
triangular cavity, upon the face of the iliacus interims and pectinalis 
muscles. It presently gives off two great arteries, which turn upwards 
along the joint; one round the outer side, the other round the inner 
side, of the joint. Then it passes downwards, turns in behind the 
femoral artery, sinking deeper and deeper towards the back parts of 
the thigh. It passes down along the face of the triceps muscle ; and as 
it moves along its fore part, it sends through three or four great arteries to 
the back part, which are called the perforating arteries of the thigh. And, 
lastly, the profunda itself, or its last branch, passes through the triceps ; 
and this last branch is named perforans ultima vel descendens femoris. 
ARTERIA CIRCUMFLEX A EXTERN A. 
The circumflex artery, which goes to the outside of the hip-joint, 
proceeds from the very highest point of the profunda. It takes its 
course outwards, passing under the sartorois, fascialis, and head of 
the rectus: it runs over the tendinous head of the vastus externus, 
where that muscle takes its rise from the outer trochanter : it divides 
very early into the following branches. First, Branches go to the inner 
sides, to the internal iliac muscle, upon which this artery lies ; and 
round it they bend over the lesser trochanter, making inosculations 
with the internal circumflex artery. Secondly, An artery goes in the 
opposite direction, viz. outwards to the iliac muscle, the sartorius, the 
head of the rectus, the fascialis, and round to the glutasal muscles. 
Thirdly, It sends many lesser branches upwards and forwards into the 
heads of those muscles which 1 have just enumerated, and which lie 
immediately over the artery. Fourthly, It sends large branches round 
the root of the great trochanter, some of them going into the hollow 
above the trochanter; others keeping so low as the root of the tro- 
chanter, where the greater glutreus is inserted. Fifthly, The most im- 
portant of all its branches is a very long one. which it sends directly CRURAL ARTERY. 
527 
downwards under the rectus, or between it and the vastus internus mus- 
cle. This artery is divided into two great branches, which run down 
the whole length of the thigh, somewhat resembling in their shape the 
profunda humeri : they are named the greater and lesser descending 
branches of the circumflex artery, and they inosculate in a most par- 
ticular manner with a large anastomosing branch from the femoral 
artery. The larger branch of this artery emerges from between the 
rectus and vastus externus, a little above the knee, to inosculate with 
one of the articular arteries of the knee. Its smallest branch inoscu- 
lates with the anastomosing branch of the femoral artery. These two 
anastomoses seem to be the chief use of these two long arteries, though 
they do also send some branches to the muscles. 
But to give a more simple notion of this circumflex artery, it should 
be described thus. It is divided into three chief branches: 1st, A 
descending branch, which goes down to the knee-joint; 2d, A trans- 
verse branch, which crosses the upper part of the thigh, and turns 
round the neck of the thigh-bone ; 3dly, It sends a less important 
branch up upon the dorsum ilii. 
ARTERIA CIRCUMFLEX A JNTERNA. 
The internal CIRCUMFLEX artery is a thick short artery, which 
goes off opposite to the ball of the thigh-bone ; and as the external 
one goes round the great trochanter, this goes round the lesser tro- 
chanter. It is a smaller artery ; it has not so many muscular branches: 
it keeps closer to the joint: it goes off from the inner side of the 
profunda, just opposite to the circumflexa externa, or a little lower, 
but never more than an inch lower; it passes over the insertion of the 
psoas muscle, and under the belly of the pectinalis ; it attaches itself 
then to the lesser or inner trochanter, and goes round the neck of the 
thigh-bone round the joint, and is expended on the muscles at the back 
of the joint, as the quadratus femoris, gem ini, &c. 
The artery having turned towards the inside, the muscles which lie 
there are the triceps, gracilis, &c. The first branches, therefore, 
which this artery gives off before it passes under the pectinalis, are to 
the triceps and gracilis. After having passed under the pectinalis, and 
while it is turning round the root of the lesser trochanter, it gives 
branches to the pectinalis and triceps ; and especially it gives to the 
capsular ligament of the hip-joint an artery which is named articularis 
acetabuli. 
The artery now lying upon the pelvis, under the neck of the thigh- 
bone, divides itself into two chief arteries ; one goes upwards and 
forwards along the triceps, till it ends at last round the symphysis 
pubis. The chief muscular twigs of this branch are given to the 
triceps, and to the obturator muscles ; it is this branch which inosculates 
so freely with the branches of the obturator artery ; it is a twig of 
this artery which enters into the cavity of the hip-joint, by that breach 
which is in the inner edge of the acetabulum ; and this branch enter- 
ing then by its proper hole, goes to the gland in tiie bottom of the 
socket, or chiefly to it. The other branch turns away in the opposite 528 
Of THE PROFUNDA. 
direction, viz. backwards between the little and the great 
turning round the neck of the thigh-bone. It gives branches also to 
the triceps and obturator, inosculating with the obturator artery. But 
its chief branches are towards the other side, as to the capsule of the 
hip-joint, to the neck of the thigh-bone, to the quadratus temoris. It 
is this artery which gives most of those branches about the roots of 
its trochanters named trochanteric arteries; and it is from this artery 
that many branches go backwards along the tuber ischii, to unite with 
those of the sciatic and pudic arteries. 
OF THE PERFORATING ARTERIES. 
The two first perforating arteries are very large ; the two next per- 
forating arteries are smaller and less regular; the fifth perforating artery 
is just the termination of the profunda. But still it must be understood, 
that these perforating arteries are extremely irregular in place, size, and 
number, as indeed all muscular arteries must be ; and that there are 
besides the greater perforating arteries many like them in this part of 
the thigh, though not distinguished by name. 
ARTERIA PE RIO RAIS'S PRIM A. 
The first perforating artery is the largest branch of the pro- 
funda, bigger than both the articular arteries joined. It arises from 
the profunda, just under the lesser trochanter, between the pectinalis 
and triceps brevis ; and perforates the triceps about an inch below the 
trochanter, and close upon the thigh-bone. Here the artery lies under 
the lower edge of the glutaeus, and close by the origin of the biceps, 
semi-tendinosus and semi-membranosus muscles, the three muscles 
which form the hamstrings ; and the chief division of the artery is into 
one great branch, going upwards along the glutaeus, and another going 
downwards along the flexor muscles. First, The artery which goes 
upwards turns over the glutaeus, spreads innumerable branches about 
the great trochanter ; and meeting with the trochanteric branches of 
the arteriae reflexae, make a most beautiful inosculation, or rather net- 
work of inosculations, over the trochanter. Another transverse branch 
of this upper artery turns quite round the lower part of the trochanter, 
and round the thigh, among the flesh of the vastus internus ; and a 
third branch of the same artery meets in inosculation with the lower 
branches of the sciatic artery. 
The lower or descending branch of the perforans prima goes down 
along the three flexor muscles of the leg, viz. the biceps, semitendi- 
nosus, and semi-membranosus ; nourishes their fleshy bellies, and plays 
over their surface in beautiful net-work. 
ARTERIA PERFORANS SECUNDA MAGNA. 
The second or great perforating artery is a much larger and 
more important branch of the profunda than this first, at least it is so 
when the other perforating branches are wanting, and when this, a? OF THE PROFUNDA. 
529 
often happens, represents the continued trunk of the artery : but I 
shall describe it as a second perforating artery to be succeeded by 
others.* The second perforating artery, comes off from the profunda, 
about two inches lower than the first; it passes through between the 
first and second heads of tire triceps, or through the flesh of the second; 
and turning obliquely downwards and backwards, close by the thigh- 
bone, it passes into the cellular interstice between the flexor muscles 
of the opposite sides, i. e. between the bellies of the hamstring mus- 
cles, and ends there. 
Before it passes through the triceps, it gives branches to the triceps 
and vastus, and to the great trochanter, and to the thigh-bone. Its 
two chief branches, after it perforates the triceps, are, first, one great 
transverse branch, which goes directly across below the tendon of the 
glutasus, and gives one great branch up upon the glutaeus, and another 
to the vastus externu3, making inosculations with the reflected arteries 
of the joint. Secondly, Its descending branch goes down in the hol- 
low between the great hamstring muscles, and its branches go into 
both muscles, but chiefly into the biceps, and in these the artery is 
exhausted. 
ARTEKIA PERFORANS TEliTlA. 
The third perforating artery comes off about a finger’s breadth 
lower than the former; it makes a gentle waving turn inwards before 
it pierces the triceps ; and after having perforated the triceps, it gives 
its branches to both the hamstring muscles, but chiefly to the semi- 
tendinosus. 
ARTERIA PERFOKANS QUARTA. 
The fourth perforating artery may be regarded as the last, of 
as the termination of the profunda, though sometimes there is a fifth. 
It perforates again still lower, about a finger’s breadth below the last, 
through the flesh of the triceps magnus. Its first branch, while on the 
fore part of the triceps, is the nutritia magna femoris, or proper nutri- 
tious artery of the thigh-bone ; and after it perforates the triceps, it 
gives its arteries to the two hamstring muscles, but more especially to 
the biceps; and so this last branch of the profunda ends. 
But this minute description of any important set of arteries never 
presents any clear idea to the reader’s mind, nor any knowledge which 
he can easily retain ; I expect rather to do so by one short description. 
The title of perforating arteries in one which comprehends all 
the great muscular branches of the profunda, except the two circum- 
flex arteries belonging to the joint. They vary in number, as all mus- 
cular branches must do, and are proportioned in size and number to 
the bulk of the thigh. The profunda passes down along the fore part 
of the triceps, while it is giving off' these arteries ; they must, of 
course, perforate the triceps before they can get to the back part of the 
* My reason for saying this is, that sometimes there are but two perforating arteries, 
While there are often five which, need to be described, 530 
OF THE FEMORAL ARTERY. 
thigh. When they do perforate, they come into a great muscular in- 
terstice or hollow which is formed by the hamstring muscles of oppo- 
site sides, by the biceps on one side, and by the semi-membranosus 
and serni-tendinosus on the other. It is to these two great muscles of 
the back part of the thigh that the branches of all the perforating arte- 
ries are chiefly directed. Each perforating artery succeeds another 
at about the distance of an inch or more ; each successively coming 
out into this interstice at a lower and lower point. Each artery gives 
branches to the triceps, &c. before it perforates, and to the hamstring 
muscles, &,c. after it has come into the hollow. The two first per- 
forating arteries are the only arteries which are large and absolutely 
certain ; the third is always very much smaller ; the fourth is generally 
the termination of this great artery ; the fifth perforating artery is rare. 
Such a general idea as this of their size and value, and situation in 
the very heart or deepest part of the thigh, (for the profunda turns 
backwards from the very first, and all its branches keep the same di- 
rection,) is of more importance than a particular knowledge of every 
branch of each perforating artery ; a thing really unattainable, since 
they vary more in their ultimate branches than almost any other ar- 
teries in the whole body ; for they have more space, and a greater 
mass of irregular muscle to wander in, and produce varieties. 
ARTERIA FEMORA LIS. 
Though the profunda is plainly the artery of the thigh, yet from the 
ignorance of anatomists and surgeons, (who never knew till about 
twenty years ago that there was more than one great artery,) the su- 
perficial artery lias been named the artery of the thigh. 
The femoral artery makes a spiral or serpentine turn round the 
whole thigh. It appears first on the fore part; it turns obliquely round 
to the inner side, following the lower edge of the sartorius muscle ; it. 
passes through tiie triceps, after it has got about two-thirds down the 
thigh, by which it gets into the ham, and its spiral turn is completed. 
It lies deep where it is giving off the profunda; it rises then, and is 
Superficial all along the middle of the thigh ; and when it has ad- 
vanced two-thirds down the thigh, it again gets too deep to be felt; 
but all along it is covered by the thick strong fascia of the thigh. 
Through the whole of this course it gives no one branch out that is of 
any considerable importance. They are all muscular arteries, very 
small, nearly of one size, nameless, and undistinguished, going into 
the muscles of the fore part of the thigh ; or if any are distinguished, 
it is only by their relation to other arteries, when the trunk gets low 
enough to make anastomoses with the arteries of the joint. 
The nameless muscular branches of the femoral artery go, in one 
word, to all the muscles on the fore part of the thigh ; to the rectus, 
sartorius, vasti, gracilis, and triceps ; to the glands, fascia, fat and skin ; 
and it thus continues giving successive branches to each of these long 
muscles as it passes the several points of them. 
There is no distinguished branch till, having arrived within two 
hands’ breadth of the knee-joint, it. gives out, (just where it. is about OF THE POPLITEAL ARTERY. 
531 
U> pass through the tendon of the triceps,) a larger branch named 
(like a similar branch of the humeral artery) ramus anastomoticus 
MAGNUS. 
This branch goes out from the inner side of the femoral artery just 
where it is about to perforate the triceps ; it passes into the flesh of 
the vastus internus; it first sends smaller branches to the vastus in- 
ternus and sartorius, and through the interstice of these two muscles 
to the skin of the knee. But having penetrated into the fleshy belly 
of the vastus internus, this artery, which is itself very short and thick, 
sends out its slender inosculating branches : one goes downwards 
along the tendon of the great triceps; and when the tendon of that 
muscle stops above the inner condyle, this artery goes forwards over 
the condyle, makes a net-work upon it, joining in numberless inoscu- 
lations with the articular arteries from below, and gives twigs also into 
the joint. The other branches of this ramus anastomoticus tend all 
forwards and upwards to join the descending branches of the circum- 
flexa externa, which come down along the rectus muscle. 
There are two other arteries lying close upon the joint, remarkable 
enough to deserve a name, and they are called perforating arteries ; 
not perforating like the branches of the profunda, to get deeper among 
the flesh; but perforating so as to get out from the cavity of the ham 
upon the surface of the thigh again. 
The upper perforating autery arises from the inner side of the 
popliteal artery, just after it has perforated the triceps ; but it must not 
be accounted a popliteal branch, because it immediately perforates the 
triceps muscle again. It gives branches to the semi-tendinosus, semi- 
membranosus, and sartorius ; in short, it turns its branches towards 
the muscles on the inner side of the knee, and is a smaller artery. 
The lower or second perforating artery goes off nearly op- 
posite to this. It is a much larger artery. In order to escape from 
the ham, it perforates the shorter head of the biceps, or outer ham- 
string muscles. It first crosses the ham at its very upper point, and 
within the substance of the triceps; it then perforates the shorter head 
of the biceps flexor-cruris ; it then emerges upon the thigh by the 
belly of the vastus externus muscle. Before it passes across the ham, 
it gives a branch to the semi-membranosus : while it is passing through 
the flesh of the biceps, it gives a lower nutritious artery to the lower 
and back part of the thigh-bone : after it perforates the biceps, all its 
branches are to the flesh of the biceps and vastus externus, and its ex- 
treme branches are spent in inosculations with the descending branch 
of the circumflex or articular artery of the hip-joint. 
But these branches, which are the last of the lemoral artery, are 
extremely irregular. There is no artery from the profunda downwards 
worth naming, not even those which l have just described. 
POPLITEAL ARTERY. 
The artery having passed through the sheath or canal formed by the 
tendon of the triceps, or rather having passed between the triceps and 
the hone, lies flat, against the flat part of the thigh-bone as deep as 532 
OK THE POPLITEAL ARTElCV. 
possible in the cavity of the hum. There, as no muscles are lodged, 
it can give no muscular arteries of any importance ; none but trivial 
ones to the ham-strings or to the heads of the gastrocnemii. In its 
whole length from the place of its perforating the triceps tendon to its 
great division, which is under the longer head of the solasus muscle, 
it gives none but articular arteries, i. e. small arteries to the knee-joint, 
which are no less than five in number, and encircle it in all directions. 
First, The popliteal artery semis off from each side two muscular 
branches, not deserving a particular name nor description : the one 
goes to the biceps or muscle of the outer hamstring, the other to the 
semi-tendinosus and sartorius, or inner hamstring muscles. 
Then come off the arteries of the joint, which are thus arranged : 1. 
The upper arteries coming off’ above the joint are three in number ; 
one turning round the inner side of the joint, and one round the outer 
side, and one in the middle ; whence it is named azygous, as having 
no fellow. 2. The arteries below the joint, are two only in number ; 
one to the inner side, and one to the outer side, of the joint: and 
these directions of the arteries settle both the order of description and 
also their names. 
ARTERIA ART1CULARIS SUPERIOR EXTERNA. 
That upper articular artery which comes off above the knee, and 
which turns round the outer side of the joint, arises from the popliteal 
artery above the outer condyle ; its trunk is, like all these arteries about 
the joints, short and stumpy; but its branches long and slender. It 
passes under the flesh of the biceps ; it appears again at the edge of the 
vastus externus : one branch plunges into the vastus externus, mounts 
upwards, and, besides supplying the muscle, inosculates with the long 
descending branch of the circumflexa externa ; while another branch 
turns as directly downwards over the face of the outer condyle, and 
spreads beautifully over the side of the joint, inosculating in many 
net-works with the corresponding artery from below. 
The upper articular artery of the inner side goes off in like 
manner over the inner condyle, pierces the tendon of the triceps, where 
it is implanted into the condyle, and passing under the edge of the 
vastus internus, turns towards the fore part of the knee, proceeds 
towards the patella, and covers chiefly the inner side of the joint with 
its net-work of inosculations : its little twigs slip in under the great late- 
ral ligament, and under the sides of the patella, to the cavity of the joint 
itself. It inosculates like the outer artery with the lower arteries of its 
own side. 
ARTERIA ARTICULARIS SUPERIOR INTERNA. 
ARTERTA ARTICULARIS MEDIA. 
The middle or azygous articular artery usually arises from the 
back part of the popliteal artery, but. sometimes from one or other of OF THE POPLITEAL ARTERY. 
533 
those last described ; but this branch, at all events, is seldom wanting. 
It runs down behind the main artery upon the back part of the joint, 
into the great hollow between the condyles ; and all its branches are 
expended upon the back of the capsule, the posterior crucial ligament, 
the semilunar cartilages, and the tat about the back of the joint. 
The lower articular arteries are more slender, longer, run down- 
wards very slow, and return upwards with a very sudden angle. 
LOWER ARTICULAR ARTERIES. 
ARTERIA ARTICULARIS INFERIOR EXTERNA. 
The external articular artery below the knee goes off from the 
popliteal at the middle or centre of the joint, turns downwards along 
with the popliteal artery for a considerable way; it passes under the 
heads of the small plantar muscle and the outer head of the gastrocne- 
mius, and having passed through, encounters the head of the fibula, 
and passes above it to the side of the joint, spreading its branches 
towards the patella. 
In the ham this artery gives muscular branches to the heads of the 
muscles, as of the gastrocnemius, solaeus, plantaris, and the popliteal 
muscle, that muscle which lies obliquely across the ham. When it 
reaches to the side of the joint, it passes under the external lateral liga- 
ment ; and several of its branches, besides their external anastomoses, 
go into the cavity of the joint, one of which, within the joint, is espe- 
cially large. 
ARTERIA ARTICULAR1S INFERIOR INTERNA. 
The internal articular artery below the knee is larger than the 
external one. Like it, it bends downwards, passes under the inner 
head of the gastrocnemius muscle, crosses behind the head or rather 
neck of the tibia, on the inner side of the knee. It first gives arteries 
to the back of the joint: then it communicates downwards with a large 
recurrent artery from the tibialis antica; it inosculates upwards with 
the articularis superior interna ; it contributes (as all the other articular 
arteries do) to the forming of that profuse net-work of arteries which 
is spread over the whole*of the capsule of the knee-joint. It sends also, 
like the others, certain twigs, which creep under the internal lateral 
ligament, and go into the cavity of the joint along the borders of the 
semilunar cartilages. 
Before the popliteal artery passes under the head of the solasus, it 
gives two long arteries, which run down upon the two heads of the 
gastrocnemii muscles. It often also sends small twigs to the head of 
the solseus, and to the popliteal and plantar muscles. These are of 
size to require ligatures in an amputation below the knee, and are 
named surales. 534 
OP THE THREE ARTERIES 
RECAPITULATION AND PLAN OF THE 
1. Rami Irregulares Musculares. 
2. Ratau» Anastomoticus Magnus. 
3. Rami Perforantes. 
Femoral 
and 
PorLITEAL 
Artery. 
4. Artema Articularis Supe- 
rior Externa. 
6. Arteria Articularis Supe- 
rior Interna. 
Ramus Profundus. 
Ramus Superfirialis. 
Ramus Profundus. 
Ramus Superficialts. 
6 Arteria Articularis Media. 
7. Arteria Articularis Inferior Externa. 
8. Arteria Articularis Inferior Interna. 
9. Surales. 
OF THE THREE ARTERIES OF THE LEG AND 
FOOT. 
The three arteries are, the tibialis antica, going on the fore part of 
the leg; the tibialis postica, passing deep along the back part of the 
leg ; and the peronea, which is the smallest and least regular artery of 
the leg, and which has its name from passing down behind the fibula. 
The popliteal artery divides below the ham, under the longer head of 
the solas us muscle, into two arteries, the tibialis antica, and tibialis 
postica. The tibialis postica continues its natural direction down- 
wards under the solaeus muscle, and behind the tibia. 
ARTERIA TIBIALIS ANTICA. 
The tibialis antica makes a sudden turn forwards, perforates the 
interosseous membrane just under the lower edge of the popliteal mus- 
cle ; passes out towards the fore part of the leg, between the heads of 
the tibia and fibula ; but still it does by no means become a superficial 
artery: on the contrary, it lies deep under the heads of the tibialis 
anticus, and the extensor of the toes; which are covered here with a 
very strong fascia. It is only about two inches above the ancle that 
the leg grows tendinous and naked ; there this anterior artery can be 
felt beating ; it lies between the tendons of the tibialis anticus muscle 
and that of the extensor of the toes ; it passes down along with these 
tendons through the annular ligament, and over the bones of the tarsus : 
it sends one branch across the foot, another forward to the great toe ; 
but the artery itself dives between the first and second metatarsal bone 
in the middle of the foot, and so gets to the sole, where it ends in inos- 
culations with the plantar arteries. 
The tibial artery, before it passes out of the ham, gives a small branch 
which ascends towards the back part of the joint, and is distributed to 
the heads of the bones, viz. the tibia and fibula, and to the origin of 
some of the muscles. 
There is here an anterior recurrent, larger than any in the arm, 
and much resembling the recurrens interossea. It is a branch which 
comes off from the fore part of the tibial artery, instantly after it has 
ARTERIA RECURRENS. OF THE LEG FOOT. 
535 
perforated the interosseous membrane ; it turns immediately upwards 
under the flesh of the tibialis anticus ; it gives many muscular branches, 
some to the head of the tibialis, others to the upper part of the exten- 
sor digitorum, and branches go round the head of the fibula to the 
origin of the long peronaeus muscle. One branch goes directly up- 
wards, and spreads all over the lower part of the knee-joint, mixing its 
branches in the common vascular net-work. 
The tibialis antica gives no other branch of importance, or which 
should be named, even from the place of this recurrent quite down to 
the ancle-joint; for this, like the radial or femoral, or any long mus- 
cular artery, continues giving off branches from either hand to the mus- 
cles between which it runs, of nearly equal size, and all equally unim- 
portant. The tibial artery, then, as it runs down the fore part of the 
leg, gives branches to the Tibialis Anticus on one hand ; to the Com- 
mon Extensor of the toes on the other; and to the Extensor of the 
great toe, which is the last of the three muscles that occupy the fore 
part of the leg. It also gives little arteries to the tibia, to the fibula, 
and to the interosseous membrane which lies between them ; but still 
it arrives unexhausted at the fore part of the ancle joint. 
But before it crosses the joint, (which it does by passing obliquely 
along with the tendon of the great toe,) it gives out two malleolar arte- 
ries, i. e. two arteries, one to the outer, and one to the inner ancle. 
ARTERIA MALLEOLARIS INTERNA. 
The artery of the inner ancle goes off ju3t where the head of 
the tibia begins to bulge. It turns over the inner ancle in many small 
branches ; some mounting upwards along the tibia, but more going 
downwards over the inner side of the joint, i. e. over the tibia or inner 
ancle, over the astragalus, and some down as low and as far backwards 
as the heel-bone. 
ARTERIA MALLEOLARIS EXTERNA. 
The artery of the outer ancle goes off a little lower down. It 
sends smaller branches upwards round the outer ancle, which go to the 
Peronaeus Brevis muscle, to the joint, and to the common extensor of 
the toes, inosculating round the outer ancle with the fibular arteries. 
But its chief branch descends along the fore part and outer side of the 
foot, gives twigs to the short extensor of the toes, and ends in inoscu- 
lations with the tarsal arteries, or arteries belonging to the fore part 
of the foot. 
The arteries which belong to the fore part of the foot are usually 
three in number : one goes off from the tibial artery a little above the 
ancle-joint, and is named Arteria Tarsea, because it crosses the foot 
over the bones of the tarsus. To this succeeds a second about the 
distance of half an inch from it, and which crosses the foot at the place 
of the metatarsal bones; it is named Arteria Metatarsa : and the one 
or other of these gives the interosseous arteries, according as the 
one or the other is small or wanting. The third is that remarkable 536 
OF THE THREE ARTERIES 
branch which goes forwards along the great toe, whence it is named1 
Arteria Halucis. 
ARTERIA TARSEA. 
The tarsal artery, which is sometimes of a very considerable size, 
almost equal to the tibialis itself, comes off a little below the ancle, 
upon the fore part of the foot. It lies upon the second row of the 
tarsal bones ; it passes under the head of the extensor brevis of the 
foot; it crosses the foot obliquely, so as to end in the abductor muscle 
of the little toe, and in inosculations with the arches of the sole of the 
foot 
This branch gives small inosculating arteries upwards, which first 
give branches to the joint, and then join with the external malleolar 
and peroneal arteries. Next il gives branches to the bones and joints 
of the tarsus, which it lies upon ; as the cuboid and cuneiform bones, 
and their joints. Thirdly, It gives small arteries to the bellies of the 
extensor brevis, where it lies under it. 
But its greatest arteries are the interosseous arteries, which it sends 
along the interstices between the metatarsal bones. These interos- 
seous arteries are three in number ; they run along in that interstice 
which holds the interosseous muscles; and when they arrive at the 
end of that furrow, or, in other words, at the place of the forking of 
the toes, each interosseous artery turns down to the sole of the foot, 
and goes into the fork of each digital arch, on the lowest side of the 
toes. Sometimes these arteries give also small dorsal arteries to the 
backs of the toes. 
The tibial artery having proceeded along the tarsal bones, and ar- 
rived at the lower heads of the metatarsal bones, and having first 
given off some trivial branches to the joints of the foot on its inner 
side, and to the bones and muscles about the root of the great toe, 
next gives off a metatarsal artery.* 
ARTERIA METATARSEA. 
The artery of the metatarsus or instep goes off at the head of 
the first metatarsal bone. It bends across the roots of the metatarsal 
bones to the root of the little toe ; and it distributes branches to the 
tendons of the peronrei muscles, and ends in the abductor of the little 
toe, and in the skin over the outer edge of the foot. But sometimes 
it is a larger and more important artery ; for when the (arsal artery is 
small or wanting, this metatarsal one gives off the interosseae, anti- 
supplies its place. 
DORSALIS EXTERNA HALUCIS. 
The third branch is the artery of the back of the great toe 
* N. B.—Between the tarsal and metatarsel artery, there is usually a small branch 
gfoing outwards to the outer edge of the foot, *. e. in the same direction with both these 
arteries, but very small. OF THE LEG AND FOOT. 
537 
This artery is of very considerable size ; it gives no muscular branches, 
because it lies upon the bony part of the foot; it runs all along the 
metatarsal bone which supports the great toe ; and it ends at the 
forking of that toe in two great branches ; one the dorsal artery of 
the great toe, which goes along it to the point; another to the side 
of the toe next the gTeat toe, which it also runs along, somewhat like 
the forking arteries of the thumb and fore finger. 
The anterior tibial artery ends here (i. e. where it gives off the 
artery of the great toe). By sinking in between the metatarsal bones 
of the great toe and of the toe next to it, and going directly into the 
arches of the sole of the foot, it produces a great and important 
anastomosis, similar to that of the radial and ulnar arteries. 
I have given here the most common distribution of those arteries 
on the back or upper part of the foot, but they are very irregular < 
1. Arteria Artieularis Tibialis. 
2. Arteria Reeurrens Tibialis. 
3. Arteries Musculares. 
4. Artei'ia Malleolaris Intern a. 
&. Arteria Malleolaris Externa. 
Arteria Tibialis 
Antica. 
6. Arteria Tarsea. 
Inter ossea. 
7. Arteria Metatarsea. 
Iknsales 
Digitorum, 
8. Arteria Dorsalis Halucis. 
9. Arteria Profunda Anastomotica. 
AUTERIA TIBIALIS POSTICUS 
The posterior tibiae artehy is so named from its passing along 
the hack part of the tibia. The anterior tibial artery passes through 
the interosseous membrane only at the lower edge of the popliteal 
muscle: this artery comes off’from the general trunk at the upper 
edge of the popliteal muscle, and passes obliquely towards the inside 
of the tibia, to take its place behind that bone. Its whole situation 
and general course is this : It lies under the fascia which covers the 
three lesser muscles on the back of the tibia, consequently under the 
solaeus muscle, but over the tibialis posticus and flexor digitorum ; 
coming near the foot; it turns round the inner ancle close upon the 
bone. Having passed the lower head of the tibia, it goes down along 
the inside of the heel-bone, in its deep arch, upon which the body is 
supported ; it divides at the heel bone, and advances along the sole of 
the foot in two great branches ; one running along the sole, next the 
outer edge of the foot; the other along the inner edge of the foot; 
whence they are named external and internal plantar arteries. From 
this arch the artery gives branches to all the toes, and so it ends. 
This posterior artery is chiefly a muscular one, at least in its course 
down the leg ; and though it gives many branches as it passes along, 
there are hardlv any worthy of being described : and from the knee 
to the ancle-joint there is one only which needs be distinguished by 
name, viz. the artery which nourishes the tibia. 
First, The tibialis postica often gives arteries to the heads of the 
gastrocnemii muscles : next it gives off the arteria mrFMTiA Tim®. 538 
OK THE THREE ARTERIES 
which begins a little below the lower edge of the popliteal muscle* 
runs downwards along the interosseous ligament, gives muscular 
branches to the popliteus, solaius, and tibialis posticus, and then sends 
the nutritious artery into the great hole in the middle of the tibia. It 
gives many branches to the periosteum of the tibia, and to the inter- 
osseous membrane all down the leg, and it ends near the lower end of 
the tibia in inosculations with the peroneal artery. This nutritious 
artery of the tibia is very important, from the peculiarity of its situa- 
tion more than its size, for an artery in a bone being wounded or torn, 
bleeds in an extraordinary manner. I have seen the compound frac- 
ture of the tibia where this artery was torn, bleed so as to make the 
consultants imagine the main artery was torn. 
Other nameless muscular arteries succeed to this, going to the 
tibialis posticus, to the flexor communis, and to the flexor of the great 
toe. When the artery arrives near the ancle-joint, it gives many small 
twigs to the periosteum, tendons, sheaths, and bursae mucosae behind 
the ancle ; and then passing in the very deepest part of the ancle, 
under the annular ligament, and between the tibia or process of the 
inner ancle and the heel-bone, it adheres closely to the bones and cap- 
sule of the joint; and there gives a great many little tortuous arteries, 
making net-works over this joint and its bones, as over the other joints 
already described. But especially two delicate arteries go out at this 
hollow at the side of the heel-bone : one forwards towards the side of 
the ancle-joint, the other downwards and backwards over the heel- 
bone, which ramify very profusely and very beautifully. 
The artery now lying deep under the abductor magnus of the 
great toe, which arises from the heel-bone, forks into its two great 
branches, the external and internal plantar arteries. 
ARTEBIA 1‘LANTAIUS INTERNA. 
The internal PLANTAR artery is much the smaller branch, not 
to be compared in importance (though their names are contrasted) 
with the external plantar artery ; and it is named internal, because as 
it runs along the sole of the foot it keeps to the inner edge, viz. that 
to which the great toe belongs, it comes off under the head of the 
abductor of the great toe, and under the belly of that muscle, and 
close upon the bone ; its branches run forwards, quite up to the root' 
of the toe, all along its metatarsal bone. The internal plantar artery 
has in general four branches, which all run pretty nearly in the same 
direction, viz. straight forwards. 
It gives, while under the head of the abductor, small branches, 
which go backwards to the joint, its capsule, and tendons, and some 
into the spongy substance of the heel-bone; some also to the short 
flexor of the foot, and to the massa carnea. But its four greater and 
more regular branches are these : 
The first lies nearer the inner edge of the foot; is the largest and 
most considerable ; it runs along, under the inner border of the abduc- 
tor ; it goes quite up to the ball of the great toe, and unites with the 
proper artery of the toe. As it goes along, it gives small twigs to the 
nermsleum and bone. OF THE LEU AND FOOT. 
539 
The second resembles the former, except that it does not come off 
so early by two inches ; it is of course shorter, but it passes along in 
the same direction, only a little distant from the first, lying along 
the middle of the metatarsal bone. It also advances up to the root 
of the great toe, and runs also into the proper artery of the great toe 
(which comes from the external plantar branch) so as to enlarge and 
strengthen it. 
The third lies still nearer to the centre of the foot, and deeper among 
the muscles. It runs the same general course, viz. along the side of 
the metatarsal bone up to the ball of the great toe, and ending like 
the others in the artery of the great toe ; but as it lies deeper, it gives 
branches to the short flexor, to the tendons, and to the inner surface of 
the aponeurosis plantaris, forming a sort of superficial arch. 
From these three arteries, much of the skin on the sole of the foot 
has its branches. 
The fourth and last branch of the plantaris interna, is one which goes 
down deep into the centre of the foot; it lies close upon those liga- 
ments which bind together the bones of the tarsus, and under all the 
tendons, except those of the tibial muscles, which are like ligaments 
to the bones. Its destination is chiefly to the tarsal joints and cap- 
sules ; its inosculations with the external plantar artery can be of no 
importance. 
PLANTARIS EXTERNA. 
The external plantar arterv is the greater artery of the sole of 
the foot, from which the arches of the foot and the inosculations with 
the anterior tibial artery are formed. 
It turns outwards towards the outer edge of the foot; it runs its 
great circle round by the metatarsal bone of the little toe ; and its 
plantar arch, or the arch of the sole of the foot, passes over the middle 
of ail the other metatarsal bones. It receives the anterior tibial artery 
under the middle of the metatarsal bone of the great toe. It is this 
great curve of the artery turning round in the sole of the foot that we 
name the plantar arch ; and it is from it that all the proper arteries 
of the toes arise, expressly after the same order in which the fingers 
receive their arteries. 
The great or external plantar artery lies deep, but not upon the 
naked bones like the former. It passes through between the heads of 
the short flexor and massa carnea ; it turns its first turn outwards till it 
gets under the flexor and abductor of the little toe ; then it turns in- 
wards towards the centre of the foot, and lies between the tendons of 
the flexor muscles, and the metatarsal bones and their interosseous 
muscles. 
First, It sends a large branch backwards to the heel-bone, which 
belongs entirely to that spongy bone, forms, like all such arteries, a 
sort of net-work over all the surface of the bone ; it first touches the 
bone under its extreme point, or that which rests upon the ground ; 
and it goes branching over it so high as to inosculate round the ancle 
Ayith twigrs of the tibialis antica; it gives branches also hereabout to 540 
OF THE THREE ARTERIES 
the great ligament of the heel-bone. The external plantar artery next 
gives branches to those muscles between which it lies imbedded, viz. 
the flexor accessorius and flexor brevis ; then advancing to the side 
of the flexor digiti minimi, it gives out two or three branches, which 
first go into the flesh of the abductor and flexor of the little toe, and 
then turning over the edge of the foot, terminate in inosculations with 
the arteries of the fore part of the foot and in the skin. 
It then begins from the root of the metatarsal bone of the little toe 
to form that great circle, which is named the arch of the foot, and which 
gives out two ranks of arteries : First, of interosseous arteries going 
to the spaces between the metatarsal bones, upon which the toes stand ; 
and, secondly, the proper arteries of the toes themselves. 
The first of these arteries proceeding from the tarsal arch is a small 
one, the artery of the little toe. It begins at the lower head of the 
metatarsal bone, lies under the flexor and abductor muscles, gives 
branches to these muscles and to the skin, and to the bone itself; it 
runs up the outer edge of the little toe, and this is immediately suc- 
ceeded by the first interosseous artery ; which lies deeper, passes 
along the first interosseous space, gives branches to the bones and in- 
terosseous muscle, and inosculates between the toes with the branches 
of the anterior tibial artery. 
The next artery is properly the first of the great arch. It is what is 
called the ramus digitalis, or proper artery of the toes. It is a long 
artery, runs over the interosseous space lying upon the interosseous 
muscles ; it advances to the root of the little toe, and like those of the 
fingers divides into two branches, one to the inner side of the little toe, 
and the other to the side of the toe next it. A second and a third digi- 
tal artery go out in the same manner, and split the roots of the toes 
into two branches, and with so little variety that it is needless to de- 
scribe each part. 
In the interstices of each of these arteries lie two or three small 
perforating arteries, which perforating between the metatarsal bones 
inosculate with the interosseous arteries which lie on the fore part of 
the foot. 
But the great external plantar artery, while it is giving out these ar- 
teries alternately, i. e. large branches to the toes, and smaller twigs to 
the interosseous muscles, and some smaller still which go olT from the 
concave part of the arch, and go into the sole of the foot to the liga- 
ments and joints ; the principal artery goes still onwards, and com- 
pletes its arch at the middle of that metatarsal bone which supports 
the great toe. There, a little behind the ball of the great toe, it re- 
ceives an anastomosing branch of the tibialis antica, which perforates 
from the fore part of the foot. This completes the arch of -the ante- 
rior and posterior arteries, and permits the blood to pass, according to 
the pressure, or other accidents, in either direction; and this union 
strengthens and enlarges the artery of the plantar arch so much, that, 
it is not exhausted by the many branches which it has given off, but 
gives at this point the largest artery of all, viz. the artery which sup- 
plies the great toe, one side of the toe next it. This artery of the 
great toe is the very last, or extreme branch of the aortic system. It OF THE LEG AND FOOT. 
541 
very closely resembles the great artery of the thumb ; it gives out three 
chief branches, viz. one to each side of the great toe, and one to the 
inner side of the toe next it. This arteria pollicis pedis sometimes 
seems to proceed entirely from the perforating branch of the anterior 
tibial artery ; at other times it arises fairly from the plantar arch. 
These lesser branches in the foot require a description as tedious as 
the larger arteries, and we have the more occasion for a plan, serving 
at the same time as a recapitulation. 
1. Rami Musculares. 
2. Arteria Peronaa. 
Rami Musculares. 
Arteria Peronaa Anterioi'. 
Arteria Peroneea Posterior. 
3. Arteria Nutritia Tibia. 
4. Arteria Calcanea. 
Arteria Tibialis 
Posterior. 
Ramus Transversus. 
Anastomoticus. 
Rami Profundi. 
Arterue Digilales 4tee. 
Arteria Interosseee. 
5. Arteria Plantaris Externa. 
6. Arteria Plantaris Interna. 
Ramus Anastomoticus 
Profundus. 
ARTERIA PERONEEA. 
The fibular artery, or the third artery of the leg, which is much 
smaller than the other two, in its course and connexions, and its being 
exhausted nearly by the time it reaches the ancle-joint, greatly resem- 
bles the interosseous artery of the fore arm. 
It comes off from the posterior tibial artery, near the head or origin 
of the tibialis posticus muscle, and accompanies that muscle down to 
the ancle-joint, lying between the flexor pollicis and the acute edge or 
spine of the fibula. 
This is entirely a muscular artery for supplying those deeper parts 
which the other arteries do not supply. Its branches, like those of all 
muscular arteries, are extremely irregular ; its chief branches are to the 
solaeus, to the peronaei muscles, to the tibialis posticus, to the flexor 
of the great toe. Several little arteries turn round the fibula from 
point to point, going to the fore part of the leg. All the way down 
the leg, it is giving off repeated branches to the same muscles ; and 
in this course it gives some little arteries, which pierce through the in- 
terosseous membrane, and also gives the nutritious artery of the fibula. 
When it approaches the ancle-joint, the fibular artery gives off an 
anterior branch, which perforates the interosseous membrane, passes 
through between the tibia and fibula nearly where they are joined ; it 
turns downwards over the outer side of the ancle, by the extensor 
communis and peronaeus brevis tendons. This is named peronea 
anterior, though it is an artery of little importance. Its branches 
are given not to muscles, for this is a naked and bony part of the foot; 
but are expanded upon the lower heads of the tibia and fibula, and 
upon the os cuboides. They nourish the tendons, ligaments, and 
bursa; of the outer ancle ; they end in inosculations with the malleolar 
artery, from the tibialis anterior, and with the tarsal arterv. 542 
OF THE VEINS 
ARTERIA PERONEA POSTERIOR. 
As this anterior Fibitear artery branches over the fore part 
of the outer ancle, the posterior fibular artery passes deep be- 
hind the same ancle, and is just the continuation of the main artery; 
which having passed down behind the acute angle of the fibula, sinks 
into that deep hollow which is behind it upon the side of the heel-bone. 
Behind the tibia the artery makes large inosculations with the posterior 
tibial artery, and gives many branches to the tendons. Branches also 
turn round the ancle, making a network of vessels upon it, and inos- 
culating with the anterior tibial artery. It continues to give the same 
small arteries to the outer ancle, to the peronaci tendons, to the outer 
side of the heel-bone, and to the abductor of the little toe. It ends 
usually in that muscle, and in inosculations with that branch of the 
external plantar artery which turns backwards upon the heel-bone and 
ramifies upon it so beautifully. 
These are the last branches of the three great arteries of the leg and 
of the aortic system. 
OF THE VEINS. 
The veins are the vessels by which the blood carried outward by 
the arteries is returned to the heart. The system of the veins, how- 
ever, is not so simple as that of the arteries, for while there are only 
two great arteries carrying the blood from the heart, viz. the aorta and 
the pulmonic artery, there are three great trunks of the veins, viz. the 
superior and inferior vena cava, which are the trunks of the great veins 
of the body ; the pulmonic vein, which returns the blood to the heart 
from the circulation through the lungs ; and the vena portae, which 
collects the blood of the intestines, and conveys it to ihe liver. There 
is, besides, a greater variety in the distribution ot the veins than in that 
of the arteries. 
The French physiologists have departed from the old method of 
Harvey, in explaining the circulation. He wisely took the heart as 
the centre of the system, and described .the vessels going out from it, 
forming the two circulations, viz. through the body and through the 
lungs ; but they have assumed the lungs as the centre ; and the veins 
of the body, and the arteries of the lungs, they call systeme d sang 
noir, because it contains the dark-coloured blood ; and the pulmonic 
veins and the arterial system of the body they call systerne a sang rouge, 
because it conveys blood of the bright vermilion colour. 
This conceit is perhaps admissible, when introduced as an additional 
illustration of the relation of the lungs to the body ; but it causes in 
a difficult subject an usual degree of intricacy, and does not serve the 
purpose of demonstration : besides, the arteries and veins of the body, 
and the pulmonic artery and vein, have that strict and mutual depend- 
ancc in action, which show's how improper and how unnatural it is to 
make this change, and to separate them in explaining the general 
system. At all events, let those who adopt this noveltv cease to speak 543 
IN GENERAL. 
of the two circulations, lor although in regard to the heart, there are 
two circulations, yet as the movement of the blood respects the lungs, 
there is only one. By this division, the blood returning from the body, 
and carried into the lungs, cannot be called a circulation ; but only 
when it has passed through the lungs, and returned to the same point 
of its course through the body. 
I retain the old method, corresponding with what has been delivered 
in the preceding volume, and in describing the veins will follow the 
course of the blood through them. 
The capacity of the veins is greater than that of the arteries; the 
coats are thinner but stronger comparatively, and admit easily of dila- 
tation to a certain extent. The coats of the lesser veins are compara- 
tively stronger than those of the larger ones, and the veins of the lower 
extremity much thicker and stronger than in the upper parts of 
the body, as they have to beai a higher column of blood. The 
veins are transparent and the blood is seen through their coats. The 
veins have three coats. The outer coat is composed of a reticula- 
ted tissue of cellular membrane, which is wrapped somewhat loosely 
around the proper coats. The second coat has the same character 
of an interwoven texture of filaments ; but is more dense, espe- 
cially on its internal surface, where it approaches the inner coat. 
The inner coat is dense and unelastic, resembling the inner coat 
of the artery, but stronger, more pliant, and less easily ruptured by a 
ligature than the inner coat of the artery. Between all the coats there 
is a fine cellular substance interposed.* The inner coat being smooth 
and flexible is formed into valves in various parts of the veins ; which 
valves are semi-lunar, and resemble those in the root of the great 
arteries in the heart. 
In all the larger veins, excepting those of the viscera, of the abdo- 
men, and those of the lungs and there are valves ; but in the 
smaller veins there are no valves : theoe valves, as I have said, consist 
of the inner coat, forming folds like a curtain, hung across the calibre 
of the vein ; but at .the same time attached so obliquely to the side of 
the vein, that they present a sacculated membrane, the edge of which 
is caught by the blood, the instant that the stream is retrograde, and 
thus the valve is raised, and falling back, stops the return of the blood 
against its natural course. The loose margin of the valve is some- 
what stronger than the other part, and between the duplicature of the 
inner membrane forming it some little filaments may be observed. 
Each valve consists, in general, of two semi-lunar membranes, the 
margins of which fall together; but they yield and give freedom to 
the current of blood when flowing towards the heart. 
Authors have not noticed a part of the structure essential to the opera- 
tion of a semi-lunar valve. 1 mean the little sinuses or more dilatable 
part of the coats of the veins just above the attachment of the valve. 
The sinuses are of the same use here, that they are at the origin of 
ihe great arteries from the heart. By their means the margin of the 
GENERAL CHARACTER OF THE VEINS. 
* Unless near the amide no muscular fibres have been observed. See Halleri Opera 
Minora, p. 175. 544 
OK THE VEINS 
valve is Hot permitted to touch the side of the vein. The blood always 
intervenes between the valve and the side of the vein, consequently the 
slightest retrograde motion of the blood throws down the valve. 
Without this provision, the valve being collapsed to the side of the vein, 
the blood would have been permitted to pass retrograde. 
A ligature high on the arm or thigh not only causes the veins to swell 
by preventing the free course of the blood back to the heart, but it 
shows the veins in their distinct and natural character, and causes the 
sinuses of the valves to rise, showing the places of the valves. 
The sacs formed by the valves of the veins are much deeper some- 
times than the term semi-lunar implies, insomuch that the term pyri- 
formis has been used. Neither are the valves always double, for some- 
times they are single, and sometimes three in number.* They are 
best seen by opening the veins under water, and drawing them to and 
fro, by which it will be perceived how the valves rise and float, 
s As the veins are provided with valves only where they are exposed 
to occasional pressure, and particularly to the compression of the 
muscles, the use of the valves would seem to be, to prevent the retro- 
grade movement of the blood, in consequence of the occasional 
and partial compression of the veins ; but, no doubt, they at the 
same time support the column of blood, as in the lower extremities : 
and when those veins suffer distention by disease, a great aggravation 
of this condition is, that the valves lose their action, for the vein is 
now too large to be closed by them, and the whole column of blood 
presses upon the veins of the legs. 
Fabricius ab Aquapendente, who discovered the valves of the veins, 
though ignorant of the circulation, and, consequently, of the true use 
of the valves, yet argues very ingeniously ; for he imagined that ex- 
ercise, by heating the limbs, would draw the blood from the trunk, 
to the injury and rupture of the vessels of the limbs, and the too great 
diminution of nourishment in the vital parts, were it not for the office 
of these valves. See, says he, how the veins swell, and the valves 
become marked and distinct, when a man is in full exercise. By 
this we may perceive, that exercise forces the blood out from the 
body towards the extremities, and would do it too powerfully, but 
for the operation of the valves. But Harvey, observing the me- 
chanism of these membranes, was drawn to conclude that the blood 
must always run in one direction in the veins, and, consequently, that 
there must be a circulation of the blood. 
The commencement of the minute branches of the veins is from 
the extreme ramifications of the arteries ; they are continuous, and 
convey back the blood in that course which is called the circulation. 
In contemplating the capillary tissue of vessels, the most striking cir- 
cumstance is, the predominance of the dark venous ramifications : 
and in general, two sets of veins will, even in these minute ramifica- 
tions, be observed ; one superficial, the other more intimately blended 
with the minute ramifications of the arteries ; but in the internal parts 
of the body, and particularly the viscera, the veins uniformly ac- 
* Fabricius dc Vcnarum Osteolis. Morgagni Epist. Anatom. XV. Kerckrinsrii 
Spicileginra Anatnmicum. Tab. 4. JS GENERAL. 
545 
company the ramilications of the arteries, and in the solid viscera, a 
dense cellular membrane gives lodgment to both sets of vessels. 
It was supposed even after the time of Harvey, that there was a 
spongy or cellular substance between the extremities of the arteries 
and veins ; but there is no such thing in the microscope. I see the 
globules of the blood following each other in rapid succession, and 
turn, and accumulate, and retrace their course. There can be no 
doubt, that when they are passing rapidly, as one may say in single 
files, they are in the extreme arteries. That again, when they turn 
back, and go, two and two, or three abreast, they are in the extremities 
of the veins. I may further observe, that in the microscopical expe- 
riments we do not see the coats of these small vessels, but must con- 
clude, that they are there, from the globules of the blood being accu- 
rately confined to a certain tract or course. 
In the extremities and head, indeed every where but in the viscera, 
the veins form two distinct sets ; the deep and the superficial veins : 
1. the deep veins accompanying the arteries : and 2. the sub-cutaneous 
veins, which emerge from the compression of the muscles, and run 
above the fascia. The union between the branches of the veins is very 
frequent, not only between the veins, ramifying in the same plane inso- 
much as to make them a net-work, but also between the deep and the 
superficial set of veins : such are the venie emissariae of the skull, the 
free communications between the external and internal jugular vein, 
between the deep and superficial veins of the arm, &c. When in 
bleeding, the blood flows from the vein of the arm, accelerated by the 
working of the muscles, the blood escapes by the anastomosis, from 
the compression of the muscles, and fills the superficial veins ; but the 
increase of the jet of blood is principally produced by the swelling of 
the muscles, causing the fascia to compress the internal veins of the 
fore arm. 
In the dead body the veins are flat, but when distended, they resume 
the cylindrical figure which they possessed in the living body ; yet 
they are in general of the cylindrical figure for a very small part of 
their course only, owing to the irregular dilatations by the side of the 
valves, and to the frequent union of their branches. The manner in 
which the branches join the trunk has a peculiarity which always dis- 
tinguishes them from the ramifications of arteries : the arteries branch 
direct and at an acute angle, the veins in a direction more removed 
from the course of the trunk, and in general with a curve or shoulder. 
In infancy and youth the veins are but little turgid, and especially the 
cutaneous veins are so firmly embraced by the elastic skin and cellular 
membrane, that they have a less degree of prominency than in more 
advanced years. In old age the veins are enlarged, and rise turgid 
on the surface ; the internal veins also become enlarged, and the 
whole venous system is extended. 
Soemmerring says, with increasing years the resisting power of the 
veins is diminishing, that of the arteries increasing. I believe this to 
be incorrect in regard to both kinds of vessels. 
I do not consider the change in the vascular system as the effect of 
mere distention, or of the enlargement of the veins, from the long con- 546 
OP THE VEINS 
tinned action of the arteries ; but as a necessary change in tne propor- 
tionate distribution of the blood, which is preceded or accompanied 
with other peculiarities, which characterize old age. When we corn 
sider the great size of the veins, compared with the arteries, we must 
conclude that the blood flows but slowly in the venous system ; that 
from the narrowness of the trunks of the veins near the heart, the 
blood must be accelerated as it approaches the heart; and that receiv- 
ing the impulse from the ventricle, it must take a rapid course through 
the arteries, until, again approaching the extreme branches of the 
arteries, and passing into the veins, its motion becomes more languid 
and slow. In youth, as the size of the veins is not in so great a pro- 
portion to the arteries as in advanced life,-the blood in a young person 
must be in more rapid and quick circulation : but in old age, owing 
to the largeness of the veins and the accumulation of blood in them, 
the blood moves slowly through the venous system, and is almost stag- 
nant in the dilated veins and sinuses ; upon the whole, it moves less 
briskly through the vessels, and the proportionate quantity immediately 
under the influence of the arterial system, is less than in youth. 
There is no pulsation to be observed in the veins, but what they 
receive laterally from the contiguous arteries. There is no pulsation 
in the veins, because they are removed from the heart; because they 
do not receive the shock of the heart’s action in their trunk, but only 
by their widely-spread branches ; because the contraction of the heart 
and of the arteries so alternate with each other, as to keep up a per- 
petual and uniform stream of blood into the veins ; whereas the pulsa 
tion in the arteries is owing to the sudden and successive contractions 
of the heart. 
In living animals I have undoubtedly seen the course of the blood 
in the great veins near the heart alternately checked and accelerated in 
its motion. But this is a subject which I have no disposition at present 
to pursue. This motion does not prove that there is here a muscular 
Contraction.* 
FUNCTIONS, OR USES OF THE VEINS. 
Are the veins merely for carrying back the blood to the heart, and 
are they entirely passive, while the arteries alone are agents ? Although 
it appears that the veins have no muscular action in their coats, yet 
such is the peculiarity of their situation, that they become, in an indi- 
rect manner, powerful agents in circulating the blood. In the first 
place, we see that by their great number, their width, and large diameter, 
they contain a large proportion of the blood ; in the second place, 
they are under the influence of the muscular system, so that every 
motion or effort compresses them, and causes a movement of the blood 
within them. If a long tube be attached to a vein of a living animal, 
so that the blood may rise into the tube, in height proportioned to the 
fbree of circulation, and if the animal be excited to exertion, in the 
moment of exertion, the blood is forced in a jet from the mouth of 
*< Haller found contraction produced in the veins by touching them with oil of 
Vitriol. Opera Minora, p. 375, lSf UENEKAL. 
547 
the tube. This explains what the influence of exercise must be, in 
accelerating the circulation. And now we see the proper use of the 
valves ; for these sudden efforts of the muscular frame, compressing 
the veins, would cause a movement of the blood backward ; the im- 
pulse would be at least as powerfully retrograde upon the course of the 
blood as forward. But as these flood-gates are thrown down on the 
slightest movements of the blood, contrary to the course of the cir- 
culation and the retrograde motion of the blood thereby prevented, 
the muscular force is all given in aid of the circulation, and the blood 
of the veins is thereby forced on to the right side of the heart. 
In this general account of the venous system, it remains only to 
speak of the subject of absorption by veins. Before the suite of ex- 
periments made on this subject by Mr. Hunter, a vague notion was 
entertained that the veins were absorbents ; but about that time,* the 
doctrine that lymphatics were absorbents having been established, the 
opinion that the red veins were also absorbents, was first questioned, 
and finally confuted, at least in the opinion of most physiologists. 
The chief argument to show that veins, arising from cavities, par- 
ticularly from the intestines, acted as absorbents, was, that some anato- 
mists said they had seen white chyle in the blood taken from the 
mesenteric veins. It was, however, soon observed that the serum of 
the blood, taken from the veins of the arm, was sometimes white, 
which must arise from some other cause than the absorption of the 
chyle. | 
The experiments of Mr. John Hunter proved that there is no ab- 
sorption of fluid from aliment contained in the intestinal canal, by the 
veins of the mesentery, while the lacteals were rapidly absorbing. 
Emptying a portion of the gut, and the veins of their blood in a living 
animal, he poured milk into the intestine. The veins remained empty 
and without a drop of the milk finding its way into them, while the 
lacteals became turgid with it. In another experiment, leaving the 
arteries and veins of the mesentery free, and the circulation through 
them perfect, still no white fluid could be discovered, tinging the 
stream of blood in the veins. Neither did pressure upon the gut in 
any instance force the fluid of the intestines into the veins. He re- 
peated and varied these experiments, so as to show, in a very satis- 
factory manner, that chyle, or the fluid of the intestines, never is ab- 
sorbed by the veins. 
Yet I must say that these experiments are still unsatisfactory, as 
they regard the general doctrine of absorption by the veins : in the 
intestines there is a peculiar set of vessels evidently destined to the 
absorption ©f the chyle and of the fluids of the cavity ; but there re- 
mains a question which will not be easily determined : do not the 
veins throughout the body resume a part of that substance, or of those 
qualities, which are deposited or bestowed by the blood of the arteries? 
Are we assured that in the circulation of the blood through the lungs, 
and in the extremities of the pulmonic veins, there is no imbibing or 
absorption ? In the veins of the placenta, there is not only an operation 
* 1758 
+ See Hewwn, Exper. Essays and Lymphatic System. 548 
OF lHE VEINS 
similar to what takes place in the extreme branches of' the pulmonic 
circulation, but the matter and substance which goes to the nourish- 
ment of the foetus, must be imbibed from the maternal circulation.* 
So by the vessels in the membrane of the chick in ovo, there is ab- 
sorbed that which being carried to the chick, bestows nourishment and 
increase. If it be observed that in those operations of oxygenation 
matter is not absorbed, but only carbon thrown off, it only shifts the 
argument, without weakening it; for if the carbon be thrown off in 
the lungs, this carbon is absorbed by the veins in the circulation of 
the body, which amounts to the same thing to our present argument. 
For my own part, I cannot but suppose that, while the lymphatics 
absorb the loose fluids which have been thrown out on surfaces, or into 
cavities, the veins receive part of what is deposited from the arteries; 
but, which is not so perfectly separated from the influence of the cir- 
culating system, as that which the lymphatics receive ; and that there 
are certain fluids, which, by an affinity of the venous blood, they im- 
bibe in the course of the circulation. We must at the same time 
acknowledge that the conclusions made in favour of absorption by 
veins, from experiments upon the dead body, are fallacious, and have 
no weight. It is seldom we can determine whether minute injections 
have taken a course by a natural or by a forced passage ; neither are 
the experiments of some of the older physiologists more satisfactory 
or conclusive. Lower affirmed that, by throwing a ligature on the 
inferior cava of a dog, he produced ascites. He tied the jugular veins 
of a dog, and the head became dropsical. Hewson repeated these 
experiments, but without the saino result. And if the tying of the 
veins had always produced oedema or dropsy, the experiment would 
have proved nothing more than is already established by the very com- 
mon occurrence of oedema of the legs from the pressure of the womb 
on the iliac veins, or a tumour in the groin or in the pelvis. Now in 
these instances the compression of the vein does nothing more than 
cause a difficult circulation of the blood from the extreme arteries-into 
the veins, and consequently a greater profusion of the discharge into 
the cellular texture by the serous arteries. But even the experiments 
of Mr. Hunter on the veins of the intestines, are not in unison with 
the experiments of Sir Everard Home, who finds that the matter in 
the stomach and intestines is received into the system, although the 
thoracic duct has been tied or cut. 
On the whole, we must either admit absorption by veins, or that 
there are many communications between the lympliatic vessels and 
red veins in tlie extremities of these vessels.! 
OF THE VEINS, BRANCHES OF THE SUPERIOR VENA CAVA. 
The superior vena cava, or the descending cava, is the superior 
trunk of the venous system ; which receives the veins of the head, 
* Dr. Hunter, Hewson, &c. say that it is probable there are many small lymphatics 
in the placenta, which open into the branches of the veins,. and do not take a course 
.floiw the chrd. 
t S*e Appendix B- OF THtl HEAD AjN'D NECK. 
549 
neck, and arms, and throws the blood directly into the great right sinus, 
or auricle of the heart. 
But I hold it better to begin my description from the extremities of 
the veins, following the course of the blood. I therefore commence 
with the veins of the forehead. 
OP THE VEINS OF THE HEAD AND NECK. 
The anterior facial vein.* The facial, or anterior facial vein, 
runs down obliquely from the inner canthus of the eye, towards the 
angle of the lower jaw-bone. Here, uniting with the temporal vein, 
it forms the external jugular vein. The most remarkable branches of 
veins which assist in forming the facial vein, are the frontal veins ; 
which receive the blood from the forehead and frontal portion of the 
occipito-frontalis muscle, and the ophthalmic vein, which is one of 
the emissariae, and comes from the cavernous sinus through the orbit. 
In its course down the cheek, the facial vein receives the several cu- 
taneous branches of the veins from the surrounding parts : but which 
have in reality no such importance as to require description.”! 
The POSTERIOR FACIAL VEIN Or, GREAT TEMPORAL VEIN. This 
vein descends from the temple before the ear, and passes through or 
under the mass of the parotid gland, and behind the angle of the 
lower jaw. 
This posterior vein receives those branches which are the proper 
temporal veins, and which are four in number, and descend upon the 
side of the head ;§ and those which answer to the submaxillary artery, 
and also the vena transversa faciei, and the auricular veins. Finally, 
into some of the deep branches of this veinii the blood enters from 
the veins accompanying the arteria meningea. The posterior facial 
vein, uniting with the anterior one, forms a common trunk, which in 
general lies over the division of the carotid artery. 
EXTERNAL JUGULAR VEINS. 
The external jugular vein lies under the fibres of the platysina 
myoides muscle, takes a course obliquely down the neck, and across 
the middle of the mastoid muscle, and drops either into the subclavian 
vein, or into the internal jugular vein. Sometimes there are two 
external jugular veins on each side ; more commonly there are two 
branches high in the neck, from the anterior and posterior facial veins, 
which unite about the middle of it. When they are double they have 
this course ; the anterior and external jugular vein may be said to 
begin from the anterior facial vein ; it then receives the submental 
* Facial vein; V. Angularis; V. Triangularis. 
t Vena dorsalis nasi, superior et inferior—Vena palpebralis inferior externa et 
interna—Vena alaris nasi—Vena labiales magna et minores, fj-c.— Vena buc- 
cales, &c. 
| Joannis, Gottlieb tValteri, tab. ii. 65.—Venarum Capitis et Colli. 
§ Being in two sets, the deep, and superficial. Walter, tab. ii.— Vena temper, 
superf. llO. et Vena temp, profund. 111. 
fj Viz, Vena Pterygoidea. 550 
OF THE VEINS 
vein, which comes in under the base of the lower jaw—the ranine 
veins also, and veins from the glands under the jaw join it here : where 
it is before the mastoid muscle, it forms free communications with the 
internal jugular veins ; and here also, it receives veins from the side of 
the throat.* 
Almost all the ramifications of veins, which in one subject unite in 
the external jugular vein, and which come from the face and throat, do 
in others sink down into the internal jugular vein.! 
Sometimes the anterior and external jugular veins join the internal 
jugular vein ; sometimes the subclavian vein. 
The posterior external jugular vein is formed chiefly by the 
temporal vein, or posterior facial vein, which comes down from under 
the parotid gland; it is then joined by the occipital veins,J a little lower 
by the cervical veins, and lastly, on the lower part of the neck it re- 
ceives the muscular branches from the flesh of the shoulder ; it then 
sinks into the subclavian vein. 
Of the thyroid veins.—The thyroid gland has two sets of veins 
as it has of arteries; the superior thyroid veins carry back the blood 
from the muscles of the fore part of the throat, from the larynx, from 
the substance of the thyroid gland, and from the neighbouring part 
of the trachea and pharynx, and even from the fauces. Sometimes 
these thyroid veins enter the external jugular vein ; sometimes they 
descend upon the neck, taking the name of guttural veins, and 
unite themselves with the internal jugular vein. 
The lower thyroid veins come from the lower part of the thy- 
roid gland, and descend upon the fore part of the trachea, and enter 
the subclavian; or, more generally, the great, or internal jugular veins. 
Of THE INTERNAL JUGULAR VEIN. JuGULARIS INTERNA.§ VENA 
jugularis CEREBRALis.il—The internal jugular vein is formed by the 
conflux of the several great and posterior sinuses of the dura mater 
into the lateral sinus, which coming out by the foramen lacerum 
posterius of the basis cranii, ceases to be constricted into the triangular 
shape, and takes the form and peculiarities of a vein. From this fo- 
ramen, common to the temporal and occipital bone, the jugular vein 
descends obliquely forward and downward, becoming from its deep 
situation somewhat more superficial, but in all its extent protected by 
the sterno-cleido-mastoideus muscle, and passes under the omo-hyoideus 
muscle. The internal jugular vein is very irregular in its form ; being 
sometimes much contracted under the angle of the jaw ; bulging and 
much enlarged, or rather capable of being much distended in the 
middle of the neck ; and again contracted before it joins the subcla- 
vian vein. The carotid artery, the internal jugular vein, and the par 
vagum lie together in the same sheath of loose cellular membrane. 
The vein is to the outside of the artery, and the nerve is between them, 
lying a little deeper. 
* Viz. The superior thyroid veins, and the deep laryngeal veins, 
t Walter, loc. cit. tab. ii. 13. 
X These communicate with the vertebral veins, and through the posterior mastoid 
foramen with the lateral sinus. 
§ Haller, Icon. Si Walter. OF THE ARM. 
551 
The internal jugular vein receives these communications and 
branches : behind the angle of the lower jaw, a branch of communica- 
tion generally goes down from the posterior facial vein, and often it is 
joined by the internal maxillary vein ; under the jaw, it either forms 
free communications with the beginning of the external jugular vein, 
or it receives the ranine and guttural veins : at all events, there is a 
branch from the side of the throat and the muscles of the os hyoides, 
which passes into the internal jugular vein. From under the back 
part of the mastoideus muscle, the internal jugular receives branches 
from the occipital veins, and at the same time has communications with 
the vertebral veins. Near its termination the great jugular vein re- 
ceives the guttural and lower thyroid veins. 
Of the vertebral veins.—There is difficulty in assigning origins 
to these veins, for they are rather like a chain of communication ; they 
run in the holes of the transverse processes of the cervical vertebrae, 
and surround the processes with areolae. First, a communication is 
formed with the great lateral sinus, then they receive the flat sinuses 
from under the dura mater, covering the cuneiform process of the occi- 
pital bone, (the basilar sinuses,) and as they descend they form trans- 
verse communications, which receive the branches of that chain of 
inosculations, which runs down upon the spinal marrow. The verte- 
bral veins, in their descent, send out divisions which run down upon 
the outside of the canal, and receive branches of veins from the 
muscles on the fore part of the vertebra;, and some of the proper 
cervical veins from behind. The vena cervicalis, coming from the 
side of the neck, unites with the vertebral vein near its termination, in 
the bnck part of the subclavian, or sometimes in the axillary vein. 
OF THE VEINS OF THE ARM. 
The veins of the arm are in two sets, the venae comites ; and the 
external or sub-cutaneous veins, being those without the fascia, and 
not subject to the compression of the muscles. Of these, the latter 
are the more important and require a particular description. 
On the palm of the hand, the veins are few and small, because they 
are there subject to compression in the frequent grasping of the hand ; 
but on the back of the hands and fingers, the veins are numerous and 
large. The veins creeping along the fingers, make a remarkable in- 
osculation on the back of the first phalanges, and then passing in the 
interstices of the knuckles, form a great and irregular plexus on the 
back of the hand :* the principal branch of which sometimes takes 
the form of an arch.j 
The plexus of veins from the back of the hand is continued over 
the back of the wrist: when some of the larger branches, after play- 
ing over the heads of the radius and ulna, take a course, the one on 
the lower, and the other over the upper edge of the arm, whilst the 
back of the arm is left without any remarkable veins taking their 
course there. 
* Plexus dorsalis manus. 
t Arens venoms dorsalis 552 
Of THE VEINS 
The veins on the back of the hand have nerves intermingling with 
them, viz. branches of the ulnar nerve, and the extreme branches of 
the muscular spiral nerve ; so that it is a great mistake to suppose 
that bleeding in the back of the hand might be substituted with ad- 
vantage for the common operation in the bend of the arm, in order to 
avoid pricking the nerves. 
Vena cephalica.— The vein of the back of the thumb running 
into a trunk, which takes a course over the outside of the wrist, 
is called cephalioa pollicis. 
From this vein and the division of the plexus of the back of the 
hand, a considerable trunk is generally formed, which takes its course 
on the radial edge of the arm, and is called cephalica minor, or 
radialis externa. This vein in its tract over the extensor radialis, 
and the supinator longus, has many lateral communications, particularly 
with the median vein. 
This vein, now joined by the median cephalic, and rising upon the 
outside of the humerus, becomes the great cephalic vein ; and it 
passes, first between the biceps and triceps brachii, and then between the 
deltoides and pectoralis major muscles. In this course it is joined by 
several small cutaneous branches, which play over the belly of the 
biceps muscle, and communicate with the basilic vein ; a little below 
the external condyle of the os humeri, the cephalic vein detaches a 
branch which ascends between the brachialis internus and supinator 
longus, and which afterwards forms inosculations with the basilic vein, 
on the back of the arm. 
The great cephalic vein passing up between the tendons of the 
pectoralis major and the deltoid muscles, sinks into the axilla and joins 
the axillary vein. 
Vena basilica.* We trace the origin of the basilic vein from 
those veins which, being continued from the plexus, on the back of 
the hand, take their course over the lower head of the ulna. (A con- 
spicuous branch of these veins, from the little finger, was called 
salvatella! by the ancients.) From this origin, the basilic vein 
takes a spiral course on the ulnar edge of the fore arm, sometimes in 
one great trunk, oftener in two, sometimes in a plexus of veins ; here 
it may be called ulnaris superficialis, or cdbitalis interna. This 
vein, now rising before the inner condyle of the humerus, passes on 
the inner margin of the biceps flexor muscle ; here it forms very free 
and numerous connections with the internal or brachial vein, the 
satellites and cephalica ; still passing np, it sinks by the outside of the 
tendon of the pectoral muscle, and joins the axillary vein. 
The great basilic vein, or the great trunk, after in has ascended 
above the elbow, and received the median basilic, is joined by several 
deep branches of veins ; as those which accompany the brachial artery, 
called satellites or comites, and a vein which is called profunda brachii; 
and still nearer its termination, it receives the addition of the vena 
sub-humeralis, or articularis, and the venae scapulares, viz. those an- 
* Brachialis. The ancients termed the basilic vein of the right arm, the vein of the 
liver, or vena hepatica brachii, and that of the left, the vena splenica brachii. 
+ Salvatella quasi. Salvator being opened as a sovereign remedy in Melanchofia. OF THE AKM. 
553 
sWermg to tiie arteries of that name, and coming from under the 
scapula. 
Vena mediana major.*—This is a vein which runs up the middle 
of the fore arm, beginning from the plexus of veins, which play over 
the flexor tendons, and come from the ball of the thumb ; it is very 
irregular, being sometimes double, and sometimes assuming the form 
of a plexus ; often it is particularly short, and can be considered as a 
trunk, only for a few inches as it approaches the bend of the arm ; not 
unfrequently it is entirely wanting, and, as if annihilated by the greater 
size of the branches of the cephalic or basilic veins. But, for the 
most part, when this vein has ascended on the middle of the fore arm, 
near to the bend of the arm, it divides ; one branch passes obliquely 
outward, and joins the cephalic vein ; the other inwards and unites 
with the basilic vein; the first is of course the median cephalic vein,! 
the second the median basilic vein. 
These are the two branches which the surgeon most commonly 
selects for bleeding. Around the median cephalic the cutaneous 
nerves play more profusely, and under the median basilic vein the 
humeral artery passes. It is by the awTkward plungingof the lancet 
into the median basilic, that the country bleeder sometimes produces 
the aneurism of the artery; but the dreadful symptoms following the 
pricking of the nerve, are more frequently produced by bleeding in the 
median cephalic ; cases however occur of the pricking of the nerves, 
while bleeding in the median basilic vein. 
Axillary vein.—The trunk of the veins of the arm passes through 
the axilla, until it arrives between the first rib and clavicle, under the 
name of axillaris. Here lying by the side of the artery, it receives 
many muscular branches from the flesh of the shoulder, the external 
and internal scapular veins, and the thoracic veins ; in general where 
it passes by the head of the humerus it receives the cephalic vein. 
Subclavian veins.—The axillary vein continuing its progress over 
the first rib, becomes the subclavian vein, and is joined by the external 
jugular vein. It then takes a direction downward, and being joined 
by the great internal jugular vein, and having received the trunk of the 
absorbent system just at the angle of the meeting with the great 
jugular vein, it terminates in the superior cava. On the right side the 
subclavian vein is shorter, and descends more directly ; on the left it 
is longer, but still its direction is downward and across the upper part 
of the chest; passing before the trachea and the branches of the arch 
of the aorta, it joins the subclavian of the right side, and together 
they form the superior cava. Besides the jugular veins, the left sub- 
clavian vein receives these : a vein from the shoulder and lower part 
of the neck; the vertebral vein ; with some lesser plexus of veins 
descending from the neck, and the thyroid veins. From below they 
receive the lesser internal thoracic veins, and the mammarise.| 
* Vena media; vena superjicialis communis. FabrieiiJig. brachii viva. 
t Portio cephaiica, A. B. loc. cit. 
j Haller, Icon. Anatomic. Coo'poris humani Fasciculus III. tab. nrter, Pectanis 554 
«F THE VEINS 
THE 8EPERKH4 VENA CAVA, THE VENA AZYGOS, AND LESSER VEINS Oi 
THE TnORAX. 
The superior vena cava is the trunk of all the veins of the head, 
neck, arms, and of the parts in the thorax ; soon after it is formed by 
the union of the subclavian veins, it is joined by the vena azygos, and 
receiving the internal mammary veins, and the ven® thymic® and 
pericardiac, and the intercostal and uronchial veins, it descends 
into the pericardium, and dilates or opens into the right sinus or 
auricle. 
Vena aztoos.* The vena azygos is the principal vein of the 
thorax, and chiefly of the walls of the thorax. It is observed to take 
its origin upon the vertebra of the loins from some of the lumbar 
veins, or by inosculations with the renal, spermatic, or lesser branches 
of the abdominal cava, receiving the first and second lumbar veins, as 
in its ascent in the thorax, it receives the intercostal veins on either 
side ascending between the crura of the diaphragm, and by the side 
of the aorta, it sometimes receives the lower phrenic veins. In the 
thorax lying on the right side of the bodies of the vertebrae, and before 
the intercostal arteries, it receives the bronchial veins from the root ol 
the lungs, and from the trachea it receives the veins of the posterior 
mediastinum and oesophagus; through the intercostal veins, it com- 
municates with the external and internal mammary veins, and with the 
venal circles of the spinal marrow. 
Upon the third vertebra, the azygos vein separates from the spine, 
and after forming an arch, and bending round the root of the lungs, it 
opens into the superior cava, just where it is about to enter the peri- 
cardium. And here where it opens into the great vein, it is guarded 
by a valve. 
This vein, however, like most others, has considerable variety, and 
does not always merit the name of azygos, for sometimes it is double, 
a division ascending on the left side of the spine, and uniting with the 
branch of the other side, just as it is about to enter into the superior 
cava. 
Of the lesser veins in the thorax.—The ven® mammari® take 
a course by the side of the internal mammary artery, and require no 
description. Like the arteries, they spread their branches on the mus- 
cles of the belly, and communicate with the diaphragmatic and lum- 
bar and epigastric veins. The left mammary vein terminates in the 
left subclavian vein, the right in the superior vena cava. 
The ven® thymic® enter, either into the union of the subclavian 
veips, or they enter into the guttural veins, or the internal mammary 
veins. 
The pericardiac veins gather their branches from the pericardium, 
from the aorta, trachea, and lymphatic glands; they send down 
branches by the side of the phrenic nerve, which inosculate with the 
veins of the diaphragm ; they enter the internal mammary vein, or the 
superior cava, or join the right subclavian near its termination. 
* Sine pari. 
t We except some of the veins from the interstices of the higher ribs, particularly OB 
the right side, which enter the subclavian vein- 555 
OF THE LEO AND TlIIGIl. 
The superior intercostal veins.—The right and left intercostal 
veins differ in their size and distribution ; the right is small, and re- 
ceives only one or two of the upper intercostal veins, which do not 
enter into the azygos vein. The vein of the left side begins even so 
low as the interstice of the seventh rib ; it receives branches from the 
veins of the pleura, pericardium, and lungs, (viz. the bronchial veins,) 
and from the veins of the oesophagus, and they enter the subclavian 
veins. 
OF THE VEINS WHICH UNITE TO FORM THE INFERIOR VENA CAVA. 
The inferior vena cava receives the veins of the lower extremities, 
the hypogastric and abdominal veins, and the veins of the viscera of 
the abdomen ; but those of the spleen and the membranous conlents 
of the abdomen, are received by it, only indirectly, and through-the 
circulation of the liver. 
OF THE VEINS OF THE LEG AND THIGH. 
We have observed that the veins of the extremities are in two sets ; 
the deep and the superficiai. In the leg and thigh, the deep seated 
veins accompany the arteries, and receive the same name : the cuta- 
neous veins may be included under the name saphena major and minor, 
and their branches. 
Saphena major.*—A large and beautiful plexus of veins is formed 
on the fore part of the foot, by veins coming from the back of the 
toes, and outside of the foot. Two principal veins arise from the 
arch which these form : one takes the course behind the inner ancle, 
and is the saphena major ; the other passes over the outer ancle, and 
forms the saphena minor. 
The great saphena may be traced from the great toe, from the in- 
side of the foot, and behind the ancle : it receives one or two branches 
from the sole of the foot. Sometimes the principal branch passes 
behind the lower head of the tibia, sometimes before it, or it forms 
circles here : a little above the ancle a vein from the middle of the 
metatarsal arch comes obliquely over the tendon of the tibialis anticus, 
and joins it. 
The saphena, now a considerable trunk, runs up the leg, before the 
inner margin of the belly of the gastrocnemius muscle, and on the 
inner ridge of the tibia. In this course, it receives numerous cutaneous 
branches, and backward, over the belly of the muscles, it forms inos- 
culations with the lesser saphena. From the inside of the leg the 
trunk ascends on the inside of the knee, where it receives several 
branches, coming round the joint, and over the head of the tibia. Now 
passing somewhat obliquely, it ascends upon the thigh, and at the 
same time turns from the inside to the fore part of the thigh. In the 
thigh the great saphena receives many branches, and is not always a 
single vein : for sometimes the branches collecting, form a small trunk, 
which runs collateral to the greater vein ; these join in the groin. In 
* Saphena maeim interna. 556 
TIIB VEINS 
all its course the saphena vein is superficial, and lies imbedded in the 
cutaneous fat; with but a very slight and imperfect aponeurosis en- 
closing it; while it is external to the proper fascia of the leg and 
thigh. As it ascends upon the thigh, however, it does not dive sud- 
denly under the fascia; but is gradually enveloped and embraced by 
the condensed cellular membrane and fascia, until it finally terminates 
in the crural vein. 
When it was more the practice than at present to bleed in the ancle, 
the saphena major was the vein selected : but as in all the course of 
the vein, from the great toe to the knee, it is connected with the 
nerve which bears its name, there are not wanting instances of those 
bad effects from pricking of this nerve, which not unfrequently follow 
the bleeding in the arm. 
The surgeon has much to do with this long vein of the thigh, sinee 
it is more than any other vein subject to dilatation. By costiveness, 
principally, and straining at stool, the blood of the abdominal vein is 
pushed back upon the valves of the crural vein. They yield, or what 
is the same thing, the coats yield ; the diameter of the vein is increased ; 
the valves do not reach across the vein ; their action is lost; the 
column of blood is thus extended, and its pressure increases. The 
consequence of this is a painful distention of the veins of the thigh 
and leg. 
In consequence of the rapid distention of the veins of the thigh in 
this manner, 1 have repeatedly seen suppurations on the thigh, a com- 
plaint not described or understood. The more common consequence, 
however, is a varicose enlargement of the veins of the leg; and ac- 
companying this source of debility in the circulation of the limb, an 
ulcer near the ancle, and depending on the state of saphena. 
Saphena minor.*—This vein arises from the plexus on the outside 
of the dorsum of the foot: it runs over the outer ancle, and above the 
fascia, covering the tendons of the peronaei muscles. Here receiving 
many branches, and forming frequent deep inosculations, it mounts on 
the outside of the vagina or fascia, which covers the back of the leg, 
but gradually becoming deeper, it is found under the fascia, on the 
calf of the leg, and arriving between the hamstring tendons, it sinks 
into the popliteal hollow, terminating in the popliteal vein. 
The lesser saphena vein, like the anterior one, is subject to become 
varicose ; and when we imagine that the varicose state of the limb, 
and the consequent ulceration, is depending on the long anterior vein, 
it may be a consequence of the posterior and lesser saphena. 
The other veins of the lower extremity which accompany the arteries 
in their course, need little description. 
Anterior tibial veins.—The veins accompanying the anterior 
tibial artery form many inosculations, and when minutely injected, 
almost conceal the artery. They are the anterior tibial veins, and only 
unite into a trunk, where, perforating the interosseous ligament, it 
joins the popliteal vein. 
Posterior tibial veins.—In the sole of the foot we have the ex- 
ternal and internal plantar veins, which uniting into trunks, accompany 
* Vena saphena pawn externa OF THE LEG AND THIGH. 
557 
the artery behind the inner ancle. In its course between the solasus 
and the tibialis posticus muscles, it cannot be called the posterior tibial 
vein ; for it is a mere net-work of veins surrounding the posterior tibial 
artery. It receives, near its termination, a branch called suralis, 
from the gastrocnemii and solaeus : it terminates in the popliteal vein. 
The venjE perone*, are the venae comites of the fibular artery, and 
are two or three in number. All these veins have free inosculations 
with each other. 
The popliteal vein.—This vein is formed by the three divisions of 
deep veins accompanying the arteries of the leg, and the saphena 
minor. It lies more superficial than the artery, and seems to cling 
round it. As it ascends, however, it twists round the artery, the artery 
being nearest the bone—a little above the joint it receives the lesser 
saphena. It then perforates the tendon of the triceps, comes to the 
fore part of the thigh, still united to the artery, and lying posterior to 
it: it is now the crural vein. As it ascends it gets from behind the 
artery, so that in the groin it lies nearer the pubes than the artery does: 
opposite the trochanter minor it receives the internal and external cir- 
cumflex veins, and the vena profunda femoris. About an inch 
below Poupart’s ligament the crural vein receives the saphena major, 
and the small external pubic veins, and finally the veins which descend 
from the integuments of the belly. 
The veins of the lower extremity are very strong in their coats, and 
indeed equal the arteries in the thickness of their coats : for example, 
in an amputation, it will not be possible to distinguish the vein from 
the artery upon the face of the stump, unless by their relative position. 
These veins do, in fact, sustain a long column of blood, and great pres- 
sure consequently ; and so powerful is this pressure, that when a vari- 
cose vein bursts in the ancle, some pounds of blood are suddenly lost. 
A rupture or wound of a vein in the thigh has an effect like an artery 
in sending the blood abroad into the limb. 
External iliac vein.—The femoral vein lying on the inside of the 
artery, or nearer the pubes, enters the abdomen under the femoral liga- 
ment, and passing by the side of the Psoas muscle becomes the external 
iliac vein. It receives several lesser veins just within the ligament, 
particularly the epigastric vein from the muscles of the belly, and the 
veins accompanying the arteria circumflexa ilii. 
Veins of the Pelvis.—The veins of the integuments of the penis 
join the superficial veins, which are called pudicje extern*, and fall 
into the crural vein in the groin. The proper veins of the cavernous 
body of the penis, and of the 3pongy body of the urethra, form the 
vena dorsalis or vena ipsius penis. This is a large vein which runs 
down between the dorsum of the penis and the ossa pubis. This vein 
having made good its course into the pelvis, is joined by a large plexus 
which is around the prostate gland and the vesicnlae seminales in the 
inale. Here, indeed, the veins are so large, and so irregular, as to 
deserve the name of sinuses. How much blood they contain is known 
to the lithotomist, since they are cut in that operation. These pros- 
tatic veins are joined by the ven* vesicales. These unite to the 
branches collateral to the pudic*, finally to the veins returning from 
the gluteal arterv. These form the internal iliac veins or hypogastric 558 
OF THE VEINS OF THE LEG AND THIGH. 
vein, ascending from the pelvis, join the external iliac vein coming 
from the thigh, and form the common iliac vein. 
The common iliac veins.—The common iliac vein begins at the 
sacro-iliac symphysis, and runs up upon the sacrum to join its fellow of 
the other side opposite to the cartilage, which joins the fourth and fifth 
vertebra? of the loins. 
Vena cava abdominalis.*—A little lower than the bifurcation of 
the aorta, the right and left common iliac veins unite, and by this union 
they form the vena cava. 'Phis vein ascends upon the right of the 
aorta. It receives fewer branches than would naturally be imagined, 
because the veins of the viscera take their course by the vena porta? 
into the liver. It receives the lumbar veins, four on each side, the 
spermatic veins, the renal, supra-renal, and phrenic veins. Passing 
upward, it is received into its appropriate fossa in the liver, and se- 
ceding a little from the spine it receives the vena: cava: hepatic.*:, and 
perforates the diaphragm ; entering the pericardium, it expands into 
the great sinus, or right auricle of the heart.! 
Renal veins.J—These veins are less irregular than the arteries of 
the kidney, which relation of the veins and arteries is uncommon. 
From the relative situation of the kidneys to the cava, it is evident that 
the right vein must be short; the left comparatively longer, and taking 
a course from the kidney over the aorta.§ 
Supra-renal veins.—These little veins are like the arteries in their 
course. The right one enters sometimes into the vena cava, sometimes 
into the renal vein. The left sometimes receives the phrenic vein of 
that side and enters into the renal vein. 
Spermatic veins.—The veins of the testicles return from the minute 
extremities of the spermatic artery, distributed in the body of the gland 
and in the epidydimis, one beautiful and tortuous artery may be seen 
upon the tunica albuginea testis. As these veins reach the cord they 
become very tortuous, and encircling the convolution of the spermatic 
artery, form a thick vascular body. They are joined by the vein of the 
epidydimis as they ascend. The higher these vessels are, the nearer 
to the ring, the less convoluted they are, which makes the cord of a 
pyramidal shape. This is most remarkable in brutes; and in them 
chiefly have these vessels got the name of corpus pyramid ale and 
PAMPINIFORME.il 
The spermatic vein before it enters the abdomen, has collected the 
principal branches and is fortified with valves. These valves, however, 
sometimes lose their office in consequence of dilatation of the veins, 
and then comes a very unpleasant varicose swelling of the spermatic 
cord, which is attended with a gravitating pain, and some degree of 
weakness of the gland. 
The spermatic vein passing the spermatic passage, and forming a 
very considerable part of the whole cord, enters the abdomen, but still 
* Vena Cava inferior'. 
1 Verne Cava lusus. Act. Petrop. tom. xii. p. 262. Sandifort Thes. vol. i. p. 348. 
j Emulgent veins. 
§ The renal veins, however, sometimes vary in their number, the right being double 
or triple, the left even sometimes in four branches. 
|| Pampiniformis, i. e. resembling the tendrils of the veins. Iron. Anatomic. Cor- 
poris ftnmani Fasciculus iii. tab. Arter. Pectoris. 559 
OF THE CAPILLARY VESSELS. 
behind the peritonaeum. Here coursing round the loins, it gathers 
branches from the fat of the kidney, the ureter, &c. The right vein is 
generally double, the left single ; the one joins the cava, the other the 
emulgent vein. 
From the point where the crural vein terminates in the external iliac 
vein up to the heart, there is no valve. This circumstance of there 
being no valves in the veins within the abdomen, proves that they are 
useful only, to guard against the effects of external and muscular pres- 
sure, and that where the veins are safe against partial pressure they 
require no valves. 
This circumstance of there being no valves on the lower cava and 
its branches, makes the wounds of these vessels as full of danger as 
the wounds of the great arteries. I have known a wound of the external 
iliac vein prove fatal by a gush of blood, as formidable as if it had 
come from the artery, because it descended unobstructed from the 
heart. 
I must refer to the anatomy of the abdominal viscera, for the de- 
scription of the peculiarities in the circulation in the liver. . 
It is sufficient that at present I remind the student that the blood of 
the stomach and spleen, the small and great intestines, does not fall 
into the cava. The veins from these floating viscera, as they have been 
sometimes called, form a trunk, which running obliquely across the 
abdomen, and entering the liver, is called vena portal The vena: 
cava: hepatica: are two large veins which come out of the liver, and 
which join the vena cava just as it is passing the diaphragm. 
OF THE LYMPHATIC AND LACTEAL SYSTEMS 
OF VESSELS. 
We have understood that the red blood circulates in the body, through 
the arteries and veins, and that these vessels have a direct communi- 
cation at their extremities by inosculation; that although these vessels 
lie parallel to each other, and extend from the heart to the remotest 
part of the body, yet the blood is said to pass through the circulation, 
because it is transmitted from the arteries into the veins, and so back 
to the heart. In this transmission of the blood through continuous 
tubes, there is in the coats of the vessels an alternation of contraction 
and relaxation which impels it forward. But besides these arteries and 
veins carrying the red blood through the body, there are other pellucid 
vessels, more remote in their connection with what is generally called 
the circulating system, and which neither receive an impulse from the 
heart, nor exhibit any sort of pulsation by their proper force. 
OF THE CAPILLARY VESSELS, AND THE PHENOMENA PRESENTED BY THE 
MICROSCOPE. 
The capillary vessels are those extreme branches which are as minute 
as hairs: but this, though the literal, is not the general meaning of the 560 
OV THE CAPILLARY VESSELS. 
term. By capillary vessels is rather understood those brandies iu 
which the changes are wrought from the blood, and which are either 
so minute as not to allow the promiscuous flow of the particles of the 
blood, or possessed of such a degree of irritability and appetency, as 
only to allow certain parts of that fluid to be transmitted. 
It is proved, that in the living body there is no exudation ; but no 
sooner is the animal dead, than the fluids exude from the vessels, the 
secretions pass through the coats of those receptacles which formerly 
contained them, and one part partakes of the colour of another which 
is contiguous. From this fact, we are led to think that a property 
exists in the living fibre, which repels the fluids. Admitting this, it is 
very natural to suppose that the fibres, and more particularly the vessels 
in the capillary texture of each organ, possess sensibility, which has its 
relations to the fluids passing through them, or to be secreted from 
them. 
The most beautiful phenomenon may be seen by the aid of the 
microscope, in the circulation of the blood, that is, the transmission of 
the blood from the arteries into the veins. When the web between the 
toes of a frog is submitted to the microscope, the eye at first discovers 
only a confused motion of particles. But by a steady continuance of 
the observation, we are soon able to observe the motion of the red 
particles of the blood. WTe do not discover the coats of the vessels, 
but conclude, that they exist from the confined and certain course of 
the particles which are in motion. We distinguish the arteries by the 
rapidity of the particles passing through them in single files, and pur- 
suing these particles, they are observed to turn suddenly into larger 
vessels. These vessels, by the number and slower motion, and altered 
direction of the red glohules, are recognised to be the veins. When 
the animal is disturbed, there is a general acceleration of the motion of 
the blood in the small vessels. When the web or membrane is pricked 
and irritated, (as with salt and Cayenne pepper in solution Upon a 
needle,) the motion of the particles in the arteries is accelerated in a 
very singular manner ; if the excitement to inflammation be continued, 
the veins are seen to enlarge, and an accumulation of red particles takes 
place in them by which they are visibly distended. These accumu- 
lated particles are urged forward with a difficulty which seems to be 
occasioned by the attraction of the fluid to the sides of the coats. 
It is remarkable, that while we admire this proof of the circulation, 
we see the influence of the heart’s action upon the blood in these 
minute veins; for at each pulsation of the heart the red globules are 
sent forward, being stationary, or recoiling during the diastole. 
During the disturbance of the circulation of the part by the applica- 
tion of stimulus, there seems to be a certain attraction or cohesiveness 
between the sides of the vessels and the red globules, which occasions 
the remora and accumulation of the red globules. The same was the 
consequence of cutting the vein across, for the blood, instead of flowing 
from the cut, became arrested in the vessel. 
Since we see that in an inflammatory state the pellucid veins trans- 
mit red blood, and that this red blood must be supplied by the serous 
arteries ; then it is proved that answering to the pellucid arteries (in their OF THE CAPILLARY VESSEL!?. 
561 
natural state) there are pellucid veins. We acquiesce, therefore, in the 
opinion that supposes both the arteries and veins to have pellucid capil- 
lary branches answering to each other, collateral to the larger and 
more evident anastomoses of their red extremities. These anastomo- 
sing branches of the arteries and veins in which the red blood is seen 
to circulate, perpetuate the flow of the greater part of the blood back 
to the heart, while the several secretions are performed in the capillary 
vessels ; but there is no reason to suppose that the fluids sent from the 
arteries into these pellucid capillary vessels are all poured out in form 
of secretions ; part returns into the extremities of the circulating veins. 
The secreted fluids and solids are either carried away by ducts into 
their receptacles, or thrown out from the body : while those fluids, 
which are exuded on the cellular membrane and cavities, are re- 
absorbed by the system of absorbing lymphatics. 
We say then, that arteries terminate, first, in red veins, which is 
proved by the microscope, and by mercurial and other injections ; 
secondly, in glands ; thirdly, in cells receiving red blood ; fourthly, in 
lymphatic veins ; fifthly, in exhalents, which pour their fluids into the 
cellular membrane, cavities, joints, &c. and which fluid is taken up 
by the valvular lymphatic absorbents. 
But these absorbent vessels, of which we are now to treat under the 
division of lymphatics, do also perform a circulation, inasmuch as they 
convey back to the centre of the system the fluids which have been 
thrown out from the extremities of the arteries. But as these lym- 
phatic vessels are not continued from the extremities of the arteries as 
the red veins are, as they imbibe the fluids, which have been thrown 
out of the other system of vessels; their fluid contents cannot be con- 
veyed through them by the force of the heart and arteries ; these vessels 
must be peculiar in having powers withip themselves, first of absorbing 
and then of propelling their fluid onward to the heart. Neither can 
they be said to be circulating vessels according to the use of that term, 
for although they carry the lymph back to the heart, yet the continuity 
of the vessels is broken ; they are not continuous with the extremities 
of the arteries. 
The lacteals are vessels which, distributed to the intestines, absorb 
and convey into the system the milky opaque fluid which is generated 
in the intestines by the process of digestion. 
The common property of absorption in the lymphatics, absorbents, 
and lacteals, and their being connected with the same trunk, occasions 
their being considered as one system of vessels; yet looking upon the 
general economy of the living body, we find them ministering to very 
different purposes. The one branch of the system, the lymphatics, 
convey the waste of the body again into the circulating system. The 
lacteal vessels, on the contrary, are those vessels which opening upon 
the inner .surface of the intestines, receive into them the nutritions fluids 
prepared by the organs of digestion, and suited to supply the incessant 
waste and destruction of the solid and fluid parts of our frame, which 
have been absorbed and carried away*by the lymphatics. Following 
this simple view, although the absorbent system be commonly divided 
into the thoracic duct, lymphatics, lacteals, and glandular apparatus 562 
OV THE LYMPHATIC SYSTEM. 
attached to them, I shall throw the present section into the division of 
the lymphatics and of the lacteals. 
OF THE LYMPHATIC SYSTEM IN PARTICULAR. 
The lymphatic vessels are tubes whose coats are perfectly pellucid, 
having a remarkable power of contraction, which causes them to shrink 
and disappear, so as to render it difficult to demonstrate them. Indeed 
they are only to be observed by an eye accustomed to make lymphatic 
injections. They are called lymphatics, or ductus aquosi, from their 
transmitting a fluid colourless as water. When they are distended with 
their fluids they show that they possess a very distinct character from 
the other vessels. They are irregularly distended, knotty, and some- 
times like a chain of beads, or little irregular vesicles connected 
together. This irregularity is owing to their numerous valves, which 
are semilunar membranes, like those of the veins, hung across their 
cavities, so as to catch and interrupt the refluent lymph.* They say, 
in general, that in the space of an inch the lymphatic vessel has three 
or four pairs of valves. But this bears no certain proportion ; for as 
these vessels run where they are exposed to occasional compression 
from the surrounding parts, or bear the weight of a high column of fluid, 
their valves are more frequent. The lymphatics are improperly called 
cylindrical tubes, since they are irregular from their valves, their 
branching, and frequent communications. The coats of the lymphatic 
vessels are the strongest of any in the body ; for although extremely thin 
and pellucid, they give resistance to distention beyond a certain point, 
and bear a column of mercury which would burst through the valves of 
veins, and tear the coats of arteries. If there be a muscular coat, and 
no one ever denied the muscularity of the lymphatics, then we may 
reckon three coats : First, the inner coat, which is the continuation of 
the inner tunic of the veins, as may be observed in the opening of the 
thoracic duct into the left subclavian and left jugular veins. It is 
smooth and polished, forms duplicatures or valves, and prevents the 
transudations of their fluids : it is connected by cellular membranes to 
the middle coat. Secondly, the muscular or middle coat, which con- 
sists chiefly of muscular fibres, which, according to Sheldon, run in 
every possible direction, though the greater number take the circular 
direction. And, lastly, the outer coat, which is connected with the 
general investing cellular membrane. As the inner coat must chiefly 
form the valves, and as the valves possess a very remarkable power of 
resisting the column of mercury, I conceive that the inner coat is that 
on which the strength and resistance to distention of the lymphatics 
depend, though it has been said that it is to the outer coat that they 
owe this property. The muscularity of these vessels is rather inferred 
than proved : it is inferred from the unassisted action which they have 
to perform in pressing the absorbed fluid onward to the heart. . Never- 
theless we sometimes see the lymphatics of the lower extremities of 
a colour so red, that we may say their muscularity is demonstrable. 
The lymphatics seem to possess little elasticity ; when they are 
blown into, they rise with the slightest force, and remain distended. 
* Ruyschii Diluddatio Valtmlantm, Vet. Oper. vol. i. OF THE GLANDS OF THE ABSORBENT SYSTEM- 
563 
although the passage of the air forward be uninterrupted ; whereas 
had they considerable elasticity, they would contract and disappear. 
Indeed, when empty in the dead body they may be rather said to be 
collapsed than contracted. Although the lymphatics can be distended 
with the slightest inflations, yet when distended, as we have already 
observed, they firmly resist further dilatation. This is a quality neces- 
sary to their valvular structure, for if they were elastic beyond this 
degree of dilatation, the calibre of the vessel would be occasionally 
so enlarged as to render the valves incapable of meeting, and conse*- 
quently of preventing the retrograde movement of the fluids. 
Indeed they appear sometimes to suffer this kind of enlargement or 
distention, for we occasionally find that the mercury runs backwards 
along the vessels, contrary to the proper course of fluids in them. • 
OF THE GLANDS OF THE ABSORBENT SYSTEM. 
Every where throughout the human body and viscera, between the 
extreme branches of the absorbent system and the trunk, glandular 
bodies are interposed. Though these glands be of various forms they 
are generally of an oval shape, and they vary in size from the twentieth 
part of an inch to a full inch in diameter. Sometimes they are segre- 
gated, sometimes accumulated, and clustered together. The colour of 
those bodies is various in the several parts of the body : in young ani- 
mals they are redder, and become pale only with age. They are red- 
der and stronger in the outer parts of the body, as in the thigh, axilla, 
&c. less so within the abdomen and thorax. 2. The latter will not 
bear so high a column of mercury as the former. The mesenteric 
glands are said to disappear in old age.* They certainly diminish very 
remarkably. 
It would appear that the glands of this system arc of more import- 
ance to young animals than to adults. In the foetus and in children, 
the lacteal and lymphatic glands are exceedingly numerous ; but they 
shrink with old age. In the foetus, they can be of no very essential use; 
they are then rather in a state of preparation for the actions necessary 
in infancy and youth. It is during infancy and youth that they are 
most liable to disease, and seem more irritable and ready to inflame, 
especially when they are placed superficially. About the age of four- 
teen or fifteen this disposition is changed, which is commonly said to 
proceed from the increased vigour of the constitution, and the change 
which then takes place on the organs of generation. It is rather to be 
attributed, however, to the diminution of irritability and activity of the 
vessels of the glands at this age, for, as we have said, the glands are 
now smaller and paler. We may further observe, that the lymphatic 
glands, even in the scrophulous diseases, are seldom primarily affected; 
they partake of diseased action from an impression on the surface of the 
body, or from an infection of the intestines, or from the absorption of 
the matter. The structure of these glands has not been satisfactorily 
investigated. There is at least some obscurity over this subject. 
Some anatomists have said, that they consisted of the convoluted ab- 
* By Ruyscb, Morgagni, Halier, Sheldon 564 
ORIGIN OF THE LYMPHATICS, 
sorbent vessels ; others, that they are of a cellular structure. When 
they affirm that these cells are totally distinct from the lymphatic ves- 
sels, it is not so easy to understand them : for cells communicating 
with each other, and into which the lymphatic vessels enter, are very 
much the same with a scries of convoluted, varicose, and irregularly 
dilated vessels. If we could dissect this series of cells, as Haller did 
the vesiculae seminales, we should have represented to us the appearance 
of a convoluted varicose vessel. 
There is a coat of cellular membrane which surrounds the glands. 
This coat is pervaded by a peculiar fluid, which has given rise to some 
speculation. It is observed chiefly in young animals, and is for the 
most part, though not always, white and milky, and in the glands of 
the lungs it is of a blackish colour. This is the fluid which, having 
globules in it, was supposed by Mr. Hewson1 to be the first stage of 
the formation of the red globules of the blood. It is distinct from the 
absorbed fluids, and is a secretion from the arteries. Physiologists 
have not determined the nature or use of this fluid. The arteries and 
veins which supply the lymphatic glands, differ in their course from, 
those branches which are supplying the common surrounding parts. 
The artery takes a long circuitous course, and twists and turns before 
entering into the gland. 
At present there seems no better hypothesis to be offered regarding 
the use of the lymphatic and lacteal glands, than that they serve to 
check, control, and measure the flow of the absorbed fluids into the 
mass of the blood : without them it appears to me probable that at 
one time the lymph, returning from the body, or at another time the 
chyle, might flow too rapidly, and in a disproporlioned quantity, into 
the veins and heart. But by the check which the glands impose upon 
this flow, giving a remora, and serving as receptacles of the absorbed 
fluids, the fluids are poured with a more uniform and constant flow 
upon the heart. 
As to the opinion, that these glands prevent poisons entering into 
the system, it cannot be sustained. Is it really so ? Have they this 
effect ? And the answer must be, No ! On the contrary, they seem 
the first to inflame, and hence to propagate bad action rather than to 
prevent the contamination of the system. 
ORIGIN OF THE LYMPHATICS, AND OF THE DOCTRINES OF ABSORPTION. 
The lymphatics, forming a system of absorbents, we might say, in 
general, that they take up all the fluids which have been thrown out 
upon the surfaces of the body. Thus they arise from the pores of the 
skin ; from the surface of the cavities and viscera, which are covered 
by the pleura and peritonaeum ; from the cells of the interstitial and 
adipose membrane ; from all the ducts and cavities of the body. This is 
the use assigned to this system of vessels ; but whether they are the only 
system of absorbents ; whether they carry away all the parts of the sys- 
tem, fluids, and solids ; whether they absorb the muscles, membranes, 
bones, tendons, &c. of which the solid body consists, as well as the se- 
creted fluids, is a question requiring examination: for there is much pre- 
sumed ; a great, deal of very loose reasoning brought forward in support of AND OF THE DOCTRINES OF ABSORPTION. 
565 
lymphatic absorption,—and this much I must say, although I do not 
object to the doctrine of absorption by lymphatics. We shall first ex- 
amine the proofs of the lymphatics being the vessels which absorb the 
fluids of the cavities and surfaces of the body. The animal machine 
universally partakes of motion. A principal provision for this mobility 
of parts, is the looseness of the cellular membrane which every where 
pervades the body, and supports the vessels, and connects the several 
parts. This interstitial membrane is elastic, and being cellular, to 
allow of motion, its surface is bedewed with serous exudation. This 
fluid is perpetually passing from the extremities or sides of the lymphatic 
arteries or capillaries into the cellular membrane, and upon all the 
cavities of the body. The fluid extravasated is called serum, and 
some have supposed that it passes through inorganized pores, an ex- 
pression that is not very intelligible ; but if by this is meant (as has 
sometimes been explained) “ accidental pores” in the sides of the 
vessels, it is a supposition quite improbable and unlikely.* The pores 
or vessels from which this fluid exudes are called exhalent; and their 
action is no doubt as completely secretion as that which produces the 
fluids, which in our wisdom we call more perfect secretions. 
That the lymphatics take up the fluids thrown out in the cavities of 
the body, as the abdomen, thorax, pericardium, &c. there is what 
nearly amounts to an absolute proof in comparing the fluids of those 
cavities with that contained in the vessels ; for by the experiments of 
Ilewson it is found that if the fluid moistening the cavities be collected, 
it will form a jelly when exposed to the air, as the contents of the lym- 
phatics do. Thus, if a lymphatic vessel be tied up in a living animal, 
and then opened so as to allow the fluid to flow into a cup, it will form 
a jelly like the coagulable lymph.t The fluid of cavities alters in ani- 
mals diseased; sometimes retaining its coagulability, and even ac- 
quiring stronger powers; sometimes losing it altogether. But, which 
is most essential to our present purpose, it has been observed, that 
whatever change takes place in the fluids of the cavities, the same is 
found to have taken place in the fluids of the lymphatics. 
But the student naturally asks, How is the lymph taken into the 
lymphatic vessels ? and here it must be confessed, there is too much 
field for conjecture. 
It wa3 thought formerly that the lymphatic arteries terminated in 
small pellucid veins : these veins carrying only the thinner, and refusing 
the red part of the blood, were called lymphatics. When the anato- 
* Dr. Hunter supported this opinion, (Commentaries, p. 40.) viz. “ that the fluids of 
cavities were collected by transudation, and not thrown out by exhalents an opinion 
which could only have arisen from not correcting the ideas received in making injections 
in the dead body by the phenomena of the living system. See Hevison on the Lymphatic 
System, chap. viii. where the opinion of inorganical filtering is successfully combated.— 
See also Cruickshanks. 
t But, by disease, the fluids in the cavities and cellular membrane are altered. In 
dropsy, for example, the fluid of the abdomen loses the property of coagulating on mere 
exposure ; it comes to resemble more the serum of tHe blood : this were sufficient proof 
that the collection is not owing merely to the diminished absorption, but that there is a 
change of action in the vessels of the peritonieum, pleura, pericardium, &c. An inflam- 
matory action of the vessels will throw out a fluid more coaghlable, and which in a high 
degree of action, will form a film of coagnlable lymph or even pus on the surface. But 
in a state the reverse of inflammation, such, for example, as the debility following 
inflammation, a serous effusion will be poured out having little tendency to coagulate. 566 
ORIGIN OP THE LYMPHATICS, 
mist threw in his minute injection, and saw the coloured fluid return 
by the red veins, and the colourless fluid return by the lymphatics,* it 
was held as a sufficient proof of tlfe accuracy of the preconceived 
notion, and tallied with the observations of Leewenhoeck, and the 
theory of Boerhaave.f VV hen, however, anatomists more carefully 
examined the state of parts, they found that the lymphatics wrere not 
filled, unless the cellular membrane was previously injected by the ex- 
travasation of the fluid from the blood-vessels. Finding that this 
alleged experiment was really no proof of the anastomosis, and direct 
communication between the extreme arteries and lymphatics, they 
conceived that it was a proof that these lymphatics took their rise from 
the cellular interstitial texture. Then injecting with mercury, they 
found that when the vessels burst, and the column suddenly descended, 
and the cellular membrane was filled, the mercury was seen to rise in 
the lymphatics. Following up this, they blew air, or injected various 
fluids directly into the cellular membranes, and -by this means injected 
the lymphatics. Thus by an error, by an accidental effect of their 
injection, the minds of Drs. Hunter and Monro were opened to a freer 
discussion of the received opinions and approved authorities. Soon, 
however, it was understood by those conversant with anatomy, that 
these accidental injections of the lymphatics did not prove the lym- 
phatics to take their origin either from the cells or from the extreme 
arteries; but already this good effect, at least, was produced, that men’s 
minds were excited to inquire after new facts, and to follow a new 
train of observation. It was now recollected, that a strict analogy 
and correspondence subsisted between the lymphatics and lacteals; 
the proofs of the lacteals being absorbents, were recalled to memory ; 
new proofs of their being the sole absorbents of the intestines were 
brought forward ; the nature of the fluids effused into the various cavi- 
ties and cells of the body was attended to ; and the conviction followed, 
that the most essential use of the lymphatic vessels was to serve as a 
system of absorbents, to take up the fluids extravasated, or, secreted 
on the surfaces of membranes and cavities. 
An additional proof of lymphatic absorption has been derived from 
the manner in which the venereal virus is received info the system. 
Venereal matter being allowed to lodge upon the delicate skin of the 
glans penis or preputium, causes an ulcer there. The matter of this 
ulcer is absorbed by the lymphatic of the part ; an inflamed line is 
sometimes to be traced into the groin ; and the lymphatic gland of the 
groin, receiving this absorbed matter, inflames and forms the bubo. 
Here then is a proof that the red veins do not absorb, and that lym- 
phatics do : else why are they inflamed ?—and why are the lymphatic 
glands inflamed to suppuration. 
We must observe, however, that there is here by no means an abso- 
lute proof of absorption of venereal matter. Although we believe in 
the general system, we may hazard these queries : If this matter be 
absorbed, why is there no infection without ulcer (chancre) of the 
glans ? If this ulcer be produced by absorption, how comes it that the 
+ It was probably Nuck who first injected the lymphatics from the arteriqp 
t See introduction to the account of the viscera. 567 
AND OP THE DOCTRINES OP ABSORPTION. 
constitution is not infected by the first absorption of the matter, and 
before it has formed an ulcer ? Is it not probable that the irritation 
of the venereal matter, lodging on this vascular surface, and without 
being absorbed, causes a peculiar inflammation, the tendency of which 
is to form a pustule, and to produce matter similar to that which origi- 
nally infected the part with the specific and peculiar action ? Again 
it will be said, however the venereal pustule was originally produced, 
it appears evident that the absorption of this matter, the conveying of 
it along the lymphatic, inflames the vessel, and the next lymphatic 
gland into which it enters, receiving the venereal matter, inflames and 
suppurates, &.c. But again, I choose to say, with every show of like- 
lihood, that neither is this a proof of absorption ; but that the lym- 
phatic vessel being very irritable, and always receiving its stimulus to 
action from its extremities, it has partaken of the venereal inflamma- 
tion : that this inflammation has been propagated to the gland ; that, 
the gland being formed of the convoluted lymphatic vessels, the effect 
of this inflammatory action is there accumulated to so great a degree 
as to lead to suppuration. If a bubo in the groin were a consequence 
of absorption, to injure and inflame the mouth of the lymphatic, would 
be the method to prevent it. But, on the contrary, to irritate a chancre, 
is the means of producing bubo. If a chancre be indolent, although 
matter be formed in it, no bubo will be produced ; but if the surgeon 
applies some corrosive dressing, which, instead of entirely destroying 
the diseased spot, inflames it, then will the gland in the groin sympa- 
thize and rise into a bubo And further, that the disease is received 
into the constitution only in consequence of the system at large par- 
taking of the irritation (a word which but imperfectly expresses the 
change) of the local action of vessels. .Matter might be absorbed and 
taken into the constitution, and the disease propagated according to 
the common explanation ; but, according to that offered here, there 
must be a primary and local disease, from which the general affection 
is propagated. If we are to take the inflammation and hardening of 
the lymphatics and axillary glands as a symptom of absorption from a 
diseased mamma, we must acknowledge the same proof in evidence of 
the veins absorbing. The lymphatics are more active, and their ac- 
tivity depending on the state of their origins arid extreme branches, 
they are more liable to inflammation than the veins ; yet are the veins 
affected in a way that would, on this proof being admitted, prove them 
to be absorbents. We see how they enlarge around a diseased breast, 
become prominent and hard, and lose their softness and elasticity ; 
how they show themselves on the surface of a white swelling, or on a 
cancerous tumour. But, as we would not say that this is a proof of 
absorption by the veins, neither is the proof unequivocal that there is 
absorption by the lymphatics. Again, a suppurating stump, with bad 
inflammation, will cause inflammation of the lymphatics, and suppura- 
tion in the glands of the groin ;* a proof of absorption of the matter 
of the stump ; but do we not find that from such a stump the veins 
ascend, inflamed and suppurating, while sometimes a chain of abscesses 
is formed for a considerable extent ? This, we can have no doubt, is 
* Sfle Hunter’s Commentaries 568 
OF THE ABSORPTION OF SOLIDS. 
the effect of the inflammation continued along the vessel; and is not 
the inflammation produced precisely in the same way in the lymphatic ? 
1 found my opinion of the lymphatics being absorbents,—first, on 
the circumstance that their structure is adapted to this action ; secondly, 
on the analogy between them and the lacteals, in which absorption is 
proved ; thirdly and lastly, upon their continuing to receive and trans- 
mit their fluids, after the heart and arteries have ceased to beat, and 
the red blood to circulate: for then how can they act, but by their 
own powers ? How can they receive fluids but by absorption ? Finally, 
they exhibit a greater degree of irritability, and stronger principle of 
activity and tenacity of life, than the vessels which carry red blood. 
OF THE ABSOUPTIOX OF SOLIDS. 
On examining the works which within the last fifty years have con- 
tributed to throw light on this subject, we are forced to acknowledge 
how necessary it is for that part of a systematic book of anatomy, 
which professes to treat of absorption, to take the form of a critical 
inquiry. When the absorption of the fluids in the cellular substance, 
or contained in the cavities, was universally assented to, physiologists 
did not make sufficient distinction between the absorption of this fluid 
thrown out of the influence of the circulating vessels, and that matter 
which continued to be involved in the membranes and vessels, and 
which formed the solid part of our frame. It will readily be allowed,, 
that the fluid thrown out upon the surfaces of the body and in the 
cells, might be absorbed without inferring that every part of the body, 
solids and fluids, were also taken up by the lymphatic absorbent ves- 
sels. But physiologists observing that the solid parts of the body were 
suffering perpetual change, that the whole body and the vessels them- 
selves were formed, decomposed, and carried away, they hesitated not 
to attribute this to the deposition from the arteries, and the absorption 
by the lymphatics. This alternate destruction and renovation of parts, 
the perpetual change which the whole body suffers, has been universally 
acknowledged to be the operation of the lymphatic system, without 
any other proof than what is offered by a slight analogy. 
There is proof that the interstitial fluids, and the fluid in the ca- 
vities, are imbibed by the absorbing mouths of the lymphatics on the 
surface of the membranes ; but where is the similarity between this 
and the destruction of solid parts ? It has been said that the absorbents 
eat down the solids, and nibble like the mouth of a worm! a mere 
conjecture, and most improbable. The solids are raised by the agency 
of the vessels on the chemical affinities of the circulating fluids. They 
must be resolved by a process, reducing them again to the state of 
fluids ; or the secreting vessels throw out fluids which dissolve them ; 
there must be an operation anterior to their absorption. From the 
comparative simplicity of the fluids of the circulating vessels, and in 
the absorbents, with the various compounds forming the solid and fluid 
mass of the body, we are authorized to conclude, that as from the 
blood the several secretions, solids, and fluids are formed ; these fluids, 
before they are again taken into the active system of vessels, are re- 
solved into their original simple and constituent parts. We are not OP THE ABSORPTION OF SOLIDS. 
569 
then to look for the matter of the component parts of the body in the 
absorbing system of vessels more than in the blood, from which these 
parts were originally formed ; nor are we at liberty to suppose that 
they are taken down by a process like eating or abrasion. I conceive 
that the absorption of the solids depends but in a certain degree on the 
agency of the absorbents ; and that there must be a change in the 
aggregation of the matter previous to the absorption. 
Mr. Hunter says that his conception of the matter is, that nature 
leaves little to chance; and that the whole operation of absorption is 
performed by an action in the mouths of the absorbents. Physiologists 
have laboured, he observes, to explain absorption on the principle of 
capillary attraction, because it was familiar ; but as they were still 
under the necessity of supposing action in the vessels after the matter 
was absorbed, they might as well have carried this action to the mouths 
of these vessels. 
VVe are surprised at the extravagant conclusion to which this idea 
has led Mr. Hunter.. He proceeds to consider the many kinds of 
solids the lymphatics have to carry away, and the variety of mouths in 
different animals, suited to the great variety of substances they have 
to work upon, and then draws the conclusion, or leaves his reader to 
do so,—that not only are the mouths of the lymphatics calculated to 
absorb fluids ; not only do they carry away the solids, but each vessel, 
according to the hardness and toughness of the material upon which 
it has to operate, has a mouth adapted for the work. 
He admits that oil, fat, and earth of bones, had always been con- 
sidered as subject to absorption ; and that. some other parts of the 
body, liable to waste, had been supposed to suffer by absorption; but 
that any solid part should be absorbed, he supposes to be entirely a 
new doctrine. Now, I think we may venture to affirm, that not only 
was it known that solid parts of the body were taken away during l;r 
but that physiologists knew that every part of the living body was 
undergoing a perpetual decay and renovation. Nay, we may venture 
further to say, that Mr. Hunter did not comprehend, in its full extent, 
the relation in which the secreting and absorbing vessels stand to each 
other. He is fond of calling the absorbents modellers,—u modellers 
of the original construction of the body,”—“ modellers of the form 
of the body while growing.” 
Mr. Hunter could contemplate no change in the body during growth, 
decay, or disease, where there was an alteration of form or quantity 
of matter, without attributing it to the “ modelling absorption.” A 
bone cannot be removed without absorption ; nor a part which is use- 
less to the economy (as the alveoli of the teeth, the ductus arteriosus, 
the membrana pupillaris, the thymus gland,) diminished in size or 
totally carried away, without the absorbents being in action. This, 
he continues, is the only animal power capable of producing such 
effects; and like all other operations of the machine, it arises from 
stimulus or irritation, &c. On the contrary, I conceive that the ab- 
sorption of parts in the natural action of health or in disease, is not 
owing to increased stimulus, but often to a diminution of it. 
Does it not strike us forcibly, that when a gland swells, and leeehes 570 
OF THE ABSORPTION OF SOL1US. 
and blisters are applied, and it subsides, this can be no means ot exci- 
ting absorption ; that when pressure is made on a part, and that part 
is absorbed, this is a strange way of stimulating ? Or, when we bleed, 
is it not odd that this should give new power to the lymphatic system? 
For these are the means of giving a counter irritation, and of sup- 
pressing action. 
According to Mr. Hunter’s ideas, the lymphatics do nothing without 
forethought and intention : when they absorb, it is because they have 
found the parts useless in the economy. He has carried this notion 
so far, that he does not only speak of the absorption of the thymus 
gland, membrana pupillaris, alveoli of the teeth, &.c. ; but of the body 
in fever as a consequence of its becoming useless when under disease! 
—The following may perhaps appear to be the more natural suppo- 
sition. 
In a living body we may observe the agency of the nervous, vascular, 
and absorbing systems : and the phenomena of life are not to be at- 
tributed to any one, but to the whole of these. We must also observe, 
that life, or the mutual action of parts producing the phenomena of life, 
is proceeding from excitement, and as in the whole system, so in the 
individual parts of the body, the healthy action depends on the influ- 
ence of this excitement to action. The tendency of the growth of the 
body to peculiar forms, and the increase of parts in disease are produced 
by it. It acts upon the vascular system in disease, by producing increased 
action and secretion ; as a muscle, in the use of frequent and strong 
action, will become more fleshy and vascular; as a gland will be ex- 
cited to greater action and more profuse discharge, whilst it enlarges 
and swells up. When a part enlarges in consequence of the stimulus 
to increased action, whether arising from the natural law of the con- 
stitution, or from disease, it proceeds from the secreting vessels pre- 
ponderating over the absorbent vessels. There is a deposition of 
matter which the latter are unable to take away. But diminish this 
action of the arteries, or take away their excitement, or cause an ex- 
citement of some neighbouring part, and thereby subdue their action, 
relieve them of their fulness, and the absorbents regain their propor- 
tioned actions, and the swelling subsides. The parts of the body 
which, in the natural changes from youth to age, are absorbed and 
carried away, are those in which there is no longer the stimulus to 
vigorous action, and of course the lymphatics overcome the power of 
the secreting vessels, and the part gradually diminishes, loses its appa- 
rent vascularity, loses its redness, and is at last totally absorbed. And 
as the tooth of a child after lying long hid under the jaw, when it par- 
takes of the stimulus to the action of its vessels, grows, and rises up, 
and the alveoli, partaking of this natural excitement also, form around 
it; so, when the tooth decays and falls out, the alveoli will also decay 
and be absorbed ; because the moment these vessels have ceased to 
partake of the increased action, their absorbents, though acting with 
no greater powers than formerly, do yet so preponderate, that a gradual 
wasting is the consequence. Thus we have to consider, not the 
action of the absorbents merely, but the relations which their actions 
have to activity of the arteries. 
1 should conclude, that a part which has ceased to be of use in the OF THE ABSORPTION OF SOLIDS. 
571 
economy, and is absorbed, has not been carried away by the stimulus 
applied to the modelling lymphatics, but in consequence of a want of the 
usual excitement of the arteries to action by a decrease of their action, 
and consequent deficiency of secretion. Since, in the natural body, 
every part holds its due form and proportionate size, by the balance 
established between secretion and absorption, we have to decide whe- 
ther its disappearance be an affect of the diminution of the former, or 
the increase of the latter action. We have to inquire whether the 
arterial system which secretes, or the lymphatics which absorb, are the 
most subject to influence. Now, when we see the pulsation of the arte- 
ries, and the colour and degree of vascularity of parts, continually 
varying upon the excitement: when, on the other hand, we see the 
lymphatics continuing their office unimpaired even after the death of 
the general system, and after the heart and arteries have ceased to 
move, we cannot be at a loss to'determine which system of vessels is 
most subject to influence. Let us only suppose that the lymphatics 
are more permanent in their activity, least subject to change, and all 
difficulty is removed. Then we see how stimulating the arteries 
increases the growth, and how fluids are poured out in swellings, and 
how, by diminishing their activity at any time, the lymphatics, merely 
by the continuation of their usual action, produce an absorption and 
evident wasting. 
Before we speak so familiarly as we do of stimulating the lympha- 
tics, we ought to prove that it is possible to stimulate to absorption, 
in the same way in which we can demonstrate the effect of stimulus 
upon the arteries ; and we should in the next place prove, that it is 
possible to stimulate the lymphatics, without influencing the arterial 
system in a similar degree. 
We speak very commonly of stimulating the lymphatics to absorb 
by mercury ; for example :—There may be a speck on the cornea, 
and calomel, or corrosive sublimate is given to excite absorption. The 
practice is good, but surely this is the language of an erroneous 
theory. Suppose that we were rather to say, an inflammation from 
general disorder of the system, or of the viscera, has taken place, 
where it is most of all likely to take place ; a course of mercury cor- 
rects this disposition ; the cause removed, the inflammation subsides, 
and with it the speck. The same argument suits the phenomenon 
when a tumour or enlargement of a viscus is diminished, better than 
to say, that the mercury excites the lymphatics to the absorption of the 
tumour. 
As to pressure causing absorption and producing the wasting of 
parts, I cannot agree with Mr. Hunter in supposing that the lympha- 
tics are here excited to action ; but should rather infer that the nerves 
of the parts being benumbed, and tfie action of the arteries dimin- 
ished, the lymphatics continue to do their office, while the arteries are 
prevented from depositing new matter.—For example, when we see a 
curvature of the spine, from a habitual inclination of the body to one 
side, and consequently greater pressure on the one side of the bodies 
of the vertebra), it is natural, at first sight, to say, since the one side 
of the vertebrae is of its natural depth, and the other diminished, that 
the side which is deep has remained, but the other side has been ab- 572 
OF THE COURSE 
sorbed ; but, when we inquire further into the phenomenon which ha>- 
taken place, we recollect that the matter of bone is undergoing a per- 
petual change, and that the matter of both sides of the vertebra is 
changed ; we then comprehend that the pressure may not have ex- 
cited the vessels to greater action so as to cause absorption, but that 
the pressure has prevented the deposition of new matter, when the 
old was taken away in the natural routine of the system. 
Mr. Hunter has assigned five causes of absorption, which I con- 
ceive may be very naturally resolved into one.—These are, 1. parts 
being pressed ; 2. parts being irritated; 3. parts being weakened ; 
4. parts being rendered useless ; 5. parts becoming dead. Of the 
first wrehave already spoken. The second I should deny, unless when 
it resolves into the third ; for irritation does not cause absorption, 
unless when it is to an extent sufficient to destroy the natural action 
and weaken the part. The third and fourth come under the effect 
of the loss of the natural and accustomed stimulus to action in the 
arterial system, wdiich of course gives the balance in favour of the 
absorbents. Of the fifth we can have nothing to add illustrative of 
the living system. 
A question is still undetermined; Do the lymphatics absorb the 
loose or free fluids secreted on the surfaces ? Do they always take up 
what is offered to their mouths, in the manner that wTe know they do 
extravasated blood or bile ? And is it the office of the veins to return 
the matter, which formed that part of the texture of animal bodies, 
which was never separated from the influence of the circulating sys- 
tem? What is this carbon, for example, which forms the distinction 
between the venous blood and the arterial ? Is not this carbon the 
waste of the animal frame returned by the veins, and is not this pro- 
cess of the nature of absorption ? In short, there appears to me still 
an open field for inquiry, where an ingenious man may gain in future 
as much reputation as Dr. Hunter and Dr. Monro acquired by their 
investigations into lymphatic absorption. 
The lymphatics, in their course and relation to the fascia and mus- 
cles of the extremities, bear a great analogy to the veins ; for there are 
two sets or grand divisions,—the deep lymphatics which accompany 
Ihe arteries in their branchings among the muscles ; and the superficial 
set which run a course external to the fascia. 
Of the foot, leg, and thigh.—Even in the toes the same distinc- 
tion of the origins of the lymphatics may be observed, as in the limb. 
For while a plexus covers the toes superficially, and runs up upon the 
foot with the veins, deeper branches accompany the arteries on the 
side of the toes. When we 6bserve the course and origins of the 
greater and lesser saphena vein, we cannot fail to understand the course 
of the several sets or divisions of the lymphatics of the foot and legs. 
From the toes, dorsum, and edges of the foot, the lymphatics climb 
up the leg in four classes. 1. One takes a course from the root of the 
great toe and inside of the foot, over the tendons of the great toe and 
tibialis anticus tendon. It then passes on the inside of the tendon of 
OF THE COURSE OF THE LYMPHATICS. OF THE LYMPHATICS. 
573 
the tibialis anticus muscle, and before the head of the tibia, following1 
the principal branch of the great saphena vein ; and then continues its 
course in company with the saphena to the inside of the knee. 
2. There is at the same time a considerable number of lymphatics, 
taking their origin from nearly the same place, viz. the inside of the 
foot, and before the inner ancle ; but they take a different course on the 
leg from the last class ; for they pass behind the lower head of the 
tibia : they attach themselves to some branch of the saphena vein, and 
join the former set of vessels on the inside of the knee. From this 
they ascend superficially above the fascia to the glands of the groin. 
3. From the outside of the foot there ascend several lymphatics ; a divi- 
sion of which passes before the outer ancle and across the tibia to join 
the lymphatics, parasites of the great saphena vein, and here they some- 
times form plexuses and contortions ; others turn in behind the outer 
ancle, and join the branches accompanying the lesser saphena vein. 
The lymphatics which turn round behind the outer ancle pass on the 
outside of the tendo Achdlis; and accompanying the lesser saphena 
vein, sink into the popliteal hollow. Here they unite with the lymph- 
atics which have accompanied the several arteries of the leg and foot, 
arid particularly the posterior tibial artery. 
The deep lymphatics accompany the arteries, as we have said ; and 
to inject them we should look for a very large vessel which is coming 
out from under the plantar aponeurosis to rise behind the inner ancle. 
Popliteal glands.—The glands of the ham-string cavity are gene- 
rally three in number, and very small. They receive some of the 
lymphatics which pass with the posterior tibial artery and with the lesser 
saphena, but they are most apt to be disturbed and to swell when the 
interior of the knee joint and bones are affected. They are very seldom 
diseased, which 1 attribute to their deep situation. 
From the popliteal glands there ascend two large lymphatics, which 
accompany the popliteal artery and venae comites, and ascend with the 
latter through the adductor magnus to the fore part of the thigh. They 
run irregularly, or form a kind of net-work round the great vessels. 
On the fore part of the thigh, and still deep, they enter the lower and 
deep inguinal glands. 
Sometimes these deep lymphatics, instead of being accumulated into 
larger trunks, divide into many branches, and only unite in the glands 
of the groin. 
Inguinal glands.—The inguinal glands are in number from five to 
ten ; they lie involved in cellular membrane on the outside of the femo- 
ral ligament. Some of them are superficial and moveable under the 
integuments ; some involved in the laminae of the fascia, which descend 
from the abdominal muscles ; some are close on the femoral artery and 
vein, and under the fascia. Nearer to the pubes may be observed a 
division of these glands which belong to the lymphatics of the penis, 
perineum, &,c. . 
The greater cluster of glands on the top of the thigh becomes affected 
from disease of the integuments on the fore part and inside of the 
thigh and leg ; and of that part of the foot where the great saphena 
vein commences; these inguinal glands swell also from sores of the 
buttocks, about the anus and private parts. And this is a very common 574 
OF TUB COUKSK 
source of error. Many times I have seen a patient under mercury lor 
a supposed bubo of venereal origin, when the real cause was irritation 
at the verge of the anus. 
Lymphatics of the farts of generation in both sexes.—From 
the penis there run backwards two set of lymphatics ; superficial ones, 
which take a course to the groin ; and deeper ones, w hich take a course 
along the arteries of the peuis into the pelvis, or under the arch of the 
pubis. The superficial lymphatics are the cutaneous vessels, and take 
their origin from the prepuce, and it is these which, either absorbing 
the venereal matter of chancre, or sympathizing with the venereal 
action, form sometimes an inflamed line along the penis and cause the 
bubo in the groin. But as there are two sets of lymphatics, the chancre 
may be in a place where the deep-seated vessels are the absorbents, and 
consequently the constitution may be contaminated without any bubo 
in the groin ; and indeed it has been observed, that a venereal ulcer of 
the prepuce will, in general, produce bubo, when an ulcer of the glans 
will not.* When the tract of the matter is through the deep lymph- 
atics which enter the pelvis from below, the gland through which the 
vessels pass, is not inflamed to form a bubo; neither do the lymphatic 
glands within the ligament of the thigh inflame to the extent of forming 
a bubo, either from chancre or from bubo in the groin. This, says the 
celebrated Mr. Cruickshanks, is very fortunate; for if the external 
iliac glands, like the inguinal glands, should suppurate, they could not 
be opened by the lancet, they must be left to themselves; they might 
burst; the pus might fall into the cavity of the abdomen ; might pro- 
duce peritonaeal inflammation ; and might probably destroy the patient. 
Now, there appears no reason to dread any such catastrophe. The 
matter of these glands would form an abscess, which, like other ab- 
scesses in the tract of these vessels, would fall down upon the thigh. 
The fact, however, is curious ; that when the inflamed lymphatic enters 
one set of glands, there will be no bubo ; when it takes a course to the 
other, the gland inflames and suppurates. This 1 believe may be ex- 
plained, on considering the position of the inguinal glands, as being 
immediately under the skin : for experience shows that a part near the 
surface will inflame and proceed to suppuration much more readily than 
a part deep-seated, though suffering from the same degree of excitement. 
A foreign body, if lying deep, will cause no suppuration or distress ; 
but if it be under the skin and superficial, inflammation and suppura- 
tion will be the inevitable and immediate consequences. This may 
serve to explain why the two glands equally irritated, may be affected 
differently, and why it is the superficial one that inflames. And here 
it may be well to notice, that the suppuration which attends these 
inflamed glands is not in the body of the gland, but in the surrounding 
cellular membrane. 
In the external parts of a woman (by Mr. Cruickshanks’ observa- 
tion) there are also two sets of lymphatics. Those near the clitoris 
pass up in a direction to the ring; and those from the lower part of 
the vulva and perineum to the glands of the groin. 
Lymphatics and glands within the ligament of the thigh.— 
The vasa efferentia of the inguinal glands are in number from two to 
* Cruickshanks, p. ISP 575 
OF THE LYMPHATICS. 
six. The deep lymphatics which accompany the femoral vein and 
artery, lying under the cellular membrane, pass under the ligament, and 
soon form a large net-work of vessels accompanying the iliac vessels, 
and here they are joined by the branches of lymphatics from the super- 
ficial glands ; sometimes the trunks, accompanying the great vessels 
of the thigh, pass into a gland immediately within the ligament; some- 
times one or two of them only enter into the glands high in the loins; 
nay, sometimes a large vessel passes on directly to the thoracic duct. 
From six to eight or ten glands are seated in the tract of the external 
iliac vessels, under the name of external iliac glands. And upon 
the inside of the brim of the pelvis, and on the hypogastric vessels, the 
glands are called the internal iliac glands. In proportion to the 
frequency of disease in the pelvis, these external iliac glands, being 
in the tract of the lymphatics of the private parts and rectum, &.c. are 
particularly subject to disease. Those glands also which are called 
sacral glands, as lying on the mesorectum, and in the hollow of the 
sacrum, have been observed to be often diseased. On the psoas muscle, 
and on the loins it is impossible to trace the vessels as single trunks ; 
we way observe that one net-work of vessels ascends upon each psoas 
muscle from the thigh ; and it is there joined by the lymphatics of the 
pelvis. These vessels are in a manner united to those which cover the 
prominency of the sacrum, and pass under the bifurcation of the aorta. 
These two great lumbar plexuses of the lymphatics continuing their 
ascent, many of the vessels enter into the lumbar glands ; and on the 
loins they are joined by the absorbents of the testicle. By the union 
of the lymphatics ascending from the right and left side, with several 
large trunks of the lacteals from the root of the mesentery, the thoracic 
duct is formed on the third and fomth vertebrae of the loins. 
OP THE LYMPHATICS OF THE AKM. 
In the arm, as in the leg and thigh, there are two sets of lymph- 
atics :—the superficial and the deep-seated. The first of these accom- 
pany the cutaneous veins, the latter the deep arteries. 
As in general there are two great veins on the fore-arm, the basilic 
and cephalic veins ; but particularly as the veins which gather into the 
basilic trunk, on the inner and lower edge of the fore-arm, are the 
larger and more numerous class ; so it is found that the course of the 
more numerous class of lymphatics is on the lower and inner side of 
the fore-arm, and that they accumulate about the basilic vein. These 
are derived from the palm of the hand, and from the ulnar edge of the 
hand. This set sometimes passes into glands, seated on the brachial 
artery, near the inner condyle of the humerus. 
The absorbents which accompany the cephalic vein arise from the 
side of the thumb and fore finger upon the back of the hand ; they run 
on the radial edge of the arm, with the veins which ascend to form the 
cephalic vein. From the bend of the arm these vessels take a course 
on the outer edge of the biceps, and then get between the inner edge 
of the deltoid, and outer edge of the pectoral muscles ; they then pass 
under the clavicle, and descend into the axillary glands. This set of 
absorbents receives the branches from the outside of the arm in their 
whole course. OK THE CO UR Ml 
576 
There are absorbents arising from the back of the hand, next the 
little finger, which following some of the branches of the basilic vein (a 
larger branch of which is called the tilnaris externa) turn round the 
ulnar edge of the arm, are inserted into a gland, very commonly found 
before and a little above the inner condyle of the humerus. From this 
gland a large lymphatic passes upwards, and attaching itself to the 
brachial artery, splits and plays around it. 
The deep-seated lymphatics of the arm accompany the arteries in 
the same manner as the vena; comites do ; in general two with each 
artery. They all terminate in the glands of the axilla, and can require 
no particular description. The lymphatics, from the muscles and inte- 
guments on the back of the shoulder, also turn round and enter into 
the glands of the axilla. 
The glands of the ARM are small, and irregularly placed in the 
course of the humeral artery, from the condyle to the axilla. They are 
from three to six in number. 
The glands of the AXLi.LA are large and numerous; they receive 
the lymphatics from the arm, breast, and shoulder;* they lie in the 
deep cavity of the axilla, formed by the tendons of the pectoralis major, 
and latissimus dorsi muscles. They are imbedded in a loose cellular 
membrane, which, while it surrounds and supports the vessels of the 
axilla in the motions of the joint, gives them strength from its elas- 
ticity. These glands do not all surround the axillary artery; but a 
lower cluster is attached to the branches of the subscapular artery, 
going forward on the side of the chest, and to the thoracic arteries. 
These are the glands which become indurated from cancer of the 
breast. The glands of the axilla when greatly enlarged, close upon 
the artery and plexus of nerves, so as to preclude the possibility of an 
operation ; they compress the veins and benumb the arm by pressure 
upon the nerves. , When they suppurate, even from causes less formi- 
dable, and in scrofulous patients, they sometimes produce a con- 
densation of the cellular membrane in the axillary cavity, which, 
involving the nerves of the arm, produces weakness and shrinking of 
the arm. 
When a wound or puncture, such as that which the student of ana- 
tomy may receive in the dissecting room, has been made on the little 
or ring finger, the red lines which often appear in consequence of it, 
have taken the course of the ulnar edge of the fore arm, and terminate 
in the inside of the arm, near the condyle ; in instances they have been 
continued into the axilla. If venereal matter be absorbed at any part 
of the hand, near the little or ring finger, or bv a sore on those fingers, 
the gland at the inner condyle of the humerus, or some one in the 
course of the brachial artery, will most probably inflame and form a 
bubo, and the surgeon will be aware of this .absorption ; but if the 
venereal matter be absorbed on the thumb or fore finger, it is possible 
that it may not pass into the glands until it comes into the inside of 
the clavicle. These glands being out of our sight and feeling, the pa- 
tient may be infected without the surgeon suspecting it.j 
* “ They even receive absorbents from the cavity of the chest, and I have known them 
swell from the pleurisy, peripneumonv, and pulmonary consumption.—C-ruickshanks. 
t Cruickshanks, p. 182. OF fllE LYMPHATIC s 
577 
LYMPHATICS OF THE HEAD AND NECK. 
Oi the absorbents of the brain, little is known precisely ; but none 
can deny the probability, that the arteries, veins, and lymphatics bear 
the same relations in the brain as in the other parts of the system. 
Lymphatic glands are observed in the course'of the internal jugular 
vein, and even in the foramen caroticum, which are understood to 
belong to the lymphatics of the brain. The lymphatics of the head are 
to be observed in the course of the temporal and occipital arteries ; 
the latter class terminate in glands, seated behind the mastoid process 
of the temporal bone. The lymphatics of the face have been observed 
to be very numerous, accompanying the facial and temporal arteries. 
But those from the internal parts of the face and nose accompany the 
internal maxillary artery, and fall into the glands under the parotid, or 
in the course of that artery. These glands are liable to disease, from 
absorption of the matter of abscess in the face, throat, and nose. The 
lymphatics from the gums and jaws accompany the internal maxillary 
artery, and emerge under the angle of the jaw ; and some of them 
joining the external jugular vein, pass through glands near the top of 
the shoulder. The lymphatic vessels from the tongue and parts about 
the os hyoides, take also the same course. To know the glands about 
the face and jaws is of the greatest importance to the surgeon. When 
brought to a child with a diseased lymphatic gland in the neck, they 
should not, as I have seen too many do, immediately declare the child 
scrofulous. They ought to consider the place of the gland and the 
lymphatic vessels that belong to it, and the part from which that 
lymphatic comes. By this they will in all probability be directed to 
some local irritation. There is an inflammation and discharge from 
behind the ear, and it has produced a swelling of the gland seated 
below the lobe of the ear. Or the swelling is anterior to the ear, and 
has proceeded from some irritation in the eyelid or nostril. Or it is a 
swelling of that gland which is situated upon the facial artery, just 
under the angle of the jaw, and has come from some excoriation of 
the lips. Or it is a swelling of some of the glands on the side of the 
neck, and may have come from some excoriation at the roots of the 
hair. Or it is more forward and deeper, and then in all probability it 
has come from some inflammation of the throat. 
There are in general several small lymphatic glands, on the side of the 
face, on the buccinator muscle, immersed in the surface of the parotid 
gland, and under the zygomatic process. There are also glands to be 
carefully noted, which lie under the tip of the parotid gland, where it 
extends behind the angle of the jaw, and also lying under the base of 
the jaw-bone, close to the sub-maxillary gland, and on the course of 
the facial artery. 
The glands and absorbents of the neck are very numerous, and 
the latter form an intricate and beautiful plexus, several branches of 
which are to be observed accompanying the external and internal 
jugular veins. Some of the glands lie immediately under the skin, 
and in the cellular membrane, on the outer edge of the platisma 
myoides ; many under that muscle, and in the course of the external 578 
OF THE etilihSE 
jugular vein. But there are many seated deep, tor the greater num- 
ber accompany the internal carotid artery, and internal jugular vein, 
or their branches. 
The lymphatics of the thyroid gland have been raised by Mr. 
Cruickshanks, by plunging a lancet at random into the substance of 
the gland, and blowing into it, or throwing quicksilver into its cellular 
membrane. The trunks of these lymphatics join the thoracic duct on 
the left side ; and on the right side, the right trunk of the absorbing 
system, just as it is about to enter into the jugular vein. 
OF THE TRUNKS OF THE ABSORBENT SYSTEM. 
The larger and proper trunk of the lymphatic system is generally 
called the thoracic Direr, because it was first observed by Pecquet* 
to be a vessel which conveyed the chyle through the diaphragm, and 
which took its course through the whole length of the thorax, to dis- 
charge its fluids into the veins near the heart. Before his time the 
laeteals which were discovered by Asellius,! were supposed to ter- 
minate in the liver. The first discoverers of the thoracic duct, described 
it as beginning from a pyriform bag, to which they gave the name of 
receptaculum chyli. In dogs, fish, and the turtle, such a cistern or 
bag may be observed ; but in the human body nothing further is to be 
observed than an irregular dilatation of this vessel, like a varicose disten- 
tion, where it receives the accession of the laeteals from the root of the 
mesentery. The origin of this great trunk called the thoracic duct, 
is tho union of the vessels which ascend by the side of the common 
iliac arteries and veins, and are derived from the pelvis and lower ex- 
tremities. Upon the third and fourth vertebrae, and under the aorta, 
this trunk is frequently joined by a large trunk of the laeteals, and 
then ascending, it receives the greater number, or the larger trunks of 
the laeteals. On the vertebnc of the loins, the thoracic duct is by no 
means regular, either in its course, or size, or shape ; often it contracts, 
and again irregularly dilates, as it seems to emerge from under the 
aorta. On the uppermost vertebra of the loins, the thoracic duct lies 
between the right crus of the diaphragm and the aorta. From this 
point it runs up on the face of the dorsal vertebra, and between the 
vena azygos and the aorta. On the fourth dorsal vertebra it passes under 
the aorta to gain the left side of it. Here it is considerably enlarged, 
from the contracted state which it assumes in the thorax. Sometimes 
it splits, and again unites on the vertebra) of the back. Still ascending, 
it continues to incline to the left; side, and may be found by the side of 
the oesophagus. 
The thoracic duct now emerges from the thorax, and lies deep in 
the lower part of the neck, behind the lower thyroid artery, and on 
the longus colli muscle. 
It gets above the level of the subclavian vein of the left side, and 
here it receives the absorbents of the head and neck (of the left side), 
* In the year 1651. T 
t In the year 1622.—About the year 1652, the other branches of the system, which 
take their course to every part of the body, were discovered by Rudbeck, Jolyffe, and 
Thom. Bartholin OP THE LYMPHATICS. 
579 
and descends again with a curve, and terminates in the angle of the 
union of the subclavian vein and jugular vein of the left side. $ 
Sometimes there are two thoracic ducts ; but this is very rare. 
Sometimes the duct splits near its termination, and the two branches 
enter the veins separately ; but, in general, when it splits in this man- 
mer, it again unites before it terminates in the vein. 
There is constantly a trunk in the anterior mediastinum under the 
sternum, almost as large as the thoracic duct itself, which is some- 
times inserted into the termination of the thoracic duct; sometimes 
into the trunk of the absorbents of the left side, to be immediately 
scribed. 
THE TRUNK OF THE ABSORBENTS OF THE RIGHT SIDE. 
The absorbents, from the right side of the head and neck, and from 
the right arm, do not run across the neck, to unite with the great 
trunk of the system ; they have an opportunity of dropping their con- 
tents into the angle between the right subclavian and the right jugular 
vein. These vessels then uniting, form a trunk which is little more 
than an inch, nay, sometimes not a quarter of an inch in length, but 
which has nearly as great a diameter as the proper trunk of the left side. 
The trunk of the left side lies upon the subclavian vein, and re- 
ceives a very considerable number of lymphatic vessels : not only 
does it receive the lymphatics, from the right side of the head, thyroid 
gland, neck, &c. and the lymphatics of the arm ; but it receives also 
those from the right side of the thorax and diaphragm, from the lungs 
of this side, and from the parts supplied by the mammary artery. 
Both in this and in the great trunk there are many valves. 
OP THE LACTEALS AND LYMPHATICS OP THE INTESTINAL CANAL. 
We shall afterwards have to observe the great length of the intesti- 
nal canal, the effect of the imperfect valvular structure, in extending the 
inner coat to a great length ; we have remarked that while every surface 
of the body secretes, it is at the same time an absorbing surface ; and, 
finally, that while we chiefly contemplate the intestinal canal, as im- 
bibing and receiving the nourishment, wc must not forget that it is also 
a secreting surface of the first importance to the economy. But at 
present we have merely to understand that structure and organization, 
by which this canal absorbs the nutritious fluid, the chyle, from the 
food. 
In the first place, as to the terms lacteals and lymphatics, we pre- 
sume that the absorbents throughout the whole length of the canal 
have the same structure and use ; and that the term lacteals has been 
suggested merely by the colour of the fluid which is absorbed from 
the small intestines. At one time these lacteals convey a milky fluid ; 
at another a transparent fluid, like that which the stomach and great 
intestines in general absorb. 
The lacteals, as it is natural to suppose, were the first discovered of 
any part of the system of absorbents ; or, at least they were first, 
understood to form a part of an absorbing system. For although E'us- 
tachius, a Roman anatomist, discovered the thoracic duct in the year 
1563, yet. he had very imperfect notions of its importance, and the 580 
OF THE COURSE 
discovery was very little attended to till after the discovery of the 
lacteals by Asellins in 1622. This anatomist, in opening living ani- 
mals, to observe the motion of the diaphragm, saw white filaments on 
the mesentery, which he took at first for nerves; but, on puncturing 
them, and observing them to discharge their contents and to collapse, 
he proclaimed his discovery of a new set of vessels—a fourth kind.* 
Had Asellius only chanced to observe these vessels, his merit would 
have been inconsiderable ; but he also investigated and announced 
their peculiar office, viz. of absorbing the chyle from the intestinal 
canal, and carrying it into the blood. 
Eor some time, however, after the discovery of the vasa lactea, the 
opinion of Hippocrates and Galen, that the mesenteric veins absorbed 
the chyle from the intestines, and conveyed it to the liver, still pre- 
vailed. Even after the discovery of the lacteals was known and re- 
ceived, a part of the old system was still retained, and it was supposed 
that those vessels carried the fluids absorbed from the intestines into 
the liver ; and that the chyle was there converted into blood. 
About twenty years after the discovery of Asellius, Rudbeck, a 
Swede, and Bartholin, a Danish anatomist, saw Asellius’s vessels in 
many other parts of the body ; discovered the trunk of the system, and 
showed that the lacteals did not pass to the liver, but that they were 
branches of a totally distinct system of vessels; they also demonstrated 
the unity of this system. 
We have seen from this sketch that the ancients supposed the veins 
of the intestines to be absorbents ; and even after the discovery of the 
lacteals, this idea was retained by some of the best modern anatomists, 
and principally by Haller and Professor Meckel of Berlin. If the 
veins absorb from the surface of the intestines, their doctrine would 
imply that they are also absorbents in general throughout the body. 
Although Bartholin, in his epistle to Harvey, had asserted and given 
sufficient proof that the mesenteric veins were not absorbents, yet the 
controversy was left in so undecided a state, as to give occasion to the 
series of experiments in the school of the Hunters, which seems to 
have put the question to rest, in as far as it is connected with the lym- 
phatic system, f 
We have already mentioned that Asellius was employed in opening 
the belly of a living dog, when he first discovered the lacteals. He 
perceived upon the surface of the intestines and mesentery a great 
many small threads, which, at first sight, he took for nerves, but soon 
discovered his error ; and to dissipate his doubt, opened one of the 
largest white cords, when no sooner had the incision been made, than 
lie saw a fluid like milk or cream issue from the vessels. Asellius 
says he could not contain his joy at the sight of this phenomenon ; 
and, turning himself to Alexander Tadinus, and the senator Septalius, 
who were present, he invited them to enjoy the spectacle ; but his 
pleasure, he adds, was of short duration, for the dog died, and the 
vessels disappeared. The natural and simple narration of Asellius 
represents his astonishment, and gives an idea of the sensation, which 
* Tlie nerves being counted as vessels; there were arteries, veins, nerves, anti 
lymphatics. 
+ See the Vf.IKS in this volume. 07 THE LYMPHATICS. 
581 
the anatomist experiences in the instant of making an interesting dis- 
covery. 
Origin of the lacteals.—When the young anatomical student 
lies the mesenteric vessels of an animal recently killed, he finds the 
lacteals gradually etvell ; he finds them turgid, if the animal has had a 
full meal, and t«ie has been afforded for the chyle to descend into the 
small intestines ; he finds them empty, or containing only a limpid 
fluid, if the animal has not had food. When he sees this, he has had 
sufficient proof that these are the vessels for absorbing the nutritious 
fluids from the intestines. Again, when coloured fluids thrown into 
the intestines of a living animal are absorbed, there is sufficient proof 
of the free communication, and that the extremities of the lacteal are 
absorbing mouths ; but the actual demonstration of the absorbing 
mouths of the lacteal vessels is very difficult. The difficulty arises 
from these vessels being in general empty in the dead body, from the 
impossibility of injecting them from trunk to branch in consequence 
of their valves ; and, lastly, from their orifices never being patent, ex- 
cept in a state of excitement. The anatomist must therefore watch 
his opportunity when a man has been suddenly cut off' in health, and 
after a full meal. Then the villi of the inner coat may be seen turgid 
with chyle, and their structure may be examined. Perhaps the first 
observations which were made upon this subject by Lieberkuhn, are 
still the best and the most satisfactory. 
The villi are apparently of a cellular structure, for although they are 
flat or conical, or like filaments when collapsed ; yet when minutely 
injected, and especially when they are full of chyle, they take a globu- 
lar form, and are called the amittlul.e. Their distention, in conse- 
quence of a minute injection of the veins or arteries, is probably 
owing to their cellular structure and into which the injection is extra- 
vasated. This cellular structure is a provision for their distention and 
erection by the blood, when excited by the presence of the chyle in the 
intestines ; this erection gives rigidity to the orifice of the lacteals ; the 
first absorption being by capillary attraction, while the further propul- 
sion of the fluid in the extreme absorbents is by the contraction of their 
coats excited by the presence of the fluid. Thus the absorption is not 
by an organized pore, but depending on excitement and action. 
Lieberkuhn’s observations of the villi are the most accurate and 
curious. He observes, that having opened and washed a portion of 
the small intestine, its whole surface will be found covered with little 
pendulous conical membranes of the fifth part of a line in size, and 
the basis of which almost touch each other. From the vascular mem- 
brane, to which they arc attached, he observes there is given off to 
each villus a branch of a lacteal, an artery, a vein, and a nerve. He 
found it difficult by injection to show both the vein and artery, the 
fluid passed so easily from the one into the other. He found that the 
extreme branch of the lacteal was distended into a little vessel within 
the villus; and surveying the apex with his microscope, he saw one, 
or, sometimes, several openings, lie also observed, with his glasses, 
the arteries ramifying on the ampulukc, and again collecting into 
veins ; and he supposed that still more minute branches plunged into 
the centre. But he made a still more minute observation than this. 582 
OF fHE COURSE 
Insulating a piece of intestine between two rings, only leaving o 
space for the entrance of the ramification of the artery which sup- 
plied it, he injected with a column of mercury, and examined its pro- 
gress at the same time with his microscope. As he raised the tube, 
he saw the artery going in serpentine turns to the villus, and the 
injection returning by the veins ; at last the injection passed into the 
ampulla lactea, distended it, and made its exit by the for&tnina. He 
prepared the villi in another way :—he inflated the ampullae, and kept 
them so until they died ; then he cut them with a razor, and found them 
cellular. This cellular structure Cruickshanks thinks is the common 
cellular substance, uniting the vessels of the villus. When this gen- 
tleman examined the villi of a patient who died suddenly after a meal, 
he observed some of them to be turgid with chyle, so that nothing of 
the ramifications of the arteries or veins were to be observed ; the 
whole appeared as one white vessel without any red lines, pores, or 
orifices; others of the villi contained chyle in a less proportion ; and 
here the ramifications of the veins were numerous, and prevailed by 
their redness over the whiteness of the villi. 
Among some hundred villi he saw a lacteal vessel forming by ra- 
diated branches, one branch from each villus. 
Mr. Cruickshanks has remarked a deep and a superficial set of 
lacteals on the intestines ; but for this division there seems no neces- 
sity. Deep in the coats the lacteals seem to accompany the blood 
vessels ; but when they get more superficial, they take a course longi- 
tudinally on the canal, and after running a little way, they take a sud- 
den turn towards the mesentery. 
As the greater frequency of the valvula* conniventes in the jejunum, 
greatly increase the extent of the inner surface of that gut, and con- 
sequently give a greater extent of origin to the lacteals ; and, as here 
the chyle must be in the greater quantity, so the lacteals of this por- 
tion of the gut are larger and more numerous than in any other part of 
the canal. 
The lacteals do not attach themselves to the vessels of the mesen- 
tery, but take a more superficial course. Before they enter the mesen- 
teric glands, they have been called lacteals of the first order ; when 
they emerge from the first into the second glands, secondary lacteals, 
or glands of the second order. The manner of their entering and 
going out of glands is exactly the same with that of the lymphatics. 
The lacteals (or perhaps we should now say the absorbents merely) 
of the great intestines are smaller and less numerous than those of the 
small intestines; for although the intestines be large, still their inner 
surface is by no means so extensive : besides, the chyle is absorbed, 
and the contents of the gut altered before they have descended into the 
great intestines. Both Winslow and Haller, however, assert that they 
have seen chyle in the absorbents of the great intestines. We know 
that the lacteals absorb chyle when it is presented to them : while at 
other times they absorb other fluids. That the absorbents of the great 
intestines imbibe the fluid contents is evident, from the change pro- 
duced on the faeces in their passage. Copious and nutritious injec- 
tions have been given, which did not return in the same liquid form, 
and which have supported the strength for some time. QV THE LYMPHATICS. 
583 
Clysters of turpentine give the urine a smell of violets; and the 
Peruvian bark has cured fever when given by the rectum. 
The absorbents of the stomach form three divisions : one set accom- 
panies the coronary artery and vein, and enters the glands on the lesser 
curvature of the stomach and the omentum minus. Those of the 
second set accompany the left gastro-epiploic artery, and are joined 
by the of the omentum. The third pass down upon the 
upper part of the duodenum, following the arteria gastro-epiploica 
dextra : these descend to pass into the same class of glands, which 
receive the lymphatics of the liver. The lymphatics of the stomach 
are joined in their course by the lymphatics of the right side of the 
omentum. 
The lacteals on the mesentery pass from one gland to another, till 
they form one or two large trunks only. These accompany the trunk 
of the superior mesenteric artery, and run down on the right side of the 
aorta, and join the thoracic duct. The absorbents, from the rectum 
and colon of the left side, pass into their proper glands, or sometimes 
into the lumbar glands, and join the thoracic duct separately ; those 
from the right side of the colon join or mingle with the lacteals in the 
root of the mesentery. 
or THE KEMAIXIXG ABSOK11ENTS OF THE SOLID VISCEKA. 
Where the lymphatics of the lower extremity descend over the brim 
of the pelvis, they are joined by the absorbents of the bladder, vesiculse 
seminales, and other parts in the pelvis:—small glands belonging to 
this set are attached to the internal iliac vessels. In the female, the 
lower set of lymphatics, from the womb and vagina, also come by this 
route to join those of the lower extremity, or run mingling with them. 
Another set of lymphatics of the womb pass up with the spermatic 
vessels. 
The lymphatics of the testicle are very numerous. They come in 
distinct sets from tUo body of the testicle, from the epidydimis, and 
from the tunica vaginalis : then reaching the cord, from six or ten 
trunks, and run up direct to the abdominal ring ; passing the ring, they 
turn outward, and then pass over the psoas muscle and into the lumbar 
glands. 
The lymphatics of the kidnev are in two sets, superficial and deep- 
seated ; but the former are seldom to be observed. Sometimes disease 
makes them distinct. The internal lymphatics are demonstrated by 
blowing into the veins, or tying a ligature and kneading the substance 
of the kidney with the fingers ; when they rise, they are seen attached 
to the emulgent vessels, and go to join the lumbar glands, or terminate 
in large lymphatics near the aorta. 
It is needless to repeat that the absorbers of the spleen are deep 
and superficial,—for this arrangement is general in the solid viscera. 
Emerging from the spleen, the lymphatics pass along the splenic ves- 
sels, and enter into glands attached to the splenic artery in its whole 
course. In this course they receive the absorbents from the pancreas, 
and near the head of the pancreas they are joined with those of the 
liver, and with them enter into the thoracic duct 584 
OP THE COURSE OP THE LYMPHATICS. 
The lymphatics of the liver are the most easily detected, and they 
may be injected to greater minuteness, than any other lymphatics of 
the body. Although they have many valves, yet they do not seem to 
close the vessels entirely, nor interrupt the mercury from passing from 
trunk to branch. The superficial lymphatics, which are so numerous 
that we may sometimes see the mercury in them covering completely 
ami obscuring a considerable part of the liver, have free communica- 
tion with the internal set of vessels which are also numerous and large. 
The principal route of the lymphatics of the upper surface of the liver 
is by the broad ligament : these perforating the diaphragm, jom the 
trunk, which we have noticed under the sternum, and'in the anterior 
mediastinum. It would appear, however, that these lymphatics of the 
broad or suspensory ligament, are by no means constant and uniform 
in their course : for sometimes they run down towards the lateral liga- 
ment, and perforate it there ; sometimes they pass down into the tho- 
racic duct while still in the belly. While other lymphatics of great 
size run off from the convex surface of the liver upon the lateral liga- 
ments, and pierce the diaphragm there. The lymphatics on the lower 
or concave surface of the liver are more irregular than those of the 
convex side. They unite with the deep lymphatics coming out of the 
porta along with the vena port®, enter into the glands, which are seated 
on the trunk of that vessel, and join the thoracic duct near the root of 
the superior mesenteric artery. 
The lymphatics of the lungs are nearly as numerous as those of the 
liver ; but, indeed, it is more in relation to the facility of injecting and 
demonstrating the lymphatics, than to theii comparative number, that 
we speak of them in this manner. For example, if the lymphatics of 
the other viscera could be injected to as great minuteness as those of the 
liver, we should cease to consider that viseus as more abundantly sup- 
plied than other parts. The superficial lymphatics of the lungs form 
areolae, and cover the surface almost completely. They take a course 
to the root of the lungs, where they are joined by the deep-seated 
vessels, and together pass into the bronchial glands, and here the lym- 
phatics of both sides freely communicate. 
The glands of the lungs are constantly found both before and behind 
the bifurcation of the trachea ; often these glands are of a very dark 
colour, nay, their substance is often found resolved as it were into a 
sac of inky-like fluid. Upon the arch of the aorta and the root of the 
great branches are the cardiac glands, which receive the lymphatics 
from the heart. The absorbents from the heart are small but very 
numerous, and their larger branches attach themselves to the coronary 
vessels ; they then pass to the cardiac glands and unite with the lym- 
phatics which come from the lungs, and so join the thoracic duct. 
END OF VOL. I.