CONVERSATIONS
ANATOMY,  PHYSIOLOGY,
       SURGERY.


   A.  ROBERTSON, M.D.
LECTURER ON THE PRACTICE OF PHYSIt*.
First American Edition, toith Pathological and
            other Additions.
       IS TWO VOLUMES,.^ Cv.1.f> e
          VOL. I]/          '^



                            -*"

PUBLISHED BY TOWAR & HOGAN,
     .\». 255, Market Street
           1828. 

^
 3
( 
            CONVERSATIONS

                       ON

ANATOMY, PHYSIOLOGY, AND PATHOLOGY
          ANATOMY OF THE THORAX.

  Q. How are the parts of the thorax commonly di-
vided?
  A. Into external and internal parts.
                 OF THE MAMMJE.
  Q. We have discussed the bones and muscles of
the thorax; describe now the situation and structure
of the mamma.?
  A. The Diammst  are situated on the anterior and
lateral parts of the  thorax, adhering by cellular sub-
stance to the pfctoralis major on each side. Their
structure is whitish  and glandular, being of the con-
glomerate kind; a great number of smaller glandular
masses, separated by adipose substance, compose the
mamma; and each of them  has its lactiferous ducts,
which unite with others, and form larger tubes that
open in  the papilla.
  Q. 'What is the nature of the Papilla or JVipple?
  A. It is composed of tough cellular substance, en-
veloping the  terminations  of the  lactiferous tubes
opening upon  its apex; it is red-coloured, and  of a
conical shape;  its base is surrounded by the Areola,
of a colour different from the rest of the skin.
  Q.  What is the use of the mammas?
  A. They ornament the breast of females, and se-
crete milk for their offspring.
  Q.. Do the mammre differ in size  at different pe-
riods of life? 
4
OF THE MAMMjE.
  A. Yes; in girls they are small; after puberty they
become prominent; during utero-gestation they in-
crease in size; after the cessation of the menses they
become smaller, soft, flaccid, and pendulous.   After
fecundation there arc peculiar feelings in the breast,
and these organs begin to swell; on the  approach of
gestation, a serous fluid escapes, sometimes in great
quantities, called the colostrum.
  Q. Does Titillation alter the size of the Nipples,
or influence the secretion of the mammae ?
  A. Yes; titillation of the nipple increases its size
and distension;  affections of the mind do the  same.
By titillating, handling, or applying a child frequent-
ly to the nipples, milk has been brought into  the
breasts both of" young and old women; nay, even into
those of men.
  Q. What are the properties of milk ?
  A. It is composed of cream and of milk ; the last
contains water  28.75 parts;  cheese with a trace of
sugar,  28.00 ; sugar of milk, 35.00;  muriate of pot-
ash,  1.70;  phosphate, 0.25, lactic acid, acetate of
potash, and lactate  of iron, 6.00; phosphate of lime
0.30. Cream contains, butter 4.5 ; cheese, 3.5;  whey,
92.0, in which 4.4 parts of sugar of milk and some salt.
   Q. Does the nature of  the  aliment change that of
the milk ?
   A.  It is more abundant, thicker,  less acid, when
the diet is animal;  vegetables produce a contrary ef-
fect in all these respects: purges taken  by the  mo-
ther render the milk cathartic ; alcohol renders  it
stimulating,  &c.  The milk continues  good during
the course of the second year.
   Q. What organic derangements take  place  in the
Mammx?
   A. Their structure is  frequently destroyed  by in-
 flammation and induration,  or followed by suppura-
 tion ; by schirrous tumours ,  by cancer, &c.

   ANATOMY OJ THE INTERNAL PARTS OF THE THOnAT.
   Q. What are the internal parts of the thorax' 
      OF THE PLEURA AND MEDIASUNUM.     5

  A. The pleura, mediastinum, lungs,  pericardium,
heart, vessels, nerves, and thymus gland.
  Q. Describe the pleura ?
  A. The pleura is a thin pretty  strong membrane,
whose external  surface is cellular, adhering  to the
parts surrounding it; its internal surface  is smooth
and  polished, moistened by a serous fluid emitted
from its exhalant arteries.  The pleura forms the me-
diastinum, which divides the thorax into {wo distinct
cavities.  The pleura adheres to the internal surface
of the ribs, intercostal and stemo-costal muscles, ster-
num, dorsal vertebrae, and upper  surface of the dia-
phragm, and  is called Pleura costalis,- it also  covers
the pericardium and lungs, and is  there called pleura
pulmonalis.
  Q. Do the  contiguous surfaces of the pleura costa-
lis and pleura pulmonalis not adhere?
  A. Not in their  natural and sound  state; the ex-
haled fluid prevents adhesion : in  cases of  inflamma-
tion, however, they frequently adhere.  The  poten-
tial space between them forms  the  cavity of the
thorax.
  Q. Describe the mediastinum?
  A. It is double, being formed by the reflection  of
the pleura, whose  two layers are united by cellular
substance; the  anterior mediastinum is connected
with the sternum before, and witli the pericardium
and large vessels of the heart behind.
  Q.  What is contained in the interior Mediastinum?
  A. The two layers of it separate at the upper part
of the thorax near the sternum, and include the Thy-
mus Gland.
  Q. What does the Posterior Mediastinum contain?
  A. It extends from the root of the lungs and back
part of the heart to the dorsal vertebrae : between
its layers a triangular space is formed, containing the
under end of the Trachea, the OZsophagus, the Aorta
Descendens,  the Vena Azygos, the Thoracic Due'.
and the two trunks of the eighth pair of Nerves.
  Q. What is the use of the Mediastinum7
         a2 
6          ORGANIC DERANGEMENTS.
   A. It divides the thorax into two cavities which do
 not communicate with each other;  it supports their
 contents, and  prevents  the weight of the one  side
 from pressing the other; or any fluid effused in  the
 one  lung from passing into the other.
   Q. What organic derangements is the Pleura  sub-
 ject to ?
   A. It is very subject to inflammation, during which
 it pours out a great quantity of a serous fluid into
 the cavity of the thorax, and it is often mixed with
 pus: its texture is thickened and pulpy, and its sur-
 face is often covered with a layer of coagulable lymph,
 which forms adhesions to the contiguous parts. Some
 portions of the pleura have been found ossified. When
 pus is collected in the cavity of the thorax, it is called
 Empyema.  When a serous or watery fluid is poured
 out by the Pleura into the cavities of the thorax, it
 produces Hydrothorax.

             ANATOMY OF THE LUNGS.
   Q. How many lungs are there ?
   A. Two; a right, which is divided into three lobes,
 and a left, which is divided into two,  the heart occu-
 pying the middle space.
   Q. Do the Lungs in their natural condition fill  the
 cavities of the thorax ?
   A. Yes;  they are in contact with the surrounding
 parts, and completely fill the thorax.
   Q. What are the connections  of the Lungs?
   A. They are connected with the  trachea by  the
bronchia, with the spine  by the two layers of the Me-
diastinumj and with the heart by the pulmonary ves-
sels.
   Q. Is each lobe of the  lungs again subdivided ?
   A. Yes;  each is again divided into a great many
lobules of different forms and sizes; and these  di-
minish, and ultimately degenerate into Cells or Ve-
sicles.
   Q. How many Coats have the Lungs ? 
OF THE  LUNGS.                7
  A. Two; their external coat is a reflection of the
pleura; their internal or proper  coat adheres firmly
to the former, insinuates itself between the Lobules,
and is intimately connected with  their cellular sub-
stance.
  Q. Of what Vessels are the Lungs composed ?
  A. Of bronchial vessels, blood vessels, absorbents,
and  nerves.
  Q. Describe the structure of the Bronchial Tubes?
  A. Their structure in the larger tubes is nearly the
same as that of the trachea; the  cartilaginous rings
are divided into pieces, which  however can keep the
tubes  open; they  become thinner,  and  after they
have descended a considerable way into  the  sub-
stance of  the lungs, the cartilaginous  fabric disap-
pears ; the muscular coat goes down from  the trachea
into the substance of  the lungs upon the bronchial
tubes, farther than the cartilaginous rings are ob-
servable :  and after the bronchial tubes become small,
having dropt their  cartilaginous and muscular tex-
ture, the elastic ligamentous coat, and the innermost
irritable membrane of  the trachea, are continued to
their terminations in the numerous cells of the lungs.
  Q.  Do the Bronchial  Tubes form many ramifica-
tions ?
  A. Yes,  a great many; for there branch out from
the larger  tubes innumerable smaller ones, which be-
ing still much more minutely  divided,  are disposed
in such a manner as to occupy the whole of the neigh-
bouring space; their  ramifications resemble the
branches of a tree, and their terminations in the cells
a cluster of grapes:  and this disposition is continued
throughout the whole of the  lungs, which are thus
made, when the bronchial tubes and cells are filled
with air, to occupy the whole space of the thorax,
not taken  up by other viscera.
  Q. Is the Membrane which lines the bronchia a mu-
cous one?
  A. Yes ; it is strictly speaking a mucous membrane;
and this in a very thin attenuated  state forms the in- 
A
PULMONARY VESSELS.
numerable Cells at the termination of the bronchial
tubes.
  Q.  What Blood-Vessels are dispersed throughout
the lungs?
  A.  The Pulmonary and the Bronchial Vessels.
  Q.  Describe the Pulmonary Jlrtery?
  A.  This artery, arising from the Right Ventricle of
the heart, ascends behind the sternum within the pe-
ricardium, as high as the concave part of the arch of
the aorta, where it divides  into two brandies; the
right being the longest and largest, passes behind the
curvature of the aorta, and  the  superior vena cava;
these branches divide into ramifications,  which ac-
company the bronchial tubes through the  substance
of the lungs.
  Q..  Describe also the Pulmonary Veins?
  A.  The extremities of  these  veins receive the
blood from the Pulmonary Arteries; then they  unite
and form larger and larger trunks, which accompany
the course of the bronchial tubes and branches of the
pulmonary artery; at last  the  pulmonary veins  in
each lung form two trunks, which, with the two of
the other lung,  making in all four venous trunks,
terminate in the  left auricle of the heart.
  Q. Describe the Bronchial Jlrteries?
  A. They arise from the anterior part of the de-
scending Aorta; two are  commonly sent to  each
lung, they divide and follow the distribution of the
rronchia through the lungs.
  Q. Describe the course of the Bronchial Veins?
  A. These veins receive the blood from their  arte-
ries, unite into larger and larger trunks, accompany
the branches of  the bronchia, and terminate in the
Vena Azygos and left  Superior Intercostal Vein.
  Q.  What course do the deep-seated Lymphatics ob-
serve in the Lungs ?
  A.  They follow the course of the bronchial tubes
in the same manner as the pulmonary  veins do ; and
lastly, pass through the bronchial glands. 
PHYSIOLOGY OF THE LUNGS.        9
  Q.  What course do the Nerves take which are dis-
persed through the deep-seated parts of the lungs?
  A.  They arise  from the anterior  and posterior
pulmonary plexuses near the division of the trachea
into the bronchia, accompanying the branches of the
bronchia and blood-vessels in  the substance of the
lungs, and are ultimately dispersed upon the internal
membrane of the Air Cells.
  Q.  What connects the lobes, lobules, cells,  bron-
chial  tubes, blood-vessels, absorbents, and nerves of
the lungs together ?
  A.  Cellular Substance, completely destitute of fat,
is interposed, unites the different vessels and parts
firmly together, and supports them in their relative
situations.
  Q_.  Have the Cells of the bronchial tubes any com-
munication with those of the cellular substance of the
lungs ?
  A.  No; the bronchial cells communicate with each
other through the  medium of their tubes ; but they
have no communication with the common cellular tex-
ture  of the lungs?
  Q.  Do  the Cells in the cellular substance of the
lungs communicate with each other ?
  A.  Yes; most freely, as they do in other parts of
the system ; hence when they are filled with an ef-
fused fluid, they constitute the disease  called Hy-
drops Pulmonum.

             PHYSIOLOGY OF THE LUNGS.
  Q.  What causes produce the motion of the  blood
in the pulmonary veins ?
  A. The contraction of the right ventricle, and the
approach of the sides  of the pulmonary artery:  the
capillaries which are supposed to drive on the  blood
would be as likely  to send it backwards as forwards,
as it is supposed, that when the blood  gets to the ca-
pillaries, it ceases to obey the influence of the heart.
The  agency of these vessels is beyond the cognizance
of the senses, and therefore not a matter of science, 
 iO         REMARKS ON THE AIR AND

but of supposition.  In reptiles, the  passage of the
blood from  the artery to the vein can be seen by
glasses, and there is no pause in the capillaries.  The
action of the right ventricle is the true cause.  There
can be no doubt that the compression of the sides of
the small and large vessels of the lungs by their col-
lapse, has some effect in retarding the course of the
blood : this, however, is a mere mechanical obstruc-
tion.  In it, the capillaries are passive.
  Q.  Are there any other causes  which influence
the motion of the blood through the lungs?
  A. The eighth pair  modifies most probably the
state of the vessels of the lungs, and thus facilitates
or retards its passage.  When it is divided the circu-
lation is retarded, by the infiltration of the cells with
serosity: it is probable that its division facilitates this
infiltration by rendering the membranes of the lungs
more porous.
  Q.  Do the pulmonary veins absorb ?
  A.  They do,  as is evident from the inhalation of
turpentine, which  soon appears  in the urine.   It is
in this manner that deleterious gases, medicines, and
miasmata in the air often produce their effects upon
the system.

              OF THE RESPIRED AIR.

  Q. What is the air or atmosphere ?
  A. It is a fluid surrounding the earth to the height
of 45  miles, composed of oxygen and azote, and  a
small  portion of fixed air, the former of which sup-
ports life.  It is elastic and compressible ; the high-
er strata are more rare  than those below,  which bear
the whole weight of the atmosphere, which is suffi-
cient to support a column of mercury equal in height
to 28  inches, forming the instrument called the baro-
meter.
  Q.  Does this pressure vary ?
  A.  It is less of course as we ascend  the upper re-
gions of the air, as upon  the summits of mountains
than at their bases ; greater when the air is charged 
BLOOD IN RESPIRATION.
11
 with humidity, than when it is dry, changes exhibited
 by the barometer.
   Q.  What are ics other properties ?
   A.  It dilates by  heat; it is heavy, thus a balloon
weighed when filled with air, is heavier than when it
is empty; air is 770 times lighter than water: it is
always more or less charged with humidity, in pro-
portion as its temperature is raised.   The degree  of
moisture is shewn  by the  hygrometer: when the
temperature  is  depressed, the moisture is precipi-
tated, and forms clouds and  rain.  Though  transpa-
rent,  its colour is light blue; as is proved from the
colour of distant objects.
   Q.  How and  by what means does  the air  gain ad-
mittance into the lungs ?
   A.  When the thorax is dilated, the lungs  being
extensible, and  each  lobule communicating with a
branch  of the  wind pipe, the air is pressed  in
through the  nose and mouth  into  their cavity, the
one or other  being opened by the raising or depres-
sion of the velum of the  palate: when  we breathe
through the nose, this partition falls upon the tongue ;
therefore when we wish to examine  the posterior
parts  of the fauces, it is necessary  to make the pa-
tient  breathe through the mouth.   If the mouth  is
full of food we breathe through the nose; when the
nose is obstructed by mucus, through the mouth.
   Q. What is the number of respirations in a minute?
   A. It differs in different individuals ^from 14 to 27)
varying according to distension of the stomach, exer-
cise, fever, the capacity of the  lungs, &c.
   Q. Does the volume of air diminish in the lungs ?
  A. By the latest experiments there appears to be
no difference in the air after breathing and before.
  Q. Do any  changes  take place on the air inspired
into the lungs ?
  A. Yes; the air expired is loaded with vapour, and is
charged with Carbonic Acid Gas, which is demonstra-
ted by passing it through Lime Water, which is ren-
dered turbid  by the formation of Carbonate of  Lime 
 I 2        REMARKS ON THE AIR AND

  Q. From what source comes the  Carbonic  Acid
 Gas?
  A. From part of the Oxygen of the inspired Air
uniting chemically with the Carbon emitted from the
blood.
  Q. How is it proved that a portion of the Oxygen
of the inspired air is thus disposed of t
  A. It has been found by repeated and accurate ex-
periments, that a portion of the oxygen in the air in-
spired disappears, when it is  expired ; and that the
quantity of oxygen necessary to constitute the carbo-
nic acid expired is exactly equal to that which had
disappeared.
  Q. Whence comes the Vapour in the air expired ?
  A. The exhalant vessels of the  lungs throw  out a
fluid, which by acquiring' caloric is  converted into va-
pour, and emitted with the expired air.
  Q. How is this proved ?
  A. Water injected into the pulmonary artery passes
in innumerable drops through the  air cells   If water
be injected into the arteries of a dog, its vessels will
be extremely distended, so that it will have great
difficulty to move: in a short time  the movements of
the thorax will be increased in number, and the wa-
ter will be discharged  by pulmonary transpiration.
Weak alcohol, a solution of camphor, of ether, intro-
duced into the cavity of the  peritoneum, or in  other
parts, are also discharged by the lungs.  Phosphoric
acid  is discharged by the nostrils, after injecting a so-
lution of oil and phosphorus into the crural vein.
  Q.. From what source comes the  Caloric generated
in the Lungs?
  A. From the differences of capacity of the Oxygen,
and of the Carbonic Acid, for retaining Caloric ;  for
the Oxygen, when it forms a part of the atmospheric
air, has a greater capacity for combining with and re-
taining Caloric, than it has when in combination with
Carbon in the Carbonic Acid; hence a part of the
latent Caloric is set at liberty, and becomes sensible,
 when the Oxygen changes its state, and enters into 
            BLOOD IN RESPIRATION'.          13

 the formation of the Carbonic Acid.  This evolution
 of Caloric is the source of heat communicated to the
 animal body.
   Q.  Does this evolution of free Caloric then increase
 the temperature of the lungs above that of other parts
 of the body?
   A.  No; but it would increase the  temperature of
 the lungs very much indeed, were no provision made
 in the animal economy for its reception.
   Q.  By what provision of Nature is the free Caloric
 absorbed or disposed of in the lungs ?
   A.  The  venous  blood  is  charged with  Carbon,
 which, when the blood circulates through the lungs,
 is brought into near contact with the Oxygen in the
 bronchial cells, separates from the blood, enters into
 combination with part of the Oxygen of the atmos-
 pheric  air,  and  forms Carbonic Acid;  wliile the
 Blood, having thus lost its superfluous Carbon, has
 its capacity for receiving and entering into combina-
 tion with Caloric  much  increased.  The  Caloric,
 therefore, as soon as it is  evolved  by the Oxygen
 changing its state,  is immediately absorbed by the
 Blood, enters into combination with  it, and  becomes
 latent.
   Q.  Is the  colour of the Blood affected by the  Car-
 bon?
   A. Yes; the  blood much charged with Carbon  is of
 a  purple colour; but when  it has parted with the
 Carbon, it becomes much redder, and what is com-
 monly called arterial blood.
  Q. How does Carbon affect  the  capacity of the
 blood for retaining Caloric?
  A. The matter necessary for the formation and de-
 position of particles, requisite for the renovation of
 wasted parts of the system, is prepared by the ex-
 treme arteries, whether in glands, or otherwise ; and
during that  preparation Carbon  is disengaged,  and
enters into the blood, which is  received into  the
veins.  In proportion as the carbon thus  accumu-
 lates,  the capacity of the blood for retaining Caloric
         B 
 14      REMARKS ON RESPIRED AIR, StC.

 is diminished;  the latent Caloric therefore is  disen-
 gaged from  its combinations, become* sensible, and
 produces animal heat: and as the extremities of ar-
 teries are general every where  in the system, so is
 the evolution of free  Caloric, and the generation of
 animal heat.
   Q.  Does the oxygenation  of the  blood alter its
 qualities in any other  respect ?
   A.  Its taste and smell become more decided.  Its
 coagulability also increases;  its specific gravity  is
 lessened; the serum is also less in arterial blood.
   Q. Does oxygenation take place after death ?
   A.  Yes ; it is on this principle that resuscitation of
 drowned persons is effected ; the venous or black
 blood becoming suddenly arterial on blowing air into
 the lungs;  this change also takes  place through a
 bladder, when filled with venous blood, and plunged
 into oxygen gas; or on exposing the surface of venous
 blood to the  air.
   Q. How  is  the colour of the blood accounted for ?
   A. Some attribute  it to iron, but this is doubtful.
Its cause is unknown.
   Q. What is the effect of the  respiration of other
gases ?
   A. They are all  mortal; even oxygen, and the
 components of atmospheric air, in other than the na-
 tural proportions.
   Q. Are the different gasses all equally pernicious?
   A. Azote,  hydrogen, &c. destroy life by  being
non-respirable; others  are directly deleterious, as
sulphuretted  hydrogen, ammoniacal gas, arseniated
hydrogen, nitrous gas, oxymuriatic acid gas.  The ni-
trous oxide is for  a short time respirable, produces
great intoxication, and if the respiration be continued,
death.
  Q. What is the influence of the eighth pair  in re-
spiration ?
  A. Its division destroys the animal sooner or later,
at most in three or four days : It produces its effects
upon the glottis,  which it  closes by the  suspension 
          PATHOLOGY OF THE CHEST.         15

of  the powers of the recurrent, which supplies the
muscles which open the glottis, and thus the animal
cannot inspire and dies of suffocation.  This is the
cause when death  takes  place immediately: when
life  continues for  three  or  four  days, the animal
breathes with difficulty, is easily fatigued, lies per-
fectly still; the difficulty of breathing increases ; the
arterial blood loses its scarlet colour, the animal be-
comes colder and at last dies.  The lungs are found
filled with froth,  with some serum effused into the
parenchyma  of the  lungs.   The  functions  of the
lungs are in this case gradually destroyed, the blood
not being arterialized.  If only one nerve is cut, life
is continued by the lungs alone, for many months.
  Q. How is respiration kept up by artificial means?
  A. By blowing with a bellows  into the  nose or
mouth; by applying the  mouth of a person to the
mouth of the  person whose respiration is suspended.
Life can  be preserved for several hours in this way,
even after the spinal marrow has been divided : after
some time, from the effusion  of air into the cellular
membrane  about the air-cells, the lobules  do not
dilate, and the distension  of  the lungs is thus pre-
vented.
  Q. What Organic Derangements are the lungs sub-
ject to ?
  A.  The lungs are subject to the following diseases.
        PATHOLOGY OF THE CHEST.

           Affections of the Air-Tubes.

                angina laryngea.

  Q..  Wliat are its symptoms ?
  A.  They are pain in the region  of the larynx, in
creased by pressure, by the action of deglutition,
coughing or speaking; the stethoscope indicates the
presence of the  " rale muqueux;" and as this de- 
16       PATHOLOGY OF THE CHEST.
 pcnds on the fluid in the trachea, it is evident  in
 proportion as that fluid is more abundant and less
 tenacious, the air bubbles being evolved with great-
 er  or less facility according to its degree of consis-
 tence. The voice is sensibly altered, becomes hoarse,
.frequent  cough, increased by speaking, which also
 becomes hoarse, painful, suffocating, and is accom-
 panied by an expectoration, the product of which is
 variable,  sometimes consisting of mucus, sometimes
 of pus, or of a mixture of both.
  Q. What are its anatomical characters ?
  A. The mucous membrane lining the larynx, and
 particularly  the glottis  and  epiglottis, is red and
 injected; which appearance  is either  in  spots, or
 diffused  to  a  greater  or less extent.  It is also
 somewhat swollen, and  on its  surface is effused a
 viscid  or puriform  fluid.  When the  disease  has
 continued for any length of  time,  the redness dis-
 appears, and the membrane acquires an increase of
 thickness; small ulcerations are occasionally in this
 case observable  upon it, particularly at the sides of
 the glottis.

                    TRACHITIS.
  Q. What are its symptoms  ?
  A. They are pain in the inferior part of the neck
 below the layrnx, extending downwards behind the
 sternum ; this is increased by pressure and by inspi-
 ration, and is accompanied by a mucous rattle, such
 as occurs in  laryngitis,  which is perceptible in the
 trachea but  not in the lungs, or even at the root of
 the bronchi; the voice is but little altered except at
 intervals, when the  mucus secreted  in  the trachea
 becomes accumulated in the  larynx, but this hoarse-
 ness of the voice ceases after  expectoration.
   Q_. What are its anatomical characters ?
   A. Kedness of the mucous membrane, which  is
 covered with a viscid or purulent fluid, and if the
 affection has passed into the chronic  form, the
 membrane usually presents  several small spots of 
PATHOLOGY OF THE CHEST.        17
 ulceration, always less  numerous than in the larynx.
 In some cases the ulceration extends so  as  to per-
 forate the walls of the trachea.

                      CROUP.
   Q. What are its symptoms ?
   A. In this  disease there is a combination of the
 symptoms of  the two  preceding affections, toge-
 ther with  spasm  of  the glottis, accompanied  by a
 peculiar alteration of the voice, and a cough which
 comes on in fits, the intervals between which diminish
 as the disease  advances ; the dyspnoea is extreme, the
 respiration  sibilant.  This disease, which usually at-
 tacks children, and occasionally adults, sometimes be-
 gins, with a slight cough, attended  with pain, though
 not  very acute, of the larynx or trachea;  to this
 sometimes  is  added a tracheal mucous "rattle;" at
 other ^mes, however, it sets in suddenly without any
 perceptible premonitory symptoms; the patient in
 many instances is awakened during the night by a se-
 vere fit of coughing, which is at first dry, but is  soon
 followed by the expectoration of a viscid fluid, some-
 times puriform or combined with flocculi of an albu-
 minous  substance.  Th,e cough may  be either acute
 and shrill, like the crowing of ayoungcock, or may be
 hoarse, low, and deep ; the voice too becomes hoarse,
 particularly when  the inflammation approaches the
 glottis; the inspiration is sibilant, in consequence of
 the spasm at the glottis,  and is always heard at a con-
 siderable distance.  The little patient experiences a
 severe constriction in the throat, frequently raises his
 hands towards his  neck ; the face becomes swollen,
and presents the appearance of considerable conges-
tion ;  the dyspnoea increases in intensity.
  Still the  symptoms may diminish, and a remission
supervene, but the cough retains its peculiar charac-
ter, and  the voice its hoarseness; a second attack,
more violent than the first, comes on, and induces fits
of coughing attended by an expectoration, either of
a mucous or purulent fluid, or of portions of false
         b2 
 18       PATHOLOGY OF I HE CHEST.

membrane, or even of membranous tubes of a form
perfectly cylindrical, the removal of which, in gene-
ral, gives some momentary relief.
  When the expectoration consists of a viscid mucus,
we can distinguish a " rale muqueux," with an easy
disengagement of the air-bubbles ; if the expectora-
tion be puriform, the " rale sibilant" is perceived, giv-
ing a sensation which announces the presence, in the
larynx and trachea, of a more thick and viscid fluid.
When false membranes are being expectorated, there
is no "rale," but we can distinguish a sound similar
to that of the valve or  clapper of a pump,  which is
audible  only at intervals, when the false membrane is
partially detached by the passage of the air through
the larynx.  If this sound is perceived during inspira-
tion, it indicates that the membrane is detached at its
superior extremity, but if during expiration, then
the detachment must have occurred  at the inferior
one.
  Finally, the hoarseness of the voice and  the dys-
pnoea increase as  the inflammation proceeds; some-
times complete aphonia takes  place,  but is removed
momentarily, by expectoration ; the fits become more
and more violent,  and occur at shorter intervals ; the
"cough becomes more frequent as the consistence of
the expectorated  matter diminishes, and death, if the
termination be fatal, soon closes the scene.
   The diseases with which croup may be confound-
ed are simple laryngitis, suffocating catarrh, and oede-
ma of the glottis.
   Q.  What are its Anatomical  Characters ?
   A.  The mucous membrane  lining the  larynx,
upper part of the trachea, and sometimes even the
larger divisions of  the bronchi, exhibits a greater
or  less degree  of redness,  which  disappears  ra-
ther suddenly; it is sometimes  covered by a false
membrane,  of a pale yellow, or  greyish colour,  the
thickness of which depends on the intensity and ex-
tent of the inflammation.  This production lines  the
inner surface of the larynx and trachea and com- 
           PATHOLOGY OF THE CHEbT.         19

 mencementof the bronchi ;  it is either moulded into
 a tubular form, or appears in  detached  portions,
 blended with mucus, or flocculi  of albuminous mat-
 ter ; it is sometimes separated from the mucous mem-
 brane, by a viscid or puriform  fluid;  at others it ad-
 heres  more or less intimately, according to the  de-
 gree of the inflammation, and also as its seat is nearer
 to the glottis.  When the disease has been of short
 duration, the false membrane  is usually confined to
 the trachea.   The redness of the mucous membrane
 and tumefaction of its follicles, are  considerable.
 In several cases,  the under surface of the epiglottis
 becomes coated by the false membrane, and the rima
 glottidis is obstructed by it, or by the purulent mat-
 ter which  frequently occurs in place of it.  Finally,
 cases have occurred in which the mucous membrane
 of the  air-tubes was covered  merely by a viscid fluid,
 or by pus, ami still death took  place as speedily, and
 with precisely the same symptoms, as mark the pro-
 gress of the disease in those in whom the false mem-
 branes really exisied.   Those  who die of croup ge-
 nerally exhibit a high  degree of congestion of the
 lungs, and also of the vessels of the brain.

              03nEMA OF THE GLOTTIS.
  Q. What are»its symptoms ?
  A. They are pain, or a feeling  of uneasiness at the
 upper  part of the larynx, giving to the patient the
 sensation as if a foreign body were lodged there ; this
 impression is so decided, that he fancies the body is
moved during deglutition, and changes its place, so
as to occupy the aperture of the  glottis, or one of its
 sides during expiration.  From the commencement
of the  disease, respiration is performed with extreme
difficulty, recurring by  fits, which threaten instant
suffocation ;* inspiration is sonorous or sibilant—ex-

  * Cases have occurred in which tracheotomy has been resorted
to, for the removal of foreign bodies supposed to be lodged in the
larynx or trachea—but in some  of them nothing of the kind 
20
PATHOLOGY OF THE  CHEST.
piration/h?if and easy. The voice is hoarse and some-
what weakened, occasionally altogether suppressed.
If the finger can be carried along the tongue, as far
as  the upper  extremity of the larynx, a soft tumor
may be felt, about the margin of the aperture of the
glottis.  The severity of the symptoms gradually in-
creases.andthe patient generally dies rather suddenly.
  Q. What are the diseases  with which it may be
confounded ?
  A. They are croup or suffocating catarrh.
  Q. What are its Anatomical Characters ?
  A. The  margins of the glottis are thickened and
swollen, forming  a tumor of greater or less size,
caused by a serous, or still more rarely, a sero-puru-
lent infiltration of the sub-mucous cellular tissue, but
without any constant redness of the  mucous mem-
brane.  A  similar turgescence is sometimes found on
the inner surface of the larynx, which sometimes re-
sembles phlyctense, caused by the  application of a
blister to the skin.  The epiglottis occasionally pre-
sents the same appearance.  We  also in some cases
find chronic alterations of different descriptions in
the larynx.

             catarrh.  (Suffocating,')
  Q. What are its symptoms ?       •
  A. The  attack comes on very suddenly, often du-
ring the night, attended by considerable difficulty of
respiration,  threatening of suffocation, a sensation
of compression of the thorax, and cough more or less
painful; to this state a remission generally succeeds,
which is soon followed by a more violent attack, which
is in general fatal.

could be discovered even after the most careful examination.  It
would appear that such a mistake may occur from the close re-
bemblance that exists between the symptoms of oedema of the
glottis, and those caused by the presence  of a foreign body.
Expiration is comparatively free and easy  in edema,  but in
cases of foreign bodies in the trachea both inspiration and expi-
ration are sibilant and difficult. 
PATHOLOGY  OF THE CHEST.        2l
   Q. What are its Anatomical Characters ?
   A. They are unknown.
   Q. What are  the  diseases with which it may be
 confounded ?
   A. They are, croup, asthma, and oedema of the
 glottis.

               PULMONARY CATARRH.*
   Q. What are its symptoms ?
   A. Catarrh, considered  as an inflammation of. the
 pulmonary mucous membrane,  is divisible  into two
 stages, the acute and chronic.   Its degrees of inten-
 sity vary from the slightest cough to such a  derange-
 ment as  makes it resemble phthisis in almost every
 particular.  It begins with  irritation in the throat,
 and dry cough ; but, after  an interval, which  varies
 according to the constitution of the individual, or the
 treatment resorted to, each fit of coughing is follow-
 ed by the expectoration of a clear, transparent, glairy
 mucosity, somewhat similar  to the white of an eg^;
 the greater (he degree of inflammation in the mucous
 membrane, the greater is the viscidity and tenacity of
 its secretion.   When the patient is seized  with vio-
 lent fits of coughing, accompanied by a sense of heat
 in the interior of the chest;  by general anxiety and
 oppression; the expectorated matter acquires a de-
 gree of viscidity, somewhat approaching the gluti-
 nous sputa of acute pneumonia.
   In the midst of this transparent matter we  some-
 times find several small  particles of a dull white co-
 lour, which have been frequently mistaken for por-
 tions of  pulmonary  tubercle, and therefore indica-
 tive of phthisis.f  They do not, however, come from

  • Thii chapter is somewhat too brief in tha original, it hai
 been therefore written anew, or rather compiled from the first
volume of Andral's work.
  t If there be  any doubt as to the nature and origin of these
 substances, it can readily be satisfied by placing some of them
on a piece of paper, and exposing them to heat. If they are
merely sebacious matter from the raucous crypt*, in the fauces 
22        PATHOLOGY OF THE CHEST.
the lungs, they seem to be secreted  in the mucous
cryptae of the pharynx  and fauces.   Whilst the ex-
pectoration presents  these  appearances, the  symp-
toms  of bronchial irritation  remain unabated ; but
according as this tends to resolution, the sputa pro-
gressively change their character.  The mucosity of
which they consist, by degrees loses its transparence,
becomes mixed with opaque yellow, white, or green-
ish masses, which at first few in number, gradually in-
crease, and ultimately constitute the whole of the
expectorated matter.  This change is generally ac-
companied by a perceptible remission of the  symp-
toms  of the acute affection, indicative of  its resolu-
tion.
  When the disease,  instead of thus terminating,
passes into the chronic form, the sputa retain the
same  appearance as in the latter period of  the acute
stage. They are opaque, white, yellow or greenish ;
they sometimes adhere to the bottom of the vessel, at
others they float in a transparent mucosity, or are
suspended in the midst of it.  They are generally in-
odorous, and to the patient insipid; and in most cases
expectorated without difficulty.
  Thus the expectoration resembles what is very com-
monly observed in  phthisis ; the respiration too  is
short  and frequent; there may  be night sweats, and
a considerable degree of marasmus.  Under such cir-
cumstances, none of the ordinary modes of examina-
tion are sufficient to distinguish chronic catarrh from
phthisis;  the stethoscope  alone can furnish signs
really pathognomic; and these vary according as the
catarrh is dry or humid.   In the former,  there is a
feebleness, or even total absence of the respiratory
murmur, in parts of greater or less extent, of  the
affected  lung.   This,  however, is not constant, it
changes almost incessantly, so that the respiration

and pharynx, they will leave on the paper a greasy slain, which
efTect will not be produced if they are tubercular tuatter from
tbe lungs. 
PATHOLOGY OF  THE CHEST.       23
becomes distinct in the parts where it had but a mo-
ment before been inaudible, and ceases to be heard
where before it had been distinct.   These effects are
produced by the altered bronchial secretion momen-
tarily stopping up the air-tubes in some places ; and
of course they  cease when the impediment is remov-
ed.  This state of the respiration is accompanied by
the " rale sonore" and  " rale sibilant ;"*  the former
is little liable  to change its seat; the latter, on  the
contrary,  is very variable.  It disappears for a while,
probably after  an effort of coughing, then suddenly
returns with the same intensity as ever.  Sometimes,
however,  both are constant,  strongly  marked, and
occupy the greater part of the organ, which indicates
that the affection is extensive and violent.
  Acute catarrh  may  be confounded with emphy-
sema of the lung, and  with croup; chronic catarrh
presents several of the characters of phthisis.
  Q. What are its anatomical characters ?
  A. On  opening the  body of a patient,  who  has
died of any  infection,  during the  course of'which
he  had been attacked  by acute catarrh, the  mu-
cous membrane  is found red to a greater or les9
extent.   This  most  usually occurs towards the end
of the trachea,  and in the first division of the  bron-
chi. In very severe  cases it may  be found even in
the smallest  ramifications.  If it is  confined to  the
bronchi of one lobe, it is  rather  remarkable  that
those of  the superior  lobe are most constantly af-
fected.  In some  cases, the membrane seems as if
finely injected  ; in others there is  no appearance of
vessels, we see merely  a number of small red points
aggregated closely together.  Finally, the redness

  • The " rale sonore" is permanent in its duration, because it
depends  on a change of  structure either in the bronchi or their
lining membrane ; the " rale sibilant" is variable, because it de-
pends on the presence of a viscid secretion plugging up the bron-
chial tubes, which is constantly liable to be displaced and expec-
torated. 
24       PATHOLOGY  OF THE  CHEST.

may be confined to particular spot9 of various forms,
constituting so many distinct inflammations, between
Which the membrane is white and healthy.
  This bright redness disappears in chronic cases,
and is replaced by a livid, violet, or brownish tinge,
but this is not an invariable occurrence.  Bayle and
Andral report cases of inveterate chronic bronchitis,
with puriform expectoration, in which the membrane
scarcely presented any trace of redness, or was  even
in some instances perfectly pale  in its entire extent.
The small bronchial tubes, particularly those towards
the summit of the lungs, are occasionally found dilated
in some parts, so as to be considerably larger than in
the rest of their trajet,  which may increase to  such
an extent as to  emit a real pectoriloquy.—See An-
dral, vol. ii. p. 29.

                 HOOPING-COUGH.
  Q.  What are its symptoms ?
  A.  This  affection  which  is peculiar  to infancy,
and  sometimes epidemic, commences  usually  with
symptoms  of catarrh, either of the  lungs or  la-
rynx, which last  for  about fifteen days; the cough
then becomes convulsive, and recurs by fits at varia-
ble intervals.  These are attended with violent ef-
forts, and  consist  of one long sonorous inspiration,
followed  by  several rapid, quick expirations; there
is at the same time congestion of the face, and occa-
sionally are accompanied by a sensation of suffocation
and constriction, more or less intense, give rise to a
vomiting of large quantities of mucous matter, and an
expectoration which is thin, transparent, and viscid
at the commencement, but afterwards becomes thick
and opaque ; after this there succeeds a complete re-
mission, with every  appearance  of perfect health.
The duration of this affection is variable.
  It may for  a short time  be taken  for  croup, or
suffocating catarrh, in children.
  Q. What are its anatomical characters ?
  A. Pathology has  not as yet thrown any light on
the  causes of this complaint;  in  fatal cas«.g,  it is 
            PATHOLOGY OF THE CHEST.       25

  usual to find  an  inflammation of the mucous mem-
  Inane lining the larynx, trachea or bronchi, and some-
  times even some  ulcerations.

                   PLRURODINIA.
    Q. What are its symptoms ?
    A. Pain in  one  side of the  chest,  with  immo-
  bihty of the ribs  during respiration, which also be-
  comes  more  or less  incomplete.  The murmur of
  respiration is weak, or altogether inaudible in some
  parts ot the thorax ; percussion  gives a dull sound ■
 inspiration and pressure on the muscles cause pain!
 There is no trace of any of the phenomena peculiar
 to other diseases of the chest.such asoegophony, pec-
 toriloquy, rale, &c. &c.
   Q. What are its anatomical characters ?
   A. Its anatomical characters are unknown.
   It may be confounded with pleuritis.

               03DEMA  OF THB LUNGS.
   Q.  What are its symptoms ?
   A. This affection,  which is seldom idiopathic,
 usually supervenes either  with  other diseases__
 at  the  close  of  fevers of long  duration—or  of
 organic diseases,  particularly  those of the heart.
 The respiration is laborious and difficult; the  respi-
 ratory murmur is  scarcely  perceptible, though the
 thorax is largely expanded;  there is a slight " rale
 crepitant," particularly at the base and inferior part
 of the lungs.  The sound on percussion is clear, and
 on  both sides equally so; the cough is  followed by
 an aqueous expectoration.   In some cases the respi-
 ration becomes "puerile," in a small part of the sum-
 mit of the lung. This affection is sometimes compli-
 cated with pneumonia,  or with emphysema, in which
 case its diagnosis is very difficult. The nature of the
 " rale," and the general symptoms,  alone can distin-
guish it from catarrh.
  Q. What are thediseases with which it may  be con
founded ?
        C 
'26        PATHOLOGY OF  THE CHEST.

  A.  They are pneumonia and catarrh.
  Q..  What are its anatomical characters ?
  A.  The tissue of the lung,  of  a pale greyish colour,
is more dense and heavy than in the natural state ;
it is crepitant, and collapses only when,  by compres-
sion,  it is freed from  the  liquid that is infiltrated
into it; the lung seems to contain very  little blood,
but is gorged  with a colourless, transparent, frothy
serosity : the air-cells retain their natural texture.

                   PNEUMONIA-.
  Q.  What are ita symptoms ?
  A.  Laennec has established three periods or stages
of this disease, each characterized by a distinct group
of symptoms.   In the first, the respiration is difficult,
accelerated, laborious, becomes also unequal, and im-
perfect, and so bears no proportion to the dilatation
of the walls of the thorax.   When both sides  are  af-
fected it becomes abdominal, the ribs over the affect-
ed  part  are  unmoved;  occasionally  there is a dull
pain in some part of the chest, but this is by no means
a constant occurrence, except  when the  disease is
complicated with pleuritis.  On percussion the chest
sometimes sounds as in health, but most commonly
its resonance is rendered dull,  or lost  altogether in a
greater or less extent, always, however, limited to that
of the affected  part of the lung.
  When we examine the respiration in those parts
in which  the resonance is altered, we find  it feeble,
scarcely perceptible,  or altogether  masked by " a
rale crepitant," which indicates  both  the nature and
extent of the alteration.  The respiration  becomes
"puerile," in  the parts that remain  unaffected, and
sometimes also in the other lung.  These phenomena
soon  change, either by the  resolution of the disease.

  This chapter has been compiled from Andral and Collin, that
 in the original  not being sufficiently  full, considering the impor-
 tance  of the subject. The chapters on Emphysema and Phthisis
hare been for the same rwason taken chiefly from l.aennrc 
PATHOLOGY  OF THE CHEST.       27
 •r by its making further progress.  In the former
case, the «• rile crepitant" diminishes in  extent and
intensity; the murmur of respiration approaches He
natural state; the sound  of the chest becomes less
dull,  and its movements  more regular;  and finally,
a " rale muqueux"  is audible, which indicates the
change of the expectoration, and approach of conva-
lescence.   But if, on the contrary,  the disease pro-
ceeds unabated; the alterations in the movements of
the thorax still  continue; the sound becomes alto-
gether dull,  the  "rale crepitant" ceases,  for the
lung is no longer permeable to  the air; there is a
total absence of the murmur of respiration, except in
some points  corresponding to the  large bronchi, in
which the  respiration  becomes  cavernous, and the
voice resounds,  so as frequently to produce a real
bronchophony.   The expectoration  is more or less
difficult; the sputa are white, slightly yellowish, or
semi-transparent, and so viscid as to adhere firmly to
the vessel  even when inverted; they contain some
bubbles of air, and present some striae of pure blood,
or are so intimately  blended with it, as to exhibit a
dusky or perfectly red colour.
  If  the disease occupy  but a small part of  the
lung, it may still end in resolution.   It will then be
found to retrace its steps, as it were,  and go back
through the very same stages  by which it had as-
cended.  But if, on the contrary, it still advances, a
purulent effusion takes place into the affected part of
the lung; the movements of the chest become more
restricted, weak, and difficult; symptoms of general
debility supervene—a peculiar "rale maqueux," is
heard, at first in some points, then  in the whole of
the affected part. This soon degenerates into a gurg-
ling sound, indicating that the pus is collected into a
mass, or  cavity, from which it escapes by the neigh-
bouring bronchi; and so, a real pectoriloquy is esta-
blished by means of this communication between the
cavity and the air-tubes. 
28        PATHOLOGY OF THE CHEST.

  As each stage of this complaint exhibits a distinct
set of symptoms, we can seldom be in error as to its
character  or extent, if we have an  opportunity of
following it  from  its commencement to its termina-
tion.  But if we are called in, after  the  second pe-
riod  is established, we experience much difficulty
in deciding  what  the complaint really is.   Thus, we
find the sound dull, the respiration suppressed,  and
the ribs immoveable : but are not these common to
empyema  and hydro-thorax,  as well as this stage of
pneumonia ? The previous history can alone establish
the distinction.
  Again, in  the third stage, the respiration is caver-
nous, a gurgling sound is heard in the part, together
with pectoriloquy, which  constitute the leading cha-
racters of phthisis.  How then are they distinguisha-
ble ? The previous history and the nature of the ex-
pectoration  must be our chief guides.
  A. From  pulmonary apoplexy, it  is distinguished
by percussion and the examination of the movements
of the thorax, which  furnish us in general with suffi-
cient data for establishing the diagnosis.  The respi-
ration is always complete in apoplexy,  but,  in most
cases, incomplete in pneumonia.  In  the first degree
of the latter, while  the  "rale crepitant" exists, the
sound  is  obscure  or dull, but remains clear in the
first  degree of the  apoplexy;  the "rale," is rare-
ly diffused  in pneumonia;  it is usually in the other
affection.
  What is the part of the lung chiefly affected in
pneumonia ? Is it the cellular tissue between  the
cells, or rather the air-cells themselves ?  As yet we
cannot affirm any thing with positive certainty ; we
may state what appears probable.
  Whilst  there is but a  simple  congestion, we re-
cognize it during  life by the existence of the "rale
crepitant."  Now  this "  rale," seems to be but the
diminutive,  as it were, of the "rale  muqueux," and
if it  is quite certain that the latter  is seated in the
bronchi, we can scarcely hesitate to admit that a 
PATHOLOGY OF  THE CHEST.        29
 mixture of air and fluid in the bronchi of the smallest
 size produces the "rale crepitant;" but the pulmo-
 nary cells are nothing but the ultimate  terminations
 of the bronchi expanded into forms of a cul-de-sac.
 These cells then are the seat of the " rale crepitant,"
 in the first stage of pneumonia.  If this reasoning be
 correct, it follows that this disease consists essentially
 in an inflammation of the air-cells, whose inner sur-
 face secretes a fluid at first muco-sanguinolent, and
 afterwards purulent.
   As the  inflammation advances, the fluid becomes
 more thick and  viscid,  it can no longer be expelled
 from the vesicles in which it is formed ; it accumu-
 lates, obstructs,  and distends them, and so gives rise
 to  those  granulations,  which give to  the lung its
 hepatized appearance in the second degree of pneu-
 monia.  At a  later period, it is not mucus or blood
 that is poured out; it is pus, which  in its turn fills
 the air-cells, and so constitutes the grey granulations
 which characterize this last stage,  or "hepatization
 grise." Ifaportion of a lung in this state be pressed,
 we see the pus escaping in the form of drops, each
 seeming to come from  the  vesicle in  which it had
 been  contained.   If the distention of  the cells be
 general and carried to a great degree, they burst their
 contents, become blended,  and so the granular ap-
 pearance is lost.
  The walls of the vesicles become soft and friable,
just as all tissues do when inflamed.   Hence the re-
 markable softening of the  substance of the  lung in
 pneumonia.—See Andral, vol. ii. p. 313.
  Q. What are its anatomical characters ?
  A In the first  stage of pneumonia the substance of
 the lung presents an increase of weight and density  ;
 it is infiltrated with a frothy, sanguineous serosity in
 considerable quantity ; it still crepitates on pressure,
 and its alveolar texture can be recognized; the exter-
 nal surface is a deep violet, the interior is more or less
deeply red. In the second stage, or that of " heptiza-
 tion rouge," it no longer crepitates on pressure.  It 
30       PATHOLOGY OF  THE CHEST.
  presents the heaviness, appearance and density of the
  liver, its tissue seems granular when torn ; its external
  surface is not so much of a violet colour as the prece-
  ding degree: its internal is red, and presents some
  white spots, caused by the pulmonary cells and ves-
  sels ; these are occasionally mixed with black spots, si-
  milar to those observedon the surface of granite.  The
  sanguineous serosity with which it isinfiltred is dimi-
  nished in quantity, and  does not trickle out  when a
  section is made.   In the third stage, or.that of "he-
  patization grise," the interior of the lung becomes of
• a pale yellow tinge, its granular aspect becomes even
  still more manifest;  a  purulent fluid issues from it
  on incision, which may be collected by the scalpel;
  lastly, the pus  infiltered  into  the substance  of the
  lung may unite in  some points, and then gradually in-
  crease so as to present the appearance of abscesses,
  the walls of  which  exhihit  no trace of false mem-
  branes; on the contrary, they are softened alid bro-
  ken down, so that not a trace of their original struc-
  ture remains.

                     PLEURITIS.
    Q. What are  its symptoms ?
    A. At the commencement of the disease, before
  any false membranes are formed or fluid effused,
  an acute pain occurs in some part of the chest, to-
  gether with immobility of the ribs, particularly those
  corresponding to the seat of the  affection ;  respira-
  tion is frequent, (especially if both sides are affected
  at the same time) painful,  hurried, quiclc during in-
  spiration, and slow in expiration ;  percussion is pain-
  ful, in other respects it gives the same results as du-
  ring health.  The respiratory murmur is  weakened,
  but not  altered in character, except the disease be
  complicated.
    When an effusion takes place to a moderate ex-
  tent, the sound becomes dull in the lower part of the
  thorax, both  laterally and posteriorly.  This effect
  may also be produced  in any  other part of the ca- 
           PATHOLOGY  OF THE  CHEST.        31

 vity, in  which the effusion shall  have become cir-
 cumscribed  by bands of adhesion left by a former
 pleurisy.
   When the stethoscope is applied along the poste-
 rior border of the scapula, or towards its inferior an-
 gle, in fact opposite to any point to which the  effu-
 sion may have  extended,  we perceive, when the pa-
 tient is desired to speak, the diminutive, as it were,
 of his voice, sharp,  thin and  tremulous,  to which
 Laennec has applied the term oegophony.
   When the effusion is verv considerable  from the
 roininencement,  or becomes so during  the progress
 of the disease,  the sound is altogether dull, the oego-
 phony disappears, and the  respiration  is no longer
 heard, unless where old adhesions retain some part of
 the lung near  the  ribs, and prevent it from being
 forced back by the effusion.  The intercostal spaces
 become  enlarged, and elevated ; the affected side is
 more expanded than the sound one, but  is no longer
 influenced by respiration, its immobility forming a
 striking contrast with the great mobility of the other,
 in which the respiratory murmur  is increased in in-
 tensity, so  much so as to  assume the puerile charac-
 ter.
   When the  disease begins to decline, and the fluid
 becomes absorbed, so that its quantity is reduced to
 the proportion necessary  for the production of the
 phenomena,  the  oegophony  recurs for a while, but
 gradually diminishes as the effusion is lessened, and
 ultimately disappears altogether when its absorption
 is  complete.   Still  the soundj given by percussion
 remains dull for a considerable time, and the respi-
 ration  weak  or imperceptible; which effects con-
 tinue in greater or less degree,  until the adhesions
 of the pleura are  converted  into cellular bands, or
 into a structure similar to fibro-cartilage.   Then the
 intercostal  spaces are contracted, the ribs are made
to  sink inwards, the thorax becomes narrowed, and
the affected side never again resumes its former di-
 mensions or  mobility. The  diseases with  which it 
32       PATHOLOGY OF  THE CHESI.

may be confounded are hydro-thorax, chronic pneu-
monia or phthisis.                            i
  While  the  oegophony exists, there  is  no  pos-
sibility of mistaking  pleuritis for any other disease,
except hydro-thorax :  as that phenomenon is altoge-
ther peculiar to these  two affections, the other local
and  general symptoms of each must be taken  into
account in order to  establish  the diagnosis.   But
when the effusion is abundant, or  the disease has
passed  into  the  chronic form,  if we have not ob-
served  it from  the beginning, we may mistake it for
hydro-thorax,  or chronic pneumonia;  or,  on the
other hand, these affections  for pleurisy.  However,
the  previous  history, together with the general
symptoms,  will  enable  us  to distinguish them.—
There seems no probability of  its being confounded
with phthisis.
  Q. What are its anatomical characters ?
  A. The inflamed membrane presents a great num-
ber of  red points, which, though situated  under the
pleura, are visible through its substance. The spaces
between them  retain their natural colour ; sometimes
the membrane  is  injected, but is scarcely ever thick-
ened. The inflammation always determines the effu-
sion of a serous, transparent, citron-coloured fluid,
somewhat similar to unclarified whey ; and which con-
tains some detached portions of the false membranes,
which  are formed on the surface of the pleura. The
extent of these is determined by that  of the inflamma-
tion ; if it be confined to the pleura costalis or pulmo-
nalis, then the  surface  is covered with a layer of coa-
gulable lymph, which  is gradually  converted into a
false membrane ; but if the  pleura lining the wall of
the thorax, and that covering the adjacent portion of
the long, be  at the same time inflamed, then both are
covered with  layers of membrane, and become con-
nected by transverse bands passing from one to the
other, through the fluid which is effused between
them.  When  these new structures become red, anf}
traversed by vessels, the portion of the pleura subja- 
TATHOLOGY  OF THE  CHEST.       33
 cent to them becomes red also, and the  effused fluid
 partakes of the same colour. The surface of the lung
 beneath the inflamed pleura usually remains unaffec-
 ted, but  is somewhat more dense and less crepitant
 than natural. When the effusion is considerable, the
 lung is compressed  and flattened, and if the pleurisy
 becomes chronic, it  may be forced buck towards the
 vertebral column, and be reduced to the form of a
 membranous lamellae, so as to be with difficulty dis-
 covered, and so induce a belief that it had been alto-
 gether destroyed.
  In this chronic state the pleura is more red, and
 the false membranes more friable than  in the acute
 form ; the  effusion  also is more abundant, but  less
 limpid, and is mixed with minute albuminous nocculi,
 which give it a puriforrn appearance.
  If resolution and absorption of the fluid take place,
the lung becomes distended with air ;  the false mem-
 branes contract  adhesions,  which  are usually  of a
 cellular structure, or sometimes that of a fibro-carti-
 lage;  the membranes themselves  present the same
 organization.   It is  during this process that the ribs
 approach each other, the chest becomes narrowed,
 and the affected side contracted. When the effusion
 is circumscribed, as happens when it is poured out
 amongst old adhesions closely  united  together, it
 may be mistaken for a cyst  in the lung,  particularly
 if it occurs in one  of the interlobular  fissures.  In
 such a case the lung, being compressed against the
 vertebral  column,   renders the mistake still -more
 likely to occur, as at first it may be supposed to have
 been altogether destroyed;  but the error is removed
 as soon as tiie false  membrane  is removed from the
 pleura.
  Gangrene sometimes  takes place  in the pleural
 presenting itself in the form of circumscribed spots
 of a dark  brown or  greenish colour, penetrating the
 substance of the membrane,  and extending in some
 cases to the subjacent cellular tissue, or to the sur-
 face of the adjacent  soft parts, which become mfilter- 
34       PATHOLOGY  OF THE  CHEST
ed  by a serous fluid.  If the gangrene be the  result
of an intense pleurisy, which is a very rare occur-
rence, the false  membranes partake of the same stat®
as the pleura, become softened, broken down, lose all
consistence, and give out the peculiar odour of gan-
grene. If it be caused by the rupture of gangrenous
abscess of the lung, which pours its contents into the
pleura, pleurisy, with formation  of false membranes,
first takes place, and then the gangrene supervenes
consecutively.  The walls of the thorax  may  some-
times be engaged in the disorganization, and  an ab-
scess, caused by the infiltration of the effused fluid,
may burst externally.

                 HTDRO-THORAX.
  Q. What are its symptoms ?
  A. If the effusion  be not very abundant, oegophony
is perceived in the same places as in pleuritis, and
presents the same modifications.  The sound  of the
chest is dull on percussion, and the respiration inau-
dible, except along the vertebral column.
  Q. With what diseases may it be confounded ?
  A. The only disease with which hydro-thorax can
be  confounded  is chronic pleurisy ;  hence the pre-
vious history, together with the absence of the symp-
toms of the latter, can only determine the diagnosis.
  Q What are its Anatomical Characters ?
  A. S"ne  cavity of  the pleura contains  an effusion,
in most cases consisting of a citron coloured sero-
sity, transparent and without  any albuminous floc-
culi.  The  lung void  of  air is  compressed towards
the mediastinum.  But if instead of serosity, the pleu-
ra exhales blood,  then the membrane is studded
with numerous  small red points, and covered with
blood in a semi-coagulated state.

      EMPHYSEMA OF THE LUNGS.   (Asthma.")
  Q. What are  its Symptoms ?
  A. This  is one of the many diseases long con-
founded under the common name, Ant/ima.  It  is cha 
PATHOLOGY OF THE CHEST.       35
racterized  by habitual  dyspnoea, recurring  by fits,
which are exceedingly irregular in  their periods of
return and duration, and are subject to be  increased
by any cause, however slight, that affects the respira-
tion.  The movements of the thorax  are  irregular,
and  habitually unequal;  inspiration  is  short, high
and rapid; but expiration is slow, incomplete, and as
it were graduated; there  is thus a manifest differ-
ence in the duration of the two movements.  During
the fits the respiration becomes conclusive.  On per-
cussion, the chest emits a sound more clear than in
the healthy state, but this unnatural resonance is not
given equally at  all points, as the disease seldom
extends to the whole lung.  When the affection oc-
curs at both sides, we experience much difficulty in
estimating this increase of sound, as we have then no
subject of comparison: and again, when only one side
is affected  there is another source of error; we may
mistake the  sound side, as being less sonorous, for
the diseased one; but this is soon rectified by auscul-
tation.
  There is a constant cough, returning in fits, usual-
ly dry, or  accompanied by a viscid, transparent  ex-
pectoration. When the emphysema  is of long stand-
ing and extensive, the intercostal spaces become ex-
panded, and the  thorax is rendered prominent and
rounded on one or both sides, according as the affec-
tion is single  or double.
  In all the points occupied by the emphysema, the
murmur of respiration is  very weak  or altogether
suppressed.  During full inspirations, and sometimes
during expiration,  we hear a  " rale sibilant,"  re-
sembling the sound of a small valve, or a " rale son-
ore,"  imitating the  cooing of a dove.  The contrast
between this marked resonance of  the thorax, with
the feebleness or total absence of  the respiratory
murmur,  constitutes the  distinctive  character of
rhis disease.
  Q.  With what diseases may it be confounded ?
   \.  The  diseases with which emphysema maybe 
36        PATHOLOGY OF Till'. CHEST.
confounded, are—pulmonary catarrh,  and pneumo-
thorax, unaccompanied by  effusion of fluid.—Fron.
catarrh  it may be distinguished by attention to the
following circumstances: In catarrh the  suspension
of »he respiration in any particular point is of short
duration; and when it returns, it is strong and even
"puerile,'" a constant rale, sonore or sibilant, also ac-
companies it; In emphysema the suspension of res-
piration in a particular'part may be ,on£ continued,
and  even permanent, and  when it is restored, the
respiratory murmur always continues weak, partic-
ularly if the disease has lasted long.  Further, in ca-
tarrh, the movements of the ribs remain  free, the
respiration does  not  present a constant inequality,
and the chest  retains  its natural sound and capacity.
But  in emphysema, one  side  is more moveable than
the  other, inspiration is very short relatively to ex-
piration, and the thorax becomes expanded, and ac-
quires a tympanitic resonance.
   Q. What are its Anatomical Characters ?
   A. The  pulmonary vesicles on  the surface of the
lung  are distended; their  size  varies from that of
a  millet seed, to  a  nut.   The  partitions separa-
ting  them are ruptured, hence the contained air
is readily  extravasated;  the  small bronchial rami-
fications of the  affected  part  are  also dilated.—
When the thorax is opened, the lung does not col-
lapse; on the contrary, it seems to extend beyond
it, as if too large  for  its cavity, and if it be thrown
into water, it  floats on  the  surface.  The  mucus
which obstructs the bronchi is very viscid.

                    PHTHISIS.
   Q. What are its symptoms ?
   A.  Phthisis may be considered as divisible into
three periods.  From this  it  is not  to be inferred,
that  a. disease, in many cases  so  obscure in its pro-
gress, and variable  in its duration, conforms  strictly
to any such systematic division.  Still it  is useful to
adopt it, for the purpose  chiefly of facilitating the
description of  the symptoms and diagnosis of the 
PATHOLOGY OF THE CHEST.         37
complaint.   During the first period, namely that in
which tubercles,  in  moderate number, begin to be
developed  in  the substance of the lung, we cannot
find either by the examination of the  local pheno-
mena, or general symptoms, evidence  of any other
affection than a catarrh more or less severe; in some
instances its progress is, as  it were, latent, and alto-
gether  escapes observation.  However, there usu-
ally  is some cough, which may be either hard and
dry, or accompanied by an expectoration, similar to
the saliva of the throat and fauces, which consists of
a colourless, ropy, and somewhat frothy fluid, and in
which we  occasionally find suspended some blacjc
spots, and rounded flocculi.
  In the second  period, the tubercles increase in
number, so  as to compress and obstruct the substance
of the lung to a certain extent; in which case  they
afford sufficient evidence to make us  suspect their
presence, but not to decide with positive assurance.
Finally, in the  third stage, the substance of the  tu-
bercle becomes softened, makes  an opening for it-
self into some of the neighbouring bronchi, is evacu-
ated, and so gives rise  to the formation of a cavity,
the existence of which is indicated by its character-
istic symptom—pectoriloquy.
  The movements of the chest are very variable dur-
ing the progress of this complaint, so much so, that
though  they present almost every possible alterna-
tion, they can contribute little to its diagnosis.
  In  the second  period, we  usually find  that the
summit of the side of the chest gives, on percussion,
a sound more or less dull and obscure; and if the cy-
linder be  applied on this part, a weakness  or total
absence of  the respiratory murmur is found  to exist;
and  the voice thrills with increased force under the
instrument. These symptoms, however, do not be-
come signs of the  disease  unless  they  are constant,
and exist at one  side only; for it is on the compari-
son of the sound with that of the affected side that
rheir value  depends.
  Vol. II.              D 
08         PATHOLOGY OF THE CHEST.

  After some  time  the  sound returns, occasionally
with even  increased intensity; or,  on the contrary,
diminishes; and from having been obscure, becomes
altogether dull.  The pectoriloquy, doubtful at first,
soon becomes perfectly manifest, and so continues,
except the disease  should increase so much as that
the excavation becomes of  unusually  great  extent,
when something of indistinctness is given  to  it.
Whilst these changes are taking place, the  catarrh
increases from day  to day,  and extreme  emaciation
is produced.
  If phthisis during  its progress observed these regu-
lar periods in  all cases, and exhibited this  succes-
sion of phenomena, it would no longer be a disease
difficult  to be  recognized.   But  now  frequently
does it  not happen that patients die before the sof-
tening  and evacuation  of the  tubercular  matter,
or even before  the tubercles  have increased  in
number sufficient to alter the sound of the chest, or
affect the distinctness of respiration? but it decides
its existence with certainty, only when it has passed
beyond  the reach of art.  The complaint with which
phthisis is  most liable to be confounded is chronic
catarrh, from which it is distinguishable by the pec-
toriloquy, and  other symptoms given above, as indi-
cative of the  development of tubercles.  But the
diagnosis is still rendered uncertain, for in catarrh a
pectoriloquy may be produced by the  dilatation of
the bronchi, in which case, time  and the progress
of the  disease  can alone  clear up the difficulty.
From acute or chronic pneumonia occupying the su-
perior lobe of  tfie lung,  it will be  distinguished by
the previous history, the expectoration, and general
symptoms.
  Q. What are its Anatomical Characters r
  A. Tubercles, in their first stage,  present them-
selves in the form of small semi-transparent granules
of a greyish colour, or sometimes  almost colourless
and transparent, their size being usually about that of 
           PATHOLOGY OF THE CHEST.      - 39

a millet seed, whence the term miliary tubercle. As
they increase, they become yellow and  opaque; at
first in the centre, then gradually in their whole ex-
tent; some of those that are near to each other unite,
form masses of a pale yellow colour, and  of the con-
sistence  of cheese, in  which state  they  are  named
crude tubercles.
  In this, the second stage of their  progress, it fre-
quently  happens that  the substance of  the  lung,
round the tubercles, hitherto healthy, becomes indu-
rated, semi-transparent or  greyish,  owing to a new
production of tubercular matter, which  becomes as
it were infiltrated into the pulmonary tissue.  How-
ever, it  occasionally happens  that  masses of consi-
derable size are formed by a similar process of iiHil-
tration, without the previous development of sepa-
rate miliary tubercles.  The  part  of the lung  in
which this deposition occurs is dense, humid, imper-
meable  to the air, and when cut presents a smooth
polished  surface.  In some parts of this  induration,
we  generally observe several small yellow granules,
which mark its change into the second stage, or that
of crude  tubercle.
  As the hardening began in  the  centre of each
mass*, so also does  the final process of  softening,
which progressively increases until  the consistence
of the whole is changed, when the matter by open-
ing for itself a passage into some of the bronchial
tubes, becomes  evacuated, and  so  leaves a true tu-
bercular  cavity.   The  interior of these cavities is
som times  crossed  by bands  of pulmonary  tissue,
studded  with  tubercular  matter still in the crude
state, or in some rare cases by obliterated  vessels,
but never by any bronchial ramifications.  As to the
larger vessels, they are forced  back  and compressed
by the progress of the tumour, but not altogether
obliterated; the small vessels only suffer that change.
  After  the evacuation of their contents, the inter-
nal surface of these cavities becomes lined by a soft,
friable, false membrane; or there is merely  an  exu- 
40       PATHOLOGY OF THE CHEST.

dation which exists in some parts only, and presents
variable degrees of thickness.  If the exudation and
false  membrane should exist at the same time, then
the latter is placed beneath, and  is found  to  be torn
in some parts.  Some cases have occurred in which
these  excavations are  lined  by semi-cartilaginous
lamellae, of a greyish white colour,  semi-transparent,
adherent to the substance of the lung, uniting by a
progressive increase, and  so becoming  continuous
with the lining membrane of the bronchi.  In some
cases also, the sides of these excavations have been
found united by cellular adhesions, or by a structure
similar to fibro-cartilage, which form a  cicatrix, in
which different structures may exist, such as chalky
concretions, black bronchial matter, &c. Finally, the
boundaries of the excavations  may be formed by the
substance of the lung having become red, hardened,
or infiltrated with tubercular matter.  Their form is
more or less tortuous, their contents vary, sometimes
consisting of a matter  of the consistence  of thick
pus, at  others of a friable substance, swimming in
a serous limpid fluid.
  In some cases pulmonary tubercles are contained
in cysts, semi-cartilaginous  in their texture, firmly
adherent to the tissue of the lung  by their external
surface, but  smooth and polished  on their internal.
This is most commonly found in the bronchial glands.
                   HJEMOPTTSIS.
     (By exhalation on the Mucous Membrane.)
   Q.  What are its symptoms ?
   A.  The attacks of  this affection are  always pre-
ceded by a  titillation  in the region of the trachea,
larynx, or bronchi, according as the congestion exists
in one or other of these points;  there is also a sensa-
tion of heat and irritation in the chest, together with
a cough, which is soon  succeeded  by an expectora-
tion,  consisting of frothy, red,  vermillion-coloured
blood, in greater or less quantity.   The  chest emits 
PATHOLOGY OF THE CHEST.        41
 its natural sound  on percussion;  respiration conti-
 nues unimpeded, but is accompanied by an abundant
 " rale  niuqueux," with large bubbles.
   Haemoptysis may be periodical,  or supervenes on
 the suppression of an habitual sanguineous discharge.
 It can scarcely be confounded with haematemesis or
 epistaxis.
   Q.  What are its Anatomical Characters ?
   A.  The  mucous  membrane lining the air-tubes, is
 covered  witii  blood, and presents  on  its surface a
 number of red points, but there is no trace of erosion
 or lesion of its texture.

              PULMONARY APOPLEXY.
  Q.. What are its Symptoms ?
  A. This  affection, which  is generally very sud.
 den in its invasion, is marked by  intense dyspnoea,
and sometimes even a threatening of suffocation.
 The movements of the thorax are  hurried, unequal,
 intermittent;  sometimes alternately full and con-
tracted as if convulsive ; in a word, they exhibit the
greatest possible irregularity ; the  patient seems as
if suffocating, and  every movement  indicates the
 greatest anxiety.
  At the commencement the sound of  the chest on
percussion is found very little, if at all, altered, but
the murmur of respiration is decidedly changed.  In
some points of the  lung, circumscribed and more or
less numerous, we perceive a " rale crepitant," and
in the  intervening  spaces the respiration is perfect,
or  increased  in  intensity, so as to become what is
termed " puerile."   After some time,  however, it
ceases to be heard, is succeeded by a " rale muqueux"
in great abundance, and consisting of large bubbles,
indicative of an abundant exhalation of blood into the
bronchi and air-vesicles ; these phenomena are soon
found to extend to the whole of  the lung or lobe af-
fected, and then the diagnosis which was founded
upon them, is confirmed by the expectoration and its
cnaiacters.  In tins, the second degree of the disease,
                      n 2 
42       .PATHOLOGY OF THE OHES/f.
the sound of the chest becomes in general obscure
and dull.
  Q. With what diseases may it be confounded ?
  A. Pulmonary apoplexy maybe confounded, while
in its first stage, with incipient pneumonia, in its se-
cond with catarrh, particularly  if it assumes a chronic
character, and if the expectoration of blood be not
constant, which usually is the case.
  Q. What are its Anatomical Characters ?
  A.  Some portions of the lung, generally circum-
scribed to a few inches  in  extent, are found of a
very deep dark-red colour, presenting a  degree
of density similar to that of hepatized lung: these
appearances  are not   altered  by ablution.  When
these  portions are divided by  an incision,  we gene-
rally find in their centre some  coagulated blood; the
surface of the incision is granulated and homoge-
neous,  its aspect being perfectly like that of a clot
of venous blood, as it  is impossible to discover any
trace of vessels, bronchi, or cellular intersections.
The parts of the lung which surround them are cre-
pitant,  sometimes pale, at others red and injected
with blood; but they are always separated from the
parts affected by the apoplexy, by an abrupt, well-
marked line of demarcation.

             GANGRENE OF THE LUNGS.
  Q. What are its symptoms ?
  A. This disease, of rather rare  occurrence, may
attack  the surface of the organ, and  then  produce
pleuritis with  or  without  pneumo-thorax ;  or  it
may occur in any central part.  In the commence-
ment  it presents the  signs of a slight  pneumonia,
together with a great degree of general prostra-
tion ; and then there supervenes an expectoration  of
diffluent, greenish,  fetid sputa, emitting the gan-
grenous odour: this  is  accompanied  by frequent
cough, and sometimes by an abundant haemoptysis.
  This disease can scarcely be said to  have any
symptom peculiar to it. In its first stage, its charac- 
PATHOLOGY OF THE CHEST.        43
ters are those of pneumonia or intense catarrh ; and
in the second, when an excavation is formed by the
gangrene, we  find pectoriloquy as in phthisis—and
if a communication be established between the bron-
chi and pleura, then the stethoscope indicates its ex-
istence by the " tintement metallique,"—but the ge-
neral adynamic symptoms, and peculiar odour of the
sputa, sufficiently indicate the nature of the disease.
  Q. What are its anatomical characters ?
  A. When the gangrene is not circumscribed, its
borders  are  blended insensibly  with the adjacent
parts,  the transition  being  marked by  traces of
inflammation in  the  first or  second  degree, but
the  substance of the  lung is  more humid,  and
more easily  torn than in the  first  stage of pneu-
monia. It is of a dirty pale colour, or of a green, bor-
dering on brown or black, interspersed  with  por-
tions of  a livid red tinge, infiltered with blood in a
very liquid state.  In other parts, it is so much sof-
tened that it falls into deliquescence, and when di-
vided by an  incision a sanious fluid oozes out, of a
greenish colour, and emitting a gangrenous foetor.
In some cases the gangrene is  circumscribed, and
presents the appearance of a dark, livid eschar, some-
what similar to that produced  by the application of
caustic potass to the skin.  Sometimes this eschar is
enclosed within an excavation, but  more commonly
is converted into a putrid, sanguineous pulp, which
finds an exit into  the bronchi or pleura, or into both
together. When an ulcerated cavity is thus formed,
after a previous inflammation, it is  sometimes lined
by a false membrane, which secretes a dark fetid sa-
nies ;  but when there is no membrane, then the walls
of the excavation seem to secrete the sanious fluid.
Their tissue is granular, sometimes fungoid, soft, and
of a reddish brown colour. In  some instances, the
vessels, though denuded, cross these cavities unin-
jured; at other times, on the contrary, their coats ul-
cerate, slough, and discharge their contents. 
44         PATHOLOGY OF THE CHEST.
                PNEUMO-THORAX.

  Q. What are its symptoms ?
  A. This complaint is sudden in its invasion, and
dangerous in  its  character;  it consists  essentially
in the effusion  into  the pleura of an aeriform fluid,
to  which is  added in  many instances a  liquid
effusion  also.  Its  signs vary according as there
is, or is not,  a communication between the pleura
and the bronchi.  The  affected side gives a hollow
tympanitic sound,  even when the thickness of the
walls of the thorax is considerable.  It it should hap-
pen that the lung is connected to the  walls of the
thorax by bands of adhesion, the sound in these points
is almost natural, which renders the change in all the
others still more manifest.   When the respiration is
suppressed in  all the space occupied by the gaseous
effusion, it is  scarcely  heard even at the root of the
lung.   This depends on two circumstances.  1. The
compression of the lung by the air contained in the
pleura: 2, the pressure  of that air, which is a bad con-
ductor of such feeble sounds as those produced by the
passage of the air  into the bronchial tubes.  At the
sound side the respiratory  murmur is  distinct, often
" puerile."
  When the effusion  is considerable, the affected
side is dilated, but there is no " rale" of any descrip-
tion.  When a gaseous and a liquid effusion are pre-
sent at the  same time, then on making percussion,
we find the sound of the thorax clear at its superior
parts, but altogether dull in the inferior; hence by
varying the patient's position,  and by consequence
that of the contained fluids, we can vary  the  seat of
the clear and the dull sound.
  When this  gaseous  effusion is owing  to a fistu-
lous communication between the  pleura and the
bronchi, it is known by the existence of those pecu-
liar phenomena described by Laennec,— " la respira-
tion et la resonnance metalliques," or the metallic
resonance and respiration. 
           TATUOLOGY OF THE CHEST.         45

   Finally, if there be a gaseous and liquid effusion,
 and at the same time a fistulous communication, in
 addition to these signs another is added—" le tinte-
 ment metallique,"—or metallic tingling.
   The presence of the  fluid can always  be ascer-
 tained by the peculiar sound  caused by succussion.
 This is sufficient to distinguish this affection from all
 others in  which the  respiration is suppressed for a
 considerable time, and to any great extent.  It can
 then be confounded only with emphysema of the lung
 —but in this latter the sound of the chest is rarely
 increased to such a degree ; the respiration is never
 altogether suppressed, it  is heard distinctly at the
 root of the lung, it is accompanied by some " rale,"
 and returns occasionally  in  parts in which  it  had
 ceased to  be perceptible.
   Q. What  are its anatomical characters ?
   A. We  find effused into the cavity of the pleura,
 an elastic fluid, sometimes containing sulphuretted
 hydrogen gas.  This seldom occurs without some
 perceptible  lesion.  It usually is accompanied  by a
 sero-purulent effusion, and by a  communication with
 the bronchi.  In other instances, it results from the
 rupture of  a tubercular cavity  into the pleura, or
 even of a gangrenous eschar of the lung; in this lat-
 ter case, we also find traces of pleurisy.  Finally__
 pneumothorax may arise from gangrene of the pleu-
ra, effusion of blood into its cavity,  or from rupture
 of some pulmonary vesicles.

 ACCIDENTAL PRODUCTIONS DEVELOPED IN THE LUNGS.
   Q. What are their symptoms ?
  A. There is a degree of dyspnoea proportioned to
the size of the  tumor, accompanied by a dry cough,
or by an expectoration, whose characters are exceed-
ingly various: there is no fever, or general distur-
bance of the functions.  After some time the sound
of the chest and murmur of respiration diminish at
the points which correspond to the seat of these pro-
ductions, and finally cease altogether when they have 
46        PATHOLOGY OF THE CHES I .
acquired any considerable size.  When " ramollisse-
ment" of these productions  occurs, then that series
of symptoms beirins to be manifested which attends
the same alteration in tubercle, and which has alrea-
dy been detailed in the chapter on Phthisis.
  They may be mistaken for pleuritis, chronic peri-
carditis, or phthisis.
  Q.  What are their anatomical characters ?
  A.  These tumors vary very much both  in their
size and composition.  They are, in some cases, mere-
ly cysts in the  lung, invested by^a membrane whose
structure is sometimes similar to serous, at others to
mucous membranes.   At other times  these produc-
tions consist of a cellular,  fibrinous or  cartilaginous
structure, in the centre of which, we sometimes find
calcareous or osseous concretions.   These latter pro-
ductions also exist without  any cyst,  in which case
they  adhere immediately  to the substance of the
lung;  in  some instances  they  are developed in a
mass of cartilage or tubercle.

ACCIDENTAL PRODUCTIONS DEVELOPED IN THE PLEURA.
  Q.  What are their symptoms ?
  A.  When small, or in the  state of crudity, there
are no means of ascertaining their presence.  This
can only be done when serous effusions take  place,
or when the tumours pass into the state of  " ramol-
lissement," and  symptoms  of hydrothorax  set  in,
namely oegophony at the commencement, and then
absence of respiration, and dull sound of the chest,
to which, in some cases, symptoms of  pleurisy are
added
  Q.  What are the diseases with which they may be
confounded?
  A.  They may be confounded with pleurisy, pneu-
monia, or pericarditis.
  Q.  What are their anatomical characters ?
  A.  These productions vary according to the  na-
ture of the tissues  that compose them.   In some
cases they consist of encephaloid,  in the form  of 
          PATHOLOGY  OF THE CHEST. '      47

small  tumours, in  no  great  number,  occasionally
combined with melanosis;  the  pleura to which they
adhere is, in general, red towards the point of union.
  In other instances  they are tubercular, appearing
as small, transparent, grey granules, united together
by a false membrane in which they seem  to have
been developed,  rather than  in  the pleura itself.
These at a later period  became opaque and yellow,
but seldom pass into the state of " ramolissement."
On  the surface  of  the pleura we sometimes  find
small,  white,  opaque  granulations,  analogous to
fibreus structures.   Other serous membranes pre-
sent occasionally similar productions, which seem to
be the result of inflammation.  And lastly, we some-
times  find on the surface  of this membrane, deposi-
tions of cartilage—fibro-cartilage, and even osseous
matter.

   ANATOMY AND PHYSIOLOGY OF THE PERICARDIUM.
  Q. To what parts is the Pericardium attached ?
  A. Its external coat fixes it firmly to the middle
tendon of the diaphragm, and also to its muscular
part opposite  the fifth rib ; and to the mediastinum
anterius, while the large vessels themselves fix it to
the spine.
  Q.  What  is the structure of the Pericardium?
  A. It is composed of two layers, the external of
which is a continuation of the Pleura; the internal is
strong and tendinous-like, smooth within, and com-
posed of fibres running in  different directions.
  Q. Is the  Pericardium larger than the heart ?
  A. Yes ; it is much more capacious than merely to
contain the heart, and of course so large as to admit of
the motions of the heart most  easily.
  Q. Does  the Pericardium also cover the origin of
the large blood-vessels near the heart ?
  A. Yes; its upper and anterior part  is reflected
upon, and includes the Aorta, Pulmonary Artery, and
veins.
  Q. Does the Pericardium adhere to the heart ? 
48              OF  THE HEART.
  A. No; from the exhalants of its internal surface a
fluid is poured out, called Liquor Pericardii, which
lubricates the surfaces, facilitates the motions of the
heart, and prevents it from adhering to the Pericar-
dium.
  Q. What is the use of the Pericardium ?
  A. It keeps the heart in its situation, allows it to
have free motion, defends it from injuries, and re-
strains its inordinate motions.      *
  Q. What are the Chemical Constituents of the Li-
quor Pericardii ?
  A. It contains much water, some Albumen, Mucus,
and  Muriate of Soda.

     ANATOMY AND PHYSIOLOGT OF THE  HEART.
  Q. What is the situation of the Heart ?
  A. It is situated between the right and left lungs,
resting upon  the superior tendinous part of the dia-
phragm, with its apex between the lobes of the left
lung, and behind the cartilages of the fifth and sixth
true ribs.
  Q. What is the division of the heart ?
  A. It is divided into a base placed  towards the
spine ; a body, consisting of a  right or anterior, and a
left  or posterior side ; and an apex turned forwards
and obliquely to the left side.
  Q. How many Cavities are in the Heart ?
  A. Two Auricles at its base, and two Ventricles in
its body.
  Q. What separates the right cavities of the heart
from the left  ?
  A.  A middle septum, which is generally complete
in the adult;  but is performed by the Foramen Ovale
between the right and left Auricles in the foetus.
  Q.  What is the structure of the Auricles?
  A. The structure of the auricles is strictly muscu-
lar ;  and besides, they have muscular pillars on their
inner surface, called musculi pectinati, which  have
smaller columns or threads running in different di-
rections, exhibiting a reticulated appearance. 
OF  THE HEART.               49
 *~ $. What is the structure if the  Ventricles of the
 heart ?
   A. The parietes of the Ventricles are composed of
 a congeries of muscular fibres variously disposed ; on
 their inner surface are several eminences, called co-
 lumnae carneae, running in different directions, form-
 ing a net-work ; from many of their extremities the
 chordae tendineae arise, as so many tendons from mus-
 cles, and are inserted into the margin of the tricuspid
 valves.
   Q. What wse,dothe Musculi  Pectinati, and the Co-
 lumnae Carneae serve?
   A. The former assist in the contraction of the Au-
 ricles, and the latter in that of the ventricles :  while
 the chordae tendineae, occupying less  space and at-
 tachments to  the Valves, prevent them from going
 back into the  Auricle.
  <i. In what do the right auricle and ventricle  differ
 from the left ?
  A. In the thickness and strength of their parietes;
 for the left ventricle having to  propel the blood into
 the arteries of the system, is composed of parietes of
 greater thickness and consequent strength for that
 purpose.  Whereas  the right ventricle  having to
 propel the blood only through the lungs, is furnished
 with much thinner and weaker parietes.
  (%. Are the right auricle  and ventricle of a larger
 capacity than the left ?
  A. In the dead body the cavities in  the right side
 of the heart seem the largest, in consequence of be-
 ing distended  with blood ; but the actual capacities
 of these cavities in each side must  be  equal in the
 living body ; otherwise  an accumulation of  blood
 would take place  in the lungs.
  Q. What is the situation and structure of the Tri-
cuspid Valves?
  A. Between the right Auricle and Ventricle there
is a tendinous ring, from the  whole margin of which a
circular membrane arises, and forms  three triangular
or tricuspid valves, which when shut and applied to
    Vol. II.             E 
JW              OF  THE HEART.
each other, completely prevent the blood from flow-
ing out of the ventricle into the auricle.  The chor-
dae tendineae attached to  their margin keep them
directly transverse when shut.
  Q.  What is the situation and structure of the Mit-
ral Valve?
  A.  Between the left auricle and ventricle, there is
a circular margin  from which the valve rises mem-
branous, and is  divided into two  portions,  which
when shut, are adapted to each other, and close the
passage.  The Valvula Mitralis has all the apparatus
of the tricuspid valves.
  Q.  Are both  the portions of the Mitral Valve equal
in size ?
  A.  No; one of the portions, considerably larger
than the other, shuts the mouth of the Aorta while
the valve is open, and the blood is flowing into the
left ventricle ; and  when  the  regurgitation  of the
blood shuts the two portions  of the valve in order to
prevent its reflux into the left auricle by the  con-
traction of the ventricle, the  blood  is propelled into
the open Aorta.
  Q.  Are Valves  placed at the Mouths of the Pulmo
nary Artery,  and  Aorta ?
   A. Yes ; Semilunar Valves are placed at the  mouth,
or beginning of each.
   Q. What is the structure  and appearance of the
 Semilunar Valves?
   A. They consist of three membranous portions,
 each of which adheres to a third part of the internal
circumference of the artery ; the other edge  is  loose
 and thicker, having a hard corpuscle in the middle,
 called corpusculum aurantii vel morgagni. When
 these three portions are shut, they  come close  toge-
 ther, and prevent the reflux  of blood into the ventri-
 cles, during which they are convex towards the ven-
 tricle, and concave next the arteries.
   Q. Do the Sinus  Venosus on the right side of the
 heart, and the Sinus Yendsus  on the  left, differ  in
 structure from the proper Auricles ? 
OF  THE HEART.
51
    A. Yes ; the proper auricles of the heart are com-
 posed of strong muscular fibres : but the sinuses are
 lormed by the junction of veins, and by consequence
 Cave the same structure as veins.
   Q.  Is the structure of the veins muscular ?
     n ?me anatom'sts have thought so ; but it is ge-
 nerally believed that the veins have no muscular coat,
 and that  they are composed of strong  membranous
 coats possessed of much elasticity.
   Q.  Describe the veins which form the Sinus Veno-
 8iis on both sides of the heart ?
   A.  The right sinus venosus is formed by the junc
 tion of the Superior and Inferior Venae Cavae, which
 resembles a membranous bag; the left sinus venosus
 is formedViy the union of the four Pulmonary Veins,
 making a sac equal to the size of the right sinus. The
 structure of both the venous sinuses of the heart,
 therefore, is purely membranous, as that of the veins
 is, which compose them.
   Q.  Describe the course of the blood throueh therieht
 tide of the heart ?                      s      6
   A.  The two Venae Cavae pour their blood into the
 right sinus and auricle, which make but one cavity;
 by the contraction of the auricle it is propelled into
 the right ventricle, which it stimulates to contraction,
 by which it is  propelled into the Pulmonary Artery ;
 for the Tricuspid valves being shut, prevent its re-
 flux.
   Q.  Describe the course of  the blood  through the
 Lungs?
   A.  The blood propelled into the Pulmonary Artery
 stimulates it to contraction, by which the  semilunar
 valves are shut, and the blood is forced into the small-
 er branches of the artery.  The extremities of the
 branches of the  Pulmonary Artery are minutely dis-
persed around the air-cells of the bronchial tubes, and
there transmit their blood into the extremities of the
Pulmonary veins, which unite into larger and larger
trunks, that carry their blood towards the left auricle 
52
OF  THE HEART.
of the  heart, in which they  ultimately terminate in
four tru nks.
i  Q. Describe the course of the blood through the left
side of the heart ?
  A. When the blood  is poured by the four pulmo-
nary veins into the left auricle, it is stimulated to con-
traction, by which the blood  is driven into  the  left
ventricle, which in turn being stimulated, contracts,
shuts the Mitral valve, and propels the blood into the
Aorta,  and  other arteries of the  system, from which
the veins receive it, and carry it again back to tho
heart.
  Q. What prevents the blood from flowing into the
Venae  Cavae and  pulmonary veins when the auricles
of the heart contract thi-mselves ?
  A. The weight of the column of blood in the veins,
commonly called  the vis a tergo ,- because no valves
are placed at  the terminations of the Venae Cavae
and pulmonary veins.
  Q. But is the  blood completely prevented  from
flowing back into the veins near the heart ?
  A.   No ;  its reflux from the auricles is sometimes
perceived as far as the jugular, and always in the venae
cav;e, forming a  perceptible pulse-   The extent of
this pulse depends upon the quantity of blood in the
right auricle, which  cannot be  passed into the ven-
tricle, and also, upon the obstruction, which may ex-
ist to its passage through the  lungs, retarding it also
in the pulmonary artery.
  Q. The cavities of the heart do not then at  each
contraction  expel all their blood ?
  A. No: observation  proves that both in the right
auricle and ventricle, the whole  of the blood is not
expelled ; so that the right side of the heart is actually
never empty.
  Q. In what manner does the Heart receive its own
nourishment?
   A. From the blood which  the two Coronary Ar-
teries transmit  into its substance.
  Q. Describe the origin of the coronary arteries ? 
OF THE HEART.
63
   A. The two Coronary Arteries  arise from the be-
 ginning of the aorta, opposite to two of the semilunar
 valves, which  cover their mouths when the blood
 flows into the aorta ; and when these valves are shut
 during the contraction of the aorta, the blood flows
 readily into the Coronary Arteries.
   Q. What is the course of the Coronary Ajteries ?
   A. The  one runs in  the  depression  between the
 right auricle and ventricle, and chiefly sends its blood
 to the right side of the heart; the other runs between
 the left auricle and ventricle, aftl partly also between
 the ventricles on the foreside of the heart.   Their
 branches communicate freely.
   Q_. Describe the course of the Coronary Vein's?
  A. The  Coronary  Veins are all collected into one
 called  the  Great  Coronary Vein, which turning from
 the left side  and running between the left  auricle
 and ventricle, terminates in  the  under part of the
 right auricle, where it is covered by a semilunar valve
 peculiar to itself.
  Q. What is the cause of the beating of the heart
 against the side ?
  A. It  depends upon three causes;  1. upon the di-
 latation of the  auricles, during the  contraction of the
ventricle; 2. The dilatation of the aorta and the pulmo-
nary artery, the consequence of the introduction of
the blood which is driven into it; 3.  The projection
 of the curve of the aorta, by contraction of the heart.
  Q. How  many pulsations does the  heart make in
a minute ?
  A. They decrease with age ;
      at birth they are from 130 to 140 in a minute;
      at 1 year    -    -    120 to 130
      at 2 years     -    -  100 to 110
      at 3 years  -    -     90 to 100
      at 7 years    -    -    85 to 90
      at 14 years -   -      80 to 85
      at the adult age    -    75 to 80
      at old age commencing 65 to 75
      in confirmed old age    60 to 65
                       e 2 
54
OF  THE  HEART.
Other circumstances, however, vary these data very
much, as affections of the mind, diseases, &c.
  Q. What is the force of the contraction of the ven-
tricles ?
  A. It is difficult to determine; age, stature,  and
manv other causes have an influence upon  it:  the
heart also; exerts great power in dilating the  ven-
tricles as well as in contracting them,as is evident by
attempting to compress it with the hand when an ani-
mal is still alive.
  Q. From whence rftes the heart derive its power
of motion ?
  A. By the experiments of Legallois it appears, that
the cause of the motion of the heart is derived from
the spinal marrow, because in proportion as it is de-
stroyed, the heart becomes debilitated; and when the
spinal  marrow  is  completely removed,  its action
ceases  altogether; as, however, the  heart still  con-
tinues to contract after it is removed  from the body,
the spinal marrow must  be regarded  as one of the
causes  which influence this organ.
 Q. What is the amount of the whole quantity of blood
in the  body?
  A. From 24 to 25 pounds :  it varies according to
innumerable causes.
  Q. How rapidly does the blood move ?
  A. It is different in different persons, and in differ-
ent parts of the arterial  and  venous systems; very
rapid in the great trunks, diminishing towards the
extremities ; increasing again in the veins as it passes
towards the heart.
  U. What different appearances or  symptoms do
these different degrees of motion produce ?
  A. The contractions of the  heart produce pulsa-
tions in the arteries; contraction and diminution of
their cavity, succeed ; the first is called the pulse ;
which is best examined at the  place where thearterv
passes over a bone. 
OF  THE HEART.
55
    Q. What qualities of the blood-vessels are known
  by the pulse ?          .
    A. The quickness, power or weakness, regularity
 and irregularity of the motions of the heart; also the
  juantity of the blood in the system; if it is great the
 artery is "round, large and resisting : if it is small in
 quantity,  it is small and  easily compressed.  Cer-
 tain states of the arteries also influence them and
 render the pulse different in different parts.
    Q. Has this pulsation  of the arteries any  effect
 upon the functions of the different organs ?
   A. It  is thought to favour the operation of  their
 functions ; this is, however, hypothetical. The arte-
 ries  are curved and  very much divided in  entering
 the brain, to prevent the effect of the sudden shock
 upon that organ which would otherwise take place.
   Q. What is the influence of the nervous system on
 the blood ?
   A. The  nerves influence  the circulation in two
 ways : 1. in modifying the movements of the heart;
 2. in modifying the capillaries, by accelerating or re-
 tarding the blood.
   Q. What is meant by the transfusion of the blood ?
   A. It is the injection of  the blood of an animal or
 a person into the veins of another ; formerly it was
 used with the vain hope of  producing a renewal of
 youth ; now for the purpose of experimenting on the
 properties of  the arteries, veins, and of medicines,
 and for supporting the strength in hemorrhages  from
 the womb,  exhaustion by inanition, &c.
  Q. How  is  it used to discover the  properties of
 medicines ?
  A. The medicine is injected into the veins, and if
poisonous it soon shows  itself: in this  way medicine
operates in a smaller dose.  In Copenhagen  they ad-
minister medicine to horses; with the above excep-
tions  it is not now applied to the human system, as
idiocy and death have resulted from it.
  Q.  What are the organic diseases of the heart ?
  A.  They are specified below. 
   PATHOLOGY OF THE HEART AND ITS
                 MEMBRANES.

                   AORTITIS.

  Q. What are its symptoms ?
  A. Considerable development  of the pulsations of
the aorta, and sometimes of the large  arteries;  those
of the aorta can be recognized at the depression at
the top of the sternum.  In some cases there is a sen-
sation of heat or pain, which  is referred to the infla-
med part, accompanied at  the same time by sinking
and anxiety.  When aortitis becomes chronic, the ar-
terial pulsations usually  become more slow, and then
we observe symptoms of dilatation or hypertrophy of
the heart.  Accidental tissues developed in the  tra-
jet of the aorta  may simulate aortitis, particularly
when their density is such as to  facilitate the trans-
mission of the pulsations of the vessel.
  Q. What are the  diseases  with which  it may be
confounded ?
  A. They are any accidental productions developed
in the  course of the aorta, particularly when they are
so dense as  to facilitate the transmission  of the pul-
sations of the vessel.
  Q.  What are its anatomical characters ?
  A. Redness of the lining membrane of  the  aorta,
variable in degree, and  appearing in  some cases as if
it had  been painted.  This colour is, in  general, cir-
cumscribed ; in most cases it is scarlet;  but when it
extends to the right cavities of the heart and pulmo-
nary artery, it is of a more or less deep shade of vio-
let.  The lining membrane presents no distinct tra-
ces of injection ; it is, however, quite otherwise with
the cellular coat; it is not much thickened.   On its
surface we  sometimes  find  a  layer of coagulable
lymph;  it is also frequently  the seat of deposits of
fibrous lamella;, or of osseous or calcareous matter ;
in this latter case all the coats of the artery are  thick- 
           PATHOLOGY OF THE  HEART.       57

 ened, friable, and destitute  of their usual elasticity.
 We sometimes find spots  of ulceration affecting the
 lining membrane only, or penetrating more  deeply
 into the coats of the vessel.

             ANEURISM OF THE AORTA.
   Q. What are its symptoms ?
   A. This affection is  marked by strong and loud
 pulsations, synchronous with those of the nulse, and
 accompanied by a « bruit de soufflet."  The  seat of
 these  symptoms varies according to the situation
 which the tumour occupies; and if it be so situated
 as to compress the trachea or bronchi, it will deter-
 mine a peculiar hissing sound during the act of respi-
 ration or speaking.   The sound of the chest is dimi-
 nished, and sometimes above the heart  there is a
 murmur or thrill perceptible by the stethoscope, or
 even by the hand.
   When  the  aneurism is seated in the  ascending
 aorta, the pulsations are most perceptible at the ster-
 num and  cartilages  of the  ribs; but when the de-
 scending  aorta  is  dilated,  then  they are  percei-
 ved  along the dorsal  vertebrae ; finally, when it oc-
 curs in the abdominal aorta, we observe them with
 great distinctness, and to a great extent in the abdo-
 men.  Aneurism of the thoracic  aorta may be con-
 founded with contractions of the orifices of the heart;
 that of the abdominal portion of the vessel may be
 simulated  by tumours placed upon  its trajet.
  Aneurism of  the thoracic aorta may be mista-
 ken for a contraction  of the orifices  of the  heart;
that of the abdominal aorta may resemble the effects
of tumours placed along its course.
  Q. What are its anatomical characters ?
  A. Dilatation of the aorta occurs  most usually in its
curvature  and ascending portion ;  it may occupy the
whole circumference of the vessel, or only a part of it;
in which latter case it generally occupies the anterior
or lateral part of the tube.  The three coats of the ar-
tery almost always have some degree of redness, to- 
58        PATHOLOGY OF THE HEART**
gether with some exudations, ulcerations, or spots of
ossific matter.   In some cases the dilatation does not,
(as in true aneurism) extend to all the coats of the
vessel, the inner and middle coats are torn, the cellular
alone forming the wall of the sac.   Finally, we some-
times find  the coats of the artery both dilated and
torn, the blood being effused beneath the  cellular
membrane,  which serves  as  its  investment.   The
fibrine of the blood, which lines aneurismal tumours,
is disposed  in successive concentric layers, deposited
one upon the other.   Of these the external Ones are
the most dense in texture and dark in colour, and
also most firmly united to each other: they are thinner
in  the true aneurism than in that  which is accompa-
nied by ulceration of the two inner tunics, and  com-
plete rupture  of the walls of the artery.

INDURATION AND CONCRETION OF THE VALVES OF THK
                     HEART.
  Q. What are their symptoms ?
  A. From the very commencement there is habitual
dyspnoea (which is increased by the least exercise,)
together with  palpitations  ; and during the contrac-
tions of the heart, the sound it emits is rough,  and,
as it were,  stifled.   Such symptoms as these  may in-
duce us to suspect an incipient contraction of the ori-
fices ; but when it becomes considerable, it may be
recognized by the following signs: If the affection is
seated in the auriculo-ventricular openings, we hear,
during the  contraction of the auricles (which is  then
prolonged beyond its  usual duration) a slight "bruit
de rape," (sound of a file) or a " bruit de soufflet,"
(sound of a bellows.)  These phenomena are  con-
stant in their duration ; the former depends on an os-
seous induration  of the valves, the latter is heard
when its structure is that  of cartilage or fibro-carti-
lage.  When the contraction is seated in the arterial
openings (aortic and pulmonary,) the sound above in-
dicated is synchronous with the pulse and contraction
of the ventricles:  if the left orifices (the  mitral val- 
           PATHOLOGY  OF THE HEART.       59

 rule's, and sigmoid valves of the aorta,) are contrac-
 ted, the " bruit de rape "  or " de souffiet," is heard
 between the cartilages of  the fifth  and seventh ribs
 at the left side, whilst, if  it  occupies the orifices at
 the right side of the  heart (the tricuspid valves, and
 sigmoid of the  pulmonary artery,)  the sound is most
 distinctly heard at the inferior part of  the sternum.
 This murmuring, or thrilling,  is in some cases sensi-
 ble to the hand placed  on the region  of the heart;
 particularly when the mitral valve is ossified, and the
 contraction of the  left auriculo-ventricular opening is
 considerable.   In  this disease  the  palpitations are
 frequent; the  strokes of the  heart generally inter-
 mittent, unequal,  and sometimes very strong, whilst
 those of the pulse, on the contrary, are small  and
 concentrated ;   they  are more irregular when the
 contraction  occurs at  the left than at the right side.
 The face is of a violet hue, the limbs  are ccdematous,
 the patient is  constantly  afflicted  with a dyspnoea,
 which increases until  it proves fatal.
  These productions  may  be  mistaken  for dilatation
 or hypertrophy of the heart;  for pericarditis or  pal-
 pitations.
  Q.  What are their anatomical characters ?
  A.  When the valves of the heart are affected by
 these alterations in their  whole extent, their natural
 form is lost, they become coiled upon themselves  in
 such a way as to contract the orifice at which they are
 placed, which in some instances has been thus redu-
 ced to a diameter of  three or  four lines.  The sur-
 face of the valve, which is the seat of the induration,
is sometimes red, and  is always smooth, unless there
 be osseous particles or other depositions upon it; its
con?istence  is  that of fibro-cartilage,  cartilage, 01
even bone.  Sometimes the fibrous band which exists
between the layers of the  valves is alone  affected;
sometimes  it is the points of the valve  that contract
adhesions to one another, and so reduce  the orifice to
the form of an osseous canal; in other cases we find,
in the  duplicatures of the valve, nothing more than 
CO        PATHOLOGY OF THE HEART.

some osseous or cartilaginous concretions, which may
pierce through it, and so  come into immediate con-
tact with the blood ; finally, the valves may contain
in their  free border, some pisiform concretions.
These different alterations occur most usually in the
mitral valves, and sigmoid valves of the aorta, partic-
ularly in the former, whilst,  on  the other hand, they
are very rarely found  in the tricuspid valves, or sig-
moid valves of the  pulmonary artery.
  Vegetations on the  valves exhibit the appearance
of veruncae, and are usually seated on the surface of
the valves of the left cavities; they are round, rough,
elongated, placed  close to each other;  their colour
is somewhat blue, violet or red ; they adhere closely
to the subjacent parts, their texture is fleshy, resem-
bling that of compact polypous concretions:  there
sometimes exists in their centre a small  dot of black
blood.  These vegetations sometimes resemble small
cysts, adherent to the  valve, usually at its free border,
and most commonly are found on the aortic and mi-
tral valves.

                   PERICARDITIS.
  Q.  What are its symptoms?
  A. These are  very  uncertain; still when  the  fol-
lowing phenomena are present, we  may suspect  the
existence of pericarditis.   When the contractions of
the heart,  in a man otherwise healthy,  without any
perceptible cause, begin to give a strong impulse, anil
produce a sound more intense  than in the natural
state; when at intervals its stroke becomes more weak
and short, corresponding to intermissions of the pulse,
which is very small and frequent, or even insensible.
In some cases we hear a sound, similar to the crack-
ling of new leather, but this lasts only for a few hours.
There is more or less of dyspnoea; considerable anxie-
ty, acute pain, and fainting on the slightest exertion ;
sometimes the patient feels an acute or lancinating
pain, or of heat and weight at the region  of the heart;
occasionally the sound of the thorax in this pan t? 
           TATHOLOGY OF THE HEART.        6 I

 dull.  When the disease is chronic,  these symptoms
 are less decisive and come on more  slowly.  When
 the pericardium adheres to the heart, Dr. Sander in-
 forms us that a continued undulating motion is per-
 ceptible, distinct from that undulation which natural-
 ly exists at the re^.on of the heart;  sometimes the
 contractions of the auricles are more obscure than in
 the healthy state.  To establish the diagnosis of peri-
 carditis, all these symptoms should  be present, and
 even so, some doubts must rest upon it.
   Pericarditis may be confounded with pleuritis, hy- *
 drops, pericardii, or with certain  tumours developed
 in the vicinity of the heart.
   Q. What are its anatomical characters?
   A. The redness of the pericardium in this affection
 is not intense ; it is sometimes dotted on the surface ;
 in the chronic form it is more strongly marked, and
 diffused in patches, but there is no perceptible thick-
 ening of ttie meml rane.  In the  greater number <A
 cases a layer of false membrane  is deposited on the
 serous surface of the. pericardium, which in most ca-
 ses covers its whole extent, but in some only a part
 of it.  The cavity of the pericardium contains more
 or less of a straw coloured  serous effusion, in which
 float some  small  albuminous flocculi; the quantity
 of this fluid diminishes when the  disease is  of  long
 standing.

               HYDROPS  PERICARDII.
  Q. What are its symptoms ?
  A. Bv no means decisive,  the  sound emitted by
 percussion is more dull than natural;  there is a sen-
 sation of weight and oppression in the region of the
 heait, its pulsations are  perceptible in a very wide
range, but vary both in degree and situation every
instant,  being sometimes towards  the right side,
sometimes towards the left, but  always tumultuous
and obscure ; the pulse small, frequem, and irregu-
lar;  the extremities oe<'ematous, the patient is threa-
tened with suffocation if placed in  the horizontal po-
  Vol.  II.              F 
 62        PATHOLOGY OF THE HEART.

 sition, and is subject to faintings,  but not often to
 palpitations.
   Q. What are the diseases with  which it may be
 confounded?
   A. Pericarditis, pleuritis, and some organic affeo
 tions of the heart.
   Q. What are its anatomical characters ?
   A. The  heart  is usually sound, so is the pericardi-
 um, it contains, however, a quantity more or less con-
 siderable, of a transparent citron-coloured serous fluid;
 this is sometimes tinged with  blood, its quantity is
 less when  the affection is connected with a general
 dropsy than when it is purely  local; in some cases
air is also contained in  the serous membrane.

            HYPERTROPHY OF THE HEART.
   Q. What are its symptoms ?
   A. The left ventricle gives a very strong impulse
between the cartilages of the fifth and seventh ribs,
 to which space  the pulsations of the heart are cir-
cumscribed, and on which the sound on percussion
 is dull.   The impulse of the ventricle is very much
lengthened when the  hypertrophy is considerable ;
the contraction of the auricle, on the contrary, is very
short, and  when  examined in  the  praecordial region
its sound is scarcely perceptible, whilst at the supe-
rior part of the sternum, and under the clavicles, it is
loud and distinct.  The stroke of the heart is heard
only in a very small space, and is scarcely perceptible
at the top  of* the sternum, or under the left clavicle,
and scarcely at all at the  right side, though it is con-
tinually perceived and heard by the patient.  We
usually find the  pulse strong and full, the sound on
percussion  at the region of the heart dull, and  the
face presenting a red tinge.  These are symptoms of
secondary importance, but still deserve attention.
  When the hypertrophy occurs in the right ventricle,
the stroke of this  cavity is stronger than natural, and
the impulse which it gives is perceived more plainly
at the bottom of the sternum than  between the car- 
           PATHOLOGY OF THE HEART.        63

 tilages of the fifth and seventh ribs.  It is also more
 strongly marked at the right than at the left side of
 the chest.  The sound  on percussion is dull in this
 same region, and the patient is  frequently attacked
 by haemoptysis.
  When the hypertrophy exists in both ventricles at
 the same time, we of course find the symptoms pe-
 culiar to  each ;  those  which  indicate hypertro-
 phy of the right ventricle usually predominate.
  This affection may be confounded with contraction
 of the orifices of the heart or aorta, or with inflam-
 mation of the latter vessel.
  Q. What are its anatomical characters ?
  A. There are some differences according to the
 ventricle which is affected.  When the hypertrophy
 attacks the left ventricle, there  is an  increase of
 thickness, and also of density in its walls and,in its
 base; but the thickness diminishes gradually towards
 its apex. It is also less in the septum ventriculorum ;
 it is however in  proportion to  that of the columnae
 carneae;  its  muscular substance  is more  firm  and
 deeply coloured than in the natural state, and its ca-
vity is diminished in  proportion  to the  increase in
thickness of its walls.  The size  of the right ventri-
 cle  is diminished in  proportion as that of the left is
 increased ; it becomes flattened, and appears as if it
 were a cavity contained within that of the left. When
 the hypertrophy is seated in the  right ventricle, its
 thickness and density are always less than in the left
cavity;  it does not collapse when divided ;  its thick-
ness is uniform over its  whole extent, except proba-
bly  towards the tricuspid valves and origin of the pul-
monary artery ; the columnae corneae are also increased
 in thickness.

  DILATATION OF THE  VENTRICLES AND AURICLES OF
                    THE HEART.
  Q. What are its symptoms ?
  A. When the left ventricle is dilated, the contrac-
 tions of the heart give rise to a clear and loud sound 
64       PATHOLOGY OF  THE HEART.
      »
between the cartilages of the fifth and seventh ribs.
The loudness of this sound,  and ext-.i.t in v" tch it is
perceptible, are in proportion to the ut.gvee o. '';•"! di-
latation; when the  dilatation is :'t ttu: r:ght m 'e the
sound of the heart is louder at the inferior part of the
sternum, than opposite the cartilages of the ribs. The
extent in which the  sound is heard is in proportion
to the degree  of the  dilatation; when  palpitations
occur their impulse is more  weak than in the natural
state.   The externa! jugular veins are swollen, but do
not present any pulsation ; the countenance is usual-
ly of a  purple colour; in most  cases dilatation of the
heart occurs in ooth ventricles at the same time.
  It may be confounded with contraction of the orifi-
ces of the heart.
  Q. What are its anatomical characters ?
  A. The capacity  of the ventricles or auricles,  is
found to be increased, and the thickness of their walls
proportionally  diminished, particularly towards the
point of the left ventricle.  The dilatation is some-
times partial, being confined to a single  point.   The
substance of the heart is more or lets deeply red ;  in
some cases its colour is altered, and its firmness con-
siderably diminished.

DILATATION WITH HYPERTROPHT Or THE VENTRICLES.
  Q. What are its symptoms ?
  A. The  impulse of the ventricles is strong, and
their contraction  determines a sound ; that of the au-
ricles also is sonorous.   The stroke of the luart is
heard over a very wide range, and is perceived par-
ticularly in thin and young persons, even to the pos-
terior part of the right side of the chest.  The con-
tractions of the ventricles are perceptible to the hand,
when placed at the region of the heart, and are some-
times interrupted by  short  and even violent pulsa-
tions.   When  the left side of the heart  is affected,
these results are perceived by the  cylindei  placed
between the cartilages of the fifth and seventh ribs.
In these cases the pulse is usually strong, hard, vibra- 
           PATHOLOGY OK THE HEART.        65

ting and resisting; but when  the  right cavity is the
seat of the affection  its contractions are perceived at
the inferior part of the sternum.  We may infer that
the two sides of the  heart are affected, when the phe-
nomena above described  are perceived equally at the
right and left side.
  This affection may be  confounded with inflamma-
tion of the heart.
  Q. What are its anatomical characters ?
r A. They partake of the characters above enumera-
ted, when treating of each of these affections.

 DILATATION, WITH  HYPERTROPHY  OF THE AURICLES.
  Q. What are its symptoms ?
  A. The  contraction of the auricles  emits a dull
sound, instead  of the  clear one  which exists in the
natural state.  Conjointly with this dull sound of the
auricles, we usually find symptoms which indicate an
induration of the valves, for dilatation of the  auri-
cles is the necessary GOnsequence  of a contraction of
the corresponding auriculo-ventricular opening; that
is to say, dilatation of the right auricle is the result of
a contraction in the right auriculo-ventricular open-
ing, that of the left auricle being dependent on the
contraction of the left auriculo-ventricular opening.
When dilatation  with hypertrophy of the auricles  oc-
curs together with hypertrophy of the ventricles, the
contraction of the auricles is most  distinctly heard at
the superior part of the sternum,  and under the cla-
vicles.
  This affection may be confounded  with  contrac-
tion of one or other of the auriculo-ventricular open-
ings.
  Q. What are its anatomical characters ?
  A. The  name expresses the lesion of structure
found on examination.   The cavity of the auricle is
found increased  in its capacity, and  its walls  thick-
ened.
f2 
<J6       PATHOLOGY OF THE HEART.
                     CARDITIS.
   Q. What are its symptoms ?
   A. Pathologists have not, as yet, been able to as-
 certain with sufficient precision any symptoms which
 enable us to indicate satisfactorily,  the  existence  of
 inflammation of the substance of the heart.
   Pericarditis, aortitis, pleuritis at the left side, may
 be confounded  with this affection.
   Q. What are its anatomical characters ?
   A. Carditis is a rare disease.   The inflammation is
 usually confined to some detached  part of the  sub-
 stance of the  heart; in these  cases  pus  is usually
 found diffused amongst the fleshy fibres of the organ,
 or united into  one  cyst.   When ulcerations  exist,
 they are found  more frequently on the internal sur-
 face than at the external.

  "llAMOLLISSEMENT," OR SOFTENING OF THE HEAIIT.
   Q. What are its symptoms ?'
   A.  They are  very  obscure ; so much so, that its
 existence is often not  even suspected.   When the
 disease is in its acute state we usually find a degree
 of anxiety in the patient;  his pulse small, soft, and
 accelerated, the contractions of the heart are quick,
 hurried, and, as it were, convulsive ; thesound.which
 they emit is dull, the impulse is  feeble.  Patients un-
 der such circumstances  are subject to fainting  fits,
 and death takes place suddenly.  When the "ramol-
 Iissement" of the heart is chronic, its contractions, as
 well as those of the pulse, are usually frequent, and
very feeble ; in this respect, however, they are ra-
 ther variable, being sometimes slow, sometimes hur-
 ried.
  Pericarditis may be confounded with  this disease.
  Q.  What are  its anatomical characters?
  A. The consistence of the heart is considerably di-
 minished, and it may be torn very  readily.  It is so
soft and friable that the  finger easily penetrates into
it; in some cases, this change of structure is found to 
           PATHOLOGY OF THE HEART.       i, i

 exist only at one side of the heart.   Wh-n the dis-
 ease is acute the colour of the he:.rt is deep  r^d, or
 even brown ; but if it has been  chronic. 1* is  found
 pale and  yellowish. The  walls of the v(.  Tides,
 when cut through, collapse and sink  dow \.   When
 ramollissenient is followed by rupture, v Inch lias hap-
 pened in u few cases, this accident was observed to
 have occurred near the point of the left ventricle.

            INDURATION OF THE HEART.
  Q. What are its symptoms ?
  A. At the commencement of this disease we usu-
 ally find the same symptoms as in hypertrophy of the
 heart; but in proportion as the  induration  makes
 progress, the stroke of the heart diminishes in ener-
 gy.  When the induration is moderate in degree, the
 contractions of the heart are sometimes so strong, as
 to be heard even at some distance  from the patient.
 The diagnosis of this disease is still involved in great
 obscurity.
  Hypertrophy may be mistaken for it.
  Q. What are its anatomical characters ?
  A. The structure of the heart is sometimes of a
 rosy red;  its  consistence approaches that  of fibro-
cartilage, and when cut is  found so firm as to grate
 under  the  edge  of the  scalpel.  This induration,
 which is variable  in degree, has not yet been obser-
ved to  extend to the  whole substance of the  heart;
it is usually confined to one or other of its surfaces.
It is sometimes found in the form of incrustations, and
seems as if it had commenced in the first instance in
the pericardium.   Induration of the  heart does not
necessarily give rise to any increase or diminution of
the capacity of its cavity.

      POLYPOUS  CONCRETIONS  OF THE HEART.
  Q. What are their symptoms ?
  A. When the concretions are recent the contrac-
tions of the heart are obscure,  confused,  and  so jr-
 ivgular as to be  with  difficulty analysed.   These 
68        PATHOLOGY OF THE HEART.

symptoms usually supervene in a person in whom the
action of the organ was regular.  We  may presume
that the obstacle'to the transmission of the blood ex-
ists in the right cavities when these phenomena are
perceptible at the inferior part  of the sternum, but
the left cavities are obstructed when the irregularity
of the contraction is heard between  the cartilages  of
the fifth and seventh ribs.   The diagnosis becomes
almost certain when the disturbance  in  the move-
ments of the heart exists only at one side. When the
concretions are of long standing, they give rise to a
considerable  degree of dyspnoea,  extreme  anxiety
and anasarca, which is confined  to the superior or in-
ferior parts of the body, according as the  concretions
occupy the superior  or inferior  vena cava.
  Pericarditis and contraction of the orifices may be
confounded with it.
  Q.  What are their anatomical characters ?
  A.  When the concretions are recent,  the clot  is
surrounded at its margins by an opaque whitish layer,
which does not adhere to the walls of the  heart, or
its  vessels ; but after some time a connection is estab-
lished between them.  These  concretions are usual-
ly free from the colouring matter of the blood ; they
resemble  a mass of fibrine, the  consistence  of which
varies in different cases ;  in some  instances they be-
come organized.  In dropsical  subjects,  the concre-
tions at their commencement,  are gelatinous and se-
mi-transparent ; they are usually found in the  sinus
of the right auricle, in the venae cavae, and in the left
ventricle  ; the columnae  earnest, to which they  ad-
here, are flattened.  The walls of the auricles, and
also the sinuses, may  be lined with  concretions  of
much less consistence  than those just described, be-
 ing like a mere paste,  and therefore presenting none
 of the characters of fibrine.

   COMMUNICATION BETWEEN THE RIGHT  AND LEFT
              VENTRICLE OF THE HEART.
    Q. What are its symptoms ? 
           PATHOLOGY OF THE HEART.        69

   A. The colour of the skin and  mucous membranes
is livid, blue, or vioiet,  particularly when  the  affec-
tion exists truin the time  of birth.   The  respiration
is always laborious ; pulpitationsof the heart and syn-
cope frequently occur ; the general heat of the body
is diminished, and ''m patient is  very susceptible of
the  mpression of cold.   In soma cases  all the  symp-
toms, of hypertrophy  of the  right cavities are pre-
sent.
  This disease may be  simulated by contraction  of
the auriculo-ventricular openings, or of the  arterial
oiihc'r;;; but as these latter affections seldom  occur
before the age of l.'.beny, ihe history of the case will  -
clear up th<*  -.!• i^rovs.
  Q. What ar- iisMv»tT '.-.*.  ;har.-oieis?
  A. The f)f:..iii!i' o'ale ist ■  md to hav.-.  continued
open, or to hn e  been  again up. tea after it had been
closed, the two '.atnel.'ae uf the v.»lve  which exists in
the fuetus not having i-een completely unit  d, so that
a probe can readily bv.  passed  <r >ii tilt, light to the
left auricle.   The walls of the r%ht vciitricL are usu-
ally found '. hickened, the auricle atthe vttnc side be-
ing dilated   In some cases an ooatac!e to  the  trans-
mission of the blood is found either in the ventricle
or pulmonary artery ; the foran.cn ovale and ductus
art*, riosus sometimes continue  as in  the foetal  state.
The septum which separates the ven^rir'^s  n.ay be
perforated to a greater or less  extent ;  so  .uuch so,
that sometimes the two ventricles s:em to form one
cavity.   This accident  usually takes place towards
the base of the heart,  in which  case the aorta re-
ceives  blood from the right ventricle as well  as from
the  left.  The two auricles have been found imper-
fectly separated,  and opening into the right ventricle
which  communicated freely  with the left;  this  latter
being deprived of its auricular opening, but giving
rise to the aorta as usual.  Finally, several other mal-
formations may be found. 
70        PHYSIOLOGY OF THE VOICE.
                ANGINA  PECTORIS.
  Q. What are its symptoms ?
  A. The patient complains of a sense of constriction
in the chest, with very acute and lancinating pains
in the region of the heart, occurring suddenly, and in
fits  When the disease is recent, these occur usually
in the day, and are of very  short duration, lasting on-
ly a few seconds.   The dyspnoea  is considerably in-
creased when  the patient  walks  against the  wind.
The pulse during the attack is  frequent and almost
insensible, but is not intermittent or irregular, unless
the affection be complicated with  some other.   Pain
extends down the left arm, and sometimes, but  rare-
ly, to the right.  The patient is troubled with palpi-
tations, anxiety, and a sense of impending  suffoca-
tion.  As the disease makes progress,  a painful sen-
sation of numbness extends  to the  fore-arm, and even
to the fingers ;  the attacks become more frequent,
and of longer duration, and  the patient  is afflicted by
the constant apprehension  of death.   This  disease,
which is always mortal, is  neither regular in its pro-
gress or fixed in its duration, which remark is also
true with regard to the recurrence and duration of
the fits.
  Angina pectoris may be  confounded  with various
organic affections of the heart, particularly with di-
latation  of its cavities ; also with  emphysema of the
lungs, with hydrothorax,  hydrops  pericardii, and ab-
scess situated in the interior mediastinum.
  Q. What are its anatomical characters ?
  A. They are altogether unknown.  In  some cases
we find various alterations  of the  valves, old  adhe-
sions of the pericardium, ossification of the coronary
arteries, or deposits of fat round the  heart and its
large vessels.
            PHYSIOLOGY  or THE VOICE.
  Q_. By what organs are  vocal sounds uttered ?
  A. By the Cartilages of  the  Larynx, or the  Tra-
chea, and of thg Bronchial  tubes, and  by the  lungs 
PHYSIOLOGY OF THE VOICE.       71
   propelling the  air with force sufficient to excite
   sound.
     Q. Describe the manner in which the Voice is pro-
   duced.
     A. A pretty full inspiration is taken in, and while
  the glottis and epiglottis are prepared by the action
  of their  respective muscles for producing a certain
  sound, the air is voluntarily propelled  from the lungs,
  by which the  ligaments  are put  into tremors  that
  agitate the air passing through the aperture of the
  glottis, and thus  produce sound.
    ■Q. How are those  Sounds or Tones of the voice
  changed ?                           I
    A. They are changed by  an alteration in the aper-
  ture  of the Larynx, by stretching or relaxing the tra-
  chea; and by propelling the air from the lungs with
  more or less force.
    Q. How is this proved ?
    A. By experiment;  if the trachea of a  man or an
  animal be taken and blown  into from its lower end,
  towards the larynx, no sound is produced; but if
  the arytenoid cartilages are approached so that they
  touch on  their interior faces, the sound peculiar to
  the animal when  alive will  be produced:  it will be
 more  or less  grave according as the  cartilages are
 more strongly pressed together, and the sound will
 be more or less intense in proportion as it is blown
 into with a greater or less force; proving  evidently
 that it is the ligament of the glottis which  produces
 the sound : for an opening made into the trachea any
 where below the ligaments, prevents the voice com-
 pletely.  On the contrary a  wound made above the
 ligaments of the glottis produces no effect.  These
 ligaments are tightened or relaxed by the  action of
 the thyro-arytenoid muscles, and in this mode, accord-
ing to their force or relaxation, is produced the pecu-
liar modifications of the voice.
  Q. If the muscular contraction have  any  thing to
Jo with it, the destruction of the nerves which go tv
;k';m will prove it; is it so ? 
72        PHYSIOLOGY OF THE VOICE.
    A. Yes ; if the two recurrent nerves be cut, which
  supply these  muscles, the voice is  destroyed :  cut
  one, and it is only half left.
    Q. But how  (•'•  wc explain the cries of animals
  which sometimes taice place after the recurrents are
  completely  divided ?
    A. They resemble the sounds produced :\v blow-
  ing with violence  into the trachea of an  animal re-
  ce: ily dead, when  the arytenoid carril -ges are  ap-
  proximated, but thev have not the character of arti-
  culate  sounds;  they arise  from  the influence  of
  branches of the  superior laryngeal nerves, which are
  distributed to *-he arytenoid muscle, winch contracts,
  and draws together the uryttn.ml cartilages, render-
  ing the passage of the glottis sufficiently close to pro-
  duce vibrations and sounds.
    Q. How is the intensity of the voice produced ?
  ►  A. i'he intensity of the voice is regulated by the
  extent  of the vibrations, which  depends upon the
  length of the  ligaments acted  upon by a strong cur-
  rent of air, and is proportional to the strength of this
  current.  A strong man in health has a voice of  great
  intensity; let him become feeble, and his voice be-
1  comes so likewise, because he has not the same pow-
  er of chest.   Women,  children and eunuchs whose
  larynges are small, have always weaker voices.
    Q. How are the different tones produced by the
  voice explained ?
    A. By the  experiments of  Magendie,  it appears
  that the grave sounds are produced by vibrations of
  the ligiments of the glottis throughout their whole
  length, and the expired air is discharged through the
  whole extent of  the glottis : but in "the more acute
  sounds the ligaments vibrate only on their posterior
  part, and the air only passes through that part of the
  glottis which  vibrates, so that when the sounds be-
  come very acute, the ligaments  only vibrate at the
  extremity next to the arytenoid cartilage, and when
  the sound is raised as high as possible and ceases
  from its acuteness, the air ceases to pass. 
         PHYSIOLOGY OF  THE VOICE.        73

  Q.  What is the mechanism by which this effect is
produced ?
  A.  The arytenoid muscle; as Magendie proved by
the section of the nerves, appropriated to that part.
It  was attended with complete loss of the  power of
forming acute sounds.
  Q.  What does the mouth, fauces and nose contri-
bute to the voice?
  A.  The larynx is raised in the acute and depressed
in  the grave sounds, it of course in the former makes
the cavity of the mouth and fauces  (which  may be
considered as the pipe of the instrument, the larynx
corresponding to the mouth  piece) longer when grave
sounds are uttered, and shorter when acute arc form-
ed, both of •which are most  favourable for these re-
spective  sounds:  when the larynx  is depressed for
the formation of grave  sounds, the cavity of  the
mouth and fauces is rendered larger, of course more
favourable to the production of such sounds; and the
contrary, when the sounds are acute, it is narrowed
by the raising of the larynx and  the parts about'it.
  Q.  What is the use of the ventricles of the larynx ?
  A.  To leave the ligaments free to vibrate, Which
diey would not be if these ventricles were filled up,
as  is proved from the presence of foreign bodies  be-
hind them, which makes the voice feeble.
  Q.  What is the use  of the epiglottis ?
  A .From some experiments related by Magendie, it
would appear that it has the effect of preventing  the
sound from becoming  acute, when it becomes neces-
sary to increase its intensity,  by discharging the air
from the lungs with more force.
  Q.  What is the influence  of the voc.il pipe formed
by the fauces and mouth, &c. on  the voice ?
  A.  The intensity of the  voice is increased by the
mouth being more open, the tongue thrown back  and
the palate raised,  shutting out all communication
with the nose.   If on the contrary  the lips are  ap-
proached, and carried forward,  the sound has more
rotundity, and an agreeable pitch, but \+ loses its in
  Vol. II.               <• 
74        VHYSIOLOGY OF THE VOICE.

tensity : for the same reason, when it passes through
the n iso it becomes dead, and less intense.
  Q   What effect has the cavity of the mouth  and
pharynx, fauces and nose, upon the pitch of the voice ?
  A.  Ah in the last case, the breadth and length of
the passage  after the sound leaves the larynx, the
contraction of the pharynx, the open or shut state of
the passage to the nose, the volume of the tongue,
&c. all influence the pitch : when it passes llnough
the nose it becomes disagreeable.
  Q.  How is the voice dividec! ?
  A. Into natural and acquired.
  Q.  What is meant by the natural vojee ?
  A   It consists of those sounds which  are pronoun-
ced instinctively, and are intended by nature  to ex-
cite emotions of fear and pity in those who hear them:
it is  common to men and animals.
  Q.  What do you mean by the acquired voice ?
  A.  The acquired  voice  does not differ from the
natural excepting in its intensity and pitch ; they are
both  formed of inappreciable sounds.  It is  said  to
be acquired,  because idiots, the deaf, and the lower
animals, who cannot be exposed to the moral circum-
stances which require it, do not possess it: if it was
derive! from nature they would.
  Q  What do you mean by pronunciation ?
  A.  It is that format ion of the vocal organs, by which
letters, the components of words, are  pronounced ;
thus  some are formed  principally  by  the tongue,
others by the teeth  (as d and t), others by the lips
(as b and p), by the palate and tongue (as 1), b)r the
throat (asg and k), by the nose (as m and n), by the
larynx alone, (as the vowels.)  If there be a defect
in any of these structures, the pronunciation  will
also be defective.
   Q. Does language consist onjy of the articulation  ;
of words ?
   A. No; it  presupposes  the existence of mind,
without which language means  nothing ; as in the •
case  of complete idiots; their sounds are irregular,
confused, and without meaning. 
          PHYSIOLOGY  OF THE VOICE.        75

  Q.  How does the singing differ from the speaking
 voice ?
  A.  It is formed of appreciable sounds, of which the
ear can easily distinguish the intervals, and with which
it is easy to form  sounds  i'i unison :  the native voice
or the cries of men and anim ils, as also the speaking
voice, have not these qualities.
  Q.  What is the extent of the singing voice ?
  A Ordinarily about eight tones;  never above two
octaves in perfect and good tones.
  Q_.  How many kind of voices are there ?
  A. There are two ; the grave and the treble .•  the
difference between  them  is  about an octave.  By
raising the voice above its natural power of forming
perfect  tones,  treble ones can  be produced:  the
voice is then said to  be in falsetto  ; no doubt pro-
duced by the imperfect vibration of the larynx:  the
treble voice is only found among eunuchs, women and
children.  The bass voice is divided  into counter,
tenor and bass.  There are, however, differences of
the voice, which cannot be appreciated by these  cir-
cumstances,  as we hear of strong, sweet, correct,
flexible voices.
  Q.. What is meant by declamation ?
  A. It is that kind of speaking in  which  the  inter-
vals of the tones are  not  entirely harmonic, and  the
tones themselves are not completely appreciable.
  <i. Are articulated sounds  formed  ny expiration
alone ?
  A. No ; they can also be produced by inspiration;
how this is done, it is difficult to say.
  Q. In  what does the art of tiie ventriloquist con-
sist ?
  A. In imitating the exact degree of intensity,  pitch,
and modification,  which is produced upon sou uls by
distance, &c. in every situation ; thus persons beheve
necessarily that the sound proceeds from tiv person
or place with which  that sound is ordinarily associa-
ted, and in proportion to the accuracy of tne imitation
will be the deception : all motion of the lips is  avoid- 
76        PHYSIOLOGY OF 1 HE VOllJE.
cd  by not pronouncing the labials; articulation in
performed  in this act as in common speaking, and
not from the belly as the term ventriloquism imports.
  Q.  What is the difference in the organs  of  voice
in the different ages?
  A. Every part of the larynx  and thyroid cartilages
is smaller in proportion, which continues till puberty,
when the structure enlarges and the voice changes,
In man, at the  adult age  a slight ossification  takes
place in the cartilages ; in  old men it becomes nearly
complete ;  the muscles of the  glottis lose their elas-
ticity, and the voice grows hoarse and  disagreeable.
It is the changes of structure from infancy to old age
that makes the difference of voice.
  Q.  Whether do the organs of the human voice pos-
sess the properties of a stringed or wind instrument ?
  A.  They possess the properties of both ; for the
tension and tremors of the trachea and bronchia,  and
even  of the cartilages of  the ribs  themselves, cor-
respond to  the properties  of a  stringed  instru-
ment ; while the adaptation of the aperture of the
glottis,  by means of the muscles of the Larynx,  and
by the application of the  Epiglottis, corresponds to
the properties of a wind instrument.
  Q.  Does the human voice possess also the property
of articulation ?
  A.  Yes ; while the  human  voice possesses all the
properties of stringed  and wind instruments,  it  also
by the assistance of the tongue articulates the tones
into intelligible words, and thereby possesses also the
properties of speech.
   ti.  Describe  the situation  and  structure of  the
Thymus GUnd ?
   A.  This gland is situated in  the upper part of the
thorax, between the layers of  the anterior  Mediasti-
num ; it has two long corntia,  extending upwards to
the fore part of the neck, and two broad lobes below,
lying over the Pericardium.  It seems peculiar to the-
foetal state; a whitish  fluid may be squeezed  out of
it; no excretory  duct has been  detected issuing
from  it.  It is large in  the foetus; but,  in the  adult. 
         PHENOMENA Or RESPIRATION.        77

 it is. so completely absorbed,  that scarcely a vestige
 of it remains, except cellular  substance.
  Q. What is the use of the Thymus Gland ?*
  A. It seems to be of great importance in the foetal
 state, as it  is then large, and always present; but Us
 use in the svstem has not hitherto been ascertained.

 METHOD OF  EXAMINATION APPLICABLE TO DISEASES
                   OF TIIE  CHKST.
  Q. What particular train of symptoms are to be in-
 vestigated, after examining the  external conforma-
 tion of the thorax, local pains, the seat and character
 of the disease ?
  A. 1st, From the act of respiration ;
      2J, Those which depend on the voice ;
      3d,  The product of exp< ctoration ;
      4th, The symptoms given by percussion ;
      olh, Those which are referable to the heart and
           its connexions.

 OF THE  FHKNO.'Ul.NV. WHICH RESt'LT  FROM THE ACT
                 OF RESI'IICATION.
  Q.  What are the phenomena which  are characte-
 ristic of healthy respiration ?
  A.  Inspiration and expiration are performed slow-
 ly and with ease, none of the  muscles appearing to
 make any particular effort ; they succeed each other
 regularly, their rythm is constant and  uniform; all
 the ribs are alternately elevated and depressed,  and
 the dilatation and contraction are equal at both sides,
 except in cases of deformity of the thorax.  Respira-
 tion in children is  performed in  a great degree by
 the motion of the  ribs  alone; in adults, by that of
 the ribs and diaphragm ; and by this last muscle alone,
 in old persons in whom the cartilages have become
 ossified.
  The younger the subject is, the more frequent is
the respiration.   Thus,  during the first year, an in-
fant r spires p.bout thirty-Hvc  times  in a minute, but
an adult makes :!>out eighteen or twentv respirations
                       u2 
78
PHENOMENA OF Rtbl'tHVI ION'.
in the same time. Its frequency is greater in women
and persons of a nervous or irritable hab'rt.
  Q. What are the phenomena which appear in  the
organs of respiration in a state of disease ?
  A. The movements of the chest present many va-
rieties, which may be referred to the following heads:
They may be frequent or unfrcquent, quick or slow,
regular or irregular, great or small, equal or unequal,
easy or difficult, complete or incomplete ; antl, final-
ly, the respiration may be abdominal or thoracic.  All
these phenomena are within the reach of the ordina-
ry means of examination ;  but auscultation conducts
us to the knowledge of others, which we now pro-
ceed to detail.
  Q. How is  auscultation conducted ?
  A. Auscultation may be  made either by applying
the ear to the walls of the thorax, or by means of the
stethoscope invented by Laennec.
  Q.. In what cases is immediate auscultation to be
used ?
  A.  Immediate auscultation  is  more  particularly
useful to persons who have not acquired  much expe-
rience  in this mode of examination; for when  the
phenomena have been rendered sensible by the ap-
plication  of the  ear, and the  observer  has formed
some idea of  them,  it becomes more easy for him to
seize their minute shades, than if he had commenced
in the first instance by employing the stethoscope.
However, it  should  be remembered  that there  arc
cases in which the use  of the  instrument is  altoge-
ther indispensable, where,  in fact, the car cannot be
applied ;  for instance, immediately above and below
the clavicle, in the hollow  of the axilla, and beneath
the mnmmae in females. Besides, the head can scarce-
ly follow the movements of the chest, as it is elevated
and depressed; and even  if it could, the friction  it
produces must   render the  sound soivicwhat  con-
fused.  "
  Q. Describe the manner in wl>;ch the stethoscope
•J to be »:sefi. 
         PHENOMENA OF RESPIRATION.       79

   A. When using the stethoscope, it should.be held
 like a writing pen, the fingers being so placed on the
 instrument, as to feel at once its extremity and the
 point of the  thorax to which it is to be applied.  It
 should be also placed evenly upon the  surface, and
 perpendicular to it.
   Before we begin the examination, or at ail events
 before we  note its results, we should wait until any
 impression this process may have made on the patient
 shall have passed away ; for if this precaution he ne-
 cessary in examining the state of the circulation by
 means of the pulse, it is no less so when investigating
 the respiration by the stethoscope.  The phenomena
 which exist in the healthy state of the organs should
 first be studied, in order that they be not confounded
 with those which are  produced by disease; and that
 their various changes may be accurately estimated,
 or their  absence determined, which  is by no means
 an unusual occurrence.
  Q.  How  is the respiration to  be examined in its
healthy state ?
  A.  When examining  the respiration, the  funnel
should be removed from the end of the cylinder.  On
applying its extremity to the chest, we perceive in a
healthy adult, during inspiration and expiration, a
slight, though  distinct murmur, marking the entrance
of the air into the cells, and its passage out of them.
This murmur is loud in proportion to the depth and
frequency of  the respiration—to the youth  of the
subject, to the thinness of the walls of the thorax,
and completeness of their dilatation.  In females it is
more strongly marked than in males, and still more
so in children, whence the term "puerile" is applied
to.respiration when it becomes very sonorous.
  'I he respiratory murmur is most perceptible in the
hollow of the  axilla, in the  space between the ante-
rior border of the trapezius muscle and  the clavicle,
immediately beneath  this bone, and at  the inferior
and posterior  part of the chest; for these are the
;> i;-ts in which the lun;:- are nearest to  the surface 
BO        PHENOMENA OV RESPIRATION.

Opposite the trachea, larynx and root of the bronchi,
the sound of the respiration is much more loud and
distinct;  it is not unlike that of a bellows,  and gives
the idea of a considerable  column of air passing
through a tube of large diameter ;  the- air also ap-
pears as if sucked in from the cylinder, during inspi-
ration, and  expelled again during  expiration.  To
this peculiar sound the term " tracheal respiration"
is applied.
  Q. How is the respiration to be  examined in dis-
ease ?
  A. The respiratory murmur may be stronger or
weaker than natural, may be altogether suppressed
or heightened, so as to resemble what we have de-
scribed as the  " tracheal" respiration;  and, lastly,  it
may be pure,  or mixed with some  of those various
sounds, to which the term " rale"' has been applied.
  When  the respiration becomes more strong than
natural, it assumes the character it manifests in  chil-
dren, and therefore is  termed by Laennec "puerile
respiration."  This intensity of sound is  not owing
to a  lesion  of the part of the lung  in which  it  is
heard ; on the contrary, it is heard only in the healthy
parts, whose action becomes momentarily increased
to supply that of the diseased parts. Thus, in pneu-
monia, we usually  find the  "puerile"  respiration,  in
those portions of the lung which  are not yet attack-
ed by the inflammation.
  Q.  How are we to judge of the state of  the lungs
by the respiratory murmur ?
  A.  As  the respiratory murmur  presents a number
of varieties  even in the healthy state, it is only by
comparing different parts of the  lungs that we can
judge of any diminution of its intensity that may oc-
cur.  It is always easy to make this comparison ; for
the respiration is seldom weakened in the entire  of
the lung, or in both lungs at the same  time.  But its
degrees vary from  a slight weakening of its  natural
intensity to total suppression.  A diminution of the
movements of the thorax seems to be the most usual 
         PHENOMENA OF RESPIRA HON.        81

 tause of this weakening of the respiratory murmur -,
 n sometimes arises from a partial obstruction of the
 smaller bronchial tubes, either  by a thickening of
 their mucous membrane, or by the presence of some
 viscid matter.  It is also found to  occur in cases in
 which  false membranes are yet soft and just begin-
 ning to be organized.
  Complete  suppression of the respiratory murmur
 arises from various causes.  It occurs when the lung
 becomes impermeable to the air,  or when there is
 interposed between it and the walls of the thorax
 any liquid or gaseous exhalation, which prevents the
 sound  from being transmitted.  It seldom happens
 that the sound is suppressed through the whole ex-
 tent of a side of the chest.   Some  trace of it can al-
 most always  be discovered near the  clavicles, and
 opposite the root of the  lung; and probably it is
 never  altogether inaudible at the latter  of these
 points.
  When treating of the natural phenomena, we de-
 scribed the " tracheal" respiration, and indicated the
 points in which it is heard.  It sometimes happens
 that a  similar sound is emitted from other parts, be-
 sides those in which it is audible during health.  This
 occurs either when there are cavities of a certain ex-
 tent communicating freely with the  bronchi: or when
 the tissue  of the  lung becomes  indurated, and  so
 transmits more readily the sounds which the air pro-
 duces in passing through the  large bronchial tubes,
 Tn the parts of the lung which remain unaffected, we
 find that the respiration has become "puerile."
  Q. What are  the other varieties of the respiratory
murmur?
  A. The respiratory murmur, whatever be its de-
gree of intensity, may be pure, which indicates that
the air tubes are free from obstruction ; or it may be
blended, and as  it were disguised  by other sounds, to
which the term  " rale" has been applied. By " rate"
 or rattle, is understood any sound produced by the ri:
dilation of the air in the bronchi and air-vesicles, diffc- 
82         PHENOMENA  Ob RESPIRATION.
rent from that  murmur which it determines in the
healthy state*
  The " rale" seldom occupies the entire extent of
the lung;  they are us.ially audible only  in a certain
part of it, the  respiration remaining natural, or be-
coming "puerile" in the rest.   They indicate either
a contraction of some part of the bronchial tubes, or
the presence of a fluid  which obstructs them or the
air  vesicles.  The "rales" are divided into four spe-
cies;—1st, the  "rale  muqueux;"—2d, "rale so-
nore;" 3d, "rale sibilant;" 4th, " tale  crepitant."
  Q. Describe  the " rale muqueux."
  A. The "rale muqueux" or mucous rattle, is pro-
duced by the passage of the air through  sputa accu-
mulated in the brOnchi  or trachea, or through soften-
ed tubercular matter.   The  character of the sound
indicates that the fluid,  which fills up the air-tubes, is
unctuous but not tenacious.   Sometimes it is weak,
and audible only from time to time, at others it is ra-
ther loud  and  continuous.  In the former case  the
air  meets  only at intervals portions of mucus, which
determine the sound;  in the  latter the  bronchi are
almost entirely filled with it. When carried to a very
high degree, it constitutes a gurgling, or " gargouille-
ment."  This is the term that has been applied to the
loud murmur, which is  produced by the  agitation of

  * Some persons seem disposed to use the English translations
of th< »i terms. It appears, however, preferable to adopt at once
the  terms dt'Msed by Laennec, which will savt us from having
new translations of them, according to the whim or the fancy of
particular p.rsom.  The inconvenience of this practice, should
it become general,  will soon  be rendered apparent, as histories of
cases begin to b< publi&lu d, containing statements of the signs
furnished by the stethoscope. For as all these consist of simple
ideas.il each of them be not marked by a term precise and de-
finite, it will lead to endless confusion and  'discrepancy.   'I he
terms devised by Laennec, are purely terms of art-and if we
paraphrase or translate  them, we can never be  sure that they
will excite iu the minds of hearers or readers the precise ideas
which he racajit them to express,  and which we seek to con-
vey. 
         PHENOMENA OF RESPIRATION.      83

the matter of tubercles, or puriform sputa, by the pas-
sage of air through  them.  This " rale" occurs in
catarrh and in softened tubercle.
  Q. Describe " the rale sonore."
  A. The "rale sonore " consists of a sound more or
less grave, and  occasionally  very  loud,  resembling
sometime s the snoring of a person  asieep, at  others
the sound of the bass string of an  instrument when
rubbed by the finger, and not unfrequently the coo-
ing of a dove.  It seems to be caused by a contrac-
tion of the bronchial tubes, by a thickening of their
mucous membrane, or by some change  in the form of
these canals, induced probably by the thickening of
the spur-like processes or folds of membrane at the
points of division of the bronchi ; at least tlv.s change
is almost constantly observable in subjects that have
died during the existence of chronic catarrh, of which
this " rale" is characteristic.
  Q. Describe the " rale sibilant."
  A. The " rdle sibilant," consists of a  slight, though
prolonged, hissing round, which occurs either at the
termination or commencement of inspiration.  It may
be grave or acute, dull or sonorous.   These two va-
rieties may exist at the same time  in different parts
of the lung, or may succeed each other at variable in-
tervals,  in the same part. It is owing to the presence
of mucus, thin, and  viscid, but not abundant, which
obstructs, more or less completely, the smaller bron-
chial ramifications, which the air has to pass through
before it arrives at the air-cells.  This  "rale" seems
to indicate a more serious affection of the lungs than
the one last described, inasmuch as it is seated in the
more minute bronchial ramifications; hence, when it
extends to any considerable portion of the lung, it is
attended by great difficulty of respiration.  It is du-
ring the existence of this "rale" that the sputa pre-
sent that aborescent appearance, which resembles so
much the form, dimensions, and ramifications of the
small bronchial tubes, from which they  have been ex-
pelled by the efforts of coughing.  It occurs  in the
first stage of bronchitis. 
84       PHENOMENA WHICH DEPENB
  ti. Describe the "rale crepitant."
  A.  The " rale crepitant" resembles very accurate.!j
the crackling or crepitation of salt, when thrown into
a heateil vessel, or .that emitted by a piece of dried
lung, when pressed between the fingers.  It depends
on an exhalation of blood on the internal surface of
the air-cells, such as occurs in the first stage of pneu-
monia, of which this "rale" is the distinctive sign.
It occurs also in haemoptysis and oedema of the lungs.
  These are the different "rales"  which the ste-
thoscope enables us to recognize.  It would appear
from this description of them, that their characters
are so strongly marked, that  they  cannot be  con-
founded  or mistaken one for the other; but  still it
frequently happens that their differences are not so
striking, and that they glide into each other, by a sort
of transition indicative of a mixed lesion, or one more
nearly allied to one than the other.   It is by habit and
practice alone that we can learn to appreciate these
shades;  words cannot convey an adequate idea  of
them.

  OF THE PHENOMENA WHICH DErEND ON THE VOICE.
  Q. Describe the varieties of the phenomena of the
voice, as ascertained by the stethoscope.
  A. When examining the voice, the funnel should
be retained in  the extremity of the  cylinder, and
then the phenomena will be  found  to vary: 1st, ac-
cording to the points at which they  are examined;
and, 2d, according to the natural character of the
voice.
  When a person speaks or sings, his voice thrills in
the interior of the chest, and produces in its  whole
extent a trembling motion, which we can readily per-
ceive on the application  of the hand.  This pheno-
menon is not of much importance,  and seldom de-
mands any particular attention.  However, when a
large cavity happens to exist, the trembling becomes
so forcible, as of itself to make us suspect its exist-
ence.  When the cylinder is applied to the thorax-, 
ON  THE VOICE.             85
 we hear a confused resonance of the voice, the inten-
 sity of which  varies in different points of its extent.
 It is most distinctly heard in the arm-pit, at the back,
 between the internal border of the scapula and the
 vertebral column, and anteriorly at the angle formed
 by the clavicle with the sternum.  We do not hear
 any thing distinct or articulate, it is rather  a sound
 more or less confused,  which seems to  waste  itself
 against the  walls of the thorax.  In other parts of the
 chest, particularly   posteriorly  and inferiorly, the
 sound is much more weak, and produces only an in-
 distinct murmur.  It is in all cases rendered more
 manifest where old adhesions exist.
  In persons whose voice is deep and grave, the de-
 gree of resonance is greater, but it is confused, and
 nearly equal at  all points of the thorax; but in  fe-
 males and children, whose voice is acute, it is clear
 and distinct.
  Q.  Describe the  varieties of the  phenomena fur-
 nished by the voice in disease.
  A.  In Disease, the phenomena furnished by the voice
 are referable to  three heads :  Resonance, Pectorilo-
 quy, and jEgophony.   By the term resonance, is un-
 derstood a thrilling of the voice more loud than is na-
 tural, or its existence in a part in which it is not heard
 during health.   It sometimes becomes so strong as
 that the sound seems to be produced at the very ex-
 tremity of the cylinder which  is placed on the tho-
 rax, but  it never conveys the impression  as if it  tra-
 versed the length of the tube to reach the ear of the
 observer.  A thickened  and hardened state of the
lung, caused either by a mass of crude tubercles, or
by inflammation, produces this phenomenon, by ren-
dering the lung a better conductor of the murmur of
the voice in the bronchi.   Hence the origin  of the
term " broncophony."  This symptom,  though  not
usually of much importance, becomes occasionally of
considerable value ; when it co-exists with phenome-
 na furnished bv other means of examination, and al-
  V..t.  If.              IT 
36       PHENOMENA  WHICH DEPEND

so as enabling us to make a comparison between the
state of the two sides of the thorax.
   Q.  What is meant by " pectoriloquy."
   A.  This phenomenon  is said to  exist when the
voice of the patient, distinctly articulated, seems  to
issue from the point of the chest on  which the cylin-
der is applied, and traverses its whole length to strike
the ear of the observer, with  its natural tone, or pro-
bably more strongly.  These are the  circumstances
which constitute perfect pectoriloquy ; but it admits of
two other degrees, namely, the imperfect and the doubt
ful. It istermedtmper/«tf, when the voice thrillsstrong
ly under the cylinder, seems  to approach the ear, but
never traverses the whole length of the tube.   And,
lastly, it is said to be doubtful, when the voice seems
acute and suppressed like that of a ventriloquist, and
is arrested at the thoracic extremity of the tube, thus
approaching to the character of simple resonance.
   Q.  What are its other varieties?
   A.  Pectoriloquy  presents  some  varieties,  which
depend on the tone of the voice, the size and form of
the excavations, the firmness of their walls, the de-
gree  of facility with which  the air  can penetrate
them ; and finally,  the existence or non-existence of
adhesions with the  pleura costalis.
   The more acute  the voice is, the more evident does
the pectoriloquy become;  hence, in  persons whose
voice is grave and deep, the  thrilling  or vibration of
 the walls of the thorax may be sufficiently intense to
 mask it, and render it doubtful.
   In  cases of aphonia, the pectoriloquy is not entire-
 ly suppressed.   It sometimes occurs that we can dis-
 tinguish  better what the patient endeavours to  ex-
 press, by placing the cylinder on  the  point  corres-
 ponding to the excavation in the lung, than we  can
 by the naked ear at the same distance.
   The pectoriloquy is sensibly affected by the size of
 the cavities.  Thus, when they are unusually large,
 it becomes changed into a very full and grave sound,
 similar to that of the voice transmitted to  some  dis- 
UN  THE VOICE.              87
 tance through a tube, or cone of paper.  In  very
 small cavities, on the contrary, it becomes doubtful,
 particularly when  parts of the lung  which  sur-
 round them, are still permeable to the air.
  The more dense  and firm the walls of the excava-
 tion are, the more  perfect is the pectoriloquy.  It
 sometimes acquires  even a metallic tone when the ca-
 vity has become lined by a membrane, whose struc-
 ture approaches that of fibro-cartilage.
  It is also rendered very distinct when the cavity is
 superficial, and its  walls  thin, and adherent to the
 pleura costalis; but when there is no  adhesion, and
 the sides of the cavity become compressed together
 during expiration, the pectoriloquy  becomes doubt-
 ful ; the existence of the excavation  must then be as-
 certained by other  symptoms.
  Again, its force becomes increased, and the voice
 seems as if transmitted through a tube, when new ca-
 vities begin to communicate with those already exist-
 ing ;  but if the excavations become very numerous
 and tortuous, the sound is  rendered somewhat con-
 fused and indistinct.
  The less  liquid the cavity  contains, the more evi-
 dent is the pectoriloquy,  for then the communication
 with the  bronchi is usually open, and allows a free
 passage to the air.
  If this communication be obstructed for anytime
 by  the accumulation of matter in the bronchi, the
 pectoriloquy is rendered doubtful, and acquires some-
 what of an intermittent character.
  It sometimes happens that  we can find scarcely  a
 single individual with pectoriloquy in the wards of a
 hospital, though at  the previous visit there had been
 several; in such cas#s, we observe that in the greater
 number of the patients, the expectoration had been
-very much diminished or altogether suppressed.
  Q. What is meant by  " ffigophony ?"
  A. This phenomenon  consists of a strong reson-
 ance of the voice, which is more acute and sharp than
 that of the patient, but never seems to traverse the 
 38       PHENOMENA WHICH DEPKNU

 cylinder as pectoriloquy does ; its tone is thrilling ami
 tremulous, like that of a goat;  whence the term is
 derived.
   Though its limits are usually circumscribed,  they
 are  not so much so as those of pectoriloquy ;  it is
 found between the base of the scapula  and vertebral
 column, towards the inferior angle and external bor-
 der  of that bone, and sometimes in the  direction of a
 line, which may be  conceived to pass from its centre
 to the sternum, following the direction of the  ribs.
 When tegophony exists at both sides at the same time,
 it is difficult  to determine whether it is produced by
 disease ; for in some persons the natural resonance of
 the  voice presents this acute and tremulous charac-
ter at the reot ofthe,'lungs.  If old adhesions exist at
 one  side of the chest, the xgophony becomes much
 more evident.
   JEgophony, though it may vary in its force and ex-
 tent, always indicates the existence,  in  the cavity of
 the  pleura, of a moderate quantity of fluid, or of false
 membranes, somewhat thick and soft: it ceases when
 the effusion becomes too considerable : hence, in the
 former case it indicates pleurisy in its first stage  : and
 in the latter, it marks its passage to the  chronic state,
 if the  general symptoms still continue  after the ces-
 sation  of the aegophony ; but it is not a  sign of its re-
 solution, if these symptoms cease as it disappears.
   JEgophony does not prevent us altogether  from
 hearing the respiratory murmur, when  it is not sup-
 pressed by hepatization of the lung.
   Q. What is meant by Metallic tingling, Respira-
 tion, and Resonance ?
   A.  The Metallic Tingling, JietOiration, and Reso-
 nance  are very remarkable phenomena, with which
 we shall conclude this account of the signs furnished
 by the voice and respiration.
   The metallic tingling, or " tintement metallique,"
 resembles the sound  produced by  any  very small
 hard body striking against  a metallic  or glass  cup.
 When the phenomenon is not so  strongly marked, it 
ON  THE VOICE.
89
 produces only the metallic resonance;  lastly, the re-
 spiration  also  may assume this character, in which
 case it resembles the murmur produced by air blown
 into a metallic vessel with a narrow aperture; these
 different sounds  cease occasionally for a short time,
 but recur soon after.
   The metallic tingling occurs when there exists a
 large excavation filled with air and fluid, communi-
 cating with the bronchi, and is heard  when  the pa-
 tient coughs or speaks.
   The metallic respiration occurs when there  is a
 fistulous communication between the bronchi and the
 cavity of the pleura.
   The metallic resonance and respiration indicate, in
 addition to the  fistulous communication between the
 bronchi and pleura, an effusion of gaseous  fluid into
 the cavity of that membrane.
   When the metallic tingling occurs together with
 the metallic resonance and respiration, it denotes the
 existence of a vast excavation, whose walls are thin,
 adherent and compact.

              OF  THE  EXPECTOBATION.
   Q. What are the qualities of the  expectoration in
 the healthy state ?
   A. In the Healthy State, the expectoration consists
 of a viscid,  ropy fluid, which is transparent,  colour-
less, inodorous, insipid, and exists only in  sufficient
 quantity to moisten the inner surface of the air  pas-
sages.
  Q. What are its qualities in disease ?
   A. In Disease,  the  sputa sometimes consist of a
transparent, limpid, and slightly viscid fluid, the  con-
sistence of which  gradually  increases, until it  ulti-
mately becomes changed into an opaque, yellow, or
greenish mucous  matter, such as usually occurs in
pulmonary catarrh.
  In other cases, the expectoration is composed of a
transparent mucous fluid, so tenacious as to _adhere
closclv to the bottom of the vessel in which it is de-
                       h2 
Vi)            OF EXPECTORATION.

posited, even  when  it is  inverted.  This  may  be
marked by  bloody stnae, or the blood may  be  com-
bined with  it in greater or less quantity, so that its
colour varies from a yellow slightly tinged with red,
to that of the deepest mahogany.   These  are the
characters of the expectoration in acute pneumonia.
  We sometimes observe the product of expectora-
tion to consist of a frothy, colourless fluid, containing,
suspended, several portions of flocculent matter, or
presenting on its surface some yellow, rounded, puru-
lent it.asses, in greater or less quantity : in other cases
it is composed of mucous matter, marked by striae of
a dull  white colour.   These varieties occur during
the early stages of pulmonary tubercles.   As the dis-
ease  advances the quantity  of the  yellow diffluent
fluid increases, and ultimately forms the whole of the
matter expectorated.   It sometimes  contains bubbles
of air,  and  presents  more or less the characters of
pus.   Such is the expectoration in the last stage of
phthisis.
  In some cases the sputa are  ejected forcibly, and
in large quantity at a time, so that the patients seem
to vomit them.  This occurs when an effusion into
the cavity of the thorax finds  an exit through the
bronchi.
  Again, we  sometimes observe portions  of false
membrane expectorated, either in the form of lamel-
la, or moulded into that of the bronchial tubes, tra-
chea, or larynx.   This is characteristic of croup.
  Lastly,  the  expectoration  n y  consist  of pure
blood,  sometimes of a bright, at others of a dark red
colour, as  occurs  in  hemoptysis.   When  a  large
quantity is brought up at a lime, we should take care
to examine whether  the blood is frothy, and aenm-
panied by cough, as  these are the symptoms which
distinguish haemoptysis from  haematemesis.
  In all cases the observer should ascertain whether
the sputa exhale any particular odour, particularly
when the general symptoms induce him to suspect
the existence of a gangrene of the lung, or of a  tti- 
Ut  PERCUSSION.             9i
  bercular  cavity, or  collection  of pus,  which  mav
  have opened a passage for itself from the pleura into
  the bronchi.
   In cases of gangrene of the lungs, the sputa are as
  dark as the lets of wine, or greenish ;  and the odour
  is so strong as to prevent any mistake as to their real
  character.

                   or pehcussion.
   Q. Describe  the sounds  perceived on, and  the
 mode of applying percussion in  the  healthy state of
 the chest.
   A. The value of percussion, as a mode of examina-
 tion, has not been by any means diminished by the dis-
 covery  of auscultation.   It is still considered a very
 efficient  means  of  distinguishing  diseases of the
 chest.  Though it appears to be a very simple ope-
 ration, it requires some precautions in  performing it,
 so  as  to obtain  satisfactory  results.  The fingers
 should be semi-flexed, their extremities placed close-
 ly together, and so adjusted as to  be on the same
 plane, none of them passing beyond the  others.   In
 this way they are made to strike the chest  perpen-
 dicularly, the  integuments being made tense by  the
 Sngcrs of the  other hand. The percussion should be
 made alternately on the corresponding points of each
 side of the chest, with the same  degree of force and
 same angle of incidence.  The wrist should  be free
 and unrestrained, so as not to strike too forcibly and'
 -ause pain.  Percussion  may occasionally be made,
 11 y striking the walls of the thorax with the hand  flat
 and extended  ; but  in this case allowance must be
 made for the sound emitted by skin.
  The position of the  patient should also be properly
adjusted.   He should be made  to  sit upright,  his
arms being carried backwards when the anterior part
of the chest is to be examined ; elevated towards his
head, when percussion is being  made on the lateral
parts, or crossed in front, whilst  we strike the back.
He should at the same time be directed to bend for- 
92              OF  PERCUSSION.
wards, so  as to  give the  back an arched position.
These several measures are intended for the purpose
of rendering tense the muscles which cover the walls
of the thorax.
  The condition of the external parts  should be at-
tended to ; thus the sound will be more clear when
the patient is  thin  and  his fibres dry, than when he
happens to be very fat,  or when the  flesh is soft and
flaccid; but if the  integuments be  infiltrated  by  a
serous effusion,  no sound  will be emitted on percus-
sion.
  The sound is  more clear when we make percus-
sion on those  parts that are covered  merely by the
skin, or by thin and tense muscles ;  for instance, on
the clavicles,  or immediately below them to  the
distance of two  fingers' breadth  on the sternum;—
towards the cartilages of the ribs, within the margins
of the axilla as far as the third rib ; and posteriorly on
the angles of those bones;—on the spine of the sca-
pula,  and, in  thin  subjects,  on its supra and  infra
spinous fossx.
  The sound must obviously  be dull  at the region of
the heart, opposite the mammae in females, and great
pectoral muscle in males;  and. also inferiorly at the
right side, in consequence  of the position of the liver;
at the left side, on the contrar}-, the sound is render-
ed more clear by its vicinity to the stomach, particu-
larly if that viscus be distended by flatus.
  Q.  Describe the sounds  perceived on applying per-
cussion in disease.'
  A The sound emitted  by  the  chest, frequently
becomes altered, being  rendered  dull, obscure, or
even  totally suppresse-d;  or, on  the contrary, may
become more clear than in the natural state; so
much so, as in some instances to  give rise to a gurg-
ling, or even  a  metallic tingling.  When this  phe-
nomenon occurs, it is observed most usually beneath
the clavicles.  This exaltation of sound occurs when
the lungs contain a greater quantity of air than is na-
tural,  or when this fluid is effused into the cavity of
^ic pleura. 
                  OK PERCUSSION.            95

   When the elasticity of the lung is diminished by
 its becoming infiltrated, without at the same time
 losing altogether its permeability to  the  air, the
 sound is rendered dull or obscure, according to the
 degree in which the pulmonary  tissue is affected.
 This change takes place in cases  of intense  catarrh,
 in the first degree of pneumonia, and in oedema of the
 lungs.
   The sound is suppressed altogether in the second
 degree of pneumonia,  when  the substance  of the
 lung becomes dense  and heavy like that of the liver,
 and so is rendered  impermeable to  the air.  The
 same effect  is produced when the lung is compressed
 by a fluid effused into the cavity of the pleura, or by
 the development of any accidental production in its
 substance.  This suppression is, however, but partial
 in most cases.  Its extent depends on that of the ef-
 fusion, hepatization, or tumour with which-it is con-
 nected, the  remainder of the  side still emitting its
 natural sound on percussion.
   When the lung contains an unusual quantity of air,
 or when an elastic fluid is effused into the pleura, the
 sound becomes more clear than natural.  And lastly,
 its tone may be increased so as to resemble a metallic
 tingling, in cases of pulmonary excavations, or pleu-
 ritic abscess, which are circumscribed and rilled part-
 ly with air, partly with fluid.

     OF THE PHENOMENA REFERABLE TO THF. HEAB.T.
  Q. How are these  divided ?
  A. Laennec has referred  them to  four heads:—
 1st, the extent in which the movements of the heart
 are perceptible ; 2d, the impulse which they com-
 municate ; 3d, the sound which accompanies them ;
 4th,  their rythm.
  Q. What  arc  the qualities of its pulsation on ex-
 amination ?
  A. In a healthy man whose heart is  properly pro-
portioned, we can distinguish its pulsations  only in
the praccordial region ; that is, in the space between 
94         PHENOMENA REFERABLE

the cartilages of the fifth and seventh ribs ; and at
the inferior part of the sternum.  The movement of
the left cavities is most perceptible in the former sit-
uation, that of the right, in the latter; but if the ster-
num be very short, they are sensible even in the epi-
gastrium.
  In some corpulent persons  we cannot by the hand
distinguish the  pulsations of the heart,  and the space
in which  we can perceive them by  the cylinder, is
very limited, being not more than a square inch ; but
in emaci.itcd persons, particularly when their chests
are narrow, they are heard in a much  wider range,
namely,  in the  inferior  fourth, or probably  three-
fourths of the s'ernum, or, occasionally, even along
the whole length of that bone, under  the  left clavi-
cle, and  sometimes even as far as th • right.
  When  the stroke of the heart is  confined within
these bounds, and when  it is less strong under the
clavicles  than in the praecordial region, in  persons of
that conformation which  has just been  described  we
may still consider the organ as retaining  its proper
proportions.
  The stroke of the heart, will, of course, be heard
in situations different from those here stated, in cases
in which a transposition  of  the viscera has  existed
from infancy.
  Q. What is meant by the impulse of the heart ?
  A. When one extremity of a stethoscope is placed
on the cartilages of  the ribs, or base of the sternum,
and the ear is applied to the  oiher,  a sensation is
communicated as if it were elevated  by each stroke
of the heart; this is termed its impulse.
   It is very slight in a healthy person,  particularly if
somewhat corpulent; but even when altogether im-
perceptible by the hand, it  is  rendered distinct by
the cylinder.  In general, it is distinguishable only
in the praecordial region, or, at furthest, along the in-
ferior half of the sternum.
   ]t is most  forcible opposite  the cartilages of  the
ribs, being the part  which corresponds to  the point 
IO  THE HEART.              95v
of the heart.   Its degree of strength is extremely va-
riable ; we learn, however, by practice, to distinguish
when it is more intense than it ought to be.
  Q.  What is known of the motions of the heart, by
the sounds which are emitted ?
  A. The alternate contractions of the auricles and
ventricles, emit sounds  peculiar to  each ;  which,
though  imperceptible  by the ordinary means of in-
vestigation, are rendered quite manifest by the cyl-
inder, no  matter how small the volume and force of
the organ may be.
  In the healthy state, there are two distinct sounds ;
one, dull and lengthened, coincides with the arterial
pulse, and sensation of impulse above described, and
therefore  indicates the  contraction of the ventricles ;
the other clear and sudden, somewhat  like that of the
valve of a bellows,  corresponds with  the systole of
the auricles.
  The sound of the right cavities is heard most dis-
tinctly opposite the base of the sternum, that of the
left at the cartilages of the ribs.
  When the walls of the heart happen to be more
thin than usual, which may occur in persons  who are
enjoying  uninterrupted  health,  the  pulsations  are
heard in a greater extent of space than in  persons
differently constituted, but the sound  is always loud-
er in the region of  the heart  than in any other part.
In such persons we  also observe that the contraction
of the auricles is more  audible under the clavicles
than that  of the ventricles, which is not the case ei-
ther at the base of the  sternum, or cartilages of the
r'bs.   .
  In some cases, the anterior border  of the lung is
prolonged in front of the pericardium, which renders
the sound of the auricles more dull than that of the
ventricles, but still  not so much so as to make it in-
distinct. This evidently arises from its being masked
by  the murmur of respiration, or by  that of the air
forced,out from this process of the lung, by the com-
tstn'\-r.\  x erted upon it  by the heart. 
96            OP THE PHENOMENA

   Q. What is rythm ?•
   A. The movements of the heart are performed in
a determinate order, which  constitutes their rythm.
Each contraction of the ventricles coincides with the
dilatation  of the arteries, and is accompanied by a
dull, prolonged sound ; this  is instantly followed by
a clear and  rather quick sound,  which is owing  to
the  contraction of the auricles ; a moment of repose
succeeds, when the ventricle  again acts,  and so the
succession goes on.

   OF THE PHENOMENA  FURNISHED BT THE HEART.

   Q. What are these in a state of disease  ?
   A. When treating of the derangements of the heart,
we shall follow the arrangement adopted  when  con-
sidering its actions in health.
   Extent.—The pulsations of this organ are some-
times heard,  beyond  the limits above assigned  to

   *  By means of the stethoscope,  we can analyse the honrt's ac-
tion, and assign the time occupied hythe contraction of each of
its cavities.  When the instrument is applied to the precorneal
region, we hearat first a dull lengthened sound, synchronous with
the arterial pulse, and therefore produced by the contraction of
the ventricles ; this is instantly succeeded (without any interval)
by a sharp quick sound, like that of a valve, or the lapping of a
dog; .this corresponds to the interval between two pulsations, and
therefore marks the contraction of the auricles; then conies the
interval of repose.  The relative duration of these three periods
may  be thus stated—one half or somewhat less may  be assigned te
the contraction of the ventricles—a quarter or a little more to that
of the auricles—the remainder for the repose.—According to this
statement, if we take any given period, say 24 hours, we at once
arc compelled to  conclude that the ventricles are in action 12
hours, and therefore rest 12 hours, the  auricle sare in action 6
hours, and rest 18 hours.
   This calculation is applicable to a healthy adult, whose pulsi-
beats 70 strokes in a minute.  It assumes, wha tsonie will be dis-
posed to deny, that the heart is passive in its dilation—but  opin-
ions on the subject are so various that it would be  impos.,il>l<" to
give  any summary of them in a note.—See I.aenitc'c Vpl. ?. 
FURNISHED  BY THE  HEART.      97
them, or they may be restricted and confined to a very
limited portion of the walls of the thorax.
  The increase of extent is perceptible, first  along
the left side from the axilla to the region of the sto-
mach, then for the  same space at the right side, next
at the posterior part of the left; and, finally, but ve-
ry rarely, in the same region of the  right side ;  the
intensity of the sound becoming progressively less in
the order here indicated.
  The possibility of thus perceiving the pulsations of
the heart in these  different points always indicates a
diminution of the thickness of its walls, particularly
those of the ventricles.  It also marks a weakness or
dilatation of the organ, which in the latter case strikes
the sternum and ribs with a large surface.  However,
it should not be forgotten, that similar effects are oc«
casionally produced by causes altogether  indepen-
dent of any affection of the heart; for instance, nar-
rowness of the chest, emaciation,  hepatization  of the
lung, or its compression by a liquid or gaseous effu-
sion, the presence  of an excavation with firm  walls,
nervous agitation,  fever, or in a word, by any thing
that can increase the frequency of the pulse.
  Sometimes the pulsations  of the heart are distin-
guishable  only in  a very circumscribed  extent of
space.   This is a more rare occurrence than the pre-
ceding, and is  produced by an increased thickness of
its walls.
  It sometimes happens that we perceive the  pulsa-
tions more distinctly at the right side than at the left,
or more high or  low than usual.  These  variations
are  determined by  the existence of a fluid or tumour
at one side of the thorax,  in  the  mediastinum, or in
the cavity of the abdomen ;  and finally, the seat of
the pulsation may vary, being pereeptible now  in one
place, now in another.
  Q. What is  known of the heart from the impulse r
  A. As the intensity of the impulsion communicated
by the heart varies very much during health, it be-
comes difficult to decide positively upon its absolute
  Vol.  II-                I 
98           OF THE PHENOMENA
increase  or diminution in disease, unless it be very
strongly marked, or be  more  manifest at one  side
than the other, which is the deviation  most usually
found to exist.  This increase  is sometimes very
slight, but in  some cases becomes so great as to ele-
vate the walls of the thorax so strongly as to render
this  movement perceptible at  a  considerable dis-
tance.  This  is the pathognomic  sign of hypertrophy
of the heart.
  The force of the impulse is  directly proportion
ed to the  thickness of the walls of the ventricles,
and therefore, to the narrowness of the limit within
which their contractions are audible.   When the ear
is applied to  a stethoscope laid  on the cartilages of
the  ribs, a jirking motion  is communicated to  it,
which is  strongly felt  by the observer, and manifest
to all around  him.
  Whatever increases the  activity of the circulation,
such as walking, running, fever, &c, may momenta-
rily determine this state; and causes of an  opposite
tendency, rest, bleeding, &c, produce  the  contrary
effect: hence, when we want  to examine a patient,
we should  wait until a perfect  calm is established.
  The diminution of the heart's  impulse is never so
strongly marked as its  increase.  It depends some-
times on the weakness of the organ and the thin-
ness of  its walls, and therefore occurs in cases in
which its contractions are  perceptible in a wide ex-
tent of space; at others, it is produced  by extreme
embarrassment of the respiration  and difficulty of
the  pulmonary circulation, and then may co-exist
with a well-marked hypertrophy;  we  also observe
this  diminution  to occur towards the close of this
latter disease.  Certain emotions, such as fear and
depressing passions, may also produce it.
  Q. What is known of  the  diseases of the heart
from its sound?
  A. The sound of the heart's contractions may be-
come more dull, or more  clear  and loud than natu-
ral;  or sounds altogether  new  may  be  produced, 
FURNISHED BY THE  HEART.       99
 Which bear no similitude to any that are emitted in
 the  healthy state of the organ.   A diminution of
 the intensity of the sound is caused by an increased
 thickness of the walls of the heart; but if it  occurs
 together with a weakness of the impulsion, it indi-
 cates a " ramolhssement," or softening of its struc-
ture.
  The alteration most  usually observed, is  an  in-
 creased loudness  and clearness of  the sound, which
 always denotes a  thinness of the walls of the  heart.
This may be emitted by the auricles or by the ven-
tricles   The place  in which it is  audible marks its
seat, and the time determines whether it arises from
the contraction of  the auricles, or that of the ven-
tricles.
  As to the sounds, which possess no similitude
with any that occur during health, a knowledge of
which is necessary as a means of distinguishing  se-
veral of  the derangements of the  heart, they may
 be referred to the three following  heads:—
  Q.  Describe that sound called the " Bruit de Souf-
flet," or  the sound like that of a bellows.
  A.  Its name accurately expresses the character of
this  phenomenon.  It may accompany the contrac-
tion  of the ventricles, auricles, or  large arteries;
it  may be continued or intermittent; the  slightest
cause being sufficient to induce its return after it  has
 ceased.  It is observable sometimes in hysterical
and nervous persons, and also  in  those disposed to
 haemorrhagies, even  though there is no  alteration
 of the functions or structure of the heart; however,
 in other instances,  it  co-exists with affections of
 that organ.
  Q.  Describe that sound called " Bruit de Rape,"
 or sound of a file, and what it indicates.
  A. This, like  the former, may occur during the
 contraction of either of the cavities of the heart,
 but it is not intermittent; when once developed, it in-
 variably continues, with, however, some occasional
 changes in its  degree of force. The contraction of 
iOO
OF  THE PHENOMENA
 the auricles or  the  ventricles, is  more  prolonged
 than natural, and emits a sound, hard, rough, and as
 it were, stifled.
   This  phenomenon indicates  a contraction of the
 orifices  by cartilaginous deposits  or ossification  of
 the valves. The place and time in which it is heard,
 indicate its  situation.  If it coincides with the sys-
 tole of the ventricles, the contraction  exists in the
 sigmoid valves; if, on the contrary, it occurs during
 the contraction of the auricles, it occupies the auri-
 culo-ventricular opening.
   QL. What is indicated by the Craquement de Cuir,
 or sound like the  crackling of new leather ?
   A. It  was observed by M. Collin in the case  of
 pericarditis, of which he looks  on it as symptoma-
 tic.
  Q. What does the rythm of the heart indicate?
  A. The contraction  of  the  ventricles may  be
 lengthened beyond  their ordinary duration,  so may
 that of the period of repose  also; this indicates hy-
 pertrophy of these cavities, which  is the more con-
 siderable, as the time of the contraction is the more
 prolonged.
  In other cases, on  the  contrary, the contractions
 are found to be  more  rapid,  and the repose more
 short than natural: this variation may coincide with
 quickness, or even with slowness of the pulse, and
 is not considered as indicative  of any morbid altera-
 tion.
  The time of the systole of  the auricles is rarely
 observed to be lengthened, or  shortened. Their con-
 traction seems, sometimes, to  anticipate  that of the
 ventricles, particularly  during palpitation, the con-
 sequence of which is  that the  sound of  the auricles
 is masked by that  of the ventricles, and  in cases ot
 strongly  marked  hypertrophy becomes altogether
 imperceptible.
  Sometimes, during  one systole of the ventricles,
the auricles may make two or three contractions, or,
on the contrary, while the auricles are making one,
the ventricles may make two. within the time of an 
FURNISHED  BY THE  HEART.      101
 ordinary  contraction.  These phenomena do not
 mark any particular lesion; the pulse even, does not
 participate in their anomalies.
   We sometimes observe several equal contractions,
 followed  by one  or more, which are shorter and
 qu;cker than the  'est, or by a perceptible  pause
 constituting an intermittence ;—this should be con-
 sidered as indicative of disease.
   Sometimes again, the contractions are so frequent
 and irregular, that it is impossible  to  analyse them;
 this is always connected with some organic affection.
   After having examined the  heart, attention should
 be  directed towards  the region  of the sternum
 and  the first ribs  on the right side, to  ascertain
 whether there are  any pulsations determined by an
 aneurism of the arch of the aorta.
   Having thus concluded our remarks on the meth-
 od of examination,  applicable to the  heart as the
 central organ of the circulation, we shall, in the
 next place  proceed to consider the varieties which
 the pulse  presents, though these  are not confined to
 affections of the chest, more particularly than to
 those of the other cavities.
   Q. Describe the  method of examining the pulse.
   A. The observer should  wait  until any emotion,
 which his presence  may have caused, has subsided.
 He  may then proceed to  examine the pulse at the
 wrist, temple, lateral  parts of the  neck, or,  in a
 word, in any other part  where" an artery of a cer-
 tain  size happens to  be superficially seated.   After
 having ascertained  that the course of the  blood is
 not interrupted in the arm, by tight clothes, or by a
ligature, he takes the wrist of the  patient, who ought
to be either sitting, or lying in such a way as that the
 weight of his body may not incline more to one side
than  the other ; the arm  being placed in extension,
and the fore-arm in pronation,  supported by its ulnar
border while the radical  is somewhat elevated, the
artery is felt with the hand opposite  to that of the
patient.
                     i2 
102
OF  THE PHENOMENA
   The fingers should be  laid in a right line on the
 course of the artery, the index finger on the anteri-
 or, and the thumb on the posterior or dorsal side of
 the wrist, furnishing a support to the others.  The
 little finger, which receives the first  impulse of the
 blood, should be applied to the vessel  but slightly,
 but the others may compress it more or less.   We
 should continue  this process  for a minute or two,
 and always observe the precaution of  examining the
 pulse in both  arms.  The abdominal  aorta  and cru-
 ral arteries may be  examined by  means of the ste-
 thoscope, which enables us readily to  distinguish the
 circulation in those vessels.  A watch, with a second
 hand, is in  general necessary, in  order to ascertain
 exactly the  number of pulsations  that  are made in
 a  given time.
   In Health the pulse is equal and regular, of a mo-
 derate degree of strength and frequency. The  num-
 ber of its beats vary according to the age, sex, tem-
 perament, stature,  and idiosyncracy of each indivi-
 dual.   In the first  months of life there are  one hun-
 dred and forty arterial pulsations in a  minute ; up to
 the completion of the second  year, there are about
 one hundred;  at  puberty the number is reduced to
 eighty ; in middle life we count from sixty to seventy-
 five ;  and finally in old age  from fifty  to sixty.  The
 pulse is generally more frequent in females, and per-
 sons of a nervous temperament; it becomes quicken-
 ed after meals  and exercise, during  pregnancy, or
 after any sudden emotion ; but it is rendered slow by
 repose, fasting and blood-letting.
   The observer should also recollect, that the pulse
 is  subject to variations, both as to the duration and
 order qf its beats ; it is necessary to bear this in mind,
 lest he attribute to disease what may  be altogether in-
 dependent of it.
   In Disease the pulse may be quick or slow,  strong
 or weak, full or small, hard, contracted, resisting, or
soft and compressible, requiring a greater  or less
 pressure on the artery to measure its degree.  I' ma% 
FURNISHED BY THE HEART.        103
  also be frequent or the reverse, regular or irregular,
  in which latter case there are sometimes intermitten-
  ces coinciding with the contraction  of the auricles;
  and  further, it may be equal or unequal, distinct or
  confused, thready or insensible.
   In general, tiie larger the artery is, the stronger is
 the pulse ; this should be taken into account when it
 happens to be stronger in one ann than in the other.
 The strength of the pulse diminishes gradually, when
 a tumour is developed near the  trajet of the artery,
 as we observe in cases of aneurism of the arch of the
 aorta, when the subclavian artery suffers compression
 against the walls of the thorax.
   The veins  sometimes present pulsations synchro-
 nous with those of the arteries.  This may be ob-
 served in the jugular veiny, when, in  consequence of
 an aneurism of the right cavities of the heart, a reflux
 of blood  is determined into them, which may occa-
 sionally be perceived even as far as the superior part
 of the neck.  When a communication is  established
 between an artery and vein which are contiguous, it
 determines a similar result.
   There still remain to be described two other means
 or procedures, which are occasionally used in exa-
 mining diseases of the chest.

       Or  THE MEASUREMENT OF THE THORAX.
   Q.  How is the thorax to be measured?
  A.  This process  may be performed as  follows:—
 The  patient being placed in  a  sitting posture,  or
 standing upright, with  his arms hanging freely by his
 sides, or raised towards his head, a cord is  .drawn
 round his chest at any part of it; if this be doubled
 upon itself, we ascertain the natural extent of each
 side.   The cord should then be applied successively
to each side, beginning atone of the spinous proces-
ses of the vertebrae, and extending to the middle of
the sternum, care  being taken that  it passes  in a
 right line from one of these points to the other; by
 nrtmparingthe result of this latter measurement with 
104              OF SUCCUSSION.
that given above, we ascertain the dilatation or con-
traction, that may exist at either side of the cavity.
  In making  this calculation, we should, however,
recollect, that even  in the  healthy state,  the  two
sides rarely present the same capacity,  and that in
persons who have  been  attacked  by very severe
pleurisies, the side  that  remained unaffected,  ac-
quires an increase of development, whilst that which
had been the seat of the disease becomes narrowed
and flattened ; the point of the shoulder is depressed,
the side hollowed, and the muscles thin and wasted.
Sometimes, also, in cases of phthisis we observe the
upper  ribs somewhat depressed, which is caused  by
adhesions between  the pleura costalis and pulmo-
nalis.
  The thorax is  dilated in cases of  fluid or gaseous
effusions into the cavity of the pleura or pericardium,
or of any considerable  development of accidental
tumours.  It is contracted by" original malformation,
or after the termination of pleurisies, as has been al-
ready stated.

                  op succtrssioN'.
  Q. What is meant by succussion ?
  A. This process consists in giving to  the body
one or  more slight jerks, for the purpose of ascer-
taining the existence of a fluid supposed to be in the
thorax.  This motion  determines  a  sound  similar
to that  produced by shaking a bottle  which is  half
full.
  The sound is  not  emitted unless the effusion con-
sists at the same time of air, or gas and liquid.   For
if the effusion be liquid only, then the lung will fill
exactly all the rest of the cavity, and cannot be com-
pressed by the fluid,  sufficiently for the succussion to
excite any sound ; and again, if the gaseous effusion
be too abundant, or not sufficiently so, no result will
be obtained.   Hence these fluids must be combined
in certain fixed proportions. 
OF SUCCUSSION.            105
   These are the principal indications which mark the
 different affections of the chest.
   Q. What other circumstances are worthy  of note
 in examining the  chest?
   A. The observer should also note the expression of
 the  countenance,  the colour of the  cheeks and  lips,
 their state of emaciation or injection, the manner in
 which the patient lies, the distribution of tempera-
 ture in the limbs,  the existence of partial sweats, and
 the  state of the blood after bleeding,  particularly in
 acute disease.
   In phthisical cases, he should always inquire whe-
 ther there be any  hereditary predisposition.  We
 shall recur to each  of these points more in detail,
 when treating of the diseases peculiar to each organ.
   Q. Give a summary of the different points to be at-
 tended to in this investigation ?
   A. He should begin with examining the expecto-
 ration, as being of considerable value in distinguish-
 ing diseases of the chest.  If limpid and viscid, it in-
 dicates  acute  catarrh;  if, after presenting this ap-
 pearance, it becomes opaque, yellow, greenish or pu«
 riform, it marks chronic catarrh ; if it adheres firmly
 to the vessel in which  it is received, and is more or
 less  tinged with blood, it announces pneumonia; if
 round and opaque  masses float in a quantity of frothy
 fluid, or if they are puriform, and streaked with white
 lines, and containing small white masses insoluble in
 water, we conclude  that they are produced in a tu-
 bercular excavation.  If the expectoration is fluid,
 purulent, and suddenly coughed up  in great  quanti-
 ty, it should make us presume, that a fluid contained
 in the pleura, has made its way through the bronchi,
 and  so  is  evacuated.  When pieces of false mem-
 brane are expectorated, they are recognized  at once
 as the product of croup ; and a dark green fluid, ex-
 haling  a fetid smell, marks gangrene of the lungs.
In haemoptysis, bright red,  and frothy blood is ex-
 pectorated ; th*i3 should not  be confounded with that 
106
OF SUCCUSSION.
which occurs in haematemesis, or with the bleeding
which occasionally comes from the gums or the nares.
  The effects of percussion should next be attended
to, as they tend to direct the observer in the exami-
nation he'is about to make with the assistance of the
stethoscope.  It should not be forgotten that,  even
in health, there are some parts of the chest which
give a dull sound, as for instance  the  region of the
heart, and the lower part of the  right side ; there
are others in  which the sound is heightened, as the
lower part of the left side.   Percussion indicates the
parts in which the sound has become more dull, and
those in winch it is more clear than natural;  diminu-
tion and absence of the natural sound, characterize
pneumonia,—accidental tissues developed in the lung
or cavity of the pleura, hypertrophy of the heart, and
effusions into the pleura or pericardium;  increased
loudness of sound occurs in emphysema of the lung,
or effusion of gaseous fluids into the pleura; finally,
the gurgling and metallic tingling indicate pulmonary
excavations, or circumscribed cavities in the pleura,
communicating with the bronchi.
  Inquiry should next be  directed to ascertain the
state of the respiration^ (whether it  be painful and
provokes cough,) the character of the cough  and also
of  the  voice, which may be hoarse, croupal, &c.
after which by  the stethoscope the observer may as-
certain the parts of the lung which are or are not per-
meable to the air.  The "rale crepitant" will indi-
cate to him the first degree of pneumonia, oedema of
the  lung, and  pulmonary apoplexy;  acute catarrh
will be distinguished by the " rale sonore" or " sibi-
lant,"—chronic catarrh, and the gurgling of soften-
ed tubercle, by the •• rale muqueux,"  and interlobu-
lar  emphysema,  by the peculiar sound  described
above, as the murmur frictionis.
  The phenomena  of the voice should be explored
in the different parts of the chest.  If pectoriloquy"
is heard under the clavicle, or in  the hollow of the
axilla, particularly at one side, it  indicates phthisis. 
                 OV SUCCUSSION.             107

 tegophony is the proper sign of effusion into the ca-
 vity of the pleura; finally, the metallic tingling an-
 nounces a cavity communicating with the  bronchi,
 and the metallic respiration, a simple bronchial fis-
 tula.
   When any symptoms of effusion exist, it will be
 necessary to measure each side of the chest, and try
 by succussion to discover the presence of  the fluid
 Bupposedto be present.
   When the  heart is  supposed to be affected, the
 observer, after having ascertained that there is no
 unnatural enlargement in the precordial region, and
 after making percussion, should  proceed to  examine
 the  pulsations of the organ, between the fifth  and
 seventh ribs, and at the base of the sternum.  He
 should  consider these in reference  to their extent,
 impulsion, sound, and rythm. If they are feeble, and
 heard in different parts of the thorax", lie may suspect
 a dilation of the ventricles j if, on the contrary, they
 are strong and circumscribed, they  indicate hyper-
 trophy ; if they emit a clear sound,  it is a symptom
 of thinness of the walls of the heart.   The disease is
 proved  to exist at the right  or left side of the organ
 according as these eff'ecis are more audible at  the
 base of the sternum, or between the cartilages of the
 ribs ; and the time at which they are heard, marks
 whether it is  the auricles or ventricles tlvut are af-
 fected.  When the " bruit de rape," or sound like a
 file, is heard at the left siele, and is synchronous with.
 the  contraction  of the ventricle and the pulse, it
 indicates a  narrowing of the sigmoid-aortic,  and mi-
 tral valves : when, on the contrary, it is synchronous
 with the contraction of the auricles, the narrowing is
at the auriculo-v entricular opening: when it  is heard
 at the base of the sternum, it is a sign of contraction
of the tricuspid or sigmoid valves of the pulmonary
 artery.
  The observer should examine the anterior  part of
 'he sternum, to ascertain whether there be an aneu-
 rism t.f  the. rm-h of t!r: aorta, and the posterior part 
108           OF THE OESOPHAGUS
of the thorax, to determine that of the descending
portion of this vessel.  In all  these cases he should
attend particularly to the state of the pulse, whether
it be frequent, small, irregular, contracted, or deve.
loped ; lastly he should conclude this examination by
noting the expression of the countenance, the ap-
pearance of the body, and the  symptoms referable to
affections of other organs.

           ANATOMY OF THE (ESOPHAGUS.
  Q. What are the situation and course of the (Eso-
phagus ?
  A. The (Esophagus begins  from the upper part of
the Pharynx, descends on the fore part of the cervi-
cal  vertebrae behind the trachea;  in the thorax  it
S asses down between the layers of the posterior Me-
 iastinum behind the base of the heart,  and turning
slightly to  the right, descends upon the fore  and
right  side of  the Aorta Descendens; towards the
fower  part of the thorax, it  inclines forwards, and
rather to the left, perforates the muscular portion of
the diaphragm about the ninth  dorsal vertebra, and
terminates  in the left and upper  orifice  of the sto-
mach,  called Cardia.
  Q. How many Coats has the (Esophagus ?
  A. Four; a cellular, muscular,  nervous, and mucous
or villous; the external cellular coat connects the mus-
cular to the surrounding parts; the muscular consists
of two layers of fibres, the external  layer has strong
longitudinal fibres which shorten the tube, the inter-
nal has circular  ones, which  contract its diameter;
the nervous coat connects the muscular  to the mu-
cous or innermost coat, which is continuous from the
mouth, and  has  many  longitudinal plicae when the
oesophagus is collapsed, but they  disappear when it
is distended ; this innermost  coat is well lubricated
with mucus.
  Q.  Whence does the (Esophagus receive its blood?
  A.  The cervical part of it  receives branches from 
AVATOMY OF THE ABDOMEN.        109
the Inferior Laryngeal  arteries;  the  thoracic part
from  the  (Esophageal, and branches of the bron-
chials which arise from the descending Aorta.
  Q.  What is the use of the (Esophagus?
  A.  It transmits the aliment  from the mouth  and
pharynx to the stomach.                        *
  Q.  What Organic Derangements is the OEsophagus
subject to?
  A. A fungous tumour hanging from the Pharynx,
spasmodic stricture, stricture from a thickening and
puckering of the inner membrane; it  sometimes be-
comes partly cartilaginous.

            AXATOMI OF THE ABDOMEN.
  Q. What are the boundaries of the Abdomen?
  A.  It is bounded by the diaphragm  above, by the
pelvis below, by the abdominal muscles before and on
the sides, and by the lumbar vertebrae behind.
  Q.  Into how many regions is the Abdomen generally
divided ?
  A. Into  nine ;  a transverse line from the  last rib of
the one side to that of the  other, marks out the three
superior regions, viz. the Epigastric in the  middle,
and the right and  left Hypochondric  on either side
of it; another transverse line between the superior
anterior spinous processes of the Ilia,  divides the
three inferior,  viz.  the Hypogastric  region in the
middle, and the right and  left Iliac ; from  the three
middle transverse regions, viz. the Umbilical in th«
middle, and the right and left lumbar regions on either
side of it.
  Q.  What Viscera are contained in the Abdomen?
  A.  The Chylopoietic Viscera : namely, the Sto-
mach, Intestines, Omenta, and Mesentery;  and the
Assistant Chylopoietic Viscera, viz. the Liver, Spleen,
and Pancreas.   The Kidneys, fundus of the bladder,
and of the Uterus in gestation, are also in the abdo-
men.
  CI.  What is the situation of the Peritoneum ?
  A.  The Peritoneum is situated in the abdomen,  5s
  Vet.. II                K 
 HO         OF THE PERITONEUM

in the  form of  a  shut sac,  the  anterior and lateral
parts of which, line the parietes of the abdomen ; the
posterior cover and involve the  intestines; and the
superior part of it lines the under surface of the dia-
phragm.
  Q. What is the structure  of the Peritoneum ?
  A. It is a thin firm elastic membrane; its external
surface is  rough and cellular, adhering to the conti-
guous parts; its internal surface  is very smooth, and
lubricated by a fluid exhaled from its own vessels.
  Q. What is meant by the cavity of the Abdomen?
  A. The cavity of the abdomen is  between the an-
terior and lateral portions of the Peritoneum which
line the parietes of the abdomen, and that portion of
it which covers the intestines.
  Q, What  retains  the Viscera of the abdomen  in
their respective situations ?
  A. The Peritoneum, which includes the intestines
in a duplicature, and its substance forming two layers
constitutes the Mesentery, Meso-Colon, and Omenta.
  Q. What is the Mesentery?
  A. It is a doubling of the Peritoneum, including
between its two layers numerous blood-vessels, lac-
teals, glands, nerves, fat, and cellular substance, which
binds them together.
  Q. What is the situation  of the Mesentery?
  A. It commences at the duodenum, where the in-
testine becomes moveable, includes the whole length
of the Jejunum and Ilium, in its duplicature, ends  at
the termination of the Ilium, and is situated between
these small intestines and  the  lumber vertebrae,
where  it becomes so contracted  as to be attached to
the first, second, and third lumbar vertebrae, running
obliquely downwards towards the right side.
  Q What is the Meso-Colon?
  A. It is that portion of the peritoneum, which after
including the Colon in its duplicature, passes double
between it and the body, and fixes it in its situation.
  Q. How many Omenta are there ?
  A. Three; the Omentum majus, or Omentum Gas- 
AND OMENTA.
Ill
lio-colicum ; the Omentum minus, or Omentum He-
pa to-gastricum ; and the Omentum Colicum.
  Q.  What  is  the situation  and formation of the
Omentum Gastro- Colicum?
  A.  The Peritoneum gives a covering to the sto-
mach ; the portion of  it covering its anterior and su-
perior side, and the other covering its posterior and
inferior, meet at the large curvature of the stomach,
are unite.I by cellular substance; this anterior layer
being double descends below the umbilicus, and  is
then reflected backwards and ascends, forming the
posterior layer of  the Omentum, and  is attached to
the transverse  arch of the Colon   The Omentum
majus thus composed of four layers of the peritoneum,
neither adheres to the abdominal muscles, nor to the
small intestines.
  Q.  Does the Omentum majus contain any thing be-
tween its layers?
  A.  It contains much adipose matter, which exudes
from it, and lubricates the external surface of the in-
testines.
  Q.  What seems to be the use of this  Omentum Gas-
tro-colicum?
  A.  It is interposed between the abdominal muscles
and the intestines,  as  a soft cusliion to defend them
from injuries, and to facilitate their peristaltic motions
by its lubricating quality.
  Q.  What is the situation of the Omentum minus?
  A.  The Omentum Hepato-gastricum  is composed
of two layers of the peritoneum, and extends from the
under and back part of the Liver, to the whole small
curvature of the stomach and beginning of the duo-
denum; it does not contain  much  fat between its
layers.
  Q.  What is the situation of the Omentum Colicum?
  A.  It descends double  from the right portion of the
arch of the Colon in a wedge-like form,  and is con-
nected with the Caput caecum coli. 
112
THE ANATOMY
   THE AWATOMY OF THK CHTEOPOIETIC VISlEflA.
  Q. Into what parts^is the Alimentary Canal  di-
vided ?
  A. Into the Pliarynx,  OZsophagus, Stomach,  Duo-
denum, Jejunum, Ilium, Caput Caecum coli, Cdlon,
and Rectum.

         THE ANATOMT  OF THE STOMACH.
  Q. What is the situation of the Stomach ?
  A. The Stomach  is situated  obliquely across the
superior  and posterior  part of the abdomen in the
left Hypochondric and Epigastric regions.
  Q. What is the form of the stomach ?
  A. It is long and round, being much larger at the
left extremity and tapering towards its right; it is
curved from end to end. Between the Cardia, its left
orifice, and the Pylorus, its right, the smaller curva-
ture is  placed; and the larger curvature extends
along its  inferior and anterior margin from the left to
its right extremity.
  Q. What parts is the stomach contiguous to ?
  A. Its  large or left extremity is in contact with the
Spleen,  and  is  considerably higher than its pyloric
extremity,  which lies under the left  lobe of the
Liver; its superior part  is in contact with the dia-
phragm,  its inferior, with the intestines.
  Q. By what is the stomach retained in its situation ?
  A. It is connected by the Cardia to the Oesophagus,
by the Pylorus to the Duodenum, by the Peritoneum
and blood-vessels  to the Spleen, by the Peritoneum
to the root of the Liver  and transverse arch of the
Colon, and by blood-vessels to the Aorta.
  Q. Is the Stomach moveable at the Cardia ?
  A. The oesophagus at the Cardia, binds it firmly
down, and retains it in  situ, but its body and larger
curvature can rise up as  it becomes distended with
food, and form almost a right angle with the oesopha-
gus.
  Q. Is the Pyloric extremity of the stomach fixed in
situ ? 
OF  THE STOMACH.          113
   A. The Pyloric extremity of the Stomach situated
under the left lobe of the Liver on the right side  of
the vertebrae is lower, turned more forward than the
Cardia, is quite moveable, so that it can be drawn to-
wards the Cardia by the contraction of the stomach
longitudinally.
   Q. How many  Coats has the Stomach?
  A.  Four,- the peritoneal, muscular, nervous or cel-
lular, and the inner or villous coats, bound together
by cellular substance.
  Q.  Describe these coats ?
  A.  The peritoneum is reflected  over the stomach,
and gives it its external coat.   The muscular situated
immediately under the  peritoneal coat, to which  it
adheres, by cellular substance, is  composed of two
planes of fibres;  the external plane is longitudinal,
being continued from the oesophagus,  extends from
the large to the small extremity; and on each side  of
the small curvature being collected,  they form a
strong thick band: the internal plane has thick, strong,
circular, and transverse  fibres.  The nervous coat  is
composed of cellular substance intermixed with apo-
neurotic-like filaments crossing each other obliquely.
The inner or villous coat, being the same  as that  of
the oesophagus, only having a great many more pro-
minent Villi crowded with minute  vessels.
  Q. Are the nervous and villous coats more extensive
and larger than the others ?
  A.  They are thrown  into many rugae of a waving
transverse direction when the stomach is rimpty; this
appearance is the effect of the natural partial contrac-
tion of the fibres of the muscular coat; but when the
stomach is filled, they are stretched, and  the rugae
disappear:  hence, they are not more extensive than
the other coats.
  Q.  What use can these rugae serve in the internal
surface of the stomach?
  A.  They support the vessels and nerves dispersed
in them ; enlarge the internal surface of the stomach,
and thus  favour the flow of the Gastric Juice; and
                       k2 
114
0F THE  STOMACH
 perhaps they tend to retain the aliment in the sto-
 mach till it be properly chymified.
   Q. B} what apparatus is the Gastric Juice secreted?
   A. li is secreted by the extremities of the Arteries
 on the internal surface of the stomach.
   Q. What is the nature of the  Gastric Juice?
   A. It is a limpid fluid, somewhat similar to saliva,
 of very great solvent power, of antiseptic properties,
 and well calculated to dissolve our food.
   Q. Is there a sphincter at the Cardia ?
   A. No proper sphincter;  but the muscular fibres
 are  so disposed in various directions around it, and
 the  end of the oesophagus projects a little into its in-
 ternal surface, that nothing  can return from the sto-
 mach towards the mouth, even when the head is turn*
 ed downwards, unless ejected  by vomiting.
   Q. Describe the Sphincter of the Pylorus.
   A. The two innermost coats of the stomach forma
 large circular ruga or fold, which includes a fascicu-
 lus of muscular fibres, which form a ring projecting
 into the internal part of the passage.  This muscular
 ring contracts and completely shuts the passage  from
 the stomach into the duodenum, and thus constitutes
 the Sphincter Pylori.
   Q- What Arteries are sent  to the  Stomach ?
   A. The superior gastric, which is a branch of the
Casliac; the right inferior gastric, sent off from the
Hepatic ; and the left inferior gastric, sent off  from
the Splenic, are the  principal arteries ; but besides,
the arteriae breves from the splenic are dispersed
upon the  left extremity of  the stomach ; and the
Pyloric branches, from  the hepatic are  distributed
near to the Pylorus.
   Q.  Where do the veins of  the stomach  terminate ?
   A,  They have their  names from the arteries,  they
follow their course, and terminate in the Vena Portae.
   Q.  Has the Stomach many Absorbents ?  "
  A.  Yes, the  absorbents of the stomach are  both
numerous and  large ; they however convey Lymph 
AND ITS ARTERIES.           115
 and  not Chyle, because chyle is  not formed in the
 stomach.

         THE ANATOMT OF THE DUODENUM.

   Q. Describe the course and situation of the Duode-
 num.
   A. The  Duodenum  being the commencement of
 the small intestines, begins at the Pylorus, turns up
 and backwards by the neck of the gall-bladder; then
 bends downwards before the great vessels going into
 the liver, and before the renal artery and vein ; and
 near the under part of the kidney it makes a turn to
 the left  side, going before the Aorta and Vena Cava
1 at the first  or second lumbar vertebra, and perforating
 the root of the Mesentery and Meso-colon, it turns
 forwards and terminates at the left side of the spine
 in  the Jejunum.
   Q_.  How many Coats  has the Duodenum ?
   A.  It has three complete coats, the muscular, ner-
 vous, and villous, and a partial coat from the perito-
 neum, which covers the anterior portion of it  only;
 the posterior part of the Duodenum being fixed to
 the parts behind by cellular substance.
   Q. Is there any thing peculiar in the coats of the
 Duodenum ?
  A. Its muscular  coat is very thick and strong;  its
 villous coat has many mucous glands under  it, espe-
 cially near the pylorus;  the Villi are very conspicu-
ous, and becoming longer, are converted into Rugae ;
and lastly, into  Valvulae Conniventes, towards  the
termination of the duodenum.
  Q. Do any of the Lacteal Vessels arise from the
Duodenum ?
  A. Yes; when the Villi and Valvulae Conniventes
become considerable near the end of the duodenum,
the Lacteals are apparent.
  Q. What is the form and use of the Valvulae Con-
niventes ?
  A. They are fixed tu the internal surface of the 
1  16'          OF THE  DUODENUM,
intestine by one side, and hang loose with the other;
they are of different lengths, and the end of one is
insinuated between the eneis of two, occupying the
interstices of each other.   They afford a very exten-
sive surface, on which the mouths of ihe Lacteal ves-
sels open and absorb Hie Chyle.   They  also in some
degree  retard the p;.*sage  of the Alimentary mass,
and give more time t< v the formation of Chyle.
  Q. Is the  Duodenum perforated by the entrance of
any ducts ?
  A. Yes;  the end of the  Ductus Communis Chole-
dochus, and the end also of the Pancreatic Duct, pe-
netrate the coats of the Duodenum, very obliquely,
in its posterior part just at  the root of the Mesentery
and Meso-Colon, and terminate in its cavity.
  Q. Do the Biliary and Pancreatic Ducts terminate
separately in the posterior part of the Duodenum?
  A. They most commonly terminate  together, and
sometimes separately, but always near to each other.
  Q  Do the contents of the Duodenum  not return
into the open terminations  of these Ducts?
  A. No ; their termination is so oblique in penetrat-
ing the coats, particularly the planes of muscular fi-
bres, that the contents of  the Duets can be poured
into the Duodenum when it is a little distended,  but
nothing can return into the Ducts.
  Q. Why do these Ducts  terminate in  the posterior
part of the Duodenum rather than in the anterior ?
  A. The posterior part of the Duodenum is always
fixed, and affords  a ready exit to the contents of the
Ducts at all times:  whereas, the anterior part of it is
moveable, particularly when the presence of aliment
stimulates it to strong action ; the terminations of the
ducts therefore would have been constantly changing
their situation, and the egress of their contents would
have been uncertain, and often interrupted.

         THE ANATOMY OF THE JEJCXUM.
  Q. What  is the situation  of the Jejunum ?
  A. T4ie Jejunum  begins  at the duodenum, where 
JEJUNUM,  AND  ILIUM.          117
the gut becomes moveable, forms numerous convolu-
tions in the upper  part of the Umbilical Region, and
terminates in the Ilium.
  Q. What is the structure of the Jejunum ?
  A. It has four coats; a complete one from the Pe-
ritoneum ;  a thin  muscular, a nervous and a villous
coat;  the Villi, Valvulae  Conniventes, and Lacteals,
are very numerous and  conspicuous on its internal
surface.  It is smaller than the duodenum.


           THE ANATOMY OF THE ILIUM.

  Q. What is the situation of the Ilium?
  A. It commences where the Jejunum terminates;
the limit, however, is not well determined, the Jeju-
num is generally empty; the Ilium  is smaller in dia-
meter and  of a paler  colour, it occupies the under
part of the umbilical region, extending to the Hypo-
gastric and Iliac regions, and in women sometimes to
the cavity of the Pelvis.
  Q. Do the Coats of the Ilium differ in any respect
from those of the Jejunum ?
  A. The coats of the Ilium are generally thinner;
its internal  surface exhibits fewer and  smaller Lac-
teals ; the Valvulae Conniventes, though  large at its
commencement, gradually decrease in size and num-
ber towards its termination,  and at last disappear.
Mucous Glands are numerous  and large near its ter-
mination.
  Q. Where does the Ilium terminate ?
  A. Its extremity passes across to the  right Iliac
Region, and terminates in the left side of the Colon,
about three inches from its beginning.
  Q. Is there any Valve placed at  the termination of
the Ilium ?
  A. Yes, the Valvula Ilea, or Valvula Coli; the Vil-
lous and nervous coats of the Ilium form a duplicature
which encloses  some circular muscular fibres, it pro-
jects into the colon in  the form of two  lips, which
are placed transversely in the posterior and left side 
 118         OF THE  VALVULA  COLI

of the Colon.  The lips of the Valve are bound in
their situation by the Retinacula,or Fraena Mohgagni,
and admit of the passage of the alimentary mass into
the Colon, but prevent any thing from returning into
the Ilium.
           THE ANATOMY OF THE  COLON.

  Q. Into what parts is the Colon divided ?
  A. Into the Caput Caecum Coli, Colon, and Rec-
tum.
  Q. Where is the Caput  Caecum situated ?
  A. The  Caecum, about  three  inches long,  and
nearly the same in di;i.oeter, is situated in the Right
Iliac Region; its extremity is shut.   The Appendix
Vermiformis hangs 'roui it.
  Q.  What is the course of the Colon ?
  A. It encircles the Small intestines, beginning at
the Caput Caecum, it  ascends in the right Lumbar
Region  over th  Kidney, to which it is  connected,
from the Kidney it forms an :t-ch across the abdomen,
first passing,  n ihe r.ght Hvpochoncic, under the
liver and Gall-Bladder,  then in the  hpigastric, and
lastly, in the .c f.  Hypochondric  region, under  the
stomach, being  connected to the Duodenum ; this is
called the Great .Irch ->t th.-. Colon.   In the left Hy-
pochondric region, the  Colon turns backwards under
the Spleen,  and descends in the left  Lumbar region
en the foreside of the Kidney to which it is attached;
in the left Iliac rig on, it forms the Sigmoid Flexure,
which is continued do»vn into the Hecttim.
  Q.  What fixes the Colon in its situation ?
  A.  The Peritoneum surrounds  the  Colon, and be-
tween it and the body  its  two layers are connected
by cellular substance, and thus form the Meso-Colon,
which keeps the Colon in its place.
  Q.  Haw many Coats  has the Colon?
  A.  Four ; they are stronger and thicker than those
of the small  intestines.  The longitudinal fibres of the
muscular coat are  collected into three   fasciculi or
bands, which begin at the root of the  Appendix Ver- 
       AND  STRUCTURE  OF THE  COLON.     119

miformis, and are continued along  the Colon to the
Rectum.  The internal surface  is divided into cells
by transverse  folds running from  one longitudinal
band to another.
  Q. By what means is the feculent mass thrown out
of these cells and moved along ?
  A. The muscular longitudinal bands are  shdrter
than the rest of the Colon ; the transverse muscular
fibres included between  the layers of the two inter-
ternal coats, forming the folds  or partitions, and Ihe
circular muscular fibres  dispersed  upon  the whole
substance of the Colon,  contract themselves,  and
move along the contents of the gut.
  Q. What is the use of those Cells of the Colon ?
  A. The transverse septa answer the same purpose
as the Valvulae Conniventes: they enlarge the inner
surface of the intestine,  and retard the too rapid
movement of the feculent mass, that every particle of
a nutritive quality may be absorbed.
  Q. Are many Mucous Glands placed in the Colon?
  A. In the  Caecum there  is a  considerable number
of pretty  large ones; the appendix vermiformis too
contains a number, and pours  their mucus into the
Caecum ; many others  are dispersed over  the inter-
nal surface of the Colon, and the Rectum is well sup-
plied with them.
  Q. On what part  of the Colon are the Appendicu-
lae Pinguendinosae situated ?
  A   On the outer surface of the muscular, and un-
der the Peritoneal coat of the Colon these Appendi-
culae, thin at their roots,  and  becoming  larger and
thicker in their bodies, are situated, at different dis-
tances from one another.
  O.. What is the use of the Appendiculae Pinguedi-
nosae ?
  A. They  seem destined  to lubricate the external
surface of the intestines in a manner similar to the
Omentum.
  Q. What is the precise situation of the Rectum ?
  A. It begins at the last lumbar vertebra, descends 
120     OP  THE LOBES, LOBULES,  ANB
 curved upon the fore part of the Os Sacrum and  On
 Coccygis, and ends in the Anus.
   Q  Describe the Rectum particularly ?
   A. The Rectum becomes wider as it descends to»
 wards the Anus, and thus forms a reservoir for the
 faeces.  Near to the  Anus its internal surface is dis-
 posed in longitudinal  folds, but higher up they are
 transverse.   The muscular fibres  of the Rectum are
 strong, thick, and spread uniformly over it; and at its
 extremity they are collected into a firm circle, which
 forms the Sphincter Ani.

      OF THE ASSISTANT CHYLOPOIETIC VISCEIIA.
   Q_.  What viscera are denominated Assistant Chylo-
 poietic ?
  A. The Liver, Spleen, and Pancreas.

    THEANATOMY AND PHYSIOLOGY  OF THE LIVEB.
   Q.  What  is the situation of the  Liver?
  A.  It is situated immediately under the diaphragm
 in the right Hypochonc'rium and Epigastrium chiefly,
 and partly also in the left Hypochondrium.
  Q.  What is its colour and figure ?
  A. It is of a dusky reddish colour; its upper sur-
 face in close  contact with the diaphragm is convex ;
 its under surface is concave,  and receives the con-
 vexity of the stomach,  duodenum and  colon; it is
thick on  its right and posterior parts, becomes thin
 towards its left, and acute before.
  Q. Into how many Lobes is the Liver divided ?
  A. Into two, the right or great lobe, and the leftoi
small lobe : and  besides, into three lobules.
  Q.  What is the precise situation of the Right Lobe?
  A. It is situated  obliquely in the right hypochoa-
drium, following the  curve of the diaphragm, and
rests upon the pylorus, colon,  and top of the right
kidney.
  Q..  What is the situation of the Left Lobe?
  A. It is situated nearly in a  horizontal  position, ">n 
           ! MOMENTS OP THE LIVER.      121

 ♦lie Epigastrium  chiefly, and reaching a small way
 into the left hypochondrium.
   Q.  Where are the Lobules situated ?
   A.  On the under surface of the right lobe.
   Q.  Describe their relative situations ?
   A.  The  Lobulus  Spigelii being  the largest, is
situated near the spine between the fossa of the duc-
tus venosus on the left side, and the fossa of the vena
cava on the right, and behind the sulcus transvei'sus,-
the Lobulus Caudatus is an angle of the  former, in-
clining towards the middle of the right lobe ;  the  Lo-
bulus  Anonymus,  or Quadratus, is a small portion of
the right lobe between the  fossa ductus venosi and
the gall-bladder.
   Q.  How  many fossae or sulci are observable on the
inferior surface of the Liver ?
   A.  Four ,■ the fossa umbilicalis  situated between
the right and left lobes; the sinus portarum, or sulcus
transversus, situated across the  right  lobe, between
the lobulus  Spigelii behind, and the  lobulus anony-
mus before; the fossa venae cavae between the right
lobe and the lobulus Spigelii ;  and the fossa ductus
venosi is situated between the left lobe and the lobu-
lus Spigelii.
   Q.  How  many  Ligaments retain the  Liver in its
situation ?
   A.  Five; the Coronary Ligament, which connects
the root of the Liver to the tendinous part of the dia-
phragm ; the Broad or Suspensory Ligament, which
is triangular, and runs from the umbilicus and ensi-
form cartilage  to the fossa  umbilicalis between  the
right and left lobes ; the Round Ligament, which was
the umbilical vein in the foetus, runs in a doubling of
the former along its inferior margin to the Liver,  be-
tween its  left  lobe  and the lobulus  Spigelii; the
Right Lateral Ligament, which is short, and fixes the
back and right  portions of the great lobe to the dia-
phragm ; and the  Left Lateral Ligament, which con-
nects the left lobe to the diaphragm.
   Q.  Has the Liver no other Ligaments ?
                         L 
122     OF  THE VENA PORTAE,  HEPATIC

  A. Yes; the celebrated Haller described the He-
patico-colicum, which  passes from the  sinus porta-
rum and  gall-bladder, over the duodenum to the co-
lon, and the Hepatico-renale,  which runs from the
root of the Liver to the right kidney.
  Q. How many Coats has the Liver ?
  A.  Two ,- a peritoneal, which surrounds the liver,
except  at  the coronary ligament; and a condensed
thin cellular coat, which  both covers the surface, and
enters into the substance of the Liver.
  Q_.  What vessels enter the Liver ?
  A. The hepatic artery, vena  portae, hepatic veins,
absorbents, and biliary ducts.
  Q.  What is the structure of the Liver ?
  A. It is glandular, being of the conglomerate kind.
The Vena Portae, and Hepatic  Artery,  enter the
Porta of the Liver, branch out into repeated and mi-
nute ramifications in its substance ;  their extremities
are coiled up in  cellular substance so as to form innu-
merable pulpy corpuscles, called Acini; which con-
stitute the glandular apparatus for secreting the Bile.
The Hepatic Veins and Biliary Ducts also commence
in these glandular Acini, and accompany the branches
of  the  Vena Portae through  the  substance of the
Liver.
  Q.  What Vessels compose the Vena Portae ?
  A.  It is made up of the Veins of the Stomach,  of
the Intestines, of the Spleen, of the Pancreas, and of
the Omenta.  These  veins  all meet at the Porta  of
the Liver, and form one large  trunk, which is thence
called Vena Portae.
  Q.  What is peculiar in the Vena Portae?
  A.  Its partaking of the nature of a Vein, and of an
Artery, while its branches coming from  the different
abdominal Viscera are  uniting and forming  larger
trunks, and all these ultimately conjoined constitute
the Vena Portae : It partakes of the nature of a Vein;
but when it enters the  Liver, divides into branches,
which are again and again  minutely divided in the
substance of the Liver, and nltimatelv terminate  \r> 
         VESSELS,  AND  GALL-BLADDER.      123

the  Acini, it  clearly partakes of the  nature of an
Artery.
  Q#> Does the Vena Portae, when performing the of-
fice of an Artery in the substance of the Liver, pulsate?
  A. No ; its coats are thick and strong, but membra-
naceous, as those of the other veins  are ;  of course
having no muscular coat, it cannot pulsate.
  Q. Is the blood in the  Vena Portae  of the Liver
arterial ?
  A. No ;  it is venous.
  Q. Is the Bi>e secreted from  Venous blood?
  A. Yes; but some extremities of the Hepatic Ar
tery anastomose with those of  the Vena Portae, and
thus its arterial blood may  assist in affording bile.
  Q. Can Bile be secreted from arterial  blood alone ?
  A. Yes ; in  one or two cases the  Vena Portae did
not enter the Liver, but terminated in the Vena Cava;
in such  cases the bile was found to have been secre-
ted from the arterial blood of the hepatic artery.
  Q. Describe what  happens in the  Acini of the
Liver? .
  A. The glandular extremities of the Vena Portae
prepare and secrete the Bile,  which is instantly ab-
sorbed by  the Tubuli Biliferi,  and carried into the
biliary ducts: the blood,  after the bile is secreted,
passes into the extremities of the  Hepatic Veins,
which accompany the  arteries and  branches of the
Vena Portae.
  Q. What course do the Biliary Ducts follow ?
  A. They form larger and larger trunks by their re-
peated junction, and follow the branches of the Vena
Portae towards the  root of the Liver, where they be-
come one trunk, called Ductus Hepaticus.
  Q. Where do the Hepatic Veins terminate ?
  A. The  Hepatic  Veins  receive the  blood partly
from the extremities of the Hepatic Artery, and partly
from those of the Vena Portae, unite by degrees, ac-
companying the branches of the Vena Portae towards
the root of the Liver, where they form two or three 
 124         OF THE GALL-11LADDER.

large trunks, which terminate in the ascending \ ena
Cava just before it perforates the Diaphragm-
  Q.  What connects these sets of vessels together^?
  A.  Fine  cellular substance deprived  of fat enters
into the composition of the innumerable Acini,  sur-
rounds the different vessels,  and  supports them in
their relative situations.
  Q. Where have the Lymphatic vessels of the Liver
their course ?
  A.  They are very numerous, and cover almost all
its external surface ;  they form  larger trunks, which
terminate  partly in  the  beginning of the  Thoracic
Duct, and partly in a Plexus situated behind the ster-
num.
  Q.  What is the situation of the Gall-Bladdeh ?
  A.  It is  situated  obliquely transverse on the infe-
rior or concave part of the right lobe of the liver,
with its cervix at the Sinus Portarum, and its fundus
at the anterior margin of the Liver, and sometimes
beyond it when full: its  fundus is  rather lower than
its cervix, when the body is erect.
  Q. Describe the Vesicula Fellis ?
  A. It is a small pyriform sac, consisting of a cervix,
a body, and a fundus, composed of  three coats, and a
partial one  from the  Peritoneum.                   ,
  a.  What is the fabric of its Coats?
  A. It receives a covering from the Peritoneum, ex-
cept where it is attached to the  Liver ; some pale
fibres scattered in various directions have been con-
sidered its  muscular coat; under  which is cellular
membrane, frequently  considered its  nervous coat;
and its innermost villous  or mucous coat, exhibits nu-
merous rugae.
  Q. Is the internal surface of the Gall Bladder co-
piously supplied with Mucus ?
  A. Yes;  it is perforated by innumerable ducts of
small follicles situated under it, which pour out much
Mucus to defend its surface from the acrimony of the
Bile.
  Q. What cunnects the  Gall- Bladder to the Liver? 
            ©P  THE RILIARV Dl CIS.        125

   A. A cellular substance, Blood-Vessels, and Ab-
 sorbents.
   Q. Has the Gail-Bladder a Duct ?
   A. Yes; its neck is twisted and folded upon itself,
 and contracted into a duct, called Cystic, which runs
 about an inch and a half, and then joins the Hepatic
 Duct.
   Q. Describe the Common Duct formed by the junc-
 tion of the Hepatic and Cystic Ducts?
   A. It is called Ductus  Communis  Choledochus,  of
 the size of a goose-quill;  it descends under the head
 of the  Pancreas, to the back part of the Duodenum,
 which it enters about five inches from the Pylorus.
   Q. Describe the passage of the Ductus  Communis
 Choledochus through the coats of the Duodenum.
   A. It is generally joined by the  Pancreatic  Duct,
 either while passing through the coats of the Duode-
 num, or before it enters them ;  having pierced the
 muscular coat obliquely, it runs a considerable space
 in the cellular or nervous coat along the gut, and
 then  opens  upon a considerable eminence of a fold
 of the inner  coat of the  Duodenum.  This oblique
 entrance through the coats answers all the purposes
 efa  Valve.
  Q.  What is the structure of the Biliary Ducts ?
  A.  They have two coats; the external of which is
 fibrous and strong ; the internal mucous coat is reti-
culated  in such a manner as to catch a probe pushed
along the duct as  a valve would do; hence  these
transverse folds have been mistaken for real obstruc-
tions.  These coats admit of great dilatation, as some-
times happens in Gall-stones.
  <&.  Is the  Bile constantly  secreted in  the  same
 quantity ?
  A.  No ; its secretion  is  constantly going on, but its
 quantity depends upon  the state of the circulation and
a ready passage into the Duodenum.
  Q. How can the state of the  circulation of the Blood
 affect the secretion of Bile ?
   A. When the blood flows with great strength and
                         l2 
126
OF  THE BU.E.
velocity', a much greater quantity is sent into the Li
ver in a given time, than a slower and weaker circu-
lation could have sent, hence the quantity of Bile se-
creted is much larger; this may explain the super-
abundance  of bile in hot climates, particularly in Fe-
vers.
  Q. How can a ready or difficult passage of the Bile
into the Duodenum affect its secretion ?
  A. When the  coats of the Duodenum are collapsed
in consequence of no digestion going on,  or when
the Ductus Communis  Choledochus, or  the  Hepatic
Duct, is obstructed, or at least  nearly impervious in
its diameter  by Calculi ; or when constipation re-
tards the natural actions of the  Intestines and has in-
duced indigestion, then the  Bile accumulates in  the
ducts, produces  a Bilious plethora  in them, and pre-
vents the secretion of new bile; in such a  case the
blood passes into the hepatic veins without the natu-
ral bile being secreted from it; and that accumula-
ted in the  ducts is partly  absorbed, and produces
Jaundice.
  Q. How does the Bile get into the Gall-bladder >
  A. When the coats of the Duodenum are collapsed,
or the extremity of the duct any way obstructed, the
Bile cannot flow readily  into  the duodenum ;  the
cystic duct being free  and  open,  it naturally  turn*
into the Gall-bladder, as a receptacle, and fills it.
  Q. By what means is the  Bile propelled from  the
Gall-bladder?
  A.  By the pressure of  the  distended   stomach
against the  Gall-bladder, and partly perhaps bv a con-
tractile power of the coats of the Gall-bladder itself,
while the entrance into the Duodenum is free, in con-
sequence of digestion going  on, and the Chyme pas-
sing into the duodenum.
  Q. Is the quality  of the Bile  changed  in the Gall-
bladder ?
  A. Its thinner part is absorbed if it is detained long
in the Gall-bladder ; and the remainder becomes more
acrid, thick, and bitter: but  when it is detained for a
short time,  it is very little changed. 
OF THE BILE.
127
    Q.  Is the quality of the Bile ever vitiated?
    A. Yes , its quality is vitiated by  several circum-
 stances, such as by a slight inflammation of the Li-
 ver; or even by irritation  of it in consequence of a
 large influx of blood into it in hot climates, or in acute
 Fevers.
   Q.. When the quality of the Bile is vitiated, is its
 quantity also increased ?
   A. Yes, in  general ; it then becomes thinner, and
 more acrimonious, as  its effects upon the stomach
 clearly show.  We have a good example of a changed
 quality .md cpiantity of the  mucous secretion of the
 nostrils in  Catarrh.  Instead of the bland mucus in
 spare quantity, the secretion is very copious, thin,
 watery, and so acrid sometimes, as  to excoriate the
 nostrils and upper lip.  Something very analogous
 happens to  the Bile when  its  quantity is much  in-
 creased, and its quality vitiated and acrid; it excites
 great uneasiness and  pain in the liver, stomach, and
 intestines.
   Q. What is the  use of the Bile?
   A. The Bile and Pancreatic Juice are poured into
 the Duodenum, and there mixed with the Chyme ; it
 occasions various rapid compositions and decomposi-
 tions in the Alimentary mass, by which the Chyle is
 generated  and  separated; it gives a considerable
 stimulus to  the intestines, as its deficiency in Jaun-
 dice, and its increase in Fevers  show ; it checks too
 much acidity in the intestines ;  and it carries off some
 impurities from the mass of blood.
   Q. How can it be proved that the  Bile carries off
 impurities from the Blood ?
   A. This is most  evident in  the foetus, which re-
ceives no food into the stomach, passes neither urine
 nor faeces, and yet a great accumulation takes place
in the intestines : whence can it, the  Miconium, come,
 but chiefly from the Liver, and  in small quantity per-
haps from the intestines ?  In the adult, the same dis-
charge of impurities by the Bile continues.
   Q.  What  Chemical Constituents  docs the B-:>
consist of ? 
 128          OF THE STRUCTURE

   A. Dr. John Davy found by analysis, that the Bile
 of a person  executed, consisted of 86.0 Water, 12.5
 Resin of Bile, and 1.5 Albumen in the hundred. The-
 nard however found, that 1100 parts of Human Bile
 consisted of 1000.0 Water, 2 to 10  Yellow insoluble
 matter, 41.0 Resin, 42.0 Albumen,  5.6 Soda, 4.5 Sul-
 phate of Soda, Muriate of Soda, Phosphate of Soda,
 Phosphate of Lime, and Oxide of Iron.

 THE ANATOMY, PHYSIOLOGY, AND PATHOLOGY OF THE
                     SrLEEN.
   Q. Describe the Spleen ?
   A. It is a soft, very vascular viscus of a dark pur-
 ple colour, of an irregular oval figure, smooth and con-
 vex externally, and rather concave next the spine.
   Q. What is the situation of the spleen?
   A. It is situated in the  left Hypochondric region,
 between the  left or large extremity of the stomach
 and false ribs, with  its lower end  behind the colon,
and over the left kidney.
   Q. What parts is the spleen attached to ?
   A. To the large extremity  of the Stomach by cel-
lular membrane, by the omentum,  and by the vasa
hrevia; to the left extremity of the Pancreas by cel-
lular membrane, and blood vessels;  to the  Dia-
phragm, Colon and left kidney,  by cellular substance
and reflections of the Peritoneum.
   O.. What is the structure of the Spleen ?
   A. It has two coats, a peritoneal, and  a proper
coat: they are closely connected to each other; it
consists of a congeries of blood-ve.-sels, lymphatics,
and nerves, involved in, and supported  by  much cel-
lular substance.  Tne extremities of the arteries are
coiled up into penicilli, which have been mistaken for
a glandular apparatus.
  Q. Is the Spleen not a Gland?
  A. No; it has much the appearance of one, but no
excretory duct has hitherto been discovered proceed-
ing from it, and in consequence, it is generally con-
u'.dered not glandular. 
AND USE OF THE SPLEEN.        129
   Q. Are there any real  glands  in the system from
 which no excretory ducts have been traced ?
   A. Yes; the Thyroid and Thymus Glands are of this
 description, no excretory ducts have  been detected
 issuing from them ; but their glandular structure has
 never been disputed.
   Q. What Blood-vessels enter the Spleen ?
   A. The  Splenic Artery, which is very large in pro-
 portion to the size ot the  Spleen; this artery enters
 it in a very winding serpentine manner,  and is divi-
 ded in its substance into innumerable branches, which
 ultimately form plexuses and penicilli, with which the
 extremities of the veins communicate.
   Q. What Arteries are sent off from the Splenic ?
   A. Two  or three small  branches to the Pancreas,
 the Gastrica Inferior Sinistra, which runs along the
 large curvature of the stomach towards the  pylorus,
 communicating freely with the Gastrica Superior, and
 Gastrica Inferior Dextra;  and three or four conside-
 rable short branche>, named urteriae  breves, or vusa
 brevia, which are dispersed  upon the large extremity
 of the stomach.
  Q.  What is  the use of the Spleen?
  A.  Various opinions have at different  times  been
 entertained of the use of the Spleen.  The Ancients
 thought it the Receptacle of Black Bi'e ; others  more
 lately, that a particular Mens'mum is secreted  in it,
 and transmitted to  the stomach for the purpose of
 Digestion ;  others, that it assists in forming the red
globules  of the blood; others, that when it is com-
 pressed by the full stomach, a greater quantity of
 blood is sent to the Pancreas to promote its secre-
 tion ; others lately, that the Llood undergoes  some
 change in it useful in the secretion ot the Ble  ; but
 it seems most  probable  that the use of the spleen is
 to allow  the free circulation of a quantity of blood
 through  it, which, when the Stomach is empty and
 its coats collapsed, is not wanted for the  secretion of
 Gastric  Juice: but when the stomach is distended
 with food, it presses upon the Spleen, interrupts the 
 130    ORGANIC DISEASES OF THE SPLEEN

 free circulation of the blood through it, and turns the
 current of circulation into the stomach through the
 Gastrica Inferior Sinistra, and the Vasa Brevia;  from
 which increase of blood in the Stomach Gastric  Juice
 is secreted in large quantity at a time, when it  is in-
 dispensibly  necessary  for  Digestion.   Thus  the
 Spleen is useful for regulating the quantity of blood
 sent to the stomach, and also the quantity of Gastric
 Juice for the purposes of Digestion.
   Q. What  Organic Derangements is  the  Spleen
 subject to ?
   A. The coats of the Spleen have been found  infla-
 med, adhering to the contiguous parts, and in some
 instances cartilaginous; its substance too  has  been
 found in a state of inflammation ; it is sometimes ex-
 tremely soft, and much enlarged ; sometimes  dimin-
 ished in  size; it sometimes contains  much purulent
 matter, which has been evacuated by  tapping,  or
 which has burst into the abdomen  and proved fatal;
 it is frequently indurated and enlarged ; it is in some
 rare cases tuberculated ; hydatids, and calculous con-
 eretions have been found in it;  it has been ruptured
 when unnaturally large ; several small ones have been
 found near to the natural spleen ; it has been found
 wanting.

   THE ANATOMY AND PHYSIOLOGY OF THE PANCREAS.
   Q. Describe the Pancreas ?
   A. It is a flat conglomerate gland about six inches
 long, not unlike the tongue of a dog; it resembles
the Salivary  Glands in colour, consistence and struc-
ture.
   Q. What is the situation of the Pancreas?
   A. It is situated  in the Epigastric Keg ion, across
the spine, behind the stomach, and before the Aorta,
Vena Cava, part of the splenic vessels, and the edge
of the transverse part of the Duodenum.
   Q. What are its attachments ?
  A. The right extremity of the Pancreas is attach-
ed to the duodenum; its left  extremity is fixed to 
         DISEASES OF THE ABDOMEN.        131

 the spleen by the  omentum majus; its body is con-
 nected with the Duodenum, Aorta, Vena Cava, and
 Spine, and it is covered  anteriorly by the meso-co-
 Ion.
   0..  Describe the structure of the Pancreas?
   A.  It is composed of a number of lobules, in which
 are Acini; from each lobule a small duct arises, which
 terminates in the common Pancreatic Duct running
 from  the left extremity to the right,  becoming gra-
 dually larger till it attains the size of a crow's quill.
 From the right extremity of the Pancreas, an elonga-
 tion or process is sent downward adhering to the
 Duodenum, this process is called the head ot the Pan-
 creas, or sometimes the Pancreas minus ; the princi-
 pal duct of this joins the other common pancreatic
 duct before its terminal ion in the Duodenum, along
 with the Ductus Communis Choledochus.
  Q. What is the use of the Pancreas?
  A. It secretes a liquor or juice resembling saliva in
 appearance, and chemical properties.
  Q. What is the use of the Pancreatic Juice or Li-
 quor ?
  A. It dilutes the Chyme, and incorporates it with
the Bile so as to produce  the chemical changes ne-
cessary for the formation of Chyle.

THE METHOD OF EXAMINATION APPLICABLE TO DISEASES
                OF THE ABDQMF.;*.
  Q. What are the phenomena presented by  the ab-
domen in the healthy state, which  are necessary to
 be known ?
  A. Its size and form present  some varieties, ac-
 cording to the age, sex, and temperament of  the  in-
 dividual. In infancy, the size  of the abdomen is con-
 siderable ; its walls are thick, its form round, parti-
 cularly in the inferior region, but its size diminishes
 as the  person advances in  age.   In the adult it pre-
sents no prominence, unless such as depends on obe-
sity, or particular  conformation  depending on tem-
 perament.  In the male it is  much more flat than it 
 1„>2      DISEASES OF THE ABDOMEN.

is in the female, in whom, after repeated pregnancies,
it becomes prominent, particularly in the hypogastric
region.   In persons who exhibit the physical signs of
the sanguineous temperament, the abdomen is in ge-
neral rather  small; but if the lymphatic  tempera-
ment be  combined with the preceding, then it is sus-
ceptible  of considerable enlargement.  On the con-
trary, in  persons of a nervous temperament, the ab-
domen is small, and as it were constricted ;  finally, in
those who eat much, it becomes considerably enlarg-
ed, as in them the abdominal viscera become very
much developed. In health, it is not sensible to pres-
sure,  it is soft and compressible ;  its temperature is
moderate—percussion causes a dull sound.
  Q.  What is the mode of examining the abdomen ?
  A.  The patient being placed on his back,  the abdo-
men exposed, and the head inclined forward  on the
chest, supported  by  pillows,  the thighs  and legs
should be placed  in the flexed position, 30 as to re-
lax the abdominal muscles as much as possible ; the
examination  is proceeded with as follows :
  The temperature may be at once determined by
ascertaining its degree in other parts of the  body, and
then placing the hands on the abdomen.
  In order to ascertain the state of its sensibility, the
hand  should be laid flat on the centre of  the abdo-
men, and  then pressed successively on every part of
it, observing at the same  time the patient's counte-
nance, which will at once indicate pain, if  the abdo-
men be sensible.  Care should be taken not to make
pressure  with the ends of the  fingers ; for then, by
being applied to one point, it becomes considerable,
and will  excite pain where there may be no disease.
  Finally, to determine the presence of  fluid in the
cavity, if the patient cannot get out of bed, it becomes
necessary to render  the  abdominal muscles  tense;
but if possible, it is better  to place him in  the erect
posture,  then laying  one hand steadily on  the side,
percussion should be  made with the fingers of the
other. 
DIGESTIVE APPARATUS.         133
   When flatus is suspected to be confined in the in-
 testines  or  peritoneal cavity, percussion should  be
 made with one or two fingers; the phenomenon will,
 however, be made more evident by the aid of the ste-
 thoscope applied on the abdomen. '

     EXAMINATION OF THE DIGESTIVE APPARATUS.
   Q. How is the examination of the* digestive  appa-
 ratus to be conducted ?
   A. The observer should first examine the state of
 the tongue and mouth, then the manner in which de-
 glutition is performed, and the effect which the pas-
 sage of the food produces on the oesophagus; he will
 inquire concerning the state of  the appetite, and di-
 gestion, and also whether the breath exhales any par-
 ticular odour; if there be vomiting, it will be advi-
 sable to know how soon after taking food it occurs,
 and what are the appearances which the matter vo-
 mited presents.  If the bowels be constipated, then
 the tenesmus, flatus, sense of distension, character of
 the stools, and the  existence of  haemorrhoidal, or
 other tumours round the anus, form the proper sub-
ject of inquiry.  Attention should, in the next  place,
 be paid to the degree of sensibility manifested by the
 different parts of the digestive system, and the vari-
 ous modifications they may present  in reference to
 their form, size, hardness,  temperature.   Lastly, a
 rapid view may be taken of the systems that are con-
 nected by sympathy with it, as well as of the manner
 in which  the process of nutrition generally is carried
 on.  It is under this head that we generally find in-
 cluded the  headache,  dull  pain  of the  limbs, and
cramps which so often accompany affections of the
intestines, and  also the marasmus, peculiar expres-
sion  of the countenance, and altered colour of the
skin.
  We shall now recur to these different phenomena,
and treat of each of them more  in detail.
  Q. What qualities are nerceived in the tongue ?
  Vol. II.              'M 
134        DIGESTIVE APPARATUS.

  A. Its colour may be white, dirty grey, yellowish
white, with red dots, red more or less deep, or it may
be  brown, dusky, or even  black.  These  d.fferent
shades,  which are sometimes observable at the same
time, may occur on the whole surface of the tongue,
or only  on some part of  it;  its base and centre are
usually  white, brown or yellow; its margin and point
red.  These conditions are attended with more or
less dryness, which sometimes, goes on to such a de-
gree, as to make the surface chipped and rough like
a rasp.  Sometimes, however, it is red, dry, smooth,
and rounded at  its point, at others elongated  and
pointed ; lastly, it may be flat and broad, but then is
moist and free from redness.   As to the colour of the
tongue, we may here remark, that  when its point and
margin  are red, and its base white,  we should make
some estimate of the effect of the contrast of the two
colours, by  which the red may be  made to appear
more deep than it really is.
   The  tongue is frequently covered with  a coating,
m<»»e or less thick, whose colour is variable, being
either  whitish, yellow, grey, brown, black, or dusky,
adhering intimately to its surface, or capable of being
easily detached from it, in which case it leaves it red,
and stripped of its epidermis.  This coating does not
extend to the margin of the tongue.
   The tongue may be enlarged and swollen so as to
protrude out of the mouth, when it is inflamed, or it
may be covered with small white  vesicles or aphthae.
These different conditions may lead us to suspect the
following derangements :
   The  red  and dry tongue indicates inflammation of
the stomach and small intestines.
   When it  is dusky and tremulous, it marks  acute
inflammation of the intestine, particularly of its ileo-
 ccecal portion.
   When white, clean, and  broad, it usually indicates
 chronic irritation of the intestinal canal, or derange-
ment  of the chylopoietic viscera,  abo  cer'.ain ner-
 vous affections. 
DIGESTIVE APPARATUS.         135
   0. What do the mouth, teeth, &c. indicate ?
   A. The lips and teeth may be dry, and covered, un-
der the same circumstances as the tongue, with a coat-
ing which may be considered as indicating intense in-
flammation of the gastro-intestinal mucous membrane.
  Q. What qualities of the digestive apparatus are
indicated  by vomiting ?
  A. This may occur without any effort,  immediately
after deglutition, as in  cancer of the  oesophagus;  in
which case the food  is covered with mucus, but has
suffered  no change except that  by mastication.   In
other cases it occurs some time after the  food has
passed into the stomach, when'it  is found changed
more or less.   It  may be habitual or accidental, may
occur with or without effort, afford sensible relief,  or
produce  serious  accidents, such as cramp, violent
pains of the stomach, &c.—finally, it may take place
without deranging the  health in the slightest degree.
  The contents of the matter vomited, must of course
be various—consisting of half digested pieces of food,
mucus, yellow or  green bile, aqueous and colourless
fluids, or such others as have been drunk.  In some
cases it is black  or  brown, resembling chocolate ;
in others it consists of coagulated blood, or foecal mat-
ter-  Pus, biliary calculi, lumbrici, have been brought
up by vomiting; the quantity of the matter ejected
must be  very variable.  In its  passage along the
throat and oesophagus it gives rise to a dry and parch-
ed sensation
  Q. What is denoted by the state of the alvine
evacuations ?
  A. These may be soft,  fluid, yellow, brown,  or
black,  intensely  foetid ; or  they  may be colourless,
grey, harder than natural, marbled, or elongated and
compressed, as occurs in cases of scirrhus of the rec-
tum.  In some instances the stools consist chiefly of
greenish bile, mucus,  and an acrid serous fluid;  in
others they are  tinged  with blood,  or intimately
blended  with it; finally, they may be  mixed with
pus, sanious fluids,  layers of membrane, or  differ-
ent sorts of intestinal worms. 
136         DIGESTIVE APPARATUS.
  Tenesmus, sense of heat, lancinating pains are of-
ten excited at the arms and lower part of the rec-
tum by the passage of the faeces, and sometimes even
along the anterior part of the thighs, as in dysentery.
In some cases, on the contrary, the colic pains which
previously existed, cease altogether after the evacua-
tion.  When any acute pain is seated in the rectum,
it becomes necessary to introduce the finger, and as-
certain its cause.  It  is in this way that  we discover
the various  alterations which so frequently  occur,
such as contraction of the gut, excrescences, haemor-
rhoids, foreign bodies, &c. &c.
  Q.  What  is denoted by the various modes of the
sensibility of the abdomen ?
  A.  In order to judge of the sensibility of the abdo-
men,  it  is not sufficient  merely to question the pa-
tient, pressure should be made  on different  parts of
the cavity;  for it sometimes happens, that there is
no sensation of pain except it be compressed.  The
mode as  well as  the degree of the pressure will be
different, according as it is sought to determine the
sensibility of the walls of the  cavity, or that of the
contained viscera. Its direction may be perpendicu-
lar to the point on which the fingers are applied, or
it may be so oblique as to affect only a part beneath
it.  Thus, though direct pressure affects the stomach,
that from above downwards acts against the trans-
verse colon.
  The observer should note with care, the  sort of
pain caused by this pressure as well as the region in
which it is  felt ;  thus, if in the  epigastrium, it indi-
cates inflammation of the stomach or transverse co-
lon, according to the direction in which it is applied;
if in the  umbilical region, it marks that of the small
intestines and mesenteric glands ; towards the loins,
between the false ribs, and crest of the ileum, it indi-
cates inflammation of  the kidneys, or ascending, or
descending  colon, according to  the side at which it
exists ;  in the hypogastrium it coincides with cystitis
or matritis ;  in the iliac regions it induces a suspicion 
             DIGESTIVE APPARATUS.         137

 of inflammation, of the coecum at one side, or of the
 descending colon at the other.
  Pressure may not excite any pain in some cases,
 it may even diminish it, as in painters' colic ;  so also-,
 when it is directed  not against the part affected but
 on those of its neighborhood.  In these cases, there
 is no  heat at the surface, and the general symptoms
 of acute inflammation of the  intestine are wanting ;
 or if they exist, they are disguised by stupor, or some
 affection of the nervous system.
  In all cases the temperature of the different parts
 examined should be attended to, and compared with
 the state of the sensibility.   In  acute  inflammations
 of the intestinal canal,  the surface of the abdomen is
 usually hot, dry, and even pungent; its degree marks
 that of inflammation.
  Q..  What is denoted  by size and hardness ?
  A.  An increase  of size may depend  on  flatus, '
 which may be general or  partial,  and confined to
 some  particular part,  as the  epigastrium, or one of
 the hypochondria.   By percussion,  a  clear  sound is
 emitted, which proves that the effect is owing to the
 presence of an elastic fluid ; but when the increased
 size  is  caused  by a tumour,  percussion produces a
 dull sound.
  Tumours in the abdomen may be prominent and
 visible, or they may  be  so situated as to be discover-
able only by  careful examination.  Their situation
 should always be stated, and also all the other impor-
tant circumstances connected with them, for instance,
where they are hard,  soft, irregular, or  nodulated ;
pulsate or fluctuate; whether the pulsations are syn-
chronous with those of the pulse, are produced by the
impulsion of an adjacent artery or by the  expansion
 of their own walls.
  A tumour in the epigastrium may make us  suspect
 an organic disease of the stomach or pancreas ; at the
 umbilicus, it indicates some affection of the small in-
 testines ; but in these cases we should not forget that
 indurated fasces may accumulate in the alimentary ca- 
 138         DIGESTIVE APPARATUS.

 nal, and stimulate  tumours of a very different cha-
 racter.  In such cases we maybe assisted in our dia-
 gnosis by knowing when the patient was at stool, and
 also by making pressure on the abdomen, which will
 sometimes displace the hardened faecal matter.
   When any increased development occurs in the
 hypochondria, we suspect some organic  affection of
 the liver or spleen,  but  we ought to ascertain whe-
 ther the alteration  of size depends on a dilatation
 of the abdomen, or exists in the thorax.   In the
 former case, the anterior extremity of the ribs, and
 lower border of the thorax are projected forwards;
 in the  second, the convexity of the ribs is merely in-
 creased.
   The abdomen may in some cases  be  more  or less
 contracted, so that its  anterior paries is compressed
 upon the vertebral column.  This is most percepti-
 ble in the epigastric  and umbilical region, and occurs
 generally in nervous or painters'colic.
   In some cases, though  rarely, evacuation  by stool
 is altogether  suppressed, the  abdomen becomes
 swollen and irregularly distended, and then vomiting
 supervenes.  As these phenomena may  arise from
 strangulation, internal as well as external, examina-
 tion should always  be made to ascertain  whether
 there is a hernia, which may be the cause of the de-
 rangement. If this  does  not exist, we should then
 endeavour by pressure directed to the different parts
 of the abdomen, to discover whether the suppression
 be not caused  by an accumulation  of freces;  if not,
 it may be caused by an internal strangulation.
  The  throat and fauces should always be examined,
 particularly if any pain be referred to the«e  parts, as
 they are not unfrequently covered by false mem-
 branes, or attacked by ulceration and gangrene. The
condition of the functions  with which the digestive
system sympathises should also be attended to, as the
pulse, skin, expression of the  face, the existence of
headache, dull pains or cramps ;  lastly, in cases of in- 
          EHYSIOLOGT OF THE STOMACH.      139

  tense inflammation  of the gastro-intestinal mucous
  membrane, the state of the mind should be noted.

             PHYSIOLOGY OF TnE STOMACH.
    Q.  What is the oh;ect of the preparation of food
  by the art  of cookery ?
    A. To render it easy of digestion, and agreeable.
  •  Q. Is this the end generally attained in this art?
    A. No;  it is too often prostituted to excite appe-
  tites worn  out by too much indulgence, or to grati-
 fy vanity.   It  is therefore necessary for a physician
  to know exactly what is proper for the stomach, and
 the errors  generally made in this art, in order  to
  warn his patients against them.
   Q.  What are the comparative nutritive qualities of
 different kinds of food ?
   A.  According to the report of Percy and Vauque-
 len, it  is  as  follows: —In bread,  every hundred
 pounds weight are found to contain eighty pounds of
 nutritious  matter.  Butcher's  meat, averaging the
 various sorts, contains only thirty-five pounds in one
 hundred.  Broad beans, eighty-nine.  Pease, ninety-
 three.  Lentils (a kind of half-pea, but little known
 in  England,) ninety four  pounds in one  hundred.
 Greens and  turnips, which are the most aqueous of
 all the vegetables used for  domestic purposes, fur-
 nish only eight pounds of solid nutritious  substance
 in  one hunelred.  Carrots, fourteen  pounds.  And,
 what is remarkable, as being in opposition  to  the
 hitherto acknowledged theory,  one hundred pounds
 of potatoes  onb/ yield twenty-five  pounds of  sub-
 stance, valuable as nutrition.
  One pound of good bread is equal to two pounds
 and a half, or three  pounds of the best potatoes; and
 seventy-five pounds of bread,  and thirty pounds of
 meat, are  equal to three  hundred pounds of pota-
 toes   Or, to go more into detail, three-quarters of a
 pound of bread, and five ounces of meat, are equal to
three pounds of potatoes;  one pound* of potatoes is
 »qual to four pounds of cabbage, and  three of tur- 
140     PHYSIOLOGY OF THE STOMACH.
  nips ;  but one pound of rice, broad beans, or French
  beans, is equal to three pounds of potatoes.— Edin-
  burgh New Philosophical Journal.
    Q. What difference is there  in  the  organs of di-
  gestion in animals, which  live on different kinds of
  food ?
    A. In herbivorous it is  more complicated, in car-
  nivorous more simple.  In man, who lives on bothe
  vegetable and animal matter, it is a medium between
  the two.
    Q  Whence are the nerves of the stomach deri-
  ved ?
    A. From two branches of the 8lh pair, and the sub-
  diaphragmatic ganglion of the great sympathetic.
    Q. What are the structures, which discharge fluids
  into the intestines ?
    A. 1st, the mucous membrane, which secretes
  fluids from its surface ; 2d, mucous follicles, for the
  discharge of mucus; 3d,  mucous follicles  about  the
, isthmus of the fauces; 4th, mucous glands, in  the
  oesophagus, in the arch of the palate, and on the sides
  of the jaw; 5th,  the parotid glands, the submaxillary,
  the liver and pancreas.
    Q. Of what is the fluid  of the stomach composed ?
    A. It consists  of a frothy fluid slightly viscous, and
  acid ; with a  small quantity of mucus floating through
  it, composed of the saliva, the mucus of the passa-
  ges, and the  proper secretion  of the stomach or the
  gastric juice  : By the analysis of Thenard, it is com-
  posed  of a  great quantity of water, a little mucus,
  and some salts, with a base of soda  and lime, with-
  out any sensible acidity ; lactic acid, with hydrochlo-
  rates of ammonia,  soda,  and potash have also been
  found in it.
    Q.  What are the fluids of the intestines ?
    A  The intestines are covered with mucus, as the
  stomach is, and receive the juice of the pancreas, the
  biie, with the chyme from the stomach ; it is from the
  fluids first  mentioned  that purges produce a great
  discharge, though the person has  eaten nothing for
  some time before. 
        PHYSIOLOGY OF THE STOMACH.     141

   «i. What kinds of air do these organs contain ?
   A. Atmospheric air, and sometimes carbonic acid
:ire found in the stomach ; azote and carburetted or
sulphuretted hydrogen  are found  in the small intes-
tines.
   O.. Whence does the oesophagus derive its nerves?
   A. From the eighth pair.
   Q  Does the oesophagus obey the will in its mo-
tions?
   A. Its upper two  thirds are  entirely  obedient  to
the will; but the lower third has a motion peculiar to
itself.  This motion is involuntary, and commences at
the junction ot  the lower third with the upper two
thirds, continues for  about30 seconds, rendering the
oesophagus in that part hard like a cord: when it
commences, it continues for a variable space of time;
its object is no doubt to pass the  food into the sto-
mach, as this part of the canal, unlike any other part
of it, is not capable of distention.
   Q. What is the nature of hunger?
   A. It is  a sensation intended to warn us of the
necessity of  taking   food, and  its phenomena are
either local or general:  the  local are  the follow-
ing; after 24, 48, or 60 hours of complete abstinence,
the dimensions of the stomach still continue conside-
rable; about the 4th  or 5th day it becomes somewhat
smaller, the pressure of the abdominal  parietes is
less, and on this account it is that  the gall-bladder
becomes filled with  bile, which never is found in the
stomach except some disease is present.  The quan-
tity of blood  which circulates in the stomach is less
when the stomach is empty than when it  is full.
   Q_. Wnat are the general phenomena of hunger ?
   A. General debility of all the organs, diminin on of
the heat of the body, of the secretions and circulation}
and the respiration becomes slower.
   Q. What circumstances increase the feeling of hun-
ger ?
   A. Exercise, cold  baths, frictions on  the skin, a
cold and dry air, winter, spring, and all circumstances 
142     PHYSIOLOGY OF THE STOMACH.

which increase the motion of the blood without ad-
ding to the nourishment of the system.
  Q. What circumstances diminish it ?
  A. Depressing passions, as grief, hot climates, and
wet situations, opiurfi, and hot drinks.
  Q. What is the cause of thirst ?
  A. The want of water in the system ;  this ia the
whole history of our knowledge on this subject.   To
say that it is owing  to the foresight of the  mind, or
to the state of the nerves,«as has been done, is of no
account; such statements are not matter for the phi-
losophy,  but for the history of physiology.
  Q. What are the causes which increase thirst ?
  A. The dryness and.heat of  the atmosphere, the
loss of  a  great quantity of fluid by the body;  salt-
ed  meats; a  substance stopped in the throat;  the
habit of drinking frequently, to prove the quality of
certain liquids, as spirits of wine, wine, &c.  It differs
however in different constitutions; some never feel
thirst, others drink a great deal.
  Q.  What are  the processes performed by  the
mouth on the aliment previous to swallowing it ?
  A. Its temperature approaches to thatof the mouth,
its  parts  are  intimately divided, by the teeth and
tongue, and they are mixed with the saliva.
  Q. How is the mass pushed forward into the  oeso-
phagus ?
  A. The tongue  gradually presses the mass back
into the oesophagus by raising itself from the tip gra-
dually to the  base, till it is  thrown into the passage,
the sides of which  contract  behind and  gradually
push it on till it arrives at  the  stomach: the upper
two thirds contracting by something like a voluntary
power; the lower third being involuntary, continues
in a contracted state for some  instants after the mass
has gained admittance into the stomach.     /
  Q. What effect has the admission of aliment into
the stomach on the adjoining viscera ?
  A. Distension is its most general effect, which nro-
duces difficulty of  breathing, of speaking, singing,
and often a desire to go to stool. 
PHYSIOLOGY OF THE  STOMACH.      143
  ft. What prevents the escape of the food from the
stomach, when it is very much distended ?
  A.  The contraction of  the oesophagus,  at the
cardia, which experiment  proves  to be  very  con-
siderable ;  the alternate contraction  of its lower
third  becomes the more considerable  and  its re-
laxation short, in  proportion as the stomach is more
distended; the contraction  of the  oesophagus  cor-
responds with the movement  of inspiration, when
the stomach is most pressed upon^and the relaxation
with expiration.   The pylorus is  straitened by  a
ring of  circular fibres which forms it, and above  it
there is often another contraction of the fibres, which
prevents the  descent of the food to the pylorus ; and
also by  a reversed peristaltic motion, which  is pro-
pagated from the duodenum upwards and  throws
the aliment in the stomach towards its splenic portion.
Besides, as the pressure occasioned by the distension
of  the stomach is general, the food has no tendency
to pass  into the smaller intestines.
  Q. When this distension is complete, is the feeling
of hunger always  removed ?
  A.  The removal of this sensation does not depend
alone upon distension, for substances which have not
nutritive qualities will  not* produce this effect; the
stomach, therefore, has a peculiar sensibility to the
qualities of the  substances,  which it takes in; thus
certain poisons produce great pains, and a small por-
tion of matter exceedingly nutritive is sufficient to sa-
tisfy hunger.  Its internal surface  is much injected
with blood after taking in  food, which shows that its
surface  is greatly excited,  and no doubt for the pur-
pose of secreting the gastric juice.
  Q.  What is meant by the chyme ?
  A.  It is the fluid  which is the result of the first
process of digestion in the stomach;  it  differs ac-
cording to the aliment of  which it is formed, being
more easily produced from animal than  vegetable
substances; for parts of the latter often pass  into the
intestines without change, except a slight loss of co
lour   it  appears more frequently near the pyloru 
144     PHYSIOLOGY OF  THE STOMACH.
than in any other part, though it is sometimes found
on the surface of the food ; its taste and smell are al-
ways  slightly acid;  and it  reddens the tincture  ot
turnsole: during its formation very little air is formed;
Magendie discovered, in one instance, a portion of air
which contained oxygen, azote,  and carbonic  acid:
in general, in animals, there was no air discovered in
the stomach during digestion, an important fact, which
shows that miasmata, as  has been believed, are not
taken down  with the air in this mode.
  Q. What quantity of chyme is seen in the stomach
at one time ?
  A.  Magendie says it occurs in  quantities from one
to two ounces
  Q.  How is the chyme discharged into the duode-
num?
  A.  By a motion of the stomach from left to right,
the pylorus opening as it approaches.  When the sto-
mach is full, the motion is  confined to that portion
of it which is near the pylorus; when nearly empty,
it is  more extensive, and can even be felt  by some
persons.
   Q.  What  are the substances which are most easily
converted into chyme ?
   A.  The farinacea, and.the  fleshy parts of certain
animals, as mutton, beef, and  fowls, are more digesti-
ble than tendon, cartilage, the whites  of eggs, muci-
laginous and sweet vegetable  substances.  The bones,
the cuticle, hair, and  feathers, are entirely indigesti-
ble.  In all  cases the size of the portion swallowed
affects the digestion of every substance, it being more
difficult as the substance is larger.  The quantity, the
chemical nature as regards their solubility, their more
or less  complete mastication, and the powers of  di-
gestion of the individual, all influence digestion.
   Q.  How is the chyme formed ?
   A.  It is most  probably the result of the  action of
a fluid  secreted by the  stomach acting on the food
kept  at the temperature of 98°, and mixed intimately
with  the saliva, and  continually moved by the dia-
phragm, and carried  away by the peristaltic motioi\ 
        PHYSIOLOGY OF THE STOMACH.      145

 which exposes a new surface to its action ; the par-
 ticles  thus collected  at the bottom of the stomach
 form the chyme.
   Q.  Have the nerves any effect upon digestion ?
   A. It is certain that the section of the eighth pair
 in the neck  prevents  digestion, but as it also influ-
 ences  respiration and renders it imperfect, it is im-
 possible to say whether it acts on the stomach by dis-
 turbing the  functions  of the lungs, and thus produc-
 ing an imperfect  digestion,  or directly on the sto-
 mach,  or both : it has been supposed that electricity
 passing through these nerves from the brain is the
 cause  of digestion, but  of  this there is  no  direct
 proof.
   Q. What general effects has digestion on the sys-
 tem ?
   A. In persons of ordinary health, excepting dis-
 tension, and a slight influence upon respiration, no
 effect  is perceived.  In delicate people, sleepiness,
 discharge of flatulency, sense of weight, burning at
the stomach, are sometimes felt, but their digestion
is equally complete after it is over as others who have
not these symptoms.

       PHYSIOLOGY OF THE SMALL INTESTINES.
   Q. What is the office of the small intestines ?
   A. They appear to secrete a viscous, ropy, saltish
fluid,  which reddens the tincture  of  turnsole',  and
which has been denominated the intestinal juice, and
has been supposed to possess properties similar to the
fluid of the stomach.
   Q. How does the chyme find its way into the small
 intestines ?
   A. The duodenum  takes on a vermicular move-
ment  towards the pylorus,  which contracts ;  the
stomach above the pylorus takes on the same move-
ment, directed from the pylorus towards the side of
the spleen, in which direction the chyme is thrown;
immediately after a contrary motion takes  place, by
which the chvme is thrown from the splenic side to-
   r-u. TI                N 
146      PHYSIOLOGY OF THE STOMACH.
wards the pylorus, which opens, and  it passes into
the duodenum.  These motions cease and  are re-
peated  after short intervals,  and are increased to-
wards the  conclusion of the  process of digestion in
the stomach.
  Q.  How is the chyme passed from the small  intes-
tines to the large ?
  A.  By a  vermicular contraction taken on at  inter-
vals similar to the above, as appears  from observa-
tions made  upon living animals; the peristaltic mo-
tion, which takes place in recently dead animals, is
constant and does not at all resemble the above.
  Q.  What  changes does the  chyme undergo in the
sm:<U  intestines?
  A.  None, till it meets the bile and pancreatic juice;
from being a greyish thick fluid of a sourish smell, a
taste  slightly acid, it  becomes,  on mixing with the
bile and pancreatic juice, yellow, bitter, with a  smell
less sour ; and when it is formed of substances of an
oily nature,  filaments  are seen forming of a flat and
sometimes  a round} figure, which attach themselves
to the valves, and appear to be the chyle in its rude
or forming state ; what the process of precipitation
is which produces it, is unknown; these are the facts :
the same changes go  on throughout the upper two
thirds of the small intestines ;  in the lower third, the
chyle becomes  yellowish,  dark  and faecal,  giving to
the ilhim a colour quite distinct  from the duodenum
and jejunum. In the ccccum it becomes quite sterco-
race-ous. In the whole tract the process varies some-
what with the quality  of the aliment.
  Q. Do the intestines contain any air ?
  A. The small intestines rarely contain any air du-
ring the formation of chyme ; at cording to, the ex-
periments of Magendie, carbonic acid, azote'and hy-
drogen in somewhat variable pn portions have  been
found in the intestines of persons recently executed :
whence  they come  is not certainly known.   Magen-
die has  seen gas escape from the chyle as it  was
forming in one instance, in a man four hours execut-
ed, from the opening of the bile  duct, to the ilium. 
PHYSIOLOGY OF THE STOMACH.    .  147
   Q. How long is the chyle in forming ?
   A. It is  supposed it requires three or four hours
after eating.

    CHANGES PRODUCED IN THE LARGE INTESTINES.
   Q. What kind of air is found in Jhe large intes-
tines ?
   A. The same species as mentioned above, only in
somewhat  different proportions.   Carbonated  and
sulphuretted hydrogen are also found.  The fixed air
increases in the lower intestines.
   Q. How  are the  contents of the lower intestines
discharged ?
   A. By the power  of the  abdominal muscles and
diaphragm, and the  contraction of the muscles of the
rectum, which alone is sufficient if the contents are
fluid.
   Q. How often should the contents of the rectum
be discharged  in a healthy state of the body ?
   A. Once  in  24 hours; its contents have been re-
tained for 8 or 10 days  without deranging the health
in the least.   In women, clysters are absolutely ne-
cessary: exercise, fluid aliments,  and  the habit  of
going to stool at a certain hour, will at length make
the bowels regular every day.

   CHANGE  PRODUCED ON DRINKS BY DIGESTION IN
                  THE STOMACH.
  Q. How are liquids divided in respect to their diges-
tibility ?
  A.  Into  such as  are convertible into chyme  in
whole or in part,  and into those which do not form
chyme at all.
  Q.  What are those substances, which are converti-
ble into chyme in whole or in part ?
   A.  Oil is almost wholly converted into chyme, and
remains  a long time  in  the stomach; gelatine, albu-
men, osmazome, sugar, gum, fecula, colouring or as-
tringent matters; these are digested as other solid
substances are, and  the fluids,  as water or spirits of 
U8      PHYSIOLOGY OF THE STftMACH.
wine, with which they are mixed, are either absorbed
or they pass into the small intestines.
  Q. What are the changes which  simple water or
diluted alcohol undergoes when introduced into the
stomach ?
  A. It is mixed with the mucus and absorbed from
the stomach or passes into  the small intestine, and
if the water be without any  air, as in distilled water,
it remains in the stomach a long time, and no changes
are produced in it; well water, in which there is a
great deal of salt, has the same effect, and is follow-
ed by a sense of weight.
  Alcohol acts rather differently : it coagulates the
albumen of the mucus, which is increased in quanti-
ty ; it disappears very  soon, producing drunkenness
or  death  according to the quantity.  Milk coagu-
lates immediately,  and is digested.   In general the
watery part of wine, of soup, &c. is absorbed, and the
solids remain to be digested, as usual.
  Q. How do liquids influence digestion ?
  A. By dividing and  softening them,  they favour
their digestion ; alcohol stimulates the secretion of
the gastric juice and thus increases the power of the
stomach, but as it becomes accustomed to the stimu-
lus, and requires an increase, it is £*bad practice.
  Q. How are the matters contained in the stomach
rejected ?
  A. By eructation, which consists in the simple dis-
charge of air, contained in the stomach ;  by regurgi-
tation, which is the involuntary passage of matters
contained in the stomach into the mouth, and may
happen when the stomach is too full as after a meal,
or when  it is nearly empty, as  happens often  in the
morning:  it is then effected principally by the  pres-
sure of the sides  of the belly.  It is sometimes a
voluntary, but most generally an invofuntary, power.
In  the former case it is considered and stated as the
power of vomiting at will.  This power resembles ru-
mination, which some few possess. 
        PHYSIOLOGY OF THE STOMACH.      149

   Q. In what does the process of vomiting consist?
   A. It consists in sudden repeated and violent con-
 tractions of the abdominal muscles and  diaphragm
 pressing on  that viscus  and expelling its contents,
 the  stomach being entirely  passive;  it  is proved
 that the diaphragm and  the  abdominal muscles  can
 each produce it separately, though in ordinary cases
 they both contribute to it.
   Q. What effects have  the  organs of digestion on
 the senses ?
   A. A moderate appetite  sharpens, hunger  de-
 stroys or weakens, a full stomach blunts their power.
   Q. What effects have  the  organs of digestion on
 the muscular system ?
   A. They increase the activity and produce the ex-
 ercise ot it in order to procure food, and  during  di-
 gestion it becomes languid : in cold countries how-
 ever, the  presence of food in the  stomach, renders
 the muscular system more active.
   Q, \\ hat effect have the organs of digestion on the
 mind ?
  A. During hunger, the pleasure of eating is con-
tinually present to the mind; the state of the mind on
the  contrary affects the digestion, thus  fear  often
takes it away for two or  three days ; joy and laugh-
ter always increase it.

                  OF THE CUYLE.
  Q. What are the properties of the chyle ?
   A. It is a white milky fluid, rather heavier than wa-
ter, saltish, with a slightly  alkaline taste, separating
in a  short  time into  three  parts; 1.  a  coagulum,
which sinks to the bottom;  2, a watery substance;
and thirdly,  a part  which swims on the surface  of
tiie liquid.   When there  is  no fat in  the  food, it is
transparent.  The coagulum is formed  of fibrine and
a  reel colouring  matter.   The chyle  is in fact  the
blood nearly formed.
> 2 
150    PATHOLOGY OF  IKE A BOOM I
PATHOLOGY OF  THE  ABDOMEN
AFFECTIONS OF  TIIE  DIGESTIVE ORGANS
          AND THEIR CONNEXIONS.

           INFLAMMATION OF THE GUMS.

  Q. What are the symptoms of inflammation of the
gums ?
  A. The gums swollen and red; when pressed, al-
low blood to ooze  out from  their  surface.  They be-
come painful, and if the inflammation  passes to the
t hronic  state,  excrescences shoot out  from  the sur.
face, supported by a pale red pedicle, and often ex-
tend to such a length as to cover the teeth.   In some
cases, they become so firm in their texture as to re-
semble fibro-cartilage, in which case they cease to be
painful.   Inflamed gums are often attacked by ulcer-
ations, or abscess ; they occasionally continue for a
considerable time  soft and spongy.
  Q. What are its anatomical characters ?
  A. They are merely what we  have  just enumer-
ated.

                    APHTH£.
  Q,. What are the symptoms of Aphthae ?
  A. These consist of an eruption of small white, su-
perficial vesicles,  single or confluent,  filled with a
glutinous or puriform fluid.  They usually  are suc-
ceeded by a crust, or by ulcerations,  the surface of
which may  be grey or reddish.   The vesicles  are
seated in  the  mucous membrane of the cheek,  ex-
tending  backwards to the fauces; they produce  a
sensation of heat, with some difficulty of mastication
and of deglutition.  This affection is sometimes  en-
demic, and occasionally contagious; it usually affects
children in early infancy. It is not  dangerous,  ex- 
         PATHOLOGY OF THE  ABDOMEN.      1 5 i

cept it passes to the state of gangrene, or extends to
the digestive  tube, or larynx and trachea;  in which
cases it constitutes oesophagitis, or gastro-enteritis ? t

                    GLOSSITIS.
  Q.  What are the symptoms of Glossitis ?
  A.  The tongue is attacked by an  acute or pulsa-
ting pain ;  it becomes red, hard,  and very sensible,
then swollen, and covered with a thick mucous coat-
ing.  The  tumefaction is sometimes so great that it
shuts down the epiglottis, compresses the larynx, and
tends to produce suffocation ;  it is  pendent outside
the mouth, becomes immoveable,  and  incapable of
serving the purposes of articulation.  The mouth is
open, and from it flows a viscid, and sometimes  fetid
saliva;  deglutition is impossible, respiration much
impeded, and the face red  and swollen;  there  is
usually some cough, and more or less fever.

      AMYGDALITIS, OR ANGINA TONSILLARIS.
  Q.  What are the symptoms of Amygdalitis, or an-
gina tonsillaris ?
  A.  Heat and pain, increased by deglutition, in the
posterior part  of the mouth, with swelling and  red-
ness of one or both tonsils, which are studded  with
whitish specks ; the inflammation sometimes extends
to the Eustachian tubes;  the mucus of the fauces
which is at first diminished,  afterwards increases in
quantity, is expelled with pain and difficulty;  red-
ness,  swelling and extension of the uvula,  which
causes a frequent desire of swallowing.  If the in-
flammation be  intense, and attacks both tonsils at the
same  time, the respiration  becomes impeded, some-
times to sueh  a degree  as to  threaten suffocation.
Amygdalitis is frequently combined with inflamma-
tion of the  larynx.  The tongue is generally covered
with a thick coat of a  yellowish white colour ;  it is
seldom red, even at the edges.  It may be confound-
ed with  pharyngitis, or with angina laryngea,
  Q. What are its anatomical characters > 
 152     PATHOLOGY  OF THE ABDOMEN-.

   A. Redness and tumefaction of the tonsils, more or
 less considerable ; suppuration or induration of these
 glanels.

                  PHARYNGITIS.
   Q. What are  its symptoms ?
   A. Swelling and redness in  the back part of the
 pharynx,  which  is generally spotted with whitish
 patches; deglutition  difficult,  often  impracticable;
 no impediment to  respiration ; heat and dryness of
 the pharynx, followed by a copious secretion of mu-
 cus, which is expelled with pain ;  the tongue is gene-
 rally foul and coated, but without redness.  Pharyn-
 gitis is often accompanied by amygdalitis.
   Q.  What are its anatomical characters ?
   A.  To the morbid alterations which have been
 pointed out in treating  of glossitis and amygdalitis,
 we may add, that the inflamed tissue may be increas-
 ed in thickness, penetrated by pus, or covered with
 a false membrane.

             CANCER OF THE  PHARYNX.
   Q_.  What are its symptoms?
   A.  The first symptoms of this affection  are  very
obscure, and usually consist  of uneasy sensations in
the throat,  and slight impediment to deglutition, con-
secutive, in general, to inflammation of the pharynx ;
afterwards  prickly pains, supervening at intervals, are
often perceived in the inferior part of the pharynx ;
deglutition becomes painful ; fluids  are rejected as
soon as swallow.d.  If the pharynx be examined, it
is found tumefied, hard and insensible to pressure ;
at  a more advanced period ulceration takes place, and
the ulcer presents an uneven  surface with everted
edges, and  secretes a foul, putrid sanies;  at this pe-
riod acute lancinating pains are experienced.
  Q.  What are its anatomical characters ?
  A.  The parietes of the pharynx  are  thickened,
hard, and transformed  into  a scirrhous substance ;
encephaloid.  matter is sometimes, though very sel- 
         PATHOLOGY  OF THE  ABDOMEV     152

 dom, to be found there.   The mucous and muscular
 coats are almost always distinct, though degenerated,
 at  least whenever  the  soirrhus does  not become'
 softened ; one or more ulcers, with thick, hard, and
 everted edges, present themselves; their surface is
 unequal, granular, or fungous.  The disease extends
 more or less to the adjacent parts.

                   OESOPHAGITIS.
  Q. What are its symptoms  ?
  A. Pain in apart of the oesophagus, increased by pres-
 sure applied to the neck, when  the iHflammation is
 seated in  its superior portion, between the trachea
 and spine ; difficulty of swallowing ; solids and fluids
 produce a burning sensation along the whole or some
 part of the oesophagus; they are  sometimes rejected
 by the nostrils ; continued hiccup.  When this affec-
 tion assumes a chronic form it is usually accompanied
 by vomiting, which  supervenes immediately after ta-
 king food.  It may be confounded with cancer of the
 oesophagus.
  Q. What are its anatomical characters ?
  A.  Redness and thickening of the  mucous mem-
 brane, more  or less conspicuous; it  is sometimes
lined with a false membrane, very thin and intimately
 adherent.

           CANCER OF THE OESOPHAGUS.
  Q. What are its symptoms ?
  A. This disease  frequently commences with hie-
cup, and shooting pains in the course of  the oesopha-
gus, with interruption to the free passage of food im-
mediately after deglutition. When it affects the su-
perior portion of the oesophagus, its symptoms are the
same as those of cancer of the pharynx.  If it be si-
tuated lower  down, gnawing  pains, and a  burning
sensation is experienced behind the trachea, particu.
larly  if the  patient make use of drinks containing
spirit,  which  always exasperate the disease.  If the
disease be seated near the cardia the food remains foi 
 154    TATHOLOGY  OF THE  ABDOMEN.

a short time in the oesophagus, and is then rejected
without effort, mixed  with  mucus.  If it  communi-
cates with the air tubes, deglutition is always follow-
ed by a violent fit of coughing.
  Q_. What are its anatomical characters ?
  A. Similar to those of cancer of the pharynx. The
cavity of the oesophagus is narrowed by the thicken-
ing of its walls ;  sometimes the degenerated part re-
tains the cylindrical form of the oesophagus ; some-
times it is transformed into an irregular mass adhe-
ring to the trachea, to the lungs, or even to the dor-
sal vertebrae.

              ANGINA GANGRENOSA.
  Q. What are its symptoms ?
  A. There are   no signs at the commencement of
this disease by which we  would be led to suspect its
real nature, as all its primary symptoms are perfectly
similar to those  of common  amygdalitis;  but in a
short time it assumes its  peculiar characters, and all
doubts as to its   nature are removed by the appear-
ance of gangrene, which sometimes occurs so early
as the first day.   From the severity of this affection,
we should always be  on the watch, in inflammation
of the throat, and dread its approach ; 1st, in delicate
women and  weak children; 2d, in persons who are
already affected  with gangrene of other parts ; 3d, in
cases of sore throat, occurring in scarlatina, or other
eruptions of a livid colour; 4th, when the  disease is
epidemic ; 5th, when the individual affected has at-
tended others in  the complaint, for under some cir-
cumstances it appears contagious ; 6th, when  the in-
flamed parts  are livid, or of a  deep red:  or when,
after having been of a  lively red, they become pale,
at the same time that the patient complains of dry-
ness of the fauces, and consielerable general depres-
sion ; or when the parts are covered with those false
membranes,  which so frequently occur in all inflam-
mations of the throat; 7th, in fine,  when general or
local bleeding induces a state  of weakness, neither 
        PATHOLOGY OF  THE ABDOMEN.     155

proportionable to the strength of the patient or quan-
tity of blood drawn.
  Angina  gangrenosa may be known  by the small
white or ash-coloured specks which  appear on the
tonsils and other parts  of the mucous  membrane,
spreading with rapidity,  and running into one another
so as to form large patches; the surrounding mem-
brane is of a  pale or livid colour;  these patches be-
come grey, or  even black, towards the conclusion ;
as soon as they are completely developed, the throat
ceases to  give  pain, deglutition becomes easy, the
breath loses its foetor; but symptoms of general pros-
tration supervene.
  When the breathing through the nostrils becomes
difficult, and the voice  nasal, the  gangrene has ex-
tendeel to  the nasal parts;  when this occurs, an irri-
tating discharge flows from the nares, the circumfer-
ence of which becomes inflamed.
  When gangrene  is about  to extend into the air-
tubes, it is preceded by pain in these parts, together
with difficulty of respiration, cough, and aphonia.
  When it extends to the oesophagus, deglutition be-
comes impossible.  When the isthmus faucium is af-
fected, the affection is at once recognized by the ap-
pearance  which the part presents, by the sense  of
suffocation, and impossibility of deglutition.  It par-
takes of the characters of angina.
  Q_.  What are its anatomical characters ?
  A. The amygdalae, velum, palate, pharynx, mucous
membrane, the cheeks and nares, oesophagus,  larynx
and trachea, are either together or separately cover-
ed with eschars, which may be white, grey, or black,
adherent or detached; these  can scarcely be said  to
be putrescent, or in a state of complete decomposi-
tion.  We also, in general, observe ulcerations, per-
forations,  and loss of substance to a greater or less
extent.

             ANGINA " COUENNF.USE."
  Q.  What are its symptoms ? 
 Oo"     PATHOLOGY OF THE ABDOMEN-.

   A. These are the same as in the preceding disease,
 but seldom so severe. The white ash-coloured patches
 never become black; there  are  merely some false
 membranes,  which fall off" without destroying the
 substance beneath them, and are thrown up by vomit-
 ing or coughing; sometimes they gradually  decay,
 and are in a manner absorbed.

                ANGINA PULTACEA.
   Q. What are its symptoms ?
   A.  Slight sore throat, with  patches of a pultaceous
 cheesy matter, of a white, grey, or yellowish colour,
 spread at intervals over the affected part; easily re-
 moved by the  fingers, but appearing again in a short
 time, and ending by being coughed up.

            GASTRO-ENTERITIB ACUTCS.
   Q.  What are its symptoms  ?
   A.  This affection is usually marked by the follow-
 ing symptoms :—viz.  uneasy sensations of compres-
 sion and weight are experienced in the epigastric re-
 gion, accompanied by wandering pains in the abdo-
 men ; general lassitude and dull pains in the extremi-
 ties ;  restlessness, heat, and  dryness of  the throat,
 with  thirst, accompanied by  a particular desire for
 cold drinks ; the eyes are dull and heavy ; the com-
 plexion pale  and sallow; the appetite usually dimi-
 nished, sometimes increased ;  the digestion accompa-
 nied  with  colicky pains, flatulence, hiccough ani
 nausea.  It often begins by  a dislike for food, and
 distension of the stomach ; the mouth becomes clam-
 my ; the tongue is red at its point and margins.
  Again, it makes its attack more suddenly and with-
 out any  precursory symptoms; first appearing by
 vomiting and frequent alvine evacuations, with  tormi-
 na and tenesmus.  These symptoms may exist con-
jointly or separately,  according as the inflammation
may be seated  in the stomach or small or great inte«
tines.   The epigastrium becomes tender and partial -
Jatly sensible to pressure; however, this  symptom ;■ 
         PATHOLOGY  OF THE  ABDOMEN.    157

 ■*ften altogether absent.   The head-ache is generally
 constant, and the brain or its membranes may become
 secondaxily  affected.  In the  course of the disease,
 the sensibility and activity  of the senses and mental
 faculties are blunted, which does  not necessarily
 imply any structural alteration of the nervous cen-
 tre ; and even the locomotive powers are more mani-
 festly deranged than in many essential disoi ders of
 the brain.
   The pungent heat and dryness of the integuments
 is  remarkable; the pulse frequent,the tongue red,
 which depends upon the degree of the inflamma-
 tion.  Stupor and  muscular prostration  are  more
 frequent in this affection than paralysis or spasms :
 if these last  appear and affect  one  side  only, they
 show thnt the brain is implicated.  The pulse, dur-
 ing the progress of the disorder, is usually frequent;
 in the onset it is full, but soon becomes small, concen-
 trated, irregular, and intermittent; when the inflam-
 mation is intense, however, this frequency is some-
 times less remarkable, particularly if the patient be of
 the lymphatic temperament.
  The urine  is small  in  quantity, and red; the ex-
 ternal margins of all the mucous  membranes are red ;
 the  conjunctiva injected; the pituitary membrane
 dry; tiie mouth which is  at first clammy, becomes
 hot  and parched  when  the inflammation is  at its
 height j the tongue, white or yellow in the commence-
 ment, liecomes red at its tip and edges, and even over
 all its siurface in the course of the disease.   Now and
 then  i ts anterior portion  is found covered with a
 multitude of small  projecting red or violet-coloured
 spots, separated by the mucous membrane, which is
 pale o.r covered with mucus ; this appearance rather
 indicat.es a slight or chronic gastro-enteritis.   More
freque ntly, however, the tongue is covered by a thick
adher> :nt coat,  which becomes dry and rough as the
inflam mation becomes more intense.  At this period
the  to ngue, gums, lips, and teeth are encrusted with
a brow 'nish-black matter.
  Vor„ II.               0 
 158    PATHOLOGY OF  THE ABDOMEN.

  The thirst is considerable, and increases as  the dis-
ease extends from the stomach to the small intestines;
the skin is dry and arid, with a pungent heat, which
is extended  over all the body, or  only occupies the
chest and abdomen.
  Finally, towards the conclusion  the countenance is
indicative of suffering, the eyes are red, hollow, and
dull; the nostrils expanded, and the cheek-bones pro-
jecting, of a deep red colour.
  Q.  What are its anatomical characters ?
  A. The external membrane of the stomach is usually
natural ;  sometimes this viscus is distended with air ;
but occasionally it is contracted.   The mucous mem-
brane of  the stomach is sometimes studded with red
dots, or covered by patches arising from the effusion
of blood  into the substance of  the membrane itself;
at other times  a uniform redness  is  diffused over its
whole extent, being particularly conspicuous, and a
deeper shade around the cardia and pylorus.
  Occasionally the redness follows the course of the
blood-vessels, which are injected and arborescent;
this colour is of a vivid red or  of a darker shade, al-
most brown; both shades are alternately mixed or in-
timately blended one with the  other.  In some cases
an  effusion of gas takes place beneath the  mucous
membrane.
  Gangrene is rarely met with; ulceration is  also un-
usual,  and seldom  penetrates  as far as the muscular
coat.   When the mucous follicles are affected, they,
resemble small reddish pimples.
  When  contraction of the stomach  accompanies
inflammation the creases of the mucous coat are con-
spicuous,  and of a deeper tint than  the surrounding
parts.
  The exterior of the small intestines usually appears
healthy, but when the inflammation is intense  Jie red-
ness of the subjacent mucous coat is visible through
its thin parietes; they may be  ultimately contracted
or distended.
  The redness of the internal coat is  interrupted 
       PATHOLOGY OF  THE ABDOMEN.      1 59

suddenly in various parts,  and is less deeply marked
in the duodenum than at the further extremity of the
intestine.
  If the inflammation be slight, the valvulae conni-
ventes are alone affected, the intervals which sepa-
rate them appearing  perfectly natural.  In  a more
advanced degree, the vessels are strongly injected,
and we perceive patches of paler or deeper red ; the
membrane is covered with an adhesive mucus.  The
muscular and serous coats seldom participate in the
disease
  Gangrene of the intestine is of very rare occur-
rence ; when it takes place  the intestine becomes
black,  dull and friable, and emits a gaseous odour.
Ulceration, on the  contrary, is very common, and is
found in the  ileum,  particularly in the neighbour-
hood of *he ileo-coecal valve ; it is in general confined
to the mucous coat, but it sometimes extends to the
other tissues, and not unfrequently produces perfo-
rations through the intestine.
  The edges of the ulcers are sometimes  quite per-
pendiculur, and other times rugose, thick and irregu-
lar ; their circumference is red or pale ; their floor is
often formed by the muscular coat.
  During the process of cicatrization their edges sink
down, approach each other, and unite by a little emi-
nence, which in the course of time gives place to a
small depression.
  If the ulcer be large, the cicatrix is formed by a
whitish or rosy pellicle, and if it be still more  con-
siderable the mucous membrane is  puckered and
drawn in, so that the intestine may  be contracted in
this part.
  Thickened patches or excrescences are frequently
met with in  the small intestines, formed of a white,
greyhh,  or  red substance, possessing considerable
tenacity, and chiefly occupying that portion of the gut
which is placed next the ileo-coecal valve, the rest of
the intestine generally remaining sound.  These oc-
cur most frequently in young subjects. 
 !68    PATHOLOGY OF THE ABDOMEN.

  The mucous follicles resemble so many p imples,
hard and depressed in  the centre,  which afterwards
soften  and  suppurate,  or appear  in  the  lorm of
brownish patches,  circumscribed and without swell-
ing. The invaginations which  are occasionally  met
with in enteritis are formed by the  introduction of
the superior portion  of the gut into the inferior, or
the reverse takes place, which is infinitely more un-
usual.

          GASTRO-ENTERITIS  CHRONICUS.
  Q. What are its symptoms?
  A. This occurs as a consequence of the former dis-
ease, or supervenes in a very slow  and gradual man-
ner, with symptoms more mild,  but in other  respects
resembling those of the acute form.   There ig. epigas-
tric uneasiness, often with a sensation as if a trans-
verse  and painful band is perceived  extending from
one side to the other, and particularly evident at the
right;  it may be continuous, interrupted, or  remit-
tent, and is increased after meals, more or less, accord-
ing to the quantity and quality of the food, and is ex-
asperated by the depressing passions.
  The  pain is gnawing, pungent and burning', accom-
panied by a sense of constriction in the oesophagus,
or with difficulty of deglutition and respiration, with
a sensation of compression along the base of  the tho-
rax, or in some part of it only ; it is someti mes at-
tended with  a dry cough ; occasionally the  pain ex-
ists solely in  the epigastric region, which  is then in-
capable of supporting the slightest pressure.   Usual-
ly the patient experiences a dislike for food;  but now
and then he has an extraordinary  appetite, which,
however, soon gives place to a distaste for every sort
of food.
  The  digestion is  imperfect, and accompanied by
bitter  acrid  eructations ;  thirst, and a sense of epi-
gastric fulness are not unusual.  The  ideas  become
confused, and the head heavy ; dullness, somnolency, 
PATHOLOGY OF  THE ABDOMEN.     161
 and a dislike to movements of any description take
 place.
   The skin is hot, particularly on the  palms of the
 hands; the pulse is tense, and generally frequent;
 vomiting takes place when the stomach is overloaded
 or much irritated; there is habitual and obstinate con-
 stipation, giving place occasionally to  diarrhoea  of
 short duration.
   In general the tongue is small and red at its tip and
 edges,  or even over  all its  surface, but in other
 cases it is merely dotted with red specks or cover-
 ed with a dry mucous coat.   The breath is fetid ;
 the  heat and thirst are augmented after meals ; the
 puis::  becomes frequent towards evening;   a bitter
 tat  is complained of in the morning ; the complexion
 is salhiw
   The patients become sad, uneasy, low spirited, dis-
 trnU'ii! and peevish, and suffer hallucinations, errors
 of jutigmenr, and other mental disorders, particularly
 if 1 hey be of the nervous temperament;  the  counte-
 nance is firrowed, its expression  altered, and its co-
 lour changed to a pale sallow, whilst the cheeks re-
 in lin red or become  livid ; the muscular powers are
 weakened, and there is the greatest objection to tak-
 ing  exercise.  The  skin adheres to the bones  and
 muscles, and insinuates itself into their interstices, and
 exchanges its natural colour for that of an obscure red,
 or ochery yellow.
   Such are the  symptoms of this disease; but they
 are  never  all  united in the same case ;  indeed, we
 often meet with only one or more of them, variously
 combined, so as to form almost innumerable varieties
 of this perplexing affection.
  It may be confounded with  peritonitis, scirrhus of
 the stomach, hypochondriasis.
  Q. What are its anatomical characters ?
  A. The left end of the stomach  is frequently found
thinned, and admits of being torn with the greatest
facility.    I'he mucous coat, softened, varies in colour
from a  white or grev to the deepest shade of  red;
                         o 2 
162     PATHOLOGY OF THE  ABDOMEN.
scraped with a knife  it is easily detached,  in the
form of a pulpy matter ; occasionally it presents slight
erosions.
  If the vessels be injected, the blood  appears  of a
bluish tint, and patches, varying from violet to the
darkest brown, are seen on the internal surface  ; the
lining membrane  is usually thinned, particularly to-
wards the fundus, so much so, as sometimes to  occa-
sion perforations with irregular edges.
  As  we proceed  from this part, the mucous mem-
brane becomes thick and red, which arises in  some
cases, from a varicose state  of its vessels.  Ulcerations
are very common, especially near the pylorus, where
they penetrate through the coats of the viscus; oc-
casionally it becomes  of a slate colour  or entirely
black, without in any degree changing the consistence
of the membrane.
  The small intestines  are  generally pale externally,
and sometimes contracted or almost entirely oblitera-
ted.  Ulcers are very common  in the jejunum and
ileon: they are more extensive and deeper than in
the acute form of the disease; finally, the mucous
coat changes to a bluish slate colour, nearly analogous
to that of the stomach itself.

             CANCER OF THE STOMACH.
  Q_.  What are its symptoms ?
  A.  This disease is  generally a  consequence  of
chronic inflammation of the stomach, and seldom oc-
curs except in those who have passed thirty, and  have
been addicted to an immoderate use of spirits or some
medicinal excitants.
  It may be recognised by  a sense of uneasiness and
obtuse pain, situated in the region of the epigastrium,
and sometimes extending to the oesophagus, hypo-
chondria, or even the lumbar regions; giving rise to
habitual flatulency with irritating, acid eructations,
nausea and vomiting of a liquid, at first aqueous,  then
mixed with the undigested food, and afterwards  coin- 
         PATHOLOGY OF THE ABDOMEN.     163

 bined with a brownish matter, becoming more  and
 more frequent, and finally habitual.
   All aliments are not equally offensive, and not un-
 frequently the  most  indigestible  are  those which
 agree best with the  stomach.   The  epigastrium  at
 this period becomes the seat of a tumour,  which is
 irregular, and sometimes projects so as to be percep-
 tible externally either to the sight or touch.  This
 affection usually gives origin  to a cough, attended
 with an abundant aqueous expectoration.  The  skin
 soon becomes dull and yellowish ; the appetite  is
 completely destroyed, and the patient wastes or be-
 comes oeelematous ; the matter ejected from the sto-
 mach assumes a sooty blackness; the  countenance is
 shrivelled; the pains acquire more and more  intensi-
 ty ;  the diarrhoea gives place  to  constipation ;  the
 fever increases ; and  the  patient expires, preserving
 to the last  the intellectual faculties entire.
  We  may judge from the following symptoms what
 particular  part of the viscus is  chiefly affected.   If
 the pylorus be the part exclusively or chiefly affected,
 the vomiting is very abundant,  and occurs at a cer-
 tain  precise period after taking food ; the epigastrium
 is much more distended with flatus;  the tumour  is
 seated more towards  the right side, between  the
 false ribs  and the navel; diarrhoea does not super-
 vene till after its obstruction, or the ulceration of its
 edges.
  If the cancer be  seated in the cardia there is no
 tumour of the epigastrium ; the pains are only felt in
 the  superior part of  the  stomach,  and in the back ;
the patient  often brings up a mouthful of mucous mat-
 ter, or even of the undigested food, and is harassed by
 «n abundant salivation.
  When the affection attacks the body of the viscus
the lesser curvature more  generally suffers;  the  suf-
ferer takes  little food or drink,  as  they  always occa-
sion  a very  painful distension, and are  ejected up al-
most as soon as swallowed.
  Universal degeneration of this viscus produces al- 
I 64    PATHOLOGY  OF THE  ABDOMEN.

most unceasing pains, and is attended with scarcely
any vomiting, a circumstance which may also be re-
marked, when this organ has  contracted  adhesions
with the adjacent viscera.
  Nausea  only  exists when the pylorus is contract-
ed, the stomach  partially ulcerated or recently per-
forated ; or when some abdominal inflammation is ex-
isting.
  This disease may be mistaken for certain  chronic
nervous vomitings ;  for chronic gastritis;  or  may be
confounded with aneurism of the abdominal aorta, or
tumours formed by the accumulation of foecal matter
in the colon.
  Q. What are its anatomical characters ?
  A. When the change of structure is seated in the
pylorus, the stomach is enlarged ; in almost all other
cases this  viscus is found smaller than in  the natural
state.  It is filled  with a blackish liquid, which exists
in the absence as well as presence of ulcerations. The
thickness of the morbid part varies  from two lines to
half an inch or more ; its internal surface  is  uneven,
ulcerated, and covered with a whitish grey or black-
ish fungous matter, in the intervals of which nume-
rous depressions are  perceived;  its external surface
may be either free or adherent  to  the  liver,  perito-
neum,  or other neighbouring  parts.  The  morbid
matter is composed of the cancerous tissue ;  of cere-
brifonn matter, or sometimes of  both combined. In
the beginning the mucous may be distinguished from
the other  coats of the stomach;  it  is of a dull white
and homogeneous structure, whilst  the muscular coat
becomes more firm and thick, and appears of a bluish
colour. Sometimes, though rarely, the disease spreads
from the cardia to the oesophagus, and from the pylo-
rus to the duodenum.

                 H"EMATEMESIS.
  O.. What are its symptoms ?
  A. Flatulence, anxiety, general  lassitude, pain of
the stomach, coldness of the extremities, and vomit- 
PATHOLOGY  OF THE ABDOMEN.     165
 ings of blood at longer or shorter intervals; the blood
 is sometimes pure,  never frothy, but  more usually
 black, clotted, or mixed with the matter contained in
 the stomach ; these are attended with cough, but no
 fever, and accompanied with a distension of the left
 hypochondrium;  when the blood accumulates to  a
 certain extent in the stomach, the stools often appear
 bloody.  It  may be confounded with Haemoptysis.
   Q.  What  are its anatomical characters ?
   A.  Sometimes  the mucous membrane of the  sto-
 mach is of a brownish black,  and its vessels appear
 gorged with blood; the haemorrhage arises from sim-
 ple exhalation from the  surface.   Sometimes  the
 membrane is red, and presents at intervals patches
 resembling ecchymoses covered with adherent blood,
 and retaining their colour, though submitted to fre-
 quent ablution.

                 COLITIS  ACUTPS.
    (Acute  Inflammation of the Large Intestine.)
   Q.  What  are its symptoms ?
   A.  Slight diarrhoea, unaccompanied by disturbance
 of the constitution,  if there exist only irritation or
 slight inflammation ; usually wandering pains of the
 abdomen, particularly  about the navel, increasing in
 severity by starts; eructations,  a sense of weight in
 the pelvis preceding the evacuations, and again re-
 curring some time  afterwards; frequent scanty de-
jections, consisting  of a mucous, serous, or bilious
 matter, giving rise to a sense of heat at the margin of
 the anus, to tenesmus  and straining, particularly if
 they  occur at very short intervals.  When colitis ex-
 ists to this extent, it is complicated  with gastroen-
 teritis, and consequently with  fever, and the other
 symptoms peculiar to this disease*

                   DYSENTERIA.
   Q.  What  are its symptoms ?
   A.  Often  epidemic, having  the peculiarity of be-
coming contagious when it is joined to typhus fever; 
166     PATHOLOGY OF THE  ABDOMEN.
commencing by slight symptoms,  or by  a general
prostration of strength, with severe pains in the ab-
domen, becoming more and  more insufferable, and
producing a sensation of twisting along the course of
the colon from  its origin to the anus ; frequent calls
to  stool, attended with considerable and often una-
vailing efforts, followed by the dejection of some fila-
mentous mucus mixed with red streaks, or even pure
blood, which only gives momentary  relief; painful
strainings, pungent and burning sensations m the rear
turn in the intervals of griping;  abdominal pressure
does  not occasion very great pain ; the  weakness,
which is sometimes extreme, is generally in relation
to the violence  of the gripmgs, and frequency of the
evacuations.  It may be confounded with peritonitis,
colic, or cholera-morbus.
  Q.  What are  itsanatomical characters ?
  A.  The large intestines usuall*  appear  natural:
they are contracted  if the inflammation be recent,
and very much  dilated if it be of longer standing. In-
ternally the ileo-coecal valve and large intes  nes pre-
sent numerous red dots, and occasionally large dark
coloured patches.  Ulcerations are not  unfrequent.
The parts bounding the ileo-coecal valve are frequent-
ly studded with brown or reddish pustules, occasion-
ed by the inflammation of the mucous follicles.  In
dysentery the ileo-coecal valve and the commencement
of the colon are the  parts principally affected; the
sigmoid  flexure and rectum  more  slightly.   The
mesenteric glands,  corresponding to the inflamed
parts, are often found red and tumefied.

                COLITIS CHHOMCCS.
  0..  What are  its symptoms ?
  A.  This succeeds the acute  form, or exists prima-
rily in a mild or mitigated character ; in this last case
it frequently  arises  from  a  chronic affection of a
neighbouring viscus.   The tormina and tenesmus are
slight, or perhaps do not occur.  The  diarrhoea is
abundant, but less frequent than in the former affec 
       PATHOLOGY  OF  THE ABDOMEN.       167

tion;  the evacuations vary in colour, consistence, and
quantity ; the food sometimes passes unaltered along
the whole track of the intestinal tube, a state  which
constitutes what is called lientery.  The countenance
becomes pale, furrowed, and  of a dirty yellow co-
lour ; the skin is  dry, rough, and assumes a clayey
aspect;  morning sweats occur, the superior  extremi-
ties are infiltrated, and the  sufferer usually is carried
off by an acute gastroenteritis, which supervenes
on the primary disease.  It may be confounded with
enteritis of the small intestines, with hypochondriasis,
or cancer of the intestine.
  Q.  What are its anatomical characters ?
  A.  Thickening and  ulceration of  the  ileo-coecal
valves are discovered, with unusual density of the li-
ning membrane, which appears  of a brownish black
colour.   The inflammation is  sometimes  pustular,
sometimes diffused ; the inflamed follicles resemble
white or reddish fleshy pimples depressed in the cen-
tre ; in a more  advanced stage they are filled with
pus, and assume a whitish colour, whilst their base is
surrounded by a red circle.  The subjacent cellular
tissue occasionally passes into suppuration, and then
the mucous membrane may be  detached in shreds,
more  or less extensive.

           CANCER OF THE INTESTINES.
  Q.  What are its symptoms ?
  A.  Habitual constipation occurring  after a chronic
enteritis ; pains, transient at first, but after some time
becoming constant and accompanied  by eructations
and painful distention of the abdomen without loss of
appetite  or perceptible alteration of the pulse; pro-
gressive  wasting, and  occasionally   liquid  alvine
evacuations, containing blood  or purulent matter.
The distention of the abdomen is more considerable,
according as  the disease is distant from the pylorus,
and obliterates more or less perfectly the calibre of
the intestine.   When the cancer is large, it presses
against  the  integuments, and may be discovered by 
k 68     PATHOLOGY OF THE ABDOMEN.

pressure with the hand.   This affection is extremely
difficult to be detected, and may be confounded with
tumours, having their seat in the cavity of the abdo-
men.
  Q. What are its anatomical characters ?
  A. Similar to those of cancer of the stomach.

                   DYSPEPSIA.
  Q. What are its symptoms ?
  A. A sense of weight and fullness in the stomach,
usually supervening some hours after meals, particu-
larly when the food has been too abundant or of bad
quality, and accompanied with distention and sensi-
bility of the epigastric region with general uneasiness,
nausea, some difficulty of respiration, pain and hea-
viness over  the orbits, and eructations, and some-
times hiccough; signs which  may  disappear in part
after the occurrence of vomiting. Occasionally,  diar-
rhoea, flatulency, and borborygmi are added to these.
  Q. What are its anatomical characters ?
  A. The stomach is filled with half digested matter,
and distended, as well as the intestines, with an acid
gas ; the jejunum is usually filled with food, and the
ileum contains a liquid matter, which has already the
appearance of excrement.  Sometimes the gastro-in-
testinal mucous membrane appears  slightly inflamed.
We sometimes discover food or drink in the trachea,
which had entered it whilst vomiting.

                    CHOLERA.
  Q. What are its symptoms ?
  A. Vomitings, and very frequent alvine dejections,
of a green, whitish, or brown  mucous or bilious fluid;
supervening suddenly and continuing with such vio-
lence as to threaten speedy dissolution, accompanied
with violent pain of the stomach, severe gripings, not
increased by pressure, extreme praecordial anxiety,
anguish, syncope, and in most cases cramps  of the
extremities.  In this disease, which may occur as an
endemic or epidemic, especially in hot climates, the 
        TATHOLOGY OF THE ABDOMEN.      16*

pulse is small and  contracted, the extremities cold,
and the countenance, even from the commencement.
suffers a peculiar and very  remarkable change ; this
affection sometimes proceeds from irritating  undi-
gestible matter taken into the stomach.   It may be
confounded with gastritis, enteritis, peritonitis, or in-
tus-susceptio.
  Q.  What are its anatomical characters ?
  A.  When death occurs in a few hours after the in-
vasion of the disease, the mucous membrane under-
goes no alteration; in some epidemics, however, the
intestines are found inflamed and contracted;  when
death takes place,  after some days, the lining mem-
brane appears more or  less strongly injected.

                INTUS-SUSCEPTIO.
  Q.  What are its symptoms ?
  A.  In general  the diagnosis is extremely difficult.
 The disease usually commences by obstinate consti-
pation, which yields to  no purgative ; it may happen
that an enema may bring away some foecal matter ac-
cumulated  in the large intestine, but this  does not
continue to take place,  and even the flatus ceases to
escape. The abdomen soon swells and hardens, oc-
casionally in an unequal manner, so that the convolu-
tions of the intestines are perceptible externally.  To
these succeed nausea,  hiccough,  colic pains, and in
some  cases a fixed pain  in a  particular part of the ab-
domen ; thin  mucous,  bilious, and infirm stercora-
ceous vomitings  occur; these last however are not
common.  In some instances obstinate constipation,
prostration of strength, and coldness of the limbs, are
the only symptoms that precede  death.  It may be
confounded with peritonitis, ileus, or  constriction of
the colon.
  Q.  What are its anatomical characters ?
  A.  On some occasions the strangulation is produced
by bands,  or  adhering  false membranes, the conse-
quences of former inflammations existing  between
the affected part and the epiploon, or convolutions of
  Vol. II.               P 
170     PATHOLOGY  OF THE  ABDOMEN.

the intestines; the intestine slips in between these
productions, and  becomes compressed and strangu-
lated ;  in other cases, without the intervention of any
of these causes, it becomes twisted and contorted  on
itself;  the  knot which results from  this, becomes
more and more strained as the tube increases in vo-
lume from the distention caused by the evolution of
gas, or by the enemata or drink given to the patient.

                 SPASMODIC COLIC.
  H. What are its symptoms ?
  A.. This disease commences suddenly with a sensa-
tion of twisting, usually occupying the umbilical re-
gion or the course of the colon : the pain is not in-
creased by pressure, on the contrary it is usually  al-
leviated ; it is accompanied by  borborygmi, consti-
pation, small contracted pulse, anxiety, and a particu-
lar expression of countenance.
  It may be  confounded with peritonitis, colitis, or
cholera morbus.
  Q. What are its anatomical characters ?
  A. The viscera of the abdomen suffer no percepti-
ble alteration.

                COLICA P1CTONUM.
  Q. What are its symptoms ?
  A. Acute pains in the abdomen, attacking those
persons only who have  been employed in  working
lead, or some of its preparations;  not increased, be-
ing even relieved by pressure ;  pain and difficulty at
stool, then constipation ;  retraction and hardening of
the abdomen, nausea, and vomiting ; pain in passing
urine, sometimes  strangury; wandering pains of the
extremities, with paralysis, or extreme weakness of
the  extensor  muscles  of the fingers;  occasionally
convulsions of the superior extremities ; slowness and
hardness of the  pulse; in  some  cases severe head-
ache, dyspnoea occurring at intervals, and a sensation
of constriction at the praecordia, coincident  with the 
fATHOLOGY  OF THE ABDOMEN.     171
numbness of the arms.  It may be mistaken for peri-
tonitis or enteritis.
  Q. What are its anatomical characters ?
  A. None to be  discovered.

             CANCER  OF  THE RECTUM.
  Q. What are its symptoms ?
  A. Weight  and pain in the fundament;  burning
pain, especially whilst at stool; then tenesmus, with
or without griping, borborygmi, and  a scanty san-
 uineous  or  mucous  discharge; on introducing the
 nger into the rectum, its orifice is found  hard, con-
tracted, and unequal;  irregular furrows, or a circular
induration are  perceived on its internal surface, not
insensible to pressure ; soon after lancinating pains
are felt, which are seldom increased by pressure. The
anus becomes more and more contracted, and violent
tormina occur ; the faecal matter, if it be soft, is al-
ways voided in a cord  like form, and causes great ago-
ny  in  its passage.  When ulceration is established,
a sanious or purulent discharge  takes place, which is
attended with diarrhoea or obstinate constipation.
  Cancer of the  rectum  may be  mistaken for lym-
phatic indurations in the neighbourhood of the parts,
for venereal ulcers, or certain species of haemorrhoids.
  Q. What are its anatomical characters ?
  A. The disease is not always confined to the verge
of the anus, it sometimes extends up the gut for two
or three inches or more ; the appearance of this can-
cer and its morbid structure, are perfectly similar to
that which occurs in the  oesophagus, and which has
been already described.

                  HEMORRHOIDS.
  Q. What are their symptoms ?
  A. A determination of blood towards the end of the
rectum recurring  periodically or irregularly;  accom-
panied  with  a sense of weight, tension, and itching
about the anus ; with  a sense of bearing down in the
loins and perineum, and with frequent  calls to stool;
I 
172     PA1H0L0GY  OF THE  ABDOMEN.
giving rise to an  oozing of a sanguineous, or more
rarely, of a mucous matter, and producing in its course
the development of tumours, which may be either dry
or contain a bloody fluid, painful or indolent, or
sometimes dependent upon a varicose  state of the
veins of the rectum, or they may be cellular in their
structure, and formed at the expense «-f the gut it-
self.  Piles  may be mistaken  for  venereal  excres-
cences, or fungoid tumours in the rectum.
  Q.  What are their anatomical characters ?
  A. Piles appear under the form of tumours, varying
in size, and more or less thickly set, arising from the
dense cellular tissue which connects the  mucous to
the muscular coat.  Contained in a sort of cyst, thin,
smooth, or sometimes villous as to its interior, and
adhering  by its external surface to the sub-mucous
cellular membrane. In many instances, these tumours
are formed of a reddish vascular spongy tissue, or of
a sort of parenchyma or fungous flabby tissue, analo-
gous to the erectile.   Sometimes they depend  upon
a partial dilatation of the veins, which may be easily
proved by the introduction of a probe into the vessels.

                    WORMS.
  Q.  What are their symptoms ?
  A.  They  vary  according  to the species  of the
worms :  direct symptoms are sometimes observable ;
such as sudden disgust for food, increase of appetite,
nausea, vomiting, pain of the belly, hiccough, borbo-
rygmi, tenesmus, flatulency, &c.; occasionally sympa-
thetic signs, the principal of which are dilatation of
the pupils, itching about the nose, disturbed sleep,
perspirations, irregularity of the pulse, and disagree-
able breath.   They may be confounded with it.flam-
mation of the intestines, hypochondriasis, or inflam-
mation of the brain.
  Q.  What are the  symptoms of Ascandes Lumbri-
coides ?
  A.  A  sense of itching v:th sharp  pains  in  one or
more  points of the intestines, particularly about the 
        1'ATHOLOGY OF THE ABDOMEN.     173

navel ; the ejection  of  one or more worms by the
mouth  or anus.
  Q. What are the symptoms of Ascarides Vermicu-
laris ?
  A. Dull irritation and itching about the anus,  in-
creasing towards the evening; the escape of many
of the  worms with the stools.
  Q. What are the symptoms of Taenia ?
  A. Twisting and weight in  the abdomen, with a
sense of pinching  or gnawing in  the vicinity of the
stomach;  swelling and  irregular  retraction of the
lower  part of the abdomen;  enormous appetite;
ptyalism ;  the rejection of part of the worm by stool
or vomiting.
  Q. What are their anatomical characters 7
  A. They differ  according to the species of the
worms.
  Q. What is the appearance of the Ascarides Lum-
bricoides ?
  A. Body whitish or of a reddish grey;  round, from
four inches to a foot in length ;  very elastic; tail ter-
minating in a blunt end; head furnished with three
oblong tubercles, between which  the head is placed.
  Q. What is the  appearance of  the Ascarides Ver-
micularis ?
  A. Body very thin, and from two to nine inches in
length; tail terminating in a very fine and  transpa-
rent point: head furnished with two vesicles, lateral
and transparent, or with three tubercles.
  Q. What is the appearance of the Taenia ?
  A. Flat  and articulated,  having at its smaller ex-
tremity a tubercular head and mouth, surrounded by
four suckers : there are many varieties of them.

                   HEPATITIS.
  Q. What are the symptoms of Hepatitis ?
  A. A heavy dull pain, occurring in the right side,
increased  by  pressure, deep  inspiration or cough :
sometimes, however, it is alleviated by doubling the
body forwards : in some cases an acute pain is felt in
                       p2 
 171     PATHOLOGY OF THE  ABDOMEN.

 .he right shoulder, and along the vertebral column :
 the size and consistence of the liver may be augment-
 ed, in which case it projects beyond  the false ribs
 and extends more or less  into the abdomen. The pa-
 tient lies on the right  side, and finds it sometimes al-
 most  impossible  to rest on his back or left  side.
 Respiration and digestion are impeded, and there is
 occasionally a  slight  dry cough:  very  generally a
 yellow tinge is communicated  to the skin and con-
 junctiva : the urine is of a  saffron colour: there is
 constipation, and the feculent matter is found grey ish
 and discoloured.  If the disease terminate in suppu-
 ration, a fluctuating tumour may be felt  beneath the
 integuments of the right side.  This affection, which
 is of more frequent occurrence in hot  countries than
 in our temperate climate, is always difficult to be de-
 tected :  writers have  constantly  assigned  to it the
 symptoms which belong  to  the inflammation  of the
 peritoneum, on its concave or convex  surface.  He-
 patitis  may be easily  confounded with  pleurisy or
 with inflammation of the peritoneum, enveloping the
 substance of the liver.
   U. What are its  anatomical characters ?
   A. The size of  the liver is not  increased by acute
 inflammation;  its  investing  membrane adheres less
 firmly to  it than in  the healthy  state  ; its surface is
 brown or reddish,  and marbled.   The substance of
 the organ becomes brittle and friable in proportion to
the degree  of the inflammation ; and when cut, blood
 oozes  from its  surface, but cannot be  said to  flow
 from its  vessels,  as in the  natural condition.  It is
 also granular, the granulations  consisting of the pa-
 renchymatous structure; they are, however, increased
 in size; some of them  are red, more or  less bright;
 others yellowish,  which  gives rise to a  striated ap-
 pearance.  In this state the liver resembles much the
 aspect of an inflamed lung before it has become com-
 pletely solid ; but when pressed between the fingers
 it is very  friable, and is reduced to a soft pulp  like
 an inflamed spleen, which arises from the quantity »f 
PATHOLOGY  OF  THE ABDOMEN.     175
 sanguineous fluid which is  poured into its texture :
 its weight is evidently increased ;  the  lining mem-
 brane of the different biliary canals is  injected, and
 of a  reddish  brown colour.  These are the appear-
 ances presented by the liver when  inflamed, and be-
 fore suppuration has set in.   When the  latter takes
 place, the pus is infiltrated into the substance of the
 liver, sometimes it is found in several small abscesses,
 and mixed with blood, which gives it a greenish yel-
 low colour;  sometimes it is united with one large
 cyst  which  may make its way either into the abdo-
 men, into the chest, and bronchial tubes, into the in-
 testines directly, or by means of the biliary canals, or
 lastly, may point externally through the integuments
 of the abdomen, and so be evacuated.

              CANCER OF THE LIVER.
   Q_.  What are the symptoms of cancer  of the liver ':,
   A.  The marks of this affection are very uncertain ;
 it cannot be detected till the organ extends itself be-
 low the edges of the false ribs, and affords an oppor-
 tunity of perceiving the projections, varying in size
 and number, which exist on its surface.   The diges-
 tion is attended with pain and difficulty,  but without
 vomiting, and is most generally accompanied by con-
 stipation,  colic, borborygmi  and more  or less acute
pain of the right hypochondrium and shoulder of the
same side, with uneasiness in the  epigastric region ;
emaciation commences ; the skin and conjunctiva be-
come jaundiced ; the limbs are affected with oedema;
 and ascites soon  supervenes, which speedily carries
off the patient.  It may  be  confounded  with any of
 the diseases of which this organ is susceptible.
  Q.  What are its anatomical characters  ?
  A.  The liver commonly extends across the epigas-
trium ; sometimes occupying the left hypochondrium.
Its  surface is covered  with furrows,   occasionally
pretty deeply marked.  When the substance is cut
into, tumours are  met  with  in  different parts, of a
.:wff,' o'is nature, and mixed with tuberculous or en- 
 176     PATHOLOGY OK THE ABDOMEN.

 cephaloid matter in various degrees of advancement.
 The  structure of the viscus surrounding these  is
-usually natural, and is, in many cases, attached to the
 tumours, (which are now and again very numerous,)
 by vascular connexions only, which admit of being
 easily separated; in other cases, however, the con-
 nexion is more intimate, and the parenchyma of the
 organ seems gradually to degenerate.  When these
 morbid  degenerations,  which  compose the  cancer-
 ous substance, become  softened, the  whole is con-
 verted into a pultaceous  mass,  which increases by
 degrees, at the expense of the lower tissue  of the
 viscus.  This  softening, however, is seldom general,
 several of the  tumours usually preserving their origi-
 nal consistence.

         ENCYSTED DROPSY OF THE  L1VEH.
   Q. What are the symptoms of  encysted  dropsy of
 the liver?
  A. A smooth shining tumour, little or not  at all pain-
 ful; without  discoloration  of the integuments,  and
 with evident fluctuations ;  seated in the right hypo-
 chondrium  and  epigastric  region; not being  dis-
 placed by change of position : the patient  is  unable
 to  lie on the back or left side.  It  may be mistaken
 for encysted abscesses in the liver.      /
   Q. What are its anatomical characters ?
   A. These cysts are sometimes formed of fibrous
 tissue, sometimes of serous ; their size is very varia-
 ble ; they are  developed occasionally in the  substance
 of the liver, and contain  a  serous or semi-gelatinous
 liquid, containing,  in some  instances, a* greater or
 lesser number of hydatids.

              BILIARY  CONCRETIONS.
   Q. What are their symptoms ?
  A. Very difficult, generally impossible to be dis-
 tinguished; the presence of the concretions in some
 cases gives rise to a sort of pressure in the  epigastric
 region, to  violent colic, to eructations, to  obstinate 
PATHOLOGY  OF THE  ABDOMEN.     177
 vomitings, and to acute pain, seated in the course of
 the common  duct, and increased after taking food.
 These symptoms become more  certain if the patient
 has voided any biliary calculi, either by vomiting or
 stool.

           INFLAMMATION  OF  THE SPLEEN.
  Q.  What are its symptoms ?
  A.  This affection  is seldom observed during iti
 acute stage;  it  is marked  by pains felt under  the
 left false ribs: increased by pressure  or by motion.
 The patient finds it disagreeable to rest on his side.
 The skin is discoloured, being of a yellow tinge, but
 not sufficiently deep to stimulate jaundice.  In some
cases of splenitis,  blood is occasionally  vomited.
 It occurs  epidemically in low and marshy districts,
 and on the sea shore.   When chronic, it is more easi-
 ly recognised; for besides the symptoms above men-
 tioned, a hard, large tumour is felt  in the left hypo-
 chondrium, which is sensible  to pressure.  Splenitis
is a common consequence of intermittent fevers.  It
may be confounded with gastritis,  peritonitis, or tu>
mours in the left hypochondrium.
  Q.  What are its anatomical characters ?
  A.  The substance  of  the spleen  is sometimes
softened, gorged with blood, and almost d'ffluent; its
size is generally  much increased ; it is sometimes fill-
ed with pus, accumulated into a mass, or diffused in its
substance. The spleen has often been found filled with
tubercles, either indurated or softened.  Its external
membrane is sometimes torn  through, at others it is
thickened and hardened, being almost cartilaginous.

                  PERITONITIS.
  Q.  What are its symptoms ?
  A.  Acute pain, producing an extreme degree of
weakness,  occurring over the whole extent, or part
of the abdomen, increased by the slightest pressure;
obstinate constipation  and burning heat of the abdo-
minal integuments; pulse small, contracted, concen- 
 178     PATHOLOGY  OF THE ABDOMEN.

 trated, and frequent; particular expression of coun-
 tenance ;  the patient lies on his back, with his thighs
 drawn up ;  urine  scanty ;  in many cases vomiting
 and hiccough.  The tongue  is white, covered with
 mucus, and  more or less dry ; the respiration is diffi-
 cult (particularly  during inspiration), frequent, and
 chiefly carried on  by the ribs.
   If the disease attack women after their accouch-
 ment,  the breasts  become collapsed, and the lochia
 suppressed ; the pain in that  case usually commences
 in the hypogastric  region.  The symptoms of perito-
 nitis are not always so well marked, particularly if it
 come on more slowly ;  or if the chronic form succeed
 the acute, it then  becomes difficult to detect it, for
 the pain is  often  very obscure;  the belly little dis-
 tended, the pulse unaltered, and the constipation less
 conspicuous.  The increased size of the abdomen,
 and the evident fluctuation  which soon succeeds, are
 the symptoms chiefly to be depended on.
   When  it occurs  in consequence of perforation of
 the intestine, it  is rapid and  violent in its progress,
 and soon causes death.   It  may be confounded with
 enteritis, hepatitis, and splenitis.
   Q. What are its anatomical  characters ?
   A. Numerous red spots are discovered on thpperi.
 toneum, penetrating its whole thickness, and separa-
 ted one from the other by  parts  of the  membrane,
 retaining their natural  colour ;  in some cases the se-
 rous membrane is injected or thickened.
   Inflammation more generally occupies the covering
 of the intestines, than the part which lines the walls
 of the abdomen.  False membranes,  varying in thick-
 ness and  softness,  according  to the duration  of the
disease, are  found spread  over the peritoneum :
these insert themselves into the intervals of  the in-
testines, and unite them one to the other.   The cavi-
ty of the abdomen  is filled  with a whitish, milky
liquid  of very fetid smell,  containing suspended  a
 great number of small albuminous streaks of a white
 greyish,  or  red colour; the  contained fluid  some- 
        PATHOLOGY OF  THE ABDOMEN.     179

times consists of a bloody serosity, more or less lim-
pid, particularly if the disease had lasted but for a
very short time, and that death quickly supervened.
  Peritonitis sometimes  also shows livid patches and
real gangrenous spots.  In the chronic form the albu-
minous concretions possess more solidity, and these
bands which unite the intestines often become cellu-
lar ; finally, peritonitis often gives rise to hard, semi-
transparent granulations, and the serosity which then
exists in the cavity is limpid, and contains a few al-
buminous streaks; it resembles whey, slightly turbid.

                    ASCITES.
  Q.  What are its symptoms ?
  A.  Tumefaction of the abdomen, commencing from
below upwards, and unaccompanied by the  symp-
toms of peritonitis ; a sensation of fluctuation  upon
striking the parietes of  the  abdomen, winch appear
smooth, then  stretched  and  covered  with turgid
veins; the  liquid changes  place when the patient
changes  his position ; the urine is much less abun-
dantly secreted than in health ; and difficulty of res-
piration, varying in intensity, according  to the disten-
tion of the abdomen, is complained of. It may be
confounded with encysted dropsy, and tympanitis.
  Q.  What are its anatomica .'characters ?
  A.  Abdomen distended to a greater or less extent
by citrine transparent serosity, without  the  slightest
trace of albuminous streaks;  peritoneum sound; there
usually exists some organic alteration of some one of
the abdominal viscera, generally the liver or spleen.

          OF THE URINARY ORGANS.

             ANATOMY OF THE KIDNEYS.
  Q.  What is the situation of the Kidneys?
  A.  They are situated in the Lumbar Regions, one on
either side of the spine, extending about five inches
from  the eleventh rib  to near the crest of the Os
Ihi.  They lie upon the Diaphragm, the Psoae Mag- 
 180       ANATOMY OF THE KIDNEYS.

nae, Quadrati Lumborum, andTransvtrsales Abdomi
nis Muscles.  The right is  placed under, and at the
back part of, the great lobe of the Liver, and be-
hind the Colon ; it  is a little lower  than  the left.
The left is placed at the under and back part of the
Spleen, and behind the left portions of the Stomach,
of the Pancreas, and of the Colon.
  Q. What is the general figure of the Kidney?
  A. It is rounded before, flattened  behind, convex
on its outer margin, has a deep sinus  towards the
spine, and surrounded with unequal edges: it is some-
what broader behind than before, broader and more
curved above than below.
  Q. What are the Connexions of the Kidneys ?
  A. The right Kidney  is connected to the  Liver
and Duodenum, the left to the  Spleen, and both to
the Psoae and Quadrati Lumborum muscles, to the
Colon, and Renal Glands, by cellular Substance, and
by the Peritoneum.
  Q. How many Coats has the Kidney ?
  A. Two; the tunica adiposa, which  covers  both
the Kidney and its  large vessels ; under the adipose
coat is its proper   coat incorporated with cellular
membrane.
  Q What is the  exterior appearance of the Kid
ney?
  A. It is generally smooth and uniform; sometimes
however, it is irregular and lobulated.
  Q. What is the interior appearance of the Kidney1
  A. It exhibits an  exterior cortical, and an interior
medullary part.   The cortical, considered the secern-
ing part, surrounds the kidney, forming one third of
its breadth, and sends processes towards the  pelvis,
which  divide the medullary  part.   The medullary,
considered the uriniferous part, is redder coloured
than the cortical, and  is  separated into a number of
distinct columns, each of which terminates in a Pa-
pilla.
  Q. What Arteries are sent to the Kidney?
  A. The Emulgent or Renal Artery arises from the 
         ANATOMY GF THE K.ID.M VS.        '81

Aorta, passes across, and  enters the Kidney at the
upper part of the sinus ; it then divides into numer-
ous branches, which become very minute,  anasto-
mose frequently, and form arches in the cortical sub-
stance ; their extremities at last wind in toward the
medullary  substance, and are coiled up into Acini,
which seem corpuscles disposed in clusters.
  Q. Is the  Urine secreted in these Corpuscles?
  A.  Yes;  in these corpuscles situated in the cor-
tical substance the urine is secreted, and received by
the  extremities of  the  Vrinifcrous tubes,  which
commence  there, and  gradually uniting  together,
form larger tubes, that converge in a radiated man-
ner towards the pelvis of the Kidney, and ultimately
terminate in the Papillae.
  Q.  How many Papillae are generally  in a Kidney?
  A.  They vary in number, but in general are twelve
or fifteen.
  Q.  Into what  vessels do the  Papillae  pour the
Urine ?
  A.  Into Infundibula, or Calices, which are tapering
membranous tubes;  each arising from around the base
of a Papilla.
  Q. Are there as  many Infundibula as Papillae in
each Kidney?
  A.  Yes, they are  generally the same in  number;
sometimes, however, two or three Papillae  open into
the same Infundibulum.
  Q.  Where do the Infundibula terminate?
  A.  Their  apices  converge, join, and form two or
three trunks, which ultimately unite into a dilatation
of considerable size, called the Pelvis of the Kidney.
  Q.  Is  each Papilla  to be considered  a  distinct
gland ?
  A.  Yes ;  in the foetal state the Kidney consists of
a number of separate glandular  Lobules, each of
which generally forms a Papilla; the number of Pa-
pillae therefore depends on the original number of
Lobules. In the course of time they are firmly united
externallv into one smooth kidney.
  Vol 11.               Q. 
 182       or  THE  RENAL  CAPSULES.

  Q. Is the Pelvis of the Kidney without its body?
  A. The pelvis is conical, and partly within, and
partly without the Kidney; it contracts gradually into
a tube of the size of a common goose quill called
 Ureter.
  Q. What is the course of the Ureters ?
  A. They descend  obliquely inwards  behind the
Peritoneum, pass over the Psoae  muscles and Iliac
Vessels Jn a wavering  manner into the Pelvis, and
terminate in the lateral and back part of the Bladder
near its cervix.
  Q. What is the structure of the Ureters ?
  A. They are  composed of three coats and a partial
covering from the Peritoneum on their anterior part.
Their external coat is membranous; their middle one
is muscular, consisting chiefly of circular fibres ; and
their internal coat is villous or mucous, as it is very
vascular, and perforated by many small ducts, which
pour out mucus on its internal surface, to  defend it
from the acrimony of the Urine.

            OF THE  RENAL CAPSULES.
  Q. What are the Renal Capsules ?
  A. They are two small, flat, glandular-looking sub-
stances, of a dark yellow colour, and somewhat  of a
triangular figure, about two inches long.
  Q. What is the situation of the Renal Capsules ?
  At. They are  situated, one on each side, at the up-
per, inner, and fore part of the Kidneys, higher  than
the Renal vessels over the Psoae muscles and dia-
phragm.
  Q_. What parts are they connected with  ?
  A. The right Renal Capsule is connected with the
Liver;  the  left with  the Spleen and Pancreas; and
both with the small muscles of the diaphragm, and
with the Psoae  muscles and Kidneys by cellular sub-
stance.
  Q. What Coats have they?
  A. They are surrounded  by cellular substance,
which is a part of the tunica adiposa of the Kidneys; 
OF  THE URINARY BLADDER.       18$
 and they have besides a thin  proper coat adhering
 firmly to them.
   Q. What is the use of these Renal Glands or Cap-
 sules ?
   A. Their use is unknown ; they seem however to
 be useful in the foetal state, as they are proportionally
 larger than in the adult: perhaps to divert the blood
 from the Kidneys.
   Q. What  Organic Derangements  are the Kid-
 neys subject to ?
   A. To inflammation, abscesses, scirrhus, scrofulous
 tumours, calculi, hydatids, great spongy softness, en-
 largement or diminution of size, ossification, to a car-
 tilaginous state, and to dropsy.
   Q. What diseased  appearances have  the Renal
 Capsules presented ?
   A. They are very seldom found diseased: but they
 have become enlarged, and exhibited a white matter
 similar  to a scrofulous absorbent gland; sometimes
 they have become  cartilaginous, or have contained
 calcareous granules in their substance.
   Q. What Organic Derangements are the Ureters
 subject to ?
   A. To inflammation, and a thickening of their coats
 from the irritation  of Calculi, to dilatation in conse-
 quence of an obstruction near the bladder, to pus,
 hydatids, to spasm, and to be ruptured.

            OF THE URINARY BLADDER.
   Q. What is the situation of the Bladder ?
   A. It is situated in the anterior part of the Pelvis,
 before the Rectum,  and behind the Ossa Pubis; when
 distended, it rises up  above the brim of the Pelvis,
 almost to the Umbilicus.
   Q. To what parts is  the Bladder attached ?
   A. It is attached by cellular substance to the Ossa
 Pubis;  by the  peritoneum reflected from its sides,
 and by cellular substance to the Pelvis, and below to
 the Rectum; by two or three ligaments, viz. the ura-
chus and shrivelled umbilical arteries, to the Umbili- 
 184      or 111E UlUNAllY  BLADDER.

cua; by a strong ligamentous expansion from each aide
of its neck and Prostate Gland to  the inside of the
Arch of the Pubis; and by the Urethra to the Penis.
  Q.. How many Coats has the bladder ?
  A. Four,- the Peritoneal, which covers it all except
its cervix; the muscular,  composed of fleshy fibres
disposed in fasciculi, of which the external are longi-
tudinal, and are connected at the under and fore part
of the Bladder with the Ossa Pubis; the internal fibres
run in all  directions, and  are interwoven with  each
other: at the  neck of the  bladder they are collected
into the Sphincter Vesicae; the third coat called ner-
vous is composed of cellular substance,  which con-
nects the muscular to the innermost mucous coat.
  Q. How many openings are in the Bladder ?
  A. Three;  one for the Urethra, anteriorly  coming
off at almost a right angle with the Bladder; and two
openings formed by the termination of the Ureters
on the posterior and lower part of the bladder at
about an inch and a half's distance from each other,
and from the  commencement of the Urethra.
  Q. In what manner do the Ureters terminate ?
  A. They run down between the peritoneal  and
muscular coats a long way,  and then penetrate the
muscular coat obliquely, and passing between it and
the mucous coat, ultimately pierce  it also obliquely,
and terminate by open oval  mouths in the bladder.
  Q. Can the urine not return from the Bladder into
the Ureters ?
  A. No;  the obliquity of the termination of the Ure-
ters in passing through  the coats of the Bladder an-
swers all the purposes of valves.
  Q. What is the use of the Bladder ?
  A. It receives the urine guttatim from the Ureters,
and retains it  till a convenient opportunity occurs for
passing it.
  Q. What retains the urine in the bladder ?
  A. This question  is difficult to solve ;  the angle
made by the  Urethra with the Bladder has some ef-
fect ; the action of the  levatores ani probably much 
          Or  THE URINARY BLADDER.       185

 more: by pressing the bladder upwards,  and thus
 approximating its sides, they shut its posterior orifice.
   Q. By what means is the Urine expelled from the
 Bladder ?
   A. Its expulsion  is partly voluntary, and  partly
 not.  When the stimulus of the Urine and the disten-
 tion of the blaelder are great, it is expelled involunta-
 rily: but in  general by the contraction of the bladder
 itself,  assistetl by the Abdominal Muscles  and Dia-
 phragm, we can pass urine at pleasure.
   Q. What are the chemical properties of the Urine?
   A. It is composed of water, mucus, uric,  phospho-
 ric, and lactic acids, muriate of soda and ammonia, of
 phosphate of soda, ammonia, lime, magnesia, sulphate
 of potash, lactate  of ammonia, and silex.
   Q. Do these properties vary according to circum-
 stances ?
   A. Yes;  thus,  rhubarb or madder taken by the
 mouth, colours it,  the former yellow, the latter red;
 the breathing  of spirits of turpentine gives it a violet
 odour; large draughts of water render it watery; sugar,
 gum, butter, or oil taken as the puncipal food, cause
 the uric acid almost wholly to disappear;  on the con-
 trary, it increases as the regimen becomes more sub-
 stantial, and as the  exercise is diminished: certain
 salts taken  into the stomach appear in small quanti-
 ties in the urine.
  Q. Is there any other passage to the bladder than
through the  blood ?
  A. It has  been believed so from the appearance of
certain salts  in the bladder, after swallowing them; as
nitre, the prussiate of iron.  Magendie from experi-
 ments  concludes  that the  blood conceals the salts,
 which are absorbed into it, and therefore they ap-
pear not to  pass by the blood, but by the supposed
passage.

   OF THE ORGANS OF GENERATION IN THE  MALE.
  Q. What  parts does the Penis consist of?
  A. Of five principal parts, the two corpora caver-
                      ft  2 
186
OF  THE  PENIS.
nosa; the corpus spongiosum, the glans, the prepuce,
and the urethra.
  Q. Describe the situation  of the  Corpora Caver-
nosa Penis.
  A. They form the tipper and lateral parts of the
penis, and are covered  by a strong, elastic, ligamen-
tous sheath.  Their crura arise from the crura of the
Ischium and Pubis, at the lower part of the symphisis
they are united, and continue closely applied to each
other, till they terminate in a  rounded extremity at
the Glans.   There is a  depression  above, in  which
the principal Vein of the Penis runs; and another
between them below for the  Urethra.
  Q. What is the structure of the Corpora  Cavernosa?
  A. Their ligamentous sheath sends up a triangular
process to  be fixed to  the Symphisis Pubis, called
the Ligamentum Suspensorium, which supports the
Penis in its proper position :  their internal structure
is reticulated, and divided into Cells, which are very
similar to the cancelli in the extremities of long bones,
and communicate  very freely with each other; among
these cells the Arteries are copiously dispersed, and
pour their blood  into them, distend them, and thus
produce an erection of the Penis.
  Q. Do the Cells of the one Corpus Cavernosum com-
municate with those of the other ?
  A. Yes;  the membranous  sheath forms an imper-
fect  septum between them;  and between the cords
or fibres of which, fissures of communication are left,
through which the blood easily passes from the one
corpus cavernosum to the other.
  Q. What is the situation of the Corpus Spongiosum
Urethrae?
  A. It is situated under, and between the Corpora
Cavernosa Penis;  it begins nearer  the bladder than
the junction of the Corpora Cavernosa, is connected
firmly to them by condensed cellular substance, ami
terminates at the point of the penis, projecting con-
siderably farther than the Corpora Cavernosa.
  Q. Describe the Corpus Spongiosum Urnhrac. 
OF  THE PENIS.              187
   A. Its posterior part is dilated into a longitudinal
 conical prominence, called the Bulb of the Urethra,
 its anterior is expanded into the Glans, which covers
 the extremity of the Corpora Cavernosa.
   Q. Describe the Glans Penis ?
   A. It adheres to the Corpora Cavernosa by a con-
 tinuation of the  ligamentous  sheath, which  covers
 them ; its posterior part forms a prominent  circle,
 termed  Corona Glandis,  behind which is the Cervix;
 the  surface of the Glans is furnished with numerous
 blood vessels and  nervous Papillae covered by a de-
 licate membrane  continued  from  the inside  of the
 Prepuce.
   Q. What is the Prepuce ?
   A. It is a loose  fold  of the common Integuments,
 which generally covers the Glans,  and preserves  its
 sensibility; it can be moved forwards and backwards;
 it is  connected to the under and anterior surface of
 the Glans by a triangular fold, termed Fraenum Pre-
 putd.
   Q. Are there any Mucous follicles situated  under
 the Prepuce?
   A. Yes ; around the Cervix and Corona Glandis aro
 many Glandulae Odoriferae, which throw out a seba-
 ceous secretion, for keeping the parts moist, and fa-
 cilitating the movements of the Prepuce.
   Q. What is  the Structure of the Corpus Spongio-
 sum  Urethrae?
   A.  Its structure is cellular, being the same as that
 of the Corpora Cavernosa, only its cells are smaller ;
 the Bulb of the Urethra, and the Glans Penis are also
 cellular in their internal structure.
   Q.  Describe the canal of the Urethra.
   A.  It proceeds from the under and fore part of the
Bladder, bends round the Symphisis Pubis, runs along
the Corpus Spongiosum, and terminates in the point
of the Penis.
  Q   Has the Urjthra any Dilatations or Contraction*
in its course ?
  A.  Yes ; it has  three Dilatations,  til? first at the 
188
OF THE  URETHRA.
 Prostate Gland, the second  in the Bulb, and  the
 third at the beginning of the Glans: and it has three
 slight Contractions, one at its Origin near the neck of
 the  Bladder,  another  between  the Prostate Gland
 and Bulb, and the  third at the point of the Glans.
   Q. Describe the internal part of the Urethra.
   A. Between the Prostate Gland  and the Bulb,  the
 Urethra is entirely membranous, and covered only by
 cellular substance;  its internal membrane is very
 vascular and sensible, possessed of  very considerable
 contractibihty, and moistened  by  mucus,  which is
 poured out from numerous Lacunae, situated between
 it and the Corpus  Spongiosum.
   Q. Has the internal surface  of  the  Urethra any
 Glands ?
   A. Yes ; these Lacunae are mucous follicles, two
 or three larger than the  rest are situated  near  the
 Glans;  but at the sides of the membranous parts of
 the Urethra, two about the size of a  garden pea, have
 been called Cowper's Glands.
   Q_. What Arteries are sent to  the Penis ?
   A. Branches from the Pudic,  and from the Femo-
 ral Arteries are sent into  the Penis  ; they inosculate
 freely with each  other, and  pour their blood chiefly
 into  the Cells, and partly into the Veins.
   Q. Whence do the Veins  of the  Penis commence,
 and where do they direct their course?
   A. The Veins  commence chiefly by open mouths
from the Cells, and partly from the extremities of the
 arteries. The greater  number  unite and form the
 VenaMugnaPenis, which runs  in  the superior groove
between the Corpora Cavernosa : it is furnished with
Valves.
   Q. What produces an Erection of the Penis ?
   A. An influx of blood into its cells, which become
distended.
   Q. What seems to be the  cause of that influx ?
  A. A venereal  affection of the  mind ; a local stimu-
lus from the semen niasculinum ; or  from a collection
of Urine in thf Bladder ; or from irritation of the Rec- 
             THE PROSTATE GLAND.         189

 turn, or of the Penis ; or sometimes from heat, aided
 by some of the above.
   Q. Where have the Lymphatics of the Penis their
 course ?
   A. Those arising from the Prepuce run on the dor-
 sum of the penis and pass into the inguinal glands ;
 those from the Glans and deep parts accompany the
 arteries into the under part of the Pelvis.
   Q. What are the Organic Deranbements of the
 Urethra ?
   A. Inflammation of its  internal membrane ; stric-
 ture in the membranous part, or two or three inches
 from the Glans; Dilatation near the bladder, in conse-
 quence of  Obstructions near the extremity of the
 Urethra; Abscesses; Fistulae; Calculi; Ulcers; Carun-
 cle, or a smallfleshy excrescence ; preternatural Ori-
 fice of the Urethra placed where the fraenum usually
 is; and  a layer of earthy matter along  its whole
 length.
       J
             OF THE PROSTATE GLAND.

   Q.  What is the exact situation of this Gland?
   A.  It is situated on the beginning of the Urethra,
 with its base at the neck of the bladder, and its apex
 immediately behind the under part of the symphisis
 pubis: it closely embraces the neck of the bladder
 and urethra below, and projects with its two lobes on
 either side of it.
   Q.  Describe the Prostate Gland.
   A.  It is of the size of a walnut, and of the figure of
 a  heart, its internal structure is spongy, and rather
 firm; it sends out ten or twelve ducts, which open ob-
 liquely at the beginning of the Urethra, and pour out
 a thin whitish fluid.
   Q.  What is the use of this secretion of the Prostate
 Gland?
   A. It is supposed to dilute the semen, and facilitate
its passage along the Urethra: perhaps in ordinary it
lubricates the posterior part of the Urethra. 
196           PATHOLOGY  OF THE
  Q.  What are the Organic Derangements  of the
Prostata Gland?
  A.  The Prostate Gland is sometimes inflamed, en-
larged and hardened, or scirrhous;  suppurates! and
forms an Abscess containing  common pus, or scrofu-
lous white curdy matter: calculi are found in its ducts:
it is sometimes preternaturally small.

  PATHOLOGY OF THE URINARY ORGANS.

                   NEPHRITIS.
  Q.  What are its symptoms ?
  A.  A dull weight or pain, in general perceived on
one side only of the lumbar region, soon giving place
to sharp deep seated pain, causing a sensation of ten-
sion and bearing  down; occasionally lancinating or
pulsatile, increased by pressure, or by lying on the
belly or unaffected side; scantiness or suppression of
urine, which  is, in  general,  red, tinged with  blood,
and voided with difficulty;  the pain often extends it-
Belf from the loins  to the bladder, penis, or groin,
and is accompanied with a numbness  or tremulous
motion of the thigh, and with  painful retraction of
the testicle : vomiting with general febrile symptoms
usually supervenes.  In  some cases, the pain  ceases
for  a time, but returns again with increased violence;
when this happens, we may suspect  the existence of
calculi in the  kidneys, particularly if the urine at the
same time contains some calcareous matter.   When
the complaint is chronic, the pains  are less, a heavi-
nessis complained of in the loins, and the urine usu-
ally becomes  troubled, and contains a purulent fluid.
It may  be confounded  with cystitis, peritonitis, or
lumbago.
  Q_. What are its anatomical characters ?
  A.  We seldom meet with more than one affected
kidney,  which is red, indurated, and infiltrated with
pus: the ureters  sometimes participate in the dis-
ease,  and are  then  found red, their mucous  coat
thickened, and covered with pus. 
URINARY ORGANS.
191
                    GRAVEL.

  Q. What are its symptoms ?
  A. Urine  depositing, soon after being voided, a
gravelly matter more or less fine, hard, and resisting
the pressure of the fingers, which is composed of uric
acid  united  to animal  matter, and, in some few in-
stances, of oxalate or phosphate of lime: acute pains,
with a sense of heat and heaviness in the lumbar re-
gions: urine  generally voided with pain and difficulty.
This complaint is very commonly met with  in gouty
subjects.  It may be confounded  with nephritis or
haematura.
  Q. What are its anatomical characters ?
  A. A gravelly substance similar  to  that which ex-
ists in the urine, is usually detected in the kidneys,
ureters or bladder.   The substance of the kidney, in
most cases, of a perfectly natural appearance.

                    DIABETES.
  Q_. What are its symptoms ?
  A. The urine is considerably augmented in quan-
tity, and is clear, white, or yellowish, insipid or sweet,
and preceded  in most instances by frequent calls to
make water, and pain in the course of the ureters:
thirst insatiable, appetite immense, wasting and  ex-
treme  debility.
  Q. What are its anatomical characters ?
  A. The kidneys are  at one time found red, and
unusually large, at others they present a remarkable
flaccidity; their vessels are  occasionally considerably
distended with fluid, dilated, and easily torn: in other
instances their substance has suffered a sort of disor-
ganization or solution more or less complete. Again,
they have been found smaller than  natural.

                    CYSTITIS.
  Q. What  are its symptoms ?
  A. Acute  permanent pain  and heat in the hypogas-
trium,  which  is sometimes  protruded: weight and 
 i02          PATHOLOGY OP THF

 tension of the perinaeum : frequent, painful, and often
 ineffectual efforts to make water : frequent and pain
 ful erections: the urine, at first limpid, becomes trou-
 bled and reddish, and is voided with pain and scald-
 ing heat:  a concomitant  fever  generally  attends.
 When the chronic form  succeeds the acute, the fever
 disappears, the heat and tension of the hypogastrium
 and perinseum are also diminished: the calls  to make
 water become less  urgent, and the scalding during
 emission is considerably less distressing: the patient
 often voids, with an effort, a viscid fluid, resembling
 the semen in appearance, but differing in smell.  On
 other occasions, chronic cystitis comes on gradually:
 a  heaviness and uneasy sensation is experienced in
 the perinaeum, and the patient finds a desire to void
 his urine, which can be  accomplished with difficulty:
 the urine is yellow, and deposits a mucous matter
 more or less abundantly, similar to the white of eggs;
 the pain is slight and permanent, or returns  at inter-
 vals: finally, the  introduction of the sound is attended
 with great difficulty and intense  suffering.   It may
 be confounded with nephritis, peritonitis, or matritis.
   Q.  What are its anatomical characters?
   A.  Redness of the lining membrane of the bladder,
 more or less considerable, confined to some particular
 parts, or diffused over its whole surface.  When cys-
 titis is chronic, the viscus is lessened and contracted ;
 or, on the contrary,  distended by a fetid urine mixed
 with blood or purulent matter ; its parietes are thick-
 ened in proportion to the duration and slow progress
 of  the disease;  its  internal surface  is of a reddish
 brown colour: we often  meet with a net work of ves-
 sels distinctly  developed,  similar to varicose veins,
 and particularly resembling the venous plexus which
 surrounds its neck ; it is in general furrowed more
 or less deeply, according to its degree of contraction.
 The mucous follicles are considerably developed, and
 ooze out, when pressed between the fingers,  a glairy
matter similar to that deposited by the urine.  Ulcer-
ations of the internal coat of the bladder arc also fre- 
URINARY  ORGANS.
193
 quent, and it then contains more of pus than of this
 glairy fluid.  In some cases gangrene or even perfo-
 rations, exist: and, finally, it is occasionally changed
 into the true cancerous tissue.

                   HEMATURIA.
   O.. What are its symptoms ?
   A. A passing of blood through the urethra, which
 may proceed from the kidney, ureters,  bladder,  or
 urethra: when it proceeds from an affection of the
 kidneys, it is attended with a sense of heat and pain
 in the loins, and not unfrequently by coldness of the
 extremities : it is only when the blood accumulates in
 considerable quantities that the  hypogastrium in-
 creases in  size, and becomes tender,  and that the
 calls to pass urine are  frequent and urgent.   When
 the disease is seated in  the ureters, it causes a sense
 of  pain and tension along  the line of  their course.
 Hemorrhage from the bladder is usually preceded by
 frequent desire  of passing urine,  by heaviness and
 tension above the pubis, extending to the perinaeum,
 groins, and lumbar regions;  sometimes the patient
 complains of tenesmus, constipation, and heat about
 the anus; the passing of urine is attended with pain
 and difficulty; the blood is scarcely or not at all com-
 bined with the urine.   When the hemorrhage takes
 place from the urethra, a pain is perceived in a parti-
 cular part of the  canal, and the blood is red, liquid,
 and pure, and  generally voided without  effort.  It
 may be confounded with nephritis, cystitis,  or me-
 norrhagia.
  Q.  What are its anatomical characters ?
  A.  Sometimes  the mucous membrane, which has
 given rise to the effusion, is tumefied and red, and the
 blood still oozes  from it when pressed  between the
 fingers ; on  the other hand, it is occasionally pale,
and shows no marks of congestion: in other instances
we find rupture of the vessels, or some other morbid
changes in the kidneys, ureters, bladder, or urethra,
which have given rise to the hemorrhage.
  Vol. H.               R 
194      STRUCTURE OF  THE TESTES.
                 OF THE TESTES.
   Q. What is the situation of the Testes ?
   A. They are generally situated in the cavity of the
Scrotum : sometimes one or both are retained in the
abdomen.
   Q. What are the coverings of the Testes ?
   A. They are covered  by  the Scrotum externally,
and  by the Tunica Vaginalis, and the Tunica Albugi-
nea  internally.
   Q. What is the structure of the Scrotum?
   A. It is a continuation of the common integuments,
contains no fat, is copiously  supplied with sebaceous
follicles, on its internal surface is a  vertical longitudi-
nal Raphe: its internal  surface is lined with cellular
substance of a red and fibrous appearance, which has
been supposed a muscle called Dartos.  A middle
partition divides the Scrotum into  two separate cavi-
ties.
   Q. Describe the other two Tunics of the Testes.
   A. The Tunica Albuginea adheres most  firmly to
the surface of the Testes, covers the Epididymis, and
supports it in  its situation : it is strong, thick, dense,
and  inelastic ; it  is very smooth on its surface : the
Tunica Vaginalis incloses the testicle, is much larger
than merely to surround it, in order to  allow it room
to change its place, adheres to the  tunica albuginea
behind,  where the vessels  enter the testis; its ex-
ternal surface is connected with the cremaster mus-
cle :  both coats are derived from the Peritoneum.
   Q. How do  the testes happen to  receive these two
coats from the Peritoneum ?
   A. In  the foetus,the Testes lie in the abdomen on
the Psoae muscles, a little below the Kidneys;  they
receive a covering from the Peritoneum as the other
viscera of the abdomen do, which is their Tunica Al-
buginea ; they receive also  their arteries from the
Aorta, and their nerves from the aortic plexus: the
testes slide downwards carrying their  blood-vessels
and nerves enveloped in the peritoneum  along with
them: at the upper abdominal Aperture they come 
OF  THE TESTES.             195
in contact with the  Peritoneum, which  lines that
aperture, push it down before them through the in-
guinal canal,  through the external abdominal Ring
into the Scrotum, and there it forms the Tunica Va-
ginalis Testis.
  Q.  About what period does that change of the posi-
tion of the Testes take place ?
  A. Generally from the fifth to the seventh or eighth
month of the  foetus in utero: their descending pro-
gress is slow,  during which the vessels and  perito-
neum become  so much  elongated as  to allow their
descent easily.
  Q. What is  the Distribution of the Spermatic Arte-
ries in the Testicle ?
  A. The internal part of the Testicle is  composed
of Septulae or  partitions,formed by cellular substance,
which  extend in a radiated  manner  from its back
part towards its circumference ; on these the minute
ramifications of the arteries are dispersed in a very
intricate convoluted manner.
  Q. Describe the origin of the Seminal Vessels.
  A. The Tubuli  Seminiferi,  after communicating
with the extremities of the arteries, are collected into
bundles, which are coiled up  into others of a smaller
size, and of a conical form, with their apices towards
the posterior edge of the Testicle, and are  placed
between the Septulae.   These tubes are extremely
small,  have no  division into  branches,  and  when
drawn straight are  several feet in  length.
  Q. What vessels are continued from these ?
  A. From these Convoluted Seminal Tubes an equal
number of straight vessels is sent backwards, called
Vasa Recta, which communicate and form aa irregu-
lar plexus, termed  Rete Vasculosum Testis.
  Q.  What  vessels proceed from the  Rete Vasculo-
sum Testis ?
  A. From  it  twelve  to eighteen straight  tubes are
sent out, called Vasa Efferentia, which are soon rolled
up into Cones, called Coni Vasculosi.
  Q.  What vessels communicate with these Cones ? 
196          OF THE STRUCTURE
   A. These  Coni Vasculosi,  connected by cellular
 substance, compose rather more than a third part of
 the Epididymis ; they gradually unite into one tube,
 called Epididymis, which is much convoluted ;  and
 then becomes larger and straighter, termed Vas De-
ferens.
   Q. Recapitulate the different parts of the Seminal
 Tubes.
   A. From the coiled up extremities of the Tubuli
 Seminiferi, Vasa Recta arise, and by their communica-
 tions form the Rete Vasculosum Testis, from which
 the Vasa Efferentia arise, and terminate in the Coni
 Vasculosi, which unite and form the Epididymis,  and
 this again ends in the Vas Deferens.
   Q.  What is the Caput Gallinaginis ?
   A.  It is an eminence on the lower part of the Ure-
thra, where it is surrounded by the Prostate Gland:
it  is larger towards the  bladder,  and stretches  for-
wards into a narrow point. On either side  of its sum-
mit the  two canals common to the Vasa Deferentia
and Vesiculae Seminales open ;  around which  the
ducts of the Prostate,  and of mucous follicles termi-
nate.
   Q. What vessels compose the Spermatic Cord?
   A.  The Spermatic  Arteries, Veins,  Lymphatics,
Nerves,^ and  Vas  Deferens, connected by cellular
membrane, and surrounded by the  peritoneal pro-
cess, which forms the vaginal coat of the testicle.
   Q.  What is the Structure of the Vas Deferens  ?
  A.  Its coats are of considerable strength and thick-
ness ; its outer one seems condensed  cellular sub-
stance, and its inner one thin and dense mucous mem-
brane : perhaps some muscular fibres are interspersed
between them.  When compressed between the fin-
ger and thumb, it communicates the same sensation
as  whip-cord does.
  Q.. Describe the course of the Vas Deferens.
   A. It  arises from the posterior and inferior part of
the Epididymis, ascends on the back part of the sper-
matic cord through the abdominal apertures, at  the 
OF  THE TESTES.            197
 upper of which it  separates from  the cord, passes
 down on the Psoas muscle to the lateral  part of the
 bladder;  and  descending obliquely inwards behind
 the umbilical artery, it crosses the ureter at the lower
 surface of the bladder, and near the prostate gland
joins the cylindrical  canal of the Vesicula Seminalis at
 an acute angle ;  which canal, common to both, being
 about an inch long, perforates the prostate gland, and
 opens on the under  surface of the Urethra at the side
 of the Caput Gallinaginis.
  Q. What  Organic Derangements affect the Sper-
 matic cord?
  A. Scirrhus, varicose veins, and drorJsy.
  O.. What is the situation of the Vesiculae Semi-
 nales ?
  A. They are placed obliquely on the inferior and
 posterior part of the bladder, their apices at the neck
 of the  bladder  nearly touch each  other, but  their
 bases recede from each  other as they extend back-
 wards.  They have  a flattened pyriform appearance,
and  are surrounded by much cellular substance.
  Q. What  is the structure of  the  Vesiculae Semi-
nales ?
  A. Each of them is composed of a single Tube,
much convoluted, and bulging out into irregular pro-
 cesses, which resemble cells ; it has a strong coat of
 condensed cellular substance, and an internal mucous
coat: and is covered and compressed by part of the
Levator Ani Muscle.
  Q. What is the use of the Vesiculae Seminales ?
  A. Various opinions have been entertained con-
 cerning their use : some have supposed that they se-
 crete a fluid for diluting the semen, and  facilitating
 its passage along the urethra ; others, that this fluid
 was  in some way useful in generation : but the most
 probable and most  simple opinion  is, that they are
 Reservoirs in which  the  semen is lodged after it has
 been secreted in  the Testes, and sent thither until it
 be ejected in coitu  or absorbed.
                      a 2 
198
OF  THE  TESTICLE.
  Q.  Does any mechanism of the  Vessels favour the
last opinion ?
  A.  Yes; the Vesiculae Seminales can be filled with
a coloured injection when it is thrown into the Vasa
Deferentia, without any of it passing into the urethra.
I'he semen, therefore, in proportion as it is secreted,
fiils the seminal tubes of the Testicles, by its own sti-
mulus is propelled along the  Vasa Deferentia, and
when it comes to the canals of the Vesiculae Semi-
nales, it returns into them.  This reflux of the semen,
and temporary retention of it in the Vesiculae Semi-
nales, is very similar to those of the Bile in the Cystic
Duct and Gall-Bladder.
  Q.  Enumerate the Organic Derangements of the
Vesiculae Seminales ?
  A.  They have  been found  inflamed, scrofulous,
scirrhous, terminating in a cul-de-sac,  very small, and
sometimes  one wanting.


           physiology of the  testicle.
  Q.  Of what is the Semen composed ?
  A.  Of the liquor of the Vesiculae Seminales, and
the proper secretion of the testicle.
  Q.  What are the properties of the semen ?
  A.  It is of a slightly opaline colour; it liquefies in
a few minutes after ejection, it has a  strong and pe-
culiar smell, a saltish and slightly  acid taste, and is
composed, according to Vatiquelin, of 900  parts of
water, 60 of animal mucilage, 10 of soda, 30 of phos-
phate of lime ;  and when  examined  by the micros-
cope, numberless  small animals are  seen  floating
through it, which have a round head,  and a long tail,
and which avoid the light, and fly to the shade.
  Q. At what time does the secretion of the seed
commence?
  A. At puberty; the hoarseness  of  the voice the.
appearance of the hair in certain places, the growth
of the muscles and  the bones, arc intimately connect
ed with the appearance of the  semen ; for if  thv.se 
            THE FEMALE URETHRA.         199

organs  be taken away, these changes  do not take
place.
  In eunuchs, the timorous air,  the beardless chin,
the small larynx, and boyish voice continue:  in their
moral character  they resemble women  very much,
and though they can  never have children, yet their
disposition to  the indulgence of their passions with
the other sex still remains.
  Q. How is the erection of the male organ produced?
  A.  By the blood distending the Corpora cavernosa.
  Q_.  What causes lead to this effect ?
  A. Mechanical excitements, as friction, venereal
desires, fullness of the Vesiculae Seminales,  the use
of certain aliments, and of certain medicines, certain
diseases, and flagellation ; of  all causes the imagi-
nation acts the most rapidly: erection is  generally
followed by the discharge  of a viscous fluid.

     OF THE URINARY ORGANS IN THE FEMALE.

  Q. In what does the Urinary Bladder of the female
differ from that of the male ?
  A. It is generally larger and broader in proportion
to the size  of the pelvis.
  Q. In what does the female Urethra differ?
  A. In shortness, wideness, and straightness,  being
about two inches in length, and slightly  bent.
  Q_. Has the female Urethra any Prostate Gland?
  A. No ; it has no gland,  but is furnished with seve-
ral Lacunae, which pour mucus into it in order to
defend it from the acrimony of the urine.
  Q. Enumerate the External parts of the Female.
  A. The  Labia Pudendi, Clitoris,  Nymphae, and
Vestibulum, or Fossa Navicularis.
  Q. Describe the Labia Pudendi.
  A. They extend from  the Pubis to within an inch
of the Anus ;  their upper part being covered with
hairs on the pubis, is called Mons Veneris,- they-are
thickest above,  and becoming thinner  bcliuv, ter-
minate in a transverse fold, called  the  frucnum or 
 200            EXTERNAL ORGANS

fourchette, between which  and the Anus is the Peri-
 neum.
   Q.  What is the structure of the Labia pudendi ?
   A.  They are composed of the integuments eleva-
 ted by much cellular substance and fat, and lined  by
 a very thin vascular membrane,  constantly moisten-
 ed by the secretion of sebaceous follicles.
   Q.  Describe the Clitoris.
   A.  It is situated between the tipper parts of  the
 Labia, about an inch in length, and bound to the fore
 part of the Symphisis Pubis ; it is very vascular and
 sensible, has two corpora Cavernosa, separated by a
 septum, and two crura twice the length  of its body,
 which arise from the crura of the Ischium and Pubis ;
 it has its Ligamentum Suspensorium and Glans,  has
 no perforation like the penis; is covered by a conti-
 nuation of the sensible delicate membrane of the La-
 bia, and at its inferior part forms a fold, called Prepu-
 tium  Clitoridis.
   Q_.  Describe the Nymphae.
   A.  They arise from the under and outer part of the
 clitoris, narrow from the prepuce of the glans, and
 are formed  by  a production of the inner membrane
 of the Labia; they run downwards along the inside
 of the Labia, increasing in breadth nearly for an inch
 and a half, and then suddenly diminish to their lower
 extremity at the Vestibulum.
   Q.  What  is their structure and use ?
   A.  The nymphae contain cellular substance, blood-
 vessels, nervous papillae, and  sebaceous follicles  be-
 tween their layers, by which they are very sensible,
 and always well moistened.  They lie close together,
 and cover the orifice of the Urethra and of the Vagi-
 na, and assist in directing the urine from the Urethra.
   Q.  What  is the Vestibulum,  or Fossa Navicularis?
   A.  It is the smooth depressionbetween the Nym-
 phae  and Perineum; it leads to  the  Urethra above,
 and to the Vagina below.
   Q.  What  is the precise situation of the Orifice of
 the Urethra ?                              J    J 
OF THE FEMALE.
201
   A. Its  orifice is in  a direct line, about an inch
 down from the glans of the clitoris, between the
 Nymphae, situated in a slight spongy eminence pro-
 jecting below, which  is perforated by Lacunae of
 considerable size for lubricating its extremity.
   Q. Describe the Orifice of the Vagina?
   A. The external orifice of the Vagina is situated
 immediately under the Urethra, about half an inch
 below the symphisis pubis ; it is surrounded and con-
 tracted by its corpus cavernosum, and its sphincter
 muscle ; and generally in Virgins,  two thirds of it
 are closed by a thin dense membrane called the Hy-
 men, generally of a semi-lunar shape, placed next the
 perineum.
   Q. Is the Orifice of the Vagina not partly contract-
 ed also by the Caruhculae Myrtiformes?
   A. Yes; in the posterior and lateral parts of the
 orifice are three  or four little bodies,  of the size of
 myrtle berries, supposed to be the remains of the
 ruptured  hymen ; they seem, however, rather to be
 corrugations of the inner membrane of the Vagina,
 for admitting of its dilatation, which is naturally ra-
 ther contracted near the sphincter.
   Q.  What are the  organic diseases  of the Labia
 Externa ?
   A.  The Labia are sometimes aedematous, and very
 large; are inflamed, adhere to each other, and leave
 no opening into  the vagina, but a small one before
 for the discharge of urine ;  are sometimes affected
 with Erisipelas, which spreads rapidly;  are ulcerated;
 Venereal excrescences, and Polypi grow from them :
 scrofulous and scirrhous tumours  have their seat in
 them.
   Q.  What Organic derangements  happen to the
 Nymphae ?
   A. They are sometimes so much elongated as to pro-
 trude beyond the Labia, and occasion inconvenience
 in walking.
   Q.  What Organic derangements is the Clitoris sub-
ject to ?
   A.  It is occasionally so much enlarged and elonga- 
202             OF THE UTERUS.
 ted as to be mistaken for a male penis :  its enlarge-
 ment is sometimes accompanied by induration, thick-
 ening, and cancerous ulceration.
   Q.  What are the  Organic derangements of the Hy-
 men, and Carunculae Myrtiformes ?
   A.  The Hymen in some rare cases is so thick that
 it cannot be ruptured by the ordinary means ; it is
 sometimes imperforated, and retains the menstrual
 fluid  behind it ; the  Carunculae Myrtiformes are
sometimes of an unnatural length, and occasion much
 uneasiness.

      OF THE INTERNAL PARTS IN THE FEMALE.
   Q.  Enumerate the internal Organs of Generation
 in the female.
   A.  They are  the Uterus and  its appendages, viz.
 the Ovaria, Fallopian Tubes, Broad and Round Liga-
 ments, and the Vagina.
   Q.  What are the figure and dimensions of the Ute-
 rus?
   A. Its  figure much resembles a pear, somewhat
 flattened, with its base or fundus uppermost,  and its
 cervix below:  the Uterus varies in size, becoming
 larger in  women who have had children : in Virgins,
 however, it is about two inches and a half long ; one
 and a half, or at most, two inches broad at the fundus;
 one at the cervix, and about one inch in thickness.
   Q.  What is the situation of the Uterus ?
   A. It is situated in the unimpregnated  state in the
 Hypogastric Region ; the anterior and inferior part of
 its body, and its cervix adhere firmly to the Bladder;
 and the posterior part of its cervix, to the Rectum,
 by cellular substance, and by the Peritoneum reflect-
 ed over the bodies of both.
   Q.. To what parts  is the Uterus attached}
   A.  To the bladder and rectum as  we have just
 mentioned ; to  the sides of the Pelvis by the Liga-
 menta Lata; and to the external parts  by the Va-
 gina.
   CL  Describe the structure of the Uterus ? 
OF THE UTERUS.
203
   A. Its external coat is smooth and polished, being
 a portion of the Peritoneum ; under which is its mus-
 cular coat of compact  structure, firmly connected
 by cellular substance ; it is  very vascular  in  its
 body and fundus ;  it is lined by a very soft vascular
 membrane, rather of a villous appearance ; its cervix
 is contracted by  numerous rugae, between  which
 are many follicles for secreting mucus to lubricate
 the parts.
   Q. Describe the mouth of the Uterus ?
   A. The lower part of the cervix projects into the
 Vagina, something similar to the Glans penis, and is
 perforated by a transverse slit, called Os Tincae, a
 little larger in a Virgin  than the orifice of the male
 urethra,  but much larger in a  woman who has born
 children.   The Os Tincae is  formed by two thick
 lips, the  anterior of which is the larger,  hangs farther
 down, and  gives it an oblique,direction backwards.
  Q.  Describe the Broad Ligaments of the Uterus?
  A.  The Peritoneum, after giving a coat to the Ute-
 rus, is reflected forwards upon the blaekler, and back-
 wards over the rectum;  it then passes laterally from
 the edges of the Uterus, and upper extremity of the
 Vagina, to  be fixed to the sides of the Pelvis, thus
forming the Broad Ligaments by its doubling.
  Q..  What purposes do  the Broad Ligaments  serve?
  A.  They, together with the Uterus, divide  the
 Pelvis into an anterior and a posterior cavity: they
 attach the  edges  of  the Uterus to the sides  of the
 _,_>'is;  support the Round  Ligaments, its  blood-
vessels, lymphatics, and nerves between their layers ;
contain  and support the Ovarium on either side in
their posterior layer, and the Uterine or Fallopian
Tube in their anterior ala, or layer.
  Q.  What is the situation of the Uterine or Fallo-
pian Tubes ?
  A. These Tubes are connected with the corners of
the fundus  of the Uterus, open into it by a very small
perforation, and pass laterally in the duplicature of
the Broad Ligaments towards the sides of the Pelvis. 
204
O? THE OVARIES.
  Q. Describe the Fallopian Tubes ?
  A. These Uterine Tubes begin small near its fun-
dus, are about three inches in length, a little curved,
become larger and convoluted ; but near their extre-
mity they are suddenly contracted and terminate  by
open mouths, which can contain a goose-quill; their
extremity is free, loose,  and fimbriated.  They are
lined by "a soft pulpy membrane converted into many
small longitudinal plicae.
  Q_. What Organic Derangements affect the Fal-
lopian Tubes?
  A. Inflammation; obstruction  from adhesion  of
their sides;.dropsy when both  ends are  shut;  an
ovum inclosed by its  proper membranes has been
found lodged in the Tube ; the Tube has been found ^
to end in a cul-de-sac ; and tumours grow from their
outside.
  Q. What is the situation of the Ovaria ?
  A. The Ovaries are situated in the posterior layer
of the broad ligaments, one on either side of the fun-
dus, about an  inch from the Uterus.
  Q. Describe the figure and size of the Ovaria?
  A. The Ovary is somewhat of the figure  of the
Testicle, but rather less in size, is placed transverse-
ly, is largest in the prime of life, becomes smaller and
shrivelled in old age.
  Q. What is the structure of the Ovaria?
  A. They have an external coat from the perito-
neum,  and a dense cellular  coat, within which is a
complicated intermixture of vessels and nerves, vejj^^
much resembling a glandular structure, and a num-
ber of small vesicles, called Ova, containing a limpid
fluid.
  Q. In what do the Ovaria of a woman, who has ne-
ver born children, differ from those of one who has?
  A. In  a woman who has never been impregnated,
the surface of the Ovaria is smooth and uniform ; but
in the  Ovaries of a woman who has  had children, a
cavity  is  found, called Corpus Luteum, from which
the impregnated ovum had escaped ; and these Cor- 
OF THE VAGINA.            205
pora Lutca have been found to correspond with the
number of impregnations of the same woman.
  Q. From what part of the Uterus do the Round
Ligaments arise ?
  A. They arise, one on each side, from the corners
of the fundus of the Uterus, before and rather below
the Fallopian Tubes, they descend obliquely, be-
coming rather smaller in the Ligamenta Lata.
  Q. What are the course and  termination of the
Round Ligaments?
  A. They pass along the  Broad Ligaments to the
sides of the pelvis, pass  through the abdominal aper-
tures or Rings, as the Spermatic Cords do in the male,
ami are afterwards divided into  a great number  of
branches, which terminate upon  the Mons Veneris,
sides of the Pudendum,  and groins.               ij*
  Q.. What parts compose  the Round Ligaments?
  A. The Round Ligaments are of a  pale red co-
lour, composed of strong  longitudinal ligamentous
fibres,  blood-vessels,  nerves,  and cellular substance
interposed.
  Q. What is the use  of the Round Ligaments ?
  A. They seem to  assist the Ligamenta  Lata,  to
give the proper inclination to the Uterus forwards
in pregnancy, and to direct its ascent before the in-
testines.
  Q. Do the Round Ligaments increase in  size and
length  as the Uterus rises in pregnancy ?
  A. Yes ; they are augmented in the  same manner
as the other parts of the Uterine system are.
  Q. What is the situation  of the  Vagina ?
  A. The Vagina is situated at the under and poste-
rior part of the bladder and urethra,  before the rec-
tum, to all which it  is  firmly connected by cellular
substance: it reaches from  the  Pudendum to the
cervix  of the Uterus,  extending higher up  at the
posterior than the anterior  part.  It issliglrtly curved.
  Q. What is the structure of the Vagina?
  A. It is a thick, strong, membranous canal, having
numerous rugae on its anterior and posterior internal
  Vol. II.               S 
206          OF THE VAGINA, &C.
  surface, which diminish its diameter; and also many
  nervous papillae, which give it great sensibility.  Be-
  tween the rugae a great number of mucous follicles is
  situated for moistening the canal.  The external end
  of the vagina is covered on each side by a substance
  composed of blood vessels and cells, similar to those
  of the Penis, called plexus retiformis, or corpus caver-
  nosum Vaginae;  which corpora are compressed  by
  the sphincter vaginae, and tend very much to con-
  tract the orifice, and to increase the sensibility of the
  parts during coition.
   Q. What Organic Derangements have been found
 in the Vagina?
   A. Inflammation ; adhesion of  its  sides; ulcers;
 scirrhous tumours;  deficiency in  length or width ;
 too wide, being preternaturally stretched by tumours
 or polypi; and inversion from procidentia Uteri.
   Q. What Arteries are sent to the Uterus ?
   A. The  two Spermatics,  which are sent off from
 the Aorta;  and  the two Uterine Arteries, from the
 Internal Iliacs.  The former are dispersed upon the
 Ovaria, Fallopian Tubes, and Uterus near its fundus ;
 the latter much larger than the former, run to the
 under part of the Uterus, send  branches to the Va-
 gina, and bladder, and are reflected upwards along
 the edges of the Uterus towards its fundus.  They
 are all very tortuous in their course, and anastomose
 most freely with each other.

            PHYSIOLOGY OF THE UTERUS.
  Q. What is the usual period of menstruation ?
  A. Four weeks ; in some  few women fifteen days ;
 in others two months,  and in others it comes on at
 irregular seasons.
  Q. What are the symptoms that precede menstrua-
tion?
  A. Lassitude, pain in the breasts, pricking  in the
 skin ; sometimes there are no premonitory symptoms.
  Q. What is its most general quantity ?
  A. In from one to three days are discharged four,
five, or six  ounces;  to this, there are exceptions ;  it 
PHYSIOLOGY OF THE UTERUS.      207
 amounts to several pounds in some ; in others hardly
 a few drops of almost colourless fluid, are discharged
 at different times in the same day.
  Q. What is the state of the system during menstrua-
 tion ?
  A. It is extremely susceptible of fear and of anger:
 the state of the system has a great effect upon the
 prevailing symptoms during the discharge ; the qua-
 lity of the latter, its regularity or its irregularity, and
 its  duration, are  also much altered by the state of
 the health.
  Q.  What part of the uterine system furnishes the
 menstrual blood ?
  A.  The  internal surface  of the womb, as appears
 from dissection.  When the womb, or the general sys-
 tem is out of order, other parts perform this function ;
 as, the eye, the stomach, the  lungs, the surface of
 sores and different points of the skin.
  Q.  At  what period  does this secretion usually
 make its appearance ?
  A.  Sooner in hot than in cold  countries: it gene-
 rally appears at thirteen or fourteen in this climate,
and disappears at fifty.
  Q.  How are  the menses  connected with concep-
 tion?
  A.  The power of conception generally ceases with
 the disappearance, and commences with the first ap-
 pearance of the menstrual flux; though  this is not
 universal, as women have conceived both before the
appearance, and after the disappearance of the men-
 ses, and some, who  have never menstruated, have
 notwithstanding borne children.
  Q. In what respects is the Uterus changed by preg-
nancy?
  A.  It receives a new stimulus, by which it becomes
enlarged, in proportion to the growth of  the Ovum,
Embryo, and Foetus: its mouth, immediately after
 conception, is sealed up by  a ropy mucus, and its in-
ternal surface forms the membrane, called Decidua,
or spongy Chorion.  The menstrual flux is stopt. 
208      PHYSIOLOGY OF THE UTERUS.

  U. Are the parietes of the uterus thinner in con
sequence of its enlargement ?
  A. No; the increased action of the arteries depo-
sits new matter* sufficient for the increase of all  its
parts without any diminution of the size or thickness
of their texture.
  Q. Do the arteries and veins become less tortuou9
by the enlargement of the Uterus ?
  A. No ; they increase in size, and retain their tor-
tuous course in  proportion to the increase  of  the
Uterus.
  Q. Is the enlargement of all the parts of the Ute-
rus owing to the deposition of new substance ?
  A. Yes;  particles of new matter are deposited suf-
ficient for the growth of all its parts.
  O.. By what means is the enlargement of the Ute-
rus diminished after the birth of the foetus?
  A. By Absorption,  and by the Lochial Discharge,
which gradually removes the great determination and
influx of blood to the Uterus, and  reduces  it to  its
usual size.
  Q. How is fecundation effected ?
  A. This is one of the mysteries of nature; some of
the circumstances  under which  it takes place are
known, but these  only  certainly in the lower ani-
mals : Spallanzani, for instance, has proved that three
grains of seed, put into two pounds of water, commu-
nicate to it the fecundating power, which is entirely
independent of the animalcules floating  in  it, and
also of the halitus of that fluid.
  Q. Is there any thing certain in the symptoms,
which are said to precede fecundation, such as uni-
versal starting, dull look of the eyes, dilated  pupils,
pale visage ?
  A. They sometimes occur, but are by no means
universal.
  Q. What changes take place in the ovary on fecun
dation ?
  A. Its vessels  increase in size, its exterior mem-
brane becomes thicker, changes from  a  grey to a 
         PHYSIOLOGY OF  THE UTERUS.     209

yellow colour within from 24 to 30 hours after a suc-
cessful coition.  It is then called the corpus luteum :
the vesicle enlarges the second, third and fourth day ;
the corpus luteum grows in the same proportion, and
contains in its areolae a white liquor, resembling milk;
at the end of that term the  vesicle breaks the exter*
nal  coat of the ovary, and hangs by one of its sides ;
in the bitch it is of the size of an ordinary hazel-nut:
the corpus luteum remains in the ovary and contracts
gradually and slowly.
  Q. How is it conducted to the womb ?
  A. The ovum is received  by the fringed extremity
of the fallopian  tube, and conducted to the uterus ;
the tube enlarging as the  ovum passes along, and
contracting afterwards.  In  women, it is thought that
the ovum does not arrive at the  womb before the
twelfth day.
  Q. What changes  take place in the womb after
fecundation ?
  A. The egg unites to  the sides of the uterus and
gradually grows larger, the  womb changing its form,
and enlarging accordingly.
  Q. What are the stages of this enlargement ?
  A. In the three first months, it  is confined to the
pelvis; it then is so large that it passes into the hy-
pogastrium, gradually growing larger till the end of
the ninth month, and displacing all the viscera: the
neck of the womb is little changed during  all this
time, its neck preserving its conoid shape ; but next,
the neck diminishes in  length, opens and is effaced
almost entirely, the womb assuming a shape resem-
bling that of an egg, and is about twelve times as great
as when completely empty.
  The uterus is drawn forward by  the round liga-
ments which are put upon  the  stretch; the ovaries
fall by its side ;  the abdominal parietes are distended
and present on the surface  of the skin streaks, after
two or three pregnancies. The womb becomes more
lax in its texture, has a red color, and is considerably
spongy:  its fibrous texture is more evident; the in- 
 310     PHYSIOLOGY OP THE UTERUS.

 terior surface has a membrane which is very adhe-
 rent to it, and is called by Mr. Hunter, the deciduous
 membrane; and is intended to favour the adhesion of
 the ovum to the sides of the womb.  The arteries of
 the womb grow larger, and also the veins, and the
 lymphatics.
  Q. What changes take  place in the system of the
 female ?
  A. The eyelids look swelled and bluish ; the coun-
 tenance is discolored; the  perspiration has a peculiar
 odour; the face is pale,  with disgust for particular
 kinds of food ; constant nausea, headache, sometimes
 loss  of  sleep occur; sometimes terrible diseases
 cease, the delicate and valetudinary becoming heal-
 thy ; the mind is  dispirited, easily alarmed and af-
 fected by melancholy impressions : pregnancy is also
 attended with spasms of the extremities, swelling of
the veins, with costiveness and difficulty of making
 water.
  Q. What is the progress of the ovum at different
 periods ?
  A. In the course of the  second month, it begins to
grow and to send  forth vessels which are implanted
in the deciduous membrane. In the third month one
side only of the ovum is seen, the remainder of it has
become thicker  and larger, and  is implanted in the
caducous membrane, forming  the  placenta : the re-
maining surface of the ovum,  presents  a soft cadu-
cous  reflected membrane  called the reflected deci-
dua: it enlarges till birth, its two membranes thick-
ened and more resisting:  the  outer called the cho-
rion, the inner the  amnios,  inclose a fluid composed
of water, albumen, soda, muriate of soda, and phos-
phate of lime: this fluid increases  in quantity as the
ovum increases in  size.
  Towards the end of the third week, there is per-
ceived on the side of the ovum, which is transparent,
a slightly opaque gelatinous substance, homogeneous
 in all its parts, adhering to the side of the womb : im-
mediately two vesicles united Ly a  pedicle, and n^r- 
          PH\alOLOOY Ot  THE UTERUS.      211

 ly equal in size, of which one is adherent to the am-
. nios by a small filament, appear : one of these is the
 embryo.  In its middle appears a red point with yel-
 low fibres ; this is the heart: at the beginning of the
 second  month, the head  becomes visible,  the  eyes
 form two large black points, small openings shew the
 place of the ears, and the  nostrils; the mouth, already
 very large, becomes smaller, by the formation of the
 lips, about the 60th day.  It increases  till about the
 middle of the fourth month, when it ceases to be called
 by the name of embryo, and  assumes that of foetus till
 delivery.
      PATHOLOGY OF THE  ORGANS OF
                 GENERATION.

                   XATRITIS.
  Q.  What are its symptoms ?
  A.  Obtuse pain and sense of bearing down in the
hypogastric regions, sometimes joined to an obscure
swelling or circumscribed  tumour of the part; the
last only occurs when the body of the viscus is in-
flamed.  The pain, which is augmented by pressure,
soon  extends to the loins, perineum, pudendum, and
superior part of the thighs ; add to these a sense of
weight  about  the rectum, frequent  desire to pass
urine and stools, and often also constipation anddysu-
ria.  When the inflammation occupies the#neck of
the uterus, it becomes extremely hard and tumefied,
and acutely sensible to the slightest touch ; it is con-
tracted on itself, and its temperature  is considerably
augmented ; a reddish liquid flows from the vagina,
being preceded by colic and pains in the lumbar re-
gions ; the breasts are in general retracted and pain-
ful.  In chronic hysterics these different  symptoms
are lighter, anel there is usually an habitual flow of
matter,  sometimes very fetid,  from the vagina.  It
may be confounded with catarrh of  the uterus, or
with scirrhus of that organ. 
312           FATHOLOOY OF THE

  Q. What are its anatomical characters ?
  A. Augmentation of the size  of the uterus, at least
if death occur a few days after delivery ; its walls are
swelled, softened, and  gorged with  blood, and,  in
some instances, it is infiltered with purulent matter.

             CANCER OF THE UTERUS.
  Q. What are its symptoms ?
  A. Irregularity of menstruation, sometimes alarm-
ingly abundant discharges, sense of pain and bearing
down in the hypogastrium, tenesmus, dysuria, and
wandering pain of the breasts: to these  in a short
time succeed acute lancinating pains in the neck  of
the uterus, uneasy  sensations in  the loins, hips, and
hypogastrium; an abundant fetid fluor  albus, or dis-
charge  of  sanious matter through the vagina.  If at
this period the finger be introduced into the vagina,
the neck  of the  uterus is found  to have become
Boftened over all its extent, or only in particular parts,
the intervening portions  appearing hardened.  Its
orifice is  more open than natural,  and of irregular
form; upon pressing the os tincae, a sanious or san-
guinolent liquid escapes, and a flow of this matter is
soon established ; as the disease proceeds, the lanci-
nating pains become more frequent and intense ; the
neck of the viscus becomes irregular, fringed, pain-
ful, and bloody, and if the disease be seated in the
body of the womb, it evidently acquires an increase
of size, which may be perceived externally ; pres-
sure on the hypogastrium augments the pains, which
are then extended to  the groin,  thighs, lumbar and
sacral regions.  The examination of the neck of the
uterus by means of the speculum, invented by Pro-
fessor Recamier, gives us a certainty as to the nature
of the affection,  even in the very commencement:
hence we should always have early recourse to it.  It
may be confounded with chronic matritis, scirrhus, or
some forms of leucorrhaea.
   Q.. What are its anatomical characters ?
   A. In the greater number of cases, cancer com- 
            ORGANS  OP GENERATION.       213

 mences in the neck of the uterus, more rarely in its
 internal surface.  In the greater number of instances,
 the cancerous or cerebriform matter which consti-
 tutes the  disease, or both united, are interiorly blend-
 ed with the substance of the  viscus ; in other cases
 we only meet with an ulceration of its tissue, the ul-
 cer appearing studded with fleshy vegetation, irregu-
 lar, and reddish, or whitish,  or covered with a fun-
 gous matter, or a kind of putrescent substance, vary-
 ing in colour, and extremely fetid.  When the body
 of the organ has not been destroyed, we find its struc-
 ture perfectly healthy at some lines distant from the
 surface of the ulcer;  its volume is not augmented in
 this  case, but its internal surface is livid, tumefied,
 and  discoloured.  If, on the other hand, the ulcer
 first commences in the interior of the womb, its size
 is greatly increased,  and the fungous matter which
 covers the ulceration is extremely thick; the os tincae
 appears livid, blackish, tumefied, and  converted into
 a lardaccous'substance.  The superior part of the va-
 gina and the appendages of the uterus often partici-
 pate in the disease, and are disorganized.

        FIBROUS TUMOUR OF TUB UTERUS.
   Q.  What are its symptoms ?
   A.  A tumour  varying in size, round, and slightly
 furrowed,  which may be perceived by the touch ;
 heaviness and dull pain in the loins,  hypogastrium,
 ami superior part of the thighs, frequent ha:morrhage,
 various irregularities or suspension of menstruation.
   It  may  be confounded with cancer of the neck
 of the uterus.
   Q.  What are its anatomical characters ?
   A.  These tumours are attached to the  internal sur-
 face  of the uterus, or to its  neck—they are formed
from a collection of whitish fibres, closely united, and
 are very firm and extremely tenacious, much more
 flexible than cartilage, but less so than cellular sub-
stance. 
314         PATHOLOGY OF  THE
                  MENORRHAGIA.
   Q. What are it9 symptoms ?
   A. An abundant flow of liquid or coagulated blood
 through the vagina, occurring continually or at short
 intervals, and accompanied with a sense of weight in
 the hypogastrium, loins, and thighs, and with painful
 contractions during the expulsion of the blood.  It
 may be confounded with cancer,  polypi, or fibrous
 tumours.
   Q. What are its anatomical characters ?
   A. Redness and  tumefaction  of the  lining mem-
 brane of the uterus ; in other cases polypi, fibrous tu-
 mours, and other organic affections of this viscus are
 discovered.

        ENCYSTED DROPSY OF THE OVARIES.
   Q. What are its symptoms ?
   A. A partial tumour of the  abdomen, occupying
 one side of the hypogastrium,  or  both, if the two
 ovaries be conjointly affected, proceeding slowly, and
.in general co-existent with some irregularity in men-
 struation ;  a sense of fluctuation in the tumour, which
 is  not displaced when the patient changes position.
 It may be confounded with tumours developed in the
 pelvis.
   Q. What are its anatomical characters ?
   A. A cellular or fibro-cellular cyst is usually found
 in  the  ovarium, containing a limpid citrine serosity,
 and in some instances a greater  or lesser number of
 hydatids.
             CATARRH  OF  THE UTERUS.
   Q. What are its symptoms ?
   A. Slight itching of the pudendum  and vagina,
 sometimes extending to the uterus, and accompanied
 by a discharge of a  serous  limpid liquid which pro-
 gressively becomes more and more consistent, and as-
 sumes a green or yellow,  and finally a white colour;
 from this period it begins to decline, and the urine in
 its passage ceases  to give pain.  The mucous mem- 
ORGANS OF  GENERATION.        215
 brane of the labia and vagina is red and tumefied, and
 th§ patient complains of pain in the groin, perinaeum,
 and hypogastrium, and of scalding during emission of
 urine.  When the affection is chronic, there is but
 little  pain about the genital organs, and the discharge
 is abundant and lasting, or only occurs for a few days
 after  the menses :  it is accompanied, in  such cases,
 by pain of the loins and thighs,  by languor, by  ir-
 regularities in digestion, and by a gnawing sensation
 in the stomach.  It may be confounded with chronic
 matritis, or cancer of the uterus.
  Q.  What are its anatomical characters ?
  A.  Redness,  more  or less evident,  of the lining
 membrane,  which  in some instances appears rather
 thicker than in its  healthy condition.  In the chronic
 complaint, the membrane presents no marks of red-
 ness,  but is  occasionally covered with fungous vege-
 tations.

          INFLAMMATION OF THE TESTICLE.
  Q.  What are its  symptoms ?
  A.  This affection often arises from the suppression
 of acute or chronic gonorrhoea. It begins with a dull
 pain in the epididymis, which  soon increases, ex-
 tends to the testicle, and causes a swelling  and en-
 largement of it.  The pain  becomes very acute, ex-
 tends up to the loins, following  the course of the
 spermatic cord, which is often sensible to the touch,
 and swollen ; the  scrotum  frequently  becomes in-
 flamed, and increases the size of the tumour.
  The diseases with which  it may be confounded are
hydrocele and sarcocele.
  Q.  What are its anatomical characters ?
  A.  The testicle, and particularly the epididymis, is
swelled, red, and increased  in density ; in some cases
these  parts have passed into the state of suppuration.

                OF THE PLACENTA.
  Q.  Describe the Placenta ?
  A.  It is composed of Arteries, which proceed from 
216
PATHOLOGY  OF  TIIK
the Uterus  in  a tortuous manner, and terminate in
cells of the Placenta.  Veins receive the  blood fr^n
the cells, and carry it back to the Uterus: these  are
termed the Maternal Vessels: they are on the side of
the Placenta next the Uterus.   The two Umbilical
Arteries of the Foetus enter the Placenta by the cord
on the Foetal  side, divide  into minute branches,
which are distributed through  the  whole Placenta,
and spread their terminations around the cells, into
which the maternal blood is poured,  without  having
any direct communication with them.  The extremi-
ties of the Umbilical Vein receive the Foetal blood
from the Arteries, and carry it back to the Foetus.
  Q.  Is the distribution of the arteries of the  Foetti9
around the  cells of the Placenta, similar to that of
the Pulmonary Artery round the air cells  ?
  A.  Yes, very similar ; the extremities of the Umbi-
lical Arteries being very minute, are dispersed around
the maternal cells of the Placenta,  just  as those of
the Pulmonary Artery are around the Air Cells of the
Lungs: and the extremities of the veins communi-
cate with those  of the arteries in both cases.
  Q.  Is any change  produced upon the blood of  the
Foetus in the Placenta?
  A.  Yes ; the Placenta to the Foetus in Utero seems
to perform the same  important function, as the Lungs
do to the Adult, namely, to purify the blood, and thus
to render it fit for the purposes of nutrition and
growth of parts in the Foetus.
  Q.  What, besides the Maternal and Foetal Vessels,
forms the substance of the Placenta ?
  A.  Fine cellular substance completely  destitute of
fat  is  interspersed among them, supports them in
their  relative situations, and gives to the Placenta its
necessary  firmness and tenacity.
  Q.  What are the Organic Derangements of the
Placenta ?
  A.  It is occasionally ossified in certain  points, and
adheres firmly  to  the Uterus after the birth of the 
           ORGANS  OF GENERATION.       217

child.  It has been found in some rare cases to have
been converted into a mass of Hydatids.

       OF  THE PECULIARITIES OF THE FOETUS.
  Q. In what do the bones of the Foetus differ.from
those of the adult ?
  A. They are generally soft, yielding, and often im-
perfect.  Those of the head are joined by membrane,
which admits easily of an alteration of form in facili-
tating parturition.
  Q.. Do the Fluids abound in the Foetus ?
  A. Yes;  they are much more copious in proportion
than in after life.
  Q. Is there any difference in its Nervous System ?
  A. Yes, the Brain,  Spinal  Marrow, and Nerves of
the Foetus, are proportionably larger and softer.
  Q. Is there any difference in the Glands ?
  A. The Thymus Gland is larger in the Foetus, and
seems to act  some important part in its system: the
Liver is  very large,  and indeed all  the glandular
organs.
  Q. Is there any difference in the Lungs ?
  A. The Lungs of  the Foetus in Utero are small,
collapsed, and sink in water, and are of a dark red
colour.
  Q. What difference is there in the blood vessels of
the Lungs ?
  A. The Pulmonary Artery divides in the Foetus,
as in the  adult, into a right and left branch  sent
through the respective  lungs of the thorax: at its
division in the  Foetus,, however, the Ductus or Ca-
nalis Arteriosus,  larger than both the other branches,
arises, passes obliquely  over, and terminates in the
Aorta, where it begins to descend: it forms nearly one
half of the Aorta.
  Q. In what does the Heart of the Foetus differ from
that of the adult ?
  A. In having the Foramen Ovale in the back part
of the septum between the Auricles; it has a thick
muscular margin ; upon the side of the foramen next
  Vol. II.           T 
218          PATHOLOGY  OF THE
  the  left Auricle,  a membranous  valve is placed,
  which allows the blood to flow through the foramen
  into the left Auricle, but prevents its return.
   Q.  What purposes do the  Canalis Arteriosus and
  the Foramen Ovale serve ?
   A.  As the lungs are in a collapsed state in the foe-
  tus,  a small  quantity of blood only can  circulate
  through them, the  Canalis Arteriosus therefore trans-
  mits the remaining quantity, sent into the pulmonary
 artery, directly into the descending Aorta; while a
 large part of the blood sent to the heart by the Ve-
 nae Cavae, flows directly through the Foramen Ovale
 into the left Auricle.
   Q.  How is  the Circulation  equal in both sides of
 the Heart by these means ?
   A. For the sake  of demonstration, let us suppose
 that a third part of the blood flows directly through
 the Foramen  Ovale at every  dilatation of the Auri-
 cles, and that two thirds are propelled by the contrac-
 tion of the right Auricle  into the right Ventricle, and
 thence by its contraction into  the pulmonary artery,
 which transmits one third through the Lungs, and the
 Canalis Arteriosus  carries the remaining third part
 into the Aorta.  The pulmonary Veins carry the one
 third circulating through  the Lungs into the left Au-
 ricle, which by its  contraction propels this third, to-
 gether with the other third part which passed through
 the Foramen  Ovale,  into the left Ventricle.  Each
 Ventricle therefore receives exactly  two thirds,- and
 by this construction of parts, the same  quantity of
 blood circulates through both sides of the heart in a
 given time.
   Q.  What difference do we find in the Liver of the
 Foetus from that of the adult ?
   A.  The Liver of  the Foetus is so large, that it oc-
 cupies the right and left Hypochondric, and the Epi-
gastric Regions.  It receives the  blood from the um-
bilical vein.  This  vein  returns the Foetal blood
from the Placenta,  is twisted  round  the Umbilical
Cord, together with the arteries,  enters the abdomen 
           ORGANS OF GENERATION.        219

by the umbilicus, passes in the posterior and inferior
duplicature of the Broad or Suspensory Ligament to
the Porta of the Liver, and there sends oft a pretty
large branch, called Ductus Venosus, which runs in a
waving direction to the left Vena Hepatica, where it
enters the Cava and terminates;  while the trunk of
the Umbilical Vein itself terminates in the left branch
of the Vena Portae, which is distributed through the
left lobe of the Liver.
  Q_. What  is the use  of such  a distribution of the
Foetal Blood in the Liver?
  A. By such distribution, nearly a half of the blood
of the Foetus, which has been purified in the Placen-
ta, is sent by the Ductus Venosus  directly to the Ve-
na Hepatica, which soon joins the Vena Cava, or to
the Cava  itself, to be transmitted to the  Heart, and
whole  system;  while the other part  of the Foetal
blood circulates through the left Lobe of the Liver,
and perhaps throws off some other  impurities to be
discharged with the Bile into the Intestines, before it
is sent to the heart again to circulate through the
system.
  Q. In what do the Intestines of the Foetus  differ ?
  A. They are filled with black green, tar-like, viscid
faeces, called Meconium.
  Q. In what do the Kidneys of the Foetus differ from
those of the adult?
  A. They are irregular and lobulated on their sur-
face; each lobule consists of a Cortical and a Medul-
lary part, has its Papilla, and is covered by its proper
membrane or  coat:  while  their surface becomes
smooth in the adult.
  Q. Do the Renal Capsules or Glands differ ?
  A. They are large in the Foetus,  and nearly equal
to the size of the Kidneys.
  Q. Does the Urinary Bladder of the Foetus differ
from that of the adult ?
  A. It is of a longer form, rises nearly to the Umbi-
licus, and has the Urachus of a conical shape and so-
lid consistence as a ligament, arising from its fundus 
220      OF  THE CIRCULATION, AND

between the umbilical arteries, and between the Pe-
ritoneum andlinea alba, and extending to the Umbi-
licus, where it disappears in the umbilical cord.
  Q. What difference takes place in the Iliac Arte-
ries ?
  A. The common Iliac Artery of the Foetus divides
into a small external, and a large internal branch on
each side; the principal part, being the trunk of the
Internal Iliac, is reflected upwards by the side of the
Bladder on each side ; on the outside  of the perito-
neum both Arteries perforate the Umbilicus, and are
entwined in the Umbilical Cord.
  Q. Is there  any difference  in the  Pelvis of the
Foetus ?
  A. It is very small, and its Viscera seem contained
in the cavity of the abdomen.
  Q. Is there any difference in the Female Organs of
Generation ?                        x
  A. The prepuce of the Clitoris is much larger; and
in consequence a female has sometimes  been mista-
ken for a male.
  Q. What difference is there in the Male Organs of
Generation ?
  A. The Testes, in the early months, are lodged in
the Abdomen on the Psoae muscles a little below the
Kidneys ; between the Testicle and Scrotum on each
side a fibrous vascular conical substance  is extended,
called Gubernaculum  Testis, which is supposed to
make way for the descent of the Testis, and to direct
its course into the Scrotum, which happens about the
seventh or eighth  month  of pregnancy.  The Tes-
tes carry down with them  their Coats, Vessels,  and
Nerves.
  Q. State as shortly as possible the Foetal Circula-
tion of the bloodin the Thorax, beginning  at the Vena
Cava ?
  A. From the termination of the Cavae,  a part of the
blood is sent through the Foramen Ovale  into the left
Auricle, and the two parts retained in the right  Au-
ricle are propelled by its  contraction into the right 
       NOURISHMENT OF THE FOETUS.     221

Ventricle ; which  again  by its contraction  throws
these two  parts into the Pulmonary Artery, one of"
which  it transmits through the Lungs, the other is
carried by the Canalis Arteriosus directly to the de-
scending Aorta. That part of the blood sent through
the Lungs is collected and brought to the left Auricle
of the Heart by the Pulmonary Veins ;  this part and
that  sent directly through the Foramen Ovale, mak-
ing two,  stimulate the left Auricle to contraction, by
which  they are propelled into  the left Ventricle,
which by its contraction throws them into the Aorta
and systemic arteries.
  d. State also the Foetal Circulation  of blood in the
Abdomen, beginning at the Iliac Arteries ?
  A. The larger branches of the Internal Iliac Arte-
ries,  reflected upwards, pass out of the Abdomen by
the Umbilicus, are entwined in the Umbilical Cord,
enter the Placenta, are minutely divided into branches
in its substance, and  ultimately terminate around the
innumerable Cells in  which the mother's blood is con-
tained.   With the extremities of these Arteries Veins
communicate,  receive  their  blood, join again  and
again into  larger and  larger trunks, till at last they
form one, the Umbilical Vein, which comes out of the
Placenta where the arteries enter, is entwined along
with them  in  the  Umbilical Cord, enters the Abdo-
men at the Umbilicus,  passes up to the Porta of the
Liver,  where it sends off the Ductus Venosus, which
terminates in the Hepatic Vein just  before it ends in
the ascending Vena  Cava, or sometimes in the Vena
Cava itself: the Umbilical Vein af erwards terminates
in the left branch of  the Vena Portae, which is dis-
persed through the  left lobe of the Liver, and the
Hepatic  Veins carry  its blood to the Inferior Cavaand
Heart.
   Q. Do the Blood vessels of the Foetus communi-
cate with those of the Mother in the Placenta ?
   A. No;  they have no direct communication ; they
do not  anastomose; in some very rare instances a
small branch or two  may pass between the Maternal
                       ■r2 
 922     PHYSIOLOGY  OF THE  FOETUS.

 and Foetal vessels, but it is  by no means a common
 occurrence.
   Q. What is the result of injecting penetrating odo-
 rant substances into the blood vessels of the mother?
   A. After a time they are perceived in the vessels
 of the foetus; the effect of purges taken by the mo-
 ther on the child proves their absorption.  As it is de-
 monstrated that alcohol is absorbed into the blood ves-
 sels in its natural state, there can be no doubt but that
 the effect is the same upon the child as upon the mother,
 as also are all kinds of diet prescribed with a medical
 intention.  There is therefore a communication be-
 tween the  blood of the mother and that of the foetus:
 whether on  the  contrary the blood of  the foetus is
 conveyed back to the mother is not ascertained. Ma-
 gendie states that no effect is produced upon the mo-
 ther from the injection of poisonous substances into
 the umbilical cord, towards the placenta.  The heart
 of the foetus is therefore the  principal cause of the
 motion of the blood in its body.

            PHYSIOLOGY OF THE FtETUS.
   Q.  From what source  does the Foetus in utcro de-
 rive its nourishment ?
   A.  Various opinions have been entertained on this
 subject, such as the nourishment of the Foetus being
 received from the mother's blood by a direct commu-
 nication of the vessels of the mother and child : or by
 absorption  from the blood of the cells by the veins of
 the Placenta: or  from serum secreted into the  cells
 and absorbed by Lymphatics of the Placenta and Um-
 bilical cord : or from the Liquor Amnii being swallow-
 ed: but, it seems  probable, that a nutritious quality
 is received from the blood of the mother, by the mi-
 nute extremities of the Umbilical Vein spread round
 the cells of the Placenta, and conveyed to the blood
of the Foetus ; from which the Arteries form, and de-
posit proper nourishment in every part of the  Foetal
system.
  Q.  What appearances are observed in the stomach
of the Foetus ? 
         PATHOLOGY OF  THE FOETUS.      223

  A.  It contains a viscous, very acid, gelatinous Jfluid,
which forms a sort of chyle, and from which is formed
the meconium in the lower bowels: as hairs similar
to those of the skin of the foetus are discovered in its
stomach, there can be no  doubt but that the substance
swallowed is the liquor of the Amnios.
  Q.  What is the probable use of this function in the
stomach ?
  A.  The nourishment of the foetus.   As in the case
of foetuses without stomachs, the skin or some other
part may assist in supplying the food, and thus  sup-
port the system, these instances cannot be brought to
invalidate the explanation.
  Q.  Is chyle  or  lymph  discovered  in  the thoracic
duct of animals in the foetal state ?
  A.  Magendie says not.
  Q.  Do there exist exhalations in the  internal ca-
vities of the foetus ?
  A.  There do, as in  adults.
  Q.  Do the other secretions also go on  in the foetal
state ?
  A.  The mucous and cutaneous follicles  possess
great activity, and the glands of digestion  are  also
fully developed from the  seventh month.

            PATHOLOGY OF  THE FOETUS.
  Q.  Enumerate some of the causes of disease in the
foetus.
  A.  The physical and moral state of the mother is
communicated to the foetus: if the nourishment taken
be sufficient and wholesome, the foetus is affected in
a correspondent manner : if she is terrified, the foe-
tus is suddenly killed  or becomes weak and emaciat-
ed.   Fractures, dropsies, the smallpox, the venereal
disease, gangrene, ulcers, cutaneous eruptions, are
some of its maladies.
  O..  Are there any other bodily defects in the foetus ?
  A.  Yes;  different parts of the body, as the stomach,
the lungs, the  head, the heart,  are entirely wanting;
sometimes  parts  exist in greater numbers than na-
tural. 
 224     OF  THE GENERATIVE SYSTEM.

     EXAMINATION OF THE GENERATIVE SYSTEM.
   Q. Does the mode of investigating the  different
 symptoms induced by diseases of the generative or-
 gans, differ in the two sexes?
   A. It does : in man the parts affected can be view-
 ed, hence the observer has only to describe what he
 sees; but he ought to pay particular attention to the
 cause which has produced the disease.  We shall, for
 the  present,  merely refer the reader to the part of
 this  work which gives the symptoms and characters
 of each of these affections ; as to those which are con-
 nected with the generative system  in females, they
 are more complex, and require more particular atten-
 tion.
  The best means of examination is the touch, which
 enables us to ascertain the state of the vagina, uterus,
 and adjacent cellular texture.
  The touch  consists of introducing into the vagina
 one or more fingers, while the other hand is placed on
 the abdomen, for the  purpose of ascertaining the state
 of the uterus  and its connexions.
  It  may be performetl as follows : the  bladder and
 rectum being previously unloaded of their contents,
 the physician proceeds to examine the uterus, the pa-
 tient standing or laid on her back, according to cir-
 cumstances; she should stand up when it is intended
to examine a case  of relaxation of the vagina, prolap-
sus uteri, or, in a word, any affection in which it is ne-
cessary  to estimate the weight and  mobility of the
uterus:  she should be lying on the back in order to
have the state of the  ovaria ascertained, or any other
disease  besides those just mentioned. In this latter
case, the patient's head should  be supported by pil-
lows, so as to be raised above  the trunk, the  legs
should be semi-flexed, in order to relax the abdominal
muscles.  The index finger of the right hand is most
usually employed, and if the patient be standing, the
physician  kneels  on  the opposite  (the  left) knee.
When the  finger touches the neck of  the uterus, 
OF  THE  GENERATIVE  SYSTEM.     225
 pressure should be made with the other hand placed
 on the abdomen, so  as  to force down the uterus,
 which is felt  as a  hard  and somewhat moveable
 body.
   Q. Describe the Uterus in the healthy state ?
   A. The neck of the uterus somewhat resembles the
 extremity of a cylinder slightly flattened from before
 backward ; it projects more posteriorly than anterior-
 ly ;  its centre is marked by an oval aperture, whose
 longest diameter is from side to side;  in females who
 have had children, this is  from five  to jeight lines
 long, in the  adult virgin it is about three.  As this
 opening is placed nearer to the posterior than anteri-
 or part of the neck, it causes the anterior lip of the
 os uteri to appear somewhat thicker.  The portion
 of the neck which projects into the vagina is about
 four or five lines anteriorly, and a little  more poste-
 riorly; its thickness from  side to side is from eight to
 ten  lines, and from before backwards from  six  to
 eight, as the neck is somewhat compressed in that di-
 rection. In women who have borne children, the neck
 is thicker, more rounded, and the orifice is more open;
 its margin uneven and puckered, sometimes pre-
 sents one or two depressions, particularly at the left
 side.   The neck of  the  uterus  is about an inch in
 length, but it may be much more, which may lead to
 mistake, unless attention be paid to the projection
 formed by the two lips of the orifice, which will dis-
 tinguish this from any of the tumours developed in the
 uterus*
  Q.  Describe it in disease  ?
  A.  The observer should examine whether there is
 any hardness at the neck of the uterus, or in its vicini-
 ty: if there be a tumour,  whether it is hard or soft, is
 attached by a broad base, or slight pedicle : whether
 the orifice is dilated, giving passage to a tumour, fo-
 reign body, polypus, fungus, &c.: or whether it con-
 tains a fluid accumulated in it, as occurs  when the
menstrual flux is retained:  this maybe  ascertained
 by the fluctuation.  The  size and  weight of the
body  should  be ascertained,  also the  length of 
226     OF THE GENERATIVE SYSTEM.
the neck,  the state of the os tincae, its sensibili-
ty and temperature,  which  is sometimes  increas-
ed, as in hysteritis.   The nature of  the  fluid by
which the finger may  be stained should not be over-
looked, whether it is blood,  pus,  sanies;  what its
colour is, &c.  The touch will also ascertain the ex-
istence  of spasm  of  the vagina,  or its sphincter,
and the consequent accumulation of menstrual blood,
or mucus ;  it will distinguish tympanitis of the intes-
tine from that in the uterus, ascites from uterine or
ovarian dropsy, prolapsus of the vagina, or matrix
from hernia, and anteversion from retroversion of the
organ :  and in some instances, the diseases which oc-
cur in the cellular tissue surrounding the vagina and
rectum : in this last case, it becomes  necessary to in-
troduce the finger into the anus also.
  We cannot conclude these remarks without recom-
mending to the notice of the reader the speculum
uteri, constructed by M. Recamier some years since.
By means of it we can correct the errors and reme-
dy the deficiencies of the touch, and gain a view of
parts that seem totally removed beyond the reach of
inspection.
  Q. What phenomena are necessary to be attended
to in discovering the diseases of the womb ?
  A. After having examined  the state of the organ
itself, the inquirer should proceed to investigate the
sympathetic phenomena to which  its diseases give
rise.  The  following are the  points to which his at-
tention should be directed: the pain the patient suf-
fers, and its characters, whether it is pulsating, lan-
cinating, &c.;  its situation, and whether it is increas-
ed by pressure; whether any sense of weight is felt
in the rectum, or painful contractions in the uterus ;
whether the pain extends to the loins,  the region of
the sacrum, &c.; whether the menses are  more or
less abundant  than usual, or occur  at irregular peri-
ods ; the character of the evacuation, if it is pure, or
mixed with some other fluid; the existence of any
vaginal or uterine discharge, whether the patient has 
OF  THE  GENERATIVE  SYSTEM.      227
had children, or is pregnant at the present time; the
existence of any tumours in the abdomen, their pro-
bable cause, and  progress; if there be a fluctuation,
whether the fluid changes place as the patient varies
her position ; the existence of retention  or inconti-
nence of urine, and finally, the state of the digestive
function.  To complete what has been here suggest-
ed  on the examination of the abdomen, it remains
only to say a few words  on a peculiar state of that
cavity, which sometimes occurs, namely its hardness.
This condition sometimes  arises from the intestines
contracting adhesions with one another, or with the
peritoneum  lining the abdomen ; in such cases pres-
sure made on the parietes of the cavity will displace,
to  a  greater or  less extent, the contained viscera;
this occurs in chronic peritonitis.   The hardness, in
other instances, is caused by tumours in some  of its
regions,  and is then considerable,  unless the con-
tents are fluid, which  may  be  ascertained by the
fluctuation.   These tumours should be examined
with great care, to determine whether they pulsate ;
and if so, whether the pulsation is synchronous with
that of the pulse.  Each of the organs should be ex-
amined in detail as  well as the functions which they
perform, in  order that the positive information sup-
plied by the organ affected, may be strengthened by
the negative evidence  deduced from this investiga-
tion of the other  viscera.  This  is frequently the
only means  we possess of removing the difficulties
that beset the diagnosis of these obscure affections.
The hardness is sometimes diffused generally, whilst
the abdomen  becomes excessively sensitive:  then
gentle pressure should be  made on different parts to
ascertain the degree of their sensibility, the heat of
the skin, &c.   The  observer should enquire if the
bowels be constipated,  and examine the state of the
pulse which is usually small,  concentrated and fre-
quent ; vomiting sometimes occurs, this gives him oc-
casion to look at the colour of the tongue, and at the
same timejnote that it is broad at its extremity;  final- 
 228      OF THE GENERATIVE SYSTEM.

 ly, if the disease occurs in a female, it becomes ne-
 cessary to ascertain whether she did not lately lye-in.
 These symptoms decide the complaint to be peritoni-
 tis. We shall now conclude these remarks by stating
 the phenomena furnished by percussion.
   Q. Describe the effect of percussion.
   A. It gives different results according to the parts
 to which it is applied.  The sound  emitted  is some-
 times like that of a drum, and indicates the presence
 of some gaseous fluid in the intestines or peritoneum.
 We can generally ascertain its existence in the latter
 situation, by placing a stethoscope on the part which
 gives the tympanitic  sound, and then striking the ab-
 domen gently with the nails, when a very clear sound
 is heard, the character of which  is intermediate be-
 tween  the proper tympanitic sound, and that pro-
 duced by striking an  empty jar with  the finger.
   Percussion sometimes produces only an  obscure
 or altogether dull sound ; in which case, if the abdo-
 men be struck with one hand, whilst the other rests
 on an opposite point of it, the latter receives an im-
 pulse communicated by the fluid contained in the pe-
 ritoneum.
  In cases of effusion it becomes  necessary to ascer-
 tain  whether the fluctuation is sensible in every part
 of the abdomen, or is confined to  some  particular
 part of it, which is the sign of encysted dropsy.
  If the abdomen gives at its most prominent part a
tympanitic sound whilst the  patient  is lying down,
and if,  when he stands  erect, the sound is dull in the
depending parts, it indicates the existence of ascites,
together with flatus in  the intestines ; for these, by
their greater lightness, occupy the  higher situation,
when the fluid by its gravity sinks to the  lower.
  But if when the dropsy is considerable, a  fluctua-
tion is  perceived at the most prominent part of the
abdomen, whilst at the sides, towards which the in-
testines incline, the sound is tympanitic, we may infer
the existence of encysted dropsy.
  Q. Recapitulate  generally what has been said on
the diseases of the abdomen. 
           THE  GENEHATIVE  SYSTEM.        229

   A. In summing up the symptoms which character-
 ize the diseases of the abdominal viscera, we see
 that they differ according to the functions with which
 these organs are connected ;  and therefore, that it is
 in the disturbance of these functions, that we are to
 seek for the means of distinguishing them.
   Pressure is the first means which we ought to re-
 sort to, as by it we ascertain the seat of the pain, and
 the organ affected.  The patient, however, sometimes
 feels it himself from the commencement of the attack,
 and  points to its situation.  Its degree and  extent
 should  next  be  ascertained, namely whether it ex-
 tends over the cavity, or is confined to  some part of
 it; the heat of the surface should at the same time be
 noted.  Irritation of the stomach and transverse colon
 is  marked by increased sensibility in the epigastrium,
 that'of the Tver by pain in the hypochondrium and
 right shoulder—that of the small intestines and me-
 senteric glands,  by pain at the umbilicus—of the as-
cending and descending colon and  kidneys  by pain
in  the lumbar regions—of the ilium, coecum, and ova-
ria in females after accouchement, by pain in the iliac
fossae—and that of the bladder, uterus and rectum by-
 pain in the hypogastrium and perinaeum, and by the
 propensity to make water, or go to stool:  finally, pe-
 ritonitis is marked  by great sensibility all over the
 abdomen, increased by the slightest pressure, but
 this seldom exists to any such degree in inflammation
 of the digestive tube.
   Again, the observer  should attend to the state of
 the tongue, whether it  is moist or dry, white or red,
 clean, or coated—the state of the digestion, and the
 symptoms, which indicate the various lesions of the
 alimentary canal—if there be vomiting, what is the
 nature of the matter—also the appearance of the al-
 vine evacuations.  Diarrhoea indicates irritations in
 the large intestine,  whilst obstinate constipation fur-
 nishes grounds for suspecting the existence of perito-
 nitis, concurrently of course with the other indications
of this affection. He should ascertain whether the
   Vol. U.               U 
230       THE  GENERATIVE SYSTEM.
intestines are glued together, in which case by pres-
sure on the abdomen they are displaced, as it were,
"en masse:" this marks  chronic peritonitis.  When
percussion indicates a  fluctuation  in  the cavity, it
then becomes necessary to attend both to the present
symptoms and previous history, to determine whether
it  is an encysted dropsy  or ascites;  and if it be  the
latter, whether it is symptomatic of an  affection of
some organ in the abdomen or thorax, or depends on
chronic inflammation of  the peritoneum.*
  Pressure will determine the  presence in this cavity
of a tumour; its seat will pretty nearly mark the or-
gan affected, but not with positive certainty, for some-
times a viscus is drawn  somewhat out of its place, and
the pressure which it produces on the adjacent parts,
by disturbing their functions, will render the diagno-
sis obscure.
  Percussion will indicate the  degree of consistence
of these tumours, the sound being dull if they are so-
lid, and clear and tympanitic if they be produced by
an elastic fluid: finally, if the tumour pulsates, it will
be necessary to determine whether  the  pulsation is
produced by elevation of its whole mass, or by dilata-
tion  of its walls ;  if it be the latter,  and also synchro-
nous with the stroke of the heart,  it is refernble to
aneurism of the aorta.
  When any local  pain  or  particular symptom, any
accidental discharge, or alteration in the state of the
alvine evacuations, urine, or menstrual flux,  indicates
a derangement of the rectum,  uterus, or bladder, ex-

  • The state  of the muscles is often, of itself, sufficient to
mark the existence of irritation of the mucous membrane, even
without the aid of other symptoms, such as heat of skin, redness
of tongue, hcad-r.che, &c. On exposing the abdomen, and laying
the hand on its surface, the  muscles  are instantly thrown  into
action, and present their outlines distinctly and strongly mark-
ed.   It is  this tense and rigid state of the  muscles which  pre-
vents the indication  of sensibility, by bearing off the pressure
from (he subjacent parts. 
        EXAMINATION OF THE  TISSUES.     231

amination by the touch should be made, and if neces-
sary with the speculum above recommended.
  We cannot conclude these remarks on the methods
of examination applicable to affections of the three
cavities, without again urging the necessity of paying
to each of them a degree of attention proportioned
to its severity, and also to its complication with others.
It should not be forgotten that  the physician who
wishes to arrive at an accurate diagnosis, should not
be satisfied with examining the cavity which contains
the organ apparently affected, he ought to go farther,
and ascertain whether others are not affected  at the
same time ;  for symptoms are not merely the indica-
tion of a lesion of one organ—they are phenomena
common  to several—they are effects, with  whose
theory and cause we are but imperfectly acquainted;
the observer therefore should never omit examining
the three cavities; it js the only  means by which he
can  collect complete histories of cases, arrive at a
sure diagnosis, and practise his profession with suc-
cess.
METHOD OF EXAMINATION APPLICABLE TO  DERANGE-
         MENT OF THE  PHIMAHY TISSUES.

  Q. What are the rules to be observed  when the
disease exists in the skin, or is seated in the sub-cuta-
neous cellular texture ?
  A. The following rules will serve as a sufficient
guide to the observer in this investigation.
  The precise part of the skin that is affected should
first be stated; also whether the  disease is local—
confined to one or two spots, or is diffused over the
whole  surface.  Thus, for example, erysipelas in ge-
neral is found  only in some  particular part of the
skin, whilst zona encircles the whole trunk;  tinea
capitis attacks the hairy scalp, and measles and small
pox cover the entire surface of the body.   It is ne-
cessary to ascertain from the patient whether he ever
had the disease before, what part of the body  it oc- 
232     EXAMINATION  OF THE TISSUES.

cupied, whether it continued in one spot, or changed
its place, as so often occurs  in erysipelas.
  Any change of colour presented by the skin or mu-
cous membranes, should always be stated ;  also whe-
ther it is diffused,  and loses itself insensibly in the
adjacent parts, or is bounded by a defined line:  we
should also note  the  effect of  pressure upon it—for
in some cases the change of colour continues even
when it is pressed,  in others the blood flows back ra-
pidly into the capillary vessels of the part; and last-
ly, we sometimes find that this  occurs very slowly.
These  things  deserve attention, as indicating the
degree of activity in  the capillary circulation, and
the vitality of the part affected.   The  blood some-
times stagnates in  the capillary  vessels, assuming a
blue colour as we see in certain spots  on  the  skin:
sometimes, on the contrary, it is red, presents all the
characters of arterial blood, and gives to the skin a
bright red colour.  As, however, the various shades
of colour presented  by the  skin and mucous  mem-
branes are almost infinite, we shall not extend  these
remarks farther ; it is quite sufficient to indicate the
method of ascertaining and the necessity of attending
to them.
  When  we have to examine a case of eruptive fe-
ver, it is necessary, in the first place, to ascertain in
what part of the  body the eruption commenced, and
then the  parts to which  it gradually extended.  In
cases of small-pox  and varicella, we should always
examine those parts of the body which are not  ex-
posed to the atmospheric air, such as the arm-piti,
and loins, in order  to ascertain whether it exerts any
influence on the  progress of the  eruption:  attention
should also be directed to the roots of the hair, to
see whether the  pustules correspond with  the  pores
of the skin.  In every species of eruption, the colour
of the  areola  deserves notice as well as that of the
pustule, which present many shades caused by the
liquid which it contains:  when it is depressed  at its
centre, as occurs in small pox, we may ascertain  by 
         EXAMINATION OF THE  TISSUES.     233

 dissecting a pustule at an early  period whether the
 depression is  caused by a cellular band, whether  it
 consists of only one cell, or is divided into several.
   Tumefaction of the skin is either diffused or cir-
 cumscribed, and presents avast variety of characters
 according to the affections with which it is connected;
 thus in small  pox and varicella it assumes the  form
 of single or confluent pustules—in herpes, of irregu-
 lar crusts—in  erysipelas, of vesicles caused by the ef-
 fusion of a serous fluid under the epidermis—in em-
 physema, of an elastic swelling, which crepitates when
 pressed on.  In these different cases, the state of the
 skin, the extent of the swelling, and the effect of
 pressure upon it should be stated.
   When gangrene  occurs, we shtuild always ascer-
 tain whether the skin had  been  previously red and
 inflamed, or whether the disease commenced with  a
 black or white spot, and thence gradually extended
 to  the  neighbouring parts; the  general  symptoms
 should be attended  to, an inquiry  should be made to
 determine whether  the mortification  arose from ino-
 eulation of some morbid matter.
   In  some affections of the cellular texture and mu-
 cous  membranes, such as  furuncle, ophthalmia, &c.
 it is useful to ascertain whether the  patient had any
 previous attacks of the disease.   In exanthematous
 affections the  progress of the inflammation from one
 mucous membrane to another should be noted ;  thus
 it usually begins with the conjunctiva, and then  pro-
 ceeds from above downwards, successively attacking
 the nasal fossw, throat, trachea, and bronchi.
  Q.  How does pain indicate disease ?   v
  A.  The character of the pain often leads us to as-
 certain the seat of the affection, of Which the patient
 complains;  hence it should be particularly attended
 to.  The  effects of pressure on the skin should be
 noted, but in order to press it alone, it must be pinch-
 ed between the fingers, as otherwise we shall not be
able to determine whether the pain  arises from an
affection of the skin or of the  subcutaneous cellular
                      u 2 
234    EXAMINATION OF  THE TISSUES.

substance.  Pain of the skin is marked by a sensation
Of heat, itching, and tension—that of the cellular tex-
ture, on the contrary, is pungent and throbbing, but
both are fixed and limited to the seat of the disease.
When  the  mucous membrane is affected, it is quite
otherwise ; as the pain is sometimes felt  only at the
extremity of  the canal, there being no indication  of
it in any intermediate part; thus irritation  in  the blad-
der caused by the presence of a calculus,  is often in-
dicated only by pain at  the extremity of the glans pe-
nis; and irritation in the intestines, caused by worms,
is marked by  a sense of constriction in the throat,  or
itching at the nares, &c.
  The changes induced in the  secretion  of the mu-
cous membranes should be carefully examined ;  its
quantity may  be increased, or its colour and consist-
ence altered. The  observer should  ascertain the
temperature of the part affected, and also whether
the sensation  which the heat gives is parched or pun-
gent ;  if there be any  ulcerations, their appearance,
colour, state of the margins, as well as of the adjacent
parts,  should be noted.  In cases of exanthematous
eruptions, the cause which may  have produced them
should be  inquired into.  Whether it be epidemic,
contagious  by inoculation, or  the use  of  certain ali-
ments, such as muscles, lobsters, &c.  In  such cases,
attention should always  be paid to the state of the
mucous membranes, as  in these  the affection usually
commences, the skin being attacked but secondarily.
When  reporting the case, the day on which the fever
set in should  be stated  ; then the appearance of the
eruption, and the changes  induced in  the  previous
symptoms  at this  period: in the  next  place, the
time at which the suppurative stage began,  and
its effects on the system generally, which  are usually
manifested  by a new access of fever ; and  finally, the
process of  desquamation or desicalion.   In cases  of
small-pox, particularly when it is confluent, the state
of the  lungs and their membranes should  be indicat-
ed ; and when the disease terminates favourably, the 
              MUSCULAR SYSTEMS.          235

 state of the skin and  appearance of the cicatrices
 should not be overlooked.


 EXAMINATION  OF THE MUSCULAR, FIBROUS, SYNOVIAL,
          VASCULAR AND  NERVOUS SYSTEMS.

   Q. How is this to be effected ?
   A. After having  ascertained whether there exists
 any swelling,  heat, or redness, in the  integuments
 covering  the parts to which the patient  refers the
 pain, the observer proceeds to determine which of
 the  primary textures  is affected, viz.  the muscles,
 membranes, arteries, veins, nerves, or lymphatics.
   These  should be successively passed in review;
 the observer will have  to ascertain whether the arti-
 culations  are swollen, present symptoms of a fluid
 affused in their cavities, or of calcareous deposits.
 When the muscles are  sensible to  the touch, and
 when  motion  causes pain, it  becomes  necessary to
 learn the  character  of the latter; for if it consists in
 a sensation of dragging, tearing, or lassitude,  it indi-
 cates fibrous or synovial rheumatism.           •
   When the pain is felt along the course of the nerves,
 arteries, veins, or lymphatics, the observer should as-
 certain whether any tumor exists upon them, or whe-
 ther they give the  sensation merely of a hard cord
 sensible to pressure.  The pain in such cases is very
 variable in its character.  Sometimes it is marked by
 a shooting sensation taking the course of the  nerves
from the centre to the extremities, or vice versa;  in
 other cases there is a feeling  of numbness, heat, or
cold; and lastly, it may be continued, or may only
recur  at  intervals.  Its mode  of commencement
 should be stated, and also the effect produced upon
it by heat, cold, moisture, dryness, rest or motion; or
finally, by pressure applied to  the muscles or  in the
course of the nerves.  When the affection depends
on the puncture of a vein in bleeding, the pain and
 swelling extend  from  the wounded  point along the
course of  the vessel towards the heart. 
236      OF  THE COATS OF ARTERIES,
      OF THE BLOOD  VESSELS OF THE  SISTKM.
  Q.  How are the Blood Vessels of the human body
divided ?
  A.  Into Arteries  and Veins.
  Q.  What are  the general characters of the Arte-
ries ?
  A.  They are  elastic  tubes dispersed through the
whole body,  are  distinguished from Veins by their
pulsation, by the whiteness of their colour, and by the
thickness  of their coats.
  Q.  How many coats have the Arteries ?
  A.  Three ; the  external is membranous, or cellular;
the middle muscular, composed of transverse fibres
forming the segments of a circle interposed between
each other;  and  the inner  coal is remarkably thin,
smooth, and dense.  They are connected by fine cel-
lular substance.
  Q.  How do the Arteries receive their own nourish-
ment ?
  A.  Vessels termed Vasa Vasorum, sent from the
nearest small branches of arteries, are dispersed upon
the surface of the larger arteries and afford them nou-
rishment.
  Q.  Do the Arteries receive their Nerves and Lym-
phatics in  the same manner?
  A.  Yes: the nerves  in the neighbourhood give
small  twigs to the Arteries ; and the Lymphatics are
frequently so  numerous as to cover them.
  Q.  Have the Arteries any Valves in their internal
cavity ?
  A.  The only  Valves in the arterial system are those
at the commencement of the Aorta,  and Pulmonary
Artery.
  Q.  When an  artery divides into branches, does its
diameter diminish in  proportion to their size ?
  A.  Yes; the  trunk of the artery is diminished, but
the Areae of the branches conjunctly are nearly a
half larger than that of the trunk. 
AND OF THE VEINS.
2S7
  Q. Why is the Area of the capacity of the branches
larger than that of the trunk ?
  A. That the momentum  or velocity of the blood
may be continued the same  in the branches, where
the friction of their sides is much greater, as in the
trunk itself.
  Q. In what different  ways do the Arteries termi-
nate ?
  A. In four  ways ;  they terminate  in  Veins; in
Glands or Follicles; in Exhalants or  Capillary  ex-
tremities,  which open upon the internal surfaces, and
upon the  skin;  and  in Cells,  as those of the Pe-
nis, Clitoris,  Placenta, and Corpora  Cavernosa Va-
ginae.
  Q. What effect has the curvature of the arteries
on the movement of the blood ?
  A. Contrary to the opinion of Bichat, it must re-
tard it, since a certain degree of force is necessary to
straighten the tube, which, of course, must be  lost.
  Q. What is the effect of the dilatation and contrac-
tion of the arteries on the circulation ?
  A. The arteries dilated by the  impulse of the heart,
contract,  by their elasticity, and  drive on the blood
to the  smaller vessels.  This is proved by the fact
that ossification of the Aorta near the Iliacs, produces
mortification  in the toes, and also  by direct experi-
ments proving that when the impulse of the heart is
removed by putting a ligature round the thigh so as
not to compress the crural  artery and vein, and then
if another be put round the vein, and the artery be
pressed between  the fingers and the  vein be punc-
tured, the blood continues with an uniform jet, till the
artery is wholly emptied, when the flow ceases.
  Q.. Do the lymphatics and blood vessels directly
communicate ?
  A. Injections pass easily from one to the other.
  Q. What are the geperal characters of Veins ?
  A. They are flexible elastic tubes, capable of great-
er distention than arteries, and composed of thinner, 
238       COATS  OF THE ARTERIES,

and almost transparent coat9, through which the pur-
pie colour of the blood is conspicuous.
  Q. How many Coats have the Veins ?
  A. Three ;  an external cellular, a middle membra-
naceous, and  an internal firm,  compact, thin cOat.
These  coats,  however, are so intimately united to
each other, that some Anatomists  have considered
them only two, an external cellular, and an internal
membranous.
  Q. Are the Veins  of the same size and number as
their corresponding Arteries ?
  A. The size of the Veins is more than double that
of their corresponding Arteries, excepting the pul-
monary, bronchial, and renal  veins, which are rather
smaller.
  Q. How are the Valves in  Veins formed ?
  A. The Valves are formed  of semilunar folds of the
inner coat of  the veins,  placed in pairs  at ii regular
distances : they are concave next the heart, and when
applied to each other, prevent the  blood from flow-
ing along  the trunk towards  the extremity of the
veins.
  Q. Are Valves to be found in all the Veins ?
  A. No ; the veins of the Cranium, of the Thorax,
and of the Abdomen  want  Valves ; excepting the
Spermatic, and  Internal Mammary  Veins, and  the
Vena Azygos, which have Valves.   All the Veins of
the extremities, and of deep muscular parts, have nu-
merous Valves.
  Q,. What is meant by secretion ?
  A. It is a power in certain  glands and other parts,
of producing from the blood new fluids.
  Q. Enumerate the different secretions ?
  A. 1. The serous exhalation, which takes place in
the head, pleura and peritoneum, which prevents the
union of the viscera with their sides ; and that which
takes place between the fine plates of  the cellular
membrane, scattered  every  where throughout the
body, to assist the motions of the  parts.  2. The fat
intended for  different purposes,  in different parts 
              AND  OF THE  VEINS.         239

of the body;  on the  soles of the feet, to render
pressure easy, and to prevent the loss of the caloric of
the body.   3. The secretions of synovia in the joints
to lubricate them,   4. The mucous secretions on the
surface of the urethra, the intestines, the eye, nose,
ear, larynx, trachea, and  the  bronchiae, fauces, and
mouth.  5. The perspiration from the skin.
   PATHOLOGY OF THE  VASCULAR AND
              NERVOUS TISSUES.

                 ELEPHANTIASIS.
  Q. What are its symptoms ?
  A. Hani and permanent swelling, at first confined
to the lymphatics of the diseased part, commencing
with a fixed pain in  a cluster of glands,  or in the
course of  the  lymphatic  vessels; redness  and irre-
gular swelling, with difficulty of  motion.  When the
disease has lasted for a few days, the swelling disap-
pears, and returns again find again; the part becomes
harder and harder, at the same time sjnall irregular
tubercles are formed ; the feet, the  legs, the hands,
and the face, which are most  commonly affected in
this manner, lose all  shape, and are covered with
thick white  crusts,  or small ulcerations, which dis-
charge sanious matter.
  Q. What are its anatomical characters ?
  A. The lymphatic vessels and  glands swollen, dis-
coloured and softened; the coats of the former easily
torn, if we attempt to inject them : the cellular tissue
connecting these parts undergoes the same change,
and appears as if scirrhous.

      PHLEBITIP, OR INFLAMMATION OF VEINS.
  Q. What are its symptoms ?         *
  A. Pain and swelling in the course of the affected
vein, extending from the  point where it commenced
towards the  heart; the  cellular substance near the 
240     PATHOLOGY  OF THE  VASCULAR
part, and sometimes that of the whole limb swollen :
in the course of the vein a kind of cord is felt rolling
under the finger.  This affection  is generally produ-
ced by bleeding.
  Q. What are its anatomical characters ?
  A. On opening the body, the coats of the vein are
found thickened,  red,  and easily torn,  with pus
effused into  its cavity.  The inflammation generally
extends more towards the heart than in the opposite
direction.

                   NEURALGIA.
  Q. What are its symptoms ?
  A. Fixed pain in the trunk,  or branch of a  nerve
extending along  its course, speedily changing from
one part to another, sometimes affecting all together,
or confined  to one or two branches.  The pain is
very various: an  icy coldness  is complained  of by
some, or burning heat, disagreeable numbness, sense
of touch impaired, or a kind  of electric shock ; in
others we have lacerating or quick lancinating  pains,
transitory pricklings, or  permanent pulsations.   This
pain is very irregular, its paroxysms coming on gene-
rally  without  any evident  cause.  Pressure of the
nerve or its filaments in  the most violent paroxysms
rather lessens the pain,  or if it  should cause any,
none of the characteristic marks  of neuralgia are ob-
served ; it is rather a slight numbness of the part
which is pressed, but never that lancinating pain in
the course of the nerve.   No alteration can be  ob-
served in the integuments of the  affected part; heat,
in some  instances, lessens  the  pain, in others, in-
creases  it;  in the latter  case,  cold affords  relief.
Neuralgia may change instantaneously from one nerve
to another ;  it may attack any nerve in the body, but
as its symptoms are  alway s the  same, we shall only
speak of its chief varieties.  Neuralgia may be con-
founded with inflammation of the nerve, or certain
rheumatic affections. 
            AND NERVOUS  TISSUES.         241

   Q. What are the symptoms of Neuralgia of the
facial nerves ?
   A. Pain in some facial branch of the portio dura of
the  seventh pair, or in some of  the numerous divi-
sions of the fifth.  This species  is generally inter-
mittent,  and accompanied with the most violent and
variable pains, and all  the characteristic phenomena
of which we have given an account. The paroxysms
are commonly very short, but recur very frequently.
   Q. What are the  symptoms of Neuralgia  (Ileo-
scrotal) ?
   A. Of very rare occurrence, situated in the second
branch of the first pair of lumbar  nerves.  The pain
commences at the crest of the ilium,  extends to the
spermatic cord,  to the  scrotum, attended by  contrac-
tion of this covering and retraction of  the testicles.
   Q. What are the symptoms of Sciatica ?
   A. Pain extending from the ischiatic notch,  along
the posterior part of the thigh, to the ham ;  then- af-
fecting the  knee, from that  to the leg, on its fibular
side, and terminating in the calf.
   Q. What are the symptoms of Neuralgia cruralis ?
   A. Pain following the  course of the crural nerve,
from Poupart's ligament on the inside of the leg to
the dorsum of the foot.
   Q. What are the symptoms of Neuralgia (cubito
digital) ?
   A. Pain from the internal condyle of the humerus,
to the dorsal or palmar regions of the  fore-arm.
   Q. What are its anatomical characters ?
   A. No alteration can be perceived  in the  affected
parts.

          INFLAMMATION OF  THE  NERVES.
   Q,. What are its symptoms ?
   A. A  fixed,  lacerating, numbing,  or lancinating
pain in the trunk,  or  branch of a nerve, increased
very much by  pressure, but unaccompanied by the
various.characteristics  of neuralgia; it  is generally
continued, or its remissions are not well marked ; in
   Vol. 11.               X 
 242       PULMONARY CIRCULATION.

 some instances a slight swelling of the nerve may be
 observed.
  Q.  What are the  diseases with which it may  be
 confounded ?
  A.  They are neuralgia and certain rheumatic af-
 fections.
  Morbid appearance, more or less marked, redness
 of the nervous tissue, with injection of its vessels, or
 of those of the surrounding cellular substance ; par-
 tial ecchymosis ; sero-sanguineous or  sero-purulent
 effusion in the nervous filaments: sometimes thick
 pus is found in the nerve.  A few cases are related, in
 which the  nerves were found gangrenous in many
 points;  even small tumours like tubercles are said to
 have formed in the  nervous tissue, or between the
 filaments of the nerve.

      OF THE PULMONARY  ARTERY AND VEINS.
  Q..  Repeat the course of the Pulmonary Artery?
  A.  It arises from the right Ventricle of the Heart,
 ascends inclining to  the left to the arch of the Aorta,
 divides into right and left branches, which accompany
 the bronchial tubes,  and divide again and again into
 numerous branches,  that ultimately become very mi-
 nute,  and have their terminations  spread round the
 Bronchial Cells.
  Q.  Repeat the course also of the Pulmonary Veins?
  A. Their extremities being very small, receive the
blood from the minute extremities of the Pulmonary
 Artery,  unite  repeatedly  and form larger trunks,
 which accompany their corresponding arteries; all
the veins of each Lung ultimately unite, and form two
trunks, which  uniting with  the two trunks of the
other  Lung, terminate  in the  left Auricle  of  the
 Heart.
  Q.  What happens  to the blood circulating through
the Lungs?
  A. The whole blood of the body is gradually sent
through the Lungs, where  it comes nearly in contact
 with the atmospherical air, the thin membrane of the 
OF  THE  CORONARY  VESSELS.      243
cells only  intervening: notwithstanding this mem-
brane it comes within the sphere of attraction of Che-
mical Affinity;  the  Oxygen of the  air attracts  the
Carbon from the blood, which immediately becomes
more florid, has also its  capacity increased  for re-
ceiving the Caloric, disengaged from  the Oxygen
changing its state of combination in the air-cells. The
blood  now  becomes arterial, and is fitted for being
again transmitted by the arteries through the  sys-
tem.

        OF  THE AORTA AND  ITS BRANCHES.
  Q. Describe the origin and course  of the Aorta ?
  A. It arises from the left Ventricle of the Heart,
turns rather to the right, ascends backwards and to-
wards the left, as far as the top of the thorax, where
it  is reflected  obliquely  backwards over the  left
branch of the Trachea, and  then descends, running
close upon the  vertebrae ; thus forming the Arch of
the Aorta.
  Q. What Arteries does the Aorta  first send off?
  A. The two Coronary Arteries, which arise im-
mediately above the Semilunar Valves at the origin
of the Aorta.
  Q,, What is their  course ?
  A. The right Coronary Artery is the larger, runs
in a groove between the right Auricle and Ventricle,
and is distributed  upon the right side  of the heart:
the left being divided, runs  partly between  the left
Auricle and Ventricle,  and partly between the Ven-
tricles on  the fore  part, is distributed upon  the left
side of the heart, and anastomoses  very freely7 with
the right Coronary.
  Q. How many Coronary Veins are there ?
  A. By far the greater part of the  Coronary Veins,
after uniting together  repeatedly,  form one trunk,
termed the Great  Coronary Vein, which terminates
in the under part of the right Auricle, where its ori-
fice is covered by a  semilunar Valve. 
244     BRANCHES  OF THE  EXTERNAL
  Q.  What Arteries arise from the Curvature or Arch
of the Aorta?
  A.  From the upper or convex part of the Arch,
three large  Arteries arise, viz. the Arteria lnnomi-
nata  on the right side, which -soon divides into the .
right  Carotid, and right  Subclavian ; andon the left,
the left Carotid, and left  Subclavian.
  Q.  Describe the course and division of the Carotid
Arteries ?
  A.  On each side of the Trachea they ascend be-
tween the cervical vertebrae and the sterno-mastoidei
muscles, diverging a little from each other, till they
reach the upper part of the Larynx, opposite to the
Os Hyoides, where they  divide into external and in-
ternal Carotids.
  Q. How many principal branches does the Exter-
nal Carotid send off ?
  A.  The External Carotid is smaller than the Inter-
nal, and seems a continuation of the common trunk ;
it sends off seven Arteries, viz. the Superior Laryn-
geal,  or Superior Thyroid ; the Lingual; the Facial;
the Inferior  Pharyngeal; the Occipital; the Poste-
rior Auris; and the Internal Maxillary ; the trunk it-
self,  ascending under the  Zygoma, on the Temples,
is named the temporal artery.
  Q.  These  arteries  may be divided into three or-
ders ; do so ?
  A.  The first order may comprehend those running
forward,to the Thyroid Gland, to the Tongue, and to
the  Face ; namely, the  Superior Thyroid,  Lingual,
and  Facial,  which are much exposed, and are ,the
subject of many particular  operations.  The second
order comprehends the three smaller arteries running
backwards and inwards to the Pharynx, the Occiput,
and the  Ear, namely, the  Inferior Pharyngeal, the
Occipital, and the Posterior Auris; which  run  so
deep, that wounds in them are rare.  The third or-
der comprehends those running to the inside of the
Jaws, and to the Temples, namely, the Internal Max- 
               CAROTID ARTERY.           245

illary, and the Temporal, which are of great impor-
tance, and should be well known.
  Q. Describe the Superior Thyroid  Artery?
  A. It is named also Superior Laryngeal, Superior
Guttural, it is large, and comes off just after the di-
vision of the Carotids ;  it runs downwards and for-
wards in a very tortuous form, and sends branches to
the Os Hyoides and contiguous parts, to the Thyroid
Cartilage ; sends off the Laryngeal branch, and the
trunk itself is dispersed in the Thyroid Gland.
  0_. Describe the Lingual Arteiiy ?
  A. The Arteria Lingualis comes off immediately
above the Thyroid, runs forwards and upwards along
the side of the tongue,  sends  a branch to the Pha-
rynx; the ramus hyoideus to  the muscles between
the tongue and the larynx ; the dorsalis linguae to the
fauces, amygdala, epiglottis, and pharynx; the ramus
sublingualis  to the  sublingual gland  and adjacent
muscles; and  the ramus raninus  to  the apex of the
tongue.
  Q. Describe the Facial or Angular Artery, cal-
led also External Maxillary, or Labial ?
  A. The Facial or Labial Artery runs forwards deep
under the Stylo-hyoideus, and tendon of the Digastric
muscles, perforates the  submaxillary gland, is very
tortuous, mounts suddenly in a circular turn over the
lower jaw at the under and fore part of the M issett r,
then ascends tortuous  b'y*the side of the nose, to-
wartls the inner angle of the eye.   In its course it
sends off the Palatina Inferior vel Ascendens to the
velum palati, and parts near it ; several small twigs
to the tonsil, tongue, inferior maxillary gland,  mus-
cles, and skin ; the  Submentalis to the muscles and
adjacent parts ; the Inferior Labial to the  under lip;
the Inferior and Superior Coronary to  the margin of
the lips: the trunk is then divided and spent upon
the cheek and nose.
  Q.. Describe the inferior or ascending pharyngeal
artery ?
  A. This is a small arterv, which arises near the
                       x2 
 246           BRANCHES OF THE

 Lingual, runs upwards deep in the neck, and sends
 twigs to the pharynx, fauces, and base of the skull,
 where some of them enter the foramina, and are dis-
 persed upon the Dura Mater : twigs are also sent to
 the sterno-mastoideus, and neighbouring glands.
   Q.  Describe the Occipital Artery ?
   A.  It arises  next the Pharyngeal  from the  back
 part of the Carotid, runs close upon  the bones, then
 over  the Internal Jugular Vein,  then between the
 transverse process of the  Atlas  and Mastoid  Pro-
 cess ; it passes under the bellies of the Digastric, Tra-
 chelo-mastoideus, Splenius, and Complexus muscles,
 and becomes superficial near the middle ridge of the
 occiput, where it rises with many beautiful branches.
 It is very tortuous, and in its course gives off' branch.
 es to the muscles already named, and to the glands ;
 a branch, which runs  backwards along the jugular
 vein,  enters the cranium  by the foramen lacerum
 posterius, and is dispersed upon the under and back
 part of the Dura Muter under the lobes of the Cere-
 bellum : it, when among the muscles, sends down a
 long branch, which inosculates with a branch of the
 Axillary Artery, and also with the Vertebral Artery
 through the interstices of the vertebrae.
  Q.  Describe the Posterior Aums ?
  A.  This artery sometimes comes off' from the  Oc-
 cipital, or Pharyngeal, orjs sometimes wanting.   It
 comes off from the  CardWd, very high in the  sub-
stance of the Parotid Gland, passes across  under  the
styloid process, then over the belly of the digastric,
and lastly, runs up behind the ear.   It semis small
branches to the Parotid Gland, Digastric, und Sterno-
mastoid muscles, to the Meatus Auditorius externus,
to the Membrana Tympani, and the Slylo-mustoid
branch goes through the Foramen  Stylo-niastoideum
to the Internal Ear and Tympanum : while the trunk
itself is dispersed upon the back part of the ear, and
side of the head.
  Q. Describe the origin and course of the Ixteknal
 Maxillary Artery ? 
          EXTERNAL CAROTID ARTERY.      247

   A. The Carotid passes up through  the Parotid
 Gland; and the Internal Maxillary comes off from it,
 embedded in this gland, behind the broad plate,
 whence the condyloid and coronoid processes of the
 inferior Maxilla arise.  It passes  between  the  jaw,
 and external  Pterygoid muscle, then ascends  in a
 very tortuous manner to the back of the Maxillary
 Antrum, and there terminates in numerous branches.
   (i. Enumerate the principal branches of the In-
 ternal .Ifaxillary Artery.
   A. It first sends  a number of twigs to the external
 ear, to the glands near it, one enters the Tympanum
 by the fissura Glassevi,to the muscles of the Malleus,
 and some-times one through the Foramen Ovale to
 tiie Dura Mater.   The Internal Maxillary Artery then
 sends off seven branches, viz. the Meningeal or Mid-
 dle Artery of the Dura Maier,\/\\\ch [-asses between
 the external and internal Carotids, then through the
 Foramen Spinale of the sphenoid bone, and ramifies
 beautifully over  the surface of the Dura Mater, and
 inside of the Parietal bone, sending twigs to the  sub-
stance of the bone and internal ear: Secondly,  The
Inferior Maxillary Artery, which enters the Foramen
Maxillare  I'osteritis, runs along the Inferior Maxilla-
ry canal, sends off'twigs  to the teeth, and substance
of the jaw, and ultimately emerges by the Foramen
 Menti to be distributed  upon the  chin;  it gives off
small branches to the  Pterygoid, Masseter, and Tem-
poral muscles as it passes into the canal:  Thirdly,
The Alveolar Artery,  which runs  round  behind the
Antrum in very tortuous branches, some of which go
to the soft parts, others to the substance of the bones,
to the Antrum, and to the back teeth; the  proper
trunk enters  into the substance of the jaw, runs in
the Canal, and gives  branches to the other teeth:
Fourthly,  The Infra-Orbitar Artery, which runs in
the canal  under  the orbit, gives off small branches
to the soft parts, the substance of the bone, the an-
trum maxillare, and fore-teeth, and then emerges by
the Foramen lnfra-Oibitarium to be dispersed upon 
248     BRANCHES OF THE EXTERNAL

the cheek: Fifthly, The Palatino-Maxillary Artery,
which passes through the Foramen Palatinum poste-
rius, runs between the bony antl fleshy parts of the
palate, sending twigs to them, and to the sockets of
the teeth; it then frequently turns  up through the
Foramen  Incisivum  into the  cavity  of the  nose:
Sixthly,  The Superior Phamygeal,  which is  small,
and comes off at the back of the orbit, it is dispersed
upon the pharynx and adjacent parts, a twig runs to-
wards the Pterygoid or Vidian hole, where it inoscu-
lates with a  branch from the Internal  Carotid : and
lastly,  The Lateral Nasal Artery, which passes
through the Foramen Spheno-palatinum into the up-
per and back part of the nostril, where it divides into
branches, of which one  goes to the posterior Eth-
moid cells, another to the cells of the Sphenoid bone,
a third  to the. back  part of the septum  narium, a
fourth passing through the spongy bones to the bot-
tom of the nose, gives twigs to the mucous  mem-
brane,  to the Antrum  Maxillare, and  inosculates
with the termination of the Palato-Maxillary coming
through /the Foramen Incisivum.
  Q. Describe the course of the Temporal Artery ?
  A. After the trunk of the external Carotid gives
off the  arteries already described, it emerges  from
the substance of the Parotid  Gland,  between the
Meatus Auditorius and root of  the  Zygoma, and is
afterwards named the Temporal Artery, which  forms
some sharp turns before  the ear; and a little above
the Zygoma, where its pulsation can be felt, it divides
into an anterior and a posterior  branch, which  run
superficially between the aponeurosis of the tempo-
ral  muscle and the integuments, and are distributed
upon the brow, and side  of the head.
  Q. Describe the branches sent off from the Temporal
Artery?
  A. The Temporal Artery first gives off several
branches to the Parotid Gland ; then the Transversa-
lis Faciei of considerable size, which runs across the
cheek in  the direction of the Parotid Duct,  gives 
       AND INTEIINAL CAROTID ARTERIES.  249

twigs to the parotid gland, to the articulation of the
jaw, the masseter and buccinator muscles, and inos-
culates with the facial and internal maxillary arteries:
then  the Articular Artery, which sends branches to
the articulation of the jaw, to the external meatus, and
membrana tympani, and penetrates into the internal
ear: then the Deep Temporal, which ascends obliquely
forwards under the aponeurosis of the temporal mus-
cle to the outer part of the orbit: then the Anterior Au-
ricular branches, which are dispersed upon the fore
part of the ear, and inosculating with the Posterior
Auris, and then small twigs to the masseter.
  O..  What is the distribution of the Anterior Tem-
poral ?
  A.  It is ramified in a very serpentine manner upon
the side  of the forehead,  as  far down as the orbit
where it inosculates with the Facial, and upwards to
the Sagittal Suture, where it communicates with its
fellow of the  opposite side.  It is dispersed in the in-
teguments and muscles.
  Q.  What is the  distribution of the Posterior Tem-
poral?
  A.  It seems the continuation of the trunk, ascends
obliquely  backwards, is distributed to the muscles
and integuments, inosculates with the Anterior, with
the Occipital  of the same side, and with  its fellow of
the opposite  side of the head; from all which,  nu-
merous small branches  are sent to the Pericranium,
substance of the bones, and even through the Sutures
in young subjects to the Dura Mater.

             OF THE INTERNAL CAROTID.
  Q.  Describe the  course  of the Internal Carotid
into the cranium ?
  A.  The Internal Carotid is very tortuous  in its as-
cent, is inclosed in the same sheath with the Par  Va-
gum antl Great Intercostal  Nerves; at the base of the
cranium, it makes  a bend  forwards in entering  the
Carotic Canal, then upwards, again  forwards, then
upwards and forwards to emerge from the canal; af- 
250         THE INTERNAL CAROTID

ter it leaves the canal, it turns upwards and then for-
wards by the side of the Sella Turcica, perforates the
Dura  Mater at the root of the anterior Clinoid Pro-
cess, and then bends backwards and upwards, where
it divides into branches.
  Q. What branches does the Internal Carotid Artery
send off?
  A. The Arteria Ophthalmica; Arteria  Communi-
cans cum Vertebrali; the Anterior Cerebri; and the
Media Cerebri.
  Q. Describe  the course and terminations of the
OPHTHALMIC ARTERY ?
  A. It enters the Foramen Opticum ; passes under
the Optic Nerve towards the outer part of the  orbit;
it then takes a spiral turn towards the nose, and gives
off the Arteria Lachrymalis to the  lachrymal  gland
and adjacent parts ; the Centralis Retinae, which pe-
netrates  the  optic nerve, runs  in  its  centre,  and
spreads out into numerous small branches upon the
inside of the Retina ; the Ciliares sent to the coats,
the iris, and ciliary processes; the Muscularis Supe-
rior and Inferior dispersed upon  the muscles,  mem-
branes, and fat of the eye ; the Ethmoidalis Anterior,
and Posterior, which  pass through the Foramina Or-
bitaria Interna,  anterius and posterius, to the nose,
the frontal, ethmoidal,  and sphenoidal sinuses;  and
the trunk itself of the Ophthalmic^emerges from the
socket of the  eye,  passes  through the Foramen
Supra-orbitarium, is then named the Frontalis, and is
dispersed upon  the forehead.
  Q. Describe the Arteria Communicans cum Ver-
TEBRALI?
  A. It goes directly baokwards from the trunk of the
Internal Carotid, and meets the posterior cerebral
branch of the Vertebral Artery,  and thus forms an
important communication between the Middle Arte-
ry of  the brain, which  is the trunk of the Internal
Carotid, and the Posterior Artery, which  is the lar-
gest branch, of the vertebral.
  Q. Describe the Anterior Cerebri?
\ 
AND VERTEBRAL ARTERIES.      25 1
   A.  This, called sometimes Arterior  Callosa, goes
 off from the Middle Artery or trunk, at nearly a right
 angle forwards, turns in towards its fellow, and they
 become almost contiguous near the fore part of the
 union of the Optic Nerves,  where they anastomose
 by means of a short, but large Transverse Branch :
 the Anterior Cerebri is dispersed through the Ante-
 rior Lobe of the  Brain, and is reflected backwards
 upon the Corpus Callosum.
   Q. Describe the Arteria Media Cerebri  ?
   A. This Artery, called also Arteria Fossae Sylvii,
 runs outwards  to the lateral part of the brain, along
 the  Fossa Sylvii,  is tiie trunk of the Carotid conti-
 nued,  and is distributed chiefly to the Middle Lobe,
 but  it also gives branches to the  Anterior and Pos-
 terior  Lobes ;  it inosculates with its fellow, with the
 Anterior  Cerebri,  and with branches of the  Basilar
 Artery.

           OF  THE VBRTEBRAL ARTERIES.
   Q. What other Arteries are sent to the brain ?    '
   A. The Vertebral Artery on each side, being very
 little smaller than the Internal Carotid.
   Q. Describe  the origin and course of the Vertebral
 Arteries ?
   A. They arise from the Subclavian Arteries, and in
 a  short space, each on its own side, enter the Canal
 formed by the perforations in the transverse processes
 of the cervical  vertebrae, ascends  in nearly a straight
 direction to the second vertebra, where it turns late-
 rad ; in passing from the Dentata to the Atlas it bends
 still more  laterad and forward ; after passing the per-
 forations of the Atlas,  it turns suddenly backwards
runs horizontally in a groove of the Atlas, turns up-
wards into the Foramen Magnum, perforates the Dura
Mater,  enters the Cranium, inclines towards its  fellow,
and at  the beginning of the  Medulla Oblongata, the
two  Vertebral  Arteries  unite, and form  the Basilar
Artery. 
252       ARTERIES  OF TIIE  HRAtN,

  Q.  Why do the Vertebral Arteries form such turn-
ings before they enter the Cranium ?
  A.  By these  windings they are accommodated to
the motions of the head without any risk of their  be-
ing ruptured from over extension ;  but chiefly that
the impetus or force of the circulating blood may be
much diminished by those various and sudden  turn-
ings, before it enters the tender and delicate substance
of the brain.
  Q.  Do the  Vertebral Arteries send off any branches
during their ascent in the neck ?
  A. Yes; they send some twigs outwards, between
the vertebrae to the deep-seated muscles;  and others
inwards by the  holes  which transmit the Cervical
Nerves to the Spinal Marrow, and its membranes.
  Q.  Do the Vertebral Arteries send off any branches
where they enter the Cranium, before they form the
Basilar ?
  A. Yes;  each Vertebral Artery sends off the Pos-
terior  Meningeal to the posterior part of  the  Dura
Mater, twigs to the Medulla Oblongata, and frequent-
ly the Posterior Artery of the Spinal Marrow : near
its junction with its fellow, it sends down the Anterior
Artery of the Spinal Marrow.
  Q. Describe the Arteria Basilaris ?
  A. The Basilar Artery runs up between the basilar
aspect of the Tuber Annulare,  which it  impresses,
and the Cuneiform Process of the occipital bone ; at
the upper and fore part of the Tuber, it divides into
four branches, two to each side, namely, the Anterior
or Superior Cerebelli, and the Posterior, or Profunda
Cerebri.
  Q. Does the Basilar Artery send off any branches
before its division into  right and left branches ?
  A.  Yes ; from its sides several small twigs are sent
off to  the Tuber and adjacent parts ;  and one larger
than the rest, called Auditoria Interna, enters the  ca-
nal of the Portio Dura on each side, is spread on the
Vestible, Semi-circular Canals, and Cochlea.
  Q. Describe the Anterior or Superior Cerebelli ? 
             AND THE  SUBCLAVIAN.         253

  A. It turns round the crura cerebri, gives branches
to the Nates, Testes, and upper part of the Cerebel-
lum, and is dispersed in its substance.
  Q. Describe the Posterior or Profunda Cerebri?
  A. This Artery is rather larger than the former, is
distributed chiefly through the Posterior Lobe of the
brain on each side ; sends a considerable branch into
the posterior corner of the Lateral Ventricle, whicli,
inosculates with branches of the  Caroiid,  and forms
the posterior Arteries  of the Choroid Plexus;  near
its root it receives the  Communicating Artery from
the Carotid,  and  this union  forms  the  Circle of
Willis.
  Q.  Mention particularly how the  Circle of Willis
is formed ?
  A.  The two Anterior Arteries of the Brain, near
the fore part of the junction of the Optic Nerves, have
a free communication by means of a short large trans-
verse branch, proceeding from the  one to the other.
This forms the anterior part of the Arterial communi-
cation, called a Circle.  The communicating Arteries
running on each side between the Internal Carotids,
and the two Posterior Arteries of the Brain, form the
sides of the Circle ; and the Posterior Arteries them-
selves issuing from the Basilar Artery, form the  pos-
terior part of the Arterial communication,  or Circle,
as it is called.
  Q.  What purpose does such a communication serve ?
  A.  It seems calculated to guard against accidents,
which might  obstruct  the flow of blood in the Caro-
tids,  or in the vertebrals  in different  cases.  For
should the one Carotid be obstructed by Aneurism,
or by a Tumour pressing upon it,  the other, commu-
nicating with  the two Vertebral Arteries by the Circle
of Willis, would supply the deficiency of blood in the
brain, and vice versa.

           OF THE SUBCLAVIAN ARTERY.

  Q.  Describe the course of the Subclavian Artery?
  A.  The Subclavian arises from the Arch  of the
  Vol. II.              Y 
254
THE BRANCHES  OF
Aorta on the left side, and from the Arteria Innomi-
nata on the right, ascends  to the upper part of the
thorax, then passes transversely outwards behind the
origin of the  Sterno-mastoideus, then between the
Anterior and  Middle Scaleni, and between  the Sub-
clavian muscle,- and  first rib ;  which it  crosses, and
passes finder the Pectoral muscles into the Axilla,
where it is called the Axillary Artery.
  Q. What branches does the  Subclavian Artery on
each side send off upwards ?
  A. Five; the Vertebralis, Thyroidea  Inferior, or
Gutteralis, Cervicalis Anterior, Cervicalis Posterior,
and Dorsalis Superior Scapulae.
  Q. What branches does the Subclavian  send off
downwards ?
  A.  Two; the Mammaria Interna, and the  Intercos-
talis Superior.
  Q.  Describe the course of the Thyroidea Inferior,
as the Vertebral has been already described.
  A.  The Inferior Thyroid Artery ascends in a wind-
ing manner obliquely inwards behind the Carotid, and
is chiefly dispersed through the Thyroid Gland, inos-
culating freely with the Superior Thyroid, or Laryn-
geal Artery.
  Q.  What branches does the  Inferior Thyroid give
off in its ascent ?
  A.  It  sends  branches to the Trachea, which de-
scend into the thorax, and  inosculate with the Bron-
chial Arteries ;  it sends branches also to the  Oesopha-
gus, Pharynx, and Larynx.
  Q. To what parts are the Cervicalis Anterior, and
Posterior, distributed ?
  A. Tothe muscles, glands, nerves, and  integuments
of the neck: the Anterior sends twigs through the
inter-vertebral  foramina, where the  cervical nerves
pass out, to communicate to the Spinal Arteries ; the
Posterior sends a principal branch downwards to the
parts about  the top  of the shoulder,  and upper and
lateral parts of the thorax; while both  anastomose
with the Vertebral and Occipital Arteries. 
           THE SUBCLAVIAN ARTERY.       255

   Q.  Describe the course and distribution of the Dor-
salis Superior Scapulae.
   A.  The Superior Dorsal of the Scapula runs trans-
versely behind the origin of the Sterno-mastoideus,
perforates the notch in the superior costa of the Sca-
pula,  and disperses its branches through the muscles
on the dorsum of the Scapula ; it also sends branches
to the shoulder-joint.
   Q.  Describe the course  and  distribution  of  the
Mammaria Interna.
   A.  The  Internal Mammary Artery  descends  be-
tween the pleura and cartilages of  the true ribs, and
between the internal Intercostal and  Sterno-costal
muscles, perforates the Diaphragm under  the carti-
lage of the seventh rib, and is dispersed upon the pos-
terior surface of the Rectus, and Obliqui Abdominis,
muscles.
   Q.  What branches does the Internal Mammary send
off in its descent ?
   A.  It  gives branches to the integuments near the
Clavicle, to the Thymus Gland, to the  Mediastinum,
to the Pericardium, to the  Diaphragm; and exter-
nally,  to the Mamma,  Pectoral muscles, and integu-
ments.
   Q.  What are the principal communications of the In*
ternal Mammary Artery ?
   A.  It inosculates freely  with the external tho-
racics, the Intercostals, the Phrenics,  and the Epi-
gastric.
   Q.  Describe the  course of the Inter-costaUs  Supe-
rior ?
   A.  The superior Intercostal descends near the ver-
tebrae, and divides into two or three branches, which
run forwards in the superior intercostal spaces corres-
ponding  to their number.
   Q.  Why do the superior  intercostal spaces not
receive their Arteries  from the same  source as the
inferior?
  A.  Because  the Aorta, after forming the arch, has
not come near to the spine until it descends to the 
256     BRANCHES OF THE AXILLART

third or fourth dorsal vertebra, where it gives off tho
Inferior Intercostals ; whereas the Subclavian Artery
lies near to the head of the first rib, where, in conse-
quence, it sends, off the  Superior Intercostal  to sup-
ply the two or three upper intercostal  spaces.

            OF THE AXILLARY ARTERY.
  Q. What is the situation of the Axillary Artery ?
  A. It lies in the Axilla between the  Subscapulars
and Serratus  Major,  is surrounded  by lymphatic
glands, veins, nerves, and fat.
  Q. What branches does the Axillary  Artery send
off?
  A. Four or six thoracics,  the Scapularis Interna,
Dorsalis Scapulae Inferior, the Circumflexa Anterior,
and Posterior.
  Q. Describe the Thoracic Arteries.
  A. These arteries vary in number and origin ; but
they are generally from  four to six. They sometimes
arise by two or three trunks,  and branch out from one
another: they are dispersed through the muscles ly-
ing upon the thorax ; one longer than  the rest,  some-
times  called  External Mammary,  is distributed
through  the Mamma.   They  inosculate  with the
Intercostals, and Internal Mammary, and with each
other.
  Q. Describe the Scapularis Interna.
  A. It is also named Subscapularis; it often sends off
the Dorsalis Scapulae Inferior; it is large, and runs
near the inferior costa of the Scapula, gives off seve-
ral large branches  to the Subscapular muscle, the
Teres  major, Latissimus dorsi, and to the joint and
parts near it.
  Q. Describe the Dorsalis Scapulae Inferior.
  A. It turns round near the cervix of the Scapula to
the fossa infra-spinata, and spreads out into branches
among the muscles upon the posterior  surface of the
Scapula.
  Q. Describe the Circumflexa Anterior, vel  Articu-
lar* t. 
AND HUMERAL ARTERIES.        257
    A. It arises from the  Axillary,  runs transversely
  round the fore part of the joint between the os hu-
  meri, and the heads of the Coraco-brachialis and Bi-
  ceps, is dispersed upon the Capsular Ligament, Peri-
  osteum, and muscles covering the joint.
   Q. Describe also  the  Circumflexa, vel ArHcularis
  Posterior.
   A. It is larger than the former, passes between the
  Sub-scapularis and  Teres Major to get to the joint;
 it  then turns round backwards, between the os hu-
 meri and long head  of the Triceps and Deltoid, gives
 branches to the joint, and adjacent muscles; and an-
 astomoses freely with the  Anterior Circumflex.

             OF TnE HUMERAL ARTERY.
   Q.. Describe the Humeral or Brachial Artery.
   A. When the Axillary Artery  passes down below
 the edge of the tendon of the Pectoralis Major, it is
 called the Humeral or Brachial Artery, which is con-
 tinued down the inner side of the humerus, until its
 division into the Radial and Ulnar Arteries.
   Q. Where does its division take place ?
   A. The exact place is uncertain, being sometimes
 higher and sometimes lower;  but in general it divides
 near to the bend of the elbow joint.
   Q. What is the course of the Brachial Artery ?
   A. It runs along the inner side of the Biceps before,
 and the Triceps behind,  covered by the tendinous
 Aponeurosis, and giving off branches to the muscles
 in its course.
  Q. What principal branches  does it send off?
  A. The Brachial  Artery sends off three:  the Pro-
 funda Humeri Superior vel Spiralis; Profunda Infe-
 rior vel Minor ;  and the Ramus Anastomoticus.
  Q. Describe the Profunda Humeri Superior.
  A. It arises opposite to the  insertion of the Teres
 Major and Latissimus Dorsi, runs downwards and out-
 wards in a spiral manner,  between the Triceps and
 the bone, towards the outer condyle, where it anas-
tomoses with the  Radial  Artery; near its  origin it
                       x 2 
25S           RADIAL  ARTERY.
sends branches upwards, which inosculate with others
from the Humeral and Scapular Arteries.
  Q. Describe the Profunda Inferior or Minor.
  A. It arises near the middle of the humerus from
the Brachial, or frequently from a branch of the Pro-
funda Superior; it is dispersed among the muscles on
the inner side of the arm.
  Q. Describe the Ramus Anastomoticus Magnus.
  A. It arises from the Brachial two or three inches
above the  bend of the elbow,  sends branches to the
Triceps, Brachialis Interims, and parts contiguous ; it
also forms  various anastomoses with other branches of
the Profunda  upwards, and with the Recurrents of
the Radial and Ulnar  downwards.
  Q. Do no other branches arise from  the Brachial
Artery in its course along the humerus ?
  A. Yes ; a great many smaller branches arise from
it, which  are short and dispersed in the contiguous
muscles, periosteum, and bone ; one of these is the
Medullary Artery, which nourishes the  bone.
  Q. What branches, did we say, are formed by the
division of the Brachial Artery?
  A.  The Radial, and Ulnar, and sometimes the In-
terosseal Arteries.

             OF THE RADIAL ARTERY.
  Q. Describe the origin and course of the  Radial
Artery.
  A. The origin of the Radial Artery is  most general-
ly at that place where the Brachial divides into two
branches, near to the elbow-joint, sometimes higher
up ; it passes over the Pronator Teres, passes along
the Radius between the Supinator Longus and Flex-
or Radialis, and near the wrist it lies immediately un-
der the integuments  upon the Flexor Longus Polli-
cis ; at the carpal end of the Radius it turns anconad,
or  towards the back of the hand, under the tendons
of  the Abductors and Extensors of the thumb, and
gets between the  metacarpal bones of the thumb and
fore-finger, where it passes to the palm or vola, runs 
             INTEROSSEAL ARTERY.          259

 across ulnad close to the metacarpal bones, forming a
 curve  convex towards  the fingers, called the Deep
 Volar Arch.

              OF  THE ULNAR  ARTERY.
  Q. Describe the origin  and course of the Ulnar
 Artery.
  A. It is generally the continuation of the trunk of
 the Humeral Artery, and is larger than the Radial ; it
 runs deep below the flexors of the hand, keeping its
 course a good way between the Flexor Sublimis, and
 Profundus  Digitorum; near the Carpus it becomes
 more superficial, runs under the Fascia and over the
 Annular Ligament, close by the radial side of the os
 pisiforme, and thence under the Aponeurosis Palma-
 ris towards the radial side of the Carpus, forming the
 Superficial Volar Arch.

          OF  THE INTEHOSSEAL ARTERY.
  Q. Describe the origin and course  of  the  Interos-
 seal Artery ?
  A. The Interosseal Artery arises generally from
the Ulnar, sometimes from  the Humeral at  its  divi-
 sion into the Radial and Ulnar : sometimes there are
two  Interosseal Arteries by  different  origins;  but
 generally the Interosseal shortly after its origin sends
 off a Posterior Interosseal branch,  which perforates
 the Interosseous Ligament, and runs along the'anco-
 nal aspect of  the arm.  The  Interosseal itself  runs
 close upon the interosseous ligament, in the middle
 between the Radius  and Ulna, always on the fore or
 thenal aspect; near  the wrist the principal branch
perforates the  interosseous ligament, goes to the pos-
terior side of the carpus and back  of the hand, and
 divides into inosculating branches.
  Q. Describe the Recurrent Arteries situated at
the bend of the elbow?
  A. At the elbow joint, Recurrent branches are sent
upwards from  the Radial, Ulnar, and  Interosseal Ar-
teries, which inosculate freely with others sent down 
 260         INTEROSSEAL ARTERY.

 from the Profunda, and Anastomotic of the Brachial
 Artery.  These Recurrents are to be seen supplying
 the parts on all the four aspects of the arm.
  Q. What advantage do we expect from these Re-
 currents  in the operation for Aneurism at the elbow
joint ?
  A. When the trunk of the principal artery affect-
 ed by the Aneurism is tied, these Recurrent Arteries
must carry on the  circulation to the  fore-arm and
hand.  They become much dilated, and, in a short
time are quite fitted for transmitting the usual quan-
tity of blood without inconvenience.
  Q. Do  the  Radial,  Ulnar,  and  Interosseal Arte-
ries send off branches in their course  along the fore-
arm ?
  A. Yes; after the Recurrents, they send off a great
many nameless and irregular branches to the differ-
ent muscles, membranes, and bones as they pass.
  Q. From what arteries do  the Nutritious  Arteries
of the Radius and Ulna rise ?
  A. From the Interosseal  Artery which runs on the
thenal aspect of the Interosseous Ligament.
  Q. Describe the course,  branches, and connexion!
of the Radial Artery at the wrist more minutely ?
  A. When the Radial Artery turns  under the ex-
tensors of the thumb towards the back of the hand,
and gets  between the metacarpal bones of the  fore-
ringer  and thumb,  it sends off the Arteria Magna
Pollicis, which runs along the side of the thumb  next
the fore-finger, or it sometimes divides and supplies
both sides of the thumb ; it also sends off the Arte-/
ria Radialis Indicis, which runs along the fore-finger
next the thumb;  and it sends off  a  Thenal branch
running generally above the transverse Ligament of
the Carpus,  inosculates with the Ulnar Artery be-
neath the  Aponeurosis Palmaris, and completes the
deep Volar Arch.  A number of irregular branches
anastomose with others of  the  Ulnar and Interosseal
Arteries.
  Q. Describe the course,  branches, and connexions 
             INTEROSSEAL ARTERT.         261

of the Ulnar Artery at the wnisT  and palm, more
minutely ?
  A. The Ulnar Artery at the wrist sends off a Dor-
sal branch, which passing behind the tendon of the
flexor carpi ulnaris to the back of the hand, inoscu-
lates there with branches of the Interosseal and Ra-
dial, and forms  a plexus, from which many small
branches arise to the carpus, metacarpus, and fingers.
From its Superficial Volar Arch branches are sent to
the integuments and superficial parts; the Ulnarit
Profunda, of considerable size near the root of the
metacarpal bone of  the little finger, passes deep,
and  inosculates  with the Radial Artery, and forms
part of the Deep Volar Arch ;  three Volar branches
which run opposite to the interstices of the metacar-
pal bones, and at the roots of the fingers, divide into
Digital Branches.
  Q. Describe the course and connexions of the In-
terosseal Artery more minutely, at the carpus and
hand ?
  A. Near the  carpus, the great Interosseal Artery
passes chiefly to the back of the  carpus and hand;
and partly passes under the annular ligament of the
carpus,  inosculates with the superficial  volar arch,
and volar branches, and is dispersed  upon the neigh-
bouring parts of the wrist  and palm.  The posterior
branch inosculates with the extreme  branches of the
Posterior Interosseal, which runs  along the anconal
aspect of the interosseous ligament,  and is dispersed
upon the muscles, tendons, and ligaments in its course;
it assists in forming the arterial plexus or arch on the
back  of the carpus, and metacarpus, which sends
three arteries downwards to the fingers  along  the
spaces between the metacarpal bones.
  Q. Do these Arches communicate  with each other?
  A. Yes; the  Superficial and  Deep Volar Arches
anastomose by the Ulnaris Profunda, and by other
smaller irregular branches ; tho Ancono-carpal Arch
or Plexus on the back of the hand,  inosculates with
the perforating branches of the deep volar arch.   In 
 262      ARTERIES ARISING FROM

 short there is a general communication among the
 arteries, both superficial and deep seated, of the palm,
 and also among the arteries on the back of the hand,
 and between them and those of the palm.
   Q.  What parts do the  Volar Branches supply ?
   A.  The Volar Branches spread  upon the Interos-
 sei and Lumbricales muscles, and give twigs to them,
 and ultimately divide into the Digitals.
   Q.  Do other branches of Arteries run along and
 supply the anconal aspect, or back, of the interossei
 muscles ?
   A.  Yes; branches sent from the ancono-carpal arch
 run along  them, and perforants pass between them
 and the volar branches.
   Q.  Describe the origin, course, and termination of
 the Digital Arteries ?
   A.  The three volar arteries, arising from the Super-
 ficial Volar Arch, receive at the roots of the  fingers
 an equal number of branches from  the deep Volar
 Arch : and then each of these volar arteries  divides
 into two Digital branches, the one running along the
 radial, and the other along the ulnar side of the flex-
 or tendons of all the fingers, except the ulnar side of
 the little finger, and the  radial side of the fore-finger;
 the former is supplied from the Volar Arch, and the
 latter from the  Radial Artery.  Near the extremity
 of the distant phalanx, the Digitals gradually converge
 and inosculate with each other, forming the  Digito-
 Volar Arch, which sends off a great number of small
 branches to the tip of the finger, where the sense of
 the touch is most acute.

            of the thoracic aorta.
   Q. What Arteries are  sent off from the Descend-
 ing Aorta in the Thorax ?
  A. The  Thoracic  descending Aorta,  sends off
three  sets  of Arteries, namely the Bronchials, the
OZsophageals, and the Inferior Intercostals.
  Q. Describe the Bronchial Arteries ?
  A. The  Bronchial  Arteries are three or  four in 
THE THORACIC AORTA.        263
 number, and  are generally sent off from the fore
 part of the Aorta; sometimes  some of them  arise
 from the Intercostals, or by common trunks with the
 OZsophageals.   They are but small, and some of them
 are distributed to the right, and others to the left
 lung ;  they follow the ramifications of the  bronchial
 tubes,  and in their passage give twigs to the bron-
 chial glands.
  Q. Do  the  Bronchial  Arteries inosculate  with
 branches of the Pulmonary Artery ?
  A. Not in general; they sometimes anastomose by
 some of their minute branches, but this seems an ac-
 cidental occurrence, as  by far the greater number
 do not inosculate with the Pulmonary Artery.
  Q. What is the use of the Bronchial Arteries ?
  A. They carry blood from which nourishment is
 derived to the whole substance of the lungs.
  Q.. Do the Bronchial Arteries send branches to any
 other parts besides the lungs ?
  A. Yes ; they send small branches also to the oeso-
phagus, to the  posterior mediastinum, and to the peri-
cardium, before they enter the lungs.
  Q. Describe the Oesophageal  Arteries ?
  A. The OZsophageals, four or five in number, are
small, and arise from various parts of the Aorta, and
from the  Bronchials or Intercostals, and are dispersed
chiefly upon the OZsophagus, and partly  upon the
posterior  mediastinum, lungs, pericardium, and dia-
phragm.
  Q. Describe the origin and course of the  Inferior
Intercostal Arteries ?
  A. They are sent off from the back  and lateral
parts of the Aorta on each  side, and consist of nine or
ten pairs.  They run along the groove in the inferior
margin of the ribs, towards the sternum between the
external  and internal layers of the Intercostal mus-
cles; and give branches backwards to the spine, spi-
nal marrow and  its membranes ; in their course for-
wards, to the intercostal and pectoral muscles, and to
the pleura costalis. They anastomose freely with one 
264           BRANCHES OF  THE
 another, and with the internal Mammary,  and exter-
 nal Thoracics  above; and with the Phrenic or Dia-
 phragmatic, the Epigastric and Abdominal Arteries,
 as they descend to the last rib.

            OF THE  ABDOMINAL AORTA.
   Q. What portion of the Aorta is strictly called Ab-
 dominal?
   A. The Aorta passes down through the diaphragm
 between its long crura into  the abdomen ; and that
 portion of it from the last dorsal vertebra at the Dia-
 phragm, to its division into the common Iliacs at the
 fourth lumbar, is properly called the Abdominal Aorta.
  Q. Enumerate the Arteries sent off prom the
 Abdominal Aorta from the Diaphragm downwards?
  A. The Phrenic, Coeliac, Superior Mesenteric, In-
 ferior Mesenteric, Renal or Emulgent, the Spermatic,
 Capsular, Adipose, Ureteric, the  Lumbar, and the
 Sacra Media, Arteries, in  the exact order of descrip-
 tion.
  Q.  Describe the Phrenic  or Diaphragmatic Ar-
 teries ?
  A.  They are two in  number, and arise from  the
 Aorta as soon as it passes through the Diaphragm, or
 sometimes from the Coeliac, are ramified on the con
 cave or abdominal side  of the Diaphragm, and their
 extreme branches  anastomose  with the Inferior In-
 tercostals, the  Lumbar, and  the Internal Mammary
 Arteries.
  Q.  Do the Phrenic Arteries send  branches to other
 parts ?
  A. Yes; they generally send small branches to the
 Capsulae Renales, Cardia, and adjacent parts.
  Q.  Describe the origin and distribution  of the
 Coeliac Artery ?
  A.  The Coeliac Artery arises from the fore part of
the Aorta, between the  two crura of the Diaphragm,
nearly opposite to the  eleventh dorsal vertebra, at the
upper margin of the Pancreas, below the Liver, be-
hind the Stomach, and on the right of the Spleen ; its 
ABDOMINAL  AORTA.
265
 trunk  is scarcely half an  inch long, when it divides
 into three branches,  viz. the Superior Gastric, He-
 patic, and Splenic.
   Q. Describe the Superior Gastric Artery ?
   A. This Superior Coronary of the Stomach, as it is
 sometimes called, is the  smallest of the three Coeliac
 branches, it runs along the smaller curvature  of the
 stomach, from near the Cardia towards the Pylorus ;
 it sends branches towards the left to  the Cardia,
 which inosculate  with the QLsophageals,  Phrenics,
 and Vasa Brevia ; in its course to the right it sends
 numerous branches to the sternal  and dorsal aspects
 of the  stomach,  which  anastomose  freely with
 branches of the right and left Gastro-Epiploics, and
 of the Omentum, with the Pylorics, and Pancreatics.
   Q.  What seems to be the use of  this Superior Gas-
 tric Artery ?
   A.  It has its course in the concave gastric arch
 from the Cardia to the Pylorus, and spreads its ramifi-
 cations on both sides of the stomach ; in consequence
 of such a course and distribution, it carries a quantity
 of blood, nearly equal, to the stomach, whether it be
 full or empty.  This equality renders it the most pro-
 per Artery for carrying nourishment to the  coats of
 the stomach itself, hence it may be considered the
 Nutrient Artery of the stomach.
   O..  Describe the course and distribution of the He-
patic  Artery ?
   A.  The Hepatic is the largest  of the  Coeliac
 branches, runs dorsad of, or behind, the right  extre-
 mity of the Pancreas, and behind the Pylorus to the
 Porta of the  liver, where it divides into the right In-
 ferior Gastric, and the proper Hepatic.
   Q.  Describe the Right Inferior Gastric Artery, or
 Right Gastro-Epiploic, as it is sometimes called?
   A.  It runs along the convex arch of the stomach to-
 wards the left, and sends branches to both sides of
 the Stomach, which inosculate with the Superior
 Gastric, and with the  Left Inferior Gastric;  it sends
Vol. H.               Z 
366           BRANCHES  OF THE
branches also to the  Pylorus, Duodenum, Pancreas,
and Omentum.
  Q.  Describe the Proper Hepatic Artery ?
  A.  The Hepatic Artery, having sent off the Gastro-
Epiploica D extra at thePorta of the Liver, soon di-
vides  into two branches, the  larger of which is dis-
tributed  through  the  right  lobe, and the  smaller
through the left lobe  of the Liver.
  Q.  Is the Bile secreted by the extremities of the
Hepatic Artery ?
  A.  Not in  general;  the blood  which this Artery
transmits, is destined for the nourishment of the Li-
ver; while the  extremities of the Vena Portae are
coiled up into the Acini, which secrete the Bile.  In
some  chance  places  of the  Liver, some of the ex-
tremities of the Hepatic Artery and of  those of the
Vena  Portae anastomose, but this seems accidental.
In a very few rare cases indeed, the Vena Portae has
been found to terminate in the Vena Cava, and the
extremities of the Hepatic Artery, which was much
enlarged, secreted the  Bile.
  Q_.  From what  source does the  Gall-Bladder re-
ceive  its blood ?
  A.  From the right  hepatic branch the Arteria Cys-
tica is sent off, which divides, and  is dispersed upon
the Gall-Bladder.
  Q.  Describe the Splenic Artery ?
  A.  It runs first behind, and then along the upper
margin of the Pancreas, to the concave side of the
Spleen, where it divides into several branches, which
send  off the Gastro-Epiploica  Sinistra  or left Infe-
rior Gastric, and the Vasa Brevia four or five in num-
ber : the Splenic branches enter the substance of the
Spleen, and are minutely dispersed through it.
  Q.  Does the Splenic  Artery send off any branches
in its  way to the Spleen ?
  A.  Yes; it sends off several Pancreatic branches,
and others to the Omentum, and Meso-colon.
  Q..  Describe the Left Inferior Gastric or  Gastro-
Epiploica Sinistra ? 
ABDOMINAL  AORTA.
26T
   A. It runs along the convex or large curvature of
 the Stomach  dextrad,  or towards the right,  until it
 inosculates with the trunk of the Right Inferior Gas-
 tric ; in its course it anastomoses with branches of
 the Vasa Brevia,  of the Superior Gastric, and the
 other Inferior Gastric on both sides of the Stomach.
   Q. Describe the Vasa Brevia or Arteriae Breves ?
   A. These Arteries,  generally from four to six in
 number, are distributed upon the left great extremi-
 ty of the Stomach,  where the branches sent  from
 the  Superior and Inferior Gastrics are but small and
 few in number; hence these  Vasa Brevia copiously
 supply the deficiency on that part of the Stomach,
 and freely anastomose with the other left Gastrics.
   ft. Which of these Gastric  Arteries  seem to con-
 tribute most to the secretion of Gastric Juice ?
   A. The Right and Left Inferior Gastrics, and the
 Vasa Brevia.
   Q. How do you account for that ?
   A. When the Stomach is emgty, and its coats con-
 siderably contracted and collapsed, the flow  of the
 blood in these  Arteries is very much impeded, and
 its positive quantity in a given time is most probably
 diminished by more  than a half,  while in the mean
 time it circulates readily through the  Spleen and Li-
 ver without interruption. But, on the contrary, when
 the Stomach is distended with food, the blood flows
 freely  in these Inferior Gastrics and  Vasa Brevia,
 hence a much greater quantity is present, from which
 the Gastric Juice is copiously  secreted, and at a time
 too when it is wanted for the purposes of digestion.
   Q. Describe the origin and course of the Superior
 Mesenteric Artery ?
   A. It arises from the fore part of the Aorta  imme-
diately below  the Coeliac, it lies behind  the Pan-
creas, then passes over the  Duodenum,  enters be-
tween the layers of the Meso-colon and Mesentery,
forming a large arch,  and proceeding a little  towards
the right in its descent to the beginning of the Colon; 
2&8           BHANCHES OF THE

from the convexity of which many branches are sent
off.
   Q.  What branches  are sent off from the Superior
Mesenteric Artery, and to  what viscera are they dis-
tributed ?
   A.  From its  left or convex side  between twenty
and thirty branches are sent off, which are distributed
upon the Pancreas, Duodenum, but particularly up-
on the Jejunum, Ilium, and Mesentery; from its con-
cave  or right side four pretty large branches arise,
viz. the Ileo-Colic, which supplies the termination of
the Ilium, Caput Caecum Coli, and part of the right
side of the Colon ; the Colica-Dextra, which inoscu-
lates with the former, and is dispersed upon the right
Colon and part  of its transverse arch ; the Colica Me-
dia or Anastomotica is sent to the middle of the trans-
verse arch, and there divides into a right and left
branch; the former is dispersed upon the colon dex-
trad, and anastomoses with the Colica Dextra; the
left branch runs sini|frad, and  is  dispersed upon the
left side of the arch, and joins the Colica Sinistra and
Inferior Mesenteric Artery ; and several other smaller
branches, which are distributed on the Omentum, and
anastomose with branches  of  the  Gastro-Epiploicae.
Thus  the Superior Mesenteric Artery  supplies the
Mesentery, Omentum, and the whole of the small
and large Intestines, except the Left Colon and Rec-
tum.
   Q.  In what manner are  these numerous branches
of the  Superior Mesenteric Artery disposed in their
course and termination ?
   A.  They anastomose and form  numerous  arches,
upon  which others are again constructed in a beauti-
ful manner, and this is continued repeatedly, till they
reach the  intestines,  when the  branches become
straight, are  minutely  subdivided upon their villous
coat, and terminate in the villi.
  Q.  Describe the Inferior Mesenteric  Artery ?
  A.  It arises from the fore part of the Aorta, a little
to the left, in the space between the Renal, and Com- 
ABDOMINAL  AORTA.
269
 mon Iliacs ; it descends obliquely behind the Perito-
 neum, upon the left Psoas muscle, and  soon divides
 into branches, which  join  and separate,  and join
 again, forming a number of arches, from which many
 branches are  sent off; the principal are, the Ramus
 Ascendens, which  divides into two branches, one of
 which anastomoses with the Colica  Media, forming
 the Meso-Colic Arch, and the other is dispersed upon
 the left part of the Colon : the Colica Sinistra, which
 also divides into two branches, the one joins the Ra-
 mus Ascendens, the other is dispersed upon the Sig-
 moid Flexure  of the Colon ; and the Haemorrhoidalis
 Interna, which is the continuation of the trunk ; it in-
 osculates with the  Colica Sinistra, and then descends
 upon the back part of the Rectum.
  Q.  Describe the Renal, or Emulgent Arteries ?
  A.  They arise, one on each side, from the lateral
 parts of the Aorta, immediately below the Superior
 Mesenteric Artery,  run  transversely  and obliquely
 downwards over the Psoas muscle, on  each side to
 the Kidneys.   The right Renal passes  behind the
 Vena Cava, and is longer than the left, in conse-
 quence of the Aorta being situated on the left of the
 Vena Cava.
 1 Q.  What is  the  distribution of the Renal Arteries
 in the Kidney ?
  A. When the Artery comes to the concave edge of
 the Kidney, it divides into several branches, which
 enter the substance of the Kidney, surround its pel-
 vis, divide  repeatedly  into smaller and  smaller
 branches, which anastomose as they diverge towards
the circumference, till their extremities  become ex-
ceedingly minute in the Cortical substance, where
they are coiled up into Corpuscles or Cryptae, which
secrete the urine from the blood at the roots or bases
 of the Papillae.
  ft. Describe the  Capsular Arteries ?
  A. These Arteries generally arise from the Aorta
 laterally, sometimes from  the Renal, or Diaphragma-
 tic,  and are dispersed through the Capsulae Renales.
                       %2 
270           OF  THE spermatic
  ft. Describe the Adipose Arteries?
  A. These Arteries arise from  the Aorta, and fre-
quently from the Diaphragmatics, or Renals, or Sper-
matics, or Capsular, and are dispersed upon the Tu-
nica Adiposa of the Kidney.
  Q. Describe the Ureteric Arteries ?
  A. The Ureterics arise  from the Aorta laterally,
and sometimes from the Renal, Spermatic, or others
in the vicinity, and are spread upon the Ureters.
  ft. Describe the origin and course of the  Sperma-
tic Arteries.
  A. They arise, one on  each side, from the  fore
part of the Aorta, a little below  the Renal, proceed
at a very acute angle from the Aorta, over the surface
of the Psoae muscles behind  the Peritoneum; the
right  passes obliquely over the Vena Cava, the left
passes behind the Colic Arteries, and both descend
obliquely over the  Ureters, to  the Internal Abdomi-
nal Aperture,  where each, in its respective side,  is
involved in the Spermatic Cord. They are very long,
and rather small in size, but become larger before
they reach the testicle, in consequence of the branch
received from the Iliac.
  ft. Describe the course and distribution of the Sper-
matic Arteries in the Cord and Testicle.
  A. The Spermatic Artery, when it has joined the
Cord  at the upper Abdominal Aperture, receives a
branch from the origin of the Epigastric Artery, and
inosculates freely with it in its descent to the testicle,
which it enters at its posterior part, and turns round
in a serpentine form, waving along the upper part of
the testicle, and sending coronary branches  all over
its convex surface, which  terminate in the septulae,
between which the fasciculi of the seminiferous tubes
are situated.
  Q.  Are the extremities  of the  Spermatic  Arteries
coiled up in the manner of a gland?
  A. They are so  very minutely  divided, and  so in-
tricately disposed, that  it is not easy to say what  is
the precise form of their extremities in the numerous 
AND LUMBAR^ arteries.        271
 septulae in the substance of the testicle: it is very
 probable, however, that they are coiled up in a glan-
 dular manner to secrete the semen.
   ft. Do the  Spermatic  Arteries send  off  many
 branches, and  communicate  with  other arteries in
 their descent to the testicle ?
   A. Yes: the testes  in the foetus lie in the Psoae
 muscles, in  the vicinity of the Kidneys, and before
 birth, pass gradually down into the Scrotum ;  hence
 they receive arterial branches from the Renal, and
 Capsular, as well  as their  principal artery from the
 Aorta; these inosculate, and in their descent commu-
 nicate with branches of the Lumbar and Iliac Arte-
 ries.  They give branches to the Spermatic Cord and
 Cremaster muscle, to the Scrotum, to  the  Epididy-
 mis, to the Septum Scroti,  and they inosculate freely
 with each other in the substance of the Testicle.
   Q. Do the course and termination of the Spermatic
 Artery in the Female differ from those  in the Male ?
   A. Yes : the  origin and course down the abdomen
 are the same in both : in the Female,  however,  the
 Spermatic does  not pass through the Abdominal Ring,
 as in the male, but it descends into the Pelvis, between
 the  layers of the Broad Ligament of the Uterus,
 spreads its branches upon  the  Ovarium, Fallopian
 Tube, Fundus of the Uterus, and Round Ligament,
and it also inosculates with its fellow of the opposite
side, and with the Uterine Arteries.
   ft. Describe the Lumbar Arteries.
   A. They arise from the back and lateral parts of
the Abdominal Aorta in pairs,  in the same manner as
the Intercostal  Arteries do :  they are generally four
or five on each side ; those  on the right  side  are long-
er, and pass across  behind the Vena Cava, and  the
Psoae Muscles, but before the Quadratus Lumborum;
they then perforate the Transversalis  and Oblique
Muscles, and are dispersed upon them.
   ft. What branches do the  Lumbar  Arteries send
off?
  A. They give branches backwards to the Spine, 
272
BRANCHES  of the
 Spinal Marrow, and large muscles and integuments
 of the loins, others inwards to the Psoae, and Iliacus
 lnternus.
  ft. What arteries do the Lumbar  communicate
 with ?
  A. The Lumbar Arteries inosculate with the Inter-
 costals, Internal Mammaries, Diaphragmatics, Epigas-
 trics, Circumflex Iliacs, and with each other.
  ft. Describe the Sacra Median Artery.
  A. This artery arises from the back and under part
 of the Aorta, just at its bifurcation; it is but small; it
 generally gives off  a right and a left branch, which
 are  distributed similar to the Lumbar Arteries ; its
 trunk  descends along the mesial  line of the Os Sa-
 crum and Os Coccygis, sending out lateral branches
 in its course.

             of thb iliac arteries.
  Q. Into what arteries is the aorta divided ?
  A. The Aorta at the lower  part of the fourth Lum-
 bar Vertebra divides into the right and left Common
 Iliac Arteries.
  ft. What is the course  of the Common Iliac Arte-
 ries ?
  A. The common Iliac Artery of the left side runs
 obliquely downwards and outwards on the lateral or
 left  side of the  Iliac Vein ;  that of the right  side
 crosses over before the Vena Cava, and takes  its situ-
 ation also on the lateral or right side of the Common
 Iliac Vein:  at the symphisis, which joins the  Sacrum
 and Ilium, each divides into the Internal and External
Iliac;  the former follows the course of the Sacro-
iliac Symphysis into the Pelvis, the latter is consider-
 ed the continuation of the trunk, and runs down on
the inner or mesial aspect of  the Psoae towards the
 Crural Arch.

             OF THE INTERNAL ILIAC.
  Q. Enumerate the principal Branches into which
the Internal Iliac or Hypogastric Artery is divided ? 
           INTERNAL ILIAC  ARTERY.       273

   A. The Internal Iliac soon divides into a number
 of Arteries, viz. the lleo-lumbar, Lateral Sacral, Glu-
 teal, Obturator, Umbilical, Vesical, Uterine, Hemor-
 rhoidal, Pudic, and the Sciatic or Ischiatic.   Of these
 the Gluteal and Ischiatic are by much the largest.
   Q.  Describe the Ilec-Lumbar Artery.
   A.  It  is small, and passes  outwards under the
 Psoas, and is dispersed upon the Psoae, Iliacus Inter-
 nus, and Os Ilium, giving to it its Nutrient artery.
 This artery has also several anastomoses with others,
 as the Lumbar, and Circumflex of the Ilium.
   ft.  Describe the Sacrae Laterales.
   A.  These Sacral arteries are  generally two or
 three in number; they pass down by the foramina of
 the Os Sacrum, and give branches through each to
 the Cauda Equina; they supply the muscles, mem-
 branes, and nerves  on the Sacrum, inosculate with
 the Sacra Media, and  near the  apex of the  Sacrum
join those of the opposite side, forming an arch.
   Q.  Describe the Gluteal Artery.
   A.  This is the largest branch of the Hypogastric,
 and by way of eminence has been called the Posterior
 Iliac.  It passes  out  of the Pelvis at the upper part
 of the Iliac Notch, and is soon divided into branches,
 which are ramified principally through the  Glutei
 Muscles, and inosculate with neighbouring arteries. J
   Q.  Describe the Obturator Artery.
   A.  This Arteria Obturatoria arises sometimes from
 the Ileo-Lumbar, or Ischiatic, or Gluteal;  it passes
 along the under side of the Psoas and upper  edge of
 the Obturator  Internus at  the oval hole at the  supe-
 rior part of the Obturator  Ligament, where, in com-
 pany with  the Obturator Nerve, it goes out  of the
 Pelvis; it then divides into two sets of branches, the
 one set is dispersed  upon the parts about the hip-
 joint,  the  other upon the Obturator Externus, and
 adjacent muscles.
   Q.  Describe the Umbilical artery in the fojtus.
   A.  The Umbilical artery in the foetus being a con-
 tinuation of the trunk of the Iliac, rises  by the side 
274
BRANCHES OF THE
 and fundus of the urinary bladder, and directs  its
 course to the Umbilicus, where it and its fellow of the
 opposite side, pass out of the abdomen, are entwined
 in the Umbilical Cord, enter the Placenta, are minute-
 ly ramified  in its  substance,  and  ultimately spread
 their extremities  around the  cells, which contain
 blood of the mother.
   Q. Do these Umbilical Arteries of the Foetus ter-
 minate in the arteries or  veins of the mother, or  even
 anastomose with them ?
   A. Many anatomists have described the  arteries
 of the Foetus, and those of the mother, as commu-
 nicating in  the placenta, but  it is a  mistake ; the
 Foetal and Maternal vessels do not communicate  or
 run into one another.   Sometimes, indeed, a chance
 inosculation or two may be found in the Placenta, but
 it is not a common occurrence.
   Q.  Describe the Umbilical Artery in the adult.
  A.  This artery  in  the Foetus  sends off  several
 branches to the urinary bladder, which in the adult
 become much larger, and form the Vesical Arteries,
 while the  Umbilical artery, which was large  in the
 Foetus, is shrivelled into a Ligament in the adult.
  ft.  What arteries are sent to the Urinary Bladder}
  A.  These Vesicates  from the umbilical; branches
 from the Uterine arteries in the female;*and branches
 from the other neighbouring arteries in the Pelvis.
  Q.  Describe the Uterine Arteries.
  A.  They arise either from the Internal Iliacs,  or
 from some of their principal branches; they are larger
 than the Spermatic ; they enter the Uterus near its
 Cervix,  extend their  branches to the Vagina  and
 Bladder, and run in the edges of the uterus towards
 the fundus; they inosculate with each other, and with
 the Spermatics.
  Q.  Describe the Haemorrhoidal Arteries.
  A. The  Middle Haemorrhoidal Arteries arise either
from the Internal Iliacs, or from some of their ramifi-
 cations,  and are irregular in their size,  number, and
 extent of ramification.  They are distributed to the
 Rectum, the Bladder, Vesiculae Seminales, Prostate 
            INTERNAL  ILIAC ARTERY.       275

 Gland, and to the Vagina: they anastomose freely
 with others.
   Q. Describe the course of the Pudic Arteries.
   A. This artery, on each side, arises either from the
 trunk of the Internal Iliac, or from  the Ischiatic; it
 passes out of the Pelvis, along with the Sciatic ar-
 tery, through the lower part of the Sciatic Notch of
 the Os Ilium, at the under edge of the Pyriform Mus-
 cle, over the upper Sacro-Sciatic Ligament. As soon
 as it gets outside the Pelvis,  it gives off a few small
 branches, turns round  the ligament into the Pelvis
 again, between the  Sacro-Sciatic Ligaments to  the
 inner side of the tuberosity  of the Ischium, where
 it is lodged deep, and protected by a process of  the
 larger Sacro-Sciatic Ligament from lateral pressure ;
 it continues its course close to the inner side of  the
 ramus of the Ischium and Pubis, behind the Crus  Pe-
 nis, till it reaches the Symphysis Pubis; then it  turns
 suddenly on the dorsum of the Penis, stretches along
 it, parallel to its fellow under the Integuments, and
 terminates  in the glans and prepuce.
  Q.  Does the Pudic Artery give off many branches
 in its course ?
  A. Yes: near its origin in the pelvis, it give branches
 to the Rectum, Bladder, Vesiculae Seminales, Pros-
 tate Gland, the Obturator Internus Muscle, the Va-
 gina and Spermatic Cord; to the Pyriformis, Gluteus
 Maximus, the Coccyx, the Gemelli, the Ischium and
 muscles attached to it; and  then  having returned
 into the pelvis, it sends branches to the Rectum, call-
 ed External  Haemorrhoidals, to the Levator  and
 Sphincter Ani, to the Perineum and  muscles there,
 to the Scrotum, the Corpus  Cavernosum Urethrae,
 and Corpora Cavernosa Penis.
  Q.  What Arteries particularly belong to the Penis}
  A.  The trunks of the two Pudic arteries, about the
size of a crow's quill, are continued along the Penis.
 Each of them at the Symphysis Pubis pierces the  Cor-
pus Cavernosum, and divides into two branches; of
which the one runs along the Corpus Cavernosum near
to the septum, through which it communicates with its 
276      BRANCHES  OF THE EXTERNAL
 fellow, and  pours  its blood, by numerous branches,
 into the cells, which, when filled and distended, pro-
 duce erection ; the other runs along the dorsum of
 the Penis till it reaches the Corona Glandis, which it
 encircles and terminates.
   ft. Describe the Sciatic or Ischiatic Artery.
   A. It is next to the Gluteal  in size ; it passes out
 of the Pelvis at the under part of the Sciatic Notch,
 accompanied by the  Sciatic Nerve, between the Py-
 riformis and Gemelli, and being separated from the
 Gluteal Artery by the Pyriformis, it descends a consi-
 derable way with the nerve of  the same name under
 the Gluteus Maximus, in the hollow between the Tro-
 chanter Major, and the tuberosity of the Ischium, but
 rather inclining to the latter.   It is dispersed among
 the  muscles, tendons, and ligaments,  near the hip
 joint, viz. the Pyriformis, Gemelli,  Quadratus Femo-
 ris, Coccygeus, Sacro-Sciatic and Capsular Ligaments,
 Levator Ani, Gluteus Maximus and Medius; and it
 inosculates frequently with other arteries.

         OF THE EXTERNAL ILIAC ARTERY.
   Q. Describe the course of the  External Iliac Ar-
 tery.
   A. It appears in the adult to be a continuation of
 the trunk of the Common Iliac; it winds along the
 brim of the  Pelvis, behind the Peritoneum, rises over
 the Psoas, passes under Poupart's Ligament, and, as
 soon as it emerges from the abdominal aperture, it is
 called the Femoral Artery.
   ft. What  arteries does the External Iliac send
 off?
   A. It sends off some small twigs to the Peritoneum,
 Muscles, and Lymphatic Glands ; but two principal
 arteries, viz. the Epigastric and Circumflex Iliac.
   Q.  Describe the Epigastric Artery.
   A.  It arises from the mesial  or inner  side of the
 Iliac, just before it  goes under the Ligament of Pou-
 part, at nearly a right angle; it first ascends oblique-
ly upwards  and inwards, between the Peritoneum
and Transversus Abdominis, then between the Peri- 
        U.IAC AND  FEMORAL ARTERIES.     277

 toneum and Rectus, and lastly between the Rectus
 and its sheath, till it reach  the Epigastric  region.
 Near its origin it passes behind the Spermatic Cord
 in the male, and the Round Ligament in the female.
 It divides and sends off many branches, which anas-
 tomose with their fellows of the opposite side, with
 the adjacent arteries, such as the Lumbar, Inferior
 Intercostals,  Internal Mammaries and Phrenics.
  ft. Does the EpigastricArlery send off any branches
 near its origin ?
  A. Yes: it gives small twigs  to the neighbouring
 parts, particularly a branch, in the male, to the Sper-
 matic Cord;  and, in the female, to  the Round Liga-
 ment.
  ft. Describe the Circumflex  Iliac Artery.
  A. It arises nearly opposite to the Epigastric, from
 the outer or lateral side of the External Iliac, it fol-
 lows the curvature of the Crest of the Ilium on its cen-
 tral aspect between the Transversahs and Obliquus
 Internus, till it arrives  at the highest point of the
 Ilium, where it ascends more directly, and inosculates
 with branches of the Epigastric,  Lumbar, Inferior
 Intercostal, and Internal Mammary Arteries.
  Q. To what parts are the branches of the Circum-
 flex Iliac distributed ?
  A. To the Inguinal glands, to the different muscles
 in its course; and sometimes  to the Cremaster and
 Spermatic Cord.

        OF  THE FEMORAL  OR CRURAL ARTERY.
  Q. Ddscribe the course of the Femoral or  Crural
 Artery.
  A. It is the External Iliac continued, which, when
 without  the abdomen, assumes the name of Femoral
 or Crural.  It begins nearly under the middle of the
 Ligament  of Poupart;  runs centrad, or under the
 Fascia and Inguinal Glands, is surrounded by much
fat,  and unusually strong cellular membrane; has the
Crural Nerve and Iliacus Internus situated laterad,
the  Pectinalis and the Crural Vein mesiad; descends
  Vol. II.              A a 
 278      BRANCHES OF  THE  FEMORAL

 in the hollow between the Adductors on  the  inner
 side,  and the Rectus and Sartorius on the outer, co-
 vered first by the Integuments  and Fascia, then by
 these and the Sartorius, and lastly by these and  the
 Aponeurosis, which stretches down from the Vastus
 Internus to the Large Adductor, which it perforates,
 turning obliquely towards the ham, where it is called
 the Popliteal Artery.
   ft.  What Arteries does the Femoral send off?
   A.  It sends off the Profunda nearly opposite to the
 Trochanter Minor, and  between this situation and
 the Crural Arch, it gives off Inguinal branches, In-
 guinal Pudics, and  two Circumflex femorals.
   Q.  Describe the Inguinal Branches.
   A.  These Inguinal Arteries arising from the Femo-
 ral near the Crural Arch,  are  generally  small and
 irregular in their number; they sometimes arise from
 the Inguinal Pudics, or Circumflex; they are ramified
 on the Inguinal Glands, neighbouring Muscles, Liga-
 ments, and Integuments.
   ft.  Describe the  Inguinal or External Pudic Arte-
 ries.
   A.  They are small and indefinite, are ramified on
 the Integuments of the Symphisis Pubis, on the Dor-
 sum Penis, and Scrotum, and on the Labia Pudendi.
 They inosculate with other arteries in these parts.
   ft.  Describe the  Circumflex Arteries of the Thigh.
   A.  The Circumfiexae Femoris are two, the Internal,
 which is the larger, and is ramified deep among the
 Adductors of the Femur, antl Flexors of the leg, aris-
 ing from the Pelvis ; and the External, which  is ra-
 mified upon the Abductors of the Femur, and Exten-
 sors of the Leg.
   Q.  Describe the  Profunda Femoris.
   A.  It arises from the Femoral artery, in general
 opposite to the" Trochanter Minor ; it frequently gives
 off the Circumflex; it runs down towards the inser-
 tion of the Adductor Brevis, and  origin of the Vastus
Internus in the linea aspera ; crosses the linea ob-
liquely, and terminates in the Flexors of the leg.  In 
       AND THE  POPLITEAL ARTERIES.      279

 its course  it sends off branches, called Perforants,
 which are  distributed through the different muscles,
 some turn  round close to the Femur, from the Popli-
 teal to the Fibular aspect, to be dispersed upon the
 Vasti Externi and Gluteus Maximus. They inosculate
 with  the Gluteal,  Ischiatic, and other arteries, and
 with each  other.
   Q.  Does the Femoral Artery send off from its trunk
 any Perforant Branches ?
   A.  Yes; just  before  the Femoral perforates the
 tendon of the Triceps, it gives off the Ramus Anas-
 tomoticus Magnus, which descends with many ramifi-
 cations on  the Ligaments, Tendons, and  Fascia, to-
 wards  the Patella,  and inosculates with the  External
 Circumflex and other branches about the knee; near
 the same place it sends off also Perforants across the
 Poples, which succeed to  those  of the Profunda, to
 be distributed upon the Biceps and Vastus Externus.

            OF THE POPLITEAL ARTERY.
   ft. Describe the  Popliteal artery.
   A. When the  Femoral pas'ses  down between the
 Condyles of the Os Femoris, it is called the Popliteal
 artery.   It  has the Popliteus and Capsular Ligament
 between  it  and the joint, the tendons of the muscles
 forming the ham-strings upon either side, and covered
 by the nerve, vein, much adipose substance, and the
 integuments ; and  a little farther down it is covered
 by the belly of the Gastrocnemius Externus, and in-
 teguments.  It terminates  at the under edge of the
 Popliteus, in the arteries named Tibialis Antica, and
 Postica.
   ft. What branches does  the Popliteal Artery send
 off?
  A. An External  and an Internal Superior Articu-
lar ; and  an External and Internal Inferior Articular;
an Azygos  or Median Articular, and two Surales.
  ft. Describe the Superior External, and Superior
Internal Articular Arteries ?
  A. They are circumflected proximad of, or above 
280       OF THE TIBIAL ARTERIES.
the Condyles; disperse their branches through, and
under the two Vasti to the Rotular aspect, and form a
part of the vascular plexus spread upon, and round
the Patella.   The Internal turning round by the Ti-
bial aspect inosculates with branches of the Anasto-
motic, and Perforants of  the Femoral;  the External
turning round by the Fibular aspect, inosculates with
the External Circumflex.
  ft.  Describe the Inferior External, and Inferior In-
ternal Articular Arteries ?
  A.  They are circumflected nearer to the joint and
the Lateral Ligaments—unite conspicuously with the
Recurrents from the  leg in  forming the  Plexus.  In
their course they send branches to the Soleus, Popli-
teus, Gastrocnemius, Tendons of the Flexors, Capsu-
lar and Lateral Ligaments, Ligament of the Patella,
and Semilunar Cartilages.
  ft. Describe the Azygos or Median Articular?
  A.  It arises either from the Popliteal, or from one
of the superior Articular;  it spreads between the
Condyles on the  Capsular Ligament, fat, Semilunar
Cartilages, and Crucial Ligaments; it inosculates
with the neighbouring Arteries.
  ft. Describe the Surales or Gastrocnemic Branches?
  A. These two Arteries arise from the Poplitical, be-
tween the origins of the Superior and Inferior Articu-
lar branches,  and enter the  heads of the Gastrocne-
mius ; a branch often runs superficially down almost
to the heel.

             OF THE TIBIAL ARTERIES.
  Q. Describe the Anterior  Tibial Artery?
  A. The Tibialis Antica is  sent off  from the Poste-
rior Tibial at  the Lower edge of  the Popliteus Mus-
cle, perforates the Interosseus Ligament, descends
along its anterior surface, first between the Extensor
Digitorum and Extensor Pollicis, and then between
this and the Tibialis Anticus : near the  ankle  it be-
comes more superficial, rises upon the  fore  part of
the  Tibia, passes under the  Annular Ligament, over 
OF THE FIBULAR ARTERIES.      281
the Tarsus, and along the interstice between the me-
tatarsal bones of the great toe and index pedis, where
it divides into the  sole in the middle of the foot, and
inosculates with the Plantar Arteries.
  Q.  What Branches does the Anterior Tibial Artery
send off?
  A. Near its origin it gives various small branches
to the  Soleus, Tibialis  Posticus, Capsular Ligament,
which  inosculate with the Inferior and Arygos Arti-
culars. Having perforated the Interosseous Ligament,
it sends oft' a Recurrent, which ascends, and inoscu-
lates with the Articulars, and vascular plexus of the
knee;  in its course downwards, it gives small branch-
es to the muscles  on the fore part of the leg;  near
the Tarsus  it gives off the External and Internal
Malleolar; the Arteria  Tarsea, which runs across the
1'arsus under the tendons of the Extensors ; the Me-
tatarsea, which runs obliquely towards the root of the
little toe, and gives branches to the Interossei Mus-
cles ;  before it  sinks into the sole,  it sends off the
Dorsalis Pollicis to the great and second toes.
  ft. Describe the Posterior Tibial Artery?
  A. The  Tibialis Postica, being a  continuation  of
the trunk, runs down under the Soleus, near to the
Tibial Nerve, passes between the Tendo Achillis and
Malleolus Internus into the sinuosity of the Os Calcis,
where it divides into the External and Internal Plan-
tar  Arteries.
  ft. What Branches does the Posterior Tibial  send
off?
  A. About an inch below the origin of the  Anterior
Tibial, it sends off the Fibularis or Peroneal;  and,
in its descent, it gives oft' many lateral  branches  to
the muscles and adjacent parts, as also the Medullary
Artery, for the  nourishment of  the Tibia, about the
middle of the leg.
  Q. Describe the Fibular or Peroneal Artery?
  A. It runs down on the inner or Tibial side of the
Fibula, under the Flexor Pollicis Longus, towards
the Malleolus Externus, behind which it runs deep
                       Aa2 
282       OF THE PLANTAR ARTERIES.
by the Os Calcis, and is lost in anastomoses with the
Posterior Tibial,  External Plantar, and among the
Muscles and Ligaments, near the external side of the
Os Calcis.
  ft.  What Branches does the Peroneal Artery send
off?
  A.  It sends off lateral branches to the muscles, fas-
cia, interosseous  ligaments,  and  bone, particularly
the Medullary Artery, for nourishing the  Fibula ;
about three inches above the ankle-joint, one branch,
called Peronea Antica, larger than the other perfo-
rants, passes through the Interosseous Ligament, anas-
tomoses with branches of  the Anterial Tibial, and is
dispersed upon the fore parts of the external ankle
and Tarsus.
  ft.  Describe the Internal Plantar Artery?
  A.  It passes along the  inner or Tibial side of the
sole,  between  the Aponeurosis  Plantaris  and the
Abductor Pollicis, towards the root of the great toe,
passes under the Flexor Longus Pollicis, anastomoses
with the Arcus Plantaris, and then gives off a branch,
which divides it  into  two ; the one runs  along the
Tibial side of the  great toe, and the other along that
of the toe next it.
  Q.  Describe the External Plantar Artery?
  A.  This is a continuation of the trunk of the Ante-
rior Tibial, being  larger than the former ;' it runs ob-
liquely fibulad between the  Flexor  Brevis Digito-
rum, and Flexor Accessorius, to the base  of the me-
tatarsal bone of the little toe, where it bends forwards
between the Flexors and  Metatarsal bones of the
small  toes to the Tibial side of the foot, until it gets
to the interstice of the metatarsals of the  great toe,
and index pedis, where it  inosculates with the Inter-
nal Plantar, and forms the Arcus Plantaris.
  ft.  Do the Plantar Arteries communicate with
those on the upper or convex part of the foot ?
  A. Yes, very freely, by many anastomoses, but par-
ticularly by the perforating branch of the Anterior Ti-
bial,  which passes down between the  metatarsal 
             DISEASES OF ARTERIES.        283

 bones of the great toe and the one next it, to join
 the Plantar Arch.
   Q. What Arteries are sent  out  from the Plantar
 Arch?
   A. Two sets of Arteries  are sent from it, namely,
 the Interosseal, which are small, running to the spaces
 between the metatarsal bo"nes, and the Digital Arte-
 ries, which are larger, running to the toes.
   Q. In what manner do the Digital Arteries, direct
 their course ?
   A. They are sent off from the Plantar Arch, run in
 the spaces between the metatarsal  bones to the roots
 of the toes, and there each  divides into two branches,
 which run along the sides of two contiguous  toes
 corresponding to the metatarsal bones.  The Digitals
 on both sides of each toe anastomose freely, and form
 an Arch or Plexus near their extremity.

         ORGANIC DISEASES OF THE ARTERIES.
   Q.  Enumerate the  principal Diseases of the Arte-
 ries?
   A.  The Arteries are subject to Ossification, Inflam-
 mation, Dilatation, and Rupture,
   Q.  In what particular part of the Artery is the os-
 seous matter deposited ?
   A.  It is observed to be deposited in  small points,
 in various parts of the Artery, or in thin spicular lay-
 ers between the muscular and internal coats.  These
 points or  spicula increase  in extent, and sometimes
 either surround  the Artery, or, at least, the greater
 part  of its circumference.
  Q.  By what circumstances and symptoms can we
discover inflammation of an Artery?
  A.  If the Inflammation be considerable, by great
pain,  increased  by violent pulsation, by a red streak
on tfie integuments, painful to the touch, and by an
increase of heat in the course of the Artery.
  ft.  Enumerate the Varieties  of Dilatation or Aneu-
rism of Arteries ?
  A.  The Circumscribed and the diffused True Aneu- 
284
OF THE VEINS.
 rism ;  the Circumscribed and Diffused  False ;  and
 the Aneurism by Anastomoses.
  Q. What is understood  by a  Circumscribed True
 Aneurism?
  A. It is  when the circumference of the Artery is
 uniformly enlarged into a round circumscribed  pul-
 sating Tumour.
  Q. What is meant by a Diffused True Aneurism?
  A. It is so called when the tumour of the Artery
 is oblong, and  not distinctly  circumscribed ;  and
 when a sac communicates with the artery by a  nar-
 row neck.
  ft. Is the trunk of the artery near to the Aneurism
 of its natural  size?
  A. It frequently is; but, at other times, it is consi-
 derably enlarged.
 t ft. What is meant by Circumscribed False Aneu-
 rism?
  A. It is  produced by the blood finding its  way
 through an aperture, formed by a puncture or burst-
 ing of the coats of the artery into the annexed cellu-
 lar  substance, which becomes condensed, and forms
 a cyst, in which the blood is confined.
  Q. What is understood by Diffused False Aneu-
 rism?
  A. It is formed by the blood escaping as in  the
 former case into the cellular substance,  insinuating
 itself into its  cells, and extending along the course
 of the Artery, for a  very considerable way.
  ft. What is signified by Aneurism by Anastomosis?
 •" A. It is  formed by the Dilatation of  a cluster of
 small Arteries.

  ANATOMY AND PHYSIOLOGY OF THE VENOUS SYSTEM
                  - GENERALLY.             ,
  Q. What are  the physical qualities of the venous
blood ?
  A. It is dark   brown;  of a  peculiar  odour;  its
specific gravity greater than that of water; its capa-
city for caloric greater than that of arterial blood; it 
OF THE VEINS.
285
forms, when drawn out of the vessels, a soft mass, se-
parating by degrees into a transparent yellow liquid,
called serum, and a soft substance  nearly solid, of a
dark  reddish brown, called the cruor or clot; form-
ing sometimes on its surface a pellicle called its buffy
coat.  Rest permits the  formation  of the coagulum
more rapidly.
  Q.  What are the chemical qualities of  the venous
blood ?
  A.  Put into  contact with oxygen gas or atmosphe-
ric air, venous blood becomes scarlet; with azote, of
a reddish brown ; with ammonia, cherry red ; it con-
tains  water, albumen, muriate  of  soda and potash,
lactate of soda, and extractive  and animal matters,
phosphate of soda, and sometimes it has upon its sur-
face a fatty matter ; the clot is composed of colour-
ing matter and fibrine;  the former is solid, white,
without taste or smell:  phosphate of lime, charcoal
and carbonate of ammonia are the  principal ingredi-
ents yielded by this substance on combustion : a little
phosphate of magnesia, carbonate of lime, and carbo-
nate of soda are also found. The clot yields also car-
bon, hydrogen, oxygen and azote.
  ft.  What are the physical properties of the colour-
ing matter of the blood ?
  A.  They resemble small globules ; dried and  cal-
cined in the air, they burn, and form a charcoal very
difficult to reduce to ashes : oxide of iron principally,
phosphate of lime, pure lime and carbonic acid form its
component parts chemically considered.
  ft.  What are the causes of the coagulation of the
blood?
  A.  It is not owing to congelation or to the contact
of the air as has been supposed, but it is a peculiar
property, which appears in certain situations, and not
in others:  thus blood coagulates speedily out of the
body, though if thrown out into a cavity, as the scro-
tum, it does not for a long time.
  ft.  Is there any change of temperature upon the
coagulation of the blood ? 
286              OF THE VEINS.
   A. There is none according to the latest experi-
 ments.
   Q. How are the Veins to be distinguished from Ar-
 teries ?
   A. The veins may be distinguished by their want
 of pulsation, by their bluish colour, by their larger
 6ize, and by the thinness of their coats.
   Q. Do the Veins accompany the Arteries ?  .
   A. Yes, in general; in the extremities, however,
 and fleshy  parts, one set of veins runs deep, and ac-
 companies their respective arteries ; while another
 set runs more  superficially, and is termed subcuta-
 neous.
   ft. Do the Veins observe the same regularity in
 their situation, and division into branches, as the Ar-
 teries do ?
   A. No ; they exhibit a much greater variety, both
 in the situation of their trunks, and in the division of
 their branches.
   ft. Have veins as frequent anastomoses with each
 other as Arteries ?
  A. They anastomose much more frequently than
 the Arteries ; and that too by large trunks, while the
Arteries, with a few exceptions, anastomose by small
branches.
  Q.  Whether are the Veins or Arteries capable of
the greater distension ?
  A.  The Veins are more  flexible, and capable of
bearing greater distension than the Arteries, and ow-
ing to this, their  coats  become so attenuated, that
they are more subject to be ruptured.
  ft.  Why  are the veins of the muscular and ex-
treme parts furnished with Valves?
  A. That the flow of the blood may not be retarded,
but rather promoted by the muscular actions of those
parts, while the Valves prevent it from flowing back
towards the extremities.
  ft.  Why are the Veins of the Cranium, Thorax,
and Abdomen, with a few exceptions, not furnished
with Valves ? 
OF THE VEINS.
287
  A. Because the veins in these cavities are not sub-
ject to pressure from muscular  action, and, in conse-
quence, the blood is not easily retarded, and render-
ed subject to regurgitation.
  Q. What powers propel the blood in the Veins ?
  A. A velocity of very considerable strength is given
to the blood in the Arteries, by the contractile pow-
er of the heart and arteries themselves ;  by which
means it  is propelled into the extremities of  the
Veins  with considerable force, and then the elasti-
city  of the coats of the veins, and the motions of the
surrounding parts,  assisted  by the Valves, continue
its movement with the same  velocity towards  the
heart.
  Q. Have the veins the power of absorbing  sub-
stances placed in  contact with them ?
  A. They have,  provided these substances are solu-
ble in fluids; thus,  if camphor is introduced into one
of the cavities, whether serous or mucous, the odour
of this substance  is discharged  in the breath by the
lungs; the absorption is  more rapid in the serous
membranes, as that  of the peritoneum, than it  is in
the mucous, and  is always more copious  where  the
surface is very vascular, than where it is otherwise.
  ft. How is it proved that the veins possess the
power of absorption ?
  A. Odorous substances introduced into the intes-
tines are, immediately after  their introduction, per-
ceived in the vena cava, and not for a long time after
in the thoracic duct, or the lacteals.
  Q. Do the veins of the skin possess the power of
absorption ?
  A. According to Magendie they form an excep-
tion  to the general rule, because the  cuticle inter-
venes; if this membrane be removed, the veins ab-
sorb as usual:  thus  caustics, as arsenic applied to the
skin, have produced death.  Experiments made in
the United States by Rousseau, Mussie, Klapp  and
others, prove clearly that the cuticle is no obstacle to
the passage of certain lubstances through the skin- 
288          THE VEINS OF THF.
         VEINS OF THE INFERIOR EXTREMITY.
   Q. Describe the deep-seated Veins of the Foot and
 Leg?
   A. The deep-seated Veins being generally two in
 number,  called  Venae Comites, or  Satellites, run
 close at each side of their respective arteries,  from
 which they receive their names, and they unite into
 trunks where their arteries divide.  They frequently
 anastomose with each other, and sometimes also with
 the subcutaneous veins.  The Plantar unite and form
 the Tibial and Fibular  Veins,  which  ascend to the
 Poples, or upper part of the leg, where they join and
 constitute the Popliteal  Vein.
   ft.  Does the Popliteal Vein receive  others ?
   A.  Yes ; the Popliteal Vein lies close upon the
 posterior part of the Artery of that  name, and re-
 ceives the Vena Surales, Vena Saphena  Minor, and
 the Venae Articulares, in its ascent, becomes larger,
 and at the upper part of the Condyles is named the
 Femoral Vein.
   ft.  Describe the course of the Femoral Vein?
   A.  It ascends close by the side of the Artery,  pas-
 ses through the tendon  of the  Triceps with it;  near
 the middle of the femur it  lies deeper than the Ar-
 tery, it  then turns gradually to the inner, or Tibia),
 side of the Artery, and, in this situation, it passes un-
 der the Crural Arch  into the Abdomen, where it re-
ceives the name of the External Iliac Vein.
   ft.  What Veins does the Femoral receive in its as-
 cent?
   A. It receives all the Veins which correspond with
 the branches of the Femoral Artery : namely, those
 of the Perforant branches of the Profunda below the
Tendon of the Triceps ; opposite to the Trochanter
Minor, the trunk of the Vena  Profunda, which  has
previously received the veins corresponding with the
branches of the Arteria Profunda; above  the Tro-
chanter Minor, it receives small veins  from the  Ex-
ternal Parts of Generation, Inguinal Glands, and from 
INFERIOR EXTREMITY.         289
 the Integuments of the fore part of the Abdomen and
 of the Groin.
   Q. Describe the course of the External Iliac Vein?
   A. It  commences at the Crural Arch, runs up on
 the mesial or inside of the External Iliac Artery, and
 near to the vertebrae it crosses behind this Artery on
 the right side of the Pelvis, and behind the Internal
 Iliac Artery on the left side, where each joins its re-
 spective Internal Iliac Vein, and after their junction,
 the common  Iliac Vein begins.
   ft. What Veins does the External Iliac receive in
 its ascent along the brim  of the Pelvis?
   A. It receives at the Crural Arch the Epigastric,
 and the  Circumfiex of  the Ilium, and sometimes  the
 Obturator Vein.
   Q. Describe the course of  the Hypogastric or In-
 ternal Iliac Vein?
   A. The different  Veins which accompany  the
 branches of the Internal Iliac Artery, are named af-
 ter their respective Arteries, unite and form the In-
 ternal Iliac, or  Hypogastric Vein,  which is  situated
 on the outer side,  or lateral aspect, of  the  Internal
 Iliac  Artery, and soon joins the external Iliac Vein,
 to form the common Iliac.
   ft.  Have the Veins, of which the Internal Iliac is
 composed, any Valves in their  Structure ?
   A.  The Veins, situated in the muscular fleshy parts,
 are uniformly furnished with Valves ; other Veins, or
 a portion of others, not subjected to muscular pres-
 sure,  have no Valves.
   ft.  Describe the Common Iliac Vein?
   A.  This Vein lies on the right side of the Common
 Iliac Artery, joins its fellow just below  the bifurca-
 tion of the Aorta.  By their junction  the lower part
 of the Vena Cava is formed, and has its situation, on
 the right side of the Aorta.
  ft.  What Veins does the Vena Cava receive in its
 ascent ?
  A.  It receives first the  Sacral Vein, the  Lumbar,
the Renal,  and .right Spermatic;  and,  at the Dia-
  Vol. II.               B b 
 290           THE VEINS OF THE

 phragm, the Diaphragmatic and Hepatic Veins, after
 which it soon terminates in the Right Auricle of the
 Heart.
   ft. In what manner do the Left Lumbar Veins, and
 the Left Renal, pass the Aorta ?
   A. The left Lumbar Veins cross behind, and the
 Jeft Renal passes over before the Aorta to terminate
 in the Vena Cava.
   Q. Where does the left Spermatic Vein terminate ?
   A. It terminates in the left Renal Vein.
   ft. Are the Spermatic Veins furnished with Valves?
   A. These Veins are much larger than their corre-
 sponding Arteries, are  always furnished with valves
 without the Abdomen, and most frequently also with-
 in it.

        VEINS OF THE SUPERIOR EXTREMITY.
   Q.  What Veins do we find in the hand ?
   A.  The Veins of the hand consist of a deep-seated
 set, which take their names from the arteries;  and
 of a superficial set, quite irregular in their course and
 distribution.
   ft.  What Veins form the Cephalic Vein?
  A.  The veins running up from the back of  the
 hand, turning towards the radial aspect of the fore
 arm, unite, and by degrees form a large trunk,  fre-
 quently called the Cephalic Vein.
  Q.  What veins compose the Basilic  Vein?
  A.  The superficial veins on the ulnar aspect  gra-
 dually unite in their ascent, and form a trunk, named
 the Basilic Vein.
  ft.  Are there any more superficial  veins on  the
 fore-arm ?
  A.  Yes ;  between  these on the thenal or  volar as-
 pect of the arm, several veins are seen anastomosing
 with one another, and sometimes with the Cephalic,
sometimes with the  Basilic: when they anastomose
 with the Cephalic they are called Median-Cephalic,
 when with the Basilic, Median-Basilic.
  ft.  Describe the course and termination of the Ba-
silic Vein? 
SUPERIOR EXTREMITY.
291
  A. It lies near the Ulnar Condyle, and runs up the
inner or ulnar side of the humeral artery, forming the
Humeral Vein, which receives the superficial veins,
and has various communications with the deep-seated
in its course to the Axilla, where it joins the deep
veins, and forms the Axillary Vein.
  ft. Describe also the course and termination of the
Cephalic Vein.
  A. The Cephalic  Vein ascends on the outside  of
the Biceps, receiving superficial  branches, and form-
ing several  communications with the Basilic; then
passing between the Pectoralis Major and Deltoid, it
terminates in the Axillary Vein.
  ft. Do the deep and superficial veins anastomose ?
  A. Yes; the deep seated or satellites run one on
each side of their respective arteries, anastomose fre-
quently with each other, and sometimes with the su-
perficial veins.
  ft. Describe the Axillary Vein.
  A. The Axillary Vein, formed by the junction  of
the  superficial  and  deep seated  humeral  veins,
passes  up towards the Clavicle, and when it goes be-
tween it and the  first rib, it is then  called the Sub-
clavian Vein.
  ft. What veins does the Axillary one receive ?
  A. The Axillary  Vein receives  the  Circumflex,
Scapular, and External Thoracic  Veins.
  Q. Describe the Subclavian Vein}
  A. It commences from the Axillary, where it passes
between the Clavicle and  first rib,  runs across near
the artery, and over the anterior portion of the Sca-
lenus Anterior muscle, joins its fellow of the opposite
side, and both conjoined form  the Vena Cava Su-
perior.
  Q. Does the Subclavian Vein of the left side differ
in any  respects from that of the right?
  A. Yes; the left  Subclavian Vein is much longer
than the right, and passes across  the fore part of the
Arteries arising  from the arch of the Aorta, to join 
 292         VEINS OF  THE HEAD.

 the right Subclavian behind the cartilage of the first
 rib.
   ft.  What veins does the Subclavian receive in its
 course ?
   A.  It receives several veins from the superior dor-
 sal part of the Scapula, from the muscles and integu-
 ments of the neck, the external and then the internal
 Jugular Veins, and the Vertebral Vein,
   Q.  Does the  Subclavian  not  frequently receive
 other Veins ?
   A.  Yes;  it frequently receives the Inferior Laryn-
 geal, Anterior External Jugular, and  Internal Mam-
mary Veins; and on the left side the  Superior Inter-
costal Vein.
   Q. Do the  Vertebral  Veins not terminate in  the
Brain ?
   A. Yes;  the Vertebral Veins, properly so called,
terminate  in  the Inferior Petrosal, or Occipital Si-
nuses ; but small veins from the Spinal Cord, and its
membranes, and from the bones and deep seated
parts, form  a trunk, which occupies the place of the
Vertebral Vein in  the canal  of the  transverse pro-
cesses of the Cervical Vertebrae, and in consequence
is  called the Vertebral Vein.

               VEINS OF THE HEAD.
   ft.  Mention the  principal veins of the  external
parts of the head and face ?
   A.  Superficial and deep seated veins from the  up-
per parts and side of the head, after several anasto-
moses with the frontal and occipital,  unite and form
the Temporal  Vein,  which descends near to  the arte-
ry, penetrates the substance of the Parotid Gland,
from  which,  from  the  ear  and  cheek,  it receives
 branches, and passes down below the Inferior Maxilla,
 where it is joined by the Facial Vein.
   ft.  By what veins is the Facial formed ?
   A. Numerous small veins of the forehead form the
 Frontal Vein, which accompanying the artery of that
 name, passes downwards, receiving many branches 
JUGULAR VEINS.
293
 from the great facial plexus, until it gets below the
 lower jaw, where it unites with the Temporal Vein,
 and their  union constitutes the External  Jugular
 Vein.
  Q. What is the course and termination of the Ex-
 ternal Jugular Vein ?
  A. The  External Jugular, formed  chiefly by the
junction of the Temporal and Facial Veins, descends
 on  the neck,  under the Platysma Myoides, or Muscu-
 lus Cutaneus, and anterior to the  Sterno-Mastoideus,
 until it terminates in the  Subclavian Vein.
  Q. What veins does  the  External Jugular receive
in its descent ?
  A. It receives branches from  the Internal Maxilla-
ry Vein, the  Lingual, and  some from  the Occipital
 Vein.
  ft. What veins form the Anterior External Jugu-
lar  i
  A. The Subcutaneous and Superficial Veins on the
fore part of the  neck form a small trunk called by
that name, which  descends and terminates in the
Subclavian Vein.
  ft. Into what veins are those of the Eye sent ?
  A. The Vena Centralis Retinae, the Ciliary veins,
termed  Venae Vorticosae, the  Lachrymal, Ethmoi-
dal, Muscular, and other veins in  the orbit, by their
union form  the Ocular Vein.
  Q. Describe the situation, connections, and course
of the Ocular Vein.
  A. It is  situated at  the  nasal angle of the eye,
where  it forms large anastomoses with the  Facial
Vein, after  which it runs across, covered by the Attol-
lens, towards the temporal angle,  and turning  back-
wards passes  through the Superior  Orbitar  Fissure
into the Cranium,  and terminates in the Cavernout
Sinus.

        VEINS AND  SINUSES OF  THE BRAIN.
  ft. Where  do the Veins of the Brain terminate ?
  A. The veins  of  the Brain are but small,  run be-
                     b b 2 
294
JUGULAR \EINS.
tween the Convolutions, and terminate obliquely in
the different Sinuses.
  Q. Into which Sinuses do  all the others pour their
blood?
  A. All the other Sinuses pour their blood into the
Lateral Sinuses.
  ft. Enumerate the manner in  which  the Sinuses
communicate with each other ?
  A. The  Superior Longitudinal divides  into  the
Lateral,  the Inferior Longitudinal terminates in the
Torcular Herophili, which again terminates in the
commencement of the Lateral Sinuses.   The Circu-
lar Sinus of Ridley, situated  round the  Pituitary
Gland, pours its blood into  the  Cavernous Sinuses,
which having their situation  at the sides of  the Sella
Turcica, send it into the Petrosal Sinuses, which com-
municate with the Lateral.   All the Occipital Sinuses
communicate with the Lateral, which ultimately pass
out of the Cranium on each side by the Foramen La-
cerum Posterius, and terminate  in the Internal Jugu-
lar Vein.
  Q. Describe  the Internal Jugular  Veins ?
  A. The Internal Jugular receive all the blood car-
ried to the brain by the Internal Carotid and Verte-
bral Arteries, descend in the neck behind the Sterno
Mastoideus, included in a sheath of cellular substance
along with the  Common Carotid  Artery ; becoming
considerably enlarged, they terminate in  the Subcla-
vian Veins.
  Q. What veins does the Interior Jugular receive in
its descent ?
  A. It receives branches from  the  Pharynx and ad-
jacent muscles, the  principal part  of the Internal
Maxillary Vein, several branches from the Occipital
Vein, sometimes the Lingual, the  Superior Laryn-
geal, and  occasionally  the Inferior Laryngeal, and
also some irregular branches from the  muscles of the
neck. 
VEINS  WITHIN THE  THORAX.      295
              VEINS OF THE THORAX.
  ft. Describe the Internal Mammary Veins ?
  A. They ascend near to the arteries behind the
Cartilages of the true ribs,  and terminate in the Sub-
clavian Vein, sometimes the right terminates  in the
commencement of. the Cava Superior.
  Q. Are the Internal Mammary  Veins furnished
with Valves}
  A. They very frequently have valves, but  some-
times they have none.
  ft. Where do the Inferior Intercostal Veins termi-
nate ?
  A. They accompany their arteries along the infe-
rior margin  of  the ribs ; the  lower left Intercostal
Veins unite, and form the commencement of the Ve-
na Azygos, which about the middle of the Thorax
crosses the spine, generally behind the  Aorta, some-
times before it, and ascends at  the  right side of the
Aorta, over, or anterior to, the Intercostal arteries of
the right side.   The Vena Azygos,  frequently with
its lower extremity communicates with a Lumbar, or
the Renal Vein, or the Cava itself; the  inferior right
Intercostal  Veins unite  also into a trunk, which as-
cends, after sending a communicating branch down-
wards to the Lumbar or Renal, and joins the trunk
of the Vena Azygos, which receives the other Inter-
costal veins as it ascends, those of the left side cross-
ing behind  the Aorta, and  those of the  right uniting
with it directly.
  ft. Where does the  Vena Azygos terminate ?
  4. Near the upper part of the Thorax the Vena
Azygos makes a bend forwards over the commence-
ment of the right pulmonary vessels, and terminates
in the Superior Cava.
  ft. Has the Vena Azygos any Valves ?
  A. Yes;  it is generally furnished with valves ; but
sometimes not.
  Q. Where do the Superior Intercostal Veins termi-
nate ?
  A. Those of the right side terminate in the Vena 
296        DISEASES OF  THE VEINS.
Azygos :  those of the left side form a trunk, called
the Left  Vena Azygos or  Left Superior Intercostal,
which terminates in the  Subclavian Vein.
  Q.  Where do the Bronchial  Veins terminate ?
  A.  The right  Bronchial Vein  terminates  in the
Vena Azygos; the  left  in the Superior Intercostal
Vein.
  Q.  Where do the Oesophageal Veins terminate ?
  A.  In the Vena Azygos, Left Superior Intercostal,
and Subclavian Veins.
  Q.  Where do the Thymic,  Pericardiac, and Veins
from the  Mediastinum terminate ?
  A.  In the Subclavian Veins, or in the beginning of
the Superior Cava?
  Q.  Describe  the  course of  the  Vena  Cava Supe-
rior }
  A.  The Vena Cava Superior formed by the junc-
tion  of the two  Subclavian and  Azygos Veins, de-
scends on the  right side of, and rather  anterior to,
the ascending Aorta,  and soon penetrates the peri-
cardium,  and afterwards  terminates in the right Auri-
cle of the Heart, opposite to the Inferior Cava.

              DISEASES OF THE  VEINS.
  Q.  What  organic Diseases are  veins  particularly
subject to ?
  A.  To Varicose enlargement, and to Inflammation.
  Q.  What is meant by Varicose Veins ?
  A.  It is a permanently dilated state of a Vein,  con-
taining much blood, and  impeding the circulation.
  Q.  What are the symptoms of an inflamed Vein/
  A.  Fever, acute pain  and redness in the course of
the vein, and swelling of the part affected.

       OF  THE ABSORBENT SYSTEM.

  ft.  Of  what  vessels does the Absorbent System
consist ?
  A.  It consists of  Lacteal and Lymphatic Vessels,
and of Conglobate Glands. 
ABSORBENT  SYSTEM.
297
  ft. Where are the Lacteals situated, and what is
their peculiar office ?
  A. They commence  in the  small intestines, pass
between the layers of the Mesentery, and carry the
Chyle absorbed from the chymified mass of alimenta-
ry matter to the Thoracic Duct.
  ft. Where are the Lymphatic Vessels situated ?
  A. They have been discovered in almost all parts
of the system, and a strong presumption is afforded
that they exist in all parts of it: although as yet they
have not  been  satisfactorily  demonstrated in  the
Brain, Placenta, and its  Membranes.
  Q. What is the office  of the Lymphatics ?
  A. They take up the Lymph, and decayed parts of
the system, and convey  them into the general mass of
blood.
  ft. What ar*e  the properties of the Lymph ?
  A. It is red, and slightly opaline in colour;  some-
times yellow,  saltish to the taste,  disposed to form
reddish filaments ; and thus to separate into two parts,
the one a serous fluid,  the other a coagulum, resem-
bling in its qualities the  clot of the blood.
  ft. What are  the chemical components of Chyle ?
  A. Water, fibrine and albumen, with the carbonate,
the phosphates of lime and soda,  also the muriate of
soda, and the phosphate of magnesia.
  ft. Where are the Conglobate Glands situated ?
  A. In the cellular substance under the skin, or up-
on the trunks of blood-vessels belonging to the  visce-
ra of the different cavities.
  ft. What is their size and texture ?
  A. These Glands differ in size from a millet seed
to a walnut; are generally found in clusters.   Their
form is somewhat oval and flattened ; their colour is
reddish brown, becoming paler in advanced age.
They are composed of a congeries of vessels minute-
ly dispersed through their substance, and connected
by  cellular substance,  which forms a membranous
covering on their surface. 
298          ABSORBENT  SYSTEM.
  Q.  What is supposed to be the use of these Con-
globate Glands ?
  A.  The Lymphatic and Lacteal Vessels all pass
through  these Glands, by which the  Lymph  and
Chyle are  supposed to undergo certain  unknown
changes: but it is more probable that these Glands
entangle acrid and noxious particles,  and prevent
them from passing into the mass of blood.
  Q.  Are the Vessels which enter a Gland, designa-
ted  by names different  from those which pass out
of it ?
  A.  Yes;  the vessels entering it are called Vasa In-
ferentia ,■ and those passing out at the opposite side,
Vasa Efferentia.
  ft.  What is the texture of the Lymphatics ?
  A.  They have  two or three coats, thin, somewhat
transparent, and strong; composed of fibres possess-
ing contractile power to a considerable degree, and
therefore have been supposed muscular  by some
Anatomists.
  Q.  Are  the Lymphatics and  Lacteals  furnished
with Valves ?
  A.  Yes;  Valves of a semilunar form,  at small dis-
tances from each other, there being sometimes four,
six, or eight, in the space of an inch, are placed in
pairs throughout their whole extent, and prevent the
retrograde motion of their contents.
  Q.  In what manner do the Absorbent Vessels com-
mence ?
  A.  They commence by open extremities or mouths
of a calibre too minute to be visible to the naked eye.
  Q.  By what power do they take up their fluids?
  A.  They take  in  the  fluids  applied  to  their ex-
tremities by Capillary Attraction, and partly, perhaps,
by a vital action of the vessels.
  Q. Does the Lymph flow from their trunks to the
extremities, or how ?
  A. No; it is absorbed by their extremities, and
passes into larger and larger trunks in its course, to
be poured into the mass of blood. 
             INFERIOR  EXTREMITY.        299

   ft. By what means  are the fluids propelled along
 the Absorbent Vessels?
   A. They are sucked in by Capillary and Vital At-
 traction, are moved  along  by the elasticity or con-
 tractile power of the vessels, accelerated in their mo-
 tion by the pulsation  of the  arteries and movement
 of surrounding muscles or parts, and prevented from
 flowing back by the valves.
   Q. Where do the Absorbents terminate ?
   A. They all terminate either in the Thoracic Duct,
 or Veins.
   ft. Have they any Valves at their terminations ?
   A. Yes;  they have always  one,  generally  two
 valves,  placed there to prevent the contents of the
 Thoracic Duct, or Veins, from entering them.

      LYMPHATICS OF  THE LOWER EXTREMITY.

   ft. Are  the  Lymphatics  divided into superficial
 and deep seated ?
   A. Yes ; in the same manner  as the  Veins.
   Q.  Where have the Superficial Lymphatics their
 course ?
   A.  They are situated between the skin and mus-
 cles, are much more numerous than the Veins; they
 form a plexus or net-work with  each other in their
 course, by joining and separating so repeatedly.
   ft.  Describe the general course of the Superficial
 Lymphatics in the foot ?
   A.  They are observed to form a plexus around  the
 toes,  from  which numerous branches are dispersed
 over the upper  part  of the foot forming a plexus :
 while others are dispersed in a similar retiform man-
 ner along the sole towards the heel and ankles.
   ft.  Describe their general course on the Leg ?
   A.  From the  plexus on the upper part of the foot
 many branches ascend diverging towards the ankles,
 and on the fore part of the  leg, and many also from
tli* plexus at the heel, ascend on the hind part of the
leg : these Lymphatics communicate very frequently
with each other, and  pass up,  some on the inside, 
 300     ABSORBENTS  OF THE  PELVIS.

 others on the outside of the knee, and some enter the
 Popliteal Glands.
  Q.  Describe the  course  of the Superficial Lym-
 phatics on the Thigh ?
  A.  A plexus ascends from the inner side of the
 knee, spreading on  the inner and fore parts of the
 thigh, to the groin; the Other Lymphatics from the
 outside of the knee  ascend, and form branches which
 either terminate in the inner plexus of the thigh, or
 in the Inguinal Glands.
  ft.  Describe the deep-seated Lymphatics ?
  A. They are situated among the muscles, and gene-
 rally accompany the  blood-vessels, either running one
 or two on each side  of them, or forming a plexus over
 them.  Those of the foot and leg pass into the  Pop-
 liteal Glands.
  Q. Describe the situation and number of the  Pop-
 liteal  Glands.
  A. These  Glands  are situated in the ham, around
 the Popliteal Artery, immersed in adipose substance.
 They are generally three or four in number.
  ft. What deep seated Lymphatics arise from the
 Popliteal Glands ?
  A. Two or more  trunks  of considerable  size ac-
 company the femoral Artery, anastomose frequently
 with each other, and with some of the superficial in
 their ascent, and  ultimately terminate in the Ingui-
 nal  Glands.
  Q. Describe the situation and number of the Ingui-
 nal  Glands ?
  A; They are generally eight, twelve, or more  in
 number ; some of which are situated external to the
 tendinous facia, others below it and close upon the
 blood-vessels of the groin.
  ft.  What  Lymphatic Vessels do these  Inguinal
 Glands receive ?
  A. They receive the superficial and  deep seated
Lymphatics of the thigh; the superficial ones Of the
Loins, Nates, Scrotum, Penis,  Labia  Pudendi, and
under part of the abdomen. 
         ABSORBENTS OF THE PELVIS.      301

   Q. Where do the deep seated Lymphatics of the
 Genitals pass ?
   A. They pass generally into the abdomen, and ter-
 minate in the Iliac and Lumbar Glands: some of them
 sometimes  terminate in the deep  seated cluster of
 the Inguinal Glands.
   Q. What Vasa Efferentia proceed from the Ingui-
 nal Glands ?
   A. A few trunks of considerable size go out of
 them, pass into the abdomen under  the Crural Arch
 and  over the blood vessels, and terminate in the Iliac
 and  Lumbar Glands.
   Q. Describe the Lymphatics of the  Urinary Blad-
 der}
   A. They accompany its blood vessels, pass into
 Glands situated upon its sides, and  terminate in the
 Iliac Glands.
   ft. Describe the Lymphatics of the Uterus ?
   A. They accompany  the Hypogastric and Sperma-
 tic Arteries, forming a plexus upon them, pass through
Glands situated on the sides  of the Vagina, and ter-
minate in the Iliac Glands.
   ft. Where do the Lymphatics of the Rectum pass ?
   A. They pass through  small Glands  situated  be-
tween it and the os sacrum, and then terminate in the
 Lumbar Glands.
   Q. What is the situation of the Iliac Glands ?
   A. They are scattered along the course of the Iliac
 Arteries, and are pretty numerous.
   Q. What is the situation and number of the Lum-
bar Glands ?
   A. They are placed on  the fore part of the Abdo-
minal Aorta,  of the Inferior Vena Cava, and of the
 bodies of the Lumbar Vertebrae.  They are very nu-
 merous.

            OF  THE  LACTEAL VESSELS.
   ft. Describe the origins of the Lacteals.        «
   A. Each Lacteal takes its origin by numerous short
radiated branches in one of the Villi, on the internal
   Vol. II.             C c 
302   ABSORBENTS  OF THE  ABDOMEN.

surface of the Intestines; each radiating branch han
an orifice by which it absorbs Chyle, and being four
or six in number, they unite and form the Lacteal
trunk, which runs a little way obliquely through the
coats  of the intestine, uniting with other trunks  of
the same kind, and becoming larger.
  Q.  What course do the Lacteals take ?
  A.  They accompany the  blood-vessels, but being
more  numerous, one or two are generally situated on
each side of them.
  ft.  Do no Lymphatics arise from the Intestines?
  A.  Yes;  Lymphatics  appear  between the pe-
ritoneal and muscular  coats of the Intestines, run
along  them, and have fewer  anastomoses  than the
Lacteals.
  Q.  Do these Lymphatics and the Lacteals unite ?
  A.  Yes; they unite, and their different trunks form
a plexus, which runs between the two layers of the
Mesentery and Meso-colon.
  ft.  From which of the Intestines do the  greatest
number of Lacteals arise ?
  A.  From the Jejunum the largest and greatest num-
ber arises ; but from the termination of the Duode-
num,  and the upper  portion of the Ilium, a great
many  also arise.
  ft.  Do the Lacteals pass through Glands ?
  A.  Yes; a great number of Glands is situated in
adipose substance between the layers of the Mesen-
tery, at small distances from each other, and the Lac-
teals all pass through one or more of these Mesente-
ric Glands in their way to the Thoracic Duct.
  Q.  Are the Mesenteric Glands of the same struc-
ture as Absorbent Glands in other parts of the sys-
tem ?
  A.  Yes;  they  are whitish when containing Chyle,
are flattened, and of different sizes from a mere point
to a half or two-thirds of an inch in diameter.
  ft.  Are the Mesenteric Glands continued from the
intestines to the Thoracic Duct ?
  A.  No: They are seldom seen nearer to  the Intes- 
MESENTERIC GLANDS.
305
 tines than two or three inches, and they become fewer
 in number neat to the Thoracic Duct.
   Q. What is supposed to be the use of the Mesente-
 ric Glands ?
   A. Their use is not known ; but it is probable that
 they entangle noxious and  poisonous fluids, and pre-
 vent them from getting easily into the mass of blood;
 and in this theyagree with Lymphatic Glands in other
 parts of the system.
   ft. Where do the Lacteals terminate ?
   A. After they have passed through the different
 Mesenteric Glands, they unite into two or  three or
 more trunks  which accompany the branches of the
 Superior Mesenteric Artery, and at the right side of
 the Aorta terminate in the beginning of the Thoracic
 Duct; or, sometimes, in the trunks of the Lymphatics
 of the inferior extremities,  and thus constitute the
 commencement of the Duct.

        LYMPHATICS OF THE OTHER VISCERA.
   Q. Are the Lymphatics of the Colon as large and nu-
 merous as those of the small Intestines ?
   A. No; they are smaller, and comparatively fewer
 in number.
   ft. Do they pass through Glands ?
   A. Yes; they pass through Glands situated between
 the layers of the Meso-colon.
   Q. Are these Meso-colic  Glands numerous and
 large ?
   A. They are neither so numerous nor so large as
 those of the Mesentery.
   ft. Where do the Lymphatics of the Colon termi-
 nate ?
   A. Those of the Caput Caecum and right portion
 of the Colon, join the trunks of the Mesenteric at the
 root of the Superior Mesenteric Artery; while those
 of the left portion join large trunks near the root of
 the Inferior Mesenteric, and terminate either in the
Lumbar Glands, or in  the  commencement of the
 Thoracic Duct. 
304   ABSORBENTS OF THE STOMACH, 8cC.
  Q. How are the Lymphatics of the Stomach dispos-
ed?
  A. Into two fasciculi,the one composed of branches
from both sides of the Stomach, occopies the small
curvature, and passes through a few stiall glands situ-
ated at the junction of the Omentum Minus with the
Stomach; they become larger, enter other Glands to-
gether with the deep-seated Lymphatics of the Liver,
and, with them, terminate  in the Thoracic Duct.
The other  fasciculus, formed like the former by
branches from both sides of the stomach, occupies the
large curvature;  some of its vessels running to the
left, and receiving the Lymphatics of that side of the
Omentum Majus, pass through  two or three small
glands on the left of the curvature, and, together with
the Lymphatics of the Spleen and  Pancreas, termi-
nate in the Thoracic Duct: others of its vessels run-
ning to the right receive the Lymphatics of the right
side of the  Omentum,  pass  through two or three
Glands situated on the right, descend by the Pylorus,
and, together with the plexus of the small curvature,
and with the deep-seated Lymphatics of the Liver,
terminate in the Thoracic  Duct.
  Q. Describe the Superficial Lymphatics  of the Li-
ver?
  A. The Superficial communicate freely with the
deep-seated Lymphatics of the Liver.   They form a
plexus on its convex surface, which sends several
trunks to the Suspensory and  Lateral Ligaments ;
these  trunks perforate the Diaphragm, pass through
Glands situated upon the  anterior part of  the CEso-
phagus, the Pericardium, or in some contiguous part,
and then terminate in the  Thoracic Duct.
  ft. Do some of the Superficial Lymphatics of the
Liver not terminate differently sometimes ?
  A. Yes; they sometimes run up between  the layers
of the Mediastinum Anterius, or in company with
the Internal Mammary blood-vessels, and  terminate
either in the upper part of the Thoracic Duct, or 
       ABSORBENTS OF THE SPLEEN, kc.   305

in the large Lymphatic trunks on the right side of the
neck.
  ft. Where do the Lymphatics on the concave sur-
face of the Liver direct their course ?
  A. They converge and run towards the Porta, where
they are united with the deep-seated Lymphatics.
  ft. Describe the course  and termination of the
Deep-Seated Lymphatics of the Liver.
  A. They accompany  the  blood-vessels and biliary
ducts in the substance of the Liver, pass through se-
veral Glands situatecl about the trunk of the Vena
Portae, and, near the root of the Superior Mesenteric
Artery, terminate in the Thoracic Duct.
  Q. Describe the  Lymphatic Vessels of the Spleen.
  A. The Lymphatics  of the Spleen form a plexus
upon its surface, accompany  its blood-vessels, pass
through Glands situated about the Splenic Artery, re-
ceive the Lymphatics of the Pancreas in their course,
unite with the Lymphatics of the Stomach, and with
some from the concave surface of the Liver, they
form a  plexus near  the head of the Pancreas, from
which considerable branches are sent out, passing on
both sides of the  Duodenum to  terminate in the Tho-
racic Duct near the entrance of the Lacteals.
  Q. Describe the Lymphatics of the. Kidneys.
  A. The Lymphatics of the Kidney are seldom seen,
excepting when  the Kidney is in a diseased state.
They,  however, converge towards the pelvis, where
the Superficial and deep-seated  unite, forming a
plexus  round  the  blood-vessels,  which sends  out
trunks  that pass through some of the Lumbar Glands,
and terminate in the  large Lymphatics near  the
Aorta.
  ft. Where do the Lymphatics of the Renal Capsules
terminate ?
  A. They are numerous, and all go to join the Renal
Plexus.
                      cc 2 
306            THORACIC  DUCT.
             OF THE THORACIC DUCT.
  Q. What vessels form the commencement of the
Thoracic Duct ?
  A. The lower extremity of  the  Thoracic Duct is
formed by the junction of the trunks of the Lymphat-
ics of the right and left Inferior Extremities, and  of
the Lacteal Vessels.
  ft. In what part of the spine does that union take
place ?
  A. On the anterior part of the third Lumbar Ver-
tebra.
  ft. Describe the course of the Thoracic Duct.
  A. The Duct so formed is large, and placed behind
the Aorta;  it crosses obliquely to the right, and as-
cends on the right side of the Aorta. At the first Lum-
bar Vertebra it dilates into an oval or pyriform shape,
called the Receptaculum Chyli, situated above the
right Renal Artery, and behind the right crus of the
diaphragm :  from this the Duct ascends between the
crura of  the Diaphragm into the Thorax, and there
runs on the anterior part of the Spine in the Medias-
tinum posterius, still on the right of the Aorta, and
on the left of the Vena Azygos.  About the fourth
Dorsal Vertebra, it ascends obliquely  over to the left
side of the spine, behind the OZsophagus and descend-
ing Aorta, till it reaches the left Carotid;  it rises
from the Thorax behind the Longus Colli and Inter-
nal Jugular Vein, to the  sixth Cervical Vertebra,
where it bends  forwards  and  downwards,  and ter-
minates  in the  Subclavian Vein,  at  the  upper and
back part of the angle formed by the Internal Jugu-
lar.
  Q. Does the  Thoracic Duct  observe a  straight  or
winding course ?
  A. It forms several windings, and not  unfrequent-
ly divides and unites repeatedly in its course.
  ft. Is the  Thoracic Duct furnished with Valves ?
  A. Yes; it has a  great many valves in its internal
surface. 
          ABSORBENTS  OF THE  THORAX.     307

    Q. By what powers does it convey its contents up-
  wards ?
    A. By its elastic contractile power, which is often
  increased by the division of the duct into branches,
  (for the  smaller the vessel the greater is  its elastic
  power, aided perhaps by capillary attraction,) by the
  pulsation of the Aorta, by the valves, and the Vis a
  tergo, after the fluid is put in motion.
    Q. Describe the course and termination of the In-
  tercostal  Lymphatics.
    A. One or two  trunks  accompany the Intercostal
  blood-vessels in the intercostal spaces, and all of them
  pass through glands situated near the dorsal vertebrae,
  before they terminate in the Thoracic Duct.
   ft.  Describe the Lymphatics of the Lungs.
   A.  The superficial  ones form Areolae,  which run
 between the Lobules, and cover almost the whole
 surface;  they run towards the  bronchia, and pass
 through the Bronchial Glands, where they are united
 with the deep-seated Lymphatics, which followed the
 blood-vessels and bronchial tubes in the substance of
 the lungs.
   ft.  Where do they terminate ?
   A. The greater  number of the left  lung form a
 trunk which terminates in the Thoracic Duct, behind
 the bifurcation of the Trachea ; the rest pass through
 Glands behind the arch of  the  Aorta, and terminate
 also in the Thoracic  Duct near its end.  Those of
 the right  Lung, after passing through the  Bronchial
 Glands, terminate partly in the Thoracic Duct, and
 partly in the common trunk of the right side of the
 neck.
   ft.  Describe the course and termination of the Lym-
phatics of the Heart.
   A.  They follow the  course of the Coronary Arte-
ries ;  the right passes over the arch of the Aorta, goes
through a gland behind the origin of the Carotid Ar-
tery,  and terminates  in the  Common Lymphatic
Trunk on the right side of  the neck ; the left Lym-
phatic trunk of the heart being the  larger, composed 
308          ABSORBENTS OF THE
of a branch running between the ventricles on its up-
per part, and of another running in the groove be-
tween them on its under part, runs through a gland
placed behind  the Pulmonary Artery, between the
arch of the Aorta, and division of the Trachea, and
terminates in the upper end of the Thoracic Duct.

    LYMPHATICS OF  THE SUPERIOR EXTREMITY.
  ft. Describe the Lymphatics of the Hand.
  A. The Lymphatics of the Superior Extremity,
like those of the Inferior, are divided into superficial
and deep-seated.  The superficial commencing upon
the fore and back parts of the fingers, have frequent
communications  with  each other, and soon form a
plexus upon the back of the hand,  and also in the
palm, from which they rise upon the fore-arm.
  Q. Do the Superficial Lymphatics observe any de-
finite course in the fore-arm ?
  A. No ; they are found generally near to the veins;
hence they may be said to  accompany the numerous
ramifications of the Cephalic and Basilic Veins.  The
Lymphatics on the Anconal aspect divide ;  some turn
obliquely over the Radial Muscles, and run up in the
course of the Radius; others turn over those of the
Ulna and follow the Basilic Vein.
  Q. Do these Lymphatics pass through glands any-
where ?
  A.  Not in the fore-arm; but while they ascend
in  the  inner and fore part of  the Humerus, they
pass through some small glands in the course of the
Humeral Artery, and the  rest go  into the Axillary
Glands.
  ft.  Do  these  Superficial Lymphatics anastomose
with the deep-seated ?
  A. Yes; and very frequently with each other round
the whole arm, till they terminate in the Axillary
Glands'.
  Q.  Where have the deep-seated Lymphatics of the
Arm their course and termination ?
  A.  They run on each side of the Arterial branches 
SUPERIOR  EXTREMITY.         309
and trunks the whole way up the arm, and terminate
in the Axillary Glands.
  ft. What other Lymphatics  terminate in the Axil-
lary Glands ?
  A. Besides the Superficial and Deep-seated of the
Arm, the Lymphatics of the Mamma and lateral part
of the Thorax, after passing through some small glands
at the edge of the large Pectoral Muscle, the Sub-cu-
taneous Lymphatics from the back part of the Tho-
rax, from the integuments and muscles of the Scapula,
terminate all in the Axillary Glands.
  Q. Describe the Axillary Glands.
  A. These Glands vary in  size and number, but are
considerable in both respects ; they are situated in
the hollow of the Axilla, between the Pectoralis Ma-
jor and Latissimus Dorsi, embedded in adipose sub-
stance,  and connected by  it  with  the blood-vessels
and nerves.
  Q. What Vasa Efferentia go out from the Axillary
Glands ?
  A. Several large vessels go  out from them under
the clavicle, and  there unite into  a trunk, which,  in
the right side, receives or joins the short trunk form-
ing the general termination of the Lymphatic System
on this side, and  which, in the left side, generally ter-
minates in the Thoracic Duct.

       LYMPHATICS OF THE  HEAD AND  KECK.
  ft. What Lymphatics do we find on the Occiput ?
  A.  A great  many accompanying  the different
branches of blood-vessels pass through small glands
behind the ears,  and over the Mastoid processes.
   Q.  What is the course of the  Lymphatics on the
side of the Head ?
   A.  They accompany the branches of the Temporal
Artery, pass down through glands either situated at
the root of the Zygoma, or through others connected
with the Parotid Gland.
   ft.  Describe the course of the Lymphatics of the
face. 
 310    ABSORBENTS OF  THE HEAD, 8cC.

  A. These Lymphatics also follow the general course
 of the blood-vessels ; some of them passing through
 glands situated on the outside of the Buccinator,
 others through large glands at the outer and under
 part of the Inferior Maxilla.
  ft. What course do the Lymphatics of the nose and
 mouth take ?
  A. Those of the inner parts of  the Nose accompa-
 ny  the  branches  of the Internal Maxillary Artery i
 those of the  Tongue, Muscles, and parts about the Os
 Hyoides, pass through glands situated behind  the an-
 gle of the Lower Jaw.
  Q. What course do all these Lymphatics take in
 the Neck ?
  A. Both the Superficial and Deep-seated follow the
 External andlnternal Jugular Veins and Carotid Ar-
 teries,  receiving  many  branches as they  descend
 from the integuments and muscles of the Neck, and
 forming a remarkable plexus, which goes through nu-
 merous  small  glands,  called Concatenatae, situated
 around these blood-vessels.
  ft. Where do these Lymphatics of the Neck termi-
 nate ?
  A.  After that  plexus has  passed  through  the
 Glandulae Concatenatae, the different Lymphatics
 unite into one trunk, which, in the right side, goes
 into the  General  Lymphatic  trunk, and which, on
 the left, enters the Thoracic Duct near its termina-
 tion.
  Q. Describe the General Lymphatic Trunk in the
 right side ?
  A. It  is large and scarcely half an inch long ;  it is
formed by the  Lymphatics of the right Lung, right
 side of the Heart, of the Diaphragm, and of the Liver;
and also by the Lymphatics of the right arm, right
 side of the Neck, and of the Thyroid Gland, and of
the Head.
  Q. Do all the Lymphatics  on the left side termi-
 nate in the Thoracic Duct ?
  A. Yes; almost all of them terminate in it, except- 
REMARKS ON THE  CHYLE.       Sll
 ing one or two occasionally in the Internal Jugular,
 or Subclavian Vein.
   ft. Are there no Lymphatics in the Brain ?
   A. Anatomists have not been able to  trace them
 satisfactorily; but it is highly probable that they exist
 in the Brain, because they have been supposed to have
 been seen  on its membranes; because they have been
 found occasionally in the passages of the blood-ves-
 sels : because the Lymphatic Glands of the  occiput
 and neck have become enlarged from diseases of the
 Brain;  because  Lymphatics have been found in the
 Brain of Fish ; and because effusion of serum in seve-
 ral cases of Hydrocephalus Internus has been remov-
 ed by suitable remedies.

            PHYSIOLOGY OF THF.  CHYLE.
   Q.  Is the Chyle  completely formed in the Intes-
 tines before it is absorbed by the Lacteals ?
   A.  It has been supposed that its passage through
 the Mesenteric Glands, along the Thoracic Duct, and
 through the Lungs, is necessary for proper Chylifica-
 tion.  But  although  it may be  purified in passing
 through the Mesenteric Glands, yet it seems perfect-
 ly formed by the chemical changes in  the Alimentary
 Mass previous to its absorption.
   ft.  What is the  rapidity  of  the  course  of  the
 Chyle >
  A.  It varies with the quantity formed in the small
 intestines ;  it is slow when small  in quantity; rapid
 when large.
  Q.  Do the qualities of the  Chyle differ with the
 aliments taken in ?
  A.  Dr. Marcet has found that Chyle produced from
 vegetable food contains more Carbon  than  that from
 animal.
  ft.  Is the Thoracic Duct the only passage for the
 Chyle into  the blood ?
  A. It would appear so ; Liquids, as, alcohol, solu-
tions of camphor, gain  admittance into the blood by
the Lymphatic vessels uniting with the Veins, as is 
312      OF THE NERVOUS SYSTEM.

proved by distillation  of the blood, which demon-
strates them in that fluid ? though none can be found
in the Chyle or in the  Thoracic Duct.
  ft. By what outlets are the Lymph and its vitiated
particles, taken up from decayed parts, cast out of the
system ?
  A. By the four Emunctories, viz. the faeces, urine,
perspiration, and exhalation from the Lungs.
  ft. Can the discharge of noxious particles from the
blood be accelerated ?
  A. Yes; by means of medicines which  stimulate
the Intestines, the Kidneys, Skin, and Lungs, to in-
crease their peculiar discharges, together with which
the vitiated Lymph is carried off.

             OF  THE NERVOUS SYSTEM.

  Q. What membranes form the theca of the Spinal
Marrow ?
  A. The same membranes,  which surround the
Brain, are continued down the spinal canal, and form
the sheath of the Medulla Spinales, and it receives a
partial ligamentous covering also from the ligament
lining the vertebral canal.
  Q. Do these membranes embrace the Spinal Cord
closely ?
  A. No; the involucra envelope the spinal marrow
loosely, so as to admit of the flexions  of  the spine
without inconvenience.
  Q.  Doesthe Spinal  Marrow consist of a Cineritious
and Medullary substance, as the Brain does?
  A.  Yes;  but they are placed the reverse of the
Brain ; the Medullary  matter being exterior, and the
Cineritious interior.
  Q.  Is the Spinal Cord of the same size during its
whole length ?
  A.  No ; it  is much  larger near the lower part of
the cervical and lumbar vertebrae, than in the dorsal.
  Q. Why is  it larger  in these places ?
  A. Because the large nerves which are sent to the
Superior Extremities,  pass out from the Spinal Mar- 
             OF THE  SPINAL  CORD.         313

row through the four lowest cervical holes; and the
large nerves,  also, which send off those of the Inferior
Extremities,  come out  from the  Spinal Marrow
through the holes between the Lumbar Vertebrae ;
whereas the dorsal spinal cord only gives off the In-
tercostal Nerves, which are comparatively small.
  Q. Is the Spinal  Cord made up of different por-
tions corresponding to the crura of the Cerebrum and
Cerebellum ?
  A. Yes; there are an anterior and a posterior fis-
sure on its surface, which form two lateral portions;
and these  again are subdivided by a lateral fissure into
a large anterior, and a small posterior portion.
  ft. Are  these four portions firmly united ?
  A. They seem united only by fine cellular sub-
stance  to  near their middle,  where cineritious sub-
stance, passing from one to another,  connects them
intimately.
  ft. In what manner are the Nerves, sent out from
the Spinal Cord, formed from these portions ?
  A. A flat fasciculus of  nervous filaments is sent off
from the anterior, and another from the posterior sur-
face of the lateral portions; each is furnished with a
sheath proper to itself,  and the two sheaths are con-
nected by cellular substance till they get into the
hole between the vertebrae.
  Q. When they get there what happens ?
  A. Between the vertebrae, each posterior fascicu-
lus forms a Ganglion, from the opposite part of which
a nerve issues, which is  immediately joined by the
anterior fasciculus to constitute the origin of a spinal
nerve.
  Q. Is any provision made for preventing the spinal
marrow and  the  delicate filaments  of the fasciculi
from being overstretched and ruptured ?
  A. Yes; the Ligamentum  Denticulatum seems of
that description; it is attached to the Dura-Mater,
where it comes out of the cranium, accompanies the
spinal cord to its lowest  extremity,  and from its op-
posite  side,  sends off Denticuli, which run trans-
  Vol. II.              D d 
 314  SUB-OCCiriTAL AND CERVICAL NERVES.

 versely among the nervous filaments,  and support
 them.
   Q. What happens when the Spinal Nerves  come
 out from the holes between the vertebrae ?
   A. Each sends branches backwards to the muscles,
 and  others forwards, to join the Great Sympathetic
 Nerve; while the trunk itself passes on to its place of
 distribution.
   ft. How many pairs of Spinal Nerves go out from
 the Cord ?
   A. Thirty pairs; one sub-occipital;  seven cervical;
 twelve dorsal; five lumbar; znAfive sacral.
   ft. Describe the origin and course of the sub-occi-
 PITAL NERVES ?
   A. The  sub-occipital  nerve  on each side arises
 from the beginning of the spinal marrow by an ante-
 rior and a posterior fasciculus, which fasciculi form a
 ganglion in passing out between the bones,  from
 which one nerve goes out under the Vertebral Artery,
 and  over the transverse process of the Atlas to the
 neck, where it  is connected above to the ninth pair
 by an arch,  and below, to the first cervical also by
 an arch ;  anteriorly to the upper ganglion of the
 Great  Sympathetic by small  branches,  while the
 trunk of the  Sub-occipital itself divides, and is dis-
 persed among the muscles.
  Q.  Describe the origin and course of the first cer-
 vical nerve?
  A. It passes out from the Spinal Cord between the
 Atlas and Vertebra Dentata, and immediately divides
 into an anterior, and a posterior branch.
  Q.  Describe the anterior branch of the first Cervi-
 cal Nerve ?
  A. It passes under the  transverse process of the
 Atlas, and is joined  by an arch to the Accessorius,
and by branches to the ninth pair,  and by a ganglion
to the uppermost ganglion of the Great Sympathetic,
from which a branch  is sent down  to the second cer-
vical nerve ; filaments also go to the muscles.
  ft. Describe its Posterior branch. 
CERVICAL  NERVES.
315
    A.  It is the larger of the two, perforates the mus-
 cles, giving off branches to them, ascends upon the
 occiput, dividing into many branches, which are  dis-
 persed  among the  muscles and integuments,  and
 communicate with branches of the Frontal, and Portio
 Dura.
   ft. Describe the Second Cervical Nerve?
   A. After being formed by two fasciculi in the ordi-
 nary way, and passing out between the vertebrae, it
 sends off a branch to the middle ganglion of  the
 Great Sympathetic, another downwards to join  the
 third cervical, sends  branches  to the Sterno-Mas-
 toideus, communicates with the Accessorius behind
 it, and more forwards with the Descendens Noni; it
 also sends off a small branch to assist in  the forma-
 tion of the Phrenic Nerve,- it is ultimately divided
 into branches, some  of which  form the cutaneous
 nerves,  and others are spent among  the  muscles of
 the neck.
   ft. Describe the  Third Cervical Nerve}
   A. It  is formed and passes out as the others, and
 then sends a  branch to the middle ganglion of the
 Sympathetic, another to the fourth Cervical, another
 towards  the formation of the Phrenic or  Diaphrag-
 matic Nerve, and a filament to the Descendens Noni;
 it afterwards  divides  into  posterior and  anterior
 branches, which are dispersed among the muscles.
   Q. Describe the connexions of the Fourth Cervical
 Nerve}
   A. It communicates with  the middle ganglion  of
 the  Sympathetic, it sends  one  or  two filaments to
 the formation of the Diaphragmatic Nerve, and  then
 it joins the fifth Cervical.
   ft. Describe the other Cervical Nerves'}
  A. The fourth runs downwards, joins the fifth,
 their trunk running down joins  the sixth, and  then
 the seventh behind  the clavicle,  and  lastly to this is
added  the First Dorsal Nerve  over the first rib.
These four Cervicals and the first Dorsal are of large
size, and pass  between the anterior and middle  Sea- 
316       PATHOLOGY OF THE SPINE.
leni Muscles, and then between the Subclavius and
first rib, at the lateral side of the Subclavian Artery
into  the  Axilla, where  they separate,  unite,  and
separate  repeatedly, forming a plexus which  sur-
rounds the artery.
  Q. What  nerves are  sent  out from the Axillary
Plexus}
  A. Nerves sent to the muscles behind, and the
Thoracics accompanying  the  blood-vessels  to the
Pectoralis, Mamma, and Integuments.   The nerves
of the  Superior extremity, viz.  the Scapularis, Arti-
cularis, Cutaneus,  Musculo-Cutaneus or Perforans,
the Spiral-Muscular, the Median or Radial, and the
Ulnar.
  PATHOLOGY OF THE SPINAL MARROW.
              ARACHNITIS SPINALIS.

  Q. What are its symptoms ?
  A. In this affection the head is drawn backwards,
the muscles  on the posterior part of the trunk are
in a state of permanent  contraction, pain more or
less violent  is  felt along the vertebral column, more
acutely however in some particular parts of it; the
intellectual  faculties are not engaged;  the head
moves from one side to  the other,  when inflamma-
tion attacks the upper  part  of  the medulla oblon-
gata.  We shall  have additional reason to conclude
that the disease  is arachnitis, if  the patient has  re-
ceived a fall, or  suffered any injury of the vertebral
column; or if there exists at the same time symptoms
of arachnitis of the brain, in which case the symp-
toms of both affections will be blended.
  ft. What  are  the diseases with which it may be
confounded ?
  A. Arachnitis of the spine may be confounded
with tetanus, and with  different  acute affections of
the medulla spinalis.
  ft. What are its anatomical characters ? 
PATHOLOGY  OF THE  SPINE.      517
   A. They are the same as those enumerated when
 treating of arachnitis of the brain.

                  HYDRO-RACHIS.

   ft. What are its symptoms ?
   A. Hydro-rachis, or spina-bifida, though generally
 congenital, may sometimes be observed at more ad-
 vanced periods of life ; one or more tumours, broad
 at the base, or attached by a pedicle, are found in
 the  lumbar region, or  more  rarely in the superior
 parts of the  spine; their size is variable, their  sur-
 face in general transparent, without any change of
 colour of the  skin.  Pressure exerted on  one of them
 increases the size of the others, if there be several,
 and  at the same time causes symptoms of compres-
 sion of  the brain;  the same effect takes  place when
 the  brain is  pressed, if there should  happen to be
 hydrocephalus.   The limbs  of  these patients are
 feeble and ill-developed; the rectum and bladder
 are paralysed.
  ft. What are its anatomical characters ?
  A. When the skin forms a covering for the tumour
 it is  thickened, or, on the contrary, is thin and trans-
 parent; in some cases it is wanting altogether,  and
then the coverings of the tumour consist  of the dura
 mater, pia mater, and arachnoid membrane ; the pia
 mater is in general much injected and red.  In some
 instances, the lateral arches of the corresponding
 vertebrae are  wanting ;  in  others they present but a
 slight separation ;  and  finally, in some  rather  rare
cases,  the  vertebra is  divided  altogether.    The
 cavity of the  arachnoid membrane contains a fluid,
serous and  limpid, sanguinolent  or purulent,  which
may communicate with the brain  itself, or be merely
enclosed in the pia mater.   We sometimes find a di-
vision to a greater or less extent  of the substance of
the  medulla, in other  cases very few traces  of its
structure can be found where the tumour had been
situated.
                    nd2 
318       PATHOLOGY OF THE SPINE.
  INFLAMMATION AND  " RAMOLLISSEMEWT," OF TH*
                MEDULLA  SPINALIS.
  Q. What are its symptoms ?
  A. This disease usually supervenes after  contu-
sions of the vertebral column, and is distinguishable
by pain referred to some point of the spine, and by a
sensation of pricking,  and darting in the extremities;
there is no derangement of the intellectual faculties,
or of the senses, unless the inflammation be near the
pons Varolii; in which case there may be total loss
of sense, with aphony, trismus, paralysis of the whole
body, retroversion of  the head, and embarrassed re-
spiration.  When the cervical portion is affected, we
usually observe a rigidity of the neck, permanent
contractions or convulsions of the upper extremities,
which are succeeded  by paralysis and considerable
disturbance of the respiration.   When the  dorsal
portion is the seat of the disease, the trunk is some-
times agitated   by continued  convulsive motions;
there are at the same time palpitations, high fever,
and greater or less difficulty of respiration.  Finally,
when the lumbar portion becomes inflamed, we find
paralysis of the lower extremities, constipation and
retention of urine, or involuntary evacuations.  When
the disease is chronic, there sometimes is no pain,
and then the paralysis of the lower limbs, of the blad-
der and rectum, come  on gradually.
  ft. What are the diseases with  which it may be
confounded ?
  A. They are certain forms of rheumatism, or neu-
ralgia of the limbs.
  ft. What are its anatomical characters ?
  A. They are  the same as those of inflammation,
and ramollissement of the brain.
TUMOURS OF THE MEDULLA SPINALIS  AND ITS  MEM-
                    BRANES.
  ft. What are their symptoms?
  A. The present state of knowledge  does not fur-
nish  any signs by which we can-distinguish the ex- 
          PATHOLOGY  OF THE  SPINE.      319

istence of the different  tumours that are developed
in the medulla spinalis and its membranes; we can
only say that they sometimes induce paraplegia and
various epileptic symptoms.
  ft. What are their anatomical characters ?
  A. These tumours  may in general be referred to
the heads, tubercle, scirrhus, and hydatid.
  Q. With what diseases may they be confounded ?
  A. With tumours external to the vertebral column,
compressing the nerves or their origins.
                    NOTES.

  1. Though authors so constantly speak of inflam-
mation of the arachnoid membrane, still anatomy has
not yet been able to discover any vessels in its tis-
sue.  Ribes and Ollivier are of opinion that the seat
of the inflammation is not in the  arachnoid of the
spine,  but in the dura mater, which receives a great
number of vessels in the pia mater, and in the vessels
of this latter membrane,  which penetrate into the
substance of the medulla.   Hence  they  account for
the red tinge and thickening (which are reported by
different persons as having  been  observed in the
arachnoid)  by attributing  them to injection of the
vessels of the other membranes, and infiltration or
thickening of the sub-serous cellular tissue.   Inflam-
mation of the membranes of the  medulla  spinalis,
very frequently extends to those of the brain.  The
symptoms of both affections are  therefore, usually
found united; however there are two which may be
considered pathognomic of arachnitis  of the spine—
the first is a general contraction of the posterior mus.
cles of the trunk, producing a complete opisthotonos.
As this has   been observed in cases wheve examina-
tion has demonstrated an inflammation of the arach-
noid of the spine, that of the  brain  being free  from
any such affection, it may be  regarded as diagnostic^.
of arachnitis spinalis.—The other  symptom is  pain 
320       PATHOLOGY  OF THE  SPINE.
extending along the spine, but more particularly re-
ferred to some parts of it.
  Tetanus  has  been attributed  to  inflammation of
the membranes of the spinal marrow.  This, it is
true,  has been  observed in many subjects that had
died of tetanus; but as in  several others no trace of
such inflammation  could be found to  exist, we can-
not admit the conclusion that it is the essential cause
of the disease.  Some pathologists are of opinion
that t,his inflammation is connected chiefly with trau-
matic tetanus.  When we consult  the  writings of
those  who have treated of this subject, we find  that
they speak of inflammation of the medulla  spinalis,
in such a way as to leave it a matter of doubt, whether
they mean inflammation of the medulla  itself, or of
it, together with  its membranes;  so  that  we find
it difficult to ascertain whether there had been in-
flammation of all these parts, or whether it had been
confined  to one or other of them. Dupuytren, how-
ever,  found the investments alone inflamed in an in-
dividual who had died of tetanus, caused by a punc-
tured wound of the foot; and Brera says, that  he has
seen the substance of the  medulla altered in  similar
cases.
  The progress of arachnitis spinalis is, in general,
rapid, and its termination fatal.  Ollivier reports one
case that lasted thirty days, but death  usually  occurs
from the  tenth  to the fourteenth.—See Ollivier, p.
319.
  2. Several writers consider  " ramollissement" of
the substance of the brain and medulla spinalis, as a
peculiar alteration  of the nervous  system altogether
dependent of inflammation.  It is true that this mor-
bid alteration  has been observed in cases in which
no trace of local congestion could be  found;  but in
general the membranes in the neighbourhood of it
are red and thickened, and their vessels injected with
blood ; and  sometimes those which penetrate  into
the substance of the medulla, though  not visible in
the healthy state,  become so by being  injected,  and 
PATHOLOGY  OF THE SPINE.        S21
 give to the part a more or less deep  tinge of red.
 These circumstances tend to show that " ramollisse-
 ment" is produced by inflammation, which is further
 confirmed  by the fact that it most constantly is seated
 in those parts of the brain and medulla, which are
 most vascular in their structure—such as the corpora
 striata, optic thalami and convolutions of the brain—
 and those  swellings or enlargements which the me-
 dulla presents in its  lumbar, cervical, and dorsal re-
 gions.   These  are  the most vascular parts, as they
 contain the greatest quantity of gray substance. The
 c« ranaollissement" may extend to the whole thickness
 of the medulla, may occupy but one  of its lateral
 halves to a variable extent, or be found  only in either
 its anterior or posterior lateral facette—it may exist
 in the medulla oblongata solely, or in  the  cervical,
 dorsal, or lumbar region.  Sometimes an increase of
 volume is observable in the affected portion—in some
 cases the^ limbs, even at the commencement, are at-
 tacked with convulsive movements of variable dura-
 tion, which after some time are succeeded by paraly-
 sis : in others they are in a state of permanent and
painful contraction—and lastly, they are sometimes
altogether relaxed and flaccid.  On what do  these
remarkable differences depend ? According to Jan-
son, as quoted by Ollivier, paralysis of the limbs with-
 out contraction, is owing to inflammation of the ner-
vous structure alone, whilst the contraction depends
 on  its complication with inflammation of the mem-
 branes.
  3. We can, as is pointed  out in the text, indicate
 almost the  very spot in which  the  inflammation is
seated ; and those distinct groups of symptoms enu-
merated  as  characteristic of the lesions  of the differ-
 ent regions of the medulla spinalis, are readily ex-
 plicable  by considering the destinations of  these
nerves that arise respectively from them. But it is
not sufficient to consider  merely their  destination,
we must take into account their function also.  And
here we find how the  improved physiology and pa- 
322
PATHOLOGY  OF THE  SJ»INE.
 thology of the present day can mutually assist and
 enlighten each other.  When the researches of that
 distinguished inquirer, Mr. Charles Bell, had demon-
 strated that the anterior  roots of the spinal nerves
 preside over motion, and the posterior over sensi-
 bility, it became evident that the loss or derange-
 ment of these functions must  be  determined by the
 lesion of those roots, or  of the part of the  medulla
 from which they arise.  Ollivier reports a very re-
 markable case, that clearly proves the correctness of
 this inference.  This individual,  an old soldier, had
 been for some years taciturn and indolent, wished to
 remain constantly in bed from finding an inability to
 get out of it.  His gait was tottering,  his lower ex-
 tremities weak, both being equally affected.  These
 symptoms increased until  he ultimately became con-
 fined altogether to his bed, in which he lay with his
 thighs flexed  towards the pelvis, his legs on his
 thighs, without being able to extend or move them in
 the least degree.   Still these parts retained their na-
 tural sensibility, as was evident on pricking or pinch-
 ing them.—The  excretions were passed involunta-
 rily, the voice and intellectual faculties were lost—
 after death the corpora pyramidalia and olivaria were
 found softened, and  converted into a greyish difflu-
 ent pulp, which alteration extended along the whole
 of the anterior part of the medulla—almost  to  the
 lumbar region.  The " ramollissement" could also be
 traced upwards into the brain, through the commis-
 sure of the cerebellum, the crura cerebri, the thalami,
 and corpora striata, even to some of the convolutions,
particularly towards the middle of the anterior lobe.
None of the other parts of the brain or cerebellum
presented  any  sensible change, and the posterior
part of the medulla, as well as  the other membranes
investing it, were perfectly healthy.

       NERVES OF THE SUPERIOR EXTREMITY.
  Q. Describe the Scapular Nerve?             '
  A. It generally  arises  from the fourth and fifth 
   NERVES  OF THE SUPERIOR EXTREMITY.  323

Cervicals, passes through the semilunar notch of the
Scapula, and is dispersed upon the Supra and Infra-
spinatus muscles.
  ft.  Describe the Articular Nerve?
  A.  It arises from  the common  trunk of the fourth
and fifth Cervicals, sinks deep in  the axilla, then fol-
lows the course of the Posterior  Circumflex  Artery,
and is spent upon the  Teres Minor, Capsular liga-
ment, and Deltoid.
  Q.  Describe the Cutaneous Nerve.
  A.  It comes off from  the  trunk  common  to
the last Cervical  and first  Dorsal, and is  much  in-
creased by  fibrillae from the latter, rtins down the
inner  and fore part of the arm, giving off small  branch-
es to  the muscles,  integuments, and coats  of the
blood-vessels ; and  near the bend of the fore-arm it
divides into an external and internal, which  are dis-
persed over the elbow joint and fore-arm.
  ft.  Is there not another Cutaneous Nerve?
  A.  Yes ; the   Cutaneus  Internus of Wrisberg,
which arises  from the Axillary Plexus, descends a
little  and divides into two branches; the larger runs
down the inner edge of the Triceps, and is dispersed
upon  it and the  integuments near the elbow ; the
smaller, turning to the  anconal aspect of the arm, is
dispersed upon the Triceps and skin«
  ft.  Describe the  Musculo-Cutaneus, or Perforans
Casserii ?
  A.  It arises by filaments from almost all the nerves
forming  the  Axillary Plexus, perforates the upper
end of the Coraco-Brachialis, to which it gives twigs,
passes down between the Biceps, and Brachialis In-
ternus, giving filaments to  both  ; at the elbow-joint
it passes  on the out or radial side of the  tendon of
the Biceps, down the fore-arm between the  Supina-
tor Longus  and Integuments, giving twigs to  them in
its course, as far as the thumb and back of the hand.
  ft.  Describe the Spiral or Spiral Muscular Nerve?
  A.  It is formed  by  fibrillae,  from  the Cervical
Nerves entering the Axillary Plexus, it is larger than 
324
NERVES OF  THE ARM.
the rest of this extremity, and is distinguished by its
spiral course.  It is situated in the Axilla between
the great artery and the ulnar nerve, turns obliquely
downwards between the two heads of the Triceps,
and then behind the Os Humeri to the radial side of
the elbow, where it descends as far  as the hand
among the muscles of the  fore-arm.  In its whole
course it  gives  twigs to the  muscles and integu-
ments.
  ft. Describe the Median or Radial Nerve.
  A. It is composed of fasciculi from all the nerves
forming the Axillary  Plexus, descends along the an-
terior surface of  the  Humeral Artery, to which, and
the deep Veins, it is firmly connected by cellular sub-
stance ; at the elbow it passes over the  tendon of the
Brachialis Internus, and perforates the back part of
the Pronator Teres,  and passes along  between the
Flexor Carpi Radialis, and Flexor Sublimis, in its way
to the hand.
  ft. Mention particularly the branches and termi-
nation of the Radial Nerve.
  A. This nerve at the elbow-joint gives branches to
the integuments, the Pronator and Flexor muscles,
and sends off  the Interosseous Nerve, which is spent
on the Flexors of the thumb and fingers;  at the
wrist it passes under the annular ligament, and below
the Aponeurosis Palmaris,  and  superficial arterial
arch ; it is divided into seven branches, two of which
go to the opposite sides of the thumb, one to the side
of the fore-finger next it, the others are divided, and
run along the ulnar side of the fore, and back sides
of the middle, and the radial side of the ring finger;
these  unite at the point of the fingers : other small
filaments are  sent to the Lumbricales, integuments
of the palm, and contiguous parts.
  Q. Describe the origin  and course of the Ulnar
Nerve.
  A. It is of considerable size, arises chiefly from the
last cervical and first dorsal nerves, runs along the 
            KERVES OF THE THORAX.       S25

inside of the Triceps, and at the elbow gets into the
groove between the Olecranon,  and inner Condyle,
perforates the heads of the flexors of the fore-arm,
and  follows  the  course of the  ulnar artery to the
wrist, where it sends off the Dorsal Nerves, and, to-
gether with the artery, passes over the Annular Liga-
ment into the Palm, where it is covered by the Apo-
neurosis Palmaris.
  Q. Describe the course and termination of the Dor-
sal Branches of the  Ulnar Nerve  ?
  A.  They have their course between the Flexor Ul-
naris and Ulna, to the back of the hand, and, in their
course, they  give twigs to the integuments of the
wrist and metacarpus, and anastomose with others of
the Spiral Nerve.  One of them runs  to the Ulnar
side  of  the  little finger, where  it divides into two
branches, one continues its course along the ulnar
side of that finger ;  the other is subdivided, one of its
branches runs along the radial side of the little finger,
and the other along the ulnar side of the ring finger.
  Q.  Describe the  distribution of the  Ulnar  Nerve
after it has passed into the  Palm of the hand ?
  A. In the  palm the Ulnar Nerve is divided into
Superficial and Deep-seated branches.  The Superfi-
cial are sent to the Ulnar and Radial sides of the little,
and to the Ulnar side of the ring finger, and  to the
muscles in their course.  The Deep-seated form  an
arch, from which  branches go to  the muscles, as the
Abductor  Minimi |Digiti,  Flexor,  Brevis Abductor
Pollicis, Lumbricales and Interossei;  and also to the
adjacent parts.

              NERVES OF THE THORAX.
  ft.  What large trunks of Nerves are found within
the Thorax ?
  A.  On each side of it we find the Phrenic or Dia-
phragmatic, the  Par Vagum, and the Great Sympa-
thetic, descending behind the Pleura to their differ-
ent destinations:  and, besides, we find the Intercos-
tal Nerves running transversely.
  Vol. II.             E e 
 326          RECURRENT NERVES.

   Q. Describe the origin and course of the Phrenic
 or Diaphragmatic Nerve.
   A. On each side it derives its origin partly from
 the second, but chiefly from the third and fourth Cer-
 vical Nerves, descends in the neck along the fore and
 lateral part of the Scalenus Anticus, enters the Tho-
 rax between the Subclavian Artery and Vein behind
 the anterior extremity of the  first rib, passes over
 the root of the Lungs, then along the Pericardium,
 to which it adheres, in its course to the Diaphragm,
 upon the superior surface of which the Nerve divides
 into branches, and is dispersed in the form of radii
 towards the fleshy  parts of that muscle.
   Q. Describe the general course of the Par Vagum
 or Pars Vaga?
  A.  This  eighth pair of Nerves arises from the Me-
 dulla Oblongata, passes out of the cranium by the Fo-
 ramen Lacerum  Posterius, descends behind the Ca-
 rotid Artery, inclosed in the same sheath: enters the
 Thorax between the  Subclavian Artery and Vein,
 passes behind the bronchia or root of the Lungs, de-
 scends with the OZsophagus through the Diaphragm
 into  the Abdomen.
  ft. What principal branches  are sent off from the
 Pars Vaga in the Thorax ?
  A. The Recurrent Nerve;  filaments to assist  in
 forming the Anterior  Pulmonary Plexus ; six or se-
 ven branches to form the Posterior Pulmonary Plex-
 us ; lastly,  it divides to  form the Great Oesophageal
 Plexus.
  Q. Describe the  Recurrent Nerves.
  A. The right Recurrent is reflected upwards be-
hind the Subclavian Artery;  and the left behind the
Arch of the Aorta ; each ascends in the neck at the
posterior and lateral part of the Trachea, and sends
filaments to the internal Membrane  of the Trachea,
 OZsophagus, Pharynx, Thyroid Gland, Larynx, and
 its different muscles.
  ft. What connexions  does the Recurrent Nerve
form in the Thorax ? 
NERVES OF THE LUNGS.        327
   A. The  Recurrent near its origin, is  connected
 with one or two branches of considerable  size, from
 the middle and lowest ganglia of the Great Sympa-
 thetic ; it sends off branches to assist in forming the
 Anterior Pulmonary Plexus ; and, a little higher, it
 sends filaments to join the Superficial and deep Car-
 diac Nerves.
   Q. Describe the formation and situation of the An-
 terior Pulmonary Plexus?
   A. Filaments sent from the Par Vagum, the Recur-
 rent, and the Cardiac branches of the Great Sympa-
 thetic, on each side meet, and by their varied connec-
 tions form this Plexus, situated on the largest branch-
 es of the Pulmonary Artery at the root of the lungs.
 From this Anterior Pulmonary Plexus, filaments are
 sent to the Pericardium, and Cardiac Nerves; and
 many follow the Bronchial Tubes, and are dispersed
 through the substance of the Lungs.
  ft. What  Nerves form the Posterior Pulmonary
 Plexus?
  A. The branches sent across from the one Par Va-
gum to the other,  when running  down behind the
root  of the  Lungs, form the Posterior Pulmonary
Plexus, from which several nerves arise, and follow-
ing the Pulmonary Vessels, are distributed through
 the substance of the Lungs.
  Q. How many Plexuses are formed on the Oesopha-
 gus?
  A. Two]; the Small Oesophageal Plexus, formed by
twigs sent off from the Paria Vaga, and  from the
 roots of the Recurrents, sends nerves to the  fleshy
 parts of the Trachea, near to the OEsophagus,  upon
which this plexus lies, and gives many nerves  to it:
 and the Great  Oesophageal Plexus,  embracing the
tube and sending filaments to all its substance, is form-
 ed by the division of the two Paria Vaga into several
 Cords, between which funiculi run, and form a plexus.

              NERVES OF THE HEART.
  Q. From what sources do the  Cardiacus Magnus
 Profundus arise ? 
328        NERVES OF THE HEART.
  A.  On the right side the Cardiacus Magnus Pro-
fundus arises from branches sent out from the se-
cond  Cervical Ganglion of the  Great Sympathetic,
from  the Cardiacus Supremus or Superficialis, and
Par Vagum, descends between the Superior Cava
and Ascending Aorta, joins the Cardiac Branches of
the left side behind the Aorta, and forms the Plexus
Cardiacus Magnus, from which is formed the Gan-
glion  Cardiacum.
  Q.  Does the Cardiacus Magnus Profundus on the
left side rise in a different manner ?
  A.  It derives its origin from several filaments sent
from the middle and lowest Ganglions of the Sympa-
thetic, passes down across the arch of the Aorta, then
receives the Cardiac branch of  the Par Vagum, and
shortly afterwards the Right Cardiacus Profundus to
form the Plexus.
  Q.  Describe the Nervus Cardiacus Minor.
  A.  It is only found in the right side ; it arises from
the lowest cervical  Ganglion of the Sympathetic,
crosses over the Arteria Innominata and Aorta, and
terminates in the Reticulum of nerves dispersed upon
the left side of the Aorta Ascendens.
  ft.  Describe the origin and course of the Cardia-
cus Supremus, or Superficialis.
  A.  This Superficial Cardiac Nerve arises from the
highest ganglion of the Sympathetic, and from the
Superior Laryngeal,  descends in the right side and
joins  the  Superficial  Cardiac branch of the eighth
pair before the Subclavian Artery ; in the left side it
terminates in the Cardiac Plexus.
  ft.  Whence is the Right Coronary Plexus formed ?
  A.  It proceeds from the Reticulum of nerves situa-
ted on the left part of the ascending Aorta, passes
between the Pulmonary Artery  and Aorta, and then
follows the course of the right Coronary Artery to  be
dispersed upon the right side of the Heart.
  Q.  Describe the Left Coronary Plexus.
  A.  The Great Cardiac Plexus,  having sent fila-
ments to the Lungs, gives out branches, which unite 
            THE GREAT SYMPATHETIC.        329

 and form the Great Cardiac Nerve of a gangliform ap-
 pearance, situated on the left side of the Pulmonary
 Artery ; from which nerve numerous branches arise,
 which form the Coronary Plexus of the left side, and
 communicate freely with the right.

            OF THE GREAT SYMPATHETIC.
   Q. Describe the origin and course of the Great
 Sympathetic nerve into the  Thorax?
   A. It arises by two or three filaments sent off from
 the Sixth  Pair in  the  Cavernous Sinus, descends
 forming a Plexus around the Internal Carotid Artery,
 where it receives the Retrograde Nerve from the Se-
 cond Branch of the Fifth Pair, descends through the
 Foramen Caroticum, is included  in the same sheath
 with the Carotid Artery and Par Vagum, and, after
 forming three ganglia, and making numerous com-
 munications in the neck, it splits into two portions,
 one of which goes down before,  and the other goes
 down behind the  Subclavian Artery,  they immedi-
 ately unite into a trunk, which runs down the Tho-
 rax near the heads of the ribs.
  Q.  Describe the connexions of the Sympathetic in
 the Thorax.
  A.  The  Sympathetic  Nerve having  got into the
 Thorax, forms a ganglion at the head of every rib,
 which receives two or three short branches from the
 commencement of each  Intercostal Nerve.   From
 many of the dorsal ganglia, small filaments are sent
 to the coats of the Aorta.
  ft. Do any particular Nerves arise from these Dor-
 sal Ganglions of the Sympathetic ?
  A. Yes ; from the sixth, seventh, and eighth dor-
 sal Ganglia branches are sent  off, which pass oblique-
 ly down over the  sides of the Vertebrae,  and  unite
into a trunk called Nervus Splanchnicus, which goes
into the Abdomen.
  ft. Is another nerve  not generally found of the
same sort ?
  A. Yes ; another Splanchnic Nerve, called Secunda-
                      x. c2 
330         INTERCOSTAL NERVES.

rius, or Accessorius, arising from the ninth and tenth
ganglia, descends into the Abdomen, and terminates
with the former.

           OF THE INTERCOSTAL NERVES.
  Q. Describe the origin and course of the Intercos-
tal or Dorsal Nerves.
  A. They arise from the Spinal cord in the manner
already  described, pass out  laterally between the
Vertebrae, and  run along the groove in  the  lower
margin of the ribs to the anterior part of the Thorax,
where they are  dispersed.
  Q. What branches do the Intercostal Nerves- send
off?
  A. After they emerge from between the  Verte-
brae, they are connected by two or three short twigs
to the ganglia of the  Sympathetic,  and opposite to
which they send some principal branches backwards
to  the  muscles situated near the Spine; in  their
course forward between the external and internal
layers of Intercostal Muscles, they send off' branches
to these and other muscles, to the integuments of the
Thorax, and other parts of the Abdomen.
  Q. Do not  some of the Intercostal Nerves contri-
bute to" the formation of the Axillary Plexus?
  A. Yes; the first  Intercostal Nerve sends a branch
backwards, which enters into the Axillary Plexus.
The branches reflected from the Second and Third
Intercostals are  also dispersed by numerous filaments
upon the Axillary Glands and their integuments, and
upon the back part  of the arm and Latissimus Dorsi.
  ft. Have these branches of the three or four upper
Intercostal Nerves any  particular names ?
  A. Yes; they are called from their origin  and
destination Intercosto-Humeral, which communicate
with the Cutaneous Nerve of the arm, and with each
other.

        '     NERVES OF THE ABDOMEN.
  Q. What nerves are dispersed upon the Chylopoie-
tic and  Assistant Chylopoietic Viscera ? 
ABDOMINAL NERVES.
331
  A.  The Paria Vaga, Rami Splanchnic"], and the
Sympathetic.
  Q. Describe the course and termination of the Left
Par Vagum.
  A. It enters  the abdomen at  the anterior part of
the Cardia, sends several  filaments to the left Hepa-
tic Plexus, and then ramifying, is spent on the ante-
rior or upper and left portion of the stomach.
  Q. Describe also the course and termination of the
Right Par Vagum.
  A. It descends upon the posterior part of the Car-
dia, soon divides into two fasciculi, of which the one
proceeds to  the root of the  Hepatic Plexus, and to
the Coeliac Ganglion ; the other, being the principal,
is ramified on the posterior or under and left portion
of the Stomach.
  Q. Describe the termination of the Rami Splanch-
nici.
f*'A. The Splanchnic Nerves arising from'the dorsal
ganglia of the Sympathetic, perforate the lateral and
upper part of the smaller muscle of the Diaphragm,
divide into a number of branches, which incorporate
with the sides of the great Semilunar Ganglion.
  ft.  Describe the Semilunar or Solar Ganglion.
  A. It is composed of the Splanchnic Nerves, and
the branches of the Par Vagum on both sides; it is
long and curved in  figure, with its convexity down-
wards, and seems made up of a congeries of smaller
ganglia, of different sizes and shapes, called the Coe-
liac Ganglia.
  ft.  What is the situation of these Coeliac Ganglia?
  A. They are situated  upon the Aorta at the roots
of the Coeliac and Superior  Mesenteric Arteries,
and extend upon the fleshy crura of the Diaphragm.
  ft.  Do many Nerves issue from the  Coeliac  Gan-
glia?
  A. Yes ; innumerable nerves  issue from them in
every direction, forming the Solar Plexus which lies
along the Coeliac and Superior  Mesenteric Arteries.
  ft.  What nerves arise from the Solar Plexus?
  A.  Various Plexuses of nerves arise from it, named 
332          SPLENIC, MESENTERIC,
 after the  arteries which they embrace, such  as the
 Hepatic,  the  Splenic, Superior Mesenteric, Aortic,
 Sc.
   ft. Describe the Hepatic Plexus ?
   A. It follows the course of the Hepatic Artery, gives
 filaments  to the Renal Capsules, to the  Diaphragm
 along its arteries ; it divides into a right and left He-
 patic Plexus,  following the division of the Hepatic
 Artery: the right  sends branches to the Pancreas,
 Pylorus, Duodenum, and gives origin to the Gastro-
 epiploic Plexus : the left sends branches to  the Sto-
 mach, and is afterwards spent in the left lobe of the
 Liver.
   ft. Describe the Splenic Plexus?
   A. It  embraces the Splenic Artery, and  sends
 branches to the Pancreas in  its vicinity.
   Q. Describe the Superior Mesenteric Plexus?
   A. It embraces the trunk  of the Mesenteric Arte-
 ry, and sends filaments along its different  branches
 to the Glands  of the Mesentery,  to the Small  Intes-
 tines, and  right portion of the Colon.
   Q. Describe the Aortic Plexus.
   A. It closely embraces the Aorta, and is joined by-
 nerves from the Sympathetic.  From this plexus the
 Inferior Mesenteric Plexus is sent off, which is dis-
 tributed to the left portion of the Colon and to the
 Rectum.
  Q. Do any  other Nerves  arise from the Aortic
 Plexus?
  A. Yes; the Aortic Plexus descends, receiving addi-
tions from the Sympathetics  of both sides, under the
name of the Hypogastric Plexus, which, at the lower
end of the Aorta, divides into aright and left Plexus,
which descend into the Pelvis, and are dispersed upon
its different viscera.
  ft. Describe the Renal Plexus?
  A.  It is sent off from the  Coeliac Ganglia, and re-
ceives some filaments from the Ganglia of the Sympa-
thetic; it soon divides into an anterior and a posterior
plexus, which run along the corrcbpoiiding surfaces of 
AND RENAL NERVES.
333
 the Renal Artery, and are dispersed in the substance
 of the Kidney.
   ft. Do any Nerves go o/Trom the Renal Plexus?
   A. \es ; some twigs are sent off to the Renal Cap-
 sule, which receives other branches from the Coeliac
 Ganglia; The  Renal Ple#s also gives  filaments to
 the Ureter, and Spermatic Cord.
   Q. Describe the Hypogastric Plexus.
   A. It  is a continuation of the Aortic  Plexus, re-
 ceiving filaments from the Sympathetics, and Sacral
 Nerves ; it gives off  branches to the Rectum, Urina-
 ry Bladder, and Spermatic Cord, in the male, and to
 the Uterus and Vagina in the Female.
   ft. Describe the Spermatic Nerves?
   A. They  are of small size, and given off from the
 Renal, and Hypogastric Plexuses; they accompany
 the  Spermatic Arteries through the substance of the
 Testicles.  They also receive a filament or two from
 the second Lumbar Nerve ; but they are spent upon
 the  Substance of the Cord, Cremaster Muscle, and
 Scrotum, chiefly, and partly upon the Testicle, in the
 male, and upon the Round  Ligament, Uterus, Vagi-
 na, Mons Veneris, and Labia Pudendi, in the Female.
   ft. Describe the Nerves of the Uterus particularly ?
   A. They are sent from the Hypogastric Plexuses
chiefly, and partly from the Spermatics ; they enter
the Uterus by the lateral broad Ligaments near its
 cervix, and  are  dispersed  through  its substance,
communicating freely with one  another.
   ft. Describe the Nervi Pudici.
   A.  The Pudic Nerve, on each side, arises  in two
Fasciculi, formed by fibrills from the branches which
compose the  Sciatic  Nerve;  these  fasciculi pass
through  the Notch of the Ilium, then between the
Sacro-Sciatic Ligaments, following the course of the
Pudic Arteries.
   ft. To what parts are the Pudic Nerves distributed?
  A.  In their course they give many branches to the
Muscles,  Anus, Perineum, and Penis.  On this last,
the Superior fasciculus forms the Dorsalis Penis, si-
tuated between the Artery and Vein, sending branch. 
334             LUMBAR NERVES.
es to the upper part of the penis, andjthe Inferior fas-
ciculus supplying its under part.

        OF THE LUMBAR AND SACRAL NERVES.
   Q. What situation do Jhe Sympathetic Nerves oc-
cupy in th% Loins?     *
  A. After entering the Abdomen, the Sympathetics
pass obliquely towards the Mesial line of the Lumbar
Vertebrae, between the tendinous Crura of the Dia-
phragm, and the Psoas, forming Ganglia, from each of
which two or three filaments are sent  backward to
join the root of the Lumbar Nerves ;  and others for-
ward to the Aortic Plexus.
  Q. What course does the Sympathetic take in the
Pelvis?
  A. It descends at the inner or mesial side of the
sacral foramina, becoming of smaller  size it forms an
arch with its fellow on the surface of the Os Coccygis,
and thus terminates.  In passing down, however, it
forms] Sacral Ganglia, from which nerves are sent
out to join the Sacral Nerves, and others to the parts
lining the Pelvis, and to the Rectum.
  Q. Describe the five Lumbar Nerves.
  A. They emerge between the Vertebrae, form
connexions  with  one another,  upwards and  down-
wards, with  the Sympathetics, by branches running
obliquely over the Vertebrae, and send large branch-
es backwards to the large muscles and integuments
of the Loins.
  Q. What nerves form the Lumbar Plexus?
  A. The different connections of the  Lumbar Nerves
with each other, form a sort of Plexus  situated behind
the Psoas, from which nerves are sent to the Quadra-
tus Lumborum and Flexors of the Thigh.
   ft. Describe the first Lumbar Nerve particularly ?
   A. It is connected by a branch to  the last Dorsal,
and by its trunk to the second Lumbar Nerve.  It
sends filaments to  the Muscles of the Loins, and a
principal branch over the Quadratus Lumborum to-
wards the spine of the Ilium, where it is ramified on
the Integuments  of the Pelvis, on  the upper and 
       OBTURATOR AND CRURAL NERVES.  335

outer part of the Thigh, on the lower part of the ab-
dominal muscles, groin, pubes, and scrotum, or labia
pudendi.
  Q.  Describe the Second Lumbar Nerve, also, parti-
cularly ?
  A.  It perforates the Psoas, to  which it gives seve-
ral twigs, and then unites with the third Lumbar.  It
sends off the External Spermatic, which generally re-
ceives some twigs from the first Lumbar; this Sper-
matic perforates the upper part of the Psoas, near
Poupart's Ligament it divides into two branches, one
of which  passes through the abdominal Ring, and is
dispersed upon the Pubes, Spermatic Cord, Scrotum
and Testis, and Round Ligament, Uterus, and Labia
Pudendi.
  Q.  Are the other three Lumbar Nerves connected
in like manner ?
  A.  Yes;  they unite also,  and form a Plexus.
  ft.  Do  any other  Nerves arise  from  the Lumbar
Nerves ?
  A.  Y'es;  the  Cutaneus Externus, the Obturator,
and the Crural Nerve.
  ft.  Describe the External Cutaneous ?
  A.  It arises  from the second  and third  Lumbar,
passes behind the Psoas, and across the Iliacus  In-
ternus to the Superior Anterior  Spinous Process of
the Ilium, goes over Poupart's Ligament, and is dis-
persed on the Vastus Externus,  and Integuments of
the Thigh.
  Q.  Describe the Obturator Nerve ?
  A.  It is of very considerable size,  and arises from
the Second,  Third,  and Fourth Lumbar Nerves,
passes between the External and  Internal Iliac blood-
vessels, along the side of the Pelvis; accompanies
the artery of the same name through the upper part
of the Obturator Muscles, and Ligament; and having
sent branches to the Obturator and Pectineus, it  di-
vides  into an anterior, and a posterior fasciculus, the
former dispersed upon the two small Adductors and
Gracilis, the latter upon the Adductor Magnus.
  ft.  Describe the Crural Nerve? 
336
SACRAL NERVES.
  A. It arises chiefly from the Third  and Fourth,
and partly, also, from the First and Second Lumbar
Nerves; its different origins unite,  and form a trunk
of great size.   This Crural Nerve passes behind the
Psoas,  and descends at its lateral side, passes out un-
der the Crural Arch at the outside of  the  Femoral
Artery, where it is soon  divided into branches.
  Q. What are the principal  branches of the Crural
Nerve ?
  A. The Cutaneus Medius, Anterior, Internus, and
the Saphaenus.
  ft. Describe these Cutaneous Nerves ?
  A. They descend upon the  fore and internal parts
of the thigh,  and are distributed  to the integuments
and cellular substance, as far as the knee.
  Q. Describe the Nervus Saphaenus ?
  A. This  nerve descends  among  the muscles,  and
gives branches to them ;  passes behind the tendon of
the Sartorius  to the inside of the Tibia,  and is rami-
fied upon  the integuments and cellular substance of
the leg, generally following the veins.

              OF  THE  SACRAL  NERVES.
  Q. How many pairs of Sacral Nerves are  there ?
  A. Five  pairs; each  of which is  divided into  a
small posterior, and a large anterior trunk.
  Q. Describe the course of the Posterior Trunks of
the Sacral Nerves ?
  A. They pass  out of  the Vertebral Canal by the
small holes in the posterior part of the Os Sacrum,
and are dispersed upon the Muscles and integuments
there.
  Q. Describe the connexions of the Anterior Sacral
Nerves ?
  A. They go out by the large anterior holes  of the
Os  Sacrum.  The first,  second,  and  third,  are  the
largest; they unite into a trunk which  receives the
trunk of the  fourth and fifth  Lumbar, they form a
Plexus from which the  Sciatic Nerve take its origin.
  Q. Describe the destination of  the fourth  and fifth
Sacral Nerves ? 
       GLUTEAL  AND  POPLITEAL NERVES.   337

  A.  They send branches to the Hypogastric Plexus,
to the Muscles and ligaments of the Os Coccygis: and
then run outwards to be dispersed  upon the parts
about the Anus.
  Q.  Describe the course of the Sciatic Nerve?
  A.  The Sciatic Nerve issuing from  the Plexus,
formed by the three upper Sacral,  fourth  and fifth
Lumbar, and branches from the Sympathetic Nerves,
goes through the Notch of the Ilium, under the Pyri-
form muscle over the short Rotators, and gets  be-
tween the Tuber Ischii and Trochanter Major; it
then descends in  the back part of  the  Thigh,  be-
tween the Flexors and  Adductor Magnus, twisting
gradually into the ham,  where it is called  the Pop-
liteal Nerve.
  ft.  What  particular  branches does  the  Sciatic
Nerve give off in the Pelvis and Thigh ?
  A.  In the Pelvis it gives rise to the fasciculi, which
compose the Pudic, and also the Gluteal Nerve ; in
the thigh it gives  rise to various irregular branches,
ramified among the muscles, integuments, scrotum,
labia externa, anus, perineum, and several of them
descend, spreading on the back part of the thigh even
to the ham.
  ft. As we have already described  the Pudic,  de-
scribe now the Gluteal Nerve ?
  A. The Gluteal Nerve arises by a superior fascicu-
lus sent oft'from the common trunk of the fourth and
fifth Lumbar, and by an inferior fasciculus from the
same  Lumbar,  and first Sacral Nerves; they both
pass through the  notch of the Ilium; the former is
dispersed upon the Glutei medius and minimus, and
the latter upon the Gluteus Maximus and Integuments.
  Q. Describe the Popliteal Nerve}
  A.  It has the  tendons  forming the ham-strings on
each side, the blood-vessels below and  the integu-
ments above ; a short space above the  bend of the
knee it divides  into a small  external or Fibular, and
a large internal or Tibial Nerve.
  ft.  Describe the Fibular or Peroneal Nerve ?
  Vol. H.              F f
V. 
338     FIBULAR  AND  TIBIAL  NERVES.
  A. It passes clown over the head of the Fibula, and
divides into superficial and deep branches.
  ft.  What superficial  branches does  the Fibular
Nerve send off ?
  A.  The  Cutaneus Externus  sent to the Biceps,
Gastrocnemius, and integuments ; the superficial Fi-
bular perforates the Peroneus Longus, passes over
the Peroneus  Brevis, giving filaments  to both, and
becoming subcutaneous about the middle of the leg,
sends branches to the Metatarsus, Extensor  Digito-
rutn Brevis,  and other branches, which anastomose
on  the  upper part of  the  foot, and  send  dorsal
branches to the toes.
  ft. Describe the  Deep Branches  of the Fibular
Nerve ?
  A. It crosses over the Fibula higher than the Su-
perficial, sends a reflected branch to the soft parts of
the joint, a branch to the Peroneus Longus, another
to the Tibialis Anticus, others to the Extensor Polli-
cis, and Extensor Digitorum Longus, filaments to the
Periosteum  of the Tibia.  The  part, which  seems
the trunk of the nerve, accompanies the Anterior
Tibial Artery, divides into branches upon the foot,
which are dispersed upon the Extensor Digitorum
Brevis, Interossei, and toes; one passes with a branch
of the Artery into the sole,  and forms a connexion
with the plantar Nerves.
  Q. Describe the Tibial Nerve}
  A. It passes down between the heads of the Gas-
trocnemius Externus, perforates the Internus, and
follows the Posterior  Tibial Artery between the
Flexor Digitorum Longus,  and the Gastrocnemius
Internus, passes in the sinuosity of the Os Calcis into
the sole, where  it divides into the External and In-
ternal Plantar Nerves.
  Q.  What branches does the Tibial Nerve give off
in its course down the leg?
   A. The communicans Tibiae, which is distributed
to the back part of the leg, and external side of the
foot, various other nameless branches to the muscles
and integuments. 
          REMARKS  ON  THE NERVES.       339

  Q.  Describe the Internal Plantar Nerve?
  A.  It runs on the tibial side of the sole,  giving
twigs to the muscles, divides into four nerves, which
split into others that run along the plantar sides  of
the three  first toes, and tibial side of the fourth, ac-
companying the arteries.
  Q.  Describe the External Plantar Nerve ?
  A.  It gives twigs to the heel, and runs with the
artery along the Fibular edge of the sole, and ulti-
mately divides  into three principal branches; two
run along the contiguous sides  of the fourth and fifth
toes, and fibular side of the little toe; the third gives
filaments  to  the muscles.  These Plantar Digital
Nerves furnish twigs to the integuments, and com-
municate freely with one another, and also with the
Dorsal Digital branches.

           OF DISEASES OF THE NERVES.
  Q.  What Diseases are Nerves subject to ?
  A.  It is impossible to answer that question in the
present state of our knowledge of the Nervous Sys-
tem ; for various morbid aft'ections of the Nerves take
place without our being able by dissection to ascer-
tain the cause.
  Q.  Is not the Nervous Energy of the whole system
sometimes preternaturally increased ?
  A.  Yes; in Mania  the  Nervous Energy given  to
the muscles  increases their strength  and  powers
sometimes to an amazing degree.   In  Epileptic and
Hysterical fits too,  the Nervous Energy thrown into
particular muscles,  especially  Flexors,  is for a time
excessive and morbid.
  ft.  Is not the Nervous Energy of the body some-
times morbidly diminished ?
  A.  Yes; from any inordinate pressure on the Brain,
or on a part of it, or on some of the large  nerves, the
Brain or Nerves are impeded in the performance  of
their  functions,  and,  in  consequence, cannot  give
Nervous  Energy to the  muscles  necessary for their
healthy actions.
  ft.  Are Nerves subject  to tumefaction ? 
340       CONSTITUTIONAL  DISEASES.

  A. Yes; when a nerve is punctured it swells con-
siderably,  to  a  greater or less extent according  to
the nature of the injury.
  Q. Are Tumours not found in Nerves independent
of puncture ?
  A. Yes; a tumour  attended with the most excru-
ciating pain, in a few rare instances has occurred ; it
has a cyst which contains blood; and when divided it
seems composed of thick viscid jelly, in which are a
few white fibres.
  ft. When Nerves  are divided  across, do they re-
unite?
  A. Yes; when kept in contact the divided extre-
mities of nerves re-unite by real  nervous matter,  as
repeated experiments have demonstrated.
  Q. Are Nerves subject to inflammation?
  A. Yes; they are affected with  local Inflammation,
and this seems the reason why symptomatic Fever is
excited, and  a  constant concomitant of acute  local
Inflammation.
  PATHOLOGY  OF CONSTITUTIONAL DIS-
                    EASES.
                    SCURVY.
  Q. What are its symptoms ?
  A. Lassitude, with a sense of weight in the mus-
cles of the lower extremities; indolent and inelastic
swelling of the legs, which are covered with blotches
of greater or less size, not elevated; red, blue, violet,
or yellow, very similar to those ecchymoses arising
from contusions, changing colour as the former,  be-
coming brown, and gradually disappearing;  pain,
swelling, and bleeding of the gums; fetid  smell
from the mouth, and the teeth get loose, and fall out,
and hemorrhage  occurs  from  the various mucous
membranes.
  Q. What are its anatomical characters ?
  A. The blood is generally found fluid, the muscles
flaccid, the bones softened, yellow, and uneven. The
viscera present various appearances, they are gene- 
CONSTITUTIONAL DISEASES.       341
  rally softened, pale, and gorged with watery blood.
  I he brain something softened.
                     SYPHILIS.
   ft. What are its symptoms ?
   A. These differ much in the various tissues which
 may be  affected,  but in all  cases  arising from a
 syphilitic taint, and attended with ulceration and dis-
 charge of matter,  capable of re-producing the same
 disease by inoculation.  When the mucous membrane
 is affected, we find gonorrhoea,  ophthalmia, or ulcers ;
 these ulcers commence in a pimple,  and afterwards
 have the following characters .—a greyish  base, the
 edges hard, thick, red, and conical; they generally
 occur on the glands, on the internal  surface of" the
 prepuce, in the vulva,  the mouth, in the throat, or
 about the anus.  When the skin is affected, we ob-
 serve patches of a  copper or reddish brown colour;
 dry  furfuraceous crusts at  the roots  of the hairs;
 greyish ulcers, which proceed from prominent pim-
 ples, appearing like boils; round transparent pustules
 covered by crusts ;  dry  or suppurating fissures; and,
 finally, we  may have the epidermis very rough  or
 uneven.
   When syphilis attacks the glands, the inflammation
 has a great  tendency to run to  suppuration or indu-
 ration ; the inguinal glands are  those most  exposed.
 The periosteum and bones, especially of the cranium
 and  face ; the sternum  and tibia are very frequently
 affected;  the  parts swell, and  a hard, more or less
 prominent tumour  is observed: the pain which  is
 produced is much more  violent  during the night.  A
 deep caries is often  the consequence.
   ft.  What are its anatomical characters ?
   A.  They are just  described above.
                   SCROFULA.
   ft.  What  are its symptoms ?
   A.  Indolent swelling of the glands in  various parts
of the body,  but occurring most  commonly in the
neck and abdomen of children : no change is observed
                      Ff2 
342        PATHOLOGY OF FEVERS.

in the skin  at  the  commencement, but  after some
time it becomes red, gets thinner, and finally ulce-
rates ; this is attended with very little pain.  Scrofula
often induces swelling and caries of the long bones;
various  affections of  the joints,  especially of the
knee, hip, foot, and ankle.  The  affected glands re-
main for some time  without change, at length they
soften and ulcerations take place, discharging a se-
rous fluid, sometimes mixed  with albuminous floccu-
lent matter.   The cicatrices  of these ulcers are pale,
irregular, and wrinkled.  When scrofula attacks the
lungs it causes phthisis.  Persons whose lymphatic
system is much developed, seem particularly subject
to this disease.  It  is  remarked  to be endemic  in
moist and cold valleys, where the rays of the sun can-
not penetrate.
  ft.  What are its anatomical characters ?
  A.  On dissection, the cervical maxillary or mesen-
teric  glands  are found  variously  affected: those of
the axilla and groin are  not so commonly diseased.
Tubercles are often discovered in the lungs. In some
instances we  find swelling and softening, or destruc-
tion of the articular  surfaces and caries of the ends of
the bones.
          PATHOLOGY OF FEVERS.

                ERUPTIVE FEVEnS.

                  SCARLATINA.
  ft. What are its symptoms ?
  A. A contagious  disease, commencing with the
symptoms of inflammation of the different mucous
membranes, especially of the throat, followed, on the
second, third, or fourth day, by an eruption of small,
isolated and  little prominent pimples, at first of a
palish red, then scarlet colour : these pimples enlarge
and approach each other, becoming in this way con-
fluent, and forming large patches, giving the skjn
the appearance of being covered by raspberry juice,
or the  sediment of wine.  These patches appear on 
^  /
              PATHOLOGY  OF FEVERS.        343

  the face and neck, then on the chest, abdomen, and
  extremities: last from seven to nine days,  and then
  disappear in the same order, and are followed by a
  furfuraceous desquamation of the epidermis.
    ft. What are its anatomical characters ?
    A. The red spots disappear after death, but traces
  are found of inflammation of the digestive tube, and
  more frequently of the lungs  and trachea.
    Before the eruption has taken  place,  it may be
  confounded with  arachnitis, or inflammation  of the
  digestive or respiratory organs.   After the  eruption
  has taken place, with measles.

                     MEASLES.
   ft. What are its symptoms ?
   A.  This disease is contagious,  occurs  but once
 during life;  appears  in an eruption  of semilunar
 spots of vermillion red, separated by colourless inter-
 vals of an angular form ; the spots do not generally
 rise  over the skin, sometimes, however,  they are
 swollen in the middle like small pimples,  and more
 easily felt than seen ; do not  contain any fluid, and
 disappear without  suppurating, leaving, on going off",
 a slight degree of  roughness.  These spots are first
 seen on the face and neck,  then on  the chest,  abdo-
 men, and  extremities,  and  form, by spreading and
 approaching each  other, irregular,  prominent, and
 vermilion coloured patches,  more red and broad on
 the extremities than any other part; their duration
 from seven to nine  days, and  terminate by desqua-
 mation.  The eruption is preceded and accompanied
 by a certain degree of irritation of the mucous  mem-
 brane of the nose, eyes,  and intestines, and still  more
 particularly of that of the pulmonary organs.  There
 is also some fever attending.  The disease terminates
 by desquamation of the cuticle.
  Q.  What  are  the diseases  with  which it may be
confounded ?
  A. They are arachnitis, inflammation of the mu-
cous membranes of the digestive or pulmonary or- r, 
344           ERUPTIVE  FEVERS.

gans before the eruption appears; after this takes
place, scarlatina.
  Q. What are its anatomical characters ?
  A.  All traces of the  eruption disappear after
death; the mucous surfaces of the digestive and pul-
monary organs are often found more or less extensive-
ly inflamed.

            VARICELLA (CHICKEN-POCK).
  Q. What are its symptoms ?
  A. On the first or second  clay there appears an
eruption  of small pimples, which are  at  first red and
slightly prominent, then spread, turn white, and the
summit fills with a white, transparent, and inodorous
fluid.  This fluid does not possess the power of in-
ducing the same disease by inoculation.   The three
stages of eruption, suppuration, and desiccation, are
not well  marked ; it terminates from the sixth to the
tenth day.  Never fatal, nor does the skin retain any
mark whatever.
  It may  be confounded with  variola.
  Q. What are its anatomical characters ?
  A. These are described above.

             VARIOLA  (SMALL POCk).
  Q. What are its symptoms ?
  A. After a febrile attack for two or three days, or
some symptoms of gastric irritation,  an eruption of
pimples appears successively on the neck, face, chest,
and then  on the rest of the body; their duration is
from four  to five days,  and present the following
characters: Their form is  lenticular and depressed
at the centre ; at first  they are very small and red,
then enlarge, become  white,  but are surrounded by
a red areola ; at this period they are filled with a se-
ro purulent, nauseous fluid, which possesses the pro-
perly of  producing a similar disease by  inoculation.
The skin near those pustules  is swollen and  painful,
especially on the face  and hands, and still more  re-
markably so in the confluent species, in which form 
ERUPTIVE FEVERS.
345
the pustules are quite flattened :  and as they are de-
prived of the red areola, they become blended, and
form large patches covered by phlyctense, or a whitish
pellicle.   From  the ninth to the eleventh day the
pustules exsiccate in the order of their appearance,
are followed by  incrustations, which are cast off'from
the fifteenth to the  twentieth day, leaving cicatrices
or pits, which are at first red, then colourless, varia-
ble in depth and extent, but in all are  very perma-
nent in their duration.  This  disease is remarkably
contagious, often epidemic; occurs most commonly
in infancy ; usually  but once during life.
  The diseases with which it may be confounded are,
inflammatory affections of the brain, or its depen-
dencies, the lungs or intestines, the various exanthe-
matic fevers,  before the  eruption.   After this,|va-
ricella.
  Q. What, are its anatomical characters ?
  A. The characters and appearance of pustules dif-
fer in their different stages.   In the first, or eruptive
stage, it is formed in a solid red mass, like a phleg-
mon in th^ rete mucosum, and adhering to the true
skin ; during the second or inflammatory stage, it  is
found filled with a fluid of variable characters ;  in the
third, or suppurative, it  contains  pus, and depresses
the true  skin;  fourth, after  desiccation has taken
place, we find incrustations on the skin, which are
red, and more or less deep.  In many instances we
find variolous pustules on the gastro-intestinal and pul-
monary mucous surfaces, which appear like aphthae.

              VACCINA,  OR COW-POCK.
  ft. What are its symptoms ?
  A. This is always produced by the inoculation of
matter either taken directly from the cow,  or from
vaccine pustules on the  human subject.  On the third
or fourth day, a  small, hard, and colourless eminence
is observed where the matter was  inserted, then  a
vesicle depressed in the centre, which gradually in-
creases in size, and  on the sixth or seventh day pre- 
 346        INFLAMMATORY FEVERS.

 scnts a tense prominent head, surrounded  by  an
 areola of a deep red colour ; if at this period we open
 the vesicle, a limpid, transparent, and viscid fluid ex-
 udes, which has the power of reproducing the same
 affection ;  on the eighth and tenth  days, the swelling
 and redness increase, the vesicle becomes broad,
 whitish,  and less prominent; on  the twelfth, desic-
 cation commences, and spreads from the  centre  to
 the circumference ; a hard, dry, reddish crustatiou is
 formed,  which  falls off  about the twentieth  day,
 leaving a well marked and indelible cicatrix.
  Every eruption after  vaccination not  presenting
 these characters is spurious, and not to be relied on.

              INFLAMMATORY FEVER.
  Q.  What are its symptoms ?
  A.  This  is ushered  in  by shivering fits; the face
 red and flushed, eyes bright and injected, pulsations
 of the temporal and carotid arteries ;  intolerance of
 light and sound ; great sense of weight in the head ;
 faintness; the pulse full, strong, and frequent; the
 beating of the heart increased ; respiration deep and
 frequent; the tongue whitish ; constipation; hemor-
 rhagies often occur, giving temporary relief; secre-
 tion of urine diminished ; it is first  very red,  but  af-
 terwards deposits a dirty sediment; dull pains in the
 limbs ; an exacerbation  generally takes place in the
 evening,  and  during the night.  In the advanceel
 stages of this disease, the skin, which was  at first hot,
 becomes  parched, and the tongue dry,  or covered
 with a brownish crust; the intellectual functions de-
 stroyed ;  great debility, and the patient dies.
  ft. What are its anatomical characters ?
  A.  On  dissection the  signs of  inflammation are
 found in some of the principal organs.

                 BILIOUS FEVER.
  Q. What are  its symptoms ?
  A. Bitter taste in the  mouth, the tongue covered
with a whitish or brownish coat; nausea,  and desire 
INFLAMMATORY  FEVERS.        347
of vomiting; thirst, particularly for acidulous drinks;
complete disgust for animal food ; bilious vomiting,
constipation or diarrhoea, head-ache, principally com-
plained of around the orbits;  a yellow tinge observed
in the lips afid alx nasi; skin  hot, dry, and parched
to the touch ; tenderness of the epigastrium on pres-
sure; dull pains of the extremities; pulse full,  hard,
and frequent; in some instances a complete jaundice
occurs.   Morning and evening exacerbations.
  These  symptoms should rather  be  considered as
proceeding  from some inflammation of the digestive
organs,  than as an  idiopathic  disease.
  ft.  What are its anatomical characters?
  A.  For these the reader  is referred to the descrip-
tions given when treating of the affections of the gas-
trointestinal canal.

                  MUCOUS  FEVER.
  ft.  What are its symptoms ?
  A.  Irregular rigors; tongue moist  and white, or
coated with a  thick mucus  ; the mouth clammy ;  in-
creased  secretion of saliva ; the breath fetid;  aptha:
observed in  the mouth ; acid  or fetid eructations ;
mucous  diarrhoea,  with expulsion of  worms ; pulse
rather slow, small,  and weak; heat of skin moder-
ate ;  urine diminished in quantity, sometimes the se-
cretion  of it is very abundant, limpid, whitish, and de-
positing a greyish sediment; dull  head-ache, gene-
ral lassitude, pains in the joints, dullness of intellect,
irregular exacerbations.
  Q.  What are its anatomical characters ?
  A.  Inflammation of the digestive respiratory tubes.

                ANDYNAMIC FEVIilt.
  ft.  What are its symptoms  ?
  A.  General languor, and  great  prostration of
strength : great reluctance, and slowness in moving:
the muscles quite flaccid, so that  the limb?, when
raised, fall like dead masses ;  the  patient  lies on his
back: great  tendency  to gangrene in wounds, and 
348
NERVOUS FEVER.
those parts on which the.body rests ;  it is very diffi-
cult to redden the skin :  appearance of petechix and
ecchymosis: the skin dry, and the heat trifling ; cold,
viscid, and partial sweats: great sinking of the counte-
nance: the energy of the intellectual faculties much di-
minished: drowsiness: wild dreams: answers very slow-
ly given : the eyes contorted:  the tongue at first pale,
then becomes parched, and is covered, as well as the
lips and teeth, by a brown black coat of viscid mat-
ter ; the breath fetid: great difficulty of swallowing,
often impossible : dark and fetid feces passed invo-
luntarily :   meteorism of the abdomen; the  urine
either passed in  bed, or  completely retained : he-
morrhagies  occur  often, and increase the debility:
the pulse  rather slow, soft, and easily compressed :
pulsations of the heart weak: the blood is found very
thin, and sometimes of a greenish colour.
  Q.  What are its anatomical characters ?
  A.  In the present state of the science, we  cannot
exactly describe these :  the bodies  run into putrefac-
tion in a very short time : the parenchymatous visce-
ra are found softened: the lungs and the lining mu-
cous membrane of its numerous  canals are gorged
with a thin black blood.

                 NERVOUS FEVER.
  Q. What are its symptoms ?
  A. Great irregularity  and  confusion of the differ-
ent functions, and  of the phenomena which depend
on  them, accompanied  with various nervous affec-
tions : no consistency between  the  symptoms, and
the generally fatal termination  of this  disease: the
sensibility  and the various senses  more acute than
natural, or confused :  the tone of the  voice changed :
delirium: dreaming:  stupor: restlessness: general
or partial  convulsions : trembling fits, with subsultus
tendinum : rigidity of the muscles,  and temporary
paralysis:  swooning, fainting:   finally,  a comatose
state comes on;  pulse  very irregular:  it  is found
sometimes quick,  sometimes slow, intermitting, and 
TYPHUS  FEVER.
349
changes instantaneously from one to the other:  face
pale, alternating with flushings :  perspiration may be
either suppressed, or very copious :  the tempera-
ture varies  in the same  way from  hot to cold, &c;
the diagnosis of this disease is  often  very difficult.
Diseases with which it may be confounded: The dif-
ferent cerebral affections of the gastro-enteritic in-
flammations.
  ft. What  are its anatomical characters ?
  A. In  the simple nervous fever no alteration is
found on dissection.

                     TYPHUS.
  ft. What are its symptoms ?
  A.  This disease  always arises from infection, is
generally contagious,  and confined  to  European
countries ; the symptoms are  those observed in the
inflammatory affections of the viscera  of the three
great cavities, or those of the five different fevers we
have just  described.  Typhus,  in  its  first stage, is
characterized by the symptoms  of the inflammatory,
bilious,  or  mucous  fevers, and in its second, by
those of the adynamic or ataxic ;  it is very often epi-
demic, and the principal phenomena are stupor, ver-
tigo,  petechise,  constant confusion of the nervous
functions, and a great tendency to a fatal termination.
  ft.  What are its anatomical characters?
  A.  These vary very much ;  the viscera of the
head, thorax, or abdomen, sometimes are seen with
all the marks of most  acute  inflammation ; in other
cases it seems to have been very slight, or no traces
of any  disorganization may be observed, especially
where death has occurred very  rapidly ; the  bodies
generally putrefy quickly.

                  YELLOW FEVER.
  ft. What are its symptoms ?
  A. A most fatal disease, occurring in hot climates,
and running its course in a very short time ; the prin-
cipal symptoms are, violent head-ache, often confined
  Vol. II.             G g 
350
YELLOW FEVER.
to the orbitar region, with redness or paleness of the
face at its commencement, and soon followed by itch-
ings,  nausea, violent  thirst, yellowness of  the skin
observed  on the temples, the conjunctiva, the sides
of the neck, and so6n spreads over  the whole body ;
violent pains in the epigastric region of the abdomen
and loins now supervene ; excessive internal burning
heat,  with coldness of the extremities; vomiting of
yellow, then dark matter; urine diminishes, and fi-
nally is suppressed; passive hemorrhagies occur; lo-
cal gangrene ; syncope, hictfup,  subsultus tendinum,
and gradual sinking of the pulse.
  ft. What are  its anatomical characters ?
  A.  General yellowness of the. skin, interspersed
with blue  livid  spots ; the muscles soft  or contract-
ed ;  congestion of blood in the membranes of the
brain, and occasionally  an effusion of a sanguinolent
serum is found at the base of the  brain and along the
spine ; red, livid, or dark black spots on' the mucous
membrane of the stomach, which is filled by a dark
fluid matter similar to what was vomited. The lining
membrane of the intestines  often brown coloured;
the liver softened ; the kidneys red, or covered with
gangrenous spots ; the bladder contracted, sometimes
inflamed.

                     PLAGUE.
  ft. What are its symptoms ?
  A. An  essentially  contagious  disease confined  to
the eastern  countries, inducing  death very rapidly,
always accompanied  by carbuncles and  buboes,
which terminate in gangrene ; petechia on different
parts of the  body; these are attended with general
symptoms, the  same as described in the ataxic and
adynamic  fevers.
  ft. What are its anatomical characters ?
  A. Gangrene of different portions of the digestive
tube; sanguineous congestions in  the head or chest;
suppuration more or less of the principal viscera, and
invariably gangrene is  found in  the skin and glands
of the groin and axilla. 
            PATHOLOGY OF POISONS.        351

      INTERMITTENT AND REMITTENT FEVERS.
  Q. What are their symptoms ?
  A. The returns of this fever are more or less re-
gular, the fits being divisible into  three stages, the
cold, the hot, and the sweating; if during the fits
there is a complete cessation of fever, it  is called in-
termittent ; if on the contrary,  the fever  does  not
cease altogether during the intervals, it is called re-
mittent ; these fevers in general present the symp-
toms peculiar to one or other of the five orders de-
scribed above.
  Q. What are their anatomical characters ?
  A. The appearances  presented after  death  are
very variable; we  know of none that may be called
pathognomic of the disease; the spleen is sometimes
found increased in size and consistence, particularly
when the disease has been of long standing.

              CONTAGIOUS FEVERS.
  Q. What are their symptoms ?
  A. The febrile attacks or paroxysms present va-
rious symptoms at their commencement, but still as-
sume some special  character marked by some phe-
nomenon which  threatens life directly, and increases
at each attack.  These fevers, which are endemic in
certain countries, owe their origin usually to the in-
fluence of marsh miasmata.
  ft. What are their anatomical characters ?
  A. The organs to which those symptoms are refer-
rible, which characterized the  disease,  present va-
rious alterations in their  appearance and texture, but
in some cases there is no appreciable alteration, par-
ticularly when the patient dies in the early stages of
the disease.


          PATHOLOGY  OF POISONS.

  THE METALLIC CORROSIVE POISONS.
    POISONING BY THE PREPARATIONS OF  ARSENIC.
  ft. What are its symptoms .•' 
352                 poisons.
   A. Taste  acrid and metallic: constriction of the
 pharynx:  nausea:  vomiting:  the  ejected matter
. brown, sometimes bloody:  salivation  copious: pre-
 cordial anxiety : heat and pain in the stomach : stools
 black, sometimes green,  fetid : violent colic pains :
 tenesmus : pulse small, quick, and irregular: intense
 heat of skin:  burning thirst, cold sweats: difficult
 respiration:  urine scanty, red,  or bloody: delirium:
 convulsions: total change in the  expression of the
 countenance.  When the poison has been taken in
 large quantity, the  sufferer dies quickly, without
 presenting the symptoms characteristic of this mode
 of poisoning.
   Q. What are its anatomical characters ?
   A. Traces of inflammation, more or less considera-
 ble, of the mucous membrane of the digestive canal,
 from slight redness to ulceration,  and even to gan-
 grene.

   POISONING  BY THE  PREPARATIONS OF ANTIMONY.
   Q. What are its symptoms ?
   A. The same as those of  poisoning  by the acids :
 they usually  commence in very  abundant and  obsti-
 nate vomiting,  with acute pain of the stomach : there
 are observed extreme prostration of strength, copious
 stools, violent  colic  pains, cramps, cold sweats, and
 delirium.

   POISONING BY THE PREPARATIONS OF COPPER.
   Q. What are its symptoms ?
   A. Coppery taste  in  the mouth:  eructations of
 the  odour  of copper:  nausea: vomiting, with diffi-
 culty and pain, a green matter: pain of the stomach,
 most painful griping: alvine evacuations frequent,
 black, and bloody, accompanied  by tenesmus, ten-
 sion of the  belly: pulse small, hard, and quick:
 anxiety: cold sweats : head ache :  vertigo : convul-
 sions.

    POISONING  BY THE PREPARATIONS OF SILVER.
   ft. What are its symptoms ? 
CORROSIVE POISONS.
353
  A.  Same as those which characterize the other cor-
rosive substances.

    POISONING  BY THE PREPARATIONS OF GOLD.
  Q. What are its symptoms ?
  A.  Same as those  which result from the action of
the greater number of other metallic  salts.

  POISONING  BY THE PREPARATIONS OF MERCURY.
  Q.  What are its symptoms ?
  A.  Of the same  character with those produced by
other corrosive substances: acrid and metallic taste :
tumefaction and burning heat of the throat: pain of the
stomach and abdomen increased in a short time to an
intense degree: salivation quickly induced, with the
characters peculiar to mercury, when the corrosive
sublimate has caused the poisoning.

   POISONING BY THB PREPARATIONS OF BISMUTH.
  Q.  What are its symptoms ?
  A.  Same as those  caused by  the action of other
yery active corrosive poisons.

    POISONING  BY THE PREPARATIONS OF LEAD.
  Q.  What are its symptoms ?
  A.  Taste  sweet, metallic, and astringent:  pain of
stomach :  constriction  of the throat: vomiting  ob-
stinate, very painful,  sometimes bloody : hiccup: con-
vulsions. Sufferers, if they survive, are very general-
ly afflicted with palsy, or various painful affections.—
See the article Colica Pictonum.

     POISONING BY THE PREPARATIONS OF  TIN.
  ft.  What are its symptoms ?
  A.  Those  common to all the corrosive poisons:
sometimes paralysis supervenes, but most frequently
death is the result.

     POISONING  BY THE PREPARATIONS Of ZIXC.
   ft. What are its symptoms ?
                      Gg2 
354
CORROSIVE POISONS.
  A.  Taste sour, with a sense of strangulation :  nau-
sea : vomiting.  The symptoms often cease quickly, in
consequence of the poison being ejected by means of
its emetic property.   Should it, on the contrary, re-
main in the stomach, the symptoms produced by other
corrosive poisons are observed.

            POISONING BY THE  ACIDS.
  ft. What are its symptoms ?
  A. All the acids produce very nearly the same  ef-
fects—viz : a taste sharp, burning, and disagreeable:
heat and acute pain of the throat, then of the oesopha-
gus, stomach, and intestines: foetor of the breath :
eructations : nausea : vomiting repeatedly a  bloody
liquid of a yellowish or brown colour, which produ-
ces an effervescence on the ground, and deeply  red-
dens tincture  of turnsole: stools copious, more  or
less tinged with blood: extreme sensibility of the ab-
domen : burning, incessant thirst: pain increased  by
drinking: pul3e small and irregular: urine scanty,
and evacuated with difficulty : respiration laboured:
extreme  paleness,  with alteration of the face:  cold
sweats, and in some instances, convulsions : the intel-
lectual faculties generally remain unimpaired.  Very
often  the poison causes, by its contact with the lips,
tongue, and pharynx, yellow or brown eschars, which
drop off, and produce a loss of

    POISONING  BY  ALKALIES AND TnEIR SALTS.
  The Prussic acid,  when inoculated on  the surface
of the body, even in very small quantity, causes almost
instant death.

POISONING BY THE  ALKALIES AM) THEIR COMrOUNIl*.
  ft. What are its  symptoms ?
  A. Taste pungent, urinous, and caustic, accompr-
nied generally by the symptoms of poisoning by  con-
centrated acids ; the  liquid of the vomited matter and
the stools render syrup of violets green.
  Ammonia produces total derangement of the facul-
ties, and sudden death. 
VEGETABLE  POISONS.          355
            POISONING  BY PHOSPHORUS.
  Q.  What are its symptoms ?
  A.  Taste  of garlic in the  mouth,  with  peculiar
purched sensation, together  with all  the symptoms
which result from poisoning by the acids.

   POISONING BY  IODINE AND  ITS PREPARATIONS.
  ft.  What are its symptoms ?
  A.  Same as those which are characteristic of  poi-
soning by the acids, and, in addition, a strongly mark-
ed yellow colour of the tongue and fauces.

    POISONING BY ALCOHOL AND ITS COMPOUNDS.
  Q. What are its symptoms ?
  A. Intoxication, then complete insensibility: pa-
ralytic phenomena:  stupor: the face swollen, and of
a deep red hue:  respiration  stertorous: the breath
smells strongly of the liquors which have produced
the intoxication.
 POISONING BY  VEGETABLE SUBSTANCES.

                 ACRID POISONS.
  Q. What are its  symptoms ?
  A. All the poisons of'this class produce very near-
ly the same effects, which generally consist in the fol-
lowing:—viz. taste acrid and pungent, or intensely
bitter; heat  in the throat;  dryness of the mouth
and pharynx, with constriction:  vomiting continuing
even after the ejection of the poison : acute pains in
the stomach and intestines : alvine evacuations abun-
dant: pulse strong and quick: sometimes dilatation
of the pupil: general insensibility: smallnessand ir-
regularity of the pulse: death.

                NARCOTIC POISONS.
  ft. What are its symptoms ?
  A. Heaviness in the head: stupor:  torpor: inch- 
356
ANIMAL  POISONS.
nation  to  vomit:  great tendency to somnolence :
countenance dull: face swollen :  eye-lids tumefied :
pupils always much dilated, with little or no power of
contraction : relaxation of the muscles of the limbs,
particularly the inferior: sometimes convulsive move-
ments of different parts of the body :  the pulse at first
generally strong and full, afterwards becomes feeble,
slow, and irregular:  finally, precordial anxiety, alvine
dejections, and death.
  Q. What are its anatomical characters ?
  A. After death there are not discovered any traces
of inflammation in the  parts with which the poison
is found in contact, but there is congestion of the ves-
sels  of the brain and the lungs:  these latter  do  not
crepitate on pressure, and are of a deep red colour:
the  blood  contained in  them, as  well as that of  the
heart, is sometimes liquid, sometimes coagulated.
    POISONING BY ANIMAL SUBSTANCES.

        POISONING BY THE  FLESH OF FISHES.
  ft. What are its symptoms ?
  A. In a time more or  less considerable, after the
fish has been  swallowed,  there are  experienced a
heaviness in the stomach, vomiting, griping pains, ce-
phalagia, vertigo: the head and circumference of the
eyes are intensely hot: the face is red and swollen :
the patients feel burning  thirst: a rash like that of
urticaria frequently appears over the entire body: the
pulse i3  accelerated,  small, and hard: convulsions
sometimes  come on:  the  extremities are rarely
cold.

  POISONING BY THE STING OF  VENOMOUS INSECTS.
  Q. What are its symptoms ?
  A. Generally pain, swelling,  and sometimes high
inflammation of the part stung,  in some cases termi-
nating in gangrene, and accompanied by nausea, vo- 
ANIMAL  POISONS.
357
miting,  fever, numbness:  general  shivering, and in
some instances death.

  POISONING BY  CANTHARIDBS TAKEN INTERNALLT.
  Q. What are its symptoms ?
  A. Breath fetid: taste acrid;  heat excessive : pain
in the throat, stomach, and belly : vomiting frequent
and bloody: alvine evacuations abundant:  heat in the
lumbar  regions and the bladder: strangury or entire
retention of urine, with frequent desire to make it:
obstinate and  very painful priapism: fever:  convul-
sions: delirium: death.

  POISONING BY THE BITE  OF  VENOMOUS SERPENTS.
  Q. What are its symptoms ?
  A. Acute and sharp pain in  the part  which has
been bitten, and extending  over  the  entire body:
there immediately appears swelling, with hardness
and paleness at  first, then with livid redness, and a
gangrenous appearance: the pulse small, frequent,
and  irregular: then  supervene syncope,  vomiting,
anxiety, difficulty of respiration, with cold and abun-
dant perspiration : the sight becomes weak, delirium
is manifested, a yellow tinge is spread over the entire
body: after a certain time  the bitten part becomes in-
sensible, discharges a serous fluid, is covered  by gan-
grenous specks, and the sufferer sinks.

    POISONING BY THE  BITE OF  RABID ANIMALS.
  At a  time more or less considerable, after the in-
fliction of the wound (usually between the twentieth
day and third or fourth month,) the  bitten part be-
comes painful, opens afresh, emits a reddish serum;
if it has  not been cicatrized it becomes red, and affords
a serous and reddish pus; restlessness, anxiety, spasms,
troubled respiration  succeed:  the sufferer  feels a
trembling, which extends  from  the sore over the en-
tire body, and appears to end in the throat: he is ago-
nized by internal heat, and  sometimes excessive thirst,
but he dares not to drink:  the sight of water or of po- 
358        METHOD OF CONDUCTING
lished or shining bodies irritates him, and aggravates
the symptoms:  deglutition is impossible.  At the ex-
piration of four  or five days the symptoms are increas-
ed : violent convulsions pervade the entire body, pro-
duce a frightful expression of the countenance:  the
eyes are red and prominent: the tongue hangs out-
side the mouth, from which flows a  viscous  saliva: in
a few cases there is an inclination to bite :  the pulse
becomes unequal  and intermittent: a cold  sweat ex-
tends over the entire body, and death speedily takes
place.

 METHOD OF MAKING POST MORTEM  EXAMINATIONS.
  Q. What is to be observed previous to making this
examination, to render  it most useful ?
  A. The physician should, whilst conducting it, be
divested of every preconceived opinion, and  be guided
solely by the desire of discovering the truth.
  ft. How is the head examined ?
  A. The shortest method of opening the head, and
which is therefore the most convenient in the dissect-
ing room, is, after supporting the  back part of the
head on a block, to make a circular incision through
the scalp around the head, passing along the frontal
sinus, the petrous portion of  the temporal  bone, and
the occipital protuberance.  Having made this down
to the skull, the latter may be broken all around by
the claw of a hammer, taking care not to tear the dura
mater or brain : when the vault of the skull  is detach-
ed, it may be torn off by introducing the end of the
hammer between the divided portions of the frontal
bone. In some cases the dura mater adheres so close-
ly to the parietal bones, that it is  impossible to de-
tach it  without using  the scalpel.  Whilst  going
through the first step of the examination, the quanti-
ty of blood which  flows from the incision in the scalp
should be observed, and also the state of congestion
of the face.
  After the  skull has been removed, the dura mater
should be examined,  in order to ascertain whether 
POST  MORTEM  EXAMINATIONS.     350
there is  any fungous production upon it, or depres-
sion in  the corresponding part of the bony  arch ;
when adhesions exist,  when  the sinuses are gorged
with blood, the fact should be  stated in the report.
When pus or blood is effused between the membrane
and  bone,  we  should  ascertain whence it comes;
and  should never omit to examine the  scalp, to see
whether it presents a wound, or the bone  a fracture;
finally, the  dura mater should  be  washed, in order
that we  may  be able to determine  whether any
change of  colour  which it  presents is  owing to a
fluid effused on its surface, or is produced by inflam-
mation.
  After these preliminary steps, we should proceed
to -divide the  dura  mater circularly with a scalpel or
pair of scissors, and  when the falx is detached, the
whole may  be drawn back, gently separating it from
the arachnoid, in order that we  may see  whether any
slight adhesions exist between them. Before the con-
tact of the air has reddened  the vessels of the pia
mater, we  should see whether they present any ap-
pearance of injection. After having ascertained whe-
ther pus, blood, or serum is effused between the two
layers of the arachnoid, or infiltrated between it and
the pia mater, we should inspect the convolutions of
the hemispheres, to see whether they are flattened ;
for  when that exists to any  considerable degree,
it indicates an effusion of fluid into the lateral  ven-
tricles.
  Whilst examining the arachnoid, we should recollect
that in the healthy state this  membrane is exceed-
ingly thin and transparent, even at the summit of the
hemispheres, and can scarcely be detached from any
part without being torn, except opposite the pons va-
rolii, where it presents some degree of firmness and
thickness.  Examination should then be  directed to
ascertain if it has lost its transparence, or presents on
its surface any purulent exudation or false membrane.
When viewed horizontally, it sometimes appears co-
vered with minute granulations, giving it a velvety 
360     POST MORTEM EXAMINATIONS.
appearance ; we should carefully avoid mistaking for
these, small bubbles  of air effused beneath the  pia
mater.   Whenever  it appears opaque or studded
with white points, it should be pressed on by the fin-
ger in order to ascertain its degree of consistence, as
in some cases it approaches that of cartilage.  When
the arachnoid is white and thickened, so as  to  re-
semble a false membrane, it should be detached from
the pia mater, to discover how far each of these mem-
branes  is concerned in the alteration.  Though at
first sight it occasionally  appears red, we find the
effect to depend on  an alteration in the state  of the
vessels  of the pia mater,  which are found to be in-
jected.   When detaching the membranes from the
surface of the brain, the finger may be insinuated be-
tween the convolutions, so as to draw them from
within outwards,  and then it will be  easy to ascertain
their  degree of thickness, strength and tenacity ; and
also whether there exist any adhesions between them.
We should thus pass in review successively the  dif-
ferent parts of the arachnoid which line the base of
the brain, the decussation of the optic nerves, and the
pons varolii;  as from the loose connexions which  ex-
ist in these parts, as well as the number and  size of
the vessels,  effusions of lymph or of pus are more
perceptible and more common than elsewhere, par-
ticularly in children.
   Q.  How is the substance of the brain to be  exam-
ined ?
   A.  The appearance of the grey substance  should
be noted, it may be of a slightly rosy tinge, or may
present a sort of dotted redness, particularly when
the pia mater is  much injected:  in other cases the
texture  of the  convolutions is  altered, being ren-
dered soft, or almost diffluent,  by inflammation and
suppuration.   An incision may be made from above
downwards, across  the substance of each anterior
lobe,  so  as  to penetrate through the lateral ventri-
cles, and then by compressing the brain from behind
forwards,  the fluid (if any be  contained  in  them) 
POST MORTEM  EXAMINATIONS.     S61
 may be made to flow forwards, and  its quantity as-
 certained by receiving  it in a graduated glass ves-
 sel.
   The substance of the brain should, in the next place,
 be sliced off by several horizontal incisions, and any
 change,  either of colour  or consistence,  carefully
 noted.  In cases of " ramollissement," the existence
 of pus or serosity should be ascertained if possible :
 and whether the softening is connected with sangui-
 neous injection.  When infusion of  blood has taken
 place into the  brain,  the change of  appearance and
 colour of the  affected part should be stated; it is
 also necessary  to ascertain  the size  and consistence
 of the clot, and whether it  is enclosed in a membra-
 nous sac,  or mingled  with a serous fluid ; in a word,
 we should describe the physical character of the clot,
 as well as those of the cyst which surrounds it. When
a  tumour is found  developed in the brain or its in-
vestments, its mode of connection with those parts
should be examined, also the degree  of compression
which it exerts upon the substance of the brain, and
 the consistence of the parts of the latter which sur-
round it.  This can  be ascertained  by gently pour-
ing water on the part  ; but when the membranes a^<?
affected, they may be washed in  a vessel of water,
and dissected according to convenience.  The state
of the corpus callosum,  fornix, corpora striata, optic
thalami, and pons varolii, should be  fully stated, ta-
king care, with regard to this last, to indicate the side
of it which is particularly affected.  When the ven-
tricles are laid  open,  we should never omit examin-
ing with care the state of the serous membrane which
 lines them.
   Q.  What is the method of  examining the  cerebel-
lum, medulla oblongata, and their membranes ?
   A.  They should be  dissected in the way just point-
eel out for the brain ;  in order to remove these parts
from the occipital fossa, the tentorium cerebelli should
be cut through, and  after detaching the nerves, the
medulla oblongata should be divided as far down as
   Vot.. H.             H h 
36S
METHOD OF
CONDUCTING
    possible.  If the patient has had a discharge from the
    ear, attention should be directed to the state of the
    bones which support the posterior lobe of the brain,
    particularly the petrous portion of the temporal bone;
    we should ascertain whether there is a caries of the
    bone, or any collection of pus, which may be recog-
    nized by its colour or smell; or finally, whether the
    dura mater  is detached at any point from the skull.
    We should always endeavour to determine  whether
    the  disease  commenced in the bone, membranes, or
    substance of the brain;  and whenever any lesion of
    the  cerebellum is discovered, the  testicles in the
    male, the ovaries, uterus, and its connexions in the
    female, should be carefully examined.
     Q. What is the method  of opening the vertebral
    column ?
     A. The body  being turned  forwards on its  face,
    the cervical  vertebrae may be raised to a level with
    the dorsal, by placing a block under the neck.  The
   great mass of muscle which fills up the depression at
   each side of the  spinous processes  of  the vertebrae
   should be dissected away from the occipital hole to
   the  sacrum  (a large portion of the occipital  bone
   having been previously removed by  two cuts made
   by a saw from above downwards).  The posterior or
   annular portion of the vertebrae being thus laid bare,
   it may be cut through with a chissel; or with a " ra-
   chisome," the cutting edge of which being placed on
   the transverse process of each vertebra, its division
   is easily effected by striking the  instrument with a
   hammer or mallet; the same is to be done at the op-
   posite side,  and  the portion thus insulated is  then
   easily detached.   A continuance  of this operation
   will, in a short time, expose the entire of the  medulla
#  spinalis, as it lies enveloped in its membranes, which
   need not  be in the slightest degree injured by it.
   The membranes, and substance of the spinal  marrow
   should then  be examined, with those precautions
   which have been  already  detailed in the previous
   section. 
         POST MORTEM EXAMINATIONS.     363

   Q. What is the method of opening the thorax ?
   A. The shortest  and simplest process consists in
 dividing the cartilages of the ribs, as near as possible
 to their bony arches, with a strong scalpel, proceed-
 ing from below upwards, after having previously di-
 vided the abdominal muscles which are attached to
 the zephoid cartilage.  The sternum should then be
 raised up towards the face of the  subject, which is
 facilitated  by luxating the bone from  its connexions
 with  the clavicles,  having previously divided the ar-
 ticular ligaments.   By this process we avoid  break-
 ing the ribs, and  leaving thereby projecting spiculae
 of bone, which may wound the operator whilst en-
 gaged  in examining the contained organs.  When
 it becomes requisite to expose the cavity of the chest
 to a greater extent,  we may proceed according to the
 process recommended by M. Chaussier.
   With this intent a large elliptic incision is made in
 the integuments, commencing immediately below the
 clavicles,  and  extending  downwards  towards  the
 crest  of the ileum, and thence forwards towards the
 margin of the pubis.  After having  made a similar in-
 cision at the opposite side, all  the ribs except the
 first  and two last, are to be sawed through with a
 saw convex at its cutting edge;  the sternum should,
in the next place,  be divided  by a transverse  cut.
 The  upper part  of this large flap should then be
raised up,  in  order that its attachments to the me-
diastinum, lungs and diaphragm may be divided by a
scalpel, so  that being left attached  to the  pubes
merely by a narrow  band, it  may be laid down upon
the lower extremities.  In this way a full view is got
of the whole extent of the chest and abdomen, and
the  alterations presented by  the different viscera
may be  examined  as they lie in their natural situa-
tions.
  When we want  to examine the state  of the large
 vessels  at their origin, or the lower part of the tra-
chea,  it becomes necessary to saw across the first rib,
 and part of the clavicle at each side;  after having 
364       METHOD  OF CONDUCTING
turned back this flap, the blood should be wiped
away so as to expose the parts more clearly.
  In examining the  lungs, we commence by  ascer-
taining whether there are any adhesions between the
two layers of the pleura.  When such connexions ex-
ist, they should  be  detached from the serous mem-
brane,  which gives an opportunity of seeing what
their colour and consistence  is, whether they consist
of a single band or of several, and whether vessels
are developed in their substance.   In order to de-
termine whether the corresponding points of the
pleura are thickened, opaque or injected, it should
be removed from the lung or the wall of the thorax,
and held up to the light, when any change of struc-
ture which it presents is at once perceptible.   In do-
ing this, care should be taken not to attribute to the
pleura a change of  colour which may  exist only in
the false membrane. The serous membrane should
be examined in every part  of its extent, on the in-
ternal surface of the ribs, the diaphragm, and fissures
between the lobes  of the lungs.  When, after de-
taching the bands of adhesion, the pleura appears red
and injected, we should ascertain  whether the red-
ness exists  in  the  membrane  itself,  or has taken
place only  in the subjacent cellular texture;  when
any fluid is contained in  its cavity, its quantity, co-
lour, and other  properties should be noted.  In cases
of interlobular pleurisy, care should  be taken not to
mistake an effusion enclosed amongst the adhesions
for an abscess of the lung.  When gangrene exists,
its seat should  be ascertained, as it may attack the
false membranes, the pleura, or both.  Where a com-
munication exists between the pleura and bronchi, a
probe  should be passed along the  fistulous canal,
which then may be laid open, and the state  of its
walls examined; finally, if air be contained in the ca-
vity of the seroti3 membrane, it should be stated in
the report.
   When the lungs  are removed from the thorax, in-
cisions should be made through their substance, that 
         POST MORTEM  EXAMINATIONS.      365

 we may be able to ascertain their colour, consistence,
 weight, degree  of cohesion, and also whether they
 contain any  fluid blood, serosity or pus, infiltrated
 into them.  In cases of gangrene it is useful to deter-
 mine whether it is circumscribed by a defined line, or
 is blended insensibly with  the healthy structure,  or
 whether this transition is effected by an inflamed por-
 tion of the lung.  The bronchi are to be laid open in
 their whole extent, even to their final terminations,
 that we may ascertain the degree of consistence and
 colour of their lining membrane, and also whether it
 presents any effusion, false  membrane on ulceration.
 In pursuing this examination, we sometimes find some
 accidental substance developed in  the  bronchi, or
 their traj'et dilated, or that they are contracted  in
 some particular part.  In some cases also, we find air
 effused under the pleura, or contained in some of the
 pulmonary lobules  distended or torn, as occurs  in
 emphysema of the lung,
  In cases of  tubercular excavations, we should not
 omit ascertaining whether  they are covered with a
 false membrane, also whether they communicate with
 the bronchi.  For a full description  of the different
 changes of structure presented by the lungs, we shall
 refer the reader to the pathological articles which fol-
 low  those  on the diagnosis of  each disease, and par-
 ticularly to the description  of the accidental tissues
 which we shall give in page 369.
  When the heart is  removed from its situation  it
 may be cut across, in order that we may discover the
 thickness and consistence of its walls,  the colour of
 its lining membrane, and the dilatation of its cavities.
 The state  of the different orifices, their contraction,
 obliteration, ossification of their valves,  &c. may be
 ascertained by the  introduction  of the  finger, after
 which  the  ventricles, auricles,  and great  vessels
 arising from them should be  cut open to expose their
 cavities, and show whether  there is  any thickening
 or induration of their coats,  or change of colour in
their lining membrane.  As  the  method  of examin-
                      11 h 2 
366    EXAMINATION OF THE PHARYNX.

ing the pericardium is the  same  with that  above
pointed out when treating of the pleura, it is unne-
cessary to repeat it in this  place ; we shall merely
observe that in all diseases of the heart and  lungs, the
liver should be examined.  In cases of aneurism  of
the aorta, it becomes necessary to inquire whether
the dilatation extends all round the vessel, or occu-
pies only one side of it; whether all the tunics are di-
lated, or only one of them.  When rupture or ulcera-
tion exists, its seat should be  noted, and also  the
manner in which the layers of blood are disposed in
the sac.

EXAMINATION OF TnE MOUTH, PHARYNX, LARYNX, AND
                    TRACHEA.
  ft.  How is this effected ?
 ' A.  Having put the neck of the  subject  on the
Btretch, a longitudinal incision is made along the me-
dian line, from the lower lip to the top  of the ster-
num,  another  may then  be  made  in the  course  of
the base of the lower jaw bone,  the symphysis of the
jaw is then sawed through, and its lateral  halves se-
parated after having removed all the soft parts which
are attached to its base.  The same should be done
with  regard  to those  muscles which are  placed on
the lateral parts of the neck, and interfere with the
examination of the oesophagus and trachea.
  To  examine the air-tube, it is  necessary to remove
the thyroid gland, and then make  an incision along
the whole extent  of the  trachea and bronchi, having
previously sawed  through the clavicle and first rib at
each  side. To what has been  already said when
treating the  mode  of examining  the  bronchi, we
shall here merely add that the state of the  epiglottis
and ventricles of the larynx should always be attend-
ed to.
  ft.  Describe the examination of the abdomen ?
  A.  This may be commenced  by  making a crucial
incision through the parietes of  the cavity, or a dou-
ble elliptic one from the cartilages of the ribs at each
Bide to the pubes, and having detached the flap from 
       EXAMINATION OF  THE PHARYNX.    367

this latter point, it may be turned upon the thorax of
the subject.  When the cavity of the abdomen is
thus exposed, we  can readily see whether there are
any adhesions between the intestines or between the
two layers of the  peritoneum,  or whether there is
any fluid effused within it.  The digestive tube may
be laid open in its whole extent  with the " ente>o-
tome," and after having detached it from the mesen-
tery, it should be washed and examined from the
oesophagus to the rectum.   We should attend par-
ticularly to the colour of the mucous membrane, and
to the different appearances  of congestion and in-
flammation which it presents, also to its degree of
adhesion to the muscular coat, and to its thickness,
consistence, and elasticity in different  parts.  When
ulcerations, fungous excrescences or cicatrices exist,
their extent and situation should be described on the
report of the  case.
  As derangements  of the gastrointestinal mucous
membrane are exceedingly frequent, and as disputes
constantly  arise on the subject of its inflammation,
it may be useful to describe the physical characters
which  this membrane presents in its  healthy state,
as the first step towards distinguishing the changes
induced by disease.
  Q. Describe the appearance of the mucous mem-
brane in the healthy state.
  A. The thickness  and tenacity of the  membrane
in general diminishes from the stomach to  the anus,
but its degree of adhesion to the subjacent parts di-
minishes in the opposite direction.  2d. It is soft and
pulpy in infancy, increases in density as  age advances,
but in some cases in old persons it again becomes soft
as in children.  3d. In the foetus it is somewhat of a
rosy colour, in infancy it is of a pale colour, in adult
age it is greyish white ; during digestion, the part of
the membrane which lines the stomach, duodenum,
and the commencement of the ileum, is of a slightly
rosy tinge.   4th. The membrane of the  stomach is
never marbled or  studded  with black spots in the 
 368     EXAMINATION OF THE PHARYNX.

 healthy state.  5th.  The age of the individual, the
 sort of death, the last agonies of life, the vicinity of
 certain organs, the nature of the matter contained in
 the canal,  the time  which has elapsed since death
 took place, the position  given to the body (particu-
 larly whilst it was warm), the contact of air, are
 all so many causes capable of altering the appearance
 of the mucous membrane.  6th. The prominences or
 villi perceptible on the surface of the membrane are
 most numerous in the stomach, (particularly at its py-
 loric extremity)  and in  the duodenum ; their num-
 ber gradually diminishes  from thence along the course
 of the intestine.   7th. Mucous  glands are  not very
 apparent, or  rather appear in  a very small number
 on the internal surface of the stomach and intestines.
  After having examined the  digestive  canal,  we
 should proceed to inspect the different organs con-
 tained in the cavity of the abdomen : the liver, gall-
 bladder, spleen, mesentery :md its glands, kidneys,
 ureters, bladder, genital  organs, aorta, vena cava, &c.
  We shall conclude these remarks by recommend-
 ing the examination of the lining membrane  of the
 large arteries and veins in  cases  of eruptive  fe-
 vers, particularly of small-pox.  When giving the
 account  of a  post mortem examination, we   should
 never omit to state how many hours have elapsed
 since death took place,  and the position in which the
 body has been placed, for position exerts a material
 influence on the appearance of congestion presented
 by bodies  after death.
  These remarks on  the subject of the knowledge
 necessary to  enable  an  observer accurately  to tie-
scribe the different species of alterations which oc-
cur in the  human body, may now be concluded by
a brief statement of the anatomical characters  of the-
non analogous accidental tissues: tubercle, scirrhus,
encephaloid, melanosis, cyrrhosis, sclerosis, and scaly-
scirrhus.
  Q. What is Tubercle ?
  A. It is the most common of all the productions  of 
       EXAMINATION  OF THE PHARYNX.     369

this sort;  it is a morbid structure, common to all or-
gans, and generally occurs in several at the same
time.  Tubercles are  found  either  in  the  form of
spherical tumours, or of masses infiltrated into the
substance of the organ in which they are developed;
their size  varying  from that of a millet seed, to a
small egg.  They sometimes adhere intimately to the
surrounding substance, and appear as if formed at its
expense (non-encysted Tubercles); at other times they
are enclosed in a distinct membrane, whose character
may be merely cellular or approach that of fibro-car-
tilage ; as this completely separates them from the
surrounding parts, they are termed encysted tubercles.
  In their crude state tubercles consist of a grey,
transparent, semi-cartilaginous substance,  without
any trace of vessels, and which in process of time be-
comes opaque and of a yellow colour.
  Tubercles after some time become softened; the
process begins at the  centre and proceeds  towards
the circumference until the whole mass  is converted
into a cheesy pultaceous matter, and then into a cur-
dy, puriform fluid, which, when expelled from its si-
tuation, leaves an ulcerated cavity ;  the latter may,
though very rarely,  be  cicatrized by means of a fibro-
cartilaginous structure.
^ ft. What is Scirrhus?
  A. This is white, grey,  or bluish, somewhat semi-
transparent, colourless, or very slightly coloured.  In
the crude state its consistence varies  from  that of
hog's skin, which it very much resembles, to that of
the  intervertebral cartilages;  scirrhus is usually di-
vided into irregular homogeneous masses, which are
again subdivided into lobules united to each other by
fibrous bands or dense  cellular texture ;  it sometimes
presents an alveolar or regularly radiated  appear-
ance, somewhat like that presented in the interior of
a turnip ;  in such cases the scirrhus is so firm that a
scalpel grates upon  it as if it were cartilage.
   When it becomes soft, its consistence and appear-
ance resemble those of meat jelly, or a thick syrup 
370     EXAMINATION OF  THE PHARYNX.

whose transparence is disturbed by a dirty grey tinge
or by some blood;  at other times it resembles honey,
gum, or a grey pultaceous mass.
  Q. What is Encephaloid ?
  A. In its  crude state encephaloid is somewhat more
opaque  and white, but not  so firm as scirrhus.  It
consists of  masses, sometimes lobulated, sometimes
not so ;  these are usually disposed like the convolu-
tions of the brain, and separated from one another by
a very soft, delicate, or rather imperfect cellular tex-
ture, in  which we find blood vessels of rather a large
size, but whose coats are very thin and weak.  The
sub-divisions of the lobes, as in scirrhus, are marked
by septa or lines which are whiter than the rest of
the tumour, they assume no regular distribution and
in some instances are but very slightly marked.
  When encephaloid becomes soft it resembles  very
much the substance  of the brain when inclining to
decomposition ; when an incision  is made into it some
drops of blood ooze out.  If the softening has ex-
tended through the whole mass  it presents the ap-
pearance of a reddish or violet  coloured pulp, the
consistence of which, however, is variable in different
parts of its extent.  We  sometimes  find  in these
masses effusions of blood, either  in the liquid or so-
lid form, not unlike  those found in  the brain after
haemorrhage has taken place into that organ ;  at
other times the blood is diffused amongst the ence-
phaloid  structure in such a way as to resemble that
in aneurismal tumours ; and the resemblance in some
cases is so  complete that the distinction  between
them can only be established by finding some portion
of the encephaloid, which at once marks the true na-
ture of the tumour.
'  These masses  are sometimes enclosed by a sort of
membrane,  or by a semi-cartilaginous cyst, whose in-
ternal surface  is lined by a  soft, vascular,  cellular
structure ;  in other cases  the cyst is incomplete  in
some part of its extent, or it may be altogether want-
ing,  the tumour being merely  enclosed  by some 
         EXAMINATION OF THE PHARYNX.     371

  loose  cellular  substance;  finally,  we  occasionally
  find serous effusions into the encephaloid itself or
  into the parts which surround it.  When exposed to
  the air its surface becomes of a  grey or  somewhat
  greenish colour, and as it decomposes it  exhales a
  very fetid  smell.
   ft.  Describe  Melanoides.
   A.  This accidental production may exist  in the
  form of single masses, enveloped in a cyst,  infiltrated
  into the substance of  organs," or lastly,  in lavers dif-
 fused on the surface of membranes.  In some cases
 the masses are extremely small,  they are however
 occasionally found as large as a nut—they are some-
 times lobulated or nipple-shaped,  united by cellular
 texture, but never penetrated by vessels.
   In the crude state it is opaque, brown or black, ho-
 mogeneous, without smell or taste, somewhat moist,
 and of the consistence of a lymphatic gland.
   When " ramollissement" or softening begins, a thin
 reddish fluid, mixed with small black clots,  can  be
 forced out by pressure.  After the softening is com-
 plete  the  mass  is converted into a thick dark pulp,
 which may  be effused or infiltrated so as to stain the
 surrounding parts.
   Its chemical analysis, according  to Breschet, gives
 the  following results—1st.  coloured fibrine; 2d. a
 dark colouring  matter soluble in diluted sulphuric
 acid, or in a solution of sub-carbonate of soda,  which
 fluid it tinges of a red colour ; 3d, a small quantity of
 albumen; 4th. sub-carbonate of soda,  phosphate  of
 lime, and oxide of iron.
   ft. Describe Cyrrhosis.
   A. In the crude state this is somewhat of  a fawn
 colour, inclining sometimes to greenish, and presents
 some resemblance to  the supra-renal capsules in  an
adult.  To the touch it feels flaccid, like fungoid pro-
ductions, and when cut into, it appears compact and
humid; but though  in some cases we find  divisions
which separate the mass into lamellae, still there are
no traces of fibres. 
 372     EXAMINATION OF THE PHARYNX.

   When cyrrhosis becomes softened, it assumes the
 appearance of a glutinous pulp, of a greenish brown
 colour, but without smell.
   According to Laennec, who first described this ac-
 cidental production, there are three  species of it;
 1st. Cyrrhosis in masses ; 2d. in layers; 3d. in cysts.
   When it exists  in the liver, (which is the organ
 most frequently attacked by it) it assumes the  form
 of small masses, never exceeding the size of a cherry
 stone, and sometimes not larger than a grain of millet
 seed.  In such cases, these granular bodies  being ex-
 ceedingly small and numerous, and diffused through
 the whole substance of the liver, give it a homogene-
 ous appearance, and a yellowish colour, not unlike
 that of boot leather; on closer examination however,
 the liver is found to be studded with a multitude of
 small bodies not unlike  those hard fatly granules,
 fpund in  the sub-cutaneous cellular texture of the
 lower extremities in anasarcous subjects. The cysts
 which sometimes  enclose  these productions,  con-
 sist of a  thin layer of cellular  membrane,  which
 renders them capable of being  easily detached  from
 the substance of the liver, to which they form and ad-
 here when there are no cysts.   The substance of the
 organ, in  these different  cases,  shrinks,  becomes
 wrinkled and indurated.
  Cyrrhosis has hitherto been discovered only in the
 liver, kidneys, prostate gland, epididymis, ovaria and
 thyroid  gland.
  ft.  Describe Sclerosis.
  A. This was found infiltrated beneath the perito-
 neum in a subject affected with cancer; it was of a
dull white colour, and  not  unlike cyrrhosis.  It ap-
pears disposed to extend itself; but has not as yet
been discovered in the  softened state.
  Q. Describe Scaly Scirrhus.
  A. M. Laennec found  this accidental production
enclosed in a cyst,  in the case of a person who  died
of cancer; it was of a dull white colour, semi-trans-
parent, and disposed in layers or flakes like those of
fish. 
ACCIDENTAL PRODUCTIONS.       373
                      NOTKS.
   1. The method pointed out in this section for the
opening of bodies answers very well in the French
hospitals, as the greater number of those who die are
consigned to the dissecting rooms immediately after
the examination is completed.  It is, however, alto-
gether inadmissible in  private  practice, and cannot
be adopted  even in hospitals in this country, where
the botliesare almost invariably claimed by the friends
for the purposes of burial.  When opening the head,
an incision may be made through the scalp, from ear
to ear, transversely over the vertex; two flaps may
then be made of the integuments, one of which should
be reflected forwards over the  face, the other back-
wards over the occiput; the bones can then be sawi
ed through all round.   After the brain has been exa-
mined, the roof of the skull may be restored to  its
place, and the flaps drawn over it, and united by su-
ture.   The thorax and abdomen may be laid open by
a  straight incision made along  the central line; the
integuments may then be dissected off the ribs, for
some way at each side, so as to expose their attach-
ments to the cartilages, which should be cut through
with a strong scalpel;  and the triangular  flap thus
formed, consisting of the sternum and the cartilages
of the ribs, can be readily turned upwards on the
neck  and face of the subject. In  addition to the
straight  incision  from  the sternum to the pubes,
through the integuments of the abdomen,  it is usu-
allv necessary to make another at each side at right
angles with it, extending into the loins, in order to
give trreater room for continuing the examination of
the contained  viscera.  When these incisions are
properly united, there will be  no appearance of un-
necessary mutilation.   It has been lately  proposed
to open the spinal column from the inner side, name-
ly, by cutting out the bodies of the vertebrae,  after
having removed all the thoracic and abdominal visce-
ra  The process, however, is very tedious and trou-
   VOL. H.              1 I 
374
ACCIDENTAL PRODUCTIONS.
blesome; and as it can serve no other purpose than
that of avoiding another external  incision along the
back, it cannot be recommended as being either use-
ful or necessary.
  2.  It is very difficult to make a satisfactory classifi-
cation of those accidental productions which are de-
veloped in the living body.  Each species of them
presents some modifications according to the organs
in which  they are  found ; fh many cases several of
them are found blended together in the same mass,
so that it is difficult to ascertain which predominates;
in other instances, the shades of difference  between
them are so slight that it is difficult, if not altogether
impossible, to determine to which species some par-
ticular accidental  growths belong.  These produc-
tions  have,  however, been divided  into  two clas-
ses :  the first consists of those which are  analogous to
some of the textures existing naturally in the body: in
the second are placed those which have no analogy
or similitude to any thing  found in the body during
health.   Hence has arisen the use of the terms ana-
logous, and non-analogous  accidental  productions.
Under the former may be  included those ossific de-
posits,  fibrous  textures,  fibro-cartilage,  cartilage,
horn and hair, which are developed by disease, and
deposited in situations different from those in which
they naturally exist.  To these may be added the se-
rous membranes which Bichat first noticed at the in-
ner side of some serous cysts, and the mucous mem-
branes which, as Hunter pointed out, line the trajet of
fistulae.  To this class  may also be referred that pro-
duction,  like enamel, which  covers the  heads  of
bones  after  the  termination of certain affections of
the articulations,  and  also the synovial  membranes
which  line false joints.
  In the text, the reader will find an enumeration  of
the non-analogous accidental productions, and a short
description of the appearances which they present.
The nature and character of tubercle, the most fatal 
ACCIDENTAL PRODUCTIONS.        375
because the most common of them, have long engag-
ed the attention  of pathologists; on this  subject a
considerable difference of opinion still prevails.  Ac
cording  to Laennec,  tubercles  go through three
stages, each presenting a distinct set of characters.
In the first they are  small, transparent, colourless,
about the size of a millet  seed, and are thence term-
ed miliary  tubercles.  In the second  they become
yellow, opaque, and  firm—in which form they are
said to be crude,  their consistence being about that
of cheese.  In the third stage the mass becomes soft-
ened, a passage  for it  is made  by ulceration into
some of the neighbouring bronchi, through which it
is evacuated, and so is formed a tubercular cavity.
Bayle and Laennec agree in considering tubercle to
be a production sui generis; but the former patholo-
gist considered the transparent granules,  above de-
scribed as the first stage of tubercle,  to be a dis-
tinct production.   Other writers are of opinion that
they are nothing more  than the lymphatics of the
lungs, slightly altered in their appearance. This idea
was inculcated long since  by Morton and Portal, and
has lately been revived by Broussais.
 ' Dupuy, professor at the Veterinary school at Al-
fort, after having investigated the production of tu-
bercles in several of the ruminant animals, has come
to the  conclusion that the matter of tubercle is, in
the first instance, secreted, in a semi-fluid state, which,
after a while, becomes indurated. In several cases in
which hydatids were developed in the lungs of ani-
mals, he found a pale liquid deposited  between the
external surface of the hydatid, and the cellular mem-
branes which invested it.   This, when dried perfect-
ly, resembled tubercle.  In some cases the hydatid is
destroyed,  and the cavity which it occupied became
filled with  tubercular matter, secreted by the  cyst.
These observations are  confirmed by Andral.  He
found  in the  liver of a rabbit a mixture of tubercle
and  hydatids,  the latter  being  in a great variety of
conditions.  Some were  entire,  and separated from 
376       ACCIDENTAL PRODUCTIONS.
the substance of the liver by a thin layer of condensed
cellular membrane ;  others, also entire, were  sur-
rounded by a matter not unlike a mixture of chalk
and water; finally, a  third set were broken down, so
that only a few portions of their gelatinous structure
could be recognised, the place which they occupied
being nearly filled up by the matter just described.
These facts are important in many points of view, and
particularly as they throw some light on the opinions
of Dr. Barron on the nature of tubercle.   He consi-
ders that a transparent vesicle, which he calls an hy-
datid, constitutes the first stage of tubercle; but
though this opinion is inculcated in a very decided, I
had almost said dogmatic tone, it is by no means so
tenable as the Doctor seems to think.  Tubercle and
hydatid are constantly found together in the  same
part, and under every variety of form  and size, and
as we have just seen, the one is  often supplanted as
it were  by the  other; but this  is quite  a different
process from the conversion of  one into  the other.
If hydatids be living organised beings, according to
the opinions of all those naturalists who have examin-
ed  the  entozoa, it  is very difficult to  conceive  how
they can be  considered as  identical with tubercle,
which all agree in regarding merely as an accidental
production, or texture developed in the substance of
organs.
  M. Andral, in his late work, contends, that tubercle
is the product of a morbid secretion, and that this pro-
cess is preceded by an active congestion in the part,
similar to that which  occurs in  every case while se-
cretion  is  going on,  whether healthy or  unhealthy.
Meckel has long since advanced the same doctrine.
He says, (vol. i. p. 531,) "accidental formations are
sometimes produced  by a peculiar fluid effused ex-
pressly in order to give them origin.  This is the way
in which all accidental textures are formed, whether
they have or have not any resemblance with parts al-
ready existing in the  economy." Mr. Wardrop seems
to have come to the same  conclusion, at least with 
           ACCIDENTAL PRODUCTIONS.       377

 regard to one of the productions of this class.  When
 treating of fungus melanodes, he observes, that  " it
 has no smell, and seems more to resemble a secretion
 than  a decomposition."  M. Andral, as has been ob-
 served, asserts the same of tubercle, whilst Meckel
 extends the position to them all.  This is a remarkable
 coincidence of opinion between inquirers of such de-
 served celebrity in their respective countries.
   3.  The accidental production which the French
 pathologists describe as  "encephaloid,"  is that to
 which most of those  in this country apply the term
 fungus haematodes.  Mr. Abernethy, however, in his
 classification of tumours, calls it medullary sarcoma.
 This appears to be a contradiction in terms, or rather
 (to use the precise and forcible language of Mr. War-
 drop,) " it is inconsistent to speak of a tumour being
 a medullary species of a sarcomatous or fleshy genus."
 Meckel, in the following passage, has evidently con-
founded structures which are altogether different, or
rather the descriptions given of them by the authors
whom he  quotes.   "The fungus haematodes of Hey,
the spongy inflammation of Burns, and  the melanosis
of Laennec, are really one and the same production,
which differs  from cancer by being less firm in its
texture, and of a black colour; still it resembles can-
cer so much,  that some persons have called it soft
cancer."  (vol. i. p. 540.)  It  is  the  encephaloid  of
Laennec, and not the melanosis, which agrees with
the descriptions of fungus haematodes, given by Hey
and Wardrop.  It  is rather remarkable, that though
Breschet has commented on the passage, he has not
noticed this oversight.
  4. In extirpating cancer of  the lip, Dupuytrcn, in-
stead of removing a triangular portion, and then unit-
ing the cut surfaces by suture, in some cases makes a
semi-lunar incision, so as to remove all the  hardened
part,  and then covers the surface with simple dress-
ing; after a while, there is scarcely any perceptible
Joss of substance, as the margin  of the lip rises up
nearly to its natural level.  This plan of proceeding .s 
378       ACCIDENTAL PRODUCTIONS.
particularly applicable to cases in which the breadth
of the diseased part is greater than is depth; for in-
stance, when it extends across the whole lip.   This
operation  is practised on the  principle  that cancer
being an accidental  production, developed in  the
part, compresses and  forces back the aeljacent sub-
stance, in  proportion as it grows ; consequently, the
substance  of the lip can restore itself to its original
position, when, by the removal of this new growth,
the compressing power is taken away.   The Editors
of the new edition of the  " Medecine Operatoire,"
have given  this  rationale of Dupuytren's  practice;
(vol. in. p. 339,)  where they say that the deficiency
produced  by the operation is filled up, not by a new
growth, but by the extension of the substance of the
part; "par  l'extension de la substance  de l'organ."
This method of operating has as yet, so far as I recol-
lect, been adopted but in one instance in this coun-
try.  The case will be found reported in one of the
Numbers of the Medical Repository for 1824 or 1825;
it occurred in the practice of Dr. Bull, of Cork, and
was attended with complete success.
  5. When examining the  different accidental tex-
tures here described, it is necessary to remember that
they are  very frequently  blended together in the
same organs.  The following remarks by Mr. Ward-
rop, in his observations on diseased structures, place
this subject in a very  clear light:—
  "Though it cannot be doubted that scirrhus, scro-
fula, and fungus  haematodes have each a distinct cha-
racter, yet it is of importance to be aware that several
of these diseased structures may exist  at the  same
time in the same organ, or either of them may appear
along  with diseased  changes of structure  of  some
other kind: this led  Laennec to form a class of Com-
pound Diseased Structures.  Different  diseases  are
also seen existing at the same time in the  lungs,
brain,  liver, and in the different coats of the intes-
tines.
   " A tumour is sometimes met with, one portion of 
ACCIDENTAL  PRODUCTIONS.       379
  which is scirrhous, another portion is medullarv, and
  another is osseous or cartilaginous.  It also happens,
  that when a disease attacks an organ already changed
  in some part of its structure, the one disease produces
  a certain  influence on the  other.  For example, an
  injury, as  has  been already noticed, often increases
  the growth of a scirrhous  tumour,  creating in it all
  the symptoms of simple inflammation ; the common
  wart of the skin, from some accidental irritation, has
  often been known to become cancerous, one disease
  thus appearing  either to be a complete conversion
 .or transformation into another, or showing  that two
  or more deviations from  the  natural structure may
  occur in the same part.  So also it often happens that
  a syphilitic sore is accompanied by more or less com-
  mon inflammation, a circumstance necessary to  be
 attended to in the treatment of the disease;  mercury
 increasing such an ulcer until the simple inflamma-
 tion  be previously subdued by antiphlogistic treat-
 ment.
   " Sometimes  compound tumours consist of a sim-
 ple juxta-position of two or more different structures,
 and sometimes they are formed of an intimate and
 apparently confused mixture of the primitive tumours.
 Frequently some portions of each of the component
 primtiive structures may be distinguished,  but  in
 other instances it is not easy precisely to define the
 primitive structure,  and this is to be considered, as
 Laennec lias justly observed, the conjectural part of
 pathological anatomy.
  " In all tumours,  it is not only difficult but impos-
 sible to describe the various  modifications which re-
 sult from the combination of scirrhus, fungus haema-
 todes, and scrofula with one another, and with other
 morbid alterations of structure.  The  characters of
 different tumours  are drawn from cases where one
 disease has alone existed; for, like colours, those that
are primary are easily  distinguished, yet language
cannot describe their various and almost infinite com-
binations ; therefore it is only in their unmixed state 
330               DIAGNOSIS.
that we can learh to distinguish each morbid struc-
ture ;  their various complications must be afterwards
discriminated.
  " It is  not impossible that when an organ is thus
affected with more than one disease, each different
affection  may exist in a different texture of  the  or-
gan."

                   DIAGNOSIS.
  Q. What is Diagnosis ?
  A. Diagnosis is the most important part of Patho-
logy, for  it not only enables the.physicianto ascertain
the'nature of diseases,  but also the  treitment best
adapted  for their relief.  Hitherto we have  limited
our attention  to the study of symptoms,  in order to
distinguish the different  phenomena wh ch diseases
present during  their progress.  We now proceed to
assign a value to these  phenomena, and appreciate
them as signs, whereby an observer maybe enabled,
in a given affection, to  ascertain what organ suffers,
and the nature of its derangement.
  If diseases presented  themselves always and at
every period under the same form;  if the phenomena
which  characterize them  were not  subjec: to infinite
modifications and varieties elepending 01 unknown
causes, and if they were  not complicated with^hose
sympathies which the diseased organ has with others
more or less distant from  it, our diagnosis would  not
be enveloped in  so much  obscurity ; for the  local
symptoms which result from the derangement in  the
function  of the affected organ would be sufficient, in
most cases, to resolve our doubts.   Frequently, how-
ever, the principal organ of a function is materially
altered, and yet the function is but slightly deranged;
at other times, on the contrary, a function is consider-
ably disordered while the disease  has its seat in an
organ which is but indirectly subservient to it.   Yet
notwithstanding the numerous exceptions tothis great
physiological law, " that the disease of an organ ma-
nifests itself by a derangement of the function over 
DIAGNOSIS.
381
 which it presides," we still must take the state of the
 function into account, and consider it as the chief ba-
 sis of our diagnosis.  In doing so, however, we must
 remember to employ a greater degree of care and
 attention, according as the disease has been of long
 standing, its progress slow, and its symptoms indis-
 tinct.
   As the following remarks are confined chiefly to
 diseases of frequent occurrence, they shall be direct-
 ed to supply the means of distinguishing them by ra-
 tional  principles,  rather than to attempt  a degree
 of precision in this particular, which medicine cannot
 as yet lay claim  to ; with  this view, we shall  en-
 deavour  to  determine  this  important   problem:
 " What  is t/ie  organ which  is affected, and what is
 the nature of its derangement in any particular dis-
 ease ?"
  Q. What is to be said on the diagnosis of the dis-
 eases of the brain ?
   A. When, together with headache more or less
 severe, we find a marked  change in the state of the
 intellectual faculties—a derangement of the power of
 motion and sensibility, without any symptom of acute
 gastro-enteritis; and when  these  phenomena  conti-
 nue for any length of time,  or set in suddenly, it is
 evident that the brain is the organ affected.
  When the disturbance of the powers of sensation
and motion occurs at one side of the body, the affec-
tion of the brain is at the opposite  side.
  When paralysis with relaxation of the muscles oc-
curs, the substance of the brain is disorganized; or,
what amounts to  the  same thing, an effusion has
taken place in its substance or on its surface.
  If the derangement consist of  paralysis, with  a
slight degree of rigidity in the muscles, or with con-
vulsive  attacks, and if  these  symptoms  have been
preceded by headache and other marks of a cerebral
affection, we may conclude that the brain is in a
 state of irritation  or inflammation, which  is not uu< 
382
DIAGNOSIS.
frequently produced  by the contact of some  extra-
neous substance, such as effused blood, or serum.
  When, after a violent headache,  without paralysis
of either side of the body,  the intellects become dis-
turbed or deranged, or when  a state of complete
delirium  sets in,  without  any  symptom  ot  gastro-
intestinal inflammation, the pia  mater, or arachnoid
membrane covering the superior parts of the brain
is inflamed.                                     ,
t> When, more especially in children, a severe head-
ache is succeeded by slight delirium,  or coma coin-
ciding or alternating with  convulsions of  both sides
of the body, and spasmodic motions of the eye-balls,
together with dilatation of the pupils, we may infer
that the arachnoid membrane,  or pia mater  at the
base of the middle lobe of the brain is inflamed.
  Q. What is to be said of the  diagnosis of the me-
dulla spinalis?
  A.  If an acute  pain occurs in some  point  of the
vertebral column, together with a disturbance of the
function of respiration, of the power of motion and
sensation in the limbs,  rectum,  or bladder, and if at
the same time the powers of the mind are unimpair-
ed—the derangement  is seated in  the medulla spi-
nalis or its membranes ; and the iffection of the me-
dulla will be found after death  at the  side in which
the paralysis  had manifested itself.
   When the  paralysis  takes place  in the upper ex-
tremities and in the respiratory muscles, the derange-
ment is seated in  the cervical portion of the medulla
spinalis.
   When it occurs in  the lower limbs, rectum and
bladder, the  alteration of structure exists in the lum-
bar portion.
   When violent pain is referred to  some point of the
vertebral column,  and when after tie pain the spine
is bent backwards, its membranes are inflamed.
   Q. What is  to  be  said on the  diagnosis  of  the
 organs of respiration ? 
DIAGNOSIS.
383
   A.  When none of the symptoms here mentioned
 present themselves  (all of which  are referable to a
 derangement of the functions of the brain,) and when
 pain is felt in some part of the chest, with difficulty
 of respiration,  cough and expectoration, the respi-
 ratory organs are affected.
   When the pain is referred to the larynx, and when
 there  is an acute or hoarse cough, with a change in
 the character of the voice, we infer that the larynx is
 inflamed, particularly if by auscultation a "rale," is
 heard in that part.
   If, besides these symptoms, there are fits of cough-
 ing, with extreme dyspnoea,  and  expectoration  of
 pieces of false membrane, the complaint is croup.
   We  infer the existence of acute  or chronic catarrh
 from  the following  symptoms:—the chest  sounds
 clearly on  percussion, the respiratory murmur  is
 masketl by a mucous " rale," the expectoration con-
 sists of sputa, which  may be transparent or opaque,
 viscid  or puriform, colourless or of a greenish yellow.
   When,  in  addition to these symptoms, there is a
 considerable degree  of dyspnoea,  congestion  of the
 face, and considerable quickness of the pulse, with-
 out any symptom of disease of the  heart, the catarrh
 is seated in the last ramifications of the bronchi.
   When the sputa are round and opaque, with white
striae, and when pectoriloquy is heard  in some  part
 of the chest, it indicates the existence of phthisis,
 with a cavity in the lung.
  When the sound emitted by the chest is dull, when
the sputa are viscid and streaked with blood,  at the
same time that the respiration is incomplete and ac-
 companied by a " rile crepitant," the lung is inflamed,
 no matter whether pain is felt in the part or not.
  If the pain is acute, and the respiration impercepti-
 ble by the stethoscope, at the same time that the
 voice determines an oegophony, the disease is pleu-
 ritis.
   When the sound of the chest on percussion,  is 
384
DIAGNOSIS.
more loud than natural at one side, the  respiration
being completely suspended in that part,  it indicates
pneumo-thorax.
  When  the respiration  is laborious,  without any
other symptom of an affection of the lungs, and when
there is at the same time an irregularity in the action
of the heart, we conclude that this latter is the organ
which is affected.
  Q. What is to be said on the diagnosis of the dis-
eases of the heart ?
  A. When the stroke of the heart is  weak, and
gives a clear sound,  which is audible in several parts
of the chest, its cavity is  dilated, and its walls thin.
If these phenomena are  perceptible  at the base of
the sternum, the dilatation is seated in the cavities of
the right side; if at the cartilages of the ribs, it indi-
cates that the left cavities are dilated.
  When the stroke of the heart  is strong and circum-
scribed, and when a dull sound is emitted by percus-
sion at the region of the heart, there is an hypertro-
phy of that organ, the situation of which,  (whether
in the right or left cavities)  will be  determined  ac-
cording as  the phenomena are most  perceptible at
the base  of  the sternum, or on the cartilages of  the
ribs.
  When  the " bruit de rape," or sound like that of a
file is heard at the laft side, simultaneously with  the
contraction  of the ventricle, and  the stroke of  the
pulse, it  indicates that the mitral valves, and the sig-
moid valves of the aorta are indurated;  but  if this
sound is heard at the base of the sternum, the altera-
tion of structure is situated  in the tricuspid  valves
and the sigmoid, which are  placed at the origin of
the pulmonary artery.
  Q. What is to be said on the diagnosis of the dis-
eases of the abdomen ?
  A.  When the  abdomen is  painful  on  pressure at
some point, and when the functions of some of  the
viscera contained in this cavity are deranged,   the
disease must be looked for in one of  its regions'. 
DIAGNOSIS.
385
   The digestive apparatus is deranged when there
 is vomiting or purging, or when the tongue is loaded
 and the digestion impaired.
   If the tongue is red, and its point dry,  if there  is
 pain in the  epigastrium with vomiting,  loaiJiing of
 food,  and fever, the mucous  membrane of the sto-
 mach  is inflamed.
   If to these symptoms there  is added a diarrhoea
 with pain in  the umbilical or iliac region, particularly
 of the right side, the inflammation extends to the in-
 testines.
   When, in addition to these phenomena, the tongue,
 lips, and teeth are covered with a dark coating, the
 intellects disturbed, and the patient lies in a  state of
 Btupor, the  gastro-enteritis has reached an extreme
 degree.
   When the  tongue is white and broad, when there
 are colic pains with flatus,  diarrhoea,  and acute pain
 in either of the loins,  extending along the course of
 the colon, the large intestines are inflamed.
   If the abdomen is hard, and contracted with obsti-
 nate constipation,  and occasionally vomiting, and if
 there be violent colic pains, particularly at the um-
 bilicus, which so far from  being increased by pres-
 sure are often relieved by it, and if the pulse be not
 increased in frequency, the disease is colica pictonum.
   When the  abdomen is tumid and excessively sen-
 sitive to pressure, either at some point or in its en-
 tire  extent, and if the pulse is small, contracted, and
 febrile, the tongue white and humid, and the counte-
 nance  anxious, the peritoneum is inflamed; in some
 cases there is vomiting, in others not.
   When the  digestion is painful and difficult, and is
 attended with flatus, and vomiting—and when a hard
 irregular tumour is felt in the epigastrium, there is a
 scirrhus or cancer in the stomach.
   When a dull pain is felt  in the right hypochon-
drium, and when pressure on that part produces pain,
the stools being suppressed or  of a grey colour, the
  Vol. II.             K k 
386
DIAGNOSIS.
skin and mucous surfaces presenting a yellow tinge,
the urine turbid  or  saffron coloured,  the liver is in-
flamed ; in such cases the patient usually rests on the
affected side. 
387  ,
          THE

RUYSCHIAN  ART.
      PREPARATIONS  OF THE VISCERA.

   Q.  Describe the mode of preparing the viscera.
   A.  The various parts of the body may be preserved
in a healthy state, either to exhibit their form or struc-
ture,  or to compare them with morbid parts.

              GENERAL OBSERVATIONS.
   1. When removed from the body, and the useless
parts  dissected away, the part to be  preserved is to
be soaked in water, in order to get out the blood.
   2. When it is necessary to give parts their natural
form,  which  is lost by macerating, put them into a
saturated solution of alum, retaining them by  any
means in the required form, until they become hard-
ened.  If it be a hollow part, as the stomach, bladder,
Sec. All it with, and immerse it in the solution.
   3. When an opening is to be exhibited, as that of
the ureter, the bile-duct, the lacunae of the urethra,
Stenonian duct, Fallopian tube, 8cc. introduce a bris-
tle.   After this manner preserve the uterus and its
appendages,  cutting open the vagina and cavity of
the uterus, the bladder,  intestine, stomach, heart in
the pericardium, liver, spleen, kidney, &c. &c.
  4. All preparations of the brain are best hardened
in a saturated solution of corrosive sublimate.
   5. The parts are to be suspended in proof spirit by
raw silk, in a tie-over bottle, and covered with blad-
der, taking care to exclude all air.   When dry, var-
nish the bladder with mucilage of gum arabic several
times; then put a sheet of thin lead over, and varnish 
 388        THE  RUTSCH1AN ART.

its edges with mucilage; and, lastly, tie another blad-
der over, and give it a coat of common  spirit varnish,
in which lamp-black, or other colouring matter, is
mixed.

    PREPARATIONS OF MORBID  PARTS.

  Q. What are the directions for the preparation  of
morbid parts ?
  A. All morbid parts should, immediately after their
removal from the body, be put into rectified spirit of
wine for a day or two, and then preserved in proof
spirit.   These preparations foul a  great quantity of
spirit, and should therefore be kept in stopper-glasses,
from which  the  spirit can easily be removed, and
fresh  put in, until the preparation ceases to foul the
spirit, when it may be put into a tie-over bottle.

  PREPARATIONS MADE BY MACERATING.

  ft. How are preparations made by maceration ?
  A. Preparations obtained by this process are very
various.

             GENERAL OBSERVATIONS.
  1. Let the water be frequently changed, until it is
no longer coloured  with blood, but never after the
blood is steeped away.
  2. L 4 the  macerating  pan be placed in a  warm
place, to facilitate putrefaction.
  3. The macerating pan should never be in a cold
place, for the spermaceti-like conversion of the soft
 parts will be formed, and the bones spoiled.
  4. The soft parts  surrounding bones are  a long
 time before they detach themselves from the bones.
  5. Bones, when macerated,  should  be exposed to
 the sun's rays, and frequently wetted with clean wa-
 ter, or they may be bleached with the diluted  oxyge-
 uated muriatic acid. 
THE RUTSCHIAN  ART.          389
                     BONES.
  Bones are macerated to be preserved whole, or
they are sawed to expose their internal structure.
  Bones of the Head.—Put the whole head, without
disturbing the flesh or brains, into the pan.   When
sufficiently  macerated,  all the soft parts will come
away with the periosteum; then  detach the verte-
brae, and wash  out the brain.  Bones are separated
from each other by filling the cranium with peas, and
putting it into water.  The same method is to be adopt-
ed with other bones.
  Bones in general, for structure.—Divide the femur
into  two halves ;  the os innominatum, the petrous
portion of the temporal bone, the parietal bones, &c.
these, when macerated, will exhibit the compact, the
spongy,  laminated, and reticular substance of bones.

                    A FOETUS.
  Cut carefully away the fatty substance enveloping
a foetus, but do not cut any of' the  cartilages.   Steep
out its blood, and macerate.   It should be frequently
looked at, and taken out when the flesh is all destroy-
ed, before the cartilages are separated.  The follow-
ing preparations are obtained in this way:—
  1.  The superior extremity, to show its bones, the
progress of ossification, and the cartilage to be form-
ed into bone.
  2.  The lower extremity, toexpose the same circum-
stance.
  3.  The spine, which forms a  beautiful prepara-
tion.
  4.  The pelvis, not less elegant.
  Preservation.—The above  all to be preserved in
proof spirit.

                     CUTICLE.
  The cuticle of the head and foot may be separated
by maceration;  the  former is called  chorotheea, the
latter podatheca. The arm and foot of a large foetus
                     Kk2 
390         THE RUTSCHIAN  ART.
 are to be preferred ; they are first to be well washed
 with a soft sponge in soap and water.
   Preservation.—Suspend them in proof spirit; first
 tie the part by which they are to be suspended, then
 put them into  the bottle with the spirit, and gently
 pour some spirit into the cuticle, to distend it like a
 glove or stocking.


          INJECTING INSTRUMENTS.

   Q. Describe the instruments used for injection.
   A. The celebrated Dutch anatomist, Ruysch, first
 invented the art of injecting animal bodies.
   There are three kinds of apparatus used in making
 injected preparations.  The one for the coarse and
 fine injections,  and the minute injection; the other
 for injecting with quicksilver ; and the third, called
 the  oyster syringe,  for injecting minute preparations
 with the minute injection only.
   The first consists  of  a  brass syringe made for the
 purpose, of various sizes, from one carrying six ounces
 to one sufficiently  large to hokl two pounds.   The
 point of these syringes is adapted to the pipes into
 which it is to be affixed.  To this syringe belong a
 stop-cock, and a great variety of pipes.
   The instrument for injecting quicksilver consists of
 a long glass tube, at whose end is fixed, by screwing
 in, a steel pipe, the end of which is extremely fine.
   The oyster syringe is similar to the large syringe,
 except in size.  It is so small, that when the syringe
 is in the hand, and full, its piston may be commanded
 by the thumb of that hand to throw  its contents into
any preparation in the other hand.  Th* pipe affixed
 by being screwed to the end of this syringe is nearly
as small as that belonging to the quicksilver tube.
  These instruments are always to be had at the sur-
gical instrument makers. 
              TUB RUYSCHIAN  ART.          391

                  INJECTIONS.

   ft. What are the injections used for anatomical pur-
 poses ?
   A. The injections employed for anatomical purpo-
 ses are of four different kinds: coarse, fine, minute,
 and mercurial.

                COARSE INJECTIONS.
   Red.  Yellow beeswax, sixteen ounces—the palest
 resin, eight ounces—turpentine varnish,  six ounces,
 by measure—finely levigated vermillion three ounces.
   Vellow.  Yellow beeswax, sixteen ounces—pale re-
 sin, eight ounces—turpentine  varnish, six ounces—
 king's yellow, two ounces and a half.
   White.  Fine virgin's wax, sixteen ounces—pale
 resin, eight ounces—turpentine varnish, six ounces—
 best flake white, five ounces and  a half.
   Pale  blue.  Fine virgin's wax, sixteen  ounces—
 pale resin,  eight  ounces—turpentine  varnish, six
 ounces—best flake white, three ounces and a  half—
 fine blue smalt, three ounces and a half.
   Dark blue.  Fine virgin's wax, sixteen  ounces—
 pale  resin,  eight  ounces—turpentine  varnish, six
 ounces—blue verditer, ten ounces and a half.
   Black.  Yellow  beeswax, sixteen ounces—pale re-
 sin,  eight ounces—turpentine varnish, six ounces—
 pure lampblack, one ounce.
   Green.   Yellow  beeswax, sixteen ounces—pale re-
 sin,  eight ounces—turpentine varnish, six ounces—
 levigated crystallized verdigris, four ounces and a half
—best flake  white, one ounce—levigated gamboge,
one ounce.
   Liquefy the wax, resin, and turpentine varnish over
a slow fire, in an open pipkin ; then add  the colour-
ing matter, having  previously mixed it in another pip-
kin,  with a very small quantity of the melted compo-
sition.   Stir the whole well together with a wooden
pestle, so that the  colouring ingredients may be inti-
mately and smoothly blended; place the whole again 
392          THE RUYSCHIAN ART.
over the fire, and when they have acquired their due
heat, the injection will be fit for use.

                FINE  INJECTIONS.
  Brown spirit varnish, white spirit varnish, of each
four ounces—turpentine varnish, one ounce.
  These  are to be put together in  an earthen pipkin,
over a slow fire,  until they have acquired the neces-
sary degree of heat.  To make it of a red colour, put
one ounce of finely levigated vermillion into another
pipkin, and gradually add the heated materials,  stir-
ring the whole with a wooden pestle, that the colour
may be equally diffused.
  One ounce and a quarter of king's  yellow—two
ounces of best flake  white—one ounce and a half of
fine blue smalt, with one ounce and a quarter of best
flake white—four ounces of blue  verditer—half an
ounce of pure lampblack—are the proportions for the
various colours to the  quantity of ingredients ordered
above.

              MINUTE INJECTIONS.
  The size, which forms the vehicle to the colouring
matter in these injections, is made in the  following
manner:—
  Take of the finest and most transparent glue, one
pound, break  it into small pieces, put it into an ear-
then pot, and pour  on it three pints of cold water,
let  it stand  twenty-four  hours, stirring it now and
then with a stick ; then set it over a slow fire for half
an hour,  or until all the pieces are perfectly dissolv-
ed ;  skim off  the froth from the surface,  and strain
it through a flannel for use.
  Isinglass and the cuttings of parchment make an
elegant size for very particular injections ;  and those
who are not very nice may use the best double size
of the shops.
  Red.   Size, one pint—Chinese  vermillion,  two
ounces.
  Yellow.  Size, one pint—king's yellow, two ounces
and a half. 
               THE RUTSCHIAN  ART.         393

    White. Size,  one pint—best flake  white,  three
  ounces and a half.
    Blue. Size, one pint—fine blue smalt, bIx ounces.
    Green. Size, one pint—levigated crvstallised verdi-
  gns,  two ounces—best  flake white, levigated eam-
  boge, of each eight scruples.
    Black. Size, one pint—lamp-black, one ounce.

               GENERAL OBSERVATIONS.
    1. All injections are to be heated to such a degree
 as not to destroy the texture of the vessels they are
 intended to fill; the best criterion of this degree of
 heat is dipping the finger into the injection.  If the
 finger can bear the heat, the texture of the vessels
 will not be hurt.
   2.  All the coloured  materials should be as finely
 levigated as possible, before they are mixed with the
 injection.
   3.  Great care  should be taken lest  the oily ones
 boil over, or bubble;  and that the heat be gentle,
 otherwise the colour will  be altered.
   4. They should be constantly stirred, lest the co-
 louring material, which is much heavier than the ve-
 hicle, fall to the bottom.
   5. The instrument to stir them with  should  be a
 wooden pestle, and there should be one for each co-
 lour.
   6. A large tin  pan to contain water,  with two or
 three lesser ones fixed in it for the injections, will be
 found  very useful, and prevent all accidents, and the
 colour from spoiling, when on the fire.


   PREPARATION  MADE WITH COARSE IN-
                    JECTION.
   ft.  How are preparations to be made with coarse
injections ?
   A.  The blood-vessels arc mostly filled with coarse
injection, and  the   parts  dissected, to  show their
course ; and when the anatomist wishes to exhibit the 
 394          THE RUYSCHIAN ART.

 minuter branches, the fine injection is to be thrown
 in first, and followed by the coarse.

              GENERAL OBSERVATIONS.
   There are several  circumstances to be observed
 in injecting with the fine and coarse injections, which
 are applicable to every  part into which they  are
thrown; these are—
   1. The part to be injected should be freed from its
 blood as much as possible, by steeping it for several
 hours in warm water,  and repeatedly changing it.
  2. Having emptied the part of its  blood, the pipes
 are to  be fixed in their proper vessels, and all other
 vessels to be tied with a ligature.
  3. The heat of the  water  is then  to be gradually
 increased to the same temperature with the injection
 to be thrown in.
  4, The injecting syringe should be steeped in the
 water with the part to be injected until wanted.
  5. The injection being finished, and the  subject
 cold, remove the pipes, and tie up the parts they
 were in. Whenever a vessel is open, by accident or
 otherwise, be sure to secure it by a ligature, or cover
 it with a piece of thin and moist bladder, or the in-
jection will always be  oozing out.
  6. The parts dissected and dried are to be varnish-
 ed  twice with copal or hard varnish, first washing
 them free from grease with some soap  lees, and weS
 drying them again.


          BLOOD-VESSEL SUBJECT.
  Q. Describe the mode  of injecting a blood-vessel
 subject.
  A. Select an emaciated subject, between the age
 of two and fourteen years.
  Preparation. Make an incision through the  integu-
ments the whole  length of the sternum ; then, with a
saw, divide  the sternum longitudinally into two equal
 parts;  introduce  a dissecting knife under the divided 
THE RUYSCHIAN ART.
395
 bone on each side, separate it from the mediastinum,
 and lay open the thorax, by bending back the two
 portions of the sternum and the cartilages of the ribs:
 an incision is then to be made into the pericardium,
 and the left ventricle of the heart, and a large pipe
 introduced into the aorta,, and secured by a ligature.
 The subject is next to be put into warm water, and
 gradually heated.  The  time generally required  to
 heat the whole subject is four hours in a large body
 of water.
   If the veins are to be injected, three  more pipes
 are required:  one to be put into the angular vein at
 the corner of the orbit;  another into  a vein as near
 the fingers as possible ; and the third into a vein  as
 near the toes as possible.
   Q. Describe the injection of a blood-vessel subject.
   A. The subject and injection being properly heat-
 ed, throw the coarse red injection into the heart-pipe,
 which will fill the arterial  system ; and  then the
 coarse yellow injection into the head pipe first, and
 next into the pipes of the extremities.   The subject,
 when injected, should be put into cold water, with
 its face downwards.
   ft. How is the dissection to be conducted?
   A.  Open the abdomen by an incision from the ster-
 num to the umbilicus, and from thence to  each ilium.
 Cut away the abdominal viscera, the stomach, spleen,
 and intestines; leaving the mesenteric vessels as long
 as possible :  dissect away the liver, leaving the vena
portae and hepatic artery as long as possible.  This
done,  dissect away the fat and cellular  membrane
from the vessels; secure the mesenteric vessels in an
arborescent form on a piece of pasteboard.  The kid-
nies, urinary bladder, uterus, and its appendages, are
to be preserved and dried in their situations.  From
the thorax are to be removed, the  lungs  and  heart,
or the latter  may remain.  The  integuments  being
carefully dissected from the sternum, it is to be bent
back, and kept in that situation, to expose the inter-
nal mammary arteries.  The dissecting away the skin 
396         THF «L VSOUIA.v AHT.
 is the next, in order to exhibit the muscles, and ex-
 pose the arteries and veins.  The skin  should  only
 be removed from time to time to carry on the dissec-
 tion, and never more than that  covering the part to
 be dissected; otherwise the parts  from which  the
 skin is removed will become dry, and the dissection
 be spoiled.  In dissecting the arteries and veins, the
 dissector will find no difficulty, if he proceeds  cau-
 tiously from the  larger trunks towards their extremi-
 ties.  The  brain is to be removed by sawing away a
 large portion of the bone on each side of the longitu-
 dinal sinus of the dura mater.   The  cheeks should
 be pushed out  by introducing horse hair  into  the
 mouth.
   Drying.  When dissected, or before,  the subject
 should be hung up by the head in a frame :  one arm
 is to be placed at a little distance from the side, and
 the other turned up over the head, with the palm of
 the hand in front; the legs at  a little distance from
 each other, and kept in these postures by packthread.
 Should any muscles obstruct the sight of the arteries,
 they are to be separated to  a proper  distance by
 pieces of wood.  This done,  expose it to a current
 of air, in a place where it cannot get wet; and if the
 weather  be moist, remove, from time  to  time, all
 moisture, by a soft sponge.
  Preservation. Varnish it several times, and keep it
 in a dry place, and in a proper case, with a glass front
 and back.

        A HEAD, FOR ARTERIES  AND VEINS.
  ft. How is  the head to be prepared ?
  A. Choose  an emaciated head of an  adult, sepa-
rated from  the body, by a transverse section, about
the sixth or seventh vertebra.
  Preparation.  Put a pipe into each carotid, or, what
is better, one  pipe with a bifurcation ;  remove a por-
tion of bone over the longitudinal sinus of the  dura
mater, about the middle of the parietal bones, and se-
cure a pipe in the longitudinal sinus, pointed towards 
THE RUTSCHIAN ART.          397
the occiput.  Put the head into warm water to soak,
pressing the blood occasionally out of the external
and internal jugulars.  Then tie up the jugular veins
and vertebral arteries, and all the small vessels.
  Injection. Into the carotids throw the red injection,
and the  yellow, or  dark blue, into  the pipe in the
sinus  of the dura  mater.  The  former will fill the
arteries, the latter the veins.
  Dissection. Follow the course of the larger trunks,
dissect out the globes of the eyes, and remove, with
a fine saw, the portion of the jaw bone behind the
last molaris, to show the course of the internal caro-
tids.  To prepare the whole  head, a portion of the
cranium must  be removed, by sawing on one side of
the longitudinal  sinus of the  dura mater, from the
frontal sinus to the horizontal  spine of the occipital
bone, and then  sawing  horizontally above the ear,
from one extremity of the former incision to the other.
The dura mater should  be removed with a pair  of
scissors, the brain carefully washed out, and the ten-
torium and falx preserved.   It is better to make a
perpendicular section of the head, a little to one side
of the sagittal suture,  through the nose, foramen
magnum, and vertebrae ; and thus prepare  each side.
The course of the  cervical artery is to be  shown  by
dissecting away the muscles, &c. from between the
transverse processes.
  Preservation.  Varnish it several times,  and keep
it in a glass case, suspended ; or fix it by the neck,
and cover it with a glass bell.

         AN ARM, FOR ARTERIES AND VEINS.
  ft.  Describe its  preparation.
  A.  Remove the  superior extremity from the trunk,
by separating the clavicle from the sternum, raising
it, and passing the knife  under it to  the articulation,
including the  greater part of the pectoral muscle.
Then cut under the scapula, so as to remove with the
arm the clavicle, scapula, and subscapularis muscle.
  After soaking it in warm water, force out the blood
  Vol. II.              I-1 
398
THE RUTSCHIAN \HT.
 from the veins, by pressing the  extremity from the
 fingers toward the shoulder.  Fix a pipe in the axil-
 lary artery, and another in the  largest vein on the
 back of the hand ; some warm water may be injected
 into the vein, so as to wash out the blood; and, when
 pressed out, the axillary vein should be  tied,  lie
 any muscular  branches that may  be  gaping.
   Red  injection may be thrown into the artery, and
 yellow, or dark blue, into the vein.
   This is very  simple; it requires only the  removal
 of all the cellular and fatty membrane, and exposing
 the course of  the vessels.   Tie up the limb by the
 clavicle.
   When varnished, keep it in a cool and dry  place,
 to preserve it.

   A LOWER EXTREMITT,  FOR ARTERIES  AND VEINS.
   ft. Describe the preparation of the lower extremity
 for arteries  and veins?
   A.  Having removed the contents  of the abdomen,
 make a section through the symphisis of the pubis,
 and the ligaments connecting the ilium and sacrum,
 so as to remove one side of*the pelvis.
   Fix  a pipe in  a vein as near the toes as possible,
 and another in the iliac artery.   When  the limb lias
 been well soaked in warm water,  press out the blood
 from the veins, or throw in some warm water at the
 venal pipe ; but carefully press it out again, and tie
 up the iliac vein.  Secure all divided vessels.
   Blue injection, or yellow, may be put into the vein,
 and red into the artery.
   Expose the course of the artery and  veins,  parti-
 cularly the profunda of the thigh.

   THE ORAVID  UTERUS, FOR AHTEBIE9 AND VEINS.
  ft. Describe the preparation of  the gravid uterus,
for arteries and veins ?
  A, The gravid uterus, or the uterus soon after it
has expelled the foetus,  may be  injected,  to  show
its  large and tortuous vessels. It may  be injected 
             THE  RUYSCHIAN ART.         399

whilst in the body ; but this is  always attended with
much difficulty,  and never succeeds so well as when
removed from the  body.  Therefore  separate  the
spermatic and hypogastric vessels as far from the
uterus as possible,  and cut out the  uterus with the
bladder, vagina,  and external parts of generation.
  Put a pipe  in each spermatic  artery, and  each
hypogastric, and also one into each spermatic  and
hypogastric vein ; so that, at least,  there  will be four
pipes for arteries, and four for veins, necessary.  Be
very careful that all the  divided vessels  be  secured
by ligature, which only can ensure success.
  Red and yellow are mostly preferred;  the former
for the arteries, the latter for the veins.  Be careful
that the red be thrown into all the  arterial pipes, and
the yellow into the venal;  and, to  prevent mistakes,
it will be better to have the pipes of the veins dif-
ferent from those of the arteries.
  Distend  the vagina and uterus with  horse  hair,
either by introducing  it through the vagina, or, if the
foetus be in it,  by a perpendicular section  through
the anterior parietes, which is to be sewed up again.
Then dissect away all loose cellular structure and fat,
preserving the round and broad ligaments, and  Fal-
lopian tubes.  Should the foetus  be in  the uterus,
an incision should be made, as above directed, except
the placenta be  adhering there, which is known by
the great number of vessels,  and  then on the oppo-
site side,  and through the membranes,  to remove
the child;  cut the umbilical cord close to the foetus,
and fix a pipe in one umbilical artery,  and another
in the umbilical vein;  the latter carrying  arterial
blood, should be filled with red  injection,  and the
artery with yellow ; the cord is to be laid round the
placenta.
  Preservation.  When well varnished, suspend it in
a case, with a glass front and back.

        A PLACENTA, FOB ARTERIES  AHD VEIXS.
  ft.  How is a placenta for arteries and veins to  be
prepared ? 
400          THE RUTSCHIAN ART.

  A. This is perhaps the easiest preparation to make
with coarse injection, and should,  therefore, be the
first attempt of the student.
  Fix a large  pipe in the vein, and a small one in
one of the arteries.  The difficulty usually attendant
on getting the pipe into the artery is obviated  in a
great measure by introducing the  point of the scis-
sars  into these vessels,  and slitting them down for
about half an inch,  then spreading the artery open
upon the fore-finger, and keeping it so by pressure
with the thumb, by which the pipe may be carried
in without  difficulty.  A ligature  should  be passed
round each pipe with a needle, taking care not to
puncture any of the vessels.
  Injections. The usual colours are  to be selected j
but  instead of throwing the  yellow into the vein,
it should be  pushed into the artery, for the artery
here performs the function of a vein, and vice versa.
When there are two placenta: there should be differ-
ent colours used.
  Dissection. The  spongy substance is to  be care-
fully dissected away from the injected vessels,  the
placenta soaked in cold water,  to get rid of its blood,
and  then dried, curling the  cord  around it;  and
should the membranes not be much torn, they may
be distended with curled hair over it.
  Preservation.  Varnish it well j fix  its bottom in a
case with a glass top.

THE HEART, IN SITU ; WITH THE BEAD AND ADJACENT
                    VESSELS.
  Q. How is it made ?
  A. For this purpose choose the head of a young
subject,  or an adult whose heart is free from  fat.
The liver,  stomach, spleen, &c. are to be removed
from the abdomen, and the aorta divided just as it
gives off the coeliac artery.  The incision  into  the
chest should be carried through the integuments,
from the trachea to the ensiform  cartilage, the ster-
num sawed through, and bent one half on each side, 
THE RUTSCHIAN  ART.
401
from the extremity of the cartilages nearest the ribs;
then divide one of the pulmonary veins as near as
possible to the lungs, and remove a portion of bone
over the longitudinal sinus of the dura mater.
   Preparation. Having well soaked the parts in warm
water, and squeezed  the blood from  the heart and
vessels, by the inferior cava and pulmonary  vein, put
a pipe into the longitudinal sinus of the dura mater,
pointed towards the occipital bone, another into the
pulmonary vein, a  third into the  vena azygos, and
one  into the receptaculum chyli,  or  thoracic duct.
Tie up carefully the aorta and the vena cava inferior,
and  put a strong ligature around the middle of each
arm.
   Injection. Three colours are required;—one for
the arteries,  which should be red; another for the
veins, which may be yellow or  blue;  and the third
for the thoracic duct, which should be white, to imi-
tate  chyle.  Throw the red injection into the pipe in
the pulmonary vein, which will fill the left auricle,
ventricle,  aorta, and  all the arteries.  The pipe in
the  head  is for the yellow injection; by  this will
be filled the veins of the head, face, neck, and chest,
the right auricle of the heart, the right ventricle, and
the pulmonary arteries.  Should the vena azygos not
be injected, the yellow injection is to be thrown into
it.  A  small quantity of  white injection is sufficient
for the thoracic duct.
   Dissection.  Remove the body by a transverse sec-
tion  at  the last dorsal  vertebra, then amputate the
arms at their middle, saw away one side of the bones
of the skull, and wash away the brain: then dissect
away all  the loose cellular membrane and   fat, and
expose the various parts in the best manner; dissect
away the  lungs, leaving the  pulmonary  arteries  as
long as possible.
   Preservation. This is, when well done, a valuable
preparation, and deserving of great care.   Varnish
it well, and preserve it in a,square  glass case.
                       l!2 
402         THE RUYSCHIAN  ART.

 A  FOXTCS, TO  EXHIBIT THE PECULIARITIES OF ITS
                  CIRCULATION.
  ft. How is it  prepared ?
  A. For this purpose select a still-born foetus; and,
if possible, one that died from a  flooding of the
mother.
  Dissect the umbilical vein from the arteries, about
four inches from the umbilicus, and fix a pipe in it,
taking care not to  include  the arteries.   Throw
warm water into this pipe,  and wash out the blood,
which will flow out by the umbilical arteries. Having
drained away as much of the water as possible, tie a
ligature very loose on the umbilical arteries.
  Injection.   The  foetus  being heated, throw  in
gently any coloured injection.  The water will come
away first through the umbilical arteries;  and, when
the injection appears, make the ligature firm, to pre-
vent its further egress.
  Dissection.  The peculiarities in the foetal circula-
tion are the umbilical cord, the ductus venosus,  the
ductus arteriosus,  and  foramen ovale.   When  the
body is cold, proceed to the dissection ; remove  the
head from the cervical vertebrae, the arms,  with the
scapulae, and  pectoral muscles;   the inferior  ex-
tremity at the articulation with the  pelvis, the whole
of the parietes of the abdomen,  leaving the arteries
running to the cord by the sides of the bladder ; the
anterior part of the thorax, with the sternum, carti-
lages, and part  of the ribs, the integuments and mus-
cles of the back.  Next cut away the lungs, and re-
move the pericardium ; keep the  diaphragm in  its
place, and turn up the liver, so as to expose the duc-
tus venosus.   Some dissection and care  is here ne-
cessary.  Dissect away  the stomach and intestines,
and lay out the mesenteric vessels,  distend the blad-
der with air,  and cut away any  thing that  may  ob-
struct the view of the vessels.   The foramen ovale
cannot be exhibited.
  Preservation.  After ljaving varnished  it, hang it
in a glass bell, with a hook at its top. 
THE RUYSOHIAN  ART.
403
                      PENIS.
  Q.  How is this preparation made ?
  A.  The penis may be injected, to show the two
corpora cavernosa, the corpus spongiosum, and glans,
with the arteries and veins.  For this purpose any
healthy penis will do, but large ones are generally
preferred.   Having cut through the integuments and
soft parts in the pelvis, in the direction the saw is to
be passed, saw through the middle of each crista of
the pubis, straight down and through the ascending
ramus of each ischium, close to their commencement,
and thus  remove the pubis, with the bladder and
external parts of generation.
  Make an incision into either of the crura  of the
corpora cavernosa, and into the bulbous part of the
urethra,  as  near to the prostate gland as possible ;
soak it  in hot water, and carefully press out the
blood from every part.  Introduce a probe along the
vena magna ipsius penis, by an  incision at its root,
to break down its valves ; fix a pipe in each of these
incisions, and another in each vas deferens, at its en-
trance into  the vesiculae seminales,  and secure all
the divided  vessels.
  Injection.    Four colours  are  necessary;   those
generally preferred are red, yellow, blue, and white.
Throw  the  red into the corpus spongiosum, which
will  distend the glans; the yellow into the  corpus
cavernosum pipe;  the blue into the vena  magna
ipsius penis ; and the white  into the vasa deferentia.
  Dissection.  Inflate  the bladder, dissect away all
the soft parts, and keep the penis erect  against the
symphisis pubis.
  Preservation. In a covered box.
                     TESTICLE.
  ft.  Describe its preparation ?
  A.  A testicle of an adult should be chosen free
from disease, and^reat care is requisite in removing
it from the body.   First, enlarge the ring  of the
oblique muscle, push  the testicle through from the
scrotum, and  separate  its cellular connecting sub- 
404         THE RUYSCHIAN ART.
stance; then cut the spermatic  artery and pampini-
form  plexus as high as possible, and then the vas
deferens.
  When well soaked, press  out the blood from the
veins; put a pipe into the spermatic artery, and ano-
ther into a vein ;  and secure all other open mouths.
  Injection. Red is to be sent into the artery, and yel-
low or blue into the  vein, which is without valves.
Then fix the quicksilver tube in the vas deferens,
and suspend itj in water;  this done, fill it with mer-
cury, and in twenty-four hours it may be removed to
be dissected.
  Dissection.  Cut away the tunica vaginalis, and the
tunica albuginea,  which requires great care:  then
remove all the cellular and adipose  membrane, and
dry it on a board previously waxed.
  Preservation.   In a common preparation glass, on
a blue or green paper ground.

         THE SYSTEM OF THE  VENA FOHT.E.
  Q. Describe this preparation ?
  A.  Remove the liver, spleen,  stomach,  and intes-
tines all  together, of a person whose  mesentery is
free from fat, cutting away at the root of the mesen.
tery, behind the peritoneum.
  Cut into a mesenteric vein, as near to the intes-
tine as possible, and secure it with a ligature passed
around it with a needle, taking care not to wound
any other vein.  Inject warm water,  and let it again
run out by the  divided vessels.  Drain its water off,
and secure all the veins, the haemorrhoidal especially.
  Injection. Throw  any colour into the pipe, which
will  pass into the  splenic,  mesenteric, and  internal
haemorrhoidal vein, and into the vena portae.
  Dissection.  Remove all the soft parts;  the sto-
mach, spleen, and intestines; cutting the vessels as
long as possible, and dry them in the  best manner,
cither attached to the liver, or dissect away the liver
from the vena  portae,  taking  care to preserve some
of its ramifications.
  Preservation.  In a covered box. 
THE RUTSCHIAN  ART.
405
                     HEART.
  Q. Describe the preparation of the heart ?
  A. The heart is mostly injected out of the body,
to show its common and proper vessels.  For this
purpose, choose a lean heart.   Cut through the tho-
racic viscera immediately at the top  of the thorax;
divide the intercostal arteries by drawing the knife
down the pleura,  over the  ribs beyond their originj
separate the vena cava inferior and aorta, in the ab-
domen,  with the cava hepatica ; and remove the tho-
racic viscera, with the portion of the diaphragm sur-
rounding the vessels.
  Soak  the blood and coagula out of the cavities of
the heart, and  press the blood from  the coronaries.
Put a pipe into the vena cava superior, and another
into one of the pulmonary veins.  Then tie the lungs
at their root, and the vena cava inferior, the arteria
innominata, the left carotid and subclavian ; and pass
a ligature, with a slip knot, round the sinus of the
aorta, and secure all other open vessels.
  Injection.  The common  coloured injections, red
and yellow, only are wanted.  Throw the former in-
to the pulmonary vein, which will fill the left auricle,
ventricle, aorta, and  coronary arteries. The yellow,
being sent  into the superior cava, will distend the
right auricle, coronary, veins, right ventricle, and pul-
monary artery.   In order to fill the  coronaries well,
the injector must stop  two  or three times in the
course of the process, to squeeze on the injection in
them with his nail; then heat the whole  again, and
throw  in more injection.   The preparation  having
cooled, a pipe is to be fixed at the bottom  of the
aorta, and some red injection, just  hot enough to run
through the syringe, is to be pushed along the aorta,
an assistant throwing cold water on the intercostals,
if the injection runs through them.
  Dissection.  Cut away the lungs, pericardium, and
all the soft parts. 
406          THE RUYSCHIAN ART.
   Preservation.  Either in a covered box, or under a
 glass bell.

     STOMACH.  INTESTINES.  BLADDER.
   Q. Describe these preparations ?
   A. These are best injected  with the whole sub-
 ject, but may be removed and injected separately.

              GENERAL  OBSERVATIONS.
   1. The anatomist can only succeed by having the
 preparation constantly  heated  as he is throwing in
 the  injection.
   2. The injection should be thrown in very gradually.
   3. When injected, the part should be immediately
 immersed in cold water.

  PREPARATIONS WITH MINUTE INJECTION.

                      BORES.

   ft. How are these made ?
   A. The vascularity of bones is to be demonstrated,
 by throwing fine injection into an extremity, cutting
 out the bone when cold, separating it  from  all the
 soft parts, immersing it in  water for a few days,  to
 soak out  the  blood, and then putting it into  a mix-
 ture of muriatic acid and water in the proportion of
 one ounce to a quart, for three or four months, adding
 about every month, a drachm of acid. The limb of a
 ricketty child is to be chosen.
   Injection.   Put a pipe into the largest artery of the
 extremity, and throw gradually the red injection into
 it, fixing the stop-cock in the pipe.

                    A  FOETUS.

   Q. How is a foetus prepared ?
   A. Still-born children, when injected with minute
 injection, afford a number of beautiful preparations.
   Preparation.  No water should be thrown into the
vessels. Fix a pipe with a stop-cock, into the umbi-
lical vein, and tie the arteries in the ligature. 
THE RUYSCHIAN  ART.          407
   Injection.  Red injection is always chosen for this
 purpose;  and throw it in with great care, until the
 abdomen and skin all over become very tumid. First
 mucus comes from the nose and mouth, then the me-
 conium from the anus, and often pure size.
   Dissection.   Cut off the head from the  shoulders,
 the arms below the shoulder joint, and  the legs just
 below the acetabulum ; then preserve  a small quan-
 tity of the integuments around the navel, and remove
 all the anterior parietes of the abdomen and chest,
 so as to exhibit the thoracic and abdominal viscera.
 Cut away the integuments and posterior part of the
 theca vertebralis, to exhibit the medulla spinalis.
   Preservation. Soak out the blood, and preserve it in
 proof spirit, to show the viscera and their vascularity.
   From a  well-injected foetus  may  be  obtained the
 following preparations:
   1.  If the foetus be about  seven months old, the
 membrana pupillaris.
   2.  If it be male of this age, the testicle in the abdo-
 men, with  the gubernaculum.
   3.  The vascular and radiated fibres of the parietal
 bones.
   4. The vascular membrane, including the  teeth.
   5. The viscera of the chest separate, if  better in-
jected than those of the abdomen, showing the vascu-
larity of the lungs, thymus gland, and heart.
   6. The stomach,  which is to be inverted, to show
its vascular villous coat.
   7. The intestines, which are  to be separated from
the mesentery, and inverted, to show their villous coat.
   8. The glandulae renales and kidnies  together, to
exhibit their relative  size,  and the  lobulated struc-
ture of the kidney.
   9. The uterus and its appendages, to show the long
ovaria and  plicae of the neck of the uterus and va-
gina.
   10.  The  external parts  of the  female organs of
generation, to show the hymen.
   11. A red portion of the skin, to exhibit its vascu-
larity. 
 403         THE  RUYSCHIAN ART.

   12.  The  medulla spinalis,  to show its vessels, and
 the eauda equina.
   13.  The membrana tympani, to exhibit its  vascu-
 larity.
   14.  The cavity of the tympanum, to show its vascu-
 larity,  and that of the periosteum of its bones.
   15.  The vestibulum and cochlea, to show the mem-
 branous semicircular canals of the former, with their
 ampullae injected, and the vascularity of the zona
 mollis.
   16.  The head, to show the natural appearance of
 the face, the papillae of the lips, tongue, &c.
   17.  The hand, to show its natural colour.
   Preservation.  The above preparations are all to
 be well soaked from their blood, and  preserved in
 proof spirit of wine.
   18. A portion of skin,  freed of its adeps, to show
 its vascularity,
   19.  The membrana tympani, to show its vessels.
   20. The heart,  to show the foramen ovale, by dis-
 tending the cavities with  air; and, when dry, cutting
 away the outermost sides  of the auricles,  and intro-
 ducing a bristle.
   21. Any large muscle, freed from its cellular mem-
 brane and fat, and dried,  to show the vascularity of
 the muscle.
   Preservation.  These are all to be dried, well var-
 nished, and preserved in  bottles.   Some prefer put-
 ting them into spirit  of turpentine ;  but this should
 be avoided as much as possible, for the turpentine is
 always oozing  in warm  weather,  and dirtying  the
 glass.

                     UTERUS.
   Q. Describe  this preparation ?
   A. The object  of injecting a uterus with  fine  in-
jection is to exhibit  the vascularity  of its  internal
 membrane, which furnishes the catamenia.   For this
 purpose the uterus of a person whose menstruation 
THE RUYSCHIAN ART.         409
has not been stopped by age or disease is to be se-
lected.
   Remove the uterus, by dividing the vessels as long
as possible, the round  and broad ligaments, and as
much as possible of the vagina.   Tie a pipe in each
hypogastric artery, and secure all the divided ves-
sels.
   Injection. Any coloured  injection may be chosen,
but red looks best.
   Dissection.  Cut away all the  loose cellular mem-
brane, bladder,  and rectum,  if there be any, from
around the vagina, and  cut it open along the middle
of its superior part; continue this incision on each
side of the anterior part of the uterus, so as to exhi-
bit the posterior surface of its cavity.
  Preservation.—If the injection be successful, which
it seldom is more than one time  in ten, suspend it by
the ligaments, and preserve it in the proof spirit.

                 AN ADULT HEAD.
  Q. How is the preparation made ?
  A.  Separate the head as  low as the last cervical
vertebrae from the shoulders.  Put a bifurcated pipe
into the carotids.   Secure the vertebral arteries and
jugular veins, and all the divided parts.
   Injection.—The  red injection is always preferred.
  From  an adult head injected in this way may be
made the following preparations:
   1. The  upper eyelid to show the  vascularity of
Meibomius's glands.
   2. The choroid membrane, exhibiting its vascularity.
   3. The retina, suspended by the optic nerve, exhi-
biting its vascularity.
   4. A section of the optic nerve, to exhibit the cen-
tral artery.
   5. The whole of the  cerebrum, cerebellum,  and me-
dulla oblongata, with the pia mater ; or,
   6. The pia mater, separated from the convolutions
of the brain, to  exhibit the intergyral processes  and
the tomentum cerebri.
   Vol. II.             M m 
 410         THE RUYSCHIAN  ART.

   7.  One half of the nostrils, to exhibit the vascularity
 of Schneider's membrane, and that  of the membrane
 lining the antrum of Highmore.
   8.  The tongue, lying in the jaw, and suspended by
 the palatum molle, with the posterior fauces cut away,
 to show the epiglottis and glottis, the uvula and velum
 pendulum palati, the tongue, its papillae and excretory
 ducts, and the vascularity of the  gums and sublin-
 gual glands.
   Preservation.—The above preparations are  to  be
 soaked well in cold  water, to get  out all the blood,
 and then preserved in proof spirit.


    PREPARATIONS WITH QUICKSILVER.

   Q.  Describe these preparations.
  A.  Mercury cannot be coloured  by any substance;
 it must,  therefore,  always  present the same  silver
 colour.

             GENERAL OBSERVATIONS.
  1.  The parts should always be injected in a proper
 tray, that the mercury may be easily collected.
  2.  A lancet, with a curved needle ready threaded,
 should be always at hand.
  3. A bottle, whose neck is not so wide as to permit
 the quicksilver tube going to the bottom, when put
 into it.
  4.  When injecting, if any circumstance  render it
 necessary for the injector to put aside the tube with
 the mercury, it should  be placed in the bottle, the
 mercury remaining in it, to be handy and prevent de-
 lay.
  5.  Injecting with  mercury is always tedious, and
frequently  unsuccessful.  The parts exposed  must
be kept moist, by sprinkling them with cold water.

             A SUPERIOR EXTREMITY.
  To  inject the lymphatics of an  arm, choose one
from a dropsical subject,  without fat;  make an inci- 
THE RUYSCHIAN  ART.         411
 sion into the skin around the wrist, and seek diligent-
 ly, with  a magnifying glass, for an  absorbent, into
 which the pipe is to  be put, when  the quicksilver
 will immediately run.  The shoulder should now be
 placed considerably lower than the hand; and, when
 the mercury runs out at the divided vessels  in the
 axilla, tie them up, and also the lymphatic, into which
 the pipe was  introduced.  Then seek for another
 absorbent.  When  the mercury ceases to run in a
 lymphatic, tie  the vessel, and seek for another.
  Dissection.—Begin  at  the lymphatics,  where the
 mercury entered, and  trace them ;  removing  every
 thing  that obstructs  their  view, but  preserve the
 glands.

            AN INFERIOR EXTREMITY.
  The limb for this purpose should also be taken from
a dropsical person, and the same method adopted as
with the  superior extremity, seeking as near to the
toes as possible for the lymphatics.

                A PAROTID  GLAND.
  Cut down upon the masseter  muscle, and seek for
the Stenonian  duct, which is the excretory duct of
the parotid.  Tie the  quicksilver pipe in it, then fix
the tube, and pour into it the quicksilver; and, when
it ceases  to run, remove the tube and  pipe, and tie
the duct.  Be particularly careful, in dissecting away
the gland, not to cut it.
  Preservation.  Dry it on a waxed board,  and pre-
 serve it on a blue paper and pasteboard, in spirit of
 turpentine.

                     LIVER.
  The lymphatics running on the peritoneal coat of
 the liver, and over the gall-bladder, make a beautiful
 preparation.  The liver should be well soaked for
 several days, and the pipe put into the lymphatics of
 the suspensory and coronary ligaments, and the mer-
 cury forced  along them, breaking down the valves 
413
THE RUYSCHIAN  ART.
 with the nail, by pressing on the mercury.  Secure
 the vessels at the portae of the liver, when the mer-
 cury gets there, and tie the lymphatics when filled.
 Should the anatomist's attempt to force the quicksil-
 ver beyond the valves  be unsuccessful, he must fix
 upon the most minute obvious branch, and let it run
 its proper course.
   Preservation.   Throw some coarse injection into
 the cavae hepaticae and vena portae, without heating
 the liver thoroughly; inflate the  gall-bladder, and
 dry the whole.  Varnish it, and preserve it in the
 best manner under a glass bell, or preserve the inject-
 ed part in proof spirit, without any wax injection.

                     LUNGS.
   The superficial lymphatics of the lungs  are  to be
 filled from the part most remote from the root of the
 lungs.
   Preservation.   Cut away the part on which the
 lymphatics are filled.  Dry it on a waxed board, var-
 nish it, and preserve it in a bottle, on a green or blue
 piece of paper;  or preserve it in proof  spirit,  with-
 out drying it.

                     HAND.
   Select the hand of an aged female (separated from
 the arm by a transverse section, three inches above
 the wrist), that has died of a lingering disease.  8oak
 out the blood  in warm water;  fix the pipe in the ra-
 dial artery, then add the tube, and pour into it the
 mercury.  As the mercury appears in the other arte-
ries and veins, take them up and secure them  with
ligatures.  Should the  mercury still  escape  from
■mall branches, put a cord round the arm, and with a
piece of wood tighten it, by twisting the wood, tak-
ing care not to prevent the mercury passing into the
hand.  Then suspend the hand  in a glass filled with
water, and suspend also the tube and quicksilver in
the manner represented  in the annexed  plate,  for a
day or two, that the mercury may get into the small 
              THE RUYSCHI.VN  ART.         413

vessels.  When injected remove the pipe, and tie, by
a strong string, the fore-arm; put the hand into wa-
ter,, until putrefaction separates the cuticle.
   Preservation.   Dry it carefully,  and  varnish it;
then fix the fore-arm in a pedestal of plaister of pa-
ris, and keep this beautiful preparation under a glass
bell.

                     LACTEALS.
   Remove the mesentery and intestines, if the former
be perfectly fret from fat, and let them remain seve-
ral days in water, which should be frequently chang-
ed.  Search for an absorbent, on the intestine, into
which introduce the  quicksilver, which will run on
to the glands in  the  mesentery, where it will stop.
When the lacteals are filled, the  preparation will be
more elegant if red and yellow coarse injection be
thrown into the mesenteric arteries and veins.
   Preservation.   Spread the mesentery on a waxed
board, inflate a  portion of the intestine, clear away
all that is useless ; dry and varnish, and preserve it in
a glass frame.

         CORRODED PREPARATIONS.

  Q. How are these made ?
  A. These preparations are made by filling the ves-
sels  with coarse  injection,  and  corroding the soft
parts, so as to exhibit those  vessels.

             GENERAL OBSERVATIONS.

  1.  The liquor for corrosion is  to consist of three
parts of muriatic  acid, and one of water.
  2.  The liquor  should be  kept in a well glazed
earthen vessel, with a top to  it, also well glazed.
  3.  The part to be  corroded should be carefully
moved in and out of this liquor, as the slightest force
may  break the vessels.
  4.  When corroded, the pulpy flesh is  to be  carc-
                     m m 2 
414         THE RUYSCHIAN ART.

fully washed away, by placing it under a cock of wa-
ter, the water flowing very slowly t or, in some in-
stances, by squirting it away.
  5. When the preparation  is freed of it9 flesh, it
should be fixed in the  situation it is  to remain in,
either in a plaister of Paris pedestal, or on a flat sur-
face.
  6. If the flesh be not perfectly destroyed, the pre-
paration is to be returned to the corroding liquor for
a fortnight  or month longer, or  until it becomes
pulpy.

                HEART  AND LUNGS.
  These viscera,  occupying less space in children
than adults, are to be preferred.  It is of no conse-
quence whether they are fat or lean.   The  integu-
ments should be cut  from the fore part of the neck;
and the trachea, jugular veins, and carotid arteries
removed, and, with them, the viscera of the  thorax,
carefully separating the subclavian vessels from the
clavicle, without injuring them, and dividing the axil-
lary vessels and the cava inferior and aorta, just be-
low the diaphragm.
  Preparation. Soak the whole well, to free it of its
blood, and press out all  the fluids : fix a pipe in the
inferior cava, and another in one of the pulmonary
veins, taking care not to injure the others, by tying
it.  Then secure the carotids, the jugulars, the axil-
lary vessels, the vertebral artery,  the intercostals, the
aorta  after it has formed its  arch, the internal mam-
maries, and every vessel that can be found.
  Injection.  Red and yellow are generally preferred,
but red and  blue are more proper, and  more elegant.
Throw the blue into the vena cava inferior, which
will distend the right auricle, the superior cava, the
jugular veins, and great coronary vein,  the right ven-
tricle, and pulmonary arteries.   The  red injection
will fill the left  auricle and pulmonary veins,  the
aoita, subclavians, carotids, &c.
  Preservation, Great care is requisite  in freeing the 
                THE  BUYSCHIAN ART.         415

 injectiott from the pulpy flesh.   When done, let the
 apex of the heart be placed immediately inaplaister
 of Paris pedestal, and cover it with a glass. If the pul-
 monary vessels are well preserved, it forms a valuable
 preparation.  If one good preparation be obtained in
 ten trials, it will amply repay the anatomist.

                      HEART.
   A fat heart will do for this purpose.  Inject  it as
 directed in page 405, and put it into the corroding li-
 quor.
   Preservation.  Lay it on some cotton, on a pedes-
 tal, and cover it with a glass.

                      LIVER.
   The liver of  a child is to  be preferred to that of
 an adult, it occupying much less room:  its vessels
 should be cat long, and with it  the  portion of the
 duodenum, perforated by the bile duct.
   Preparation.  Fix  a pipe into the hepatic artery,
 another into the vena portae, a third into the ductus
 communis choledochus, and a fourth in the vena cava
 hepatica.
   Injection. The four injections are to be the red, yel-
 low, dark blue, and light blue.   First, throw the red
 injection into the  hepatic artery, next the dark blue
 into the vena portae, then the light blue into the cavae
 hepaticae, and lastly, the yellow into the ductus com-
 munis  choledochus.
   Preservation.   Remove the pipes  as soon as the
 injection  will  permit; and, when corroded,  fix  the
 trunks in the  best manner possible, upon a  proper
 pedestal: then wash  away the flesh, dry it, and co-
 ver it with a glass.

                     KIDNEY.
  Choose the  kidney of an old drunkard.  Cut  the
 emulgent vessels close to the aorta and cava, and the
 ureter, very low ;  then remove the  kidney, with all
its surrounding adeps. 
416         THE RUYSCHIAN ART.

  Preparation. Soak out the blood, and press out al!
the fluid.  Fix a pipe in the emulgent artery, another
in the vein, and  a third in the ureter; and tie up all
the open-mouthed vessels.
  Injection.   Red, blue, and yellow.  First throw the
yellow into the vein,  then the red into thi  artery,
and lastly, the blue into the ureter.
  Preservation.  Under a glass  bell.   The  kidneys
of different animals form a beautiful exhibition. 
417
        OE


INCISIONS.
  Though it may appear superfluous to lay down
rules for performing the first and most simple of all
surgical operations, yet, it is universally allowed, that,
if strict attention  be not paid by the learner to the
principles of any science, little  hope can be enter-
tained of his ultimate success.  It is not sufficient,
however, that  the student be able to perform these
primary operations, by any fixed rules, unless he ac-
quire also, that ease and facility, which so strikingly
distinguish the  dexterous from the clumsy operator.
Hence, the necessity is manifest, of careful and minute
attention to a proper method of holding the bistoury,
or scalpel, while making  the various incisions about
to be described.  Quickness, and flexibility of hand,
are, indeed, generally obtained, by long and frequent
practice; yet a proper method of holding an instru-
ment, tends, in  no small degree, to facilitate these de-
sirable attainments:  and, to show that this point is
not too trifling  to be insisted on, the words of a dis-
tinguished Professor are here introduced.  " When
that which is simple is fully attained, that which is
more complex will be easier understood, and better
performed ; and it will  often be found, that the final
success of that which is great, very much depends on
the accurate execution of that which is little."

          TO MAKE A STRAIGHT  INCISION.
  Q.  Hdw is a straight incision to be made ?
  A.  \Vith  the fingers  and  thumb of the left hand, 
 418   STRAIGHT AND CRUCIAL INCISION.

 put the integuments on the stretch, and in tie right,
 take the scalpel  or bistoury, holding it between the
 thumb and  middle finger, at that  part  who*e  the
 blade and handle unite, resting the fore-fingeron the
 back of  the blade, and applying the ring aid little
 fingers closely round  the  handle, the  extrenity of
 which will rest against the side of the metacarpil bone
 of the little  finger.  In this form, pass the instrument
 perpendicularly through the  integuments, andwhen
 it has penetrated to the necessary depth, lowtr  the
 handle gradually, till the blade be almost horiajntal,
 continuing  the  cut from  left to  right.  Whet near
 the point at which it is intended to terminate tie in-
 cision, raise the handle, so as to bring the instrument
 perpendicular, in order that  the  incision maybe of
 equal depth from one extremity to the other.
  In making this incision, care should be taken  not
 to introduce the instrument so deep, as to wound any
 important part, which may be situated beneath | par-
 ticular attention should also  be  paidto the stite of
 the integuments, which, if not kept tense, roll before
 the instrument, prolonging the operation, and causing
 unnecessary pain to the patient.
  These precautions being attended to, nothingrnore
 will, in general, be required to make the first inci-
 sions in the  operation for hernia, in  cutting upjn ar-
 teries, for the removal of small subcutaneous tumours,
 &.c. &c.

          TO  MAKE A  CRUCIAL INCISION.

  Q. How is this to be done ?
  A. This is formed of two straight incisions, the first
 of which is made from  left to right,  as directed;  the
second consists of two cuts, each of which (supposing
 a circle drawn round the first) is made from the  cir-
cumference to the centre, or middle of the first inci-
sion, and at right angles to it. By making the second
 incision in two opposite directions, the integuments
are kept tense during the  operation, and the  cut is 
ELLIPTICAL  INCISIONS.
419
 made wlh less pain to the patient, than if performed
 at once.
   The s»cond incision may also be made thus.  The
 bistoury is to be held flat in the hand, with its cutting
 edge tuned towards  the operator's right;  it is then
 to be puihed under the integuments, from the middle
 of the father border of the first incision, till its point
 arrives at the spot where it is intended to commence
 the  secoid.  The cutting edge, being now turned to-
 wards tin surface, is to be protruded through the in-
 tegument} from the point to the  heel, and half of the
 incision finished, by drawing the bistoury from heel
 to point.   In the same manner the opposite half is to
 be made, :he operator thrusting the bistoury beneath
 the  intcgiments towards himself.  This method is
 more  tedous and painful than the former, which, if
 cautiously performed,  is always preferable.
   In dissecting back the flaps, as in the operation of
 Trephinirg, the bistoury is to be held like a writing
 pen, the Doint of the nearest angle is to be raisedbe-
 tween the thumb and fore-finger of the left hand, and
 dissectel  back with the point of the bistoury; then
 the  cuttng edge of the knife is to be turned in  a con-
 trary diection, and the opposite angle dissected back;
 again  the direction  of  the cutting  edge  is  to be
 changed, and so on alternately, for either of the re-
 maining angles.

          TO MAKE  ELLIPTICAL INCISIONS.
   Q. How is this to be done ?
   A. These are frequently employed in surgical ope-
 rations, as in the removal of scirrhous breasts,  tu-
 mours of  considerable size, and in all cases  in which
a portion of integument is to be taken away  with  the
diseased part.
   The operator with his  left hand draws the integu-
ments towards him away from the line  which the in-
cision is to take ; whilst an assistant keeps them tense
by pulling them in an  opposite direction.  The infe-
rior luilf of the ellipsis is to be first formed, the course 
420
DILATING A SINUS.
and extent of which being fixed, the  cut is  to be
made from left to right.  The superior is tlcn  to be
finished in the same manner, taking care tlat it cor-
respond  at every point with its fellow.  The part
may now be dissected out, and the lips of tie wound
brought in contact, to ascertain whether thy exactly
coincide.
  The parietes of the abdomen, and the gluteal re-
gion, are the  parts best adapted for practising these
incisions, there being generally more fat between the
integuments and muscles in those situations, than  in
any other parts of the body.

           TO  PUNCTURE  AN ABSCESS.
  Q. Describe this operation ?
  A. A collection of matter,  when superficially seat-
ed, is generally evacuated by a puncture made with a
lancet; but when the abscess is a considerable dis-
tance from the surface, a  straight bladed bistoury is
the best instrument  for performing  the operation,.
which should  be done thus.
  The bistoury is to be held nearly perpendicular,,
with its point  downwards, grasping the heel between
the thumb  and fore-finger of the right hand, the
middle finger  being placed on the side of the blade,
at the same distance from its point, as the matter is
supposed to be  from  the  surface.  The hand  being
supported by  the ring and little fingers, the bistoury
is to be passed through the integuments into the ab-
scess :  the situation  of the middle finger thus pre-
vents the instrument from puncturing too deep.

   TO  DILATE A SINUS ON A  GROOVED DIRECTOR.
  Q. How is this to be done ?
  A. The handle of the director is to  be  held be-
tween  the index, the  middle  fingers, and the thumb
of the right hand, and its  point introduced inCo the
sinuous opening: then the handle is  to be taken in
the same manner in the left hand, and a Phymosis
knife, or a straight narrow bladed bistoury, is  to  be 
       RADIAL  ARTERY AT  THE WRIST.   421

held in the right, with its cutting edge directed up-
wards; and in this way passed along the groove,
lowering the handle of the director as the knife is
pushed forwards, till it reaches the extremity of the
sinus ; then it is to be  forced  upwards through the
integuments, and  the operation finished by cutting
towards the left  hand; withdrawing the director as
the incision is  terminated.

             LIGATURES  ON ARTERIBS.
  Q. What cautions are  to be  observed in applying
ligatures in surgical operations ?
  A. That the fingers of the  left hand be applied
parallel  to the direction of the incision, so as not on-
ly to mark its course and extent, but also to keep the
integuments tense.  The ligatures should be round
and  compact; those composed of a single waxed
thread, are generally strong enough for securing any
artery.  The  eyed probe  slightly curved, and  the
aneurismal needle, are the instruments best adapted
for passing the  ligature beneath  the vessel, which
should be separated from its lateral connections as
little as  possible,  yet  dissected clean at that part
where it is about to be secured. The ligature should
be  applied horizontally, and  drawn  with an even
force, so as to divide the internal and middle coats of
the artery; taking care that no accompanying nerve
or vein be included within it.  As it is an extraneous
body, it should be rendered as small as possible ; one
of its ends should therefore be removed, unless Mr.
Lawrence's method be preferred, of cutting off both
extremities close  to the knot.  If the,patient faint
during the operation, the wound should not be closed
till he recover, in  order to see if haemorrhage takes
place from any other vessel.

    TO TIB THE RADIAL ARTERY AT THE  WRIST.
   Q. Describe this operation ?
   A. Feel for the styloid process of the radius, at
which point begin your incision; continue it through
   Vol. II.            N n 
422  RADIAL  ARTERY  NEAR THE  ELBOW.

the integuments for two inches, in  the direction of a
line, which, if continued, would pass between the
condyles of the os humeri; the artery will be found
superficially situated, having the tendon  of the supi-
nator radii longus muscle on its outer side.

          ULNAR ARTERY  AT THE WRIST.
  Q. Describe this operation ?
  A. Feel for the Pisiform bone, half  an inch above
which, and on the outer side of the flexor carpi ul-
naris muscle, make a straight incision  of two inches
in extent through the integuments  ; cut  through the
fascia, an assistant  drawing the internal  edge of the
wound to the inner side ; dissect  carefully by the
side of the tendon, and you find the artery situated
on the  outer side of the nerve.   The colour of these
smaller arteries remote from  the  heart, may occa-
sionally lead the student to mistake them for veins,
as the blood frequently remains in them  after death,
especially in old subjects.

  ULNAR ARTERY IN THE MIDDLE OF THE FOREARM.
  Q. Describe this operation.
  A. About three  fingers breadth  from  the internal
condyle of  the  os humeri, on the anterior surface of
the ulna, but near its inner edge, begin the incision ;
continue it  in the  direction  of that bone for three
inches; divide the fascia to the same extent, separate
the presenting muscles, which are, on the outer side,
tiie palmaris longus lying more superficial, and the
flexor subliinis deeper ;  and on the inner, the flexor
carpi ulnaris. The  nerve will be found  situated deep-
ly in the inter-space, on the outer side of which the
artery is placed.

     RADIAL ARTERY NEAR TnE  ELBOW  JOINT.
  Q. Describe this operation ?
  A. In the axis of the angle formed by the two con-
dyles of the os humeri, and the extensors and flexors
of the  hand, an incision is to be made through the 
BRACHIAL ARTERY.
423
integuments, commencing a little below the joint,
and continued downwards for three inches.  This ex-
poses the fascia of the forearm, which is to be divided
to the same extent; when the artery will be laid bare.
  In wounds of these small arteries, which have free
anastomosing branches, two ligatures are required
to suppress  the  haemorrhage;  one above,  the other
below the wounded part; these are most readily ap-
plied by enlarging the incision, and thus exposing
the bleeding vessel.  But if the artery be completely
divided,  its cut extremities retract to a considerable
distance, the blood continues to flow into  the neigh-
bouring cellular membrane, and it becomes extremely
difficult to find the bleeding orifice.   In such a case,
it is better first to cut down on the vessel at one of
the before mentioned  points, between the wound and
the heart,  and apply the first ligature;  the  lower
bleeding extremity will then be  more readily disco-
vered.

       BRACHIAL ARTERY,  NEAR THE ELBOW.
  Q. Describe this operation.
  A. This  artery is  occasionally punctured  in  the
operation of venesection ; producing an aneurism at
the bend of the arm, which requires  for its cure the
obliteration of the vessel. Philagrius is said to be the
first who tied this artery for an aneurismal swelling;
he secured it above and below the tumour, which he
extirpated, and filled the wound with such dressings
as tended to promote suppuration.  Dominique Anel,
a French military surgeon, first tied the artery with-
out opening the sac.  The operation  may be per-
formed as follows :
  Begin the incision  half  an  inch above the inner
condyle of the os humeri; continue it upwards along
the inner edge of the biceps muscle for at least two
inches ;  when, having cut through the integuments,
and generally, a little fat, you find the median nerve
rising before the artery, which  has an accompanying
vein on each side.  Pass the ligature beneath  the 
424
AXILLARY  ARTERY.
vessel from its inner side, by which means the nerve
is readily excluded.

  BRACHIAL  ARTERY IN THE MIDDLE OF THE ARM.
  Q. Describe this operation.
  A. Make an incision through the integuments two
inches long on the inner edge of the biceps muscle;
this first exposes  the median nerve, which  has the
artery on the inner side between its two accompany-
ing veins; the internal  cutaneous nerve is situated
on the inner side  of the artery, diverging from it, aa
it descends in the arm.
  The operator may be occasionally confused by this
artery dividing unusually high in the arm ; in the last
extremity that I dissected, the separation took place
in the axilla ; the two trunks ran down the arm pa-
rallel to each other, till they reached the tendon of
the biceps, where they diverged into radial and ulnar.

               AXILLARY ARTERY.
  Q. Describe this operation.
  A. A wound or aneurismal tumour of the upper
part of  the  brachial artery would require the appli-
cation of a ligature on the axillary, which may be ap-
plied as follows:
  The part being shaved, or the hairs cut closely off
with a pair of scissors, place the patient on his side,
and let the arm be raised up by  an assistant; then
feel in  the axilla for the head of the bone, which is
thus lowered by the position  of the arm; over it
make an incision, in the direction of the limb, three
inches long,  the  middle part of which should be ex-
actly over the head of the bone;  this will  expose a
part of  the axillary plexus, behind the largest nerve
of which, the median, the artery will be found: the
vein passes rather below the artery at this part.   Af-
ter the first  incision through the integuments, use
the blade of the  knife as little  as possible, to avoid
wounding any of the branches of the vessel. 
SUBCLAVIAN ARTERY.
425
     SUBCLAVIAN  ARTERT BELOW THE CLAVICLE.
   Q. Describe this operation.
   A. The following on the dead subject, I have found
the most ready method of securing this vessel.   Put
the pectoral muscle on the stretch by raising the arm,
and  extending it backwards; then observe the de-
pression formed by the junction of its clavicular with
its sternal portion, the direction of which must be the
course of the incision.  Begin it half an inch from
the sternal extremity of the clavicle, and continue it
through the integuments for three inches in the above
direction ; separate the two portions of muscle from
each other exactly in the  course  of its  fibres, then
bring the arm to the side, which, by allowing of a
wider separation, exposes more readily the parts be-
neath :  at exactly one-third of the length of the cla-
vicle from its sternal extremity, you  find the vein
which is situated directly anterior to the artery, often
concealed by fat and  cellular membrane.  To avoid
wounding the vein,  the greatest care is requisite.
For  this purpose the  dissection had better be carried
on with the handle of the scalpel, after having divided
the muscle.

     SUBCLAVIAN  ARTERY ABOVE THE  CLAVICLE.
   Q. Describe this  operation.
   A. Make an incision three  inches long just above
the upper border of the clavicle,  beginning half an
inch from its sternal extremity, or immediately  on
the outer edge of the origin of the  sterno mastoid
muscle; continue it  through the integuments  and
platysma myoides, taking care not to wound the vein,
which is situated  before the artery, crossing it nearly
at right angles; having separated it from the artery,
it  should  be held on one side by an assistant; then
feel for  the eminence formed by  the junction of the
bony, with the cartilaginous  portion  of the first rib,
on the outer side of which you find the  artery; the
nerves forming the axillary plexus are situated rather
                      x n 2 
426           POSTERIOR TIBIAL.
 behind and to its outer side.  Owing to the depth of
 the vessel considerable  difficulty  will be  found in
 passing the ligature.
                 CAROTID ARTERY.
   Q. Describe this operation.
   A. Begin the incision at the lower edge of the
 Thyroid cartilage; continue it upwards and outwards
 through the integuments and platysma myoides for
 two inches and a half, immediately on the inner side
 of the sterno mastoid muscle,  so as to form an angle
 with the Thyroid cartilage: dissect very carefully by
 the edge of the muscle, drawing it a little outwards,
 and the artery is found where it emerges from be-
 neath that muscle and the Omo-hyoideus.  Be care-
 ful not to wound the internal jugular vein, which is
 situated on the outer side of the artery, and rather
 anteriorly ; the nervus vagus is behind and to its outer
 side, and the descendens noni runs down the front of
 the artery: the  whole is surrounded by condensed
 cellular membrane forming a kind of sheath.

         POSTERIOR TIBIAL AT THE ANKLE.
   Q. Describe this operation.
   A. The patient being placed with his face down-
 wards, make an incision two inches  long between
 the inner malleolus and tendo Achillis, but nearer the
 former; cut through the aponeurosis, and you  find
 the  artery  nearly  under the malleolus, having the
 tibial nerve rather behind and to its outside, and an
 accompanying vein on each side.

 POSTERIOR TIBIAL BATHER BELOW THE MIDDLE 01
                    THE LES.
  Q. Describe this operation.
  A. A little below the middle of the leg,  begin an
incision on the inner edge of  the gastrocnemius;
continue it  obliquely for three inches in the direction
of that muscle, so as to separate it from those beneath;
elevate it with the upper part of the  tendo Achillis, 
PERONEAL ARTERY.
4*7
  and on the first division of the muscle beneath, you
  find the artery with the nerve  rather behind and to
  its outer side,  and an accompanying vein on  each
  side.

       POSTERIOR TIBIAL HIGH  UP IN THE LEG.
   Q. Describe this operation.
   A. Begin the incision below and between the con-
 dyles of the femur; continue it through the integu-
 ments four inches down the  middle of the calf of the
 leg; cut through the aponeurosis and gastrocnemius
 externus nearly to  the same extent till you come to
 the internus, on the inner side of the  outer head of
 which  you) find the artery, with the nerve situated
 anteriorly and to its outer side,  and the vein  rather
 before it.

                POPLITEAL ARTERY.

   Q. Describe this operation.
   A. Begin an incision between the condyles of the
 femur,  and continue it upwards for three inches; the
 artery will be found deeply imbedded in fat, with the
 tibial nerve and popliteal vein situated more super-
 ficially.

  PERONEAL ARTERY RATHER BELOW THE  MIDDLE 01
                    THE LEG.
   Q. Describe this operation.
   A. Let the incision be three inches long, parallel
 with the  fibula, but behind  its outer edge;  a few
 muscular fibres will require to be divided; the arte-
 ry may  then be felt by  passing the finger across the
 bone to its posterior and inner  border, where it is
 situated ; as it is small  and  deeply seated, there will
 be some difficulty in passing the ligature.
   Mr. Guthrie, in the seventh volume of the Medico-
 Chirurgical Transactions, has related a case in which
lie secured this artery higher up the leg, to suppress
the hemorrhage caused by  a gun-shot wound. 
428
FEMORAL ARTERY.
   ANTERIOR  TIBIAL  IN  THE MIDDiE OF THE LEG.

  Q. Describe this operation.
  A. Begin an incision rather below the middle of
the tibia on its outer edge ;  continue it upwards and
outv^rds, for three inches, in the direction of the in-
terspace of the tibialis anticus, antl extensor longus
digitorum muscles;  cut through  the fascia to the
same extent, then separate the  muscles,  between
which  on the interosseous ligament, you find the ar-
tery, having before it a branch of the peroneal nerve,
and an accompanying vein on each side.  These ar-
teries,  like  the smaller of the upper extremity, re-
quire when wounded, to be secured by two ligatures.

   FEMORAL ARTERY IN THE  MIDDLE OF THE THIGH.
  Q. Describe this operation ?
  A.  The  operation of tying the femoral  artery
where  it is  situated in the middle third of the thigh,
for the cure of popliteal aneurism, was first perform-
ed by Mr. Hunter, and it is the operation now gene-
rally practised.
  Put the Sartorius in action by placing  the leg in
the tailor's position; then make an incision, three
inches in length, rather above the middle of the
thigh, in the  oblique direction of the muscle, and on
its inner edge ; continue it through the integuments
and fat, till  the border of the muscle is exposed.
Observe the direction of the fibres to ascertain  that
you have not  come upon the Vastus, then elevate the
Sartorius, drawing it a little outwards, which brings
the femoral sheath into view; open this with care,
by a small incision, and then dilate it by cutting from
within  outwards;  this exposes the artery, which has
the vein rather behind and  to its outer side.

         FEMORAL ARTERY IN THE GROIN.
  Q. Describe this operation ?
  A. The patient being placed on  his back, sepa-
rate the thigh to be operated on from the other, and 
EXTERNAL ILIAC.            420
let the leg hang over the edge of the table | this
renders the artery more superficial, by  putting the
integuments and sartorius muscle  on the stretch.
Begin the incision half an inch below the  middle of
Poupart's ligament; continue it downwards for three
inches, inclining it slightly to the  inner side of the
thigh,  to avoid the saphena vein which is  rather su-
perficially seated, and nearly over the artery. Having
cut through the integuments,  fat,  aponeurosis, and
fascia lata, you come to the sheath  of the vessels.
This being cautiously opened, as  in the last opera-
tion, exposes the artery, which has  the vein on its
inner side, but separated from it by a process of the
sheath: the anterior  crural  nerve, not included in
the sheath, is a little to its outer side.  An interest-
ing case of ligature on this artery, for a  wound of
the vessel caused by a hay-fork,  is related by Mr.
Norman of Bath, in the tenth volume of the Medico-
Chirurgical Transactions.

                 EXTERNAL  ILIAC.
  Q. How is this operation performed i
  A. The hairs being  previously  shaved  from the
part,  begin the incision about an inch within, and
rather below, the anterior and superior spinous pro-
cess of the ilium ; continue  it, in a semilunar  form,
in the direction of Poupart's ligament, for a  little
more than three  inches, so  as to make it  terminate
just above the external abdominal ring: this exposes
the tendon of  the  external oblique muscle,  which
being divided to the same extent, and turned aside,
lays bare the internal  oblique where it arises with
the transversalis from the outer half of  Poupart's
ligament.  With your finger, or the  handle of the
scalpel, turn  up the borders  of these muscles, and
the  spermatic  cord  becomes exposed ;  pass your
finger behind it, push the peritoneum upwards, and
you feel  the artery with the vein  on its inner side;
they are closely connected by cellular membrane,
and must be carefully separated with the  handle of 
430
INTERNAL ILIAC.
the scalpel, or a blunt probe.   After  having cut
through the tendon of the external oblique, be  care-
ful  to use the knife  as  little as  possible, lest you
wound the epigastric artery, which is generally situ-
ated near the inner extremity of your incision, cross-
ing behind  the spermatic cord.  This  accident hap-
pened  to the celebrated surgeon  Mons.  Dupuytren,
when  performing the operation at the  Hotel  Dieu
in  Paris, in  the  autumn of 1821: the haemorrhage
was so copious, that two ligatures were required on
the wounded vessel: the patient afterwards  died  of
peritonitis.
                 INTERNAL ILIAC.
  Q. How is this operation to be performed ?
  A. "An  incision about five inches in length, was
made  on the left side, in the lower and lateral part of
the abdomen, parallel with  the epigastric artery, and
nearly half an inch on the outer side of it.  The skin,
the superficial fascia, and the three thin abdominal
muscles were successively divided ; the peritoneum
was separated from its loose connection with  the ilia-
cus internus and psoas  magnus, it was then turned
almost directly inwards, in a direction from the ante-
rior superior spinous process of the ileum, to the
division of the common iliac  artery.  In  the  ca-
vity which I had now made I felt for  the  internal
iliac,   insinuated  the point  of  my  forefinger  be-
hind  it, and then pressed the artery between my
finger and  thumb.  I  then  passed  a ligature  be-
hind the vessel and tied it about half an inch  from its
origin.  I found no difficulty in avoiding the ureter :
when I turned the peritoneum inwards the ureter fol-
lowed it.   Had it remained over  the  artery I could
easily have turned it  aside with my finger.  The wo-
man did not complain of much pain, and I  am cer-
tain she did not lose  one ounce of blood."
   This artery is also said to have been successfully
tied in Russia, by an army surgeon, upon whom  the
Emperor Alexander  has since settled a pension, as a
reward for the dexterity and skill, displayed in  the
treatment of the case. 
THE AORTA.
431
                   THE AORTA.
  Q.  How is this operation to be performed ?
  A. "The patient's shoulders were slightly elevated
by pillows, in order to relax as much as possible, the
abdominal muscles; for I expected that a protrusion of
the intestines would produce embarrassment in the
operation, and was greatly gratified to find that this
was  prevented  by  their  empty  state,  in  conse-
quence of  the involuntary evacuation of the faeces ;
and here let me remark that I should, in a similar ope-
ration, consider it absolutely necessary, previously to
empty the bowels by active aperient medicines.
  I then matle an incision three inches long into the
linea alba, giving it a slight curve to avoid the umbi-
licus : one inch and a half was above, and the remain-
der below the navel, and the inclination of the inci-
cision was to the left  side of the umbilicus in this
form ( }> ).   Having divided the linea alba, I made a
small aperture into the peritoneum, and  introduced
my finger into the abdomen ; and then with a probe-
pointed bistoury, enlarged  the opening into the pe-
ritoneum to nearly the  same extent as that of the ex-
ternal  wound.  Neither the omentum  nor intestines
protruded; and during  the progress of the operation,
only one small convolution projected  beyond the
wound.
  Having made a sufficient opening to admit my fin-
ger into the abdomen, I then passed it between the
intestines to  the spine, and felt the aorta greatly en-
larged, and beating with excessive force. By means
of my  finger nail, I scratched through the peritoneum
on the left side  of the aorta, and gently  moving my
finger from side to side, gradually passed it between
the aorta and spine, and again penetrated the peri-
toneum on the right side of the aorta.
   I  had  now my finger under  the artery, and  by its
side, I conveyed the blunt  aneurismal needle armed
with a single ligature behind it; and my apprentice
Mr. Key, drew the ligature from the eye of the nee-
dle to the  external wound; after which the needle
 was immediately withdrawn. 
432
THE AORTA.
  The next circumstance which required considera-
ble care, was the exclusion of the intestine from the
ligature, the ends of which were brought together at
the wound, and the finger was carried down between
them, so as to remove every portion of the intestine
from between the threads: the  ligature was  then
tied, and its ends were left hanging from the wound.
The omentum was drawn behind the opening as far
as the  ligature would admit, so as to facilitate adhe-
sion, and the edges of the wound were brought  to-
gether by means  of a  quilled suture  and adhesive
plaster."
  JV. B. It may here be remarked that the additions
have been selected for their usefulness to the stu-
dent and practitioner;  and though  they do not pre-
tend to the merit of originality in any respect, it is
believed that they form an invaluable body of know-
ledge, drawn from the best sources,* which will in-
struct  the teacher whilst  examining  his  pupil?,
and by entering fully into the subject,  give the stu-
dent every thing necessary to a complete elementary
acquaintance with physiology, pathology, and ana-
tomy.

         • Martinet, Magendie, Fyfe and Averill. 
THE INJECTING TRAY
              AND ITS APPENDAGES,

For the purpose of facilitating the process of Quick-
  silver Injections, and preventing the loss of Quick-
  silver, which is constantly occasioned by the old
  method.     •
EXPLANATION OF THE PLATE.
  A. The Tray; this should be made of mahogany,
about three quarters of an inch in thickness, and the
several parts should be joined together with screws ;
every joint should be made perfectly water-tight, and
the inside painted  black ; as this is much more fa-
vourable for seeing the fine parts of white membranes
lying upon it,  and  the quicksilver flowing through
the minute ramifications of their  vessels.  The  ma- 
         EXPLANATION OF THE PLATE.

 chine being made in this form, is  intended to be
 occasionally filled with water, for the purpose of in-
 jecting broad and flat parts, which require to be so
 managed as to prevent their drying, and to which the
 common jar, represented in the plate, is not adapted,
 as placentae, large portions of mesentery and intes-
 tine, female breasts, &c.
  B. An iron pipe with an ivory plug, for the pur-
 pose of drawing off the water and quicksilver remain-
 ing in the tray after the injection is finished: it is made
 of iron, that it may not be affected by the quicksilver.
  C. C. The right and left sides of  the  Tray, cut
 down to form a rest for the arms, whilst the hands
 are employed upon a preparation at the bottom of it.
  The front D. is also made considerably lower than
 the sides, for the more convenient management of
 the preparation.  The bottom of the tray should be
 about twenty inches square ; -the front about three
 inches high, and the sides four and a half; the clear
 dimensions on the inside, are here meant.
  E. A ledge in one corner, for the convenience of
 fixing the  bottle containing the quicksilver; it has a
 hole sufficiently large  to receive the bottle which is
 let through, and stands on  the bottom of the tray to
 preserve it from any accident, which it is very liable
 to from its weight.
  F. F.  Two uprights; the foot of each fixes in two
square staples, and with the right and left sides of the
 tray, and ought to be about twenty-four inches high.
  G. The cross piece, the ends of which slide up or
 down in the mortise of the uprights, and are fixed to
 any height, by means  of pins passing through them
 and the ends of the cross-piece to keep them steadily
 fixed to each other.  In the lower edge of this cross-
 piece is fixed several small hooks, from which may be
 suspended one or more injecting tubes.
   H.  Is a glass jar containing water, in which is im-
 mersed a  hand, with the quicksilver injecting pipe
 fixed in the artery, as in  the process of'  filling the
 vessels.  The hand is suspended by a string from the
 edge of the jar. 
INDEX.
Abdomen, anatomy of,                     ;;. iQg
--------pathology of,                    H. 150
--------regions of,                      ii. 109
--------■ mode of examining,              ii. 365
--------mode of examining,              ii. 13J
--------■ viscera of,                       [u iq9
Abdominal aorta,                          ii' 264
--------■  absorbents,                     ii# 30 j
--------aperture or ring,                   228
----■      muscles,                          221
--------  nerves,                         ii. 330
—-----  veins,                          ii. 289
Abducentes,                               ii. 373
Abductors,                                  ' 25s
Abscess of bones,                             144
-------how to puncture,                  ii. 420
Absorbents, cutaneous,                 278, ii. 299
Absorbent system,                          ii. 296
Absorption, cutaneous,                        278
Accelerator urinae,                            234
Accessory nerve,                           ii. 329
Acids, poisoning by,                        ii' 354
Acrid poisons,                              ii. 355
Acute hydrocephalus,                       ' 345
Adductors,                                  258
Adipose substance,                           305
----->— arteries,                           i]  970
    Vol. II.             O 0 
434
INDEX.
Adult head, to prepare,	ii. 409
Adynamic fever,	ii. 347
iEgophony,	ii. 85 87
Air, changes on,	ii. 11
Alcohol, poisoning by,	ii. 355
Alkalies, poisoning by,	ii. 354
Alveolar artery,	ii. 247
Amentia,	366
Amnios,	ii. 210
Amygdalae	413
Amygdalitis,	ii. 151
Anchylosis,	149
Ancle, pathology of,	255
Angina pectoris,	ii. 70
^—— laryngea,	ii. 15
■ couenneuse,	ii. 155 ii. 154
	
------ pultacea,	ii. 156
—— tonsillaris,	ii. 151
Ani, sphincter,	235
---levator,	235
Animals, elements of,	7
--------rabid bite of,	ii. 357
--------substances, poisoning by,	ii. 356
Aneurism,	ii. 283
	ii. 57 ii. 250
Anterior cerebri,	
Anus, muscles of,	235
Anthrax,	308 309
Antimony, poisoning by	ii. 352
Aorta, and its branches,	ii. 243 362 ii. 431
	
Aortic plexus,	ii. 332
Aortitis,	ii. 56
Aponeurosis	ii. 204
Apophyses, what	36
Apoplexy,	350
--------pulmonary,	ii. 41
Appendicula vermiformes,	ii. 118
Appendicula pinguedinose,	ii. 119
 
INDEX.
435
Aphths,                                    ;i# 150
Aqueduct of Fallopius,                         52
------------Sylvius,                          318
Aqueous fluid of the labyrinth,                 379
---------humor of the eye,                    392
Arachnitis,                                    339
Arachnitis spinalis,                          ii. 316
Arrangement of facts,                           23
Arm, for arteries, to prepare,                ii. 397
Arch of the aorta,                           ii. 243
-----------palate,                             413
----crural,                                    228
----parts lying under the,                     230
Arsenic, poisoning by,                       ii. 351
Art, Ruyschian,                             ii. 387
Arteries,                                    ii. 236
---------and veins, to  prepare,              ii. 396
Arteries,  coats of the,                       ii. 236
--------- coronary,                          ii. 243
---------terminations of the,                ii. 237
---------basilar,                            ii. 252
--------- valves of the,                      ii. 236
---------of the brain,                    ii. 251-2
---------vertebral,                          ii. 251
---------of the head, face, &c.              ii. 244
---------of the arm,               ■       ii. 256-7
---------of the thorax,                     ii.   8
          of the abdomen,                   ii. 264
---------of the pelvis,                      ii. 272
---------of the leg,                        ii. 280
--------. articular,                          ii. 279
---------organic diseases of,                ii. 283
---------ligatures on,                       ii. 421
Arytenoid cartilage,                            415
Ascites,                                    ii. 179
Assistant chylopoietic viscera,                ii. 120
Astragalus,                                    136
Atlas,                                           84
Attitudes,                                  264 269
Auditory nerve, 
436                 INDEX.
Auricles of the heart,
Auscultation,
Axillary artery,
how to tie,
— vein,
   plexus,
Azygos vein,
------  uvulae
    ii.  48
    ii.  12
    ii. 256
    ii. 425
    ii. 291
ii. 316 330
    ii. 295
      189
                        B.

Basilar artery,
Basilic vein,
Biceps flexor cubiti,
-------------cruris,
Bile,
Bilious fever,
Bismuth, poisoning by,
Bladder, urinary,
---------------to prepare,
Blood, colour of,
Blood, quantity of,
------transfusion of,
*------vessels  of the system,
Blood-vessel  subject, to prepare,
Body, how divided,
Boil,
Bones, analysis of,
------organic diseases of,
------preparations of,
------how covered,
           divided,
■ of the face,
■ ethmoid,
- frontal,
• maxillary superior,
- malar,
• nasal,
■ occipital,
■ parietal,
ii. 252
ii. 290
ii. 204
   241
ii. 126
ii. 346
ii. 353
ii. 183
ii. 406
ii.  13
ii.  54
ii.  55
ii. 236
ii. 344
    35
   307
   141
   142
ii. 406
    36
    36
    65
    60
    38
    68
    67
    65
    43
    42 
INDEX.
437
Bones of the palate,                            71
-----■ sphenoid,                              55
■------temporal,                              47
------ungual or lachrymal,                    66
------pathology, surgical, of,                  142
Brachial artery,                             ii. 257
------------ how to tie,              ii. 423 424
Brachialis internus,                         ii. 204
Brain and its membranes,
----  ventricles of
----  sinuses of,
----  nerves,
----anatomy of,
----  compressed,
----  functions of,
----  lymphatics of,
----  uses of,
Bronchial veins,
Bronchocele,
Broncophony,
Bruit de soufllet,
----  de rape,
Buccinator  muscle,
Bulb  of the urethra,
Bursae mucosae

                        C.
Cxcum caput coli,
Caeliac artery,
Calcis os,
Caloric, generation of,
Canals of the cochlea,
Canaliculi lacrymales,
Cancer of the intestines,
------of the rectum,
._____of the stomach,
______of the brain,
Cantharides, poisoning by,
Capsular arteries,
Capsules, renal,
   r                   o o 2
	310
	63
	321
11.	311
	320
ii.	296
	418
n.	85
ii.	99
ii.	99
ii	99
n	187
	260
ii.	118
ii	264
	136
u	12
	378
	385
ii	167
ii	171
ii	162
	360
ii	.357
ii	269
ii. 182 3U5	
 
488
INDEX.
Carbuncle,	309
Cardia,	ii. 112
Cardiac nerves,	ii. 327
Carditis,	ii. 66
Caries,	143
Carotid arteries,	ii. 244
	53 ii. 249
	ii. 426
Carpal bones,	118
Cartilages;	150
---------organic diseases of,	151
——---- semilunar,	250
Cartilago ensiformis,	97
Caruncula lacrymalis.	385
Cases, necessary,	14
Cataract,	403
Catalepsy,	363
Catarrh,	ii. 20
Catarrh, pulmonary,	ii. 21
Cava vena,	ii. 296
Cellular substance,	306
------ tissue, hardening of,	310
Centralis retinae arteria,	ii. 250
Centrum ovale Vieusenii,	314
——----semicirculare geminum,	215
Cephalic vein,	ii. 290
Cerebellum,	319
	ii. 361
	
Cerebri anterior,	ii. 250
------ media,	ii. 251
Cerebrum.	310
Cervical arteries,	ii. 254 ii. 314 ii. 293
	
	
	82
	
Cheek bones,	67
Chest, pathology of,	ii. 13
Cholera,	ii. 168
Chorda tympani.	373
Chorea,	364
 
INDEX.
439
Chorion                                    ii. 210
Choroid coat.
-------plexus,
Chyle,
Chylopoietic viscera,
Chyme,
Cilia.
Ciliary circle, plicae, &c.
Cineritious substance,
Circulus arteriosus Willisii,
Circulating system a sign of disease,
Circumflexa iliaca arteria femoris,
-----------------------humeri.
Circumflexus palati.
Clavicle,
-------ligaments of,
Clitoridis erector.
Clitoris.
Coats of the eye.
Coccygeus,
Coccygis os,
Cochlea.
Coeliac artery,
------ganglia.
Colon, anatomy of,
Colica pictonum,
Colic, spasmodic,
Colitis acutus,
------chronicus,
Columnae carneae,
Commissura cerebri,
Communicans arteria cum vertebrah,
Commissura mollis,
Complexus,
Constitution,
Contractility of relation,
____—.----— animal,
Concretions, biliary,
Congestion in the brain,
	315
i. 149 3:	
ii	120
u.	146
	384
	384
	314
ii.	253
	332
u.	277
ii.	257
	105
	162
	234
n	200
	386
	235
	91
	377
u	264
ii	331
u	118
ii	170
a	170
u	165
ii	. 166
n	49
317 318	
u	250
	317
	195
	30
	10
	10
ii	.176
	349
 
440
INDEX.
Conglobate glands, *"CT**I	ii. 297
Constrictor isthmi faucium.	190
	190
	
Contagious' fevers,	ii. 351
Contractility of the muscles,	10
Copper, poisoning by,	ii. 352
Coraco-brachialis.	199
Cord, spermatic,	229
Cornea,	387
Cornu ammonis.	317
Coronary artery of the lips.	ii. 245
---------------of the stomach.	ii. 265
	ii. 243
Corpora albicantia.	*316
-------cavernosa penis.	ii. 186
	320
	
------- striata,	315
Corpus callosum,	314
------ cavernosum vaginae.	ii. 206
	274 ii. 186
	
	
Corroded preparations,	ii. 411
Corrugator supercilii,	175
Cortical substance,	314
Coryza,	407
Cough, hooping,	ii. 24
Countenance, a sign of disease,	333
Cranium,	36
—-------bones of,	37
Craquement de Cuir,	ii. 100
Cremaster,	230 233
Cretinism,	367
Cricoid cartilage,	415
■----------------its muscles,	191
Croup,	ii. 17
Crural arch,	230
------artery,	ii. 277
—-----vein,	ii. 288
------ nerve,	ii. 336
Crura cerebri et cerebelli,	316 317
 
INDEX.
441
Cruralis,                                      248
Crystalline lens.                               393
Cuboides os,                                v  138
Cuneiforme os,                                138
Cuspidati,                                      77
Cutaneous nerves,                   ii. 335 336 338
Cuticle,                                       274
Cutis vera,                                    274
Cyrrhosis,                                   ii. 371
Cystic duct,                                 ii. 125
Cystitis,                                     ii. 192

                        D.
Dartos,                                     ii. 194
Decidua,                                    ii- 210
Delirium, how many kinds of,                  326
Deltoid,                                       198
Demeanor of a physician,                       19
            fangulioris,                        183
            J labii.inferiorls,                   183
Depressor  < ----superioris,                  183
            j alaeque nasi,                      182
            \j)culi,                            181
Diabetes,                                   »• 192
Diagnosis,  what,                          22 n. 380
---------of diseases of the brain,             n. 381
________of diseases of the medulla spinalis,   ii. 382
---------of the diseases of the organs of re-
            spiration,                        "• 382
---------of the diseases of the heart,        ii. 384
______— of the diseases of the belly,        ii. 384
Diaphragm,     .                             224
-----------arteries of,                      }}• ^°^
            nerves of,                       }}• 326
          - veins of,                        »• 290
       ---- muscles of,                        224
Digestive system a 6*ign of disease,              332
Digastric muscles,                             J°°
Digestive organs, affections of,               »• ls\j
________________mode, of examining,        ». !•«
Dorsal vertebne, 
442                 INDEX.
Drinks, changes produced on,               })• l47
Dropsy of the pericardium,                 }]>  "1
Ductus communis choledochus,              ij> 125
------hepatic,                            "• 12«*
------pancreatic.                            lo1
-----parotid.                            ,.  408
-----thoracic.                            i|» 306
Duodenum, anatomy of,                     ii- ^^
Dura mater,                                  310
-      ---- inflammation of,                _  328
Dysenteria,                                }}• 165
Dyspepsia,                                "• 168
                       E.
Ear, internal,                                 376
----pathology of the                          383
----muscles of,                               176
Effusion of blood,                             348
Elements of animals,                            7
Embryo,                                   «• 209
Emulgent artery,                           ii. 269
--------vein,                            ii. 290
Emphysema of the lungs,                   ii.  34
•       ----subcutaneous,                     310
Encephalitis,                                 358
Encephalocele,                               337
Encephaloid,                              ii. 370
Epidermis,                                   274
Epidydimis,    '""                         ii. 196
Epigastric artery,                          ii. 276
Epiglottis,                                    415
Epilepsy,                                     361
Epiphysis, what,                               36
Erector clitoridis,                            234
------ penis,                                233
Erysipelas,                                   280
Esophagus,                                ii. 108
Ethmoid bone,                                60
Eustachian tube,                               51
Examination in general,                         24
Examination post mortem,                  ii. 358 
INDEX.                 443
Examination of the brain,                   ii. 360
-----------of the tissues,                  ii. 231
-----------of the womb,                  ii. 224
-----------of the muscular, fibrous, vascu-
               lar, and nervous system,      ii. 235
Exostosis,                                    142
Expectoration,                             ii.  88
External abdominal ring,                     228
Extremity, superior, bones of,                 105
■-----------ligaments of,              162
——------------muscles of,                198
——------------arteries of,              ii. 256
----------------nerves of,               ii. 322
                   veins of,                ii. 290
 inferior, arteries of,               ii. 277
------- to prepare,              ii. 398
--------bones of,                  125
-------ligaments of,              168
-------muscles of,              .. 236
-------nerves of,               }"}• 337
         veins of,                "• 288
Exfoliation,                                  _ ^
Extensors of the knee-joint,                   £«
-------------foot,                  251 254 257
Eye, anatomy of the                          ^ g
----coats of,
----humours of,
----nerves of,
----artery of,
----veins of,
----muscles  of,
----diseases  of,
____. surgical organic derangements ot the
       392
       386
386 ii. 250
    ii. 293
       180
       402
       402
             F                                 65
Face, bones ot,                                1g4
_.—  muscles of,                               22
Facts, what,                                i;  245
Facial artery,                              » ' 393
-----veins, 
 444                  INDEX.

 Facial nerves,                               ..  370
 Fallopian tubes,                             "• -«"*
 False vertebrae,                                 °*
 Falx major,                                    311
 Falx minor,                                    J*'
 Family,                                         |8
 Fascia lata,                                     j*f
 ------transversahs,                            ZjiV
 ------■ superficialis,                            232
 Fat,                                           305
Faucium, isthmus,                           ..  *^
Fecundation,                                «• 208
Femoral artery,                             ii- ^7J
--------------how to tfe,                  ii- 428
--------vein,                              ii- 288
nerves,
ii. 337
Femoris, os,                                    126
Fenestra ovalis,                                381
        ■ rotunda,                              381
Fever, inflammatory,                        ii. 347
----—  eruptive,                             ii. 342
-----  bilious,                               ii. 346
-----mucous,                              ii. 347
——  adynamic,                            ii. 347
-----  nervous,                              ii. 348
——-  typhous,                              ii. 349
-----  yellow,                               ii. 349
-----contagious,                           ii. 351
Fibula,                                         134
Fibular artery,                              ii. 281
      ■ vein,                                 ii. 288
       nerve,                           ii. 337 338
Fifth pair of nerves,                          ii. 338
Fingers, bones of,                              123
Femur,                                        126
Fishes, poisoning by,                        ii. 356
Fissure of Sylvius,                              314
Fluids,                                           9
Flexors,                                   253 259
Foetus, growth of,                          ^ii. 222 
INDEX.   '             445
Foetus, nourishment of,                     ii. 222
------physiology of,                      K. 222
------peculiarities of,                      ii. 217
       to prepare,                          ii. 402
------pathology of,                        ii. 223
------circulation of,                       ii. 220
------preparation of,                    ii. 402-6
------exhalations of,                       ii. 223
------secretions of,                        «• 223
Foot, bones of,                               135
Fontanelle,                                   41
Foramen monroianum,                        316
Fornix,                                    %  316
Fossa navicularis,                           ii. 200
Sylvii,
314
Fragilitas ossium,                             146
Frontal bone,                                 38
Frontal sinuses,                                39
Frontis, os,                                   38
Functions of the body, what,                  ^10
Fungus of the dura mater,                    336
Furunculus,                                  307

                       G.
Gall-bladder,                               »• 124
Gangrene of the lungs,                      "• 42
---------------bones,                      . x~
Gastrica superior,                           fi- 265
-------inferior,                            »• 2o5
Gastric juice,                              ."• 1™
Gastro-enteritis acutus,                     »• }-^>
-------------chronicus,                   »• 1°"
Gastrocnemius,                            249 2o2
Gemini,                .   .                  _„.
Generative system, examination, mode of,    n- ^*
Generation, male organs of,             ..   "• J°*
----------female organs of,            »• 1?? 202
----------pathology of,                    •«. 211
Genio-hyoideus,                              ^
---.— hyoglossus,
  Vol. II.              P p 
446                  INDEX.
 Glands, mesenteric,                         ii. 303
 Gland, prostate,                            ii. 189
 -----conglobate,                          ii. 297
 Glossitis,                                   ii. 151
 Glottis, oedema of,                          ii.  19
 Gluteal artery,                              ii. 273
 ------nerves,                              ii. 337
 Glutei muscles,                            237 238
 Gold, poisoning by,                         ii. 353
 Goitre,                                        418
 Gout,                                         273
 Gracilis,                                       240
 Gravel,                                     ii. 191
 Gravid uterus, to prepare,                   ii. 398
 Great sympathetic,                          ii. 329
 Gustatorius,                                    372 -

                       H.
 Hairs, #                                      304
 Hamstrings,                                    242
 Haematuria,                                 j}. jgg
 Haemoptysis,                                ji] 40
 Haemorrhoidal arteries,                       ii.' 274
 Haemorrhoids,                               y' ^J\
 Hand, bones of,    •                          ' \ jg
 -----ligaments of,                            jg/
 Head, muscles of,                             177
 -----mode of examining,                    '  324
 Heart, anatomy of,                           y. 43
 ------communication between the right and
          left ventricle of,                    ii. gg
 ■------dilatation of the ventricles of,          ii] 63
 ------dilatation with hypertrophy,        ii. 64' 56
 ■------■ induration of,                       ' ;;_  g^
 ------polypous concretions of,              ii]  67
 ■----— lymphatics of,                   ii. 307 30g
------■ hypertrophy of,                       iit  62
——— circulation through,                      51
------in situ, to prepare,               ii. 400 405
------pathology of,                         ij   56 
INDEX.
447
Heart, physiology of,                       j).  53
------softening of,                        «•  66
------nerves of,                          ii. 327
------phenomena referable to by the ste-
         thoscope,                     ii..?3  96
------impulse of,                         ii.  94
------rythm of,                           «•  96
Helicis major and misor,                    .  179
Hematemesis,                             '}}• l6*
Hepatitis,                                 »• 1J3
Hepatic artery,                            «• *°°
__L_ veins,                             »• 290
       plexus,                            "• 332
Hereditary predisposition,                     28
Hernia,                                      231
Hernial sac,
Herpes,                                      ^u
Hey's saw,                                   b%
Hip and thigh, pathology of,                   ***
Hip-joint, ligaments,                          j£V
---------muscles of,                          ~y
Humeri,  os,                               ..  }}jj.
Humeral artery,                           "• j£°
-------vein,                             ... f?i
Hydrorachitis,                             ".-. •>*'
Hydrothorax,                              "•_•**
Hypochondriasis,                             ^
Hydatids,                                    if*
Hydrocephalus, acute,                        ^~
_-----------chronic,                        J*£

gygiene                                 a. 201
Hymen,                                   ..  272
Hypogastric artery,                        »• Jg
veins,
plexus,
n. o
;33
Icthyosis,                                     21
Idiosyncrasies,                               266
Idiotism, 
448                 INDEX.
 Internal ear,                                  376
 Inflammation of the ear,                        383
 Intellectual faculties a sign of disease, how,      326
 Jejunum, anatomy of,                       ii. 116
 Iliac, internal,                               ii. 430
 .----arteries,                               ii. 272
 -------------external,                      ii- 276
 -------------to tie,                        ii. 429
 Iliacus internus,                                227
 Iliac vein, external,                          ii. 288
 Ilium, anatomy of,                           ii. H7
 Iliios,                                          98
 Incisions, how to make,                      ii. 417
 Incus,                                          54
 Induration of the valves of the heart,         ii.  58
 Infra-orbitar artery,                         ii. 247
 Infra-spinatus,                                  198
 Inferior extremity, bones of,                    125
 <------  ■         muscles of,                   236
 -i----------------ligaments of,                 168
 Infundibulum of the brain,                      317
 -------------of the cochlea,                    377
■■            of the kidney,                  ii. 181
Inguinal artery,                             ii. 278
 Inguinal canal,                                  228
Inguinal glands,                             ii. 300
Injections,                                  ii. 391
——-----coarse,                           ii. 392
      ■  ■ fine.                              ii. 392
———— minute,                           ii. 392
Innominata, arteria,                          ii. 244
 ■■     — ossa,                                 98
Inspiration, muscles of,                          219
Instruments, injecting,                       ii. 390
Intestines, large,                            ii. 147
Intestines, small, physiology of,               ii. 145
Integuments,                                  274
Intervertebral eubstance,                         81
Intermittent fever,                          ii. 351
 Interossei,                                 217 259 
INDEX.
449
Intercostal muscles,
---------arteries,
---------- veins,
---------nerves,
Intussusceptio,
Intestines,
Iodine, poisoning by,
Iris,
Irritability,
Ischiatic artery,
--------nerve,
Ischium, os/
Judgment,
Jugular vein, internal,
---------— external,
  219
ii. 263
ii. 295
ii. 330
ii.  69
ii.406
ii. 355
  389
    10
ii. 276
ii. 337
   100
   322
ii. 294
ii. 293
Kidneys, anatomy of,
.--------lymphatics of,
Kneeling,
Kneejoints, ligaments of,
----------pathology of,
_____-----dislocation of,
179
305
267
170
250
251
Labia pudendi,
Labyrinth,
Lachrymal gland,
__________organs,
Lachrymalia ossa,
Lacteal vessels,
Lamina spiralis,     #
Language of description,
Languages, what necessaiy,
Larvnx,             .  .
__J___ mode of examining,
Laryngeal superior artery,
Laryngeal superior nerve,
    J °                r p 2
          377
          384
          384
           67
ii. 115 297 301
          378
           19
           13
          415
        ii. 366
        ii. 245
          374 
450                INDEX.
Lateral ventricles of the brain,                 ^l4
------sinus,                           »• 294 ol2
Latissimus dorsi,                              200
Laxator tympani,                           .. 1' -j
Lead, poisoning by,                         »• 353
Leg, bones of,                                131
 —- ligaments of,                            171
Life,                                       ..   9
Ligamenta lata of the uterus,                i». 263
Ligament of Poupart,                         229
Ligaments,                                   15°
——----organic diseases of,                 173
Lineae  transversae,                            222
Linea semilunaris,                            221
Linea alba,                                 .. 221
Lingual artery,                             ii. 245
Liver,  anatomy of,                          ii. 120
-----cancer of,                            ii- 175
■-----encysted dropsy of,                   ii. 176
■      lymphatics of,                        ii- 304
Loins,  sympathetic nerves,                  ii. 334
Longissimus dorsi,                         217 220
Longitudinal sinus,                     ii- 294 311
Lumbar nerves,                            ii. 334
'       arteries,                            ii. 271
------ vertebrae,                               88
------ vein,                               ii. 290
Lumbricales,                                 259
Lunare, os,                                   119
Lungs, anatomy of,                         ii.    6
------accidental productions developed in,  ii.  45
—-----circulation of,                       ii.    8
——-— gangrene  of,                        ii.  42
------physiology of,                       ii.   9
     -Jnerves of,                           ii.   9
Luxations of the fingers, how reduced,       ii. 217
Lying,                                        267
Lymphatic system,                          ii. 297
Lyra,                                         317 
INDEX.
451
                       M.

Malleus,                                      54
Malleolus internus,                            135
--------externus,                            135
Mammae, anatomy of,                         ii.  1
--------organic derangements of,            «•  4
Mammary arteries, internal,                 ii- 255
..----------external,                 ii. 256
--------veins,                           '})• 295
--------nerves,                          ii- 316
Mania,                                       365
Marrow,  what,                                 36
--------spinal,                           ii-212
Mater, dura,                                 •>««
-----P-,                                   3} J
Materia Medica,                               **
Maxilla,  superior,                              °8
.         inferior,                           ..  ^5
Maxillary artery,                          "• 246
Meatus auditorius externas,                    51
----------------internus,                    o52
Measles,                                   "• 34^
Medicine,                                     lj
Medicines, qualities of,                      ..  **
Median basilic vein,                         »• jf™
----------— nerve,                       \\- °2*
Mediastinum,                              U'<?if
Medullary matter,                          .. ^1*
Medulla spinalis, tumours of,                n »• J">
Medulla oblongata,             .  .         °}f ifi
_________________mode of examining,       "• ooi
-------spinalis,                        "• 312 320
                inflamed,                   »• 313
Melanoid,                                   " „-g
Membrana tympani,                           ^2
Memory,                                   .; 2U
Menorrhagia,                               ..' 2.-
Meningeal artery,                           .\- 253
Mercury, poisoning by, 
452                 INDEX.
Menstruation,	ii. 207
Mesenteric artery, superior,	ii. 267
1----------inferior,	ii. 268
	ii. 297
	
Mesentery,	ii. 110
Mesocolon, anatomy of,	ii. 110
Metallic tingling,	ii. 88
Metacarpal bones,	121
Metatarsal bones,	140
Miliaria,	282
Milk, properties of,	ii. 4
Mind, qualities of, necessary,	16
Modiolus,	377
Minute injection, preparations,	ii. 406
Motions,	267
Mollities ossium,	147
Morbid parts, preparation of,	ii. 388
Motions and attitudes,	261
Motores oculorum,	180
Mouth, anatomy of the,	408
	ii. 366 186
■ moae 01 examining,	
	
Mucous fever,	ii. 347
■------■ membrane, in its healthy state,	ii. 367
Mucous membranes, pathology of,	403
Multifidus spinae,	218
Murmur, respiratory,	ii. 79 80
Muscular motion, physiology of.	176
----■----system, physiology of,	261
- pathology of,	271
Musculo-cutaneous nerve,	ii. 323
Myology,	174
N.
waits,                                        304
Narcotic poisons,                           ii. 355
Nates                                       ' 218
Naviculare os                                 137
Neck, bones of,    #                           82 
                      INDEX.                 453

 Neck, ligaments of,                           155
 Necrosis,                                     145
 Nephrites,                                 i;. 190
 Nerves,                                    ii# 2l2
 ------, anatomy of,                           369
 —■—, inflammation of,                     ii. 241
 ------, diseases of,                         ii. 339
 ■-----, physiology of the,                    367
 Nervous system,                            ii. 212
 -----■- fever,                              ii. 348
 Neuralgia,                                 ii. 240
 -------~ facial, symptoms of,               ii. 241
 "--------crural,                           ii. 241
 ——-----cubito-digital,                    ii. 241
 Ncevus,                                       299
 Nose, bones of,                                65
 ----anatomy of,                              404
 Nymphae,            •

                        0.

 Obliquus abdom. descend.                      221
 --------descend, extern.                      221
 --------ascend, intern.                       222
 ■-------oculi,                              . 181
 Observation, assistants of,                       21
 1            copying of,                        22
 ---------what,                              19
 ---------inaccurate,                         14
 ---------special                  19. 25, 26,27
 ---------recording, what,                    24
 Observed, what cavities to be,                   25
 Observer, what necessary to,                    13
 Obturator  artery,                            ii. 273
--------muscles,                         237 239
 -------- nerve,                            ii. 335
------— externu9,                           237
-------- internus,                            239
Occipital artery,                            ii. 246
———- bone,                                 43 
454                 INDEX.
Occipital  nerve,
Occipito-frontalis,
Ocular vein,
GSdema,
-------of the glottis,
-------------- lungs,
Oesophagitis,
Oesophagus, anatomy of,
------—— cancer of,
Oesophageal arteries,
.----------nerves,
^—---- veins,
Otitis,
Olfactory nerves,
Olivaria corpora,
Omentum, anatomy  of,
Omo-hyoideus,
Opening bodies, mode of,
Ophthalmia,
Ophthalmic  artery,
Optic nerve,
Orbicularis oris,
----------palpebrarum,
Orbiculare os,
Organs of the senses,
------ of urine,
       . of generation in the male,
-------------------. in the female,
                     pathology of,
of locomotion, a sign of disease,
of sense, a sign of disease,
Organic sensible contractility,
Os hyoides,
Ossicula auditus,
Os tincae,
Osteology,
Osteo-sarcoma,
Ovaries,
------  encysted dropsy of,
Ovum, progress of,
    ii. 314
       177
    ii. 293
       309
     ii. 19
        25
    ii. 153
    ii. 108
    ii. 153
    ii. 263
    ii. 327
    ii. 296
       383
       369
       320
    ii. 110
       187
ii. 358. 373
       403
    ii. 250
       391

       180
        54
       369
ii. 179.199
     ii. 185
     ii. 199
     u.211
       329
       328
         10
         79
      .  54
     ii. 203
         35
        149
     ii. 202
     ii. 214
     ii. 200 
INDEX.
455
p.
Pacchioni glandulae,	312
Pain, a sign of disease, how	ii. 233
Palate, arches of the	413
Palate bones,	71
Palpebrae,	384
Pancreas,	ii. 130
Papillae nervosae,	275
Par trigeminum,	
----vagum,	ii. 326 331
Parietal bones,	42
Parotid duct,	408
	408
giana,	
Passions,	324
■ how expressed,	324
Patella,'	131 240 251
Pathetic nerves,	370
Pathological anatomy,	12
Pathology,	11
----------general,	13
----------of thorax,	ii. 15 77
r +u^ *.«,,	383
	336
Pectinalis,	236
Pectorales,	199 200
Pectoris, angina,	ii. 70
Pectriloquy,	ii. 85 86
Peculiarities of the foetus,	ii. 217
Pedes hippocarpi,	317
Pelvis, bones of	98
	104
—;----- ligaments of	160
Pemphigus,	282
Percussion,	ii. 91 228
Pericardii hydrops,	* ii. 61
Pericarditis,	ii. 60
Pericardium, anatomy of	ii. 47
------------physiology of	ii. 47 36
Periosteum,	
 
456
INDEX.
Peritoneum,                                ."' j_7
Peritonitis,                                  ' 2-4
Peronei muscles,                            .. 2gl
Peroneal artery,                            ]}.' j„_
______________how to tie,
nerve,
ii. 337
   276
Perspiration,                               .. 244
Pharyngeal artery,                          "• fz*
—---------nerve,                          .. \(*
Pharyngitis,                                "• l0Z
Pharynx,                .                   .. „fifl
--------mode of examining,                «• °°v
--------cancer of                         U   u,
Phenomena, medical                        ..   ™
Phlebitis,                                  »• ££
Phlegmon,
Phosphorus,                                »■ %*
Phrenic arteries,                           }}- £?*
 ------nerves,                            ».-. 3^
Phthisis,                                    !!•  ^°
--------anatomical characters,              "•  ^°
Physician, qualities of                          1^
Physiology,                                ..   "
______—- of the foetus,                    »;. 222
----------of the heart,                     »•  53
______.—— of the pericardium,               »• 47
---------- of the voice,                     '"• 70
Pia mater,                                    313
Pigmentum nigrum,                           ^°
Pineal gland,                               ..  -*)*
Placenta,                                   ."• **£
--------for arteries and veins, to prepare,    n. o99
--------organic derangements of           ii. 215
Plague;                                    )!• 350
 Plantar arches,                              »• *°£
 ------nerve,                              ii- 339
 Plantaris,                                   „ 249
 Pleura, accidental productions in             "■  46
 Pleuritis,                                    »•  30
 Pleurodyne,                                 "•  25 
index.               457
Pneumo-thorax,	ii. 44
Pneumonia,	ii. 26
Poisons, pathology of	ii. 351
--------metallic	ii. 351
	ii. 355
	
--------animal	ii. 356
Pons varolii,	319
Popliteal artery,	ii. 279
----------------how to tie,	il 427
---------glands,	ii. 300
Popliteal nerves,	ii. 337
---------veins,	ii. 288
Popliteus,	249
Portae of the liver,	ii. 122
Portio dura,	52
------mollis,	53
Posterior auris,	ii. 246
Post mortem examinations, mode of making	ii. 358
Position a sign of disease, how	334
Predisposition, family, what	28
Preparation of a foetus,	ii. 389
---------------cuticle,	ii. 389
Preparation of morbid parts,	ii. 388
■ ----by maceration,	ii. 388
-----------with coarse injection,	ii. 393
■-----------of bones,	ii. 389
Profunda femoris,	ii. 276
---------cerebri,	ii. 253
Prostate gland,	ii. 189
--------------organic diseases of	ii. 190
Prurigo,	285
Psoae muscles,	227
Pterygoidei,	185
Pustule, malignant,	308
Pubisos,	102
Pudic artery,	ii. 275
------nerve,	ii. 333
Pulmonary apoplexy,	ii. 41
■ ----artery and veins,	ii. 242
-----------plexus,	ii. 327
Vol. II.           Q q 
458
INDEX.
Pulse,                                  "• 5S 101
Puncta lacrymalia,                            ~°°

Pylorus,                                  «• 1}3
Pyramidaha corpora,                          "**
Pyramidalis,                                  224
Pyriform muscle,                             238

                       Q.
Quadratus femoris,                            239
          lumborum,                         220
Quicksilver, preparations with              u. 410
Radial artery,                          ii. 258 422
-----------how to tie                    ii. 421
------muscles,                              206
------nerve,                              ii. 324
Radius,                                      H6
Rale,                                    ii- 8? 82
Ramollissement of the heart,                 ii. 66
-----------------medulla spinalis,       ii. 318
-------------. brain,                    357
Receptaculum chyli,                       ii. 306
Rectum,                                  »• 120
Rectus abdominis,                            224
------capitis,                                195
------femoris,                              240
Recurrent nerve,                           ii. 326
Reflection, what                               12
Renal artery,                               ii- 269
Renal capsules,                            ii. 182
-----vein,                                ii. 290
-----plexus,                              ii- 333
Respiration, mode of examination of organs of  ii. 77
Respiration,                              ii- 10 77
---------tracheal, what                      80
Respired air,                                ii. 10
 Respiration, puerile,                         ii. 80
Respiration a sign of disease,                   333
 Resonance,                              ii. 85 88 
INDEX.
459
Rete mucosum.
Retina,
Rheumatism,
■----------articular
Rhomboideus,
Ribs,
----physiology of
Rickets,
Rotula,
Rush on the philosophy of vocal expression,    324
Rythm of the heart,                     ii.  95 100
S.
Sacra median artery,	ii. 272
Sacral artery,	ii. 273
------nerves,	ii. 334 336
Sacrum, os	89
Saliva,	409
	409
Salivary glands,	
Saphcenavein,	ii. 336
Sartorius,	240
Scala tympani et vestibuli,	378
Scald head,	283
Scaleni,	193
Scaphoides, os	119
Scapula,	107
Scarlatina,	ii. 342
Scapularis interna,	ii. 256
Scapular nerves,	ii. 322
Sciatic artery,	ii. 276
Scirrhus,	ii. 369
Scirrhous nerve,	ii. 337
Sclerosis,	ii. 372
Sclerotic coat,	387
Scrophula,	ii. 341
Scrotum,	194
Scurvy,	ii. 340
Secretions,	ii. 238
Secundines,	ii. 207
Semicircular canals,	ii. 378
   274
   391
   272
   273
   217
    92
95 226
   148
   130 
T
460             index.
Semilunar ganglion,	ii. 331
Semimembranosus,	241
Semispinalis dorsi,	ii. 217
Semitendinosus,	241
Sensibility,	320
Sensibility a sign of disease,	328
Sensitive system a sign of disease,	328
Septum lucidum,	314
Serpents, poisoning by	ii. 357
Serrattis magnus,	219
Serrati,	220
Sesamoid bones,	125
Short sighted, what	397
Sinus of the septum lucidum,	314
Silver, poisoning by	ii. 352
Sinus, how to dilate	ii. 420
Sinus venosus,	ii. 50
Sinuses of the brain,	ii. 293
Sitting,	267
Size of objects,	399
Skeleton, artificial	35
---------natural	35
Skin,	
----physiology of	275
----pathology of	280
Softening of the heart,	ii. 66
Softening of the brain,	357
Solar plexus,	ii. 331
Soleus,	252
Sound, remarks on	379
Spermatic artery,	ii. 270
---------->■ cord,	229
---------vein,	ii. 290
———— nerves,	ii. 333
	
Sphenoidal sinuses,	59
Sphenoid bone,	55
Sphincter vaginae,	234
——---- ani,	235
Spina ventosa,	144
Spinal marrow,	ii. 312
 
461
Spinalis dorsi,
Spinal nerves,
Spine, bones of
------ligaments of
Spiral nerve,
Splanchnic nerves,
Spleen, anatomy, &c. of
------ lymphatics of
.       inflammation of
Splenic artery,
------ plexus,
■       vein,
Splenius,
Spongiosa ossa,
Spots in  the eye,
Stapedius,
Standing on one foot,
Stapes,
Sterno-cleido-mastoideus,
Sterno-costalis,
.----- hyoideus,
------thyroideus,
Sternum,
Stomach, anatomy of,
----.----absorbents of,
--------arteries of,
--------nerves of,
________organic diseases of,
.--------to prepare,
Structure, arrangement of,
Stylo-glossus,
----• hyoideus,
---- pharyngeus,    ,
Subclavian artery,
  _____---------how to tie,
-----—■ vein,
Subclavius,
Sublingual gland,
Submaxillary gland,
Suboccipital nerve,
                      aq2
	217
ii.	313
	80
	157
ii.	323
ii.	331
ii.	128
ii.	305
ii.	177
ii.	266
ii.	332
ii.	128
	194
	73
	398
	180
	267
	54
	185
	219
	187
	187
	97
ii	112
ii	.304
ii	. 265
ii	on 1
ii	. 156
ii	.406
	35
	49
	49
	49
ii	. 253
ii	.425
ii	.291
	218
	409
	409
ii	.314
 
462                  INDEX.
Subscapularis,                                 199
Succussion,                                ii. 104
Superior extremity, arteries of,              ii. 257
---------------bones of,                   1C5
---------------ligaments of,                162
---------------lymphatics of,            ii. 308
---------------muscles of,                 198
----;-----------nerves of,                ii. 322
Supinators,                                   206
Supra-orbitary artery,                       ii. 250
Supra spinatus,                                198
Surgery,                                       14
Sutures, kinds of,                               37
Sympathetic nerve,                     ii. 334 331
Synovia,                                      154
■-----  analysis of,                             154
Synovial organs,                               154
Syphilis,                                   ii. 341
Systems, muscular, nervous, fibrous, and
    vascular, examination of,                ii. 235
Taenia semicircularis,                           315
Tarsus, bones of,                              135
------ ligaments of,                           173
Taste, sense of,                                411
Tears,                                        386
Teeth,                                         ^
Temperaments,                                 30
Temporal artery,                           ii. 248
--------bones,                                47
-------vein,                             ii. 292
Tensor vaginae femoris,                        236
Tentorium,                                    3H
Teres major,                                  199
Testes,                                    jj# ^4
------preparation of,                      ii. 403
------organic diseases of,                  ii. 197
----—- cerebri,                                318
Testicle, physiology of,                     ii. 198
-----— inflammation of,                    ii. 215 
INDEX.
463
Tetanus,                                      271
Thalami optici,                                315
Thigh, luxation of,                             244
------ bone,                                  126
Thoracic arteries,                            ii. 256
--------duct,                              ii. 307
Thorax, anatomy of,                            ii. 1
------  arteries of,                          ii. 262
------  bones of,                               92
------  internal parts of,                       ii. 4
———  ligaments of,                          158
>-----  lymphatics of,                      ii. 310
------  measurement of,                    ii. 103
------  mode of opening,                   ii. 363
.        nerves of,                          ii. 325
------  veins of,                           ii. 295
Throat,                                       414
Thymus gland,                              ii. 76
Thyroid cartilage,                             415
------  gland,                             .   417
Tibia,
artery, superior and inferior,     ii. 245. 254
131
Tibial arteries,                                254
-----------how to tie,          ii. 426, 427, 428
Tibial nerve,                                »>• 338
Tibialis posticus,                             .  252
Tin, poisoning by,                           »• 353
Tinea,                                      ..283
Tintement metallique,                       "■ 88
Tissues, pathology of,                   280.  ii. 239
Tissues,                                    ..    8
.------examination of,                      »• 2il
Toes, bones of,                                140
----ligaments of,                            173
----muscles of,                              253

TOIlffUe'     • A'        f                     US
.------  organic diseases ot,                     ***
Tonsils,                                    ..  4Jj*
Torcular herophili,                          »• ^*
Touch,                                        fl
Trachea, 
464                 INDEX.
Trachea, mode of examining,
Tracheal glands,
Tracheitis,
Tractus optici,
Transversahs abdominis,
----------pedis,
----------fascia,
Transversus perinei,
Trapezium os,
Trephine, remarks on,
Triangularis,
Triceps adductor femoris,
----- extensor cubiti,
Tricuspid valve,
Trochlearis
Trochanter major et minor,
Trunk, muscles of,
Tuber annulare,
Tubercle,
-------of the brain,
Tubercula quadrigemina,
Tubes, Eustachian,
——— Fallopian,
Tunica adnata sclerotica,
------arachnoidea,
■       aranea, vitrea,
------hyaloidea,
------choroidea,
-----vaginalis and albuginea,
Tympanum,
Typhous fever,
Ulna,
Ulnar artery,
U.
to tie
Umbilical cord
-------- artery
--------veins
Unguis, os
ii	366
	418
	i. 16
	316
	223
	258
	223
	234
	119
	62
	219
	236
	205
u	49
	181
	126
	217
	319
n	.308
	360
	318
	51
u	204
	387
	312
	393
	393
	388
n	194
	54
n	349
	114
h	259
n	.422
u.	324
n	221
n	.275
n	221
	66
 
INDEX.
465
 Ureters                                    ii. 184
 Urinary organs in the female                ii. 199
 Urinary system, a sign of disease               333
 Urticaria                                     282
 Uterus                                     ii. 202
 Uterus, arteries of                      ii. 206 274
 ------• nerves of                            ii. 333
 ■------• preparation of                       ii. 408
 ■------■ organic diseases  of                  ii. 206
 ------physiology of                        ii. 206
 ■------pathology of                        ii. 211
 ------cancer of                            ii. 212
 ------fibrous tumour of                    ii. 213
 ------catarrh of                            ii. 214
 ------healthy state of examined,            ii. 225
 ------diseased do.                         ii. 225
 Uvula                                        413

                        V.
 Vaccina                                    ii. 345
 Vagina                                     ii. 205
 ------organic derangements of              ii. 206
 Valves of the heart indurated                 ii. 59
 Valvula coli                                ii. 117
 ■        vieusenii                             319
 Varicella                                   ii. 344
 Variola                                     ii. 344
 Varicose veins                              ii. 296
 Vasa brevia                                ii. 267
 ---- lactea                                 ii. 297
 ----vasorum                               ii. 236
 Vascular and nervous systems, pathology of   ii. 239
 ----------------------------- anatomical
       characters of                         ii. 239
 Vasti muscles                                 248
 Vegetable substances, poisoning by           ii. 355
 Veins, general character of             ii. 237, 284
 ------inflamed                             ii. 239
.,------physiology of                        ii. 284
 Velum pendulum                             413 
466                  INDEX.
Vena cava inferior
---------superior
Vena portae
._____.----to prepare
Venomous insects
Ventricles of the brain
Vertebrae
-------ligaments of
Vertebral arteries
-------- column, mode of opening
.     ----veins
Vesiculae seminales
Vestibule
Viscera, preparation of
Vitreous humour
Voice
---- physiology of
---- passions expressed by
Volar arches
Vomer

                       W.
    ii. 289
    ii. 296
    ii. 122
    ii. 404
    ii. 356
  314, 317
    80,82
       157
ii. 251, 254
    ii. 362
    ii. 292
    ii. 197
       377
    ii. 387
       393
      ii. 70
      ii. 70
       324
     ii. 259
      ii. 74
Walking
Will
Womb
.-----cancer of
.------examination of in health and disease
------fibrous tumour of
Worms
  267
  323
ii. 202
ii. 212
ii. 225
ii. 213
ii. 172
Xiphoid cartilage
97
Yellow fever
ii. 349 
                   INDEX.                467

                      Z.

Zinc, poisoning by                        ii. 353
Zona                                      281
Zygoma                                    48
Zygomatic muscles                          183 
I? 
 
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