( | *Si/ pU-'>"W^/"t6 cAw>^ NEW MEDICAL WORKS, PUBLISHED AND FOR SALE BT TO WAR AND HOGAN, 255 Market Street, Philadelphia* ECLECTIC D^PENSATORY. THE ECLECTIC AND GENERAL DISPENSA- TORY, comprehending a System of Pharmacy, Materia Medica, the Formulae of the London, Edin- burgh, and Di/blin Pharmacopoeias, Prescriptions of many eminent Physicians, and the Receipts for the most common empirical Medicines, collated from the best authorities. In one vol. 8vo. with plates. This work embraces more matter than any other American Dispensatory in print. Those already be- fore the public contain little more than the Edin- burgh Dispensatory, on which they are based. It comprises all the valuable matter of the London Dis- pensatory, with the formulae of the Edinburgh and Dublin Pharmacopoeias, and notices of American pre- parations. The publishers can unhesitatingly say of the Eclectic Dispensatory, that the matter it contains is equally valuable with, and far superior in quantity and comprehensiveness to, any pharmaceutical work within the reach of the American public. Extract of a Letter from Dr. Dudley, of Lexington, Kentucky. " This work is better than those previously before the public on the same subject, and will therefore NEW MCU1UAL WORKS. secure a liberal patronage. The single consideration that an effort appears therein to divest nostrums of the charm through which so much imposition has been practised on society, is a sufficient recommenda- tion with the enlightened physician in favour of the work." From Professor Mac JVeven, of New York. " I have given myself time to look carefully through the Eclectic and General Dispensatory, with which I am greatly pleased." From Dr. ffosack, of New York. "As far as a cursory view of the work enables me to form an opinion of its merits, I have been highly gratified to observe its subserviency to practice, by containing details, prescriptions,Scc. not usually found in works of this nature." The Eclectic Dispensatory has been favourably no- ticed in the American Quarterly Journal of Medicine, the Medical Recorder, and the Medical Reviews, ge- nerally throughout the country. GREGORY'S THEORY AND PRACTICE OF PHYSIC, with Notes and Additions, adapted to the Practice of the United States. By Nathaniel Potter, M.D. Professor of the Theory and Practice of Medicine in the University of Maryland, and S. Colhoun, M.D. M.A.F.S. Philad. 2 vols. 8vo. Extract from Dr. Potter's Preface. " Any commendation of the following work would be almost superfluous. The young and inexperienced cannot duly estimate a system which constitutes ra- ther a converging series of maxims, than the minutiae of practical detail. If we were inclined to adopt a text-book, as a guide to a practical course, Gregory's Practice would claim a preference to all other works. NEW MEDICAL WORKS. " The most prominent feature in his character, seems to be his judgment, or that gift of nature which confers on a few distinguished individuals the faculty of discriminating between the true and the false, al- most intuitively, certainly without any tedious pro- cess of reasoning." The followingtestimonial is from the pen of a celebrated practitioner of New England, (Dr. Miner, of Mid' dletown, Conn.) " A Treatise on the Theory and Practice of Phy- sic has lately been published at Philadelphia, edited by Drs. Potter and Colhoun. The original work of Dr. Gregory, in many points of view, appears to be possessed of a higher character than any systematic treatise of his cotemporaries ; but what makes the present edition peculiarly valuable, is the notes and additions of the two learned editors, and the pains which they have taken to make it applicable to the diseases of this country. The introductory discourse, written by one of these gentlemen, is unquestionably one of the ablest specimens of medical logic that ever has appeared." From the Medico- Chirurgical Review of 1826. "It is really refreshing to read the pages of Dr. Gregory, for while we read them we feel that we hold converse with a man who loves truth. He de- scribes that which he has seen or believes to be true from indisputable testimony; his opinions, his descrip- tions, his observations, and his deductions may be aptly compared with the useful labours of a faithful biographer, and not to the imposing efforts of a novel or romance writer." Johnson's Journal—New Series, July 1827. The notes and additions to this transatlantic repub- lication of Dr. Gregory's Practice of Physic, do great credit to the talented editors, who have transplanted our able countryman's production to a foreign soil: NEW MEDICAL WORKS. they give us a good idea of the actual state of medical practice in America—and that idea is calculated to raise the character of the transatlantic profession wherever this edition may find its way." Extract of a Letter from Dr. Dunglison, Prof. Theory and Pi uc. Med. in the University of Virginia. "I have no hesitation in recommending it (Grego- ry's Practice,) to my class, as the most valuable text book they can adopt." PROUT ON CALCULUS. AN INQUIRY into the Nature and Treatment of D1AISETES, CALCULUS, and other affections of the Urinary Organs; with Remarks on the import- ance of attending to the state of the Urine in Or- ganic Diseases of the Kidney and Bladder ; and some Practical Rules for determining the Nature of the Disease from the sensible and chemical pro- perties of the Secretion. By William Prout, M.D. F.RS. From the London edition, revised and much enlarged; witli Notes and Additions, by S. Colhoun, M.D. M.A.P.S. of Philadelphia. In 1 vol. 8vo. TESTIMONIALS. "We have just closed Dr. Prout's book, with an admiration at once of his scientific attainment, and moderate pretensions. We have seldom perused a treatise so free from the vice of book-making, or so little tinctured with the cant of medical hypoflieses." —London Medical Repository. "In the course of our critical avocations, it has seldom occurred to us to rise from the perusal of a medical work with such favourable impressions as in the present instance : it is the work of an accurate, as well as of an original writer."—Johnson's Medica- Chirurgical Review. NEW MEDICAL WORKS. " In its present form we believe the work embraces more interesting and authentic information relative to these affections than any other we know of, as in addition to the store furnished by the author, the American editor has added to the volume nearly all the valuable matter upon the subject to be found dis- persed through the writings of others. The close- ness with which they have adhered to practical points, is certainly very praiseworthy, and the chemical de- tails of the former, which constitute the basis of most of his inquiries, are exceedingly concise, pliant, and intelligible."—American Journal of the Medical Sci- ences, p. 418, vol. i. " A very acceptable service has been done to the medical profession in this country by the present re- publication of Dr. Prout's work on affections of the urinary organs. The American physician will now have it in his power, at a reasonable cost, to possess one of the best treatises on this interesting subject. From the known accuracy of Dr. Prout as a chemist, and his reputation as an accurate observer of nature, much new light was naturally expected as the result of his observations- Nor, indeed, have these high expectations been disappointed. After a careful pe- rusal of his work, we have formed the highest opi- nion of his powers, both as an original thinker, and experimental enquirer."—North American Med. and Surg. Journal. **** M*'//< •/(<< ■/ js?J' j^ /^^rfj > *; CONVERSATIONS ANATOMY, PHYSIOLOGY, i- AND SURGERY. BY A. ROBERTSON, M.D. LECTURER ON THE PRACTICE OF PHYSIC. First American Edition, with Pathological and other Additions. IN TWO VOLUMES. VOL. I. TTiTiG7 Pitlatelirtifa: PUBLISHED BY TOWAR & HOGAN, No. 255, Market Street. 1828. Cr'J tSJSf Eastern District of Pennsylvania, to wit „• BE IT REMEMBERED, that on the twenty-eighth day of January in the fifty-second year of the indepen- dence of the United States of America, A.D. 1828, Towar & Hogan of the said district have deposited in this office the title of a book, the right whereof they claim as propri- etors, in the words following, to wit: " Conversations on Anatomy, Physiology, and Surgery. By A. Robertson, M.D. Lecturer on the Practice of Phy- sic. First American, Edition, with Pathological and other Additions. In two volumes." In conformity to the act of the Congress of the United States, entitled," An act for the encouragement of learn- ing, by securing the copies of maps, charts, and books to the authors and proprietors of such copies during the times therein mentioned;" and also to the act, entitled, " An act supplementary to an act, entitled, ' An act for the encou- ragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies during the times therein mentioned,' and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints." D. CALDWELL, Clerk of the Eastern District of Pennsylvania. Ul] TO THE GENTLEMEN ATTENDING THE ANATOMICAL AND SURGICAL LECTURES, THIS LITTLE WORK IS DEDICATED, WITH MUCH RESPECT, AND BEST WISHES, BY THEIR MOST OBEDIENT SERVANT, ARCHIBALD ROBERTSON, M.D. GtvJ PREFACE. 4* _______ Notwithstanding the numerous Manuals of Anatomy in the hands of Anatomical and Surgical Students, it occurred to me that something of a concise and more practical form was still wanted. In consequence, I have employed my leisure hours in composing this small Treatise, in which I have endeavoured to give a correct Epitome calculated to instruct those anxious of acquiring practical knowledge, and also to refresh the memory of Practitioners, who have little leisure to read volu- minous works. The conversations are conducted in a manner deemed the best for conveying neces- sary information to my readers, and in a style fa- miliar and plain. The organic derangements of the different parts are shortly pointed out; and the diseases occa- sioned by, or inducing, them are enumerated, ' A 2 LTV VI PREFACE. without entering into any particular description of them, which would have been foreign to my pre- sent purpose. These are generally placed after the Anatomical, Physiological, and Surgical de- scriptions of the different organs. I have not scrupled to make repetitions, when they seemed to be requisite for impressing impor- tant facts upon the mind of my^oung readers. For their assistance also, I have frequently marked the accentuation of words most apt to be mispro- nounced, without any view of dictating to those advanced in their studies, and familiar with Ana- tomical phraseology. It is presumed that this concise Treatise, be- sides being an agreeable and useful pocket com- panion to Anatomical and Surgical Students, will also be found well adapted to the purposes of those who read for general information. CONVERSATIONS ON ANATOMY, PHYSIOLOGY, AND SURGERY. PHYSIOLOGICAL PRELIMINARIES. Q. What are the elements which compose the sub- stance of animals ? A. They are either solid, liquid, gaseous or incoerci- ble. The solid elements are sulphur, carbon, iron, man- ganese, lime, soda, magnesia, silex, alumen and phos- phorus. The liquid elements are water, which forms three parts of the animal, and muriatic acid. The ga- seous are, azote, hydrogen, oxygen. The incoercible are light, caloric, electricity and magnetism. Q. Are these substances found existing in the animal body in a pure, or in a combined state ? A. They are combined with each other; three and three, four and four, &c. and thus form the immediate principles of animals: thus the azotized principles are, albumen, fibrine, gelatine, cheese, mucus, urea, uric acid, osmazome and the colouring principle of the blood: The non azotized principles are, the acetic, benzoic, lactic, oxalic, formic and rosacic acids, sugar of milk, su- 8 PHYSIOLOGICAL PRELIMINARIES. gat of diabetes, the yellow colouring principle of the bile, cantharidin, spermaceti, biliary calculus, the odo- rous principles of amber, of musk, of castor, of civet > and the two fatty principles discovered'by Chevreuil. Q. What are these substances called ? A. They are called the organic elements of the sys- tem, for by their combination with each other arc formed the different structures of the human body. Q. What are those structures or tissues called ? A. 1. S. 5. Systoms < 7. 8. 9. 10. 11. Osseous Vasculai Nervous Cellular Fibrous Muscular Erectile Mucous Serous C Arterial < Venous { Lymphatic C Cerebral I Ganglionic T Fibrous J Fibro-cartila- J ginous |^ Dermoid C Voluntary ( Involuntary Horny or epidermic £ Epidermoid Glandular w Parenchymatous This is the arrangement of Dupuytren and Richerand, and is the most comprehensive. These structures com- bined with and acting on the fluids form the instruments by which life and all its functions are performed: When several organs are united, they form an apparatus, the number and distribution of which constitute the diffe- rence between animals. Q. What arc the properties of the tissues ? A. They have the ordinary physical properties of bo- dies ; as different degrees of solidity, transparency, elas- ticity, &c.: besides they have certain properties which are peculiar to them, as extensibility and contractility: PHYSIOLOGICAL PRELIMINARIES. 9 they have also properties when considered as to their composition; as some, as the bones, are principally com- posed of phosphate of lime; others, of fibrine; others, of albumen: The first are called their physical proper- ties, the second their vital, and the third their chemical: It is the province of general anatomy, to study their properties in these three respects. Q. What proportion of fluid is there in the human body ? A. Nine to one, as has been proved by drying a dead body in an oven. Q. What are the principal fluids of the human body ? A. 1. The blood; 2. The lymph; 3. The perspira- tory fluid, comprehending the cutaneous perspiration, that of the mucous membranes, as of the lungs and intes- tines ; of the serous, the synovial, adipose membrane, medullary membrane, the interior of the thyroid, thy- mus, &c.; 4. The fluids of the follicles, as the wax of the ear, the fatty substance of the skin, the mucus of the follicles, of the tonsils, of the glands of the cardia, of the prostate, and of the neighbourhood of the anus; 5. Glandular fluids; as tears, saliva, pancreatic juice, bile, urine, the fluids of the glands of Cowper, the semen, milk, the liquid of the renal capsules; that of the testi- cles, and of the breasts of new born children; 6. The chyme and the chyle. Q. How are the fluids classified ? A. By some they have been arranged as follows, the chyme, the chyle, the blood, and the fluids which ema- nate from that fluid. By others, they have been said to be recrementitious, or alimentary; excrementitious, or those which are thrown off from the system, as the perspiration, &c. and lastly those which partake of the nature of both. They have also been classed according to their chemical properties. Q. What is meant by life ? A. It is a property peculiar to living animals and vege- tables, is incapable of definition, and is best known by the enumeration of the structure, the functions and qua- lities of living bodies in their healthy and diseased states, which are the objects of the following pages. 10 PHYSIOLOGICAL PRELIMINARIES. Q. Enumerate some of the most generally admitted vital properties. A. 1. The sensibility of the brain, by which tho mind perceives external objects. 2. Organic sensible contractility, or what was former- ly denominated irritability, as evinced in the vermicular motion of the intestines, in the contractions of the mus- cles after death, and of the heart. 3. The contractility of the muscles obedient to the will, called by the French the contractility of relation, or animal contractility. Q. Are there no others ? A. Some physiologists enumerate two, viz. organic or vegetable sensibility, or that quality by which the particles of bodies are united to form the vegetable or the animal; and insensible organic contractility by which the fibres are formed: but as they regard operations beyond the cognizance of the senses, it is evident that they are entirely hypothetical. Q. What are the functions of the human body gene- \v rally considered ? A. 1. Those of mind and its instruments, the brain, senses, and muscles, &c. or those by which our relations with external nature are kept up, called by the French the functions of relation; 2. The nutritive or assimila- ting functions; 8. Those of generation. As the first thing in order is to describe the anatomy previous to the detail of the peculiarities of each function, we proceed, after a few preliminaries, to give the anatomy of the body in all its parts, describing after each its physiology and pathology. 11 PATHOLOGICAL PRELIMINARIES. EXPOSITION OP THE VARIOUS METHODS OF EXAMI- NATION USED IN MEDICINE. Q. Upon what does the'success of the science of me- dicine depend. A. Medicine, which may be termed a science of facts, is indebted for its present distinction to observa- tion, and on it must depend for its further advancement. To observation the physician owes the most exact and valuable parts of his knowledge, and upon it he rests the basis of his diagnosis, prognosis', and treatment of dis- ease. As then observation is, at once, the surest pledge of the future improvement of the healing art, and the safest guide to those who practise it, we must see at once the necessity of applying diligently to its cultiva- tion. Q. Where are observations best made ? A. It is at the bed-side of the patient that the obser- ver must study disease; there he will see it in its true cha- racters, stripped of those false shades by which it is so frequently disguised in books. There, freed from the vagueness and illusion of systems, the student can ac- quire fixed and defined notions of diseases, and learn the difficult art of distinguishing them. If physicians had always confined themselves within the limits of strict observation—if they had restricted themselves tt> such conclusions as are fairly deducible from facts, the science of medicine would not now be overloaded, as it is, by hypotheses, and we should possess a sufficient body of materials to enable us to establish sound general princi- ples. Q. Is observation the sole requisite ? A. Though clinical studies are necessarily long and laborious, still they should not discourage the young ob- server ; they will amply requite him for his pains. Let it not, however, be supposed that observation is to be confined to the mere acquisition of facts: it will be of 12 OP OBSERVATION. comparatively little value unless directed by reflection. To observe Nature is not enough; she must be interro- gated, if we wish to wrest her secrets from her, and ac- quire at the same time the means of communicating to others the result of our researches. Q. What are the more conspicuous improvements in assisting observation of the present day ? A. The improved means of investigating diseases which have been devised of late years, by rendering the methods of examination more strict and rigorous, have given a very decided impulse to medicine. Pathological Anatomy has raised it to a level with the descriptive sciences, when considered in reference to organic alte- rations, and the " Auscultation Mediate" has placed it amongst the physical sciences, so far as the doctrine of symptoms is concerned. Every well informed person now admits that the discovery of Laennec has effected for medicine what Petit and Desault have already done for surgery. For if a catheter, introduced into the blad- der, gives an assurance of the existence of a foreign body in that viscus, pectoriloquy is a no less decisive test of the presence of a preternatural excavation in that part of the lung in which it is perceived. Q. Does not the science still labour under great un- certainties ? A. Notwithstanding the advances that have been made in the investigation of diseases, particularly those of the brain and its investments, and those of the chest and digestive organs,—notwithstanding the improve- ments that have followed the researches of Laennec, Broussais, &c. &c, we cannot deny that many points remain immersed in obscurity, and that several ques- tions of primary importance continue undecided. As, however, it is by observation alone that these and other difficulties can be removed, it cannot fail to be instruc- tive to inquire what are the qualifications necessary to be possessed by those who engage in the difficult un- dertaking of correcting erroneous impressions concern- ing the doctrine of diseases, and removing the obscuri- ties that beset them. OF THE OBSERVER. 13 OF THE OBSERVER. Q. What preparatory studies are necessary ? A. Whoever wishes to e"xtend the boundaries of Me- dicine should commence his education by acquiring a perfect knowledge of the Greek and Latin languages, and should then proceed to learn the modern languages, particularly the French, Italian and German. This is necessary to enable him to study with effect the many excellent works published by our neighbours; ana (should he visit those countries) to observe with advan- tage their clinical practice, and form an accurate esti- mate of their modes and principles of treatment. The observer should acquire correct ideas of seve- ral sciences which may be deemed accessary to medi- cine. He should be acquainted with Chemistry, Na- tural History and Natural Philosophy, as he will con- stantly have occasion to make application of their prin- ciples ; and if he be ignorant of them, many physiologi- cal and pathological phenomena will appear altogether unintelligible. Q. What are the sciences more strictly medical ? A. The sciences more strictly medical, and therefore indispensable, are General Pathology, Physiology and Anatomy, particularly the anatomy of the tissues and viscera in their healthy state, which has hitherto been too much neglected, and which has begun to be properly regarded only since pathology has been more carefully studied. How can any person know a particular tissue to be diseased, if he be ignorant of its characters in its healthy state ? How can he distinguish the effects of disease from those changes which occur after death has taken place, if he does not possess correct notions of each, and of the anatomical characters which are pecu- liar to them ? Until anatomy is studied in this way, disputes and controversies will go on, as they have hitherto done, and medicine will make no real progress towards improvement. These remarks apply with at least equal force to pathological anatomy, without a B 14 OF TnE OBSERVER. knowledge of which it is quite impossible to give pre- cise and detailed statements of the various alterations of which the tissues and organs are susceptible, or avoid confounding the different structural lesions which occur in them. These, however, are not the only requisites which an observer should possess. He should be acquainted with Materia Medica, Surgery, " Hygiene;" and, above all, Pathology, without which he can establish no claim to the character he assumes; and still it is by observa- tion only that he can become a pathologist. Hence the second part of this work is calculated to remove some of the difficulties that stand in the way of the young observer, by giving such an exposition of the characters and diagnosis of diseases as will enable him to prosecute his studies with effect. Q. What farther requisites are necessary for the suc- cessful study of medicine ? A. In order to draw up correct histories of cases, it is not sufficient merely to observe the phenomena which they present during their progress; they must be ob- served accurately; and he who expects to do this must possess many requisites both of tact and discrimination, which can be acquired only by a long and regular at- tendance on clinical practice. Q. How should a case be stated ? A. A statement of a case should not consist of a mere detail of such symptoms as accident has caused to be perceived, nor of a confused, unconnected enumera- tion of them. It requires no small degree of sagacity to group them together according to the relations which subsist between them, so as to refer them to a common centre, or to a derangement of some particular function or organ, and thence ascend to a knowledge of the seat and nature of the affection of which they are character- istic. Q. Is the observation of medical phenomena diffi- cult ? A. It is quite impossible for an inexperienced person to appreciate the many shades of difference which dis- OP THE OBSERVER. 15 eases assume. How can his unpractised eye distin- guish a mere accidental phenomenon from a leading symp- tom, a remote sympathy from a direct effect, or an insig- nificant circumstance from that which should constitute the very basis of his indication of cure ? If he cannot assign their respective values to all these circumstances, how can he derive any advantage from the facts which he collects ? or how can his reports be ever considered as exact descriptions of the diseases he has seen ? A statement of a case can never be useful to him who makes it, or profitable to Science, unless it be a faithful transcript of the phenomena that have occurred. For if it be not correct in all its parts, it will but mislead the judgment and confirm error ; whilst exact facts, on the contrary, strengthen the judgment, and contribute to the establishment of an exact Science. When such results as these follow from the mere fact of the observer's knowledge being inadequate, what must be the conse- quence, if it be but a mass of falsity and error ? Q. What are the results of inaccurate observation of medical phenomena ? A. Instead of transcribing a faithful history of the diseases presented to him, he will give an incorrect and inadequate account of them, and the only result of his observations will be, to lead to false theories, which may be considered as so many pathological romances that have long retarded, and still retard the progress of Medicine. Even under the most favourable circum- stances, such a person can only attain an imperfect mode of examination; the degree of its imperfection will of course be lessened in proportion as he acquires a better knowledge of pathology, or has opportunities of observ- ing, and reflecting on, the facts collected by others : hence we can generally form an estimate, on reading a pase, of the degree of knowledge possessed by the per- son who has detailed it. But these are not the only sources of error to be guarded against. Q. Are there any other defects to be obviated in stu- dying medicine ? A. It will be found necessary to review such re- 16 OF THE OBSERVER. ports and observations as had been made during the earlier years of study, which are generally incorrect or incomplete. This is not done for the purpose of supplying their deficiencies, or correcting their errors, but, in order to guard against any erreoneous impressions they may have left on the mind,—impressions which, in too many instances, have exerted an injurious influ- ence on the whole course of men's professional career. Q. What other assistants are necessary ? A. Correctness and discrimination are qualities indis- pensably necessary for a physician ; and these he can only acquire by constant exercise and observation, which will so sharpen his senses and faculties, that he will seldom fail to seize and appreciate symptoms and phenomena which escape the notice of others. But it is not suffi- cient that the senses should be thus exercised, as we know that there are many minute circumstances that will escape them ; hence the necessity of assisting them by certain auxiliaries. Thus it is that certain alterations of structure, which are not perceptible by the naked eye, are rendered manifest by a lens or a microscope ; and a virus, which cannot be detected by our senses, or even by chemical tests, becomes evident by inoculation. Q. Are there any others ? A. Each of our senses being adapted for special pur- poses, all of them are made to render important service to medical inquiries, and ought to be employed concur- rently in conducting them. Percussion, and still more auscultation, have clearly shewn the great value of one sense, that hitherto was seldom directed to this sort of investigation: in a word, by the eye we can distinguish small-pox from cow-pock; by the ear, ascites from tym- panites ; by the smell, gangrene of the lung from phthi- sis ; by the taste, diabetes mellitus from simple pththi- suria; by the touch, aneurism from various other tu- mours. Q. What qualities of mind are necessary ? A. The observer should possess penetration, not sub- tlety ; sagacity, to follow the thread of a narration too often obscure; discernment, to overcome the obstacles OF THE OBSERVER. 17 which false modesty or want of candour may throw in his way; a sober judgment, to form just ideas of the im- pressions conveyed by his senses; correct reasoning pow- ers, that he may deduce no conclusions but such as fairly follow from the premises; perseverance, that he may not be discouraged by the difficulties that stand in his way ; and lastly, resolution and humanity to disregard the dan- ' ger of contagion, as he does the disgust and risk of the dissecting room. The observer should, not allow any circumstance of a case, however trivial it may appear, to escape him. He should be free from prejudice and prepossession, if he wishes to avoid giving to his observations an errone- ous direction, and impressing on his statements the bias he has contracted. He should see things as they really are, not as he may wish them to be. He should always recollect that the slightest error or negligence may be in- jurious, not only to himself, but also to those who repose confidence in his statements. The duty of an observer is that of an historian; from that he should not depart, his chief merit is correctness and fidelity. But if even experienced persons have to contend agabist difficulties such as are here mentioned, we can readily see what care and exertion are required on the part of those who are just entering on their clinical pur- suits. Hence the necessity of their receiving a regular course of instruction, which, while it fully impresses their minds with the importance of the pursuit in which they - are engaged, may point out to their notice the various phenomena that present themselves, and indicate their relative value and connexion. A system of clinical instruction so conducted should be considered as indis- pensible in every hospital which is resorted to by stu- dents. " Life is short, and Art is long," says the father of Plysic. No man can see every thing by himself; but reading will make him acquainted with the observa- tions Df his predecessors and contemporaries, and enable him b profit by their experience; in fact, it becomes an imperative duty to read and study, as a most efficient means of acquiring new and useful information; but if B 2 18 OF THE OBSERVER. this be not a sufficient incentive, then it should be re- collected, that if we do not read, wp run the risk of being left behind by others, and that our knowledge is receiving no addition, while theirs is progressively advancing. The observer should be scrupulously exact in his descriptions and statements. He should, above all things, be impressed with that integrity and love of truth* which are indispensable to a physician. The mere gra- tification of self-love should give way to considerations of higher consequence, and which concern so nearly the interests of humanity. : Q. Enumerate some of the means by which these qualities of mind are to be acquired ? A. One of the most efficient means of acquiring these different attainments, and becoming skilful practitioners, is, when we see a particular case, to consult the writings of those who have treated expressly upon the disease to which it is referred. The work will then be studied with advantage, when we have an example before us with which we can compare its descriptions, &c. In this way, precept and practice are made to go hand in hand, tact and discretion are acquired, and the experience of those who have already distinguished themselves is made to supply our deficiencies in this particular. We should not, however, follow this course as servile imita- tors. We must exert our own discretion, for though we find much to approve, we shall meet with something to condemn; while we adopt the one, we appropriate to ourselves part at least of the spirit of our masters; when we reject the other, we feel reason to distrust ourselves, seeing the errors into which our predecessors haire fal- len. When the mind is disciplined in this way, the scope of its inquiries will be greatly expanded, and a new importance be given to circumstances previously jegard- ed as insignificant. It is on this principle that such great advantage is derived from reading the works of the ancient physicians, who paid so much the more atten- tion to the signs and symptoms of diseases, as they had not the lights of pathological anatomy to guide them. OF THE OBSERVER. 19 Q. With regard to the demeanour to be observed to- wards the sick what is to be said ? A. We may here conclude these remarks, by saying a few words on the demeanour which ought to be ob- served toward sick persons in order to gain their confi- dence, and obtain the disclosures which are necessary to form a proper decision on their cases. The physician should be calm and conciliating, should hear with atten- tion the communications which his patients make, should put his questions to them with mildness, listen kindly to tlieir complaints, and never fail to demonstrate an active interest in their welfare. OF OBSERVATION IN GENERAL. Q. On what does the science of medicine rest ? A. The basis of medicine, says Baglivi, rests altoge- ther on observation—Ars Medica est tota in observa- tionibus. But the facts which observation presents should be collected with care, method, and discrimina- tion. According to the object which an inquirer propo- ses to himself, observation maybe general or special. It is termed general, when directed to ascertain the gene- ral phenomena; for instance, of sporadic, endemic or epidemic diseases; and special, when confined to single cases, collected at the bed-side of the patient; it is to this latter that our attention for the present is directed : the former shall be treated of when we come to consider tlie subject of medical constitutions. Q. AVhat is the advantage of the first kind of obser- tion ? A. Special observation has this marked advantage, that when a number of cases are detailed with judgment and fidelity, and every circumstance of them carefully noted, they present to us the different characters which a disease puts on in several individuals, which will al- ways give to Monograph Works a decided advantage over general treatises. Q. With regard to the language of description what is to be observed ? 20 OF OBSERVATION. A. In drawing up a case, it should always be recol- lected that it is done with a view to convey to others an exact representation of the facts which we have observ- ed. In order to effect this, the words used, and their va- rious shades of meaning sbould be carefully considered, so that they may convey to the mind of the reader the facts as they really existed, without adding or suppres- sing any thing. The report of a case should be like the copy of a picture. It should be so faithful as to preserve all that individuality which marks each particular case, and distinguishes it from every other of the same class. Even when the phenomena of a case are confused and intricate, the observer should still express it3 real charac- ter, and should not seek to make it appear clear and sim- ple, as is too often done; for that can only be effected by misrepresentation. The statement of a case should not be loaded with superfluous detail; it should contain what is necessary, or rather what is indispensable ; but when the subject is obscure, the details should be extended and minute. In the descriptive part no reflections or opinions should be introduced, as that cannot fail to interrupt the narrative. Q. In what order should the symptoms be arranged ? A. The leading symptoms, particularly those which serve to establish the diagnosis, should first be noted down, ranged according to their importance, reference always being made, as far as can be done, to the order of their appearance. These should be expressed clearly, so as to impress them on the mind of the reader. If se- veral organs be affected at the same time, the symptoms referrible to each should be collected into separate groups ; those which are common to all, or of secondary importance, should follow; and then if the treatment be given, it will be necessaiy to mark the state of the pa- tient before and after the exhibition of medicine. Su- perfluous details should, of course, be omitted ; and no- thing stated but what u indispensably necessary. It may, however, be sometimes useful to note the ab sencc of any particular symptoms wluch usually exist in similar cases, lest the omission may be attributed OF OBSERVATION. 21 to negligence or forgetfulness on the part of the observ- er, and so discredit be cast on the facts he has detail- ed. When a disease is obscure, attention should then be redoubled, particularly if there be any controversies on the subject, and even the minutest details should be noted. Q. In ascertaining the qualities of medicine, what is to be observed ? A. When therapeutics are the objects of research, and when attention therefore is directed to ascertain the action of particular medicines, it is not necessary to report all the details of the cases ; it is enough to state their general nature, and the circumstances of the patient both before and after the administration of the medicine. Its form and dose should be stated, as well as the effect produced; and lastly, some remarks should be made on the state of the patient, when the treatment was discon- tinued. It is, in general, advisable to say a few words as to the state of the medical constitution, particularly when there exists any endemic or epidemic disease, as it must be evident that a symptom, which under other circumstances would be of no consequence, may then be of considerable importance; for instance, the existence of an epidemic varicella may throw much light on a pustu- lar eruption with a central depression. Q. What other assistants are useful in assisting obser- vation ? A. In some cases, words cannot convey to the reader all that is necessary to be expressed, particularly in de- scribing morbid appearances, which a disease presents : this can only be remedied by sketching or drawing the parts. To execute our task in this way must necessarily be attended with many difficulties; but a case drawn up with adequate exactness and fidelity becomes a complete monograph. In it we shall find stated the causes and distinguishing symptoms of the djsease described, its pro- gress and periods—the treatment adopted and its effects; and the reader may profit almost as much by it as if he had seen it himself. 22 OF OBSERVATION. Q. Is there great uncertainty with regard to the facts of medicine ? A. Nothing more fully proves the absence of suffi- cient precision in the conduct of observations, than the disputes about facts which we so constantly witness. If the same phenomena be accurately observed, there will be no room for any difference of opinion. Still, when we look over a number of cases, and observe the total want of conformity that there is in the descriptions of the same diseases, as given by different writers, we are often astonished at the discrepancy they exhibit, and feel disposed to consider it as a proof of the uncertainty of medicine, as if the errors of individuals should be laid to the charge of the science they profess. But whence, it may be asked, arises this difference in the reports of the same facts r It arises from the different degrees of know- ledge possessed by the persons who have observed them, —from some error in their methods of observation,—from ignorance of the exact meaning of the terms they employ, or from want of attention in the examination of their pa- tients. In fact, let any number of persons describe the same affection, if their judgments be equally correct and matured, if they possess the qualities above mentioned, as being necessary for the proper conduct of observations, and if they be equally well acquainted with pathology, the cases which they collect cannot fail to be marked by the same characters of truth and similitude, and in all we shall at once recognize the complaint described, whether it be arachnitis, pneumonia, peritonitis, &c. But if the disease according to one seems to be pleurisy, according to another pneumonia, a third, phthisis, it clearly follows that the statements are given inaccurately, and that those who have made them are ignorant of the differences which distinguish these diseases one from another. Q. With regard to copying observations what is to be observed. A. The observations should be transcribed immedi- ately after the visit, in a book kept for the purpose, as being the only means of ensuring correctness in the statements. Whilst the facts are fresh in the mind, they will be noted down with accuracy; and if any thing be OF OBSERVATION. 23 omitted, it can readily be supplied. But if any length of time be allowed to elapse, it must be at the risk of for- getting some of the leading circumstances, and of giving probably a false colouring to the whole. Q. When is the diagnosis most properly made out? A. It is only when the case is concluded, that it be- comes necessary to make reflections on the diagnosis,— on any particular circumstances that may have occurred, —on the treatment pursued,—or, finally, on the con- nections of the symptoms with the organic alterations found after death, if the termination has been fatal. By these means, materials really useful are collected, either for the guidance of our own future practice, or the in- struction of others; and so the most advantageous use is made of our experience. Q. What arrangement of the matter is found useful ? A. In order to save time and trouble in the subse- quent perusal of these cases, it will be found useful to place at the head of each of them an abridged summa- ry, containing the distinguishing signs—most important circumstances that occurred during the course of the disease—the plan of treatment pursued, and its effects; —and finally, the organic alterations, if it has ended in death. The following formula seems well adapted for the purposes here stated. It will enable the observer to arrange his cases, and see at one view their most im- portant phenomena. The clinical reports in the Hotel Dieu are all drawn up in this way. Case of------- Year— No. Month. Residence. Causes....... Particular Symptoms Duration of the disease . Termination ..... Treatment . . . Effects...... Morbid appearances . 24 OF OBSERVATION. Q. What is the best style for recording observations > A. In the first place, care should be taken that the terms employed should convey a precise meaning, and never admit of ambiguity ; they should fully express the facts without being strained. It is sometimes preferable to repeat a particular expression, and rather than, by en- deavouring to vary it, run the risk of sacrificing clear- ness. The style should be plain and unaffected, free alike from ostentation as from mannerism. The narra- tive part should be written with simplicity and ease; but all that relates to the condition of the patient, and to the enumeration of symptoms, had better be given in the aphoristic form; it carries with it a greater degree of precision, as each word expresses an idea. Occasion- ally, however, it will be found necessary to deviate from this routine, to avoid the sameness that would neces- sarily be produced by too rigid adherence to it. METHOD OF EXAMINATION APPLICABLE TO ALL DIS- EASES. Though the acquirements here pointed out are Varied and numerous, it should not thence be inferred that they are too difficult to be attained. By industry and attention, if properly directed, much may be effect- ed, even in a moderate space of time, and a greater progress may be made than could at the commencement have been expected. It will here be asked, what course should be pur- sued in the conduct of our researches ? Can we adhere to any fixed and uniform plan? Certainly not. For how could the same method of investigation be made to apply to diseases whose seat and nature are totally dif- ferent ? Would it not be absurd, when examining a case of effusion into the brain, to proceed in the same way as if the effusion were seated in the thorax ? And what resemblance can there be between the questions addres- sed to a person with malignant pustule, and one labouring under scirrhus of the stomach ? Surely the means of ascertaining the difference between small-pox and vari- METHOD OF EXAMINATION. 25 cella—between hydrophobia and certain nervous affec- tions which stimulate it, must be very different from those adopted when we want to distinguish mania from arachnitis, inflammation of the stomach from peritonitis or gout from articular rheumatism. For it would evi- dently be irrational to pursue the same routine of exam- ination in diseases so totally different in their seat, na- ture and character. Q. What particular parts of the body are particularly necessary to be made the subject of observation ? A. Our methods of examination then should partake of all that precision which marks the improved patholo- gy of the present day; and though they may not be di- rected in every case to each viscus and tissue, they should invariably be directed to explore each of the great cavities, where the vicinity of the contained vis- cera, and their numerous sympathetic relations consti- tute so many fertile sources of error.. Q. But should not the observer always have a direct object in view, in making his examination ? A. Several plans of examination have been pointed out and insisted on; yet we too often find that though after putting many questions without any direct object, the observer may be able to collect a greater or less number of symptoms, he still has acquired no knowledge of the disease about which he is inquiring. Such a course is not merely injurious from the time it wastes, but also by conveying the erroneous impression that the symptoms are to be considered apart from the organ to which they are referrible. Q. What is the preparatory examination necessaiy to be made ? A. Whilst examining the general appearance of the pa- tient, and the expression of his countenance, the obser- ver should at the same time ascertain the state of his tongue and pulse, should see the expectoration if there be any, make him respire, and ask whether he feels pain, in any particular part, and if he does, what has been its duration. In this way, which is particularly useful in acute ca- C 26 METHOD OF EXAMINATION. ses, a skilful person passes rapidly in review the princi- pal functions of the system, and obtains some idea of the state of the organs contained in the three great cavi- ties, which are generally the scat of all serious diseases. The countenance and general appearance are good in- dices of the state of the intellectual and muscular sys- tems, the tongue and mouth mark that of the diges- tive organs, and the pulse indicates either the direct derangement of the organs of circulation, or their con- nexion with the disturbance of others.—The expectora- tion, respiration, and voice mark the state of the lungs and their appendages, whilst the seat of the pain of which the patient complains, and the time it has lasted, cast additional light on the information obtained by the previous inquiries. The observer is still far from having ascertained the precise character of the lesion he is examining, but by means of the distinguishing signs of the diseases of the principal cavities, he will, in the first place, be able to determine whether the affection be acute or chronic; and in the next, by following the plan of examination we are now about to detail, he will learn how to give to his questions that degree of precision which is necessary for strict diagnosis and accurate description. By these means may be avoided that oversight so commonly committed in elementary works, namely, of supposing that to be known which is unknown, and of sending the reader to the perusal of a case, of which he as yet knows not even the denomination. Q. What appearances are first to be noted ? A. When commencing to take down a case, first note the name, sex, age, and occupation of the patient; this should be done according to the form above given. In some cases it becomes necessary to state the country or district from which the patient comes, and the disea- ses which prevail there. For example, many cases of intermittent fevers found in Paris got the infection else- where, which ought to be noted. In general, it is advisable to collect the principal facts and circumstances of the case in the presence of METHOD OF EXAMINATION. 27 those in attendance on the patient; it tends much to in- spire confidence. In Hospitals, pupils should avoid fa- tiguing those unhappy persons whom misfortune com- pels to take shelter in such asylums ; and when they are seized by ^ny dangerous disorder, surely their own feelings should teach them, that it is worse than incon- siderate to repeat the same questions many times over, and often without any determinate object. It should never be forgotten that misfortune has the strongest claims on the sympathy of every man ; and that every principle should prompt us not to expose ourselves to such a censure as Martial passed.on one of the physi- cians of his time— Languebam; sed tu comitatus protinus ad me Venisti centum, Symmache, discipulis. Centum me tetigere manus, aquilone gelatse Non habui febrem, Symmache, nunc habeo. Q. At what period of the disease is the examination best made ? A. The time of making the explanation is not altoge- ther a matter of indifference. When it is intended to put a number of questions, and enter into all the details necessary for a complete narrative, it is advisable to do so during the period of the remission, as then the patient can better bear the fatigue and exertion of conversa- tion. But when, on the contrary, we wish to observe the symptoms presented by the disease, and the chan- ges induced in the functions, in a word, the actual state of the patient, then it is better to choose the moment of exacerbation, as all the symptoms are more strongly marked, and their relative importance can be more ea- sily assigned. Q. Do diseases of different intensity require a differ- ent mode of examination ? A. The acute and chronic forms of disease require a plan of examination and narration altogether different. Every thing connected with the previous history should be known, and stated fully in chronic cases; it is the 28 METHOD OF EXAMINATION. only means of throwing any light on the obscurity which so generally surrounds them. But in acute cases this is far less necessary; it is of very little use, when consi- dering a case of arachnitis, or pericarditis, or when giv- ing its history, to go back to any previous affections of the patient, or inquire what has been his usual manner of living, or what influence any particular agent may have exerted upon him. When the symptoms are ur- gent, our object is to ascertain speedily the nature and ex- tent of the disease, and meet it by an energetic plan of treatment. Though this principle is true as to the treat- ment, it is not strictly so with regard to the prognosis, which must be modified by the existence of any parti- cular organic disease, or hereditary predisposition, known to exist in the individual himself, or in his family. After having examined the different parts of the bo- dy, in order to ascertain its external conformation, and any malformations it may present, the existence of which might lead us to suspect others deeply seated; after having ascertained whether there be any venereal or scrofulous cicatrices, which may throw some light on the present affection, tbe history should then be entered on in full detail, which will be found useful, particularly in consultations. Q. What other sources of information are to be sought ? A. The inquiries should be directed not only to the patient himself, but also to his family. A family consists of its ascending, descending, and collateral branches. It is then necessary to know whe- ther there has existed amongst any of these, but particu- larly in the father or mother, any habitual or chronic disease ; such as haemorrhoids, gout, rheumatism, phthi- sis, asthma, &c, which may be in any way connected with the present disease, or throw any light upon it. It sometimes happens, that a sort of general disposition to disease is transmitted from one generation to another, in such a way as to determine, in one, gout; in another, phthisis; in a third, some other disease, according as the METHOD OF EXAMINATION. 29 occasional causes may tend to develop the one or the other. The history of the collateral, or even of the de- scending branches of the family, may occasionally furnish some useful information. Thus we lately had an oppor- tunity of seeing a female, about forty-eight years old, who had been attacked, for the third time, by apoplexy, and whose father, mother, uncle, and two maternal aunts, had died of the same disease. What a prognosis for her! What a dreadful inheritance for her children ! When an intimate connexion subsists between the patient and any particular member of the family, it will be useful to ascertain whether there exists also between them any si- militude in person, disposition, or habit; it constitutes an additional circumstance to be added to the others; for the closer the physical and moral resemblances between the individuals are, the more likely is the transmission of the disposition to disease. Q. What questions arise out of the functions of the diseased parts and their derangements ? A. He should pass rapidly over the different periods of the patient's life, observing particularly its septenary divis- ions, and dwelling on the more important eras, such as in- fancy, puberty, adult age, and the critical period. He should inquire into the habits, mode of life, and state of the functions at these periods ; and ascertain what were the diseases to which the patient had been exposed, such as eruptions of the scalp, cerebral affections, glandular tumours of the neck or abdomen, during the first pe- riod of life; measles, small-pox, epistaxis, before puberty; catarrh, haemoptysis, palpitations, dyspnoea, when the organs of the thorax were assuming a certain degree of preponderance; and lastly he will make inquiries concern- ing any visceral or functional disturbances that may have occurred during the succeeding periods. It is only by accurate information on all these subjects that we can obtain such knowledge of the peculiar disposition and constitution of the individual, whose case is under con- sideration, as will enable us to give him advice as to the future management of his mode of living, at the same C 2 30 METHOD OF EXAMINA TION. time that it throws much light on the plan of treatment to be pursued for his present relief. A knowledge of the constitution will enable us to foresee in a great measure the form which diseases are likely to assume, and the course they will probably run. According to Professor Re'camier, constitutions may be divided into the active, passive, ataxic, and. re- fractory. Observation has shewn that in persons who present the characters of the active constitution, namely, those whose functions and actions are performed with energy and regularity, the return to health is more prompt and easy, and their diseases are more regular and less fatal, if properly treated from the commencement; that in those of a passive constitution, whose functions and actions are feeble, slow, and dull, though still regular, diseases are tedious in their progress, and tardy in their return to health, and consequently have a tendency to remain stationary; that in those, whether active or pas- sive, who are of an ataxic habit, that is, who exhibit in their different vital phenomena, any incoherence, irreg- ularity, or confusion, diseases will present similar char- acters, will arise from apparently insufficient causes, and often assume such a formidable character as to render it impossible to arrest their progress; lastly, in persons whose constitutions are such as to merit the appellation of refractory, that is, who manifest a certain energy in their functions, with considerable resistance in their dis- turbance, disease when once excited presents a similar tenacity, and generally resists every method of treat- ment. Q. With regard to the temperaments, what is to be required ? A. These have been divided into the sanguineous, lymphatic, and nervous, according as one or other of these organic systems predominates in the economy. By a knowledge of the prevailing temperament, the observer, in the first place, is enabled to know the different affections to which this peculiar organic de- velopment disposes: and the reader can more readily METHOD OF EXAMINATION. 31 represent to himself the aspect and appearance of the patient. Q. With regard to idiosyncrasies, what is to be ob- served ? A. The study of idiosyncrasies is probably even of still more importance, when considered in reference to the peculiar dispositions and susceptibilities of particular organs, and also to the influence which different thera- peutic and hygienic agents exert on the system. It is thus we can sea how an organ, too active re- latively to others, must be more liable to contract those diseases to which the temperament of the patient already disposes him; how cephalitis, for instance, is more fre- quent in sanguineous children, in whom the brain is the organ most active and best developed ; and thus we can give some explanation of those affections which occur in particular parts, which, though not endowed with much activity, exhibit a peculiar susceptibility for this or that agent; for instance, some persons contract catarrh only when they suffer from cold to the feet, and others get colic during stormy weather. In this way we may pass in review the different organs of the system, and consider them in reference to their predominance of action, their susceptibility relative to climate, seasons, different tem- peratures, food, drink, exercises, passions, and habitual or accidental diseases, such as issues, or haemorrhoids ; final- ly, it is only by considerations of this nature, that we can appreciate the advantage of this or that substance, or re- ject from our treatment a medicine that would be perfectly indicated in similar affections, and have recourse, occa- sionally, to others, the success of which can only be accounted for by some peculiarity of constitution in the individual. Q. How is the present affection to be examined Into ? .A. The observer first seeks to determine the causes wbich are presumed to have given rise to the disease, if they are appreciable, if not, he has only to slate them doubtingly: he then considers the different phenomena that have preceded the attack, the symptoms which ush- ered it in, the signs which chaiucteiizc it, its progress, 32 METHOD OF EXAMINATION. its influence on the different functions; and, finally, the treatment that has been pursued, and its effects. This plan is peculiarly applicable to acute diseases, and is in fact the only one that need bo resorted to. When the preparatory examination has given grounds for supposing that a certain organ, or system of organs, is particularly affected, we begin by stating the symptoms referrible to it, and then pass successively in review the state of the whole body, comprising the skin, face, state of intellectual faculties, apparatus of sensation, digestion, respiration, circulation, locomotion, secre- tion, and generation. When we come to treat of the diseases of each of the cavities, we shall give all the de- tails that bear on this part of the subject. After this is done, it remains only to add the changes that occur from day to day, or at more distant periods, if the diseas£ be slow in its progress. Attention should be redoubled on the critical days; for though the doctrine of crises is almost discarded of late years, it is still supported by the authority of so many ages, that we can scarcely neglect any thing that may throw light on a subject of such importance. When any new medicament is employed in the treatment, its effects should be care- fully noted. Finally, the mode in which the disease has terminated should be mentioned, whether it be suddenly, slowly, or by metastasis; so also if it passes to the chronic form, or is followed by another affection. If the patient recovers, his progress to convalescence should be briefly mentioned, as it is always useful to know what influence the disease has exerted in the state of the different func- tions. But if death takes place, the fullest details should be given of the appearances presented on examination ; in doing this, it is not sufficient to describe merely the state of the organs known to be affected during life. If any other tissue or organ present any alteration, it should be fully detailed. The subjoined tabular view exhibits a summary of all the objects of examination referred to in these re- marks. After having marked the name, sex, age, physi- cal conformation, constitution, temperament, and pro- METHOD OF EXAMINATION. 33 fession of the patient, we should pass successively i History of the Family History of the Patient ' Ascending Descending Collateral During Health Habits Regimen State of Functions Sympathies f Active Constitution J ?assi.ve ) Ataxic During dis- ease, observ- ing the Criti- cal Periods History of the present Disease, con- sidered in its Tempera- ment Idiosyncra- sies relative to 'Infancy Puberty Adult age Critical pe- riod Old age ^Refractoiy C Sanguineous < Lymphatic ( Nervous {Morbid Sus- ceptibility, Hygienic agents, Medi- cinal agents Causes C Predisposing Occasional Previous cir- cumstances Attack Progress Termination Present condition 34 METHOD OF EXAMINATION. f Habit of Body.—The Skin. Face. Intellectual System. Apparatus of Sensation. ---------—- Digestion. -----------Respiration. -----------Circulation. .-----------Locomotion. -----------Secretion. Generation. 2. Present State « C Health. 3. Termination in < Other Diseases. ( Death—Morbid Appearances. 35 CONVERSATIONS, &c. OSTEOLOGY. Q. How are the solids divided of which the human body is generally said to be composed ? A. Into hard and soft parts. Q. What are denominated hard ? A. The bones and cartilages. Q. What soft? A. The muscles, viscera, and all other parts. Q. How are the fluids divided ? A. Into the chyle, blood, lymph, secretions, and ex- cretions. Q. By what are the bones bound together in the re- cent subject ? A. By ligaments and cartilages, and sometimes by concretion. Q. By what in the skeleton ? - A. By their own ligaments, and form what is called a natural skeleton; or by wires and plates, to form an artificial skeleton. Q. Do bones present different arrangements of struc- ture in different bones and different parts of the same bone ? A. In the long bones the sides are thick in the middle and thin at the extremities, in the middle of the long bones it is reticular, containing marrow; in the extremity of the larger it is cancellated. The fibres in the long bones of children are longitudinal, in the broad bones ra- diated, and in the same bones»of adults, lamellated. 3G OSTEOLOGY. Q. How are the bones covered ? A. With a membrane called periosteum without; in the long bones within by the periosteum internum, run- ning through the cancellated structure. Their ends are tipped with a smooth substance called cartilage or gristle, for the formation of joints, which last is covered with a membrane called perichondrium. Q. Of what is the marrow composed ? A. Of fat. Q. What other circumstances are worthy of note about the bones ? A. Their epiphyses or the ends of bones united by car- tilage, and the apophyses, or parts standing out from the body of the bone and united by the same medium, which harden into bone. The epiphyses are called coronoid, condyloid, &c. according to their figures. There are sub- stances also called glands of the joints for the secretion of synovia. Q. How are the bones of the human skeleton gene- rally divided ? A. Into those of the head, trunk, superior and inferior extremities. THE SKULL OR BONES OF THE HEAD. Q. How is the skull divided ? A. Into the cranium and bones of the face. Q. What is its figure ? A. On the sides flat; smooth on its upper surface, and the general figure of its upper part that of an egg. On its under and outer surface irregular for the origin of muscles and perforated with holes for the passage of ves- sels and nerves. It is hollow on its under and fore part, and on the back part marked by muscles. Its upper and inner surface is hollow for lodging the brain ; and its un- der and inner surface is a! REMARKS. 63 A. A depressed portion of bone, or a collection of pus, or extravasated blood, in consequence of an injury. Q. How is a fracture of the bone distinguished from a suture ? A. The situation of the sutures is well known: and a fracture, though near one or more sutures, is accompani- ed with a roughness in its edges, which the surgeon can discover by a probe, or his finger. Q. Are there not some small bones sometimes in the course of the lambdoidal suture, and how could they bo distinguished from broken pieces of bone ? A. Ossa triquetra, or Wormiana, as they are called, are often situated in the lambdoidal suture, but in that case the sutures feel smooth, while the edges of a frac- ture are rough, and often ragged to the touch. (I. Is the application of the trephine necessary in every case of fracture, or when ? A. No ; not in every case; in those only where there is a portion of bone evidently depressed, and in conse- quence of which symptoms of compression of the brain supervene. Q. What are the symptoms of a compressed brain ? A. Vomiting, drowsiness, or insensibility, dilated pu- pil, slow pulse; sterterous breathing, and involuntary dis- charge of urine and faeces. Q. Does a depressed portion of the cranium then always require the operation ? A. No; a depression may be attended with no bad symptoms, such as those just mentioned^and then any operation is quite unnecessary. Q. May not the injury applied to the cranium be suf- ficient to rupture some arteries of the dura mater, and perhaps to produce a long fracture without depression of bone ? A. Yes; and in that case the symptoms already enu- merated, which indicate compression of the brain, appear and increase in aggravation. Q. Is the application of the trephine necessary in every case where pus or extravasation has taken place ? A. Yes; if the symptoms become urgent we have no alternative. 64 REMARKS. Q. How could the precise part where the pus Is col- lected, or where the rupture of the vessels has happened be ascertained ? A. It is difficult, and often impossible to ascertain the situation of the matter collected, or the fluid effused; because it may be collected in a part of the brain far from the ruptured vessel, or the seat of the injury re- ceived. Q. What rule must direct the surgeon in such cases, where the urgency of symptoms demands his interfer- ence ? A. He must apply the trephine a little below that part where marks of external violence are most evident; or if no violence be apparent, at a depending part on the side seemingly affected. Q. In a case of a fractured and depressed portion of bone, which requires an operation, is the trephine to be applied to the fractured and depressed part only, or where ? A. Yes; if the depressed portion is firm enough to bear the force necessary for the rotation of the trephine ; if not, the trephine should be placed partly on the solid bone, capable of bearing the force, and partly on the fractured portion. Q. What object has the surgeon in view by this op- eration ? A. To make an opening in the cranium sufficient to introduce an instalment to elevate the depressed portion of bone. # Q. Would Mr Hey's saw, in a number of cases, not answer this purpose better than the trephine ? A. Yes; and in such cases the saw should be pre- ferred. Q. If the extravasated fluid, after removing a portion of bone with the trephine or saw, be found under the dura mater, what is to be done ? A. It has been evacuated by puncturing the dura mater, but it is a dangerous practice, and nothing can justify the perforating of the dura mater, but the urgent and fatal aspect of the symptoms. THE BONES OF TIIL FACE. 65 OF THE BONES OF THE FACE. Q. How arc the bones of the face divided ? A. Into those of the upper and lower maxilla. Q. What bones are contained in the superior maxil- la? A. It contains six pairs of bones and the vomer, be- sides the teeth. Q. What bones does the inferior maxilla consist of? A. Of one, together with the teeth. OF THE OSSA NASI. Q. Where is the os nasi situated ? A. In the upper part of the nose. Q. What is its figure? A. Oblong, rather thin, bent backwards, convex exter- nally with its fellow forming an arch, and broadest at its inferior extremity. Q. Has the os nasi any processes ? A. One, the spinous process. Q. Has it any foramina? A. One or two generally. Q. What do they transmit ? A. Bloodvessels to the substance of the bone, or into the internal membrane of the nostrils. Q. What are the connexions of the nasal bone ? A. Its thick ragged upper end is joined to the frontal bone by the transverse suture ; its thick anterior edge to its fellow by the nasal suture ; its lower end to the car- tilaginous part of the nose, and its spinous process to the nasal lamella of the ethmoid bone ? Q. Is it complete in the foetus ? A. It is proportionally shorter and thinner, but pretty complete. Q. What is the use of the ossa nasi taken together? A. They cover and defend the root of the nose. F 2 66 THE OSSA UNGUIS. OF THE OSSA UNGUIS, OR LACHRYMALIA. Q. What is the situation of the os lachrymale ? A. At the inner and interior part of the orbit, and cov- ering the ethmoid cells'. Q. What is its figure ? A. Irregular and thin, having two depressions exter- nally, and a ridge between them ; and internally or pos- teriorly having a groove between two convexities. Q. What do the external depressions form ? A. The posterior forms part of the orbit; the anterior depression, being a deep groove or fossa larger above, lodges part of the lachrymal sac and duct. Q. What is the use of the middle ridge ? A. It forms the proper boundary of the orbit. Q. What do the groove and convexities internally form ? A. They correspond to the ethmoid cells, to which they are contiguous. Q. What are the connexions of the os lachrymale ? A. It is connected above to the frontal, behind to the os planum of the ethmoid bone by the transverse suture; before and below to the maxillary bone by the lachrymal suture. Q. What are the uses of this bone ? A. It composes part of the orbit, lodges a part of the lachrymal sac and duct, and covers part of the ethmoid cells. Q. Is the os lachrymale complete in the foetus 7 A. Yes, fully formed. Q. Is the os lachrymale ever subject to a Surgical op- eration ? A. Yes; in the Fistula Lachrymalis, when the nasal duct, which conveys the tears from the eye to the back part of the nostrils, is obstructed, a perforation is madein this bone, and an artificial duct formed. THE OSSA MALARUM. 67 OF THE OSSA MALARUM. Q. What is the situation of the os malae ? A. In the outer part of the cheek, forming the promin- ence. Q. What is its figure ? A. Somewhat square, with four acute angles. Q. What appearance has its external and internal sur- face ? A. It is convex and smooth externally, and posterior- ly or internally hollow. Q. What processes has it ? A. Five; the superior orbitar, forming part of the outside of the orbit; the inferior orbitary, forming its lower edge ; the maxillary, having a broad and rough surface, by which it is joined to the superior maxilla; the zygomatic, joining the temporal bone ; and the internal orbitar plate, forming the outer and fore part of the or- bit. Q. What muscles are attached to its external sur- face ? A. The massSter arises from the space between the maxillary and zygomatic processes below; the zygomat- leus major, and minor, from that near the zygomatic process; part of the origin of the massBter, and of the insertion of the temporal aponeurosis, are attached to the under edge of the zygoma. Q. What is lodged in its posterior hollow behind the zygomatic process ? A. Part of the temporal muscle. Q. Describe the connexions of the malar bone ? A. It is joined by its superior and internal orbitary processes to the frontal and sphenoid bones; by the edge of its internal and inferior orbitar processes, and inner side to the os maxillare ; and by its zygomatic pro- cess to the zygoma of the temporal bone. Q. Is the os malae perfect in the foetus at full time ? A. Yes; it is fully ossified. 68 THE OSSA MAXILLARIA SUPERIORA. OF THE OSSA MAXILLARIA SUPERIORA. Q. Where is the superior maxillary bone situated ? A. In the anterior part of the upper jaw, and side of the nose. Q. What is its figure and size ? A. Its figure is irregular, and its size the largest of the bones of the face. Q. How many elevations or processes has it? A. Seven; the nasal, making part of the side of the nose ; the orbitar, forming part of the orbit; the malar, joining the os malae, and forming part of the prominence of the cheek; the bulbous behind, forming the back boundary of the antrum; the alveolar, in which the teeth are fixed; the palatine, forming part of the roof of the mouth; and the spinous process, rising to form part of the septum narium. Q. What muscle arises from the bulbous process ? A. Apart of the pterygoidSus externus. Q. What is attached to the orbitar process ? A. A portion of the orbicularis oculi, but chiefly fiom its nasal process ; and the obliquus inferior, arise from it. Q. How many depressions are in the os maxillare superius? A. Seven; one behind the malar process; a second at the under and fore part of the malar process ; a thitd in the under arch of the palate; a fourth the semicircu- lar notch above the palatine plate; a fifth the alveolar arch; a sixth the lachrymal fossa in the nasal process; and a seventh, the canal in the orbitar plate. Q. What occupies the temporal depression behind the malar process ? A. The under part of the temporal muscle plays in it. Q. What occupies the second depression between the malar and alveolar processes ? A. The origin of the levator anguli oris, and part of the levator labii supcrioris alaeque nasi; and a brunch oi the fifth pair of nerves embedded in fat. THE OSSA MAXILLARIA SUPERIORA. 69 Q. What occupies the third, or palatine depression ? A. It forms a part of, and enlarges the cavity of the mouth. Q. What occupies the fourth, or nasal depression ? A. The cavity of the nostril. Q. Where is the alveolar process, or arch, situated ? A. Along the inferior margin of the maxilla. Q. What is the structure of the alveoli ? A. The bone is soft and spongy, having holes, or de- pressions, corresponding in size to the fangs, or roots, of the teeth. Q. Why is it porous and spongy ? A. To give a firmer insertion to the teeth, and ad- hesion to the membrane reflected from the gums, and a passage to blood-vussels into the substance of the bone. Q. What occupies the lachrymal fossa ? A. This fossa, together with that of the os lachrymale/ or unguis, forms.a canal, which is occupied by the lach- rymal duct ? Q. What does the canal in the orbitar plate con- tain ? A- The superior maxillary nerve, and a branch of the internal maxillary artery. Q. How many foramina has the os maxillare supe- rius? A. Five; three proper to it, namely the foramen infra-orbitarium, foramen incisivum, and the opening into the antrum maxillare ; and two common to it with other bones, viz. the spheno-maxillary fissure and the palatine foramen. Q. Describe the situation and use of the foramen infra-orbitarium ? A. The foramen infra-orbitarium situated just below the orbit, is the opening of the canal in the orbitar plate, and transmits the superior maxillary nerve, being the second branch of the fifth pair; and infra-orbitar artery, being a branch of the internal maxillary, to be distributed upon the face. Ci. Describe the situation and use of the foramen 70 THE OSSA MAXILLARLA SUPERIORA. incislvum, or palatlnum anterius, as it is sometimes called ? A. It is situated in the mesial line behind the inner incisores, common to both the palate bones below, but separates above into two holes, each of which opens into its respective nostril, just at the side of the septum narium: it forms a communication for small blood-ves- sels and nerves passing between the membranes of the mouth and nose. Q. Describe the situation of the antrum maxillare, or Highmorianum, and its orifice. A. It occupies the whole inner part of the bone un- der the orbitar plate, and above the dentes molares, and before the tuberosity ; its orifice is large in the separate bone; but in the connected state of the bones, it is about the size of a crow's quill, and is situated between the os spongiosum superius and inferius in the nos- tril. Q. Is this antrum lined with a membrane ? A. Yes ; with the same membrane as that of the nos- trils, but a little thinner. Q. Describe the situation and use of the spheno-max- illary fissure ? A. This fissure, composed partly by this bone, and partly by the malar and sphenoid, situated in the outer and under part of the orbit, transmits small branches of arteries, veins, and nerves, to the adjacent parts; lodges fat for lubricating the globe of the eye, and part of the temporal muscle. Q. Describe the situation and use of the foramen palatlnum ? A. It is situated at the inner side of the back plart of the tuberosity ; and is formed by a fossa in the superior maxillary, and a corresponding one in the os palati; it transmits a branch of the superior maxillary nerve, and of an artery to be distributed in the substance of the bone, and to the palate. Q. Describe the connexions of tho superior maxillary bone ? { A. It is connected above to the frontal bone by the THE OSSA MAXILLARIA SUPERIORA. 71 transverse suture ; to the os unguis by the lachrymal su- ture; to the os nasi by the lateral nasal suture ; to the os malae by the internal and external orbitar sutures; to the os planum by the ethmoidal suture; to its fellow below by the longitudinal palatine suture; and to its fellow between the nose and mouth by the mystachial suture. Q. What is the state of the os maxillare superius in the foetus at full time? A. It has no tuberosity, scarcely any maxillary sinus, and only six alveolar processes. Q. What is the use of the maxillary sinuses ? A. They serve to give strength and tone to the voice. Q. Is ever any surgical operation necessary upon these sinuses ? A. Yes; they are subject to inflammation and sup- puration ; and when the openings into the nostrils are obstructed, the pus or matter collected must be evacu- ated by a surgical operation. Q. How is that operation to be performed ? A. It may be done various ways ; but to extract one of the dentes molares immediately under the sinus, in which the fluid is contained, and to make a perforation in the sinus with a trocar, is the best method ; for by this the fluid can be thoroughly evacuated. OF THE OSSA PALATI. Q. What is the situation of the palate bone ? A. In the posterior part of the arch of the palate, be- tween the pterygoid processes and the superior maxillary bones. Q. What is its figure ? A. It is very irregular, though generally considered a kind of oblong square. Q. Into how many portions is it commonly di- vided ? A. Into four; namely, its palatine, pterygoid, nasal, and orbitary portions, which are named processes 72 THE OSSA PALATI. t). Describe the palatine portion? A. This seems the base or body of the bone, is con- cave above and below, and completes the arch of the pa- late and the bottom of the nostrils; its inner edge is raised into a spinous process, which with its fellow of the opposite side forms a groove; its posterior edge is pointed internally, where it joins its fellow; its anterior edge is unequal and ragged, and firmly joined to the palatine process of the maxillary bone. 2. Describe the pterygoid portion ? . This is the lower and posterior part of the bone, of a triangular shape, with its base below, and becoming smaller as it ascends: its posterior part has three fossae, the two lateral receive the ends of the two pterygoid plates of the sphenoid bone; the middle fossa makes part of the fossa pterygoidea ; its anterior aspect is irre- gularly concave, receiving the back part of the tuberosity of the os maxillare. Q. Describe its nasal portion ? A. It is very thin and brittle, is situated on the side of the nose; its internal surface is a little concave; it rises up from the external and upper edge of the palatine por- tion and from the narrow extremity of the pterygoid pro- cess, forms a considerable part of the side of the max- illary sinus, and closes the space between the sphenoid and maxillary bones; across the middle of its inner surface there is a ridge corresponding to that of the maxillary bone. Q. Describe the orbitar portion of the os palati ? A. It rises from the upper and back part of the nasal plate, and is divided from it by a notch, which forms part of the foramen spheno-palatinum; it forms a small part of the bottom of the orbit behind the os planum and maxillary; it has its anterior and lateral part contiguous to the maxillary sinus, and more posteriorly it covers the ethmoid cells; it also closes the sphenoidal sinus, except at its upper and fore part a hole is left. Q. What is attached to the posterior arch of the pa- late bone ? A. The velum pendulum palati. THE OSSA PALATI. 73 Q. What is attached to the posterior point formed by the junction of the two palate bones? A. The muscle named azygos uvulae. Q. What is lodged in the groove formed by the spi- nous processes ? A. The under edge of the vomer. Q. What purpose does the transverse ridge on the inner surface of the nasal plate serve ? A. The back part of the inferior spongy bone rests upon it. Q. What are the connexions of the os palati? A. Its palatine plate is connected to the os maxillare by the transverse palatine suture; its nasal and orbitar processes, to the same bone by the palato-maxillary suture ; its pterygoid and back part of the nasal process, to the sphenoid bone by the sphenoidal suture; its transverse ridge of the nasal plate, to the os spongiosum inferius. Q. What purposes does the os palati. serve ? A. It forms part of the palate, of the nostril, of the orbit, of the fossa pterygoidea, of the side of the maxil- lary, ethmoidal, and sphenoidal sinuses. Q. What is the state of this bone in the foetus? A. It is very complete; its nasal plate is thicker than in the adult; no cells are attached to its orbitar process. Q. Why are the eyes often affected in cases of ulcer- ated palate ? A. The palate, by means of the os palati and its ves- sels and nerves, has a direct communication with the orbit, and thus affects the eyes through sympathy. OF THE OSSA SPONGIOSA INFERIORA. Q. What is the situation of the os spongiosum infe- rius? A. In the lateral and under part of the nostril, adher- ing to the transverse ridge of the maxillary and palate bones. Q. Describe its processes ? G 74 THE OSSA SPONGIOSA INFERIORA. A. The inferior spongy bone lies horizontally with it* convex suiface towards the septum; from its upper edge two processes arise, the anterior ascending forms part of the lachrymal groove ; and the posterior, descend- ing in the form of a hook, makes part of the side of the maxillary sinus. _ " Q. What purposes do the spongy or turbinated bones serve in the nostrils ? A. They afford a large surface, on which the mucous membrane is expanded, in whose substance the olfactory nerves are dispersed, and the organ of smell greatly strengthened; they also cover a part of the antra maxil- laria, and assist in forming the under part of the lachry- mal ducts. Q. What is their state in the foetus ? A. They are almost complete. OF THE VOMER. Q. Where is the vomer situated ? A. In the lower and back part of the septum narium. Q. What is its figure ? A. It is compared to a plough-share. Q. Describe the vomer ? A. Its sides are flat and smooth, its superior and pos- terior edge appears oblique at the back of the nostrils; is thick and grooved to receive the azygos process of the sphenoid bone, and the nasal plate of the ethmoid; its inferior edge is received into the groove formed by the spinous process of the palate and maxillary bones,; its posterior part unconnected with any other bone is over the fauces; and its anterior edge is furrowed for receiv- ing the middle cartilage of the nose. Q. What are the connexions of the vomer ? A. It is connected above to the sphenoid and eth- moid bones, and to the middle cartilage of the nose; below, to the maxillary and palate bones. Q. What are the uses of the vomer ? A. It divides the nostrils, supports the other bones of THE VOMER. 75 the nose, and enlarges the internal surface for increasing the organ of smell. OF THE INFERIOR MAXILLA. Q. Where is the inferior maxilla situated ? A. In the lower part of the face. Q. How is it commonly divided ? A. Into seven parts, the chin, between the two ante- rior foramina; the sides, between these and the angles; the two angles ; and the two rami arising from them. Q. What processes has the inferior maxilla ? A. Five ; the two condyloid, two coronoid, and the alveolar processes. Q. Are there not others ? A. Yes, of less consideration: such as, a protuber- ance externally, and another internally, extending from the base of the coronoid process on either 6ide to the chin; the transverse ridge in the middle of the chin, called symphysis menti, and some small eminences on either side of it, both on the out and inside of the bone. Q. Describe the situation and use of the condyloid processes ? A. They are placed at the two extremities of the rami; they have an oblong head, situated obliquely transverse, supported by a cervix ; they are covered with cartilage, and adapted to the glenoid cavity of the tem- poral bone, with which they form an articulation. Q. Describe the situation and use of the coronoid pro- cesses ? A. They project upwards, about an inch anterior to the condyloid ; are thin, and give attachment to strong muscles. Q. Describe the situation and use of the alveolar processes ? A. They extend along the upper edge of the bone, from the base of the one coronoid process to that of the other; are broadest behind, and serve to give insertion to the teeth. Q. What purposes do the other eminences serve ? 76 THE INFERIOR MAXILLA. A. They give insertion and origin to various mus- cles. Q. What secures the head of the condyle in the gle- noid cavity ? A. A strong capsular ligament, attached to the cer- vix, and to the margin of the cavity ; and also the diffe- rent muscles. Q. What muscles are attached to the anterior part of the condyloid process ? A. The pterygoidSus externus is inserted into the fore part of the condyloid process, from the base of the coronoid upwards, and partly into the capsular ligament. Q. What muscles are attached to the coronoid pro- cess ? A. The tendon of the temporal muscle is inserted around it. Q. What muscles are attached to the external and in- ternal parts of the angles ? A. The massSter is inserted into the external, and the pterygoidSus internus into the internal side of the an- gles. Q. What muscles are attached to the longitudinal ridges from the base of the coronoid process to the chin ? A. The buccinator partly arises from the outer, and the mylo-hyoidSus from the inner ridge, together with the membrane of the gums. Q. What muscles are attached to the chin ? A. On either side of the symphysis externally, the levator, and depressor labii inferioris, the depressor anguli oris, and the digastricus, arise ; internally near the symphysis the fraenum linguae, the genio-hyoi- dSus, and the genio-liyo-glossus. Q. How many foramina are in the inferior maxilla ? A. Four; two in the external aspect, called foramina menti; and the two foramina maxillaria posteriora ; one on each side, on the internal aspect, in the centre between the angle and the extremities of the condyloid and coronoid processes. Q. What purpose does the posterior maxillary fora- men on either side serve ? THE INFERIOR MAXILLA. • 77 A. It receives the trunk of the inferior maxillary nerve, which is the third branch of the fifth pair; and the inferior maxillary artery, which is a branch of the in- ternal maxillary, and its vein. Q. What purposes do the foramina menti serve ? A. The nerve and artery just mentioned, as entering the posterior maxillary foramen, run forwards in the maxillary canal, and ultimately emerge from it by the foramen menti, on either side, to be distributed on the chin. Q. What happens while the artery and nerve are pas- sing along that canal ? A. They give off branches to the teeth, apd substance of the bone. Q. Are there any grooves observable in the inferior maxilla ? A. Yes ; a large one between the condyloid process and the foramen maxillare posterius ; and a less one from this foramen directed forwards. Q. What forms and occupies these grooves ? A. The trunks of the artery and nerve entering the canal form the larger; and the lingual branch sent off from the inferior maxillary nerve, just where it enters the canal, forms the smaller groove, in its course for- wards to the tongue. Q. What is the state of the inferior maxilla in the foetus ? A. It is composed of two pieces, joined in the middle by cartilage, which becomes ossified in after life, and forms the symphysis menti. OF THE TEETH. Q. How many teeth are inserted into each jaw in the adult ? A. Sixteen. Q. How are the teeth classed ? A. Into incisores, canlni or cuspidati, and molares which include the bicuspldes. Q. How many of each class are in each jaw ? G 2 78 THE TEETH. A. Four incisores in front; on either side of these, a caninus or cuspidatus, two bicuspldes, and three mo- lares. Q. What is the division of each tooth ? A. Into a body or corona above the gum, a cervix at the socket, and fangs or roots fixed in the bone. Q. What substances compose the teeth ? A. One very hard, on the cortical or external surface of the corona or body, called enamel; another softer and similar to common bone towards tbe centre of the corona, and in the cervix and roots. Q. Has each tooth any foramen ? A. Yes; in the point of its roots a hole receives its nerves and blood-vessels. Q. Are the fangs surrounded by a membrane ? A. Yes; a vascular membrane, reflected from the gums, covers the roots of the teeth, lines their sockets, and answers the purposes of a periosteum. Q. Has each class a certain number of roots ? A. Yes; the incisores and canlni have a single root, and also the two bicuspldes of the lower jaw; while those of the upper have generally two, and the large molares three or four roots. Q. What is the state of the teeth in the foetus at full time ? A. There are in each piece of the inferior maxilla, and in each side of the superior, two incisores, one cus- pidatus, and two molares, in the form of shells within the jaw, or under the gums. Q. Does any membrane surround the foetal teeth ? A. Yes; each tooth is included in a capsule, which is connected with the gums. Q. When do the teeth appear above the gums ? A. About the sixth or seventh month after birth. Q. How long is it before all the ten teeth in each jaw are cut ? A. They are generally all through the gums within the first two years of age. Q. When do these temporary, or deciduous teeth loosen and come out ? THE TEETH. 79 A. About the seventh or eighth year of age. Q. What is the cause of their coming out ? A. The second or permanent teeth lying concealed in the maxillae, increase in size and firmness, shoot up on the roots of the deciduous, which, by their irritation, are absorbed, and the bodies of the teeth, of course, fall out; while the permanent ones grow up, and occupy their place. Q. What seems to be the course of a second set of teeth being provided ? A. The temporary ones are adapted to the size of the maxillary bones in the infantile state; and when the jaws shoot out and grow larger, these teeth become too small; another larger set is therefore provided, suited to the increased size of the jaws, and destined to be permanent. OF THE OS HYOIDES. Q. Where is the os hyoides situated ? A. Horizontally, between the root of the tongue and the larynx. Q. What is its figure ? A. It has been compared to the Greek letter upsi- lon v. Q. How is the os hyoides divided ? A. Into a body and two cornua. Q. Describe the body of it? A. It is convex before, concave behind, and pretty broad in the middle. Q. Describe its cornua ? A. They extend backwards and upwards from either side of its body, with their two plain surfaces slanting downwards and onwards; each cornu becoming small- er, ends in a round tubercle. Q. Where are its appendices situated ? A. An appendix projects upwards from the articula- . tion of the cornu with the body on each side. Q. To what parts are the cornua attached ? A. Their round tubercles are connected with, and, as 80 THE OS HYOIDES. it were, rest upon the upper cornu of the thyroid carti- lage. Q. What are the connexions of its appendices ? A. From each appendix a liganyent ascends to the styloid process of the temporal bone. Q. Are these attachments sufficient to keep the bone in its situation ? A. Yes; assisted by the various muscles attached to it. Q. What muscles are attached to the body of the os hyoides ? A. The sterno-hyoideus, part? of the thyro-hyoideus, omo-hyoideus, genio-hyoideus, part of the genio-hyo- glossus, are inserted into it on either side. Q. What muscles are attached to its cornua ? A. The origin of the hyo-glossus, and the insertion of the stylo-hyoideus, on each side. Q. Is the os hyoides attached to other parts ? A. It is attached to the root of the tongue, epiglottis, and thyroid cartilage, by ligaments and membranes. Q. What is the use of the os hyoides ? A. It serves as a lever for the muscles acting upon the tongue, larynx, and fauces. Q. What is its state in the foetus ? A. It is mostly all in a cartilaginous state. BONES OF THE TRUNK. Q. How are the bones of the trunk generally divided ? A. Into those of the spine, those of the thorax, and those of the pelvis. OF THE SPINE. Q. Of what bones is the spine composed ? A. Of vertebrae, denominated true and false. Q. What vertebrae are true ? A. The cervical, dorsal, and lumbar, in all twenty- four. Q. What vertebrae are false 1 THE SPINE. 81 A. Those of the os sacrum, and os eoccygis. Q. In what does the distinction of true and false ver- tebrae consist ? A. The vertebrae are said to be true, when they move upon each other; to he false, when they adhere to each other, and do not move. Q. How many parts does a true vertebra consist of ? A. A body, and seven processes. Q. Describe the body ? A. It is of a spongy texture, has a horizontal upper and under surface a little hollowed; is convex anterior- ly, forming a ring of a firmer and harder structure than the internal substance of the bone; a little concave posteriorly, to form a large, somewhat triangular hole, with the two projections, on which the processes are constructed. Q_. Why are the upper and under surfaces hollowed ? A. To receive the inter-vertebral substance, which is of a cartilago-ligamentous nature, and allows the ver- tebrae to move, as upon ball and socket. • Q. What occupies the large hole at the back of the bodies of the vertebrae ? A. The spinal marrow, its vessels, and involucra. Q. Are the bodies of the vertebrae of the same size ? A. In the adult the bodies of the lumbar vertebrae are by far the largest, and they diminish in size as they as- cend ; the dorsal are less, and the cervical vertebrae have scarcely any body. Q. Why do the vertebrae increase in size as they de- scend ? A. The vertebral column sustains the weight of the superior parts of the body; and as the weight of the head is only to be sustained by the cervical vertebrae, their body is inconsiderable; as the dorsal bear the weight of the head, neck, and superior extremities, their bodies are much larger; and as the lumbar bear the weight of all the upper parts, their bodies are the largest and strong- est of all. Q. Do the sizes of the processes follow the same rule ? 82 THE SPINE. A. Yes; the processes become more distinct, and more strongly marked as they descend. Q. Describe the situation of the seven processes ? A. Each vertebra, except the first and second, has two articulating or oblique processes above, and two below, placed upon the sides of the arch; two trans- verse processes, the one projecting to the right, and the other to the left from the sides of the arch between the oblique processes; and a spinous process projecting back- wards. OF THE CERVICAL VERTEBRAE. Q. What are the marks of a cervical vertebra? A. Their body is small, solid, and flattened before, to make way for the oesophagus, and also a little behind; the superior surface a little concave by the lateral por- tions rising, and the inferior proportionally convex from side to side, and concave a little from before to behind; their transverse processes are perforated. Q. How are their articulating surfaces placed ? A. Very obliquely; the two upper face obliquely back- wards and upwards; while the two inferior face obliquely forwards and downwards. Q. Describe their transverse process? A. They are very short; each is perforated perpendi- cularly, and from the whole to the extremity is grooved on the upper side; has a bifurcated termination. Q. Describe the spinous process of the cervical ver- tebrae ? A. It is placed horizontally backwards, is short, and forked at the extremity. Q. Why are the surfaces of the cervical vertebrae hollowed both laterally and from before backward ? A. To admit of free motion; they can move on each other, as on ball and socket, for their inter-vertebral carti- lages are thick and strong. Q. Why are their transverse processes perforated ? A. These perforations form a canal for the passage of the vertebral artery and vein. THE CERVICAL VERTEBRAE. 83 Q. What purposes does the groove on the upper part of the transverse processes serve ? A. It receives and protects the cervical nerves, which pass out from the spinal marrow. Q. In what things does the first vertebra, named the atlas, differ from the rest ? A. Instead of a body, the atlas has an anterior arch with two thick lateral portions, on the upper and un- der surfaces of which the articulating processes are placed; in the anterior part of its convexity a round- ish protuberance, with a cavity on each side, appears: instead of a spinous process, an osseous semicircle is de- scribed. Q. How are the articulating processes of the atlas placed ? A. The superior are oval and hollow, and more ho- rizontal than the rest; they rise considerably on their ex- ternal margin, and are thus firmly articulated with the condyles of the occipital bone: the inferior are con- cave and round, slanting from within outwards and downwards, forming a secure socket for the convex sur- face of the inferior vertebra. Q. Has the atlas any perforations ? A- Yes; it has a hole, which easily admits a com- mon writing quill, in each transverse process, which is very long. Q. Has it any fossae or notches ? A. Yes; under the outer and back projecting part of the superior oblique processes there is a curved groove or fossa on either side: there is another more shallow at the posterior part of the inferior oblique processes. Q. What vessels are transmitted by the hole in the transverse processes, and lodged in the groove ? A. The vertebral artery passing up, and a vein aris- ing from the spinal marrow, its membrane, and deep- seated parts of the neck, descending on either side, oc- cupy the foramen, and also the groove; but this groove contains also the tenth pair of nerves in its passage out from the spinal marrow. 84 THE CERVICAL VERTEBRAE. 0&. What does the notch between the inferior oblique and the transverse process transmit ? A. This notch, together with another similar one in the second vertebra, forms a hole through which it trans- mits theirs* pair of cervical nerves on either side. Q. Are the transverse processes of the atlas longer than those of the other cervical vertebrae, and for what purpose ? A. Yes; they are longer, in order to give the mus- cles attached to them greater power in performing the rotatory motions of the head, by their acting with a longer lever. Q. What motions of the head are performed upon the atlas ? A. The condyles of the occipital bone are so obliquely articulated with the atlas, that motions of the head for- wards and backwards can only be performed. Q. What motions of the head are performed between the atlas and second cervical vertebra ? A.' The inferior articular processes of the atlas being concave, receive the convex articular surfaces of the se- cond vertebra, and perform rotatory and other motions of the head in every direction. Q. Are not some rough protuberances and depressions observable on the fore part of the atlas ? A. Yes ; on the posterior part of the anterior arch on each side of the circular notch, formed by the processus dentatus of the second vertebra, a small rough sinuosity is observable, where ligaments are attached for securing that process in its place ; still more laterally is a small rough protuberance and depression, for the insertion of the transverse ligament. Q. What muscles are attached to the anterior part of the atlas ? A. The musculi longi colli are inserted into the tu- bercle on the convexity of the anterior arch; and the recti interjii minores arise from the small cavities on either side of it. Q. What are attached to the convex part of the pos- terior arch of the atlas ? THE CERVICAL VERTEBRAE. 85 A. On the upper and back part of the middle of this arch are two depressions, from which the recti postlci minores arise ; on its lower part are two other sinuosi- ties, in which ligaments are fixed for connecting this with the inferior vertebra. Q. What is the course of the vertebral arteries before they enter the cranium ? A. These arteries ascend in the canal formed by the holes in the transverse processes of the cervical verte- brae, almost in a straight line, until they reach the third; when they form various windings in passing the third, second, and first vertebrae, and then turn sud- denly and run horizontally round the condyloid articula- tions into the foramen magnum. Q. Why do they form such windings ? A. That the impetus of the blood in them may be diminished, before it enters the tender substance of the brain. Q. What parts are peculiar to the second, or vertebra dentata ? A. It has a perpendicular tooth-like process arising from its body; its superior articulating processes almost horizontal, circular, and slightly convex, adapted to per- form rotatory motion; its transverse processes very slight- ly grooved, and not forked. Q. What,is observable on the dentoid process ? A. Its fore part is convex and covered with cartilage in the recent subject, where the atlas turns upon it; its back part is also round and smooth, where it moves upon the transverse ligament. Q. Does the processus dentatus exhibit any marks of the attachment of ligaments ? A. Yes; on either side of it the lateral ligament arises, and goes obliquely transverse to be inserted into the atlas and occipital bone; and from its apex the perpendicular ligament arises, and goes to be inserted into the occipital bone at the margin of the foramen magnum. Q. Is any thing worthy of observation in the spinous process of the vertebra dentata ? H 86 THE CERVICAL VERTEBRAE. A. It Is short, strong, forked, and turned much down- wards, so as not to impede the rotatory motions of the atlas. Q. Are any muscles attached to it ? A. Yes; the recti capitis postlci majTires, and the obliqui capitis inferiores, arise from its spinous process. Q. What is the state of the vertebra dentata at birth ? A. It consists of four pieces, three of which are com- mon to all the vertebrae, viz. the body and two lateral pieces for the articulating processes ; the fourth, the pro- cessus dentatus, joined by cartilage to the body, is pecu- liar to this vertebra. Q. Is the seventh or last cervical vertebra like the others ? A. It retains some characteristic marks of the cervical, and assumes others of the dorsal vertebrae. Q. What are these characteristic marks ? A. Its transverse processes are perforated, and some- times a cross spiculum of bone divides the vein, which is small, from the vertebral artery. It agrees with the dor- sal in having no bifurcation at the extremities of its transverse and spinous processes; in having the superior and inferior surfaces of its body less hollow; its articu- lar processes more perpendicular; and its spinous pro- cess larger and slanting more downwards. Q. What is the form of the cervical vertebrae when put together ? A. It is pyramidal with the apex towards the head. Q. What is the figure of the canal, for the reception of the spinal marrow, formed by the holes of the cervical vertebrae ? A. It is semicircular, with the diameter or flat side an- terior. OF THE DORSAL VERTEBRAE. Q. How many dorsal vertebrae are there ? A. Twelve. THE DORSAL VERTEBRAE. 87 Q. In what do the dorsal vertebrae differ from the cervical ? A. The dorsal want holes in the transverse processes, and have four lateral depressions, two above and two be- low, at the edges of the superior and inferior surfaces, for the articulation of the ribs. Q. What are the peculiarities of their body ? A. They are flatter at the sides, more hollow behind, and larger; their articular processes are almost perpen- dicular, the upper ones slanting forwards, and the under ones backwards; their superior and inferior surfaces are horizontal. Q. What are their spinous processes ?. A. They are thick at the roots, and become long and slender as they descend obliquely over each other; are sharp above, and gently hollowed below. Q. Describe their transverse processes ? A. They are long in the upper and middle part of the back, but become shorter near the under part; they pro- ject obliquely backwards and downwards, and enlarge at the extremities, which are hollowed and articulated with the tubercles of the ribs. Q. Have the first and twelfth, or last, dorsal verte- brae any thing peculiar ? A. The first is hollowed in its upper surface, and flat in its under one; has an entire pit above, and a half one or notch below on each side, for the heads of the first and second ribs : the twelfth bas an entire pit below, and a half one above, for the same purpose ; it has no artic- ular surface on its transverse processes>- Q. Have the dorsal vertebrae any lateral notches ? A. Yes; two on each side, the same as the cervical, between the articular process and body above and below; and when the vertebrae are applied to each other, the notches immediately above and those below form round holes, through which nerves pass out from the spinal marrow. Q. What is the form of the spinal hole in the dorsal vertebrae ? A. It becomes rounder and narrower as it descends 88 THE DORSAL VERTEBRAE. from the first to the tenth vertebra, and again becomes flatter in the two last. Q. Do the articular and spinous processes of the dor- sal vertebrae admit of much motion ? A. No; the motions are very confined, being chiefly flexion and extension of the trunk. Q. What is the form of the inter-vertebral sub- stances ? A. They are generally thin, but thinnest anteriorly, to enlarge the cavity of the thorax by the curvature of the spine. OF THE LUMBAR VERTEBRAE. Q. Describe the bodies of the five lumbar vertebrae ? A. They are the largest and broadest of all the verte- brae, increasing as they descend, particularly in breadth ; are a little contracted in the middle, and have promi- nent edges at their concave, superior, and inferior sur- faces. Q. Describe their transverse processes ? A. They are flat before and behind, are long, slender, and almost erect, to allow free motion, and to give at« tachment to large muscles. Q. Describe their spinous processes ? A. They are short, straight, strong, and horizontal, with narrow edges above and below; and broad flat sides, to give origin to strong muscles. Q. Describe the articular processes of the lumbar ver- tebrae ? A. They are strong and remarkably deep; the two superior are concave from above to below, facing each other, or turned inwards; and the two inferior ones being convex longitudinally, and placed nearer each other, face outwardly; and being received between the superior articular processes of the next vertebra below, form an articulation, as with ball and socket, adapted for free motions in every direction. Q. What kind of inter-vertebral cartilage have they? A. These cartilages are very thick, particularly on THE LUMBAR VERTEBRAE. 89 the anterior aspect, and, in consequence, the spine is made convex before. Q. Are these inter-vertebral cartilages often the sub- jects of disease? A. Yes ; in scrofulous habits they frequently become inflamed, suppurate, and ultimately cause the spine to become twisted. This wasting of the inter-vertebral cartilages sometimes pervades the spongy substance of the vertebrae themselves, particularly in the loins, and produces Lumbar Abscess ; or, in infants, Spina Bifida. OF THE OS SACRUM. Q. What is the situation and figure of the os sa- crum ? A. It is situated immediately below the lumbar ver- tebrae, and forms the back part of the pelvis; its figure is that of an inverted pyramid, and concave an- teriorly. Q. What is it composed of? A. Of five vertebrae grown together, hence called false; their adhesions, however, are distinctly marked by transverse prominent lines, Q. Does the bone exhibit any appearance of trans- verse processes ? A. Yes; they are united, and form a large oblong thick process on either side, and are divided by a perpendicular ridge. Q. Has the os sacrum any spinous processes ? A. Yes; they are short,sharp, and almost erect above, and less observable below. Q. What is the form of its canal for the under end of the spinal marrow ? A. Between the bodies and processes of the three uppermost vertebrae it is triangular; becomes smaller as it descends, and below the third false vertebra it is open behind, where in the recent subject the spinal marrow is defended by a strong ligamentous membrane. Q. What is the name of the lower end of the spinal marrow ? II 2 90 THE OS SACRUM. A. Cauda equina, from its fibrous bushy appearance. Q. How many holes are on the internal surface of the os sacrum ? A. Four pairs of largS holes, with grooves leading from them. Q. How many foramina are observable on its exter- nal, or posterior surface ? A. Four pairs also, not much smaller in the dry bone, but so filled with membrane and cellular substance in the recent subject, as to become small. Q. What passes through these foramina of the os sacrum ? A. The great sacral nerves pass out from the spinal marrow through the anterior; and small nerves also pass out to the large muscles; and minute arteries pass in through the posterior foramina. Q. Has the os sacrum any notches ? A. Yes; there is a notch on either side below, corres- ponding to similar ones in the os coccygis, to form holes for the passage of the last spinal nerves. Q. How many articular surfaces has the os sa- crum? A. Four; two at the base or upper part of the bone, facing backwards, to be articulated with the two inferior of the last lumbar vertebra; and a large, uneven, irregu- ral surface on either side, where it is firmly connected with the ossa innominata. Q. What are the connexions of the os sacrum ? A. It is connected with the lumbar vertebra above ; the innominata on the sides; and with the base of the os coccygis below. Q. What purposes does it serve ? A. The os sacrum, being triangular with its base above and its apex below, forms a base for supporting the vertebral column, defends the large sacral nerves, of great importance; and behind, affords an origin to strong muscles moving the trunk and inferior extremi- ties. Q. What is the condition of the os sacrum at birth? • THE OS SACRUM. 91 A. It is composed of five distinct vertebrae, with in- ter-vertebral substances in the foetal state. OF THE OS COCCYGIS. Q. What are the situation and form of the os coc- cyx? A. It hangs from the apex of the os sacrum; is broad and flat above, and tapering below, convex behind, and curved forwards. Q. How many portions does it consist of in the young ? , A. Of four or five, which are similar to vertebrae. Q. Do these vertebrae adhere in the adult ? A. Yes; they grow together, and admit of no motion, except a general elasticity. Q. Do any ligaments strengthen it ? A. It is covered by a strong ligament, which gives origin to numerous muscular fibres on the sides of the bone. Q. What is the state of the os coccyx in the foetus ? A. At birth it is almost wholly cartilaginous. Q. Wliat uses does the os coccygis serve ? A. It, with the parts connected with it, contracts the inferior opening of the pelvis, assists in supporting the intestinum rectum, the uterus, and the urinary bladder. Remarks. Q. How are these classes of vertebrae to be distin- guished ? A. The cervical have foramina in their transverse, and bifurcations in their spinous processes: the dorsal have cavities on their sides for receiving the heads, and a smooth depression on the anterior part of the knobbed extremities of the transverse processes, for articulating with the tubercle of the ribs; and spinous processes sharply ridged above, hollowed below, and very much sloped downwards : the lumbar have no holes in their transverse processes, no depressions for the ribs on their 92 REMARKS- bodies or transverse processes, and no sloping spines; but they have larger bodies, long horizontal transverse processes, broad horizontal spinous processes with their edge up, and articular processes facing outwards and in- wards. Q. What parts of the vertebral column are best adapt- ed to motion ? A. The cervical and lumbar vertebrae admit of free motion in every direction; the dorsal admit of motion for- wards and backwards chiefly, and but of little laterally. Q. Wby are the dorsal vertebrae so confined in their motions ? A. That they may more safely defend the vital organs attached to various parts of the thorax. Q. Are not vital organs contained in the abdomen, and yet why are the lumbar vertebrae destined to have free motion ? A. The important organs, namely, the viscera, 3re loosely attached to the internal surface of the bodies of the vertebrae, and in consequence are not affected by the free motions of the lumbar Vertebrae. BONES OF THE THORAX. Q. What is the figure of the thorax ? A. It is somewhat conical, but largest near the mid- dle; its under part is shorter before than behind, or on the sides. Q. What bones compose the thorax ? A. The twelve dorsal vertebrae behind, the sternum before, and the twelve ribs on each side. OF THE COSTAE, OR RIBS. Q. How are the ribs commonly divided ? A. Into true and false. Q. How many are in each class ? A. The seven superior are denominated true, because they have their cartilages joined to the sternum : the five inferior are false, because their cartilages do not THE RIBS. 93 reach the sternum, but terminate in that of the last true rib. Q. Describe the situation and figure of the ribs ? A. They slope a little downwards from their attach- ment to the vertebrae; are concave and smooth inter- nally, convex externally, are flat near their middle; have an upper roundish edge, and a sharp under one. Q. What particular parts are in each rib ? A. A head with a middle ridge, and a plain or hollow surface on each side of it; a cervix; a tubercle ; an an- gle ; a fossa or groove on the inner side of the inferior margin ; and an oval pit in the anterior extremity. Q. (What parts are connected with the head ? A. The head of each rib is adapted to the interverte- bral space, having an articulating surface with the verte- bra above, and another with that below, excepting the first rib, which is articulated with one vertebra, and has only one articulating surface. Q. What is the situation and use of the cervix ? A. It is between the head and tubercle, and gives at- tachment to the capsular ligament of the articulation. Q. Describe the situation and use of the tubercle ? A. It is situated a short distance from the head on the posterior part of the rib, having a flat surface, by which it is articulated with the transverse process of the lower of the two vertebrae, to which the head is joined. Q. Where is the angle situated, and what is its use ? A. The angle of the rib, situated a little distance from the tubercle, is formed by the expansion of the ribs to ?jve breadth to the thorax, and by the strong sacro- umbalis attached at that place. Q. What is the use of the groove in the under margin ? A. The intercostal artery, vein, and nerve, are lodged in it; but that part of the rib between the head and angle is round, having no artery in contact with it, has no groove: near the anterior extremity too, the groove be- comes very inconsiderable and disappears, owing to the smallness of the vessels there. Q. What is the use of the oval pit in the anterior end of the rib ? 94 THE RIRS. A. The cartilage, which connects the rib with the sternum, is inserted into that hole. Q. Are not the ribs somewhat twisted ? A. Yes; the rib with its cartilage forms a curve along its superior margin, which rises considerably near the sternum, the curve is greater as the ribs descend. Q. Have the different ribs the same degree of curve ? A. No ; the first or upper rib is the most bent, and it is flat above and below, and internally; in their descent the ribs become gradually straighter. Q. Are the ribs alike in horizontality ? A. No ; with respect to the spine, the uppermost rib is nearer horizontal, and the obliquity increases as the ribs descend, their anterior extremities becoming more distant from each other. Q. Are the cartilages of the different ribs of the same length ? A. No ; the cartilages become longer, but approach nearer as they descend. Q. Do the ribs differ much in length ? A. Yes; the length of the ribs increases from the first to the seventh, and then decreases. Q. Is the distance between the tubercle and angle of the rib always the same ? A. No; the distance increases to the ninth rib, as they descend; corresponding to the breadth of the thorax, and of the sacro-lumbalis, which covers them. Q. How are the cartilages of the ribs attached ? A. Those of the true ribs are directly attached to the sternum ; the cartilages of the three upper false ribs are joined to each other, and the union of substance to that of the under true rib. Q. Are the cartilages of the eleventh and twelfth ribs not joined to the others ? A. Their cartilages are sometimes joined to the carti- lages of the other false ribs; but the anterior extremities of these ribs more frequently are not joined to the oth- ers ; and they lie loose among the muscles, hence are called floating ribs. THE RIBS. 95 Q. Has the first rib any cartilage between it and the sternum ? A. Its posterior end is firmly fixed to the first dorsal vertebra, and its anterior to the sternum, so as to ad- mit of no motion; cartilage forms its connecting me- dium. Q. Has the second rib any cartilage interposed be- tween it and the sternum ? A. The second rib has a little cartilage, which admits of a small degree of motion, but very little. Q. Have the first and second ribs any groove in their inferior margin ? A. No; it is somewhat rounded, but is not grooved in these ribs. Q. Do any of the other ribs want grooves ? A. The eleventh and twelfth generally want both the groove and tubercle. Physiological Remarks. Q. What motions are the ribs adapted to perform ? A. Two motions ; one upwards and downwards with their anterior extremities, and another somewhat rotatory motion near their middle part. Q. How can they perform such motions, seeing they are bound at both ends ? A. The articulation of their head with the bodies of the vertebrae, is to be considered the centre of motion ; and their anterior extremities, being attached to carti- lages, which are elastic and moveable, can be raised or depressed to a certain extent. Q. How can the attachments of the ribs admit of ro- tatory motion? A. The first rib is firmly fixed to the vertebra and sternum ; hence, when the intercostal muscles act, they pull all the other ribs upwards to it, as a fixed point, in proportion as they are moveable. Q. Do the ribs acquire mobility as they descend ? A. Yes; in proportion to the length of the cartilages interposed between them and the sternum, and to the 96 PHYSIOLOGICAL REMARKS. intercostal spaces, which are greatest at the middle of the ribs*. Q. How is their rotatory motion performed ? A. While the intercostal muscles contract and elevate the ribs, they have greater power over their middle, where their fibres are longer and the intercostal spaces wi- der ; hence, when the anterior extremity is checked in its ascent, they elevate the middle of the ribs, and produce a partial rotatory movement on both their extremities. Q. Do these movements of the ribs enlarge the thorax ? A. Yes; during every inspiration they enlarge the cavity of the thorax in all its dimensions. Q. What is the structure of the substance of the ribs ? A. It is spongy, particularly near their anterior extre- mities, and covered with a thin external lamella which becomes a little thicker towards their head. Q. Does this spongy texture render them more sus- ceptible of disease ? A. Yes; the anterior extremities of the ribs become soft, and enlarge in size, in Rickets ; and deformity of the thorax is the consequence. Q. What is the state of the ribs in the foetus ? A. The heads and tubercles are pretty well ossified, the other parts are cartilaginous. Q. What purposes do the ribs serve ? A. They form the sides of the thorax, cover and de- fend the heart and lungs, and materially assist in the per- formance of respiration. * This was the idea of Haller. Magendie however states just the contrary: that the first rib has the greatest motion; and the reason why it does not appear to be as moveable as the others is because it is snorter—and of course a small degree of motion at the vertebral extre- mity does not appear as in the other longer ribs; and this he infers from the structure of the ribs, of the vertebrae, and of the ligaments which unite them: he also believes that a joint formed in the sternum, opposite the cartilage of the second rib, contributes, by permitting the motion of the sternum upwards, to the enlargement of the thorax. THE STERNUM.. 97 OF THE STERNUM. Q. What are the situation and figure of the sternum ? A. It is situated in the fore and middle part of the thorax, and is of a triangular form, being broad and thick above, and thin and narrow below. Q. How many pieces is it composed of? A. Of three, joined together by cartilage, or ossified in the adult. Q. Describe the sternum ? A. Its external surface is flat; its internal is somewhat hollowed, particularly above; it has thick strong upper corners, with a cavity in each; has seven pits or depres- sions on each side, which are considerably distant from each other above, but become gradually nearer as they descend. Q. What is lodged in the cavities on the upper corner on each side ? A. The end of the clavicle on each side is firmly ar- ticulated in that cavity with the sternum. Q. Why is the sternum concave laterally, particularly above ? A. The internal surface of the thorax is round, and the internal part of the sternum forms a portion of its rotundity; the trachea descending, is lodged under its upper and more concave part. Q. What do the pits on the sides of the sternum re- ceive ? A. They receive the ends of the cartilages of the ribs, which are firmly attached by capsular ligaments. Q. What is the name of the third or lowest piece of the sternum ? A. It is shaped like the point of a broad-sword, and called cartilago ensiformis. Q. What muscles are attached to the sternum ? A. The two sterno-mastoidsi, and the two pectorales majores. Q. What is attached to its internal surface ' f 98 THE STERNUM. A. The mediastinum, and two sterno-costales mus- cles. Q. What is the structure of the sternum ? A. It is cellular, and its cancelli are covered by a thin lamella of a harder texture. . Q. Is it strengthened by any ligament in the recent subject ? A. It is invested by a strong tendinous membrane. Q. What is the state of the sternum in the foetus ? A. It is composed of seven or eight pieces, which ul- timately unite and form three. Q. What are the connexions of the sternum ? A. It is connected by cartilage to the fourteen upper ribs, and by inter-articular cartilage to the anterior ends of the two clavicles. Q. What purposes does the sternum serve ? A. It gives origin to several muscles, forms part of the thorax, defends the heart and lungs, gives attachment to the mediastinum internally, and to the ribs externally, and is a fulcrum on which the clavicles roll. BONES OF THE PELVIS. Q. Where is the pelvis situated ? A. At the inferior part of the trunk. Q. Of what bones is it composed ? A. Of the os sacrum, and os coccygis behind, and of the two ossa innominata laterally and before. Q. Of how many portions is each os innominatum composed ? . A. Of three in children, namely, the os ilium, ischium and pubis; which, though completely ossified in the adult, yet retain their names to facilitate the description of this unshapely bone. OF THE OS ILIUM. Q. Where is the os ilium situated ? A. In the upper expanded part of the os innominatum. Q. Describe the ilium ? THT^ OS ILIUM. 99 A. Its dorsum or outer surface is irregularly convex, its inner surface concave, its upper edge or spine is thick, rough, and semicircular; its articulating surface with the os sacrum on the under, posterior, and internal part, large and scabrous; from which towards the pubis a transverse ridge called linea innominata arises; and on its anterior inferior external side a curved high ridge pro- jects, exhibiting internally a semilunar cavity, behind which is a large notch. Q. How many processes has the os ilium ? A. Four; an anterior superior, and an anterior in- ferior spinous process; and a superior and an inferior spinous process also behind. Q. What is attached to the anterior and superior spinous process ? A. The sartorius muscle, Poupart's ligament, and the tensor vaginae femoris. Q. What is attached to the anterior inferior spinous- process ? A. The rectus femoris muscle. Q. What parts are attached to the posterior superior, and inferior spinous processes? A. Ligaments for connecting this bone to the os sa- crum, and for the origin of muscles. Q. What muscles are attached to the dorsum of the ilium ? A. The three glutei muscles arise from it. Q. What muscles are attached to the crest or spine of the ilium ? A. The external or descending oblique is inserted in- to it; and the internal or ascending oblique, and the transverse abdominal muscles, the gluteus maximus, quadratus lumborum, and latissimus dorsi, arise from it. Q. What muscle is attached to its internal concave surface ? A. The iliacus internus. Q. Describe the inferior and posterior notch of the ilium ? A. It is a kind of semi-circle, and when the two sa- 100 THE OS ILIUM. cro-sciatic ligaments are entire in the recent subject, a large hole is formed, named the sacro-sciatic hole. Q. What vessels pass through this foramen sacro- sciaticum ? A. The gluteal and ischiatic arteries, the pyriform muscle situated between them, and the sciatic nerve. Q. What is the purpose of the linea innominata ? A. It forms the lateral portion of the brim of the pelvis, dividing the cavity of the pelvis from that of the abdomen. Q. What is the use of that semi-lunar cavity with a highly curved ridge at the inferior anterior and exterior part of the ilium ? A. It formsv the upper and back part of the acetabu- lum, being the socket in which the head of the femur is articulated. OF THE OS ISCHIUM. Q. What are the situation and figure of the os is- chium ? A. It is situated at the lowest part of the os innomi- natum ; its figure is irregular. Q. How is the os ischium divided ? A. Into a body, tuberosity, and ramus. Q. Describe the os ischium ? A. The upper part of its body forms the inferior part of the acetabulum ,* behind which its spinous process is situated in a line with the notch of the ilium. Q. What sinuosities has the os ischium ? A. Immediately below the spinous process internally is a large depression, sometimes called the cervix; and externally, at the root of* the spinous process, and be- tween the acetabulum and tuberosity, is another sinu- osity. Q. Where is the tuberosity situated ? A. It is the lowest part of the bone, being that on which the weight of the body rests in the sitting pos- ture. Q. Where is the ramus of the ischium situated ? THE OS ISCHIUM. 101 . A. It rises up anteriorly to join the os pubis. Q. What parts are attached to the spine of the is- chium ? A. The superior sacro-sciatic ligament, the coccy- geus, superior gemellus, and part of the levator ani, muscles, arise from it. Q. What occupies the sinuosity under the spinous process ? A. The tendon of the obturator internus plays in it. Q. What occupies the sinuosity at the root of the spinous process externally ? A. The pyriformis or iliacus externus muscle. Q. What parts are attached to the upper part of the tuberosity of the ischium ? A. The inferior gemellus, and inferior sacro-sciatic ligament. Q. What passes through the foramen between the superior or internal, the inferior or external sacro-sciatic ligaments, and the great notch or sinuosity of the ilium ? A. The obturator internus muscle. N Q. What muscles arise from the upper posterior ob- lique surfaces of the tuberosity ? A. The longhead of the biceps flexor cruris and se- mitendinosus arise from the interior; and the semimem- branosus from the exterior surface, which reaches near- er the acetabulum. Q. What muscle arises from the lower and thinner scabrous part of the tuberosity, bending forwards ? A. The largest head of the triceps adductor femoris. Q. What muscle arises between the external margin of the tuberosity and the great hole of the os innomina- tum? A. The quadratus femoris. Q. What parts arise from the scabrous part of the ramus ? A. From its posterior part, the transversalis and erector penis; and from its thin scabrous part, the two lower heads of the triceps adductor femoris; the crus penis in the male, and the crus clitohdes in the female. I 2 102 THE OS PUBIS. OF THE OS PUBIS. Q. What is the situation of the os pubis ? A. At the anterior part of the pelvis. Q. How is it divided ? A. Into a body near the acetabulum; an angle at its anterior part, where it joins its fellow of the opposite side; and a ramus, which descends from the angle to join the ramus of the os ischium. Q. Describe the ridges or spines of this bone ? A. A ridge continued round from the linea innomina- ta of the os ilium along its upper and inner edge to the angle, forming part of the brim of the pelvis : another ridge from the former, extending downwards and back- wards, in the fore part of the acetabulum. Q. Where is the crest of the pubis ? A. The upper and inner scabrous part, where it joins its fellow. Q. What parts are attached to it ? A. The rectus and pyramidalis muscles, and the end of Poupart's ligament. Q. What vessels pass over the flattened part of the body of the pubis under the ligament of Poupart ? A. The psoas magnus and iliacus internus muscles play over it, the femoral artery, vein, and nerve, pass over it nearer to the angle. Q. What muscle arises from the external part of the angle ? A. The pectin&lis. Q. What is the name of the large hole formed by the os ischium and pubis ? A. The foramen thyroidSum, which in the recent subject is all filled by a membranous ligament, except- ing a hole formed by the obturator ligament. Q. What vessels pass through this foramen obtura- torkim ? A. The obturator artery, vein, and nerve. y. What forms the arch of the pubis: THE OS PUBIS. 103 A. The two rami of the os pubis form its upper part, and the rami of the os ischium continue it downwards. Q. What is the name of the junction of the ossa pubis ? A. The symphysis pubis, which is strengthened by a ligamentous cartilage, and keeps the two bones so firmly fixed together, as to admit of no motion. Q. What occupies the acetabulum ? A. The round head of the os femoris. Q. What is situated in the scabrous pit in the bottom of the acetabulum ? A. The round ligament of the head of the femur is attached to it. Q. What is situated in the breach of the anterior part leading to the insertion of the round ligament ? A. A ligament is stretched across from the one side of the breach to the other, and the synovial apparatus of the joint is lodged under it, and towards the round ligament; the vessels of the joint also enter by it. Q. WTiere is the acetabulum deepest ? A. At its upper and back part, its brim there rises very high, and besides is tipped with cartilage in the recent subject. Q. What parts retain the head of the femur in the acetabulum ? A. The round ligament attached to the head of the femur, and inserted into the bottom of the acetabulum, the height and strength of its brim when tipped with cartilage, the capsular ligament, and the muscles sur- rounding the joint. Q. What are the connexions of the ossa innomi- nata ? A. They are connected behind to the os sacrum by a thin cartilage and by strong ligaments, so as to admit of no motion; called posterior symphysis ; before to each other by a ligamentous cartilage and ligaments so as to prevent all motion, called symphysis pubis. Q. What are the uses of the pelvis? A. It forms a firm arch for supporting the whole weight of the superincumbent parts ofjfhc body; it con- tains the urinary bladder and rectum, and the utcrui 104 THE OS PUBIS. also in females; it gives a safe passage to large and Im- portant blood vessels and nerves; it gives origin behind to muscles, which extend the trunk ; below and before to those which move the thigh; and insertion to others, which bend the body forwards. Physiological Remarks. Q. What are the dimensions of the brim of the pel- vis? A. The short diameter, being a line drawn from the middle or promontory of the os sacrum to the crest of the symphysis pubis, is four inches; the long diameter in a line drawn from the one os ilium to the other is five inches and a quarter. The diagonal of these lines, however, is the longest in the recent subject, and the long diameter of the child's head descends in that di- rection through the brim of the pelvis. Q. Why is the diagonal line the longest in the recent subject ? A. Because the psoas magnus and internal iliac muscles on each side occupy a considerable space of the internal surface of the ossa ilia; and thereby diminish the long diameter in the skeleton. Q. What are the dimensions of the pelvis at its out- let below ? A. The long diameter below is the reverse of the brim, being from the symphysis of the arch of the pubis to the point of the os coccygis ./Jur inches and a quar- ter, and the diameter from the one tuberosity of the ossa ischii to that of the other is four inches. Q. What is the depth of the pelvis ? A. From the brim to the point of the os coccygis, down the middle of the os sacrum, the pelvis usually measures six inches; on the sides, three inches and a half; and before, one inchynda half. Q. Are the dimensions of the pelvis in the female dif- ferent from those in the male sex ? A. The pelvis is more of an oval figure, and generally larger in the female. THE SUPERIOR EXTREMITIES. 105 OF THE SUPERIOR EXTREMITIES. Q. What is the division of the bones of the superior extremity ? A. They are divided into the boiies of the shoulder, arm, and hand. Q. How many bones compose the shoulder ? A. Two; the clavicle and scapula. Q. How many bones compose the arm ? A. Three; the os humeri in the arm, and the ulna and radius in the fore-arm. Q. How are the bones which compose the hand sub- divided ? A. Into those of the carpus, metacarpus, and fin- gers. Q. How many bones compose the carpus ? A. It is composed of eight bones disposed in two rows; those of the first are the scaphoides, lunare, cu- neiform, pisiforme ; those of the second row, the tra- pezium, trapezoides, os magnum, et unciforme. Q. How many bones compose the metacarpus ? A. It consists of four bones for the fingers, and one for the thumb. Q. How many bones compose the fingers? A. Twelve; arranged into three phalanges. Q. How many compose the thumb ? A. Two. OF THE CLAVICLE. Q. What is the situation of the clavicle ? A. It is situated transversely between the superior angle of the sternum and the acromion process of the scapula. Q. What is the form of the clavicle ? A. It is long, and a little bent at each end in opposite directions, like the Italic/. Q. What is the appearance of its sternal extremity? A. It is considerably enlarged in size, and triangular, 106 THE CLAVICLE. with its posterior angle produced to form a sharp ridge, its end round, flat, and hollowed, for receiving the inter- articular cartilage adapted to the pit in the sternum. Q. What is the appearance of the body of the cla- vicle ? A. Its interior portion is bent obliquely forwards and downwards, rounded above, hollowed«a little below; its exterior portion somewhat flattened, sloping behind, and bent backwards to form an articulation with the scapula. Q. Has the clavicle any tubercle ? A. Yes; there is a tubercle about an inch from the scapular extremity. Q. What is attached to the ridge of the produced pos- terior angle of its sternal extremity ? A. The inter-clavicular ligament, extending from the one clavicle to the other, and binding them firmly together. Q. What is the nature of the inter-articular carti- lage ? A. It is very similar to the inter-vertebral cartilages, being very strong and elastic; it grows to the end of the clavicle, and adapted to the hollow of the sternum, and binds tbem together so as to admit of a considera- ble degree of rotatory motion. Q. Has the sternal extremity of the clavicle a capsu- lar ligament also ? A. Yes ; a strong capsular ligament, which allows the clavicle to move with a rotatory motion. Q. How is the scapular extremity fixed ? A. It is tipped with cartilage in the recent subject, which adheres very firmly to the acromion process of the scapula. Q. Has it a capsular ligament ? A. Yes; it adheres firmly around the articulation. Q. What is attached to the tubercle ? ■ A. A very strong short ligament, which connects the clavicle to the coracoid process of the scapula. Q. Does the articulation at the scapular extremity admit of much motion ? THE CLAVICLE. 107 A. It admits of little or no motion. Q. What muscles are attached to the body of the cla- vicle near its sternal extremity? A. The sterno-hyoidBus, and sterno-mastoidBus, and pectoral muscle, partly arise from it. Q. What muscle is situated in the hollow below ? A. The sub-clavian muscle is inserted there. Q. What muscles are attached to the body towards the scapular extremity ? A. A portion of the deltoid arises from the concave part, and the trapezius is inserted into the opposite con- vex part of it. Q. What are the uses of the clavicle ? A. It supports the shoulders, and keeps them at a pro- per distance from the trunk, that the motions of the arms may be more extensive : it defends the sub-clavian ar- tery, vein, and nerves, and gives attachment to various muscles. Q. What is the stale of the clavicle in the foetus ? A. It is completely formed. OF THE SCAPULA. Q. Where is the scapula situated ? A. On the superior and posterior part of the thorax. Q. What is the form of the scapula ? A. It is triangular; its longest side or base is placed towards the spinous processes of the vertebrae; its se- cond longest, or inferior costa, before ; and its shortest and most uneven side, named its superior costa, above. Q. Describe the scapula ? A. Its venter, or inner surface, is concave, correspond- ing to the convexity of the ribs ; and its dorsum or outer surface convex ; its inferior angle blunt, its superior and posterior acute, and the glenoid cavity occupies the an- terior angle. Q. Which costa is the thickest ? A. The anterior or inferior. Q. Between what ribs is the scapula extended ? A. Its superior or cervical costa ia nearly opposite to 108 THE SCAPULA. the second rib, and its inferior angle extends downwards to the eighth, in the natural easy mode of sitting erect, with the arms in their natural depending position. Q. Where is the semilunar notch ? A. Near the anterior part of the superior costa, at the root of the coracoid process. Q. What vessels does it transmit ? A. The dorsalis superior scapulae artery, its corres- ponding vein, and the nerve, named scapularis. Q. How many processes has the scapula ? A. Three; the spine, small at its beginning, and rising higher in its course forwards; the acromion process, arising from the termination of the spine ; and the cora- coid, arising from the neck in a line with the superior costa. Q. What are the names of the parts near to the glenoid cavity ? A. The anterior and superior angle terminates in the cervix, and adjoining is the head, which contains the glenoid cavity. Q. What sinuosities has it ? A. Two very conspicuous ; one large, under the acro- mion around the cervix; and the other smaller, under the root of the coracoid process in the hollow of the cer- vix. Q. What purpose does the head serve ? A. It forms the oval prominent brim of the glenoid cavity. ■ Q. What occupies the great sinuosity under the ac- romion ? A. The infra and supra-spinati muscles pass in it. Q. What occupies the sinuosity under the coracoid process ? A. The sub-scapularis muscle passes over it. Q. What muscles are attached to the end of the cora- coid process ? , A. The short head of the biceps flexor cublti, and the coraco-brachi&lis, arise from it; and the pectoralis mi- nor is inserted into it. THE SCAPULA. 109 Q. Do any ligaments arise from the coracoid pro- cess ? A. Three ; the proper anterior triangular ligament, which passes transversely from its side, to be fixed to the posterior margin of the acromion ; the ligamentum conoidBum, which arises from the root of the coracoid process, and is fixed to the tubercle of the clavicle; and the ligamentum trapezoidSum, arising from the point of the coracoid process, is fixed to the under edge of the clavicle. Q. What muscle is attached to the base above the spine of the scapulae ? A. The levator scapulae. Q. What muscles are attached to the inferior angle ? A. The teres major arises from it; and the latissimus dorsi passes over it. Q. Wrhat muscle is attached to the triangular space between the root of the spine and the base ? A. Part of the insertion of the trapezius. Q. What muscle arises from the inferior or anterior costa of the scapula ? A. The teres minor. Q. What muscles arise from the cavities above and below the spine ? A. From the large sinuosity above the spine the su- pra-spinatus arises : and from the other below it on the dorsum scapulae, the infraspinatus arises. Q. What muscle is attached to the concave surface of the scapula ? A. The sub-scapularis arises from its three costae, and whole inner surface. • # Q. What muscle arises from the superior edge of the glenoid cavity ? A. The long head of the biceps flexor cubiti. Q. What renders the glenoid cavity deeper and more secure ? A. The cartilage, which lines it in the recent sub- ject, being much thickened on the brim, deepens it; and ligaments and muscles surrounding it very closely render the articulation more secure. K 110 THE SCAPULA. Q. Why is this glenoid cavity not deeper in the bone, and thereby rendered more secure ? A. That the rotatory motions of the arm may be ex- ercised in every possible direction. Q. Has this articulation of the shoulder a strong cap- sular ligament ? A. Yes ; it arises from the neck of the scapula, sur- rounds the round head of the os humeri loosely, and is inserted into its neck ; other ligaments also strengthen this. Q. What are the connexions of the scapula? A. It is firmly fixed to the clavicle by ligaments ; to the head, os hyoides, trunk and arm by muscles, and to this last also, by its articulation with the os humeri. Q. What motions can the scapula perform ? A. It can be moved in every direction, upwards, downwards, and to either side; and has a slight rotatory motion upon the sternum, through the medium of the clavicle, by means of the different muscles attached to it. Q. What is the stateof the scapula in the foetus ? A. The acromion and coracoid processes and head are cartilaginous, and are joined by epiphysis to the body of the bone. OF THE OS HUMERI. Q. What are the figure and situation of the os hu- meri? A. It is roundish, cylindrical, slightly twisted, and nearly straight; and situated at the side of the trunk of the body. Q. How is the os humeri divided ? A. Into a head, body, and lower extremity. Q. Describe the head of the humerus ? A. It is round, and nearly a semicircle, situated on the upper and ulnar aspect, terminated by a circular de- pression, called its neck. Q. What occupies the circular depression of the neck of the humerus ? THE OS HUMERI. I 1 1 A. The capsular ligament, which is inserted into it all round the head. Q. Where is the long groove ? A. It comes from the head, along the fore or radial, and inner or thenal aspect of the bone, about three or four inches. Q. What occupies that long groove ? A. The tendon of the long head of the biceps flexor cubiti plays in it. Q. Has the os humeri any tubercles near its head ? A. Yes, two ; the smaller tubercle, situated on the inner or thenal aspect of the groove; and the larger, on the outer or radial aspect of it. Q. What parts are attached to these tubercles ? A. The sub-scapularis is inserted into the smaller; and the supra-spinatus, infraspinatus, and teres mi- nor, are inserted into the larger tubercle. Q. Has the body of the os humeri any ridges upon it? A. It has four; a rough ridge, gently flattened in the middle, runs down from each tubercle along the sides of the groove; a large ridge on the radial, and a smaller one on the ulnar aspect of the cubital extremity. Q. Does any membrane stretch across the groove be- tween those superior ridges ? A,. Yes; a tendinous sheath extends across the groove, and confines the tendon of the biceps in its course. Q. What muscle is attached to the rough ridge on the inner side of the bicipital groove ? A. The tendon of the pectoralis major is inserted in- to it. Q. What muscles are attached to the ridge on its out- er side ? A. The latissimus dorsi, and the teres major are in- serted into it. Q. Describe the surface of the body of the humerus ? A. On the outer part of the bone there is a rough pro- tuberance ; interior to this, a flat smooth surface; from which a blunt ridge descends on the fore part; on the 112 THE OS HUMERI posterior, or anconal aspect, the bone is rather sharp and smooth, diverging into two ridges leading to the two condyles, between which is a flat smooth surface. Q. What muscles are attached to the anterior rough uneven surface near its middle ? A. The deltoid and coraco-brachialis are inserted; and the brachialis internus arises there. Q. What muscles are attached to the posterior surface of the body of the humerus ? A. The second and third heads of the triceps exten- sor cubiti arise from it, and flatten the bone with their fleshy belly. Q. What vessel enters the foramen near the middle of the humerus ? A. The medullary artery penetrates it slanting ob- liquely downwards. Q. What muscles are attached to the large ridge de- scending to the radial condyle ? A. The supinator radii longus, and the longest head of the extensor carpi radialis arise from it. Q. What arises from the smaller ulnar ridge ? • A. A strong tendinous fascia arises from it, which gives origin to muscles of the fore arm. Q. Describe the cubital extremity of the os humeri ? A. It has two condyles, of which the ulnar or inner is by much the larger; between the condyles' is the trochlea or pulley, consisting of two lateral circular pro- tuberances, of which the inner is the higher, and a mid- dle sinuosity; and between the outer protuberant circle and the condyle is a rounded articular head, with a cir- cular depression separating it from the articular trochlea. Q. Has it any cavities ? A. It has two considerable cavities, of which the pos- terior or anconal is by far the larger. Q. What muscles are attached to the external or ra- dial condyle ? A. It gives origin to the extensors and supinators of the hand and fingers, namely, the extensor carpi radi- alis brevior, extensor carpi ulnaris, and the extensor THE OS HUMERI. 113 digitorum communis; the anconeus and supinator radii brevis. Q. What muscles are attached to the internal con- dyle? A. It gives origin to the flexors and pronators of the hand and fingers, viz. the flexor carpi radialis, flexor carpi ulnaris, part of the flexor digitorum sublimis vel perforatus, pronator radii teres, and palmaris longus. Q. What is the purpose of the trochlea ? A. It is smooth and covered with cartilage in the re- cent subject, and articulated with the ulna by a corres- ponding trochlear part. Q. What is applied to the round articular head ad- joining to the trochlea ? A. The upper or cubital end of the radius plays up- on it in flexion and extension of the elbow-joint. Q. What occupies the anterior and posterior cavities ? A. The anterior cavity receives the coronoid process of the ulna in the flexion of the fore-arm: the posterior receives the olecrrnon process in extension of it. Q. Is this articular surface of the os humeri directly transverse ? A. The side of it toward the ulnar aspect is longer or farther distant from the head of the bone, which renders the articulating surface considerably oblique ; by which obliquity, the hands, when raised without any turning of the os humeri, are directed towards the face, breast, or simply laid across as they descend. Q. What motions does the elboio-joint admit of? A. It is a complete hinge, and admits of flexion and extension of the fore-arm only. Q. What is the state of the os humeri in the foetus ? A. Its extremities are cartilaginous, its head with the tubercles, and its condyles with the trochlea, are de- tached, and afterwards unite to the body of the bone by epiphyses. Q. What are the connexions of the os humeri ? A. It is connected above to the scapula; below to the ulna by the articular surface of the trochlea, and to the K 2 Ill THE OS HUMERI. radius by the round head adjoining to the radial side of the trochlea. OF THE ULNA. Q. What bones compose the fore-arm ? A. The ulna and radius. Q. What is the situation of tho ulna ? A. At the inner or ulnar aspect of the fore-arm in its easy depending state. Q. How is the ulna divided ? A. Into two extremities and a body. Q. What processes are on its cubital extremity ? A. Two large processes, the olecranon and coronoid, and one smaller tubercle. Q. Where is the olecranon situated ? A. It forms the posterior prominent part of the elbow, and has a rough surface at its end. Q. Where is the coronoid process situated ? A. At the fore, or thenal, aspect of the bone, it pro- jects sharp, but not so high as the olecranon. Q. Where is the tubercle situated ? A, On the fore part of the ulna near to the root of the coronoid process, it appears small and rough. Q. How many cavities are observable on the cubital extremity of the ulna ? A. Two ; the great and the small sigmoid, or semilu- nar cavities. Q. AVhere is the great sigmoid cavity situated ? A. Between the olecranon and coronoid processes, and divided by a middle ridge into two slanting surfaces. Q. Where is the small sigmoid cavity situated ? A. At the outer or radial side of the coronoid process. Q." What parrs are attached to the olecranon process? A. The triceps extensor cubiti is inserted into its whole posterior surface. Q. What is attached to the coronoid process ? A. The strong short tendon of the brachialis inter- nus is inserted into it. Q. What is attached to the rough tubercular spot of the ulna ? THE ULNA. 115 A. Part of the insertion of the brachialis internus is extended down to it. Q. What is the use of the great sigmoid cavity ? A. It is lined with cartilage, and nicely adapted to the trochlea of the humerus, to form the articulation of the elbow joint. Q. What is the use of the small sigmoid cavity ? A. It is adapted to the round head of the radius, which plays in it when performing its rotatory motions. Q. What is the form of the body of the ulna? A. It is triangular, becoming gradually smaller to- wards its carpal extremity, and having its sharpest an- gle opposed to the radius. ' Q. What is the appearance of its sides ? A. They are flat, and marked by the attachment of muscles: there is a foramen slanting upwards on the thenal aspect. y. What is attached to the angle opposed to the ra- dius ? A, The interosseous ligament. Q. What vessel enters the slanting foramen ? A. The medullary artery. Q. What parts are observable on the carpal extremity of the ulna ? A. A small round head, and a styloid process. Q. What is the round head connected with ? A. It is adapted to a conesponding cavity on the side of the radius, in which it plays during the motions of pronation and supination of the hand. Q. What is attached to the styloid process ? A. This process, situated at the inner or ulnar side of the round head, gives attachment to a strong ligament to be inserted into the os cuneiforme and pisiforme of the carpus. Q. Has this carpal extremity any sinuosities ? A. It has two, one on the anconal or posterior aspect, and another on the thenal or anterior. Q. What occupies the sinuosity on the anconal as- pect ? A. The tendon of the extensor carpi ulnaris. I 16 THE ULNA. Q. What is placed in that on the thenal aspect ? A. The ulnar artery and nerve lie in it in their pas sage to the hand. Q. What is the use of the ulna ? A. It forms the articulation of the elbow-joint with the os humeri like a hinge, termed ginglimus; it strengthens the fore-arm, and with the radius rolling upon it, renders the hand capable of pronation and supi- nation ; is articulated with the os cuneiforme of the car- pus, and assists in forming the articulation of the wrist. Q. What are the connexions of the ulna ? A. It is connected with the humerus above, with the radius laterally, and with the os cuneiforme at the car- pus. OF THE RADIUS. Q. Where is the radius situated ? A. At the outer side of the fore-arm, in a line with the thumb. Q. How is the radius divided ? A. Into a head, cervix, body, and lower or carpal extremity. Q. What is the form of its head ? A. It is circular, hollowed in the end applied to the os humeri, and has a smooth surface on its circumference to the extent of a fourth part of it. Q. What is observable on the cervix ? A. The cervix is much smaller than the head, and im- pressed with a rough surface. Q. Why is the vertex of the head of the radius hol- lowed I A. That it may be adapted to the round head in the articular surface of the os humeri, around which it plays in flexion and extension of the fore-arm ; and at any de- gree of flexion or extension it may be capable of a rota- tory motion for pronation and supination. Q. What is the use of the articulating surface on the circumference of the head, and what part is it ap- plied to ? THE RADIUS. 117 A. It is received into the small semilunar or sigmoid cavity on the side of the ulna, and plays in it during pronation and supination of the fore-arm. Q. What is the use of the cervix ? A. It is surrounded by the capsular ligament, which is firmly attached to it in such a manner as to permit the various movements of the head of the bone. Q. Has the radius any processes ? A. It has two ; a tubercle of considerable size about an inch from the cervix on the ulnar aspect; and ano- ther process, at the carpal extremity on the outer or ra- dial aspect of the fore-arm, stronger but not unlike the styloid process of the ulna. Q. What is attached to the tubercle ? A. The tendon of the biceps flexor cubiti is inserted into it. Q. Describe the body of the radius ? A. It is round and convex on its outer side, forming the segment of a large circle from its cervix to its carpal extremity; has a sharp ridge on its ulnar aspect, with a flat surface a little hollowed on either side of it. Q. Why is the radius round and convex on its outer or radial aspect ? A. It is made round by the pressure of the circumja- cent muscles, particularly the extensors of the hand; is made convex the better to resist external injuries, and to make room for the muscles situated on its inner or ulnar surfaces. Q. What is attached to the sharp spine ? A. The interosseous ligament. Q. What muscles arise from the anterior surface of the radius ? A. The fleshy belly of the flexor digitorum sublimis, and flexor longus pollicis manus. Q. What muscles occupy the posterior surface ? A. The extensor digitorum communis, and extensor carpi radialis brevior. Q. Describe the inferior or carpal extremity of the radius ? A. It is larger than the head, flat before, and rising 118 THE RADIUS. at the extremity; has a ridge behind with a depression on either side; has a semilunar depression on its ulnar and a styloid process on its radial aspect; and in the end an oval cavity, with a slight transverse middle ridge. Q. What is placed on its flat anterior surface? A. The pronator radii quadratus covers it, and the tendons of the flexors of the hand and fingers play over it. Q. What is attached to the middle ridge on the anco- nal aspect of the carpal extremity ? A. The annular ligament for binding the tendons in their places. Q. What occupies the depressions at either side of it ? A. The tendons of the extensor muscles of the hand. Q. What is placed in its inner semilunar cavity ? A. It receives the rounded carpal extremity of the ulna, which rolls in it in pronation and supination of the hand. Q. What occupies the articular cavity of the end ? A. Two bones of the carpus, namely, the os scaphoi- des, and os lunare. Q. What is attached to the styloid process of the radius ? A. A strong ligament binding it to the bones of the carpus. " OF THE CARPUS. Q. How are the bones of the hand commonly ar- ranged ? A. Into those of the carpus, metacarpus, and fingers. Q. What is the general appearance of the hand ? A. It is convex behind, and concave before. Q. Why is it concave ? A. That it may be the better adapted to grasp and hold things. Q. How many bones is the carpus or wrist compo- sed of? A. Of eight, arranged in two rows. Q. Enumerate those of the first row, nearest to the radius ? THE CARPUS. 11!) A. The os scaphoides, lunare, cuneifoi'w, and pisi- forme. Q. Describe the situation and connexions of the os scaphoides ? A. It is situated in the radial or outer side of the car- pus, having a large round convex superior surface, adapted to the cavity in the extremity of the radius; and a projecting hook-like process upon its outer part, and is connected with the os lunare internally, and the trapezium and trapezoides below. Q. Describe the situation and connexions of the os lunare ? A. It is situated at the inner side of the os scaphoides, has a roundish superior surface joined to that of the sca- phoides, and with it forming an oval ball, fitting the sock- et of the radius; its lunated edge is towards the second row. Q. Describe the os cuneiforme and its connexions^? A. Its thin edge is towards the palm, its upper part is slightly convex, and adapted to the hollowed end of the ulna; its anterior part has an orbicular spot to be con- nected with the os pisiforme; it is situated on the inner side of the os lunare. Q. Describe the os pisiforme and its connexions? A. It is small and roundish, placed on the anterior and inner surface of the os cuneiforme, projects into the palm and can be felt externally. Q. What bones then form the joint of the torist? A. The upper surfaces of the os scaphoides, and lu- nare together, making an oval convex ball, nicely fitted to the cavity in the extremity of the radius, form the chief articulation; but the slightly convex surface of the os cuneiforme is also articulated with the hollow end of the ulna, and thus the whole articulation is completed. Q. Enumerate the bones of the second row of the car- pus ? A. The os trapezium, trapezoides, os magnum, and unciforme. Q. Describe the trapezium and its connexions? A. It is pretty large, of an irregular form, situated on 120 THE CARPUS. the radial aspect; its upper convex rJart is connected with the hollow of the os scaphoides, and its inner with that of the trapezoides; its inferior and rather external surface is hollow, with a middle transverse ridge like a pulley, to be articulated with the metacarpal bone of the thumb; and from its anterior and external part it sends out a kind of styloid process towards the palm. Q. What are the connexions of the os trapezoides ? A. It is wedged in between the trapezium and os magnum, is connected with the convex under surface of the os scaphoides above, and forms a pulley-like ca- vity below for the reception of the metacarpal bone of the fore -finger. Q. Describe the connexions of the os magnum ? A. It has a round convex head, articulated with the hollow surfaces of the os lunare and scaphoides above, and having the trapezoides on its outer, and the os un- ciforme on its inner side, it presents a slightly hollowed surface below for the articulation of the metacarpal bone of the middle finger. Q. Describe the connexions of the os unciforme ? A. It is wedged in between the os magnum and the os cuneiforme; sends out a hook-like process towards the palm; has two concave surfaces below, with which the metacarpal bones of the ring and little finger are articulated. Q. What substance connects all those carpal bones to- gether ? A. All their articular surfaces are covered with carti- lage, and they are bound to each other also by all forms of cross ligaments. Q. What prominent points is the ligamentum carpi annulare attached to ? A. It is attached chiefly to four, namely, the eminen- ces of the os scaphoides, and trapezium, on the outer or radial aspect; and to those of the os pisiforme and unci- forme on the inner or ulnar aspect. Q. Is not the annular ligament attached to more points than those four ? A. It is also firmly fixed to all the bones of the car- THE CARPUS. 121 pus, and in such a manner as to afford sheaths for the tendons of the different muscles, passing to the fingers, playing easily in. Q. What motions can the articulation formed by the radius, ulna, and carpal bones perform ? A. The construction of the joint is ball and socket, in an oblong or oval form; in consequence, it can per- form motions in every direction, but to greatest extent perpendicularly to the long axis of the cavity, i. e. flex- ion and extension of the wrist. Q. Do the bones of the carpus move upon each other ? A. Yes; the articulation of the os magnum with the os scaphoides and lunare above, being that of ball and socket, admits of motions in every direction, and its lateral connexions admit of motions radiad and ul- nad, so that the hand can readily perform rotatory move- ments. OF THE METACARPUS. Q. How many bones compose the metacarpus ? A. Four for the fingers, and one for the thumb. Q. How are they divided ? A. Into abase, body, and head. Q. Describe the base of the metacarpal bones ? A. The base of the metacarpal bone of the fore-fin- ger is a little hollow with a ridge on its inner side, and a lateral surface ; the base of that of the middle finger is oblique and triangular, with two lateral surfaces; the base of that of the ring-finger irregularly triangular and small, with two lateral surfaces, and the base of that of the little-finger slants downwards and outwards, and has no lateral surface. Q. Describe the bodies of the metacarpal bones ? A. They are long, roundish, and convex towards the back of the hand; concave and ridged towards the palm, with a flat surface on each side. That of the fore-fin- ger is the longest, and they diminish in length towards the little-finger. Q. Describe their heads ? L 122 THE METACARPUS. A. Tho heads, or digital extremities, of the metacar- pal bones, arc larger than theii bodies, and form round balls flattened on their sides, where they are in contact with each other; from the anterior part of each side of the heads a little prominence arises, to which ligaments are attached for binding the bones together; around their heads is a depression for the insertion of the capsular lig- ament. Q. What are the connexions of the metacarpal bones ? A. They are connected with the bones of the carpus by capsular ligaments, with each other on nearly plain surfaces by strong ligaments, and with the fingers. Q. What muscles lie between the metacarpal bones ? A. The interossei. Q. What muscles are inserted into the metacarpal bones before and behind ? A. The tendon of the flexor carpi radialis is inserted into the fore and upper part of that of the fore-finger ,- and that of the extensor carpi radialis into its back. part; that of the extensor carpi ulnaris into the uppei and back part of the metacarpal bone of the little finger ^ while the tendon of the flexor carpi ulnaris, and palma- ris brepis, are inserted into the pisiform bone, on the fore part. Q. Do the articulations of the metacarpal bones ad- mit of much motion ? A. No: Those of the fore and middle fingers are nearly fixed; those of the other fingers have a greater degree of motion. Q. In what does the metacarpal bone of the thumb differ from that of the fingers ? A. Its base forms a ball articulated with the concave pulley of the os scaphoides, in which it performs mo- tions in every direction; its body is thicker and shorter than those of the fingers ; it stands out obliquely, and in- flexion comes in opposition to the fingers. Q. How can a joint formed by two lateral depressions and a middle ridge, and a ball fitted to them, perform free motions in every direction ? A. The articulation may be regarded as double, com- THE METACARPUS. 123 posed of two sockets and a ball fitted to each: the cap- sular ligament is loose, and when the thumb is directed towards the palm it rolls in the socket nearest the palm, when directed towards the back of the hand it rolls in the cavity nearest that aspect, and when bent or extended in its natural position, it moves equally in both sockets. OF THE FINGERS.- Q. How many bones are in each finger and thumb ? A. Each finger is composed of three bones, and the thumb of two. Q. How are these bones arranged ? A. Into three phalanges: those attached to the meta- carpal bones compose the first phalanx; the next trans- verse row the second, and those at the ends of the fin- gers compose the third phalanx. Q. What is the general appearance of these phalan- ges? A. Their bases are larger than their distant extremi- ties, their posterior surface convex, their anterior flat and in some parts grooved; and they taper a little to- wards their points. Q. How are the bases of the first phalanx articulated with the metacarpal bones ? A. Their ends are formed into sockets to receive the round balls of the metacarpal bones, and are bound to- gether by capsular ligaments. Q. What motions are performed at their bases ? A. The ball and socket being irregular, are fitted for motions of flexion and extension most freely; or a cou- siderable degree of lateral, and also of circular motion. Q. What is the form of the distant extremity of the first phalanx of the fingers ? A. Each bone has a round prominence like a condyle on either side of its distant end, with a depression be- tween them. Q. Is the construction of the second phalanx adapt- ed to this ? A. Yes ; the bases of the second phalanx have two 124 THE FINGERS. lateral cavities, and a middle prominence, which answer exactly to the extremities of the first. Q. Is the construction of the most distant joint of the fingers the same ? A. Yes; the ends of the second phalanx are round on each side, and the base of the third phalanx is hollowed to receive them. Q. What is the form of the second bone of the thumb, corresponding to the first phalanx of the fingers ? A. It has a large base with an oblong cavity, a con- vex body behind, and flat before, a distant extremity with two round lateral protuberances and a middle ca- vity. Q. Is the most distant bone of the thumb articulated with the last as the fingers are ? A. Yes ; exactly similar. Q. What motions does the second bone of the thumb perform in its articulation with the metacarpal bone ? A. Its hollow socket being much lengthened from side to side, and of considerable depth, receives the oblong round end of the metacarpal bone, and being firmly bound in its situation by lateral ligaments1, it performs flexion and extension chiefly, and but a very small de- gree of lateral motion. Q. What muscle is attached to the back, or convex part, of the fingers ? A. The extensor digitorum communis, by a tendi- nous expansion, is inserted into all the phalanges be- hind. Q. What muscles are attached to the palmer part of the fingers ? A. The interossei and lumbricales are inserted on the lateral parts of the fingers to bend the first phalanx ; % the flexor digitorum sublimis vel perforatus, is insert- ed into the fore part of the second phalanx ; and the tendons of the flexor digitorum profundus vel perfo- rans, pass under the tendinous sheaths of the sublimis, run in the grooves defended by a ligamentous sheath from pressure, and are inserted into the third phalanx of the fingers. THE FINGERS. 125 Q. Is the surface of the third phalanx of the fingers smooth, or what ? A. It is rough where the nail, the vascular, nervous, and pulpy substance are situated. Q. Are there not ossa sesdmt^ea sometimes found connected with the fingers ? A. Yes; small bones are sometimes found between the tendons of the flexor muscles and the joints at the roofs of the fingers, and of the second bone of the thumb. Q. What purposes do these ossa sesamoidea serve ? A. They are convex, and enclosed by the tendons ex- ternally; are concave and adapted to the joint, upon which they play, internally ; and seem destined to in- crease the power of the muscle by lengthening the lever upon which it acts, and to facilitate its movements over the joint. • OF THE INFERIOR EXTREMITIES. Q. How are the bones of the inferior extremity ar- ranged ? ( A. They are commonly classed into those of the thigh, the leg, and the foot. Q. Flow many bones compose the thigh ? A. One, namely the os femoris. Q. How many compose the leg ? A. Two ; the tibia and fibula. ■Q How are the bones of the foot subdivided ? A. Into the bones of the tarsus, metatarsus, and toes. Q. Flow many bones compose the tarsus ? A. Seven ; namely, the astragalus, os calcis, navicu- iare, cuboides, cuneiforme externum, cuneiforme me- •diurn, and cuneiforme internum. Q. How many bones does the metatarsus consist of? A. Of five metatarsal bones, corresponding to the ioes. Q. How are the bones of the iocs arranged i A. Into three phalanges, excepting the ^,ieal toe, which has two bones, as in the thumb. L 2 126 THE OS FEMORIS. OF THE OS FEMORIS. Q. What are the form and situation of the osfemdris 1 A. It is long, thicOt aud strong, and situated at the under and lateral part of the pelvis; it stands obliquely, being much nearer the mesial perpendicular of the trunk below, than above. Q. How is the os femoris divided ? A. Into an upper, and lower extremity, and a body. Q. What parts of the upper end of it require particu- lar attention ? A. Its head, cervix, the trochanter major, et minor. Q. Describe the relative situation of these parts ? A. The head is the smooth round upper end of the bone ; the cervix considerably smaller adjoining to the head, and stands o|f from the body at an angle of about 45 degrees ; the trochanter major is a large tuberosity situated on the angle towards the outer side, in a line with the body of tho femur; the trochanter minor is situated about two inches lower at the under and inner part of the root of the cervix. Q. What is observable on the head ? A. Its rotundity is about three fourths of a sphere ; it is smooth, and has a rough pit a little below its centre. Q. What is worthy of notice on its cervix ? A. The cervix is long, rough, and has numerous holes for the insertion of a ligament reflected from the capsu- lar one. Q. What is attached to the rough pit on the head ol the femur ? A. The ligamentum teres, or round ligament, is in- serted into it, and attached by its other end to the bot- tom of the acetabulum, in order to keep the head firmly in the socket. Q. What purpose does the trochanter major serve ? A. It is placed on the outer part of the angle, and by increasing the lever it gives the muscles attached to it much greater power of action. THE OS FEMORIS. 127 Q. What muscles are attached to it ? AM On its anterior rough surface the gluteus minimus is inserted; on its superior part the gluteus medius; the tendon of the glutSus maxlmus passes over its pos- terior part. Q. Are any cavities placed at the root of the cervix under the prominent extremity of the trochanter major ? A. There is a large and deep cavity at its posterior part, and more superficial at its anterior. Q. What parts are attached to it ? A. The tendons of the obturator externus, and obtu- rator internus, of the pyriformis, and of the gemini, are inserted into it. Q. What is attached to the oblique rough line be- tween the trochanters before and behind ? A. The capsular ligament is inserted there. Q. What is attached to the rough ridge running downwards from the posterior and outer part of the great trochanter ? A. The quadratus femdris is inserted there. Q. What are the form and situation of the trochanter minor ? A. It is a pointed, roundish, papilla-looking process, situated an inch and a half, or two inches at most, below the great trochanter, at the posterior part of the femur, and pointing inwardly. . Q. What purposes does the trochanter minor serve ? A. It gives attachment to various flexor muscles of the thigh. Q. To what muscles ? A. The tendons of the psoas magnus, and iliacus in- ternus, and part of that of the pectinalis are inserted into it. Q. Describe the body of the o» fetndris ? A. The body of the femur is long, bent a little for- wards, round and flattish before; and forms an angle on which is a rough ridge behind, called the linea aspcra, on either side of which the bone is somewhat flat. Q. What occupies the smooth flattish anterior part of the femur ? 128 THE OS FEMORIS. A. The cruralis, and rectus muscles. Q. What forms the linea aspSra ? A. The insertions and origins of several muscles. Q. What muscles are inserted into it ? A. The triceps adductor femSris, the gluteus maxi- mus, and part of the aponeurosis femoris are inserted into the linea aspera. Q. What muscles arise from it ? A. The vastus externus, and internus, and the short head of the biceps flexor cruris. Q. What is situated on the flat surfaces on each side of the linea aspera. A. The vastus externus on the one side, and the vas- tus internus on the other. Q. Describe the inferior end of the osfembris ? A. About five inches from the extremity in an ordina- ry sized bone, the linea aspera divides into two lines, each of which terminates in the lateral part of the con- dyles : the intermediate space is triangular; the end of the bone is much enlarged, particularly in breadth. Q. Describe the condyles of the os femoris? A. They are two large protuberances with a smooth articular surface on their circumference, having a cavity deep enough to conceal one's thumb between .them, the internal condyle is longer and larger than the external; they have the articular surfaces higher on their anterior part, with a smooth depression between them. Q. Why is the internal condyle lower than the exter- nal ? A. To compensate for the oblique direction of the bo- dy of the femur approximating its fellow from above downwards; and that the le- may stand parallel to the axis of the trunk. Q. What are situated in the cavity between the con- dyles ? A. The poplitBul artery,vein, and nerves pass through it; and the two crucial ligaments arise from its bottom and roots of the condyles towards its anterior part. Q. What is lodged on the smooth hollow surface be tween the auterior parts of the condyles ? THE OS FEMORIS. 129 A. The small bone, named patella, or rotula, moves round in it as a rope in a pulley. Q. What purposes does the patella serve there ? A. It is a medium, by means of which the tendons of the extensor muscles of the leg, playing easily in the hollow surface between the condyles on the fore part of the joint, are removed farther from the centre of motion, and their lever in consequence being lengthened, they have greater power of action. Q. How do the vessels enter for the nutrition of the femur ? A. There is a hole or canal slanting upwards about the middle and posterior part of the femur, where the medullary vessels enter; and sometimes various other holes in different parts of the bone for the same pur- pose. Q. What is attached to the rough surface on the mar- gin of the condyles ? A. The capsular and other ligaments are attached there. Q. What use do the crucial ligaments serve ? A. They strengthen the joint, limit its motions, pre- vent the leg from going beyond a straight line forwards; and allow the toes to be turned outwards, but not in- wards. Q. What are the motions of the knee-joint? A. Flexion and extension chiefly; and in flexion a slight degree of rotatory motion of the toes of the foot outwards. Q. What ligaments, besides the capsular and crucial ligaments, secure the knee-joint ? A. Various strong lateral ligaments on each side, and the ligamentous expansion of the tendons of the mus- cles from the patella, secure this joint most firmly. Q. Are its condyles and the inferior surface of the pa- tella covered with cartilage ? A. Yes; they are all covered. Q. What muscles are attached to the posterior trian- gular space above the condyles ? A, The gastrocnemius externus, and plantaris, arise 130 THE OS FEMORIS. there, and also from the tuberosities on the upper and lateral part of the condyles. Q. What is the structure of the os femoris? A. It is spongy at the extremities, consisting of innu- merable cancelli; its middle is composed of a dense thick outer shell, and a medullary canal within. Q. What are the connexions of the os femoris ? A. It is connected above to the os innominatum, and below to the tibia.. Q. What is the state of the os femoris in the foetus ? A. Its different processes are cartilaginous, and after- wards form large epiphyses. OF THE PATELLA OR ROTULA. Q. What is the figure of the patella ? A. It is triangular, or heart-shaped, with its apex downwards; its anterior convex surface is perforated by a great number of holes, its posterior surface has a lon- gitudinal prominent ridge with a cavity on either sido, corresponding to the condyles of the femur, and forming a trochlea. Q. What is its situation ? A. Thcpatella plays upwards and downwards on the fore part of the joint of the knee. Q. Do the situation and office of the patella resem- ble those of sesamoid bones ? A. Yes, very much indeed ; the patella may very just- ly be regarded as the sesamoid bone of the combined tendons of the rectus, cruralis, and vasti muscles of the thigh, by means of which they play easily and freely over the knee joint in tho extensions and flexions of the leg. Q. What is the use of the numerous holes on its con- vex surface ? A. The tendons and ligaments, which cover it, are in- serted into them. Q. What is inserted into its rough circumference ? A. The capsular ligament, and the tendons of the rectus, cruralis, vastus externus, and internus. THIJ PATELLA. 131 Q. How happens the patella to be able to bear the force of these strong muscles ? A. The bone itself is of a compact texture, but the ligaments and the aponeurotic expansion of the combin- ed tendons of the muscles cover it, adhere firmly to its anterior surface, and render it very strong. Q. Is the patella ever fractured ? A. Yes; when these strong muscles act suddenly upon it, while the joint is half bent, they sometimes fracture it across. Q. What binds it to the bones below ? - A. That strong aponeurotic tendinous expansion, and strong ligaments bind it firmly to the tibia. Q. What motions does the patella perform ? A. It can be moved by the motions of the leg upwards and downwards freely, and it can be moved a little to ei- ther side. OF THE TIBIA. Q. What is the situation of the tibia ? A. It is situated at the inner side of the leg. Q. What is its form ? A. It has been compared to a pipe ; being long, some- what triangular, and greatly enlarged at its upper end. Q. How is it commonly divided ? A. Into an upper, and an under extremity, and a body. Q. Describe the upper end of the tibia? A. Its upper surface has two superficial cavities, and a rough protuberance between them, with a rough po- rous circumference. Q. How can the large condyles of the femur rest se- curely on these superficial cavities ? A. They are considerably deepened by two semilunar cartilages much thickened at their convex margin. Q. What is attached to the rough protuberance be- tween the articular cavities of the tibia ? A. The anterior and posterior crucial ligaments are inserted into its anterior and posterior parts. 132 THE TIIHA. Q. What is attached to the porous rough circumfei - ence ? A. The capsular ligament is inserted there. Q. What is attached to the anterior protuberance a little below the articular surfaces ? A. Tho strong tendinous ligament of, the patella, and, on its scabrous inner side, the tendons of the semi- tendinosus, gracilis, and sartorius muscles, and the aponeurosis of the vastus internus, are inserted into it. A. Into a head, body, and lower extremity. Q. Describe its head ? A. The head of the fibula is considerably enlarged, has a superficial, smooth, circular cavity on its inner side; a rough protuberance on its outer side. Q. What is applied to tho orbicular surface on the inside of its head ? A. This part is applied to the circular flat surface on the outer side of the tibia, and firmly secured in its situ- ation by ligaments. Q. WTiat is attached to the rough protuberance on its outer side ? A. The tendon of the biceps flexor cruris, and the external lateral ligament, are inserted into it. Q. Describe the body of the fibula ? A. It is somewhat bent inwards and backwards, hav- ing a sharp ridge on the inner part; its surfaces marked by muscles; and a canal slanting downwards a little above its middle, on its posterior part, for the entrance of the medullary vessels. Q. What is attached to the inner ridge of the fibula ? A. The interosseous ligament. Q. What muscles arise from the anterior side of the fibula? A. The peroneus longus, peroneus brevis, the pero- neus tertius being part of the extensor longus digitorum, and extensor proprius pollicis. Q. What muscles arise from the posterior side of the fibula? A. The greater part of the tibialis posticus, flexor longus pollicis, and the outer head of the gastrocnemius internus. THE FIBULA. 135 Q. Describe the under extremity of the fibula? A. Its lower end is flat, broad, and smooth on the inside; it sends down a cor&noid process, and has a si- nuosity behind. Q. What is the oblong flat smooth surface of the under end of the fibula applied to ? A. It is received into the semilunar depression on the outer side of the tibia, and firmly attached by strong ligaments. Q. What forms the malleolus externus ? A. The lower end of the fibula, a little enlarged into an oblong head. Q. Does the malleSlus externus secure and guard the joint in the same manner, as the malleolus internus? A. Yes ; exactly in the same manner, being applied to the outer side of the articulating surface of the astragalus, the joint cannot be dislocated outwardly, without the under end of the fibula being fractured. Q. What is attached to its coronoid process ? A. Ligaments, which go to the bones of the tarsus. Q. What occupies the sinuosity on the posterior part of the malleolus externus ? A. The tendons of the peronei muscles play around it. Q. What motions does the ankle-joint perform ? A. This joint is so constructed, that it is purely a hinge, and performs motions of flexion and extension of the foot only. Q. What is the use of the fibula ? A. It gives attachment to muscles, form and strength to the leg, widens the space for the interosseous liga- ment, and secures the outer side of the ankle-joint. Q. What is the state of the fibula in the foetus ? A. Its extremities are cartilaginous, and becoming epiphyses, grow to the body. OF THE TARSUS. Q. How are the bones of the foot divided ? A. Into those of the tarsus, metatarsus, and toe*. Q. How many bones compose the tarsus ? 136 THE TARSUS. A. Seven; the astragalus, os calcis, naviculare, cu- boides, cuneiforme externum, cuneiforme modium, and cuneiforme internum. Q. What is the form of the tarsus ? A. It forms an arch, being convex above, and con- cave below. Q. Describe the situation and form of the astraga- lus? A. Its head is round, smooth, gently hollowed in the middle, flattened on each side, and articulated with the tibia and fibula; its body is very irregular, having a large concave posterior articulating surface, and an an- terior one irregularly convex ; and a smooth oblong an- terior head. Q. What is connected with the concave posterior surface of the astragalus ? A. The upper and middle part of the os calcis. Q. What is opposed to the irregular convex anterior surface of the astragalus ? A. Two smooth cavities at the inner and fore part of the os calcis, and the cartilaginous ligament stretched between the os calcis and os naviculare. Q. What is its oblong anterior head received into ? A. Into the articulation with the os naviculare. Q. Describe the form and situation of the os calcis ? A. The os calcis is irregular, but somewhat oblong; it is situated under the astragalus, and forms the projec- tion of the heel. Q. Describe the parts of the os calcis most deserving of attention ? A. The large rough tuberosity projecting backwards forming the heel; the upper smooth convex surface, and two prominences at its fore part, articulated with the astragalus; .and an anterior surfaco articulated with the os cuboides ; and a large cavity downwards on its inside. Q. What is attached to the posterior rough projection of the os calcis ? A. The tendo Achillis. THE TARSUS. 137 Q. Which of the superior prominences gives attach ■ ment to the cartilaginous ligament fixed to the os na- viculare ? A. The posterior of the two at the inner and fore part of the bone. Q. What parts occupy the large sinuosity or arch at the inner and under part of the posterior projection ? A. The tendons of the flexor longus pollicis, flexor longus digitorum, and peroneus longus; the artery named tibialis postlca, and veins corresponding to it, and the tibial nerve. Q. What muscles arise from the tuberosity on the inferior and hollow part of the os calcis? A. The flexor brevis digitorum, abductor pollicis, ab- ductor minimi digiti, and aponeurosis plantaris. Q. Do any other muscles arise from the inferior part of tbe os calcis ? A. The flexor digitorum accessorius, or massa carnea Jacobi Sylvii, arises partly from the sinuosity, and partly from its anterior part, together with the flexor bre- vis pollicis. Q. What are the connexions of the os calcis? A. It is firmly articulated with the astragalus by strong ligaments, with the os cuboides before by a con- cave surface. Q. What is the situation of the os naviculare ? A. It is situated at the anterior part of the astragalus, and inner side of the foot. Q. How many surfaces has it ? A. A hollow posterior surface for receiving the con- vex head of the astragalus ; three anterior convex sur- faces to be articulated with the three cuneiform bones. Q. Has the os naviculare any prominences ? A. A considerable prominence, or tuberosity, directed inwards and downwards. Q. What parts are attached to that tuberosity ? A. The tendon of the tibialis posticus is inserted into ^ it, and the abductor pollicis arises from it: the strong ligament, which supports the astragalus, is fixed to it, M 2 138 THE TARSUS. and also another ligament stretched across the meta tarsal bones. Q. What motions does the os naviculare perform upon the astragalus ? A. They are adapted to each other by ball and socket, and are capable of performing motions in various direc- tions, turning the toes inwards, raising or depressing one side of the foot. Q. Where is the os cuboides situated ? A. In the anterior and outer part of the tarsus. Q. How many articulating surfaces has the os cu- boides ? A. Three; a posterior, smooth surface, convex at its inner and concave at its outer part, corresponding to the os calcis; its inner, articulated with the os naviculare and the .os cuneiforme externum; and its anterior sur- face, divided into a small inner, to be articulated with the fourth, and a large outer, articulated with the fifth metatarsal bone of the little toe. Q. What is the appearance of the under surface of the os cuboides ? A. It is rough and irregular; exhibiting a round pro- tuberance, with a knob on its outside, and a fossa, or groove immediately before the knob. Q. What is attached to the round protuberance ? A. The adductor pollicis arises from it, and liga- ments are also attached between this bone and the oa calcis. Q. WTiat lies in the fossa ? A. The tendon of the peroneus longus, while it runs across the sole. Q. What is the use of the knob ? A. The thin flat cartilage, or sometimes a sesamoid bone, plays on the knob, as the tendon turns round it. Q. What is the situation of the three cuneiform bones of the tarsus ? ( A. They are placed on the inner side of the o» cu- boides on the fore part of the tarsus, and applied to each other transversely, as stones in an arch. Q. In what order are they placed ? THE TARSUS. 139 A. The os cuneiforme externum is placed next the os cuboides, but it is named sometimes medium, as being of an intermediate size between the other two : the os cuneiforme medium, placed in the middle as being the smallest in size, is sometimes named minimum ; "and the os cuneiform internum, placed the innermost, is, from its being the largest in size, named sometimes maximum; this has its base towards the sole, while the apices of the other two are in that direction. Q. What is their appearance above ? A. They appear flattish. Q. What is their under surface ? A. It is concave and irregular, the os internum ex- hibiting two considerable tubercles. Q. What is attached to these tubercles ? A. The abductor pollicis arises from, and the tendon of the tibialis posticus is inserted into them. Q. What is the posterior surface of the cuneiform bones ? A. Their posterior surface is flat, and articulated with the os naviculare. (i. What is their anterior surface ? A. It is also flat, and articulated with three metatar- sal bones. Q. Describe their articulations particularly with the metatarsal bones ? A. The os cuneiforme internum is articulated with the metatarsal bone of the great toe; and the os cunei- forme medium with that of the second toe ; and the os cuneiforme externum, with that of the third or mid- dle toe ; while the fourth and fifth metatarsal bones are articulated with the os cuboides. Q. Are cartilages interposed between these bones on their articulating surfaces ? A. They have cartilages between them, and capsu- lar, and other ligaments, binding them veiy firmly to each other. (J. Do they admit of much motion ? A. Excepting the articulation of the os naviculare with the astragalus, the others are so connected as to 140 THE TARSUS. admit of no motion, but of a certain degree of elasticity . which, in the different violent motions of the body, pre- vents disagreeable concussion. OF THE METATARSUS. Q. How many bones compose the metatarsus ? A. Five; which, in general characters, agree with the metacarpal bones of the fingers. Q. What is the form of their bases ? A. Their base is large, flat, and a little hollowed, to be articulated with the fore part of the tarsal bones. Q. What is the form of the bodies of the metatarsal bones ? A. Their body is sharpish above, and flattened at the sides. Q. What is situated on their oblique flat sides ? A. The interosseous muscles arise from them. Q. What is the form of their anterior extremity ? A. It terminates in a round ball or head, longer from above downwards. Q. Does the metatarsal bone of the great toe differ from that of the rest ? A. Yes; its base is more hollowed and larger; its body thicker, stronger, and shorter; its anterior ex- tremity is formed into a middle prominence, with two lateral depressions. Q. Is there any thing particular in these lateral de- pressions ? A. Yes; a sesamoid bone plays in each of them, being placed between the tendon of the flexor muscle and the joint. OF THE TOES. Q. How many bones are in each toe ? A. Three in the small, and two in the great toe. Q. How are they arranged ? A. Into phalanges, in the same manner as the fingers. Q. How are their bases formed ? THE TOES. 141 A. They are hollowed, forming sockets for receiving the heads of the metatarsal bones. Q. Are the joints between the phalanges the same as in the fingers already described ? A. Yes ; the proximate extremities of the second and third phalanges have a middle eminence, and two late- ral depressions, and their distant extremities have a middle depression ; and two lateral prominences; which, when applied to each other, form hinge-joints, termed ginglimus. Q. What motions can the toes perform? A. Flexion and extension only. Q. Have the bodies of the phalanges grooves below ? A. Yes ; in which the tendons of the flexor muscles run. Q. Have all these articulations of the toes capsular ligaments ? A. Yes ; they have not only capsular ligaments, but also strong lateral, and other ligaments, which connect them strongly together. Q. What purposes does the arched construction of the foot serve ? A. It allows the tendons, muscles, blood-vessels, and nerves to lie, or pass along, free from pressure ; it ad- mits of a considerable degree of elasticity, by which it facilitates walking, and in violent motions prevents con- cussion injurious to the tender viscera. Q. What are the chemical constituents of bones ? A. Calcareous earth, cartilage, gelatin, and oil. Q. What chemical substances does the earthy part contain ? A. The greatest part is phosphate of lime, a small portion of carbonate of lime ; and a very minute por- tion of sulphate of lime. Q. How can the earthy be separated from the animal matter ? A. By burning the bones to whiteness, the animal matter is dissipated ; or, by immersing the bone in mu- riatic acid, its earthy part is dissolved and held in solu- 142 THE TOES. V tion, while the cartilage remains, and keeps the bone of the same figure, but flexible. Q. How are the gelatin and oil separated ? A. By boiling the bones in water, the oil is collected on the surface ; while the gelatin is dissolved, and held in solution; and may bo obtained by cautious and pro- per evaporation on cooling. SURGICAL ORGANIC DISEASES OF BONE8. Q. What diseases are the bones subject to ? A. The bones are exposed to external injuries, and may be bruised, broken, cut, or dislocated. Q. Are they not subject to organic diseases also ? A. Yes ; their organized structure is affected by va- rious causes, and very considerably changed. Q. Enumerate the or0ahic diseases of bones ? A. The principal are Exostosis, Caries, Abscess, Spina Ventosa, Gangrene, Exfoliation, Necrosis, an Excess of Earthy Matter, Rickets, Mollifies, Fragilitas, Osteo-sarcoma, and Anchylosis. Q. What is understood by Exostosis ? A. It is a morbid enlargement of a bone, or a tumor growing upon it. Q. Is Exostosis a constitutional, or local disease ? A. It is generally a local disease; but in some consti- tutions there seems to be a strong disposition to the for- mation of Exostosis in a great number of bones. Q. What bones are most frequently seized with Exos- tosis ? A. The bone9 of the cranium, inferior maxilla, ster- num, humerus, radius, ulna, carpal bones, the femur, tibia, and tarsal bones. Q. Does exostosis grow outwardly, or inwardly ? A. It generally grows outwardly, but sometimes, though rarely, it grows inwardly, and makes compres- sion upon the brain, the viscera of the thorax, or pelvis, and sometimes displaces the eye by growing into the orbit. Q. What kinds of exostosis are generally met with? OROANIC DISEASES OF BONES. 143 A. Two; the scrofulous and the venereal. Q. What bones does the scrofulous exostosis most frequently seize ? A. The hones of the spine, of the carpus and tarsus, and those of the hip and knee-joints; i. e. bones of a soft and spongy texture. Q. What bones does the venereal exostosis most fre- quently seize ? A. Those of a firm compact texture, such as the mid- dle of the humerus, tibia, fibula, ulna, os frontis, and ossa parietalia. Q. What is the internal structure of exostosis ? A. It is very different, sometimes made up of a thin external plate, with numerous thin cross plates within, whose interstices are filled with cartilage; it sometimes consists of cartilage, fungous granulations, and pus; is sometimes composed of fibres closely compacted and hard. Q. Which of these kinds grows the largest? A. Those of a soft consistence, and containing fun- gous, and ill-conditioned pus. Q. Are these denominated Cancerous Exostoses ? A. Yes, most frequently; because they degenerate speedily into Caries. Q. Which kind of exostosis continues small and sta- tionary ? A. That of a very compact hard texture like ivory. Q. Do venereal nodes or exostoses degenerate into Caries ? A. Yes; always, if they be allowed to take their course, without being checked and discussed by medi- cine. Q. When Caries supervenes upon exostosis, is the tumor removed ? A. The Carie* generally wastes, and gradually de- stroys the tumour, which formed the exostosis. Q. What is understood by Caries of a bone? A. It is a gradual wasting of a part of the bone, which had previously been deprived of nourishment, and had died; caries of a bone, and ulceration of a soft part, are I 14 ORGANIC DISEASES OF BONJ> very similar processes, carried on in parts of different textures. Q. What bones are most subject to caries ? A. Those of a spongy soft texture, covered by a thin external lamella, such as, the bodies of the vertebrae ; the extremities of the femur and tibia; the carpal and tarsal bones. Q. Does caries of a bone produce purulent matter, like an ulcer ? A. Caries produces a fetid, ichorous, ill-conditioned matter. Q. Is the skin discoloured above a caries bone ? A. Yes; it inflames and suppurates, and a fistulous opening is made to evacuate the matter generated be- low. Q. What sensation to the finger does a carious part give when probed ? A. A rough, gritty sensation; or sometimes that of softness, when the parts are 'spongy. Q. In what bones do Abscesses take place ? A. An Abscess most frequently happens in bones not much covered with thick muscles, such as the bones of the fore-arm, hand, leg, foot, cranium, and face. Q. Where does the matter form ? A. In the medullary part of the bone, or where the cancelli are soft and spongy. Q. What is the result of an abscess of a bone ? A. The matter formed irritates, inflames, and produces suppuration of the integuments, by which it finds an exit by fistulous openings. Q. Is not this the same as Spina Ventosa ? A. When suppuration has taken place, and an icho- rous matter is issuing from the fistulous orifices, the sharp cancelli standing out from the sides of the aper- tures, and the almost empty cavity of the bone, now suggested the name of Spina Ventosa. Q. Is then Spina Ventosa to be considered the se- quela of suppuration, and abscess of a bone? A. Yes, it properly is; but that name is frequently ORGANIC DISEASES OF BONES. 145 given to the whole progress of disease in the part, both in a state of inflammation and suppuration. Q. What is meant by Gangrene of a bone ? A. When a bone, by any cause, has been deprived of nourishment, and becomes dead, of an 6*paque white, brown, or blackish colour, it is said to be gangrenous. Q. Does this gangrene, or death, affect the whole bone, or a part of it only ? A. It sometimes, in consequence of an injury, affects a part only, which, when dead, is cast off by exfoliation. Q. What is the process o/exfoliation ? A. When the outer lamellae of a bone have been de- prived of their nourishment by the periosteum being torn off and the bone bruised, they become gangrenous, or dead ; the extremities of the arteries in the living bone nearest to the dead, throw out a fluid, similar to that produced by suppuration in other soft parts, be- tween the dead and the living bones; and a separation of the dead is the consequence. Q. What happens when the whole or greater part of a bone becomes gangrenous or dead ? A. The process is in effect the same as that of exfolia- tion, but to a much greater extent; the vessels of the living parts adjacent to, and surrounding the dead, throw out a purulent fluid, which cuts off all communi- cation between the living and dead parts, and then se- crete a gelatinous and cartilaginous fluid as a nidus, in which osseous particles are afterwards deposited in the formation of a new bone. Q. What is this extensive process called ? A. It is denominated Necrosis. Q. By what name is the dead bone called in necrosis ? A. It is called the sequestra. Q. Wrhat bones does Necrosis most frequently at- tack ? A. The hard or middle parts of those slightly covered with muscular substance, such as, the inferior maxilla, clavicle, os humeri, tibia, and cranium. Q. Does the new-formed osseous shell surround the sequestra ? N 146 ORGANIC DISEASES OF BONES. A. Yes; the new case is formed around the old dead bone. Q. How then does the sequestra get out ? A. It generally produces irritation, inflammation, and suppuration %f a surrounding part, and thus forms an opening for itself; or this process is facilitated by a Sur- gical Operation of making or enlarging the opening, and extracting the loose sequestra. Q. Is the sequestra not absorbed ? A. Yes; in young people especially, it is frequently all absorbed; and in every case a considerable portion of its circumference is converted into a kind of pus, and absorbed. Q. How can this absorption take place, if there be no communication between the living and dead parts, as you said before ? A. There is no vascular communication: the puru- lent matter constantly thrown out by the extreme ves- sels of the surrounding living parts, softens and dissolves the exterior of the sequestra ; and as the absorbent ves- sels of the living surrounding parts are constantly at work, removing part of that purulent fluid, part of the sequestra is of course removed with it. This is the con- stant gradual process of absorption of bone. Q. Is not the member, in which Necrosis is going on, larger than usual ? A. Yes; the new osseous shell being formed around the old bone, enlarges the bulk of the member, and makes it irregular on the surface, and ill-shaped. Q. Do bones sometimes acquire a morbid excess of earthy matter ? A. Yes: an unusual quantity of earthy matter is in some instances deposited either on the external surface, or in the internal structure of a bone : in consequence of which it acquires an unnatural size. Q. What bones attain this morbid size most fre- quently ? A. Various bones are subject to this morbid increase of earth, particularly those of the cranium, the hume- rus, femur, and tibia. ORGANIC DISEASES OK BONES. 147 Q. Is the calcareous matter deposited on the outer side of the bones of the cranium, or where ? A. It seems to be deposited between the two tables in the diploe, and the bones in consequence become very much thickened; sometimes even to half an inch, or more. Q. Where is it deposited in cylindrical bones? A. Most frequently in the substance of the bone; its general size is much augmented; its medullary ca- nal almost obliterated; and the cellular structure of its extremities filled with it. In some rare cases, an ex- crescence is attached to the outside of the bone, the cells of which are filled with matter resembling soft cheese, and a hard bony callus occupies the other parts. Q. Has not the earthy matter of bones been some- times converted into chalk ? A. In people long afflicted with Gout, or perhaps Rheumatism, chalk-like substances are formed in the joints of the hands and feet; which are to be regarded as morbid concretions of this sort. Q. Is a brittleness, or fragilitas ossium, owing to an increase of earthy matter ? A. Fragilitas is owing to an excess of earthy matter in proportion to the cartilaginous part of the bones, but it is not often attended with an increase of size. Q. Is this fragility of bones owing to age ? A. It occurs most frequently in advanced age, when the bones attain a greater degree of solidity from an in- crease of earthy matter ; and when their cartilaginous, gelatinous, and oleaginous parts are diminished. Q. Does fragility of the bones ever follow disease? A. Yes ; the bones have been observed to become re- markably brittle in the latter stage of Scorbutus, of Cancer, and of Lues. Q. Is not a deficiency of earthy matter in bones a more frequent cause of disease ? A. Yes ; much more frequent. Q. What diseases are owing to a deficiency of the usual proportion of earthy matter ? A. Rickets, Mollifies Ossium, and Osteo-Sarcoma. 148 ORGANIC DISEASES OF HONES. • Q. Are not all these varieties of the same disease r A. They all denote a deficiency of earthy matter; but Rachitis is a disease of infancy; while Mollities is rather peculiar to advanced age, and is attended with much greater softness of the bones than the former. Q. Does Rachitis affect all the bones, or one or two ? A. It commonly affects one, two, or more bones in a part, but sometimes, though more rarely, a great num- ber. Q. What bones are most frequently affected with Rickets ? A. The vertebrae of the spine; the ribs, and sternum; and the extremities of long bones. Q. What appearances occur in a case of Rickets ? A. The bones become bent and flattened; when the ribs are affected, the thorax is narrow and protuberant at the sternum, compressed on the sides, the cartilages of the ribs becoming concave instead of their natural convexity. Q. What is presented when the vertebrae are affect- ed? A. The spine becomes crooked in various places, and the head sinks, as it were, between the shoulders. Q. What is the appearance when the head is affected ? A. The cranium seems preternaturally enlarged, and often mis-shapen. Q. When Rickets affect the joints, what is their ap- pearance ? A. They become enlarged in size, and mis-shapen. Q. What happens when it affects the long bones ? A. They are bent in a direction opposite to their flexor muscles; thus the femur and tibia are bent for- wards. Q. When Rickets or Mollities affects the bones of the pelvis, what appears ? A. The pelvis becomes distorted, and diminished in capacity; the ossa innominata opposite to the acetabu- lum are pressed inwards, the pubis projects with its rami approaching closer together, and the promontory of the os sacrum often projects forward. ORCANIC DISEASES OF I'OMiS. 149 Q. Is the effect of Mollities Ossium nearly the same as that of Rickets ? A. Mollities generally affects a greater number of bones ; and seems in some cases to be constitutional, and to affect nearly the whole bones of the system. Q. What is the cause of the mollities ossium ? A. It may be owing either to a deficiency of earthy matter, as has been said, or to an increased proportion of gelatinous and cartilaginous matter. Q. How can the earthy matter become deficient? A. It may be dissolved within the body by an excess of acid, and absorbed; as we dissolve the earthy matter of bones out of the body, and keep it in solution, by the Muriatic Acid. Q. Is it the Muriatic Acid in excess, then, which dissolves the earthy part of the bones, and produces mollities ? A. It seems to be an acid, but whether the Muriatic or another, is uncertain. Q. What is meant by Osteo-Sarcoma ? A. It is a softening and conversion of bone into a snbstance not unlike to lard or fat: or the external ta- ble of the bone includes a substance like fungous, in- stead of the cancellated internal structure. Q. Is Osteo-Sarcoma a common disease ? A. No; it is fortunately very rare, and has been ob- served in a few cases to affect those, who in youth had been Rickety. Q. What is understood by Anchylosis ? A. It is the accretion of the extremities of bones, and a stiffening of the joint. Q. Is anchylosis the effect of disease of the bones ; or of the inter-articular cartilages ? A. It may be the effect of both. Q. How does a disease of the articular cartilages pro- duce anchylosis ? A. When these cartilages become inflamed, they throw out a quantity of coagulable lymph, which in the immoveable state of the limb produces adhesion of the inflamed surfaces of the cartilages tipping the extremi- N 2 150 ORGANIC DISEASES OF BONES. ties of the bones forming the joint, and ultimately partial or total rigidity of the joint. Q. What disease of the bones produces anchylosis ? A. In scrofulous constitutions, White Swelling of the knee sometimes destroys the cartilages, and soft- ens the spongy extremities of the femur and tibia, and in some rare cases ultimately produces anchylosis. The Morbus Coxarius sometimes has the same termination. Q. Is the destruction of the cartilages and the soft- ness of the bones the cause of anchylosis in such cases ? A. Both must have taken place; but the fibrin, or coagulable lymph effused by the extreme arteries, is the direct cause of the accretion of parts, or of the an- chylosis. Q. Does fibrin abound in the blood of young people ? A. The blood of the young must contain a large pro- portion of the principles necessary for the growth of the individual parts of the system ; and as fibrin is contain- ed in those most essential to our existence and loco-mo- tion, it must be derived from the blood. Q. Do the bones of the young contain a greater pro- portion of cartilaginous and gelatinous matter than those of middle age ? A. Yes; gelatinous and cartilaginous matter is ne- cessary for the tenacity and growth of the bones in young people. Hence they are more juicy, and much less apt to be fractured, than the bones of the adult of more advanced age ; when the bones acquire a greater proportion of earthy matter, and become more brittle. of cartilage. Q. What is understood by Cartilage ? A. Cartilage is a white, elastic substance, nearest to bone in density ; of a structure obscurely fibrous ; and nearly a third ligbter than bone. Q. Are the blood-vessels of cartilages very conspicu- ous ? A. No; the vessels of cartilages are so small, that they do not admit the red particles of the blood, nor OF CARTILAGE. 151 the coloured injection of the Anatomist, except when osseous particles are just beginning to be deposited in them in the formation of bone. Q. Can the nerves of cartilages be traced ? A. No; they are so small that they have never been traced in the compact dense substance of cartilage. Q. Have cartilages much sensibility ? A. They have very little sensibility in their healthy state; their situation and office could not admit of great sensibility, without producing the greatest in- convenience and pain in the different motions of the body. Q. How many offices do cartilages perform ? A. Four; they supply the place of bone; afford a nidus for the deposition of the earthy matter of bones ; form articular surfaces; and perform the office of carti- lages and ligaments at the same time. Q. In what parts of the body does cartilage supply the place of bone ? A. In the nose, larynx, ends of the ribs, and on the brim of articular cavities making them deeper. Q. In what parts does cartilage form a nidus for earthy matter? A. In the long bones of infants and children, a great part of them towards the extremities is cartilage, in which earthy matter is deposited in the due confirma- tion of the bone. Q. In what parts does it form articular surfaces ? A. In all the moveable joints cartilage covers the sur- faces applied to each other, and by its smoothness and slipperiness facilitates their motions. Q. In what parts does-cartilage perform the office of cartilage and ligament at the same time ? A. Between the vertebrae of the spine, it gives all the elasticity of cartilage and the flexibility of liga- ment ; and between the bones of the pelvis it is inter- posed, and fixes them together with all the firmness of ligaments. Q. WThat organic diseases are cartilages subject to? 152 OF CARTILAGE. A. They sometimes become thinner, thicker, and softer; or harder than natural, and ossified. Qv In what circumstances do cartilages become thin- ner? A. When the trunk of the body is kept in nearly the same position for a great length of time, whether by cer- tain occupations, or by reclining much in nearly the same posture, the inter-vertebral cartilages are compress- ed on one side, and eased on the other. Q. What is the effect of that continued posture of the trunk ? A. The pressure on one side of the cartilages produ- ces irritation there, and this in turn promotes the activi- ty of the absorbents, by which, part, or the whole, of the cartilages of the compressed side becomes much thin- ner, or is wholly removed; while the removal of the usu- al pressure from the other side of the cartilage makes it increase in thickness and density. Hence a permanent curvature of the spine is the consequence. Q. In what circumstances do the cartilages become softer and thicker than natural ? A. In Scrofulous constitutions, the cartilages, which cover the articulating surfaces of bones, become painful, thickened, and spongy in their texture. This most fre- quently happens in the knee-joint, the hip-joint, the tar- sus, and inter-vertebral substances. Q. Do this softness and thickening not happen to bones themselves ? A. The cartilaginous part of bones undergoes the same change in many instances. Hence the extremi- ties of the femur and tibia, also part of the bodies of the vertebrae ; and the bones of the tarsus, or carpus, have been softened, thickened, ulcerated, and sometimes ab- sorbed. Q. In what circumstances are cartilages converted into bone ? A. When the vessels in the cartilages are moderate- ly irritated, they deposite osseous particles, which some- times happens in diseased joints, and Anchylosis is the consequence : or, in advanced age, when the lubricating OF CARTILAGE. 153 fluid is too scanty, irritation of the articular surfaces and ossification takes place. Q. What parts are most frequently ossified ? A. The cartilages of the ribs, inter-vertebral cartila- ges, and those tipping the ends of bones in the joints: sometimes loose cartilaginous bodies have been found in the knee-joint. OF LIGAMENTS. Q. What is understood by ligament ? A. Ligament is a strong, whitish, flexible substance, composed of longitudinal and obliquely transverse fibres. Q. Have ligaments distinct blood-vessels ? A. Yes ; they are supplied with numerous blood-ves- sels, which can readily be filled in with coloured injec- tion by the Anatomist. Q. Have ligaments nerves large enough to be traced? A. The nerves of ligaments are very minute, but they can be traced upon their surface in some parts of the body. Q. Have ligaments much sensibility ? A. Their sensibility, like that of cartilage, in the sound state, is very inconsiderable ; but when inflamed, they become extremely sensible, as the acute pain in Rheumatism, Gout, and White swelling, clearly shews. Q. What offices do ligaments perform ? A. They in many instances form bags, which include the joints, and are then called capsular ligaments; others are so fixed to the ends of the articulating bones as to confine the motions of the joint; others supply the place of bones, as in the pelvis, and between the radius and ulna, giving origin to muscles; and others fix the bones almost immoveably together. Q. What is the structure of capsular ligaments ? A. The outer part of them is formed by a continua- tion of the periosteum, which is connected with the surrounding parts by cellular substance; the inner layer of the capsule being thin and dense, is reflected over 154 THE LIGAMENTS. the cartilages, which tip the ends of the articulating bones. Q. What lubricates the articulations, and facilitates their motions ? A. A mucilaginous fluid, called synovia, secreted by the vessels of the internal surface of the capsular liga- ments ; and als0 hy organs placed in some joints for the purpose. Q. What are these organs ? A. The synovial organs, or glands, are composed of little masses of fat covered by a continuation of the in- ner layer of the capsule, and projecting so as to be gently moved or pressed in the motions of the joint. Q. Are they really glands ? A. They are generally considered glands, because they secrete a fluid; although, on minute inspection, no glandular apparatus can be discovered in their struc- ture. Q. What is their colour and appearance ? A. They are whitish, and sometimes from the number of their blood-vessels tbey are reddish; from their mar- gin fimbriae hang loose, and transmit the synovial li- quor into the joint. Q. What is the nature of the synovia? A. It is of a yellow hue, like olive oil; is of the con- sistence of the albumen ovi, froths when agitated; is smooth, viscid, and slippery to the touch. Q. Does the quantity of synovia secreted vary at dif- ferent times ? A. Its quantity varies very much, and seems to de- pend on the motions of the joint; for, when the joint is at rest it is not required, but when exercised, its mo- tions stimulate the synovial organs to pour out a quan- tity of their fluid sufficient to moisten and lubricate the whole articulating surfaces of the joint. Q. What are the chemical properties of synovia? A. The quantity that can be procured of human sy- novia being too small to furnish a suite of experiments in order to establish its properties, that of the ox has been had recourse to, and contains a peculiar matter, THE LIGAMENTS. 155 albumen, gelatin, mucilage, soda, muriate of soda, and phosphate of lime. OF THE LIGAMENTS OF THE HEAD, AND TRUNK. Q. How many ligaments are proper to the inferior MAXILLA ? A. Three on each side, the capsular, suspensory, and, lateral. Q. What are the attachments of the capsular liga- ment of the inferior maxilla? A. It arises from the whole margin of the glenoid cavity of the temporal bone; and is inserted into the edge of the inter-articular cartilage, and round the cer- vix of the maxilla. Q. What are the attachments of the suspensory liga- ment ? A. It arises from the styloid process and from a liga- ment passing across from the same process to the os hyoides; and is inserted into the angle of the inferior maxilla. Q. What is the use of it ? A. The suspensory ligament supports the stylo-glos- sus muscle, and gives origin to part of it. Q. What are the attachments of the lateral liga- ment ? A. It arises from the margin of the glenoid cavity, and is inserted into the inner side of the angle near the foramen maxillare posterius. Q. What is the use of this lateral ligament ? A. It keeps the condyle in situ, and defends the blood-vessels and nerve entering the foramen, from the pressure of the internal pterygoid muscle during its ac- tion. Q. How many ligaments attach the head to the vertebrae of the neck? A. Four properly, viz. the two capsular, circular, and perpendicular; and other two assist, namely, the two lateral or moderator ligaments. 156 THE LIGAMENTS. Q. Describe the attachments of the capsular liga- ments of the head ? A. They arise from the margin of the superior articu- lar processes of the Atlas, and are inserted into the base of the condyles of the os occipitis. Q. What are the attachments of the circular liga- ment ? A. It arises from the margin of the large spinal for- amen of the atlas, is connected with the capsular liga- ments, and is inserted into the edge of the foramen magnum. Q. What are the attachments of the perpendicular ligament ? A. It aj'ises from the point of the processus dentatus, and is inserted into the anterior part of the margin of the foramen magnum. Q. What are the attachments of the two lateral liga- ments, which assist those proper to the head ? A. They arise from the sides of the processus denta- tus, ascend laterally, and are inserted into the inner part of the side of the atlas, and to the internal edge of the foramen magnum before the condyles. Q. What is the use of these two strong.short lateral ligaments ? A. They moderate the rotatory motions of the head, and prevent it from being turned too far. Q. What ligaments secure the processus dentatus in situ ? A. The perpendicular, and two lateral ligaments just mentioned; and especially the transverse ligament. Q. What are the attachments of the transverse liga- ment? A. It arises from the inner sides of the anterior part of the atlas, and running across behind the processus dentatus in a circular groove, is inserted into the oppo- site side. Q. Is there any other ligament connecting the head to the cervical vertebrae ? A. Yes; the ligamentum nuchae vel colli. Q. What are its attachments ? THE LIGAMENTS. 157 A. The ligamentum nuchae arises from the perpen- dicular spine of the occipital bone, and descending is inserted into the spinous processes of the cervical ver- tebrae. Q. How many ligaments are common to all the ver- tebrae ? A. Two; the anterior and posterior common liga- ments. Q. Describe the common anterior ligament of the vertebrae ? A. It is a tendinous ligament beginning round and small at the atlas, and gradually becoming broader as it descends to the os sacrum; it covers the convex ante- rior part of the bodies of tbe vertebrae, being much thicker and stronger on the fore part than on the sides. Q. What is the use of this anterior common liga- ment ? A. It is thinner above and below near the under part of the os sacrum, is firmly connected to the bodies and periosteum of the vertebrae, binds them firmly together, and prevents the spine from being too much bent back- wards. Q. Describe the common posterior ligament of the vertebrae ? A. It begins at the anterior part of the foramen mag- num, descends on the inner concave part of the bodies of the vertebrae, becoming broader over the inter-verte- bral substances, and adhering firmly to them, terminates at the lower part of the os sacrum. Q. What is the use of this posterior common liga- ment ? A. It binds the vertebrae strongly together, and pre- vents the spine from being too much bent forwards. Q. How many ligaments have the vertebrae in gene- ral? A. The inter-vertebral substance, and seven liga- ments, viz. the crucial, inter-spinous, inter-transverse, and capsular ligaments. Q. Describe the inter-vertebral substance? A. It is a cartilago-ligamcntous substance composed O 158 THE ligaments. of concentric lamellae, whose edges are firmly fixed to the bodies of the vertebrae; and it is very elastic. Q. W hat are the uses of the inter-vertebral substan- ces ? A. These substances fix the bodies of the vertebrae together, diminish the effect of concussion, and allow the spine to bend in all directions. Q. Describe the situation of the crucial or inter-ver- tebral ligaments ? A. These two are composed of numerous strong, short fibres, which, situated behind the anterior common ligament, cross each other obliquely in passing from the edge of one vertebra to that of another. Q. What are their uses ? A. The crucial ligaments fix the bodies of the ver- tebrae together, and adhere to the inter-vertebral sub- stance. Q. What are the situation and use of the inter-spi- nous ligaments ? A. They pass from the edge of the arch and spinous process of one vertebra to those of another, and connect them together. Q. What are the situation and use of the inter-trans- verse ligaments ? A. They are attached to the transverse processes, and connect them firmly together. Q. Describe the capsular ligaments ? A. They are two between every two vertebrae, at- tached to the margin of the articular oblique processes, fixing them together so as to admit of their proper move- ments. Q. How many ligaments attach the ribs to the ver- tebrae ? A. Five; the capsular ligament of the head, and of the tubercle, the external and internal transverse, and the external ligament of the neck of the rib. Q. What are the attachments of the capsular liga- ment of the head of the ribs? A. It arises from the spongy margin of the articul- lating surface on the head of the rib, and is inserted into THE LIGAMENTS. 159 the circumference of the cavity in the vertebrae and their inter-vertebral substance. Q. Describe the attachments of the capsular ligament of the tubercles ? A. The back part of the tubercle is applied to the fore part of the transverse process, and firmly attached by the capsular ligament, which arises from the mar- gin of the articular surface near the end of the trans- verse process, and is inserted round the base of the tu- bercle. Q. Describe the situation and attachments of the in- ternal and external transverse Ifgaments ? A. The internal arises from the inferior surface of the transverse process, and is inserted into the upper margin of the neck of the nearest rib: the external arises from the point of the transverse process, and is in- serted into the back of the neck. Q. Describe the external ligament of the neck of the ribs? A. This ligament arises from the external side of the inferior oblique process, and descending obliquely out- wards, is inserted into the upper and outer part of the neck of the ribs. Q. What motions are these ligaments calculated to allow ? A. They admit of motions upwards and downwards only. Q. What ligaments connect the ribs to the ster- num ? A. The capsular, and radiated or transverse ligaments. Q. Describe the attachments of the capsular liga- ments of the ribs with the sternum ? A. The capsular ligament of the cartilage of the seven true ribs arises from the margin of the articular cavity in the side of the sternum, and is inserted round the ex- tremity of the cartilage. Q. What are the attachments of the radiated or trans- verse ligaments ? A. They arise from the sternum, and run over the 160 THE LIGAMENTS. capsular ligaments, and are inserted into the cartilages of the ribs. Q. Are there not other ligaments connected with the ribs ? A. Yes; the union of the rib and its cartilage is se- cured by a covering of ligamentous fibres; and near the sternum a tendinous expansion of fibres connects the cartilages together. Q. What ligaments has the sternum peculiar to itself? A. A very firm tendinous expansion covers the whole sternum internally and ^xternally. Q. What ligaments has the ensiform cartilage ? A. It has various ligamentous bands from the cover- ing of the sternum, and from the cartilages of the se- venth pair of ribs. Q. How are the ligaments of the pelvis divided ? A. Into those which unite the bones; and into those on the anterior, and those on the posterior aspect of the pelvis. Q. What ligaments fix the bones of the pelvis toge- ther ? A. The uneven articulating surfaces of the ossa in- nominata and each side of the os sacrum are covered with cartilage, which, Intervening between the bones, fixes them so very firmly together as to admit of no motion. Q. Is the symphysis pubis joined in the same man- ner ? A. Yes; exactly in the same manner, and admits of no motion. Q. Have these joinings of the bones of the pelvis any other ligaments ? A. They have each a capsular ligament, which co- vers and strengthens the articulation. Q. Do these articulations relax, and open a little at the symphysis pubis during parturition ? A. It was long thought so, but it is a mistake; for these articulations of the pelvis never admit of the smallest motion even in parturition without a disease, THE LIGAMENTS. 161 which renders the woman incapable of walking for a long time. Q. What ligaments are situated on the fore part of the pelvis ? A. The inguinal, and obturator membrane or liga- ment. Q. Describe the inguinal ligament ? A. This ligament, called also Poupart's Fallo- pius' ligament, and crural arch, is considered by some as part of the tendon of the external oblique muscle ; it arises from the anterior superior spinous process of the ilium, runs transversely, and is inserted into the crest of the os pubis. Q. Describe the obturator ligament ? A. It is a strong membranous ligament, which is at- tached to the margin of the foramen thyroidBum, and closes up the whole of the foramen, except an oval notch at its superior part for the passage of the obtura- tor artery, vein, and nerve. Q. What ligaments are situated in the posterior part of the pelvis ? A. The two transverse, the ilio-sacral, the long and the short sacro-ischiatic, and other slips, on either side. Q. WThat are the attachments of the two transverse ligaments ? A. They arise from the spine of the os ilium, run transversely, and are inserted, the superior into the last lumbar vertebra, the inferior into the first transverse process of the os sacrum. Q. Describe the attachments of the ilio-sacral liga- ments ? A. They arise from the posterior spinous process of the os ilium, descend obliquely, and are inserted into the first, third, and fourth transverse processes of the os sacrum. Q. Describe the attachments of the long and short sacro-sciatic or ischiatic ligaments ? A. They arise in common from the transverse pro- cesses, from the under and lateral part of the os sacrum, and from the upper part of the os coccygis; the long O 2 162 THE LIGAMENTS. one isinserted into the tuberosity of the os ischium ; and the short one running transversely, is inserted into the spinous process of the os ischium. Q. What are the uses of these sacro-sciatic liga- ments ? Q. They bind the bones together, support the con- tents of the pelvis, and give origin to muscles. The long or external one forms the notch of the ilium into a large foramen, through which the pyriform muscle, sciatic-blood vessels, and nerve, pass out; between the two a hole is formed, through which the obturator in- ternus muscle passes out of the pelvis. Q. Where are the ligamenta vaga dispersed ? A. They are numerous slips running in various direc- tions between the os sacrum and ossa ilia. Q. What ligaments are attached to the os coccygis ? A. It has a capsular ligament, where it is articulated with the os sacrum, and a general ligamentous expan- sion descending from the sacrum covers the whole of it. OF THE LIGAMENTS OF THE SUPERIOR EXTREMI- TIES. Q. By what ligaments is the clavicle bound to the sternum ? A. By the inter-articular cartilage, the capsular, radi- ated, inter-clavicular, and rhomboid ligaments. Q. What is the use of the inter-articular cartilage ? A. It covers the articulating surfaces of the sternum and clavicle, accommodates them to each other, and adapts them for easy motion. Q. What are the attachments of the capsular liga- ment? A. It arises from the thick upper corner of the ster- num around the articular cavity, incloses th- inter-arti- cular cartilage, and is inserted around the head of the clavicle. Q. What arc the attachments of the radiated liga- ment ? A. This ligament on either side arises from the ex- THE LIGAMENTS. 163 ternal surface of the sternal end of the clavicle, and is inserted into the sternum around the capsular ligament. Q. What are the attachments of the inter-clavicular ligament ? A. It is extended from the elongated angle of the ex- tremity of the one clavicle to that of the other behind the top of the sternum, and fixes them strongly toge- ther. Q. Describe the attachments of the rhomboid liga- ment ? A. It arises from the rough inferior surface of the clavicle on each side, and is inserted into the first rib at its sternal articulation. Q. What ligaments fix the clavicle to the scapula ? A. The capsular, conoid, and trapezoid ligaments. Q. What is the situation of the capsular ligament ? A. The scapular end of the clavicle, and also the articular surface of the acromion process, are covered generally with inter-articular cartilage, and firmly fixed together by this and the capsular ligament, which close- ly surrounds the articulation, and is attached to both bones. Q. What are the attachments of the ligamentum conoidBum ? A. It arises from the root of the coracoid process, and is inserted into the tubercle of the clavicle. Q. What are the attachments of the ligamentum trapezoidSum ? A. It arises from the point of the coracoid process, and is inserted into the under edge of the clavicle near the tubercle. Q. What ligaments are proper to the scapula .' A. The anterior and posterior ligaments. Q. What are the attachments of the anterior liga- ment of the scapula ? A. It is of a triangular form, arises broad from the ex- ternal surface of the coracoid process, and becoming narrower, is inserted into the posterior and upper edge of the acromion. Q. What use does this anterior ligament serve ? 164 THE LIGAMENTS. A. It binds down the tendon of the supra-spinatus, protects and secures the upper and inner part of the shoulder joint. Q. What is the situation of the posterior ligament of the scapula ? A. It is stretched across the semi-lunar notch, form- ing it into a hole for the passage of the superior-poste- rior blood-vessels and nerve. Q. What ligaments connect the scapula and hu- merus ? A. The capsular ligament, and the tendon of the long head of the biceps flexor cubiti. Q. Describe the attachments of the capsular liga- ment of the shoulder joint? A. It arises from the cervix of the scapula near the margin of the glenoid cavity, and is inserted round the neck of the os humeri; forms a sheath on its fore part for keeping the tendon of the biceps in situ. Q. Describe the tendon of the biceps, and how it con- tributes to the security of the joint ? A. This tendon arises from the upper edge of the gle- noid cavity, passes over the ball of the humerus within the joint, and, being inclosed in its sheath, gives great security to the shoulder joint, against accidents forcing the head of the humerus upwards. Q. What ligaments bind the os humeri to the radius and ulna ? A. The capsular, the humero-cubital, humero-radial, and the two inter-muscular ligaments. Q. Describe the attachments of the capsular liga- ment of the elbow-joint ? A. It arises from the margin of the articular surface of the humerus, and is inserted into the edge of that of the ulna, and into the coronary ligament of the radius. Q. What are the attachments of the humero-cubital ligament ? A. It, called also internal lateral, arises from the an- terior part of the inner condyle of the os humeri, spreads in a radiated manner, and is inserted into the inner side of the coronoid process of the ulna. THE LIGAMENTS. 165 Q. What are the attachments of the humero-radial ? A. It, called also external lateral, arises from the ex- ternal condyle, and is expanded upon, and inserted into the coronary ligament of the radius. Q. Describe the inter-muscular ligaments, and their use? A. They arise, the one from the external, and the other from the internal condyle, and are inserted into the sides of the humerus : they are destined to give ori- gin to muscles. Q. Describe the attachments of the coronary or an- nular ligament of the radius ? A. It arises from the one side of the semilunar cavity of the ulna and capsular ligament, and is inserted into the other side, and also around the neck of the radius. Q. What is the use of the coronary ligament of the radius ? A. It binds the head of the radius to the ulna, and al- lows it to move easily round its own axis, as well as upon the articular service of the ulna, in flexion and extension of the elbow-joint. Q. What other ligaments connect the radius and ulna? A. The interosseous, oblique, and capsular or sacciform ligaments. Q. Describe the attachments of the interosseous liga- ment? A. It extends between the acute ridges of the radius and ulna, and fills up the intermediate space. Q. Are there any holes in it ? A. Yes; a large opening at its upper part for muscles passing; and a few small perforations for blood-vessels passing from its anterior to the posterior side. Q. What is the use of the interosseous ligament ? A. It binds the radius and ulna together, limits the motion of supination, and affords attachment to muscles. Q. What is the situation of the oblique ligament ? A. Some consider this a part of the interosseous liga- ment ; it arises from the tubercle at the base of the coro- 166 THE LIGAMENTS. noid process of the ulna, and is inserted into the under part of the tubercle of the radius. Q. Describe the capsular or sacciform ligament? A. It arises from the edges of the semilunar cavity at the carpal extremity of the radius, surrounds the head of the ulna, and fixes it in situ, .while it admits of their movement partially round each other in pronation and supination of the hand. Q. What ligaments connect the radius and ulna to the carpus ? A. The capsular, the external and internal lateral liga- ments, and the inter-articular cartilage. Q. Describe the attachments of the capsular ligament of the wrist? A. It arises from the margin of the navicular cavity of the radius, to the moveable cartilage at the head of the ulna, and is inserted into the cartilaginous edges of the os scaphoides, lunare, and cuneiforme of the car- pus. Q. Describe the attachments of the lateral ligaments of the wrist? A. The external arises from the styloid process of the radius, and is inserted into the os scaphoides ; the inter- nal from the styloid process of the ulna, and is inserted into the cuneiform and pisiform bones. Q. Describe the inter-articular cartilage of the ulna ? A. It is placed between the head of the ulna and the os cuneiforme, seems a continuation of the cartilage, which covers the end of the radius; it is loosely at- tached to the end of the styloid process. Q. What are the ligaments of the carpus ? A. The annular and capsular ligaments. Q. Describe the annular ligament ? A. It is frequently divided into an anterior and a pos- terior portion; it is fixed to the projections of the pisi- form and cuneiform bones, stretches across, and adheres to the os scaphoides, and trapezium, embracing the ten- dons of the muscles. Q. Does the annular ligament not form sheaths for the tendons of muscles ? THE LIGAMENTS. 167 A. Yes; the anterior portion of it, called ligamentum carpi annulare anterius, not only binds down the dif- ferent tendons of the flexors of the wrist and fingers, but forms separate sheaths for them. Q. Does the posterior portion do the same ? A. Yes; the ligamentum carpi annulare posterius, binds down the different tendons of the extensor mus- cles, and also forms distinct sheaths for them to play in. Q. Describe the capsular ligament of the carpal bones? A. It arises from the cartilaginous edge of the first row, and is inserted into that of the second row. Q. Are there other ligaments of the carpus ? A. There are various ligamentous slips, running in different directions, binding the carpal bones firmly to- gether. Q. What ligaments connect the carpal to the metacarpal bones ? A. Capsular or articular ligaments surround the dif- ferent articulations, and bind the respective bones to- gether ; as their fibres are stronger on the sides, behind and before, they have been termed lateral, dorsal, and palmar ligaments. Q. What ligaments connect the metacarpal bones to- gether ? A. They have interosseous.ligaments, which run in various directions. Q. What ligaments have the articulations of the phalanges of the fingers ? A. Each joint has a capsular, and two lateral liga- ments for strengthening the sides of the capsular, to which they adhere. Q. What retains the tendons of the flexors of the fingers in situ ? A. Viginal or crucial ligaments pass across them from one ridge to the other on the sides of the grooves in the concave or volar side of the phalanges. 168 THE LIGAMENTS. OF THE LIGAMENTS OF THE INFERIOR EXTREMI- TIES. Q. What ligaments connect the os femoris with the os innominatum? A. The round and capsular ligaments. Q. What are the attachments of the internal or round ligament ? A. It arises broad and flat from the under and inner part of the cavity of the acetabulum, runs backwards and upwards, becoming rounder, and is inserted into the pit on the inner surface of the head of the femur. Q. What is the use of it ? A. The internal or round ligament retains the ball of the os femoris in the acetabulum, and materially as- sists in preventing dislocation of the joint from accidents forcing it upwards or inwards. Q. Describe the attachments of the capsular liga- ment of the os femoris ? A. This capsular ligament is very thick and strong; it arises from the outside of the brim of the acetabulum, incloses the head, and is inserted round the root of the neck of the femur; its outer part desceiids farther than its inner, a layer of which is reflected up to the margin of the head, and transverse slips connect them. Q. Is this capsular ligament of the hip-joint not strengthened also by various other means ? A. Yes; various ligamentous slips lie on its surface, sent off from the fascia lata, and inferior anterior spi- nous process of the os ilium; it is strengthened also by surrounding muscles, particularly the iliacus internus, and quadratus. Q. What means are used to deepen the cavity of the acetabulum ? A. There is a cartilage, thick and strong, surround- ing the osseous brim, and rising to a considerable de- gree, which deepens the cavity and renders the artic- ulation more secure. Q. Is there a gland in this articulation ? THE LIGAMENTS. 169 A. Yes; a gland is lodged in a depression at the un- der and inner part of the acetabulum, for the purpose of lubricating the joint. Q. Is this glandular apparatus peculiar to this hip- joint ? • §> A. No ; a similar apparatus is found in all the large joints; thus, a fimbriated organ is placed within the capsular ligament of the shoulder-joint for the secretion of a lubricating fluid; and a fatty substance within that of the elbow-joint for a similar purpose. Q. What ligaments attach the os femoris to the TIBIA AND FIBULA ? A. The two lateral, the popliteal, that of the patella, the capsular, and crucial ligaments. Q. Describe the attachments of the two lateral liga- ments ? A. The internal lateral, of considerable breadth and strength, arises from the upper part of the internal con- dyle of the femur, and is inserted into the upper and in- ner part of the tibia; the external lateral, longer and stronger, arises from the tubercle of the external condyle-, and is inserted into the fibula below its head. Q. Describe the popliteal ligament ? A. It, sometimes called the posterior of winslow, arises from the upper and posterior part of the external condyle, descends obliquely over the capsular ligament, and is inserted into the inner and back part of the tibia. Q. What is the use of it ? A. It prevents the leg from being stretched* too far forwards, and affords origin to part of the gastrocnemius and plantaris muscles. Q. Describe the ligament of the patella ? A. It arises from a depression of the patella, descends, and is inserted into the tuberosity of the tibia; it is strengthened by the tendinous expansion of the muscles of the thigh. Q. What are the attachments of the capsular liga- ment of the knee-joint ? A. It arises from the circumference of the articular surface of the femur, and above the large notch behind, P 170 THE LIGAMENTS. and is inserted into the margin of the articular surface of the tibia, and into that of the patella, which forms a part of the capsule itself. Q. Is this capsular ligament of the knee-joint strengthened by any other means ? A. It is covered on different parts by the ligaments already described, by the aponeurosis of the thigh, and also by the tendons of various muscles. Q. Does it not form processes at the sides of the pa- tella ? A. It seems folded there, and forms the ligamenta alaria, which are merely parts of the capsule. Q. Has the Knee-joint any glandular apparatus ? A. It has the largest apparatus of any of the joints, situated chiefly round the patella, and in other parts of the joint also. Q. Describe the crucial ligaments ? A. The anterior arises from the outer part of the rough notch between the condyles, descends forwards, and is inserted into a pit before the rough protuberance in the middle of the articular surface of the tibia: the posterior arises from the inner side of the notch, and is inserted into a pit behind the protuberance of the tibia; they decussate each other. Q. What are the uses of the crucial, or internal liga- ments of the knee-joint ? A. They are situated within the capsular ligament, bind the bones firmly together, prevent the leg from being too far extended, and admit of a little rotation of the toes outwards in the bent state of the knee, but prevent rotation inwards. Q. Are any cartilages situated in the knee-joint ? A. The two inter-articular cartilages are placed on the upper surfaces of the tibia. Q. Describe these inter-articular cartilages ? A. They are also called semilunar from their shape, their circumference is thick, while their inner concave edge is thin like a sickle, their cornua are joined, and their convex thick surface adhere to the capsular liga- ment. THE LIGAMENTS. 171 Q. What is the use of these two semilunar cartilages in each knee-joint ? A. They deepen the cavities on the top of the tibia, and adapt them better to the condyles of the femur, by which they give greater security to the joint. Q- What ligaments bind the fibula to the tibia ? A. The capsular above, the interosseous in the mid- dle, and the transverse ligaments below. Q. What are the attachments of the capsular liga- ment of the fibula ? A. It is attached round the articulating surface of the two bones, and is much strengthened by the exter- nal lateral ligament of the knee, and the tendon of the biceps. ' Q. What are the attachments of the interosseous'li- gament ? A. It is attached to the posterior and outer ridge of the tibia, extends across to the inner ridge of the fibula, and fills up the intermediate space between the bones. Q. Are any holes in it ? A. There is a large opening above occupied by mus- cles, and some small holes lower down, through which bloodvessels and nerves pass. Q. What is the use of this interosseous ligament ? A. It binds the bones together, and affords origin to muscles. Q. What are the attachments of the transverse liga- ments of the fibula ? A. The anterior arises from the anterior edge of the semilunar cavity of the tibia; the posterior from its pos- terior edge, and they are both firmly inserted into the end of the fibula, which forms the malleolus externus. Q. What ligaments connect the ends of the tibia and fibula to the bones of the tarsus ? A. The anterior, posterior, and middle ligaments of the fibula, the deltoid of the tibia, and the capsular liga- ment. Q. What are the attachments of the anterior liga- ment of the fibula ? A. It arises from the fore part of the malleolus exter 172 THE LIGAMENTS. nus, and passing obliquely forwards, is inserted into the upper and outer part of the astragalus. Q. What are the attachments of the posterior liga- ment of the fibula ? A. It arises from the under and back part of the mal- leolus externus, and running backwards, is inserted into the outer and posterior part of the astragalus ? Q. What are the attachments of the middle or per- pendicular ligament of the fibula ? A. It arises from the point of the malleolus externus, and descending almost perpendicularly is inserted into the outside of the os calcis. Q. Describe the ligamentum deltoides of the tibia ? A. It arises from the malleolus internus, and descend- ing in a radiated manner is inserted into the astragalus, os calcis, and os naviculare. Q. What are the attachments of the capsular liga- ment of the tarsus ? A. The capsular ligament lying within those just mentioned, arises from the margin of the articular cavity of the tibia and fibula, and is inserted round that of the astragalus. Q. What motions does the ankle-joint perform ? A. Motions of flexion and extension only. This joint is so firmly secured by the projections of the tibia and fibula, and by the different strong ligaments, that one of the malleoli must be fractured before it can be dislo- cated. Q. What ligaments have the bones of the tar- sus? A. They have articulating cartilages between them, and capsular ligaments round every articulation; and besides, they are bound together most firmly by liga- ments passing across from bone to bone, in a variety of directions. Q. Mention the most conspicuous of these ? A. The capsular ligament, which surrounds the arti- culation of the os calcis and astragalus; the capsule of the astragalus and os naviculare, which admits of the lateral and rotatory motions of the foot; the inter. THE LIGAMENTS. 173 rial ligament passing between the under part of the os calcis and os naviculare for supporting the astragalus. Q. What ligaments connect the tarsal and meta- tarsal bones ? A. Capsular ligaments around their articulations, strengthened by dorsal, plantar, lateral, oblique or trans- verse, as their fibres are directed. Q Wlat ligaments connect the metatarsal bones to- gether ? A. The dorsal or transverse, plantar and lateral liga- ments. Q. What ligaments connect the phalanges of the toes together ? A. The capsular and lateral ligaments. Q. What ligaments retain the tendons of the muscles of the foot and toes in situ ? A. The annular ligament of the tarsus, formed by the aponeurosis. It forms also sheathstfor the tendons in playing round the ankles, and the plantar aponeurosis forms other sheaths in the sole. . OF SURGICAL ORGANIC DISEASES OF LIGAMENTS. Q. What organic derangements are ligaments sub- j ect to ? A. Ligaments are ruptured, inflamed, thickened, re- laxed, reduced to a thickened and spongy state, ossified, and give rise to morbid cartilaginous bodies. Q. In what circumstances are ligaments lacerated and ruptured ? A. In cases of luxation ; where some ligaments are always overstretched, lacerated, and ruptured, which is the cause of the acute pain. Q. From what causes do they become inflamed ? A. Ligaments may become inflamed from various causes, such as, injuries, Gout, Rheumatism, and White Swelling. Q. What are the effects of inflammation of liga- ments ? A. It renders the ligaments extremely sensible and P 2 174 THE LIGAMENTS. painful; and in the progress of disease they become often much thickened and rigid; and sometimes sup • purate. Q. In what diseases are the ligaments reduced to a thickened and spongy state ? A. In Scrofulous diseases of the joints, the ligaments, as well as the cartilages covering the articular surfaces, become soft, spongy, and thick; and are sometimes dissolved into an ill-conditioned pus. Q. In what disease do the ligaments become unusu- ally relaxed ? A. In some rare cases of general, or topical debility, the capsular ligament becomes so preternaturally relax- ed and elongated, as to allow the head of the articulat- ing bone to remove from its socket, and to produce a temporary and spontaneous luxation. Q. Is the conversion of ligament into bone a frequent occurrence ? • • A. It is pretty frequent, especially if the ligament par- takes of a cartilaginous nature. It is more frequent too in advanced age. Q. Are cartilaginous bodies frequently attached to ligaments ? A. Sometimes, though rarely, they grow from liga- ments; or are formed between the external layers of their substance, and are called tophi. Q. What seems to be the cause of the growth of these bodies ? A. They seem to arise from some strain or over- stretching, or from a bruise of the ligament of the part; in which an effusion takes place, which is gradually con- solidated and converted into cartilage. OF MYOLOGY. Q. What is understood by a muscle ? A. It is a fleshy substance, composed of fibres sus- ceptible of contraction and relaxation. Q. What parts does a muscle consist of? A. Of an origin, a belly, and an insertion or termina- tion. OK MYOLOGY. 175 Q. How is the origin known from the insertion ? A. The extremity attached to the most fixed part, to which the contraction is made, is called the origin of the muscle. Q. What is meant by the belly ? A. It is that thickest part, which in action swells and enlarges. Q. What connects the fibres of the muscles together ? A. Cellular substance. Q. What forms the tendons of muscles ? A. The cellular substance condensed into a tendinous expansion gives attachment often to the oblique fibres in the course of the muscle, and at the extremity, gene- rally becomes stronger and rounder. Q. What purposes do the tendons of muscles serve ? A. They occupy less space while passing over joints to their termination, and preserve the symmetry of the parts, and are not easily fatigued with continued ac- tion. Q. Does the tendinous expansion answer any other purpose besides giving attachment to muscular fibres ? A. It also sometimes covers the muscles, binds them in their situation, and in certain parts keeps their ten- dons from starting out of their places. Q. Are tendons to be considered different from mus- cles, although they form a part of them ? A. Yes ; the fibrous and fleshy part of muscles is that capable of contraction and relaxation; while the white, glistening, tendinous part of them having very little sen- sibility, and no contractibility, is disposed in layers, or . chords in their substance, in order to afford attachment ' to the fibres, and towards their termination it becomes \firmer and stronger for sustaining the whole power of the fibrous part. Q. Can the fibrous part of a muscle then not act without a tendinous part ? A. Yes; when the distance is small between the ori- gin and termination of muscles, they have no tendons; but when the distance is great, their fibres are generally disposed obliquely, and are attached to one or more ten- 176 OF MYOLOGY. dinous chords, or fasciae, to which they contract as to a fixed point. Q. Have muscular fibres a large supply of blood and nervous influence ? A. Yes, it is the quantity of blood in the moving fibres that gives them their red colour; and the copious supply of nerves gives their great sensibility and mobi- lity. Q. Have the tendons less blood and fewer nerves in their texture ? A. Yes, much less ; their texture is compact and firm, and does no't admit of Vessels carrying red blood; their office is such, as not to require sensibility; and in consequence their nervous filaments are so small, that they have never yet been traced. Q. Since tendons have so small blood-vessels and nerves, can adhesion take place in them after they have been ruptured ? A. Yes; the injury irritates and stimulates the rup- tured vessels to an increased action, by which, adhe- sion, though slow in progress, of the ruptured parts is effected. PHYSIOLOGY OF MUSCULAR MOTION. Q. What circumstances are to be considered with re- gard to musculaT motion ? A. 1. The intensity of the contraction of the muscle; 2. Its duration; 3. Its quickness ; 4. Its extent. Q. By what circumstances does the intensity of mus- cular action appear to be regulated ? A. The influence of the brain, and the. structure of the muscular fibre; the former when intense bracing up the most delicate and pale fibres to strong exertion, though the muscles generally exert their power in proportion to the size, redness, and strength of the fibres. Q. Upon what does the duration of muscular con- traction depend ? A. Upon the will, varied, however, by the intensity of the contraction and the weakness of the individual. PHYSIOLOGY OF MUSCULAR MOTION. 177 The change of position removing the strain of exertion from one set of muscles to another, enables the system to bear the effort longer. Q. Upon what does the rapidity of the contractions depend ? A. Somewhat upon habit; as, in fencing, dancing, &c.; yet as with the same degree of practice different persons have motions of different degrees of quickness, it depends also upon the power of constitution trans- mitted through the brain. Q. What is to be said of the extent of muscular con- traction ? A. It varies according to the length of the fibres, di- rected by the will. Q. How does the muscular contraction differ from that which is the result of wounds of the brain, diseases of that organ, &c. ? A. They are wholly independent of the will, and ex- ert themselves without regard to it. Q. What varieties do the muscles present in different ages ? A. In the foetus, they are of a pale grey, slightly red, growing with the other parts; with the exception of the muscles of respiration and digestion, at birth they are hard- ly formed. In youth they are round and beautiful; in adults, more marked and strong, containing more fi- brine, ozmazome and iron, than at an'early age. In old age, they grow paler, flatter and more weak, their con- tractility is lessened, and their texture more tough. OF THE MUSCLES OF THE HEAD. Q. In treating of the muscles, we shall begin with the head and proceed downwards, in the order best cal- culated for assisting the memory and explaining the movements of the joints. In the first place, then, des- cribe the origin and insertion of the Occiplto-fronta- lis ? A. It arises from the transverse ridge of the occipital bone, fleshy in the middle, and tendinous »iear the tem- 178 THE MUSCLES OF THE HEAD. poral bones; its broad tendinous expansion runs for- wards, adhering to the integuments, becomes fleshy on the os frontis, and is inserted into the skin of the eye- brows, and parts under it, into the orbicularis palpebra- rum and the os frontis at the inner angle of the orbit. Q. What is the use of the Occipito-frontalis ? A. It moves the eyebrows upwards, and wrinkles the integuments of the forehead. Q. Wliat are the origin and termination of the Corru- gator supercilii ? A. The corrugator supercilii arises fleshy from the in- ternal angular process of the os frontis, and is inserted into the occipito-frontalis, and orbicularis palpebrarum, at the middle of the superciliary ridge. Q. What are its actions ? A. Its name denotes its actions; it corrugates the skin of the forehead by drawing the eyebrow down and inwards. Q. Enumerate the muscles attached to the exter- nal ear ? A. They are three, the attollens aurem, anterior auris, and retrahentes aurem. Q. Describe the origin, insertion, and use of the At- tollSns aurem ?' A. It arises, broad and thin, from the tendon of the occipito-frontalis, and is inserted into the upper part of the concha or cartilage of the ear; it draws the ear up- wards, and makes the parts tense. Q. Describe the origin, insertion, and use of the An- terior auris ? A. It arises, thin and membranous, from the poste- rior part of the zygoma, and is inserted into the back of the helix; it elevates the ear. Q. What are the origin, insertion, and use of the i?e- trahentes aurem ? A. Two or three distinct small muscles arise from the upper and outer part of the mastoid process ; and are in- serted by small tendons into the back of the concha; they draw the concha backwards. THE MUSCLES OF THE HEAD. 179 Q. What muscles are peculiar to the external ear itself? A. The helicis major, helicis minor, traglcus, anti- tragtevs, and transversus auris. Q. Describe the origin, insertion, and use of the He- ticis major ? A. It arises from the anterior acute part of the helix, ascends upon it, and is inserted into the helix above the tragus ; it is destined to contract part of the helix, or to render it tenser; but few persons can use these muscles of the external ear. Q. Describe the Helicis minor ? A. It arises from the under and fore part of the he- lix, and is inserted into the helix a little higher up; it should contract the fissure over which it passes. Q. Describe the origin, insertion, and use of the Tra- gicus ? A. It arises from the middle and outer part of the concha, and is inserted into the point of the tragus; it should pull the point of the tragus forwards. Q. Describe the origin, insertion, and use of the An- ti-tragicus ? A. It arjses from the internal and lower part of the anti-helix, and is inserted into the tip of the anti-tragus; it should pull the anti-tragus and anti-helix towards each other. Q. What are the origin, insertion and use of the Transversus auris ? A. It arises from the back and prominent part of the concha, and is inserted into^the outside of the anti-he- lix; it should draw its attachments towards each other. Q. Enumerate the muscles of the internal ear? A. They are three ; the laxator tympani, tensor tym- pani, and stapedius. Q. What are the origin, insertion, and use of the Laxator tympani ? A* It arises from the spinous process of the os sphe- noides, and running backwards and a little upwards, along with the nerve named chorda tympani, through the fissura glasseri, is inserted into the long process 180 THE MUSCLES OF THE HEaD. of the malleus within the tympanum; it draws the mal- leus obliquely forwards and outwards, by which it re- laxes the membrana tympani adhering to the malleus. Q. Describe the Tensor tympani ? A. It arises from the cartilaginous portion of the Eustachian tube, and from the spinous process of the os sphenoides, and running backwards, its tendon tuins into the tympanum, and is inserted into the handle of the malleus; it pulls the malleus inwards, and makes the membrana tympani more concave and tense. Q. Describe the origin, insertion, and use of the Stapedius ? A. It arises from a small cavern in the pars petrosa, near the mastoid process, its tendon passes forwards, through a small hole of the cavern, enters the tympa- num, and is inserted into the posterior part of the head of the stapes; it pulls the stapes obliquely up and back- wards, and thereby stretches the membrana tympani. Q. What muscles move the palpebrae ? A. Two; the orbicularis palpebrarum, and levator palpebrae superioris; the movements of the occipito- frontalis also influence their motions. Q. What are the origin, insertion and use of the Orbicularis palpebrarum ? A. It arises from the orbitar and nasal processes of the superior maxilla, and from the internal angular pro- cess of the frontal bone, and running round the orbit, under the skin, is inserted into the integuments of the eyelids, and above into the corrugator supercilii and frontalis; it closes the eyelids, presses the ball and lachrymal organs. Q. Describe the Levator palpebrae superioris? A. It arises from the upper margin of the foramen opticum, and is inserted into the cartilage, or tarsus, of the upper eyelid by a broad thin tendon ; it raises the eyelid and opens the eye. Q. What muscles are concerned in moving the*EYj:- &ALL? A. Six; namely, four straight, the levator, depres- sor, adductor, and abductor oculi; and two oblique, THE MUSCLES OF THE HEAD. 181 the obliquus superior or trochlearis, and the obliquus inferior. Q. Describe the origin, insertion, and uses of the four recti muscles ? A. They all four arise from the bottom of the orbit, around the foramen opticum, and are inserted into the tunica sclerotica, near to the cornea; the Levator on the upper, the Depressor on the under, the Adductor on the inner, and the Abductor on the outer part of the globe of the eye; each pulls the eye in its own particu- lar direction. Q. Describe the origin, insertion, and use of the Obliquus superior or trochlearis ? A. It arises from the edge of the foramen opticum between the levator and adductor oculi, runs forwards, forms a round tendon, which passes through a cartila- ginous pulley fixed behind the internal angular process of the frontal bone, turns downwards, outwards, and backwards under the levator oculi, and is inserted by a broad thin tendon into the sclerotic coat half way between the insertion of the levator oculi and the op- tic nerve ; it rolls the eye-ball, turning the pupil down and outwards. Q. What are the origin, insertion, and use of the Obliquus inferior ? A. The inferior oblique arises narrow from the outer edge of the orbitar process of the superior maxilla near the lachrymal groove, and passing obliquely outwards, backwards, and upwards round the ball, is inserted by a broad thin tendon into the sclerotic coat between the entrance of the optic nerve and insertion of the abduc- tor oculi; it rolls the eye, turning the pupil upwards and inwards, and during the action of the superior oblique, it pulls the eye forwards. Q. What nerves are distributed to these six muscles of the eye-ball ? A. The third pair, named Motor oculi, is distributed to the levator, depressor, adductor, and obliquus infe- rior ; the fourth pair, the *Vervus Patheticus, is dis- persed entirely upon the trochlearis or superior oblique ; Q 182 THE MUSCLES OF THE HEAD. and the sixth pair, the Abducens, is dispersed entirely upon the abductor. Q. How many muscles are proper to the nose ? A. There is one only on each side of it, namely, the compressor naris. Q. Describe the origin, insertion, and use of the Compressor naris ? A. It arises narrow from the root of the ala nasi ex- ternally, runs upwards, spreading on the cartilage to- wards the ridge of the nose, and is inserted into the anterior extremity of the os nasi, and nasal process of the superior maxilla, and meets with fibres descending from the occipito-frontalis; it compresses the ala in smelling, and by the assistance of the frontalis pulls the ala outwards, corrugates the skin of the nose in ex- pressing certain passions. Q. What muscles are connected with the lips ? A. Nine; three above, namely, the levator anguli oris, levator labii superioris alaeque nasi, depressor labii superioris alaeque nasi; three below, the depressor anguli oris, depressor labii inferioris, levator labii infe- rioris ; 'and three lateral, towards the cheek, the bucci- nator, zygomaticus major, and minor. Q. Describe the origin, insertion, and use of the Le- vator anguli oris ? A. It arises thin and fleshy from the superior max- illa, between the socket of the first dens molaris and the foramen infra-orbitarium, and is inserted into the angle of the mouth ; it draws up the corner of the mouth, and makes the cheek prominent as in smiling. Q. Describe the Levator anguli oris alaeque nasi ? A. It arises partly from the external part of the or- bitar, and partly from the upper part of the nasal pro- cess of the superior maxilla, and is inserted into the upper lip and outer part of the ala nasi; it elevates the upper lip, and dilates the nostril. Q. Describe the origin, insertion, and action of the Depressor labii superioris alaeque nasi ? A It arises thin and fleshy from the alveoli of the two dentes incivisi, and caniuus, and running up under THE MUSCLES OF THE HEAD. 183 the levator, is inserted into the upper lip and root of the ala nasi; it draws the lip and ala downwards. Q. Describe the Depressor anguli oris ? A. It arises broad and fleshy from the lower edge of the inferior maxilla at the side of the chin, is there con- nected with the platysma myoides, the depressor labii, and skin, and becoming narrower as it ascends, is in- serted into the angle of the mouth, joining the levator anguli oris, and zygomaticus major; it depresses the corner of the mouth. Q. Describe the origin, insertion, and use of the De- pressor labii inferioris ? A. It arises broad and fleshy from the inferior part of the lower jaw nearest the chin, ascends obliquely inwards, and is inserted into one half of the under lip ; it depresses the lip. Q. What are the origin, insertion, and use of the Levator labii inferioris ? A. It arises from the roots of the alveoli of two in- cisivi and the caninus, and is inserted into the under lip and skin of the chin; it pulls these parts upwards. Q. Describe the origin, insertion, and use of the Buccinator ? A. It arises tendinous and fleshy, from the ridge extending from the last dens molaris to the coronoid process of the inferior maxilla, and from the superior maxilla between the last dens molaris and pterygoid process of the sphenoid bone, and partly from its ex- tremity, being joined to the constrictor pharyngis su- perior ; it thence runs forwards, adhering to the mem- brane which lines the mouth, and is inserted into the angle of the mouth within the orbicularis oris; it draws the angle of the mouth baek and outwards, presses the cheek, and is employed in blowing wind-instruments. Q. Describe the origin, insertion, and action of the Zygomaticus major ? A. It arises fleshy from the os malae near the zygo- matic suture, and descending obliquely forwards is in- serted into the angle of the mouth, intermixing its fibres with those of the depressor anguli oris and orbicularis; 184 THE MUSCLES OF THE HEAD. it draws the angle of the mouth and under lip upwards and outwards, and makes the cheek prominent. Q. What are the origin, insertion, and use of the Zygomaticus minor ? A. It arises from the prominent part of the os ma- lae obove the former, and is inserted into the upper lip near the corner of the mouth ; it raises the angle of the mouth obliquely upwards and outwards. Q. Describe the Orbicularis oris? A. It is a complete sphincter, composed of the fibres of the superior descending, and of the inferior ascend- ing muscles, decussating each other at the corner of the mouth, and running along the lips to join those of the opposite side; it draws both lips together, and shuts the mouth. Q. How many muscles are concerned in raising the inferior maxilla, and shutting the mouth ? A. Four on each side ; namely, the temporalis, mas- seter, pterygoideus internus, and externus. Q. Is there any aponeurosis covering the temporal muscle ? A. Yes; it is a strong tendinous membrane, arising from the bones, which give origin to the upper semi- circular portion of the temporal muscle, and descending over it, is inserted into the zyg5ma. Q. Describe the origin, insertion, and use of the Temporal muscle ? A. It arises fleshy from the semicircular ridge of the lower and lateral part of the parietal bone, from the squamous portion of the temporal, from the external angular process of the frontal, and from the temporal process of the sphenoid bone; its fibres converge, pass down under the zygoma, and form a strong tendon, which embraces, and is inserted into the coronoid pro- cess of the inferior maxilla; it pulls the jaw upwards, and a little backwards. Q. Describe the origin, insertion, and use of the Masseter ? A. It arises by strong tendinous and fleshy fibres from the superior maxilla, where it joins the os malae, THE MUSCLES OF THE HEAD. 185 and from the whole length of the under and inner edge of the zygoma, the external fibres slant backwards, and the internal forwards; and it is inserted into the angle of the lower jaw and upwards near to the top of the coronoid process; it pulls the jaw upwards, and by means of its decussating fibres, forwards or back- wards. Q. Describe the PterygoidSus internus ? A. It arises from the fossa pterygoidea of the sphe- noid and palate-bones, passing downwards and outwards, is inserted into the inner side of the angle of the lower jaw as far as the groove ; it raises the jaw, and draws it obliquely towards the opposite side. Q. What are the origin, insertion, and use of the PterygoidSus externus ? A. It arises from the outer side of the pterygoid, and root of the temporal process of the sphenoid bones, and from the tuberosity of the superior maxilla, and passing almost horizontally outwards, is inserted into the cervix and capsular ligament of the lower jaw; it pulls the jaw towards the opposite side, and with the assistance of its fellow brings it forwards, and draws the capsule from the joint, lest it should be pinched in the motions of the jaw. Q. What muscles appear superficially on the fore and lateral part of the neck ? A. Two on each side; the platysma myoides or mus- culus cutaneus, and the sterno-cleido-mastoideus. Q. Describe the origin, insertion, and use of the Platysma Myoides, or Musculus Cutaneus ? A. It arises by fleshy slips from the cellular sub- stance covering the upper parts of the pectoral and del- toid muscles, they unite into a thin muscle, which runs obliquely upwards on the side of the neck, adhering to the skin, and is inserted into the side of the lower jaw, and depressor anguli oris, and into the skin; it assists ' in depressing the lower jaw, angle of the mouth, and skin of the cheek. Q. Describe the origin, insertion, and use of the Sterno-cleido-mastoidSus ? Q 2 186 THE MUSCLES OF THE HEAD. A. It arises by a round tendinous and a little fleshy head from the sternum, and by another broad and fleshy from the sternal portion of the clavicle, they unite into a strong muscle, which ascends obliquely outwards, being covered by the platysma myoides, is inserted by a thick strong tendon into the mastoid process, and be- coming thinner as far back as the lambdoidal suture. Q. What muscles depress the inferior maxilla, and open the mouth ? A. Five on each side ; namely, the digastricus, mylo- hyoideus, genio-hyoideus, genio-hyo-glossus, and the platisma myoides. Q. Describe the origin, insertion, and use of the Digastricus ? A. It arises fleshy from the fossa at the root of the 'mastoid process, descends forwards forming a round tendon, which passes through the belly of the stylo- hyoideus, and is fixed by a ligament to the os hyoides, from which it receives an addition of muscular and tendinous fibres, ascends obliquely forwards, and be- coming again fleshy, is inserted into a rough sinuosity on the anterior and inferior edge of the chin at the sym- physis ; it opens the mouth, or raises the os hyoidea as in swallowing. Q. What are the origin, insertion, and use of the Mylo-Hyoideus ? A. It arises broad and fleshy from the inside of the inferior maxilla, between the last dens molaris and the middle of the chin, joined there to its fellow by a ten- dinous line, descends behind the digastricus, and con- verging its fibres, is inserted into the lower edge of the base or body of the os hyoides; it draws the os hyoides upwards, forwards, and to a side. Q. Describe the origin, insertion, and use of the Genio-HyoidSus ? A. It arises tendinous from a rough protuberance on the inside of the symphysis, becoming bioader as it descends, is inserted into the base of the os hyoides, under the former; it draws the os hyoides towards the chin; or when the os hyoides is fixed by muscles at- THE MUSCLES OF THE HEAD. 187 tached to the sternum, it draws down the chin, and opens the mouth. Q. Describe the Genio-hyo-glossus ? A. It arises a little higher from the same rough pro- tuberance on the inside of the symphysis, spreading its fibres like a fan forwards, upwards, and backwards, is inserted into the whole length of the tongue, and base of the os hyoides near its cornu; according to the direction of its fibres, it draws the tongue forwards, or backwards, its middle downwards, and makes its upper surface concave: or it pulls the os hyoides forwards, and thrusts the tongue out of the mouth. Q. What muscles attach the os hyoides to the trunk ? A. Four on each side; namely, the sterno-hyoideus, omo-hyoideus, sterno-thyroideus, and thyro-hyoideus. Q. Describe the Sterno-hyoidSus ? A. It arises thin and fleshy from the extremity of the first rib, from the upper part of the sternum, and from the sternal extremity of the clavicle, and ascend- ing, is inserted into the base of the os hyoides, which it pulls downwards. Q. Describe the origin, insertion, and use of the Omo-hyoideus ? A. It arises thin, broad, and fleshy from the superior costa of the scapula near the semilunar notch, and run- ning obliquely upwards and forwards, becomes tendi- nous under the sterno-mastoideus, and again fleshy, is inserted into the base of the os hyoides at the side of the former; it pulls the os hyoides obliquely down- wards; and, together with its fellow, straight down- wards. Q. Describe the origin and insertion of the Slerno- thyroidSus ? A. It arises fleshy from the upper and inner part of the sternum, and end of the first rib, and is inserted into the rough line at the under and lateral part of the thyroid cartilage. Q. Describe the origin, insertion, and use of the Thyro-hyoideus ? 188 THE MUSCLES OF THE HEAD. A. It arises fleshy from the rough line of the thyroid cartilage at the insertion of the former, and is inserted into part of the base, and almost all the cornu of the os hyoides; which it depresses when the former keeps the thyroid cartilage fixed. Q. What muscles are attached to the tongue ? A. Part of the genio-hyo-glossus, the hyo-glossus, lingualis, and stylo-glossus. Q. Describe the origin, insertion, and use of the Hyo-glossus ? A. It arises fleshy from the half of the os hyoides, and running upwards and outwards is inserted into the side of the tongue near the stylo-glossus ; it pulls the tongue inwards and downwards. Q. Describe the origin, insertion, and use of the Lingualis muscle ? A. It arises from the lateral part of the root of the tongue, and, running forwards between the hyo-glos- sus and genio-hyo-glossus, is inserted into the tip of the tongue; it contracts the substance of the tongue, and pulls it backwards. Q. Describe the origin, insertion, and use of the Stylo-glossus ? A. It arises tendinous and fleshy from the styloid proeess of the temporal bone and ligament connecting it to the angle of the jaw, and running downwards and forwards, is inserted into the root and side of the tongue near to its apex; it draws the tongue backwards to one side. Q. What muscles are situated in the fauces ? A. Four on each side ; namely, the constrictor isth- mi faycium, palato-pharyngeus, circumflexus vel tonsor palati, levator palati; and the azygos uvulae in the middle. Q. What are the origin, insertion, and use of the Constrictor isthmi faucium ? A. It arises from the side of the root .of the tongue, runs in the doubling of the skin forming the anterior arch of the palate before the amygdala, and is inserted into the velum palati at the root of the uvula, where it joins THE MUSCLES OF THE HEAD. 189 its fellow : it assists in shutting the passage into the fau- ces. Q. Describe the Palato-pharyngBus ? A. It arises from the middle of the velum palati, from the insertion of the former, and the tendinous ex- pansion of the circumflexus palati, and running within the duplicature of the posterior arch behind the amyg- dala, backwards to the superior and lateral part of the pharynx, is inserted into the edge of the upper and back part of the thyroid cartilage, and back of the pharynx; it assists in shutting the passage into the nostrils, and, in swallowing, conveys the bolus into the pharynx. Q. Describe the origin, insertion, and use of the Cir- cumflexus or Tensor palati ? A. It arises from the spinous process of the sphenoid bone, from the osseous and cartilaginous parts of the Eustachian tube, and from the root of the internal ptery- goid process, runs down along the pterygoideus internus, forms a round tendon, which passes over the hook of the internal pterygoid plate, then spreads out into a tendi- nous expansion, and is inserted into the velum pendu- lum palati and semilunar edge of the os palati, as far as the suture, where its fibres are joined to those of the two former muscles; it stretches and depresses the ve- lum. Q. Describe the origin, insertion, and use of the Lavator palati? A. It arises tendinous and fleshy from the point of the petrous portion of the temporal bone, and mem- branous part of the Eustachian tube, and descending, is inserted into the whole length of the velum palati, and uniting with its fellow at the root of the uvula; it pulls the velum upwards and backwards, and shuts the pas- sage into the nose and mouth. Q. Describe the origin, insertion, and use of the Azygos uvulae ? A. It arises fleshy from the posterior extremity of the longitudinal palate suture, runs down the whole length of the velum and uvula, adhering to the tendons of the 190 THE MUSCLE8 OF THE HEAD. circumflexi, and is inserted into the point of the uvula; it raises and shortens the uvula. Q. What muscles are concerned in the movements of the pharynx ? A. Four on each side; the stylo-pharyngeus, the con- strictor pharyngis inferior, medius, and superior. Q. Describe the origin, insertion, and use of the Sty- lo-pharyngBus ? A. It arises fleshy from the root of the styloid process, and running downwards and forwards is inserted into the side of the pharynx and back part of the thyroid car- tilage ; it dilates and raises the pharynx, so as to receive the bolus in swallowing, and it elevates the thyroid car- tilage. Q. Describe the Constrictor pharyngis inferior ? A. It arises from the side of the thyroid and cricoid cartilages, and is inserted into its fellow behind, forming a longitudinal tendinous line; it compresses the lower part of the pharynx, and draws it and the larynx a little upwards. Q. What are the origin, insertion, and use of the Con- strictor pharyngis medius ? A. It arises from the appendix and cornu of the os hyoides, and from the ligament attaching the cornu to the thyroid cartilage, spreading its superior fibres oh- 4iquely upwards, and the others more transversely, it is inserted into the middle of the cuneiform process of the occipital bone before the foramen magnum, and in- to its fellow by a tendinous fine ; it compresses the mid- dle of the pharynx. Q. What are the origin, insertion, and use of the Con- strictor pharyngis superior ? A. It arises from the cuneiform and pterygoid pro- cesses, from the upper and under maxilla near the last alveolar processes, from the back part of the buccinator, root of the tongue, and palate; and is inserted into its fellow by a tendinous line on the posterior surface of the pharynx ; it compresses the upper part of the pha- rynx, draws it forwards and upwards. THE MUSCLES OF THE HEAD. 191 Q. What muscles are concerned in the movements of the larynx ? _ A. Four on each side; the crico-arytaenoideus pos- ticus, crico-arytaenoideus lateralis, thyro-arytaenoideus, and the arytaenoideus obliquus; and one common to both sides, the arytaenoideus transversus. Q. Describe the origin, insertion, and use of the Crico- arytaenoideus posticus. A. It arises fleshy from the back part of the cricoid cartilage, and is inserted by a narrow extremity into the posterior part of the base of the arytenoid cartilage, which it pulls backwards, making the ligament of the glottis tense, and opening the rima glottidis. Q. Describe the Crico-arytaenoidSus lateralis ? A. It arises fleshy from the side of the cricoid car- tilage, where it is covered by the thyroid, and is inserted into the side of the base of the arytenoid cartilage; it opens the rima glottidis. Q. Describe the origin, insertion, and use of the Thyro-arytaenoidSus ? A. It arises from the middle and under part of the back of the thyroid cartilage, and running backwards and a little upwards, is inserted into the fore part of the arytaenoid cartilage, which it pulls forwards and out- wards, and opens the glottis. Q. Describe the origin, insertion, and use of the Ary- taenoideus obliquus ? A. It arises from the base of one of the arytaenoid cartilages, and crossing its fellow obliquely, is inserted into the point of the other; it, with its fellow, draws the two arytaenoid cartilages together, and shuts the aper- ture of the glottis. Q. Describe the Arytaenoideus transversus ? A. It arises from the whole length of the bank of the one arytaenoid cartilage, and running transversely, is inserted into the whole length of the other; it draws the arytaenoid cartilages together and closes the rima- ty glottidis. Q. What muscles arc attached to the epiglottis ? 192 > THE MUSCLES OF THE HEAD. A. Tioo on each side; the thyro-epiglottideus, and arytaeno-epiglottideus. Q. Describe the Thyro-epiglottidBus ? A. It arises by a few scattered fibres from the thyroid cartilage, and is inserted into the side of the epiglottis ; it with its fellow draws down the epiglottis upon the rima glottidis, and shuts the aperture. Q. What are the origin, insertion, and use of the Ary- taeno-epiglottidSus ? A. It arises by a few slender fibres from the lateral and upper part of the arytenoid cartilage, and running along the outer side of the external rima, is inserted in- to the epiglottis along with the former muscle; it and its fellow pull down the epiglottis and shut the glottis. Q. What are the antagonists of these muscles of the epiglottis. A. They have no antagonist muscles; but the struc- ture of the cartilage of the epiglottis is so formed, that it turns upwards by its own elasticity, and opens the glot- tis. Q. What muscles are situated near to the vertebrae on the anterior part of the neck ? A. Four, the longus colli, recti capitis anterior major, and minor, and rectus capitis lateralis. Q. Describe the Longus colli ? A. It arises tendinous and fleshy from the side of the bodies of the three superior dorsal vertebrae, and from the transverse processes of the four inferior cervical verte- brae, and is inserted by tendons covered with fibres into the anterior part of the bodies of all the cervical vertebrae ; it and its fellow bend the neck forwards. Q. Describe the Rectus capitis anterior major ? A. It arises from the fore part of the transverse pro- cesses of the four undermost cervical vertebrae, and running up and inwards, is inserted into the cuneiform process of the occipital bone ; it bends the head forwards. Q. Describe the origin, insertion, and use of the Rectus capitis anterior minor ? A. It arises from the fore part of the atlas, and run- ning obliquely inwards on the outside of the former, is THE MUSCLES OF THE HEAD. 193 inserted into the cuneiform process immediately before the condyles; it and its fellow assist the rectus major in nodding the head. Q. Describe the origin, insertion, and use of the Rec- tus capitis lateralis ? A. It arises fleshy from the anterior part of the trans- verse process of the atlas, and running obliquely out- wards, is inserted into the os occipitis behind the jugu- lar fossa; it pulls the head to one side. Q. What muscles are skuated on the lateral part of the neck? A. The three Scaleni; namely, the scalenus anticus, medius, and posticus; and the levator scapulas. Q. Describe the origin, insertion and use of the Sca- lenus antlcus ? A. It arises tendinous and fleshy from the upper edge of the first rib near the sternum, and is inserted by tendons into the transverse processes of the fourth, fifth, and sixth cervical vertebrae ; it pulls the neck to one side, or with the assistance of its fellow it draws the neck for- wards. Q. Describe the ScalSnus medius ? A. It arises from the upper and outer part of the first rib from its root to near its cartilage, and is inserted by strong tendons into the transverse processes of all the cervical vertebrae; it draws the neck to one side; or in conjunct action with its fellow it brings it forwards. Q. Describe the origin, insertion, and use of the Sca- lenus posticus ? A. It arises from the upper edge of the second rib near the spine, and is inserted into the transverse processes of the fifth and sixth cervical vertebrae ; it assists in draw- ing the neck to one side, or it and its fellow pull the neck forwards. Q. What are the actions of all the three scaleni mus- cles ? A. They co-operate in pulling the neck to one side, or with their fellows they pull it directly forwards; or, if the neck is fixed erect by the antagonist muscles on its pos- R 194 THE MUSCLES OF THE HEAD. terior part, they elevate the ribs, and dilate the thorax in difficult respiration. Q. Describe the origin, insertion, and use of the Leva- tor scapulae ? A. It arises from the transverse processes of the five superior cervical vertebrae by as many distinct heads, that unite and form a flat muscle, which is inserted into the base at the root of the spine, and under the superior angle of the scapula; which it raises, or pulls the neck to one side; or with its fellow, pulls it backwards. Q. Where is the course of the subclavian artery and nerves? A. The subclavian artery, and also the cervical nerves, which form the brachial plexus, pass outwards between the scalenus anticus, and the scalenus medius, to the axilla. Q. What muscles are attached to the posterior PART OF THE HEAD ? A. Seven on each side; namely, the trapezius, splenius, complexus, trachelo-mastoideus, rectus capitis posticus major, rectus capitis posticus minor, and the obliquus capitis superior. Q. Describe the origin, insertion, and use of the Tra- pezius ? A. It arises by a thick round tendon from the middle of the great arched ridge of the occipital bone, and by a tendinous expansion covering the splenius and complex- us, from the rough arch extending towards the mastoid process; from its fellow by the intervention of the liga- mentum nuchae covering the upper cervical spinous pro- cesses, from the spinous processes of the two inferior cervical, and from all those of the dorsal vertebrae, ad- hering all the length to its fellow, and is inserted fleshy into the scapular half of the clavicle, tendinous into the acromion and spine of the scapula ; it moves the scapu- la and clavicle in various directions, and when the sca- pula is fixed, it and its fellow draw the head backwards. Q. Describe the origin, insertion, and use of the Splenius ? A. It arises tendinous from the four superior spi- THE MUSCLES OF THE HEAD. 195 nous processes of the dorsal, tendinous and fleshy from the five inferior of the cervical vertebrae; it adheres firmly to the ligamentum nuchae; and at the third cervi- cal vertebra, recedes from its fellow, and is inserted by as many tendons into the five superior transverse pro- cesses of the cervical vertebrae; and by a tendinous and fleshy portion into the posterior part of the mastoid process, and into the os occipitis near it; it and its fel- low pull the head and neck backwards. Q. What are the origin, insertion, and use of the Complexus ? A. It arises tendinous and fleshy from the transverse processes of the seven superior dorsal, and four inferior cervical vertebrae, and is inserted into the depression between the superior and inferior transverse ridges of the occipital bone; it draws the head backwards and to one side, and with its fellow directly backwards. Q. Describe the origin, insertion, and use of the TrachBlo-tnastoidtus ? A. It arises from the transverse processes of the three upper dorsal, and five lower cervical vertebrae, where it is connected to the transversalis cervicis by as many thin tendons, and ascending under the splenius, is in- serted by a thin tendon into the posterior part of the mastoid process ; it pulls the head backwards. Q. Describe the Rectus capitis posticus minor ? A. It arises fleshy from the external part of the spi- nous process of the second cervical vertebra; becoming broader, it ascends obliquely outwards, and is inserted tendinous and fleshy into the inferior transverse ridge of the occipital bone; it draws the head backwards, and assists in its rotation. Q. Describe the Rectus capitis minor ? A. It arises tendinous from the protuberance in the place of a spinous process of the atlas, becoming broad- er and fleshy, is inserted into a depression between the smaller arch and foramen magnum of the os occipitis; it assists in pulling the head backwards. Q. Describe the origin, insertion, and use of the Ob- liquus capitis superior ? 196 THE MUSCLES OF THE HEAD. A. It arises from the transverse process of the atlas, and ascending a little inwards, is inserted at the outer part of the insertion of the rectus major into the inferior transverse ridge of the occipital bone, behind the mas- toid process; it assists in pulling the head backwards. Remarks. Q. What muscles particularly strengthen and secure the articulation of the head with the atlas ? A. The two recti capitis interni vel anteriores, the two recti capitis laterales on the sternal aspect; and the two recti capitis postici minores, and the two obliqui capitis superiores on the dorsal aspect. Q. What muscles bend the head forwards, or ster- nad? A. The two recti capitis anteriores minores, two recti capitis anteriores majores; two recti capitis laterales, and the two sterno-mastoidei; and also, when the infe- rior maxilla and os hyoides are fixed, the two platysma myoides, or latissimi colli, two digastrici, two mylohyoi- dei, two genio-hyoidei, and the two genio-hyo-glossi. Q. What muscles^ the inferior maxilla close to the superior ? A. The two temporal, two masseters, and the four pterygoid muscles. Q. What muscles fix the os hyoides, and prevent it from rising upwards, or corSnad ? A. The two omo-hyoidei, two sterno-hyoidei, and two thyro-hyoidei. Q. What muscles extend the head backwards, or dorsad ? A. Part of the two trapezii, the two splenii, two complexi, two recti capitis postici majores, and the two trachelo-mastoidei. Q. Why has the head five pairs of such strong mus- cles to extend it backwards, seeing their antagonists are so weak in proportion to them. A. The condyles of the os occipitis are placed much farther back than the line of equipoise between the THE MUSCLES OF THE HEAD. 197 anterior and posterior parts of the head; hence the head by its own gravity naturally falls forwards; strong muscles therefore are necessary to keep it perpendicu- larly erect; particularly in carrying burdens on the head. Q. What is the use of the ligamentum nuchae ? A. It assists these strong muscles in their continued action of keeping the head erect. Q. What muscles perform the rotatory motions of the head ? A. The two obliqui capitis inferiores, which arise from the spinous process of the second cervical verte- bra, and running upwards and outwards, are inserted into the transverse processes of the atlas, are wholly rotators of the head; many others assist tbem, name- ly, the recti postici majores, trachelo-mastoidei, com- plexi, splenii, trapezii, sterno-mastoidei, and latissimi colli. Q. How far can they turn the head round from the front, or sternal aspect ? A. The symphysis menti can be turned, generally speaking, to the right, or left, from the sternal aspect, about twenty-six degrees, or the seventh part of a circle. Q. Do the cervical vertebrae assist in the rotatory motions of the head ? * A. Motions of the head dextrad and sinistrad, are performed by the rolling of the atlas on the horizontal plane of the second vertebra, from which the proces- sus dentatus is raised perpendicularly to regulate and steady its motions. The other cervical vertebrae are so bound together by ligaments and muscles, by the form of their articulations, of their spinous processes, and inter-vertebral cartilages, that they have no sensi- ble motion on their individual axis ; but when taken to- gether, they are susceptible of a considerable contortion along with the head. Q. What muscles prevent the cervical vertebrae from rotating ? A. The inter-spinales colli occupy the spaces be- tween the bifurcated extremities of the spinous pro- R 2 198 THE MUSCLES OF THE HEAD. cesses, arising from each iuferior, and inserted into the superior, and the inter-transversales colli, occupying the spaces between the bifurcated extremities of the transverse processes, fix them together, and tend to draw the neck to one side. Q. What muscles arise from the scapula ? A. Seven, the greater part of the deltoid, supra-spi- natus, infra-spinatus, teres minor, teres major, coraco- brachialis, and sub-scapularis. Q. Describe the origin, insertion, and use of the Deltoides ? A. It arises fleshy from the scapular portion of the clavicle unoccupied by the pectoralis major, from the acromion, and lower margin of the spine of the scapu- la ; and is inserted by a short strong tendon into a rough surface on the middle of the outside of the hu- merus between the biceps, and short head of the triceps extensor, and just above the origin of the brachialis in- ternus ; it raises the arm upwards to a plane with the shoulder, turns it a little backwards or forwards. Q. What are the origin, insertion, and use of the Supra-spindlus ? A. It arises fleshy from the scapula above the spine, passes under the acromion, adheres to the capsular li- gament, and is inserted tendinous into the large tubercle on the bead of the os humeri at the outside of the bi- cipital groove; it raises the arm and prevents the cap- sular ligament from being pinched. It is covered by a strong aponeurosis. Q. Describe the origin, insertion, and use of the In- fraspinatus ? A. It arises fleshy from the scapula below the spine, and adhering to the capsular ligament, is inserted by a flat thick tendon into the upper and outer part of the large tubercle of the head of the os humeri; it turns the humerus outwards, and raises the arm. Q. What are the origin, insertion, and use of the Teres minor ? A. It arises fleshy from the inferior costa of the sea- THE MUSCLES OF THE SHOULDER. 199 pula, runs along the inferior edge of the infra-spinatus, adheres to the capsular ligament, and is inserted tendi- nous into the back part of the large tubercle below the infra-spinatus; it rolls the humerus outwards, draws it back, and prevents the capsular ligament from being pinched in the motions of the joint. Q. Describe the Teres major ? A. It arises fleshy from the outside of the inferior angle, and thick rough part of the inferior coata of the scapula, and running forwards and upwards along the under edge of the teres minor, passes the infra-spinatus, to which some fibres adhere, forms a broad flat tendon, which, accompanied by the tendon of the latissimus dorsi passing under the humerus, is inserted into the ridge at the inner side of the bicipital groove ; it rolls the humerus inwards, and pulls it backwards. Q. Describe the origin, insertion, and use of the Co- rdco-brachialis ? A. It arises tendinous and fleshy from the point of the coracoid process of the scapula, together with the short head of the biceps, to which it adheres, and is in- serted into the internal part of the middle of the hume- rus, whence it sends down an aponeurosis to the internal condyle : it assists in raising the arm obliquely forwards. Q. Describe the origin, insertion, and use of the Sub- scapularis ? A. It arises fleshy from the three costae, and whole internal surface of the scapula, composed of tendinous and fleshy portions, which converge, and form a tendon, which passes under the coraco-brachialis and short head of the biceps; adheres to the capsular ligament, and is inserted into the upper part of the small tuhercle at the head of the humerus ; it rolls the humerus inwards, and draws it to the side of the trunk. Q. Wrhat other muscles are concerned in the motions Of the SHOULDER-JOINT ? A. The pectoralis major, and minor, biceps, and the latissimus dorsi. Q. Describe the origin, insertion, and use of the Pec- toralis major ? 200 THE MUSCLES OF THE SHOULDER. A. It arises from the anterior half of the clavicle, from nearly the whole length of the sternum, and from the cartilages of the fifth and sixth ribs, its fibres converge towards the axilla; those of tho superior portion run on the anterior part, the fibes of the inferior ascend between them and the ribs; they form a broad twisted tendon, which is inserted into the ridge at the outer side of the bicipital groove, about a fourth part of the length of the humerus from its head, just above the insertion of the deltoid, and below that of the latissimus dorsi on the opposite side of the groove. Q. What are the origin, insertion, and use of the Pec- toralis minor ? A. It arises serrated, tendinous and fleshy, from the third, fourth, and fifth ribs, near their cartilages, becomes round, thick, and narrower, as it ascends obliquely, and is inserted by a short flat tendon into the point of the coracoid process of the scapula. Q. Describe the origin, and insertion of the Biceps flexor cubiti ? A. It arises by two heads; the long one from the upper margin of the glenoid cavity by a strong tendon, which passes over the round head of the humerus with- in the capsular ligament of the joint; descends in the groove of the os humeri, enclosed by a membranous sheath formed by the tendons of adjacent muscles : the short head arises from the coracoid process of the sca- pula, along with the coraco-brachialis, joins the former head a little below the middle of the humerus, forming a fleshy belly, which sends off a strong tendon down the fore part of the elbow;joint, which is inserted into the tubercle of the radius.' Q. Describe the origin, and insertion of the Latissi- mus dorsi ? A. It arises tendinous from the spinous processes of the os sacrum, the lumbar, and seven dorsal vertebrae, from the posterior part of the spine of the ilium, and from the extremities of the four inferior false ribs; it forms a broad thin muscle, the inferior fibres of which run upwards and outwards, and the superior ones trans- versely over the inferior angle of the scapula, and near THE MUSCLES OF THE SHOULDER. 201 the axilla, converge, and form a flat tendon, twisted si- milar to the pectoralis major; and is inserted into the inner edge of the bicipital groove. 8URGICAL PATHOLOGY OF THE SHOULDER. Q. Since the shoulder-joint is so well secured by ligaments and muscles, as we have just seen, is it often dislocated ? A. Its motions are very free and extensive; and as the arm is always used as a defence or safety, in cases of danger and accidents, the shoulder-joint is much ex- posed, and frequently dislocated. Q. In what positions can the head of the humerus be forced out of the glenoid cavity of the scapula ? A. It can scarcely be forced upwards; it may be lodged in the axilla downwards, under the pectoral muscle forwards, or under the spine of the scapula backwards. Q. What prevents the head of the humerus from be- ing dislocated upwards ? A. The coracoid, and acromion processes ; the conoid and trapezoid ligaments extending from the coracoid process to the end of the clavicle; the anterior triangu- lar ligament of the scapula, extending from the external surface of the coracoid to that of the acromion process, confines the tendon of the supra-spinatus down in situ ; the long head of the biceps flexor cubiti; the capsular ligament; the deltoid; thecoraco-brachialis; the supra- spinatus particularly, and the infra-spinatus, and sub- scapularis in a considerable degree, counteract any force thrusting the head of the humerus upwards. Q. What prevents the head of the humerus from be- ing luxated downwards, in the axilla ? A. The capsular ligament; the tendon of the long head of the biceps ; the supra-spinatus, in a particular manner, and the upper part of the pectoralis major; the teres minor, the teres major, the latissimus dorsi, and the long head of the triceps extensor cubiti, also contri- bute in preventing luxation downwards. 202 PATHOLOGY OF THE SHOULDER. Q. What muscles prevent the head of the humerus from passing forward in the application of a force pro- ducing luxation under the pectoral muscle ? A. The capsular ligament; the tendon of the biceps; the sub-scapularis ; the supra and infra-spinati; the teres minor, and major, and the pectoralis minor. Q. What opposes the head of the humerus in being forced backwards in luxation ? A. The capsular ligament; the tendon of the biceps; the pectoralis major, and the supra-spinatus; the ten- dons too of the infra-spinatus, and teres minor, lying close upon the capsular ligament, may have some effect in preventing the head of the humerus from passing un- der them. Q. When the head of the humerus is forced for- wards under the pectoral muscles in luxation, what muscles are most upon the stretch ? A. The supra, and infra-spinatus, the teres minor, and the sub-scapularis; the tendon of the biceps ; the latis- simus dorsi also, and teres major, to a certain degree, keep the arm down and backwards, with the elbow out- wards, and the fore-arm bent by the tendon of the bi- ceps being pulled upwards. Q. Does any rupture of parts happen in such a dislo- cation ? A. The capsular ligament must be ruptured, and per- haps also the sheath of the tendon of the biceps: the tendons of the muscles of the scapula have been sup- posed to be ruptured also in luxation of the head of the humerus forwards; but this seems improbable, from the situation of the parts: the supra, and infra-spinatus are very much over-stretched, but the position of the sca- pula, and that of the humerus render it very probable, that the head of the humerus is generally dislocated for- wards under the pectoral muscle without any rupture of their tendons having taken place; a rupture of them in- deed is possible, and may happen in some cases. Q. When the head of the humerus is lodged under the pectoral muscles, what are the means necessary to re- duce it ? PATHOLOGY OF THE SHOULDER. 203 A. The patient being laid on his opposite side, the fore-arm should be kept bent to relax the biceps; and a towel should be applied round the humerus under the insertion of the pectoralis, near the axilla, and given to an assistant. Being now ready, the surgeon should raise the humerus gradually upwards, till it be nearly in a line with the superior costa of the scapula, to relax the supra and infra spinatus; and in proportion as he raises it, he should pull gently, keeping the fore-arm in the same position, in order to disentangle the head of the bone, and to bring it within the capsular ligament. Having attained this, he should next order his assistant to pull the humerus outwards from the side of the trunk, by means of the towel under the axilla, while the sur- geon, keeping his pull, should use the fore-arm as a lever to rotate the humerus outwards, in order to favour the relaxation and action of the supra, and infra-spinatus, and teres minor, to draw it towards its socket. When these muscles are first relaxed as much as possible, and the head of the humerus brought into a favourable situ- ation, the assistant must keep a steady pull, and the sur- geon should bring down the humerus to the patient's side, rotating it inwards; during which, the muscles generally bring the head of the humerus into the gle- noid cavity of the scapula. Q. When the head of the humerus is dislocated back- wards under the spine of the scapula, what muscles are kept too much stretched ? A. The pectoralis major is very much stretched ; the supra-spinatus, sub-scapularis, teres major, and latissi- mus dorsi, are considerably over-stretched. Q. What means are necessary to reduce such a lux- ation ? A. The patient is to be laid on his opposite side, and a towel put round the humerus and given to an assist- ant, as in luxation forwards, the surgeon is to keep the fore-arm in the same degree of flexion, and the humerus in the same position of rotation, while he pulls gently downwards by a hold above the condyles, and, at the same time, orders his assistant to pull gradually increas- ~0 1 PATHOLOGY OF THE SHOULDER. ing the force outwards from the trunk. Having thus | brought the head of the humerus from under the spine ' of the scapula, and within the capsular ligament, he hi now to raise the arm gradually, rotating the fore-arm for- wards and rather outwards, tbe assistant all the while keeping a firm and steady pull; he is next to order his assistant to keep a strong steady pull, while he himself brings down the humerus to the patient's side, with the fore-arm bent obliquely forwards on the abdomen; du- ring which, the different muscles being brought into action, will draw the head of the humerus into the gle- noid cavity. Q. What muscles are situated on the humerus ? A. Two before, the Biceps flexor cubiti, and the Brachialis internus; and two behind, the Triceps exten- sor cubiti, and the Anconeus. Q. Are the muscles of the arm covered by an Apo- neurosis ? A. The greater part of the superior extremity is cov- ered by a tendinous membrane, or aponeurosis, which arises from the bones and muscles of the shoulder; it incloses the flexors and extensors of the fore-arm, and adheres to the ridges and condyles of the humerus: at the bend of the elbow it receives additions from the ten- dons of the biceps and triceps. It binds the muscles in their relative situations. Q. Recapitulate the origin, insertion, and use of the Biceps ? A. It arises by two heads, the long one arises ten- dinous from the upper margin of the glenoid cavity, and the short head arises from the coracoid process of the scapula; they unite and form a thick fleshy belly a little below the middle of the humerus, and it sends off a strong tendon, which is inserted into the tubercle of the radius ; it is an extensor, and adductor of the hu- merus, a flexor of the elbow-joint, and a supinator of the hand. Q. Describe the origin, insertion, and use of the Brachialis internus ? MUSCLE6 OF THE HUMERUS. 205 A. It arises fleshy from each side of the insertion of the deltoid, covering all, and adhering to most of the fore part of the humerus; it runs over the elbow-joint, adhering to the capsular ligament, and is inserted by a strong short tendon into the coronoid process of the ul- na ; it bends the elbow-joint and prevents the capsular ligament from being pinched. Q. Describe the origins, insertion, and use of the Triceps extensor cubiti ? A. The long head arises broad and tendinous from the inferior costa of the scapula near its cervix; the short head arises from the back part of the humerus a little below the large tubercle ; the third head, called Brachialius externus, arises from the back part of the humerus near the insertion of the teres major; these heads unite about the middle of the bone, and cover the whole of its posterior part, adhering to it in its course ; the muscle forms a strong thick tendon, which is insert- ed into the Olecranon and partly into the condyles, adhering to the capsular ligament; it extends the fore- arm. Q. Describe the origin, insertion, and use of the An- coneus ? A. It arises tendinous from the posterior part of the ' external condyle of the humerus, becomes triangular and fleshy, receives an accession of fibres from the tri- ceps, and is inserted into the ridge on the posterior and outer part of the ulna, a little below the olecranon ; it assists the triceps in extending the fore-arm. Q. How are the muscles of the fore-arm clas- sed? A. They may be divided into four classes, namely, flexors, extensors, supinators, and pronators. Q. What muscles are Flexors ? A. Three for the carpus, viz. the palmaris longus, flexor carpi radialis, and flexor carpi ulnaris; two long flexors, and the lumbricales, for the fingers; namely, the flexor digitorum sublimis vel perforatus, flexor pro- fundus vel perforans. Q. What muscles are Extensors ? 206 MUSCLES OF THE FORE-ARM. A, Three for the hand, namely, the extensor carpi radialis longior, and brevior, and the extensor carpi ulnaris; and one for the fingers, viz. the extensor digi- torum communis. Q. What muscles are Supinators of the hand ? A. Four ; The biceps flexor cubiti, the supinator ra- dii longus, and brevis, and the extensor secundi interno- dii pollicis. Q. What muscles are Pronators of the hand ? A. Two chiefly; the pronator radii teres, and pronator radii quadratus; and these three also assist the former, viz. the palmaris longus, flexor carpi radialis, and flexor digitorum sublimis. Q. What muscles arise from the Internal, or Ulnar Condyle of the humerus ? A. Six; the palmaris longus, flexor carpi radialis, flexor carpi ulnaris, flexor digitorum sublimis vel per- foratus, pronator radii teres, and the flexor longus pol- licis manus. Q. What muscles arise from the External or Radial Condyle of the os humeri ? A. Six ; the extensor carpi radialis longior; extensor carpi radialis brevior; extensor carpi ulnaris ; extensor digitorum communis; supinator radii longus ; and supi- nator radii brevis. Q. What muscles arise from the body of the Ra- dius? A. Two, from its body; part of the flexor longus pol- licis manus, and part of the extensor ossis metacarpi pollicis. Q. What muscles arise from the body of the Ulna ? A. Six; the flexor digitorum profundus, vel perfo- rans ; pronator radii quadratus ; part of the extensor ossis metacarpi pollicis; extensor primi internodii pollicis; extensor secundi internodii ; and the indicator. Q. Are the muscles of the fore-arm covered by a Fascia ? A. Yes ; on removing the integuments, we see a strong fascia continued from the intermuscular liga- ments, which pass downwards to the condyles of the os MUSCLES OF THE FORE-ARM. 207 humeri; it receives additions from the tendons of the triceps and biceps, forms a strong covering to the mus- cles, gives off partitions among them, and is spent upon the hand. Q. Describe the origin, insertion and use of the Pal- maris longus ? A. It arises by a muscular mass in common with other muscles from the internal condyle of the humerus, be- comes fleshy, sends off a long slender tendon, which is inserted into the ligamentum carpi annulare anterius, and aponeurosis palmaris; it bends the hand, and brings it to pronation, and stretches the palmar apo- neurosis. Q. What are the origin, insertion, and use of the Flexor carpi radialis ? A. It arises from the inner condyle and upper part of the ulna, forms a long tendon, which passing in a groove or fossa of the os trapezium, is inserted into the thenal and upper part of the metacarpal bone of the fore-fingers; it bends the wrist, and assists in prona- tion. Q. What are the origin, insertion and use of the Flexor carpi ulnaris ? A. It arises from the inner condyle and side of the olecranon, runs down the internal side of the ulna, from which it receives part of its origin, sends down a strong tendon, which is inserted into the os pisiforme ; it bends the wri9t. Q. Describe the origin, insertion, and use of the Flexor digitorum sublimis vel perforatus ? A. It arises from the inner condyle, and root of the coronoid process, and fore part of the radius ; becoming fleshy, it sends off four tendons before it passes under the ligamentum carpi annulare, which at the extremity of the first phalanx of the fingers are split to form a pas- sage for the tendons of the perforans, and are inserted into the anterior and upper part of the second phalanx ; it bends the second, and then the first phalanges of the fingers. 208 MUSCLES OF THE FORE-ARM. Q. What are the origin, insertion, and use of the Pro- nator radii teres ? A. It arises from the inner condyle and coronoid pro- cess, runs obliquely across the upper part of the flexors of tho wrist, and is inserted into the middle of the ra- dius on its posterior part; it rolls the radius inwards, and brings the hand to pronation. Q. Describe the origin, insertion, and use of the Flexor longus pollicis manus ? A. It arises from the fore part of the radius below its tubercle, interosseous ligament, and inner condyle, send9 off a tendon, which passes under the annular ligament, and is inserted into the extreme phalanx of the thumb; it bends the most distant joint of the thumb. Q. Let us now turn our attention to the muscles which arise from the Radial or External Condyle of the humerus; and, in the first place, describe the Extensor carpi radialis longior ? A. It arises from the lower part of the external ridge of the humerus and upper part of its condyle, forms a thick short belly, which passes over the side of the joint, and about the middle of the radius forms a tendon, which runs through a groove in the back part of the distant extremity of the radius, and is inserted into the upper and posterior part of the metacarpal bone of the fore finger; it extends the wrist and assists in bending the elbow-joint. Q. Describe the Extensor carpi radialis brevior ? A. It arises tendinous from the under and back part of the external condyle, in a mass with the extensor longior, and from the external lateral ligament, forms a tbick belly, which sends down a tendon, that accom- panies the former in its course through the groove, and under the annular ligament, and is inserted into the upper and back part of the metacarpal bone of the mid- dle finger; it extends the wrist, and draws the hand radiad, or towards the thumb. Q. Describe the origin, insertion, and use of the Ex- tensor carpi ulnaris ? A. It arises tendinous from the upper part of the ex- MUSCLES OF THE FORE-ARM. 209 ternal condyle, and fleshy from the posterior part of the ulna, where it passes over it, sends down a strong ten- don, which passes through a groove in the back and lower end of the ulna, and is inserted into the posterior and upper part of the metacarpal bone of the little fin- ger ; it extends the wrist, and draws the hand ulnad, or towards the little finger. Q. Describe the origin, insertion, and use of the Ex- tensor digitorum communis ? A. It arises from the external condyle, passes down the back part of the arm, adheres to the ulna where it passes over it, and terminates in four flat tendons, which pass under the annular ligament in a depression on the back, and under part of the end of the radius, and are inserted into the posterior part of all the bones of the fingers by a tendinous expansion; it extends all the joints of the fingers. Q. Describe the origin, course, insertion, and use of the Supinator radii longus ? A. It arises from the ridge, nearly as high as the mid- dle of the humerus, leading to the external condyle, forms a thick fleshy belly where it passes over the side of the elbow-joint, becomes tapering, and sends off a round tendon, which running along the outer edge of the radius, is inserted into the outer side of the carpal end of the radius; it rolls the radius outwards, and per- forms supination of the hand; it is also a flexor of the elbow-joint. Q. Describe the Supinator radii brevis ? A. It arises from the external condyle, from the ridge below the coronoid process of the ulna, and from the interosseous ligament, passes over the external and upper part of the radius, and is inserted into the upper and outer edge of its tubercle, and into the ridge de- scending obliquely from it;, it rolls- the radius outwards, and brings the hand into the supine position. Q. What are the origin, insertion and use of the two muscles, the Flexor longus pollicis manus, and the Extensor ossis metacarpi pollicis, which partly arise from the body of the radius ? 210 MUSCLES OF THE FORE-ARM. A. The former we have described; the latter arises from the posterior part of the middle of the radius, ulna, and the interosseous ligament, runs down obliquely over the radius, and sends off one or two tendons, which pass through an annular sheath in a groove at the outer side of the extremity of the radius, and are inserted into the os trapezium, and upper and back part of the metacarpal bone of the thumb; it extends the metacarpal bone out- wards from the fingers, and assists in bending the wrist radiad. Q. Describe the muscles which arise from the ante- rior or thenal aspect of the ulna; and, first, the origin, insertion, and use of the Flexor digitorum pro- fundus vel perforans ? A. It arises from the external and upper part of the ulna, from its anterior part, and interosseous ligament, forms a thick mass, which sends off four tendons, which pass together under the annular ligament of the wrist, separate, and pass through the slits in the tendons of the flexor sublimis, and are inserted into the anterior and upper part of the third phalanx of the fingers ; it bends the last joint of the fingers. Q. Describe the origin, insertion, and use of the Pro- nator radii quadratus ? A. It arises broad, tendinous, and fleshy, from the inner edge and under end of the ulna, about two inches in length, runs transversely, adhering to the interosseous ligament, and" is inserted into the lower and anterior part of the radius opposite to its origin; it turns the radius inwards, and brings the hand into pronation. Q. Describe the muscles also, which arise from the back or anconal aspect of the ulna, beginning with the Extensor primi, and secundi internodii polli- cis? A. These muscles arise from the back part of the ulna, the primus below its middle, and the secundus above it; and from the interosseous ligament, each sends down a tendon, which passes through a groove at the inner and back part of the radius; the tendon ol the prirrtus is inserted into the posterior part of the first bone of the MUSCLES of the fore-arm. 211 thumb; that of the secundus into the posterior part of the last bone ; they extend the respective bones of the thumb. Q. As we have described the Extensor ossis metacar- pi pollicis, which partly arises from the anconal aspect of the ulna; describe, lastly, the Indicator ? A. It arises from the back and middle part of the ulna, and interosseous ligament, sends down a tendon, which passes through the annular ligament of the wrist, toge- ther with the extensor digitorum communis, and is in- serted into the posterior part of the fore-finger. SURGICAL PATHOLOGY OF THE ELBOW JOINT. Q. What muscles are extensors of the elbow-joint? A.iTwo ; the Triceps extensor cubiti, and the Anco- neus. Q. What muscles are flexors of the elbow-joint ? A. Eight; the biceps flexor cubiti, brachialis inter- nus, palmaris longus, flexor carpi radialis, flexor carpi ulnaris, supinator radii longus, pronator radii teres, and the flexor digitorum sublimis. Q. Do the flexors of this joint appear more powerful than the extensors ? A. The same general law of the system holds in this elbow-joint as well as in others; the extensors, though few, are strong, and act with a long and powerful lever; the flexors are numerous, and co-operate in the perfor- mance of their action; some act with the longest lever, or the greatest power, at the commencement of the flexion; others have their lever, or power of action, in- creased, as the flexion is continued: the power of the extensors too at the commencement of flexion is incon- siderable ; but it increases as the flexion becomes great- er, in consequence of their lever becoming longer by the olecranon projecting farther from the centre of mo- tion. Q. In how many different ways can the elbow- joint be dislocated ? A. It may happen in three ways; the olecranon may 212 PATHOLOGY OF THE ELHOV.-JOIVT. be fractured, and the humerus displaced forwards, which is rather uncommon; or the ulna and radius may be forced backwards, when the extensors and also the flexors pull the ulna upwards, and place the coronoid process in the cavity, which the olecranon naturally oc- cupies in extension of the fore-arm: or the radius may be displaced from the humerus, and the ulna forced out of the trochlea upon the outer articular surface, which the radius naturally occupies. Q. What symptoms denote the fracture of the ole- cranon, and the ends of the ulna and radius dislocated forwards ? A. The elbow is lost, the back part is concave, and the fore-arm is bent backwards contrary to the natural flexion; while the olecranon is sometimes separated, pulled up, and forms a bump on the humerus behind the condyles. Q. What symptoms denote a luxation of the ulna backwards, when the coronoid process slips into the olecranon-cavity of the humerus ? A. The arm is much shorter; is kept a little bent; cannot be moved without exciting great pain; the ole- cranon projects considerably, and is much farther up the humerus. Q. Is the coronoid process not fractured in such a luxation ? A. Sometimes it is; but a luxation of this kind can happen without a fracture of bones. Q. What are the symptoms of a luxation laterally, when the ulna occupies the place of the radius ? A. The distance between the internal condyle of the humerus and the olecranon is much greater than natu- ral; the head of the radius may often be felt projecting; the motions of flexion and extension are imperfect and painful; and rotation is very imperfect and difficult. Q. How is the first dislocation, viz. of the ends of the bones forwards, and the fractured olecranon, to be reduced ? A. The fore-arm should be gently pulled, and, in the mean time, the articular surface of the humerus should PATHOLOGY OF THE ELBOW JOIXT. 213 be replaced in the sigmoid cavity of the ulna; and the fore-arm should then be fully extended and a bandage applied round the under part of the humerus to keep down the fractured olecranon in contact with the end of the ulna, whence it had been torn. Q. When the luxation is backwards, and the coro- noid process is in the posterior cavity of the humerus, how is the reduction best accomplished ? A. The humerus is to be kept down near to the pa- tient's side, that the triceps extensor may be more re- laxed ; the fore-arm is to be kept nearly in the same state of. slight flexion; and the upper end of the ulna is to be pulled gently anconad, while a gentle distend- ing force is applied to the fore-arm to pull down the ulna ; when the ulna is thus disengaged, and brought down, the fore-arm should be suddenly bent, and the flexors will bring in the joint; care being taken at this time to keep the ulna well towards the internal condyle of the humerus, lest it should be placed on the outer surface naturally occupied by the concave apex of the head of the radius. Q. How is the lateral luxation to be reduced, when the sigmoid cavity of the ulna occupies the outer surface, on which the radius naturally plays ? A. By keeping the fore-arm slightly bent, that both the extensors and flexors may be as much relaxed as possible; by using a slight distending force in that posi- tion to disengage the surfaces of the articulating bones; and, at the same time, to pull the ulna towards the in- ternal condyle, or ulnad; and when opposite to its pro- per situation, to bend the fore-arm, immediately stop- ping the distension, that the joint may be replaced: if flexion and extension can be performed, the joint is pro- perly reduced; the head of the radius sbould also be put into its proper semilunar cavity ; and if rotation can be easily performed, it is rightly placed. Q. What muscles extend the wrist anconad ? A. Five ; the extensor carpi radialis longior, and bre- vior, extensor secundi internodii pollicis, indicator, and extensor digitorum communis. 214 pathologv or the elbow joint. (J. What muscles bend the wrist thenad ? A. Six; the flexor carpi radialis, flexor caipi ulnaris, palmaris longus, flexor digitorum sublimis, flexor digito- rum profundus, and flexor longus pollicis. Q. What muscles draw the hand radiad, or towards the thumb ? A. Five; the flexor longus pollicis; extensor primi internodii; extensor carpi radialis longior, and brevior; and the flexor carpi radialis. Q. What muscles draio the hand ulnad, or towards the little finger ? A. Six ; the extensor carpi ulnaris, abductor minimi digiti, extensor digitorum communis, flexor carpi ulnaris, flexor digitorum sublimis, et profundus. Q. In what aspects can the bones of the carpal-joint be dislocated ? A. The wrist may be luxated either backwards, anco- nad ; or forwards, thenad: but scarcely ever lateral. Q. In what manner is luxation either forwards or backwards to be reduced ? A. Extension of the joint with a gradually increased pulling force will disengage the ends of the bones, and when in a proper position, the muscles will replace the carpal bones in the articular cavity of the radius. Q. Why is the carpal joint seldom, if ever, dislocated to one side ? A. The styloid process of the radius projecting on the one side, and the strong lateral ligament attaching it to the os scaphoides; the styloid process of the ulna pro- jecting on the other side of the articulation, and the strong lateral ligament also attaching it firmly to the cuneiform and pisiform bones, prevent the oval articular surface of the carpal bones, viz. the os scaphoides and lunare, from being forced either to the one side or the other. Q. May not one of the styloid processes be fractured, the lateral ligament ruptured, and the carpal-joint be dislocated to one side ? A. Yes; but the position of the hand to one side will point out the nature of the injury. pathology of the elbow joint. 215 Q. Is a lateral luxation of that kind to be reduced as the other forwards, or backwards ? A. A gradually increased distending force is first to be employed, and in the mean time, when the bones are disengaged, their articular surfaces are to be brought to- gether, by bringing the hand straight into its natural po- sition. Q. How many muscles has the thumb ? A. Eight; namely, three flexors, three extensors, an abductor, and an adductor. Q. Having described the flexor longus pollicis for- merly ; mention now the origin and insertion of the Flexor brevis pollicis manus ? A. It arises from the ossa, trapezoides, magnum, and unciforme ; is divided into two portions by the tendon of the flexor longus pollicis, and is inserted into the first bone of the thumb, and ossa scsamoidea. Q. Describe the origin and insertion of the Flexor ossis metacarpi pollicis vel opponens polUcis ? A. It arises from the os trapezium and ligamentum carpi annulare anterius, and is inserted into the under and anterior part of the metacarpal bone. Q. Having already described the extensors of the thumb; mention now the origin, insertion, and use of the Abductor ? A. The Abductor pollicis manus arises from the liga- mentum carpi annulare, and os trapezium, and is in- serted into the outer side of the root of the first bone of the thumb, which it draws from the fingers. Q. Describe the origin, insertion, and use of the Ad- ductor pollicis ? A. It arises from nearly the whole length of the me- tacarpal bone of the middle finger, crossing that of the fore finger, it converges into a short tendon, which is inserted into the inner part of tho root of the first bone of the thumb, which it draws towards the fingers. Q. Having considered the Indicator, describe the Abductor indtcis ? A. It arises from the o» trapezium, and upper and 216 PATHOLOGY OF THE Till Mil. inner part of the metacarpal bone of the thumb, and is inserted by a short tendon into the back and outer part of the first bone of the fore-finger, which it draws to- wards the thumb. Q. How many muscles are peculiar to the little finger? A. Three ; an abductor, adductor, and a flexor. Q. Describe the origin, insertion, and use of the Ab- ductor minimi digiti ? A. It arises from the os pisiforme and ligamentum carpi annulare near it, and is inserted into the inner or ulnar side of the upper end of the first bone of the little finger; which it draws from the rest. Q. Describe the Adductor metacarpi minimi digiti manus ? A. It arises from the os unciforme and ligamentum carpi annulare next it, and is inserted into the fore and inner part of the metacarpal bone of the little finger. Q. Describe the origin, insertion, and use of the Flexor parvus minimi digiti ? A. It arises from the outer side of the os unciforme, and annular ligament near it, and is inserted by a round tendon into the inner and anterior part of the base of the first phalanx of the little finger. Q. What muscles are comprehended by the Interos- sei interni ? A. Four ; the prior indicis, posterior indicis, prior an- nularis, and interosseus auricularis. Q. Describe the Prior and Posterior Indicis ? A. The Prior indicis arises from the upper and outer; the Posterior indicis from the upper and inner part of the metacarpal bone of the fore-finger; and they are in- serted into the tendinous expansion of the extensor digi- torum. Q. What are the origin and insertion of the Prior an- nularis ? A. It arises from the outside of the metacarpal bone of the ring-finger, and is inserted into the outer side of the tendinous expansion of the same finger. Q. Describe trie Interosseus auricularis ? MUSCLES OF THE FINGERS. 217 A. It arises from the outside of the metacarpal bone, and is inserted into the outside of the tendinous expan- sion on the back part of the little-finger. Q. How many Interossei externi are there ? A. Three; the prior medii digiti, which arises from the contiguous side of the metacarpal bones of the fore and middle fingers ; the posterior medii digiti, from the corresponding metacarpal bones of the middle and ring- fingers ; and the posterior annularis from those of the ring and little-fingers, and are inserted into the tendi- nous expansion of the extensor digitorum communis. Q. When the joints of the fingers or thumb are dislo- cated, how are they to be reduced ? A. The finger, or thumb, which is luxated, should be gently pulled, and placed in its natural position, and if properly reduced, the joint will move easily in flexion and extension. MUSCLES OF THE TRUNK. Q. What muscles are situated on the posterior part of the trunk, besides those already mentioned as attached to the cervical vertebrae, or arising from the scapulae ? A. The rhomboideus, longissimus dorsi, spinalis dorsi, semi-spinalis dorsi, and multifidus spinae. Q. Describe the origin, insertion, and use of the RhomboidBus? A. It arises from the spinous processes of the four or five superior dorsal, and the three inferior cervical ver- tebrae, and from the ligamentum nuchae; and descend- ing obliquely, it is inserted into the whole length of the base of the scapula; which it draws upwards and back- wards. Q. What are the origin, insertion, and use of the Longissimus dorsi ? A. It arises, in common, with the sacro-lumbalis from the side of the os sacrum, and all its spinous processes, from the posterior part of the spine of the ilium, and from all the spinous and transverse processes of the lura- T 218 MUSCLES OF THE THINK. bar vertebrae; their common head fills the space between the ilium and sacrum, and also the hollow of the loins, and that between the spine and angles of the ribs; and it is inserted into the transverse processes of all the dorsal vertebrae, and into the lower edge of each of the ribs near their tubercles; the two inferior ribs excepted; it extends the trunk and depresses the ribs. Q. Describe the Spinalis dorsi? A. 11 arises by five tendinous slips from the spinous processes of the two upper lumbar, and three lower dor- sal vertebrae; it ascends incorpoiated with the longis- simus dorsi, and is inserted into the spinous processes of 'the eight uppermost dorsal vertebrae, except the first, by .is many tendons ; it extends and keeps the trunk erect. Q. What are the origin, insertion, and use of the Semi- spinalis dorsi? A. It arises by distinct tendons from the transverse processes of the seventh, eighth, ninth, and tenth dor- sal vertebrae, and is inserted into the spinous processes of the six or seven uppermost dorsal, and two lowest ccr vical vertebrae by as many tendons ; it also extends the spine, and keeps it erect. Q. Describe the Multiftdus spinae? A. It arises from the side and spinous processes of the os sacrum, and posterior part of the ilium, from all the oblique and transverse processes of the lumbar verte- brae, from all the transverse processes of the dorsal, and of the four inferior cervical vertebrae, by as many dis- tinct tendons; and is inserted by distinct tendons into all the spinous processes of the lumbar, dorsal, and cervi- cal vertebrae ; it extends the spine obliquely to a side, or with its fellow, directly backwards. Q. What muscles, besides those already mentioned, are situated on the anterior and lateral j>\rts of the thorax? A. The subclavius, sr-rratus magnus, the inter-cos- tales externi, and iutemi, and sterno-costalis. Q. Describe the origin and insertion of the Subcla- vius? MUSCLES OF THE TRUNK. 219 A. It arises tendinous from the cartilage which joins the first rib to the sternum, and is inserted into the in- ferior part of the clavicle as far laterad as the coracoid process of the scapula. Q. Describe the origin, insertion, and use of the Serratus magnus ? A. It arises from the nine superior ribs by an equal number of fleshy digitations, runs up and backwards, and is inserted into the whole length of the base of the sca- pula; it pulls the scapula downwards and forwards, or this being fixed, it elevates the ribs. Q. Describe the Inter-costales externi? A. The fibres of the external intercostals arise from the inferior edge of each rib, excepting the twelfth, run obliquely down and forwards from the spine to the car- tilage, from which to the sternum a membrane is ex- tended ; and are inserted into the upper edge of each rib immediately below. Q. What are the origin, direction, and insertion of the Inter-costales interni ? A. The internal intercostals arise from the inferior margin also of the same ribs, beginning at the sternum, run backwards and downwards, decussating the former muscles, as far as the angle of the ribs where they cease; they are inserted into the upper edge of the in- ferior rib. Q. What is the use of the Intercostal muscles. A. The external and internal contract their fibres at the same time, and elevate the ribs in the diagonal of their forces; by which they enlarge the cavity of the thorax. Q. Describe the Sterno-costalis, or Triangularis ? A. It arises from the edges of the Cartilago ensiformis, and sternum near it, within the thorax, and directing its fibres upwards and outwards behind the cartilages of the ribs, is inserted into the cartilages of the third, fourth, and fifth ribs, by as many angular terminations. Q. What muscles situated on the posterior part OF THE TRUNK ARE ATTACHED TO THE RIBS ? A. The serratus posticus superior, serratus posticus 220 MUSCLES OF THE TRUNK. inferior, sacro-lumbalis, longissimus dorsi, and quadratus lumborum. Q. Describe the origin, insertion, and action of the Serratus posticus superior ? A. It arises by a brBad thin tendon from the ligamen- tum nuchae at the three inferior cervical, and two supe- rior dorsal spinous processes, running obliquely down- wards; is inserted by four fleshy slips into the second, third, fourth, and fifth ribs under the scapula; it elevates the ribs, and dilates the thorax. Q. Describe the Serratus posticus inferior ? A. It arises by a common tendon with the latissimus dorsi from the spinous processes of the two inferior dor- sal, and three superior lumbar vertebrae; and is inserted by four fleshy slips into the lower edges of the four in- ferior ribs, near their cartilages; it depresses the ribs, and diminishes the cavity of the thorax. Q. What are the origin, insertion, and use of the Sa- cro-lumbalis ? A. It arises in common with the longissimus dorsi, tendinous without and fleshy within, from the side and spinous processes of the os-sacrum, from the posterior part of the spine of the ilium, and from all the spinous and transverse processes of the lumbar vertebrae ; at the last rib it sends off flat tendons, which are inserted into the angles of all the ribs, increasing in length as they ascend ; it assists in keeping the trunk erect, and in de- pressing the ribs. Q. What did you say was the termination of the Longissimus dorsi ? A. It is inserted by a tendinous and fleshy slip into the inferior part of all the ribs, except the two lowest, between their tubercle and angle; and also into all the dorsal transverse processes by double tendons. Q. Describe the origin, insertion, and use of the Quadratus lumborum ? A. It arises broad, tendinous, and fleshy from the pos- terior half of the spine of the os ilium, and from the superior transverse ligament of the pelvis, extending between the ilium and the transverse process of the last MUSCLES OF THE TRUNK. 221 lumbar vertebra; and is inserted into the transverse processes of all the lumbar vertebrae, into the lowest rib near the spine, and into the side of the last dorsal ver- tebra by a small tendon; it draws the loins to one side, depresses the rib, and with its fellow bends the loins forwards. Q. What muscles are attached to the ribs to- wards the abdomen ? A. The abdominal muscles, being four on each side ; the obliquus descendens externus, obliquus ascendens internus, the transversalis, and rectus. Q. Describe the origin and insertion of the Obliquus Descendens externus ? A. It arises by seven or eight fleshy slips from the lower margin of the eight inferior ribs near their carti- lages, and from the spine of the os ilium; its fibres run downwards and forwards, and terminate in a thin broad tendon, whose fibres are continued in the same direc- tion over the fore part of the abdomen, to its middle line, called linea alba ; and it is inserted into its fellow of the opposite side, during the whole length of the linea alba, extending from the cartilago ensiformis to the os pubis. Q. Describe the under part of the tendon of the 06- liquus Descendens externus ? A. The tendon becomes thicker and stronger near its under part, where it extends from the superior anterior spinous process of the ilium over the flexor muscles, great blood-vessels and nerves of the thigh, to its inser- tion into the symphysis and angle of the os pubis. This part of the tendon has been termed Poupart's, or Fallopius', or inguinal ligament; as it is not so tense below, it forms a curve behind over the vessels, and is frequently called the crural arch. Q. What forms the Linea alba ? A. The junction of the tendons of the muscles of the opposite sides; it is broadest at the umbilicus, and de- creases in breadth towards its extremities at the cartilago ensiformis, and symphysis pubis. Q. What forms the Linea semilunaris ? T 2 222 MUSCLES OF THE TRUNK. i A. It is formed by the tendons of the external and in- ternal oblique and transversalis uniting at the edge of the rectus muscle. Q. What forms the Lineae transversae ? A. These are three, or sometimes four, in number, running across from the linea semilunaris to the linea alba, and are formed by the tendinous intersections of the rectus muscle on each side, shining through their sheaths. Q. What are the origins and insertions of the Obli- quus Ascendens internus ? A. It arises from the back part of the os sacrum, from the spinous processes of the three lowest lumbar verte- brae by a tendon common to it, and the serratus posticus inferior, from the whole spine of the ilium, and from the inside of Poupart's ligament: at the middle of which it sends off a fasciculus of fibres to form the Cremaster muscle. Its fibres run in a radiated manner; those originating from the back run obliquely upwards, and are inserted into the cartilages of all the false ribs, and ensiform cartilage ; the fibres from the spine of the ilium run more transversely, and become tendinous at the linea semilunaris, where it is divided into two layers; the anterior adhering firmly to the tendon of the external oblique, runs over the Rectus, and is inserted into the whole length of the linea alba: the posterior layer, thinner than the former, adheres to the tendon of the transversalis, runs behind the rectus, and is inserted into the linea alba; but about half way between the umbilicus and os pubis, this posterior layer ceases, and the whole tendon passes before the rectus; the inferior edge of it extends in nearly a straight line over, or be- fore the spermatic cord, and is inserted into the angle of the pubis. Q. What are the uses of the external and internal Oblique muscles ? A. Their fibres are disposed so as to decussate each other; when both on one side act, they draw the trunk obliquely to one side ; when those on both sides act at the same time, they bring the trunk directly forwards in MUSCLES OF THE TRUNK. 223 the diagonal of their forces ; while they pull down the ribs, diminish the capacity of the thorax, and compress the viscera of the abdomen. Q. Describe the origins and insertions of the Trans- versalis abdominis ? A. It arises tendinous, but soon becomes fleshy, from the inner surface of the cartilages of the six or seven lower ribs, where it intermixes with the fibres of the diaphragm and intercostals ; from the transverse proces- ses of the last dorsal, and four superior lumbar verte- brae ; from the whole inner edge of the spine of the ilium, and from the inner surface of Poupart's ligament. At the linea semilunaris, its tendon adhering to the pos- terior layer of the internal oblique, passes behind the rectu?, and is inserted into the ensiform cartilage and whole length of the linea alba. In the middle between the umbilicus and os pubis, a slit is formed in the tendon of the transversalis, through which the rectus muscle passes, and between this and the pubis the whole of the tendon of the transversalis passes before, or on the outside of the rectus to its insertion in the linea alba. Q. What is the use of the transversalis abdominis ? A. It, together with its fellow, supports and com- presses the.abdominal viscera. Q. What lies within the Transversalis muscles ? A. Its anterior surface is lined by the peritoneum. Q. Is there not a fascia between it and the perito- neum ? A. Yes; the Fascia Transversalis arising from the crural arch, and from the under part of a tendinous ex- pansion reflected over the iliacus internus, ascends be- tween the tendon of the transversalis and peritoneum, adhering firmly to both, nearly as high as the umbilicus; it is strong below, and becomes gradually thinner in its ascent. Q. Is there any Aperture through the fascia trans- versalis ? A. Yes; its fibres form a slit about half-way between the spine of the ilium and symphysis pubis, through which the spermatic cord, or round ligament, passes; 224 MUSCLES OF THE TRUNK. this slit is the internal abdominal ring, or upper abdomi- nal aperture, which is about an inch in the direction of the anterior superior spinous process above the under abdominal aperture, or external ring. Q. Is there any other fascia' connected with the transversalis muscle ? A. Yes; a tendinous aponeurosis arising from the inside of the crural arch, being firmly interwoven with the fibres of the fascia transversalis, and from the spine of the ilium, is reflected upwards over the Iliacus in- ternus and Psoas magnus, which it binds down and pro- tects. Q. Describe the Rectus abdominis ? A. It arises by a flat tendon from the fore and upper part of the os pubis, soon becomes fleshy, and flat, as- cends parallel to the linea alba, and is inserted into the cartilages of the three inferior true ribs, and extremity of the sternum; and it often intermixes with the under edge of the pectoralis major. In its course, it has three or four tendinous intersections, where its anterior sur- face adheres firmly to its sheath ; one intersection at the umbilicus, a second where it runs over the cartilage of the seventh rib, and a third in the middle between these, and it has commonly a half-intersection below the umbilicus; these form the lineae transversae. Q. What other muscle is connected with the abdo- minal ? A. The Pyramidalis, which is often awanting, arises from the symphysis pubis, ascends between the rectus and linea alba in the sheath of the rectus, and termi- nates in the linea alba and inner edge of the rectus, nearly half way to the umbilicus. Q. What muscle separates the abdomen from the tho- rax? A. The Diaphragm, which is commonly described in two portions, called the superior and inferior mus- cles of the diaphragm. Q. Describe the origin and insertion of the Superior or greater muscle of the Diaphragm ? A. It arises by distinct fleshy indentations from the MUSCLES OF THE TRUNK. 225 ensiform cartilage, from the cartilages of the seventh, and of all the inferior ribs on both sides : its fibres run in a radiated manner, and are inserted into a cordiform tendon, situated in the middle of the diaphragm, and in which the fibres of the opposite sides are interlaced. Q. Describe the Inferior, or smaller muscle of the Diaphragm ? A. It arises by four pairs of heads, of which one pair in the middle, called its tendinous crura, are the long- est. They arise from the fore part of the fourth lum- bar vertebra, and adhere to the bodies of those of the loins above this; in their ascent they leave an oval open- ing for the passage of the Aorta, and Thoracic Duct. The other heads arise from the third and second lumbar vertebrae, and are placed more laterally. From these different beads, the fleshy fibres run upwards, and in the middle form two fleshy columns, or crura, which decus- sate and leave an opening for the (Esophagus, and is in- serted by strong fleshy fibres into the posterior edge of the middle, or cordiform tendon. Q. What is the situation of the Diaphragm in expi- ration and inspiration? A. The diaphragm is placed obliquely with its ante- rior part as high as the sternum, while its posterior cru- ra are much farther down ; it is convex towards the thorax, and its middle part reaches as high within it as the fourth pair of true ribs ; it is concave below. During expiration it is relaxed, and rises up into the thorax; during inspiration, its fibres contract, and bring it down nearly to a plane towards the abdomen. Q. What are the uses of the diaphragm ? A. It forms a complete septum between the thorax and abdomen; in expiration, the abdominal and other muscles depress the ribs, and compress the intestines, which are pushed upwards against the diaphragm, which being relaxed, yields before them, and rises into the tho- rax : in inspiration other muscles raise the ribs, during which the diaphragm contracts its fibres, and descends nearly to a plane surface. The diaphragm is usually the antagonist of the abdominal muscles; but it acts along 226 MUSCLES OF THE TRUNK. with them in vomiting, and in expelling the faeces; and the foetus in parturition. Q. What perforations are observable in the dia- phragm? A. Three; one large triangular hole in the cordi- form tendon, with its margin near to the mesial line, and its diameter towards the right side, for the passage of the Vena Cava inferior: between the long or tendi- nous crura, there is a large oval hole, through which the Aorta and Thoracic Duct pass: a little above, rather before the perforation for the aorta, and somewhat to the left side of the mesial line, there is a third hole for the Oesophagus formed by the decussations of the fleshy columns of the smaller muscle of the diaphragm. Q. What organs are attached to the diaphragm be- low ? A. The liver adheres firmly to its cordiform tendon on the right side of the hole for the passage of the ve- na cava; and, excepting at this attachment, the whole of its inferior surface is covered by the peritoneum. Q. What parts are attached to the superior surface of the diaphragm ? A. The inferior end of the Mediastinum is attached nearly to its middle, but rather inclined to the left side of the cordiform tendon; the Pericardium too is attached to its left side ; the Pleura covers its fleshy convexities on both sides of the mediastinum. Q. What muscles dilate or enlarge the thorax? A. The intercostales, together with those fibres which pass over the ribs, termed supra and infra-costales, and diaphragm, usually act in the inspirations; but when respiration is rendered difficult, the serrati postici supe- riores, the serrati magni, the pectorales, the latissimi dorsi, the scaleni, and sterno-mastoidei, assist in eleva- ting the ribs, when the head is fixed, and the scapulae are raised during inspiration. Q. What muscles depress the ribs, and diminish the capacity of the thorax in expiration ? MUSCLES OF THE TRUNK. 227 A. The sterno-costales, recti, obliqui externi, and in- tend abdominis, and transversiiles, in common act in expirations: but in difficult respiration the serrati postici inferiores, longissimi dorsi, sacro-lumbales, serrati magni, and quadrati lumborum, assist the former. Q. What other muscles arise within the abdo- men ? A. Three pairs; the psoas parvus, psoas magnus, and iliacus internus, on each side. Q. Describe the origin, insertion, and use of the Psoas parvus ? i<- A. It arises fleshy from the sides of the last dorsal, first and second lumbar vertebrae, sends down a slender tendon, which, running on the inner side of the psoas magnus, is inserted thin and flat into the brim of the pel- vis at the junction of the ilium and pubis. This muscle is sometimes wanting. Q. Describe the origin, insertion, and use of the Psoas magnus? A. It arises fleshy from the side of the bodies, and trans- verse processes of the last dorsal, and of all the lumbar vertebrae by as many slips, whicb uniting, form a thick strong muscle, that bounds the upper part of the side of the pelvis; it passes down over the os pubis under Poupart's ligament, and is inserted into the trochanter minor and upper part of the os femoris; both the psoae bend the loins forwards, and this last bends the thigh for- wards, and turns the toes outwards. Q. Describe the origin, insertion, and use of the Ilia- cus internus? A. It an'ses fleshy from the transverse process of the last lumbar vertebrae, and from the inner edge of the spine and downwards, and from most of the hollow part of the os ilium, and from an aponeurosis covering it, which is sent up from the inner side of Poupart's liga- ment and spine of the ilium ; it joins the psoas magnus, where it becomes tendinous on the pubis, and is inserted along with it into the trochanter minor, and body of the os femoris immediately below it; it assists in bending the thigh, and rotating it outwards. 228 SURGICAL PATHOLOGY OF THE 6R0IN. SURGICAL PATHOLOGY OF THE GROIN. Q. Describe the formation of the External Abdomi- nal Ring ? A. The inguinal ligament of the external oblique ex- tending from the superior anterior spinous process of the ilium to the pubis, is separated into an upper and under column or pillar, about two inches from the symphysis pubis: the upper slip, which forms the upper column, goes directly to the symphysis pubis, and even beyond it, where it is inserted: the lower slip, which forms the under column or pillar, turns, or is twisted inwards be- hind, gets under the upper one, and is inserted into the os pubis within and behind the upper pillar: the inferior edge of the lower column being a little loose, forms an arch over the muscles and vessels, commonly called the crural arch. Q. Is the Aperture formed in the ligament like a Ring? A. It is a slit of a triangular form, with its base to- wards the pubis, of an inch in length, terminated at each end by transverse tendinous fibres; the more the exter- nal oblique and abdominal muscles are stretched, the closer do the columns of the aperture approach. Q. Where does the Internal Abdominal Aperture commence ? A. On the internal surface, about an inch upwards and outwards, nearer the spinous process of the ilium than the external aperture; the peritoneum exhibits a slight depression where the spermatic cord enters. Q. What forms the internal and upper aperture ? A. The fibres of the Fascia Transversalis, which arises from the posterior edge of the inguinal ligament, and ascends between the transversus muscle and the peritoneum for four or five inches, are separated, and an opening formed to admit the spermatic cord in the male, and the round ligament of the uterus in the female. Q. Describe the Inguinal Canal between the inter- nal and external apertures ? A. Tho internal aperture is through the fascia tram- SURGICAL PATHOLOGY OF THE GROIN. 229 versalis, which at this part has the obliquus internus and transversalis muscles exterior to it, or is covered by them; the canal passes downwards and inwards towards the pubes, over the fascia covering the iliacus internus; at first, having the fascia transversalis and peritoneum with- in, and the transversalis, internal, and external oblique muscles without; then,having passed down on the sur- face of the psoas and iliacus internus about half an inch, the canal gets under the lower edge of the transversalis and obliquus internus, has their edge for its superior mar- gin ; the fascia transversalis and peritoneum between it and the abdomen, and the inguinal ligament between it and the integuments; and lastly, the canal descends to the external aperture, where it has the united tendon of the transversalis and obliquus internus muscles, and the fascia transversalis behind, or between it and tbe abdo- men. The whole of this inguinal canal is about an inch in length. Q. How is the junction of the transversalis and ob- liquus in tenuis above without, and below within the in- guinal canal ? A. They decussate each other; the lower margin of these muscles arises from the upper half of Poupart's ligament, and is inserted into the pubes behind the ex- ternal ring; and, of course, runs directly transverse; while the inguinal canal runs winding like an italic f somewhat twisted downwards, towards the pubes, and forewards; and crossing the inferior edge of the muscles, gets before them, at the external aperture. Q. What does the Spermatic Cord consist of, and how does it direct its course ? A. The spermatic artery, vein, and nerves, involved in cellular membrane, form the cord placed behind the peritoneum, it descends from the loins over the surface of the psoas and iliacus internus, adhering to them by loose cellular substance, comes to the internal aperture, where the Vas Deferens, arising by the side of the pelvis from the neck of the bladder, is added to the cord, which makes a sudden bend into the aperture of the canal; about the middle of the canal, when passing under the V 230 SURGICAL PATHOLOGY OF THE GROIN. fleshy margin of the transversalis and obliquus internus, it receives a fasciculus of muscular fibres, which form the Cremasfer muscle, by which the cord is enlarged, and passing down it comes out by the external aper- ture, and descends into the scrotum. Q. What fixes the Spermatic Cord in the canal ? A. The parts composing the cord are connected to- gether by cellular substance, which also fixes it to the margin of the apertures, and to the canal through which it passes, and fills up the whole space around it. Q. When Hernia is protruded by the external ingui- nal aperture, how is the sac situated ? A. The Sac is situated above the spermatic cord, at its entrance into the internal aperture; and before it at Its exit from the external aperture. Q. How is the Hernial Sac situated with respect to the cremaster muscle ? A. The Cremaster muscle, arising from the under edge of the obliquus internus, surrounds the cord, is in- serted into the outer surface of the tunica vaginalis testis, and partly into the cellular substance of the scrotum; and, as the hernial sac insinuates itself at the upper aperture between the tunica vaginalis and the cord, it, of course, has both the tunica vaginalis, and the cremaster, spread upon its outer surface, surrounding, and external to, the Sac. Q. In Hernia of long standing, do the inner and outer apertures of the ring change their relative situa- tions ? A. Yes ; the external aperture is fixed, and remains always in the same situation; but the internal is more lax, dilates, yields to the distending power of the her- nial sac, and" is, by degrees, brought down nearly oppo- site to the external aperture. Q. Have the goodness to enumerate the parts that lie under the cr ural arch ? A. Under it the psoas magnus, and iliacus internus muscles, the external iliac artery, and the anterior crural nerve with some small branches, pass out; the large fe- SURGICAL PATHOLOGY OF THE GROIN. 231 moral vein, and trunks of the lymphatics of the leg, pass under it in their course into the abdomen. Q. How do these organs lie with respect to each other under the crural arch ? A. The great femoral vein lies nearest to the os pu- bis ; the great external iliac, or rather femoral artery, lies close by its outer side ; and the large anterior crural nerve lies the outermost or most lateral; the iliacus in- ternus and psoas, united here, partly lie-under the artery and nerve, and partly occupy the outer half of the space under the crural arch. Q. Are these parts enclosed by any membrane or sheath ? A. Yes; they are enveloped in cellular substance, in the same manner as vessels are in other parts of the body: and, besides, the psoas parvus sends down an aponeurosis, which covers the psoas magnus and iliacus internus, and descends behind the large vessels, through the external aperture, and has been named the fascia iliaca, which is firmly attached to the pubal fascia lata, and forms part of the crural sheath; the external por- tion of the fascia lata, arising from the inguinal ligament, between the spine of the ilium and the inner side of the femoral vein, covers the vessels just below the cru- ral arch: the internal or pubal portion passes behind the femoral vessels, which lie between these portions of the fascia lata in an oval depression. Besides, super- ficial fascia descending from the abdomen covers all these, and interlaces them together. Q. What part of the crural arch is most favourable for the descent of Hernia? A. Between the great vein and the insertion of the under column of the inguinal ligament into the pubes, there is a triangular space, occupied by cellular sub- stance, fat, and lymphatic vessels, through which Fe- moral Hernia protrudes. Q. Whether are males, or females most liable to Fe- moral Hernia, and why ? A. Females are most subject to femoral hernia; be- cause the dimensions of their pelvis are greater than 232 SURGICAL PATHOLOGY OF THE GROIN. I those of the male pelvis; hence the extent of the ingui- nal ligament is longer, and the triangular space be- tween the external iliac vein and the pubes is larger; in consequence, their predisposition to Hernia must bo greater. Q. Describe these different parts in the order of dis- section ? A. Under the common integuments are cellular sub- stance, lymphatic glands, superficial veins, and nerves, and the superficial fascia, which covers the obliquus ex- ternus, the groin, and the upper and fore part of the thigh; it consists of several layers of cellular membrane, which at the bend of the thigh separate and include the superficial inguinal glands and fatty matter; it de- scends over the spermatic cord, adhering to the tunica vaginalis, and to the crural arch, and covers the large vessels below the arch. Q. When this superficial fascia is carefully removed, what parts come into view ? A. We find the superficial fascia intimately connect- ed with the parts below by loose cellular tissue, in which lie the deep seated lymphatic or inguinal glands, the large vena saphena, and small nerves; under all which is the fascia lata, very thick and strong on the outside of the thigh, but becoming much thinner on the inside near to the crural arch. Q. Does the Fascia Lata cover the crural arch and large vessels emerging from under it ? A. The external portion of the fascia lata covers the sartorius and rectus femoris muscles, and is attached to Poupart's ligament from the anterior superior spine of the ilium, to the inner side of the femoral vein; as we said before, it covers the crural arch, forming a lu- nated margin with its end at the pubes, and proceeding downwards, called the semilunar or crescent-shaped fold, or falciform process; the superior end of this cres- cent portion of the fascia lata is in front of, and covers the femoral artery and part of the vein, just below the crural arch ; the vena saphena major passes over the fal- ciform edge of the ilial fascia, and terminates in that SURGICAL PATHOLOGY OF THE GROIN. 233 part of the femoral vein uncovered; the pubal portion of the fascia lata covers the pectinalis, and triceps adductor muscles, next the os pubis, and passing behind the fe- moral vessels, is inserted into the iliac fascia and os pu- bis ; and a little below the termination of the vena sa- phena, it is united to the ilial portion. Q. Where is the Hernial Sac situated in respect to the parts just mentioned ? A. The hernial sac always descends through the cru- ral arch at the inner or pubal side of the femoral vein; and lies in the hollow on the external surface of the fas- cia lata, in front of the pectinalis muscle, and as the tu- mour increases in bulk, its fundus rises on the falci- form portion of the fascia lata, and even upwards over the crural arch. Q. What muscles are connected with the organs of generation in the male ? A. Four muscles on each side; namely, the cremas- ter, erector penis, accelerator urinae vel ejaculator se- minis, and the transversus perinei. Q. Describe the origin, insertion, and use of the Cremaster ? A. This muscle, as we have already observed, arises from the under fleshy edge of the obliquus internus, sur- rounds the spermatic cord, passes with it through the ring of the external oblique, and stretching down to the testicle, is inserted into the external surface of the tu- nica vaginalis testis, and cellular substance of the scro- tum ; in coitu it elevates and compresses the testicle, and assists in evacuating its contents. Q. WTiat are the origin, insertion, and use of the Erector penis ? A. It arises from the inner side of the tuberosity of the ischium, ascends increasing in breadth, and embra- ces the whole crus penis; and is inserted by a thin ten- don into the strong tendinous membrane, which covers the corpora cavernosa penis as far as the union of the crura: it compresses the crus, by which the blood is propelled into the fore part of the corpora cavernosa, U 2 234 SURGICAL PATHOLOGY OF THE GROIN. and the penis thereby is more completely distended ] and with its fellow keeps the penis in its proper direc- tion. Q. Describe the origin, insertion, and use of the Ac- celerator urinae ? A. It arises fleshy from the sphincter ani, and mem- branous part of the urethra, and tendinous from the crus and beginning of the corpus cavernosum penis ; its fibres run obliquely transverse, and are inserted into its fellow by a tendinous middle longitudinal line, they co- ver the whole bulb of the urethra; it propels the urine and semen forwards. Q. Describe the origin, insertion, and. use of the Transversus perinBi ? A. It arises from the inside of the tuberosity of the ischium, runs transversely, and is inserted into the back part of the accelerator urinae, and adjoining part of the sphincter ani; it dilates the bulb of the urethra, prevents the anus from being too much protruded, and retracts it after the discharge of faeces. Q. What muscles are peculiar to the female or- gans of generation ? A. Three; namely, the erector clitoridis on each side, and the sphincter vaginae. Q. Describe the origin, insertion, and use of the Erector clitoridis ? A. It arises from the inside of the tuber and ramus ischii, and ramus pubis, ascends and covers the crus of the clitoris ; and is inserted into its upper part, and into the body of the clitoris; it and its fellow draw the clito- ris downwards and backwards, compress its crura, and propel the blood into its body; by which it is rendered more tense and erect. Q. Describe the Sphincter Vaginae ? A. It arises from the sphincter ani, and posterior part of the vagina near the perineum, and thence runs round the sides of the vagina near its orifice, covers the corpo- ra cavernosa vaginae, and is inserted into the union of the crura clitoridis; it contracts the orifice of the va- gina. SURGICAL PATHOLOGY OF THE GROIN. 235 Q. What muscles are connected with the anus ? A. The sphincter and one on each side, viz. the leva- tor ani. Q. Describe the Sphincter Ani ? A. It arises from the extremity of the os coccygis, and skin and fat around the anus, forms a flat oval mus- cle, which surrounds the extremity of the intestinum rectum, and is inserted by a narrow tendinous point into the acceleratores urinae, and transversi perinei; it shuts the anus, and also pulls down the bulb of the urethra, and assists in ejecting the urine and semen. Q. Describe the origin, insertion, and use of the Le- vator ani ? A. It arises from the inside of the os pubis at the up- per edge of the foramen thyoideum, from the aponeuro- sis covering the obturator internus and coccygeus, and from the spinous process of the os ischium ; from these circular origins its fibres descend, as radii to a centre, to meet its fellow, and are inserted into the sphincter ani, accelerator urinae, and under and fore part of the os coc- cygis ; it and its fellow surround the neck of the blad- der, prostrate gland, part of the vesiculae seminales, and the .whole extremity of the rectum, representing the shape of a funnel: it and its fellow support the contents of the pelvis, draw the rectum upwards after the evacua- tion of faeces, assist in shutting it, in ejecting the urine and semen, and even faeces ; and, as it appears to some Anatomists, they compress the veins, and assist in the distention and erection of the penis. Q. What muscles are connected with the os coccy- gis ? A. One on each side, namely, the coccygeus. Q. Describe the origin, insertion, and use of the Coc- cygeus ? A. It arises from the spinous process of the os ischii, becomes broader, covers the inside of the posterior sa- cro-ischiatic ligament, and is inserted into the extremi- ty of the os sacrum, and nearly into the whole length of the side of the os coccygis; it draws the coccyx for- 236 SURGICAL PATHOLOGY OF THE GROIN. wards, and assists the levator ani in raising and support- ing the end of the rectum. Q. What muscles are employed in the movements OF THE THIGH i A. Their number is twenty-three, or, by considering the triceps adductor three distinct muscles, twenty-six. Q. Enumerate the muscles connected with, or aris- ing from, the fore part of the pelvis, and inserted into the os femoris ? A. They are eight in number, supposing the triceps, three distinct muscles, namely, the tensor vaginae femo- ris, psoas magnus, iliacus internus, pectinalis, triceps adductor femoris divided into the adductor longus, bre- vis, and magnus, and the obturator externus. Q. Describe the origin, insertion, and use of the Tensor vaginae femdris ? A. It arises from the external part of the anterior su- perior spinous process of the ilium,runs down and back- wards, becoming fleshy, inclosed in a doubling of the aponeurosis forming the vagina, and is inserted into the inner surface of the fascia lata, a little below the tro- chanter major; it stretches the fascia, assists in abduc- tion, and in rotation inwards or tibiad. Q. Having formerly described the Psoas magnus, and Iliacus internus; mention the origin, insertion, and use of the Pectinalis ? A. It arises broad and fleshy from the upper and fore- part of the os pubis, just above the foramen thyroideum, runs down and outwards at the inner side of the psoas magnus, and is inserted by a short flat tendon into the linea aspera, immediately below the trochanter minor; it bends the thigh upwards and inwards, rotating it out- wards. Q. Describe the Triceps adductor femoris ? A. This muscle is generally described under three distinct heads. The Adductor longus femoris arises by a tendon from the upper and fore-part of the os pubis, near the symphysis, at the inner side of the pectinalis, and is inserted into the middle of the linea aspera, hy a broad flat tendon. SURGICAL PATHOLOGY OF THE GROIN. 237 Q. Describe the second head of the triceps, the Ad- ductor brevis ? A. It arises tendinous from the pubes at the side of its symphysis below the former, runs obliquely outwards, and is inserted by a short flat tendon into the linea as- pera between the trochanter minor and the insertion of the former. Q. Describe the origin, insertion, and use of the Ad- ductor magnus ? A. It arises from the side of the symphysis pubis be- low the former, and downwards from the ramus of the pubes, the ramus and tuberosity of the os ischium, its fibres run outwards and downwards spreading wide, and are inserted into the whole length of the linea aspera, into the ridge leading to the inner condyle, and by a long round tendon into the upper part of that condyle : these three adductors draw the thigh inwards, and upwards, and rotate it a little outwards. Q. Describe the Obturator externus ? A. It arises by a semicircular margin from the fore- parts of the pubes and ischium, composing the anterior half of the foramen thyroideum, and from the mem- brane which fills up that foramen; its fibres are collect- ed as radii to a centre, pass outwards around the back part of the cervix of the os femoris, and it is inserted by a strong round tendon into the cavity at the inner and back part of the root of the trochanter major, adhering in its course to the capsular ligament; it rotates the thigh outwards, and prevents the capsular ligament from being pinched. Q. What muscles arising from the back part of the os innominatum are inserted into the femur ? A. Seven; the gluteus maximus, medius, and mini- mus, pyriformis, gemini, obturator internus, and quadra- tus femoris. Q. What are the origin, insertion, and use of the Gluteus maximus ? A. It arises fleshy from the back part of the spine of the ilium, from the lateral surface of the sacrum, from the os coccygis, and from the posterior sacro-sciatic li- 238 SURGICAL PATHOLOGY OF THE GROIN. gament; its strong fleshy fibres run obliquely forwards and downwards, and converging, form a strong flat ten- don, which slides over the posterior part of the trochan- ter major, and here sends off a quantity of tendinous fibres, which are inseparably connected with the fascia lata; and it is inserted by a strong, thick, broad tendon, into the upper and outer part of the linea aspera, and partly into the fascia lata: it extends the thigh, draws it outwards, and turns the toes fibulad. Q. Describe the origin, insertion, and use of the Gluteus medius ? A. It arises fleshy from all the spine of the ilium un- occupied by the gluteus maximus, from the upper part of the dorsum of the bone, and from the aponeurosis, which covers this muscle, and joins the fascia of the thigh; its fibres converge into a broad tendon, which is inserted into the outer and posterior part of the trochan- ter major; it draws the thigh outwards, a little back- wards, and assists in rotation fibulad. Q. What are the origin, insertion, and use of the GlutSus minimus ? A. It arises fleshy from the lower half of the dorsum of the ilium, from a ridge continued from the superior anterior spinous process to the great sciatic notch ; its fibres converge, like radii, to a flat, strong tendon, which is inserted into the fore and upper part of the trochanter major; it assists the former in pulling the thigh outwards, backwards, and in rotating it inwards or tibiad. Q. Describe the Pyriformis ? A. It arises within the pelvis by three tendinous and fleshy heads from the second, third, and fourth false vertebrae of the os sacrum, and becoming round and tapering, it passes out of the pelvis along with the scia- tic nerve, through the great notch of the ilium, from which it receives some fleshy fibres, and is inserted by a roundish tendon into the upper part of the cavity at the inside of the root of the trochanter major; it assists in abduction of the thigh, and in rotation of it outwards or fibulad. SURGICAL PATHOLOGY OF THE GROIN. 239 Q. Describe the origin, insertion, and use of the Ge- mini? A. They are two distinct muscles; the superior head arises from the spinous process; the inferior one from the tuberosity of the os ischium, and from the anterior surface of the posterior sacro-sciatic ligament, they unite and form a sheath around the tendon of the obtu- rator internus, and is inserted into the cavity at the inner side of the root of the trochanter major; they ro- tate the thigh fibulad or outwards, assist in extension, and prevent the tendon of the obturator internus from starting out of its place. Q. What are the origin, insertion, and use of the Ob- turdtor internus ? A. It arises within the pelvis by a semicircular fleshy margin from the anterior half circumference of the fora- men thyroideum, and from the obturator ligament; its fibres converge, and send off a flattish round tendon, which passes over the sinuosity between the spine and tuber of the ischium, as a rope over a pulley, goes over the capsular ligament, inclosed in the sheath of the ge- mini, and is inserted into the large pit at the root of the trochanter major; it rotates the thigh outwards, and assists in its extension. Q. Describe the origin, insertion, and use of the Quadratus femoris ? A. It arises from the outside of the tuber ischii, runs transversely outwards, and is inserted fleshy into the rough ridge between the roots of the greater and smaller trochanter; it rotates the thigh outwards and assists in its extension. Q. What muscles arise from the bones of the pelvis, and are inserted into those of the leg ? A. Six muscles pass along the femur without being attached to it, excepting the short head of the biceps; namely, the sartorius, gracilis, rectus femoris, on the anterior aspect; and the semitendinosus, semimembra- nosus, and biceps flexor cruris on the posterior. Q. Describe the origin, course, insertion, and use of the Sartorius? 240 SURGICAL PATHOLOGY OF THE GROIN. A. It arises tendinous from the superior anterior spinous process of the ilium, becomes fleshy, runs ob- liquely downwards and inwards upon the rectus, and in a spiral manner over tne vastus internus, and about the middle of the thigh over part of the triceps, and de- scending between the tendon of the adductor magnus and that of the gracilis, behind the inner condyle ; it is inserted by a broad thin tendon into the inner side of the tibia near the under part of its tubercle ; it bends the thigh, but especially the knee-joint, and brings the leg across the other, is a rotator tibiad. Q. Describe the origin, course, and insertion of the Gracilis ? A. It arises by a thin tendon from the os pubis near its symphysis, and soon becoming fleshy, descends on the inside of the thigh in a direct course, and is inserted tendinous into the tibia immediately below the sartorius ; it assists in bending the thigh, and drawing it inwards, but it is chiefly a flexor of the knee-joint. Q. Describe the origin, insertion, and use of the Rec- tus femdris ? A. It arises fleshy from the inferior anterior spinous process of the ilium, and tendinous from its dorsum^just above the acetabulum, descends directly over the ante- rior part of the cervix of the femur, along its fore part, increasing in size as far down as its middle, and then decreasing: it has a longitudinal tendon, from which the fleshy fibres run off like the plumage of a feather; it is inserted into the upper part of the patella ; it as- sists in bending the thigh, but is chiefly an extensor of the leg. Q. Does part of its tendon not pass over the surface of the patella, to be inserted into the tibia ? A. Yes; the greater part of the strong flat tendon terminates at the patella ; but a strong tendinous apo- neurosis is sent over it, and another one under it to be connected with the strong ligament of the patella which is inserted into the upper and fore part of the tibia. Q. Does the Patella seem to perform the office of a sesamoid bone to the tendon of the Rectus femoris ? SURGICAL PATHOLOGY OF THE GROIN. 241 A. Yes; the bone of the patella, fixed like a sesa- moid bone between expansions of the tendinous fibres of the rectus, strengthened by those of the vasti mus- cles on each side, plays in the anterior and inferior de- pression between the condyles of the femur, as a rope over a pulley, in the motions of the knee-joint: hence It may be said that the rectus femoris terminates in the tibia. Q. Describe the origin, course, insertion, and use of the Semitendinosus ? A. It arises, in common with the long head of the biceps, from tbe posterior part of the tuberosity of the ischium; its fleshy belly runs down superficially be- tween the biceps and gracilis, on the back part of the thigh, and sends off a long roundish tendon, which passes by the inner side of the knee, and becoming flat, is inserted into the inside of the tibia, a little below its tubercle; it assists in extending the thigh, but is chiefly a flexor of the knee-joint, and a rotator of the thigh in- wards. Q. Describe the origin, course, insertion, and use of the Semimembranosus ? A. It arises by a broad flat tendon from the upper and back part of the tuberosity of the ischium, be- comes fleshy, with its fibres running obliquely towards a tendon at its inner side, runs at first on the fore part of the biceps, and then lower down between it and the semitendinosus, and is inserted tendinous into the inner and back part of the head of the tibia; it assists in ex- tending the thigh, but chiefly is a flexor'of the knee- joint. Q. Describe the origin, course, insertion, and use of the Biceps flexor cruris ? A. It arises by two distinct heads, the long one arises in common with the semitendinosus by a short tendon from the upper and back part of the tuberosity of the ischium, runs just under the fascia between the vastus externus and semitendinosus; the short head arises fleshy from the linea aspera just below the inser- tion of the gluteus maximus, becomes broader, and joins V J 12 SURGICAL PATHOLOGY OF THE GROIN. the long head a little above the external condyle; their fleshy belly sends off a strong tendon, which is inserted into the upper part of the head of the fibula; its long head assists in extending the thigh ; but it is chiefly a flexor of the knee-joint, and slightly an adductor, and rotator outwards. Q. Which of these muscles by their tendons forms the internal, and which the external hamstrings ? A. The tendons of the semitendinosus, and semi- membranosus chiefly; and the tendons of the sartorius and gracilis also, form the inner hamstring: and the tendon of the biceps alone forms the outer one. SURGICAL PATHOLOGY OF THE HIP AND THIGH. Q. What muscles bend the thigh ? A. The flexion of the hip-joint is performed by the combined action of eleven muscles, namely, the tensor vaginae, sartorius, gracilis, pectinalis, adductor longus, ad. brevis, ad. magnus, iliacus internus, psoas magnus, obturator externus, and the gluteus minimus; all of which are also adductors, or abductors, and rotators. Q. What muscles extend the thigh ? A. Extension is also performed by the combined ac- tion of ten muscles, viz. the gluteus maximus, part of the gluteus medius, pyriformis, obturator internus, ge- mini, quadratus femoris, part of the adductor magnus, long head of the biceps, semitendinosus, and semimem- branosus : of which the first five are also abductors, and rotators of the toes fibulad, or outwards; the last five are also adductors and rotators fibulad; the two last of them, however, have very little rotatory power. Q. What muscles are adductors, or pull the one thigh towards the other ? A. Adduction is performed by the combined action of twelve muscles, namely, the pectinalis, adductor longus, ad. brevis, ad. magnus, quadratus femoris, gracilis, se- mitendinosus, semimembranosus, long head of the bi- ceps, obturator externus, psoas magnus, and iliacus in- ternus ; of which all are besides either flexors, or exten- PATHOLOGY OF THE HIP AND THIGH. 243 sors, and nine are also rotators fibulad; and the remain- ing three, the gracilis, semitendinosus, and semimem- branosus, are rather rotators tibiad. Q. What muscles pull the one thigh from the other, or perform abduction? A. Abduction of the thigh is effected by the combi- ned action of eight muscles, namely, the tensor vaginae, gluteus maximus, g. medius, g. minimus, pyriformis, sar- torius, obturator internus, and gemini; of which all are also either flexors, or extensors, and rotators fibulad; except the tensor vaginae, and sartorius, which rotate tibiad. Q. What muscles are rotators of the toes outwards, or fibulad ? A. Thirteen, namely, the gluteus maximus, part of the gluteus medius, pyriformis, gemini, obturator internus obturator externus, quadratus femoris, iliacus internus, psoas magnus, adductor longus, ad. brevis, ad. magnus, and biceps in the extended state of the leg; by which various other motions are also performed. Q. What muscles perform rotation inwards or ti- biad ? A. Six; the tensor vaginae, part of the gluteus me- dius, gluteus minimus; and, in the extended state of the leg, the sartorius, gracilis, and semitendinosus; all of which perform other actions besides rotation. Q. Can these numerous muscles move the thigh in any other directions ? A. Yes; they co-operate so with one another, that they can move the thigh, and fix it in every possible di- rection between the four aspects just enumerated ; and besides, they can perform combined, alternate, and reci- procal actions, by which the leg, when extended, is moved round, so as to describe the circumference of a cone; the head of the femur being the apex, and the foot the base of the cone described- Q. Enumerate the means provided for protecting the hip-joint from luxation ? A. Within the joint the round ligament attaches the head of the femur to the bottom of the acetabulum; the 24 1 PATHOLOGY OF THE HIP AND THIGH. deepness of the osseous and cartilaginous brim of the acetabulum itself; the double transverse ligament stretched across the notch at its under and anterior part, where it is least exposed; the muscles which lie close upon the circumference of the joint, namely, on the pos- terior part, the quadratus, the tendons of the obturator externus, of the gemini and obsurator internus, and of the pyriformis in that order of succession from below up- wards: on the upper part, the gluteus minimus, and gluteus medius: on the anterior part, the rectus femoris and sartorius: on the inferior part, the tendons of the psoas magnus and iliacus internus, lie close to the cap- sular ligament: besides these, the gluteus maximus co- vers all the muscles above and behind, and gives great additional security to the joint. Q. In consequence of the hip-joint being guarded, and secured in that manner, is it often dislocated ? A. The strongly formed and guarded state of the hip- joint certainly renders its dislocation difficult; but the freedom of its motions ; the superincumbent weight of the body; and the accidents to which it is unavoidably exposed, render it subject to occasional dislocation. Q. In what ways can the hip-joint be dislocated ? A. In three different positions ; the most frequent is, when the head of the 03 femoris is forced downwards and forwards on the obturator foramen : the next in fre- quency is, when the head of the femur is forced upwards and outwards on the dorsum of the os ilium with the tro- chanter major forwards : the most rare position is, when the head of the femur is forced on the dorsum of the ilium with the trochanter major projecting backwards, Q. When the head of the femur is thrust down into the foramen thyroidBum or obluratorium, what mus- cles are over-stretched ? A. The three glutei, the rectus femoris, psoas mag- nus, and iliacus internus, are very much over-stretched; the pyriformis, pectinalis, sartorius, and gracilis, are also much upon the stretch ; the semitendinosus, semimem- branosus, and long head of the biceps, are considerably Btretched too. PATHOLOGY OF THE HIP AND THIGH. 245 Q. What parts seem to be injured in such a luxation ? A. The capsular ligament of the hip-joint, although naturally wide and roomy, the round ligament within the joint, and the double cartilaginous ligament stretch- ed across the notch on the fore part of the acetabulum, must be ruptured; also various connexions by cellular substance must be destroyed. Q. In what manner is such a luxation to be reduced ? A. By relaxing the muscles most upon the stretch, so as to give them power to act, and by bringing their an- tagonists into action, the head of the femur may be re- placed in the acetabulum with a very small degree of mechanical force. Q. By what means are the over-stretched muscles to be relaxed ? A. Of these muscles six are situated on the anterior aspect, namely, the psoas magnus, iliacus internus, rec- tus femoris, pectinalis, gracilis, and sartorius : and four on the posterior aspect of the acetabulum, viz. the three glutei and pyriformis : and three below, arising from the back of the tuberosity of the ischium, namely, the semi- tendinosus, semimembranosus, and long head of the biceps. In order that the two first classes of muscles may be relaxed at the same time, the thigh must be raised towards the trunk in the diagonal between flexion and abduction, at first keeping the leg in the same degree of rotation, in which it remained after the injury. After the leg is raised as far as the muscles at- tached to the ischium will permit, rotation inwards, or tibiad, should be gradually and steadily made in the act of raising it by the Surgeon; while an assistant, with a towel put round the inside of the thigh, below and near to the trochanter minor, should pull steadily outward from the other thigh in the same diagonal aspect, in or- der to disengage the head of the femur. When the sur- geon has raised the limb as far as he can, and rotated it tibiad in the mean time to rather more than its natural position, while the assistant tkeeps his steady pull, he should bring the leg suddenly, and rather forcibly, if ne- cessary, to a state of complete adduction; during which, V 2 246 PATHOLOGY OF THE HIP AND THIGH. the combined action of all the muscles of the joint will reduce the headof the femur into the acetabulum? Q. When the head of the femur is forced upwards and outwards on the dorsum of the ilium with the tro- chanter major forwards, what muscles are over-stretch- ed ? A. Eight muscles seem to be very much stretched, viz. the obturator externus, obt. internus, gemini, quad- ratus femoris, and the triceps adductor, composed of three distinct muscles, the adductor longus, add. brevis, and add. magnus. Q. What parts seem to be injured by the luxation upwards ? A. The round, and capsular ligaments must be ruptu- red ; part also of the gluteus minimus near to the ace- tabulum must be torn from the dorsum of the ilium, and the part of it stretched over the head of the femur will be greatly distended. Q. In what manner can this luxation upwards be most readily reduced ? A. Attention should first be paid to the situation of the muscles most over-stretched, and the thigh should be brought into a state of close adduction, crossing the other, and half flexion, in order to relax the muscles as much as possible. This being done, an assistant should have a towel put round the inside of the thigh, as near to the trochanter minor as possible, another towel bound round above the condyles of the femur should be given to another assistant, or two; the knee- joint to be bent, so that the leg may be at a right an- gle. The assistants should be instructed to act at the same time ; at a word given by the surgeon, the assist- ant at the trochanter should pull strongly and steadily outwards, so as to raise and disengage the head of the femur from behind the brim of the acetabulum, while the assistants at the towel fixed above the condyles should pull steadily and strongly in the direction of the femur, which is in a state of great adduction, crossed over the other leg and halt flexion, in order to bring down its head over the brim of the acetabulum; the PATHOLOGY OF THE HIP AND THIGH. 247 surgeon himself, in the mean time, using the leg half bent as a lever, should Avour the relaxation of the mus- cles by rotating the thigh outwards, which he must ac- complish by repeated progressive attempts, in propor- tion as the other forces employed by the assistants are in execution. By these means, the muscles most tense are relaxed, and fitted for action, while those relaxed arc brought into a condition for acting; the head of the femur, being first brought into a favourable situa- tion by tbe mechanical forces employed, is ultimately replaced in the acetabulum by the combined natural con- traction of the muscles themselves. Q. When the head of the femur is forced up on the dorsum of the ilium with the trochanter major back- wards, what muscles are over-stretched ? A. The quadratus femoris, obturator externus, ge- mini, obturator internus, and pyriformis, are greatly dis- tended ? Q. What steps are necessary towards the reduction of such a luxation? A. The patient should be laid upon the opposite side, inclined towards his back; one assistant should have hold of a towel put round, the inside of the thigh, to be ready to pull the head of the femur from the dorsum of the ilium at a given word; another towel should be fixed round the thigh above tbp.condyles, and given to two assistants, who should be instructed to make exten- sion in the direction of the femur, also at the word given by the surgeon. Q. When preparations have been so made, how is the reduction of the joint to be accomplished ? A. The surgeon having taken his station behind the dislocated limb, and observing that his assistants are all ready, should bend the knee-joint to a right angle, that he may use the leg as a lever, and then sbould give or- ders to his assistants to pull in their respective direc- tions ; in proportion as the femur is moved from its luxated position, he should rotate the femur outwards, and bring it into adduction at the same time; by which 248 PATHOLOGY OF THE HIP AND THIGH. the muscles, previously too tense, are relaxed; and others, previously too much relaxed, are brought into their sphere of action ; by which means, the head of the femur is replaced in tbe acetabulum. Q. What muscles arise from the body of the fe- mur ? A. Three; the cruralis, vastus externus, and vastus internus. Q. Describe the origin, course, insertion, and use of the Cruralis or CrurSus ? A. It arises fleshy from between the trochanters, but nearer the minor, and from all the fore-part of the fe- mur to near its under extremity ; its sides are connected with the vasti muscles, it lies behind the rectus, and is inserted tendinous into the upper part of the patella; it assists in extending the knee-joint. Q. Describe the Vastus externus ? A. It arises broad, tendinous, and fleshy, from the outer part of the root of the trochanter major, and down- wards along the outer side of the linea aspera to near the external condyle, by fleshy fibres, which run ob- liquely forwards, and are inserted into a middle tendon ; this muscle occupies the whole flat external surface of the femur, and is inserted into the outer and upper part of the patella; it is joined to the edge of the tendon of the rectus; part of its tendon sends an aponeurosis over the joint, and is firmly attached to the head of the tibia ; it assists in extending the leg. Q. Describe the Vastus internus ? A. It arises tendinous and fleshy from between the fore and upper part of the os femoris, and the root of the trochanter minor; and also along the whole inside of the linea aspera, by fibres running obliquely forwards ; it lies on the flat inside of the bone, and is inserted into the inner and upper edge of the patella; and it also sends down an aponeurosis over the inside of the joint, to be attached to the upper part of the tibia ; it assists in extending the leg. PATHOLOGY OF THE HIP AND THIGH. 249 Q. Are these large muscles of the thigh quite distinct, or much interlaced with each other? A. The rectus femoris is pretty distinct, being ten- dinous behind, where it plays on the cruralis and vas- ti, but the cruralis and the vasti near their origin seem to form one large fleshy mass on the surface, but deep- er, they are distinct; two or three inches above the con- dyles, they again join into an inseparable mass, whose tendinous expansion, joined to that of the rectus, em- braces the patella, and is firmly attached to the head of the tibia. Q. What muscles arise from the condyles of the os femoris? A. Three; the popliteus, gastrocnemius externus, and plantaris. Q. Describe the origin, insertion, and use of the Pop- litSus ? A. It arises by a small round tendon from the outer and under part of the external condyle, and from the back part of the capsular ligament, becomes fleshy, spreads out, runs obliquely inwards and downwards, and is inserted thin and fleshy into a ridge at the upper and inner edge of the tibia, a little below its head*; it assists in flexion, and rotation inwards or tibiad, and prevents the capsular ligament from being pinched in flexion of the joint. Q. Describe the GastrocnSmius externus ? A. It arises by two distinct heads, the one tendinous from the upper and back part of the internal condyle, and from the oblique ridge above it; the other head al- so tendinous in like manner, from the upper and back part of the external condyle ; they meet a little below the joint, and form a large fleshy mass with a middle tendinous line; below the middle of the tibia it sends off a broad thin tendon, which becoming narrower, is united with that of the gastrocnemius internus, a little above the ankle. Q. Describe the Plantaris ? \. it arises thin and fleshy from the upper and back part of the external condyle, and from the capsular li- 250 PATHOLOGY OF THE HIP AND THIGH. gament, forms a tapering belly three or four inches in length, which sends down a long slender tendon be- tween the external and internal gastrocnemii; and, where their tendons unite, it passes obliquely over to the inner side of the tendo Achillis, where it de- scends, and is inserted into the inner and posterior part of the os calcis, below the insertion of the tendo Achil- lis. SURGICAL PATHOLOGY OF THE KNEE. Q. Having now described all the muscles connected with the Knee-joint, describe also the Internal or Cru- cial Ligaments of it? A. There are tioo crucial or internal ligaments; the anterior, arising from the semilunar notch between the condyles running obliquely forwards, is inserted into a pit before the rough protuberance in the middle of the articular surface of the head of the tibia; the posterior, arising similar to the former, passes behind it, and is inserted behind the protuberance; they attach the fe- mur and tibia firmly together, while they allow the motions of the joint, and rotation tibiad, but not fibu- lad. Q. Describe the Semilunar Cartilages of the Knee- joint. A. The head of the tibia is divided by a middle ridge; on each side of which is a cavity, corresponding to the condyles of the femur; each cavity is deepened by a crescent-formed cartilage, thick on-the outer convex, and thin on the inner concave side; the circumference of these two cartilages is connected to the capsular liga- ment; their inner points, or cornua, are connected by a small transverse ligament, and to the middle protuber- ance of the tibia. Q. Are the condyles of the femur and the articular surfaces of the tibia covered ? A. Yes; they are all covered by cartilage, and well lubricated for facilitating the motions of the joint. PATHOLOGY OF THE KNEE. 251 Q. What muscles are extensors of the Knee- joint ? A. Six; the anterior part of the tensor vaginae, and of the gluteus maximus connected with it, the rectus femoris, vastus internus, vastus externus, and cruralis. Q. What muscles are flexors of the Knee-joint? .A. They are ten; the posterior part of the tensor vaginae and of the gluteus maximus attached to it, the sartorius, gracilis, semitendinosus, semimembranosus, biceps cruris, gastrocnemius externus, plantaris, and popliteus. Q. Has the Knee-joint much rotatory motion ? A. No ; its motions are chiefly flexion and extension ; a slight degree of rotatory motion of the toes tibiad and fibulad can be performed at the knee ; but the crucial ligaments check it from going far tibiad. Q. What is the use of the patella or rotula un- der the tendons of the four most powerful extensor muscles ? A. It is lined below by cartilage, and well lubricated; by which means it moves round the cavity between the condyles in flexion and extension with great facility; it removes the tendons farther from the centre of mo- tion, and thus increases their power of action. Q. Is it ever fractured or dislocated ? A. Yes ; it is occasionally fractured across, when the joint is half bent: it is also sometimes forced out of the hollow pulley between the condyles to one side, gene- rally outwards. Q. Is the Knee-joint ever dislocated ? A. Very seldom; the strong lateral ligaments, the thick capsular, and strong crucial ligaments, the tendi- nous aponeurosis, and tendons of muscles lying close upon the capsular ligament, prevent its dislocation, un- less the force applied be sufficient to rupture some of these strong natural guards and securities, and to dis- place the joint. Q. What muscles are Extensors of the foot ? A. Eight ; the gastrocnemius externus and plantaris 252 PATHOLOGY OF THE KNEE. already described, the gastrocnemius internus, the ti- bialis posticus, the peroneus longus, and brevis, the flexor longus digitorum pedis, and the flexor longus pol- licis, which two last, though principally flexors of the toes, are also extensors of the foot. Q. Describe the Gastrocnemius internus vel So- leus ? A. It arises also by two heads, the external, by much the larger, fleshy from the back part of the head, and upper and back part of the body of the fibula ; the in- ternal from the back part of the tibia, running in- wards along the under edge of the popliteus; it receives fleshy fibres from the inner side of the bene for a con- siderable way down; they unite and form a large belly, which, covered by the tendon of the gastrocnemius ex- ternus, descends fleshy and tapering near to the ankle ; then it sends off a tendon, which joins that of the for- mer muscle, and their united round tendon, called ten- do Achillis, is inserted in the upper and back part of the os calcis ; these two.muscles raise the heel, and ex- tend the foot. Q. Describe the Tibialis posticus ? A. It arises fleshy from the upper and fore part of the tibia, passes through a fissure in the interosseous ligament, and continues its origin from the posterior part of the tibia, fibula, and interosseous ligament, down to their middle; its fibres run obliquely to a middle tendon, which becoming round passes through a groove behind the inner ankle, and is inserted by separate ten- dinous slips into the upper and inner part of the os na- viculare, and partly into the under surface of the tarsal bones. Q. Describe the Peroneus longus ? A. It arises from the fore part of the head of the fi- bula, and from its outer part downwards for two thirds of its length; its fibres run in a penniform manner to a long tendon, which becoming round is inclosed in a sheath, passes behind the outer ankle through a groove in the lower extremity of the fibula, is reflected to the sinuosity of the 09 calcis, runs along a groove in the os PATHOLOGY OF THE KNEE. 253 cuboides, and then obliquely across the sole of the foot, and is inserted into the outside of the base of the meta- tarsal bone of the great toe, and partly into the os cu- neiforme internum. Q. Describe the PeronSus brevis ? A. It arises from the outer part of the fibula from its middle down to the outer ankle; its fibres run ob- liquely outwards to a tendon, which becomes round, passes behind the outer ankle, is included in the same sheath with the peroneus longus, crosses behind it, and running forwards in a sheath proper to itself, is inserted into the root and external part of the metatarsal bone of the little toe. Q. Describe shortly the Flexor longus digitorum pedis ? A. It arises from the back part of the tibia at the under edge of the popliteus, and is continued down the inner edge of the bone by fleshy slips terminating in its tendon ; also from theoutcr edge of the tibia, and be- tween this double order of fibres the tibialis posticus is inclosed; about two inches above the ankle, it sends off a round tendon, which passes behind the inner ankle in a groove of the tibia, under two annular ligaments, and through a sinuosity at the inside of the os calcis ; about the middle of the sole it receives a tendon from the flexor longus pollicis, and then divides into four ten- dons, which pass througli the slits of the perforatus, and are inserted into the base of the third phalanx of the four small toes. Q. Describe the Flexor longus pollicis ? A. It arises from the back part of the fibula, a lit/le below its head, and continued down nearly to its under extremity by a double order of oblique fibres, which ter- minate in a tendon that passes under the annular liga- ment behind the inner ankle through a groove in the tibia, then in the astragalus; in the sole it cro/ses the tendon of the flexor longus digitorum, to whic/i it gives a tendinous slip; it next passes between the sesamoid bones, and is inserted into the last joint of the great toe. X 254 PATHOLOGY OF THE KNEF.. Q. What muscles are flexors of the foot at the ankle-joint ? A. Four; the tibialis anficus, extensor longus digi- torum pedis, extensor proprius pollicis, and the peroneus tertius of Albinus. Q. Describe the Tibialis antlcus ? A. It arises tendinous from the tibia between its tu- bercle and articulation with the fibula ; runs down fleshy on the outside of the tibia, adhering to it and to the up- per part of the interosseous ligament: near the under part of the leg it sends off a strong round tendon, which crosses obliquely from the outside to the fore part of the tibia, passes through a ring under the annular liga- ment near the inner ankle, runs over the astragalus and os naviculare, and is inserted into the middle of the os cuneiforme internum, and base of the metatarsal bone of the great toe. Q. Describe the Extensor longus digitorum pedis? A. It arises from the upper and outer part of the head of the tibia, and from the head and nearly the whole length of the anterior spine of the fibula, from the apo- neurosis, which covers the upper and outer part of the leg, and from the interosseous ligament; below the middle of the leg it splits into four round tendons, which pass under the annular ligament, become flat, and are inserted into the base of the first phalanx of the four small toes, and are expanded over their upper surface as far as the last phalanx; it extends the small toes, and assists powerfully in bending the ankle-joint. A portion of this muscle is called by some peroneus tertius. Q. What are the origin, course, and insertion, of the PeronSus tertius ? A. It arises in common with the former muscle, from the middle downwards near to the malleolus externus of the fibula; it sends its fleshy fibres forwards to a tendon, which passes under the annular ligament in the same sheath wi.'h the extensor longus digitorum, and is in- serted into the base of the metatarsal bone of the little toe. Q. Describe the Extensor proprius pollicis? PATHOLOGY OF THE KNEE. 255 A. It arises acute, tendinous, and fleshy, from the fore part of the fibula, a little below its head, and down- wards near to the malleolus externus ; its fibres run ob- liquely forwards to a tendon, which passes over the fore- part of the astragalus and os naviculare, and is inserted into the base of the first and second phalanges of the great toe; it extends the great toe, anil assists in bend- ing the ankle-joint. SURGICAL PATHOLOGY OF THE ANKLE. Q. Besides flexion and extension, has not the ankle- joint other motions ? A. Yes; the toes can be turned outwards or fibulad, and inwards or tibiad, to a small extent; and by the combined alternate action of flexors, extensors, adduc- tors, and abductors, the foot can be made to describe a sort of rotatory motion describing an imperfect cone, with its apex at the ankle, and its base at the toes. Q. What muscles perform the motion of abduction fibulad ? A. Four; the peroneus longus, peroneus brevis, pe- roneus tertius, and the extensor longus digitorum pedis. Q. What muscles perform the motion of adduction tibiad ? A. Four ; the tibialis posticus, extensor proprius pol- licis, flexor longus digitorum, and flexor longus pollicis. Q. What parts secure the ankle-joint against inju- ries ? A. It is secured, in the first place, by the construction of the bones, the inferior end of the tibia being hollow, covered and deepened on its brim, by being surrounded with cartilage, for the reception of the astragalus ; de- fended on the inside by its own depending process, which forms the malleolus internus; defended on the outside by the extremity of the fibula, which forms the malle5lus externus: in the second place, by strong liga- ments, namely, the capsular ligament; the anterior and posterior superior, and the interosseous ligaments, which bind the tibia and fibula together; the anterior, perpen- 256 PATHOLOGY OF THE ANKLE. dicular or middle, and posterior ligaments, which bind the malleolus externus firmly to the astragalus and os calcis; and the deltoid ligament, which binds the mal- leolus internus very firmly to the astragalus, os calcis, and os naviculare: and in the third place, by the strong tendons of the muscles; viz. by the tendons of the tibialis anticus, flexor longus digitorum pedis, flexor longus pollicis, and of the tibialis posticus, passing close upon the joint just behind the inner ankle; by the ten- dons of the peroneus longus, and peroneus brevis, pass- ing close upon the joint immediately behind the outer' ankle; by the tendons of the extensor longus digitorum pedis, peroneus tertius, and of the extensor pioprius pollicis, spreading and passing on the fore part of the joint, and most firmly bound down upon it by the strong tendinous annular ligament of the tarsus; and by the tendo Achillis, and the plantaris behind. Q. In consequence of such security, is the ankle-joint rarely dislocated ? A. It is much exposed by its frequent exercise to nu- merous accidents, and it is frequently dislocated in- wards, more seldom outwards, and very rarely forwards, by too much extension. Q. When dislocation happens inwards or tibiad, what parts are generally injured ? A. The process of the tibia forming the internal ankle, is fractured; the capsular and external lateral ligaments, attached to the malleolus externus, are ruptured; and the tendons of the peroneus longus and peroneus brevis are over-stretched. Q. How is such a luxation to be reduced ? A. By gently pulling the foot in the direction of the tibia, and replacing the bones of the taisus in the socket of the tibia; and by the easy flexion and exten- sion of the joint afterwards, we are certain of it being properly reduced. A bandage and splints may be ne- cessary to retain it in its situation until the ligaments adhere. Q. When the ankle is dislocated outwards, what parts are generally injured ? PATHOLOGY OF THE ANKLE. 257 A. The capsular and deltoid ligaments are ruptured ; the fibula about an inch or two above the malleolus ex- ternus is fractured; and the tibialis anticus and posticus, the flexor longus digitorum, and the flexor longus pol- licis, whose tendons pass behind the inner ankle, are tense and over-stretched. Q. How is reduction in such a case performed ? A. By gently pulling the foot in extension, and re- placing the astragalus in its socket, as in the last case ; and afterwards by applying a splint on each side of the leg, and bandaging the joint in its proper situation. Q. When the ankle is dislocated by too great exten- sion, and the convexity of the astragalus thrown forward between the malleoli, what parts seem to be injured ? A. The capsular, lateral, and anterior annular liga- ments are all ruptured; and the gastrocnemii in a state of over-distension. Q. How is such a luxation of the ankle-joint to be reduced ? A. The over-stretched muscles should be relaxed as much as possible by bending the knee-joint, and then, while an assistant keeps the knee in that position, the surgeon, with one hand holding the heel, and with the fingers of the other placed over the fore part of the tarsal bones, should pull pretty forcibly in a line with the tibia, and then attempt to replace the astragalus in its socket by bending the toes and foot rotulad. Q. How many muscles are employed in the motions OF THE GREAT TOE ? A. Seven ; two extensors, viz. the extensor brevis di- gitorum, and extensor proprius pollicis; two flexors, the flexor brevis pollicis, flexor longus pollicis, assisted by the diagonal forces of the abductor and adductor polli- cis ; the adductor assisted by the transversalis, and the abductor pollicis. Q. Describe the Extensor brevis digitorum ? A. It arises fleshy and tendinous from the outer and fore part of the os calcis, forms a fleshy belly, which is divided into four portions, each of which sends off a X 2 258 MUSCLf.i OF THE FOOT. tendon, which crosses obliquely over the upper part of the metatarsal bones under the tendons of the extensor longus digitorum, and is inserted into the tendinous ex- pansion of the long extensors on the inside of all the toes, except the little one. Q. We have described the extensor proprius pollicis, and also the flexor longus pollicis, as arising from the fibula; therefore pass on to describe the Flexor brevis pollicis ? A. It arises tendinous from the under and fore part of the os calcis, and from the cuneiforme externum, di- vides into two heads, between which runs the tendon of the flexor longus; their tendons arc inserted into the external sesamoid bone, and base of the first bone of the great toe. Q. Describe the Adductor pollicis ? A. It arises by a long thin tendon from the under part of the os calcis, os cuboides, and os cuneiforme ex- ternum, and from the root of the metatarsal bone of the second toe; it divides into two fleshy portions, which are inserted into the external sesamoid bone, and base of the metatarsal bone of the great toe. Q. Describe the Transversalis ? A. It arises tendinous from the upper and fore part of the metatarsal bone of the great toe, and from the inter- ternal sesamoid bone of the first joint, forms a fleshy belly, runs transversely between the metatarsal bones and tendons of the flexors, and is inserted tendinous into the under and outer part of the anterior extremity of the metatarsal bone of the little toe, and ligament of the one next it. Q. Describe the Abductor pollicis ? A. It arises fleshy from the anterior and inner part of the protuberance of the os calcis; and tendinous from the same bone, where it joins the os naviculare; it is insert- ed tendinous into the internal sesamoid bone and base of the first bone of the great toe. Q. What muscles are peculiar to the little toe ? A. Two; the abductor minimi digiti, and the flexor brevis minimi digiti. MUSCLES OF THE FOOT. 259 Q. Describe the Abductor minimi digiti pedis 1 A. It arises from the under part of the protuberance of the os calcis, and from the base of the metatarsal bone of the little toe, sends off two small tendons ; the one is inserted into the base of the metatarsal bone, the other into the outside of the base of the first phalanx. Q. Describe the Flexor brevis minimi digiti ? A. It arises from the os cuboides, and from the outer and back part of the metatarsal bone, and is inserted into the anterior end of the metatarsal bone, and into the base of the first phalanx of the little toe. Q. What muscles Extend the toes ? ' A. The extensor longus digitorum, and the extensor brevis digitorum, the little toe excepted, which we have already described. Q. What muscles Bend the small toes ? A. The flexor longus digitorum, (profundus vel per- forans), flexor bre'-is digitorum, (sublimis vel perfora- tus); in the little toe, the flexor brevis minimi digiti, and abductor minimi digiti, all of which we have already described, also the lumbricales, and jnterossei. Q. Describe the Lumbricales? A. They arise from the tendons of the extensor lon- gus digitorum just where it divides, are four in number, run forwards through the digitations of the palmar apo- neurosis to the first phalanx, creep over the convexity of the bones, unite with the long extensors, and are in- serted into the inside of the first phalanx, and into the tendinous expansion on the upper part of tbe toes; they assist in flexion and adduction of the toes. Q. Is the Flexor digitorum accessorius, (vel massa carnea Jacobi Sylvii) connected with the lumbricales? A. This fleshy mass arises from the sinuosity at the inside of the os calcis, and tendinous from the fore and outer part of it; and forming a square belly, is inserted into the tendon of the flexor longus, just where the lumbricales commence from it; it assists the flexor lon- gus. (J. How arc the InterossSi muscles divided ? A. Into three internal, and four external. 260 MUSCLES OF THE FOOT. Q. Describe the InterossBi interni ? A. They arise tendinous and fleshy from the inner and under part of the metatarsal bones of the small toes, and are inserted into the base of the first phalanx of the three small toes. Q. Describe the InterossSi externi, or bicipites ? A. They arise by two slips from the contiguous sides of all the metatarsal bones, are situated on the back of the foot, and are inserted into the sides of the base of the first phalanx of the small toes; so that their ten- dons, the tendons of the lumbricales, of the extensor longus, and of the extensor brevis, all unite upon the sides and back of the toes, and form an aponeurotic sheath on the upper part of each toe. OF THE BURSAE MUCOSAE. Q. What are you to understand by a Bursa Mucosa ? A. It is a bag or shut sac, placed most frequently un- der the tendons of muscles, when they require space to play in. Q. What is the general shape of the Bursae ? A. They are generally either round, or oval; hence they have been arranged under two great classes, the Spherical and the Vaginal Bursae. Q. What is the structure of a bursa mucosa ? A. The internal membrane of a bursa is thin, smooth, and lubricated by a fluid in all respects similar to syno- via ; its structure is the same as that of the internal layer of the capsular ligaments, of the pleura, periosteum, and of other serous membranes : the external membrane is common cellular substance, which unites the bursa to the neighbouring parts. Q. What secretes the lubricating fluid in the bursae ? A. Within the bursae lie very small masses of fat, with fimbriae appended to them, and covered hy a con- tinuation of the internal membrane of the bursa; upon these masses numerous small ramifications of arteries are distributed, which make their colour of a pale red OF THE BURSAE MUCOSAE. 261 hue. By these, and the vessels of the internal mem- brane itself, the fluid is secreted. Q. Have the Bursae any lymphatics and nerves ? A. Yes; the fluid secreted is absorbed by the lympha- tics, and a constant renewal of it maintained; if this were not the case, they would become dropsical and burst: their lymphatic vessels, however, have hitherto eluded observation. In consequence of the extreme thinness of the coats of the bursae, nerves cannot be traced in them, and they seem in their healthy state pos- sessed of but little sensibility; but when the bursae be- come inflamed, the great pain sufficiently demonstrates the presence of nerves in their structure. Q. In what parts of the body are the bursae mucosae most frequent ? A. They are chiefly to be found in the extremities, between the tendons and bones, or ligaments, between tendons which rub against each other, between tendons and their sheaths; and, in short, between all parts where the necessary motions of the body occasion friction. Q. What are the wses of the bursae mucosae .' A. They afford room for the parts coming in contact to move easily; and the gelatinous mucus, which they contain, lubricates those parts copiously, facilitates their movements, and prevents the effects of friction. ON THE PHYSIOLOGY OF THE MUSCULAR SYSTEM. PRELIMINARY DEFINITIONS. On the motions and attitudes. Q. What is meant by the vertical line? A. It is that line in the direction of which gravity operates. Q. What is meant by the centre of gravity ? A. It is that point, in which centre all the lines com- ing from every part and in the direction of which gravity operates. Q. What is meant by equilibrium ? 262 PHYSIOLOGY OF THE MUSCULAR SYSTEM. A. When a body laid on a horizontal plane is so placed that the perpendicular let fall upon the horizontal plane from the centre of gravity falls between the two points between which the body is supported. The equili- brium of a body bearing upon a horizontal plane is the more stable as the centre of gravity of the body is nearer to the plane, and as the surface upon which it is sup- ported is the more extensive. Q. What is the base of sustentation ? A. The base of sustentation is the space between the two points of a plane surface by which a body is sup- ported. Of two hollow columns formed of an equal quantity of similar materials, and of the same height, that which has the most considerable cavity is the strongest. Of two columns of the same diameter but of different heights, the weakest is the highest. Q. What is meant by a lever ? A. A lever is an inflexible line, which turns upon a fixed point. The point of support or fulcrum, the power which moves and the resistance or weight to be moved, are the thiee things to be noticed in the lever. In a le- ver of the first kind, the fulcrum or point of support is between the resistance and the power. In the second kind of lever, the resistance or weight is between the power and the point of support. In the third, the power is between the resistance and the point of support. The power of the lever is proportional to the length of its arm, whether it be on the side of the power or of the weight: thus, if the arm on the side of the power is lon- fer than that on the side of the weight or resistance to e moved, the advantage is on the side of the power in proportion as the length of the arm on the side of the power is greater than that on the side of the resistance : so that if the first is double or three times that of the se- cond, it will be sufficient that the half or third of the power should be applied to bring the two forces to an equality. In the lever of the second kind, the arm of the power is necessarily longer than that of the resist- ance, because the last is placed between the power and the point of support, so that the power is at one end. PHYSIOLOGY OF THE MUSCULAR SYSTEM. 263 The advantage in this kind of lever is always on the side of the power: On the contrary, in the third kind of le- ver; since in this lever the power is placed between the resistance and the point of support, so that the resistance occupies one extremity. The lever of the first kind is most favourable for a balance; of the second kind, to overcome a resistance ; of the third, to put a weight into great and rapid motion. The effect of a power is the more considerable, as the power acts perpendicularly to the lever: when the force is completely perpendicular, the whole force is then in action ; when it is oblique, in proportion as it is so, a part of the force is wasted. INERTIA. Q. What is meant by inertia ? A. The disposition of bodies to continue in a state of motion or rest. The quantity of motion in a body is measured by the velocity of each part, multiplied by its mass or number of parts. This velocity may be acquired by the addition of a force in continued action, or it may be the result of one impulse. Every force therefore, im- pressed upon every body that is perfectly free, must pro- duce in that body some motion ; its direction, velocity, and the space performed in a given time, will depend upon its mass, or upon the impulse or on the intensity of the action exercised upon it, and the forces which draw it aside during its motion; thus, a body thrown from the hand acquires instantaneously a velocity the greater as the mass of the body is less ; the continued action of its weight modifies continually both the velocity and the direction of the motion, which ceases when the body reaches the earth: the resistance of the air, the effect of which is increased with the velocity and the extent of surface of the body and its specific gravity, also retards it. Q. What other circumstances influence motion ? A. The resistance or friction, produced by one body rubbing against another in passing over it. Q. What is meant by adhesion ? 264 PHYSIOLOGY OF THE MUSCULAR SYSTEM. A. The force with which two polished surfaces in con- tact are united to each other. It is measured by the perpen- dicular force required to separate them. In proportion as surfaces are polished so much greater is their adhe- sion, and in the same proportion the friction is weaker. The interposition of a liquid, as oil, has a good effect in filling up the inequalities, and polishing the surface. Q. In what light are the bones to be considered in the physiology of motion ? » A. As forming the basis of the locomotive system; they are and appear as levers of the three different classes; the first, where balancing is necessary; the second, where a considerable resistance must be over- come ; the third, where great extent and quickness of motion are desired: their projections and prominences serve to change the direction of the tendons, and to cause their insertion nearer to the perpendicular to the shaft of the bone: by their shortness and solidity, they are of use where little motion is required, and much strength, as in the foot and vertebral column : by their flatness they give origin to the muscles, and protect the cavities: by their roundness as in the long bones, they give strength and beauty to the limbs; by the enlarge- ment of the ends of the bones, they favour the perpen- dicular insertion of the tendons. The sponginess of the short bones enables thern to present a considerable sur- face, without being too heavy. Q. How do the articulations assist motion ? A. Their smooth cartilaginous surfaces, and the sy- novia introduced between them, render motion easy ; the fibro-cartilaginous bodies between the vertebrae, which moderate the effects of shocks, make it more exten- sive. ON THE ATTITUDES. On the erect position. Q. How is the erect position produced ? \ First the head, which is a lever of the first kind, is PHYSIOLOGY OF THE MUSCULAR SYSTEM. 265 supported on the vertebral column by the occipital mus- cles behind. The bones composing the vertebral column may be considered as a series of levers piled upon each other, in which the power is in the posterior muscles of the back ; they support the fibro-cartilaginous substances be- tween each, and the resistance, the viscera, the arms, and the neck, which give it a tendency to fall forward. The strength of the column consists in the bodies of the ver- tebrae, the different ligaments which unite them, and the fibro-cartilaginous substances between them. The cur- vatures of the surfaces of the bodies of the vertebrae op- posed to each other, also increase the power of the vertebrae, *o that they are not only able to bear the weight of the body, but al o great burdens. The whole vertebral column is to be considered as a lever of the third kind, in which the support is in the point of junc- tion of the vertebrae of the loins with the sacrum, the power the viscera, &c. above mentioned, and the re- sistance to be overcome the large muscles behind. The column is stronger, the processes more thick and hori- zontal, and the greatest force is exerted upon the lower part of the vertebrae near the sacrum. Q. What are the circumstances which regulate the muscular force in supporting the vertebrae ? A. It acts more efficaciously in proportion as the spi- nous processes are longer, and more horizontal. Q. Wrhat kind of lever does the pelvis represent ? A. It represents a lever of the first kind, for it is balanced upon the two femurs, the heads of which are the points of support; the weight and resistance being the abdominal viscera pressing it downwards, and the spina behind in the same direction. Q. But is not the weight of the spine more considera- ble, and would it not over balance the abdominal viscera ? A. It is prevented by muscles which go from the femur to the pelvis, which have the power of drawing it downwards, and thus counteract the weight of the ver- tebral column. As the tendency of the vertebral column Y 266 PHYSIOLOGY OF THE MUSCULAR SYSTEM. from the weight of the head and chest is forwards, the balancing of the pelvis on the heads of the two femurs is assisted by the muscles which arise from the back part of the pelvis and back, and keep the head and back erect; the large muscles also arising from the back part of the thigh, and inserted into the back part of the pelvis, assist in controlling the equilibrium of the pelvis, when from any cause it has a tendency forward ; this they are well calculated to do, from the length of lever made by the projection of the pelvis farther behind than before; the head supported on the atlas, the spine straight, and the pelvis balanced by these muscles, throw the weight of the parts above on the tibia in the erect position. Q. What is the object of the direction ot the head of the thigh upwards and inwards ? A. It supports the vertical pressure of the pelvis, and it resists the separation of the ilia, which the sacrum has. a tendency to produce. Q. How is the weight of the whole body which falls upon the head of the tibia, supported on the knee ? A. By the rectus and cruraeus inserted into its head, and also by the muscles on the back part of the leg, which arise from the posterior part of the condyles of the femur; the contraction of these muscles stiffen the leg, and enable it to support the weight of the parts above. Q. What are the circumstances to be observed about the foot, in favouring the standing position ? A. The extent of the soles, which give a broad base for standing upon; the arched form of the foot, which makes it stronger; the fatty cushion below the heel and the thick epidermis, which enable it to bear sudden shocks. Q. What is the use of the fibula ? A. From the effect of the pressure of the tibia, tend- ing to throw the foot outwards, from the form of the arch of the foot, this bone prevents by its pressure that effect. Q. What is the breadth of the base which supports* the body ? A. It comprehends the length and breadth of the*feet, PHYSIOLOGY OF THE MUSCULAR SYSTEM. 267 and tho space between them: large feet, therefore, render this position more firm as they enlarge the base. On the contrary, the more the base is lessened, as by standing upon the toes, or upon a cord, the more mus- cular exertion is required to keep the line of direction within the base. STANDING ON ONE FOOT. Q. How is this position effected ? A. By a powerful action of the muscles about the hip, the equilibrium of the pelvis is thrown upon ono thigh; the muscles of the hip on that side, the three glutei, the gemelli, the pyramidales, the obturators, the quadratus lumborum, produce a contraction, sufficiently' powerful to support the body on the thigh in such a way that the line of direction falls within the base. KNEELING, SITTING, AND LYING. Q. What is to be observed with regard to these atti- tudes ? A. The first is uneasy, from the pressure being limited to two points, the surface of the knee pans; the base of sustentation is also narrow. With regard to sitting, it is firmer, because the base is larger and more easy from the flat and fleshy surface of the muscles, on which the body is supported ; and because there are fewer muscles brought into play than in the standing position. With regard to lying, it is the easiest of all, because the mus- cles are all relaxed, and the surface of pressure is divided into many points, particularly when it is soft, as on a bed. ON THE MOTIONS. Of walking. Q. How is the motion of walking performed ? A. Supposing the person in an erect posture, to walk forward at an ordinary pace, it is performed by first 268 PHYSIOLOGY OF THE MUSCULAR SYSTEM. bending one thigh upon the pelvis, straightening the leg, raising the foot from the ground, and thus producing a general shortening of the limb, which advances it for- ward; then the limb rests upon the ground, first touch- ing with the heel, and successively the whole anterior parts of the foot. During this time the pelvis rotates upon the thigh upon the head of the limb which is im- moveable ; carrying forward the whole limb which is raised from the ground, and that whole side of the body. As yet there is no advance ; the limb which is behind is brought forward in the following manner: the foot behind is detached from the heel to the toes, by a movement of rotation, of which the centre is the articu- lation of the metatarsus with the phalanges, so that to- wards the end of this movement, the foot does not touch, except by these last; the limb is lengthened, the trunk is carried forward, by rotating the pelvis on the head of the thigh formerly carried forward. Q. What is the difference of walking forward in a straight line as regards the motions ? A. The pelvis in rotating on the respective thighs, ad- vances successively in equal circles. If one is larger than the other, the course must be crooked. Q. How is walking backwards performed ? A. One of the thighs is bent upon the pelvis, at the same time that the leg is bent upon the thigh, the ex- tension of the thigh upon the pelvis follows, and the whole of the limb is carried backward; then the limb is straigbtened upon the thigh, the points of the toes touch the ground, and then the whole lower surface; at the same moment, the foot directed backwards touches the ground, that which remains forward rises on its point; the corresponding member is straightened ; the pelvis pushed backwards, rotates upon the thigh di- rected backwards; the limb in advance quits the ground and carries itself backwards, to form a fixed point to a new rotation of the pelvis, which succeeds on the opposite limb. Q. How is walking to one side effected ? PHYSIOLOGY OF THE MUSCULAR SYSTEM. 269 A. One of the thighs is slightly curved upon the pel- vis, to raise the foot from the ground; the whole limb is abducted in that bent position, it is then applied to the ground ; the other limb is approached to it, and so on. Q. How is walking on an ascending plain effected ? A. By raising in a greater degree the leg which is thrown forward, and then raising up the body upon it; it is these circumstances which occasion its difficulty. Q. How is walking down a descent effected ? A. In the same manner as forward, only that the pos- terior muscles of the trunk must contract with force to prevent the fall of the body forward? Q. How is leaping performed ? A. By the sudden straightening of the lower extremi- ties, which have been previously fixed, and the projection of the body in a Vertical forward, or backward direction. The arms assist in leaping by the resistance necessary to raise them by the means of the muscles attached to the trunk: this resistance is of course increased by holding weights in the hands, from the greater difficulty of mov- ing the arms. Q. In what does running consist ? A. It consists in a combination of walking and leap- ing; it is different from rapid walking in this, that in run- ning there is always a moment when the body is sus- pended in the air. Q. In what does swimming consist? A. It consists in repeated impulses of the feet and hands against the water, by which the body is propelled forward : it resembles leaping: by distending the lungs the body is made nearly of the same specific gravity as the water, otherwise it would sink; it is from the great difference of the specific gravity of water and air that it is impossible to fly. ATTITUDES AND MOVEMENTS OF DIFFERENT AGES. Q. What is the position of the foetus in the womb ? A. The thighs are bent upon the abdomen, the legs arc applied to the thighs, the arms are crossed 011 the Y 2 2"<0 PHYSIOLOGY OF THE MUSCULAR SYSTEM. fore part of the trunk, and the head rests upon the chest, to take up as little room as possible: it is the result of the disposition of the muscles to shorten themselves. Q. Does the foetus move in the womb ? A. It begins to move in about four months; its motions are sudden, independent of the will, and most probably confined to the lower extremities. Q. What is the attitude most natural to a new born infant? A. The horizontal or that which best comports with its weakness. Q. Does the sight influence our attitudes ? A. It gives us a clear view of the objects which sur- round us, and thus gives confidence to every action, by enabling us to avoid danger, &c. The difference be- tween the movements of a blind man and one who can see, points out the effects of vision upon the muscular system. Q. How are the gestures to be distinguished .' A. Into those which are natural, as those of savages and idiots; and those which are acquired in the social state ;.among the latter may be enumerated the gestures of the deaf and dumb which supply the place of speech, and also of the orator. Q. What effect have internal sensations on the ges- tures and motions ? A. They have great effect; thus, pain, as that of colic, or a stitch in the side, bending the body. Q. What relation have the attitudes and gestures with the will? A. The will occasions them, but not directly: thus, I can set in motion my arm, but to do it I must first have a clear idea of the motion intended to be produced; without it, it is impossible to move either a single mus- cle or any combination of them. Q. What are the instruments of the will more particu- larly? A. The brain and the cerebellum; but the power which produces muscular motion is seated in the spinal marrow: thus, if the spinal marrow be divided behind PHYSIOLOGY OF THE MUSCULAR SYSTEM. 271 the occipital bone, the power of the will to determine the direction of the motions is taken away; for they are irregular, but the power of motion still remains. Under the idea that the action of the brain is distinct from that of the will, it is easy to conceive that in certain cases the simple irritation of the brain may produce extensive and violent movements of the muscles ; and also the dif- ficulty of the arts of fencing and dancing, in which the action of the muscles follows that of the will only after long and painful efforts. Q. How is instinct connected with the attitudes ? A. Some, as those which have been called voluntary, and which we have just enumerated, are evidently part- ly dependent upon instinct; there are others which are entirely so; as the expressions of joy, grief, hunger, thirst, fear, &c. Q. What effect have the passions on the force of the muscles ? A. Some, as anger, increase; others, as fear, grief, de- bilitate and diminish their power. Q. What are the relations of muscular motion with the voice ? A. They are intimate; the gestures and the attitudes give great assistance to the expression of,the voice: when words succeed each other slowly, the gestures are so much the more numerous; in the strong passions they are both used. PATHOLOGY OF THE MUSCULAR SYSTEM. TETANUS. Q. What are its symptoms ? A. Violent, involuntary, and permanent contraction of the muscles of the whole body, or of some part of it, un- accompanied by disturbance of the mental functions, ge- nerally induced by lacerated wounds. In many instances we observe convulsive twitchings of the muscles, sub- sultus tendinum, acute pain, slowness of the pulse, and more or less hurried respiration. Sometimes the spasms 272 PATHOLOGY OF THE MUSCULAR SYSTEM. affect the elevator muscles of the lower jaw, causing the locked jaw ; in other cases it is the extensor muscles of the trunk, and less frequently the flexors that are attack- ed, occasionally only one side is affected, hence the body may be bent backwards, forwards, or to one side. Te- tanus may be mistaken for some disease of the brain and its membranes, and, still more probably, those of the spinal marrow. Q. What are its Anatomical Characters ? A. Not known. RHEUMATISM. Q. What are its symptoms ? A. Pain, more or less acute, producing a gnawing sen- sation, increased by the action of the affected muscles; accompanied, particularly in acute cases, with swelling and slight redness of the integuments; generally brought on by cold and moisture. It is liable to sudden metas- tasis to the muscles of a different region or to the joints; when it is severe and very painful, it causes fever and various constitutional symptoms. The muscles most generally attacked, are those on the back of the neck, the parietes of the thorax, and the lumbar region, to which respectively are applied the terms torticoli, plaro- dynia, lumbago. When it comes on gradually, or when it becomes chronic, no swelling is observed; the pains are felt only at irregular intervals; sometimes, however, though rarely, they are continued, but in almost every instance they are increased by cbanges in the atmos- phere or by cold. This affection is generally very tedi- ous, lasting for many weeks, and in some instances for years, and after it has ceased, is very liable to return. Diseases with which it may be confounded, aie the neu- ralgic affections. Q. What are its anatomical characters ? A. When acute rheumatism is seated in musculai parts, if the inflammation has been very intense, pus is sometimes found infiltrated into the part affected, or even collected so as to form an abscess. The substance ol the muscles is softened, of a reddish brown colour, easily PATHOLOGY OP THE MUSCULAR SYSTEM. 273 torn, and contains a bloody serum. When the disease is chronic, no very evident alteration can be perceived in the state of the parts. ARTICULAR RHEUMATISM. Q. What are its symptoms ? A. Acute, lancinating pain of one or more of the joints, increased by motion, or the slightest pressure, and ac- companied by a greater or less degree of swelling of the affected part, and sometimes inflammation of the skin over it, with perceptible fluctuation. It most commonly attacks the large joints, as the knee, the wrist, the el- bow. This inflammation readily changes from one part to another, generally causes fever, and is of very tedious duration. Q. What are its anatomical characters ? A. The articulations are filled with purulent matter of various consistence, or with a bloody serum ; the syno- vial membrane is often found injected, swollen, and, in some cases, altogether destroyed. The articular carti- lages may be enlarged, thickened, diminished, or may have partly disappeared. Pus is sometimes found effused round the joint, or into the sheaths of the ten- dons. GOUT. Q. Wfrat are its symptoms ? A. Inflammation attacking the small joints, but more especially that of the great toe, and the phalanges; it is generally remarked to be hereditary, and continuing a great part of the patient's life, and not accidental, as acute articular rheumatism; rarely occurring before the age of thirty years, chiefly attacking those who live lux- uriously, often connected with intestinal irritation, re- curring in regular or irregular paroxysms, in which a more or less violent pain attacks the great toe, the ankle, or the heel, lasts for some time, and goes off; the affect- ed part remaining a little red and swollen. Concretions 274 PATHOLOGY OF THE MUSCULAR SYSTEM. of urate of soda or lime, are often formed on the joints after these paroxysms. In cases of long standing, or in the erratic species, the diagnosis is often very difficult. Q. What are its Anatomical Characters ? A. Calcareous concretions of the joint, with some ap- pearance of inflammation. OF THE BRAIN, AND ORGANS OF THE SENSES. THE INTEGUMENTS AND ORGANS OF TOUCH. Q. Of what parts do the common integuments of the body consist ? A. Of three ; the cuticlei rete mucosum, and cutis. Q. Describe the Cuticle or Epidermis, as shortly as possible ? A. It is a thin, semi-transparent, insensible membrane, squamous and furrowed externally, and smooth internal- ly ; it covers the whole surface of the body, except under the nails, and is reflected inwardly to line the different passages ; it is also perforated by the exhalant and ab- sorbent vessels; by excretory ducts, and by the hairs. Q. What is the use of the Cuticle ? A. It protects the subjacent sensible parts; renders the sense of touch tolerable and pleasant; defends the body from noxious substances; and regulates the exha- tation and absorption of the skin. Q. Describe the situation and structure of the Rete Mucosum ? A. It is situated under the cuticle, which it connects with the cutis vera: it is composed of extremely mi- nute vessels passing between the cutis vera and cuticle, and of a fine cellular substance binding them together; it is not found under the nails. Q. Is not the Rete mucosum the seat of colour ? A. Yes; the cellular texture contains a mucilaginous viscid matter, which gives the native colour to different tribes and nations. Q. What is the situation and texture of the Cutis Vera? INTEGUMENTS AND ORGANS OF TOUCH. 275 A. It is situated under the corpus mu"5sum, sur- rounds the whole body, is composed of fibres running in different directions, and intimately interwoven with each other; it is elastic, capable of great distension, and of recovering its former dimensions, its external surface is firm and dense, and its internal degenerates into cel- lular substance ; itjhas innumerable perforations for the passage of exhalants, absorbents, subaceous ducts, and hairs. Q. Is the cutis vera furnished with many blood-ves- sels and nerves ? A. Yes: it is supplied with innumerable blood-ves- sels and nervous filaments, so that it cannot be punc- tured with the sharpest instrument, without occasioning bleeding and pain ; indicating the presence of a blood- vessel and nerve in the point punctured. Q. Is the Cutis equally thick in all parts of the body? A. No ; it, like the cuticle, is thicker in the palms of the hands, and soles of the feet; thinner in the eye- lids, and lips, &c, where the sense of touch is most acute. PHYSIOLOGY OF THE SKIN. Q. What organs constitute the sense of touch ? A. The nervous papillae, which are situated on the external surface of the cutis vera. Q. Describe those Papillae J\rervosae ? A. They are small conical eminences, each composed of a fasciculus of nervous filaments, of an exhalant and an absorbent vessel, or perhaps of more ; their bases sit upon the cutis, and their apices pierce the thin smooth membrane of the internal surface of the cuticle, and ter- minate under the squamous rough apparatus of its ex- ternal surface : hence the extremities of the nerves are near to the objects of touch, an easy egress afforded to the perspirable matter from the exhalants, and a ready entrance of the fluid to be absorbed into the open mouths of the absorbents, provided the skin be natural- ly relaxed. Q. Is the sense of touch augmented by any particular arrangement of the Papillae ? , 276 PHYSIOLOGY OF THE SKIN. A. Yes: the cutis forms innumerable ridges, upon which the papillae are placed in double rows ; these are disposed in a circular, winding, or parallel manner, very conspicuous in the points of the fingers, palms, lips, &c. Q. What circumstances render the sense of touch more distinct and acute. A. The thinness of the cuticle; number of the papil- lae present; flexion of the part, by which innumerable papillae come in contact with the object of touch; at- tention of the mind ; and frequent exercise of the organ: hence the hand, tongue, lips, &c. are best fitted for touch, and have this sense in greatest perfection. Q. Of what things are we enabled to judge by the sense of Touch ? A. By it we judge of the qualities of bodies, such as hardness, softness, roughness, smoothness, hotness, coldness, size, figure, distance, pressure, and weight. Q. By what vessels is the perspiration thrown out on the surface of the body ? A. By the minute extremities of arteries, called ex- halants, opening in the cuticle under the scales of its external surface. Q. Is the halitus or insensible perspiration, and sweat or sensible perspiration, the same, and emitted by the same vessels ? A. Physiologists are not agreed upon this point; but it is extremely probable that the sensible and insensible perspiration are emitted by the same exhalant ve-tels, and possess the same general qualities. Q. What circumstances render Perspiration more copious ? A. A high temperature of the atmosphere, exercise, exhilarating emotions of the mind, good general health, and sometimes sudden fear, and debility of constitution. Q. What purposes in the animal economy does per- spiration serve ? A. It is one of the Emunctories, by which things useless, or hurtful to the body, are thrown out of the mass of blood ; it carries off superfluous animal heat, PHYSIOLOGY OF THE SKIN. 277 and, by its quantity, so regulates the temperature of the body, that in every climate it is nearly uniform : and it thus prevents the occurrence of many inflammatory diseases. Q. On what principles can perspiration carry off the superfluous animal heat, and cool the body ? A. On the Chemical Principles of evaporation: for, when a fluid is converted into vapour, it must have an increase of caloric to support it in that state: hence the fluid perspired receivesan increase of caloric, which instantly converts it into vapour, from the surface of the body. While perspiration continues, the evapora- tion of the fluid on the surface of the body abstracts its superfluous heat, and thus maintains its temperature uniform. Q. How can perspiration maintain nearly the same degree of temperature of the blood in every climate ? A. In northern regions, the perspiration is very in- considerable, in consequence of the cold corrugating the texture of the skin, and contracting the exhalants; nay, fleecy warm clothing, which conducts caloric most slowly, is absolutely necessary to prevent the circum- ambient cold air from abstracting caloric from the ani- mal body too rapidly, in its natural tendency to esta- blish an equality of temperature among bodies: hence the superabundance of animal heat generated in the system is abstracted mechanically by the cold atmo- sphere alone. In tropical regions, however, the atmo- spherical temperature is high, producing copious per- spiration, which being suddenly converted into vapour, abstracts caloric from the surface of the body, and maintains a constant refrigerating effect; whilst the moisture on the skin, in tbe form of sweat, and the temperature of the atmosphere being lower than that of the human body, co-operate in mechanically abstract- ing caloric from the body, and thus assist the refrige- rating powers of evaporation of the perspired fluid; by which means, the temperature of the human body is kept pretty nearly the same in both these extremities of climate. Z 278 TIIYSIOLOGY OF THE SKIN. Q. What are the properties of the cutaneous perspira- tion. A. It contains water, acetic acid, muriate of soda and potash, some animal matter, and oxide of iron. It also contains carbonic acid, and an oily matter. Q. What are the general characters of this secretion as regards its increase and diminution, &c. A. It is greatest immediately after and least during dinner; the feet, hands, armpits, forehead, perspire more freely than any other parts; i;s properties also differ in different parts of the body, as in the sole of the foot, and in the armpits. Q. Where are the extremities of the cutaneous absorbents to be found ? A. In the cuticle: their extremities are situated un- der the scaly texture of its external surface, but they are so very minute, that they have not yet been dis- tinctly seen in the human body, even by the assistance of glasses of great magnifying power. They are sup- posed, however, to commence tbere with their patulous extremities, or mouths open. Q. How can it be proved that there are such ves- sels ? A. They have been seen in fishes, and experience has taught us that various substances, as Opium, Tur- pentine, Mercury, and Camphor, can be taken into the system, when applied to its surface, with gentle fric- tion. Q. Has Cutaneous Absorption not been denied by some eminent physiologists ? A. Yes : but it has been proved by others equally re- spectable. Q. How could it then be denied ? A. They found that when the body, or a part of it, say an arm, was simply immersed in a fluid, such as oil of Turpentine, the breath and urine did not communicate any of its odour, as they would have done, had absorption of Turpentine taken place. Besides, the anatomist can handle and work among putrid parts of a subject, without PHYSIOLOGY OF THE SKIN. 279 receiving any injury from the absorption of putrid mat- ter; a proof that none of it had been absorbed. Q. Have not many Medical men fallen victims to the absorption of putrid matter in time of dissection ? A. Yes: but in those instances the cuticle had been scratched, cut, or otherwise injured; and then absorption can take place most easily; as we know from inoculation either with Variolous or Vaccine matter. Q. Is the Cuticle, then, when entire, to be consider- ed a defence against absorption; or does the cuticle pre- vent it from happening on the surface of the body ? A. The Cuticle, when sound, has certainly great pow- er in defending the system against the absorption of noxious substances; but that power is limited, and de- pends upon certain circumstances; such as the tempera- ture of the dissector's hands, the temperature and acri- mony, or stimulating power of the fluid to be absorbed, &c.; for, if the hands of the Dissector are cold, or the fluid in which they are immersed is cold and of a bland quality, the texture not only of the cuticle, but also of the cutis, is constringed and corrugated, by which the mouths of the absorbents are contracted and completely sbut; of course no absorption can take place. Again, if the fluid is acrid and stimulant, it forces- the vessels to contract, and to shut their mouths; but a continua- tion of the stimulus applied may wear out and exhaust the contractile power of the vessels, and then absorption may happen. Q. If the temperature of the Dissector's hands and the putrid fluid in which they are immersed, be nearly equal, could absorption take place ? A. Yes; particularly if the temperature be so high as 60 or 70 degrees; for then the texture of the skin is relaxed, and the mouths of the absorbents are open, and ready to take in whatever mild fluid comes in contact , with them. Q. In ordinary cases, when Mercurial ointment is rub- bed upon the surface, is its absorption owing to an abra- sion of the cuticle, or what ? 280 PHYSIOLOGY OF THE SKIN. A. It has been supposed to be in consequence of ab- rasion of it; but where the cuticle abraded by the friction used, the stimulus of the mercury would excite great pain, and a contraction of the mouths of the absorbents in the part; whereas neither pain, nor contraction of the vessels seems to take place. In order to promote ab- sorption, the common temperature of the body, which keeps the texture of the skin relaxed, and gentle friction, which may insinuate the mercury under the numerous scales of the cuticle, that it may be brought into direct contact with the open extremities of the absorbents, are only necessary. PATHOLOGY OF THE TISSUES. affections of the skin.--ERYSIPELAS. Q. What are its symptoms ? A. The skin of the affected part slightly swollen; of a red colour, with well defined but irregular edges ; the redness disappears on the slightest pressure being ap- plied, but instantly returns when this is discontinued; acute pain, attended with the sensation of burning heat; these symptoms are followed by slight desquamation; in some instances small miliary vesicles appear, and form in a short time yellowish crusts. Erysipelas is most frequently observed to affect the face and breasts. It often attacks different portions of the surface one after the other, and cases occur where it returns periodically. Generally found to be connected with disorder of the digestive organs. Many varieties are described, the fol- lowing are the chief:— Q. What are the symptoms of Phlegmonous Erysipelas ? A. This is characterized by the redness of the surface being very vivid, and diminishing in intensity from its centre to the circumference; and does not return so quickly after pressure. The swelling more distinct and hard; pain burning and pungent; it generally termi- nates by suppuration; is observed to attack the extre- mities and scalp. PATHOLOGY OF THE TISSUES. 281 Q. What are the symptoms of (Edematous Erysipelas ? A. The swelling comes on slowly; is not so hard as in the other species ; rather inelastic ; the skin smooth, shining, and retains the impression of the finger for some time; vesicles are formed, and followed by other yellowish crusts. This affection very often induces gangrene; attacks the organs of generation and the lower extremities of hydropic patients: Q. What are its Anatomical Characters ? A. On examination after death, the redness is found to have disappeared ; the skin infiltrated, and a bloody serum flows from it when cut Its texture is changed, as it is much more easily torn than when in the natural state. In the simple erysipelas the skin "is found changed in its superficial vascular layers only; but in the phlegmonoid, its whole thickness is affected, and the veins are found diseased, their internal coat red, and oc- casionally they are seen filled with pus, a phenomenon never observed in the arteries of the same parts. Pus is also met (in the phlegmonous erysipelas) effused into the cellular membrane, or collected in one or more ab- scesses. When it terminates by gangrene, the vesicles are observed to be black and friable. ZONA. Q. What are its Symptoms ? A. A successive eruption of pustules, extending half way round the trunk, and sometimes completely sur- rounding it. The pustules of different colours, white, red, or brown, are pointed towards their summits, and are surrounded by a red circle. They contain a limpid fluid which proves very irritating to the parts it comes in contact with. When one set goes off, another con- stantly appears. This affection remains longer than erysipelas; its duration maybe stated at from twenty- five to forty days. The patient suffers a very acute burning sensation in the affected part; and this disease occasionally is followed by obstinate pains. In some rare examples, a slight swelling of the subcutaneous Z 2 282 PATHOLOGY OF THE TISSUES. cellular tissue is perceived. The diseases with which it may be confounded, are pemphigus, erysipelas, and herpes. Q. What are its Anatomical Characters ? A. The same as simple erysipelas. urticaria, or nettle rash. Q. What are its Symptoms j A. A general redness of the skin, very soon followed by an eruption, sometimes general, sometimes partial, of irregular, flattened, hard, and various sized tubercles, whose bases are of a deep and vivid red, and centres of a very pale colour, and flattened. They are accompa- nied by a very hot sensation, and violent and continual itching. They always terminate in resolution or desqua- mation. Q. What are its Anatomical Characters ? A. The same as simple erysipelas. miliaria. Q. What are its Symptoms ? A. An eruption, appearing on the whole surface at the same time, or on different portions successively, of small transparent vesicles, placed sometimes in the centre of small purple spots; or of red conical granula- tions, more readily perceived by the touch than the sight: they may be distinct or confluent, and are changed into vesicles containing a serous fluid : they sometimes extend to the mucous membrane lining the mouth, aisophagus, and trachea. This affection gene- rally terminates in desquamation, sometimes by resolu- tion. PEMPHIGUS. Q. What are its Symptoms ? A. Red patches of an erysipelatous appearance, but the lednesi does not disappear under pressure, is at- PATHOLOGY OF THU TI^UE*. 283 tended by tumefaction of the skin, and formation of phlyctenoid vesicles, which vaiy in size from that of a lentil to a hen's egg, and even now and then much larger. In six or seven days these vesicles collapse, break, and discharge a limpid, yellowish, and mild se- rosity. Sometimes they dry up, scale off, and leave violet spots on the surface, which remain for some time c now and then ulceration takes place, and is fol- lowed by cicatrization. It may be confounded with zona or erysipelas. Q. What are its symptoms ? A. Small pimples, or confluent round red patches, easily felt, with prickling pain and itching, which is in- creased at night, by heat or stimulating food. This eruption may appear on the whole surface, but it is mostly observed on the face, neck, shoulders, back, and hands. It recurs very fiequently and at certain seasons. TINEA, OR SCALD HEAD. Q. What are its symptoms ? A. Violent itching of the scalp or forehead; small pustules or vesicular eminences are observed ; these are hard, of a conical shape, whitish, and contain a fluid of a very disagreeable odour; on the appearance which this take9 when drying, is founded the description of the various species of this affection. Q. What are the symptoms of Tinea Favosa? A. In this species, thick yellowish crusts are formed of various sizes, of a tubercular form, with a conical de- pression in the centre. These scabs are buried in the skin and scalp, in which large fissures are made around these, di-:chait,.ng a purulent, thick and fetid matter. This variety is observed to attack the forehead, temples, and neck of children from two to fifteen years. Q. What are the symptoms of Tinea Rugosa ? A. The crusts or scabs in this species are small, granu- lar, of a greyish or brown colour, and are compared to the pieces of mortar which are seen to fall from old walls. The smell is sour: there is no depression in the . 284 PATHOLOGY OF THE TISSUE*. centre. Rarely met with in adults, and is confined to the scalp. Q. What are the symptoms of Tinea Furfuracea ? A. There are no crusts; there are white scales, more or less thick; from under which a fetid viscid liquid oozes, which dries and gives rise to new scales. This form of tinea does not occur in adults, or even in children after their seventh year. Q. What are the symptoms of Tinea Amiantacea ? A. Small scales of a silvery or pearl colour surround- ing the hair in their entire length, and so forming fila- ments and meshes like the asbestos or amiantus, whence the name is derived. It emits no particular smell; oc- curs only during adult age, and particularly in melan- cholic individuals. Q. What are the symptoms of Tinea Mucosa ? A. Superficial ulcerations, from which exudes a mu- cous humour, somewhat like honey; this, as it dries, forms crusts of an ash colour, or greenish, occasionally yellow like wax. This species of tbe disease sometimes extends to the face, temples and limbs, in tbe same way that the tinea favosa does. It occurs usually in children from the period of lactation to their fourth year. Q. What are its Anatomical Characters ? A. The cutis remains without any perceptible altera- tion as long as the disease continues moderate, but when it makes any considerable progress the skin is altered in Us entire substance; it becomes red, and injected with a sanguineous fluid; in some extreme cases the sub-cuta- neous cellular texture, the muscles, periosteum, and even the bones become engaged and their structure al- tered. The Tinea of Alibert is the Porrigo of Willan and Bateman: The " Teigne faveuse" corresponds with the Porrigo lupinosa—the T. furfuracee' is the P. furfurous —the " Teigne muqueuse," corresponds to the Porrigo larvalis.—See Bateman's Synopsis, No. 159. PATHOLOGY OF THE TISSUES. 285 PRURIGO*. Q. What are its symptoms ? A- The characteristic symptoms of this genus are, a severe itching, accompanied by an eruption of papulae, of nearly the same colour with the adjoining cuticle. It affects the whole surface of the skin, under three varie- ties of form, as well as some parts of the body locally. Q. What are the symptoms of Prurigo mitis ? A. It is accompanied by soft and smooth papulae, some- what larger and less accuminated than those of Lichen, and seldom appearing red or inflamed, except from vio- lent friction. Hence an inattentive observer may over- look the papulae altogether: more especially as a num- ber of small, thin black scabs are here and there conspi- cuous, and arrest his attention. These originate from the concretion of a little watery humour, mixed with blood, * The translator here substitutes a few sections from Bateman's synopsis, in place of those in the origi- nal. This will probably be excused when it is consi- dered that the terminology adopted by Willan and Bate- man, is now universally used in the schools in this coun- try, and therefore will be much more readily understood by the younger members of the profession, for whom alone this little work is intended.—There is also ano- ther reason, M. Martinet has adopted the term* and ar- rangement of Alibert. This is liable to one serious ob- jection, viz. that the descriptions of the diseases are often taken from secondary characters, whilst Willan and Bateman have taken them from the primary as far as was possible. Thus, Alibert arranges the " Dartres" according to the characters of the scales which are secondary in their ap- pearance, and, of course, liable to great variety, and sub- ject to be influenced by the treatment pursued. But Bateman takes his descriptions from the appearance of the vesicles, which are primary in their occurrence, and Jir less liable to be influenced by any accidental causes. 286 PATHOLOGY OF THE TISSUES. which oozes.out when the tops of the papulae are re- moved by the violent rubbing or scratching which the severe itching demands. This constant friction some- times also produces inflamed pustules; which are merely incidental, however, when they occur at an early period of the complaint. The itching is much aggravated, both by sudden exposure to the air, and by heat; whence it is particularly distressing when the patient undresses him- self, and often prevents sleep for several hours after he gets into bed. This eruption mostly affects young per- sons, and commonly occurs in the Spring or beginning of Summer. It is relieved after a little time by a steady perseverance in the use of the tepid bath, or of regular ablution with warm water, although at first this stimulus slightly aggravates the eruption. The internal use of sulphur, alone or combined with soda or a little nitre, continued for a short time, contributes to lessen the cu- taneous irritation; and may be followed by the exhibi- tion of the mineral acids. Under these remedies, the disorder gradually disappears: but if the washing be neg- lected, and a system of uncleanliness in the apparel be pursued, it will continue during several months, and may ultimately terminate in the contagious scabies. Q. What are the symptoms of Prurigo formicans ? A. This affection differs materially from the preceding, in the obstinacy and severity of its symptoms, although its appearances are not very dissimilar. The itching ac- companying it is incessant, and is combined with vari- ous other painful sensations; as of insects creeping over and stinging the skin, or of bot needles piercing it. On undressing, or standing before a fire, but above all on be- coming warm in bed, these sensations are greatly ag- gravated: and friction not only produces redness, but raises large wheals, which, however, presently subside. The little black scabs, which form upon the abraded papu- lae, are seen spotting the whole surface, while the co- lourless papulae are often so minute as nearly to escape observation. This prurigo occurs in adults, and is not peculiar to any season. It affects the whole of the trunk and limbs, except the feet and palms of the hands; but PATHOLOGY OF THE TISSUES. 287 is most copious in those parts over which the dress is tightest. Its duration is generally considerable, some- times extending, with short intermissions, to two years or more. It is never, however, converted, like the pre- ceding species, into the itch, nor becomes contagious; but it occasionally ends in impetigo. Q. What are the symptoms of Prurigo Senilis? A. The frequent occurrence of prurigo in old age, and the difficulty of curing it, have been the subject of uni- versal observation. The sensation of itching, in the prurigo of that period of life, is as intolerable and more permanent than in the P. formicans; and the appearances which it exhibits are very similar, except that the papu- lae are for the most part larger. The comfort of the re- mainder of life is sometimes entirely destroyed by the occurrence of this disease. A warm bath affords the most effectual alleviation of the patient's distress, but its influence is temporary. The disorder seems to be con- nected with a languid state of the constitution in general, and of the cutaneous circulation in particular; hence the sulphureous waters at Harrowgate, employed both in- ternally and externally at the same time, afford on the whole the most decided benefit. A warm sea-water bath has also been found serviceable. Sometimes stimulant lotions, containing the oxy muriate of mercury, the liquor ammoniae acetatis, or alcohol, are productive of great relief, and occasionally render the condition of the pa- tient comparatively comfortable, or even remove the dis- ease. When the surface is not much abraded, the oxymu- riate will be borne to the extent of two grains to the ounce of an aqueous or weak spirituous vehicle; but it is gene- rally necessary to begin with a much smaller proportion. This mineral salt is likewise useful in destroying the pediculi, which are not unfrequently generated, when the prurigo senilis is present. Where the skin is not abraded by scratching, the oil of turpentine, much dilut- ed with oil of almonds, may be applied, with more de- cided effect, for the destruction of these insects. 288 PATHOLOGY OF Till'. TISSUK5. ICHTHYOSIS. Q. What are the symptoms of Ichthyosis ? A. The ichthyosis, or fish-skin disease, is character- ized by a thickened, hard, rough, and in some cases al- most horny texture of the integuments of the body, with some tendency to scaliness, but without the deciduous exfoliations, the distinct and partial patches, or tbe con- stitutional disorder, which belong to lepra and psoriasis. Q. What are the symptoms of Ichthyosis simplex ? A. In its commencement, this disease exhibits merely a thickened, harsh, and discoloured state of the cuticle, which appears, at a little distance, as if it were solid with mull. When further advanced, the thickness, hard- ness and roughness become much greater, and of a warty character, and the colour is nearly black. The roughness, which is so great as to give a sensation to the finger passing over it, like the surface of a file, or the roughest shagreen, is occasioned by innumerable rugged lines anil points, into which the surface is divided. These hard prominences, being apparently elevations of the common lozenges of the cuticle, necessarily differ in their form and arrangement in different parts of the body, according to the variations of the cuticular lines as well as in different stages and cases of the complaint. Some of them appear to be of uniform thickness from their roots upwards; while others have a short narrow neck, and broad irregular tops. The former occur where the skin, when healthy, is soft and thin ; the latter where it is coarser, as about the olecranon and patella, and thence along the outside of the arms and thighs. On some parts of the extremities, however, especially about the ankles, and sometimes on the trunk of the body, these excrescences are scaly, flat, and large, and occasionally imbricated, like the scales of carp. In other cases, they have appeared separate, being intersected by whitish fur- rows. This unsightly disease appears in large continu- ous patches, which sometimes cover the greater part of the body, except the flexures of the joints, the inner and PATHOLOGY OF THE TISSUES. 289 upper part of the thighs, and the furrow along the spine. The face is seldom severely affected; but in one case, in a young lady, the face was the exclusive seat of the disorder, a large patch covering each cheek, and com- municating across the nose. The mammae, in females, are sometimes encased in this rugged cuticle. The whole skin, indeed, is in an extremely diy and unperspi- rable condition, and in the palms of the hands and soles of the feet it is much thickened and brittle.' The disease often commences in childhood, and even in early infancy. This affection has been found to be very little under the control of medicine. Stimulating ointments and plasters have been industriously applied, with no material effect; and the disorder has been known to continue for several years, with occasional variations. Dr Willan trusted to the following palliation by external management " When a portion of the hard scaly coating is removed," he says, " it is not soon produced again. The easiest mode of removing the scales is to pick them off carefully with the nails from any part of the body, while it is im- mersed in hot water. The layer of cuticle, which re- mains after this operation, is harsh and dry; and the skin did not, in the cases I have noted, recover its usual tex- ture and softness; but the formation of the scales was prevented by a frequent use of the warm bath, with moderate friction. I have known the skin cleared of this harsh eruption by bathing in the sulphureous waters, and rubbing it with a flannel or rough cloth, after it had been softened by the bath; but the cuticle underneath did not recover its usual condition; it remained bright and shining : and the eruption recurred. Internally the use of pitch has in some instances been beneficial, hav- ing occasioned the rough cuticle to crack and fall off, and leave a sound soft skin underneath. This medicine, made into pills with flour, or any farinaceous powder, may be taken to a great extent, not only without injury, but with advantage to the general health; and affords one of the most effectual means of controlling the lan- guid circulation, and the inert and arid condition of the skin. Upon the same principle, the arsenical solution 290 PATHOLOGY OF THE TISSUES. has been employed in ichthyosis. In one case, in a little girl affected with a moderate degree of the disease on the scalp, shoulders, and arms, thi9 medicine produced a complete change of the condition of the cuticle,' which acquired its natural texture ; but in two others no benefit was derived from it. The decoction of the inner bark of the elm has been said to be a specific for ichthyosis, by Plenck; but this originated in a misconception as to the use of the term. HERPES. Q. What are its symptoms ? A. This appellation is here limited to a vesicular dis- ease, which, in most of its forms, passes through a regu- lar course of increase, maturation and decline, and ter- minates in about ten, twelve, or fourteen days. The vesicles arise in distinct but inegular clusters, which commonly appear in quick succession, and they are set near together, upon an inflamed base, which extends a little way beyond the margin of each cluster. The eruption is preceded when it is extensive, by considera- ble constitutional disorder, and is accompanied by a sen- sation of heat and tingling, sometimes by severe deep seated pain, in the parts affected. * The lymph of the ve- sicles, which is at first clear and colourless, becomes gradually milky and opaque, and ultimately concretes into scabs ; but, in some cases, a copious discharge of it tiikes place, and tedious ulcerations ensue. The disorder is not contagious in any of its forms. The ancients, although they frequently mention herpes, and give dis- tinctive appellations to its varieties, have no where mi- nutely described it. Hence their followers have not agreed in their acceptation of the term. It has been principally confounded'with erysipelas on the one hand, and with eczema, impetigo, and other slowly spreading eruptions, on the other. But if the preceding charac- ter be well considered, the diagnosis between these af- fections and herpes will be sufficiently obvious. From erysipelas it may be distinguished by the numerous, PATHOLOGY OF THE TISSUES. 291 small, clustering vesicles, by the natural condition of the surface in the interstices between the clusters, and by the absence of redness and tumefaction before the vesi- cles appear; and from the chronic eruptions just alluded to, by the purely vesicular form of the cuticular eleva- tions in the commencement, by the regularity of their progress, maturation, and scabbing, and by the limitation of their duration, in general, to a certain number of days. Q. What are the symptoms of Herpes Phlyctaenodes ? A. This species of the eruption, including the miliary variety above mentioned, is commonly preceded by a slight febrile attack for two or three days. The small transparent vesicles then appear, in irregular clusters, sometimes containing colourless, and sometimes a brownish lymph : and, for two or three days more, other clusters successively arise near the former. The erup- tion has no certain seat; sometimes it commences on the cheeks or forehead, and sometimes on one of the extre- mities; and occasionally it begins on the neck and breast, and gradually extends over tbe trunk to the lower ex- tremities, new clusters successively appearing for nearly the space of a week. It is chiefly the more minute, or miliary variety, which spreads thus extensively; for those which, at their maturity, attain a considerable size, and an oval form, seldom appear in more than two or three clusters togetber; and sometimes there is only a single cluster. The included lymph sometimes be- comes milky or opaque in the course of ten or twelve hours; and about the fourth day, the inflammation round the vesicles assumes a duller red hue, while the vesicles themselves break and discharge their fluid, or begin to dry and flatten, and dark or yellowish scabs concrete upon thern. These fall off about the eighth or tenth day, leaving a reddened and irritable surface, which slowly regains its healthy appearance. As the succes- sive clusters go through a similar course, the termination of the whole is not complete before the thirteenth or fourteenth day. The disorder of the constitution is not immediately relieved by the appearance of the eruption, but ceases as 292 PATHOLOGY OF THE TISSUES. the latter proceeds. The heat, itching, and tingling in the skin, which accompany the patches as they succes- sively arise, are sometimes productive of much restless- ness and uneasiness, being aggravated especially by ex- ternal heat, and by the warmth of the bed. The predisp6sing and exciting causes are equally ob- scure. The eruption occurs in its miliary form, and spreads most extensively, (sometimes over the greater portion of the surface of the body,) in young and robust people, who generally refer its origin to cold. But it is apt to appear, in its more partial forms, in those persons who are subject to headaches, and other local pains, which are probably connected with derangements of the chylopoietic organs. The same treatment is requisite for this as for the fol- lowing species. Q. What are the symptoms of Herpes zoster ? A. This form of the eruption, which is sufficiently known to have obtained a popular appellation, the shin- gles, is very uniform in its appearances, following a course similar to that of small-pox, and the other exan- thematic fevers of the nosologists. It is usually prece- ded for two or three days by languor and loss of appe- tite, rigors, head-ache, sickness, and a frequent pulse, together with a scalding heat, and tingling in the skin, and shooting pains through the chest and epigastrium. Sometimes, however, the precursory febrile symptoms are slight and scarcely noticed, and the attention of the patient is first attracted by a sense of heat, itching and tingling, in some part of the trunk, where he finds several red patches of an irregular form, at a little dis- tance from each other, upon each of which numerous small elevations appear, clustered together. These, if examined minutely, are found to be distinctly vesicular; and, in the course of twenty-four hours, they enlarge to the size of small pearls, and are perfectly transparent, being filled with a limpid fluid. The clusters are of va- rious diameter, from one to two, or even three inches, and are surrounded by a narrow red margin, in conse- quence of the extension of the inflamed base, a little be- PATHOLOGY OF THE TISSUES. 293 yond the congregated vesicles. During three or four days, other clusters continue to arise in succession, .and with considerable regularity; these are nearly in a line with the first, extending always towards the spine at one extremity, and towards the sternum, or linea alba of the abdomen, at the other, most commonly round the waist, like half a sash, but sometimes, like a sword-belt, across the shoulder. While the new clusters are appearing, the vesicles of the first begin to lose their transparency, and on the fourth day acquire a milky or yellowish hue, which is soon followed by a bluish, or livid colour of the basis of the vesicles, and of the contained fluid. They now be- come somewhat confluent, and flatten or subside, so that the outlines of many of them are nearly obliterated. About this time they are often broken, and for three or four days discharge a small quantity of a serous fluid; which at length concretes into thin dark scabs, at first lying loosely over the contained matter, but soon becom- ing harder, and adhering more firmly, until they fall off about the twelfth or fourteenth day. The surface of the skin is left in a red and tender state; and where the ulceration and discharge have been considerable, numerous cicatrices or pits are left.% As all the clusters go through a similar series»of chan- ges, those which appeared latest arrive at their termina- tion several days later than the first; whence the disease is sometimes protracted to twenty, or even twenty-four days, before the crusts exfoliate. In one or two in- stances, I have seen the vesicles terminate in numerous email ulcers, or suppurating foramina, which continued to discharge for many days, and were not all healed be- fore the end of the fourth week. The febrile symptoms comftonly subside when the eruption is completed; but sometimes they continue during the whole course of the disease, probably fiom the incessant irritation of the itching and smarting con- nected with it. In many instances the most distress- ing part of the complaint is an intense darting pain, not superficial, but deep-seated in the chest, which conti- 2 A 2 294 TATHOLOGY OF THE TISSUES. nues to the latter stages of the disease, and is not easily allayed by anodynes ; sometimes this pain precedes the eruption. Although the shingles commonly follow the regular course of fever, eruption, maturation, and decline, within a limited period, like tbe eruptive fevers, or exanthe- mata of the nosologists, yet the disorder is not, like the latter, contagious, and may occur more than once in the same individual. The disease, on the whole, is slight; it has never, in any instance that I have witnessed, ex- hibited any untoward symptom, or been followed by much debility ; in the majority of cases, it did not con- fine the patient to the house. The causes of the shingles are not always obvious. Young persons, from the age of twelve to twenty-five, are most frequently the subjects of the disease, although the aged are not altogether exempt from its attacks, and suffer severely from the pains which accompany it. It is most frequent in the Summer and Autumn, and seems occasionally to arise from exposure to cold, after violent exercise. Sometimes it has appeared critical, when su- pervening to bowel-complaints, or to the chronic pains of the chest remaining after acute pulmonary affections. Like erysipelas, it has been ascribed, by some authors, to paroxysms of anger. Q. What is the treatment necessary in the shingles ? A. It is scarcely necessary to speak of the treatment of a disorder, the course of which scarcely requires to be regulated, and cannot be shortened, by medicine. Gen- tle laxatives and diaphoretics, with occasional anodynes, when the severe deep-seated pains occur, and a light diet, seem to comprise every thing that is requisite in the cure. Experience altogether contradicts the cau- tionary precepts, whichtthe majority of writers, even down to Burserius, have enjoined, in respect to the ad- ministration of purgatives, and which are founded en- tirely upon the prejudices of the humoral pathology. In general, no external application to the clustered vesicles is necessary ; but when they are abraded by the PATHOLOGY Or THE TISSUES. 295 friction of the clothes, a glutinous discharge takes place, which occasions the linen to adhere to the affected parts, producing some irritation. Under these circumstances, a little simple ointment may be interposed, to obviate that effect. With the view of clearing off the morbid humours, the older practitioners cut away the vesicles, and covered the surface with their unguents, or even irritated it with the nitrico-oxyd of mercury, notwith- standing the extreme tenderness of the parts. These pernicious interruptions of the healing process, probably gave rise to ulceration, and prolonged the duration of the disease, and thus contributed to mislead practitioners in their views respecting its nature. Q. What are the symptoms of herpes circinatus? A.' This form of the herpes is vulgarly called a ring- worm, and is, in this country, a very slight affection; being unaccompanied with any disorder of the constitu- tion. It appears in small circular patches, in which the vesicles arise only round the circumference; these are small, with moderately red bases, andcontain a transpa- rent fluid, which is discharged in three or four days, when little prominent dark scabs form over them. The central area in each vesicular ring, is at first free from any eruption; but the surface becomes somewhat rough, and of a dull red colour, and throws off an exfo- liation, as the vesicular eruption declines, which termi- nates in about a week with the falling oft' of the scabs, leaving the cuticle red for a short time. The whole disease, however, does not conclude so soon; for there is commonly a succession of the vesicu- lar circles, on the upper parts of the body, as the face and neck, and the arms and shoulders, which have oc- casionally extended to the lower extremities, protracting the duration of the whole to the end of the second or third week. No inconvenience, however, attends the eruption, except a disagreeable itching and tingling in the patches. The herpetic ringworm is most commonly seen in children, and has been deemed contagious. It has 296 PATHOLOGY OF THE TISSUES. sometimes, indeed, been observed in several children, in one school or family, at the same time; but this was most probably to be attributed to the season, or some other common cause; since none of the other species of herpes are communicable by contact. It is scarcely ne- cessary to point out here the difference between this vesicular ringworm, and the contagious pustular erup- tion of the scalp and forehead, which bears a similar po- pular appellation. The itching and tingling are considerably alleviated by the use of astringent and slightly stimulant applica- tions, and the vesicles are somewhat repressed by the same expedients. It is a popular practice to besmear them with ink; but solutions of the salts of iron, cop- per, or zinc, or of borax, alum, &c. is a less dirty form, and answers the same end. Another form of herpes circinatus sometimes occurs, in which the whole area of the circles is covered with close set vesicles, and the whole is surrounded by a cir- cular inflamed border. The vesicles are of a consider- able size, and filled with transparent lymph. The pain, heat, and irritation in the part are very distressing, and there is often a considerable constitutional disturbance accompanying the eruption. One cluster forms after another in rapid succession on the face, arms, and neck, and sometimes, on the day following, on the trunk and lower limbs. The pain, feverishness, and inquietude do not abate till the sixth day of the eruption, when tbe ve- sicles flatten, and the inflammation subsides. On the ninth and tenth days a scabby crust begins to form on some, while others dry, and exfoliate ; the whole dis- ease terminating about the fifteenth day. All the forms of herpes appear to be more severe in warm climates, than in our northern latitudes; and the inhabitants of the former are liable to a varirly of her- petic ringworm, which is almost unknown here. This variety differs materially from the preceding in its course, and is of much longer duration. For it does not heal with the disappearance of the first vesicles, but its area continually dilates by the extension of the vesicular PATHOLOGY OF THE TISSUES. 297 maigin. The vesicles terminate in ulcerations, which are olten of a considerable depth; and while these un- dergo the healing process, a new circle of vesicles rises Beyond them, which passes through a similar course, and is succeeded by another circle exterior to itself; and thus the disease proceeds, often to a great extent, the internal parts of the ring healing as the ulcerous and ve- sicular circumference expands. Q. What are the symptoms of Herpes labialis ? A. A vesicular eruption upon the edge of the upper and under lip, and at the angle of the mouth, sometimes forming a semi-circle, or even completing a circle round the mouth, by the successive rising of the vesicles, is very common, and has been described by the oldest writers. At first the vesicles contain a transparent lymph, which in the course of twenty-four hours be- comes turbid, and of a yellowish white colour, and ulti- mately assumes a puriform appearance. The lips be- come red, hard, and tumid, as well as sore, stiff, and painful, with a sensation of great heat and smarting, which continues troublesome for three or four days, un- til the fluid is discharged, and thick dark scabs are form- ed over the excoriated parts. The swelling then sub- sides, and, in four or five days more, the crusts begin to fall off; tbe whole duration being, as in the other her- petic affections, about ten or twelve days. The labial herpes occasionally appears as an idiopathic affection, originating from cold, fatigue, &c, and is then preceded for about three days by the usual febrile symp- toms, shiverings, headache, pains in the limbs and the stomach, with nausea, lassitude, and languor. Under these circumstances, a sort of herpetic sore throat is sometimes connected with it; a similar eruption of in- flamed vesicles taking place over the tonsils and uvula, and producing considerable pain and difficulty of deglu- tition. The internal vesicles, being kept in a state of moisture, form slight ulcerations when they break; but these heal about the eighth and ninth days, while the scabs are diying upon the external eruption. The herpes labialis, however, occurs most frequently 298 PATHOLOGY OF THE TISSUKS. in the course of diseases of the viscera, of which it is symptomatic, and often critical; for these diseases are frequently alleviated as soon as it appears. Such an oc- currence is most common in bilious fevers, in cholera, and dysentery, in peritonitis, peripneumony, and severe catarrhs; but it U not (infrequent in continued malignant fevers, and even in intermittent*. Q. What are the symptoms of Herpes praeputialis ? A. This local variety of herpes was not noticed by Dr Willan; but it is particularly worthy of attention, be- cause it occurs in a situation where it is liable to occa- sion a practical mistake, of serious consequence to the patient. The progress of the herpetic clusters, when seated on the prepuce, so closely resembles that of chancre, as described by some authors, that it may be doubted whether it has not been frequently confounded with the latter. The attention of the patient is attracted to the part by an extreme itching, with some sense of heat; and on ex- amining the prepuce, he finds one, or sometimes two red patches, about the size of a silver penny, upon which are clustered five or six minute transparent vesi- cles, which, from their extreme tenuity, appear of the same red hue as the base on which they stand. In the course of twenty-four or thirty hours, the vesicles en- large, and become of a milky hue, having lost their transparency; and on the third day, they are coherent, and assume an almost pustular appearance. If the erup- tion is seated within that part of the prepuce, which is in many individuals extended over the glands, so that the vesicles are kept constantly covered and moist (like those that occur in the throat), they commonly break about the fourth or fifth day, and form a small ulceration upon each patch. This discharges a little turbid serum, and has a white base, with a slight elevation at the edges; and by an inaccurate or inexperienced observer, it may be readily mistaken for chancre; more especially if any escharotic has been applied to it, which produces much irritation, as well as a deep-seated hardness be- neath the sore, such as is felt in true chancre. If no ir- PATHOLOGY OF THE TISSUES. 299 ritant be applied, the slight ulceration continues till the ninth or tenth day nearly unchanged, and then begins to heal; which process is completed by the twelfth, and the scabs fall off on the thirteenth or fourteenth day. When the patches occur, however, on the exterior portion of the prepuce, or where that part does not cover the glands, the duration of the eruption is shortened, and ulceration does not actually take place. The con- tents of the vesicles begin to dry about the sixth day, and soon form a small, hard, acuminated scab, under which, if it be not rubbed off, the part is entirely healed by the ninth or tenth day, after which the little indented scab is loosened, and falls out. This circumstance suggests the propriety of avoiding not only irritative, but even unctuous or moist applica- tions, in the treatment of this variety of herpes. And accordingly it will be found, that, where ulceration occurs within the prepuce, it will proceed with less irri- tation, and its course will be brought within the period above-mentioned, if a little clean dry lint alone be in- terposed, twice a day, between the prepuce and the glands. I have not been able to ascertain the causes of this eruption on the prepuce. Mr Pearson is inclined to ascribe it to the previous use of mercury. VV hence- soever it may originate, it is liable to recur in the same individual, and often at intervals of six or eight weeks. NAEVUS. Q. What is to be said on the subject of naevus ? A. The various congenital excrescences and discolora- tions of the skin, to which the appellations of naevus, spilus, moles, &c. have been applied, may be conve- niently treated of together. They exhibit many pecu- liarities of form, magnitude, colour, and structure, and are seen on almost every part of the surface of the body, in different instances. Some of them are merely super- ficial, or stain-like spots, and appear to consist of a 300 TATHOLOGY OF THE TISSUES. partial thickening of the rete mucosum, sometimes of a yellow or yellowish brown, sometimes of a blueish, livid, or nearly black colour. To these the term spilus has been more particularly appropriated. Others again exhibit various degrees of thickening, elevation, and altered structure of the skin itself; and consist of en- larged and contorted veins, freely anastomosing, and forming little sacs of blood. They are sometimes spread more or less extensively over the surface, occa- sionally covering even the whole of an extremity, or one half of the tmnk of the body ; and sometimes they are elevated into prominences of various form and magni- tude. Occasionally these marks are nearly of the usual colour of the skin; but most commonly they are of a purplish red colour, of varying degrees of intensity, such as the presence of a considerable collection of blood- vessels, situated near the surface, and covered with a thin cuticle, naturally occasions. The origin, which was anciently assigned to these marks by physicians, and to which they are still as- signed by the vulgar, (viz. the influence of the imagi- nation of the mother upon the child in utero,) has occasioned their varieties to be compared with the different objects of desire or aversion, which were supposed to operate on the passions of the mother; whence the following naevi have been described :—the flat and purple stains were considered as the representa- tive of claret, or of port wine ; and sometimes of a slice of bacon, or other flesh. Sometimes the stains are regu- larly formed, like a leaf, with a very red border, and lines, like veins, across from a central rib, forming the naevus foliaceus; and sometimes a small red centre with branching lines, like legs, has suggested the idea of a spider, or N. araneus. But those naevi which are promi- nent, have most commonly been compared to different species of fruit, especially to cherries, currants, and grapes, when the surface is smooth and polished ; or to mulberries, raspberries, and strawberries, when the sur- face is granulated; whence the naevus cerasus, ribes, morus, rubus, fragarius, &c. PATHOLOGY OF THE TISSUES. 30! Some of these excrescences are raised upon a neck or pedicle ; while some are sessile upon a broad base. Some of them again, although vivid for some time after birth, gradually fade and disappear; some remain sta- tionary through life, but commonly vary in intensity of colour at different seasons, and under circumstances easily explained ; and others begin to grow and extend, sometimes immediately after birth, and sometimes from incidental causes, at a subsequent period, and from small beginnings become large and formidable bloody tumours, readily bursting, and pouring out impetuous and alarming haemorrhages, which, if they do not prove suddenly fatal, materially injure the health by the fre- quent depletion of the system. Sometimes, however, after having increased to a certain degree, they cease to enlarge, and thenceforth continue stationary, or gradu- ally diminish, till scarcely any vestige remains. In some instances, however, these preternatural en- largements and anastomoses, which constitute the naevi, are not merely cutaneous. A similar morbid structure may take place in other parts; it sometimes occupies the whole substance of the cheek, according to Mr Abernethy, and has occurred in the orbit of the eye; and Mr John Bell affirms, that it affects indiffer- ently all parts of the body, even the viscera. The origin of these connate deformities is equally inexplicable with that of other anomalous and monstrous productions of natifYe ; but it would be insulting the un- derstanding of the reader, to waste one word in refuta- tion of the vulgar hypothesis, which ascribes them to the mental emotions of the mother—an hypothesis totally irreconcileable with the established principles of physi- ology, and with the demonstrable nature of the connex- ion between the foetus and the parent, as well as with all sober observation. , It is important, however, to know that very slight causes of irritation, such as a trifling bruise, or a tight hat will sometimes excite a mere stain-like speck, or a minute livid tubercle, into that diseased action, which occasions its growth. This growth is carried on by a 2 B 302 PATHOLOGY OF THE TISSUES. kind of inflammatory action of the surrounding arteries; and the varying intensity of colour arises from the different degree of activity in the circulation. Thus these marks are of a more vivid red in the Spring and Summer, not in sympathy with the ripening fruit, but from the more copious determination of blood to the skin, in consequence of the increase of the atmospheric temperature. The same increased determination to the surface is also produced temporarily, and with it a tem- porary augmentation of the florid colour of the naevi, by other causes of excitement to the circulation; as by active exercise, by heated rooms, or the warmth of the bed, by drinking strong liquors, or high feeding, by emotions of the mind, and, in women, by the erethism of menstruation. These considerations will serve to suggest the proper means of treating the naevi and spili, where any treat- ment is advisable. When they are merely superficial, without elevation, which would render them liable to accidental rupture, and without any tendency to enlarge and spread, there appears to be no good reason for inter- fering witb them. The applications mentioned by the older writers were doubtless as futile as they were dis- gusting ; such as saliva, the meconium of infants, the lochial blood of women, the hand of a corpse, &c. and the severe resource of the knife, even if the deformity of a scar were much less than that of the original mark, is scarcely to be recommended. But when the naevi evince a tendency to enlarge, or are very prominent excrescences, and either troublesome from their situation, or liable to be ruptured, some active treatment will then be required. Either their growth must be suppressed by sedative applications, or the whole morbid congeries of vessels must be extirpated by the knife. All strong stimulants externally must be avoided, as they are liable to produce severe inflammation, and even constitutional disorder. The consideration of the mode in which these vas- cular excrescences grow, by a degree of inflammatory PATHOLOGY OF THE TISSUES. 303 action in the surrounding vessels, suggested to Mr Abernethy the propriety of maintaining a constant seda- tive influence upon those vessels, by the steady appli- cation of cold, by means of folded linen kept constantly wet. This practice has succeeded, in several instances, in repressing the growth of these unnatural structures, which have afterwards shrunk, and disappeared, or ceased to be objects of any importance. Pressure may, in some instances, be combined with this sedative ap- plication, and contribute to diminish the dilatation of the vessels; but in the majority of cases, pressure is the source of great irritation to these maculae, and cannot be employed. The temporary enlargement of these pro- minent naevi by every species of general excitement, would teach us to enjoin moderation in diet, exercise, &c. during the attempts to subdue them. The mode of extirpation is within the province of the surgeon, and the proper choice of the mode, under the different circumstances, is directed in surgical books. From the days of Fabricus Hildanus, the propriety of radically removing every part of the diseased tissue of vessels has been inculcated; but Mr John Bell has most satisfactorily stated the grounds of that precept, by explaining the structure of these excrescences, as well as the source of the failure and danger, when they are only cut into, or opened by caustic. I shall therefore refer the reader to his " Discourse." The varieties of spilus, or mere thickening and dis- coloration of the rete mucosum, are sometimes remo- vable by stimulant and restringent applications. A combination of lime and soap is extolled by several writers; and lotions of strong spirit, with the liquor potassae, as recommended for the treatment of the ephelides and of pityriasis, certainly sometimes remove these maculae. With respect to those brown maculae, commonly called moles, I have little to observe; for no advantage is obtained by any kind of treatment. It is scarcely safe, indeed, to interfere with them ; for when suppura- tion is induced in them, it is always tedious, and pain- 304 PATHOLOGY OF THE TISSUES. ful, the matter emitting at the commencement an extremely fetid odour. When moles are irritated by accident, or rudely treated, so as to produce excoriation, they are liable, it is said, to become gangrenous, and thus to produce sudden fatality. Moles are not always congenital. I lately saw an instance in a lady of remarkably fair and delicate skin, where a numerous crop of small moles appeared, in slow succession, upon the arms and neck. Congenital moles, indeed, are not always stationary; but they sometimes enlarge gradually for a time, and afterwards disappear. Q. Whether do the Nails belong to the Cuticle or Cutis ? A. They are appendages of the cuticle, they grow from it, and are removed along with it by maceration, or boiling water. Q. What is the structure of the nails ? A. They are fixed to a semilunar fold of the cutis vera at their roots, which are covered by a reflection of the cuticle adhering to them; they are composed of lon- gitudinal fibres disposed in lamellae ; they are insen- sible, have no evident vessels, and derive their nourish- ment from the vessels of the cutis, to which they firm- ly adhere. Q. What purposes do the nails serve ? A. They defend the extremities of the fingers and toes, and assist us in laying hold of minute bodies. Q. Where are the roots of the hairs situated ? A. Their roots, or bulbs, are situated under the cutis in the cellular substance. Q. Describe the bulbs of the hairs ? A. They are of various forms, and have blood-vessels dispersed upon them: each bulb is said to have two capsules or membranes, containing an oily fluid between them, from which the hairs derive their colour. Q. What is the structure of the hairs ? ON THE HAIRS, &C. 305 A. Different opinions have been entertained: some have thought that each hair is made of a number of smaller ones inclosed in a membrane derived from the cuticle; others that each hair is a tube, through which the only fluid flows, which gives the hair its peculiar colour. Q. What uses do the hairs serve ? A. They seem destined for warmth, ornament, and protection. Q. What is the situation of the sebaceous folli- CLES ? A. They are situated under the cutis vera, and are most numerous in parts exposed to the air and at- trition ? Q. What is their use ? A. They are situated at the foot of every hair, and secrete an oily fluid, which is carried by the sebaceous ducts to the surface of the body, and poured out for the purpose of lubricating the skin. They are also situated in the ear, and secrete the wax, and on the genital or- gans, glans, penis, &c. Q. Where is the adipose substance deposited ? A. The Fat or adipose matter is deposited in the cellular substance, and contained in small vesicles, that are surrounded by a net-work of blood-vessels; by which the oily matter composing the fat is supposed to be se- creted. / Q. Do these vesicles communicate with each other, and with the common cellular substance ? A. They neither have any communication with each other, nor with the cellular substance. Q. Have they excretory ducts for removing the fatty matter; or how is it supposed to be renewed ? A. No ducts have yet been perceived to come from them; the fat is supposed to transude from the vesicles, and to be taken up by the absorbents ; for it, like other parts of the body, must be constantly changing and re- newed. A. Is fat deposited in all parts of the body ? A. No: it is awanting in the substance of the vis- 2 B 2 306 ON THE FAT CELLULAR MEMBRANE. cera, such as the brain, lungs, heart, liver, spleen, kid- neys, &c.; and in other parts, as the scrotum, penis, eye-lids, and about the joints, where its bulk would have been inconvenient, but it surrounds some of them. Q. What purposes does the fat serve ? A. It fills the interstices of various parts, gives beau- ty and form to them, defends delicate organs embedded in it; lubricates and facilitates the motions of various parts, as the external surface of the intestines, and af- fords nourishment to the system in various diseases, and to some animals during their dormant state. Q. Of what does the fat consist? A. Of two distinct substances, stearine and elaine; it is inodorous and oily. Q. What is the situation and texture of the cellu- lar MEMBRANE ? A. It is a fine membrane, composed of many thinner layers irregularly joined together, which form innume- rable cells communicating freely with one another. It binds the skin to the subjacent parts, is a general cover- ing to the whole system ; and, in sbort, forms a part of almost every organ. Q. What are the purposes of its cells ? A. They admit of a considerable degree of motion to the contiguous parts, contain the adipose substance, and are every where moistened by an interstitial serous fluid. Q. Of what does this serous exhalation consist ? A. Of the serum of the blood with some albumen. Q. Of what does the exhalation of the cellular mem- brane consist ? A. It has the same components as the last. Q. What is the use of the Cellular Membrane ? A. It connects the various soft parts of the system together, insinuates itself between the muscular fibres, and affords attachment to them: when more conden- sed, it forms the fasciae and tendons of muscles, and sheaths for them to play in: also the various mem- branes throughout the body ; the periosteum which co- vers the bones; the ligaments and cartilages which con- nect them. PATHOLOGY OF THE CELLULAR TISSUE. 307 PATHOLOGY OF THE CELLULAR TISSUE. PHLEGMON. Q. What are its symptoms ? A. A round prominent tumour, with violent pulsating pain, great heat, and intensely red in the centre, gradu- ally diminishing towards its base. Pain and swelling usually precede the redness: it attacks the parts of the body which contain quantities of cellular membrane; generally terminates by suppuration, and the formation of an abscess. When it occurs in the groin, it is called a bubo ; in the region of the parotid gland cynanche parotidaea, or mumps ; and whitlow, when situated in the subcutaneous cellular tissue of the fingers, or the tendinous sheaths which surround them. Phlegmon may be confounded with anthrax, furunculus, carbuncle, or erysipelas. Q. What are its Anatomical Characters? A. In the first stage, the cellular substance is red, in- jected with blood, and very easily torn ; in a short time, when the formation of pus is commencing, we find a gelatinous fluid issues on pressing the parts, but is soon changed into real purulent matter: this at first is found in numerous small collections, but finally one sac is formed ; the parts around are injected with blood ; the internal surface of the abscess has the appearance of a mucous membrane: when tbe inflammation becomes chronic, it changes colour and turns greyish. FURUNCULUS OR BOIL. Q. What are its symptoms ? A. A conical, circumscribed, hard, and very painful tumour of a fiery red colour, and very hot; terminating in suppuration; small pieces of mortified cellular sub- stance generally come away with the purulent matter. This affection consists of an inflammation of the cellular substance which fills the conical papillae of the donnis, generally observed at the verge of the anus on the but- tocks ; the scrotum and internal parts of the thighs.. 308 PATHOLOGY OF THE CKLLULAH TISSUE. Their volume varies from the head of a pin to the size of a cherry, and are observed to appear in great numbers successively. It may be confounded with anthrax, car- buncle, erysipelas, or phlegmon. ANTHRAX (BENIGN). Q. What are its symptoms ? A. An inflammatory, circumscribed, very hard and painful tumour, of a violet red colour, exceedingly hot, especially at the top of the tumour; in this is found a thick, flocculent, and bloody matter, very fetid; eveu after the suppuration takes place, it still spreads; many irregular openings are formed, at the bottom of which the cellular substance is seen greyish and sloughing in layers; attacks the neck, back, parietes of the thorax and abdomen, and the shoulder. It sometimes is seve- ral inches in circumference. It may be confounded with furunculus and carbuncle. Q. What are its Anatomical Characters ? A. In the first stage they are the same as described in phlegmon; in the more advanced stages, the cuticle mortifies, and forms a blackish crust; it is swollen and infiltrated with blood and serum. Pus may be found in the cells of the cellular tissue, or collected iuto an ab- scess. MALIGNANT PUSTULE. Q. What are its symptoms ? A. A small spot appears on the skin without any pre- cursory symptoms; this is followed by a small vesicle, which produces most violent itching; it soon breaks, and a serous, very irritating, yellowish fluid flows from it; in its centre, a dry livid spot may be observed. In a very short time a dreadful burning heat comes on ; new vesicles are formed round the gangrenous spot; with an oedematous swelling of the skin, at first very pale and glossy, then erysipelatous ; the tumour ex- tends, and all the symptoms increase; and constitutional phenomena commence of a nervous or low tvphoid PATHOLOGY OF THE CELLULAR TISSUE. 309 type, active in their most aggravated form. In its com- mencement this disease is purely local, and easily cured by surgical means. It proceeds from the contact of the remains of animals which have died of the carbuncle. It is always sporadic. It may be confounded with anthrax, carbuncle, or erysipelas. Q. What are its Anatomical Characters ? A. The same as erysipelas, with gangrene of the skin, and cellular membrane. CARBUNCLE, OR MALIGNANT ANTHRAX. Q. What are its symptoms ? A. A very hard and painful low tumour, of a fiery red colour in its circumference, but livid and black in its centre ; surrounded very often by small tumours, which soon become black, or vesicles containing an irritating serosity: always accompanied by constitutional symp- toms, and generally preceded by them. It is one of the worst symptoms in pestilential diseases. Very often epidemic, especially amongst quadrupeds, and may be communicated from them to man by the contact of their remains, or the use of the flesh. It may arise spontaneously: when left to itself it is speedily and invariably fatal. It may be confounded with malignant pustule, or anthrax. Q. What are its Anatomical Characters ? A. Those of inflammation, and gangrene of the skin and cellular membrane. OEDEMA. Q. What are its symptoms ? A. Uniform, indolent, and inelastic swelling of the skin ; it is pale, milky-white, and glossy; no heat; retains the impression of the finger for some time. In some cases it is confined to the lower extremities, in others it is general, and is then called anasarca. It may be confounded with emphysema, phlegmon and erysi- pelas. 310 PATHOLOGY OF THE CELLULAR TISSUE. Q. What are its Anatomical Characters ? A. The cells of the subcutaneous and intermuscular cellular tissue, distended with a serous fluid. SUBCUTANEOUS EMPHYSEMA. Q. What are its symptoms ? A. Indolent, colourless, shining and elastic swelling, which does not retain the impression of the finger; but, when pressed, a particular crepitating noise, quite cha- racteristic, is heard. It may be mistaken for oedema. Q. What are its Anatomical Characters ? A. The swelling is produced by gaseous fluids passing into the cells of the cellular membrane. HARDENING OF THE CELLULAR TISSUE. Q. What are its symptoms ? A. Great hardening of a portion ot the whole of the cellular membrane; very firm, and not yielding to pres- sure ; commencing generally in the hands and feet; ex- tending along the extremities to the abdomen and face, and inducing a coldness in the integuments. It attacks infants newly born. Q. What are its Anatomical Characters ? A. The cellular tissue filled with an albuminous yel- lowish liquid, occasionally very thick and purulent. OF THE BRAIN. Q. How many membranes surround the brain. A. Three; the dura mater, tunica arachnoidea, and pia mater. Q. What is the texture of the Dura Mater ? A. It is very dense, is composed of tendinous-like fibres running in various directions, is the thickest and strongest membrane of the body. Q. Does the Dura Mater adhere to the internal sur- face of the bones of the cranium ? A. Yes; it adheres firmly to the cranium by a num- ber of blood-vessels and cellular threads, but more in- timately at the Sutures, where the vessels are much more numerous. OF THE BRAIN. 311 Q. Does the inner surface of the Dura Mater adhere to the coat immediately within ? A. No; excepting at the Sinuses, where the vein* enter; its internal very smooth surface is well lubrica- ted by a fluid emitted from its exhalant vessels. Q. What processes does the Dura Mater form ? A. It forms the falx major, the falx minor, and the tentorium cerebelli super-extensum. Q. Describe the Falx major? A. The falx cerebri is composed of a doubling of the dura mater, is situated longitudinally between the two hemispheres of the brain, arises from the middle of the sphenoid, and crista galli of the ethmoid bone, adheres to the middle of the frontal, to the junction of the pa- rietal ; and, lastly, to the middle of the occipital bone, it becomes gradually broader, and terminates in the ten- torium. Q. Describe the Tentorium cerebelli ? A. It is formed by a duplicature of the dura mater, is connected with the transverse ridges of the occipital bone, with the ridges of the petrous portions of the tem- poral bones, and with the posterior clinoid process of the sphenoid bone : the posterior end of the falx major is attached to its middle. Q. Describe the Falx minor, or falx cerebelli? A. It descends from the middle of the tentorium, and from the under and back part of the falx major between the hemispheres of the cerebellum, is attached to the middle perpendicular ridge of the occipital bone, and terminates at the edge of the foramen magnum. Q. Are any other parts formed by the Dura Mater ? A. The dura mater lines the superior orbitary fissures, and the different foramina of the cranium, and also forms a sheath for the spinal marrow. Q. Does the Dura Mater form the sinuses ? A. Yes : the dura mater forms them in a doubling of its layers, which are stretched tensely and make a trian- gular canal between them and the bone. Q. Enumerate the different sinuses ? A. The principal are four, the superior longitudinal, 312 OF THE BRAIN. the two lateral, and the torciilar Herophlli: besides these, there are other ten smaller sinuses, the inferior longitudi- nal, the circular sinus of Ridley, the two cavernous, two superior and two inferior petrosal, the perpendicular occipital, and the anterior superior, and anterior inferior occipital sinuses. Q. Is the Dura Mater supplied with many blood-ves- sels ? A. Yes: it must receive blood for its own nourish- ment, for part of that of the bones of the cranium, to which it forms an internal peri-cranium, and for the constant exhalation of the fluid, which moistens its in- ternal surface. Q. From what sources do its arteries arise ? A. Its principal arteries are the two Meningeal sent off from the internal maxillary; it receives branches also from the inferior pharyngeal, the opthalmic, the occipital, and the vertebral arteries. Q. Is the Dura Mater possessed of much sensibility ? A. In its healthy and sound state it is insensible; which has been proved by experiments of pricking and injuring it, and by mechanical and chemical stimulants, without animals shewing any signs of pain; in its in- flamed state, however, excruciating headach, and often delirium, are complete indications of its morbid sensi- bility. Q. Where are the glandidae Pacchioni situated? A. Some flesh-coloured granulations are situated up- on the external surface of the dura mater near to the longitudinal sinus, and have formed corresponding pits in the internal surface of the bones : others of a whiter colour are situated upon its internal surface and contiguous parts of the brain near the longitudinal sinus. Q. What is the use of these bodies ? A. The use of these glands is quite unknown: it has been conjectured that they belong to the lymphatic sys- tem. Q. What is the structure and situation of the Tunica ArachnoidSa ? A. It is a very thin, transparent membrane, spread Uniformly over the surface of the brain, and adhering OF THE BRAIN. 313 closely to the pia mater by fine cellular substance, with- out insinuating itself between the convolutions. Q. Is it sensible and vascular ? A. The Tunica arachnoidea is so thin and delicate, that neither blood-vessels nor nerves have been seen in it: its sensibility and vascularity therefore, must be very inconsiderable. Q. Describe the texture and situation of the Pia Ma- ter? A. The Pia Mater is a tender, thin, semi-transparent membrane, extremely vascular; which enters double be- tween the convolutions of the cerebral -substance, and also lines the different ventricles. Q. What is the use of the Pia Mater? A. It tends to support the tender substances of the brain, and to keep its blood-veSsels in their relative situ- ations, and to allow them to be divided into very minute branches. Q. Whence does the Pia Mater receive its blood for nourishment? A. From the branches of the internal carotid, and ver- tebral arteries. Q. Is there any peculiarity in the course of the veins of the Pia Mater? A. Its veins are similar to those in other viscera ; but are peculiar in not accompanying their arteries, as veins of other parts do, for they all terminate in the sinuses of the brain. Q. Describe the situation and the divisions of the Cerebrum? A. The Cerebrum, situated in the fore and upper part of the cranium, is divided into two hemispheres by the falx : and each hemisphere is subdivided into three lobes, an anterior, a middle, and a posterior. Q. What is conspicuous on the surface of the brain ? A. Its substance is disposed in various turnings and windings, termed convolutions, which are of different sizes and lengths. Q. Describe the appearance of the substance of the brain after having made a horizontal section nearly ou 2 C 314 OF THE BRAIN. a level with the corpus callosum, and having removed the upper part ? A. The exterior substance is of a greyish ash colour, and termed cineritious, or cortical: the interior is white, and called medullary. The cineritious surrounds the medullary substance, and enters deep between its con- volutions. Q. What is called the Centrum ovale Vieussenii ? A. The medullary nucleus of an oval form in this sec- tion. Q. Describe the Corpus Callosum ? A. The corpus callosum is medullary substance, situ- ated in the longitudinal middle line under the falx, and composed of transverse fibres, which unite the two he- mispheres, meet and form a longitudinal raphk in its middle. It gradually becomes broader towards the pos- terior end. Q. Describe the situation and structure of the Septum Lucidum ? A. It is placed immediately under the raphe of the corpus callosum, to which it is connected above, and it rests upon the fornix below. It is transparent, broader before, curved at its edge, and .becoming narrow be- hind : it is composed of two laminae, a little separated from each other at its anterior part. Q. Where is the fissure or fossa of Sylvius situa- ted ? A. That fissure, also called the sinus of the septum lucidum, or fifth ventricle, is situated between the lami- nae at the anterior part of the Septum Lucidum. Q. Does that fissure or fossa communicate with the other ventricles ? A. No : but in some Hydrocephalic cases, it, like the other ventricles, has been found full of fluid. Q. How many Ventricles are there in the brain ? A. Four: two lateral, a middle, and an inferior one. Q. Describe the Lateral Ventricles ? A. They are situated, one in each hemisphere, hori- zontally ; are of an irregular winding figure, and have three cornua. OF THE BRAIN. 315 Q. How are these cornua situated ? A. The anterior are separated by the septum luci- dum ; the posterior are considerably distant, but ap- proach nearer at their posterior extremities; the inferior cornua wind downwards and forwards in the middle lobes of the brain. Q. What parts are to be seen in the bottom of the Lateral Ventricles ? A. The corpora striata, thalami nervorum opticorum, taenia semicircularis of Haller, choroid plexus, the fornix, and pedes hippocampi or cornua ammonis. Q. Describe the situation and structure of the Corpo- ra striata ? A. They are situated near the anterior part of the ventricles, and recede from each other posteriorly; their structure is cineritious externally, and mixed with striae of medullary substance within. Q. Describe the structure and situation of the Tha- lami Nervorum Opticorum ? A. Their structure is medullary on the surface, and striated within; their anterior parts are placed between the corpora striata; the Thalami lie with their flat inner sides contiguous, and are covered above by the commis- sura mollis; the posterior parts of the Thalami turn downwards and outwards, forming two white cords, cal- led tractus optlci. Q. Where is the Taenia Semicircularis of Haller, or the Centrum Semicirculare Gemlnum of Vieus- sens, situated ? A. In the groove between the corpus striatum and the thalamus opticus of each hemisphere. Q. What is the situation and nature of the Choroid Plexus ? A. It is spread over the thalami nervorum opticorum, and consists of a congeries of tortuous blood-vessels. Q. Does the Plexus Choroides of the one lateral ven- tricle communicate with that of the other? A. Yes; the plexus of each side communicates through the foramen Monroianum ; and at the posterior and in- 316 OF THE BRAIN. ferior part of the fornix, where the impression of the vessels form the lyra. Q. Where is the Foramen Monroianum situated ? A. It is situated under the body, and near to the an- terior crura of the fornix ; and seems to be occupied by the vessels of the choroid plexus in the living subject, so as to admit of no foramen; but in the dead subject, these vessels are empty, and the slender adhesions of cellular substance, which confined them in situ, are de- stroyed by putrefaction; hence an opening is manifest by the blow-pipe. Q. How can it be proved that the vessels of the Cho- roid Plexus fill up the space, called foramen Monroia- num, in the living subject ? A. Because dissection has shewn one lateral ventricle to be full of effused fluid, while the other was empty. Q. Is nqt the effusion, or extravasation of blood, more frequently in both lateral ventricles? A. Yes ; in Apoplexy, a rupture of a vessel may take place in one lateral ventricle, and produce a distension sufficient to rupture the adhesions of the cellular sub- stance around the vessels of the choroid plexus in the foramen Monroianum, and thus force a passage into the other. Q. What is the situation of the Fornix ? A. It is situated in the mesial line immediately under the Septum Lucidum, and by some considered a conti- nuation of the corpus callosum. Q. Describe the Fornix ? A. It has a body, two anterior crura, and two poste- rior. Q. Describe the body of the Fornix ? A. It is somewhat triangular, narrow anteriorly, and broader behind, where it is united to the corpus callo- sum. Q. What is the direction and termination of the ante- rior crura of the Fornix ? A. The anterior crura being near together, form an angle at the anterior Commissure, bend downwards be- hind it, and either terminate in the Corpora Albicantiaia OF THE BRAIN. 317 the base of the brain, or wind round the Thalami, and terminate in the crura cerebri. Q. Describe the direction of the posterior crura of the Fornix ? A. They are prolongated, and follow the curvature of the inferior cornua of the lateral Ventricles, form a part of the Pedes Hippocampi or Cornua Ammonis, and their inner margin is fimbriated, and called Corpus Fim- bi latum. Q. Describe the Pedes Hippocampi ? A. They are composed of medullary matter external- ly, mixed with cineritious internally, commencing from the posterior crura, or pillars as they are sometimes call- ed, of the Fornix; and from the sides of the posterior extremity of the Corpus Callosum, they are rather small at first, but increase in size towards their further extre- mity. Q. Describe the anterior Commissure ? A. It is a medullary cord, which unites the anterior and inferior parts of the Corpora Striata; it is convex ante- riorly, and its extremities are lost in the middle lobes of the brain near the fossa Sylvii. Q. Where is the situation of the Lyra ? A. It is an impression made on the inferior and pos- terior surface of the Fornix by the vessels of the Tela Choroidea; and it is best seen by reflecting the Fornix backwards. Q. What is the situation of the Commissura mollis ? A. It is the connexion of the two thalami optici above, where they form one continued medullary sur- face, called Commissura mollis, which covers the third Ventricle. Q. Describe the situation of the third Ventricle 7 A. It is in the form of a deep fissure, situated be- tween the bodies of the Thalami optici, having the com- missura mollis above, and the crura cerebri and pons Ta- rini below. Q. Where is the situation of the Infundibulum ? A. Under the anterior part of the body of the Fornix at the foramen Monroianum, there is a passage called 2 C 2 318 OF THE BRAIN. foramen commune anterius, vulva, iter ad infundibu- lum, or iter ad tertium ventriculum, from which tho Infundibulum of considerable size descends obliquely forwards, gradually contracting, till it terminates in tho Gljndula Pituitaria. Q. Does the third Ventricle communicate with the Infundibulum ? A. Yes ; at its anterior and superior part. Q. What is the situation of the Glandula Pituitaria ? A. It is of on oval form, situated in the Sella Turci- ca; is cineritious without, and medullary within. Q. What is the wse of the pituitary gland ? A. Its use is unknown. Q. What is the situation of the posterior Commis- sure ? A. It is something similar to a short cord, running transversely at the back part of the third ventricle, above the iter ad quartum ventriculum, and before the tubercula quadrigenrina. Q. Describe the situation of the Tubercula Quadn- gemina ? A. They are situated at the posterior part of the third Ventricle, and behind the Thalami Optici: when the posterior part of the fornix and tela choroidea are re- moved, they come into view; or they may be seen by lifting up, and turning forward the posterior lobes of the brain. Q. Have these tubercles any other name ? A. The two superior are called Nates, of a rounder form, and of a cineritious colour than the two inferior, called Testes, of a medullary colour, and longer late- rally. Q. Where is the Glandula Pinealis situated ? A. The Pineal gland is situated on the posterior Com- missure, over the nates, and under the back part of the fornix, is of the size of a pea, and of a conical figure ; its structure is cineritious. Q. Where is the Iter ad quartum Ventriculum, Ca«. nalis medius, or Aquaeductus Sylvii, situated ? A. At the inferior and posterior part of the third V>n- OF THE BRAIN. 319 tricle, that passage is found running backwards and downwards under the corpora quadrigemina into the fourth ventricle. Q. What is the situation of the cerebellum ? A. It is situated under the Tentorium in the fossae of the occipital bone. Q. What is the general appearance of the Cerebel- lum ? A. It is roundish, but broader from side to side, ia marked by numerous convolutions on its surface, and is divided by the Falx minor into two hemispheres. Q. Does it consist of cineritious and medullary mat- ter, as the cerebrum ? A. Yes; but the cineritious is more in proportion: the convolutions run transversely, and the alternations of cineritious and medullary substance are beautiful on cutting the cerebellum vertically; the resemblance of a tree is strikingly correct, and it has been called arbor vilae. Q. What composes the Tuber Annulare, or Pons Va- rolii ? A. The junction of the crura cerebri and crura cere- belli. Q. Where is it situated ? A. The Tuber Annulare is situated on the back part of the sphenoid, and on the cuneiform process of the occipital bone. Q. Where is the fourth Ventricle situated ? A. Between the Cerebellum, the under part of the Tuber annulare, and upper part of the Medulla Oblon- gata, the Valvula and Velum Vieussenii closes the in- termediate spaces, and completes the cavity. Q. What is meant by the Medulla Oblongata ? A. The medullary substance from the Tuber annulare to the foramen magnum becomes conical, and is gene- rally called Medulla Oblongata. Q. What is worthy of obseivation on the surface of the Medulla oblongata ? A. Four longitudinal eminence*; the two Corpora 320 OF THE BRAIN. Pyramidalia lying contiguous in the middle, and the two Corpora Olivaria on each side. Q. Where does the Medulla oblongata terminate ? A. Whenever it passes through the foramen magnum, it gets the name of Medulla spinalis. PHYSIOLOGICAL REMARKS ON THE BRAIN. Qt What is the use of the Brain ? A. It seems the medium through which the mind and body affect each other; it may be said to be the recep- tacle of sensation, and the instrument of thought; or the seat of the intellectual faculties. Q. Have the various parts of the Brain their particu- lar and individual functions to perform ? A. It is very probable that they have; as we see the nerves of the different senses arising from different parts of it; so the different portions of brain may contribute to the manifestations of mind. Q. Have the different offices of particular parts of the brain been ascertained ? A. Various attempts have lately been made by Drs Gall and Spurzheim, and their followers, to ascertain this; but we cannot with full confidence rely upon their conclusions being true; much observation is still want- ed upon this head. Q. Does the power of the intellectual faculties de- pend on the bulk of brain ? A. Brain in the human species bears a much larger proportion to the Spinal Marrow, than in animals; hence the superior intelligence of man uust depend upon his quantity of brain. Q. Does the difference of the quantity of brain then constitute the different degrees of intelligence among men? A. No; a certain quantity of brain is essentially ne- cessary ; but it is on the just and requisite proportions of the different parts of brain to each other, and on the cultivation of the mental powers dependent upon these PHYSIOLOGICAL REMARKS. 321 parts for their manifestation, that the different degrees of intellect seem to depend. Q. Does intelligence, or even instinct, depend on a relative proportion between the brain and spinal mar- row? A. Yes, it seems so ; for as the size of the brain di- minishes, and that of the spinal marrow increases in animals; in the same ratio, instinctive intelligence de- creases, while acuteness of feeling, and rapidity and strength of their motions increase. Q. What movements does the brain exhibit on being denuded ? A. One which keeps pace with the arteries ; another with the organs of respiration. Q. Do tbe cerebrum and cerebellum undergo any pressure ? A. The quantity of blood sent into them produces con- siderable pressure; the pia mater by its contraction pro- duces the same effect upon the spinal marrow, which does not, as the brain and cerebellum, fill exactly the bony case, which incloses it. This pressure is neces- sary to these organs, as if it is suddenly augmented or diminished, their functions cease. OF THE FUNCTIONS OF THE BRAIN. Q. What are the functiohs of the brain ? A. They arc all modifications of feeling; and are ar- ranged under four heads. 1. Sensibility, or that by which we receive impressions. 2. Memory, or the fa- culty of reproducing these impressions. 3. Judgment, or the faculty of perceiving relations between sensa- tions. 4. The Will. OF THE SENSIBILITY. Q. How many modes of this state of the mind are there ? A. Two; one which arises from the effect of an ex- ternal object on one of the senses, called a perception ; 322 FHYSIOLOOICAI. REMARKS. another which arises from the recollection of these im- pressions, and is called an idea. Q. Is sensibility different in different persons ? A. It differs in different persons; in some it is obtuse ; in others lively; in youth it is strong; in old age it is obtuse. OF MEMORY. Q. Describe the qualities of this faculty ? A. It consists in the power of re-producing ideas which have been before in the mind ; it is more strong and lively in youth; it debilitates as we grow older, and in old age is almost entirely gone. OF JUDGMENT. Q. Describe this faculty ? A. It is the most important of all; by it we acquire all our knowledge, and direct ourselves through life ; it consists in observing the relations between the pheno- mena of nature, and tracing their causes, and appropri- ating to each its due degree of power. A train of judgments is called reasoning; and in proportion as these are correct is the individual happy, or otherwise, in his arrangements, to produce comfort and content- ment with his situation. Thus, if a man believes that arsenic is sugar, and takes it for that substance, he might destroy himself; so it is with regard to all other ideas and actions, as crimes, vices, bad conduct, &c. Some men are endowed with the happy faculty of perceiving new relations between things, and thus bene- fit greatly their species ; they are called men of genius ; if they have less of this faculty they are said to have talents. Strength of judgment is impaired by the vivacity of our thoughts; it is on this account that judgment grows better with age. PHYSIOLOGICAL REMARKS. 323 OF THE WILL. Q. Describe this faculty ? A. It means that modification of thought by which we have desires which are generally consequent on some act of judgment, and are intimately connected with our happiness ; for if our desires are not gratified we are unhappy; on the contrary, the science of morals consists in giving a proper direction to our desires, so as to produce happiness. These four faculties, by properly combining and acting upon each other, constitute intel- ligence in its highest grade ; of which the most elevated is the faculty of generalization, or abstraction, by which facts are arranged under general rules, or laws, so that the properties of all bodies, to which the rule applies, may be known at once by consulting the rule. In this manner a knowledge of vast regions of nature may be facilitated by the knowledge of a few principles, couched in a few short sentences, which are the result of this principle of abstraction. The development of this talent is much favoured by an easy mode of life, and on the contrary is retarded when it is difficult, as among savages, slaves, &.c. Q. What is meant by instinct ? A. Certain desires, by which the different parts of the animal machine are naturally excited to action to satisfy certain wants ? Q. How many kinds of instinct are there ? A. Two; one in which the desire to be gratified exists, with a knowledge of the end to be gained; the other without that knowledge; the former is more par- ticularly found in the human species, the latter in brutes. Q. What is to be considered with regard to the end or final intention of instinct? A. There are two things ; first, the preservation of the individual; secondly, the preservation of the species. Q. How manv kinds of instincts are there in man ? A. There are two kinds: one belongs to his nature, 324 PHYSIOLOGICAL REMARKS. considered merely as an animal, as those which regard thirst, hunger, the want of clothes, dwellings, the fear of pain and of death, venereal desires, the love of offspring, the tendency to imitation, to live in society; the other kind of instinct arises out of the social state, such as the gratification of ambition, of vanity, of fortune. Q. What is the object of the passions ? A. They have the same end or object as instinct; and may be divided into the animal, or those which have for tlieir object the preservation of the individual and of the species ; to which belong fear, rage, anger, hatred, excessive thirst; to the preservation of the indi- vidual belongs jealousy; rage when the family are at- tacked. The other divisions are those of the social state, as hatred, anger, vengeance, violent love, &c. It is strength of passion makes men great. All great heroes, great criminals, great poets, and orators have had strong passions. Q. How are these passions expressed ? A. By actions, gestures, and the voice; the two lat- ter with the operation of the mind, form the scienee of eloquence, and as far as the peculiar expression of the voice, and its various modifications of sounds are con- cerned, it has been elaborately and perspicuously analy- zed by Dr James Rush, whose labours on this subject, as they give a reality to eloquence as a science, have conferred a great honour on his country. The extent of the investigation, and its connection more with the expression of the passions than physi- ology as a science, must, of course, pievent its conside- ration here. METHOD-OF EXAMINATION APPLICABLE TO DISEASES OF THE HEAD. Q. When disease of tbe brain is suspected, can any light be thrown upon the question by examining the other organs of the body ? A. The brain, like all the principal organs of the eco- EXAMINATION OF THE BRAIN. 325 nomy, presents, when attacked by disease, a distur- bance, more or less evident, of the functions over which it presides; hence it is to these functions (at the head of which we place the intellectual faculties, and those which belong to the systems of sensation and locomo- tion,) that the observer ought particularly to direct his attention. The digestive apparatus should next be attended to, as its sympathetic connexions with the brain are so many and so important. As to the circu- lation and respiration, they are but very indirectly and rather remotely influenced by affections of the organs now under consideration. The expression of the coun- tenance, and the position of the patient should always be attended to whenever the brain is affected. Before we enter on each of these subjects in detail, it will be necessary to say a few words on some precautions which should be observed, and which precede the ex- amination of the symptoms. Q. What other points deserve attention? A. As the diagnosis of diseases of the brain is in general difficult, and as several of them may be con- founded with one another, or with affections of other organs, it is particularly necessary to attend to the pre- vious history of each case, as it will elucidate the manner in which it set in, its progress, changes, the state of other organs coincident with these changes, more particularly that of the digestive apparatus. The observer will thus avoid the several mistakes which arise from the resemblance that exists between acute inflammations of the brain, and some derangements of the digestive tube. He should also attend to the nature of the causes which have induced the affection of the brain ; he will recollect how constantly they are produc- ed by concussion of the cranium, or vertebral column, insolation, hypertrophy of the heart, acquired and here- ditary dispositions to cerebral congestion, abuse of spirituous liquors, the use of narcotics, mental anxi- ety, &c. In every case the skull and spinal column should be examined, to ascertain whether there be any malforma- 2 D 326 EXAMINATION OF THE BRAIN. tion, tumour, or lesion to which the present affection may be referred. If the patient be a child, the tempera- ment should be noted, and the size of the head, if it be large; the existence of worms, and the time that has elapsed since dentition. Increased vigilance will of course be required, if any organ of the thorax or abdo- men be engaged, for then the cerebral affection may be obscured and masked by the other disease. After these preliminary inquiries, we may now enter on the examination of each of those systems of organs to which we have already alluded, and which we now proceed to consider in detail. Q. How far do the intellectual faculties contribute to develope the state of the brain ? A. It is usual to commence by ascertaining the state of the patient's faculties when he was in health, in order to distinguish what is really caused by the disease. Questions should then be put to the patient, to learn how far his intellects are impaired. His answers will deter- mine whether his faculties are, as it were, exalted, de- ranged, or, on the contrary, merely weakened. To the two former heads may be referred that delirium, which is termed hallucination, when it takes one particular direction. Q. What varieties of delirium are there ? A. Delirium is presented to us in a variety of forms, for sometimes it is manifested only by a change in the patient's character: for instance, making a man habitually serious to become gay, or a mild and calm person to be impatient, irritable, or vicious ; sometimes it is marked by a sombre, or even savage expression, by phrenzied exclamations, singing, loquacity, incoherent expressions, ideas of the wildest ambition, a real state of mania; at other times there is an incoherence in the answers, some of which may be correct enough, while others are con- fused, and destitute of meaning; and lastly, the patient maybe in a state of extreme agitation, making continual efforts to escape from his bed. In general, the degree of the delirium is proportioned to that of the general reaction in acute cases, and varies as this latter does. EXAMINATION OF THE BRAIN. 327 l The delirium may be continued or intermittent, periodic or irregular, subject to particular influences or returning without any assignable cause. A better idea of the patient's case may, in some instances, be given by citing some particular word or phrase of his, than by any general description, for these are often peculiarly expressive. These circumstances, which generally con- cur with other indications of excitement, are referrible to irritation of the brain ; but they may also depend upon a reaction of such organs as sympathize with the brain, particularly the digestive tube. This is the reason why we have above insisted so much on the necessity of having a perfect knowledge of the manner in which these diseases set in. In infancy, as the intellects are not developed, it can scarcely be said, that there is delirium; hence, we must attend to the other cerebral symptoms. We have already said that there is an opposite state to that here described, and which depends on diminished action, and loss, more or less, of cerebral power. This slate is, in most cases, consecutive on the former; in others, however, it sets in suddenly, and indicates that the organization of the brain has been deranged from the commencement of the attack. This is marked by slsw- ness and difficulty in giving answers, drowsiness more or less, and then somnolence, which may increase to a state of profound carus. Its degree should be stated ; whether there be merely a disposition to drowsiness, or to actual coma, or whether it is possible to rouse the pa- tient by stimulation. This may be ascertained by pinch- ing different parts of the body, or by making slight per- cussion on the arm, or even the face, by which we may form some estimate of the condition of the nervous sensibility. Q. What other faculties deserve attention ? A. Some attention should be directed to ascertain the state of the memory, and the mode of articulation. The utterance may be hurried, quick, impeded, or even alto- gether suppressed ; in which latter case, it will be well to ascertain whether the aphonia arises from an impediment 328 EXAMINATION OF THE BRAIN. to the free motions of the tongue, or a want of cerebral power, caused by a lesion of some part of the brain. Q. What symptoms are to be derived from tbe sensi- tive system ? A. This may be divided into two great heads, the or- gans of sense, and the general sensibility. The symptoms, most usually observed, are referrible to disturbance of the sight, hearing, and touch. There may be a greater or less degree of diminution in these func- tions, or, on the contrary, an exaltation of them; or finally, there may be aberrations or illusions. ,When there happens to be a diminution, or complete suspension of the power of hearing or seeing, as in coma, for in- stance, we ought to ascertain whether it is real, or only apparent. This can be done by suddenly exposing the eye to a strong light, or the ear to a loud sound. Though the senses of smell and taste seldom furnish any assistance to the diagnosis of diseases of the brain, still we may examine their condition by bringing some pungent odour in contact with the pituitary membrane, or placing on the tongue some sapid substance. In diseases of the brain, the sensibility is variously af- fected, and requires very particular attention. As to the eye, its sensibility may be increased, which depends either on the impression of the air on the conjunctiva, in which case, if there be opthalmia at the same time, it becomes necessary to state it, or on the stimulus produ- ced by the light on the brain, through the intervention of the retina; these two causes should be carefully dis- tinguished. By tickling the interior of the nasal fossae and the surface of the tongue, we may determine whether their sensibility (considered as a result of the sense of touch generally diffused over the body), remains unimpaired. The nature and character of the headache should be particularly attended to, as it is one of the most constant symptoms; it will be necessary to ascertain exactly whether pain is felt in the internal ear, and also if there be any discharge from the auditory tube, which is some- EXAMINATION OF THE BRAIN. 329 times of consequence as indicating an alteration on the lower surface of the cerebellum. The sensibility of the limbs is sometimes increased, which is marked by shooting pains, by painful numb- ness, and creeping, which follows the course of the large nervous trunks; this increased sensibility exists sometimes in the muscles also, particularly when they are permanently contracted. In such cases we ought, as far as is possible, to indicate the tissue affected. As to the sensations of creeping, numbness, or of dif- ferent " aurae," which occur in the limbs during the course of certain affections of the brain, they require a careful examination to determine in what tissue they commenced, or whether the skin only is engaged. The state of the sensibility should then be ascertained in the different regions of the body, particularly in the chest and abdomen, and upper and lower extremities. This examination is so much the more necessary, as in inflammation of the central parts of the brain, for in- stance in the corpus callosum, septum lucidum, and fornix, the sensibility is sometimes so much increased in the integuments of the body that the slightest pres- sure produces pain: this should be distinguished from inflammation seated in the abdomen itself. When the opposite st.ite, or that of diminished sensi- bility takes place, as in the case of effusion, or dis- organization of the substance of the'brain, the different parts of the body should be examined, as has been above stated, and we ought to have recourse to pinching, in order to determine the degree in which the sensibility is diminished. In all such cases comparative trials should be made at both sides of the body, and the result stated in the report. Q. What is to be learned from the state of the appara- tus of locomotion, with regard to the state of the brain ? A. Its examination should follow that of the sensibility. After commencing with the face, the state of the eyes, mouth, neck, and limb*, should be successively review- ed. ID 2 330 EXAMINATION OF THF. BRAIN. The part of the eye which should be most attended to is the pupil, which may be cither dilated or contracted, immoveable or dilatable, or, in some cases, may present constant oscillations. The globe of the eye itself may be agitated by con- vulsive or rotatory motions, or may present a change in the direction of its axis, constituting strabismus. This last phenomenon depends upon a permanent con- traction of the muscles of the eye, at the side affected, or on paralysis of their antagonists. The eye-lids may be closed, which depends either on a paralysis of the eleva- tor of the upper lid, or of the contraction of the orbicu- laris muscle, which ought always to be stated. The contraction of this latter muscle, which is produced by the effect of the light on the eye, should not be con- founded with that spasmodic effect, which is altogether involuntary, and depends on a deep-seated irritation in the brain. The alae of the nose are in some cases immoveable at one side, and applied closely to the septum. This arises from paralysis of the muscles at that side, and therefore deserves to be noted. When the utterance is impeded, indistinct, or altoge- ther lost, we should ascertain, whether it arises from dif- ficulty of moving the tongue, lips, or larynx, or whether it depends on want of cerebral power. For this pur- pose we should endeavour, by calling aloud to the pa- tient, to excite to action the different sets of muscles that contribute to the act of speaking. As to the mouth, it presents several symptoms de- serving attention. They consist of trismus or tonic con- traction of the elevators of the lower jaw: the direction of the point and base of the tongue may be changed, or the position of the commissure of the lips may be alter- ed ; this latter deviation sometimes takes place on the affected side, in consequence of a spasmodic contraction of the commissure, which draws the mouth upwards and outwards; at others the muscles are paralysed, when the lip becomes depressed and pendant; finally, it may exist at the same side, and be caused by the muscles that re- EXAMINATION OF THE BRAIN. 331 main unaffected. In general, when there are any spas- modic attacks, the examination of the commissure of the lips, as well as of the other muscles, should be made during the intervals, for while they continue, the two sides being sometimes convulsed, it will not be possible to ascertain the distinctions above stated. The head is sometimes drawn backwards, or inclined to one side: attention should then be paid to the mus- cles of the neck, whidh arc contracted or relaxed. In some cases, the larynx experiences continued motions up and down. The trunk of the body may also present particular phe- nomena, such as momentary spasms of the muscles of respiration, retraction of the body backwards, or bend- ing forwards; these latter usually depend on irritation in the spinal column. The power of moving the upper and lower limbs, parti- cularly the former, may be diminished or lost. This para- lysis, which may exist with or without rigidity, depends, according to some writers, on a lesion of the Optic thalami and posterior lobes of the brain, or of the corpora striata and anterior lobes; the former, namely that of the optic thalamus, determines paralysis of the upper extremities, the latter, namely that of tbe corpora striata, produces paralysis of the lower limbs. We should ascertain whe- ther the immobility of the limbs arises from a state of inaction or general weakness, whether it is confined to a certain region, or extends to all; whether the limbs re- tain any position that may be given to them, as in cata- lepsy ; or whether, on the contrary, there is a real para- lysis. When this latter exists, we should examine whe- ther the muscles are flaccid or rigid, whether the flac- cidity is total or partial, or whether the limb falls down en masse when it is raised: when rigidity exists, we should ascertain whether it is confined to one part, as in trismus, or extends to the whole body, as in tetanus. In some cases the muscles are alternately in a state of rigi- dity and relaxation, as in convulsions; in others, the limbs are continually agitated, as in chorea, the intellect remaining unimpaired, but incapable of controlling the 332 EXAMINATION OF THE BRAIN. motions. And lastly, the convulsions exist in certain muscles only (and then momentarily), producing sub- sullus tendinum. We may here observe that those ir- regular motions which occur during delirium, should not be considered as convulsions, as they have a real object, and do not belong to movements merely inyoluntary. As to those motions which are termed automatic, they should be noted; such, for instance, as when children in hydrocephalus carry their hands frequently to their heads. In the expose of these various phenomena, any differences that may exist between the state of the two sides of the body should not be overlooked. Q. What is to be learnt from the digestive system ? A. The digestive organs do not ordinarily present many symptoms which may be considered as the direct effect of diseases of the brain. The most important, however, are vomiting, which sometimes occurs at the commencement of these affections, constipation and re- tention of urine, or the opposite state of involuntary evacuation, which occurs when the affection is carried to a great degree, or when the spinal column is engaged. When there is vomiting, care should be taken to ex- amine the state of the mouth and tongue, as well as the abdominal viscera, in order to determine whether it is purely symptomatic of the affection of the brain, or de- pends on inflammation of the stomach. Q. What is to be learnt with regard to the diseases of the brain from the circulating system ? A. The disturbance refenible to this part of the eco- nomy, consists in alterations of the natural rythm of the pulse, in increased frequency, or a greater or less degree of slowness. Sometimes it may become irregular or in- termittent; but this latter modification is of trilling im- portance, as it contributes little or nothing to the diag- nosis of cerebral affections. We may remark, however, that slowness of the pulse is chiefly connected with cer- tain lesions of the substance of the brain, and with con- siderable effusions, whilst increased frequency accom- panies rather the inflammatory condition of the mem- branes, and the first stage of inflammation of the sub- EXAMINATION OF THE BRAIN. 333 stance of the brain, particularly when this is complicat- ed with gastro-intestinal inflammation. Q. What is to be learnt with regard to the brain from the organs of respiration ? A. We may make somewhat the same remark on this system as on that of the circulation, as to the degree of its connexion with affections of the brain. The respira- tion may be stertorous, interrupted, sighing, elevated, or may become very slow, when the disease proceeds to an extreme degree. It becomes laborious and difficult when the spinal chord is injured, in a greater degree in proportion to the nearness of the affected part to the re- gion of the neck ; and suffocation maybe threatened if it occurs opposite the fourth and fifth cervical vertebrae, below the origin of the phrenic nerves, ki some cases the expiration is made at one commissure only, the mouth being closed; this is what has been termed "fumer la pipe." After having in this way reviewed the different systems of organs, the narrative may con- clude with stating the position of the patient's limbs, as well as that in which he lies. Q. What is to be known with regard to the brain from the urinary system ? A. The state of the bladder should never fie neglect- ed; it is sometimes paralyzed. The secretion is then retained in the bladder, acquires an ammoniacal fetor, is absorbed into the system, and produces that peculiar fe- tor so common in affections of the brain, which has been compared to the smell of mice. The urine may be thready and mixed with mucus, arising from inflamma- tion of the lining membrane of the viscus, caused by the retention of the fluid in its cavity. When the spinal co- lumn has sustained any injury, particular attention should be paid to the urinary organs, as paralysis of them is one of the most constant effects of the diseases of the medulla spinalis. Q. How does the countenance indicate disease in the brain ? A. The examination should conclude with a slight no- tice of the countenance, which may be described either 334 EXAMINATION OF THE BRAIN. in reference to its general expression, (which may be furious and menacing, or merely fixed and denoting sur- prise), or to each of its parts; thus the eyes may be red and brilliant, or dull and covered with mucus; the upper lids may be contracted, moveable, or paralyzed; the mouth may present a deviation at its commissure; hence the great variety of expression which the countenance presents in diseases; it may be tranquil, immoveable, gay or gloomy; or it may express indifference, stupidity, or total insensibility. Q. How do the position and state of the body indi- cate disease of the brain ? A. The manner in which the patient lies, the state of agitation or calm in which he is found, the position of the head and limbs, the disposition to sink down in the bed, &c, may furnish some data for distinguishing (he diseases of the brain. Finally, when there is any reason to suspect an affection of the cerebellum, when the pa- tient presents any external marks on tbe occiput, or when he complains of pain in that part, attention should be directed to the genital organs, to sec whether there be priapism. Q. Recapitulate wbat has been here said ? A. We see that the observer should attend to the age of the patient, which in some cases will assist in distin- guishing apoplexy from inflammation of the brain, as the former seldom occurs before the age of forty, while the latter may arise at any period of life. He should ex- amine the skull and vertebral column, to ascertain whe- ther there is any external injury or malformation; he should attend to the mode in which the disease has set in, its progress and symptoms; then he should exa- mine the present condition of the patient, com- mencing with the intellectual functions, having in the first instance ascertained their state in health. Deli- rium and its character should next engage his attention, and also the state of stupor, which may vary from mere somnolence to complete coma; from a slight slowness in answering questions, to total loss of understanding. The manner of articulation should also be attended to. EXAMINATION OF THE BRAIN. 335 After inquiring whether there is any pain or particular sensation in the head or vertebral column, the examina- tion concludes with a review of the organs of sense, as the sight, hearing and taste. The observer then passes in review the state of the pupils, of the globe of the eye, eye-lids, lips, tongue, neck, upper and lower limbs; he then examines the muscular system, to determine whether there is con- traction, convulsion, or paralysis in any particular part; or whether these phenomena are continued or intermit- tent. In drawing up the report of the case, he will follow precisely this same arrangement. After having thus investigated the condition of the three great functions which are affected by affections of the brain, the observer will ascertain the state of the tongue, stomach and bowels; he will state the existence of constipation or vomiting, and mark their symptoms, with so much the greater accuracy, as affections of these organs very frequently simulate those of the brain. He may conclude with a rapid glance at the state of the respiration, the pulse, action of the heart, state of the bladder, expression of countenance, and position in which the patient lies. When the medulla spinalis or cerebellum appears to be affected after some external injury, attention should be paid to the digestive, respiratory, circulating and diges- tive systems. But that the report of the case may not be incomplete, he should examine the whole of the viscera, and state whether they present any thing re- markable. This is the only way by which complete and accurate cases can be drawn up, capable of still farther elucidating the pathology of the brain, which has latterly made so much progress. 336 DISEASES OF THE BRAIN. DIAGNOSIS AND PATHOLOGY OF DISEASES OF THE BRAIN AND ITS MEMBRANES. FUNGUS OF THE DURA MATER. Q. What are its symptoms ? A. This disease is of rare occurrence, but is not con- fined to any particular period of life. It may sometimes exist without occasioning any derangement of function, or if it manifests any symptoms, they are so obscure as scarcely to indicate its existence. But after some time, probably during the progress of an old syphilitic taint, or in consequence of a contusion of the head, violent head- aches occur, which may be either dull or lancinating, continued or intermittent, and occasionally accompanied by epileptic, comatose, or paralytic symptoms; at length a tumour begins to appear, the seat of which may be either at the roof or base of the brain, or sometimes in the orbit. This production is. more or less hard, indolent or very painful, increases rather slowly, and exhibits a sort of pulsatory motion. It may at times be reduced altogether, or in part, within the walls of the cranium, and then we can distinctly trace the margins of the aperture through which it had escaped, which we find to be rough and irregular. Pressure, directed from above downwards on the tumour, gives rise to para- lytic or comatose symptoms, for by this means it is made to compress the brain; but if we press it from side to side between the fingers, no particular effect is produ- ced, or at most, only a slight degree of pain, for then no impression is made on the substance of the brain. Sometimes the cerebral symptoms cease altogether after the tumour has escaped beyond the cranium. Q. What are the diseases with which it may be con- founded ? A. This affection may, in its first stage, be confounded with any of the derangements of the brain or its invest- ments; in the second, with encephalocele—with vascu- lar tumours of the dura mater, following wounds—with DISEASES OF THE BRAIN. 337 abscess—with certain wens, or with aneurism of the occipital or temporal arteries. Q. What are its Anatomical Characters ? A. These tumours are fibrous in their texture, some- times crossed by enlarged blood-vessels : in some points they become softened and broken down, and contain blood effused into their substance. In some instances we find only one of them, in others several, which may be encysted, circumscribed, and more or less irregular. At first they are flattened before they escape beyond the skull, afterwards assume the form of a mushroom, the pedicle corresponding to the aperture in the cranium. The margins of the opening are eroded, and in many cases present asperities, which, by pressing against the tumours, excite intense pain. ENCEPHALOCELE. Q. Wnat are its symptoms ? A. In this affection, we find a soft, round tumour, which pulsates synchronously with the arteries, is little if at all painful, diminishes or altogether disappears on pressure, but is increased by crying, coughing, sneezing or forced expiration. It does not produce any change of colour in the skin, nor is it attended by any marked cerebral symptoms, unless when complicated with other affections : it is most common in children, particularly at an early period after birth, and then makes its ap- pearance at the fontanelles or sutures, when the ossifi- cation is retarded : it may, however, occur at any time of life, after caries of the bones or wounds, with loss of substance. Pressure directed in any direction upon it, either from above, downwards or from side to side, indu- ces symptoms of coma, paralysis or spasm, which at once distinguishes it from tumours of the dura mater. The margins of the opening through which it escapes, can be ascertained by examination sufficiently to distin- guish it from tumours seated on the surface. Q. What are the diseases with which it may be con- founded ? 2 E 338 DISEASES OF THE BRAIN. A. In infants it may be mistaken for sanguineous congestions—in adults, for fungus of the dura mater. Q. What are its Anatomical Characters ? A. Congenital encephalocele is generally formed by the cerebrum, seldom by the cerebellum; it is enclosed either in the meninges of the brain, or, after these have been destroyed, in the integuments of the cranium ; when this is the case, various alterations take place in the protruded portion of the brain, and effusions of va- rious descriptions are, in most instances, poured into the sac which contains the tumour. In accidental ence- phalocele, the dura mater is more or less thickened and altered, and sometimes becomes adherent to the hairy-scalp, in which case the brain is almost always healthy. INFLAMMATION OF THE DURA MATER. Q. What are its symptoms ? A. This inflammation rarely occurs except as a con- sequence of severe contusions of the skull, or wounds with loss of substance of its bony arch. It gives rise to violent headache, and is often complicated with arach- nitis, encephalitis, or with effusions of blood. The greater number of cases are accompanied by paralysis; which, when it does occur, is preceded by rigors, but not by delirium or any spasmodic affection. This para- lysis is observed usually on the side opposite to that which is the seat of the contusion, and is more or less partial, according as the effusion covers a greater or less extent of surface. In cases of fracture of the skull, when there is a perceptible interval between the bones, pus will flow out, and if there be a loss of substance sufficient to expose the dura mater, it is easy to ascertain its inflammation by the cellular and vascular masses de- veloped on its surface, and by the pus which flows from them. Q. What are the diseases with which it may be con- founded? DISEASES OF THE BRAIN. 339 A. They are, arachnitis, effusions of blood consequent on external injuries, fungous tumours of the dura mater, during their first stage, aud also that of some cancerous affections of the brain. Q. What are its Anatomical Characters ? A. The membrane presents a degree of redness, more or less intense, together with some vascular masses devel- oped on its surface, which sometimes unite with similar productions on the bones, and inflamed integuments, and in some instances pass into the state of cartilage or bone; the membrane also becomes thickened, and occa- sionally exfoliates; pus is effused on its surface, particu- larly towards the lateral parts, where it becomes accu- mulated, i arachnitis (Cerebralis). Q. What are its symptoms ? A. The characteristic symptoms of this inflammation vary according as it is seated on the convexity of the brain, at its base, in the ventricles, or according as it is acute or chronic; hence it is necessary to consider each of these cases separately. Q. What are the symptoms of Arachnitis of the Con- vexity of the Brain ? A. This occurs most commonly in persons from the age of fifteen to forty years; its causes may be divided into those which act directly on the head, such as con- tusions, insolation, burns, erysipelas of the scalp,,and those which predispose to inflammation, such as sup- pression of sanguineous discharges, abuse of spirituous liquors, co-existence of inflammations of the other se- rous membranes. It begins with headache, the seat of which is variable, it soon becomes violent, the tempe- rature of the head being at the same time very much in- creased, the face suffused, and the conjunctiva of the eyes injected. Vomiting sometimes occurs at this pe- riod, either spontaneously or excited by drinking; we do not, however, observe any other symptom of gastritis; there is much restlessness and agitation, the sensibility 240 DISEASES OF THE BRAIN. of the eye is much increased, the mode of pronunciation is altered, the expressions are short, memory deceptive, movements hurried, with general fever. After some time the headache is succeeded by delirium, which is connect- ed with this state of general re-action of the system; the delirium, however, is not constant, it ceases occasionally when the headacbe recurs, is attended with irregular though still voluntary movements, gives to the counte- nance an appearance of dullness and stupor, such as oc- curs in intoxication, or determines a general diminution of the sensibility. Finally, the arachnitis passes into its third stage, which is marked by immobility of the pupils, suspension more or less complete of the mental faculties, as well as of the general sensibility; in a word, by those symptoms which indicate a change from a state of disor- dered intellect to that of entire destruction of it. Thisstate of coma is usually joined with trismus, or (though less frequently) with subsultus tendinum of one or other of the arms; in other instances we find a rigidity of the muscles, with or without convulsions, which may at- tack both sides of the body, but more frequently the up- per extremities. These different symptoms are succeeded by a state of general relaxation, which immediately pre- cedes death. Inflammation of the arachnoid seems in some cases to commence with one of the latter stages, without having exhibited any of the symptoms of the first. * When arachnitis is caused by a contusion, it may be followed by a paralysis of one side of the body. The hemiplegia, however, does not occur before some days have passed, as it is always gradual in its approach, being preceded by delirium, and the other symptoms above enumerated. In lymphatic subjects, and in those who are weak and not capable of much re-action, disturbed dreams may occur instead of the delirium, and a state of general prostration may become the chief character of the dis- ease. In such cases also, the coma is more sudden in its occurrence, and the stupor is more decided, though DISEASES OF THE BRAIN. 34 1 the cerebral and febrile symptoms are in general less strongly marked. Q. What are the symptoms of arachnitis of the ven- tricles and base of the brain ? A. This inflammation is considered as peculiar to in- fancy ; but if it does occasionally occur in adults, it is found connected with that of the convexity of the brain. It is maiked by headache, generally confined to the forehead and temples, which is accompanied by fever, depression, and general languor; sometimes by sponta- neous vomiting, and somnolence more or less constant, without any disturbance of the intellect. These pheno- mena are usually succeeded on a sudden by a com- plete loss of the general sensibility of the intellectual functions and senses, together with spasm of both sides of the body, which may be either continued or recur- ring in fits of variable duration, and manifested chiefly in the eyes, mouth, and upper extremities. We also sometimes have occasion to observe the head drawn backwards, which indicates that the part of the arach- noid which covers the pons Varolii is engaged in the inflammation. In some cases during the progress of this inflammation, remarkable remissions occur, but are speedily succeeded by new convulsive and comatose symptoms, until at length the comatose state becomes fixed and constant, accompanied by a complete relaxa- tion of the limbs, together with, in general, a remarkable slowness of the pulse. In this latter period, the pupils of the eyes are considerably dilated. In adults, languor and somnolence occur in place of the spasmodic symptoms manifested in children; there is also a greater or less degree of weakness and inacti- vity of mind, but no delirium ; the patient replies cor- lectly to questions put to him, and may speak rationally when roused ; but after some time coma and relaxation of the limbs go on increasing until the fatal termination of the disease takes place. Q. What are the symptoms of chronic arachnitis? A. Sanguineous congestions, either continued or fre- quently repeated, precede and accompany this affection ; 2 E 2 342 DISEASES OF THE BRAIN. its progress is essentially slow; its symptoms at the com- mencement are not strongly marked; they all, however, partake somewhat of the character of those already de- tailed in the previous section. At first the power of ar- ticulation is somewhat impeded, and when the inflamma- tion begins with the arachnoid of the convexity of the brain, which usually is the case, the ideas are somewhat incoherent, the gait vacillating, and the limbs agitated by continued tremblings; the disturbance of the intel- lect, though slight at first, makes a slow but constant progress, until at length it ends in absolute maniacal de- lirium. According to Bayle, who first described this form of arachnitis, the chief characters of the delirium which accompanies it are, a " heightening and exaggera- tion of all the ideas, particularly those of ambition." After some time this state of phrenzy gradually subsides into one of fixed mental alienation; the power of articu- lation is impeded or totally lost; and finally, idiocy and' general paralysis occur during the last stage of the din- ease, which still may last several years, during which the organic functions, such as digestion, respiration, and circulation may be regularly performed, though the para- lytic symptoms, and the derangement of intellect go on progressively increasing. In some cases we observe, towards the close, spasms, accompanied by total loss of intelligence; these maybe continued or periodical, or they may recur at irregular intervals. We cannot conclude this description of arachnitis without remarking, that when it happens to be compli- cated with inflammation of the thoracic or abdominal viscera, the cerebral affeetion is rendered much more obscure, and therefore requires a mere careful examina- tion, in order to ascertain its existence. Q. With what diseases may it be confounded ? A. Some other affections may be confounded with in- flammation of the arachnoid membrane; thus permanent congestions of the pia inater, encephalitis, and ataxic or nervous fever, may be mistaken for arachnitis of the con- vexity of the brain ; dropsy of the ventricles," ramollis.se- ment," or softening of the hemispheres of the coipus DISEASES OF THE BRAIN. 343 callosum or cerebellum, and adynamic or putrid fever, may be mistaken for that of the base: and finally, hydro- cepbalus, and several chronic alterations of the brain, may be taken for chronic arachnitis. Q. What are its anatomical characters ? A. The different regions of the arachnoid membrane do not seem equally susceptible of inflammation. The following appears to be the order of its frequency in them ; on the convexity of the hemispheres, at the decussation of the optic nerves, in the interior of the ventricles, at the pons Varolii; and lastly, on the internal flat surfaces of the hemispheres. When the arachnitis has lasted only a few days, and has been slight, the membrane presents no perceptible change, it remains as thin and transparent as in the natural state, and cannot be detached from the convolutions without being torn, and therefore cannot be separated without the greatest difficulty from the pia mater. The redness and increased consistence which it appears to possess in this stage belong altogether to this latter membrane, whose cellular tissue is thickened, and vessels considerably injected. At a more advanced pe- riod of the affection, the arachnoid acquires a real in- crease both of thickness and density; it loses its trans- parence, and presents somewhat of a milky appearance. These different states are marked in proportion to the duration and intensity of the inflammation: still the thickening is never so great, nor is the change so de- cided as to give to the arachnoid the appearance of the pleura; it may, however, be easily detached from the pia mater, in fragments of sufficient extent to point out its change of structure, and show that this increase of thickness is not owing to the cellular filaments that ad- here to it. The pia mater is in such instances injected: the cellular tissue under the arachnoid, and that which connects the different vessels, are injected with a serous or albuminous fluid, so intimately combined with- them, as to give them the appearance of a single membrane, thick and whitish, from which by pressure a seropuru- lent fluid may be made to exude. These characters are presented by the pia mater in a greater or less extent on 341 DISEASES OF THE BRAIN. the braiu, particularly towards the superior part of the hemispheres. In parts where the sub-arachnoid tissue i* rather loose and abundant, for instance between the con- volutions, in the fissure of Sylvius, and more particularly opposite the pons Varolii and decussation of the optic nerves; this serous liquid, by being infiltered into the meshes of the tissue, gives it the appearance of a gelati- nous fluid diffused on the surface of the brain. Some- times under the arachnoid there is a layer of pus, parti- cularly when the inflammation has been determined by a contusion of the head; more commonly, instead of pus, is found a serous or sero-sanguineous fluid. In some cases the arachnoid is covered with false mem- branes, more or less thick, and more or less extensive ; but it is rare to find adhesions between the two layers of the membrane, and still more rare to find the inflam- mation confined to its cranial layer; when, however, it does occur, it requires care to determine whether the redness is seated in the serous membrane, or depends on the injection of the pia mater; adhesions of the pia mater to the substance of the brain arc, op the contrary, very common. Finally, the arachnoid, particularly that of the Ventricles, may lose its polished appearance, become rough, and covered with small granulations, which, when very minute, make it appear as if covered with down ; they however can be distinguished, when examined in a clear light. W'.ien these granulations are seated on the upper part of the hemispheres, care should be taken not to mistake them for the glandulae Pacchioni, which are always larger, whiter, more numerous, and in closer contact. A similar mistake may be caused by the pre- sence of air-bubbles beneath the pia mater, but this is easily removed by detaching the membrane from the surface of the brain. The arachnoid and pia mater may be both altogether destroyed, by inflammation extending to the substance of the brain. In other instances, we find in the substance of the membrane small while IaT, mellae, thicker at their centre than towards their circum- ference, at first sight resembling a soapy fluid diffused on the surface; but on closer examination, they are found to DISEASES OF THE BRAIN. 345 approach very much to the consistence and structure of cartilage. To conclude, we find frequently in the ventricles serous, sero-sanguinolent or sero-purulent effusions, which arc more abundant as the inflammation ap- proaches the base of the brain, or occurs in the ven- tricles themselves. In such cases, more especially in children, the portion of the brain that forms the walls of the lateral ventricles is softened to a greater or less extent; this is particularly observable in the digital cavity, fornix, and corpus callosum. This " ramollisse- ment" may be so great as to reduce the parts to a semi- fluid state, in which the cerebral substance presents a dull whitish colour, without any appearance of san- guineous injection. acute hydrocephalus (Essential). Q. What are its symptoms? A. Headache, confined to the forehead or temples, increasing gradually, and occurring during the first sep- tenary period of life, most usually during the process of dentition; frequent vomiting—slowness in movement, which is made with reluctance; restlessness, discom- fort, irritability of the retina, with, in general, contrac- tion, and immobility of the pupils ; inclination to i drowsiness, together with sudden startings, sleep in- complete while it lasts, sometimes gnashing the teeth. After some time, the headache is no longer complained of, or the child manifests it only by acute cries, or by carrying its hands as if instinctively towards its head. The drowsiness increases in degree, the patient lies on the back, sensibility gradually diminishes, the coma is interrupted by momentary convulsions, most usually manifested in the eyes, mouth, and upper extremities ; sometimes there is a permanent strabismus, or a turning of the eye upwards ; the pupils become dilated and im- moveable, or, in some cases, agitated by constant oscil- lations; the pulse becomes slow and irregular; the bowels are in general constipated. It is about the 346 DISEASES OF THE BRAIN. period that we begin to perceive remissions of the prin- cipal symptoms, which disappear more or les«i com- pletely ; during these intervals the patient recovers his understanding, and complains only of headache. If death does not occur during the comato-convulsive pe- riod, a state of collapse succeeds the latter, tha pupils become more and more dilated, the extremities are in a state of general insensibility and relaxation, tha pulse resumes its frequency, the skin becomes cold and co- vered with perspiration, the respiration is irregular, and death terminates this state which occasionally lasts for some days. Q. What are the diseases with which it may be con- founded ? A. They are arachnitis of the base of the middle lobes, " ramollissement," of the walls of the lateral ventricles, and worms in the intestinal canal. Q. What are its Anatomical Characters ? A. The arachnoid membrane lining the lateral ventri- cles and base of the brain presents no alteration; on the convexity, it is rather dry; the superior convolutions of the hemispheres are depressed and flattened, and when touched, give a sense of fluctuation; the lateral ven- tricles, considerably dilated, and filled with a limpid straw-coloured fluid, without any flocculi; the dilatation is most manifest towards the digital cavity; the third and fourth ventricles contain but little fluid ; the foramen of communication between the lateral ventricles is con- siderably enlarged.—Sometimes no fluid is found in the ventricles, though dilated, which arises from the fluid (being absorbed immediately) before death had occur- red. The pia mater, enveloping the external surface of the brain, may be injected with blood, but this is not a very frequent occurrence, and should not in any case be considered as the cause of the effusion into the ven- tricles. Finally, when the disease has lasted for a con- siderable time, the digital cavity, the fornix, and corpus callosum may become softened, in the same way as has been described when treating of arachnitis of the ven- tricles. DISEASES OF THF. BRAIN. 347 CHRONrC HYDROCEPHALUS. Q. What are its symptoms ? A. This disease is most usually constitutional, and then distinguishable by an excessive increase of the size of the head, separation of the sutures, transparence of the fontanelles, with fluctuation, perceptible by pressure. The activity of the senses and understanding is conside- rably diminished, or altogether Jost; the movements are weak and feeble to the last degree ; convulsions some- times take place ; the patient has not sufficient strength to support his head, it therefore droops constantly on the shoulders or chest. In some cases the head retains its natural dimensions, but we can then observe near the occiput a fluctuating tumour, surrounded by the invest- ments of the brain, by pressing on which, we can make the fluid compress the brain, and cause comatose or convulsive symptoms. If tbe hydrocephalus occurs after the child has attained its first year, it can be distin- guished by the gradual weakening of the sensitive and locomotive powers in proportion as the head increases in size; the headache becomes gradually less intense as the disease advances. Q. What are the diseases with which it may be con- founded ? A. When congenital it may be mistaken for encepha- locele in adults; for some of the chronic alterations of the brain, or for hydatids, which sometimes give rise to it. Q. What are its Anatomical Characters ? A. Separation of the sutures, incomplete ossifica- tion of the bones, in some of which the bony matter is altogether wanting; effusion of a citron-coloured serous fluid, in greater or less abundance. When the disease has la. ted for some years, the fontanelles are occupied by a fibrous substance, and the bones become thin and considerably increased in breadth. If the effusion has taken place on the surface of the brain, then this organ, reduced to a very small size, is compressed towards the 348 DISEASES OF THE BRAIN. base of the skull; if, on the contrary, the effusion occu- pies the lateral ventricles, then the bemispheres of the brain are expanded into a vast membranous pouch, the external surface of which is closely applied to the in- vesting membranes. HYDATIDS. Q. What are its symptoms ? A. We have no means of distinguishing this affection from other tumours developed in the brain. Hydatids sometimes exist without giving rise to any particular dis- turbance of the system ; at otber times, however, they cause irregular headache, vertigo, fits, and convulsions, for which it is impossible to assign any adequate expla- nation until after death, which usually takes place sud- denly. Q. With what diseases may it be confounded ? A. With any of the chronic alterations of the brain or its membranes. Q. What are its Anatomical Characters ? A. On examination we find some vesicular bodies be- longing to the genera acephalocystis, polycephalus, and echinococcus: there may be but one of these, or there may be several. They usually occupy the lateral ven- tricles, and sometimes, though more rarely, the sub- stance of the hemispheres; in this latter case they form for themselves a second covering at the expense of the substance of the brain, which increases in density, and assumes the appearance of a whitish membrane, some- what similar to the membrane of an egg; its internal sur- face, which is in contact with the hydatid, is smooth, and may be easily detached from the brain. Hydatids- vary in size from that of a pea to a large egg. EFFUSION OF BLOOD. (On the Surface of the Brain.) Q. What are its symptoms ? DISEASES OF THE BRAIN. 349 A. Most usually after a severe contusion of the head, paralysis, with either a rigid or flaccid state of the mus- cles, occurs suddenly, either at one or both sides of the body; this is sometimes accompanied by spasmodic symptoms, but more frequently by a state of coma; but in cases in which the intellectual faculties are not altoge- ther extinguished, the patient may complain of a severe headache or be somewhat delirious. As this disease so frequently induces inflammation of the arachnoid mem- brane and brain, it partakes of the characters of both, and naturally comes under the descriptions given of them. Q. What are the diseases with which it may be con- founded ? A. They are, simple concussion, congestion, or disor- ganization of a part of the brain. Q. What are its Anatomical Characters ? A. Effusion of blood between the cranium and dura mater, into the cavity of the arachnoid membrane, or between the pia mater and brain, caused by the rup- ture of some vessels, or, though very rarely, by a mere exhalation of blood. In these different cases the blood is coagulated and diffused in a layer on the brain or be- tween the convolutions; occasionally there is some in the lateral ventricles—in which case the meninges al- ways exhibit a very considerable degree of congestion. CONGESTION IN THE BRAIN. Q. What are its symptoms ? A. A sense of weight in the head, vertigo, followed by a sudden deprivation of intellect; in other cases the ar- ticulation becomes embarrassed, the limbs completely relaxed at one or both sides of the body, and sometimes momentary spasmodic symptoms occur. These pheno- mena which are in general of very short duration, for the most part not more than a few hours, and seldom lasting beyond three or four days, terminate either in deatii or restoration to health. 1 F 350 DISEASES OF THE BRAIN. Q. What are the diseases with which it may be con- founded ? A. They are, haemorrhage into the substance of the brain, effusions into the ventricles, or encephalitis. Q. What are its Anatomical Characters ? A. The substance of the brain and its investments are gorged with blood, which oozes out in minute drops on the surface of the incision when a section is made; its consistence, however, is by no means diminished. APOPLEXY. Q. What are its symptoms ? A. The predisposing circumstances to this complaint are, hereditary disposition, previous attacks, hypertrophy of the left ventricle of the heart, and the period of life from the 50th to the 70th year; in general, without any headache or other precursor, a paralysis, more or less complete, both of sensation and motion, suddenly oc- curs either in the whole of one side of the body, or only in one of its regions, accompanied by an immediate re- laxation of the muscles of the parts affected. In cases of effusion into the brain, the paralysis is always pro- tracted, the time of its duration being proportioned to the extent of the effusion; perception, though weaken- ed, is preserved unless thecoma be very profound; the respiration is more or less stertorous. At the commence- ment the pulse is hard and full, but we observe no fever, no headache, during the course of the disease; no vomit- ing occurring at its invasion, on the contrary it is diffi- cult to excite it; there is in general constipation or re- tention of urine. When the paralysis attacks the mus- cles of the face, as is generally the case, the point of the tongue when protruded inclines to the paralytic side*, * When a paralysis, whatever be its cause, affects one side of the head, the lips are drawn towards the sound side, by the zygomatic muscles, in consequence of the paralysis of their antagonists; and the point of the DISEASES OF THE BRAIN. 351 the commissure of the lips at the sound side is drawn upwards and outwards, when the patient moves it, whilst on the other it is depressed and pendant, or merely im- moveable ; the muscles of the cheek on the paralysed side, and those of the eyelid are sometimes, though not very commonly, in a state of relaxation more or less complete; the pupil is insensible, sometimes dilated; lastly, the head is drawn to the sound side by the mus- cles, which remain unaffected by the paralysis. It sel- dom attacks both sides of the body at the same time: but if it should, then the patient is found in a state of total insensibility or complete carus. It sometimes hap- pens that after the first attack, a second takes place at the sound sides, so suddenly as to induce a belief in the existence of a double paralysis occurring at the same mo- ment ; the history of the case alone can reetify the error. Apoplexy may be confounded with " ramollissement" of the brain, or with effusion of blood on its surface. tongue,' as it issues from the mouth, deviates towards the paralysed side, which seems at first rather singular, but is at once explained by considering the muscular power that protrudes tbe tongue out of the mouth. This is ef- fected by the posterior portion of the genio-glossus mus- cle, the fixed point of which is at the chin, the moveable one at the base of the tongue. When this part of the muscle acts, its two extremities approach, and so the base of the tongue is drawn forwards, towards the fixed attachment of the muscle. If then this insertion be to the right of the median line, the base of the tongue is brought forward and to the right, and its point by conse- quence forward and to the left. But when the patient draws back the point of the tongue, it always inclines or deviates towards the sound side. It is by a similar me- chanism that the face is inclined towards the paralysed side, which is caused by the contraction of the sterno- mastoid muscle of the sound side. 352 DISEASES OF THE BRAIN. Q. What are the-diseases with which it may be con- founded ? A. They are, encephalitis, " ramollissement" of the brain, or effusion of blood on its surface. Q. What are its Anatomical Characters ? A. Effusion of blood to a greater or less extent in the hemisphere of the brain, opposite to the side in which the paralysis has occurred. The fluid-is found either in se- veral small cavities, or accumulated into one mass. At other times it is intimately blended with the cerebral substance, and forms with it a red or brown pulpy mass. When the effusion is recent, having existed but for a few days, the blood is black and partly coagulated, it seems adherent to the cerebral substance, but may be removed from it by effusion with water. The part of the brain surrounding the clot Is torn and irregular, its consistence much diminished, its colour a deep red, which becomes gradually less so, as we examine it farther from the cen- tre of the effused mass—this alteration, however, ex- tends no farther in general than a few lines. In some cases we find a few shreds of the substance of the brain, which being softened and tinged with blqod, resembled very closely coagula of blood. At a more advanced period, the part of the brain sur- rounding the clot, after having been softened in the first instance, resumes its firmness, and presents a yellowish colour, a serous effusion is poured round the clot, which gradually diminishes in size, and loses its original colour, for having been black, it by degrees becomes red, then yellow and grey, and finally is absorbed altogether, when the walls of the cavity approach each other, con- tract adhesions, and after some time present a real cicatrix of a linear form, and somewhat yellow colour, which is produced by means of cellular and vascular bands. In other cases, the walls of the cavity approach and remain contiguous, without contracting adhesions to each other; and finally, we sometimes find that the walls become covered with a false membrane, which is very thin, gradually increases in consistence, and changes into a cyst, which contains some serous fluid, DISEASES OF THE BRAIN. 353 at first of a deep red, then of a paler tinge and lastly- yellow, and encloses a clot which also passes through the different changes we have just indicated. When this is completely absorbed, the walls of the cyst may become united in the same way as occurs in simple cavities. We sometimes find either in the hemis- pheres in which the recent effusion has occurred, or in the other several cavities resulting from old apoplectic attacks. The portions of tbe brain, most usually the seat of these effusions, are the corpora striata, the optic thalami, and the parts immediately surrounding them, correspond- ing ventricle, or even into the opposite one after having torn through the septum lucidum. In cases of haemorr- hagy of the substance of the brain, the parts that remain unaffected present, when divided by an incision, an infinite number of minute drops of blood, which re-ap- pear again after being wiped away. The vessels of the pia mater, and also the sinuses of the dura mater, are constantly gorged with blood. ENCEPHALITIS. Q. What are its symptoms ? A. Inflammation of the biain may occur at any period of life from infancy to old age. There are usually some premonitory symptoms, such as a sense of weight in the head, of tinglings in the ears, deception of vision, irrita- bility of the retina, numbness of one side of the body, pain or prickling of the limbs; when suddenly there supervenes a state of contraction or convulsion, con- tinued or intermittent, of the muscles of one side of the body, or only of one of its regions. If the intellectual faculties be not altogether destroyed, the patient complains of headache usually referred to the side opposite to that which is the seat of the con- traction ; there is no delirium, the understanding is not deranged, it is merely weakened. Sometimes the contracted limbs are painful, particularly when they are flexed, and an effort is made to extend them ; the pu- 2 F 2 354 DISEASES OF TUT. BRAIN. pil of the affected side is in some instances contracted, and the eye closed by the contraction of the orbicu- laris muscle; the commissure of the lips is drawn out- wards even when the mouth is not moved; but when any voluntary motions are made, the commissure of the opposite side experiences a deviation; the muscles of the neck are in a state of rigidity, and draw the head towards the affected side. Still these various effects of irritation diminish gradually in intensity, and are suc- ceeded by symptoms of collapse; the muscles fall into a state of paralysis with flaccidity; the eye remains closed, but it is by relaxation ; the commissure of the lips hitherto contracted becomes pendent; the head and mouth are drawn in the direction opposite to that to which they had previously inclined; that is to say, to the sound side; tbe pupil is dilated, the sensibility of the affected side totally lost, and the understanding com- pletely destioyed. We may here remark, that in order to trace these different effects of the disease, we must observe the patient from the first invasion of the attack to its final termination. In some cases, we find that a rigid state of the mus- cles supervenes after a sudden paralysis with flaccidity; this is caused by the apoplexy being followed by ence- phalitis ; the walls of the cavity, in which the effusion had taken place, being then seized with inflammation. If convulsions attack the side that remained unaffect- ed, and if they be not followed by paralysis, they are caused by the occurrence of inflammation of tbe arach- noid membrane. If however a paralysis succeeds, it arises from a new inflammation attacking the opposite side. And finally, when encephalitis succeeds to arachni- tis, particularly that of the base of the brain, as occurs usually in children, one of the sides affected by con- vulsions becomes paralyzed. Encephalitis presents several groups of symptoms, each indicating a lesion of a particular part of the brain. Affections of the upper extremity seem referable to lesions of the posterior fibres of the optic thalamus of DISEASES OF THE BRAIN. 355 the opposite «ide; those of the lower extremity to al- terations of the anterior half of the corpus striatum. Paralysis of both sides of the body at the same time depends on an alteration of the central part of the pons Varolii. When there is no paralysis or muscular rigidity at either side of the body, and when a comatose state occurs, and goes on progressively increasing, we may suspect inflammation of the corpus callosum, septum lucidum, or fornix. Loss of the power of utterance seems to depend on an alteration of the anterior lobules of the hemispheres. Strabismus, rotation of the eye, dijatation, contraction, immobility, constant oscillation of the pupil at one side, indicate usually an alteration of the surface of the cor- pora quadrigemina of the opposite side. Lesions of the pituitary gland, of the infundibulum, and of the grey lamella in which it terminates, by caus- ing compression of the optic nerve at one side behind the point of decussation, may induce blindness of the opposite eye. As to alterations of the transparency of the membranes and humours of the eye, and to paraiysis of the organs of sense at one side, "they seem to depend either on a derangement of the ganglion of the fifth pair of nerves where it lies, on the petrous portion of the temporal bone, or a lesion of the corresponding walls of the fourth ventricle. Finally, derangements of the circulation, respiration, and of the generative system, without paralysis of the limbs, indicate an alteration of one of the lobes of the cerebellum. Q. What are the diseases with which it may be con- founded ? A. They are haemorrhage, or" remollissement" of the substance of the brain, nervous fever, some cases of arachnitis, especially when it is circumscribed, and local effusions. Q. What are its Anatomical Characters ? A. The inflamed part of the brain presents different 356 DISEASES OF THE 11RA1N. appearances, according to the time that the disease has lasted. When it is only of some days' duration, the white substance, and still more perceptibly the grey, ex- hibits a rosy or slightly red colour, and in it we perceive several vascular filaments. The firmness of the affected part is considerably diminished, and when cut into, the surface of the incision presents (not a multitude of minute drops Of blood reappearing after being wiped away, as occurs in congestion, but) a multitude of small red points, which cannot be moved by ablution. We frequently have occasion to observe these appearances in the cortical substance of the convolutions after arachnitis or violent congestions of the pia mater. In a more advanced stage of encephalitis the brain is red, the vascular injection more strongly marked, and the " ramollissement" very considerable. Finally, in some cases the blood becomes so intimately combined with the eerebral substance, that its colour approaches that of the lees of wine, being of a deep, dusky red ; there is no actual effusion of blood, except we consider as such some small dots about the size of a pin's head, which we occasionally find in some particular points: in such cases the brain is in a state of extreme " ramollisse- ment," or softening. If it should happen that the inflammation proceeds to these two latter stages without causing death, then the part affected begins gradually to lose its softness, and ultimately becomes more dense than in the natural etate; it retains for some time its red colour, but changes finally to a dusky yellow. The third stage of encephalitis is that of suppuration; the red colour gradually disappears, the blood is replaced by a sero-purulent fluid, which is infiltered into the sub- stance of the brain, combines with it, and gives to it, according to the extent of the admixture, a greyish dull white, or yellowish green colour. The pus accumulates in some spots to a greater or less extent; sometimes there are no more than one or two drops, but still they are easily recognized by their resemblance to the pus of ordinary phlegmonia; in other cases, however, it occu- • DISEASES OF THE BRAIN. 357 pies the entire of the centre of one hemisphere where, extravasated as it were, it forms cavities for itself, in which we find mixed with it several fragments of cerebral substance; lastly, in some ca*es, we find several small cavities uniting together to form a large one. These cavities are sometimes found separated from the substance of the brain by a new membrane, formed of the remains of the cellular tissue and vessels, which had escaped the effects of the suppuration, and which, when compressed towards the circumference of the cavity, interlace mutually, become organized, gradually increase, and become changed into a membrane whose thickness and density are progressively augmented. The internal surface of these cysts becomes smooth; the pus which they contain assumes more and more the characters of pus formed in cellular tissue, by reason of the progressive destruction of the cerebral substance, and finally becomes white, yellowish or greenish, and perfectly homogeneous. Sometimes when the abscess is seated near the convolutions, the pia mater and arach- noid becoming thickened, concur in the formation of its walls. The pus of abscesses in the brain rarely emits any odour, except such as occurs in consequence of caries of the bones of the head, particularly of the pe- trous portion of the temporal bone ; in which cases it is always fetid, and the membranes are altered and perfo- rated. The grey substance is. the most usual seat of ence- phalitis ; and the parts most commonly affected are the corpora striata, optic thalami, the convolutions, pons Varolii, and cerebellum. RAMOLLISSEMENT, OR SOFTENING OF THE BRAIN. Q. What are the symptoms of this affection ? A. They arc nearly the same as those of encephalitis, only that its precursors are more common, hence we shall merely add to what has been already stated under the latter head, that if in any case the intellects remain undisturbed, and thu headache continues for a long 358 DISEASES OF THE BRAIN. time ; if sensibility and muscular power diminish gradu- ally, and somnolence becomes the leading character; and, finally, if there be neither paralysis, rigidity of the muscles, nor convulsion, the patient being in a state merely comatose, with strabismus and dilated pupils, we may suspect a " ramollissement" of the corpus callosum, septum lucidum, or fornix. Such a case is very likely to be confounded with arachnitis of the base of the brain in adults, or with the same affection in children if there be convulsions. NOTE. By "ramollissement" of the brain is understood a softening or degenerescence of part of its substance, the rest preserving nearly its ordinary consistence. This expression possesses the peculiar advantage of giv- ing an exact idea of the state of the parts, without in- volving any opinion on the nature or cause of the dis- ease. On this subject opinions have been very much divided. In the text the reader will find an outline of the peculiar views of Professor Ricamier, who still con- tends that " ramollissement" is a disease sui generis—a peculiar degeneration, which may be compared to cer- tain alterations of the spleen. He denies that these chan- ges are produced by inflammation, and considers them as the effects of a general cause—a disease of the whole system; in fact, an ataxic, nervous or malignant fever, which attacks the nervous system, and more particu- larly the brain, destroying and disorganizing its structure, and so producing " ramollissement," degenerescence, putrid abscess, &c. In direct opposition to this doc- trine, Lallemand and Abercrombic contend, that this affection is altogether inflammatory in its character, and refer the symptoms exhibited during life, as well as the appearances presented after death, to inflammation of the substance of the brain. Acute inflammation produces the same effects in the brain that it does in other organs, namely, diminution of its consistence or " ramollisse- ment," and change of colour, the various shades of the lat- ter being dependent on the degree and proportion in which DISEASES OF THE BRAIN. 359 blood in the first stage, and pus in the second, happen to be infiltrated into its tissue. In the former, we ob- serve degrees of tinge varying from a greyish red to a dark dusky hue, not unlike that of the lees of wine; and in the latter, when suppuration sets in, and pus begins to take the place of blood, the colour changes again, and varies from a dirty white to a green. The symptoms of inflammation of the brain present two characters altogether opposite, those of irritation and those of collapse. The former is marked by head- ache, sensibility of the retina, contraction of the pupil, pain of the limbs, and continued or intermittent contrac- tion of the muscles; the latter by diminution of the in- telligence, somnolence, deafness, loss of vision and power of utterance, with paralysis of the muscles, and in- sensibility of the skin. The first series, it is true, occurs in arachnitis and the second in apoplexy; but it is only in inflammation of the brain that the two are united ; for in it we find irril.ition followed by disorganization. Hence we may briefly sum up the distinctive symptoms of these three affections. In inflammations of the arachnoid membrane we find spasmodic symptoms without pa- ralysis ; in haemorrhage, sudden paralysis, without spasmodic symptoms; in inflammation of the brain, spasmodic symptoms, slow and progressive paralysis, the progress of which is unequal and intermittent." Q. What are the diseases with which it may be con- founded ? A. They are, encephalitis, nervous fever, arachnitis of the base of the biain in adults, and, if convulsions occur, with the same affection in children. Q. What are its Anatomical Characters? A. They are softness to a greater or less degree of the substance of the brain, without any trace of vascular injection or perceptible change of colour, the medullary portion being of a dull white, and homogeneous, whilst the grey substance remains in its natural state, whatever be the degree of softening, or, " ramollissement;" even when the part affected becomes perfectly diffluent, it is 360 DISEASES OF THE BRAIN. impossible to discover the least trace of real pus, nor do the sections of the brain exhibit any drops of blood oozing from this surface. If it is the convolutions that are affected, the corresponding part of the pia mater presents no appearance of injection. This sort of disor- ganization is never accompanied by any peculiar odour. " Ramollissement," if we except the mere circumstance of its being confined to parts of greater or less extent, exhibits in every respect the same physical characters, as a brain which begins to be decomposed after having been kept for some days. The parts most commonly affected are not those which in the natural state are the least firm; for we find that the walls of the ventricles, the corpora striata, and optic thalami, suffer this disor- ganization more frequently than the cerebellum. TUBERCLES AND CANCER OF THE BRAIN. Q. What are its symptoms? A. The only symptoms which can induce us to sus- pect the existence of tubercle, scirrhus, or cancer of the brain, are violent headaches, continued or intermittent, with spasms of one or both sides of the body, and total suspension of the faculties; to these in some instances are added a consecutive paralysis; whh diminution or abolition of the senses and intellects. These different tumours in general give rise to encephalitis, which then presents the train of symptoms already detailed when treating of that disease. In children, tubercles are very common, and induce acute dropsy of the ventricles of the comato-convulsive form, as we have already stated. Occasionally, however, these tumours do not give rise to any appreciable derangement. Q. What are the diseases with which they may be confounded ? A. They are arachnitis of the ventricles and base of the brain, encephalitis, fungus of the dura mater, or hy- datids in the brain. Q. What are its Anatomical Characters ? A. The accidental tissues most usually in the brain PATHOLOGY OF THE BRAIN. S61 are scirrhus, tubercle, and encephaloid. They are found in the form of round irregular masses, varying from the size of a pea to that of an egg, of a greyish or reddish colour, and sometimes nodulated on the external surface. The tumour sometimes consists hut of one of these structures, but we occasionally find several combined together; the nature of the de- generescence can be determined only by cutting into it; the interior is sometimes found softened, and con- tains some effused blood. The adjacent portion of the brain is, in general, in a state of" ramollissement" to a greater or less extent; at other times the acci- dental production is lost gradually in the cerebral substance, without presenting any line of demarca- tion. When the tumour extends to the convolutions, it generally gives rise to a chronic inflammation of the pia mater and arachnoid membrane. EPILEPSY. Q. What are its symptoms ? A. This affection is intermittent, chronic, without fever, comes on by fits with general convulsions, com- plete loss of intelligence, total insensibility, but still without any consecutive paralysis either of mobility or sensibility. At a moment when he least expects it, the patient suddenly becomes senseless, the eyes are opened widely, the pupils remain immoveable,the direction of the eyes becomes changed, the face is drawn to one side, the mouth dragged towards the ear, and the teeth firmly closed; then after some mi- nutes the muscles of the neck become rigid, the head is turned to one side, the jugular veins become dis- tended, and the face is in a state of livid turgescence; the muscles of the countenance are then seized with spasmodic contractions frequently repeated; foam is- sues from the mouth, the extremities, particularly the upper, are agitated by convulsive motions; the thumbs are buried, as it were, into the palms of the hands; still the thorax remains fixed and immovea- ble ; the respiration is high and agitated; suffocation Vol. I. Gg 363 PATHOLOGY OF THE BRAIN. imminent. To this state, which lasts from two to eight minutes, and may be repeated at very short in- tervals, succeeds a general relaxation of tbe muscular system, paleness of the face, and a gradual return to freedom of respiration ; the countenance for some time retains an expression of stupidity; the intellec- tual and sensitive faculties, which had been plunged in stupefaction, gradually resume their activity, and the patient begins to perceive a creeping sensation all over his body. At other times the attack is much less violent, and consists only of a momentary loss of sense, with slight and partial convulsions of the eyes, mouth, of an arm or a finger; and may or may not be accompanied by a fall. Sometimes the attack is pre- ceded by a peculiar sensation in some part of the body, which directs itself towards the brain, and thence causes the loss of sense, and the various other phenomena mentioned above; this is what has been termed the aura epileptica. Epilepsy may occur at any period of life; it generally goes on increasing, as the fits occur at shorter intervals; it induces a loss of memory, and tends essentially to produce mad- ness and idiocy. Q. What are the diseases with which it may be con- founded ? A. They are hysteria, worms in the intestinal ca- nal, the first stage of acute hydrocephalus, encepha- litis, with different tumours of the brain and its in- vestments. Q. What are its anatomical characters ? A. We know of none that are peculiar *o epilepsy; still several alterations of the brain and spinal marrow may give rise to epileptic symptoms, as the history of these affections demonstrates. HYSTERIA. Q,. What are its symptoms ? A. This is an intermittent, irregular, chronic dis- ease, that comes on by fits, and usually attacks females from the age of puberty to tbe critical period; it very fATHULUUY Of THK BRAIN. 3fl3 commonly occurs on the suppression or diminution of the menses, particularly in persons of a nervous or irritable temperament, who have indulged much in venereal pleasures ; or have been for a long time deprived of them. The fit begins with a yawning, numbness of the extremities, involuntary laughing and crying, alternations of pallor and redness of the face, and a sensation as if a ball, commencing at the hypogastrium, ascended through the abdomen and thorax to settle at the throat, where it produces a sense of violent constriction, with threatening of suf- focation. Then spasmodic motions of different parts of the body occur, or there is a tetanic stiffness of them, with loss more or less complete of sensation, but without any consecutive paralysis. Hysteric fits do not in general come on instantaneously, and without cause, as is the case in epilepsy ; chagrin, pain, men- tal emotions usually give rise to them. Hysteria does not tend essentially to increase, nor does it determine, as a consequence, madness or idiocy. Q. What are the diseases with which it may be con- founded ? A. They are epilepsy, certain diseases of the ute- rus, and intestinal worms. Q. What are its anatomical characters ? A. They are altogether unknown. CATALEPST. Q. What are its symptoms ? A. Suspension of sensation and motion occurring suddenly, whether the patient be sitting, standing, or lying, and accompanied with such a complete im- mobility of the different parts of the body, that they retain indifferently the position which they had be- fore the attack, or any that may be given to them during its continuance. The circulation and respi- ration are not at all disturbed; in some instances, however, they become more slow. These attacks, which occur at intervals more or less irregular, last usually from some minutes to several hours, or even 364 PATHOLOGY OF THE BRAIN. for the length of a day. This disease, which is very rare, is sometimes simulated; it should rather be considered as symptomatic than as an essential affec- tion. Pathological anatomy has not as yet been able to assign any form of alteration peculiar to this com- plaint. CHOREA, Q. What are its symptoms ? f A. A certain number of, or in some cases, all the voluntary muscles, are subject to irregular and conti- nued movements, producing remarkable grimaces and contortions. The disease is sometimes confined to one side of the body, oris more perceptible at one side than at the other. The muscles, in addition to this incoherence in their motions, are affected with a sensation of pricking, creeping, or of numbness. Chorea attacks children much more frequently than adults, and females more usually than males. l Q. What are the diseases with which it may be confounded ? A. They are chronic encephalitis, certain affec- tions of the medulla spinalis, or with tubercles on the brain. Q. What are its anatomical characters ? A. They are altogether unknown. HYPOCHONDRIASIS. Q. What are its symptoms ? A. This affection is chronic in its character, and very irregular in its course; it sometimes is inter- mittent, in general attacks adults, particularly men; it, in many cases, is consecutive on gastro-enteritis, if the persons attacked by it are of a nervous tempe- rament, and if their hepatic system be considerably developed, or if their moral and physical habits tend to derange the digestive functions, at the same time that they exalt and cultivate the intellectual. The principal effects of hypochondriasis are refer- able to disturbance of the intelligence; of digestion. PATHOLOGY OF THE BRAIN. 365 and functions of the liver; these are, gloominess, irascibility, distrust even of intimate friends, con- stant restlessness, timidity, and fear of death ; sleep becomes short and agitated; sometimes there is headache, and even vertigo ; the digestion is slow and painful, accompanied by distention and swelling of the stomach and intestinal canal, flatulence, colic, and constipation in most cases ; in some cases, however, we find diarrhoea; the pulse is sometimes frequent, contracted, intermittent; at others slow and irregu- lar ; the patient heightens the extent of his suffer- ings, and describes them in exaggerated terms. He experiences various sensations, in general momenta- tary; such as cramps, tremblings, palpitations, faint- ings, and irregular pulsations in the abdomen. The respiration is sometimes difficult, and as it were con- stricted. This affection frequently terminates in monomania. Q. What are the diseases with which it may be con- founded? A. They are chronic gastro-enteritis and mania. Q. What are its anatomical characters? A. We usually find some alterations of the brain, or of the abdominal viscera ; but it is very difficult'to decide whether they are the sole causes of the dis- ease. MANIA. Q_. What are its symptoms ? A. Derangement, more or less marked, but of long continuance, of one or more of the faculties of the mind, without any perceptible disturbance of the sensations or voluntary motions. There is no fever, except during the period of excitement, which usually manifests itself by headache, want of sleep, delirium, and various hallucinations. When some particular idea constantly haunts the patient, the dis- ease is termed, monomania. The organic functions are seldom disturbed, except the nutrition, which is not properly performed; hence many maniacs lose 366 PATHOLOGY OF THE BRAIN. flesh and become thin. This affection may be con- founded at its commencement with arachnitis, drun- kenness, or with the effects of certain poisons. Q. With what diseases may it be confounded ? A. It may be confounded, in an early stage, with arachnitis, the effects of certain poisons, or with drun- kenness. Q. What are its anatomical characters ? A. Mania may be connected with alterations of the brain or its investments, but several cases occur in which it cannot be traced to any such cause. In some it is connected with chronic inflammation of the in- testinal canal. AMEKTIA. Q. What are its symptoms ? A. Diminution, more or less considerable, of the powers of the mind, with weakness or loss of me- mory, total indifference and incoherence of ideas and actions, which have no determined object. This af- fection most commonly occurs in persons advanced in years; it is not accompanied by fever, or any disturb- ance of the organic functions; and as in most in- stances it arises in persons who had previously been of sound mind, it must in such at least be regarded as consecutive upon some affection of the substance of the brain. Q. With what diseases may it be confounded ? A. With chronic arachnitis, and with some morbid alterations of the brain. Q,. What are its anatomical characters ? A. These are referrible to various alterations of the brain when the affection is symptomatic ; some- times we find atrophy of the brain depending on old »ge. IDIOTISM. Q. What are its symptoms ? • A. The faculties of the mind are incompletely or not at all developed, in consequence of a defective or- PHYSIOLOGY OF THE SERVES. 367 ganization of the brain—a condition which may com- mence at the first moments of existence, or be pro- duced at any subsequent period before the full evolution of the understanding. In these persons the general sensibility is but little developed, the senses are generally dull, and the power of articula- tion so defective, that in many cases they may be said rather to howl or cry ; the limbs are wasted, pa- ralysed, or ill-formed ; the temperament is generally lymphatic, sometimes scrofulous. There is no per- ceptible alteration of the digestion, circulation, or respiration. Q.. Describe the character of the cretins ? A. These constitute a variety of idiots, presenting the following physical characters : head rather large, forehead and occiput usually flattened, visage square, and marked with wrinkles: nose thick, short, and broad, mouth very wide, ears thick and elongated ; " goitres" more or less voluminous and pendant to- wards the chest; thorax narrow and flat, genital or- gans much developed, height seldom more than four feet. Q. What are its anatomical characters ? A. The heads of idiots usually present a deficient con- formation; their size is most commonly small, the fore- head is flat, short, and sloping backwards, the occi- put is depressed; there is sometimes a perceptible difference in the development of the two sides of the skull. The brain presents also a corresponding de- ficiency of organization. PHYSIOLOGY Or THE NERVES. O.. What is understood by a nerve ? A. It is a cord composed of cerebral substance co- vered by membranes, similar to those which surround the brain; thus its outer membrane is tough and fibrous in structure ; its second coat is much thinner; and its third is vascular, and similar to the l'ia Mater. Besides these coats, a membrane, called neuriicma, divides its component filaments. 368 PHYSIOLOGY OF THE NERVES. Q. Are nerves dependent on the brain for sensa- tion and motion ? A. Yes ; those which arise from it are, but they possess peculiar powers themselves, when they com- municate with each other in plexuses or in ganglions, of giving an increase of substance and power to others proceeding from them ; and when they arise from the spinal marrow, they are more independent of the brain. Q_. What is the action of the nerves in producing sensation ? A. It has been differently explained; by some, it has been considered as the result of irritation, by others of a circulating fluid, by others of electricity; but as, in science, the phenomena are all we know, these terms only cover, but do not remove the diffi- culty. The phenomena of the nerves are known by the senses, and the information they give us is all we know about them. Q. How is it proved that the nerves are actually the organs of feeling ? A. Because when they are destroyed, the parts to which they are distributed lose their feeling: thus, if the optic nerve be destroyed, the person becomes blind; if the acoustic nerve be divided, he loses his hearing. The wounds of nerves produce horrible pains; every disease which alters the qualities of the nerves, alters those of the parts to which it goes. Q. What are the general properties of sensations ? A. They can be inci-eased by exposing the sense to the greatest possible surface, by receiving one im- pression only at once, and giving to them our whole attention; they can be diminished, as the sight, by contracting the brows, and drawing together the eyt- lids; habit also lessens their intensity; the loss of one sense increases the powfer of the others ; they have a reciprocal influence on each otiier; thus the sense of smell is the guide and sentinel of taste ; taste in its turn exercises a powerful influence upon smell; the same substance is not equally ngi tcablu. to the stiista of taste and smell, &.c. PHYSIOLOGY OF THE NERVES. 369 Q. How are sensations divided ? A. Into those which are agreeable and those which are disagreeable, or into pleasure and pain. Q. What is meant by internal sensations ? A. The sensations which almost all the organs on being touched give to the brain; the bones, liga- ments, aponeuroses, &c have not this faculty, as they are insensible to the most acrid stimuli, to fire, &c. There are besides these sensations others which arise without any external stimuli, as, those of hun- ger, thirst, the desire to make water, to go to stool, to respire, and the venereal appetite. These are sometimes very active and pressing, as before they are satisfied; afterwards, there follows a sensation of fatigue, with a diminution of activity in the organs which give rise to them. Another class of sensations arise in disease; it belongs to the physician to [study these deeply. Q. What is the difference between the ideas which are received from external and internal impressions? A. Those from the external furnish all our know- ledge, and are distinct and clear; those from inter- nal sources, are vague and confused, and give us no lasting impressions; they are agreeable or the con- trary, according as the organs which furnish them are in a proper state. Q. What circumstances modify our internal sensa- tions ? A. Age, sex, temperament, seasons, climate, cus- tom, and individual disposition, &c. Q. How many pairs of nerves arise within the cra- nium ? A. Nine pairs, together with the glosso-pharyn- geus and accessorius, on each side. Q. Describe the^rsr pair of nerves, called the Ol- factory ? A. The Olfactory nerves arise by several striae from the corpora striata, run forward in a groove to the cri- briform plate of the ethmoid bone, where each forms a bulb, from which various filaments are sent off, and 370 ANATOMY OF THE NERVES. pass through the cribriform plate, to be distributed upon the mucous membrane of the nostrils. Q. Describe the origin and course of the second pair, or Optic nerves ? A. The Optic nerves arise from the posterior part of the thalami optici, and partly from the tubercula quadrigemina : they converge and unite at the fore part of the sella Turcica ; they afterwards separate, diverge, and each passes out of the cranium by the foramen opticum, into the orbit, in a winding manner, perforates the coats of the ball, and is expanded into the retina. Q. Why does the optic nerve take a waving course in the orbit ? A. To prevent it from being overstretched in the different motions of the eye. Q. Describe the third pair of nerves, called Mo- tores oculorum ? A. The Motores Oculorum arise from the under, inner, and back part of the crura cerebri, by nume- rous threads collected into their trunks ; they perfo- rate the dura mater at the sides of the posterior clinoid process, run along the upper part of the cavernous si- nuses at the outside of the carotid arteries, and pass through the foramina lacera anteriora into the orbits, to be distributed upon all the muscles, excepting the trochlearis and abductor. It also reflects a small branch to assist in forming the ophthalmic ganglion. Q. Describe the origin and course of the fourth pair of nerves, the Trochleares or Pathetici. A. The trochleares are very slender, and arise from the Valvula cerebri behind the testes; each goes out between the cerebrum and cerebellum, by the side of the pons Varolii, passes through the caver- nous sinus, and out by the foramen lacerum anterius, and is entirely dispersed upon the trochlear, or supe- rior oblique muscle. Q. Describe the origin and distribution of the fifth pair of nerves, or Par Trigeminum. A. Tbe Trigemini are large, and arise by an ante- ANATOMY OF THE NERVES. 371 rior and a posterior portion from the side of the Tu- ber annulare, where the crura cerebelli join it: each perforates the Dura Mater, enters the cavernous sinus, forms a plexus, which terminates in the Gasseriajc ganglion, out of which three branches are sent, namely, the ophthalmic, superior maxillary, and infe- rior maxillary. Q. Describe the Ophthalmic branch of the fifth pair? A. The Ophthalmic nerve at the side of the Sella Turcica, is connected by nervous substance with the trunk of the fourth pair, then rises a little, crosses over the third pair, goes out by the foramen lacerum into the orbit, and sends off three principal branches, the lachrymal, nasal, and supra-trochlear; while the trunk passes through the supra-orbitary hole or notch, ascends the forehead, and receives the name of fron- tal nerve. Q. Does the Ophthalmic assist in the formation of the ophthalmic or tenticutar ganglion? A. Yes ; a small filament is sent off from the nasal branch, or from the trunk itself, to join the branch of the third pair, in the formation of the ganglion. Q. Is any other nerve reflected from the Ophthal- mic ? A. Yes; the nasal branch very generally sends a filament through the foramen orbitarium internum an- terius, which re-enters the cranium, rises upon the cribriform plate, passes out with the Olfactory nerve, and is dispersed upon the anterior part of the nostril. Q.. Describe the Superior Maxillary Nerve ? A. This second branch of the fifth pair passes through the foramen rotundum of the sphenoid bone, and then sends off two principal branches, viz. the spheno-palatine, or lateral nasal nerve, and the palato- maxillary, or palatine ; while the trunk itself after- wards enters the canal under the orbit, and, issuing, forms the infra-orbitar nerve. Q. What particular branches does the Spheno-pa- latine nerve send off? A. Two,- one of which, the Pterygoid, is reflected 372 ANATOMY OF THE NERVES. and sent through the foramen pterygoideum of the sphenoid bone, to communicate with the great sym- pathetic iu the carotic canal: the other branch of which, the Vidian, enters the foramen innominatum of the petrous portion of the temporal bone, to com- municate with the portio dura of the seventh pair in the aqueduct of Fallopius. Q. What is the distribution of the infra-orbitar nerve ? A. While in the canal under the orbit, it sends off several small filaments to the bones, to the antrum maxillare, and to the teeth; it passes out by the fora- men infra-orbitarium, and is divided into branches, which are dispersed upon the cheek, nose, and pal- pebrae. Q. Describe the third branch of the fifth pair, or Inferior Maxillary Nerve ? A. It passes out of the cranium by the foramen ovale, sends off some small twigs to the contiguous muscles, and one of considerable size, named the Lingual, or Gustatory nerve; directing its course between the pterygoid muscles, it enters the foramen maxillare posterius; and when running along the canal, it gives off nerves to the teeth and substance of the jaw, and at last emerges by the foramen menti, to be dispersed upon the chin and under lip. Q. What is the distribution of the Lingual or Gus- tatory branch ? A. It runs forward between the pterygoid musclos, gives off some filaments to them, to the submaxillary and sublingual glands, and ultimately terminates near the apex of the tongue, being chiefly dispersed upon its papillae. Q. Describe the origin, course, and distribution of the sixth pair of nerves, named Jlbducentes ? A. It arises between the tuber annulare and corpora pyramidalia, from the beginning of the medulla ob- longata, is very small, runs forwards through the ca- vernous sinus between the ophthalmic nerve and carotid artery ; on the surface of this artery it sends ANATOMY OF THE NERVES. 573 down two or three filaments, which constitute the origin of the great sympathetic nerve; it afterwards passes out of the cranium by the foramen lacerum superius, and is entirely dispersed upon the abductor muscle. Q. Describe the origin of the seventh pair of nerves? A. The seventh pair is composed of two portions, a portio mollis, and a portio dura ; the portio mollis, or proper auditory nerve, arises by transverse medullary Btriae from the anterior part of the fourth ventricle, and partly from the tuber annulare ; the portio dura, called also sympathetica minor, or the facial nerve, arises from that part common to the pons Varolii, cms cerebelli, and medulla oblongata; is situated on the mesial side of the portio mollis; the two portions are afterwards applied to each other; the portio mollis having a groove on its surface, receives the portio dura. Q. Describe the course and distribution of the se- venth pair ? A. This pair directs its course to the foramen au- ditorium internum, which it enters, and at the bottom of the foramen, the portio dura separates, and enters the aqueduct of Fallopius by the superior and anterior foramen, passes along the canal of the aqueduct, and comes out by the foramen stylo-mastoideum to be dis- tributed upon the face and side of the head: The portio mollis, being much larger than the former, is di- vided into two fasciculi of nearly equal size -, one of which by a number of fibrillae passes through the cribriform plate, in the bottom of the meatus, and is dispersed on the parts of the cochlea; the other fas- ciculus passing through the cribriform plate, in a similar manner, by fibrillae, is dispersed upon the ves- tible, and three semicircular canals. Q. What nerves does the portio dura receive and give off, while it is passing through the aqueduct of Fallopius ? A. It first receives the Vidian nerve, being a branch reflected from the superior maxillary, and then, after passing a short space, gives off the Chorda Tym- Vol. I. H h 374 ANATOMY OF THE NERVES. pani; in its passage, it sends also twigs to the mas- toid cells, and stapedius. Q. Describe the course and termination of the Chorda Tympani ? A. The cherda tympani crosses the tympanum be- tween the handle of the malleus, and inferior crus of the incus, along the membrana tympani, and, after running along the outside of the Eustachian tube, it terminates in the lingual branch of the fifth pair; in its passage, it gives twigs to the muscles and mem- branes of the tympanum. Q. Describe the origin and exit from the cranium, of the eighth pair of nerves, called Pars Vaga ? A. The pars vaga, or eighth pair, arises from the medulla oblongata at the side of the base of the cor- pus olivare, together with the Glosso-pharyngeus, which, by some anatomists, is considered a part of the eighth pair; the n^rvus Accessorius ad parocta- vum, arises a little farther down from the termination of the medulla oblongata, and beginning of the me- dulla spinalis ; hence, these three nerves arise from the side of the medulla in this order, the glosso-pha- ryngeus above, the pars vaga in the middle, and the accessorius the lowest. They all pass out of the cra- nium by the foramen lacerum posterius, but are se- parated from each other, and from the lateral sinus behind, by small processes of the dura mater. Q. What course does "the Pars Vaga take, and what branches does it send off shortly after its egress from the cranium ? A. It frequently becomes enlarged for nearly an inch after its egress; it descends at the outer and back part of the common carotid artery, and is includ- ed with it in the same sheath of cellular substance. At the upper part of the neck it sends off the pha- ryngeus ; and soon afterwards the laryngeus superior; near the top of the thorax it sends a filament or two to join the cardiac nerves, and afterwards enters the thorax. Q. Describe the principal communications and ter- ANATOMY OF THE NSRVIS. 375 mination of the glosso-pharyngeus, or Lingualis late- ralis as it is sometimes called ? A. Immediately after its exit from the cranium, it sends a branch backwards to join the digastric branch of the portio dura: a little lower, it sends small twigs to communicate with others from the pharyn- geus, and from the great sympathetic, to form a plexus, which embraces the, internal carotid artery, and sends branches down to the heart: still low/er down, it sends filaments, which communicate with others from the pharyngeus, to be distributed upon the pharynx and stylo-pharyngeus muscle ; it then gives twigs to the tonsil, pharynx, and membrane of the epiglottis, and is dispersed upon the root of the tongue. Q.. Describe the communications and termination of the Accessorius ad par octavum ? A. It first sends a branch to the pharyngeus, ano- ther smaller to the pars vaga, and at the fore part of the sterno-cleido-mastoideus, it joins the sub-occipital by an arch, and frequently the first cervical by ano- ther ; it then passes through this muscle, gives branches to its. substance, and terminates in the tra- pezius. Q. Describe the origin and egress from the cranium of the ninth pair of nerves, viz. the Lingualis, and its communications ? A. It arises from the under and lateral part of the corpus pyramidale on the fore side of the medulla ob- longata by numerous filaments; it passes out by the Buperior condyloid foramen, and afterwards is at- tached to the eighth pair by cellular substance; it se- parates and is joined by a cross branch to the sub-oc- cipital, or to an arch, which connects it with the first cervical: it descends between the internal jugular vein and internal carotid artery ; at the root of the occipital artery, it sends down the Descendens Noni, and then crosses over both carotids behind the facial and temporal veins, and over the root of the facial artery, and is dispersed upon the middle of the tongue. 376 OP VHE INTERNAL FAR. OP TUB INTERNAL EAR. Q. What parts does the Internal ear comprehend ? A. The Tympanum, Labyrinth, and passages lead- ing into them. Q. Describe the Tympanum ? A. The tympanum is somewhat hemispherical, se- parated from the external ear by the membrana tym- pani, and from the labyrinth by an osseous septum, in the middle of which is a promontory that forms the tympanum into an anterior and a posterior region. Q. How many openings lead out of the tympanum ? A. Four ,• one anteriorly into the Eustachian tube, another backwards into the Mastoid cells; and two through the osseous septum, viz. the fenestra ovalis above the promontory leading into the Vestible, and the fenestra rotunda at the under and back part of the promontory leading into the Cochlea. Q. What is the use of the Eustachian Tube ? A. It forms a communication between the poste- rior opening of the nostril and the tympanum, by means of which an equilibrium is preserved between the air in the external and internal ear; and the vi- brations of the membrana tympani are facilitated. Q. What is the use of the Mastoid Cells ? A. These cells have many windings and turnings which communicate with each other, and which are lined with a periosteum internum: they reflect the sound. Q. Describe the situation and connexion of the 0«- sicula Auditus ? A. They are four in number, and 6tretch across from the membrana tympani to the labyrinth: the handle of the Malleus is fixed to the membrana tym- pani, its round head is articulated with the body of the Incus, the long process or crus of the Incus is fixed to the Os orbiculare, which is connected with the head of the Stapes, whose base rests in the fenes- tra ovalis. Q. What is the use of the Ossicula Auditus i OF THR INTERNAL EAR. 377 A. They receive and communicate the vibrations of the membrana tympani to the labyrinth through the medium of the membrane covering the fenestra ovalis, much more strongly than they could have been transmitted in any other manner. Q. What parts does the Labyrinth consist of? A. Of three; the vestibule, cochlea, and semicir- cular canals. Q. Describe the Vestibule ? A. It is of an oval figure, situated at the inner side of the osseous septum near the base of the stapes ; it has several holes leading out of it, namely, the fe- nestra ovalis into the tympanum, another at the fore and under part into one of the canals of the cochlea : five behind into the semicircular canals, and four or five cribrifrom perforations into the meatus auditorius internus. Q. Describe the situation and parts of which the Cochlea is composed ? A. It is situated at the fore part of the Vestibule, in the petrous portion of the temporal bone, with its base towards the meatus auditorius internus, and its apex forwards and outwards. It is composed of an axis, a lamina spiralis, and two canals or scalae, which are separated by the lamina spiralis. Q. Describe the Axis or central pillar of the Coch- lea? A. It is si tut. ted nearly horizontally and is com- posed of two hollow cones, viz. the Modiolus and In- fundibulum joined together by their apices; the base of the modiolus lies at the base of the cochlea, and the base of the infundibulum is covered by the apex of the cochlea, called Cupola. Q. What occupies the cavi'.y of the axis, or of the modiolus and infundibulum ? A. The fasciculus of the portio mollis of the seventh pair of nerves destined for the cochlea; the osseous substance of the modiolus and infundibulum is cribri- form, or perforated with numerous 6inall holes, uh2 378 OF THE INTERNAL EAR. through which twigs of the nerve pass into the Sca- lae, to be dispersed upon the membrane lining them. Q. Describe the structure and situation of the La- mina Spiralis ? A. It is osseous and largest at the base of the Coch- lea, where it winds round the modiolus; towards the circumference it becomes cartilaginous and membra- nous. It is composed of two lamellx, peHorated for the passage of nerves into the scalae. It winds roiind the axis from the base to the apex of the cochlea, and terminates in a hamulus or hook in the base of the infundibulum. 0.. Describe the Canals or Scalae of the Cochlea ? A. The one canal, commencing by an open mouth from the fore part of the vestibule, is called Scala Ves- tibuli; the other, commencing from the fenestra ro- tunda of the tympanum shut by a membrane, is called Scala Tympani: they form two turns and a half round the axis in a spiral manner, and becoming gra- dually smaller, they unite and terminate in the apex of the cochlea. Q. Describe the situation and direction of the Se- micircular Canals ? A. They are situated behind the Vestibule; the su- perior or verticle is placed transversely with its con- vex side upwards ; the posterior or oblique is farther back, with its convex side backwards ; and the exte- rior or horizontal is placed next the tympanum, with its curvatures nearly upon the same plane. They form about three-fourths of a circle; at one extremi- ty is an enlargement, called ampulla: one extremity of the superior and of the posterior unite ; and the three canals in consequence, form five orifices, which are not closed by a membrane, in the Vesti- bule. Q. What covers the internal surface of all these parts of the Labyrinth ? A. A periosteum internum lines the cavities ; and besides, upon the internal surface of the periosteum, PHYSIOLOGICAL REMARKS, &C. S79 a pulpy membrane is spread, upon which the portio mollis is minutely dispersed. Q. What fills the cavities of the vestibule, cochlea, and semicircular canals ? A. An Aqueous fluid similar to the aqueous humour of the eye. Q. By what vessels is that Aqueous fluid effused ? A. It is secreted by the arteries of the perios- teum of the Labyrinth ; and it is kept in nearly the bame quantity by a corresponding absorption of it. Q. What arteries are sent to the Labyrinth ? A. One or two small branches from the vertebral arteries: the veins of which pass out of the labyrinth and terminate in the end of the lateral sinus. PHYSIOLOGICAL REMARKS. Q.. How is sound produced? A. By vibrations of the air, and is to the ear what light is to the eye. Q. What is to be distinguished with regard to sounds ? A. The intensity, the tone, and the quality. Q. Upon what does the intensity of sound de- pend ? A. Upon the extent of the vibrations. Q. Upon what does tone depend? A. Upon the number of vibrations in a given time, and it is divided into acute and grave ; the former be- ing formed of many, the latter of fewer vibrations. The gravest sound which the ear can perceive, is formed of thirty-two vibrations in a second ; the most acute of twelve thousand. Q. What is meant by an octave ? A. An appreciable sound, which has double the number of vibrations of another sound, is called the octave of that other. Between them there are seven sounds, called the notes of music. 380 PHYSIOLOGICAL REMARKS, &C. Q. What is meant by fundamental or harmonic sounds ? A. When a sounding body is set in motion by per- cussion, it is called a fundamental sound; by attend- ing a little, other sounds follow these, called har- monic. The quality of a sound depends upon the nature of the sounding body. Q. What are the peculiarities of the transmission of sound ? A. Sound passes through fourteen hundred feet in a second: and still more rapidly through water, stone, or wood; it becomes fainter in proportion to the square of the distance ; grave, acute, intense and weak sounds are propagated with equal rapidity with- out being confounded or interfering with each other. Q. Is sound capable of reflection ? A. It is reflected in the same manner as light from opposing bodies: the angle of incidence being equal to that of reflection. Q,. How do we judge of the direction of sounds? A. By the comparison of the impression made on our two ears; for if one be deaf, it is impossible to say in what direction sound comes. Sight, and the fre- quent habit of judging, assist us. Q. How is the sense of hearing modified by age ? A By infants just born the strongest sounds are not perceived: acute sounds are first perceived, but it is a long time before the intensity, direction, and the ef- fects of articulate sounds are distinctly noticed. It grows more perfect, as the person advances ; and in old age from the diminution of the water of Colun- nius, and the insensibility of the auditory nerve, it is much weakened. Q. What is the use of the various parts of the Ex- ternal Ear ? A. The cartilaginous pinna collects the undulations of sound, and transmits them into the meatus audito- rius externus, which in iis turn conveys them to the niembrana tympani. Q. What is the use of the Membrana Tympani? PHYSIOLOGICAL REMARKS, &C. 381 A. It forms a complete separation between the ex- ternal and internal parts of the ear: it receives the undulatory movements of the air, by which it is made to vibrate : and its vibrations are communicated by the ossicula auditus, and by the air in the tympanum to the Labyrinth of the internal ear. Q. By what means are the membrana tympani kept in a stat,e of tension proper for acute hearing ? A. By the muscles of the tympanum and ossicula, it accommodates itself to the strength of the impres- sions of the sonorous undulations; thus it is relaxed to receive strong impressions of the undulatory move- ments of the atmosphere, and by them too it is made tense to receive fainter and weaker impressions; while the Eustachian tube allows a free egress and in- gress of air into the tympanum itself, by which the vi- brating motions of the membrana tympani are kept free and easy. Q. By what means are the undulations of sound transmitted to the whole internal ear ? A. The strongest impressions are communicated to the vestibule by the connected medium of the ossicu- la, while weaker impressions are communicated to the cochlea through the fenestra rotunda. Q. What seems to be the reason of the stronger im- pressions being given to the vestibule, and the weaker ones to the cochlea ? A. Because, through the medium of the vestibule, the undulations of sound are communicated to the three semicircular canals, and to the scala vestibuli of the cochlea; while the undulations received through the medium of the air in the tympanum are communi- cated through the fenestra rotunda to the scala tym- pani of the cochlea only : hence the reason, why the base of the stapes is placed in the fenestra ovalis, through which the stronger impressions must be sent to the Labyrinth, rather than in the fenestra rotun- da, where much less strength of impression is re- quired. Q. Does the Aqueous Fluid in the Labyrinth re- 382 PHYSIOLOGICAL REMARKS, 8cC. ceive motion from the vibrations of the membrana tympani ? A. Yes; the aqua labyrinth', by the vibrations of the membrane covering the fenestra ovalis, is put into undulating motions, which are conveyed through the vestibule round the semicircular canals, and along the scala vestibuli into the cochlea; while the fluid in the scala tympani, by the vibrations of the membrane co- vering the fenestra rotunda, is also put into undulat- ing motions, which pass along the canal, and meet those of the scala vestibuli in the apex of the coch- lea, where the two scalae of the cochlea are united. Q. How is the sensation of sound excited by these means ? A. The portio mollis of the seventh pair of nerves is very minutely dispersed upon the internal surface of the pulpy membrane lining the cavities of the laby- rinth with which the aqueous fluid is in dgtitact. The delicate extremities of the nerves, therefore, re- ceive impressions from the undulating motions of the fluid, which excite in the mind the sensation of sound. Q. What are the Organic Diseases of the external parts of the Ear ? A. The pinna is sometimes divided: it is swelled in consequence of Erysipelas, Herpes, and other cu- taneous eruptions : the meatus is sometimes obstruct- ed by insects, extraneous bodies, or wax hardened and accumulated; or by Polypi growing from the membrana tympani, which is occasionally inflamed ; sometimes a small phlegmon in the meatus produces ear-ache. By all which deafness is produced. Q. What are the Orgtinic Diseases of the internal Ear? A. The Tympanum is sometimes inflamed and ul- cerated in consequence of injuries, and acute diseases, as Small-Pox, Measles, Scarlatina, or of Lues vene- rea; and the Ossicula situated across it are cast out. The Eustachian tube is occasionally obstructed by arevious inflammation. The Portio Mollis is some- PATHOLOGT OF THE EAR. 383 times paralysed. Coagulable lymph has been found in the Vestibule. Deafness, generally complete, is the consequence of these. PATHOLOGY OF THE EAR. OTITIS, OR INFLAMMATION OF THE EAK. Q_. What are its symptoms ? A. Violent lancinating pain, extending from the auditory canal to the throat, preventing free deglu- tition, increased by the head being moved, by cough- ing, mastication, &c.; continual humming or buzzing sound; matter at first thin, afterwards thick, of a yel- lowish green colour, very fetid, is discharged; this sometimes contains small pieces of bone ; violent head-ache, particularly severe when the internal ear is affected, when frequently a caries of the mastoid process is induced; in this case the matter may be discharged by the eustachian tube into the pharynx, either gradually or all at once. The diagnosis between external and internal otitis may be made by attention to the following symptoms. In the external the pain is not so deeply seated, mat- ter is formed veiy soon; a few hours, or at most two days, are sufficient for its formation, and it is at first of a serous nature. In the internal affection the matter does not appear before the eighth day, and it is dis- charged suddenly, of a purulent quality, mixed with blood: it may flow externally by the rupture of the membrana tympani. Q. What are the diseases with which it may be confounded ? A. The acute form may be mistaken for a neural- gia, and the chronic for affection of the cerebellum. ANATOMT OF THE EYE. Q. How many bones are concerned in the forma- tion of the orbit ? 384 OF THE LACHRYMAL A. The Orbit is composed of seven bonm, namely, the frontal, sphenoid, ethmoid, lachrymal, palate, su- perior maxillary, and malar. Q. Enumerate the external appendages of the eye. / A. The supercilia or eye-brows, palpebrae or eye- lids, tarsi, ciliary or Meibomian glands, and cilia or eye-lashes. Q. What is the use of the eye-brows ?. A. They protect the eye from intense light, and prevent the sweat from irritating the eye, by inter- cepting it in its course down the forehead. Q. What are the tarsi, and where are they situ- ated ? A. The tarsus is a thin cartilage, broadest in the middle, and becoming narrow towards its extremities, situated in the margin of each palpebra. Q. Describe the situation and use of the ciliary glands. A. These glands are numerous, and are placed be- tween the tarsus and the membrane lining the eye-lid : they secrete an oily or sebaceous matter, which facili- tates the motions of the eye-lids, and prevents them from sticking together during sleep. Q. Enumerate the Lachrymal Organs. A. The lachrymal gland, caruncula lachrymalis, valvula vel plica semilunaris, puncta lachrymalia, canaliculi lachrymales, lachrymal sac, and the nasal duct. Q. Describe the situation and nature of the La- chrymal Gland. A. The lachrymal gland is situated in a sinuosity under the temporal end of the superciliary ridge of the frontal bone ; is of the conglomerate kind, is ob- long and a little flattened, has several excretory ducts, which terminate on the inside of the eye-lid near the outer angle of the eye : it secretes the tears which are poured out by its ducts upon the eye-ball. There is also a cluster of smaller lachrymal glands situated between the larger gland and the upper eye- lid. ORGANS, &X. 385 Q. What is the Caruncula lachrymalis ? A. It is a small conglomerate gland situated in the nasal angle of the eye between the palpebrae and ball; it secretes unctuous or sebaceous matter for lu- bricating those parts; it separates the two puncta la- chrymalia, and it directs the tears into them when the eye-lids are closed. Q. What is the Valvula or Plica semilunaris ? A. It is a fold or doubling of the tunica adnata, or conjunctiva, situated between the caruncula and ball, of a crescent form, and with its extremities towards the puncta lachrymalia; it directs the tears into them, and thus assists the caruncula. Q_. Describe the Puncta lachrymalia. A. Ihese two puncta or orifices are situated near the inner angle of the eye, the one in the upper, and the other in the under eye-lid at the extremity of the tarsus, exactly opposite to each other: each is sur- rounded by a cartilaginous circle, which keeps it open. They are simply the orifices of the canaiiculi lachry- males. Q. Describe the Canaiiculi Lachrymales. A. These two small canals run in the direction of the edges of the eye-lids, between the puncta lachry- malia and lachrymal sac, in which they terminate. Q. Describe the situation and use of the Lachrymal Sac. A. It is somewhat of an oval shape, situated just below the inner canthus or angle of the orbit, in a groove formed by the os unguis and os maxillare : it is composed of a tough mucous membrane of great vascularity, and is a little contracted at its lower end, which communicates with the nasal duct. It receives the tears from the canaiiculi lachrymales. Q. Describe the Nasal Duct. A. This duct, composed of the same mucous mem- brane which forms the lachrymal sac, is situated in a canal formed by the superior maxillary bone and os unguis ; runs obliquely downwards and backwards, and terminates by a round aperture at the lower end Vol. I. I i 386 OF THE COATS of the inferior turbinated bone. It transmits the tears into the nostril. Q_. Describe the natural course of the tears. A. The tears secreted by the lachrymal gland, and by the cluster of smaller glands situated near it, are poured upon the ball of the eye by the excretory ducts opening near to the templar angle : they pass across the eye towards the nose, are diffused by the motions of the palpebrae and eye-ball over the ante- rior surface of the eye, are absorbed by the two puncta lachrymalia, are carried by the two canaiiculi lachrymales into the lachrymal sac, and thence pass down into the back part of the nostril. Q. What is the use of the Tears? A. They moisten the eye-ball, facilitate its motions, and carry off dust and other foreign bodies which may accidentally get under the palpebrae. They also express certain passions, as grief, joy, pleasure, spite. Q_. What are the chemical properties of the Tears? A. They contain water, a small quantity of mucus, a little phosphate of soda, and pure lime. Q. What artery and nerve are sent to the lachrymal gland ? A. The Lachrymal Gland receives its blood from a branch of the ophthalmic artery ; and its nervous in- fluence from a branch of the ophthalmic nerve. Q. What are the Chemical Constituents of the Tears' A. They consist of water, mucus, muriate of soda, soda, phosphate of soda, and phosphate of lime. The saline parts, however, are very inconsiderable. Q. Is the natural course of the tears ever obstruct- ed ? A. Yes ; in Catarrh, the mucous membrane of the nostrils is inflamed; and in some severe cases, the inflammation follows up the nasal duct, thickens its membrane so as to obstruct the passage : the tears in consequence flow over the cheek at the nasal angle, irritate, inflame, and excoriate the part. This, gives rise to the disease named Fistula Lachrymalis. Q. How many Coats has the eye-ball ? OF THE EYE, StC 387 A. Three ; the sclerotic, chdroid, and retina. Q. Has it no other coats besides these ? A. Some anatomists enumerate the tunica adnata, or conjunctiva, cornea, and iris, as coats of the eye, but they are merely partial, and seem rather appen- dages of the other coats. Q,. Describe the Tunica Adnata. A. The Adnata or Conjunctiva is a reflection of the skin from the internal surface of the eye-lids extend- ing over the anterior part of the eye-ball, where it becomes very thin and transparent. It adheres to the subjacent parts by cellular substance, in which numerous blood-vessels are dispersed : this therefore is the common seat of Ophthalmia. Q. What is the use of the Tunica Adnata or Con- junctiva ? A. It fixes the eye-ball to the palpebrae and socket, and prevents extraneous bodies from getting into the back part of the orbit. Q.. Describe the Tunica Sclerotica. A. It is an opaque, white, elastic, fibrous mem- brane, of unequal thickness, possessed of little sensi- bility, and has but few arteries in its substance; it surrounds the greater part of the eye-ball, and termi- nates at the margin of the Cornea. Q. What is the use of the Sclerotic Coat ? A. It determines the shape of the eye, supports and defends the more delicate and useful parts within it. The tendons of the muscles of the eye are spread upon, and inserted into its anterior part, they shine through the tunica adnata, which by this means has been called, near the margin of the cornea, the Tu- nica Albuginea. Q. Describe the Cornea. A. It forms the anterior transparent part of the eye-ball; it consists of thin lamellae; its convexity differs in different people, but it is more convex than the sclerotic coat, i. e. it forms part of a smaller circle than that of the eye-ball. Some anatomists have con- sidered it a continuation of the sclerotic coat. 388 OF THE COATS, &C. Q. By what means can it be proved that the Cornea is not a continuation of the sclerotic coat ? A. Its lamellated transparent structure is quite un- like the dense, hard, opaque structure of the sclerotic coat: it separates from the sclerotic coat by slight putrefaction : in the Whale, the circumference of the Cornea is received into a distinct groove in the con- cave margin of the tunica sclerotica; and besides, the cornea is a segment of a smaller circle than the scle- rotica, and of course it is more prominent and con- vex. Q. Has the Cornea many blood-vessels and nerves dispersed in it ? A. In its sound state, no blood-vessels are seen in it, but they can be seen when it is inflamed: its nerves are too small to be traced, but yet it possesses very considerable sensibility, and they must exist in it. Q. What is the use of the Cornea ? A. It receives and transmits the rays of light to the humours of the eye, protects the delicate parts with- in, and contains the aqueous humour. Q. Describe the Tunica Choroidea. A. It is situated immediately within the sclerotic coat, to which it is connected by fine cellular mem- brane, blood-vessels, and nerves; it is thin, and very vascular, of a brown colour, is villous internally, and covered by the pigmentum nigrum, which seems to be secreted by the vessels of its internal surface, and lies between the choroid coat and the medullary pulp of the Retina. Q. What is the nature and use of the Pigmentum Nigrum ? A. Its nature is very peculiar, being neither alter- ed by heat, by immersion ii| alcohol, nor by chemical tests. It prevents the reflection of the erring rays of light, and, in consequence, the formation of a se- cond image on the retina. Q. Is the Pigmentum Nigrum always of the same colour ? A. No; it is thickest and blackest near its anterior OF THE EYE. 389 part; becomes gradually thinner behind, and fainter towards the entrance of the optic nerve: in old age, also, it becomes more diluted, and of a much lighter colour. In fishes, graminivorous animals, and in those which go in quest of prey in the night, the Pig- ment, called Tapeium, is of a light shining colour, to strengthen and reflect the rays of light upon the sur- face of the Retina, that their vision may be more per- fect. Q. Where does the Choroid Coat terminate ? A. It begins where the optic nerve enters the eye- ball, and adhering to the sclerotic coat terminates near to the crystalline lens under the ciliary circle or ligament. Q. What is the Ciliary Ligament or"Circle? A. It is composed of dense cellular membrane, of a dark brown colour, in consequence of being tinged with the pigmentum nigrum : it is formed by the ter- mination of the Sclerotic and Choroid coats, and the margin or beginning of the Iris; their junction seems the cause of the circular enlargement. Q. What are the Ciliary Plicae ? A. They are folds of the choroid coat, about 60 or 70 in number across the ciliary ligament; their ex- tremities form the Ciliary Processes. Q. What are the Ciliary Processes ? A. The processes are the terminations of the plicae or striae, two or more of which form each ; they float in the aqueous humour in the posterior chamber at the inner side of the commencement of the Iris : they seem to be the extremities of exhalent and absorbent vessels. Q_. What is understood by the Corpus Ciliare ? A. It is the blackish ring about the sixth part of an inch in breadth, adhering to the fore part of the Re- tina and vitreous humour ; it comprehends the ciliary plicae and ciliary processes in its substance. Q. Describe the situation and nature of the Iris. A. The Iris is situated a little behind the cornea, runs transversely, is convex before, concave behind, li 2 390 OF THE IRIS, PUPIL, AND and perforated in the centre by the pupil; it, in short, forms a part of the same circle as the choroid coat; and some anatomists have thought it a continuation of that coat; but its evident muscularity discounte- nances such an idea. Its interna], or rather posterior surface, is covered by a pigment of the same colour as that of the choroid coat, called Uvea; when this is washed off, the Iris exhibits two sets of muscular fibres, one set disposed in the form of radii, which are well situated for dilating the pupil; the other fibres form a very distinct sphincter muscle, which surrounds the inner edge of the pupil and contracts it. The Iris divides the aqueous humour into two portions. It is furnished with many nerves, and endowed with great sensibility. Q. What is the use of the Pupil ? A. The Pupil being a hole in the centre, or middle part of the iris, admits the rays of light to the inter- nal parts of the eye, and allows the iris to contract and dilate itself according to the stimulus of light im- parted to it. Q.. What is the use of the Iris? A. The iris placed across the anterior part of the eye, by its circular set of fibres contracts the pupil, and excludes the rays of light when divergent, or too intense; by its radiated set of fibres, it dilates the pupil, in order to admit a greater quantity of rays : it thus regulates the quantity of light sent into the in- ternal parts of the eye. Q. By what stimulus is the Iris excited to action? A. The movements of the Iris in manure involun- tary, and depend upon the quantity of light which falls on the Retina, for it acts in sympathy with the Retina: thus when the rays of light are strong and very stimulating to the Retina, its stimulus is commu- nicated to the iris, which instantly contracts the pu- pil, excludes a great portion of the light, and renders vision tolerable. Q. May not the rays falling on the Tiis itself in a strong light stimulate it to contraction, independent of any sympathy with the retina? RETINA OF THE EYE. 391 A. It is true that many rays must fall upon the iris itself, and may impart a stimulus sufficient for its con- traction in the various degrees of intensity of light; but it is generally supposed that they produce no mo- tion of it. Q. Is not the Iris sensible in some cases of complete Cataract, when no light can be admitted to stimulate the Retina; and in some of complete blindness in Amaurosis, when the retina is paralysed ? A. Yes : in some cases of blindness, the iris con- tracts and dilates the pupil more or less according to the intensity of light presented to the eye ; hence it may act more by the stimulus of light upon itself, than upon the Retina, which can scarcely be stimulated. Q. Describe the Retina. A. The Optic Nerve being tortuous at the back part of the orbit and eye-ball, invested with the Dura and Pia Mater, and removed from the axis of the eye a little towards the nose, passes.by numerous fasciculi through a cribriform part of the Sclerotic and Cho- roid coats, and is then expanded into the delicate pulpv substance of the Retina, which forms the inner- most'coat of the eye, proceeds forwards between the choroid coat, and capsule of the vitreous humour, without adhering to them, and terminates at the greater diameter of the Crystalline Lens under the Corpus Ciliare. Q. What is the use of the Retina? A. The Retina is confessedly the seat of vision, to which all the other parts of the eye are subservient. Q. Is there any thing particular in the bottom of the Retina ? A. Yes; in the centre of the Optic Nerve, where it enters the eye, the artery called Centralis Retinae enters, and is minutely ramified upon the inner sur- face of the Retina. In the back part of the Retina, too, and exactly in the axis of the eye, there is a cen- tral foramen of a dark colour, but becoming paler and yellowish towards its circumference. The nature of this is unknown. In the ox, however, and other large 392 OF THE HUMOURS, 8cC. quadrupeds, a lymphatic vessel is observed to go through it. Q. How many humours does the globe of the eye contain ? A. Three'; the aqueous humour, crystalline lens, and vitreous' humour. Q. What is the nature and situation of the aqueous humour ? A. The aqueous humour is perfectly clear and lim- pid, and occupies the space between the cornea and crystalline lens. Q. Is it not divided ? A. Yes; the iris divides it into two portions; that between the crystalline lens and the iris is called the posterior chamber, and that between the iris and cor- nea the anterior chamber. Q. Does the aqueous humour in tbe anterior cham- ber communicate with that in the posterior? A. Yes: the pupil is the medium of communica- tion through which the aqueous humour can flow from the one chamber into the other. Q. When the aqueous humour is evacuated, can it be renewed ? A. Yes; very quickly renewed. Q_. By what vessels is it secreted ? A. By the exhalent arteries in the ciliary processes, and on the fore part of the iris. Q. What is the use of the aqueous humour? A. It distends the cornea, collects the rays of light into a focus in the bottom of the eye, facilitates the motions of the iris, and defends the internal parts from injurious pressure. Q. Describe the Crystalline Lens. A. It is of a lenticular form and a crystalline ap- pearance ; and though a solid, yet has been classed among the humours of the eye. It has two convex surfaces, of which the anterior is the less, and the pos- terior surface the more convex. Q. Describe the situation and structure of the Crys- t^' *.ii"" I.CilS, OF THE BYE. 393 A. It is situated exactly behind the pupil, and its posterior part is imbedded in the vitreous humour. It is composed of concentric lamellae, which become more and more firm and compact towards the centre of the lens. Q. Is the Lens surrounded by a Capsule? A. Yes; a very pellucid capsule called Tunica Ara- nea, or Crystallina, surrounds the lens. Q. Does the lens adhere to its capsule ? A. Very slightly if it adheres to it at all. Q. What is the use of the crystalline lens ? A. To converge the rays of light in the bottom of the eye, which it does in a greater degree than the aqueous humour. Q. Does the removal of the crystalline lens prove the above fact ? A. It does; for then the images are larger, badly defined and fainter. Q. Describe the situation and form of the Vitreous Humour. A. It is situated in the posterior part of the eye, is round externally, where it is covered by the retina ; is concave before, where it receives the crystalline lens ; is transparent and viscid, like the albumen ovi. Q. Is the Vitreous Humour contained in a capsule ? A. Yes ; it is called Tunica Vitrea, Hyaloidea, or Aranea, which sends processes into the body of the humour, forming cells that communicate freely with one another. Its capsule, near the corpus ciliare, is divided into two laminae, the external of which, ad- hering to the retina, passes forwards, and is inserted into the capsule of the lens; this layer has been called Zonula Ciliaris, the ciliary zone : the internal layer goes behind the lens and adheres to its capsule. Q. By what name is that circular cavity denomina- ted ? A. The Canal of petit, which lies between the ciliary zone and the capsule of the vitreous humour and of the lens j it has some transverse fibres running through it. 394 REMARKS ON VISION. Q. Have these humours any blood-vessels dispersed' in their capsules ? A. In the adult they are invisible ; but in the foe- tus vessels are seen carrying red blood both in the capsule of the lens, and through the vitreous humour. Q.. What is the use of the Vitreous Humour ? A. It expands the coats of the eye, and gives shape to it, keeps the lens at a proper distance from the re- tina, converges the rays, and thus renders the focus of the rays more perfect. REMARKS. Q. What is meant by a ray of light ? A. A series of particles proceeding from a lumi- nous body in a straight line, separated from each other by intervals so great that a great number may cross without interfering with each other. Q. What is the intensity of light proportional to ? A. It increases the nearer we approach to the luminous body, and the increase of the intensity of the light is as the square of the distance diminishes. Q. What is meant by a medium ? A. The body through which the light passes; thus the air, or water, when the passage of light through them is spoken of, are called media. Q. What is meant by the reflection of light ? A. When a ray of light encounters an opaque body, it is reflected or turned away from its surface : when it falls upon a transparent body, it passes through and is refracted. Q.. What are the general laws of Refraction of the rays of light ? A. When the rays of light pass out of a rarer into a denser medium they are refracted towards the per- pendicular ; and vice versa, when they pass through a denser medium into a rarer one, they are turned from the perpendicular. Q. What is the point called, at which the light pe- netrates ? A. That of immersion; that at which the ray of light leaves the transparent body, is called that of REMaUKS ON VISION. 395 emergence : if the ray enter the medium in a direc- tion perpendicular to the surface, it continues through it in the same perpendicular direction. But if it fall on the surface at an angle, on entering it, it is bent from its course as above stated. Q.. What is meant by the angle of incidence ? A. It is that angle formed by the ray falling on a transparent surface with the perpendicular drawn through the point of immersion to the surface of the medium, and the angle of refraction is that angle which is made by the broken ray with the same per- pendicular. Q. What changes does a ray of light, entering and passing out of a medium, undergo ? A. In passing out of a rarer medium into a denser, it approaches the perpendicular to the point of con- tact ; on the contrary it goes farther from it, when it passes from a more dense to a more rare medium. Q. To what is the refracting power of bodies pro- portional ? A. To their density and their combustibility; so that of two bodies which have equal densities, that which has the greatest combustibility will have the greatest refracting power. Q. Has the form of a transparent body no effect upon its refracting power ? A. It has no effect upon its power of refraction, but it influences the direction of the rays after they pass it; thus if the segment of a sphere be the me- dium, the rays incline to the perpendiculars to each point of the surface, of course each ray must approach the others, and at length meet in a point, which is the centre of the sphere of which the lens is a seg- ment : that point is called the focus. Q. What effect has a refracting body, as a glass with parallel sides, upon the light passing into it from a rarer medium ; as, the air. A. The light is bent in passing into it towards the perpendicular, to the point of incidence, and then on passing out of it into the air, it is bent from the per- 396 REMARKS ON VISION. pendicular, and to as great a degree, as it was on pas- sing into it; so that its course after passing it is pa- rallel to its original direction. Q. Is the light perfectly homogeneous, or is it com- posed of different rays ? A. It is composed of different coloured rays, and it is by means of their different degrees of refrangibihty that we are enabled to separate them : thus, if rays of light pass through a prism of glass, and be receiv- ed on a piece of paper behind it,',they occupy on the paper different relative positions, one above another on the paper, shewing that they have been in their passage turned out of their way in a greater or less degree, and this is proportional to their colour ; the red, being the least refrangible, occupying the top of the series formed on the paper ; the orange next; the yellow next; the green next; the blue next; the indigo next; and the violet last: so that the light is not homogeneous, but is composed of a variety of dif- ferent colours, and it is upon this fact, the different co- lours of bodies are explained : a white body reflect- ing all the colours; a black, absorbing all and reflect- ing none. A red body reflects those of that colour only; a yellow, the yellow rays only, and so on of the others ; violet, the violet; blue, the blue ; the other rays, with the exception of those of the colour of the body, being absorbed by the body and disappearing in it. Q. In what position is the luminous object depict- ed on the retina ? A. In an inverted position ; because all the rays of light not falling perpendicular to the middle of the crystalline lens, cross each other; i. e. those on the left are refracted to the right, and those on the right pass to the left. Q. How then do we see things in their proper po- sition ? A. We are supposed to acquire the real position of things by habit alone. Q. How happens it that we do not see things dou- REMARKS ON VISION. J97 ble, since the image of the luminous body is depicted upon the retina of both eyes ? A. The two eyes, in their sound and natural state, move alike ; hence the image is formed exactly on the same part of both retinae, and in consequence, the vision is single. Some physiologists however, suppose that we see with one eye only at a time. Q. When the cornea and crystalline lens are too convex, what happens ? A. In such an eye the focus of the rays is formed be- fore it reaches the retina; in consequence, such people are short-sighted, and require concave glasses to re- medy the defect of the eye, in order that they may see objects distinctly at the ordinary distance. Q. What is the state of vision, on the contrary, when the cornea and lens are too fiat, or when the refracting power of the humours is diminished ? A. The focus is not properly formed, therefore the object must be removed to a greater distance from the eye than ordinary to render vision perfect 5 which happens commonly to persons of advanced age: hence convex glasses become indispensably ne- cessary. Q. How is this proved, by experiment ? A. If a bullock's eye be taken and the sclerotic coat be removed from the back part of the eye, the ima- ges will be seen upon it accurately defined : if then the aqueous humour be let out, the image becomes more obscure, as the eye becomes less convex. When the cornea is removed from an eye under the same circumstances, the image does not appear to change its dimensions, but it is more obscure. Q. How do the eyes accommodate themselves to see objects at different distances ? A. By habit, the muscles of the eye increase, or diminish the length of its axis according to the dis. tance ; and the iris too allows a greater, or smaller quantity of light to be thrown into the eye; by which means vision becomes distinct. Vol. I. K k 398 REMARKS ON VISION. Q. How are the spots explained which sometimes appear in the eye ? A. They are of different kinds; thus, if a person look steadily at a white object, a black spot appears instead of the white, owing to the insensibility pro- duced in that part of the retina on which the light coming from the white object acted ; in the same manner, if the eye rest upon a white surface upon which there are black spots, the eye becomes ex- ceedingly sensible on the points of the retina corre- sponding to the black spots and insensible to those corresponding to the white ; objects, therefore, ap- pear spotted : when the eye looks upon a red spot for some time.and then is withdrawn, there appears a blue in its stead, because by looking long at the red spot the retina becomes insensible to the red ray, and for this reason, that when the red ray is withdrawn from a pencil of white rays, the remaining produce a blue colour: The other colours produce effects varying in the same manner. Q. Does one part of the retina possess more sen- si < ty than another ? A. Yes; its central part is much more sensible than any other part. Q. Do we look with one or both eyes at once ? A. According to Dr. Gall with one ; Magendie thinks otherwise, and adduces the following experi- ments to prove it; throw upon a plain surface, in a dark chamber, the image of the sun ; take thick glas- ses each one of which presents one of the colours of the* prism; put them before the eyes ; if you have a good sight, and the eyes of equal force, the image of the sun, will appear of a dead white, whatsoever may be the colour of* the glasses you employ ; but if one of the eyes be stronger than the other, you will see the image of the sun of the colour of the glass placed before the strongest eye : the same object, therefore produces really two impressions, though the brain sees but one. On this account it is necessary that the eyes should move in harmony; if one move dif- REMARKS ON VISION. 399 ferently from the other, the person squints : it is easy to produce two images of the same object by throwing the eyes a little out of the axis. Q. How do we judge of the distance of objects ? A. It is done entirely by the mind ; but, certain cir- cumstances are necessary to the correctness of its de- cision ; thus, two eyes are so, as is proved by the fol- lowing experiment: suspend a ring to the end of a string ; fit to the end of a wand a hook, that will ea- sily enter the ring; place yourself at a convenient distance and try to introduce the hook; with both eyes open, it will be easy ; with only one, it will be impossible; and if a person has his two eyes une- qual in power, he will not succeed : the loss of an eye always prevents a person from judging properly of distances, and they never afterwards can judge well of them. The correctness of our ideas of distance is much influenced also by the remoteness of the object; if very near, we form a correct opinion ; if more re- mote, we judge with less correctness, and if still more remote, we cannot form any approximation to the truth. Q. What are the items taken into account in judg- ing of distances? A. The size of the object, the intensity of the light which comes from it, the presence of intermediate bo- dies, &c. have great influence on our decisions on this point: the frequent repetition of estimates with regard to distance of bodies has a great effect; thus, if we have been accustomed to see objects on the same plain, when we look at them from a tower or height they will appear more distant because they appear smaller, from our not being accustomed to view them. The same is true of objects seen from below when situated above us ; they appear smaller. Q. How do we judge of the size of objects ? A. By the size of the image formed at the bottom of the eye ; the intensity of the light which comes from the object; the habit of estimating their dis- tance, and of seeing the objects ; so that it is diffi- 400 REMARKS ON VISION. cult to judge of an object we have seen for the first time ; thus a mountain which we see for the first time at a distance, in general, appears to us smaller than it actually is, because we believe it to be near to us, when it is still very remote. When objects are very remote, as the celestial bodies, they appear much smaller than they actually are. Q.JHow do we judge of the motion of bodies ? A. By their images upon the retina, by the varia- tion in the size of those images, or by the change of the direction of the light, which strikes the eyes. We should also be at rest, and the motion of the body ob- served must be neither too slow nor too fast; it is difficult to judge of the motion of bodies which move towards or from us when their distance is considera- ble, as it is only by the increase or diminution of their size that we can ascertain any change of place in them, and the/e are not easily appreciated, when the object is at a distance. Q. HdSv are optical illusions effected? A. Either by tfie reflection or the refraction of light, when they occur from near objects, as in the case of mirrors; the object is referred instinctively to the extremity of the prolonged ray coming to the eye, and the comparative intensity of the light, com- ing from the different parts of the mirror, give the da- ta to the mind, by which their apparent distance be- hind the glass is calculated. In the same manner, ob- jects appear larger, when viewed through a double convex lens, because tbe quantity of light from the object thrown upon the retina is increased, and on the contrary, when the glass causes the divergence of the rays, it looks smaller : and when the surfaces of the glass are planes and not paraljel, the object ap- pears fringed with colours, as in the prism, from the separation of the rays into their elementary parts. Q. Enumerate some other causes of optical illu- sion ? A. As objects appear near to us in proportion as their images occupy a considerable space in the re- REMARKS ON VISION. 401 tina, or to the intensity of light which it imparts, the larger the body and the more light its surface re- flects, the nearer it appears ; and of two bodies pla- ced at equal distances, the one which possesses either of these advantages will appear the nearer. An object also viewed without any thing interme- diate between it and the eye, appears nearer to us, than when there is some object partly to intercept the view. An object seen in a strong light, when every thing around it is dark, as in the night, is always believed to be nearer than it actually is: objects also appear smaller, as they are remote, and it is by these rules that painting, and glasses of different kinds produce their effects. Q. How is the sight modified by different ages ? A. Till seven months, the pupil is obstructed by the membrana pupillaris, which is a prolongation of the membrane of the aqueous humor, and cannot admit the rays of light to the bottom of the eye. It is, however, said, that this membrane sometimes dis- appears earlier. The other differences between the eye of the infant and the adult are not very remark- able. The quantity of the humours diminish as they approach to old age, when they are very much redu- ced in quantity. The crystalline lens becomes yel- low, and less clear, till at length it sometimes be- comes completely opaque. The infant does not till the seventh month give any certain signs of being capable of regulating the motions of the eye with any degree of precision ; at first it is most sensible to the red rays and the most striking colours; it begins to distinguish objects ; then distances ; gradually becoming more and more per- fect till it begins to decline from old age. Q. What are the causes which weaken the sight of old men ? The diminution of the humours of the eye, the loss of the transparency of the crystalline humor; and lastly, the diminution cf the sensibility of the retina. Kk2 402 ORGANIC DERANGEMENT* 0T STJBOICAL ORGANIC DERANGEMENTS OF TUB EYE. Q. What organic derangements are the eye-lids subject to? A. They are frequently the seat of chronic, and sometimes of acute inflammation; are subject to Stye, or a small phlegmon, to tumours and warts, to ulcera- tion at the roots of the cilia. The palpebrae are also turned outwards, called Ectropium; or inwards, call- ed Trichiasis, when the cilia irritate the eye-ball. Q.. What organic derangements affect the caruncu- la lachrymalis? A. It sometimes becomes enlarged and prevents the shutting of the eye-lids, called Encanthis: the inflamed tumour sometimes suppurates, or remains for years in an indolent state. Q. When the nasal duct is obstructed by pre- vious inflammation, what is the consequence? A. The passage of the tears into the nose is pre- vented, the lachrymal sac is distended, and a tumour raised at the nasal angle of the eye; by pressing which, a yellowish viscid fluid issues from the puncta lachrymalia : sometimes the lachrymal sac is ulcera- ted, and the os lachrymale becomes denuded and ca- rious. This disease is called Fistula Lachrymalis. Q. What organic derangements is the cornea sub- ject to ? A. To specks growing on it; to pustules and sup- puration ; to opacity from lymph effused between its layers ; to fleshy or fungous excrescences connected with it; sometimes, though very rarely, to partial os- sification, or to hairs growing on it. Q. What organic diseases are the coats of the eye subject to ? A. To inflammation and subsequent suppuration. Q. What organic derangements are the humours of the eye subject to? A. The Aqueous humour is sometimes rendered tuvbid and opaque by the effusion of a yellowish glu- tinou- fluid, the consequence of violence, or of in- flammation. OF THE EYE. 403 Q. To what organic derangements is the Crystal- line Lens or its Capsule subject? A. The Crystalline Lens frequently becomes opaque, soft, and rather enlarged: sometimes, but much more rarely, it becomes harder and smaller ; its Capsule sometimes becomes thickened, opaque, and adheres to the Iris. This forms Cataract. Q. What are the organic derangements of the Vi- treous humour? A. It sometimes becomes turbid in consequence of inflammation, or is secreted in an unnatural quantity, which causes the eye to protrude from its orbit; this is called Dropsy of the eye-ball. Q. What are the organic derangements of the iris? A. It frequently becomes inflamed, thickened, and changed in colour, by which the Pupil is either much contracted and immoveable, or completely closed.— When the inflammation of it is violent, lymph is effus- ed from both sides of it, and produces opacity of the aqueous humour. Q. What diseases is the retina subject to ? A. Its diseases are not well ascertained; but when the retina loses its sensibility, or becomes paralysed, it constitutes the disease termed Amaurosis. Q. Is the Eye-ball subject to any other organic dis- eases? A. Yes ; its organic structure is sometimes destroy- ed by Cancer, or by Fungus Haematodes. PATHOLOGY OF MUCOUS MEMBRANES. OPHTHALMIA. Q. What are its symptoms? A. This affection commences by a sense of weight and tightness in the eye; it then becomes difficult and painful to move it; violent and burning heat, in- creased by the action of light, with a disagreeable itchiness ; the conjunctiva reddens, either generally or partially, with some swelling round the cornea; the tears flow incessantly, become irritating, and ex- 404 ANATOMY OF THE NOSE. coriate the cheeks; matter, at first limpid, after- wards thick and white, is discharged ; vision becomes confused; violent head-ache generally complained of. When it passes into the chronic stage, the vio- lent pains cease; the edges of the eyelids swell, turn red, and become painful; the flow of tears con- tinues and vision is weakened, which obliges the suf- ferer to desist in using these organs too long at one time. Q_. What are its anatomical characters ? A. Redness, swelling, and roughness of the con- junctiva. OF THE ANATOMY OF THE NOSE. Q. What bones compose the Nose ? A. Fourteen ; the two ossa nasi, two ossa maxilla- ria, and the os frontis on its upper and fore part; the os ethmoides, and two ossa unguis on its upper, inner, and lateral part; the two maxillaria superiora, two ossa palati, os sphenoides, two ossa spongiosa infe- riora, and the vomer, on its under, inner, and back part. Q. What parts are observable on the outer surface of the nose ? A. The radix or upper part, the dorsum or promi- nent ridge, the apex or point, the alae or moveable lateral parts, and the columna or under part of the septum nearest the upper lip. Q. Describe the number and situation of the Car- tilages of the nose ? A. The Cartilages of the nose are five in number: the middle one forms the anterior part of the septum nai'ium ; the two placed anteriorly form the tip, and the two posteriorly form the alae of the nose ? 0.. What is the use of the Cartilages of the nose ? A. Their elasticity tends to defend the nose from external injuries, and to increase or diminish the opening of the nostrils, by which the current of air ANATOMY OF THE NOSE. 405 inhaled through them may bring the odorous parti- cles Wlth more or less force against the extremities of the olfactory nerves, and thus affect the sensation of smell. Q- ^"hat parts are most deserving of observation in its internal surface ? A. The Nares, or Nostrils, commencing from the face, extend backwards to the fauces, upwards to the cribriform plate of the ethmoid bone, and to the body of the sphenoid ; are separated by the septum com- posed of the nasal lamella of the ethmoid bone,-of the vomer, and of the middle cartilage ; and they con- tain the ossa spongiosa. Q. With what parts do the posterior openings of the nostrils communicate ? A. They terminate in the fauces; receive the na- sal duct and Eustachian tube on either side; and communicate with the maxillary, frontal, and sphe- noidal sinuses. Q. What membrane lines the cavity of the nos- trils ? A. A thick, spongy membrane, termed membrana mucosa, pituitaria, or Schneideriana, covers all the internal surface of the nostrils, enters also into the different sinuses, nasal ducts, Eustachian tubes, fauces, and palate. Q. Is this Mucous Membrane of the nostrils fur- nished with many bloci-veasels and nerves? A. Yes; it is very vascular and nervous; and by being kept in a proper degree of moisture by the mucus emitted from the numerous follicles dispersed on its surface, it very considerably promotes the sense of Smell. Q. What are the properties of mucus? A. It is intended to cover the internal surfaces, as the cuticle is the outer surface of the body. It is transparent, viscous, ropy, of a saltish taste, reddens the tincture of turnsol, contains much water, muriate of potash, soda, lactate of lime, of soda, and phosphate of lime. 406 ANATOMY OF THE NOSE. Q. From what sources does the Nose receive its blood-vessels ? A. Branches from the facial and internal maxillary arteries are distributed upon the outer parts; and branches from the internal maxillary and some twigs from the ocular arteries are dispersed upon the in- ternal parts of the nose. Q_. What nerves are dispersed upon the nose ? A. Filaments from the superior maxillary or second branch of the fifth pair, and from the portio dura of the seventh pair, are sent to the external parts of the nose: the whole of the Olfactory nerves, and some twigs from the first or second branches of the fifth pair, are distributed upon the mucous membrane and internal parts. The olfactory nerves, very minutely spread on the surface of the pituitary membrane, constitute the organ of S7nell, while the other nerves supply the parts with their natural sensibility. Q. What is meant by odours? A. They are produced by a number of fine parti- cles which are emitted by various bodies : Some bo- dies do not send them off; these are denominated inodorous bodies. Q.. How are odours classed ? A. They may be classed into weak, strong, agreea- ble and disagreeable ; others are acknowledged as foetid, virose, spermatic, muriatic, &c. Q. How are odours propagated ? A. By the air; though certain bodies also produce them in vacuo, and propagate them with some force. Q. How is the sense of Smell produced? A. By the application of these odorous particles to the inside of the nose, and the impression through the olfactory nerves, which results from it. Q.. What is the use of the nose in the function of smelling ? A. It is probably intended to direct the odours to- wards the upper part of the nostrils ; persons, whose noses are deformed, or wanting, have no smell, and ANATOMY OF THE NOSE. 407 it is remarkable, that when the nose is restored, they recover this sense. Q.. What are the uses of the sinuses ? A. Magendie supposes to furnish mucus : the other uses attributed to it are uncertain. Q.. How is the sense of Smell modified by age ? A. It commences soon after birth, and continues till old age. Q. What is the use of the sense of Smell ? A. It is intended to distinguish thehealthfulnessof our food, as those aliments, in general, which have a disagreeable smell, are not proper to be eaten. Q. Enumerate the Organic Deiiaxgements to which the Nose is subject ? A. In infants the nostrils are sometimes closed by a membrane stretched across them ; its cartilages and bones are sometimes destroyed by Cancer, or by Lues venerea: it is exposed also to various external injuries ; its mucous membrane frequently becomes inflamed and thickened, and gives origin to Polypi growing from it; its external surface is affected sometimes with an herpetic eruption, which when ob- stinate and corroding, is called Noli me tangere. Q. Are the Sinuses connected with the nostrils the seat of organic derangements? A. Yes ; the inflammation of the mucous mem- brane of the nostrils is frequently communicated to that of the sinuses, and followed by ulceration and suppuration of these cavities. Sometimes tumours are found in them, accompanied with Curies and erosion' of the surrounding bones. Cysts containing a watery fluid, or worms, have been found in the max- illary and frontal sinuses. CORYZA. Q. What are its symptoms? A. The nares obstructed, dry, and itching, disa- greeable heaviness in the frontal sinuses, dull head- ache, frequent sneezing, loss of smell, lachrymation, change of the voice, secretion of mucus at first sup- 408 ANATOMY OF TUT. MOUTH. pressed, but becomes very abundant, serous, and irri- tating, which causes an excoriation round the nares ; it is afterwards thick, yellowish, or green, and, finally, returns to its natural quality and quantity. When it runs into a very chronic state, there is sometimes a discharge of purulent fetid matter, ulcerations having been formed. When this affection seizes infants at the breast, it prevents them from sucking, as the nasal respiration is impeded. The disease may be easily detected by examining the parts. Q. What are its anatomical characters ? A. Redness and injection of the mucous membrane, which sometimes is thickened and ulcerated, &c. ANATOMY OF THK MOUTH. Q. What soft parts compose the mouth ? A. The lips, cheeks, gums, palate, velum palati, uvula, and tongue. Q. What membrane lines the mouth ? A. The common integument is reflected, and having become extremely thin, lines the internal surface of the mouth. Q. Is the membrane changed when reflected into the mouth ? A. Yes ; it is covered with fine villi, and constant- ly kept moist by Saliva and mucus. Q. By what organs is the Saliva secreted ? A. The Saliva is secreted by the Parotid, Sub- maxillary, and Sub-lingual glands on each side of the face. Q_. Describe the situation of the Parotid Gland? A. It is somewhat of an oval form, situated be- tween the meatus auditorius externus, mastoid pro- cess, and the angle of the lower jaw; it extends up- wards to the zygoma, and forwards covering part of the masseter muscle. Q. Describe the course and termination of the duct of the Parotid Gland? A. From different parts of the glands various ducts ANATOMY OF THE MOUTH. 409 arise, which are united into one, named the Parotid or Salivary Duct, which passes from the upper and fore part of the gland transversely over the tendon of the masseter, and descending a little, perforates the buccinator and opens into the mouth opposite to the space between the second and third molaris of the upper jaw. Q. What is the situation of the Sub-maxillary Gland? * A. It is smaller and rounder than the parotid, is situated on the inside of the angle of the lower jaw, between it and the digastric and mylo-hyoideus mus- cles. Q. Describe the course and termination of the Duct of the sub-maxillary gland ? A. The duct arises from its upper and fore part, passes forwards between the mylo-hyoideus and ge- nioglossus, along the under and inner edge of the sub-lingual gland, to the side of the fraenum linguae, where it terminates in the form of a papilla behind the dentes incisores. Q. What is the situation of the Sub-lingual Gland? A. It is of a long, flat, and somewhat oval form, situated under the anterior part of the tongue, near the inferior maxilla; it is covered by the skin of the under side of the tongue, its ducts terminate in seve- ral orifices on the sides of the fraenum near the gums. Q. What circumstances promote the flow of Sa- liva ? A. The motions of the tongue and lower jaw in speaking and eating; the smell of savoury food ; slight inflammation of the mucous membrane and throat; and the use of mercury. Q. What is the use of the Saliva ? A. It moistens the mouth, facilitates the motions of the tongue, dilutes the food during mastication, and assists in its solution in the stomach. Q. What are the chemical constituents of Saliva ? A. Saliva consists of a large quantity of water, Vol. I. LI 410 ANATOMY OF THE MOUTH. Albumen, Mucilage, Muriate of Soda, and the Phos- phates of Soda, of Lime and of Ammonia. Q. What Organic Surgical Diseases are the Sali- vary Glands subject to ? A. They are frequently inflamed, indurated, and considerably changed or destroyed in their structure. Purulent matter, too, sometimes collects in the cel- lular substance connecting the lobules of the glands, or covering them. Q. What are the Surgical Diseases of the Salivary Ducts ? A. The ducts are sometimes divided by wounds, or destroyed by ulceration, and then the saliva flows over the cheek, and occasions a fistula. They are sometimes dilated and obstructed by Concretions. Q. What is the nature of the Salivary Concre- tions ? A. They are of a whitish colour, found generally in the ducts ; but sometimes in the sub-lingual gland, and occasion Ranula. They consist of Phosphate of Lime united with coagulated Albumen. Q. What is the tongue ? A. It is a muscular mass, which is the principal or- gan of speech and of taste, and has a considerable share in deglutition. Q. What are its connexions ? A. The Tongue is firmly connected at the root to the Os Hyoides; at the sides by membranous liga- ments to the styloid processes and lower jaw ; near the point by the fraenum to the parts below. Q. Has the tongue any thing peculiar in its tex- ture ? A. Yes; its cuticle forms vaginae, which receive the apices of the Papillae; its corpus mucosum is thicker and more moist than in other parts of the body; its cutis vera is very copiously supplied with numerous blood-vessels and nerves. Q. How are the Nervous Papillae of the tongue divided ? A. Into three classes; the Papillae Maximae vel ANATOMY OF THE MOUTH. 411 Capitatae; the Papillae Mediae; and the Papillae Mimmae vel Villosae. Q. In what parts of the tongue are these Papillae situated ? A. The Papillae maximae are situated nearest the base of the tongue : the Papillae Mediae are scatter- ed over its upper surface : the Papillae Villosae are the most numerous, and are most abundant near its apex; but they also occupy almost its whole inner surface. Q. Has the Tongue any mucous follicles in its tex- ture ? A. Yes; a great many are situated under its in- teguments, especially near its base. Q. In what part of it is the foramen caecum of Morgagni? A. At its root, and near its middle part, it is seen ; it receives the terminations of several excretory ducts. Q. What arteries are sent to the Tongue ? A. The Arteriae Linguales, one on each side sent off from the external Carotids. Q. What nerves are sent to the Tongue ? A. The two Gustatory nerves, sent off from the Inferior Maxillary of the fifth pair, are distributed upon the point of the tongue; the ninth pair, the Lingualis Medii, on each side terminate in its sides or middle parts; and the Glosso-Pharyngeus on each side is dispersed upon its root, and forms the Papillae Maximae. Q. Enumerate the principal uses of the Tongue? A. It is the principal organ of taste: it is the chief instrument of speech, by articulating the voice; it turns the food in the mouth during mastication, and thrusts it backwards into the pharynx in degluti- tion } it is also useful in sucking and spitting. Q. What is meant by taste ? A. It is the impression made by sapid bodies on the tongue or organ of taste. Q. Upon what does the sapid quality of bodies depend? 412 ANATOMY of the mouth. A. Principally upon their chemical qualities and their general effects upon the animal oeconomy; for some bodies which are entirely insoluble, have a very decided taste, whilst others which are very soluble have none whatever. O.. How are they classed ? A. No regular classification has been made; acrid, acid, bitter, acerb, sweet, are all mentioned, upon the general arrangement of tastes, according to tlieir being agreeable or disagreeable, the world is agreed: a distinction which is important, because it deter- mines the noxious or healthful qualities of bodies. Q, Upon what circumstances does the proper ex- ercise of taste depend ? A. Upon the healthy state of the lining membrane of the mouth, upon abundance of saliva, without which the sense is not exercised; if the mucus, saliva, &c. are deranged in their qualities, the taste be- comes thereby depraved. Q_. What parts exercise the function of taste? A. The surface of the tongue, the different parts of the mouth, and particularly its back part. Q. What is to be observed with regard to the du- ration of tastes? A. The impressions of some bodies in this respect are lasting, as aromatics ; others disappear sooner ; some affect one part, some another; thus acrid bodies leave an impression on the pharynx; acids, on the lips and teeth; peppermint in the mouth and pharynx. Tastes also differ in the strength of the impression; thus some are powerful and others weak, and this quality is used to take away the taste of medicines: different tastes can be perceived at the same time ; a faculty which requires time and much exercise, and which is of great use in chemistry. Q. What Organic Diseases is the Tongue subject to ? A. It is inflamed, swelled, and ulcerated, from the irritation of Caries Teeth, of Lues, or of Mercury: ANATOMY OF THE MOUTH. 413 it is sometimes covered by Aphthae; or is cracked by deep fissures; or becomes cancerous; or scir- rhous tumours grow in it, and degenerate into cancer. Q. What separates the Mouth from the Fauces? A. The Velum Pendulum Palati, forms a parti- tion which prevents the fluids we swallow from pass- ing into the nostrils; and it conducts the fluid of the nostrils into the fauces. Q. Where is the Uvula situated ? A. It hangs pendulous from the middle and poste- rior part of the Velum Palati, over the root of the tongue. Q,. How many arches does the Palate form ? A. Two on each side: the Anterior ones begin from the side of the base of the uvula, and are at- tached to the root of the tongue : the posterior ex- tend also between the base of the uvula and the side of the pharynx. Q.. By what is the Isthmus Faucium formed ? A. By the two anterior arches of the palate. Q. What are the organic derangements of the Pa- late ? A. Its soft portion is often inflamed and ulcerated in Cynanche Tonsillaris, and eroded by Lues Vene- rea, which also wastes its osseous portion. Polypi sometimes grow from it and hang into the pharynx^ Q. What are the surgical organic derangements of the Uvula ? .... A. In inflammation of the fauces and palate, it is often swelled, relaxed, and elongated. Tumours sometimes grow from it. Q. What is the situation of the tonsils, amygda- lae, or almonds of the ear ? A. One is situated on each side of the fauces be- tween the anterior and posterior arches of the pa- Q. What is the structure of the Tonsils ? A They are reddish-coloured oval-shaped glands, which have several openings on tlieir surface, lead- ing into cells communicating freely with each other. 414 ANATOMY OF THE MOUTH. Q. What do the Tonsils secrete ? A. They secrete a transparent mucus in their healthy state : but when inflamed, their secretion is whitish, and gives the appearance of a slough on their surface. Q. What organic surgical diseases are the Tonsils subject to ? A. They are very subject to inflammation, and its consequences, ulceration, and suppuration; very sel- dom to gangrene. They are sometimes so much en- larged that food or drink cannot be swallowed, or with very great difficulty. Calculi have been found in them. Q. Describe the situation and figure of the pha- rynx ? A. The Pharynx is somewhat of a conical figure, and is situated behind the tongue and nostrils, adhe- ring to the bodies of the cervical vertebrae behind, and to the Larynx before ; it terminates in the oeso- phagus. Q. What communications has the Pharynx with other cavities ? A. Six; two of which lead upwards and forwards into the nose; the orifice of the Eustachian tube on either side encircled by cartilage, and thereby kept always open, leading into the Tympana; one for- wards to the mouth, and two downwards, the ante- rior through the Larynx and Trachea into the Lungs, and the posterior directly down through the oeso- phagus into the stomach. Q. What is the structure of the Pharynx ? A. Its structure is muscular, consisting of different layers of fibres ; it is lined by a continuation of the mucous membrane of the mouth, perforated by the ducts of numerous glands and follicles, by which the mucus is secreted. Q.. What is the use of the Pharynx ? A. The Pharynx receives the food from the mouth, and by the contraction of its muscles transmits it into the oesophagus; it also assists in modifying the voice. OF THE LARYNX. 415 Q. What is the situation and structure of the la- rynx ? A. It is situated between the os hyoides and tra- chea at the fore part of the pharynx, and is compo- sed of five cartilages joined together by membranes, ligaments, and muscles. Q. Describe the situation of these Cartilages ? A. The Thyroid cartilage is the largest, and is si- tuated at the upper and fore part; from its anterior and superior angle, a broad ligament ascends to fix it to the os hyoides; and two round ligaments join its two ascending posterior and superior processes, or cornua, to the cornua of the os hyoides : the Cri- coid is placed below the thyroid, where it is narrow, but rises up thick, broad, and strong behind the thy- roid ; its under edge is horizontal, £nd firmly united to the commencement of the trachea: the two Ary- tenoid are small, and placed on the upper, posterior, and lateral parts of the cricoid, at a small distance from each other: the Epiglottis is placed obliquely over the aperture of the glottis, it stands nearly per- pendicularly, and when the tongue is retracted, it is pressed down, and covers the passage into the la- rynx. Q. Which of these cartilages contribute most to the tone of the voice ? A. The Arytenoid and Epiglottis. The arytenoid cartilages are triangular, a little twisted, and bent backwards; their upper extremities are turned to- wards each other; their posterior surface is filled up by the arytenoid muscles, their anterior is convex, with slight cavities, which are occupied by glands. They are connected to each other by the membrane of the larynx, and by muscular fibres ; also to the Epi- glottis by a membranous fold on each side, which form the sides of the aperture called glottis. The diminishing or enlarging of the glottis by its muscles, and the depressing or elevating of the Epiglottis by the movements of the tongue, chang^ the tones of the voice. 416 OF THE TRACHEA Q. What organic surgical derangements is the La- rynx subject to ? A. Its cartilages sometimes become ossified, and its internal membrane is often inflamed and suppura- ted ; the suppuration takes place in the sacculi la- ryngis, and there is a scrofulous thickening of the surrounding parts. Q. What is the situation of the trachea ? A. It descends from the under part of the cricoid cartilage in the fore part of the neck, between and behind the sterno-hyoidei and sterno-thyroidei mus- cles, passes into the thorax behind the curvature of the aorta, in the posterior mediastinum, opposite to the third dorsal vertebra; the trachea divides into two branches. Q. Describe thq^structure of the Trachea ? A. It has four coats; viz. a cellular, an elastic liga- mentous, a muscular, and a mucous ; the last of which is very irritable and vascular. The trachea is also furnished with sixteen or eighteen cartilaginous rings incomplete behind, united together by an elastic li- gamentous substance. Q. Why are the cartilaginous rings of the trachea incomplete behind, and at some distance from one another ? A. They are incomplete behind, that the trachea may naturally occupy less space; but particularly that the membrane filling up the space between their extremities may give way to the bolus of food when passing down the oesophagus into the stomach,, and that the tremors of these cartilages may be more considerable in the utterance of voice. They are at some distance from each other, that the length of the trachea may be varied in raising and depressing the chin for the utterance of acute and grave tones of the voice. O.. Has the muscular coat two layers of fibres ? A. Yes; the external layer is circular between the cartilages and in the back part, where the cartilages are incomplete: the internal layer is longitudinal, and the fibres are collected into bundles. AND THYROID GLAND. 417 Q. Is the innermost coat of the trachea kept al- ways moist? A. Yes ; it is every where perforated by the ducts of mucous glands and exhalent arteries, which pour out much mucus and moisture upon its internal sur- face. Q. What organic derangements is the Trachea sub- ject to? A. Its internal membrane is frequently inflamed, and then throws out coagulable lymph, which is in- spissated and formed into a layer of a yellowish pulpy matter, as frequently happens in Croup. The secre- tion from its glands too is much increased, and often mixed with pus, which greatly, and sometimes com- pletely, obstructs the Trachea and its branches. Its internal membrane has been found thickened and tu- berculated, and contracting its diameter for some inches. The cartilaginous rings of the trachea have been found ossified. Q. How many kinds of glands are connected with the trachea? A. Three kinds; the thyroid, tracheal, and bron- chial. Q. What are the situation and structure of the thyroid gland ? A. It is situated beneath the larynx upon the fore part of the trachea, covered by the sterno-thyroid, sterno-hyoid, and omo-hyoid muscles, is composed of two distinct lateral lobes, united by a transverse por- tion, and these are made up of smaller lobules; it receives a great quantity of blood for its size, is of the conglomerate kind ; it is covered by a condensed cellular sheath. Q.. What is the use of the thyroid gland ? A. The thyroid gland has a granulous appearance within, and a viscid fluid has sometimes been observ- ed in it | anatomists have hitherto detected no excre- tory ducts coming from it; therefore its particular use is still unknown. It has been thought to lubricate the neighbouring parts. 418 TRACHEAL AND BRONCHIAL GLANDS. Q. Is the thyroid gland often subject to disease ? A. Yes, particularly in some countries: this gland becomes greatly enlarged, and constitutes the disease called Bronchocele, or Goitre. Q. What change has been observed in the struc- ture of the gland by Bronchocele ? A. When the diseased gland was divided, a gelati- nous fluid was found in its cells, or sometimes a bloody fluid. After unnatural enlargement from in- flammation, ulceration has followed, and produced a scrofulous discharge. It is sometimes, though rarely, ossified, or dropsical, or indurated, or passes into Fuflgus Haematodes. Q. What is the situation and use of the tracheal glands ? A. These glands are numerous and but small, situ- ated in the posterior part, and between the cartilagi- nous rings of the trachea; from them ducts issue, pouring their mucus upon the internal surfade, which is thereby defended from the irritation of the inhaled air, or acrid particles carried in with it. Q. Describe the situation and use of the bron- chial GLANDS ? A. The bronchial glands are situated in cellular substance around the trachea, where it divides into two branches; they are of a dark purple colour, and belong to the lymphatic system, as absorbents pass through them. END OF VOLUME I. NATIONAL LIBRARY OF MEDICINE NLI1 D3EDM51t 3 "t^V*"-;' NLM032045963