WHAT TO OBSERVE IN MEDICAL CASES. 




WHAT to obsekye AT THE BED-SIDE AND AFTER DEATH IN MEDICAL CASES. 
PUBLISHED UNDER THE AUTHORITY OF THE LONDON Tr> MEDICAL SOCIETY OP.pJ^E^V^XLQN t 
MiisN.Mc.lical College 
PHILADELPHIA: BLANCHARD AND LEA. 
III 


\N3B 
U84Tw 1853 
y 2^ '/., JN 
PHILADELPHIA: 
T. K. AND P. O. COLLINS, PRINTERS. 


V 
PREFACE. 
The circumstances under which this little book is published may be very shortly stated. Soon after the Medical Society of Observation had been formed,* it was felt by the members that the labor of analyzing and comparing clinical observations would be greatly lightened, and the precision of the observations themselves increased, if the records of these were in every instance arranged on an uniform plan. The Society in consequence adopted, with some modifications, a form of arrangement of symptoms and after-death appearances, which had been framed by Dr. Walshe. The publication of this form seeming desirable, it was referred to a Committee, who expanded and altered various parts of it, and finally threw it into its present shape. The supervision of the whole was intrusted to Dr. Ballard, who has bestowed,upon his task great labor and attention. 
The Society believes that this scheme or method of arranging the clinical and anatomical phenomena of disease, will prove useful both to those who desire to learn systematically with what amount of detail, and in what order, those phenomena should be 
i The members who took part in founding the Society were —Drs. Walshe, Jepner, Parkes, Beck, Hare, and Sieveking. V A* 


PREFACE. 
VI 
looked for, and also to those who wish to record with accuracy the results of their experience. It will probably be admitted, too, that errors in diagnosis are more frequently traceable to forgetfulness in searching for all possible evidences of disease, than to misinterpretation of those actually discovered: the physician proceeding to the investigation of an obscure case may, then, in a book of the present kind, occasionally find a useful remembrancer. 
The Society is fully aware that many portions of their scheme are far from perfect; but it is hoped that the difficulties of the task, which have been considerable, may be received as sufficient excuse. 
London, November, 1852. 


VII 
CONTENTS. 
PART I. 
* The numbers thus placed refer to the numbered paragraphs of the work. Where the heading of a paragraph is placed between commas, it indicates that the paragraph referred to contains points for observation of special importance in medico-legal inquiries. 
D. Family History op Patient 34 Parents, 34.—Uncles or aunts, 35.—Brothers or sisters, 36.—Children, 37.—Nephews or nieces, 38.—Family diseases and peculiarities, 39. 
C. Previous Sexual Condition 32 Catamenia—antecedents of first discharge—first discharge —subsequent discharges—health in intervals—suspensions—final cessation, 26.—Sexual intercourse, marriage, 27.—Masturbation, 28.—Pregnancies, 29.—Labors, 30.— Miscarriages, 31. —Children, 32.—Lactation, 33. 
B. Previous General Health 31 Infantile health, 24.—Adult health, 25. 
A. Hygeia 29 Parentage, 8.—Infantile management, 9.—Place of birth or former residence, 10.—Present residence, 11.—Trade or occupation, 12.—Food, 13.—Drink, 14.—Clothing and firing, 15.—Cleanliness, 16.—Exercise, 17.—Sleep, 18.— Study, 19.—Medicines, 20.—Habitual use of narcotic drugs, 21.—Peculiar habits, 22.—Venereal indulgences, 23. 
§ II. The Previous History of the Patient 29 
Intellectual and moral peculiarities 28 Intellectual peculiarities, 6.—Moral peculiarities, 7. 
Physical description and peculiarities 25 Kace, 1.*—Sex, 2.—Age, 3.—Anatomical peculiarities, 4.—Physiological peculiarities, 5. 
\ I. The Personal Description and Peculiarities of the Patient in Health 25 
CLINICAL EXAMINATION OF A PATIENT 25 


CONTENTS. 
VIII 
MAI \ III. The Course of Existing Disease prior to the Patient COMING UNDER OBSERVATION 36 Circumstances attending seizure, 40. 
A. Prodromata 36 Atmospheric states and changes, 41.—Exposure, to heat or cold, 42 —Exposure to atmospheric impurities, 43.— Ingesta—food—drinks—medicines, etc., 44.—Sources of mechanical injury, 45.—Alterations in health, 46.—Excesses, 47.—Exposure to epidemic or endemic influences, 48.—Alterations in pecuniary circumstances, etc., 49. 
B. Invasion 38 Symptoms not necessarily peculiar to any particular disease—symptoms connected with particular organs, 50.— Mode of progress of disease, 51. 
C. Progress of Case up to Time of Observation 38 Order of symptoms, etc.—how long off work, etc., 62. 
\ W. Condition of the Patient at the time of Observation 39 
A. Generalities 39 State of nutrition, 53.—Strength, 64.—Walk, 55.—Weight, 56.—Posture, 57.—Expression of countenance—face— features—eyes—lips—jaws, 58.—General sensations, 59.— Rigors, 60.—Spirits, 61.—Temper, 62. 
B. Integument and its Appendages 40 
Generally 40 Surface, 63.—Color—generally—locally, 64.—Temperature, 65.—Cuticle, 66.—Sebaceous follicles—oiliness, 67. — Perspiration, 68. — Vascularity, 69. — Contusion and pressure marks, 70.—Old scars and marks of previous disease, 71.—Hair—on head—on other parts, 72.—Nails, 73.—Subcutaneous cellular tissue, 74.—"Serum of vesications," 75.—Sensibility, 76. 
Special Eruptions 43 Locality of eruption, 77.—Forms of eruption—flat or minutely rough — elevated—depressed or with ulceration, 78.—Cicatrices, 79.—Alterations of sebaceous follicles, 80.—Alterations of hair, 81.—Alterations of nails, 82. 
C. Organs of Locomotion 46 Joints, 83.—Bones, 84.—Periosteum, 85.—Tendinous and fibrous structures, 86.—Muscles, 87. 
D. Organs of Digestion 47 
Mouth 47 ''Lips—labial glands," 88.—Gums, 89.—Teeth—mastication, 90.—"Cheek, palate, cavity of mouth—buccal membrane"—buccal glands—Steno's ducts, etc., 91.—Tongue — papillse — furs — sensations, etc., 92.—Protrusion of tongue, 93.—Odor of breath, 94.—Taste in mouth. 95. 


CONTENTS. 
IX 
PAGE Salivary Glands 49 Parotid, 96.—Sublingual, 97.—Submaxillary, 98.—Saliva, 99. 
Throat, etc 50 Uvula, 100.—Soft palate, 101.—Fauces, 102.—Tonsils, 103.—" Pharynx," 104.—(Esophagus, 105.—Deglutition, 106. —Regurgitation—regurgitated matters, 107. 
Physical examination of the Abdomen generally 51 Inspection, 108.—Measurement, 109.—Palpation, 110.— Percussion, 111.—Auscultation, 112. 
Physical examination of the Liver, Gall-bladder, and Ducts 65 Inspection, 113.—Palpation, 114.—Percussion, 115.—Auscultation, 116. 
Physical examination of the Spleen 57 Inspection, 117.—Palpation, 118.—Percussion, 119.—Auscultation, 120. 
Physical examination of the Stomach 57 Inspection, 121.—Palpation, 122.—Percussion, 123.—Auscultation, 124. 
Physical examination of the Colon, Rectum, and Anus 58 Inspection—examination by speculum, 125.—Palpation— examination per anum —examination by bougie, 126.— Percussion, 127.—Auscultation, 128. 
Physical examination of Abdominal Tumors 69 Inspection, 129.—Palpation, 130.—Percussion, 131.—Auscultation, 132. 
General Symptoms referable to the Abdomen 62 Abnormal sensations—pain, etc., 133.—Tenderness, 134. —Appetite—weight of food eaten—nature of food, 135.— Thirst—quantity drunk—nature of drink, 136.—Nausea, 137.—Vomiting, 138.—" Vomited matters," 139.—Eructation or regurgitation—eructated or regurgitated matters, 140.— Hiccup, 141.— Defecation, 142.—" Stools — their constituents, etc.," 143.—Anus, 144. 
Results of Paracentesis Abdominis 67 Operation, 145.—Matters removed, 146.—Physical examination of abdomen after tapping, 147. 
E. Organs of Respiration 68 
Hares, etc 68 Nares —discharge from them—hemorrhage—movements of alse, 148.—Sensibility, 149.—Sneezing, 150.—Frontal sinuses, 151. 
Upper Air-Passages and Vocal Apparatus 69 Examination of throat externally — size of larynx and trachea, etc.—manual examination—percussion—auscultation, 152.—Epiglottis, 153.—Glottis, 154.—Sensibility, 155.—Voice, 156.—Other symptoms, 157. 


CONTENTS. 
X 
PAGE Physical examination of the Lungs, Pleura), etc 70 Inspection, 158.—Measurement—chest-measurer—spiro- 159. —Palpation, 160.—Percussion, 161.—Auscultation, 162. 
General Thoracic Symptoms 73 Pain in chest—other sensations, 163.—Tenderness, 164.— Cough, 165.—Expectoration, 166.—Sputa, 167.—Expectoration of blood, 168.—Respiration—dyspnoea, etc., 169. —Expired air, its characters, 170. 
Results of Paracentesis Thoracis 76 Operation, 171. —Matters removed, 172. 
Diaphragm 76 Level of diaphragm—pain—hiccup—movements, 173. 
F. Organs op Circulation.—Blood 76 
Physical examination of the Heart and Pericardium 76 Inspection, 174.—Measurement, 175.—Palpation, 176.— Percussion, 177.—Auscultation—sounds—murmurs, 178. 
General Cardiac Symptoms 79 Pain—other sensations—tenderness, 179.—Palpitation, 180. 
Arteries 79 Inspection, 181.—Palpation, 182.—Auscultation, 183.— Radial Pulse, 184. 
Swellings connected with Arteries 80 Inspection, 185.—Palpation, 186.—Measurement of tumor, 187.—Percussion, 188.—Auscultation, 189.—Rupture of swelling, 190.—Abnormal sensation, 191. 
Veins 81 Inspection, 192.—Palpation, 193.—Auscultation, 194.— Condition of skin over veins, 195. 
Swellings connected with Veins 81 Physical examination, 196.—Abnormal sensations, 197. 
Blood 82 Phlebotomy or arteriotomy—circumstances of—condition of patient, etc., 198.—Characters of blood drawn—process of coagulation—clot—serum, 199.—Microscopical examination of blood —from finger of patient—drawn from a vein, 200.—Chemical examination of blood, 201. 
Q. Lymphatic System 83 Lymphatic vessels, 202.—Lymphatic glands, 203. 
H. Urinary Organs.—Urine 84 Physical examination of the Kidneys, Suprarenal Capsule, and 
Ureters 84 Inspection, 204.—Palpation, 205.—Measurement, 206.— Percussion, 207.—Auscultation, 208. 
Physical examination of Bladder and Prostate Gland 85 Physical examination of hypogastric region—inspection— palpation—percussion—auscultation, 209.—Examination 


CONTENTS. 
XI 
PAGE through rectum, 210.—Examination through vagina, 211. —Catheterism, 212. 
Physical examination of Urethra 85 Inspection—discharge—stains on linen, 213.—Palpation, 214.—Catheterism, 215. 
General Symptoms referable to the Urinary Organs 86 Pain—other sensations, 216.—Tenderness, 217.—Micturition, 218.—Hsematuria, 219. 
Urine 87 Quantity, 220.—Characters of urine, 221.—Microscopical examination, 222.—"Chemical examinations," 223. 
I. Organs of Generation 88 
1. Female 88 
Pudendum........ 88 Labia, nyinphse, and clitoris, 224.—Abnormal sensations, 225.—Urethral orifice, 226.—" Hymen," 227.—Protrusion from vulva externally, 228. 
Examination by the touch, through the Vagina 89 Vagina—orifice—direction, etc., 229.—Urethra, 230.— Bladder, 231. —Uterus—neck—lips—orifice—body—cavi; ty, 232.—Tumors felt through wall of vagina—ovaries and Fallopian tubes, 233. 
Examination through the Vagina and Abdominal Wall conjoined 92 Continuity of tumor—size, etc., 234. 
Examination by the touch, through the Rectum 92 Introduction of finger—of bougie, 235.—Uterus—ovaries and Fallopian tubes, 236.—Bladder, 237.—Tumor, 238. 
Examination through the Rectum and Abdominal Wall conjoined 93 Particulars, 239. 
Examination through the Rectum and Vagina conjoined. 93 Thickness between fingers, etc., 240. 
Examination by the Uterine Sound 93 Introduction of sound —uterine cavity—thickness of wall, etc., 241.—Movableness of uterus, 242. 
Examination by the Speculum 94 Introduction of speculum, 243.—Vagina—surface—openings, etc., 244. —Orifice of uterus, 245.—Lips and neck of uterus, 246. 
General Symptoms referable to the Female Generative Organs 94 Catamenia—periods, etc.—physical characters of fluid— suppression, 247.—Hemorrhage, 248.—Liquid discharge from vagina—circumstances—characters, 249.—Discharge of gas from vagina, 250.—Solid or organized matters discharged from vagina, 251.—Pain in vagina, 252.—Uterine pain, 253.—Itching, 254.—Sexual intercourse, 255. 
Mammas 96 Physical characters of mammae — nipple — areola — substance of gland, etc., 256.—Pain in breast, 257. 


CONTENTS. 
XII 
PAGE 2. Male 97 Scrotum, 258.—Testicles, 259.—Penis, 260.—Spermatorrhoea, 261. 
K. Encephalon, and its Coverings and Appendages 98 
Examination of Cranium, etc 98 Cranium —form—measurement —bones—fontanelles, 262. —Integuments—temperature, etc.—hair, 263.—Tumors, 264.—Auscultation, 265. 
Alterations of Sensibility 99 Pain in head, 266.—Altered sensibility of skin—increased —diminished—perverted, 267.—Muscular sense, 268.— Other alterations of sensibility, 269. 
Alterations of Motility 101 Attitude—erect—in decumbency—in sitting—in progression, 270.—General muscular agitation—tremblings—muscular twitchings—unsteadiness of limbs, 271.—Automatic movements, 272.—Slow movements of extension or of . flexion, 273.—Power of directing movements injured, 274. —Rigidity, 275.—Spasmodic contractions, 276.—Convulsion—antecedents—phenomena—sequences, 277.—Other reflex phenomena—strabismus, etc., 278.—Cataleptic immobility, 279.—Paralysis—limbs—thorax and abdomen— face—tongue—articulation—muscles of deglutition—stomach—rectum—anus—bladde —larynx, 280.—Muscular irritability of paralyzed parts, 281. 
Symptoms referable to the Intellectual and Moral Faculties 105 Consciousness, 282.—Sleep, 283.—Dreaming—incubus— somniloquism — somnambulism, 284.—Behavior, 285.— Temper, 286.—Spirits, 287.—Attention—exaggerated— defective — perverted, etc., 288.— Apprehension, 289.— Memory — exaggerated — defective — perverted, 290. — Speech, 291.—Conversation, 292.—Confessions and complaints of patient respecting his mental condition, 293.— Disordered judgment—reasoning, 294.—Fixed delusion or predominance of one idea, etc., 295.—Hallucinations and illusions, 296.—Vertigo, 297.—Delirium, 298.—Alterations in moral feelings and affections, 299. —Sexual passion, 300. 
L. Spinal Cord, its Coverings and Appendages 112 
Physical examination of the Spinal Column 112 Curves — antero-posterior—lateral, 301. — Spinous processes, 302.—Vertebral grooves, 303.—Tumor, 304.—Fistulous openings, etc., 305.—Other appearances, 306.— Examination of spine anteriorly, 307.—Percussion, 308. 
General Symptoms referable to the Spinal Cord, etc 113 Manual examination of spinal column—by finger—by percussion, etc., 309.—Local spontaneous pain, 310.—Alterations of sensibility, 311.—Alterations of motility, 312. 


CONTENTS. 
xiii 
A. Generalities 126 Sex, 344.—Apparent age, 345.—"Posture of body," 346. —"Expression of countenance," 347.—Measurements of 
§ II. Points to be noted during an Examination 126 
§ I. Points to be ascertained and noted prior to commencing an Examination 123 Name, 329.—Date of death, 330.—" Date of examination," 331.—Weather—temperature, 332.—"Medium in which body has lain," 333.—"Substance on which body has lain," 334.—Posture of body, 335.—"Position of body in relation to the room, etc," 336.—"Odor in the room," 337.— " Clothing on and near the body—stains of various kinds," 338.—" Degree of manipulation to which the body has been exposed," 339.—"Cord, etc. roundneck," 340.—"Articles about the body," 341.—Feces and urine found under the body, 342.—" Exhumation of body," 343. 
EXAMINATION OF A BODY AFTER DEATH 123 
PAKT II. 
Progress of case—diet, regimen, external applications and internal medicines—phenomena of death 121 
0. Vascular Glands 120 Thyroid gland—thymus gland, 327.—Suprarenal capsule, 328. 
N. Nerves 120 Pain—other sensations—tenderness, etc., 326. 
Organ of Vision and its Appendages 117 Eyebrows—eyelids—eyelashes—tar sal cartilages, etc., 321. —Eyeball generally—conjunctiva — sclerotica—cornea— iris—pupils, etc., 322.—Tears, 323.—Pain—sensibility to light, 324.—Sense of sight, 325. 
Organs of Hearing 115 Physical examination—external ear—mastoid process— meatus externus—Eustachian tube—membrana tympani, 318.—Pain referred to the ear, 319.—Sense of hearing, 320. 
Organs of Taste 115 Physical examination, 316.—Sense of taste, 317. 
Organs of Smell 115 Physical examination, 314.—Sense of smell, 315. 
Organs of Touch 115 Particulars, 313. 
PAGE M. Organs of the Senses 115 


CONTENTS. 
XIV 
PAGE body, 348.—Weight of body, 349. — " Striking individual peculiarities," 350.—Temperature of body, 351.—Cadaveric rigidity, 352.—Nutrition of body, 353.—"Putrefaction of body," 354. 
B.—Integument, and its Appendages 127 "Color of surface," 355.—" Cuticle," 356.—"White lines," 357.— " Contusions," 358 — " Eruptions, etc.," 359.— "Burns," 360.—"Mark round neck," 361.—"Wounds, cicatrices, etc.," 362.—"Hair," 363.—"Nails," 364.— (Edema,865. —Emphysema, 366.—Subcutaneous fat, 367. 
C. Organs of Locomotion 130 "Muscles," 368.—Tendons and aponeurosis, 369.— "Bones—fractures—peculiarities connected with age and sex, etc." 370.—Thoracic cartilage, 371.—Intervertebral substance, 372.—Joints, 373. 
D. Organs of Digestion 133 
Mouth 132 "Lips," 374.—"Jaws," 375.—" Cavity of mouth," 376.— " Gums," 377.—"Teeth," 378.—Cheeks, 379.—"Tongue," 380.—Hard palate, 381. 
Salivary Glands and Ducts 134 Glands (Parotid, Sublingual, and Submaxillary). 382.— Ducts, 383. 
Throat, etc 134 Fauces, 384.—Uvula and velum pendulum palati, 385.— "Tonsils," 386.—"Pharynx"—pharyngeal muscles, 387. —"(Esophagus," 388. 
Abdomen generally 136 External characters, 389.—"Umbilical cord," 390. 
Peritoneum 137 Contents, 391.—Condition of membrane, 392.—Hernise, 393.—Tumors, 394.—Subperitoneal tissue, 395.—Mesenteric and other lymphatic glands, 396. 
Stomach 137 External characters, 397.—"Contents," 398.—"Mucous membrane," 399.—Muscular coat, 400.—"Substance of wall of stomach," 401.—Cardiac opening, 402.—Pylorus, 403. 
Intestines generally 140 External characters, 404. — "Contents," 405.—Mucous membrane; secretions, etc., on surface of, 406.—Muscular coat, 407.—"Substance of wall of intestine," 408. 
Special portions of Intestines 142 Duodenum—Brunner's glands, 409. — "Jejunum and ileum—valvulae conniventes—villi—Peyer's patches— solitary glands—crypts of Lieberkiihn," 410. — Csecum— appendix vermiformis — ileo-csecal valve, 411.—Colon— solitary glands, 412.—Rectum, 413. 


CONTENTS. 
XV 
. PAGE Liver 144 External characters, weight, measurements, form, etc., 414—Capsule, 415. — Substance, 416. — "Veins, 417.— Hepatic ducts, 418. 
Gall-bladder 146 External characters, 419.—Cavity, 420.—Walls, 421.— Ductus communis choledochus —cystic duct, 422. 
Spleen 147 External characters, 423.—Substance, 424. 
Pancreas 147 External characters, 425.—Substance, 426.—Duct, 427. 
E. Organs of Respiration 148 External characters of thorax, 428. 
Pleurae 148 Contents, 429. — Condition of membrane, 430. — Subpleural tissue, 431.—Subjacent bony and muscular parietes of thorax, 432. 
Hares 148 Malformations—closure, etc., 433.—Bones, 434.—Mucous membrane, 435. 
Larynx, Trachea, and Bronchial Tubes 149 Generalities, 436.—Larynx (epiglottis, rima glottidis, cartilages, etc.), 437.—" Trachea," 438.—"Bronchial tubes," 439. 
Lungs 150 Examination in situ, 440.—"External characters," 441. —Substance, 442.—Extravasation of blood, 443.—Adventitious products, 444.—Cavities, 445.—"Hydrostatic test," 446. 
Diaphragm 153 Position—substance, 447. 
F. Organs of Circulation 154 
Pericardium 154 External characters, 448.—Contents, 449.—Internal surface, 450. 
Heart 154 Examination in situ —position—shape—measurements, etc., 451.—Examination after removal, 452.—Right auricle, 453.—Right auriculo-ventricular opening, 454.—Right ventricle, 455.—Tricuspid flaps, 456.—Sinus arteriosus, 457.—Pulmonary opening, 458.—Pulmonary valves, 459. —Left auricle, 460. —Left auriculo-ventricular opening, 461.—Left ventricle—septum ventriculorum, 462.—Mitral flaps, 463.—Aortic opening, 464.—Aortic valves, 465.— Coronary arteries, 466.—Substance generally—wounds— growths, etc., 467. 


CONTENTS. 
XVI 
PAGE Arteries 158 Examination before opening vessel, 468.—Examination after opening vessel, 469.—"Ductus arteriosus," 470.— Microscopical characters, 471. 
Dilatation of Arteries, and Aneurisms 159 External characters, 472.—Characters after opening dilatation, 473. 
Veins 160 Examination before opening vessel, 474.—Examination after opening vessel, 475. 
Blood 161 " Physical characters," 476 
G. Lymphatic System 161 
Lymphatic Glands 161 Characters observed before section, 477.—Characters observed after section, 478.—Special lymphatic glands— cervical—axillary, etc., 479. 
Lymphatic Vessels 162 Size, consistence, etc.—lymph, 480 
Lacteal Vessels 162 Particulars, 481. 
H. Urinary Organs 163 
Kidneys'and Ureters.] 163 Absence, etc., 482.—External characters—position—size, etc., 483.—Capsule, 484.—Surface of kidney after removal of capsule, 485.—Substance of kidney, 486.—Cut surface, 487.—Cortical substance, 488.—Pyramidal portion, 489. —Mammillae, 490.—Abnormal growths and deposits, 491. —Pelvis of kidney, 492.—Ureters, 493. 
Urinary Bladder 165 External characters—size—position, etc., 494.—Contents —urine, etc., 495.—Walls, 496.—Mucous membrane, 497. 
Urethra 166 Direction—calibre, etc., 498.—Mucous membrane, 499.— Contents, 500. 
I. Organs of Generation 166 
1. Female 166 
Pudendum 166 "Labia, nymphae, and clitoris," 601.—Urethral orifice, 502.—" Hymen," 503. 
Vagina 167 "Malformations—length, etc.," 504. 
Examination of Internal Organs of Generation in situ 167 Uterus, 505.—Fallopian tubes, 606.—Ovaries, 607.—Pelvic tumor, 508. 


CONTENTS. 
XVII 
PAGE Uterus (after removal) .... 168 Orifice, 509.—Lips, 510.—External characters of uterus generally—weight—measurements — form, etc., 511.— Characters observed on section—uterine cavity, 512. 
Fallopian Tubes 169 Calibre—contents, etc., 513. 
Ovaries 169 External characters, 514.—Characters of section, 515. 
Mammce 171 External characters —nipple—areola, etc., 516.—Section of gland, 517. 
2. Male 171 Inguinal canal, 518.—Testicles, 519.—Vasa deferentia, 520.—Spermatic cord, 521.—Tunica vaginalis, 522.— Vesiculse seminales, 523.—Prostate gland, 524.—Penis, 525. 
K. Encbphalon, and its Coverings and Appendages 172 "External examination of integument and cranium," 526.—"Scalp," 527—"Cranium," 528.—Dura mater, 529. —Arteries at base of brain, 530.—Arachnoid membrane, 531.—Subarachnoid serosity, 532.—Pia mater, 533.—Sinuses of dura mater, 534. 
Brain 176 Generalities—weight, etc., 535. 
Cerebrum Points to be observed before removal of arachnoid and pia mater, 536.—Parts at base of brain, 537.—Removal of arachnoid, 538.—"Convolutions externally," 539.— Section of convolutions, 540.—White substance of hemispheres, 541.—Extravasations of blood, 542.—Cavities in cerebral substance, 543.—Cicatrices in cerebral substance, 544.—Wounds of cerebral substance, 545.—Adventitious products, 546.—Minute vessels of brain, 647. —" Lateral ventricles, velum interpositum, etc.," 648.— Septum lucidum—fifth ventricle, 549.—Fornix, 550.— Third ventricle, 551.—Optic thalami and corpora striata, 552.—Condition of parts on upper surface of pons Varolii—pineal gland, etc., 553. 
Pons Varolii 181 External characters, 554.—Appearances on section, 555. 
Medulla Oblongata 182 External characters, 556.—Fourth ventricle, 557.—Section of medulla oblongata, 558. 
Cerebellum 182 External characters, 659.—Section of cerebellum, 560.— Peduncles of cerebellum, 561. 


CONTENTS. 
XVIII 
PAGE L. Spinal Cord, and its Coverings and Appendages 183 Integuments over spine, 562.—Vertebrae, 563.—Intevertebral substance, 564.—Vertebral canal, 565.—Theca vertebralis, 566.—Spinal arachnoid membrane, 567.— Cerebro-spinal fluid, 568.—Ligamentum denticulatum, 569.—Pia mater, 570. 
Spinal Cord 184 External characters, 571.—Section of cord, 672.—Roots of nerves, 573.—Cauda-equina, 574. 
M. Organs of the Senses 184 
Organs of Touch 184 Integument—nerves, 575. 
Organs of Smell 184 Nares—Olfactory nerves, 676. 
Organs of Taste 185 Tongue and fauces—nerves, 577. 
Organ of Vision and Us Appendages 185 "Eyelids," 578.—"Eyeball"—optic nerve, 579. 
Organ of Hearing and its Appendages 185 External ear, 580.—External meatus—tympanic membrane, 581.—Internal ear—Eustachian tube, 582.—Osseous structures, 583.—Auditory nerve, 584. 
N. Nerves 186 
Nerve 186 External characters, 585.—Neurilemma, 586.—Nerve tissue, 587. 
Ganglion 187 External characters, 688.—Sheath of ganglion, 589.— Section of ganglion—'microscopical characters, 590. 
0. Vascular Glands 187 Thymus gland, 591.—Thyroid gland, 592. —Suprarenal capsules, 993. 


CONTENTS. 
XIX 
APPENDIX. 
Perforations 198 Number—form—edges—direction, etc., 625. 
Ulcers 197 Number, etc.—edges—floor—granulations, 624. 
Mortification — Gangrene — Sphacelus 196 External characters, 618.—Line of demarcation, 619.— Dissection, 620.—Motility and sensibility, 621.—Marks of injury, etc., 622.—Surrounding parts, 623. 
Fistula) 195 Orifices, 613.—Fistulous passage, or canal—termination —internal orifices, 614.—Lining membrane, 615.—Discharge, 616.—Surrounding tissues, 617. 
Abscess 194 Diffused, 606.—Circumscribed, 607.—Opening, 608.— Walls, 609.—Contents, 610.—Cicatrix, 611.—Condition of parts surrounding abscess, 612. 
Adhesions 194 Situation—color, etc., 605. 
Lymph and other Exudations 193 Amount — color — form — distribution — adhesion, etc., 603.—Substance of lymph or exudation, 604. 
Purulent-looking Fluid 193 Quantity—color, etc.—deposit, etc., 602. 
Serosity 193 Amount—odor, etc.—chemical characters, etc., 601. 
Redness 192 Situation—extent—hue—form, etc., 600. 
Serous Membrane 190 Contents—gas—liquid matters—solid matters—blood, 597.—Condition of membrane—adhesions—false membranes—color, etc., 598.—Subserous tissue, 599. 
PAGE Mucous Membrane 189 " Secretions and exudations on surface—mucus-—lymph —blood," 594.—Condition of membrane—color—transparency—hemorrhagic spots—surface—epithelium, etc., 595.—Submucous tissue, 596. 


CONTENTS. 
XX 
PAGE Wounds 198 "Facts ascertainable before dissection—number—seat— form — direction — edges, etc.," 626. — " Facts ascertainable by dissection—depth—parts divided —adhe- etc." 627.—"Examination of a weapon, if any discovered," «28. 
Cicatrices 200 On the surface of structures, 629.—In the substance of organs, 630. 
Tumors 201 Number—size, etc., 631.—Superficial characters—surface—smoothness—color, etc., 632.—Characters on section or fracture, 633. 
Cysts 202 Number—situation—size, etc., 634.—Walls of cyst, 635. —Contents of cyst—hair—teeth—bones, 636.—Secondary cysts, 637. 
Cancer or cancerous-looking Matter 203 External characters, 638.—Characters on section—loculi, etc., 639.—Characters on fracture, 640.—Effects of pressure, 641.—Chemical characters, 642.—Microscopical characters, 643. 
Tubercle, or tubercular-like Bodies 204 Situation—size—color—consistence, etc., 644. 
Microscopical Characters 205 Granules—effect of reagents, 645.—Fibres—effect of reagents, 646.—Cells—cell-wall—contents—nucleus—nucleolus—effect of reagents, 647.—Crystalline or amorphous saline bodies, 648. 


C 
25 
WHAT TO OBSERVE 
IN MEDICAL CASE^r 
PAKT I. 
CLINICAL EXAMINATION OF A 
PATIENT 
§ I.—The Personal Description and Peculiarities or the Patient in Health. 
[Individual peculiarities form part of the healthystandard by which the morbid character of observed phenomena is tested. 1 ] 
Physical description and peculiarities. 
1. Race: —country of birth. 
2. Sex: —degree in which sexual characters are marked (general conformation, external sexual organs, mammae, voice, beard, pubic hair, etc.). 
3. Age —real and apparent. 
4. Anatomical peculiarities — 
Height; — width from acromion to acromion. 
Form of trunk: natural curves of spine, anteroposterior and lateral dorsal; apparent relative 
1 From particulars of this kind the " temperament" of an individual is determined. 
Physical peculiarities. 
Race. 
Sex. 
Age. 
Anatomical peculiarities: height: width: form of trunk. 



§1] 
THE PERSONAL DESCRIPTION AND 
[PART I. 
26 
size and length of thorax and abdomen; patient high-shouldered or not? 
Measurements: of head; circular (over superciliary ridges and occipital protuberance), across vertex (from ear to ear), along middle line (from root of nose to occipital protuberance) :—of neck; circumference opposite cricoid cartilage;—of trunk; circumference opposite ensiform cartilage, midway between nipples aud clavicles, at margin of false ribs, at level of umbilicus. 
measurements: of head. 
of neck. of trunk. 
Limbs: well or ill formed? proportional and symmetrical or not ? 
limbs. 
weight. 
Weight. 
muscular development. 
Muscular development (in trunk and limbs) : its degree; proportional or not in upper and lower extremities ? symmetrical or not on the two sides of body? 
Cellulo-fatty development: its amount; uniform or affecting a particular locality ? 
cellulo-fatty development. 
skin. 
Skin: its color; apparent coarseness or fineness; visibility of subcutaneous veins.—Development of hair, on the head and elsewhere; its color; arrangement and mode of growth. —Complexion. 
hair. 
complexion, countenance. 
Countenance of patient: its physiognomical expression.—Prominence of eyes; color and vascularity of conjunctivae; color of irides, alike or not in the two eyes? various in different parts of the same iris; size of pupil.— Thickness of lips, etc. 
eyes. 
lips. 
form of hands, etc. 
Form of hands, fingers and feet; conformation of nails; condition of skin on hands, etc.; connection of the above with habits and occupation of the individual. . 


PART I.] 
[§ I 
PECULIARITIES OE THE PATIENT. 
27 
5. Physiological peculiarities — 
Skin: its ordinary condition as to moisture and greasiness; readiness to sweat under exertion; proneness to sweat in certain localities, under what circumstances ?—characters of sweat as to abundance, odor, acidity, etc. 
Muscular strength (measured by dynamometer) : comparative strength of the two sides; power of enduring continued muscular exertion, whether of upper or lower extremities most remarkable ?—Patient right or left-handed ? 
Digestive system: natural amount of appetite; which is the principal meal ?—is any kind of food naturally and habitually avoided, and why ? is any followed constantly by symptoms of disease? —Natural degree of thirst. —Ha- condition of the bowels, frequency and character of the stools. 
Circulating system, etc. : sensibility to changes of temperature or of hygrometric state of atmosphere ; readiness of reaction after chilling the surface; habitual warmth or coldness of feet and hands; habitual character of the pulse as to frequency, fulness, force, and regularity ; —tendency to blushing. 
Urinary system: habits of voluntary retention of urine or of frequent micturition ;—readiness with which diuresis is produced by mental affections. 
Generative system: sexual peculiarities; natural force of instinct.—Catamenia (26). 
Nervous system: nervous excitability; habitual effect of mental influences on the pulse and respiration; habitual wakefulness or readiness to slgep; quickness or hebetude of senses. 
Physiological peculiarities: skin. 
sweat. 
muscular strength. 
digestive system. appetite. 
thirst. 
state of bowels. 
circulating system. 
urinary system. 
generative system. 
nervous system. 


§!•] 
INTELLECTUAL AND MORAL PECULIARITIES. [PART I. 
28 
Intellectual and Moral peculiarities. 1 
Intellectual and Moral peculiarities. 
Intellectual peculiarities. 
6. Intellectual peculiarities: amount of education ; readiness to learn; character of favorite studies or reading; habit of reading popular medical works. —Habits of business; power and habit of concentrating attention. —Readiness of conception.—Memory, generally or in respect of special subjects.—Reasoning powers and judgment; habitual character of association of ideas, philosophical, etiological, utilitarian, poetical, trivial, etc. —Power of imagination.—Power of language and expression. 
Moral peculiarities. 
7. Moral peculiarities: general behavior.—Disposition cheerful or melancholy; communicative, reserved or sulky; social or retiring ?—Inquisitive or careless; closely observant or not of the state of the bodily functions and of variations in health ? —Amount of ambition, its direction ; vanity ; selflove; love of applause; excess or deficiency of the above principles.—Natural boldness or timidity; fortitude.—General benevolence or malignity of disposition; readiness with which the passions are excited.—Force of domestic affections; of sexual love.—Force of sense of duty or of the moral sense; religious feeling; candor; integrity; veracity, or tendency to deceit and cunning.—Natural sympathy; tendency to imitation.—Prudence.—Tastes, etc. 
1 This subdivision has especial, but not sole, reference to cases of insanity; every man having his own standard of psychical health, by which presumed aberrations aro to be judged. 


PART I.] 
[§ II- A 
HYGEIA. 
29 
c* 
§ II.—The Previous History of the Patient. 
(Note from whom the particulars have been derived.) 
A.—HYGEIA. 
8. Parentage: —what child (first, second, third, etc.) ?—Age of parents at birth of patient.—Any known peculiarity, physical, intellectual, or moral, in either parent at time of conception, or of birth. 
9. Infantile management: —nursed by mother; by some other person : for what period ?—brought up by hand, entirely or partially. 
10. Place of birth or of former residence: — length of time resident in each; —ever abroad, or in intertropical climates ? 
11. Present residence: —for what period? if in London or some other large town, how long resident there?—Dimensions of residence; —its ventilation, lighting, warming, etc. —its position, on high or low ground? its aspect. —Drainage; neighborhood of fens, standing or running water, sewers, cesspools, trees or buildings.—Exposure to noxious gases and vapors, animal, vegetable, or inorganic (from manufactories, etc.). —Number of occupants in house or apartment, by day and by night. 
12. Trade or occupation : —age at which commenced.—Change of occupation at any time, and the reason of it. —Precise character of work; hygienic condition of work-room (11); habitual exposure to cold and wet. —Posture during work; 
i II. A. 
Parentage. 
Infantile management. 
Place of birth or of former residence. 
Present residence— duration. dimensions, etc. 
drainage, etc. 
malaria. 
number of occupants. 
Occupation. 
character. 
posture during. 


§ n. A.] 
[part I. 
HYGEIA. 
30 
hours. 
wages. 
Foodquantity, quality. 
meals. 
mastication. 
Drink— quantity, quality, intoxicating drinks. 
strong tea or coffee. 
Clothing and firing. 
tight ligatures, bedding. Cleanliness— of person. 
bedding. 
habitation. 
Exercise. 
Sleep. 
pressure made on any part of body.—Number of hours employed, by day and by night.—Weekly wages : number of persons dependent on individual; whether without work of late or at any other time? 
13. Food: —quantity obtainable or habitually taken.—Quality; frequency of animal food, of salted food; vegetables taken in sufficient quantity or scantily.—Meals; their number, regularity; hours of meals; time given to each. —Mastication of food. 
14. Drinh: —quantity habitually taken.—Quality; water or alcoholic beverages.—Time of day when alcoholic drinks are taken; taken in place of food; before, with, or after meals.—Habit of tippling (liquor commonly used) ; habit and frequency of intoxication.—Habitual use of strong tea or coffee, cool or very hot ? 
15. Clothing and firing: —sufficient or not, by day and by night ? use of flannel clothing; clothing of feet. —Habitual use of tight stays or neckcloths.—Sufficiency of bedding and bedclothes. 
16. Cleanliness: —of person; habitual change of clothing; ablutions; habitual use of baths, and of what kind ? of sea-bathing;—of bedding and bedclothes; their saturation with urine, discharges, etc.; purification of them; of habitation; flooring, walls; frequency of whitewashing; if a public institution, the use of water or dry rubbing in cleansing the wards ? etc. 
17. Exercise: —number of hours devoted to it; place ; time of day; special character of exercise. 
18. Sleep: —number of hours habitually taken; period of twenty-four hours in which taken; rest habitually broken or undisturbed ? 


PART I.] 
[§ B 
PREVIOUS GENERAL HEALTH. 
31 
19. Study: —number of hours habitually devoted to it; its special nature and object. 
20. Medicines or other therapeutical agents habitually used (purgatives, issues, blisters, bloodletting, chloroform, etc.); ostensible reason for their use. 
21. Habitual use of narcotic drugs, etc. —Opium, quantity used (stating whether the information is derived from the patient or from other sources); how long habituated to it ?—Tobacco; mode of using it (by smoking, snuffing, or chewing) ; quantity used daily or weekly; habitually used before or after meals. 
22. Peculiar habits. 
23. Venereal indulgences; habitual frequency. —Masturbation (28). 
B. —PREVIOUS GENERAL HEALTH. 
24. Infantile health. — Vaccination; age at which performed; its success. —Revaccination; age at which performed; its success; —character of cicatrices. —Variolous inoculation; age at which performed; severity or mildness of disease ; number of pustules; —character of cicatrices.—Principal diseases from which patient has suffered (scalp diseases; sore eyes, ears, lips, nose; glandular swellings; tumid abdomen; worms; fits or convulsions ; laryngismus stridulus; measles; scarlatina ; smallpox; hooping-cough) ; —dates of occurrence, duration, severity, and sequelae of each. —Dentition; period of commencement of first and second; —their connection in point of time with diseases of patient. 
Study. 
Medicines. 
Narcotic drugs— opium. 
tobacco. 
Peculiar habits. 
Venereal indulgences. 
§ II. B. 
Infantile health— vaccination, re vaccination variolous inoculation. 
diseases. 
dentition. 


§ n. c] 
[PART I. 
PREVIOUS SEXUAL CONDITION. 
32 
Adult health diseases. 
treatment. 
previous attacks similar to the present. 
I II. C. 
Catamenia— antecedents of first discharge. 
first discharge • date. character. 
25. Adult health. —Diseases from which patient has suffered (general loss of strength, color, spirits, etc.; local or general pains; fevers; inflammations; hemorrhages, from mouth, gums, nose, lungs, stomach, bowels, urinary or genital organs, skin, frequency and amount of them; colds; coughs; gastro-intestinal derangements; piles, etc.; rheumatism, acute or chronic, with or without probable cardiac complication as judged of by the employment of cupping, leeching, or blistering, over the region of the heart during treatment of one or more attacks; delirium tremens; special diseases arising from trade, c. g., lead-colic; hysterical or other fits; menstrual derangements ; venereal diseases, their sequela); ulcers, scars observable; hernia; accidental injuries, to great cavities, etc.); —precise period at which each occurred; its duration, severity, sequelae, repetition. — Treatment adopted, especially venesection and salivation.— Previous attacks of disease similar to the present. 
C.—PREVIOUS SEXUAL CONDITION. 
26. Catamenia. — An tecedents of Jtrst discharge: social condition and habits; —increase of amusement, dancing, active work or idleness, novel reading, society of males; —improvement in diet, clothing, bedding, residence, etc.; —bodily or mental phenomena observed (propensity to solitude or other marked alteration in conduct, local pains, swelling of the breasts, leucorrhcea, vaginal pruritus, particular states of any bodily functions, etc.). First discharge: precise age of patient; month, day of month ; by night or by day; —character of discharge, its color, odor, consistence; accompanied 


PART I.] 
[§ n. C. 
PREVIOUS SEXUAL CONDITION. 
33 
by coagula or not ?—attended by pain or other suffering, hysteric paroxysm, etc.; followed by development of mammae or limbs. — Subsequent discharges; regular or irregular from first; if irregular, when and from what cause ?—exact periods of recurrence ; —how commenced and attended, by sacral, femoral, mammary or hypogastric pains, cephalalgia, swelling of breasts, constipation, diarrhoea, hysteric paroxysm, etc. ?—duration of discharge in days, variable or constant; —its quantity, variable or constant, proportional each day; its quality, color, odor, coagula;—circumstances which have influenced discharge, weather, residence in town or country, moral emotions, over-work or exercise, riding, dancing, childbearing, immersion of feet or hands in cold water, baths, venesection, medicines, enemata, etc.; —effect of catamenial discharges upon any particular function, upon temper, upon general bodily or mental activity.— Health in intervals: leucorrhcea preceding or following discharge, its duration, quantity, quality (249). — Suspensions of catamenia: times of their occurrence; period of discharge at which they occurred; their presumed cause; —influence exerted by them on the function subsequently, on the general health.— Final cessation: age of patient; change of social condition, etc. preceding or accompanying it; cessation sudden or gradual;—attended or not with general or local disturbance of any kind, by flushings, perspirations, indigestion, etc. ? 
27. Sexual intercourse, marriage: —age at marriage, or first sexual intercourse; habitual frequency of intercourse. —Husband or wife living or not ?—Subsequent marriages; their dates; age of patient when each was contracted. 
accompaniments. 
subsequent discharges: regularity. 
accompaniments. 
duration, quantity. 
quality, circumstances affecting. 
health in in tervals. 
suspensions. 
cause of. 
final cessation, age. accompaniments. 
Marriage. 


§ n. d.] 
[PART I. 
FAMILY HISTORY OF PATIENT. 
34 
Masturbation. 
Pregnancies— 
accompaniments. 
menstruation during. 
Labors. 
Miscarriages. 
Children. 
Lactation— 
menstruation during. 
I II. D. 
Parents. 
28. Masturbation: —habit, when contracted? 
29. Pregnancies: —their number; duration; general character; —alteration in bodily functions or mental phenomena attending them; change of temper, spirits, etc.; constipation, diarrhoea, piles, etc. —Occurrence of menstruation during pregnancy, during every pregnancy or not ? number of months during which it has recurred; duration of discharge, in days. 
30. Labors: —their number; dates of each; — their character, natural, difficult, instrumental, complicated (with eclampsia, etc.); —important sequelae, puerperal fever, phlegmasia dolens, mania, hemorrhage, etc. 
31. Miscarriages: —their number; dates of occurrence ; month of pregnancy at which they occurred (noting on whose authority, or on what evidence each illness is stated to be a miscarriage); their presumed causes; their sequelae. 
32. Children: —their number; period of time within which produced; their sex. 
33. Lactation: —number of children nursed at a time; duration of each period of lactation; supply of milk. —Menstruation during lactation; its character, periodicity, duration, quantity, quality, etc. (26). 
D. —FAMILY HISTORY OF PATIENT. 
34. Parents: —living or dead? age at which either died; —their general state of health; diseases from which they were known to have suffered, mania, syphilis, gout, etc.; their habits, temperate or intemperate?—fatal diseases, phthisis, etc. (proof derived from some distinct symptoms). 


[§ II. 
PART I.] 
FAMILY HISTORY OF PATIENT. 
D. 
35 
35. Uncles or aunts (noting whether paternal or maternal): diseases to which they have been subject;—if dead, age at death and fatal diseases. 
Uncles or aunts. 
36. Brothers or sisters: —number of each living; number of each dead (note whether these were born before or subsequently to patient, and whether during the same or some other marriage);—diseases from which they have suffered; ages at death; fatal diseases. 
Brothers or sisters. 
37. Children: —number of each sex; —their health; any difference in the health of elder, younger, or of the two sexes; —children dead; ages at death; fatal diseases. 
Children. 
38. Nephews or nieces: —their health; —if any have died, ages at death, and fatal diseases. 
Nephews or nieces. 
39. Family diseases and peculiarities: —tem- ; malformations; tendency to bleed on trifling injuries, etc. (sex presenting these peculiarities) —Fecundity of females.—Presumed family diseases; age at which any hereditary disease has appeared in any members of the family, epilepsy, insanity, phthisis, gout, etc.—General duration of life in family. 
Family diseases, etc. 


§ ni. a.] 
[PART I. 
PRODROMATA. 
3G 
Circumstances of seizure. 
I III. A. 
Atmospheric states and changes. 
Exposure to heat or cold. 
§ III.—The Course of Existing Disease prior to the patient coming under Observation. 
40. Circumstances attending seizure: —precise period of first invasion, day of the week or month, hour of the day or night; symptom or symptoms from which commencement of illness is dated.'— Where patient was at the time, in bed, in the street, etc. ?—How employed at the time ?—Occurrence of seizure during a meal, after a meal; quantity and nature of meal; length of time intervening. 
A. —PRODROMATA. 
(Note intensity of supposed cause or causes of illness, the precise date of their application, their duration or repetition, and the exact period, in days or hours, between their application and the appearance of the first symptom of disease.) 
41. Atmospheric states and changes:—temperature ; barometric pressure; dew-point; weather; direction and force of wind; electrical state, etc. 
42. Exposures: —to heat, in what way ? insolation ; —exposure to cold, in what way ?—exposure to wet, in what way?—circumstances attending either of the above, and precautions subsequently taken; —use of cold baths or cold drinks when heated; alterations in clothing. 


PART I.] 
[§ III. A. 
PRODROMATA. 
D 
37 
43. Exposxire to atmospheric impurities:—confinement to close rooms and impure air; —respira- of deleterious gases (chlorine, carbonic acid, sulphuretted hydrogen); of metallic vapors (fumes of lead, copper, etc.); of vapor of phosphorus; of air containing metallic particles (e. g., during dry grinding, etc.) ; —exposure to marsh or other miasmata. 
44. Ingesta. — Food: excess of, deficiency of; irregularity of meals; —use of unwholesome food; prolonged use of salted provisions;—deficiency or excess of animal food; deficiency or excess of vegetable food, cooked or uncooked; —use of food cooked or preserved in poisonous vessels ; —use of certain special articles of diet (e. g., mussels or other shell-fish, ergoted rye, mushrooms, etc.). — Drinhs: excess or deficiency of; —unwholesome or poisonous water (from leaden pipes or cisterns, communication with sewers, etc.) ; —intoxicating drinks, quantity taken; nature of liquid.—Medicines : abuse of. — Poisonous substances. 
45. Sources of mechanical injury: —muscular efforts; violent exertion, etc.—Blows, falls, etc. 
46. Alterations in health: —note general condition of health at time of attack ; —excessive or defective evacuations, as to quantity and repetition; character of evacuation; —suppression of any customary discharge, etc. 
47. Excesses: —over-fatigue; loss of sleep; overwork, bodily or mental; —venereal excesses; — mental anxiety; violent emotion, grief, joy, fright, etc. 
48. Exposure to epidemic or endemic influences: —duration and constancy of patient's residence in locality of disease; exposure to infection; inoculation. 
Atmospheric impurities. 
Ingesta— food. 
drinks. 
medicines, poisons. 
Mechanical injuries. 
Alterations in health. 
Excesses. 
Epidemic or endemic influences. 


§ III. B. C.] 
INVASION —PROGRESS OF CASE. 
[PART I. 
38 
Altered circumstances in life. 
I HI. B. 
Symptoms— general. 
local. 
Mode of progress of disease. 
I III. C. 
Ordcr of svmp turns, etc. 
49. Considerable alterations in pecuniary circumstances or station in life. 
B.—INVASION. 
(Note the exact date of commencement and cessation of each leading symptom.) 
50. Symptoms not necessarily peculiar to any particular disease: —rigors, their severity, accompanied or not by chattering of teeth or sense of chilliness? their recurrence; —sense of heat, of chilliness; sweating;—general pains or soreness ; aching of limbs, loins, etc.; lassitude ; —prostration of strength; headache; somnolence; —abdominal pain ; anorexia; thirst; nausea; vomiting; diarrhoea, etc. — Symptoms connected with particular organs: skin, locomotive organs, organs of digestion, of respiration, etc. (following the order observed in § iv.). 
51. .Mode of progress of disease: sudden in invasion and subsequently stationary ; ingravescent; remittent; intermittent; diminishing. 
C. — PROGRESS OF CASE UP TO TIME OF OBSERVATION. 
(Note the symptoms in the order of their occurrence, with the precise date of the commencement and duration of each.) 
52. How long off work in consequence of illness —Has patient kept his bed, and how long?— If in hospital, etc., how was the place reached by patient ? was he able to walk there, and what was the distance walked? —Treatment employed. 


PART I.J 
[§ IV. A 
GENERALITIES. 
39 
§IV. —Condition of the Patient at the Time of Observation. 
A. GENERALITIES. 
\ IV. A. 
53. State of nutrition. —Amount of subcutaneous fat; corpulence, its degree;—emaciation, its degree, peculiarities of tenseness or looseness of integument over deeper structures, degree to which eye is sunk in orbit; —condition of muscles, lessened or not? firm, flabby. 
Nutrition. 
54. Strength: —undiminished; diminished, degree of diminution of strength (weaker than usual, very weak, unable to stand, unable to rise in bed). 
Strength. 
55. Walk: —uncertain; fearful; staggering, etc. 
Walk 
56. Weight. 
Weight. Posture. 
57. Posture: —indifferent; —recumbent, on back, on right or left side, diagonal, with legs extended or drawn up ? with shoulders elevated; sitting, supported or propped up? with head bent forwards; with arms thrown forwards; with arms pressing abdomen. —Patient composed; restless; trunk and limbs tranquil, but head restless; jactitation. — Posture of head in erect or recumbent position or in progression (head supported and steadied by the hands, chin resting on breast, etc.). —(See also 270.) 
58. Expression of countenance: —natural (calm, cheerful); suffering (anxious, haggard, risus sardonicus); heavy (indifferent, inattentive, melancholic, idiotic); excited (wild, fierce, threatening, surprised, agitated, terrified); imploring.— Face: pale, very pallid; flushed generally, locally, color 
Countenance: expression. 
face. 


[PART I. 
§ IV. B.] 
INTEGUMENT AND ITS APPENDAGES. 
40 
of flush (dark, pink, etc.); locally flushed, hut elsewhere pallid; alternating flush and pallor.— Features: pinched, drawn, distorted (in what way ?); lips retracted.— Eyes: natural; open, half closed, closed; —heavy; glistening; suffused; glazedj — staring fixedly, at observer, at some supposed object, at vacancy.— Lips: open, closed, compressed; — their color natural, pale, livid, etc. — Jaws: open; clenched. 
features. 
eyes. 
lips, jaws. 
General sensations. 
59. Sensations of patient. —General feeling of illness, in what way? feeling of getting worse, in what way ? feeling of improvement, in what way ? —Sensation of heat, of flushing; of chilliness, cold, creeping, shivering;—circumstances under which either occur. —Sensitiveness to atmospheric changes of temperature, etc.—Sense of sinking through bed; apprehension of falling, etc. —Pains (269). 
Rigors. 
60. Rigors: —their severity; accompanied or not by chattering of teeth or by sense of chilliness ? duration; period of occurrence; frequency; periodicity. 
Spirits. 
61. Spirits: —depressed, anxious, hopeful, elevated, variable ;—disposition to laugh, to cry, to sigh, etc. 
Temper. 
62. Temper: —natural; subdued, resigned; irritable, violent (under what circumstances ?); variable. 
I IV. B. Generally. 
B. INTEGUMENT AND ITS APPENDAGES. 
Generally. 
Surface. 
63. Surface: —soft, harsh; smooth, tense, shining; wrinkled; —cutis anserina. 
64. Color — over body generally: natural to the individual; pale, waxy-looking; straw-colored; 
Colorgenerally. 


[§ IV. B 
PART I.] 
INTEGUMENT AND ITS APPENDAGES. 
41 
greenish; yellow (its shade); dusky; livid. — Local alteration of color: on cheeks; over depending parts; over other parts; —apparent cause of color, vascularity or pigment? 
locally. 
65. Temperature —as felt by the hand: cool, cold, icy;—hot, very hot, pungent, mordant. —As observed by thermometer: in axilla; on front of chest; on being grasped by hand of patient; over paralyzed as compared with non-paralyzed parts.—As experienced by patient: comfortable; —cold, creeping, shivering;—warm, hot, burning. 
Temperature: to hand. 
to thermometer. 
to patient. 
66. Cuticle: —desquamating (at what points?); rough; scaly; thickened. 
Cuticle. 
67. Sebaceous follicles: —of moderate size, large —surrounding skin greasy or thickened; —orifices closed; black points; orifices widely open; —scaly appearance around orifices. —General oiliness of surface. 
Sebaceous follicles— 
oiliness. 
68. Perspiration: —its amount, generally; skin very dry, dry, moist, sweating, sweating profusely (state how this is judged of). —Local perspiration, its situation and amount. —In the case both of general and local perspiration, ascertain period of twenty-four hours when it occurs or is most abun r dant, and the circumstances which give rise to it; its odor ; color (affecting color of linen); reaction. 
Perspiration: general. 
local. 
characters. 
69. Vascidarity of skin : —apparent enlargement of small arteries and capillaries, on cheeks, on nose, on other parts; —color given to parts by such enlargement, rosy, dark, like a faded leaf.— Superficial veins (192). 
Vascularity. 
70. Contusion and pressure marhs: —their locality ; color, uniform, varying from centre towards circumference ; —flat or elevated ? borders well defined or otherwise ?—condition of cuticle over the 
Contusion and pressure marks. 


[PART I. 
INTEGUMENT AND ITS APPENDAGES. 
42 
marks, perfect, raised by effusion, detached partially or entirely;—condition of cutis vera, lacerated, ulcerated, gangrenous. 
Old scars, etc. 
71. Old scars and marks of previous disease: —their locality (examine arms for vaccination or smallpox marks); their form, color, general characters. 
72. Hair — on the head: its quantity ; color; — falling-off; thinning uniformly or falling-off in patches? with desquamating cuticle or not? (note condition of sebaceous glands.)— On other parts of body: downiness between scapula), on sternum. 
Hairon head. 
on other parts. 
Nails. 
73. Nails: —thick, thin, irregular, convex, incurvated —their color, livid, blue; presenting white patches or rings.—Excoriations and sores around nails, from picking, etc. 
Subcutaneous cellular tissue 
74. Subcutaneous cellular tissue: —puffy, oodematous, pitting on pressure; special locality of oedema, its limits, its variations with posture, time of day, etc.; —if acupuncture be performed, chemical examination of dropsical fluid (examine specially for urea). —Thickened with exudation of any kind; indurated to the feel.—Emphysematous; crepitation under pressure of hand. 
oedema. 
thickening, emphysema. 
Serum of vesications. 
75. Scrum of vesications: —its microscopical characters; its chemical characters (examine specially for urea); " examine for arsenic, etc., in cases of suspected poisoning." 1 
Sensibility. 
76. Sensibility : —alterations of (267). 
' Those points for observation which are, here or elsewhere in the work, included within commas, have special reference to mcdico-Ugal inquiries. 


PART L] 
[§ IV. B 
SPECIAL ERUPTIONS. 
43 
Special Eruptions. 
77. Locality of eruption; its extent; symmetrical distribution. 
78. Forms of eruption — 
Flat or minutely rough : —arranged in spots, in patches, in blushes, 1 in lines; diffused.— Form: round, oval, serpentine, irregular. — Size. — Color: white, pale red, rosy, dark red, livid, yellow, blue, gray-black, etc.; —effect of pressure on color; unaltered, fading, 3 disappearing, and for what length of time ?— apparent cause of color, vascularity, pigment changes, effusion of blood.— Condition of surface : smooth; minutely rough ; apparent cause of roughness, changes in true skin, changes in cuticle; effect of pressure on roughness ; —surface dry, moist (apparent cause of moisture). — Condition of borders: defined; undefined, fading into color of surrounding skin. — Sensation: spontaneous (itching,pricking, tingling, formication, etc.); developed by pricking, etc. — Temperature. — Phenomena of disappearance as regards color, roughness, sensation, temperature ; —consecutive condition of true skin and cuticle. 
Elevated : —apparent cause of elevation, thickening of skin alone or accompanied by thicken- 
1 The terms "spots, patches, and blushes" are arbitrary divisions introduced for the sake of convenience; the "spots" are always small; the "patches" larger, and the " blushes" are not less in size than the palm of the hand. 
2 Fading on pressure— i. e., becoming less marked, but not altogether disappearing. 
Special Eruptions. 
Locality. 
Forms of eruption— 
1. Flat or minutely rough: arrangement. form. size. color. 
surface. 
borders. 
sensation. 
temperature, phenomena of disappearance. 
2. Elevatedcause of elevation. 


§ IV- B.] 
[PART T. 
SPECIAL ERUPTIONS. 
44 
designation of elevation. 
number. 
distribution. 
characters of individual elevations. 
irjg of subcutaneous tissues ? effusion of fluid between cutis and cuticle, scales or crusts.— Designation of elevation, according to nosological terms (papula, 1 tubercle, vesicle, bulla, pustule, thickening in patches or diffused, scales, crusts). — Number of elevations.—Distribution of elevations, isolated, concrete, irregular ; —special character of grouping, in rings or parts of rings, in belts, in variously sized islands. 3 — Individual elevations, their size, degree of elevation; —their surface, smooth, rough, furrowed (condition of cuticle over it); —their form, flat, acuminated, rounded, umbilicated, raised in centre or at circumference ; —their base, flat, raised, hardened; its width; —their border, gradually fading, defined; condition of skin around border as to color, thickening, and sensation; —color (of solid elevation); condition of dryness or moisture (of solid elevation); —character of fluid within vesicles, bullee, and pustules; its color, transparency, reaction, chemical examination, microscopical examination (645 et seq.);—degree of attachment of scales and crusts; kind of attachment (at centre only or over whole 
1 Papula and tubercle —solid elevations, separated arbitrarily by difference of size. 
Vesicle and bulla —cuticular elevations, containing a clear, transparent, or sligh tly grayish fluid—arbitrarily separated by difference of size. 
Pustule —cuticular elevation, containing a turbid and usually thick fluid. 
2 The term "island" is used to express the condition sometimes seen, when papulte or vesicles are arranged in groups, separated from each other by intervals of sound skin. 


[§ IV. B. 
PART I.] 
SPECIAL ERUPTIONS. 
45 
surface); condition of skin under scales and crusts; —minute anatomy of elevation, of crusts and scales.— Sensation : spontaneous ; —as tested by pricking, etc. — Temperature. — Simultaneous presence of other conditions ; e. g., non-elevated eruptions, ulcers, etc. — Condition of hair at and between affected points.— Condition of skin between affected points, its color, dryness or moisture, sensation, temperature. — Duration of eruption.—Phenomena of disappearance: of solid cutaneous elevations ; change of color, subsidence of elevation —subsequent condition of skin as to hardness, color, sensation, depression or irregularity of surface.—Of liquid elevations: absorption of fluid and gradual desiccation; bursting of elevation, incrustation and desiccation ; color, thickness, form and degree" of moisture and adherence of crusts ; —condition of surface after their detachment; period of detachment after desiccation; microscopical characters of crusts (645 et seq.). —Of cuticular alterations, detachment or breaking up of scales, etc. 
Depressed or with-ulceration : —its form; color : condition of surface, of borders. (See ulcers. 624.) 
79. Cicatrices: —their form, size, color; —con- of surface, as to elevation, depression, furrowing, bridling, etc.; —sensibility;—condition of hair, sweat-glands and sebaceous follicles. 
80. Alterations of sebaceous follicles: —their size, form; condition of their orifices; condition of skin around, dry, greasy, scaly, thickened.— Contents of 
sensation. 
temperature, other conditions present. 
hair and skin about eruption. 
duration. 
phenomena of disappearance. 
3. Depressed or with ulceration. 
Cicatrices. 
Alterations of sebaceous follicles, contents. 


§ iv. C] 
[part I. 
ORGANS OF LOCOMOTION. 
46 
Alterations of hair— of roots, detachment. 
of shaft. 
Alterations of nails— detachment, shape, color. 
\ IV. C. 
Joints— pain. 
tenderness. 
temperature, color, position, size, &c-movement. 
Bones— pain. 
tenderness, shape, &c. 
brittleness. 
follicles: their consistence ; color; odor; reaction; microscopical characters (645 et seq.). 
81. Alterations of hair: —as affects roots, swelling, humidity ; —exudation into; microscopic characters of exudation. —Detachment of hair; mode of detachment.—Color of hair; moisture or dryness ?—texture and configuration of shaft. 
82. Alterations of nails: —detachment of nails; —alterations in their shape; convexity, thickenings, furrows ; —alterations in color; livid, blue, presenting white points or belts, etc. 
C.—ORGANS OF LOCOMOTION. 
83. Joints: —spontaneous pain, its character, severity; mode in which produced; most severe when warm or cool ? at what period of twenty-four hours most urgent? by what posture most relieved? how affected by manipulation and passive motion of joint ?— Tenderness on pressure, generally over joint, or in some one spot ? effect of impulse upon extremity of limb. — Temperature. — Color of skin over joint; oedema. — Position of limb. — Size of joint; its shape; is fluctuation perceptible? Power of movement by patient, by observer; amount permitted; creaking or crepitation perceptible ?- 
84. Bones: —spontaneous pain, its character, severity ; —effect of weather and temperature upon it; at what period of twenty-four hours most urgent? — Tenderness. — Shape altered generally or locally (deformities arising from this cause); —swellings, their position, size, shape, solidity, presenting quasifluctuation; painful; tender on pressure; condition of skin over them.— Brittleness (spontaneous fracture). 


PART I.] 
ORGANS OF DIGESTION. 
[§ IV- D 
47 
85. Periosteum: —thickened; tender. 
8G. Tendinous and fibrous structures, aponeuroses, fasciae, etc. —pain; tenderness; thickening; contraction; crepitation. 
87. Muscles generally :—firm; flabby; atrophied. ¦ — Locally: swollen; atrophied (name muscles or bundles of muscles which are thus affected). — Spontaneous pain: particulars as joints (83); — pain on movement; —tenderness on pressure over muscles.— Power of contraction: paralysis of special muscles (280); —effect of electricity in exciting contraction (281); — irregular muscular movements; contraction; quiverings; jerkings; cramps; their seat, severity, time of occurrence, customary mode of relief (271 et seq.). —Muscular sensibility (208). 
D. ORGANS OF DIGESTION. 
Mouth. 
Periosteum. 
Tendinous structures, etc. 
Muscles— general physical characters. 
pain. 
contractility, 
sensibility. 
\ IV. D. 
Mouth. 
88. Lips: —size; thickness; —malformations; — color; pale, red, livid, etc.;—"stains on and about, their color, reaction of stain."— Condition of surface : dry; moist; smooth; fissured, oozing of blood from fissures. — Tension; flaccidity; oedema; abscess (GOG etseq.); tumor (631); sloughing (618 et seq.); ulcers (624); cicatrices (629). — Sordes; exudations (603); foam about lips; salivary dribbling; mucous or purulent-looking matter about lips; "other matters about them."— Labial glands: their condition. 
89. Gums: —size; consistence; hard, soft, fluctuating; color, generally; blue line along edge; red line along edge, its brightness and width. — Sponginess and readiness to bleed; spontaneous 
Lips— size, color, etc. 
surface. 
tension, etc. 
sordes. 
labial glands. 
Gums— size, color, etc. 
sponginess. 


§ IV. D.] 
[PART I. 
ORGANS OP DIGESTION. 
48 
secretions, etc. 
Teethnumber, etc. 
percussion, tartar, sordes. mastication. 
Check, palate, etc.— cheek. buccal membrane. 
abscesses, etc. 
buccal glands, Steno's ducts temperature of mouth. 
hard palate, inability to open mouth. Tongue— size, etc. 
surface. 
consistence, etc. 
papilla. 
bleeding. — Abnormal secretions and exudations (603) ; abscesses; fungosities j tumors (631) ; sloughing (618 et seq.); ulcers (624). 
90. Teeth: —their number; which absent? irregularity; state of axes; absence of opposing teeth to those of upper or lower jaw;—looseness of teeth; —color; smoothness and polish; transparency, etc. Effects of percussion on teeth. — Tartar on teeth; situation; thickness.— Sordes, their characters. — Mastication: hasty or deliberate; performed only on one side of mouth. 
91. Cheek, palate, cavity of mouth: — cheek: hard, soft; tender (ascertained by external or internal examination?) — Buccal membrane: color; stains, "their color/' thickness; oedema; dryness or moisture; vesicles; exudations (603). — Abscesses (606 et seq.) : fungosities; tumors (631); sloughing (618 et seq.); ulcers (624); cicatrices (629). — Bucccd glands: their character.— Steno's ducts: state of their orifices. — Temperature of cavity of mouth (bulb of thermometer being placed between gums and cheek); sense of heat or cold in mouth. — Hard palate : malformations. — Inability to open mouth; from what cause? 
92. Tongue: (noting its characters as early as possible in the examination of the patient);—its size; form ; thickness ; —general color, pale, red, livid, etc.; —color locally, at tip, edges, etc. — Surface of tongue ; dry ; moist; smooth ; glazed; fissured ; lobulated; exhibiting marks of bites; vesicles — Consistence: hard; soft; fluctuating; tense; flaccid; oedematous; presenting sodden appearance; indented by teeth. Abscesses (606 et seq.); tumors (631) ; fungosities; sloughing (618 et seq.) ; ulcers (624). — Papilla}: their size and form, 


PART I.] 
[§ IV. D. 
SALIVARY GLANDS. 
49 
E 
(stating which papillae, and where situated). — Furs on tongue ; their position, color, thickness; degree of adhesion to surface; —mucous coating on tongue; watery aspect of tongue; —exudations, etc.; bleeding.—Sensations of heat in tongue, of coldness; pain, throbbing, etc.; —degree of tactile sensibility, at tip, sides, and base of tongue (tested by Weber's method). 
93. Protrusion of tongue : —darting, dilatory; —complete, incomplete, impossible ; tremulous; — deviation of tongue, its degree, to which side ? (280); tongue not withdrawn after protrusion. 
94. Odor of breath : —sweet, acid, sickly, maltlike, alliaceous, putrid, etc. 
95. Taste in mouth: —salt, acid, sweet, bitter, putrid, metallic, etc.; clammy sensation. 
Salivary glands. 
96. Parotid glands: —swelling externally behind ramus and angle of jaw; in course of Steno's duct; oedema; fluctuation.— Pain on attempting to open mouth; —extent to which mouth can be opened; —tenderness over gland and duct. 
97. Sublingual glands: —their size; condition of surface; —tumors (631) ; ulcers (624); —state of orifices of ducts, etc. 
98. Submaxillary glands: —swelling; pain; tenderness ; —orifice of ducts, calculi within them, etc. 99. Saliva: —deficient; —excessive in quantity; measure of saliva discharged in twenty-four hours; accompanied or not by nausea or drivelling? color; viscidity; odor ;—bloody;—sweet to taste; —its reaction; if acid, due to volatile or fixed acid? 
furs, etc. 
sensations of tongue. 
Protrusion of tongue. 
Odor of breath 
Taste in mouth. 
Salivary glands. 
Parotid— swelling, etc. 
pain, etc. 
Sublingual— size, etc. 
Submaxillary: swelling, etc. 
Saliva— amount, characters. 


[part L 
§ IV. D.] 
THROAT, ETC. 
50 
Throat, etc. 
Uvula 
Soft palate. 
Fauces— size of opening, pain, etc. noisy respiration. 
Tonsilsswelling, etc. 
Pharynx— size of cavity, etc. mucous surface, secretions, etc. oedema, etc. 
follicles. 
projections from nares. sensations, tenderness. 
(Esophagus— swelling, etc. examination with bougie. 
Throat, etc. 
100. Uvula: —length; form; thickness ; direction of its axis; —surface, smooth, glazed; color; —cedematous; flaccid; abscess (606 et seq.) ; sloughing (618 ct seq.); ulcers (624); vesicles; exudations (603), etc. 
101. Soft palate : —(particulars as Uvula). 
102. Fauces : —size of opening; state of pillars (particulars as Uvula). — Pain : its direction; — other sensations, constriction, dryness, etc.; — tactile sensibility, increased, diminished.—Noisy respiration; snoring. 
103. Tonsils : — swelling and tenderness external ly.-w-Position of tonsils; distance between them ; —size ; form ; consistence; fluctuating;— tender to touch; —color; —surface ; dry, moist, smooth, glazed, uneven ; openings on surface ; — oedema; abscess (606 et seq.); sloughing (618 et seq.) ; ulcers (624); secretions and exudations on surface (603). 
104. Pharynx: —size of cavity; — apparent thickness of membrane. —Surface of mucous membrane ; smooth, glazed, granulated; dry, moist; — vessels apparently full; —its color; "stains."—Secretions; exudations (603); blood on surface. —(Ede- ; bogginess; fluctuation ; abscesses ; tumors ; sloughing; ulcers and other destructions of substance (624) ; cicatrices (629). —Condition of follicles.— Projections from posterior nares into cavity.— Abnormal sensations in pharynx; burning, dryness, constriction, etc. —Tenderness. 
105. Oesophagus : —swelling in neck externally. —Examination with bougie; obstruction to passage, its seat, can it be overcome by moderate pressure ? 


[§ IV. D 
PART I.] 
EXAMINATION OP THE ABDOMEN. 
51 
—Signs of dilatation and sacculation ?—Is anything visible during retching ?— Pain in course of gullet, during swallowing or at other times; — sense of constriction, burning, globus, etc. 
106. Deglutition: —pain during the act; its seat, extent, duration, character.—Deglutition difficult; period of act at which difficulty is perceived;—attempt to swallow productive of sense of suffocation, of spasm of muscles of throat or pharynx;—is difficulty greatest with solids or liquids?—what matters are swallowed most easily?—is a large gulp of liquid swallowed more easily than a small one ?—has the patient any contrivance for rendering the act easier ?—does the act produce cough ?—do swallowed matters return by nostrils?—is the act affected by temperature of matters ? —is the site of obstruction distinct to patient, and how?—is deglutition favored by a recumbent posture ? (see also 280.)—Frequently or constantly repeated efforts at deglutition. 
107. Regurgitation: —period after swallowing at which it occurs; attended with effort, anxiety, or nausea? accompanied by any stethoscopic sound? —Physical characters of regurgitated matters; their reaction. 
Physical examination of the Abdomen generally. 
108. Inspection: —Development of subcutaneous fat; oedema of wall, its seat; —hernial protrusions; —swellings over recti muscles; —form of organs visible on exterior, stomach, colon, intestinal convolutions, etc.— General enlargement of abdomen, its form; — local fulness or enlargement, its seat, form; alteration in form and seat of enlargement 
dilatation, pain, etc. 
Deglutition— painful, othercharacters. 
Regurgitation. 
regurgitated matters. 
Physical examination of Abdomen generally. 
Inspection— fat, etc. in wall, form of organs visible, enlargement. 


§ IV. D.] 
EXAMINATION OP THE ABDOMEN. 
[PART I. 
52 
or fulness with changes in posture of patient, with varying states of stomach and bowels; —eversion of cartilages of false ribs, of tip of ensiform cartilage;—size of costal angles. 1 — Depression or retraction of abdomen; general, partial.— Umbilicus: position, vertical and transverse; —aspect; convex, concave, flat with or without stretching;—ulceration; discharge from umbilicus; —presence and condition of a portion of umbilical cord.— Venous enlargements: on one or both sides ? extent; size; tortuosity;—course of blood in enlarged veins.— Movements: vermicular, resembling movements of foetus, etc.; their seat. — Pulsation: its seat, extent, violence; —circumstances under which it occurs. — Fluctuation on percussion.—Abdominal respiratory movements, including those of lower ribs, amount generally or locally. — State of surface of abdomen: smooth, shining;—fissures;—lineae albicantes; — brown line from navel to pubes;—local redness; — surface dry or moist; cuticle desquamating; eruptions (B. p. 43). —Abnormal openings on surface, their seat; —discharge from them; its appearance, odor, etc.; effect of pressure or of respiration upon it.—Sloughing (618 et seq.); ulcers (624). 
depression. 
state of umbilicus. 
venous enlargements. 
movements, pulsation. 
fluctuation, respiratory movements, surface of abdomen. 
109. Measurement: —circular and semicircular; at level of umbilicus, of greatest abdominal prominence —variations of each with ordinary and deep inspiration.—Measurement between umbilicus and lower extremity of sternum; between umbilicus and pubic symphysis. —Application of chestmeasurer to determine respiratory movements of abdomen, anteriorly and laterally; of lower ribs, etc. 
Measurement 
chestmeasurer. 
1 " Costal angle" —i. e. the angle included between the middle line of the abdomen and the margin of the cartilages of the false ribs. 


[§ IV. D. 
PART I.] 
EXAMINATION OF THE ABDOMEN. 
53 
110. Palpation : —Indications afforded confirmatory of the results of inspection (108). — Temperature of surface. — Resistance to pressure unusually great; generally, or locally? its exact limits, if local; confined to one side, or observed upon both symmetrically ? confined to recti muscles, on one side or on both ? disappearing under steady pressure;—knotted feel of wall. —Sense of resistance less than natural, generally or locally? parietes flaccid. —Sense of thickening of the soft parietes of the abdomen; —its apparent cause, deposition of fat, oedema, thickening of deeper tissues; —sense of unusual thinness of wall. — Elasticity of wall; increased, diminished. — Tumor (130). — Movableness of abnormal parietes diminished; —sense of adhesion of soft wall to deep parts. — Sense of movement beneath the hand; —its character; gradual elevation or depression, vermicular movement, fluttering, resembling that of living body in abdomen, etc.; —its seat; readiness of perception; apparent depth from surface; activity; frequency, etc.— Vibration: arising from passage of intestinal gas;— friction-vibration; its locality (over a tumor or not); perceptible with or without exerting pressure; during acts of respiration; its character.— Sense of crepitation or grating under pressure;—gurgling; —their exact locality; apparent depth from surface ; connection with palpable tumor.— Fluctuation (or bogginess) : posture in which discovered; seat; deep or superficial ? following immediately the impulse given to surface or not? apparent size of waves; —effect of intervening pressure upon it; effect of change of posture upon its seat and readiness of perception;—peripheric fluctuation.—Repercussion, (stating posture in which perceived). 
Palpation— 
temperature, resistance. 
sense of thickening. 
sense of thinness. elasticity. tumor. movable ness of wall. movement. 
vibration. 
gaseous, friction. 
crepitation, gurgling. 
fluctuation. 
repercussion 


§ IV. D.] 
[PART I. 
EXAMINATION OP THE ABDOMEN. 
54 
pulsation. 
thrill. 
effect of sudden deep pressure. 
Percussion— 
resonance. 
dulness. 
resistance. 
Auscultation: 
borborygmi. 
Pulsation : seat; transmitted from heart ? connected or not with tumor (186)? superficial or deep? —in course of aorta or other known vessel, within abdomen, or in its wall? extent of vessel over which perceived; —its abruptness; expansile force; direction merely elevating hand or presenting lateral expansion also?—time of day or circumstances under which it occurs; its permanence;— accompanied or not by increased pulsation of femoral arteries?— Thrill: connected or not with tumor (186)? continuous or intermittent? synchronous with arterial systole or diastole? seat; —extent over which felt.—Effect of sudden deep pressure in various parts; tumor perceptible ? 
111. Percussion: —after determining boundaries of liver (115), spleen (119), and stomach (123). — Abdominal resonance: unusually extensive upwards ; diminished in extent (in either case note exact limits) ; —replacing dulness of liver; —unu- uniform in pitch over all parts of surface; —pitch and special characters of resonance; tubular, tympanitic, with metallic tinkling or humoric sound (noting exact seat of these and their degree of permanence).— Dulness (noting posture in which observed): exact seat, extent, and limits;—presenting or not a line of level ? limited by a curved or irregular line ?<—replaced by resonance on deep pressure; effect of change of posture on results of percussion; is the dulness the same on deep or superficial percussion ?— Sense of resistance or elasticity perceived by percussing fingers; —hydatic fremitus; readiness of perception. 
112. Auscultation: —(not including signs noted under spleen (120), and stomach (124)). — Borborygmi: locality ; loudness (heard at a distance from 


[§ IV. D 
PART I.] 
EXAMINATION OP THE LIVER, ETC. 
55 
patient); special character; —circumstances under which they occur; permanence; —intestinal sounds inaudible under all circumstances over abdomen (note extent, and whether over tumor or not). — Friction-sound: (particulars as friction-vibration, 110); its special similitude.— Crepitation or grating : how developed ? its position, connection with tumor or not, deep or superficial ?— Gurgling : its seat, audible on pressure or independently of it, with inspiratory acts; special characters, accompanied by metallic tinkling.— Fluctuation-sound : spontaneous ; its seat, connection with tumor; — observed on succession.—Taenia-sound ; —hydatic sound, superficial or deep-seated?— Sound of fcetal movements. — Sounds of aorta : impulsive sound increased.— Murmur: arterial; its seat, connection with tumor, extent, intensity, special characters; accompanying systole or diastole of vessel or both? accompanied by shock or not? influenced by pressure on either side of stethoscope ? effect of posture on its development;— venous murmur; its seat, extent, intensity, special similitude; — continuous murmur (audible at a distance from patient);— uterine murmur; effect of posture upon it; its seat, loudness, special character.— Fcetal heart sounds: where best heard, and to what extent ? their frequency ; readiness of perception; effect of posture on perception of them. —Sounds audible at a distance from patient. 
Physical examination of the Liver, Gallbladder, and Ducts. 
113. Inspection: —Fulness or bulging (specially affecting right hypochondrium, epigastrium, or up- 
frictionsound, crepitation. 
gurgling. 
fluctuationsound. 
tsenia-sound. etc. foetal movements. aortic impul sive sound. murmur. 
fcetal heart. 
Physical examination of Liver, Gallbladder, and Ducts. 
Inspection— fulness, etc. 


[PART I. 
§ IV. D.] 
EXAMINATION OE THE LIVER, ETC. 
50 
per part of abdomen) ; —state of depression below cartilages of false ribs; —visible downward extent of liver; —state of intercostal space on right side; —special prominence (pointing) apparent, their seat and form; —variation in fulness, etc., with varying states of stomach or after vomiting.— Color of skin over liver or special prominences; oedema over liver. 
color of skin, oedema. 
Palpation— resistance. 
114. Palpation : —Temperature over hepatic region.—Resistance to pressure below false ribs on right side, as compared with left; downward extent of resistance; —contraction of right or left rectus muscle on pressure; of other muscles of the soft wall.— -Edge of liver (if palpable, after evacuation of bowels) : its position and direction; effects of standing or recumbent posture or of deep inspiration on its position;—its characters, indurated, thin, thick, irregular, etc.; —interlobular notch ; its depth, direction. — Surface of liver: smooth, nodulated; —character of elevations on surface, round, pitted, etc.; —form of organ tuberous :— sense of adhesion to parietes; friction palpable over it (110); —consistence of liver; hard, soft; presenting bogginess or fluctuation (connected with tumor or not?) — Gall-bladder: is its form palpable ? tumor in its situation, its physical characters (130); presenting fluctuation (generally or in centre only ?); condition of surrounding tissues as to hardness, etc.; crepitation. 
edge of liver. 
surface of liver. 
consistence of liver. 
gall-bladder. 
Percussion— dulness. 
115. Percussion: —Extent of dulness (superficial and deep) ; vertical (in line of nipple, of axilla, and posteriorly); transverse; —effect of inspiration, posture, or varying states of stomach or colon on extent of dulness; —lower outline of dulness; amount of stomach or intestinal note near margins 


PART I.] 
[§ IV. D. 
EXAMINATION OP THE STOMACH. 
57 
of liver. —Kesonance over liver, generally (the dulness being quite lost); —locally; its special character —Hydatic fremitus. 
116. Auscultation: —Breath sound, audible or not over liver ? its special characters; —voice and cough sounds audible, their special characters; — gurgling; how developed, by respiration, cough, or pressure ? 
Physical examination of the Spleen. 
117. Inspection: —Fulness or bulging (in left hypochondrium, epigastrium, left side of abdomen, etc.); well defined?—effect of change of posture upon it; —condition of intercostal spaces over region of spleen. 
118. Palpation: —Spleen felt below margin of left false ribs; extent of tumor; —direction of long axis ; form ; outline and characters of anterior and posterior margins;—movableness of tumor; effect of posture on its position y. —condition of its surface, smooth, nodulated; —consistence; fluctuation. 
119. Percussion: —Extent of dulness, vertical and transverse (variation in its extent during and between paroxysms of ague) ; —form of organ as traced out by percussion;—hydatic fremitus. 
120. Auscultation: —Splenic murmur; its exact seat, characters, etc. (194). 
Physical examination of the Stomach. 
121. Inspection : —Prominence (in epigastrium, over cartilages of left false ribs, and hypochondrium ; elsewhere in soft wall) ; —variation of fulness with varying conditions of stomach (after 
resonance. 
Auscultation. 
Physical examination of Spleen. 
Inspection. 
Palpation. 
Percussion. 
Auscultation. 
Physical examination of Stomach. 
Inspection. 


58 
§ IV. D.] 
EXAMINATION OP THE COLON, ETC. 
Palpation. 
Percussion. 
Auscultation. 
Physical examination of Colon, Pedum, and Anus. 
Inspection— prominence. 
prolapsus. 
meals or vomiting); with change of posture; — form of stomach traceable through parietes. 
122. Palpation: —Temperature over region of stomach. —Sense of resistance or yielding at epigastrium, or below margin of false ribs; —tumor (130); effect of posture, meals, etc. upon it. —Sense of grating (as from foreign substances within it) ; —fluctuation; effect of posture, meals, and vomiting upon it. 
123. Percussion: —Stomach-resonance; its extent, position, special character (lower limit of stomach determined by percussion after a large draught of water). —Dulness; its seat, extent, permanence.—Effect of posture, meals, or vomiting upon the signs derived from percussion. 
124. Auscultation: —Gurgling under pressure over seat of stomach ; its locality, permanence ; — fluctuation sound on succussion, its permanence;— sounds of liquid and food entering stomach ; where heard? —spontaneous sounds (churning, etc.); their permanence ; special characters. —Special characters of heart's sounds as heard over stomach. 
Physical examination of the Colon, Pedum, and Amis. 
125. Inspection: — Colon: Prominence (specially affecting right or left iliac regions, flanks or elsewhere in course of colon); its amount, constancy ; —outline and course of colon traceable through parietes ; —effect of defecation upon prominence.—Anus: its form; fissures; fistulse; vegetations ; tumors; piles ; ulcers; excoriation. — Prolapsus of rectum : its extent, circumstances under which it occurs; —characters of prolapsed portion; 
[PART I. 


[§ IV. D. 
TART I.] 
ABDOMINAL TUMORS. 
59 
color, vascularity, etc. — Examination by speculum: state of mucous surface ; its color, vascularity;— hemorrhage from it; secretions upon it; —aper- ; sloughing (618 et seq.) ; ulcers (624); cicatrices (629), etc.; exact position of these. 
126. Palpation: —Tumor; in course of colon, in iliac foss83, etc.; its characters (130); effect of purgatives or enemata upon it. —Crepitation or grating; its seat, connection with tumor, apparent depth. —Gurgling on pressure; its seat.—Examination per anum: Imperforation of anus; coarctation; resistance to introduction of finger;—capacity of rectum; temperature of rectum; —fecal accumulation within it; foreign bodies; tumor; — stricture; its seat, form; length of strictured portion; yielding of walls on pressure (see also 235). —Examination by bougie; length to which bougie may be passed. 
127. Percussion: —in course of colon or in iliac regions, over tumor (131); special characters of sounds; —effect of defecation upon its results.— Length of colon over which the dulness produced by a large and forcible injection extends (noting quantity of water which may be injected).—Percussion over sacrum. 
128. Auscultation: —Audible gurgling; under pressure or independently of it; —spontaneous sounds, their seat and characters (112). —Extent of colon into which the liquid of a large and forcible injection may be heard to enter. 
Physical examination of Abdominal Tumors. 
129. Inspection: —(see Physical examination of abdomen generally, 108; of liver, 113; spleen, 117; 
examination by speculum. 
Palpation— tumor. 
crepitation. 
gurgling. _ examination per anum. 
examination by bougie. 
Percussion— 
after injection. 
Auscultation: 
with injection. 
Physical examination of Abdominal Tumors. 
Inspection. 


§ IV. D.] 
[PART I. 
ABDOMINAL TUMORS. 
60 
and stomach, 121.) —Color of skin over tumor; — oedema, pointing, etc. 
130. Palpation: —Apparent number of tumors; united or separate ?—mode in which most readily perceived; —exact position of tumor; traceable under margins of false ribs on either side, or towards anterior or lateral parts of trunk; felt descending into pelvis, from centre or from one side of abdomen; —dimensions of tumor; extent of abdomen which it occupies;—its relation to the surface, deep or superficial ? its apparent continuity with known solid organs (liver, spleen, uterus, etc.). — Form : similar to that of known organs (liver, kidney, etc.); of limbs or other parts of a child; of certain foreign bodies; —condition of its margin, well or ill-defined ? can fingers be passed beneath it, and at what part ?—margin regular or irregular, notched, hard or soft, thick or thin, etc. ?—Surface: smooth; irregular; lobulated; size, form, and uniformity of irregularities or lobulations.— Consistence: hard, soft, elastic, impressible;—presenting yielding line across surface; —bogginess; fluctuation, deep or superficial, limited or not to extent of tumor ? effect of posture upon its seat and readiness of perception. — Effect of pressure, of varying states of stomach and colon, of purgatives or enemata, and of catheterism on tumor. — Movableness of tumor; effect of posture of patient upon its position and distinctness; —readiness and extent to which it may be displaced by the hands (upwards, downwards, laterally); slipping from under hand; rolling under hand; —soft parietes movable over it; soft parietes apparently adherent to it, tumor and soft wall moving together; skin attached to tumor; —radiating portions perceived at its mar- 
Palpation— number. 
position. 
size, etc. 
forni. 
surface. 
consistence. 
circumstances affecting it movableness. 


[§ IV. D 
PART I.] 
ABDOMINAL TUMORS. 
61 
w 
gin; — movableness of apparent tuberosities of surface apart from general mass of tumor; —move- of tumor on deep inspiration; —when more than one tumor is present, note independent mobility of them. —Apparent weight of tumor. — Sense of spontaneous movement in tumor; its character. 
— Crepitation, gurgling, etc. on pressure. — Repercussion.—Pulsation: its exact seat; extent; is it confined to a line across surface of tumor? (see also Swellings connected with arteries, p. 80); — abruptness or expansile force; —direction, merely elevating hand, or in lateral direction also?—permanence; circumstances affecting it; effect of posture (on hands and knees, etc.) upon it; effect of displacing tumor upon it. — Thrill: accompanying pulsation; with arterial systole or diastole or both ? continuous. 
131. Percussion: —Resonance; its special character, uniformity of pitch, etc. —Dulness; its extent and outline; uniform or not over all parts of tumor? continuity of dulness with that of known organs, (liver, spleen, uterus, etc.) —Results of superficial and deep percussion (specially at margin of tumor); effect of posture on percussion sounds ; effect of meals, vomiting, enemata, purgation, catheterism, etc.; extent of dulness of tumor modified or not by deep inspiration?—Dulness of tumor crossed by a resonant line (exact seat and direction of line); —dulness intermixed with resonance.— Hydatic fremitus.—Sense of resistance or elasticity perceived; uniform or not over surface of tumor ? 
132. Auscultation: (see Physical examination of the abdomen generally, 112; of liver, 116; spleen, 120; stomach, 124; and colon, 128.) — Impulsive sound; —diastolic shock.— Arterial mur- 
weight, spontaneous movement. 
pulsation. 
thrill. 
Percussion— resonance, dulness. 
circumstances affecting percussion sound. 
dulness and resonance. 
hydatic fremitus, resistance. Auscultation: 
arterial murmur. 


§ iv. I).] 
[PART I. 
GENERAL SYMPTOMS. 
62 
mur: its exact seat and extent; extent of vessel upwards and .downwards from tumor over which heard; —part of tumor at which heard, in front only or laterally also? following a line on surface of tumor; —characters; loud, soft, harsh, etc.; — systolic, diastolic, or both ? accompanied or not by shock or pulsation?—effect of strong pressure upon it; of pressure on either side of stethoscope; of change of posture, from recumbent to erect, or vice versd ; of posture on hands and knees, etc.; — effect of displacing tumor upon it (see also, Swellings connected with arteries, p. 42); —effect of any other circumstances upon its loudness or other characters.— Venous murmur: its exact seat; extent; characters; —circumstances modifying it.— Continuous murmur: its loudness (heard at a distance from patient?); effect of arterial systole or inspirations upon its intensity.— Uterine sound: its seat; extent; character; intensity; influenced or not by posture of patient ?— Hydatic sound. 
venous murmur. 
continuous murmur. 
uterine sound. 
hydatic sound, 
General symptoms referable to the Abdomen. 
General symptoms. 
183. Abnormal sensations : — Pain: precise seat, extent; —severity, seat of greatest intensity;—direction; towards the spine, chest, shoulders, pelvis, etc.; —special character; like a weight, twisting, lancinating, burning, etc. —Time of its occurrence; constant, paroxysmal, periodical;—when stomach is full or empty ? if after a meal, after which meal and how soon after it ? —effect of solid food and of hot, tepid, or cold liquids, or of alcoholic or stimulant liquids, in inducing or relieving it.—Duration. —Effect of posture upon it (note posture of patient during its presence);—effect of pressure with flat hand or points of fingers in increasing or relieving 
Abnormal sensations— pain. 


[§ iv. I> 
PART I.] 
GENERAL SYMPTOMS. 
63 
it; —effect of inspiration or coughing upon it; — effect of agitation of bed or apartment upon it; — its connection with mental agitation.—Does it precede or follow acts of defecation ?—has it any connection in point of time with other symptoms, (borborygmi, vomiting, eructations, etc.)? —is it relieved by expulsion of gaseous, liquid, or solid matters from stomach or rectum ?—has the patient any contrivance for relieving it?— Other abnormal sensations: of sinking, heat, weight, fulness, dragging, constriction (particulars as Pain). —Sensation of food passing over a circumscribed sore spot in stomach. Sensation of movement in abdomen; seat, character, and special similitude; —circum- under which it occurs. 
other sensations. 
134. Tenderness: —seat and extent; —connection with tumor; —special direction of pressure necessary to elicit it; —amount of pressure by which it is elicited, pinching the skin gently, dragging finger over its surface, etc.; moderate pressure; strong and deep pressure; —is it observed when attention of patient is withdrawn ? —does patient cry out before being touched ? —is pressure of bedclothes borne? —Does tenderness extend beyond limits of the abdomen; if so, in what direction, and how far? 
Tenderness. 
135. Appetite: —wanting (partially or wholly), for all or for certain meals? with or without loathing ?—voracious ; —untimely (at night, shortly after a meal, etc.); —depraved (with voracity?)— When is most appetite felt ? —Special desire or preference for certain kinds of food; for tasteless, acid, alkaline, sweet, or bitter articles; for sugar, salt, vegetables, fruit, meat, etc.; —special dislike of certain kinds of food. — Weight of food eaten in 
Appetite— 
weight of food eaten. 


§ IV. D.] 
[part I. 
GENERAL SYMPTOMS. 
64 
nature of food. 
Thirst- 
quantity drunk. nature of drink. 
Nausea. 
Vomiting— 
its immediate cause. 
accompaniments. 
twenty-four hours; —nature of food, relative amount of solid and liquid matters contained in it; —pro- of nitrogenous and non-nitrogenous matter in food. 
136. Thirst: —wanting; —dislike or horror of liquids; horror of sight or sound of liquids; —period when thirst is chiefly felt; after meals, after special meals or articles of food; —excessive thirst; relieved by taking large draughts of water or other thin liquid (best cold or warm?), by repeatedly moistening mouth and throat. —Special desire or preference for certain kinds of liquid, tasteless, acid, alkaline, sweet, bitter, or salt; for broths, etc.; —special dislike of the above.— Quantity drunk in twenty-four hours by measure; nature of drink. 
137. JVdusea: —time of its occurrence; accompanied or not by retching or vomiting ?—duration; —occurring after food or drink generally, or after particular kinds of food. 
138. Vomiting: —time of its occurrence; frequency or periodicity; occurring after food or drink, generally; after special kinds of food or drink; after certain meals only; time after any meal at which it occurs; occurring after minute quantities of food or drink; when stomach is empty. —Occur- in one posture more than in another; on changing the posture; —during act of defecation. —Its immediate cause; —spontaneous; —induced by coughing; the tickling of an elongated uvula ; bodily effort; mental emotion or passion; the influence of pain; the influence of bad odors (arising from the patient himself or near him); the taste and smell of eructated gases or liquids, of discharges from the nares, etc.—Is it accompanied or preceded by nausea, or by any other abnormal sensation ?—is 


PART I.] 
[§ IV. D 
GENERAL SYMPTOMS. 
05 
it accompanied by coughing ? —Characters; facility; painful or not ? accompanied by straining efforts. —Does it relieve any uneasy sensations temporarily or permanently ?—Has the patient any contrivance for obviating its occurrence? 
relief it affords. 
139. Vomited matters —quantity; taste as perceived by patient; odor; color, uniform or various ? "changed by exposure to light;" aeration; yeasty appearance.— Contents: — -food; its state of division ; special articles of food distinguishable ; indigestible substances; degree of chymification of vomited food; — "foreign substances recognizable by the eye; organic (e. g. portions of seeds, leaves, elytrce), their characters, etc.; mineral (crystals, etc.);" — feces; their consistence, color, and other characters ; — blood; its quantity, consistence, aeration; pure or mixed with other matters? —sooty matters; coffee-ground matters; —oily matters; watery fluid; mucus; pus; bile; worms; hydatids; calculi, etc.— Microscopical examination of vomited matters; of matters picked out; of liquid (645 et seq.) ; —special inquiry to be made for blood, pus, exudation-corpuscles, cancer-cells, sarcinse.— Chemical examination* of vomited matters; their reaction, before and after evaporation; —of matters picked out; of liquid;—special examination for bile, sugar, ammonia, "urine; the vegetable or mineral poisons." 3 
Vomited matters— appearance, etc. 
contents. 
microscopical examination. 
chemical ex animation. 
140. Eructation or regurgitation : —time of oc- 
Eructation— 
1 These particulars apply also to matters removed by stomach-pump. 
2 In this and every other " chemical examination," note accurately the process adopted. 
3 " Poisons to be sougbt for, also, in articles of dress etc. on which vomited matters may have fallen." 


§ IV. D.] 
[PART I. 
GENERAL SYMPTOMS. 
66 
nature of eructated matters. 
Hiccup. 
Defecation— 
pain. 
involuntary. 
Stoolsphysical character. 
constituents 
currence; relation to quantity or quality of food; time which elapses after food; —accompanied or not by nausea?— Eructated or regurgitated matters: gas, liquid, food; —their quantity, taste, odor; — if liquid, its apparent temperature and physical characters. (Further particulars as Vomited matters, 139.) 
141. Hiccup: —its time of occurrence; frequency; periodicity; noisy or not? continuing or not during sleep ? 
142. Defecation : —its frequency ; time elapsed since last stool; periods of defecation; —position chosen during the act; —amount of effort required; force of evacuation.—Is obedience to the desire ever in vain? is any obstruction felt, and where? —Pain preceding, during, or after the act; its seat, characters, duration ; —tenesmus. —Stools passed beneath patient; from carelessness, wilfulness, local defect of sensibility, inability to retain motion, general stupor, etc. (280) ? 
143. Stools: —quantity; at each evacuation in the twenty-four hours (measured or weighed);— odor; —consistence, solid, liquid, pultaceous, yeastylooking; if solid, note any peculiarity in width or form, and whether it is of constant occurrence; degree of solidity or hardness; —color; aeration. — Constituents of stools: — fecal matters; unchanged food; special articles of food distinguishable; food in a state of incomplete digestion ; — foreign substances recognizable by the eye ; — blood; passed alone ; mixed with feces, uniformly, or in patches or strise ?—following the act of defecation; — physical characters of the blood ; —mucus ; pus ; fibrinous matter; oily matter; epithelial shreds; casts of intestines; portions of intestine (their 


PART I.] 
[§ IV. D. 
PARACENTESIS ABDOMINIS. 
67 
physical characters) ; calculi (their physical characters); worms; hydatids; urine, etc. — Microscopical examination of stools : of matters picked out; of liquid (particulars as Vomited matters, 139). — Chemical examination of stools : their reaction; — of matters picked out; of liquid ; —special examination for albumen, fat, phosphate of magnesia and ammonia, mineral substances taken as medicine or "as poisons." 
144. Anus: —pain; sense of itching; constriction ; dragging ; sense of heat; —discharges from anus. 
Results of Paracentesis Abdominis. 
145. Operation: —its mode of performance, seat of puncture and peculiarities of operation; readiness of flow of fluid ; completeness of evacuation ; necessity for a second puncture. 
146. Matters removed : —their quantity (measured); color; degree of transparency; consistence; odor ; specific gravity ; —relative character of fluid at different periods of its flow ; —flocculi in fluid, their quantity and apparent characters.—Changes occurring in fluid after standing, coagulation, etc. — Microscopical examination of fluid ; of matters picked out (645 et seq.). — Chemical examination of fluid; special examination for fibrin, for albumen (its kind). 
147. Physical examination, of abdomen after tapping. 
microscopical examination. 
chemical examination. 
Anus. 
Results of Paracentesii Altdominis. 
Operation. 
Matters removed. 
microscopical examination, chemical examination. 
Physical examination of abdomen after tapping. 


§ IV. E.] 
[PART I. 
ORGANS OP RESPIRATION. 
68 
I IV. E. 
E.—ORGANS OP RESPIRATION. 
Nares. 
Nares, etc. 
148. Nares: —form; condition of alao; size of anterior aperture of nares; eruption about alaa (77 et seq.) ; ulcers (624) ; excoriations from picking, etc.; —condition of cartilaginous septum ;—condition .of bones.— Mucous membrane (as visible) ; its color; raw appearance of it; covered with secretion, liquid or adherent.—Tumors on mucous membrane (631); polypi; ulcers (624), etc.—Foreign bodies. — Discharge from nares : —quantity; color and other physical characters ; fetor; —containing blood, particles of bone, etc. — Hemorrhage from nares : —its amount; circumstances inducing it.— Movements of alee in respiration :—their amount; —equal or unequal on the two sides ? 
Nares— external clia racters. 
mucous membrane. 
tumors. 
foreign bodies, discharge. 
hemorrhage. 
movements of aloe. 
Sensibility— pain, etc. 
149. Sensibiliti/, etc.: —pain, its characters; tenderness; itching;—sense of fulness, affected or not by weather ? —Alteration in tactile sensibility (tested by introduction of substances into nostrils, snuff, etc.) ; —alteration in special sense of smell (315). 
tactile sensi bility. 
Sneezing. 
150. Sneezing : —its frequency; circumstances inducing it. 
Frontal sinuses. 
151. Frontal sinuses : —their apparent development —Painful sensations referred to their site ; weight, stuffing; soreness, etc. 


PART I.] 
AIR-PASSAGES AND VOCAL APPARATUS 
[§ IV. E. 
69 
Upper Air-Passages and Vocal Apparatus. 
152. Examination of throat externally. — Size of larynx and trachea: their form; —ulcers; —fistulae or openings communicating with air-passages; passage of air through them during acts of respiration; —swellings externally about these organs; their characters, cedematous, fluctuating, etc. — Manual examination : laryngeal fremitus ; heat of surface; crepitation. — Percussion applied over larynx and trachea, its results. — Auscultation : altered respiration audible at a distance; its characters, rough, stridulous; —expiration prolonged, laborious; —con- or paroxysmal character of the above phenomena ; —auscultation by aid of stethoscope ; respiration rough, whistling, accompanied by tracheal or laryngeal rhonchus. 
153. Epiglottis (examined with or without speculum) : —wanting;—prominent; thickened; flat; curled; —its color; —irregular on surface or on edge ; ulcerated; covered with secretion; presenting enlarged glands. —Examination with the finger. 
154. Glottis: —result of examination with speculum. 
155. Sensibility: —pain or other abnormal sensation —pain on swallowing, speaking, singing, etc.; —tenderness on pressure. 
156. Voice: —wheezing; hoarse; rough; croupy; cracked; —feeble, almost inaudible, whispering;— totally lost; constancy of the aphonia or circumstances under which it occurs. 
157. Other symptoms, e. g., cough, expectoration, hemorrhage, etc. (particulars, see General thoracic symptoms, p. 37). 
Upper Air- Passages, etc. 
Examination of throat externally— size of larynx and trachea, etc. 
manual examination. 
percussion, auscultation. 
Epiglottis. 
Glottis. 
Sensibility. 
Voice. 
Other symptoms. 


§ IV. E.] 
[PART I. 
LUNGS, PLEURvE, ETC. 
70 
Physical examination of Lungs, etc. 
Inspection— form of thorax. 
size of thorax. 
movements. 
Physical examination of the Lungs, Pleurse, etc. 
(In all cases, the corresponding parts on the two sides should be compared.) 
158. Inspection. — Form of the thorax: general shape ; —elevation or flattening of the post-clavicular and infra-clavicular spaces; condition of suprasternal hollow j form of clavicles and direction of their curves. —Height of the shoulders ; shoulders thrown forwards ; —position of scapulae, their prominence, nearness to spine, rotation, etc. —Position of nipples; their distance in a vertical line from the clavicle, and in a horizontal line from the median line of the trunk.—Form of the sternum ; its relation to the median line of the body. —Form of the spine; curvatures, lateral or angular (301). — Form of lateral regions of chest; general prominence or retraction.— Condition of intercostal spaces ; their width ; bulging or depression ; "influence of respiratory acts upon them. —Local bulging or retraction, its seat, amount, etc. —Costal angles, their size.— Size of thorax (general idea of it, making allowance for fatness or emaciation). — Thoracic movements: rhythm of respiratory movements, equable or not ?—relative duration of inspiratory and expiratory acts, as measured by seconds; —amount and relation of costal and abdominal expansion in inspiration ; amount of costal elevation in inspiration as compared with expansion; —thoracic retraction in inspiration, its seat, extent; —movements at any particular spot, compared with those at a corresponding point on opposite side; — 


[§ IV. E 
PART I.] 
LUNGS, PLEURiE, ETC. 
71 
condition of intercostal spaces during inspiration and expiration. — Fluctuation. 
159. Measurement (by tape or by callipers) :— in rest and in motion ; in deep, and medium inspiration and expiration. — General measurements; circular, opposite ensiform cartilage, midway between nipples and clavicles; —transverse, from point of one acromion to that of the other, in axilla), at base of chest; —antero-posterior, under the clavicles, at base of chest; —vertical, from clavicle to most depending point of ribs.— Partial measurement; from nipple to middle line of sternum; —from sterno-clavicular articulation to nipple;— from nipple to antero-superior spine of ilium; — from most dependent point of twelfth rib to same process. —Measurement by chest-measurer, in tranquil and forced breathing.—Results of use of spirometer. 
1G0. Palpation: — Fremitus, vocal, tussive, rhonchal, friction, pulsatile;—pulsation;—fluctuation, peripheric, rhonchal. 
161. Percussion: —Pulmonary sound, too dull; special character of dulness, wooden, cracked-metal; —sound too clear; special character of clearness, tympanitic, amphoric, tubular; —seat and extent of dull or clear sounds; —fulness or emptiness of sounds.—Influence of deep inspiration or expiration upon sounds or upon their limits; influence of alteration of position upon them. —Resistance of parts percussed. 
162. Auscultation (specifying the different regions) : during easy, deep, and tussive respiration. 
— Inspiratory sound: its intensity, natural, exaggerated, weak, suppressed; —its rhythm, even, jerking, cog-wheeled;—its quality, natural, harsh, 
fluctuation. 
Measurement: 
general. 
partial. 
by chestmeasurer. 
spirometer. 
Palpation. 
Percussion— dulness. clearness. characters affecting percussion sounds. 
resistance. 
Auscultation: 
inspiration. 


[PART I. 
LUNGS, PLEURAE, ETC. 
72 
bronchial, 1 blowing (diffuse or tubular), hollow, 3 metallic. 3 — Expiratory sound: its intensity, actual and as compared with inspiratory ; —its rhythm, divided from inspiratory, jerking; —its quality (see Inspiratory sound, supra).— Rhonchi: their quality, cooing, droning, sonorous, sibilant, clicking, crackling, creaking, bubbling, metallic; —dry or moist? if moist, size of bubbles (large, small, equal or unequal);—how evolved (slowly, rapidly, in puffs, etc.) ? —at what time audible, with inspiratory act, throughout, or at its commencement or close, with expiratory act, and at what part of it, with tranquil, forced, or tussive respiration?—constantly or only occasionally audible ? —effect of coughing and expectoration upon rhonchi.— Friction-sound: its quality, grazing, rubbing, creaking; —its intensity; —when audible, during whole act or at beginning or close of respiration ? with expiration entirely or at beginning or close ? with easy or forced respiration ?—Effect of position upon it; effect of heart's impulse upon it.— Metallic tinkling : at what time heard, with respiration, cough, or voice? —con- or occasionally audible ?— Voice: intensity of vocal resonance, natural, diminished, increased ; —with or without vibration; —its qualities or special characters, twanging, nasal, aegophonic, metallic; distinctness or indistinctness of articulation; —constancy or otherwise of increased resonance or of special quality;—effect of coughing and expectoration upon vocal resonance. — Cough: its reso- 
expiration. 
rhonchi. 
frictionsound. 
metallic tinkling. 
voice. 
cough. 
1 " Bronchial:"—quality and intensity equal to natural bronchial respiration, as heard under first bone of sternum. 
2 " Hollow" includes what is sometimes called cavernous. 
3 " Hollow" and "metallic" include amphoric. 


[§ IV. E 
PART I.] 
THORACIC SYMPTOMS. 
73 
g 
nance. — Heart sounds and murmurs (178) : transmission of them; degree and direction of their transmission. — Succussion: its results; thoracic fluctuation. 
heart sounds, 
succussion. 
General Thoracic Symptoms. 
General Symptoms. 
Pain— 
163. Pain in the chest: —exact locality (if there be more kinds of pain than one, each should be distinctly particularized) ; —severity;—character, dull, aching, sharp, stabbing, catching, burning etc.; — direction, towards the spine, shoulders, down the arms, etc.; —mode in which it is developed, by breathing (ordinary or forced), by sighing, by coughing, by movement of the trunk, arms, or other parts of the body, etc.; —effect of posture upon the pain;—pain occurring after food; —relief or otherwise afforded by eructation, etc. — Other abnormal sensations: weight; oppression ; dragging, etc.; —circumstances under which they occur. 
other sensations. 
164. Tenderness: —its seat; perceived on pressure beneath margin of false ribs, between ribs, over certain muscles; —perceived on gentle pinching of skin, on rubbing the muscles over the surface of the ribs and cartilages, etc. 
Tenderness. 
165. Cough : —mode of its excitement (by breathing cold air, etc.); severity; frequency; periods of its occurrence; —character, short, hacking, prolonged, uncontrollable, paroxysmal, noisy, barking, wheezing, hoarse, ringing, etc.; —character of the back-draught, hooping, crowing, etc.; —cough, dry or accompanied by expectoration ?—attended by pain or other uneasy sensation in chest (163) or elsewhere ; —followed by vomiting, sweating, ex- 
Cough. 


§ IV. E.] 
[PART I. 
THORACIC SYMPTOMS. 
74 
hawking. Expectoration. 
Sputa— quantity, physical characters. 
special characters. 
microscopical examination. 
chemical ex amination. 
Expectoration of blood— quantity. mode of expulsion. 
characters. 
haustion, etc.; —effect of posture on cough. — Hawking. 
106. Expectoration: —easy or difficult?—accompanied or not by pain ? —effect of posture on readiness of expectoration;—relief afforded by it to dyspnoea or other uneasy sensations. 
107. /Sputa: —their quantity (measured), in each twelve hours of the twenty-four; —their form, round, flat, discoid, ragged, indefinite ; —size of the masses; —their transparency or opacity; color, white gray, yellow, green, pink, red, rusty, brown, blackish ; —viscidity or adhesion to vessel; —odor; —taste and apparent temperature to the patient. —Special characters ; thin, serous, frothy;—containing particles like boiled rice, or little matters of other kinds (e.g., tartar of teeth, etc.); containing pseudomembranous matters; like currant jelly or prune juice; mixed with fibrinous casts; mixed with blood streaks; intimately mixed with blood; containing calcareous matter, hydatids, etc. — Microscopical examination of sputa (045 et seq.) : presence of epithelium (flat, cylinder, ciliated), granular cells, nucleated cells, fibrinous coagula (their form and 'length), blood-disks, fat, molecular matter, crystals, pseudo-membrane, fibres (their characters), vessels, tuberculous matter, fungi, foreign substances derived from food (starch, muscular fibres, vegetable cells and fibres,etc.). — Chemical examination of sputa: their reaction; if liquid enough, test for albumen. 
108. Expectoration of blood: —quantity of blood expelled;—mode in which brought up; in mouthfuls, in a gush, by an action like vomiting, by hawking, etc.; —its color ; clotted or not; its degree of aeration; —pure or mixed with sputa, in streaks or uniformly, in masses surrounded by 


PART I.] 
[§ IV. E 
THORACIC SYMPTOMS. 
75 
sputa? — Immediate cause of the haemoptysis ; coughing, exertion of the voice, muscular exertion of other kinds. —Sensations preceding it; heat of chest, salt or other taste in mouth, etc. —Repetition of haemoptysis; at what intervals ? —character of each discharge (as above). —Haemoptysis followed by bloody expectoration and of what variety? by black stools, etc. 
169. Respiration : — Sense of dyspnoea : its severity, sense of suffocation; constant or not ? circumstances under which it occurs; —effect of posture upon it; variation with the times of day or night; effect of meals upon it, of exertion, of mental emotion. —Inability to hold the breath for a reasonable time; frequent arrests in the act of speaking to take breath. —Dyspnoea paroxysmal; time of occurrence of paroxysms; their duration; — appearance and posture of patient during them. — Acts of inspiration or expiration painful; —noisy; rattling; prolonged; wheezing; cooing;—inspiration crowing.— Number of respirations in a minute; their apparent fulness; —movement of alao nasi during the acts, on both sides, or on one more than the other; —visible action of supplementary muscles of respiration. —Sensation experienced by patient of the air entering unequally on the two sides of the chest. 
170. Expired air: —its temperature ; its odor. — Chemical examination of it j the absolute and relative quantities of oxygen, nitrogen, carbonic acid, and watery vapor ; presence of ammonia ? 
immediate cause. 
sensations preceding, repetition. 
sequelae. 
Respiration— dyspnoea. 
respiration noisy. 
number of respirations. 
Expired air— chemical examination. 


[PART I. 
§ iv. P.] 
ORGANS OP CIRCULATION. 
70 
Results of Paracentesis Thoracis. 
Operation. 
Matters removed. 
Diaphragm. 
Level— 
pain, etc. 
hiccup, movements. 
I IV. F. 
Physical examination of Heart, etc. 
Inspection— shape of cardiac region. 
intercostal spaces, pulsation. 
Measurement. 
Results of Paracentesis Thoracis. 
171. Operation: —(particulars as Paracentesis abdominis, 145.) 
172. Matters removed: —(particulars as Paracentesis abdominis, 140.) 
Diaphragm. 
173. Level of diaphragm (determined by inspection, fremitus, percussion, and Harrison's process). 
— Pain in course of diaphragm (particulars as 103). — Hiccup (141). — Movements of diaphragm, as estimated by movements of abdomen and lowest ribs. 
F.—ORGANS OP CIRCULATION. —BLOOD. 
Physical examination of the Heart and Pericardium. 
174. Inspection: — S hape of cardiac region: bulging or depression of second, third, fourth, and fifth left costal cartilages and ribs ; —shape of adjoining part of sternum.—Condition of intercostal spaces as to widening, bulging, retraction. — Visible pulsation : its site and extent; visible point of apex beat; —undulatory pulsation ; double pulsation, locality and time of; —force of pulsation as estimated by the eye;—effect of position and inspiration upon visible pulsation. 
175. Measurement: —distance of left nipple from middle line; of upper edge of third left costal cartilage from upper edge of sixth, one inch outside sternum, (the above compared with analogous 


PART I.] 
[§ IV. P 
HEART AND PERICARDIUM. 
77 
measurements on right side;) of clavicle from heart's apex. 
176. Palpation : — Exact position of apex of heart, during impulse, (noting the rib or interspace, and the relative position of the spot to the nipple, to the sternum, or to the ensiform cartilage;) effect of inspiration or expiration on seat of impulse; effect of change of posture on seat of impulse.— Characters of impulse; extent; strength; duration; —impulse given by apex only or by greater or less extent of heart's surface ? its frequency; strength of impulse compared with arterial pulsation. —Back- of impulse; irregularity of impulse, of what kind ?— Thrill and pericardiacfriction fremitus; its exact position; extent; amount; accompanying systole or diastole ?—Vocal fremitus over and around prsecordial region. 
177. Percussion: —of prsecordial space; its general characters as to clearness, dulness, etc. — Superficial dulness (determined by light percussion, during tranquil breathing) ; highest point of dulness ; inner and outer limits; lowest point; shape of dulness; —measurements of dulness, vertical, oblique, and horizontal diameter. —Deep-seated dulness (determined by strong percussion on full expiration; particulars as Superficial dulness). — Effects of change of posture on results of percussion. 
178. Auscultation: — sounds 1 (first and second), normal and abnormal, at second right and second left costal cartilages (for the sounds of the aortic and 
1 The term "sound" refers only to the natural sounds of the heart, either normal or abnormal— i. e., modified as to duration, pitch, or timbre. 
Palpation— seat of apexbeat. 
characters of impulse. 
back-stroke, 
rhythm. 
thrill, etc. 
Percussion— 
superficial. 
deep-seated. 
Auscultation:. sounds. 


§ iv. P.] 
[part I. 
HEART AND PERICARDIUM. 
78 
pulmonary orifices respectively);—at third left costal cartilage, and adjoining part of sternum (for both aortic and pulmonary sounds); —at third interspace and along third rib for the distance of three inches from left edge of sternum (for all the sounds); —at point where apex beats (for mitral sounds); —at left of sternum and under ensiform cartilage, if apex be not in this position (for tricuspid sounds). — Character of sounds: their intensity; pitch; quality; duration; rhythm. —Re- of sounds, of first, of second. — Murmurs .- 1 —locality and exact point of maximum intensity (See Sounds, supra) ; —intensity, absolute (estimated per se), relative (as compared with murmurs in other localities); —deep or superficial?— their special characters, blowing, rough, rasping, filing, humming, grazing, rubbing, creaking, musical. —Time of their occurrence; prao-systolic (occurring before first sound and impulse); systolic (coincident with first sound and impulse); post-systolic (continuing after first sound and impulse but before second sound) ; diastolic (coincident with or following second sound); continuous. —Rhythm of murmurs.— Transmission of murmurs (noting the exact direction) —Presumed origin of sound; endocardiac, pericardiac, or exocardiac. 2 
character of sounds. 
murmurs. 
1 The term "murmur" is applied to an adventitious and superadded phenomenon, which may occur with one or more " sounds," or at their expense. Although a line between sounds and murmurs cannot always be perfectly draAvn, this is no reason for abandoning a distinction of great importance, and one that is inmost cases easily made. 
2 " Exocardiac" —i. e., a sound produced during the heart's action, but having a cause external to the heart and pericardium. 


PART I.] 
[§ IV. F. 
ARTERIES. 
79 
General Cardiac Symptoms. 
179. Pain: —locality; severity; characters; direction ; constancy; —accompanied or not by dyspnoea —how induced?—effect of posture upon it. — Other abnormal sensations: sinking; faintness; pressure; weight; drawing, dragging.— Tenderness: its locality, in interspaces or on ribs ? by what amount of pressure caused ? 
180. Palpitation: — severity; frequency; constancy —circumstances giving rise to it, exertion, going up stairs or up hill, mental emotion, etc. 
Arteries. 
181. Inspection: —Pulsation visible or not? characters of movements. 
182. Palpation: — Pulsation; its frequency, strength; lateral impulse; —time as compared with that of heart's impulse. 
183. Auscidtation: —Sounds and murmurs, with and without pressure. 
General Cardiac Symptoms. 
Pain. 
other sensations. 
tenderness. 
Palpitation. 
Arteries. 
Inspection. 
Palpation. 
Auscultation. 
Radial pulse: number, size, force, resistance, rhythm. 
special characters. 
184. Radial pulse: —number; —size and force; large, small, thready, equal, unequal, strong, feeble; —resistance; soft, compressible, hard, incompressible ; —rhythm; regular, irregular, intermittent; — time as compared with that of heart's impulse;— artery tortuous. —Special characters of pulse ; jerking, bounding, undulatory, continuous (one pulse appearing to run into the following), vibrating, quick, tardy, vermicular, tremulous, reduplicate. — Effects of posture on pulse (its number and other characters). —Phenomena of pulse in one arm as compared with the other. 


§ iv. p.] 
[PART I. 
ARTERIES. 
SO 
Swellings connected with Arteries. 
Inspection. 
Palpation— size, etc. 
pulsation. 
thrill. 
diastolic shock. 
Measurement. 
Percussion. 
Auscultation. 
Swellings connected with Arteries. 
185. Inspection: — position of swelling; size, shape; pulsation. 
186. Palpation: — size of tumor; readiness of definition; form; surface; movableness; consistence, uniform or not ? fluctuation : capable of being emptied or not by pressure of the hand (noting phenomena of return of blood) ?— Pulsation: characters of pulsation, heaving, expansile, hammering, abrupt, etc.; force; time as compared with •heart's impulse;—perceived only in front of tumor, or laterally also ? —effect of displacement of tumor upon pulsation; effect of exercise or emotion upon it; —pulsation felt in a line along surface of tumor. —Effect of posture on the tumor and on its pulsation —effect of pressure on proximal side of tumor. — Thrill: perceived in front or laterally? with impulse or diastole of tumor, or both ? continuous ; during return of blood after compression. — Diastolic shock. 
•187. Measurement of tumor : —diameters; elevation, etc. 
188. Percussion: —sound and resistance : size of part dull on percussion;—effect produced by pressure on proximal side of tumor. 
189. Auscultation: —sounds and murmurs; single, double, continuous; —their loudness; pitch; quality and special characters; presenting suction character. —Sounds and murmurs constant or not ? effect of posture on them; effect of movement; effect of pressure on vessel; if near or in the thorax, effect of respiration on them : —period of sounds 


PART I.] 
[§ IV. F. 
VEINS. 
81 
and murmurs as compared with impulse of swelling and heart's impulse. 
190. Rupture of swelling : —phenomena attending it; —alteration in the signs derived from inspection, palpation, measurement, percussion, and auscultation. (Vide supra.) 
191. Abnormal sensations: —pain, seat, characters, intensity, direction, etc. (326); aching, its seat, etc.; tenderness; throbbing; tension. 
Veins. 
192. Inspection (on thorax, abdomen, neck, upper and lower extremities, etc.) : —size; course ; tortuosity ; apparent connection with deep veins; — direction of flow of blood in enlarged veins.—Visible pulsation (noting in which vein or veins); degree and characters; cardiac or respiratory ? its time as compared with heart's impulse; —influence of posture, exercise, emotion, respiration, coughing, etc. upon it. 
193. Palpation: — hardness of veins (noting seat and extent of this and other phenomena), thickening, cording, etc.; pulsation; thrill. 
194. Auscultation: —murmurs; their characters; rhythm; influence of position, pressure, respiration, heart's action, etc. upon them. 
195. Condition of skin over veins: —redness, etc. 
Swellings connected, with Veins. 
190. Physical examination: —Position; shape; size; —thrill; —results of percussion and auscultation. 
Rupture of swelling. 
Abnormal sensations. 
Veins. 
Inspection— size, etc. 
visible pulsation. 
Palpation. 
Auscultation. 
Skin over veins. 
Swellings connected with Veins. 
Physical examination. 


§ IV. F.] 
[PART I. 
BLOOD. 
82 
Abnormal sensations. 
Blood. 
Phlebotomy or arteriotomy— period of day. pulse. posture. vessel. flow. 
quantity drawn, effects. 
Characters of blood. 
coagulation. 
clot. 
197. Abnormal sensations, etc.: —pain, its characters ; tenderness, etc. 
Blood. 
198. Phlebotomy or arteriotomy : —Period of day when blood is drawn ; its relation to meals.—State of pulse before bleeding.—Posture of patient during operation; position of limb or part.—Name of vessel; any peculiarity connected with it ? size of incision.— Plow of the blood (noting and comparing particulars at different periods of the bleeding, and at its close): facility of the flow; force; volume; rhythm; height;—color of blood as it streams, natural, black, violet, bluish, whitish, reddish, scarlet, variegated;—its fluidity ; —its temperature (taken near the orifice, that of the atmosphere being observed at the same time); —its odor (with or without addition of sulphuric acid). — Quantity of blood drawn: time occupied in obtaining it. — Condition of patient: during and immediately after bleeding; especially as regards changes in pulse, state of skin, intellect (syncope, delirium), etc. 
199. Characters of blood drawn: —description of vessel into which blood has been received.—Process of coagulation : blood completely or partially coagulated; time of commencement and completion of process ; appearances attending it; —accidental occurrences which may affect it, temperature, exposure to air, etc.— The clot: position in respect of vessel, in respect of serum; size; form, round, ovoid, flat, cupped, etc.; color, mottled, etc.; aeration ; cohesion, etc.; —buffy coat or siziness, its color, thickness; proportion to entire clot; surface (smooth, granulated); cohesion; degree of cupping. 


PART I.] 
[§ IV. a 
LYMPHATIC SYSTEM. 
83 
— The serum: color; transparency (if milky, note effect of ether upon it); viscidity; specific gravity; chemical reaction. 
200. Microscopical examination of blood: —of drop of blood taken from finger of patient; period of day when taken ; time of last nieal.—Elements observed; —movements of red corpuscles, time of running together into rouleaux, length of rouleaux, duration of aggregation; — relative numbers of white and red corpuscles;—effect of agents on microscopic elements.—Of blood drawn from a vein and coagulated; examination of clot, buff, and serum. 
201. Chemical examination of blood :—proportion of each of normal elements; —examination of serum for presence of sugar, urea, uric acid, ammonia, etc. 
Gr. —LYMPHATIC SYSTEM. 
202. Lymphatic vessels (noting locality and extent of all observed phenomena) :— hardness; enlargement; — tenderness; pain. — Redness or other discoloration over them, occurring in patches, along line of superficial lymphatic vessels (noting exact course, and whether linear or blotch-like in form); —oedema or abscess of adjacent cellular tissue. 
203. Lymphatic glands (noting situation of glands affected) : —size; form ; readiness of circumscription ; surface; induration, general or partial, its degree; softening; fluctuation; —pain, tenderness, etc.—Cicatrices over seat of glands (76). 
serum. 
Microscopical examination: from finger. 
from vein. 
Chemical examination. 
I IV. G. 
Vessels. 
Glands. 


§ IV. H.] 
[PART I. 
URINARY ORGANS. 
84 
\ IV. H. 
Physical examination of Kidneys, etc. 
Inspection. 
Palpation. 
Measurement. 
Percussion. 
Auscultation. 
H.—URINARY ORGANS. —URINE. 
Physical examination of the Kidneys, Suprarenal Capsule, and Ureters. 
204. Inspection (in postero-lumbar, lateral lumbar, and antero-lumbar regions).—Fulness; oedema of integuments; redness; fistuke, etc. 
205. Palpation: — temperature of surface in renal regions.—Tumor; its size; state of surface, even or nodulated ? size of nodulations (their uniformity) ; firmness of tumor; fluctuation, readiness of its perception;—presence of yielding portion in front of tumor ?—(further particulars as Abdominal tumors (130).) —Movableness of kidney discoverable anteriorly. —Swelling in course of ureter; effect of pressure upon it; its movableness. 
206. Measurement: — vertical from antero-superior spine of ilium to lowest rib; semicircular; antero-posterior (with callipers). 
207. Percussion (after defining previously, if possible, the limits of liver and spleen): —extent of dulness anteriorly; how connected with that of liver and spleen? extent of dulness posteriorly; transverse dulness (measured). —Intestinal note anteriorly to tumor; course of line of intestinal note, transverse, vertical, irregular; (further particulars as Abdominal tumors, (131. )) 
208. Auscultation (with pressure or percussion) : —sound of collision of calculi; (further particulars as Abdominal tumors, 132.) 


PART I.] 
[§ IV. H. 
URINARY ORGANS. 
h 
85 
Physical examination of Bladder and Prostate Gland. 
209. Physical examination of hypogastric region : — fulness; tension.—Palpable tumor;' its form, size, consistence, fluctuation; —effect of catheterism upon it. —Form of distension as established by percussion.—Auscultation combined with use of sound; audible collision of sound against a calculus, against a tumor ; (further particulars as Abdominal tumors, p. 59.) 
210. Examination through rectum: — size of prostate gland, etc. 
211. Examination through vagina (231). 
212. Catheterism: —direction of prostatic part of urethra; calculus felt in bladder, etc.; —effect of catheterism on physical signs. 
Physical examination of Urethra. 
213. Inspection : — vegetations at orifice ; — vascular tumors; number, seat, tenderness, etc. — Discharge from urethra: abundance, circumstances influencing it; —physical characters, color, consistence, odor; coagulability;—duration of discharge;—results of inoculation with discharge (in evidence of chancre within urethra). — Stains upon linen: abundance; size; precise form; precise tint; stiffness or pliability;—results of steeping in distilled water and microscopical examination. 
214. Palpation (in course of urethra): —swell- ; hardness; knottiness, etc. 
215. Catheterism: —length and direction of urethra (determination of this and of thickness of 
Physical examination of Bladder, etc. 
Hypogastric region— inspection, palpation. 
percussion, auscultation. 
By rectum— prostate. 
By vagina. Catheterisni. 
Physical examination of Urethra. 
Inspection, orifice. 
discharge. 
stains on linen. 
Palpation. 
Catheterism: 


§ IV. H.] 
[PART I. 
URINARY ORGANS. 
86 
urethra and tissues about it assisted by finger in vagina or rectum. — Strictures: number; situation; closeness of stricture ; hardness of walls; —effects of stricture upon micturition and ejaculation of semen. 
strictures. 
General Symptoms. 
General Symptoms referable to the Urinary Organs. 
Pain— seat. 
216. Pain : —in renal regions; in direction and course of ureters; in region of bladder; in course of urethra; at extremity of penis.—Its severity ; constancy, if paroxysmal, state period, frequency, and duration of attacks; — circumstances under which it occurs; after walking, riding, jolting, etc.; effect of different kinds of food or drink upon it; —its precise seat and extent ? if in renal region, on one or both sides ?—its direction ;—accompanying phenomena; faintness, sickness, sweating, etc.; —special character of pain.— Other abnormal sensations : fulness; tension ; itching at extremity of urethra, etc. 
severity. 
circumstances affecting it. 
accompanying phenomena. 
other sensations. 
Tenderness. 
217. Tenderness (in renal and hypogastric regions, and in course of urethra) : —superficial or deep-seated ? its amount; limited to spot touched, or radiating elsewhere ? 
Micturition— desire. 
218. Micturition: —desire to pass urine or not? its frequency, its urgency.—Frequency of micturition; facility of micturition, effect of posture upon it; —stream of urine, interrupted, in drops, forked, spiral. —Painful micturition; pain preceding, accompanying, or following the act; characters of pain ; constancy; duration; seat. — Stillicidium urinae; constant or occasional? urine passed into bed at night, from what cause ? 
frequency. 
stream, 
pain. 
stillicidium. 


PART I.] 
[§ IV. H. 
URINE. 
87 
219. Hematuria: —quantity of blood passed; frequency of occurrence; —circumstances giving rise to it, walking, jolting, etc.; —blood passed at commencement or close of micturition, or mixed generally with urine ?—blood fluid or coagulated ? form of coagula, lumpy, vermicular; color of blood or of urine containing it. —Phenomena preceding the discharge. 
Urine. 
220. Quantity of urine (in ounces), in course of day and night;—relation of this to the quantity of liquid drunk. 
221. Characters of urine (in important cases, separate examinations should be made at different periods of the twenty-four hours, before and after meals, etc.); —transparency: —color; pale, yellow, greenish, tinged with blood, smoky, etc.; odor: urinous, whey-like, sweet, broomy, strongly acid, ammoniacal, fishy, musty, etc.; —specific gravity (noting temperature) before deposit; after deposit; after ebullition; —its reaction; acid, neutral, alkaline (from volatile or fixed alkali?). —Spontaneous coagulation; size, color, and consistence of coagulum —Pellicle, iridescence; —cloud; —deposit; its position, proportion to entire specimen of urine, density, color; special physical character of deposit, flocculent, cottony, fleecy, ropy, catarrhal, sandy, solid.—Foreign substances in urine; milk, feces, ink, worms (acephalocysts, dactylius aculeatus, strongylus gigas), etc.—Changes in urine on standing for several hours, days, or weeks. 
222. Microscopical examination of urine (645 et seq.) : —saline matters; lithic acid, lithate of 
IT hematuria— quantity. 
circumstances affecting. 
characters of blood. 
phenomena preceding. 
Urine. 
Quantity. 
Characters— appearance. 
odor. 
specific gravity. 
reaction. 
coagulation. 
pellicle, deposit. 
foreign substances. 
Microscopical examination: saline matters 


§ iv. i.] 
[PART r. 
ORGANS OF GENERATION. 
88 
ammonia and soda, oxalate of lime, phosphates (amorphous and crystalline), cystine, etc. (note form of crystals, .etc., their abundance in urine generally and in deposit, and effects of reagents upon them); —animal matters; blood-disks, mucus, epithelium, albuminous shreds (connected or not with salts ?), pus, pyoid corpuscles, cancer-cells, etc., portions of acephalocysts, spermatozoa (living or dead ?), vibriones, hairs (accidental or from pilimiction ?), etc. 
animal mat ters. 
228. Chemical examination of urine: —rough estimate of quantity of urea and albumen;—ascertain qualitatively the presence of sugar, biliary or coloring matter. —(In analysis specially ascertain proportion of principal constituents of urine, uric acid, urea, phosphates, etc., and the actual quantity of each passed in twenty-four hours.) —" Examination for arsenic, etc., in cases of suspected poisoning." 
Chemical examination. 
t IV. I. 
I.—ORGANS OF GENERATION. 
1. Female 
Pudendum. 
Pudendum. 
224. Labia, Nymphse, and Clitoris: —enlarge- swelling hard, soft, fluctuating, cedematous; color; degree of vascular injection;—excoriation, its seat, extent, etc.; ulcers (624); cicatrices (629); — vegetations; condylomata, elevated or flat; — tumors, their exact seat, size, form, color of surface, consistence, fluctuation, movableness, disappearing or not on lying down ?—Discharge; amount, odor, and other characters; —other matters about external genitals, blood, etc. —Fourchette lax or torn. 
Labia, etc.— swelling. 
ulcers, etc. 
tumors. 
discharge, etc. 
fourchette. 


PART I.] 
[§ IV. I. 
EXAMINATION BY VAGINA. 
89 
II* 
225. Abnormal sensations: —pain, itching, tenderness, etc. 
226. Urethral orifice: —its prominence; thickening of tissues around it; its color; sensibility.— Growths within and about it, warts, vascular tumors, etc. (their number, exact seat, size, and other characters).—Displacement of urethral orifice. 
227. Hymen: —absent or present? its precise state, " surrounding the entire vaginal orifice, or only a part of it?" imperforate; "its strength." 
228. Protrusion from vulva externally:—number of protrusions; amount; form; —condition of surface of protrusion; color; presenting appearance of os uteri upon it, etc. —Effect of posture or catheterism on protrusion.—Palpation of protrusion; —distinguished as uterus by its form, size of uterus; —protrusion soft, elastic, fluctuating. —Percussion of protrusion, resonant, dull. 
Examination by the touch, through the Vagina. 
229. Vagina: —orifice, its size; contracted by muscles; surrounded by swollen mucous membrane; —direction of vagina in relation to pelvis; length; breadth; narrowing of any part, its exact seat and degree, its apparent cause; .complete closure of canal, its seat; —mode of termination of vagina.— Mucous membrane: smooth, velvety, rough, corrugated, swollen, or thickened; presenting puckering, fraena, vegetations, etc. (their seat, etc.). —Pul- of arteries perceptible or not ? generally or limited (to what part) ? —Tension, hardness, or resistance to pressure at any part of the wall ? — Euptures, into rectum, into bladder; — other abnormal openings, their seat, communication with 
Sensations. 
Urethral orifice— appearance, growths. 
displacement. 
Hymen— presence. 
characters. 
Protrusion from vulva: inspection. 
palpation. 
percussion. 
Examination by Vagina. 
Vagina— orifice, direction, size. 
closure. 
termination. 
mucous membrane. 
pulsation of arteries. 
resistance. 
ruptures, etc 


[part T. 
EXAMINATION BY VAGINA. 
90 
felt tumors; —nature of matters discharged from the openings, hair, portions of foetal substance, bones, etc.—Tumors attached to wall of vagina; their position, size, form, etc.; sessile or pedunculated ? their sensibility.—Contents of vagina; a clot; a polypus, its size, shape, consistence, sensibility, etc., traced to os uteri (232) ; foreign substances in vagina (pessaries, etc.). 
tumors. 
contents. 
clot. polypus, foreign substances. 
Urethra. 
230. Urethra: — thickening in its course, its extent, hardness, etc. (judgment assisted by simultaneous use of catheter). 
Bladder — distension. 
231. Bladder: —distended; protruding anterior vaginal wall; fluctuation felt on impulse over supra-pubic region; effects of pressure in supra-pubic region on tumor; effect of catheterism, of efforts at micturition. —Hard tumor about situation of base of bladder; its form, irregularity, extent, mobility, etc. 
tumor. 
232. Uterus. — Neck: its position, elevated, depressed (amount of each), displaced towards either side of pelvis, forwards or backwards; —axis altered in direction, placed horizontally (partially or completely ?); os uteri directed forwards, backwards, or to either side; —neck of uterus shortened, lost (note mode of termination of vagina), elongated; increased in breadth; altogether smaller than usual; —consistence, soft, cushiony, hard; —covered with transverse folds of mucous membrane; irregularities or elevations on its surface; —pulsation of arteries on its surface; —ulceration (024); —extent to which neck has been destroyed; —tumors, their extension in direction of body of uterus or towards other organs; —adhesion of neck of uterus, at what part ?—Tenderness.—Lips of uterus : natural; of ringlike form; hard; soft; irregular; enlarged (stating which lip); 
Uterus— neck. 
lips. 


PART I.] 
EXAMINATION BY VAGINA. 
[§ IV. I 
91 
fiat; everted; thinned; smooth; lobulated (in two, three, or more lobules ?); excavated, etc. — Orifice of uterus: incapable of being reached, from what cause ? direction in which it points; its shape, natural, oval, rounded, irregular, excavated; elevated on one side; closed; —open, degree of openness (admitting one or more fingers) ; —obstructed, nature of obstruction (if ascertainable); —tumor projecting through orifice; its extent (229), narrowing of tumor opposite orifice, attachment of tumor to any part of orifice, or readiness with which finger can be passed round its neck. — Body of uterus: position; apparent size (amount of enlargement of organ above the cervix); is the enlarged part anterior or posterior to cervix, or is the enlargement in all directions?—form of enlargement; lobulation or other irregularities of surface; —consistence, hard, soft, fluctuating;—apparent weight of uterus; —fixity of uterus.—Repercussion (ballottement). —Presenting part of a foetus perceptible. —An angle perceived between neck and body of uterus; anteriorly, posteriorly, laterally. —Results of introduction of finger into cavity of uterus; escape of gas, of fluid matters (their characters); —solid substance felt within it; polypus, its point of attachment (by a neck, by an extended surface), its size, form, consistence, degree of sensibility; characters of substance, if any is brought away by the finger. 
orifice. 
body. 
repercussion 
cavity. 
polypus. 
233. Tumor felt through wall of vagina (this includes the examination of the Ovaries and Fallopian tubes'): —exact position in regard to vagina, pelvic viscera, and pelvis; anteriorly (superiorly or inferiorly ?), posteriorly (superiorly or inferiorly ?), laterally; —size; extent of pelvic cavity occupied by it; —form, cylindrical, rounded, irregular, etc.; — 
Tumor— 
seat. 
form. 


[part t. 
§ IV. I.] 
EXAMINATION RY RECTUM. 
92 
consistence. 
connections. 
mobility. 
tenderness. 
Examination by Vagina and Abdominal Wall. 
Continuity of tumor. 
size of tumor. 
Examination by Rectum. 
Introduction of finger— 
of bougie. Uterus. 
Ovnries and Fallopian tubes. 
surface; smooth, irregular, nodulated (equally or unequally?);—¦consistence; hard, soft, elastic, impressible, fluctuating; giving the idea of limbs or other parts of a foetus; —its connection with known organs, as uterus, bladder, or rectum; —effects of straining or labor-pains on its position or tension; — mobility or fixedness of tumor. —Tenderness. 
Examination, through the Vagina, and Abdominal Wall conjoined. 
234. Continuity and connection or otherwise of organs and tumors felt through vagina, with others felt above brim of pelvis;—transmission of impulse or fluctuation from one to the other; elevation of the one accompanied or not by elevation of the other?—descent or not of pelvic tumor on pressing downwards abdominal tumor?—Size of mass felt between two hands.—Effect of elevation of abdominal tumor upon the position or mobility of pelvic organs or tumor. 
Examination by the touch, through the Rectum. 
285. Introduction of finger : — facility with which permitted; passage of finger along canal opposed, by accumulated fecal matter, by foreign bodies, by compression from tumor externally, by stricture ; closeness of stricture ; extent to which finger can pass.—Introduction of bougie. (See also 126.) 286. Uterus: —position; size, form, etc., of such parts as can be reached; mobility;—its fundus, form, relation in position to pelvic tumors, etc. — 
Ovaries and Fallopian txdjes (if capable of being recognized):—position; mobility; size; form; 


PART T.] 
[§ TV. I. 
UTERINE SOUND. 
93 
condition of surface; consistence; pulsation of arteries; tenderness, etc. 
237. Bladder: —its relation in position to fundus of uterus and pelvic tumors. 
288. Tumor: —its position, relatively to rectum ! and pelvis; its characters (particulars as 233). 
Bladder. 
Tumor. 
Examination through the Rectum and Abdominal Wall conjoined. 
239. (Particulars as 23 1.) 
Examination through the Rectum and Vagina, conjoined. * 
240. Thickneat of substance between the fingers : tumor, its size and characters (283, 238); fluctuation, etc. 
.Examination by the Uterine. Sound. 
241. Introduction of sound: —facility with which effected; pain on introduction; escape of blood.— Uterine cavity : its length; direction, presenting angular flexion, direction in relation to tumors of the pelvis or abdomen. —Can the extremity of the sound be felt anywhere through the abdominal parietes, vagina, or rectum ?—Thickness of intervening substance. 
242. Movableness of uterus by means of the sound :—is it capable of being moved independently of pelvic or abdominal tumor?—can abdominal tumor be moved while uterus is fixed by the sound?—does movement of abdominal tumor oc- 
Examination by llrcinm and A bdnminal Wall. 
Examination by Rectum and Vagina. 
Examination by Uterine Sound. 
Introduction: 
uterine cavity. 
thickness of wall. 
Movableness of uterus. 


[PART I. 
§ iv. i.] 
GENERAL SYMPTOMS. 
94 
casion a corresponding movement of handle of sound? 
Examination by Speculum. 
Examination by the Speculum. 
243. Introduction of speculum (stating kind of instrument used) : —facility of introduction; pain on introduction. 
Introduction. 
Vagina— surface. 
244. Vagina : —its color; surface, smooth, velvety, rough, corrugated; — excoriations; ulcers (624); cicatrices (629); vegetations; tumors (631). —Abnormal openings: their situation; form, etc.; — character of matters passing through them.—Secretion on surface of mucous membrane; abundance, characters (249). 
openings, secretions. 
245. Orifice of uterus: —natural; open; distended from glairy or gelatinous mucus, tumors, etc.; size; form, rounded, irregular, etc.; — discharge emerging from orifice or covering its lips, its characters. 
Orifice of uterus. 
246. Lips and neck of uterus: —their size; lips flat, uneven, everted, lobulated (size and characters of lobulations); their color, bright, livid, dusky red, etc.; —raw appearance around orifice of uterus (extending or not into cervical canal ?) ; its form, size, exact situation, elevation or depression from level of surface generally? mammillation of its surface, etc.; —excoriations; ulcerations (624), etc. 
Lips and neck of uterus— size, form, color. 
surface. 
General Symptoms. 
General Symptoms referable to the Female Generative Organs. 
247. Catamenia: —periods of their recurrence; duration of discharge (in days or hours); discharge continuous or intermittent ?—quantity of discharge 
Catamcnia— periods, duration, quantity. 


PART I.] 
GENERAL SYMPTOMS. 
[§ IV. I. 
95 
natural to the individual, scanty, very abundant. —Phenomena of flow; occurring suddenly at catamenial period; on excitement; at irregular periods; —accompanied or not by pain, from first appearance or from what date ? occurring before or after the flow ? trifling or severe ? its exact seat, character, duration.— Physical characters of fluid: color; consistence; odor; accompanied or not by clots ?— Catamenia entirely suppressed: for what period ? 
248. Hemorrhage: —frequency; periods of occurrence — circumstances inducing it, fatigue, long-standing, heated apartments, etc.; —its abundance ; —relief afforded by it to uneasy or painful sensations. 
249. Liquid discharge from vagina : —amount; constant or intermittent ? periods of its occurrence ; gradual or in a gush ?— Characters of discharge : transparent; opaque; its color, white, yellow, pink, greenish; streaked with blood; —its consistence, watery, thin, glairy or viscid, stringy; —its special characters, puriform, curdy, like white of egg or jelly, bloody; mixed with urine or feces; —containing organic detritus, tuberculous or calcareous matter, cancerous matter, etc.; — stains produced by it upon linen ; their color, etc. — Microscopical characters of discharge (645 et seq.); specially, spermatozoa, urinary or other crystals. — Chemical characters of discharge. 
250. Discharge of gas from vagina: —frequency of discharge; circumstances under which it occurs, spontaneously or during vaginal examination ? accompanied or not by sound ? apparent quantity of gas discharged ; its odor. 
251. Solid or organized masses discharged from vagina: —circumstances of their expulsion; 
flow. 
pain. 
quality. 
suppression. 
Hemorrhage: periods, causes, quantities, etc. 
Liquid discharges— circumstances. characters. 
microscopical characters. 
chemical cha racters. 
Discharge of gas. 
Solid discharges. 


§ iv. I.] 
[part I. 
MAMMjE. 
96 
Pain in vagina circumstances, characters. 
Uterine pain: circumstances, characters. direction. 
Itching. 
Sexual intercourse. 
Mammae. 
Physical examination: form, surface. 
nipple. 
areola. 
substance. 
tumor. 
—their nature, an ovum (its degree of development), a coagulum, fibrous or calcareous matter, a mole (their anatomical characters), hydatids, etc. 
252. Pain in vagina: —circumstances under which it occurs; its characters, lancinating, shooting, throbbing, burning, etc.; sense of swelling or distension ; —difficulty or pain in walking ; tenderness on sitting down. 
253. Uterine pain: —circumstan ces under which it occurs; its special characters, continuous, paroxysmal, shooting, expulsive, bearing-down, etc.; its extent; direction. 
254. Itching: —seat, external or internal; severity ; circumstances under which it occurs. 
255. Sexual intercourse : —disgust of.—Intercourse imperfect from physical obstacle; painful, seat of pain;—followed by discharge of blood, by weight about anus, by hysterical fits, etc. 
Mammae. 
256. Physical examination of mammas : —their form; size, equal or unequal, affected or not by catamenial period ? surface, its smoothness, color; —silvery lines or other visible marks of previous enlargement; condition of veins.— Nipple: color; degree of fulness and turgidity; flattened or drawn in, amount of puckering inwards; dryness or moisture of surface; discharge from it; excoriations; ulcers (462), etc. — Areola: size; color; moisture; — follicles, their size, position, and color; —firmness or softness of skin.— Substance of gland: knotty; its mobility;—fulness or hardness of lymphatic vessels, of axillary or supra-clavicular glands; — tenderness.— Tumor: precise seat; form; surface; 


PART I.] 
[§ IV- I 
MALE. 
I 
97 
solidity; elasticity; adherent to skin or to deep parts; tender; painful after examination. — Ulceration : its situation, size, and precise characters (624). 
ulcer. 
257. Pain in breast: —its characters, aching, throbbing, like a weight, lancinating, etc.; limited to breast or radiating elsewhere; —influence of catamenial periods upon it. 
rain. 
2. Male. 1 
258. Scrotum: —anasarca; eruptions (77 et seq.) ; hernia, etc. 
Scrotum. 
259. Testicles: —absent from scrotum; very small; enlarged (one or both ?), character of enlargement ; mobility. —Pain; constant or occasional ? its character; —tenderness. 
Testicles. 
260. Penis : —unusually small; enlarged, cause and character of enlargement; enlargement of corpora cavernosa; hardness of corpus spongiosum;— condition of urethra (213 et seq.); tenderness, its seat. 
Penis. 
201. Spermatorrhoea: —its frequency ; amount; erotic or not ? nocturnal or diurnal ? induced by defecation ; influenced by temperature, by state of bowels, by anxiety of mind, by sexual excitement; —immediate sequelae of discharge, headache (occipital or otherwise), constipation, failure of sight, confusion of thought, insomnia or drowsiness, lumbar pain, etc. 
Spermatorrhoea. 
1 Such points alone are here noted as have especial reference to medical cases. 


[PART I. 
§ IV. K.] 
ENCEPHALON. 
98 
§ IV. K. 
Cranium, etc. 
Cranium— form. 
symmetry. 
measurement. 
bones. 
fontanelles. 
Integuments: temperature, 
etc. 
ecchymosis. wounds, etc. hair. 
Tumors — seat. 
mobility. consistence. characters. 
K. —ENCEPHALON AND ITS COVERINGS AND APPENDAGES. 
Examination of Cranium, etc. 
262. Cranium: —general form, conical, lozengeshaped, etc.; —form of frontal, parietal, and occipital regions;—prominence ; flattening;—symmetry of the two sides; —special depressions or eminences, from injury, etc. —Its size; height, length, breadth. — Measurement: circular (over superciliary ridges and occipital protuberance), compared with circumference of neck; —across vertex (from ear to ear), along middle line (from root of nose to occipital protuberance).— Cranial bones: their apparent thickness; fixed or loose.— Fontanelles : prominent or depressed ? tense; fluctuating; pulsating ; relation of pulsation to heart's systole and to respiratory acts. 
263. Integuments, etc. —Temperature, compared in different parts; color; fulness of vessels; pulsation —Ecchymosis, with or without swelling ?— Wounds (626); abrasions; ulcers (624); eruptions (77 et seq.). —Hair; its arrangement, erect, flat or depressed ? disordered; —rubbed off certain parts. 
264. Tumors: —number; precise seat, over sutures, fontanelles, bone; size; pedunculated or sessile ? mobility; fixity to skull; consistence; elasticity ; fluctuation ; —if perforating skull, note state of edges of opening, smooth or rough, sur- 


PART I.] 
[§ IV. K. 
SENSIBILITY. 
St 
99 
rounded or not by an elevated rim j* —tumor diminished in size or reducible by steady pressure; pressure productive of cerebral symptoms; —tumor erectile, pulsating (effect of pressure on carotid on these phenomena).—Murmurs audible over tumor, arterial, venous. —Precise condition of integument over tumor, its color; oedema.—Pain; tenderness, etc. 
murmurs. 
integument over. 
pain. 
265. Auscultation in course of sinuses, especially over torcular Herophili; venous hum. 
Auscultation. 
Alterations of Sensibility. 
Sensibility. 
266. Pain in the head: —complained of verbally, indicated by patient putting hand to head or otherwise ?—antecedents of pain, a fall, a blow, a strain of any kind, dietetic irregularities, unusual intellectual work, moral excitement, sexual excesses, etc.; —precise seat of pain; symmetry (hemicranial ?) ; —character of pain, sense of weight, throbbing pain, expansile, bursting, lancinating; deep-seated or. superficial? its intensity; sense of intense heat; characters changeable or not ?—accompanied or not by undue carotid pulsation ? by sense of sickness or vomiting ?—Affected by pressure, by light or sound; by movement of muscles of face of scalp ; by movement of head or body; by respiration, by deep inspiration or deep expiration ; by posture; by muscular effort, coughing, etc.; by pressure on carotid arteries, one or both; by stimulants. —Time when pain most felt, in 
Pain in head: how indicated. 
antecedents. 
seat. 
characters. 
accompaniments. 
circumstances affecting. 
time. 
> This " elevated rim" may exist without perforation, as in sub-pericranial cephalhsematoma and in collections of blood in the adult, producing a deceptive sensation of perforation. 


§ IV. K.] 
[part I. 
SENSIBILITY. 
100 
morning, evening, on waking, after eating, etc. —Duration of pain-, its constancy ; periodicity.— Connected or not with neuralgic or rheumatic pains elsewhere ?>(hk*. Mc«ti«? ill € J tillage 267. Altered sensibility of skin: —(note precise locality of altered sensibility, whether it is symmetrical or not; course pursued by it, upwards, downwards, or irregularly).— Sensibility increased: degree of increase, stating how judged of; to pinching, to gentle friction, to touch; (endeavor to distinguish between acuteness of touch, or hypencsthesia, and augmented sensibility to pain, or hyperalgesia.)— Sensibility diminished: degree of diminution (stating how judged of); results of application of Weber's test, with points of compasses placed parallel with axis of part or transversely? objects appearing separated from skin by some intervening substance; inability to distinguish form and character of surface of objects by the touch; unconsciousness of contact of bodies; (endeavor to distinguish between diminution or loss of touch, or anaesthesia, and diminished or abolished sensibility to pain, or analgesia;) total abolition of all sensibility. — Sensibility perverted : sense of heat or of cold (compare with indication of thermometer) —numbness; formication; prickling; tingling; itching, referred to surface, subcutaneous parts, or deeper in limb; —aura. 
duration. 
other pains. 
Sensibility of skin— 
increased. 
diminished. 
perverted. 
Muscular sense. 
268. Muscxdar sense: diminished or lost; patient unconscious of position of limbs; inability to perform or continue muscular acts without concentrating attention upon them. 
Other sensations. 
269. Other alterations of sensibility: —pain in back, limbs, etc.; precise locality of pain, its character; circumstances influencing it; pain affect- 


PART I.] 
[§ IV. K. 
MOTILITY. 
101 
ing course of special nerves (326); affecting muscles (87), bones (84), or joints (83). —(See also 59.) 
Alterations of Motility. 
Motility. 
270. Attitude: — in erect posture; unsteadiness on centre of gravity, with eyes shut or open successively.—Attitude in decumbency (57): tendency to turn on one side, to turn round and round.— Attitude in sittimj posture (57). —Attitude during progression; walk, staggering or faltering;— patient compelled to adopt a running pace;—tendency to fall, from what cause (vertigo, not feeling the ground, weakness of either or both limbs) ?— tendency to go irresistibly forwards, backwards, sideways, diagonally, to turn round and round.— Attitude of head in each posture (57). 
Attitude— 
in erect pos- 
ture. 
decumbency. 
sitting. 
in progression. 
carriage of head. 
271. General muscular agitation, or excitement of voluntary muscles: intermittent or continual ? automatic or delirious?— Tremblings: their site; occurring in all or in certain postures ? persistence during sleep. — Muscular twitchings: in face, extremities, etc.; subsultus tcndinum; carphology.— Unsteadiness of limbs when raised up. 
Muscular agitation— 
tremblings. 
twitchings. 
unsteadiness. Automatic 
272. Automatic movements: 11 —limbs or parts of body affected; unilateral or bilateral? affecting special muscles of tongue, pharynx, eyeball, etc.; — degree or violence of movements; character of movements; their constancy or variation; —influence of sleep upon them, of irritation, of mental excitement, of sensory impressions (tactile or special), of directing attention to them. 
movements— seat. 
circumstances affecting. 
1 Under " automatic movements," are here included the kinds of movement recognized as " choreal." 


[PART I. 
§ IV. K.] 
MOTILITY. 
102 
Slow extension and flexion. Power of direction. 
Rigidity. 
Spasmodic contractions, 
Convulsion— 
antecedents. 
seizure 
sequences. 
273. Sloio movements of extension or of flexion of limbs without apparent object. 
274. Power of directing movements of upper or lower limbs, lost or impaired; how indicated ? 
275. Rigidity: with extension or with flexion of limbs? angle of flexion at which it is perceived; rigidity affecting other parts; its degree; —persist- ; alternating with relaxation. 
27G. Spasmodic contractions: —trismal; tetanic (emprosthotonos, opisthotonos, pleurosthotonos); their duration and intervals ; —spontaneous or excited by movements, by nervous impressions (as a start), by being touched; periodical. 
277. Convulsion: —constant or occasional? intervals of recurrence; periodicity; —induced by sight or sound of liquids, etc. — Antecedents of seizure : dazzling before eyes; sudden failure of sight; fixing of eyes; dilatation of pupils; globus; aura; peculiar cry; fall, etc.; —time which elapses between these phenomena and seizure.— Phenomena of seizure: site of convulsions; on one or both sides? alteration in features; amount of convulsion ; duration of attack; —tendency chiefly to rapid jerking movements, to rigid flexions, to rigid extensions; —accompanied by foaming at the mouth, by biting the tongue, by vomiting, by ejection of feces, urine, or semen, by a tendency to bite, by a dread of liquids and shining bodies; —direction of axes of eyes during seizure; —state of consciousness, perfect, impaired, abolished; —state of skin, as to color, temperature, and perspiration; state of pupils (322), pulse (184), and respiration (169); heart's sounds (178), and impulse (176). —Evi- of occurrence of convulsions during sleep ; —influence of the will upon them. — Sequences of 


PART I.] 
MOTILITY. 
[§ IV. K 
103 
attack : sleep, comatose state, perspirations, discharge of urine, etc.; —recollection of attack by the patient. 
278. Other reflex phenomena: — strabismus (322); rolling of eyes; cramps (87); grinding of teeth; jerking or kicking movements of limbs, time when chiefly observed, painful or not? priapism, etc.—Mode of exciting any of these phenomena —time of their occurrence; —condition of sensation in limb generally at the time of their excitement, impaired, or totally absent (267); — concomitant deviation of spine. 
Other reflex acts— 
how excited 
accompaniments. 
279. Cataleptic immobility : —parts affected; its degree; frequency and duration of seizures. 
Cataleptic immobility. 
280. Paralysis: — 
Paralysislimbs. 
Affecting the limbs: how judged of?—its exact site; affecting flexors or extensors solely or principally? affecting special muscles; —ac- or not by twitchings of the paralyzed muscles?—progressing upwards or downwards ?—perfect or imperfect in degree ? constant or variable ? compared upon the two sides and in upper and lower extremities. — Bulk of limbs estimated by measuring their circumference; nutrition of paralyzed limbs and muscles estimated by the feel; —tempera- of paralyzed compared with non-paralyzed limb. 
Affecting the thorax and abdomen: rhythm of respiration; — expansion during inspiration, measured on both sides; —tendency of fluid to accumulate in bronchi, etc. 
thorax and abdomen. 
Affecting the face: any peculiarity of expression ? comparison of the two sides, condition of wrinkles on the two sides; effect of laughing 
face. 


§ IV. K.] 
MOTILITY. 
[PART I. 
104 
or smiling on the two halves.—Comparison of position of pinnae of ears; of halves of occipitofrontalis, symmetry of wrinkling on the two sides during frowning or elevation of eyebrows —comparison of height of eyebrows; degree to which eyelids are apart, ptosis, lagophthalmia;—course of tears; —size of aperture of nares, flapping of nares on either side; —condition of cheeks and lips, comparison of commissures of mouth, note manner 
of whistling, of blowing out checks, etc.; accumulation of food behind teeth. 
tongue. 
Affecting the tongue: deviation of tongue, its direction, amount, constancy; —alteration in form of tongue; wasting of either side; — induration or rigidity of either side; twitching of either side.— Articulation: thick, confused (noting class of consonants most difficult of pronunciation), mumbling, unintelligible, jerking, stammering. 
articulation. 
deglutition. 
Affecting the muscles of deglutition: state of deglutition; stage of act at which difficulty is experienced (106); —abnormality in position of larynx, etc., visible externally, in respect to median line. 
stomach, rectum. 
Affecting the stomach: facility of vomiting (138). A ffecting therectum: feces retained, accumulating. 
Affecting the anus: stools involuntary;—paralysis accompanied by local loss of sensation; • feces felt on arriving outside anus, etc. (142). 
anus. 
Affecting- the bladder: retention of urine; stillicidium urinae (218). 
bladder. 
larynx. Muscular irri 
Affecting larynx: aphonia (156). 
281. Muscular irritability compared in paralyzed and non-paralyzed parts : as tested by percussion; 
tability— how tested. 


PART I.] 
[§ IV. K. 
INTELLECT AND MORAL FACULTIES. 
105 
as tested by galvanic current (stating force of pile and kind of instrument used), with current direct, reversed, continuous, or interrupted. 
Symptoms referable to the Intellectual and Moral Faculties. 1 
282. Consciousness: —impaired; indifference; dreaminess; hebetude; stolidity; doziness, readiness with which patient is roused; patient, after being roused, relapsing immediately, or after an interval of longer or shorter duration ? stupor; somnolence; coma; coma-vigil.—Consciousness abolished; abolition gradual or of sudden occurrence ? duration of loss of consciousness; posture and occupation of patient when it occurred; phenomena attending it. 
283. Sleep: —deficient (peculiarities of the deficienc — e. g., patient a long time going to sleep, waking after a short sleep, and then not sleeping any more, etc.); totally absent, patient feeling the want of sleep or not ? exhausted by it or not ? interrupted by sudden wakings with affright; unduly protracted.—Soundness of sleep; amount of refreshment experienced.—Sleepiness at improper times, especially on sitting down or after meals. —Snoring during sleep.—Posture in which patient goes to sleep. 
1 This subdivision has especial, though not sole reference to cases of insanity. In the present state of our knowledge of the several mental conditions included under this term, it has been considered advisable, and more likely to conduce to pure observation, to group the manifestations of disordered intellect and of the disorders of the moral faculty together, rather than to attempt their separation. 
Intellectual and Moral Faculties. 
Consciousness— impaired, degree of. 
abolished. 
circumstances 
of abolition. 
Sleep— deficient. 
absent. 
interrupted. 
protracted, soundness, sleepiness, snoring. 
posture 


§ IV. K.] 
[PART I. 
INTELLECT AND MORAL FACULTIES. 
106 
Dreaming. 
284. Dreaming: —different in any way from what is customary to the individual; subject of the dreams, something habitual to the individual when out of health; their character, terrific, fatiguing, distressing, etc. — Incubus: position in which it occurs; at what period after falling asleep ?—Somniloquism: conversing somniloquism.—Somnambulism: phenomena presented during this state and on being suddenly awoke, perversions of the special senses, etc.; —condition of the pulse, respiration, and temperature of the body.—Frequency of occurrence of incubus, somniloquism or somnambulism; —conditions of their occurrence in regard of food, occupation, mental emotion, physical health, etc. 
incubus. 
somniloquism somnambu- 
lism. 
Behavior. 
285. Behavior: —generally or in some particular respect different from that of all sane persons, or from that which is habitual to the individual when in health. (If the eccentric behavior be paroxysmal, note at what time the paroxysms occur, and the circumstances which induce them.) —Un- reserve; obstinate silence; sulkiness; apathy; inactivity; neglect of business; refusal to eat or drink; melancholy; refusal to pass evacuations; dirtiness; refusal or indisposition to go to bed or to get up.—Unusual and unnecessary bustling, with or without motive; hastiness of conduct; conduct furious or uproarious, disposition manifested to strike, bite or injure persons and things (noting readiness or difficulty of controlling patient) ; unusual gesticulations; fanciful or eccentric dressing and decoration of the person, house, or room; constant repetition of the same act or acts without apparent object; individual walking about restlessly at night; absenting himself from home, and wandering.—Behavior haughty or inconsistent with in- 


PART I.] 
[§ IV. K. 
INTELLECT AND MORAL FACULTIES. 
107 
dividual's rank or station in life.—Oversight or neglect of ordinary moral obligations; disposition exhibited to solitude or to company, to extravagance, gaming, debauchery, drunkenness, indecency, cunning, falsehood, avarice; collecting or secreting odd and useless articles or articles of trifling value; attempts at stealing, murder, suicide, arson, or other crimes; unusual selfishness, etc. —Eccentri- of behavior, constant or varying in its character? 
286. Temper: —unaltered; captious; peevish; morose; surly; irascible; violent (285). 
Temper. 
287. Spirits: —even and calm; peculiar hopefulness ; ennui; indifference; melancholy; unnatural gayety and excitement; spirits variable; involuntary laughter or crying, circumstances inducing them; alternation of laughter and crying. 
Spirits. 
288. Attention: — exaggerated; engrossed by some one object of perception, external or internal, by the internal functions of the body, by certain mental ideas. —Defective; degree of impairment of attention, impossible to be fixed at all, capable of being directed for a time only (noting degree of difficulty in arresting attention); patient gazing steadily at questioner as if attending, but giving no sign by speech or otherwise of understanding him. —Perverted; want of fixedness of attention to one object, but flying off to others (distraction); attention engrossed by trivial matters. —Apparent endeavor made by patient to regulate the attention, if engrossed to distribute it to other objects, if defective to exercise it more fully, if distracted to concentrate it. 
Attention— exaggerated. 
defective. 
perverted. 
influence of •will. 
289. Apprehension : —unusually quick for the age of the individual; great readiness to learn.— 
Apprehension— quick. 


§ IV. K.] 
[part I. 
INTELLECT AND MORAL FACULTIES. 
108 
dull. 
Individual dull; stupid; unable to comprehend when addressed; unaffected in any way by passing occurrences; feeling no wants. —Total incapacity ; connection of this with physical imperfection or deformity (cretinism). 
absent. 
290. Memory (retentiveness and readiness of memory are, where possible, to be distinguished) : —memory exalted or unusually good for age of individual ; —specially exalted for certain subjects, as music, languages, rhymes, etc.; —the above subjects, after being long forgotten, recollected. —De- ; degree of impairment of memory estimated by questions respecting the course of events while patient has been under observation, respecting the day of the week, the period of the last meal, etc., by questions in multiplication table; —special impairment of memory, forgetfulness of recent events, rather than of others long passed, of the names of persons and things (note amount of assistance necessary for their recollection), of dates, of periods of time, of the sounds of printed characters (hence, the inability to read); —does memory appear to improve under emotion or excitement pleasurable or the reverse ?—Perverted; hallucinations of memory (persons, events, etc., being presumedly recollected which were never, at any time, under the notice of the individual). 
Memory— 
exaggerated. 
defective. 
special defects. 
perverted. 
291. Speech (as an intellectual act: for Articulation, see 280): —limited to monosyllables; — speechlessness, from want of volition, from trouble in speaking, from loss of memory of words; speech replaced or aided by signs;—ability to write words and answers to questions which patient is unable to pronounce. —Confusion of words (e. g., yes for no, shoulder for head, etc.); when patient has used 
Speech— peculiarities, 


PART I.} 
[§ IV. K. 
INTELLECT AND MORAL FACULTIES. 
109 
k 
a wrong word, is he conscious of its being wrong ? if so, how is consciousness of it exhibited, by anger, by laughing at himself, etc. ? —More or less constant repetition of syllables, of words, of sentences, of the same idea in different words, of the words of a question, of the words of the patient's own answer.— Peculiar cries, screams, moaning, etc. 
cries. 
292. Conversation : —individual exhibiting reserve, indisposition to enter into conversation; replies to questions, short, hasty, rude; obstinate taciturnity.—Individual entering readily into conversation ; garrulous; freely opening his thoughts, exhibiting an absence of prudent reserve upon personal or family matters, etc. —Conversation coherent; its subject and character; constant disposition to introduce some one subject or class of subjects on all occasions; —constant repetition of the same words and phrases; — indecency of conversation; swearing;—eccentric, silly, or absurd reasoning or association of ideas; absurd theorizing and speculation (where possible, trace the chain of ideas; see also Disordered judgment, 294). —Conversation hurried; rapid change of subjects (if possible, trace the general character of their association). —Conversation incoherent and unintelligible.— Soliloquism, its subject and characters ; accompanied or not by gesticulations ? 
Conversation: reserve. 
garrulity. 
coherent. 
hurried. 
incoherent, soliloquism. 
293. Confessions and complaints of patient respecting his mental condition: —expression of belief that the intellect is disordered or is becoming so; —complaints of loss of voluntary control over course of ideas; —of criminal thoughts (blasphemous, suicidal, homicidal, etc.); —consciousness of delirium and of extravagance of language, gesticulation, etc.; —of insane impulse, means which 
Confessions of mental state. 


§ IV. K.] 
INTELLECT AND MORAL FACULTIES. 
[PART I. 
110 
patient is compelled to adopt to resist its operation; —expression of misery or happiness. 
Disordered judgment— 
294.- Disordered judgment: —disbelief in selfevident truths; in personal identity; in the evidence of consciousness, perception, or memory; in the natural succession of events (e. g. } that night will succeed the day, etc.). —Defective power of deductive reasoning; conclusions slow, uncertain; degree of defect tested by the power to follow out simple processes of reasoning (e. g., a syllogism).—Perverted judgment; grossly and absurdly incorrect conclusions drawn from correct data, (endeavor to trace the cause of this in the perversion of the faculties necessary to the reasoning process, in a ruling idea, in wandering of the ideas, perverted association of ideas, hallucinations of the senses or memory, etc.) 
reasoning. 
Fixed delusion or idea. 
295. Fixed delusion or predominance of one idea, or of a certain series of ideas:—in relation to the past, the present, or the future ; in relation to realities or to mental phantasms.—Delusion in reference to patient's own body, the entire or some part of it (inquire into condition of part referred to), e. g., that animals or demons are in his belly, that portions of the body, or the entire of it, consists of wax or glue, that he is mercurialized, or suffering from syphilis, etc.; —in reference to his personality, e. g. } that he is some divine or dignified person;— in reference to rank; —in reference to wealth, e. g., that he is possessed of large sums of money, or that they are kept back from him by injustice, that poverty is impending, etc. —Belief that he is being persecuted; that his life or property is being sought after; that he is about to be incarcerated. —Morbid dread of something definite or indefinite about to hap- 


''[§ IV. K 
PART I.] 
INTELLECT AND MORAL FACULTIES. 
111 
pen, e. g., of death, of being poisoned, etc. —Reli- delusion, its character. —Erotomania. —Effect of fixed delusion or predominant idea upon behavior (285), temper (286), spirits (287), and conversation (292) of patient; —their connection with illusions or hallucinations of senses (296), as cause or effect. 
296. Hallucinations and illusions — of sight (325), of hearing (320), of taste (317), of smell (315) ; their characters; degree of belief expressed by patient in the reality of these; —their influence on the spirits (287), behavior (285), conversation (292), and reasoning (294) of the patient. 
297. Vertigo : — its severity; — circumstances which induce or exasperate it, e. g., position of entire body, of the head, impressions on the organs of the senses; —its duration; accompanied or not by nausea ? 
298. Delirium: —constant or occasional? by night or by day ?—fixed delirium, its subject, (if on any bodily function, note condition of organs performing that function;) —variable as to subject; its general character, muttering, surly, loquacious, noisy, violent (patient attempting to get out of bed, jump out of window, etc.), furious, wild, cheerful, jocular, fearful. 
299. Alterations in moral feelings and affections: —evidenced by unusual and extraordinary conduct towards relatives and friends; —sudden or violent 
1 "Hallucinations" — i.e., true mental phantasms or creations, bearing no relation to objects of perception present. 
"Illusions" — i. e., real objects,perceived with characters different from those which they actually possess. 
Hallucinations or illusions. 
Vertigo— causes. 
duration. 
Delirium— circumstances. 
subjects, character. 
Alterations in moral feelings, etc. 


§IV. 
[PART I. 
SriNAL CORD. 
112 
Sexual passion— defective, exaggerated. 
\ IV. L. 
Physical examination of Spinal Column. 
Curves— 
anteroposterior. 
lateral. 
partialities or dislikes (either eccentric, or contrary to patient's habits) manifested towards certain sounds, colors, inanimate objects, animals, etc.; — tumultuous feelings and emotions, joy, anger, sorrow, etc., alternating, with or without reasonable cause; —pleasure derived from toys or trifles. — Longings for improper or disgusting objects; for improper or unattainable articles of food.—Nostalgia.—Misanthropy; misogyny.—Suspicion (285, 292). 
300. Sexual passion: — defective; aversion to sexual intercourse; —exaggerated; satyriasis; nymphomania (signs to be sought in behavior and countenance of individual in presence of the other sex, blushing, changes of color, brilliancy of eyes, sighing, heaving or irregular respiration, etc.); priapism; masturbation, etc. 
L.—SPINAL CORD, ITS COVERINGS AND APPENDAGES. 
Physical examination of the Spinal Column. 
301. Curves, etc. (examine patient in erect posture, when possible):— Antero-posterior curves (cervical, dorsal, lumbar); their condition; degree of posterior prominence of sacrum; altered position or inclination of oscoccygis.— Lateral curves; condition of natural dorsal lateral curve; —abnormal lateral curvatures (estimate the amount by letting fall a cord perpendicularly from centre of nucha); elevation or procidentia of either shoulder; patient appearing to lean to either side or forwards; tilting outwards of either scapula; alteration in direction of ribs. 


PART I ] 
[§ IV. L 
GENERAL SYMPTOMS. 
113 
302. Spinous processes. —Any particular spinous process or processes unduly prominent or depressed, either when patient stands erect, bends forward or to either side ?—direction of adjoining spinous processes in regard to each other. 
303. Vertebral grooves: —compared in regard of fulness on the two sides; local prominence produced in either by bending forwards. 
304. Tumor: —its site; form; transparent or opaque? solid; containing fluid, amount of fluctuation perceptible; attended or not by obvious fissure of the spine ? — Condition of integument over tumor; alteration in color, thickness, etc. (B. p. 40). 
305. Fistulous openings, sinuses, etc.: —charac- of discharge from them (616); microscopical (645 et seq.), chemical. 
306. Other appearances: —wounds (626); contusions; ecchymoses or other marks of injury (70). —Bedsores. 
307. Examination of spine anteriorly, through abdominal soft parietes:—undue prominence anteriorly or laterally; tumor appreciable in connection with spinal column or dependent on bodies of vertebrae themselves (129 et seq.). —Displacement of aorta; unnatural amount of aortic pulsation (182). 
308. Percussion. — Any undue extension of percussion-duiness to side of spine? 
General Symptoms referable to the Spinal Cord, etc. 
309. Manual examination of spinal column. — Effects of gently passing the pulp of the finger or some light body along spinous processes or verte- 
Spinous processes. 
Vertebral grooves. 
Tumor. 
Fistulse. 
Other appearances. 
Spine anteriorly: 
tumor. 
Percussion. 
General Symptoms. 
Manual examination of spinal column— by finger. 


§ iv. I- ] 
[PART I. 
GENERAL SYMPTOMS. 
114 
bral grooves; sensation natural, mere tickling, shuddering, creeping sensation of cold, sickness, faintness, globus, hypochondrial pain, acute pain in spinal region;—precise point at which any of the above results are produced; does this vary by moving the skin ?—Effect of percussion of medium strength, or of kneading, over spinous processes from above downwards; —effect of strong percussion;— effect of passing a heated iron (skin being protected by brown paper or similar substance), or of a sponge squeezed out of hot water along spine;—if pain is produced, note its position, character, and direction. 
by percussion. 
310. Local spontaneous pain: —precise character, lancinating, pulsatile, vibratile, creeping, aching, etc.; —seat; course upwards or downwards? limited to spinal region; extending to right or left of trunk, or to upper or lower extremities ? its precise direction and point of termination; —pain constant or occasional? paroxysmal, slowly or suddenly developed —accompanied by special sensations, sickness, faintness; palpitation of heart with paroxysms.—Pain influenced or not in amount and character by flexion, anterior, posterior, or lateral, of trunk, or by still slighter movements; by walking; by turning in bed; by kicking either heel forcibly against the ground; by jumping on heels; by supporting body on crutches; by rotation of trunk in sitting posture; by jerking movements given to the body by observer; by various kinds of percussion ; by passing hot iron or hot sponge over spine; by nervous excitement, etc. 
Local pain— character. 
extent. 
constancy. 
accompaniments. 
circumstances affecting. 
Sensibility. 
311. Alterations of sensibility (K. p. 99) :— effect of prone, supine, or erect postures upon these. 
312. Alterations of motility (K. p. 101): —effect of prone, supine, or erect postures upon these. 
Motility. 


PART I.] 
[§ IV. M 
ORGANS OF THE SENSES. 
115 
M.—ORGANS OF THE SENSES. 
Organs of Touch. 
313. For particulars see Integuments, p. 40, and Alterations of Sensibility, p. 99. 
Organs of Smell. 
314. Physical examination, etc. (148). 
315. Sense of smell: —perception of odors, impaired, absolutely wanting;—exaggerated; perverted, illusions or hallucinations of smell.—Peculiar influence of special odors. 
Organs of Taste. 
316. Physical examination, etc. (Tongue, 92; Palate, 91; Fauces, 102). 
317. Sense of taste: —impaired; absolutely wanting;—unusually acute; —sense of taste compared at base and tip, or on two halves of tongue; any special point deficient in power of taste (state how any of the above have been determined);— particular sensibility to special tastes, e. g., sweet, bitter, etc. —Taste perverted; illusions of taste, e.g., acid substances tasting alkaline, sweet substances tasting bitter, etc.; hallucinations of taste, e. g., bitter, acid, disagreeable tastes, etc., in the mouth. 
Organs of Hearing. 
818. Physical examination: — External ear: its form; size; swellings, their exact seat, character, and contents; color; temperature; eruptions (77 
\ IV. M. 
Organs of Touch. 
Organs of Smell. 
Physical examination. 
Sense of smell: impaired, exaggerated, perverted. 
Organs of Taste. 
Physical examination. 
Sense of taste: impaired, too acute. 
perverted, illusions. 
hallucinations. 
Organs of Hearing. 
Physical examination, external ear. 


§ IV. M.] 
HEARING. 
116 
et seq.), ulcers (624). — Mastoid process: unduly prominent or depressed on either side; subcutaneous emphysema produced or not by blowing nose?—results of auscultation over mastoid process; entry of air into cells marked by distinct murmur or attended by rhonchus.— Meatus externus: tender to touch; —lining membrane swollen, turgid, discolored generally or over particular points;—fungosities, vegetations, ulcerations (624), incrustations, eruptions, etc. — Cerumen too abundant; deficient; altered in quality; microscopic examination of it (645 et seq.). —Foreign bodies in meatus.— Discharge from meatus; its abundance; its appearance, serous, purulent, bloody; its odor; accompanied by particles of bone, by foreign bodies; containing bubbles of air.— Eustachian tube: results of catheterism of Eustachian tube; test its perviousness by auscultation over mastoid process. — Membrana tympani: state of its surface; color, rosy, dull white, etc. —perforated or entire? simulation produced by forcible expiration, the mouth and nose being closed (audible by patient or on use of stethoscope) ? movement of the flame of a taper held opposite the meatus during same process? 
mastoid process. 
meatus externus. 
cerumen. 
foreign bodies, discharge. 
Eustachian tube. 
membrana tympani. 
Pain— 
319. Pain referred to the ear: —its character; apparent depth; severity; constant or periodical ? circumstances inducing it.—Sense of pulsation in ear; other abnormal sensations, as tickling. 
other sensations. 
320. Sense of hearing: —exaggerated; intolerance of sound generally, slightest sounds appearing more or less intense; intolerance of particular kinds of sound. —Defective; amount of impairment of hearing (distance at which the ticking of a watch is heard); impaired for notes of particular pitch, 
Sense of hearingexaggerated. exaggerated. 
defective. 


[§ IV. M 
VISION. 
117 
high or low; are sounds heard better when sonorous body touches teeth, mastoid process, or external ear?—Perverted; illusions of hearing, e. g., murmuring or other continuous noise mistaken for voices and conversations, etc.; —hallucinations of hearing, various sounds in the ears; tinnitus aurium, in one or both ears, its precise character, constant or transient? affected or not by posture, efforts, exercise, eating ? accompanied or not by sounds in the vessels discoverable by auscultation? voices and conversations imagined to be heard, etc. — Sensibility to discords and pleasure from concords lost. 
Organ of Vision and its Appendages. 
321. Eyebrows: —their comparative elevation, etc. (280). — Eyelids: their thickness; color; vascularity; state of integument, eruptions (77 et seq.~), oedema; solid indurations. —Degree of closure, as compared on the two sides; facility with which eyelids are closed; contraction of orbicularis, permanent or spasmodic? degree of resistance to the eye being opened by observer; nictitatory movements — Lids motionless when conjunctiva is touched, or a body is suddenly brought near the eyes.—Abnormal sensations accompanying movements of lids, pain, stiffness, dryness, etc. — Eyelashes: absent, scanty, abundant; their length, direction, etc. — Tarsal Cartilages: thickened; turned inwards or outwards; —their edges, red, injected, covered with secretion (its character). — Meibomian glands and ducts: their appearance, enlarged, obstructed, etc. — Puncta lachrymalia: freedom of orifices. — Carunculse lachrymales : 
perverted, illusions. 
hallucinations. 
Organ of Vision, etc. 
Eyebrows, etc.— eyelids. 
eyelashes. 
tarsal cartilages. Meibomian glands, puncta lachrymalia. carunculse lachrymales. 


§ IV. M.] 
VISION. 
118 
Eyeballprominence, movements. 
axes. 
conjunctiva. 
sclerotica. 
cornea. 
iris. 
pupils. 
their size; color; uneasy sensations referred to them. 
322. Eyeball generally: —its size; its degree of prominence (compared on the two sides); its form. —Its movements; eyeball motionless; movements irregular, rotatory; tendency to turn upwards or in any particular direction.—Direction of axes of eyes (luscitas, strabismus), convergent or divergent? natural direction of axis of affected eye restored or not by closing unaffected one?— Conjunctiva (generally or locally): its transparency, color, thickness; moisture, abundance of secretion; particles of mucus accumulated upon it; its degree of vascular injection; mammillations or granulations; vegetations, ulcers (624); foreign bodies. —Sensibility of conjunctiva.— Sclerotica: vascular injection, generally or in the form of a zone around the cornea ? its degree; general color of sclerotica, dull white, waxy, yellow, yellowish-green, bluish, like tarnished ivory. — Cornea: its form, degree of convexity; smoothness of surface; —transparent; opaque (partially or entirely); opaque ring at its periphery;—cicatrices; ulcers (624); wounds, with protrusion of iris or not?—Foreign bodies sticking in cornea, etc. — Iris: its color; presenting two rings, their comparative size; form; convex forwards or backwards ? borders, thin, thickened (irregularly or equally?), free or adherent? angular, puckered; —fissures in iris; deposits or tumefactions upon it. —Action under influence of light; slow or rapid? equable and isochronous in the two eyes or not ? oscillations or tremulousness of iris.— Pupils: dilated, equally or unequally? contracted, equally or unequally? one dilated and the other contracted; alternate contraction and dilatation of pupil.—Effect of light 


[§ IV. M. 
VISION. 
119 
upon pupil; contraction, slight, marked, slow or immediate ? dilatation; slight, contraction followed by dilatation; contraction followed by oscillation; —effects of admitting the light or shutting it out from the other eye. — Aqueous humor: its quantity ; color; transparency or opacity? foreign bodies in it.— Lens: its position; transparency or opacity, its degree, extent, and color. — Vitreous humor: its color and appearance. 
323. Tears: their abundance; —flow excited by trifling circumstances; —stillicidium; —epiphora; —acridity of secretion; chemical reaction of tears. 
324. Pain: —seat, deep or superficial ? characters; increased by movements of the eye, by light; following the course of any particular nerve; —at- by any temporary peculiarity of vision, by vomiting or nausea.—Extreme sensibility to light; photophobia; opsiphobia (or fear of using vision); —sympathetic effects of a strong light, sneezing, sickness, tickling in internal ear, etc. 
325. Sense of sight: —length of distinct vision of distant objects; focal distance, vision of near and distant objects compared; myopia, presbyopia; amount of light necessary for perfect vision.— Hemeralopia ; nyctalopia; total blindness, " how tested ?"—Vision defective ; amount of vision remaining, power of distinguishing light from darkness, the general form of objects, etc.; —defect constant or occasional ?—portions or points of an object not being seen, or replaced by black spots; —visibility of luminous ring on pressing eyeball.— Sensibility of eye to particular colors lost, the complementary colors being perceived.—Vision perverted ; illusions .of vision, objects appearing of different form, color, etc., or mistaken in their cha- 
aqueous humor. 
lens. 
vitreous humor. 
Tears. 
Pain— . seat, characters. 
sensibility to light. 
sympathetic effects. 
Sense of sight: focal distance. 
blindness. defective vision. 
sensibility to colors, perverted vision, illusions. 


§ IV. N. 0.] 
NERVES —VASCULAR GLANDS. 
120 
hallucinations. 
§ IV. N. 
Pain— seat. characters, accompaniments. 
duration, other sensations. 
enlargement of nerve, tenderness. 
\ IV. 0. 
Thyroid gland. 
thymus gland. 
racters; objects appearing double (tested in each eye separately), the objects lying one above the other or side by side? dazzling (effect of erect or recumbent posture upon it); —hallucinations, flashes of light in darkness, sparks, muscse volitantes, visions (their characters). 
N. —NERVES. 
Cerebrospinal and Sympathetic. 
326. Pain : —its seat; nerves affected by it; its characters, obtuse, acute, burning, shooting; direction and course of pain;—color of skin over painful parts; appearances in neighboring organs; enlarged veins; throbbing of arteries; increased secretion from neighboring mucous membranes; disturbed function of neighboring organs— e. g., intolerance of light, etc.; —pain aggravated by a slight touch ; relieved by firm pressure ;—continuous, remittent, intermittent; duration of paroxysms; time at which they occur. —Other sensations, numbness, creeping, pricking, itching, etc.—(See also Pain and other abnormal sensations referable to head (266), thoracic organs (163), abdominal organs (133), joints (83).) —Enlargement in course of a nerve. —Tenderness in course of a nerve; exact points where such tenderness is discovered. 
0. —VASCULAR GLANDS. 
327. Thyroid gland : —enlargement; its size, form, on one or both sides ? consistence; tenderness; effect of pressure, exertion, or mental emotion upon it.— Thymus gland : —fulness at lower part of neck; —dulness on percussion over region of gland, 


[§ IV. O. 
VASCULAR GLANDS. 
121 
L 
its extent; alterations in auscultatory signs (152, 162); —respiration, its characters, etc. (169). 
328. Suprarenal capsule : — (see Abdominal tumors, 27.) 
Suprarenal capsule - 
[In observing the progress of the case up to recovery or death, the phenomena should be noted in the same order as in § IV., and any new influence brought to bear upon the patient in the same order as in § III. 
The diet, regimen, external applications, and internal medicines prescribed, should be accurately noted, and likewise whether the treatment ordered has been carefully carried out, and the hours at which the several remedies have been applied or given. The period, also, at which the notable effects of remedies (e.g., vomiting after emetics, sleep or cessation of pain after narcotics, dilatation of the pupil or dryness of the fauces after belladonna, etc.) have occurred, the date of the cessation of the different symptoms of disease, and the period of convalescence or recovery, and of discharge (if the patient be in a hospital), should be closely observed and carefully described. 
If the case prove fatal, the phenomena of approaching death should be accurately noted, and also whether the fatal termination be accompanied by symptoms referable to asphyxia, coma, syncope, etc., the condition of the mental faculties, and whether convulsions be present or absent.] 




123 
PART II. 
EXAMINATION OF A BODY AFTER DEATH. 
§ I.—Points to be ascertained and NOTED PRIOR TO COMMENCING AN EXAMINATION. 
§1- 
329. Name. 
Name. 
330. Date of death, presumed or ascertained. 
Date of death 
831. Date of examination: —"in a medico-legal case, precise time (local time) when called to see the body." 1 
Date of examination. 
832. Weather, from the date of death to that of examination. — Temperature to which body has been exposed. 
Weather. 
333. "Medium in which body has lain from date of death to that of examination; —in earth, clay, sand, gravel, mud; —in water, salt, fresh, stagnant, running, turbid (from earthy, vegetable, or animal matters ?); —in gas, carbonic acid, sulphuretted hydrogen, etc. (noting circumstances under which it has been exposed to the above)." 
Medium in which body has lain. 
334. " Substance on which body has lain." 
Substance on which lain. Posture. 
335. Posture of body between death and examination ; on back, on face, etc.; —length of time it has lain in that posture. 
1 As in Part I., the several points for observation included within commas have especial reference to medicolegal inquiries. 


Si.] 
POINTS TO BE ASCERTAINED 
124 
336. "Position of body in relation to the room, stairs, etc.; to articles of furniture; —relation of parts of body to the above. —If found hanging, note posture of body, and how much touches ground." 
Position in relation to other objects. 
337. " Odor in the room, at different parts of it; near body or at a distance from it?—Odor about body itself before stripping, after clothes have been removed (of poisons, of putrefaction, etc.)." 
Odor. 
Clothing— 
838. " Clothing on body or lying near it (noting special articles). —Nature and amount of covering; its arrangement; evenly or in creases?— Vomited matters upon them, on what part? examine for poisons (139). — Blood-stains on clothes, on which articles ? chemical and microscopical examination of stains; —part of clothing thus marked, so as to indicate posture of individual at time blood flowed over clothing; — blood appearing to have been sprinkled, as by jets from an artery, over the articles of dress; smeared, generally; soaked through; stain chiefly outside or inside the garment?—does stain correspond with a wound in the dress or body ? —marks of a bloody hand on clothing, at what parts? of one or both hands?— Stains of other hinds: of semen; of discharges; microscopical examination of stains (show absence of starch); —of acids. — Wounds of dress; their situation; size; cut or torn? corresponding or not with wounds in body ?—bloody or not? side to which blood chiefly applied.— Dress blackened or burnt, extent and situation of injury.— Position of bedclothes, if body is in bed." 
vomited matters. 
blood-stains. 
other stains: 
wounds of dress. 
burns of dress 
position of bedclothes. 
339. Degree of manipulation to which body has been exposed;—removal from the place at which death occurred, or where it was first found; the 
Manipulation. 


125 
L* 
PART II.] BEFORE COMMENCING AN EXAMINATION. 
[§ I- 
manner in which this was effected, lifted by hands or feet, or both, etc." 
340. " Cord around neck: —its precise characters ; —mode in which placed round, and its exact situation ; —situation of knot; — knot single or double; firmness of each knot. — Umbilical cord; if round neck or body, note in what manner it is disposed, its condition, amount of stretching, etc." 
341. "Articles about body: —furniture and walls; —spots of blood on them, their exact situation, size, form, and direction; shining or dull. —Wea- (628). —Dishes, plates, or articles of food. — Bottles, corked or not. —Vomited matters, their exact situation, characters (139). —(Preserve and examine chemically and microscopically any of the above which may throw light on the case.)" 
342. Feces and urine, found under body. 
343. " When body is exhumed, note condition of coffin as to soundness. —Examine soil, if necessary, 
for presence of metallic poisons— e. g., arsenic or copper." 
Cord round neck. 
umbilical cord. 
Articles about body. 
Feces, etc. under body. Condition of coffin, etc. 


§ n. a.] 
GENERALITIES. 
126 
§ II.—Points to be noted during Examination. 
A.—GENERALITIES. 
§ II. A. 
Sex. 
344. Sex: —degree in which external sexual characters are marked; general conformation, external sexual organs, mammae, beard, pubic hair, etc. 
Age. 
345. Apparent age: —evidences of age (370); —if infant, proportional size of head and trunk. 
Posture. 
346. " Posture of body :—at time of examination, or when first seen by observer; on the back, on the face, etc.; —composed as in natural rest; constrained; —limbs flexed or extended? position of head, etc.; hands clenched, in what manner? thumb turned into palm of hand, and fingers closed upon it, etc.; —toes contracted. —Limbs secured by ligatures." 
Countenance. 
347. "Expression of countenance: —calm; suffering; features distorted; lips retracted so as to show the teeth; —eyes prominent and staring;— fulness of features as during life; countenance bloated." 
348. Measurements of body: — Height, from vertex to plantar surface of feet. — Width from acromion to acromion; of hips, from extreme right to extreme left borders of iliac crests. —Length of trunk, from top of sternum to symphysis pubis; length of limbs.—Relative circumference of limbs; circumference of thorax (159) ; circumference and other measurements of head (4). 
Measurements— height. width. length of trunk, etc. 
circumference of limbs, etc. 
Weight. 
349. Weight of body. 


[§ II. B. 
INTEGUMENT AND ITS APPENDAGES. 
127 
Individual peculiarities : 
deformities. 
marks on surface. form of lips, form of hands, etc. 
350. " Striking individual peculiarities : — spinal curvature; depression of lower end of sternum ; deformities of limbs, etc.; want of symmetry on the two sides of body (note in what particulars). —Marks upon the surface, their characters (e. g., tattooed marks, etc.); —complexion. —Form of lips. —Form of hands, fingers (especially their extremities), and feet; —state of nails, worn down or not?—thickening of skin on hands, corns, etc., their exact situation, size, color, etc.; —stains on hands and arms, etc. (as indicating trade or occupation of person)." 
351. Temperature of the body (as perceived by the hand and by thermometer); —on exposed parts; on covered parts; in axillae; in mouth, etc. 
Temperature. 
352. Cadaveric rigidity: —its degree at particular joints; relative degree on the right and left sides; —date of appearance and disappearance. 
Rigidity. 
353. Nutrition of body: —body apparently well nourished; muscular; fat.— Emaciation; its degree; degree of sinking in of eyeballs and cheeks; looseness of integument, etc. 
Nutrition— emaciation. 
354. Putrefaction of body: —color of surface (355); coherence of parts of body, of bones and soft parts; state of cuticle (356). —" Saponification; name parts converted into adipocire, and degree of conversion; —examination of adipocire for poisons. —Incrustation with saline matter. 
Putrefaction: 
saponification, 
incrustation. 
B.—INTEGUMENT AND ITS APPENDAGES. 
| II. B. 
355. Color of surface: —generally; over superior parts; over depending parts; over superficial veins; over abdomen; over parts exposed to pressure —tint uniform or mottled?—effect ef prcs- 
Color of sur face — 


I 
§ n. b.] 
INTEGUMENT AND ITS APPENDAGES. 
128 
sure upon it; — " stains of acids, etc." — Special color of hands and nails; of fingers at roots of nails; —" hands discolored by gunpowder, one or both?"—color of face. 
of hands. 
of face. 
356. "Cuticle: —adherent; —ruffled or shrivelled; capable of being readily detached; detached and lying on skin; absent; (note the exact spot and extent over which the above are perceived.) —Cu- dry or moist ?—In new-born infant, presence or absence of vernix caseosa." 
Cuticle— 
vernix 
caseosa. White lines. 
357. " White lines: —on abdomen and outside thighs (lineoe albicantes); on breasts.—Brown line from umbilicus to pubes." 
Contusions. 
358. " Contusions: 1 —their locality; on one or both sides? measurements; —color; condition of cuticle over them.—Form of ecchymosis; resembling or not marks of fingers ? their exact relative position (with a view to determine which hand was used in causing them); —resembling "mark of a cord, or presenting form of some weapon ?—Blood found effused on dissection, its amount; liquid or coagulated? extent of effusion; is any large vein ruptured? Firmness or tenacity of skin at ecchy•mosed spot;—does discoloration extend through its thickness, or only partially through it?" 
Eruptions. 
359. "Eruptions: —their locality, characters (p. 43); —sudamina, their number, situation, size, contents, reaction. —Bullae or vesications. —Flea- —Purpuric spots; condition of cutis on section through them. — Indurated yellow patches, as after blisters." 
1 In bodies which have been submerged, marks of bruises should be looked only immediately on removal from the water, but again when the body has become dry. 


PART II.] 
[§ II. B 
INTEGUMENT AND ITS APPENDAGES. 
129 
360. " Bums: —locality; size; depth; —condi- of edges; condition of cuticle around; —vesi- surrounded by redness or not? width of redness, terminating abruptly or shading off gradually? depth of redness; —white line surrounding the burn; —contents of vesication, air, serum; color of true skin beneath; —charring of tissues; fissures in charred part (particulars as wounds, 626 et seq.): vessels seen running across fissures or not ?—slough (618 et seq.). —Condition of clothing about parts burned or charred (338)." 
Burns. 
361. " Marh round nech: —single or double ? extending round neck entirely or partially?—exact situation, in relation to larynx;—direction, horizontal, oblique; if oblique, where is lowest part situated?—accompanied or not by a groove?—width of mark; color; ecchymosis;—cuticle abraded or ruffled, shining or not?—depth of ecchymosis;— condition of parts beneath the mark; —cellular tissue, condensed, of silvery whiteness, containing blood or not?—condition of muscles, trachaea, larynx, etc., as to laceration, fracture, or effusion of blood; —any injury of vertebrae, ligaments, or spinal cord?—Examine for marks of fingers or nails about face and throat (358)." 
Mark round neck. 
362. " Wounds (626 et seq.).—Cicatrices (629). — Punctures: their exact seat, corresponding to spinal cord, fontanelles, cribriform plate of ethmoid bone, etc. — Abrasions or scratches; their locality; size, etc.; direction of scratches; marks of nails, their situation (specially examine hands or fingers)." 
Wounds, etc. 
363. "Hair: —color; quantity; length; condition." 
Hair. 
364. "Nails: —their form; degree of develop- 
Nails. 


§ n. c] 
[PART II. 
ORGANS OF LOCOMOTION. 
130 
(Edema. 
Emphysema. 
Subcutaneous fat. 
\ II. C. 
Muscles— development. 
color, etc. 
section, extravasated blood, etc. rupture, etc. 
microscopical examination, growths. 
Tendons, etc. 
Bones— size, form, etc. 
exostoses, consistence, caries, etc. 
merit; size; —morbid conditions; color ; laceration; length;—condition of ends(e. g., split, bitten, etc.); —foreign substance under nails, their precise characters (preserve and compare these with matters near which body was discovered, etc.)." 
305. (Edema : —of trunk; of limbs; of face. —Characters of fluid obtained by puncture (001). 
300. Emphysema: —locality; degree; nature of gas. 
307. Subcutaneous fat: —amount, on limbs; on abdominal and thoracic walls; color. 
C.—ORGANS OF LOCOMOTION. 
308. Muscles: —degree of development; diminished in bulk, increased in bulk (if not general, name muscles affected) ; —color; degree of firmness ; —section, dry, moist, sticky; " odor on section:"—blood extravasated among fibres (fluid or coagulated ?); —abscess or infiltration of pus.— Rupture of fibres. —Gangrene (018). —Wounds (020). — Foreign bodies. — Parasites. — General saponification. —Microscopical examination ; fatty degeneration or other changes.—Growths in muscles, their characters. 
309. Tendons and aponeurosis: —color; consistence ; thickness; degree of moisture or dryness ; transparency; rupture; ossification; calcification. 
370. Bones: —"size;" form, alterations from normal shape ; —increased diameter or thickness ; diminished diameter or thinness; —condition of apertures on surface; —exostoses, their situation, size, and other characters; density of substance; flexibility ; fragility ; caries; necrosis ; abscess ; 


PART II.] 
ORGANS OF LOCOMOTION. 
[§ XL C. 
131 
hemorrhage; cancerous (638 et seq.) or tubercularlooking matter (644). —"Length of long bones; height of entire body as calculated therefrom."— Periosteum: color; thickness; degree of attachment, etc. — Endosteum and medulla: changes in them.—" Fractures: —their exact seat; —ununited; edges showing marks of cutting instruments or not ?—Amount of union process; —united.—Con- of soft parts over fracture.—Fracture on one or both sides ?—In bones surrounding large cavities, note condition of contained parts, extravasation of blood, wounds, lacerations, etc. —Effusion of blood about fracture, its amount.— Peculiarities connected with age: state of ossification; condition of epiphyses; condition of fontanelles, sutures, diploe; —shape of maxillse and condition of dental alveoli; —neck of femur, angle formed with shaft. — Peculiarities connected with sex : clavicles ; pelvis;—general smoothness or roughness of bones? —In cases of suspected poisoning, examine if necessary for arsenic." 
371. Thoracic cartilages: —consistence; color; degree of ossification. 
372. Intervertebral substance: —consistence; color ; degree of union to bone; foreign matter in it. 
373. Joints: —form; measurements; flexibility. —Condition of integument over them; its color, vascularity, and tension ; —fistulae ; laceration. — Fluid within joint; its characters. —Condition of the several parts of the joint; synovial membrane, cartilages, ligaments.—Anchylosis; nature of connecting medium. —Foreign bodies in joint; their number, form, size, and nature; —loose or attached? —Condition of articular ends of bones; deepen- 
length. 
periosteum. endosteum. medulla. fractures. 
peculiarities from age. 
from sex. 
Thoracic cartilages. 
Intervertebral substance. 
Joints— form, size, etc. skin over. 
fluid within tissues of joints. anchylosis. foreign bodies. 
ends of bones. 


§ II. D-] 
[part II. 
ORGANS OF DIGESTION. 
132 
surrounding soft parts, dislocations. 
I II. D. 
Mouth. 
Lips— 
matters about lips. 
relative position of lips and teeth. external characters. 
labial glands. 
Jaws. 
Cavity of mouth. 
contents. 
ing or shallowness of articular cavity; apparent cause of these conditiQns; eburnation.—Condition of soft parts around joints; thickening, etc.—Dislocations : recent or of long duration ? 
D. —ORGANS OF DIGESTION. 
Mouth. 
374. Lips: —absent? apparent cause of absence; —malformations.—Open ; closed, by rigidity of muscles, by " aid of ligatures," ete. — Foreign matters about lips or coherent to them (e. g. portions of food, of dress, or of soil); —fluid about lips; increased or not by pressing thorax or abdomen, or by moving the body? its characters, frothy, etc.; color, red (from blood or other matters ? determined by microscope), dirty green, yellow, etc. —dried foam, etc. — Relative position of lips and teeth; lips indented, clasped, or lacerated by teeth. — Size of lips; thickness; —color, pale, livid, white, brown, black, yellow; reaction of surface, if stained; —surface, moist or dry?—cuticle peeling, detached; —vesicles; exudations (sordes); sloughs (618) ; ulcers (624); tumors (631 et seq.); wounds (626), etc. — Labial glands: their size and characters. 
375. Jaws: —open, to what degree? capable or not of being closed ?—closed, completely or not ? capable or not of being opened? "means adopted to keep them closed;" —muscles rigid or not? 
376. Cavity of mouth: —contracted, from what cause?—communicating with nose or with the exterior (in what way?)—Contents; food, foreign matters, etc. "degree of impaction." 


PART II.] 
[§ II. D. 
ORGANS OP DIGESTION. 
133 
m 
377. Gums: —size; —color; generally, at edges (if purple, breadth of purple line and its definition; if red, breadth of line and intensity);—surface, dry, or moist?—consistence; hard, soft, spongy;— degree of adhesion to teeth.—Exudations (sordes), etc., on surface (594); —"foreign substances adherent to them;" —sloughs (618); ulcers (624), on surface or confined to line of junction of gums and teeth; —solutions of continuity from recent extraction of teeth.— Section of gums; characters of tissue and of fluid exuding. 
Gums— external characters. 
section. 
378. Teeth: —number? names of those present (noting whether of the first or permanent set); — number absent? names of absent teeth; cause of absence, non-development or extraction?—Loose or firmly fixed? carious; "recently fractured;" — amount of fangs left uncovered by gums; —condi- of alveoli (abscess, fracture, etc.). —Exudation (sordes), etc. on teeth; amount of tartar; —"fo- matters adherent to teeth or clenched between them." 
Teeth. 
379. Cheeks: —outer surface, its condition; — inner surface; adherent to maxillae; bulging;— condition of mucous membrane (595); secretions or exudations upon it (594). — Substance of cheek; thickness; consistence; oedema; tumors (631); wounds (626), corresponding or not in position with fractured teeth? cicatrices (629); —section; characters of tissue and of fluid exuding. 
Cheeks— external characters. 
substance. 
380. Tongue: —absent? apparent cause of absence; malformation; —adherent or not to cavity of mouth or sides of fauces?—Size; —form.— Position; retracted, protruding from mouth.— Surface; fissured, furrowed, lobulated, presenting marks of bites (recent or not?), sodden-looking, 
Tongue— 
size, form, etc surface. 


§ II. D-] 
[PART II. 
THROAT, ETC. 
134 
substance. 
Hard palate. 
Salivary Glands and Ducts. 
Glands— external characters. 
section. 
Ducts. 
Throat, etc. 
Fauces. 
Uvula aucl velum pendulum. 
denuded of epithelium, clean, furred; —edge, indented by teeth; —color, pale, white, livid, brown, black, red, yellow ("if stained, reaction of stained part"); —papillae, their condition; —vesicles, exudations, etc. —condition of under surface; minute vesicles or abscesses. —Submucous tissue at root of epiglottis, its condition (596). —Sub- of tongue; consistence; oedema; sloughs (618); ulcers (624); tumors (631 et seq.); wounds (626); —section; characters of tissue and of fluid exuding. 
381. Hard palate: —malformations; fissures, etc. 
Salivary Glands and Ducts, 
382. Glands (Parotid, Sublingual, and Submaxillary) : —swelling externally, over glands, in course of Steno's duct; oedema; —size; consistence — Section: texture of cut surface; color; — fluids expressible; abscess (606 et seq.); cysts; tumors (631 et seq.); etc. 
383. Ducts: —size; dilatation, general or partial ? its physical cause; obliteration ; thickness of coats; size of orifices; —fistulae; —calculi, their number, size, and physical characters; —retained saliva, its characters. 
Tliroat, etc. 
884. Fauces: —size of opening; if contracted, from what cause?—condition of pillars;—exudation, etc. (594); condition of mucous membrane (595). 
385. Uvula and velum pendulum palati: — malformations; fissure, etc.; — size of uvula, 


PART II.] 
[§ Hi D 
THROAT, ETC. 
135 
especially its length; condition of free extremity, excised or not?—color, etc. (595); —exudations upon surface (594); microscopic fungi present or absent? condition of subjacent mucous membrane (595); —condition of submucous tissue (596). 
386. Tonsils: —size, absolute and comparative; form; position; interval between them; —surface, smooth, uneven, rough, pitted;—condition of openings; follicles empty or blocked up with secretion?—secretions, their odor; lymph or other exudation (603); calculi; tumors (631 et seq.); — color of surface (595); "if stained, reaction of stained surface;" —sloughs (618 et seq.), their size, degree of detachment; condition of subjacent surface (595); —ulcers (624), etc. —Section; characters of cut surface, color, consistence, etc.; character of fluid expressible. 
387. Pharynx: —size of cavity; if contracted, whether from contraction of membranes, thickening of submucous tissue, or pressure of tumors, etc., external to it?— Contents of cavity; "foreign bodies; their nature and degree of impaction (if portions of linen, etc., preserve them for comparison)."— Diverticula; seat; size; form; relation to surrounding parts; tissues composing them; contents (food, etc.). — Mucous membrane; its condition (595); exudations and secretions on surface (594), presence or absence of microscopical fungi;—ulcers (624); sloughs (618 etseq.); fissures; wounds (626 et seq.). — Submucous tissue; its condition (596). Pharyngeal muscles; color, firmness, etc. 
388. (Esophagus: — malformations; — displacement ; its direction; cause, tumors or collections external to it, etc.; —dilatation; general, with hypertrophy or attenuation of muscular coat ? partial, 
Tonsils— external characters. 
section. 
Pharynx— size, etc. 
contents. 
diverticula. 
mucous membrane. 
submucous tissue, pharyngeal muscles. 
(Esophagus— displacement. 
dilatation. 


§ n. D.] 
[PART II. 
ABDOMEN GENERALLY. 
136 
its seat and size; —contraction or stricture; seat; extent; depending upon a morbid state of the substance of the oesophagus, or upon a tumor, etc., external to it ? calibre of oesophagus at strictured part, above it; below it; condition of edge of stricture; ulceration present or absent ? mucous membrane around puckered or not ? condition of submucous tissue; induration of substance of oesophagus at or around strictured part? cause of induration. — Diverticula: position; form; size; relation to surrounding parts; tissues composing them; contents. — Contents of oesophagus; food; "foreign bodies, mud, etc., their character, degree of impaction," etc. — Mucous membrane (595); secretions and exudations (594); ulcers (624); sloughs (618 et seq.), etc.—Submucous tissue (596). — Muscular coat; color; firmness, etc.; —circular or longitudinal fibres abnormally developed, generally or partially?—if stricture be present, condition of muscular coat above and below it. — Openings through oesophagus; parts with which they communicate; apparent cause of opening (congenital, bursting of abscess and aneurism, softening of cancerous matter, etc.). — Wounds. 
stricture. 
diverticula. 
contents. 
mucous membrane. 
submucous tissue. 
muscular coat. 
openings. 
wounds. 
Abdomen generally. 
Abdomen generally. 
External characters. 
389. External characters: —(108 et seq.) 
390. "Umbilical cord : —adherent or detached? length of attached portion; presence or absence of a ligature ? nature of ligature; extremity, cleanly cut or torn? color; dry or moist ? corrugated or not ?—if detached, condition of surface of umbilicus, healed or not ?" 
Umbilical cord. 


PART II.] 
[§ n. D 
PERITONEUM —STOMACH. 
137 
Peritoneum. 
391. Contents: (597) —Articles of food, etc.; their amount, position on membrane, special nature; —condition of membrane in neighborhood. 
392. Condition of Membrane : (598) —Specify the exact seat and extent of any morbid changes; —correspondence with morbid appearance of parts and organs which membrane covers; —condition of duplicatures of peritoneum, omenta, mesentery, mesocolon, ligaments of liver, spleen, uterus, etc. (particulars as peritoneum generally). 
393. Hernias : —parts through which they have occurred; —organs or parts of organs included in herniae; their condition (397, 404). 
394. Tumors (631 et seq.). 
395. Sub-peritoneal tissue: —(599) 
396. Mesenteric and other lymphatic glands (477 et seq.). 
Stomach. 
897. External characters: — Position : in relation to general cavity of the abdomen, to adjoining parts and organs; in herniae; in cavity of thorax. 
— Size : measurements (before and after opening stomach); extreme length from fundus to pylorus; extreme transverse measurement; transverse measurement in the middle of the organ; length of smaller curvature; length of greater curvature. — Form: presenting annular contraction or sacculation (401) ? effect upon these of inflating the stomach. — Adhesions (605). —Condition of peritoneal coat (598) : relation of morbid states of 
Peritoneum. 
Contents. 
Condition of membrane: 
of folds. 
Hernise. 
Tumors. Sub-peritoneal tissue. Mesenteric glands, etc. 
Stomach. 
External characters— position. 
size. 
form. 
adhesions, peritoneal coat. 


§ H. D.] 
[PART II. 
STOMACH. 
138 
peritoneal coat, as regards position, to abnormal appearances of mucous membrane (399, 401). 
398. Contents: —quantity of contained matters, (measured or otherwise estimated?) —odor; color generally; reaction; microscopical characters (sarcinae ventriculi). —" Food: its special nature, if capable of being identified; bread, etc. (tested for by iodine); fat (tested for by heat); degree of digestion."— Blood: pure or mixed with food ? fluid or coagulated ? color; apparent source, if discoverable — "Foreign matters recognizable by the eye (endeavor to identify them); — vegetable matters, their special characters and apparent source; —mineral substances, salts, powders, metallic particles; —spirits, their odor; —water, its quantity, special character, and contents (e. g., algae); mud; hair, etc." — Fecal matters: quantity; characters ; —bile; calculi; pus; worms. —" Where poisons are suspected to be present, determine presence and quantity by chemical examination; test for volatile substances with the least possible delay."— Gas: quantity; odor, and other characters. 
Contents— 
food. 
blood. 
foreign matters. 
fecal matters. 
poisons. 
gas. 
399. Mucous membrane. — Secretions, etc. on surface (594) : " Foreign particles entangled in mucus, their physical and chemical characters; condition of membrane subjacent."—Limitation of lymph, etc. to surface of rugae.— Rugae: present or absent ? their situation. — Condition of membrane (595): color generally; color of rugae; of parts between rugaa; —relative depth of hue of anterior and posterior surfaces, of cardiac and pyloric extremities.—Redness general or limited to surface or edges of rugae?—Mammillation; its seat and extent.—Absence of any part of membrane ? are 
Mucous membrane: secretions, etc. on surface. 
rugae. 
condition of membrane. 


PART II.] 
[§ n- d 
STOMACH. 
139 
submucous or muscular coats wanting at same spot ?—if a portion is absent or removable by washing, is its seat at the most depending part of organ, or at the rugae ? aspect of adjacent bloodvessels.—Length of strips obtainable from pyloric extremity; from cardiac extremity; from curvatures, greater and smaller; from anterior and posterior surfaces. —Thickness at pyloric extremity; at cardiac extremity ; at lesser curvature; at greater curvature ; on surface of rugae; between rugae. — Submucous tissue: its condition (596). 
400. Muscular coat: —thickness; alterations in thickness, general or partial ?—degree of visibility of muscular fibres. 
401. Substance of wall of stomach:—transparency when held between observer and the light;— thickness (measured in various parts). —Wounds (626). —Perforation (625) : exact situation, on which surface ? near which curvature ? etc. —" Alterations in organs adjacent to perforated spot; softening; corrosion; blackening, etc."—Rupture; its seat, extent, direction, etc. —If adhesion be observed between stomach and adjacent parts, note if it corresponds in position with ulcers, cicatrices, or perforations discovered after opening the organ. —If circular" constriction be observed, note if it corresponds in position with softening or induration of mucous or submucous coats, ulcers, perforations, or cicatrices. —Weight of stomach. —" In case of suspected poisoning, examine tissue chemically for mineral poisons." 
402. Cardiac opening: —constricted or not? cause of constriction; —condition of epithelium. 
403. Pylorus: —abnormally open; constricted; constriction overcome or not by slight force? — 
submucous tissue. 
Muscular coat. 
Substance of wall— thickness, wounds, perforation. 
rupture, adhesion. 
constriction. 
weight. 
examination for poisons. 
Cardiac open ing. 
Pylorus— openness, constriction. 


§ n. d.] 
[PART II. 
INTESTINES GENERALLY. 
140 
mucous membrane. 
submucous coat. 
muscular coat. 
Intestines generally. 
External clia racters— position, hernias. 
invagination. 
opening smooth or fissured round edges ?—Mucous membrane; its condition (595) ; puckered or not ? —Ulcer (624). —Submucous coat; its condition (596). —Muscular coat; thickness as measured; degree of visibility of muscular fibres; of different layers of fibres; —presence between the fibres of adventitious products; colloid, encephaloid, scirrhous or common exudation matter; their microscopical characters. 
Intestines generally. 
[The following particulars are to be noted throughout the canal, but it is to be specified in which division each is observed, whether in the duodenum, jejunum, ileum, cascum, colon (ascending, transverse, or descending), sigmoid flexure, or rectum.] 
404. External characters. — Position: in relation to general cavity of abdomen; to adjoining parts and organs; —in hernise, external or internal ; degree of constriction undergone by bowel; appearance of constricted part, of part involved in hernia; condition of parts above and below hernia (contracted, dilated, etc.); —cause and nature of constriction; an intestinal diverticulum, adhesions, holes in the mesentery, bands and cords formed by omentum, etc.; —twisting of portions of intestine; form and precise characters of affected portion. — Invagination: number of invaginations ; situation; size; direction, upwards or downwards? ease with which reduced; —condition of serous membrane (598), of mucous membrane (595) (distinguishing 


PART II.] 
[§ n. D 
INTESTINES GENERALLY. 
141 
the separate layers of the invagination) ; color, thickness, consistence; lymph, pus, adhesions, etc.; —condition of mesentery included within sheath. — Calibre; in general terms. —Special dilatation or contraction; extent of affected portion ;—circumference of normal, dilated, contracted, or constricted portions; of intestine above and below contracted or dilated portion;—is contraction partially or entirely removed by stretching ?—apparent cause of constriction; abnormities external to canal, in walls of canal itself; —condition of coats at, below, and above constricted or dilated portion (406 et seq.) ; degree of visibility of muscular fibres.—Diverticula : number; situation at distal or attached side of intestine ? shape; size; structure; —pre- or absence of fibrous cord ? its length; — contents. — Adhesions (605, 408). — Peritoneal coat; its condition (598); —relation of abnormal appearances, in respect of position, to morbid states of mucous membrane. 
calibre, dilatation. 
constriction 
diverticula. 
adhesions, peritoneal coat. 
405. Contents. — Gas : quantity ; odor and other characters.— Mucus: quantity; color; transparency ; consistence ; reaction; adhesion to mucous membrane. — Blood: mixed with feces or not? quantity; fluid or coagulated ? color; —apparent source, if discoverable. — Pus : quantity; apparent source. — Fecal matter : quantity; aeration; color; consistence; indurated scybala.—" Mecoiiium" — Foreign substances: indigestible alimentary matters (e. g., cherry or plum stones); concretions, their size, form, constituents; portions of non-alimentary substances, their form and physical characters; biliary calculi; —" poisonous matters ; distinguishable by physical characters; ascertained by chemical analyses."— Entozoa: number and character. 
Contents— gas. mucus. 
blood. 
pus. 
fecal matter. 
meconium. 
foreign substances. 
poisons. 
entozoa. 


§ n. d.] 
[PART II. 
SPECIAL PORTIONS OP INTESTINES. 
142 
Mucous membrane— 
secretions on surface. 
condition of membrane. 
submucous tissue. 
Muscular coat. 
Substance of wall— 
thickness, 
wounds, 
perforation, 
rupture. 
adhesion. I 
examination for poisons. 
Special portions of Intestines. 
Duodenum— Br miner's glands. 
ductus communis. 
Jejunum and ileum— valvuloe conniventes. Tilli. 
406. Mucous membrane. — Secretions, etc., on surface (594); limited or not to border of valvulae conniventes? to Peyer's patches? to prominent folds of large intestine ?—if a patch of lymph is linear, does its long axis correspond with that of intestine, or is it disposed circularly ?— Condition of membrane (595). — Submucous tissue ; its condition (596). 
407. Muscular coat: —thickness; alterations in thickness (general or partial), especially in parts altered in calibre (404); —development of longitudinal fibres; of circular fibres. 
408. Substance of wall of intestine: —transpa- when held between observer and the light; —thickness (measured in various parts), especially in parts altered in calibre (404). —Wounds (626 et seq.). —Perforations (625) : exact situation, near attached or distal side of tube.—Rupture ; its seat, extent, direction, etc. —If adhesion be observed between intestine and any other part, note if it corresponds in position with ulcers, cicatrices, perforations, or abnormal growths or deposits.—"In cases of suspected poisoning, examine tissue chemically for mineral poisons." 
Special portions of Intestines. 
409. Duodenum. — JBrunner's glands : degree of development;—if there be ulceration, note the relation of smallest ulcers to orifices of glands.— Ductus communis : condition of orifice ;—permeability of common and biliary ducts. 
410. Jejunum and ileum. — Valvulae conniventes: "present or absent?" size; peculiarities;—extent of intestine occupied by them. — Villi: degree of 


[§ II. D. 
PART II.] 
SPECIAL PORTIONS OP INTESTINES. 
143 
development; color.— Peyer's patches : number; situation; —matters adhering, mucus, phosphates, etc. (594) ; —degree of visibility; level at, above, or below that of adjacent membrane ?—rugae; pits; sacculi; —deposit; its color, consistence; in separate points, in one layer; situation, on mucous membrane, in sacculi, in submucous tissue, in muscular tissue, in sub-peritoneal tissue, in several or all of the above; —color of patch (595), condition of vessels, etc.; —transparency, of patch, of tissues around; —consistence ; length of strips obtainable from mucous membrane; adhesion between coats of intestine in situation of patch;— ulcers (624); sloughs (618 et seq.) ; cicatrices (629); puckering —condition of peritoneum corresponding to patch.— Solitary glands : number; situation; degree of prominence ; —deposit; color ; ulcers, etc. — Crypts of Lieberkiihn : degree of visibility ; color. 
411. Ceecum : —situation; extent uncovered by peritoneum ; — gelatinous softening. — Appendix vermiformis: situation; length ; calibre ; adhesions; contents; perforation; ulcers, etc. — Peocsecal valve: hypertrophy, etc. —Are morbid states of cascum or ileum arrested at the valve ? 
412. Colon : —position and course. — Solitary glands: degree of visibility; prominence; color; induration ; —ulceration (624) ; size of ulcers; situation, at apex or base of glands ?—sloughing (618 et seq.) ; size of slough; situation in reference to glands. — Ulcers unconnected with solitary glands (624); if oval, direction of long axis; —situation with reference to prominent folds in colon.—Relative number of ulcers in cascum and other parts of colon. 
Peyer's patches. 
solitary glands. 
crypts of Licberkuhn 
Caecum— 
appendix vermiformis. 
ileo-caecal valve. 
Colon— solitary glands. 
ulcers. 


§ II. D.] 
[part II. 
LIVER. 
144 
Rectum. 
413. Rectum: —hemorrhoids; their anatomical characters; —prolapsus; its extent; condition of prolapsed portion of bowel. 
Liver. 
Liver. 
414. External characters. —Absent ?—number; —malformations; —position in respect of cavity of abdomen generally, and with relation to other organs; extent uncovered by cartilages of ribs.— Adhesions (605); their length and the relation between their diaphragmatic and hepatic attachments; —if surface of liver be irregular, are adhesions attached to depressed or elevated portions ?— Weight (with gall-bladder attached, but emptied). — Measurements : transverse; antero-posterior (from rounded to thin edge); of greatest thickness. — Form : generally; —acute margin ; thick, thin, rounded, irregular; reduced to a fibro-cellular band, depth to which this band extends inwards. — Surface (noting particulars with respect to superior surface, inferior surface, acute margin, on and between the lobules, etc.): color generally, or in various parts of surface, in elevated or depressed portions;—depressions; size, form, color, etc.; corresponding or not to ribs? — pits produced by pressure; —elevations; size, form, color, consistence, etc.; —lobulation; its physical cause; — puckerings;—opacities, linear or racemose? their direction; —roughness, its physical cause; —granu- their situation, size (uniform or not ?), color, compound or single ?—cysts (634); tubercle (644), etc. 
External characters, position. 
adhesions. 
weight. 
measurements. 
form. 
surface. 
Capsule— surface, thickness. 
415. Capsule (noting various parts of surface) : —lymph on surface; pus on surface; —polish; transparency; vascularity; —thickness; —fragility; 


PART II.] 
[§ n. D. 
LIVER. 
n 
145 
—elevation of capsule; by air, serosity, pus, blood; facility with which detached from hepatic substance; amount of hepatic substance removed with capsule: condition of hepatic surface after removal of capsule; smoothness; color; —condition of substance subjacent to morbid alterations of capsule or adhesions. 
416. Substance: —cut surface; degree of moisture or dryness ? flaccidity; fragility; aspect of fractured surface ?—color; relative position of yellow and red substances; their relative proportion; —transparency;—consistence; specific gravity;— emphysema;—fluids expressible;—hemorrhage into substance. — Lobules: degree of separation; mode of separation; —situation of red and yellow substance in separate lobules. — Granulations: number; size; color; structure. — Cicatrices (630): relation to branches of portal vein, of hepatic duct; to abnormities seen on surface— e. g. puckerings, opacities, etc. — Pus in detached points; number, size, form, and arrangement of the points; condition of tissue around them; —abscesses (006 et seq.); connection with, or openings into surrounding parts; ducts opening into them; tissue surrounding them; evidence of contraction; —fistulae (613 et seq.) — Calcareous matter: number of deposits; situation; size; —relation to the several elements of liver, e.g., lobules, ducts, and veins.— Gangrene (618 et seq.) — Growths: lipoma; cancer (638 et seq.)—Tubercles or tubercular matter (644). — Ci/sts (634 et seq.): hydatids. — Wounds (626 etseq.) — Rupture: number of fissures; extent; situation; depth; direction ; condition of edges, etc.— Microscopical examination, of lobules, etc. 
417. Veins: — Portal vein: (see Veins, 474 et seq.y) —malformations; — ductus venosus, open or 
detachment. 
hepatic surface after removal. 
Substance— 
lobules. 
granulations, cicatrices. 
pus. 
abscesses. 
fistula?. 
calcareous matter. 
gangrene. 
growths. tubercle. cysts. wounds. rupture. microscopical examination. Veins— portal. ductus venosus. 


§ I>.] 
[part II. 
GALL-BLADDER. 
146 
umbilical. 
hepatic. 
Hepatic ducts. 
Gall-bladder. 
External cha racters. 
Cavity— contents. 
Walls- 
mucous membrane. 
Ductus communis cholcdochus— calibre. 
closed ? if open, its calibre, contents, thickness of coats, condition of interior; — umbilical vein, open or closed? if open, its calibre, contents, thickness of coats, etc. — Divisions of portal vein : their condition —relation of branches to linear opacities, puckered spots, abscesses, cicatrices, gangrene, etc. — Hepatic vein (for particulars, see Veins, 474 et seq.). 
418. Hepatic ducts: —contents; —calibre; contracted, obliterated, dilated; seat and extent of the above changes; —thickness of wall; —mucous membrane (594 et seq.). —Divisions of ducts; relation to puckered spots, cicatrices, abscesses, etc. 
Gall-bladder. 
419. External characters: —absent? size; shape; color of surface; adhesions (605). 
420. Cavity: —obliterated? — Contents: air; — bile; its amount, color, consistence, odor, taste, specific gravity, reaction, chemical and microscopical characters; —calculi; attached or not to bladder ? in what way ?—number, size, situation, form, surface, color, section, chemical and microscopical characters; —serous fluid; mucus; pus, etc. 
421. Walls: —thickness; transparency; oedema; emphysema; adipose deposit; cretification; tubercle; cancer; —wounds; rupture. — Mucous membrane (594 et seq.). 
422. Ductus communis choledochus: —calibre; —abnormal contraction or dilatation; their seat and extent; —impervious; from what cause ? pressure externally from enlarged glands, pancreas, etc., adhesion of walls, contraction, obstruction by calculus, etc. ?—condition of duct above and below 


PART II.] 
SPLEEN —PANCREAS. 
[§ II. D 
147 
point of contraction or obstruction; —orifice (409). —Contents of duct; —condition of walls (as 421); condition of mucous membrane (594 et seq.) — Cystic duct (as Ductus communis). 
contents. 
mucous membrane, cystic duct. 
Spleen. 
Spleen. 
428. External characters: —absent? —number; —splenculi, their size, shape, and mode of attachment to spleen (if any);—malformations;—position, in respect to cavity of abdomen generally, and in respect to other organs.— Adhesions (605). — Weight. — Measurements: length, breadth, and thickness. — Form: surface. — Capsule: —lymph or false membranes on surface (603) ; smoothness; polish; roughness, its physical cause; corrugation; color; transparency. —Thickening, general or partial? extent; form; depth; consistence; —facility of detachment. 
External characters— 
weight, measurements, form, capsule. 
424. Substance: —cut surface; degree of moisture or dryness; color; — consistence; fragility; aspect of fractured surface; —number of white spots visible; their size, etc.—Wounds (626); rupture; abscesses (606 et seq.); tubercle (644); cancer (638 et seq.) ; gangrene (618 et seq.) ; cysts (634 etseq.). — Microscopical examination of pulpy matter; of white spots, white transparent crystals present or not ? if present, their exact characters. 
Substance. 
microscopical examination. 
Pancreas. 
Pancreas. 
External characters— weight. measurements. form. 
425. External characters: —absent ?—malformations ; —position; relation to other organs of abdomen.—Adhesions (605). — Weight. — Measurements. — Form: —surface. 


§ n. e.] 
[PART II. 
ORGANS OF RESPIRATION. 
148 
Substance. 
Duct. 
§ II. E. 
External characters of thorax. 
Pleurce. 
Contents. 
Condition of membrane. 
Sub-pleural tissue. 
Subjacent pa rietes. 
Nares. 
Malformations and foreign bodies. 
Bones. 
Mucous mem brane. 
426. Substance: —cut surface; degree of moisture or dryness; color; consistence; degree of separation of lobules; color of lobules; condition of interlobular tissue; —wounds; abscesses (606 et seq.); cretaceous masses; tubercular-like matter (644); cancer (638 et seq.) ; cysts (634 et seq.). 
427. Duct: —calibre; —dilatation, general or partial ?—contraction or obliteration ; its seat; physical cause ; —contents; calculi, pus, blood, etc.— Walls (as 421); —fistulae (613 et seq.) ; with what communicating ? 
E.—ORGANS OF RESPIRATION. 
428. External characters of thorax. —(158 et seq.) 
Pleurae, 
429. Contents: —(597.) —Blood; when supposed due to a wound, examine condition of intercostal arteries. 
430. Condition of membrane : —(598.) 
431. Subpleural tissue : —(599.) 
432. Subjacent bony and muscular parietes of thorax .—(368, 370.) 
Nares, 
433. Malformations. — Closure. — "Foreign bodies: their situation, nature, degree of impaction." 
434. Bones: —their condition (370). 
435. Mucous membrane: —(594 et seq.) 


PART II.] 
[§ H. E. 
TRACHEA AND BRONCHIAL TUBES. 
149 
N* 
Larynx, Trachea, and Bronchial Tubes. 
436. Generalities. — Position ; —malformations; —shape ; size.— Mucous membrane: its condition (594 et seq.) — Wotinds (626 et seq.) — Contents: foreign bodies; mucus; lymph (603); puriform matter (602), blood, etc. —their amount; degree to which they occupy the several cavities; their degree of adhesion to subjacent mucous membrane. 
437. Larynx. — Epiglottis: shape; surface (upper and under), inequalities of them; color; thickness, thickening due to condition of mucous membrane or of submucous tissue ? oedema; ulcers (624); sloughs (618 et seq.) — /Superior aperture of larynx: size.— Aryteno-epiglottidean folds: color ; thickness ; transparency; oedema; adherent secretions; ulcers; sloughs; polypi; —submucous tissue ; its condition (596) ; fluid contained in its meshes. — Ventricles of larynx and sacculi laryngis: condition of mucous membrane (595); oedema, etc. — Rima glottidis: size and shape; plug of mucus or other body present?— Chordse vocales: extent to which they are in apposition ; their thickness, color; — oedema; ulcers (624), sloughs (618 et seq.), are these on edges of chordae vocales or not ?— Muscles of larynx : color; size ; consistence; fluids infiltrating them. — Cartilages of larynx*: condition of perichondrium (especially of parts beneath ulcers of mucous membrane); denudation of cartilages; ossification ; caries; necrosis.— State of parts adjacent to external surface of larynx. 
438. Trachea. — Mucous membrane' (594 et seq.); diverticula; tubercle, etc.— Contents (436): "mucous froth, size of vesicles."— Cartilages of 
Larynx, Trachea, and Bronchial Tubes. 
Generalities: position, etc. mucous membrane, wounds, contents. 
Larynx— epiglottis. 
superior aperture of larynx, arytenoepiglottidean folds. 
ventricles. 
rima glottidis, 
chordae vocales. 
muscles. 
cartilages. 
adjacent parts. Trachea— mucous membrane, contents, cartilages. 


§ U. B.] 
[part II. 
LUNGS. 
150 
trachea ; degree of resistance or brittleness ; degree to which denuded of mucous membranes; ulceration ; ossification. 
439. Bronchial tubes. — Contents (436); in larger or smaller divisions of tubes ? " water (its amount) j" degree to which they are filled; lymph on surface, occupying or not whole circumference of tubes? rendering them impervious to air (note 'state of pulmonary tissue to which impervious bronchial tubes lead, 442)? — Diameter of bronchi and their divisions; form, compressed or narrowed by tumor, etc. externally. — Contraction or dilatation; number and extent of contracted or dilated parts;— measurements of tube above, at, and below contracted and dilated parts; —their form; —contents of dilated part and of tubes leading to or from it; — their walls thicker or thinner than natural, etc. ? condition of mucous membrane of the parts (594 et seq.): condition of pulmonary tissue around them, absolute and comparative; state of pleura over dilated portions;—relation between dilated portions and thoracic parietes; thickness of intervening lung , substance. — Walls of tubes; thicker or thinner than natural ?—perforation of them, communicating with other parts ? size and shape of opening (direct, oblique, valvular), amount of intervening lung substance.— Cartilages; ulceration; ossification.— Mucous membrane (594 et seq.). 
Bronchial tubes— contents. 
diameter. 
contraction, dilatation. 
walls. 
cartilages, mucous membrane. 
Lungs. 
Lungs. 
(Facts to be noted in respect of each lung separately.) 
440. Examination in situ: —position; degree of collapse; am cunt to which pericardium is uncover- 
Examination in situ— position. 


PART II.] 
[§ XL E. 
LUNGS. 
151 
ed; —adhesions (005); —wounds (020); rupture; fistulas (013 et seq.). 
441. External characters. —Weight " of both after tying vessels, with trachea and bronchi attached ;" of each separately, before and after escape of fluid ; number of cubic inches of water displaced ? Form when laid on the table; —number of lobes, any peculiarity in their shape? adhesion of lobes; —puckering at apex or at any other part; —"visi- of air-cells;" —shape of margin of lung, anteriorly, at base. —Color externally (noted as soon as possible after opening the thorax); shape and position of discolored portions, and relation between them and any solid portions of lung; —amount and position of pulmonary black matter. —Appearance of lungs as if macerated. —Degree of compressibility; resiliency; flaccidity; sensation of solidity imparted to fingers; crepitation ; are the solid or the crepitant portions the more prominent ?—relation between the solid portions and disease of pleura. — Effect of inflation on color and other characters of previously solid portion. —Emphysema; interlobular; vesicular; size, shape, prominence, etc., of aircells ; —thickness of tissue between the fingers after expression of air and fluid. —Secdliko bodios; their situation, color, consistence, etc. —Tubercu- masses (044); relation to pleura, etc. — Cancerous-looking masses (038 et seq.). 
442. Substance of lung: —consistence; flaccidity; fragility, under pressure of fingers, tearing, etc.; carnified appearance; smoothness; granular appearance and color of cut or torn surface (before and after pressure).— Fluid exuding on section of different parts, especially of most dependent part, apex, etc.; its amount, color, degree of aeration, 
adhesions, wounds, etc. 
External characters— weight, etc. 
form. 
color. 
compressibility, etc. 
crepitation. 
effect of inflation, emphysema. 
seedlike bodies, tubercle. 
cancer. 
Substance— consistence. 
surface of section, fluid exuding, 


§ n. e.] 
[PART II. 
LUNGS. 
152 
crepitation. 
abscess. 
gangrene, vessels, foreign bodies. 
Extravasation of blood. 
Adventitious products— cretaceous bodies. 
tubercles. 
cancer. 
etc.— Crepitation; —its degree.—Any partially crepitant or non-crepitant portions? their size, shape, outline; —relation to each other, to pulmonary substance, to interlobular septa; —condition and contents of bronchial tubes and pulmonary vessels leading to and through them, compared with those in other parts of same lung;—condition of lung substance immediately adjacent.— Abscess (606 et seq.) — Gangrene (018 et seq.) — Vessels of lung, their condition. — Foreign bodies in lung; condition of tissue immediately surrounding. 
443. Extravasation of blood: —extent of lung implicated; —masses of hemorrhagic effusion; their number, size, and shape; degree of circumscription ; gradually blending with surrounding lung substance ; confined to certain lobules; consistence of masses, hard or pulpy ? their color, dark purple, brightish red, etc.; appearance of section, granular or smooth ? appearance of cut surface after being scraped by scalpel;—degree to which parenchyma of lung is broken down; —is effusion surrounded by a cyst ? 
. 444. Adventitious products. — Cretaceous bodies; at what part of lung situated, near surface or not ? their color, size, shape, consistence, fragility; softer at centre or externally?—condition of surrounding parts, pulmonary or pleural. — Tubercles or tuberculous-looking matter: —seat; amount and distribution, isolated, scattered, clustered, etc.; size, color, and form; transparent or opake ? opake at centre and transparent at edges, or the reverse ? consistence, etc. (644). —Condition of interstitial and surrounding tissue, natural, indurated, congested, emphysematous ; its color, etc.— Cancer or cancerous-looking matter (638 et seq.). 


[§ II. E. 
PART II.] 
DIAPHRAGM. 
153 
445. Cavities: —seat; relation to surface; — size; shape ; distinct or communicating ?—contents ; puriform matter, softened tubercle, cretaceous masses, blood; —crossed or not by septa or bands? nature of these, do they contain vessels and are the vessels pervious ? —communicating or not with bronchial tubes ? mode of termination of bronchial tubes, relation of orifice of tube to contents of cavity.—Walls of cavity; condition, smooth, irregular, coated with lymph, sloughy;—condition of tissues surrounding cavity;—relation of cavity to adhesions, thickenings, etc. of pleura.— Cysts: relation to bronchial tubes, pulmonary substance and vessels of lung;—size; —thickness of parietes, contents, etc. (634). 
446. " Hydrostatic test: —results of placing lungs, bronchi, and trachaea together in water (noting its temperature and source) ; do they sink or float ? if they sink, do they fall slowly or rapidly ? —Results with each lung separately.—Results with portions of each lung; if any of them float, do they rise above surface of water, or float below it or at its level ? do they float after compression ? do bubbles of air rise on compressing portions under water?" 
Diaphragm. 
447. Position : —on both sides ; height to which it rises into chest; —apertures (625); hernise; wounds (626), etc. — /Substance: serous surface (597 et seq.) ; muscular and tendinous tissues (368, 369). 
Cavities— seat, size, etc. contents. 
relation to vessels and bronchia}. 
walls. 
cysts. 
Hydrostatic test. 
Diaphragm. 
Position— 
substance. 


§ n. p.] 
[part II. 
ORGANS OF CIRCULATION. 
154 
I II. F. 
Pericardium. 
External characters. 
Contents. 
Internal surface— adhesions, white spots. 
Heart. 
Examination in situ— position. 
shape. 
measurements. 
consistence. 
Examination after removal— blood in vena? cavse. 
F.—ORGANS OF CIRCULATION. 
Pericardium. 
448. External characters : — shape ; measurements from above downwards, and transversely; extent uncovered by lungs. —Vascularity of surface ; effusion of serosity, pus, or fibrinous exudation on surface; cancerous-looking matter (638 et seq.); tubercle (644). —Amount of fat on sac. — Wounds (626). 
449. Contents (597). 
450. Internal surface (598 et seq.) — Adhesions: extent and other characters (605). — White spots on serous membrane; their locality, shape, size, thickness —flocculent or smooth? —facility of detachment. 
Heart. 
451. Examination in situ: —exact position; point of thoracic parietes to which apex and right and left borders correspond; —relation of heart to liver; —direction of axis of heart. —Shape; extent of left ventricle seen; degree of distension of right auricle.—Measurements; from extreme base to apex; from auriculo-ventricular groove to apex; transverse measurement at auriculo-ventricular groove. —General estimate of rigidity or flabbiness of tissues. 
452. Examination after removal: 1 —Amount of blood discharged from superior and inferior venae 
1 The venae cavae being supposed to be cut through close to the auricle, the aorta and pulmonary arteries just above the free edges of the valves. 


[§ II. F. 
PART II.] 
HEART. 
155 
cava?; —kind of blood, liquid, mixed with gas, coagulated, large pale clots, etc. (476). —Shape of heart when removed, rounded, elongated; apex formed by right or by left ventricle ? apparent relative size of right and left ventricle; if either ventricle be contracted, note its capability of dilatation. 
453. Right auricle: —quantity of blood contained in cavity;—its condition, liquid, frothy, coagulated; its color, etc. (476); —general estimate of the size of cavity after removal of blood.— Lining membrane: smoothness, polish, transparency, color, thickness; —deposition upon it, in granules, layers, etc.; deposit below membrane, its characters; — ecchymoses;—ulcers and sloughs of lining membrane.—Condition of foramen ovale; of orifices of venae cavae; of mouths of coronary veins.—Muscular walls; thickness, color, consistence; condition of musculi pectinati; —extent to which encroached upon by external deposition of fat; —fatty streaks; mottling and yellow spots among fibres; —ecchymoses; hemorrhage; pus; fibrous tissue. 
454. Right auriculo-ventricular opening: —its shape as viewed from above; —apparent diameter when stretched to a round shape;—rough estimate of its size, by introducing fingers; size as measured by a graduated cone; —projections, calcifications, etc., on auricular surface of ring; extent to which opening is diminished by them; —circumference of ring (as measured after cutting through it and stretching it out without using much force). 1 
455. Right ventricle: —amount and characters 
1 The best mode of measuring the several openings is by means of a wet piece of string, which will follow the inequalities of the opening. 
shape. 
size of ventricles. 
Right auricle: blood contained, size of cavity. 
lining membrane. 
foramen ovale, 
muscular walls. 
Right auriculo-ventricular cular openingform, form, size. projections. 
circumference. 
Right ventricle— 


[PART II. 
HEART. 
156 
blood contained. 
size of cavity. 
lining membrane. 
muscular walls. 
columnas carneae. chordae tendineae. 
Tricuspid flaps— thickness, granulations. etc. length, etc. 
Sinus arteriosus. 
Pulmonary opening—¦ shape, etc. efficiency of valves. 
circumference. 
of blood contained in cavity (476); attachment of coagula to lining membrane and interlacement among columnae carneae; —general estimate of size of cavity;—its general shape;—length of interior from centre of auriculo-ventricular ring to apex;— extent to which septum bulges into cavity.— Lining membrane: smoothness, polish, transparency, color, thickness; —depositions upon it; —ecchymoses;— readiness of detachment of membrane from muscular fibres. — Muscular walls: thickness at base, middle, and apex; color; consistence; mottling or streaking as seen before and after removal of endocardium ; —size of columnae carneae; condition of chordae tendineae, their length, flexibility, thickened or not at point of attachment to valves?—softening; rupture, its extent, situation, etc.; —ecchy- ; hemorrhage; pus; fibrous tissue, etc. 
456. Tricuspid flaps: — natural, thickened, thinned, contracted; —presenting granulations or vegetations; —shortened; rolled back; length of flaps.—Can the auriculo-ventricular opening be closed ? if not, is this due to shortness of chordae tendineae, or to what other cause ? 
457. Sinus arteriosus: —its size, shape;—deposition upon its lining membrane. 
458. Pulmonary opening: —its shape as seen from below; —smoothness of ring, of ventricular surface of flaps;—exudation upon or shrinking and apparent incompetency of flaps; does water pass through when poured into pulmonary artery ? and if so, does it pass freely or in drops ? apparent size of abnormal opening;—circumference of opening (as measured at the attached border of valves, after opening the artery and stretching out the ring without force). 


PART II.] 
[§ II. F. 
HEART. 
o 
157 
459. Pulmonary valves (viewed from pulmonary artery) : —their smoothness; color; —thickening, or irregularity, their cause; contraction; reticulation ; —competency.—If there be any malformation, etc. of flaps, note their number, size, thickness, power of closing, opening, condition of corpora Arantii, etc. 
460. Left auricle: —particulars as right auricle (453), pulmonary veins being of course noted instead of venae cavae and coronary veins. 
461. Left auriculo-ventricular opening:—appearance when looked at from above; size and shape of opening; rough estimate of size by introducing fingers; size as measured by graduated cone; —circumference of opening (measured after ventricle has been opened). 
462. Left ventricle: —particulars as right ventricle (455). — Septum ventriculorum: thickness at base, middle, and apex; —deficient, entirely or partially?—if presenting an aperture, its size, thickness, and character of edges, etc. 
463. Mitral flaps; —their size; —apparent competence or the contrary, cause of incompetency;— color; smoothness; polish;—thickening; retraction ; adhesion ; deposits upon or into them, etc. 
464. Aortic opening: —particulars as Pulmonary opening (458). 
465. Aortic valves: —particulars as Pulmonary valves (459). 
466. Coronary arteries; their size; —atheroma or calcification of them; —obstruction from coagula, etc. 
467. Substance generally: — WeigJit (the heart being supposed to be taken out as directed in the note, p. 154, and all blood and coagula to have been 
Pulmonary valves, smoothness, etc. irregularity, etc. competency, malformation. 
Left auricle. 
Left auriculoventricular opening— size, etc. 
circumference. 
Left ventricle, septum ventriculorum 1 
Mitral flaps— size, etc. 
thickening, etc. 
Aortic opening. 
Aortic valves. 
Coronary arteries. 
Substance— weight. 


§ II. F.] 
[PART II. 
ARTERIES. 
158 
wounds, growths. 
malformations, microscopical examination. 
Arteries. 
Examination before opening vessel. 
Examination after opening vessel— contents. 
size. 
walls. 
lining membrane. 
middle coat. 
removed). — Wounds (626 et seq.) — Growths; their locality, size, etc. (651 et seq.); effect on shape of heart and condition of cavities. — Malformations; their special description.— Microscopical examination of contained blood, and of the several cardiac structures. 
Arteries. 
468. Examination before opening vessel:—malformations —size; course; —condition of external coat and of tissues around it; vascularity; exudation (pus, etc.). 
469. Examination after opening vessel: —con- blood, its quantity, color, etc. (476), coagxilated or not?—degree of adhesion of coagula to lining membrane; color, consistence, presumed age and arrangement of coagula.—Size of vessel after detachment of clots; transverse measurement, when opened and laid flat; —general thickening; rigidity or flaccidity of walls.— -Lining membrane: its color; tint uniform, in patches, in streaks (on anterior or posterior wall ?) ; — transparency ; smoothness; polish; —readiness of detachment from middle coat; —thickness; —fissures; ulcers. —Inequalities on lining membrane; in points, patches, or ridges; their size, shape, degree of elevation ; —their apparent cause, as atheroma, calcification, fibrinous effusion, gelatinous effusion; —exact relation of the above to the internal coat, upon it, below it but incorporated with it, below it but easily separated from it, below with partial destruction of it.— Middle coat: its thickness; color; connection with lining membrane; —deposit between middle and internal coats; deposit in middle coat, its color, con- 


PART II.] 
[§ H. P. 
ANEURISMS. 
159 
sistence, and apparent nature (supra); —blood between middle and inner or outer coats. — External coat: its thickness; color, etc. 
470. "Ductus arteriosus: —condition, open or closed ?—diameter, at commencement, middle, and termination ; —condition of interior; thickness of wall," etc. 
471. Microscopical characters of normal and abnormal arteries; of their several structures; of contained blood. 
Dilatations of Arteries and Aneurisms. 
472. External characters: —size (as expressed in general terms and by measurement); shape, globular, pyriform, etc. —Relation to the vessel, whether a general dilatation or a lateral detrusion ? if a lateral detrusion, note exact point of vessel from which it arises, and whether anteriorly, posteriorly, or laterally ? — Sensation of thickness, thinness, density, fulness, emptiness, etc., given to hand.—Relation of surrounding parts to enlargement; are they adherent or not to enlargement?— Openings as seen externally; their position, size, depth;—free or blocked up by coagula ? degree of freedom with which a probe enters; —effusion of blood from opening, its quantity, position, etc. 
473. Characters after opening dilatation:—contents; blood, liquid or coagulated?—layers of fibrin; their number, thickness; color and density (absolute and relative) of outer and inner strata. — Size and shape of cavity in which liquid blood was free to move.—Opening from artery into cavity; size; shape; straight or oblique?—characters of lips of opening; shape, thickness, hardness; appa- 
external coat, 
Ductus arteriosus. 
Microscopical characters. 
Dilatations of Arteries and Aneurisms. 
External characters— size. shape, etc. 
feel. 
openings. 
Characters after openingcontents. contents. 
size of cavity, etc. opening into artery. 


§ Hi *•] 
VEINS. 
[part II. 
160 
inner surface. 
walls. 
lining membrane. 
artery above and below, microscopical characters of coats. 
Veins. 
Examination before openingsize, size, etc. feel. exudations. 
Examination after openingcontents. contents. 
calibre. 
lining membrane. 
rent effect on entrance or exit of blood; apparent capability of being thrown into vibrations by its entrance or exit. —Inner surface of cavity; how constituted ? by lining membrane of vessel, by adventitious membrane, by coagula or fibrin? rough; smooth; calcified, etc.—Walls of dilatation, how constituted? by all or by one or more of the coats? —state of coats forming boundary; separated, amalgamated, thickened, thinned, atheromatous, calcified, etc.—Condition of lining membrane in vicinity of opening into artery; smooth, rough, atheromatous; —does lining membrane appear to cease at orifice of aneurism or to be continued into it ?—Size of artery above and below aneurism; — effect of aneurism on branches of artery. —Micro- characters of arterial and aneurismal coats. 
Veins. 
474. Examination before opening vessel: —size and general appearance; bulging, thickening; color; vascularity;—feel to hand, hard, corded, thin, full, empty; —exudation upon and into outer coat, fibrin, pus, etc. 
475. Examination after opening vessel.—Contents of vessel; blood, liquid or coagulated ? its color; —fibrinous matter ; its color, consistence, adhesion to lining membrane; —pus or puriformlooking fluid, its microscopical characters (645 et seq.). —Calibre of vessel; if small, due to contraction of vessel or to deposit on lining membrane ?— Lining membrane: color, uniform or in patches ? depth and uniformity of tint; —smooth ; rough ; apparent cause of roughness; size of elevations; their color, consistence, degree of adherence; — 


[§ n. G 
PART II.] 
LYMPHATIC SYSTEM. 
161 
polished; dull; tarnished.—Consistence of membrane; its thickness or thinness; its degree of adherence; softening; laceration; Assuring; rupture. — Valves: condition as to thickness, color, shape, and competency. — Abnormal communication between an artery and vein : communication by a direct or oblique opening? immediate or by a sinus? size of opening;—condition of arterial and venous wall of orifice; —size of vein and artery at affected point. — Phleboliths: their number; size ; free or attached, and in what manner? relation to lining membrane; —microscopical and chemical characters. 
Blood. 
476. Physical characters: —color; consistence; —fluid or coagulated ?—characters of coagulum ; its form, size, consistence (uniform or not ?) color (uniform or not ?); relative amount and consistence of pale and dark portions; position of pale and dark portions in relation to one another and to posture of body;—microscopical characters (645 et seq.); — chemical characters.—"Examination for poisons." 
—Blood mixed with gas; amount and nature of gas; vessels in which found. 
Gr. —LYMPHATIC SYSTEM. 
477. Characters observed be/ore section : —size; color; consistence; flaccidity, etc.; —condition of capsule;—condition of tissue in which they are imbedded. 
478. Characters observed after section: —color of surface; amount and situation of black matter; 
valves. 
communication with artery. 
phleboliths. 
Blood. 
Physical characters. 
| II. G. 
Lymphatic Glands. 
Characters before section: color, etc. capsule. 
Characters after section color, etc. 
Lymphatic Glands. 


§ II. G.] 
[PART II. 
LYMPHATIC AND LACTEAL VESSELS. 
162 
consistence, tubercle, cancer, fluid exuding. 
Special glands: cervical, axillary, inguinal. 
bronchial, mesenteric. 
lumbar, etc. 
Lymphatic Vessels. 
size. consistence, etc. lymph. 
skin, etc. over. 
Lacteal Vessels. 
—general aspect of cut or of fractured surface; consistence, soft, hard, calcified; —containing tuberculous-like matter (644); containing cancerouslooking matter (638 et seq.) ; —character of fluid exuding from cut surface on pressure, to naked eye and under microscope. 
479. Special lymphatic glands. — Cervical glands: part and side of neck on which diseased glands are situated. — Axillary glands. — Inguinal glands: above or below Poupart's ligament ?—Appearance of skin covering these several groups of glands; —openings from the glands on surface of skin ; discharge from openings or not ? characters of discharge (601, 602). — Bronchial glands. — Mesenteric glands : number visible ; relation of enlarged glands to particular portions of intestines or to diseased conditions of them.— Lumbar, iliac, and sacral glands. 
Lymphatic Vessels. 
480. Size of vessels; —thickness, consistence, and color of coats; —amount of lymph contained within them; its degree of fluidity; transparency or turbidity; its color; microscopical characters; — color of skin in course of lymphatics ; abscesses in connection with them. 
Lacteal Vessels. 
481. For particulars, see Lymphatics (480). — Contents of vessels; degree of fluidity, etc. 


[§ n. H. 
PART II.] 
URINARY ORGANS. 
163 
H. —URINARY ORGANS. 
Kidneys and Ureters. 
482. Absence of both kidneys, or of either ?— Number of kidneys ?—Kidneys united ? 
(The following facts are to be noted in respect of each kidney separately.) 
483. External characters: —degree of development; position; form; —size, extreme length, extreme breadth, extreme thickness; —weight after removal of capsule; —amount of fat at hilus; — wounds (626 et seq.) ; rupture. 
484. Capsule: —transparency; vascularity; consistence ; thickness; —facility with which removed from cortical substance; readily separable or not into layers ? portions of cortical substance removed or not with the capsule ? number, size, and shape of portions of cortical substance removed. 
485. Surface of kidney after removal of capsule, (noting differences, if any, on anterior and posterior surfaces) : —smooth; lobulated, size of lobules; puckered; situation, shape, size, and color of puckered spots; —presenting depressed spots; situation, shape, size, and color of depressed spots; adhesion of capsule to these spots; —granulated; situation, size, and color of granulations; color of intergranular substance.—Color of surface of kidney; grayness of surface; its depth, situation, shape, extent; pallor, its tint; marbling; redness, dependent on staining or vascularity ? venous polygons; stellate injection; punctiform redness (size of punctse).— Cysts (634 et seq.). 
\ II. H. 
Absence, etc. 
External characters— position, size, etc. weight, fat, etc. 
Capsule. 
Surface. 
cysts. 


§ n. h.] 
[PART II. 
URINARY ORGANS. 
164 
Substance. 
Cut surface— fluid exuding, color, etc. 
Cortical substance— 
specific gravity, breadth, color. 
Malpighian corpuscles, granulations 
microscopical characters. 
Pyramidal portion— striae. 
color. 
microscopical characters. 
Mammillae. 
Abnormal growths, etc. cysts. 
fibrinous masses, tubercle, cancer, abscesses. 
486. Substance of kidney: —consistence, flaccidity, fragility;—fracture, granular or not? — wounds (627); rupture. 
487. Cut surface: —amount of blood or serosity exuding from cut surface; presence of fat on surface of exuding fluid ?—general hue of cut surface ; relative hue of cortical and pyramidal portions; line of demarcation between these portions abrupt or imperfectly marked?—amount of blood in vein at base of pyramids; hue of tissues immediately adjacent to that vein. 
488. Cortical substance: — specific gravity;— breadth at base of pyramids; —general color; red striae, their amount, breadth, continuous or made up of separate points? red punctae; ecchymoses;— Malpighian corpuscles ; their degree of visibility ; color, pale, red; —granulations, their color, consistence.—Condition of cortical substance subjacent to any puckered spots seen upon the surface. — Microscopical characters. 
489. Pyramidal portion: —degree in which normal striae are marked; arrangement of striae in the pyramidal portion, and where this passes into cortical portion; — general color; — white opake streaks; yellow deposit, granular or linear, general or limited to base ?—Microscopical characters. 
490. Mammillae,: —their consistence; color; fluid expressible from them; gangrene. 
491. Abnormal growths and deposits: —Cysts (634 et seq.); their relation to Malpighian bodies. —Fibrinous masses; their size, shape, consistence; color of tissue adjacent, red, gray. —Tubercle (644). —Cancer (638 et seq.) —Cretiform matter.—Abscesses (606 et seq.) —Microscopic characters of any of the above. 


[§ n. H. 
PART II.] 
URINARY BLADDER. 
165 
492. Pelvis of kidney. —Absent? —Calyces; their length and size; —mode in which ureter opens into pelvis, and whether in a valvular manner or not? loculated, bases of loculi radiated or not? —Contents of pelvis; fluid, its qualities, capable or not of being expressed through the ureter ?—solid (calculus), its exact situation, size, surface, structure, etc. —Walls of pelvis; thickness, consistence, transparency, color. —Mucous membrane(594 et seq.) —Wounds (626). —Fistulous openings (613 et seq.) —If any solid body lie in the pelvis, note the condition of wall and of mucous membrane with reference to its exact seat. 
493. Ureters: —absence? (if absent, note existence or not of a condensed band of fibrous tissue in its situation); —number; —calibre, if altered at one spot, note condition of tissue adjacent to that spot and calibre of ureter above and below; —contents of ureter; if a calculus, its position, size, surface, etc., condition of mucous membrane in contact with it; —mode in which ureter opens into pelvis of kidney and bladder; —consistence.—Mucous membrane (504 et seq.) 
Urinary Bladder. 
494. External characters:—Absent?—Malformations.—Adhesions (605). —Size; amount of contraction or dilatation; degree of dilatability;—position of bladder; shape; —diverticula, their seat, size, shape, tissues forming them, contents; — wounds (626). 
495. Contents: —urine, its quantity and physical characters (221); —blood, its amount and characters; pus, etc.; —calculi, their number, size, posi- 
Pelvis of kidney. 
contents. 
walls. 
mucous membrane, openings. 
Ureters— 
calibre. 
mucous mem brane. 
Urinary Bladder. 
External characters— size. position, shape, diverticula, etc. 
Contents. 


§ n, i.] 
[part II. 
ORGANS OF GENERATION. 
166 
Walls. 
Mucous membrane. 
Urethra. 
direction, calibre. 
obstructions, wounds, etc. 
Mucous membrane. 
Contents. 
I II. L 
1. Female. 
Pudendum. 
Labia, nymphse, clitoris— 
tion, shape, surface, section, and chemical and microscopical characters; —other bodies. 
496. Walls: —their thickness; condition and thickness of the several coats. —Sinuses. —Perfora- (625); rupture, seat, extent, direction; wounds (626); tubercle (644); cancer (638 et seq.) —Condition of adjacent tissues and organs. 
497. Mucous membrane (594 et seq.). 
Urethra. 
498. Absence?—malformations; —direction; — calibre; contractions and dilatations, their seat, number, mutual relations; condition of several tissues of urethra at the seat of abnormal calibre and of tissues about it; —obstructions of canal, their character and cause; —wounds; rupture. 
499. Mucous membrane (594 et seq.): —abnormal appearances uniform or not?—condition of follicles and sinuses; —excrescences, their form, size, color, vascularity, consistence. 
500. Contents of urethra. 
I. —ORGANS OF GENERATION. 
1. Female 
Pudendum. 
501. Labia, nymphse, and clitoris: —absence? —malformations; —size; color; oedema;—condition of epithelium; abrasion, its extent; —ulcera- (624); —secretion covering these parts, its appearance and characters; —abscess (606 et seq.); eruption; vegetations; condylomata, their number, 


[§ II. I 
PART II.] 
ORGANS OP GENERATION. 
167 
form, and size; tumors (631 et seq.)} gangrene (618 et seq.); —"marks of violence; blood about external genitals; appearances of recent connection." 
502. Urethral orifice: —growths within and about it; their size, number, exact seat, elevation, etc. 
503. Hymen .-—absent or present? its precise state, " entire or lacerated ? surrounding the entire vaginal orifice or only a part of it ? imperforate;— its strength." 
Vagina. 
504. Malformations and congenital deficiencies; divided vagina;—elongated; shortened; narrowed; dilated; closed; seat and extent of the above changes; apparent cause of contraction; —direction; —condition of orifice. —Prolapsus; protrusion of either wall, its cause. —Contents of vagina; " foreign substances, their exact situation, size, and other characters; poisonous substances." —Mucous membrane (594 et seq.); lying in loose folds; —" do secretions on surface contain seminal animalcules ?" —Fissures, or ruptures, their seat, extent, direction, with what part or organ they communicate ? wounds (626 et seq.); perforations (625); —cancer (638 et seq.) —Submucous tissue (596); condition of layer of erectile tissue at lower part of vagina. 
Examination of internal Organs of Generation in situ. 
505. Uterus : — absence ? — malformations. — General appearance and rough estimate of size of urerus; —position of the fundus and of the cervix 
marks of violence, etc. 
Urethral orifice. 
Hymen. 
Vagina. 
Malformations— length, width. 
prolapsus, contents. 
mucous mem brane. 
fissures, etc, 
submucous tissue. 
Examination of internal Organs of Generation in situ. 
Uterus— size. position. 


[part h. 
§ H, I.] 
UTERUS. 
168 
Fallopian tubes— position. 
size, etc. 
Ovaries— position, size, etc. 
Pelvic tumor. 
Uterus (after removal). 
Orifice— size, shape, etc. 
Lips— size, shape, color, abrasion. 
(aiding the determination of this and other points by the introduction of a finger into vagina) ; —organ straight or bent upon itself, in what way ? organ generally occupying its proper position in the pelvis, or lying diagonally, or turned forwards or backwards (noting its exact position) ? high or low in pelvis ? pressing on perineum, rectum, or bladder, or descended towards vaginal outlet, and to what extent ? —adhesions (605). —If enlarged, note general form and character of enlargement, amount of pelvis occupied, and its relation to the pelvic parietes and neighboring organs. 
506. Fallopian tubes : —their absolute position and direction; —their position and direction relatively to the uterus, ovaries, pelvic tumors, etc.; — their general characters of size, color, etc.; —adhe- (005). 
507. Ovaries : —their position;—general estimate of their size; if enlarged, general character of the enlargement; hard, soft, uniform, or irregular ? —adhesions (005). 
508. Pelvic tumor (631 et seq.) :—its relation to walls of pelvis, uterus, Fallopian tubes, broad ligaments, ovaries, bladder, rectum, etc. 
Uterus (after removal). 
509. Orifice: —size; shape, natural, oval, rounded, irregular, etc. ; —open; obstructed, nature of obstructing substance ; —discharge lying within it, its characters ; —tumor occupying it, its characters (631). 
510. Lips: —size, equal or unequal?—form, flat, uneven, everted, tabulated (size and characters of lobulation); —color, uniform or not?—abrasion,its 


PART II.] 
UTERUS. 
[§ II. I- 
p 
169 
exact situation and extent, depth;—ulcerations (624), their exact situation ; —granular-looking patches; their exact situation, size, form, color, elevated or depressed? epithelium on surface present or absent ? tumors (631 et seq.). 
511. External characters of uterus generally (distinguishing, where necessary, cervix and body) : —weight; —extreme length, breadth, and thickness; measurements at various points;—form of organ ; —characters of surface ; color; peritoneal covering smooth, shining, rough, transparent or opake, covered with lymph (603); —tumors, their position, size, etc. (631 et seq.) ; —fissures or ruptures, their seat, extent, depth, direction;—ulcerations (624); wounds (626 et seq.); cicatrices (629); —consistence of organ or of parts of it; hard, soft, flabby, boggy, irregular, fluctuating, etc. 
512. Characters observed on section: — Uterine wall: thickness at cervix, body, and various parts of these ; consistence ; color of section ; —amount of blood in tissue; condition of bloodvessels as to size, fulness with blood, etc.; —fluids* exuding from cut surface on pressure; —abscess (606 et seq.) ; —tumors (031 et seq.) ; their position, nearness to outer or inner surface, their size, characters on section; —condition of subperitoneal bloodvessels and cellular tissue; —microscopical characters of tissue, fatty degeneration, etc. — Uterine cavity (distinguishing that of cervix and body) : closure of cavity, its cause; —dimensions of cavity; —con- of cavity;—secretions or exudations covering its surface (003) ; condition of rugae and glands of cavity;—mucous membrane (594) ; —condition of submucous tissue (596); —tumors projecting into cavity (631 et seq.), their number, position, size, 
ulcerations, etc. 
External characters generally— weight, measurements, form, surface. 
tumors. 
fissures, etc. 
consistence. 
Characters on section— wall. 
cavity. contents. secretions, etc. ruga? and glands. mucous membrane. submucous tissue. tumors. 


§ n. i.] 
[PART II. 
FALLOPIAN TUBES —OVARIES. 
170 
os internum, ovum. 
Fallopian Tubes. 
calibre, color, contents, mucous mem brane, etc. 
Ovaries. 
External characters— size, color, surface. 
cysts. 
consistence. 
sheath. 
Characters of section— aspect, color, stroma, cicatrices, gysts. tumors, etc. 
characters externally and on section; character of surface; continuous or not -with disease in the wall? —size and condition of internal orifice of uterus; —cancerous growths (638 et seq.). — Ovum: its size, degree of development, etc. 
Fallopian Tubes. 
513. Absence?—malformations; —length; direction, apparent cause of alterations in length and direction; —calibre, dilated, contracted; canal obliterated —color; contents; thickness of walls; — condition of mucous membrane (595) ; secretions, etc. on surface (594); —condition of fimbriated extremity; —cysts (634 et seq.) ; tumors (681 et seq.) ; tubercle (644) ; cancer (638 et seq.). 
Ovaries. 
514. External characters: — absence ? — size ; color, generally and partially; —condition of surface, smobth, rough, irregular, lobulated; marked by cicatrices (629); fissured, etc.; —cysts beneath surface, or projecting from it (634 etseq.);—consistence of ovaries, soft, boggy, fluctuating, firm, hard, irregular, etc. — Condition of sheath: its color, thickness, consistence, etc. 
515. Characters of section: — general appearance, uniform or varied, and in what manner ? color; —state of stroma, its consistence, etc.; — fluid exuding on pressure; —section of cicatrices; —cysts, their position, number, size, contents (634 et seq.); —tumors (631 et seq.), their situation, number, size, general characters; —abscesses (606 et seq.); —collections of blood; tubercle (644); 


PART II.] 
MALE. 
[§ II. I 
171 
cancer (638 et seq.), etc. —Condition of tissues in neighborhood of diseased ovaries. 
Mammae. 
516. External characters : —number, size, position of supernumerary glands;—silvery lines on integument, or other visible marks of previous enlargement — Nipple ; its color; size ; flattened or drawn in ? excoriations; ulcers (624), etc. — Areola; its size, color, etc. — Substance of gland to feel, soft, knotty, etc., hard. 
517. Section of gland: —color of cut surface; fluids exuding on section or on pressure;—consistence of gland;—abscesses (606 et seq.)} cysts (634 et seq.); tumors (631 et seq.); tubercle (644); cancer (638 et seq.). 
2. Male. 
518. Inguinal canal; —its contents; —hernia; its size; parts forming it, their condition. 
519. Testicles: — absent ? — malformations of them; —their exact position, in scrotum or abdomen ? degree of descent: —size; consistence to the feel; —condition of fibrous coat; —character of section, color, consistence; —abscess (600); cysts (034 et seq.); tumors (631 etseq.); tubercle (644); cancer (638 et seq.). 
520. Vasa deferentia: — thickness; contents; condition of mucous membrane (594). 
521. Spermatic cord : —condition; cancer (638 et seq.), etc. 
522. Tunica vaginalis : —malformations; —ad- — contents of sac (597); —condition of serous membrane (598), etc. 
Mammce. 
External characters— silvery lines. 
nipple, areola. 
substance. 
Section— color, fluids exuding. consistence, etc. 
2. Male. 
Inguinal canal— hernia. 
Testicles— descent, size. consistence, section. 
Vasa deferen tia. 
Spermatic cord. 
Tunica vaginalis. 


§ II. K.] 
[PART II. 
ENCEPHALON. 
172 
Vesiculse seminales. 
Prostate gland, size, surface, section. 
Penis— urethra. 
I II. K. 
External examination. 
Scalp— thickness. 
section, adhesion. 
collections of fluid, etc. 
523. Vesiculse seminales: — absence ?— malformations ; — calibre ; dilated; contracted; obliterated ; — thickness of parietes; —contents ; their color, consistence, etc.; —condition of mucous membrane (595) ; secretion covering its surface (594); —tubercle (644); abscess (606); cancer (638), etc.; —condition of adjacent tissues. 
524. Prostate gland : —size; consistence; partial enlargement of middle or lateral lobes ? impediment offered by it to passage of urine; —surface of enlarged gland; —color of section; fluid exuding on section or pressure, its abundance, color, etc.; — abscess (606) ; —tumors (631) ; tubercle (644) ; cancer (638 et seq.) —Contents of ducts; calculi, their size and chemical characters. 
525. Penis: — size ; malformations; ulcers (624); tumors (631 et seq.)— Urethra (498 et seq.). 
K. —ENCEPIIALON, AND ITS COVERINGS AND APPENDAGES. 
526. External examination of integument and cranium (355 et seq., 262). —"In newly-born infants, "note presence or absence of customary tumor on scalp." 
527. Scalp: —thickness of integument and aponeurosis —amount of blood effused on section; — color of section; —degree of adhesion to surface of cranium ; —" extravasation of blood; its relation to contusion-marks externally;" collections of fluid, its characters; —cysts (634 etseq.); tumors (631 et seq.), etc.; connection of any of the above with apertures in the cranium.— "Wounds (626 et seq.)." 


PART II.] 
[§ n. K. 
ENCEPHALON. 
173 
528. Cranium. — Exposed surf ace : its color; — smoothness or roughness; seats of roughness or irregularity; degree of roughness, its extent, cause; condition of calvaria opposite diseased appearances on scalp. —" Fractures; their position relatively to marks of injury observed on scalp; with or without " depression V — Removal of calvaria: —adhesions to dura mater; their situation, and where most numerous and strongest ? —force required to detach calvaria; can it be detached at all, or is it necessary to remove any part of dura mater with it?— Inner surface of calvaria: its form, symmetrical or not ? —elevations or depressions; their seat, extent degree, and symmetry; —smoothness of vitreous table; roughness; its degree, position, corresponding to diseased appearance externally, or to adhesions of dura mater ? — vascular grooves, their depth; bloody points on surface; color of surface; characters of surface in lines of sutures.— Ossification of calvaria, its degree; state of fontanelles.— Thickness of cranial bones; abnormal thinning or thickening; their exact seat, measurement, extent, etc.; symmetry of thickness; which table is most concerned in the thickening ?—width of diploe: fulness of diploic veins; color of diploe; fluids contained within diploic structure, pus, etc.; condition of frontal sinuses, of their mucous membrane (594 et seq.). — Openings in calvaria; their position, size; —parts passing through them; —condition of edges of opening, and their relation to parts passing through.— Condition of base of cranium (noted after removal of brain and membranes): depressions and elevations; their degree, symmetry, etc. (particulars as Inner surface of calvaria, supra); — condition of foramina and of bone in their immedi- 
Cranium— surface. 
fractures. 
removal of calvaria. 
inner surface of calvaria. 
ossification. 
thickness. 
diploe. 
frontal sinuses, openings. 
base of oranium. 


§ n. k.] 
[PART II. 
ENCEPHALON. 
174 
ate vicinity; —condition of petrous portions of temporal bones, apertures leading to internal ear, fluids contained within them, etc. 
529. Dura mater: —characters of surface; color generally or partially, white, yellow, red, etc.; — bloody points on surface, their abundance and principal situation ; —hemorrhage on surface (between it and calvaria), its situation; condition of blood, fluid or coagulated ? amount; extent over surface; condition of parts about blood, of bone (fissures, necrosis, etc.); condition of vessels in vicinity of effused blood; —pus between dura mater and calvaria ; its situation, amount, extent, boundaries, etc. (606); —thickness of dura mater, separating readily into layers; transparency or opacity ?—vascularity, order of vessels filled with blood, and their situation; —sloughs (018 et seq.) ;— tumors (631 et seq.) ; their relation to depressions on inner surface of calvaria or other diseased appearance; — wounds (626 et seq.) — Falx cerebri and tentorium: depth; presence or absence of reticulation ? (other particulars as dura mater generally.) —Inner surface of dura mater. (See Arachnoid Membrane, 531.) 
Dura mater— color. 
bloody points, hemorrhage. 
pus. 
thickness, vascularity. 
tumors. 
falx cerebri and tentorium. 
Arteries at base of brain. 
530. Arteries at base of brain (468 et seq.). 
531. Arachnoid membrane: —contents of cavity; serosity (601); —fluid blood; its situation, quantity, color ; —coagulated blood; situation, form, size, color and consistence of coagulum; state of its surface; is coagulum adherent or not to arachnoid ? presence or absence of a serous membrane on surface of coagulum? presence or absence of epithelium on the serous membrane ? vascularity of coagulum, vessels capable of injection from those of membranes or not ? characters of section, condi- 
Arachnoid membrane— contents, coagulum. 


PART II.] 
[§ II. K. 
ENCEPHALON. 
4 
175 
tion of the interior as compared wiijh the exterior of the coagulum, as to consistence, color, and microscopical characters ; hydatids in cavity of arachnoid —Adhesions between the two layers of arachnoid (605). —Surface of arachnoid (noting separately that of convexity and base of brain, that covering each portion of encephalon, and that covering dura mater (598); granulations (tubercles) on membrane (644); their capability of removal, etc.; left on pia mater on stripping off the arachnoid. — Transparency of arachnoid, generally between the convolutions, in vicinity of longitudinal fissures; —special seats and extent of opacity. — Color of membrane generally or in parts; —its vascularity noted with that of pia mater; —its consistence noted with that of pia mater; its thickness. 
adhesions, surface. 
transparency. 
color, etc. 
532. Subarachnoid serosity: —its quantity; — position, occupying intergyral spaces ? raising arachnoid from surface of convolutions (to what extent ?); limited to certain spots ? — its color, etc. (601). 
Subarachnoid serosity. 
533. Pia mater (noting exact locality of all abnormal appearances, and distinguishing the membrane covering each portion of the encephalon) : amount of contained serosity, its color, transparency, etc. (601) ; —lymph, its situation, extent, color, consistence, opacity, etc. (003); —granulations (tubercles) ; their number, position, form, size, etc. (044); —cancerous matter (038 et seq.) ;—vascularity of membrane as seen through arachnoid, degree of fulness of larger vessels between and upon convolutions of smaller vessels; air in vessels, its abundance; degree of fulness of vessels situated in folds which dip between convolutions; degree of fulness of vessels which dip into gray 
Pia mater— 
serosity. lymph. granulations, etc. 
vascularity. 


§ II. K.] 
[PART II. 
BRAIN. 
176 
blood. 
transparency. thickness, consistence. 
adhesions. 
Sinuses. 
Brain. 
Generalities: weight, etc. 
a. Cerebrum. 
Points observed before removing membrane. 
Parts at base. 
matter (observed when detaching pia mater from surface of convolutions); relative degree of fulness of vessels of membrane covering anterior and posterior lobes; —fluid blood, its situation, quantity, etc.; —coagulated blood, situation, form, size, color, and consistence of coagulum; coagulum laminated or not ? adherent or not to parts adjacent ? condition of large vessels near clot; —transparency of pia mater; —thickness; —consistence ; size of portions of arachnoid and pia mater removable by the forceps from the convolutions without tearing;— adhesions of pia mater, number and size of portions of convolutions detached with pia mater when that membrane is removed by forceps. 
534. Sinuses of dura matter: —their fulness etc. (See Veins, 474 et seq.) 
Brain. 
535. Generalities: —weight generally, and that of cerebrum, pons Varolii, medulla oblongata, and cerebellum separately; —specific gravity of various parts. —Rapidity with which substance softens on exposure or by handling. 
a Cerebrum. 
536. Points to be observed be/ore removal of arachnoid and pia mater (as much as possible being noted while brain is in situ) : —degree of development; size; form; symmetry of two sides; —space between surface of brain and calvaria. 
537. Parts at base of brain. — Crura cerebri; locus niger; optic tract) optic commissure; corpora albicantia; tuber cinereum; infundibulum; pituitary 


PART II.] 
[§ n. K. 
CEREBRUM. 
177 
body, etc. —In respect of each of the above, note their size, symmetry, color on surface, consistence, appearance on surface, "appearance on section, etc. (as 541); extravasation of blood (542), etc.—Attached portions of cerebral nerves, their condition (585 et seq.) ; condition of membranes about them. 
538. Removal of arachnoid and pia mater: — tenacity with which pia mater adheres to surface of cerebrum; apparently increased or not ? its cause (softness of convolutions, absence of normal amount of serosity, increased number and consistence of vessels passing from pia mater into convolutions). 
539. Convolutions externally : —" fully developed or not ?" breadth; —breadth of intergyral spaces ; —flattening, local or general; —local bulging; local depression ; —smoothness of convolutions ; polish; granular appearance; worm-eaten appearance.—Color of convoluted surface; yellow patches; crimson spots;—situation and extent of discolored parts; number of convolutions involved. —Consist- of convolutions; amount removed in detaching membranes; gravitative flattening of surface of brain locally; consistence to the touch; effect of a stream of water (no breach of continuity previously existing);—relative consistence of convolutions of anterior and posterior lobe, or of any parts' discolored or otherwise changed.—Ulcers (624); relation between meninges, and the edges and floor of the ulcer; condition of brain-substance around and beneath ulcer, its consistence, color, vascularity, etc., extent to which it is altered.—Sloughs (618 etseq.); relation to meninges; tenacity with which slough adheres to adjacent brain-substance ; condition of brain-substance around. —Deposits; tumors (631) ; wounds (626); puckerings, etc. 
cerebral nerves. 
Removal of arachnoid. 
Convolutions externally— size. flattening, etc. 
color. 
consistence. 
ulcers. 
sloughs, etc. 


§ n. k.] 
[part II. 
CEREBRUM. 
178 
Section of convolutions— 
gray matter. 
microscopical characters. 
White substance— consistence. 
color. 
blood in vessels. 
corpus callosuui. microscopical characters. 
Extravasation of blood— situation, etc. 
coagulum. 
540. Section of convolutions: —breadth of gray matter of convolutions; hue ; consistence; specific gravity; vascularity.—Condition of gray matter subjacent to abnormal portions observed on surface.—Microscopical characters, of tissue, of minute vessels. 
541. White substance of hemispheres: —moisture of cut surface ; consistence of the substance, diminished, soft, pulpy, creamy; diffluent; consistence increased; —extent of substance altered in consistence ; —adhesion of cerebral substance to the knife; sense of resistance local or general, offered to the knife; its apparent cause (calcification of vessels, etc.) ; —specific gravity; color of cut surface, dead white, cream-colored, green, rose, orange;—fluids expressible.—Blood in vessels; number and size of red points; number and length of red lines (these facts to be noted in reference to the anterior and posterior lobes, and to corresponding parts of the two hemispheres.)— Corpus callosum (particulars as above). —Microscopical characters, of tissue, of minute vessels (especially of parts altered in color or consistence). 
542. Extravasation of blood: —its exact situation —if the layer of blood be thin, note whether it lies in the plane of the cerebral fibres, or across them (i. e., whether or not it has necessarily ruptured the cerebral fibres); —fluid blood, its amount, color, and consistence; —coagulated blood; —coagu- its measurements; color, at centre, at circumference, uniform or laminated? shade of red, shade of orange; degree of attachment to walls of cavity in which it lies; its mode of attachment, by vessels, by fibrin, etc. —Walls of cavity in which 


[§ II. K. 
PART II.] 
CEREBRUM. 
179 
blood lies (543). —Microscopical characters of coagulum, of tissue, of wall, of cavity. 
543. Cavities in cerebral substance: —their number; measurements; capacity; shape.—Contents; blood (542); —puTulent-looking fluid (602), its quantity, color (especially reddish, orange, yellow, or greenish) ; its consistence, at centre, at circumference ; —serosity (601); —fluid like milk of lime, its quantity, consistence; —microscopical characters —Bands crossing cavity; cellular, or consisting of vessels ? their consistence; —adhesions between opposite walls of cavity; readily separable or incapable of separation ? — Inner surface of cavity; consistence; —smooth; polished; lined or not by a serous membrane ? ragged; characters of flocculi, their color, consistence, structure (consisting of cerebral substance, of vessels); —color of inner surface, especially shades of yellow, green, orange, or red. —Condition of cerebral substance around cavity; consistence diminished, soft, pulpy, creamy, diffluent; consistence increased; —color, especially shades of yellow, green, orange, or red; —vascularity; —studded with points of extravasated blood; — puckering towards any part of cavity; —linear cicatrix extending from any part of cavity (544). 
Cavities— measurements, etc. contents. 
bands. 
adhesions. 
inner surface 
surrounding substance. 
544. Cicatrices in cerebral substance (630) :— radiated; linear; —their situation, size, color, transparency, consistence, etc.; —condition of cerebral substance around (541), consistence, puckering, etc. 
Cicatrices. 
545. Wounds of cerebral substance (626). 
Wounds. 
546. Adventitious products; calcareous masses, their size, consistence, microscopical characters, etc.; tumors (631 etseq.); tubercle (644); cancer 
Adventitious products. 


§ n. k.] 
[PART II. 
CEREBRUM. 
180 
(638 et seq.) — Condition of cerebral substance around each of the above (540, 541). 
Minute vessels. 
547. Minute vessels of brain: —coats thickened, calcareous, etc.; —their microscopical characters. — Note their condition, especially in and around softened and indurated parts, and around extravasation of blood. 
548. Lateral ventricles (noting any differences in the two ventricles): —contents ; fluid, its quantity, " odor," color, transparency, etc. (001) ; —solid ; lymph (603), coagulated blood (542), hydatids, etc. — Choroid plexus: pale, ©edematous; loaded with blood ; —cysts, their situation, size, structure, etc. (034 et seq.) ; —calcareous bodies, their situation, size, consistence, microscopical characters, etc. — Velum interpositum: its transparency, consistence ; vessels empty or filled with blood ?—-Foramen of Munro: degree of patency. — Lining membrane of ventricles; its integrity; dryness or moisture ? degree of polish ; — roughness, from minute pits over surface, from granulations, from vesicles ; —abnormally vascular; number, size, and situation of vessels : —consistence tough, offering resistance to knife ; thickness ; transparency ; — apertures visible leading to extravasations of blood (542), or collections of puriform matter (007); cicatrices (029), their situation, size, color, form, transparency, consistence, puckering of membrane around, etc. (Note exact situation of any morbid appearance, especially in gelation to corpora striata or thalami optici.) 
Lateral ventricles— contents. 
choroid plexus. 
velum interpositum. 
foramen of Munro. lining membrane. 
Septum lucidum. 
549. Septum lucidum: —present or not ?—apertures, their situation, size, form; state of lining membrane, at edge of aperture; —consistence; facility with which torn; —color; —oedema; —extra- 


PART II.] 
[§ n. K. 
PONS VAROLII. 
181 
Q 
vasation of blood into substance (542). —Condition of fifth ventricle ; size; contents; condition of its lining membrane. 
550. Fornix (distinguishing the condition of anterior and of posterior pillars, of intermediate portion, and of part included between posterior pillars): —consistence; color : oedema; —vascularity; extravasation of blood (542). 
551. Third ventricle: —contents; capacity; — extravasation of blood (542). — Commissures, their consistence, vascularity, etc.; soft commissure absent ? double ? — Lining Membrane, its integrity (especially to be noted where soft commissure appears absent); —consistence, etc., of surface of optic thalami in ventricle. 
552. Optic thalami and corpora striata: —size ; symmetry; condition of surface (as seen in ventricles, 548, 551). —Section (particulars as 541); if softened, extent of softened substance; extravasation of blood (542), etc. 
553. Condition of parts on upper surface of pons Varolii. — Pineal gland and its peduncles ; corpora quadrigemina; processus a cerebello ad testes; valves of Vieussens ; corpora geniculata;; noting in respect of each, external appearances, color, consistence, and characters of section; extravasations of blood, etc. 
b. Pons Varolii. 
554. External characters; — color of surface; consistence, etc.; —condition about superficial origin of nerves. 
555. Appearance on section, specifying exact situation of morbid changes (particulars as 541); —extravasation of blood (542), etc. 
fifth ventricle. 
Fornix. 
Third ventricle— contents, commissures. lining membrane. 
Optic thalami and corpora striata— section. 
Upper surface of pons Varolii— pineal gland, etc. 
b. Pons Varolii. 
External characters. 
Section. 


§ II. K.] 
[PART II. 
CEREBELLUM. 
182 
c. Medulla Oblongata. 
c. Medulla Oblongata. 
556. External characters: —size; shape; symmetry; color; —degree of adhesion of membranes; — consistence of surface (noting exact locality and extent of abnormal appearances).—Condition about superficial origin of nerves. 
External characters. 
Fourth ventricle. 
557. Fourth ventricle: —its contents; —extrava- of blood (542); —condition of floor of ventricle ; its color, vascularity, consistence, etc. 
558. Section of medulla oblongata (noting the several portions of it which are the seat of any morbid change, and its extent); color; vascularity; consistence; —extravasation of blood, etc. 
Section. 
d. Cerebellum. 
d. Cerebellum. 
559. External characters: —size; form; symmetry —general firmness or consistence; —adhesion of membranes; —consistence of surface; color of surface (noting exact locality of morbid change in this or any other respect);—local fulness; local depression. 
External characters. 
Section. 
560. Section of Cerebellum (noting the exact locality and extent of any morbid change);— color; vascularity; consistence; —extravasation of blood (542); cavities (543); cicatrices (544); wounds (626 et seq."); condition of minute vessels (547); tumors (631 et seq.); tubercle (644); cancer (638 et seq.), etc. 
561. Peduncles of Cerebellum: —their color, consistence, etc. 
Peduncles. 


PART II.] 
[§ II. L. 
SPINAL CORD. 
183 
L. —SPINAL CORD, ITS COVERINGS AND APPENDAGES. 
562. Integuments over spine (355 et seq.). — Tumors; their exact seat; form; size; shape; consistence —effect of pressure on them. 
563. Vertebras (to be examined both behind and anteriorly, in the neck, in the chest, and in the abdomen). —Condition of bodies, arches, spinous processes, etc. (370). —Angular projections or curvatures of spine; condition of vertebrae, etc., giving rise to them.—Fissures (spina bifida); their seat; extent; —size of prominence;—tissues forming the tumor observed externally;—quality of contained fluid. 
564. Intervertebral substance (372). 
565. Vertebral canal. —Peculiarities of form or size; proportional width to mass of cord; —fluid contained within it; its amount and characters; — fat contained in it; its amount, exact seat. — Spinal veins; their size, fulness, etc.(474 et seq.). 
566. Theca vertebralis: —filled out or not? bulged in any particular part? (other particulars as 529.) 
567. Spinal arachnoid membrane (particulars as 531). 
568. Cerebrospinal fluid: —amount; where accumulated ? movable or not along cord ? —color, etc. (601). 
509. Ligamentum denticulatum: —color, consistence, etc. 
570. Pia mater: —thickness; firmness; vascularity; attachment to cord (further particulars as 533). 
\ II. L. 
Integuments over spine— tumors. 
Vertebrie. 
Intervertebral substance. Vertebral canal— 
spinal veins. 
Theca vertebralis. 
Spinal arachnoid. 
Cerebrospinal fluid. 
Ligamentum denticulatum. 
Pia mater. 


[part n. 
§ n. m.] 
ORGANS OF THE SENSES. 
184 
Spinal Cord. 
Spinal Cord. 
571. External characters ;—weight; size, generally or locally (noting exact seat and extent of enlarged or diminished parts);—cervical and lumbar enlargements, obvious or not ? in what degree ?— its consistence generally; —fissures, anterior, posterior, and lateral; their condition ; color and consistence of surface about them, and of the several columns of the cord. 
External characters— weight, size. 
fissures, etc. 
Section. 
572. Section of Cord: —(distinguishing the exact seat and extent of any morbid changes, and whether involving the gra\ or white matter only, or both) —(particulars as 541). —Distinctness of gray substance; its tint, etc. 
Roots of nerves. 
573. Roots of nerves : —especially with regard to size of foramina, or pressure upon any of them. —(Other particulars as 585 et seq.) 
Cauda equina. 
574. Cauda equina. 
M.—ORGANS OP THE SENSES. 
§ II. M. • 
Organs of Touch. 
Organs of Touch. 
575. Integument: —its condition (355 etseq.). — Nerves; their condition (585 et seq.). 
Integument— nerves. 
Organs of Smell. 
Organs of Smell. 
Nares— 
576. Nares: —their condition (433 et seq.). — Olfactory nerves (537, 585 et seq.). 
nerves. 


[§ n. M. 
PART II.] 
HEARING. 
185 
577. Tongue and Fauces: —their condition (380, 384). — Nerves supplying tongue and fauces (glosso-pharyngeal, gustatory, and other branches of the fifth); their condition (585 et seq.). 
Organ of Vision and its Appendages. 
578. Eyelids: —"open or closed ? adherent?" oedema, etc. 
579. Eyeball: —prominent; depressed ; —eye dull; bright; glistening;—cornea full or flaccid ?— arcus senilis present or not? its width, microscopic characters, etc.; —lymph on iris (603); —size of pupil, medium contracted, dilated ; —" presence or absence of membrana pupillaris f" — Contents of eyeball; condition of several humors.—Retina; its condition.—Optic nerve; its size, consistence, etc. (537, 585). 
Organ of Hear ing and its Appendages. 
580. External ear : —its condition. 
581. External meatus : —its diameter; contents; —condition of lining membrane, polypi, etc.— Tympanic membrane : its thickness, color, form, opacity —perforation, its size, situation, etc. 
582. Internal ear (distinguishing the several parts which are the seat of morbid alteration) :— mucous membrane of tympanum and mastoid cells (594 et seq.); contents of tympanum and mastoid cells; —condition of Eustachian tube; its permeability ; condition of mucous membrane (594 et seq.). 
Organs of Taste. 
Tongue and fauces— nerves. 
Organ of Vision and its Appendages. 
Eyelids. 
Eyeball. 
Organ of Hearing and its Appendages. 
External ear. 
External meatus, tympanic membrane. 
Internal ear. 
Organs of Taste. 


§ n. n.] 
[part II. 
NERVES. 
186 
583. Osseous structures (370). —Connection of morbid alterations with disease of brain or its membranes (K. p. 110). 
Osseous structures. 
Auditory nerve. 
584. Auditory nerve : —its condition (537, 585). 
\ II. N. 
N.—NERVES. 
(Cerebrospinal and Sympathetic—noting the nerve and its branch or the ganglion which is the seat of abnormal appearances.) 
Nerve. 
Nerve. 
External cha racters. 
585. External characters: —size, actually and comparatively with that of opposite side of body; form ; flattening; color; consistence; tumors upon it (631 et seq.); —condition of tissue around altered part of nerve; tumors in the neighborhood of and pressing upon nerve, alterations in course of nerve from this or other causes.—Wounds (626): apparent union after wound; appearance of united part; —character of ends of divided nerve, noting size, etc. of each portion. 
Neurilemma. 
586. Neurilemma: —color; vascularity; thickness ; consistence; opacity; fluids infiltrating ; — condition of funicular sheaths. 
587. Nerve tissue; —color; consistence; fluids expressible;—tumors (631 et seq); their connection with nerve-fibres. — Anatomical characters and arrangement of nerve-fibres and neurilemma at extremities of divided nerve, or at point of union of a previously divided nerve. —Microscopical characters of nerve-substance and neurilemma of any abnormal portion. 
Nerve tissue. 


PART II.] 
[§ ii. o. 
VASCULAR GLANDS. 
187 
Ganglion. 
Ganglion. 
588. External characters: —size; general consistence ; color; condition of tissues about it. 
External characters. 
589. Sheath of ganglion: —color; vascularity; opacity; thickness; consistence; fluids infiltrating it. 
Sheath. 
590. Section of ganglion: —color; vascularity; consistence; dryness or moisture; fluids expressible. —Microscopical characters; —condition of nerve tubes passing through ganglion. 
Section. 
0.—VASCULAR GLANDS. 
I II. 0. 
591. Thymus gland: —present or absent?—its position; height to which it extends; relation to surrounding parts;—size; weight; form; color externally : general consistence ; — condition of tissues about it.—Cellular investment; its color; vascularity; thickness; consistence, etc. —Section of gland; color of cut surface; its general aspect; vascularity; consistence; fluids exuding or expressible; suppuration; microscopical characters. 
Thymus gland— presence, size, etc. 
cellular sheath, section. 
592. Thyroid gland: —size; if enlarged, special seat of enlargement, direction in which it has extended —form; weight; color externally; general consistence; —condition of surrounding parts, displacement, etc. —Cellular investment; its color, vascularity, thickness, consistence, etc. —Section of gland; color of cut surface; vascularity; matter exuding on pressure;—extravasation of blood, surrounded or not by a cyst; condition of blood; —cysts, their size, number, contents (fluid, solid, or gelatinous matters, blood, etc.); microscopical 
Thyroid gland —size, etc. 
cellular sheath, section. 


§ ii. o.] 
[PART II. 
VASCULAR GLANDS. 
188 
Suprarenal capsules— size, etc. cellular sheath. section. 
characters, of any of the above; —other abnormal growths or deposits, fibrous, calcareous, etc. 
593. Suprarenal capsules: —their size; weight; position; form; color externally.—Cellular investment; its color, vascularity, thickness, consistence, etc. — Section of body; condition of cortical substance, its diameter, color, vascularity, consistence; fluids exuding or expressible;—central substance, its size, color, consistence, etc.; —extravasation of blood; suppuration; abnormal growths and deposits, cancer, tubercle, etc. 


189 
APPENDIX. 
Mucous Membrane. 
594. Secretions and exudations on surface. — Mucus: quantity generally or at particular spots; color; consistence; degree of adhesion to membrane; "foreign matters mixed with it, their characters."—Lymph (603). — Blood: fluid or coagulated? quantity; distribution; color; odor; mixed or not with secretions? etc. —its source of blood discoverable (lens used or not) ? 
595. Condition of membrane. — Color; noting whether color observed is general, partial, or in patches or streaks; defined or gradually shading off? mottled; —white, pallid, livid, red (600), yellow, green, gray, black, slate-colored; —uniform sooty discoloration, its situation —black, charred aspect;—staining, uniformly or dotted with yellow spots; — dyeing, from what apparent cause ?— Transparency: — Hemorrhagic spots; their situation; color; definition; depth to which they extend; effect of a stream of water upon them.— Surface: dry or moist (noting length of time exposed to air) ?—smooth ; glistening ; dull; rough ; mammilla ted, situation and degree of mammillation; puckered, situation, size, shape, and color of puckered spots;—condition of papillae; condition of follicles; —eruption; vesicles; pustular eleva- 
Mucous Membrane. 
Secretions, etc., on sur face— mucus. 
lymph, blood. 
Condition of membrane, color. 
transparency, hemorrhagic spots. 
surface. 


APPENDIX.] 
SEROUS MEMBRANE. 
[appendix 
190 
epithelium. 
consistence. 
thickness. 
ulcers, sloughs, etc. 
diverticula. 
* 
Submucous tissue— color. e chymosis. thickness, consistence, infiltration, etc. tumors, etc. 
Serous Membrane. Contents— gas. 
tions, their contents and characters.— Epithelium: detached, entirely or partially ? no trace of it remaining.—Consistence : length of strips obtainable from different parts (regulated by consistence of membrane or degree of adhesion between mucous and submucous coats?); seat of altered consistence (the most dependent part, etc.); membrane removable by washing, by a stream of water, etc.; —color, thickness, transparency, and appearance of the vessels at any softened part;—are edges of softened portion well defined ? — Thickness: at different parts; relative thickness of normal, softened, and indurated parts.— Ulcers (624). — Sloughs (618 etseq.); situation; extent; color; depth; consistence, etc.; —color, etc., of surrounding tissue.— Perforations (625); fistulas (613 et seq.) —Wounds (626 etseq.) — Cicatrices (629). — Tumors; polypi, formed of local hypertrophy of mucous membrane, of fatty growth, of fibrous tissue, of vascular tissue, etc. (631 etseq.) — Diverticula: number; situation; size; shape;—condition of mucous membrane forming them ; —their contents. 
596. Submucous tissue: —color; —ecchymosis; its situation and extent; color of blood; elevation or not of mucous membrane over its seat ?—thickness ; consistence; —degree of laxity or firmness; infiltration with serum, pus, etc.; emphysema.— Tumors beneath mucous membrane; tubercularlooking matter (644); cancerous-looking matter (638 et seq.), etc. 
Serous Membrane. 
597. Contents. — Gas: quantity (how estimated ?) ; position, occupying cavity generally or 


[appendix 
APPENDIX.] 
SEROUS MEMBRANE. 
191 
limited to a particular locality ?—apparent source; odor; chemical characters; —color of surrounding textures. — Liquid matters : quantity; apparent source; —position, occupying cavity generally, or limited to a particular part ? how circumscribed ? —odor; color; transparent or opake? consistence, thick, gelatinous, thin, etc.; serous (601) ; purulent-looking (602); —special characters; mixed with bile, fecal matter, etc. —coagulable or not, on removal from body?—containing solid particles; amount and character of deposit after standing; — microscopical characters.— Solid matters: characters; their apparent source; — cysts (634); — foreign bodies, loose or circumscribed; —gall-stones; phleboliths; worms, etc. — Blood: amount; position ; color mixed or not with other matters ? coagulated or not?—apparent source. 
598. Condition of membrane — Adhesions (605): general or partial ? parts between which adhesion is observed. — False membranes: lymph or other exudations (603.) — Color: ash, gray, red (600), edges of redness denned, or shading off into color of surrounding part, etc.; —vascularity ; —size of vessels.—Ecchymoses.—Surface: moist; sticky; dry; —smooth ; rough, physical characters of inequalities producing roughness; —polished or not ? glistening, bright, pearly ; dull; —puckered; situation and extent of puckering; condition of subjacent tissue. — Substance: — transparent or opake ?— thickness; if increased, extent of thickening; appearance of thickened part on section;—consistence —opake white patches; their size and shape; are there corresponding patches on opposed serous surface ?—semi-cartilaginous patches;—ossific deposit; its thickness; size; consistence; friability; 
liquid matters 
solid matters 
blood. 
Condition of membrane: adhesions. false membranes, etc. color. 
ecchymoses. surface. 
substance. 


[APPENDIX. 
APPENDIX.] 
REDNESS. 
192 
ulcers, sloughs, etc, 
malformations. 
Subserous tissue— color. consistence, thickness, infiltration, etc. tumors, etc. 
Redness. 
Situation— extent. 
hue. 
form. 
fulness of veins. effect of gravitation. 
denuded of serous membrane at any part, or covered by it at all parts ?—tubercles or tuberculous-looking matter (644); — cancerous-looking matter (638 et seq.)— Ulcers (624); sloughs (618 et seq.); ruptures, situation, extent; perforations (625); fistulas (613 et seq.); wounds (626); cysts (634) ; cicatrices (629). — Malformations; their character; —absence of membrane; over what extent ? apparent cause of absence; condition of edges of membrane where absence commences. 
599. Subserous tissue: —color; consistence, degree of laxity or firmness; —thickness; —infiltra- with serum, pus, etc.; —containing blood, extent, character, color, etc. of effusion ; apparent source of blood ; extent to which it elevates membrane ; — emphysema. — Tumors beneath serous membrane (631 et seq.); —tubercular-looking matter (644) ; cancerous-looking matter (638 et seq.); cysts (634 et seq.), ossific matter, etc. 
Redness. 
600. Situation of redness, especially with reference to the position of the subject.— Extent of redness ; edge defined, or gradually shading off into color of surrounding parts ?— Hue: bright red, scarlet, dusky red, violet, brownish red, verging to gray; —if there be two tints, note their relative situation and amount. — Form: uniform, from staining, from juxtaposition of capillaries ; punctiform, punctae formed by minute extravasations of blood, by peculiar arrangement of injected vessels; capillary ; ramiform (large or small ?) —Degree of fulness of veins leading from the red part to be traced back towards the heart. —Effect of gravitation on 


[appendix. 
APPENDIX.] LYMPH AND OTHER EXUDATIONS. 
r 
193 
the redness; effect of washing. —Note condition of blood generally as to fluidity. 
Serosity. 
601. Amount; odor; color; transparency; specific gravity; —chemical characters, reaction, presence and quantity of albumen, presence of urea, etc.; its microscopical characters (645 et seq.). 
Purulent-looking Flu id. 
602. Quantity; odor; color; consistence; effects of liquor potassse on its consistence; specific gravity; reaction. —Presence of curdy or flakylooking matter; of clots of blood; of sloughy-looking particles. —After standing, deposition of a sediment; amount of sediment; its color, consistence; —supernatant fluid; its color, transparency, reaction —Microscopical characters (645 et seq.). 
Lymph and other Exudations. 
603. Amount and thickness ; — color generally ; color of free surface, of attached surface.— Form : an even layer; villous-looking, length of villi; granular, size of granules. — Distribution: uniformly over the surface ; limited to particular spots (e. g., on the peritoneum, to the angles formed by adjacent convolutions of intestines); in patches. — Adhesion to membrane on which it is seated; firmness of adhesion; —condition of membrane after removal of lymph ; its color, polish, consistence, etc. 
604. Substance of lymph or exudation: —its condition; elasticity;—amount of serosity expressi- 
effect of washing. 
Serosity. 
color, etc. chemical characters. 
microscopical characters. 
Purulentlooking Fluid. color, etc. 
deposit. 
microscopical characters. 
Lymph and other Exudations. color. 
form. 
distribution 
adhesion, membrane beneath. 
substance. 


APPENDIX.] 
[appendix. 
ABSCESS. 
194 
ble from it; alterations in physical characters, produced by expression of the serosity.—Microscopical characters (645 et seq.). 
microscopical characters. 
Adhesions. 
Adhesions. 
605. Parts between which they are observed.— Number; situation; form; extent; length; breadth; thickness; color; transparency; consistence; elasticity ; vascularity; arrangement of the vessels; — infiltration with serum. —New products in their substance, tubercle, cretaceous matter, etc. —Cor- of adhesions with morbid changes in adherent parts or organs. 
situation, etc. color, etc. 
new products in adhesion. 
Abscess. 
Abscess. 
Diffused. 
600. Diffused:* —the exact parts and extent occupied by it; the condition of the parts in contact with the pus, as to color, consistence, etc.; characters of pus (602). 
607. Circumscribed:* —by cyst, condensed cellular tissue, integuments, fascia, etc.; —form, ovoid, pyramidal, flat, &c.; —prominence, its degree;— color of surface; red (bright, or dull), bluish, purple; uniform or more intense at certain points? circumscribed or diffused?—if under integuments, shining appearance of surface, cracking or separation of cuticle; —any appearance of pus being seen through the thinned walls ?—Palpation; sensation conveyed to fingers; —soft, semi-elastic, boggy, elastic, tense; —fluctuation, its degree and extent; 
Circumscribed— form. 
surface. 
palpation. 
1 In living subject, note also heat of surface, pain, tenderness, etc. 


[appendix 
APPENDIX.] 
FISTUIJE. 
195 
—do parietes feel thin or the reverse? do they feel thinner at one part than another? 
608. Opening: —natural or artificial; exact position and direction, with regard to abscess itself (at upper part, centre, most depending part, etc.) and to the surrounding parts; —length; breadth; 
Opening— 
—valvular or not ?— Edges of opening: smooth; uneven; inverted; overhanging the cavity; fixed and adherent or loose ? indwated or the reverse ?— thickness; color. 
edges. 
609. Walls: —thickness; consistence; of what tissues composed?—internal appearance of walls; their color; —smooth; irregular; flocculent; granular — granulations: size, prominence; firm or flabby? color; vascularity; covered with pellicle of lymph, pus, etc. 
Walls. 
granulations 
610. Contents:— (602.) 
Contents. Cicatrix. 
611. Cicatrix: —partially or entirely formed? (629 et seq.) 
612. Condition of parts surrounding the abscess: color; consistence; swelling; puckering, etc. 
Surrounding parts. 
Fistulas. 
Fiilulce. 
613. Orifices (on surface of skin, etc.): —one or more?—size; shape;—condition of edges as regards smoothness, hardness, color, etc.; —whether raised into a papilla or depressed ? 
Orifices. 
614. Fistulous passage or canal: — direction, straight, tortuous, oblique, etc. (ascertained by probe or dissection? if by a probe, its size, etc.); —exact relation to surrounding parts;—length; diameter at different parts of its course; —sinuses in its walls.— Termination: in cul-de-sac; in a cavity; an abscess; opening into some other part 
Fistulous passage— direction. 
length, etc. 
termination. 


APPENDIX.] 
[APPENDIX. 
MORTIFICATION, ETC. 
196 
internal orifices. 
Lining membrane. 
Discharge. 
Surrounding tissues. 
Mortification, etc. 
External characters— color. 
swelling, etc. dryness or moisture. 
state of cuticle, fluid under cuticle. 
or viscus.— Internal orifices: one or more ?—their character, size (613); —if in rectum, the distance of orifice of fistula from anus; precise position of opening (determined by finger introduced into rectum or by dissection ?) 
615. Lining membrane: —its character; color; vascularity, smoothness, hardness, etc. 
616. Discharge: —color, consistence, odor; puriform (602); aqueous (601), etc.; —mixed or not with other substances, as feces, bile, blood, etc.? —occurring spontaneously or only on pressure? does pressure cause discharge when applied to any neighboring part ? 
617. Surrounding tissues: —color, swelling; firmness; — infiltration with pus, serum, urine, etc.; —abscess, slough, or gangrene.—If fistula opens on surface of body, is skin near the orifice firmly adherent to subjacent tissue or partially separated from it? 
Mortification — Gangrene — Sphactf us. 
618. External characters: —color of the part affected; yellowish, ash-colored, livid, purple, greenish, brown, or black; intensity of color; mottled or uniform; —extent of surface, etc., affected; —color well defined, diffused, shading off into natural color of surrounding textures.—Tumefied or not? flaccid, soft, or hard? shrunk or not?— Hygrometric condition; moister or drier than natural? feeling greasy. — Skin tense or loose? —Cuticle detached or not? shrivelled or not?— Fluid effused under cuticle (601); generally, or in bullae? bullae numerous or solitary? their size and prominence;—fluid movable or not, by pressure, 


APPENDIX.] 
[appendix 
ULCERS. 
197 
R* 
from one part of the gangrenous surface to another ? —Crepitation on pressure.—Odor, faint, foetid, garlic-like. — Temperature.*—Pulsation of arteries in part affected.* 
619. Line of demarcation from healthy texture; breadth of line; color, intensity of redness; small vesicles or not on line of demarcation ? width and depth of fissure or chink, if any; etc. 
620. Dissection: —depth to which discoloration, etc., extend; affecting skin, cellular tissues, muscles, tendons, bone; —in viscera, is the morbid state limited to surface, single lobules, lobes, etc., or diffused ? 
621. Motility and sensibility: 1 — Power of moving the part retained by patient. —Pain, tenderness, numbness, pricking or stinging sensation; sensation of heat or cold. 
622. Marks of injury or of prior applications to the part; redness from pressure;—other sores present or not?—infiltration of parts with urine, etc. 
623. Surrounding parts; —oedema, etc.; condition of arteries (468 et seq.) and veins (474 et seq.) leading to and from the part. 
Ulcers. 
624. Number; situation; form; superficial extent; depth.— Edges: level with surrounding tissue, bevelled, raised, everted, inverted, ragged; smooth; —their thickness; —their consistence; —color, red, slate-colored, etc. — Floor, its color; vascularity;— consistence; —covered with a scab; characters of the scab, its degree of adhesion to floor and to edges of ulcer, its consistence, thickness, color, and micro- 
1 To be noted in Hying subject. 
crepitation, odor. temperature, arterial pulsation. 
Line of demarcation. 
Dissection. 
Motility and sensibility. 
Marks of injury. 
Surrounding parts. 
Ulcers. 
form, etc. edges. 
floor. 


[appendix. 
APPENDIX.] 
PERFORATIONS —WOUNDS. 
198 
scopical-characters; —covered by fluid; degree of adhesion of fluid, its color, tenacity, and microscopical elements; —tissue constituting floor of ulcer; —floor smooth, polished, ragged; —covered with granulations, their size, color, consistence, bleeding or not on manipulation?—open mouths of vessels apparent on floor, artery or vein. 
granulations. 
Perforations. 
Perforations. 
situation, form, etc. 
625. Number; —situation, anteriorly, posteriorly or at most dependent part of organ ?—shape, circular, oval, slitlikc; effect of moderate stretching on shape; —size (in situ and when moderately stretched); —closed or not by contact with adjoining structures, partially or entirely ?—edges smooth, ragged, irregular, flocculent; perpendicular, as if punched out, bevelled; consistence, hard, soft, I pulpy; color, pale, grayish, red, etc.; dotted or streaked with sooty points or lines; —mucous coat or subjacent tissues (e. g. peritoneum) most extensively destroyed ? —direction taken by perforation, direct, oblique, etc.; —alterations (softening, etc.) in parts adjacent or subjacent to perforation, their extent; —apparent cause of openings on membrane; j their connection with abscesses, aneurism, softened cancerous matter, etc. 
edges. 
direction. 
adjacent parts. 
cause. 
Wounds. 
Wounds 
Before dissec- 
620. "Facts ascertainable before dissection;' 1 — Number; —seat (noting not only the tissue or or- 
1 These are points which, in medico-legal inquiries, are to be noted during life, as well as in the examination of a dead body, 


APPENDIX.] 
[appendix 
WOUNDS. 
190 
gan, but also the particular part of the structure injured); —extent; length; breadth; —shape, e. g. irregular, triangular, rounded, oval, valvular (in which direction?); —measurements before manipulation; depth as estimated by the eye; —direction with reference to the structure or organ in which it is seated, transverse, longitudinal oblique.— Edges of wound ; foreign matters; adhering to them; hair, weeds, iron rust, blood, scabs; —blackened by powder;—position of edges, in apposition, gaping; —tissue constituting them (if apparent);—form; cleanly cut, lacerated, jagged; contused; swollen; everted; inverted; moist or dry? gangrenous;— color; pallid, vivid red, purple, black. —Examine angles of wound, to determine direction in which a wound was made, from right to left, from above downwards, or from below upwards.— Contents of wound: foreign matters derived from without, e. g., bullets, portions of clothing, earthy particles, etc.; —blood; its consistence, degree of adhesion ; purulent-looking fluid, etc. — Condition of parts adjacent to wound; their form, swollen, puckered; —consist- boggy, indurated; —color, mottled, purple, yellow, green, etc." 
627. " Facts ascertainable by dissection. —Depth of the wound; are skin or deep parts most injured? which extremity of wound (if incised) is the deeper? —its direction below surface of wound. — Parts divided: relation to each other of the various structures divided, e. g., muscles, cellular tissue, fasciae, etc. —Relative position of the divided parts of structures, e. g., divided extremities of muscles and vessels more widely separated than the cut surfaces of other structures. — Adhesions, e. g., divided parts united so firmly as to be indistinguish- 
form. 
measurements, direction. 
edges. 
angles. 
contents. 
parts adjacent. 
On dissection: depth, etc. 
parts divided 
adhesions. 


APPENDIX.] 
[APPENDIX. 
CICATRICES. 
200 
foreign matters. 
tissues adjacent. 
Examination of weapon. 
Cicatrices. 
On surface of structures— form, etc. 
color, etc. 
able or- inseparable the one from the other; —other degrees of adhesion. — Foreign matters, e. g., purulent fluid or blood between the various structures ; their amount and extent.— Tissues adjacent to wound; their color, consistence, etc. —containing serosity, lymph, puriform matter. —Extravasation of blood; its extent; —consistence of the blood; — blood collected in a mass; infiltrated into tissues ; particular tissues into which it is infiltrated, and their consistence." 
628. "If a weapon be discovered, compare it with wound, its sharpness with character of edges of wound (626) ; —were all wounds found on body apparently inflicted with the same instrument ?— Foreign bodies found adhering to weapons; blood (determined chemically and microscopically); hair, does it agree in character with hair in neighborhood of wound, or with hair of wounded person ?— Weapon found in hand of individual; in which ? how held, and with what firmness ?—is any blood on hand grasping it or not ?—found at a distance, how far and on which side of body ?—is weapon injured (examine its edge) ?—Mode in which blood is diffused over a weapon (in a thin layer generally on edge only, in drops); are blood-stains nearest to point or handle ?" 
Cicatrices. 
620. On the surface of structures: —their number ; —form, linear, oval, irregular, radiated; — definition ;— measurements; —depressed, depth of depression; smooth ; puckered; —movable or not over subjacent tissue; —color, compared with adjacent tissue ; vascularity; —epithelium present or 


[APPENDIX. 
APPENDIX.] 
TUMORS. 
201 
not ? —is any hair growing upon it ?— Surrounding tissue: smooth; of glistening appearance; puckered; —its consistence, color, vascularity, etc. 
630. In the substance of organs: —their number; —definition; —measurements; —continuous or not with the surface of the organ ?—color, vascularity. —Parenchyma, between the cicatrix and surface, and around the cicatrix ; its condition.—Depression on the surface corresponding to cicatrix; its characters —Cavities in its substance, their size, walls, contents ; —cretaceous matter imbedded in cicatrix, its abundance, situation, consistence, adhesion.— Relations of cicatrix to the trunks of tubes and vessels permeating the organ. 
Tumors. 
631. Number; size; position;—relation to surrounding organs; connection with surrounding organs, sessile, pedunculated, adherent (605). — Weight. 
632. Superficial characters: —surface uniform; polished; rough, physical cause of roughness; granulated, size of granules; nodulated, size of nodules; furrowed, extent and depth of furrows; —color generally; color of particular parts, e. g., of furrows, nodules, etc.; transparency; —bloodvessels on surface, their size and fulness.—Elasticity, flaccidity, fragility. —Apertures leading to the interior ; their size, number, situation; condition of their edges ; substances expressible from them. 
633. Characters on section or fracture : —odor ; —consistence; flaccidity, fragility, elasticity;— specific gravity of portions of tumor. — Fractured surface; smooth; granular; fibrous.— Cut surface; 
surrounding tissue. 
In substance of organs— definition, etc. color. parenchyma about it. surface corresponding. 
cavities, etc. 
relations to vessels, etc. 
Tumors. 
Number, size, etc. 
Superficial characters: smoothness, etc. granulation, etc. color. 
elasticity, etc. apertures. 
Characters on section— consistence, fractured surface, cut surface. 


APPENDIX.] 
[APPENDIX. 
CYSTS. 
202 
substances expressible, color. 
vessels. 
microscopical characters. 
Cysts. 
Number, size, etc. 
Walls 
Contents— 
hair. 
teeth. 
smooth; granular; fibrous, arrangement of fibres; loculated, number, size, situation, and contents of loculi.—Substances expressible; substances removable by scraping;—their consistence, color, transparency, and microscopical character. —Color of section; transparency. —Bloodvessels; their size; arrangement; relative proportion of arteries, veins, and capillaries; their origin; mode of termination. —Microscopical characters.—(If different parts of a tumor vary in consistence, color, or transparency, the above facts should be noted with reference to each part of the mass.) 
634. Number; situation; size; form; —relative position in regard of each other; connection with each other and with adjacent parts;—relation of cysts to the bloodvessels and ducts of the organ in which they are seated. 
635. Walls of cyst: —their thickness; consistence; transparency; color; vascularity;—epithelium apparent or not on inner surface ?—microscopical characters. 
636. Contents of cyst: —fluid, its quality; —solid matter, its size ; — odor; consistence; transparency; color; vascularity; fracture; mode of attachment to the walls; —proportion soluble in ether; —microscopical characters; chemical characters.—Hair in cyst: its quantity; length; consistence; color; —free; aggregated in masses, their number, size form, cut surface; —attached to wall of cyst; part to which hair is attached; its mode of attachment; character of the wall at the point of attachment.— Teeth in cyst: their number; 
Cysts. 


[appendix. 
APPENDIX.] 
CANCER. 
203 
characters; —free; —attached to walls of cyst, mode of attachment; —attached to bone, mode of attachment, characters of the bone. — Bones in cyst: their number; size; form ; — mode of attachment to cyst, to each other; —microscopical characters. 
bones. 
637. Secondary cysts: — their number; size; form; —connection to containing cyst; relation of contained cysts to each other; —walls and contents (particulars as above). 
Secondary cysts. 
Cancer or cancerous-loohing Hatter. 
Cancer, etc. 
638. External characters: —size; shape; form; —precise situation in relation to affected tissues; —mode of connection with tissues; infiltration at edges of tumor with cancer or ordinary exudation matter (determined by microscope, 645 et seq.) ; — capable of being enucleated; —surrounded by a cyst (true or pseudo-cyst ?); does it send processes inwards into cancerous mass? — Surface; even, knotty, tuberous, granulated, etc.; —color; odor; — consistence, resembling that of any tissue or known object ? elasticity:—are consistence and elasticity equal in all parts ? 
External characters— shape, connection with tissues. 
cyst. 
surface. 
consistence, color, etc. 
Characters on section— 
639. Characters on section: — General resemblance to any known object;—color; consistence; —color and consistence uniform or not ?—lobulated aspect of masses or not ?—Arrangement, locular or not ? characters of loculi, their size, shape, general uniformity (or the contrary), degree of distinctness; —general comparison of locular and intralocular substances; —fineness or coarseness of locular texture —intralocular separable or not from locular substance ? with what ease ?—Vascularity; its de- 
loculi. 
vascularity. 


APPENDIX.] 
[appendix. 
TUBERCLE. 
204 
other matters. 
Characters on fracture. 
Effects of pressure. 
Chemical characters. Microscopical characters. 
Tubercles, etc. 
Situation, size, etc. color. 
consistence, etc. 
vascularity. 
microscopical characters, surrounding tissues. 
capability of removal. 
gree, color, closeness, uniformity; —connection with surrounding vessels apparent or not?—results of injection; veins, arteries. —Matters observed on section different from cancer; melanic matter, pus, tubercle, fat, pseudo-tissues, etc. 
640. Characters on fracture: —is fracture permitted ? its degree of sharpness. 
641. Effects of pressure: —on form and consistence of matter; —fluids expressible; by what degree of force ? quantity; characters to naked eye, to microscope (645 et seq.). 
642. Chemical characters: —Effects of boiling. 
643. Microscopical characters (6 15 et seq.) : — nuclei; proportion to perfect cells, their form; proportion of size of nucleus to cell (estimated by the eye or by the micrometer) ; —evidence of changes in cells, diffluence, fatty change, thickening, desiccation. 
Tubercle, or tubercular-like Bodies. 
,644. Situation; number; relative position;— size; form, spherical, pyriform —color, yellow, gray, white (if of more than one color, note relative position of the two); transparency or opacity. —Consist- ; generally, of centre, of circumference; presenting cavity in centre? fluids expressible;—character of cut surface. —Vascularity; relation of vessels to the tubercular-like matter, to adjacent tissues. — Microscopical characters (645 et seq.). —Condition of tissue surrounding tubercle as to color, thickness, consistence, etc. —Situated on a membrane ; it capable of removal without injury to membrane ? appearance of surface after its removal; —insepar- united with membrane. 


[APPENDIX 
APPENDIX.] 
MICROSCOPICAL CHARACTERS. 
205 
s 
Microscopical Characters. 
645. Granules: —number; size; color; —aggre- size and other characters of aggregation. — Effect of reagents, water, acetic acid, hydrochloric acid, ether, and liquor potassae;—granules unaffected by them; dissolved without effervescence; dissolved with escape of gas; rendered more distinct ; rendered indistinct. 
646. Fibres: —their definition; size; arrangement, parallel or interlacing 1 form, straight, wavy, curled; color; —presence of nuclei; their number, size, form, definition.— Effect of reagents, water, acetic acid, hydrochloric acid, ether; —fibres unaffected; dissolved; rendered more distinct; rendered indistinct; caused to swell up;—effect of the same reagents on the nuclei; nuclei unaffected; rendered more distinct; rendered less distinct; nuclei not previously seen brought into view. 
647. Cells: —their definition; size; form; elasticity; consistence; color.— Cell wall; transparent; granular; hyaline; plicated.— Contents of cell; granules, their number, size, color, and molecular movement. — Nucleus: number of nuclei; shape; size; definition; —if several, their situation with reference to each other and to the cell-wall.—Nucleolus; number of nucleoli; size; form; character of outline; color.— Effect of reagents, water, acetic acid, ether, liquid potassae, solution of iodine, on cell-wall, granular contents and nucleus separately; unaffected; enlarged; contracted; rendered more transparent; rendered less transparent; dissolved; rendered more distinct; rendered less distinct. 
Microscopical Characters. 
Granules— number, size, etc. effect of reagents. 
Fibres— definition, size, etc. nuclei. 
effect of reagents. 
Cellsdefinition, size, etc. consistence, cell-wall, contents, nucleus. 
nucleolus. 
effect of reagents. 


APPENDIX. 
Crystalline or salinebodies 
206 
648." Crystalline or amorphous saline bodies: — e "' P rcc^se characters; effects of reagents upon them. 
THE END. 
APPENDIX. 
MICROSCOPICAL CHARACTERS. [APPENDIX. 


THE LONDON MEDICAL SOCIETY OF OBSERVATION. 
MEMBERS. 
$mtfrent. 
Date of AT)MI3SI<JV. 
W. H. Walshe, M. D., Professor of the Principles and Practice of Medicine in University College . . . 1850 
Stctetarg. 
T. Snow Beck, M. D., F. R. S., Physician to the Farringdon General Dispensary 1850 
©ritrinars SSLtmhixs. 
W. Jenner, M. D., Professor of Pathological Anatomy in University College 1850 
E. A. Parkes, M. D., Professor of Clinical Medicine in University College 1850 
C. J. Hare, M. D., Assistant Physician to University College Hospital 1850 
E. H. Sieveking, M. D., Assistant Physician to St. Mary's Hospital 1850 
S. W. J. Merriman, M. D., Physician to the Royal Infirmary for Children 1850 
R. H. Semple, M. D., Physician to the Islington Parochial Infirmary 1850 
A. P. Stewart, M. D., Assistant Physician to Middlesex Hospital 1850 


LONDON MEDICAL SOCIETY OP OBSERVATION. 
Date of Admission. 
F. Sibson, M. D., F.R.S., Physician to St. Mary's Hospital 1850 
A. B. Garrod, M. E., Professor of Materia Medica in University College 1850 
W. H. 0. Sankey, M. D., Resident Medical Officer to the London Fever Hospital 1851 
E. Ballard, M. D., Physician to the Farringdon General Dispensary 1851 
S. Morris, Esq., Clinical Assistant at the Consumption Hospital 1851 
H. Weber, M. D., Resident Physician to the German Hospital 1851 
Handpield Jones, M. D., F. R. S., Assistant Physician to St. Mary's Hospital 1852 
G. Johnson, M. D., Assistant Physician to King's College Hospital 1852 
Lionel Beale, M. B 1852 
H. Briggs, Esq., Demonstrator of Anatomy in University College 1852 
Corttjspott&mjj JHimfurs. 
W. Beneke, M. D., late Resident Physician to the German Hospital 1850 
W. T. Gairdner, M. D., Pathologist to the Royal Infirmary, Edinburgh 1850 
R. Neale, M. B., Fazeley 1850 
T. E. Leudet, M. D., late Vice-President of the Medical Society of Observation, Paris 1851 
J. Russell Reynolds, M. B., Leeds 1851 


LONDON MEDICAL SOCIETY OP OBSERVATION. 
LAWS. 
i. 
The objects of the Society are to promote the advancement of accurate Pathology and Therapeutics, by clinical and allied investigations, the value of which shall be estimated by the numerical method; and to exhibit the special advantages which may accrue to the science of medicine, by the co-operation of several persons working on a uniform plan towards the elucidation of given medical questions. 
Objects. 
ii. 
The Society shall consist of a president, secretary, ordinary and corresponding members. 
Constitution, 
The number of ordinary members shall be limited to twenty-five. 
Candidates for admission into the Society shall be proposed by two members, and balloted for at the first subsequent meeting. One black ball in five to exclude the candidate. 
ill. 
The Society shall pursue its objects by the fol lowing means :— 
Means. 
(1.) By the collection of records of cases observed by the members, the particulars in every instance (whether observed at the bedside or after death), to be noted in writing at the moment of 


LONDON MEDICAL SOCIETY OP OBSERVATION. 
observation—fulness of detail to be constantly held in view as deeply important, but accuracy alone to be considered absolutely necessary. 
(2.) By the' accumulation of observations of special phenomena of disease, and the relations subsisting between them, with the view of ascertaining their regulating laws—it being understood that the subject and the plan of observation shall, in each instance, be sanctioned by the Society. 
It shall be competent for the Society to request the particular attention of members to certain special classes of disease. 
Any member proposing a subject for investigation, shall submit it, and the plan of observation, to the Society; and should they be adopted, the proposer shall furnish each member with a copy of the plan drawn out in a tabular form. 
In order to facilitate their arrangement and analysis, the Society can accept from its members the records of such cases only, as shall have been legibly written out on the right-hand side of Bath post paper, and the particulars of which have been arranged in the order, or according to the form, adopted by the Society. 
Each ordinary member shall be expected to read the records of two cases, and to give ten answers to questions for the special phenomena of disease during the period of each year; and in the event of any member failing to read one case, and to give five answers to questions, he shall cease to be a member of the Society—unless some satisfactory reason for his failure be assigned. 
The records of cases, etc., shall be kept in the custody of the Secretary, to be put to any use the Society may determine. 


LONDON MEDICAL SOCIETY OP OBSERVATION. 
IV. 
The Society shall, as often as may be deemed fit, publish the results of its labors, under the title of " Transactions of the London Medical Society of Observation." 
Rules of publication. 
The Transactions to consist of: — 
(1.) Analyses of the records of cases (and, when deemed desirable, the cases themselves), from the collection in the possession of the Society. 
(2.) Analyses of the observations of special phenomena of disease. 
(3.) Analytical papers by ordinary or corresponding members, founded on observations and inquiries, conducted in accordance with the principles recognized by the Society. 
The Society shall be responsible for the analyses, the individual observers for the accuracy of the facts. The analyses of the collections of records of cases, and of special observations, shall be made by one or more members, to be appointed for that purpose by the Society. 
The names of the contributors of the records of cases, etc., and of their analyzers, shall be severally prefixed to any paper published in the Transactions. 
The Society shall appoint a Committee to report upon the papers prepared for publication; but it shall rest with the Society to order their insertion in the Transactions. 
v. 
The Society shall meet on the first and third Wednesdays of each month, at eight p. m., and adjourn at ten o'clock, unless the President shall consider it desirable to prolong the meeting. 
Meetings. 


LONDON MEDICAL SOCIETY OP OBSERVATION. 
The place of meeting to be at the houses of the ordinary members, in rotation. 
Each member may introduce one visitor to the ordinary meetings of the Society. 
VI. 
The ordinary business of the Society shall consist of: — 
Ordinary business. 
(1.) The reading aloud of the observations upon special phenomena of disease. 
(2.) The reading aloud of the records of a case or cases. 
(3.) It shall be competent for each member (or visitor) to address to the author of these cases, &c, queries, having for their object the elucidation of facts obscurely or insufficiently described—it being understood that all questions are put with the direct sanction of the President. 
Discussions on general subjects shall be avoided, and may be repressed by the President. 
VII. 
Alteration of the laws. 
All resolutions affecting the laws of the Society, shall be proposed at one meeting, and considered at the first subsequent meeting of the Society. 
No alteration of, nor addition to the laws shall be made, except at a special meeting convened for the purpose. ~ — 


MEDICAL AND SURGICAL WORKS PUBLISHED BY BLANCHARD AND LEA, PHILADELPHIA. 
The following works on medical and other sciences, published by us, may be had of all the principal Booksellers thoughout the Union, who can in all cases procure, with but little delay, any books inquired for, which they may not have on hand. Physicians throughout the country will therefore find no difficulty in obtaining any of our publications, by ordering them at the nearest bookstore. Particulars respecting price, Ac, furnished on application. 
Catalogues of our Miscellaneous Publications will be sent by mail, if requested. 
BLANCHARD AND LEA, Philadelphia. 
DICTIONARIES AND JOURNALS, AMERICAN JOURNAL OF THE MEDICAL SCIENCES, quarterly, at $5 a year. CYCLOPEDIA OF PRACTICAL MEDICINE, by Forbes, Tweedie, &c .edited by Dunglison, in 4 royal 8vo. vols., 3154 double-columned pages. DUNGLISON'S MEDICAL DICTIONARY, 8th ed., 1 vol. large 8vo., 928 pages. HOBLYN'S DICTIONARY OF MEDICAL TERMS, by Hays, 1 vol. large 12mo., 402 pages. NEILL AND SMITH'S COMPENDIUM OF THE MEDICAL SCIENCES, 2d ed., enlarged, 1 vol., large 12mo„ 1000 pages, 350 cuts. MEDICAL NEWS AND LIBRARY, monthly, at $1 a year. ANATOMY, ANATOMICAL ATLAS, by Smith and Horner, imp. 8vo., 050 figs. New and cheaper edition. HORNER'S SPECIAL ANATOMY AND HISTOLOGY, new edition, 2 vols. 8vo., many cuts. HORNER'S UNITED STATES DISSECTOR, 1vol. large royal 12mo., many cuts, 444 pages. MACLISE'S SURGICAL ANATOMY, now complete in 1 large imp. 4to. vol.. strongly bound, with 68 magnificent coloured plates. SIBSON'S MEDICAL ANATOMY, imp. 4to., with coloured plates, to match " Maclise." Part I. (preparing.) 
SHARPEY AND QUAIN'S AN ATOM V, by Leidy, 2 vols. 8vo., 1300 pages, 511 wood-cuts. WILSON'S HUMAN ANATOMY", by Goddard, 4th ed., 1 vol. 8vo., 252 woodcuts, 580 pages. WILSON'S DISSECTOR, by Goddard. New edition, with cuts, 1 vol. 12mo.,453 pages. PHYSIOLOGY, CARPENTER'S PRINCIPLES OF HUMAN PHYSIOLOGY, 1 large vol. 8vo., many illustrations, new and improved edition, by F. G. Smith, M. D. CARPENTER'S ELEMENTS, OR MANUAL OF PHYSIOLOGY", new and improved edition, 1 vol. 8vo., 50(5 pases. CARPENTER'S COMPARATIVE PHYSIOLOGY, 1 vol. 8vo., pp. 11-22, 321 cuts. CARPENTER ON THE VARIETIES OF MANKIND. 1 vol., many illustrations, (preparing.) DALTON ON CORPORA LUTEA, 1vol. 8vo., coloured plates and wood cuts. DUNGLISON'S HUMAN PHYSIOLOGY, 7th edition, 2 vols. 8vo., 1428 pages, and 472 cuts. HARRISON ON THE NERVES, 1 vol. 8vo., 292 pages. KIRKE'S AND PAGET'S PHYSIOLOGY, 1 vol. 12mo., many cuts, 550 pages. LONGET'S PHYSIOLOGY. Translated by F. G. Smith, 2 vols. 8vo., many cuts, (preparing.) 


BLANCHARD AND LEA'S MEDICAL PUBLICATIONS. 
MATTEUCCI ON THE PHYSICAL I PHENOMENA OF LIVING BEINGS, f 1 vol. 12iiio. , 388 pages, cuts. i SOLLY ON THE BRAIN, 1 vol. 8vo., \ 496 pages, 118 cuts. i TODD AND BOWMAN'S PHYSIOLO-< GICAL ANATOMY AND PHYSIO- 1 LOGY OF MAN. Parts I., II., and III., £ 1 vol. 8vo., 156 wood-cuts. Part IV. in 4 press. <; 
PATHOLOGY. ;. ABERCROMBIE ON THE BRAIN, 1 \ vol. 8vo., 324 pages. ( BLAKISTON ON DISEASES OF THE i CHEST, 1 vol., 384 pages. \ BLOOD AND URINE MANUALS, by [ Reese, Griffith, and Markwick, 1 vol. < 12mo., with plates. ( BUDD ON THE LIVER, 1 vol. 8vo., 392!; pages, plates and wood-cuts. S BUltROWS ON CEREBRAL CIRCULA-£ TION, 1 vol. 8vo., 216 pages, with 6 co- < loured plates. ? BILLING'S PRINCIPLES, new and im- \ proved edition, 1 vol. 8vo., 250 pages. £ BIRD ON URINARY DEPOSITS, 12mo., < t new and improved edition. i COPLAND ON PALSY AND APO- 1 PLEXY, 12mo., 236 pages. \ FRICK ON RENAL AFFECTIONS, l\ vol. 12mo., cuts. [ GLUGE'S PATHOLOGICAL HISTOLO- \ GY, by Leidy, 1 vol. imp. 4to., with co- ( loured plates, (preparing.) [ HASSE'S PATHOLOGICAL ANATOMY, \ 8vo., 379 pages. i HOPE ON THE HEART, new edition, \ plates, 1 vol. 8vo., 572 pages. X LALLEMANDON SPERMATORRHOEA < 1 vol. 8vo., 320 pages. > PHILIP ON PROTRACTED IND1GES- 1 TION. 8vo., 240 pages. i PHILIPS ON SCROFULA, 1 vol. Bvo.A 350 pages. ( RICORD ON VENEREAL, new edition, i 1 vol. 8vo., 340 pages. 5 STANLEY ON THE BONES, 1 vol. 8vo., ) 286 pages. i SIMON'S GENERAL PATHOLOGY, l] vol. 8vo. Publishing in the Med. News .J and Lib. for 1852. \ VOGEL'S PATHOLOGICAL ANATOMY > OF THE HUMAN BODY, 1 vol. 8vo., i 536 pages, coloured plates. 2 WIF-SON ON THE SKIN, 1 vol. 8vo., 3d^ edition enlarged, 480 pages, (now ready.) Same work, with 15 plates. $ WILSON ON SYPHILIS, 1 vol. 8vo.,J beautiful coloured plates, (now ready.) <J WHITEHEAD ON STERILITY AND >. ABORTION, 1 vol. 8vo., 368 pages. '/ WILLIAMS'S PRINCIPLES OF MEDI- $ CINE, by Clymer, 2d edition, 440 pages, $ 1 vol. 8vo. ) 
WILLIAMS ON THE RESPIRATORY ORGANS, by Clymer, 1 vol. 8vo., 500 pages. 
PRACTICE OF MEDICINE. ASHWELL ON FEMALES, 2d ed., 1 vol. 8vo., 520 pages. BARLOW'S PRACTICE OP MEDICINE. (preparing.) BENNET ON THE UTERUS, 3d and enlarged edition, 1 vol. 8vo., 356 pages. BARTLETT ON FEVERS, 3d edition improved, 1 vol. 8vo., (now ready.) BENEDICT'S COMPENDIUM OF CHAPMAN'S LECTURES, 1 vol. 8vo., 258 pp. CHAPMAN ON FEVERS, GOUT, DROP SV, &c. &c, 1 vol. 8vo„ 450 pages. COLOMBAT DE L'ISERE ON FEMALES, by Meigs, 1 vol. 8vo., 720 pages, cuts. New ed. CONDIE ON THE DISEASES OF CHILDREN, 3d edition, 1 vol. 8vo. CHURCHILL ON THE DISEASES OF INFANCY AND CHILDHOOD, 1 vol. ; 8vo. CHURCHILL ON THE DISEASES OF FEMALES, new edition, revised by the • author and Dr. Condie, 1 vol. 8vo. (Now ! ready.) CHURCHILL'S MONOGRAPHS OF THE DISEASES OF FEMALES, 1 vol. 8vo., 450 pages. CLYMER ON FEVERS, 1 vol. 8vo., COO pages. : DAY ON OLD AGE, 1 vol. 8vo., 226 pp. DEWEES ON CHILDREN, 9th edition, 1 vol. 8vo., 548 pages. DEWEES ON FEMALES, 9th edition, 1 vol. 8vo., 532 pages, plates. DUNGLISON'S PRACTICE OF MEDICINE, 3d edition, 2 vols. 8vo., 1500 pages. MEIGS'S LETTERS ON DISEASES OF FEMALES, 1 vol. 8vo., 690 pages, 2d edition, improved. MEIGS ON CERTAIN DISEASES OF INFANCY, 1 vol. 8vo., 216 pages. THOMSON ON THE SICK-ROOM, 12mo., 360 pages. WATSON'S PRINCIPLES AND PRACTICE OF PHYSIC, 3d edition by Condie, 1 vol. 8vo., 1060 large pages. WEST ON THE DISEASES OF INFANCY AND CHILDHOOD, 1 vol. 8vo., 452 pages. WALSHE ON THE HEART AND LUNGS. A new work, 1 vol royal 12mo., 512 pages. 
SURGERY, BRODIE ON URINARY ORGANS, 1 vol. 8vo„ 214 pages. BRODIE ON THE JOINTS, 1 vol. 8vo.. 216 pages. 


BLANCHARD AND LEA'S MEDICAL PUBLICATIONS. 
BRODIE'S LECTURES ON SURGERY, ? i 1 vol. 8vo., 350 pages. / BRODIE'S SELECT SURGICAL ?< WORKS, 780 pages, 1 vol 8vo. £ CHELIUS' SYSTEM OF SURGERY, by i Sooth and Norris, iu 3 large 8vo. vols., < near 2200 pages. < COOPER'S (BRANSBY B ) LECTURES l ON PRINCIPLES AND PRACTICED OP SURGERY, 1 large vol. 8vo., 750 pp. I (now ready.) ( COOPER ON DISLOCATIONS AND?( FRACTURES, 1 vol. 8vo., 500 pages, ( ( many cuts. £ COOPER ON HERNIA, 1 vol. imp. 8vo.,j;i many plates. t COOPER ON THE TESTIS AND THY- \ MUS GLAND, 1 vol. imperial 8vo., many>, plates. I COOPER ON THE ANATOMY AND \ DISEASES OF THE BREAST, SUR-? GICAL PAPERS, &c. &c, 1 vol. imp. \ 8vo., plates. < DRUITT'S PRINCIPLES AND PRAC- \ TICE OF MODERN SURGERY, I vol. J1 8vo., 576 pages, 193 cuts, 4th edition. \ DUFTON ON DEAFNESS AND DIS- \ EASES OF THE EAR, 1 vol. 12mo. 120 < pages. ? DURLACHER ON CORNS, BUNIONS, ( , &c, 12mo., 134 pages. £ EAR, DISEASES OF, a new work, (pre- \ paring.) < FERGUSSONS PRACTICAL SURGERY, ', 1 vol. 8vo., 3d edition, 630 pages, 274 cuts. £ GUTHRIE ON THE BLADDER, 8vo., ( 150 pages. I . GROSS ON INJURIES AND DISEASES \' OF URINARY ORGANS, 1 large vol. \ 8vo., 726 pages, many cuts. > JONES'S OPHTHALMIC MEDICINE i AND SURGERY, by Hays, 1 vol. l2mo., \ 529 pages, cuts and plates. ] LISTON'S LECTURES ON SURGERY,] by Mutter, 1 vol. 8vo., 566 pages, many ) cuts. < LAWRENCE ON THE EYE, by Hays, 5 new edition, much improved, 863 pages, J many cuts and plates. J LAWRENCE ON RUPTURES, 1 vol J 8vo., 480 pages. > I MILLER'S PRINCIPLESOF SURGERY, \ by Sargent, 3d edition, much enlarged,; 1 vol. 8vo., 752 pages, with beautiful cuts. ] MILLER'S PRACTICE OP SURGERY, ? 1 vol 8vo., 496 pages. 5 MALGAIGNE'S OPERATIVE SURGE- ? RY, by Brittan, with cuts, 1 vol. 8vo.,> 000 pages. £ i MAURY'S DENTAL SURGERY, 1 vol.;! 8vo., 286 pages, many plates and cuts. j) PIRRIE'S PRINCIPLES AND TICE OF SURGERY, edited by Nkill, J 1 large vol. 8vo., 316 cuts, (now ready.) <ji SKEY'S OPERATIVE SURGERY, 1 vol. largo 8vo., many cuts, 662 pages, a new work. 5 
SARGENT'S MINOR SURGERY, I2mo., 31-0 pugi-'S, 128 cuu. SMITH ON FRACTURES, 1 vol. 8vo.,200 cuts, 314 pages. 
MATERIA MEDICA, fee. BIRD'S (GOLDING) THERAPEUTICS, (preparing.) CIIRISTISON'S AND GRIFFITH'S DISPENSATORY, 1 large vol. 8vo., 216 cuts, over 1000 pages. CARPENTER ON ALCOHOLIC LIi aUORS IN HEALTH AND DISEASE, 1 vol. 12ino. CARSON'S SYNOPSIS OF LECTURES ; ON MATERIA MEDICA AND PHARMACY, 1 vol. 8vo., 208 pages. BUNGLISON'S MATERIA MEDICA AND THERAPEUTICS, 4th edition, much improved, 182 cuts, 2 vols. 8vo. DUNGLISON ON NEW REMEDIES, 6th ed., much improved, 1 vol. 8vo.. 750 pages. DE JONGHON COD-LIVER OIL, 12mo! ELLIS'S MEDICAL FORMULARY, 9th ed., much improved, 1 vol. 8vo.,268 pp. GRIFFITH'S UNIVERSAL FORMULARY, 1 vol. 8vo., 560 pages. GRIFFITH'S MEDICAL BOTANY, I vol. 8vo., 704 pages, with about 350 illustrations. MAYNE'S DISPENSATORY, 1 vol. 12mo. 330 pages. MOHR, REDWOOD, AND PROCTER'S PHARMACY, 1 vol. 8vo., 550 pages, 506 cuts. PEREIRA'S MATERIA MEDICA, by Carson, 3d edition, 2 vols.8vo., much improved and enlarged, with 400 wood-cuts. Vol. I. ready. Vol. II. in press. ROYLE'S MATERIA MEDICA AND THERAPEUTICS, by Carson, 1 vol. 8vo., 689 pages, many cuts. 
OBSTETRICS. CHURCHILL'S THEORY AND PRACTICE OP MIDWIFERY, a new and improved edition, by Condie, 1 vol.8vo., 510 pages, many cuts. DEWEES'S MIDWIFERY, 11th edition, 1 vol. 8vo., GtiO pages, plates. LEE'S CLINICAL MIDWIFERY, 12mo., 2118 pages. MEIGS'S OBSTETRICS, 2d edition, enlarged, 1 vol. 8vo., 752 pages, (now ready.) RAMSBOTHAM ON PARTURITION, with many plates, 1 large vol., imp. 8vo., 520 pages, 6th edition. RIGBY'S MIDWIFERY, new edition, 1 vol. 8vo., 422 pages. SMITH (TYLER) ON PARTURITION, 1 vol. 12mo., 400 pages. 


BLANCHARD AND LEA'S MEDICAL PUBLICATIONS. 
CHEMISTRY BOWMAN'S PRACTICAL CHEMISTRY, 1 vol. 12mo., 97 cuts, 350 pages. BOWMAN'S MEDICAL CHEMISTRY, 1 vol. I2mo., many cuts, 288 pages. FOWNE'S ELEMENTARY CHEMISTRY, 3d edition, 1 vol. 12mo., much improved, many cuts. GRAHAM'S CHEMISTRY, by Bridges, new and improved edition. Part I. 432 pages, J85 cuts, (now ready.) Part II. in pi ess. GARDNER'S MEDICAL CHEMISTRY, I vol. I2mo., 400 pages. GRIFFITH'S CHEMISTRY OF THE FOUR SEASONS, 1 vol. 12mo., 451 pages, many cuts. KNAPP'S CHEMICAL TECHNOLOGY, by Johnson, 2 vols. 8vo., 936 pages, 460 large cuts. SIMON'S CHEMISTRY OF MAN, 8vo., 730 pages, plates. 
HYGIENE," JURISPRUDENCE, &c. BARTLETT'S PHILOSOPHY OF MEDICINE, 1 vol. 8vo., 312 pages. BARTLETT ON CERTAINTY IN MEDICINE, 1 vol. small 8vo., 84 pages. BEALE ON HEALTH OF MIND AND BODY, 1 vol. 12ino. BRIGHAM ON EXCITEMENT, &c, 1 vol. ISuio.j 204 pages. DUNGLISON ON HUMAN HEALTH, 2d ed., 8vo., 404 pages. DICKSON'S ESSAYS ON LIFE, PAIN, SLEEP, &c, in 1 vol. royal 12mo., 300 pages. DUNGLISON'S MEDICAL STUDENT, 2d edition, 12mo., 312 pages. TAYLOR'S MEDICAL JURISPRUDENCE, by Griffith, 1 vol. 8vo., new edition, 670 pages. TAYLOR ON POISONS, by Griffith, 1 vol. 8vo., 688 pages. 
NATURAL SCIENCE. &,c. ARNOTT'S PHYSICS, 1 vol. 8vo., 484 pages, many cuts. ; ANSTED'S ANCIENT WORLD, I2mo., I cuts, 382 pages. BIRD'S NATURAL PHILOSOPHY, 1 vol. royal 12mo., 402 pages and 372 wood , cuts. { BREWSTER'S OPTICS, 1 vol. 12mo., 423 I pages, many cuts. BRODERIP'S ZOOLOGICAL RECREA-' TIONS, 12i)io., 376 pages. j BONAPARTE'S AMERICAN ORNI-! THOLOGY, 4 vols, folio, coloured plates. ! BARTON'S FLORA OF THE UNITED j STATES, 4 vols, quarto, many coloured plates. 
: COLERIDGE'S IDEA OF LIFE, 12mo., i 94 pages. < DANA ON ZOOPHYTES, being vol. 8 ( of Exploring Expedition, royal 4to.,extra cloth. (ATLAS to "Dana on Zoophytes," imp. < folio, coloured plates. ] GREGORY ON ANIMAL MAGNETISM, ! 1 vol. royal 12mo. DE LA BECHE'S GEOLOGICAL OBi SERVER, 1 large 8vo. vol., many wood! cuts, (just issued.) HALE'S ETHNOGRAPHY AND PHILOLOGY OF THE UNITED STATES' EXPLORING EXPEDITION, in 1 large ( imp. 4to. vol. HERSCIIEL'S TREATISE ON ASTRO! NOMY, 1 vol. 12mo., 41? pages, numer! ous plates and cuts. HERSCIIEL'S OUTLINES OF ASTRO! NOMY, 1 vol. small 8vo., plates and ! cuts, a new work, 020 pages. ! HUMBOLDT'S ASPECTS OF NATURE, 1 vol. 12iuo„ new edition. JOHNSTON'S PHYSICAL ATLAS, 1 vol. imp. 4to., half bound, 25 coloured maps. KIRBY AND SPENCE'S ENTOMOLOGY, 1 vol. 8vo., 600 large pages; plates plain or coloured. KNOX ON RACES OF MEN, 1 vol. 12mo. (LARDNER'S HANDBOOKS OF NATURAL PHILOSOPHY, First Course, 1 j vol. royal 12mo., with 400 cuts, (just issued.) Second Course, same size and i style, (nearly ready.) MULLER'S PHYSICS AND METEOROLOGY, 1 vol. 8vo., 636 pages, with 540 j wood-cuts and 2 coloured plates. < SMALL BOOKS ON GREAT SUB< JECTS, 12 parts, done up in three hand; some 12mo. volumes. SOMERVILLE'S PHYSICAL GEOGRA- S PHY, 1 vol. 12mo., cloth, 540 pages, eni larged edition. WE1SBACHS MECHANICS APPLIED > TO MACHINERY AND ENGINEER. \ ING, Vol. I. 8vo., 486 pages, 550 wood-5 cuts. Vol. II. 8vo., 400 pages, 340 cuts. 
VETERINARY MEDICINE, jcLATER AND SKINNER'S FARRIER, , 1 vol. 12mo., 220 pages. YOUATT'S GREAT WORK ON THE ! HORSE, by Skinner, 1 vol. 8vo., 448 > pages, many cuts. YOU ATT AND CLATER'S CATTLE DOCTOR, I vol. 12mo., 282 pages, cuts. YOU ATT ON THE DOG, by Lewis, 1 , vol. demy 8vo., 403 pages, beautiful ; plates. YOUATT ON THE PIG, 12mo., iltusj Hated. 
Other new and important works are in preparation. 


1 
CATALOGUE OF BLANCIIARD & LEA'S PUBLICATIONS. 
CAMPBELL'S LORD CHANCELLORS. New Edition- (Now Ready.) LIVES OE THE LORD CHANCELLORS AND KEEPERS OF THE GREAT SEAL OF ENGLAND. FROM THE EARLIEST TIMES TO THE REIGN OF KING GEORGE IV. BY LORD CHIEF JUSTICE CAMPBELL, A. M., F. R. S. E. 
Second American, from the Third London Edition. Complete in seven handsome crown 8vo. volumes, extra cloth, or half morocco. 
This has been reprinted from the author's most recent edition, and embraces his extensive modifications and additions. It will therefore be found eminently worthy a continuance of the great favor with which it has hitherto been received. 
Of the solid merit of the work our judgment may be gathered from what has already been said. We will add, that from its infinite fund of anecdote, and happy variety of style, the book addresses itself with equal claims to the mere general reader, as to the legal or historical inquirer; and while we avoid the stereotyped commonplace of affirming that no library can be complete without it, we feel constrained to afford it a higher tribute by pronouncing it entitled to a distinguished place on the shelves of every scholar who is fortunate, enough to possess it — Frazer's Magazine. A work which will lake its place in our libraries as one of the most brilliant and valuable contributions to the literature of the present day.— Alkenceum. The brilliant success of this work in England is by no means greater than its merits. It is certainly the most brilliant contribution to English history made within our recollection ; it has the charm and freedom of Biography combined with the elaborate and careful comprehensiveness of History.— N. Y. Tribune. 
BY THE SAME AUTHOR—TO MATCH. LIVES OF THE 
CHIEF JUSTICES OF ENGLAND, 
From the Norman Conquest to the Death of Lord Mansfield. 
In two very neat vols., crown 8vo., extra cloth, or half morocco. 
To match the "Lives of the Chancellors" of the same author. 
In this work the author has displayed the same patient investigation of historical facts, depth of research, and quick appreciation of character which have rendered his previous volumes so deservedly popular. Though the 44 Lives of the Chancellors" embrace a long line of illustrious personages intimately connected with the history of England, they leave something still to be filled up to complete the picture, and it is this that the author has attempted in the present work. The vast amount of curious personal details concerning the eminent men whose biographies it contains, the lively sketches of interesting periods of history, and the graphic and vivid style of the author, render it a work of great attraction for the student of history and the general reader. 
Although the period of history embraced by these volumes had been previously traversed by the recent work of the noble and learned author, and a great portion of its most exciting incidents, especially those of a constitutional nature, there narrated, yet in "The Lives of the Chief Justices" there is a fund both of interesting information and valuable matter, which renders the book well worthy of perusal by every one who desires to obtain an acquaintance with the constitutional history of his country, or aspires to the rank of either a statesman or a lawyer. Few lawyers of Lord Campbell's eminence could have produced such a work as he has put forth. None but lawyers of his experience and acquirements could have compiled a work combining the same interest as a narration, to the public generally, with the same amount of practical information for professional aspirants more particularly.— Britannia. 


BLANCHARD & LEA'S PUBLICATIONS.— (History 6/ Biography.) 
2 
NIEBUHR'S ANCIENT HISTORY—(A new work, now ready.) 
LECTURES ON ANCIENT HISTORY, 
FROM THE EARLIEST TIMES TO THE TAKING OF ALEXANDRIA BY OCTAVIANUS, CONTAINING The History of the Asiatic Nations, the Egyptians, Greeks, Macedonians, and Carthaginians. BY B. G. NIEBUHR. Translated from the German Edition of DR. MARCUS NIEBUHR, BY DR. LEONHARD SCHMITZ, F. RS.E., With Additions and Corrections from his own MSS. notes. In three very handsome volumes, crown octavo, extra cloth, containing about fifteen hundred pages. 
From the Translator's Preface. " The Lectures on Ancient History here presented to the English public, embrace the history of the ancient world, with the exception of that of Rome, down to the time when all the other nations and states of classical antiquity were absorbed by the empire of Rome, and when its history became, in point of fact, the history of the world. Hence the present course of Lectures, together with that on the History of Rome, form a complete course, embracing the whole of ancient history. * * * * We here catch a glimpse, as it were, of the working of the great mind of the Historian, which imparts to his narrative a degree of freshness and suggestiveness that richly compensate for a more calm and sober exposition. The extraordinary familiarity of Niebuhr with the literatures of all nations, his profound knowledge of all political and human affairs, derived not only from books, but from practical life, and his brilliant powers of combination, present to us in these Lectures, as in those on Roman history, such an abundance of new ideas, startling conceptions and opinions, as are rarely to be met with in any other work. They are of the highest importance and interest to all who are engaged in the study, not only of antiquity, but of any period in the history of man." The value of this work as a book of reference is greatly increased by a very extensive Index of about fifty closely printed pages, prepared by John Robson, B. A., and containing nearly ten thousand references; in addition to which each volume has a very complete Table of Contents. 
MEMOIRS OF THE LIFE OF WILLIAM WIRT. 
JOHN P. KENNEDY. 
SECOND EDITION, REVISED. In two handsome 12mo. volumes, with a Portrait and fac-simile of a letter from John Adams. Also, 
A HANDSOME LIBRARY EDITION, IN TWO BEAUTIFULLY PRINTED OCTAVO VOLUMES. In its present neat and convenient form, the work is eminently fitted to assume the position which it merits as a book for every parlor-table and for every fireside where there is an appreciation of the kindliness and manliness, the intellect and the affection, the wit and liveliness which rendered William Wirt at once so eminent in the world, so brilliant in society, and so loving and loved in the retirement of his domestic circle. Uniting all these attractions, it cannot fail to find a place in every private and public library, and in all collections of books for the use of schools and colleges; for the young can have before them no brighter example of what can be accomplished by industry and resolution, than the life of William Wirt, as unconsciously related by himself in these volumes. 
HISTORY OF THE PROTESTANT REFORMATION IN FRANCE. 
BY MRS. MARSH, Author of "Two Old Men's Tales," "Emilia AVyndham," &c. 
In two handsome volumes, royal 12mo., extra cloth. 


BLANCHARD & LEA'S PUBLICATIONS.— (History &¦ Biography:) 
3 
NEW AND IMPROVED EDITION. 
LIVES OF THE QUEENS OF ENGLAND, FROM THE NORMAN CONQUEST. 
WITH ANECDOTES OF THEIR COURTS. 
Now first published from Official Records, and other Authentic Documents, Private as well as Public. 
NEW EDITION, WITH ADDITIONS AND CORRECTIONS. 
AGNES STRICKLAND. 
In six volumes, crown octavo, extra crimson cloth, or half morocco, printed on fine paper and large type. 
Copies of the Ituodecimo Edition, in twelve volumes, may still be had. 
A valuable contribution to historical knowledge, to young persons especially. It contains a mass of every kind of historical matter of interest, which industry and resource could collect. We have derived much entertainment and instruction from the work.— Allien fP.um. 
The execution of this work is equal to the conception. Great pains have been taken to make it both interesting and valuable.— Literary Gazette A charming work—full of interest, at once serious and pleasing.— Monsieur Guizot. 
THE COURT AND REIGN OF FRANCIS THE FIRST, KING OF FRANCE. By Miss Pardoe, author of ¦' Louis XIV." &c. In two very ueat volumes, royal 12mo., extra cloth. 
WOMAN IN FRANCE IN THE EIGHTEENTH CENTURY. By Julia Kavanagh, author of " Nathalie," " Madeline," &c. In one very neat volume, royal I Onto. 
MEMOIRS OF AN HUNGARIAN LADY. By Theresa Pulszky. With an Historical Introduction, by Count Francis Pulszky. In one vol., royal 12mo., extra cloth. 
MIRABEAUj a Life History. In Four Books. In one neat vol., royal 12mo., exlr i cloth 
HISTORY OF TEN YEARS, ia30-1840, OR FRANCE UNDER LOUIS PHILIPPE. By Louis Blanc. In two handsome volumes, crown 8vo., extra cloth. Perhaps no work ever produced a greater or more permanent effect than this. To its in Hue nee, direct and indirect, may in a great measure be attributed the movements which terminated in the Revolution of February. 1648. 
HISTORY OF THE FRENCH REVOLUTION OF 17S9. By Louis Blanc. In on* volume, crown 8vo., extra cloth 
PROFESSOR RANKE'S HISTORICAL WORKS 
HISTORY OF THE POPES. THEIR CHURCH AND STATE, IN THE 1GTH AND I7TH CENTURIES. Complete in one. large 8vo volume. HISTORY OF THE TURKISH AND SPANISH EMPIRES, IN THE 16TH CENTURY. AND BEGINNING OF THE 17TH. Complete in one 8vo. volume, paper. Price 75 cents. 
HISTORY OF THE REFORMATION IN GERMANY. Parts I. II. and III. Price $1. 
HISTORY OF THE HUGUENOTS. A new Edition, continued to the Present Time. By W. S. Browning. In one octavo volume, extra cloth. 
HISTORY OF THE JESUITS, from the Foundation of their Society to its Suppression by Pope Clement XIV. Their Missions throughout the World ; their Educational System and Literature; with their Revival and Present State. By Andrew Steinmet/., author of "The Novitiate," "Jesuit in the Family," &c. In two handsome volumes, ciown 8vo., extra cloth. 
WRA.XALI/S HISTORICAL MEMOIRS OF HIS OWN TIMES. In one octavo volume, extra cloth. 
WRAXALL'S POSTHUMOUS MEMOIRS OF HIS OWN TIMES. In one octavo volume, extra cloth. 


4 
BLANCHARD & LEA'S PUBLICATIONS. — (History Biography.) 
WILLIAM PENN: 
AN HISTORICAL BIOGRAPHY, from new sources; with an extra chapter on the " Macaulay Charges." By W. HEP WORTH DIXON, author of "John Howard, and the Prison Worid of Europe," &c. In one very neat volume, royal 12mo., extra cloth. 
As a biography the work has claims of no common order. Wiihin the compass of a single volume Mr. Dixon has compressed a great variety of facts, many original, and all skilfully arrnnged so as to produce an authentic moral portrait of his hero. The lite- Tary merits of the volume include great research, and a narrative at once consecutive and vivid. The author has had access to a variety of unpublished materinl- to the letters of Penn and his immediate family, and to MSS. of memoirs of several persons, yielding lights which he wanted. In a word, we can praise the work hi. once for its earnest spirit, its wealth of recovered material, and the art with which the latter has been disposed.— The Athenecum. 
NEW WORK BY I. AM ARTINE—f Nearly Ready.) 
MEMOIRS OF ILLUSTRIOUS EUROPEAN CHARACTERS. 
ALPHONSE DE LAMARTINE. 
In one handsome volume, royal 12mo. 
IMPORTANT NEW WORK—(Nearly Ready.) 
HISTORY OF NORMANDY AND OF ENGLAND. 
BY SIR FRANCIS PALGRAVE, Author of" Rise and Progress of the English Commonwealth," &c. In handsome crown oclavo. 
Nearly Ready, Vol.1. The General Relations of Mediaeval Europe; the Carlovingian Empire, and the Danish Expeditions in the Gauls, until the establishment of Rollo. 
Vols.11. and III. are in a state of forward preparation, and will shortly follow. 
SIBORNE'S WATERLOO. History of the War ill France and Belgium in 1SI5, containing Minu'e Details, wilh Maps and Plans, of the Battles of Quatre-Bras, Ligny, Wavre, and Waterloo. In one large oclavo volume, extra cloth, with 11 Maps. 
WHITE'S ELEMENTS OF UNIVERSAL HISTORY. Edited by J. S. Hart. In one very large volume, royal 12mo., extra cloth. 
MEMORANDA. OF A RESIDENCE AT THE CuURT OF LONDON. By the Hon. Richard Rush. In one large 8vo. volume. 
GRAHAM E'S UNITED STATES. 
HISTORY OF THE UNITED STATES FROM THE PLANTATION OF THE BRITISH COLON IKS TILL THEIR ASSUMPTION OF INDEPENDENCE Second American edition, enlarged and amended, wiih a Memoir by President Quincy, and a Portrait of the Author. In two large octavo volumes, extra cloth. 
HISTORICAL SKETCH OF THE SECOND WAR BETWEEN THE UNITED STATES OF AMERICA AND GREAT BRITAIN. By Charles J. Ingersoll. Vol. ]., embracing the events of 1812-13; Vol. II., the events of 1814. Octavo. 
HISTORY OF CONGRESS UNDER THE ADMINISTRATION OF GENERAL WASHINGTON. One very large octavo volume. 
SMALL BOOKS ON GREAT SUBJECTS. By a few well wishers to knowledge. Comprising a Series of Short Treatises on Subjects of Universal Interest In twelve parts, paper, price 15 cents each; or in three neat royal 19mo. volumes extra cloth. 
MEMOIRS OF THE REIGN OF GEORGE II., from his Accession to the death of Queen Caroline. By John Lord Hervey. Edited, from the original MSS , by the Right Hon. John Wilson Croker. In two handsome royal 12mo. volumes, extra cloth. 
WALPOLE'S MEMOIRS OF THE REIGN OF GEORGE III., now first published from the original MS. In two handsome oclavo volumes, extra cloth. 


BLANCHARD & LEA'S PUBLICATIONS.— (Fiction.) 
5 
DICKENS'S WORKS, various Styles and Prices. 
THE ONLY COMPLETE_AMERICAN EDITIONS. CHEAP EDITION. 
In ten volumes, paper, any volume sold separate, as follows :— 
David Copperfield, with plates, complete, price 37J cents. Dombey & Son, with plates, 50 cents. Christmas Stories and Pictures from Italy, 37J cents. Mania Chuzzlewit, with plates, 50 cents. Barnnhy Rudge, illustrated, 50 cents. 
Old Curiosity Shop, illustrated, 50 cents. Sketches of Kveryday Life and Everyday People, 3?i cents. Pickwick Papers, 50 cents. Oliver Twist. 25 cents. 
Nicholas Nickleby, 50 cents. 
Any of these works can be sent by mail, on remittance of their respective prices. 
COLLECTIVE LIBRARY EDITION. 
In four very large octavo volumes, extra cloth, containing over three thousand very large double columned pages, handsomely printed. 
Price only Five Dollars. 
Volume T. contains Pickwick and Old Curiosity Shop. '' II. " Oliver Twist, Sketches, and Barnaby Rudge. " HI. " Nickleby. and Manin Chuzzlewit. " IV. " Copperfield, Dombey & Son, and Christmas Stories. 
Copies of Volume Four may still be had separate by those who possess the first three volumes of this edition. 
FINE EDITION. 
In ten handsome volumes, Svo., black cloth extra, printed on fine paper, and profusely illustrated on copper and wood. Each volume contains a novel complete, and may be had separate. 
COOPER'S SEA TALES, 6 vols., 12mo , extra cloth, and COOPER'S LEATHERSTOCKING TALES, 5 vols. 12mo., extra cloth. 
DON QUIXOTE DE LA MANCIIA. Translated from the Spanish of Miguel de Cervantes Saavedra, by Charles Jarvis, Esq. ly revised and corrected, with a Memoir of the Author and a notice of his works. With numerous illustrations, by Tony Johannot. In two beautifully printed volumes, crown octavo, various bindings. 
FIELDING'S SELECT WORKS. In one large octavo volume, extra cloth,or in four parts, paper covers, viz., Tom Jones, 50 cents; Joseph Andrews, 25 cents; Amelia, 23 cents, and Jonathan Wild, 25 cents. 
SMOLLETT'S SELECT WORKS. In one laree octavo volume, extra cloth, or in five parts, paper covers, viz.: Peregrine Pickle. 50 cents; Roderick Random, 25 cents; Humphrey Clinker, 25 cents; Lauucelot Greaves, 25 cents, and Ferdinand Count Fathom, 25 cents. 
PICCIOT.A, the Prisoner of Fenestrella, or Captivity Captive. By X. B. Sainline. New edition, with illustrations. In one very neat volume, roy al 12mo., paper covers, price 50 cents, or in extra cloth. 
MRS. HOWITT'S CHILDREN'S YEAR. A Popular Juvenile. In square 18mo.,with four plates, extra cloth. 
WILLIAM HOWITT'S HALL AND HAMLET. Sketches of Rural Life in England. In one volume, 12rno., price 50 cent*. 
READINGS FOR THE YOUNG, from the works of Sir AValtcr Scott. Beautifully printed in two large lSino. volumes, extra crimson cloih, with handsome plates. 
TALES FROM HISTORY. By Agnes Strickland. In one neat volume, royal ISmo., crimson doth, with illustrations. 
5 


BLANCHARD & LEA'S PUBLICATIONS.— (Voyages and Travels.) 
6 
NARRATIVE OP THE UNITED STATES EXPEDITION TO THE DEAD SEA AND RIVER JORDAN. 
BY W. F. LYNCH, U. S. N., Commander of the Expedition. 
New and condensed edition, with a Map, from actnal Surveys. 
In one neat royal 12ino. volume, extra cloth. 
This is a condensed and cheap, yet very handsome edition of Lieut. Lynch's admirable Narrative of the Expedition to the Dead Sea. The interest which was excited and gratified by the first publication of this work, demanded that it should be placed in a form for more general circulation, and this demand is met in the edition we have betore us. Of the work itself nothing need be said in its praise, the judgment of the public having confirmed its excellence. It is a narrative that must have an abiding interest for all time, and that library that is without it is imperfect; as is the knowledge imperfect of the man who, however otherwise versed in the subject it treats of, should be ignorant of the facts it details. We cannot dismiss the work without saying that, apart from the absorbing interest which belongs to the subject, the author has given it a charm in the easy, flowing, and correct style in which the narrative is writien. lhat makes the reader reluctant, when he has taken up the volume, to lay it down before it is finished, and which will cause him to return to it again and again, with renewed interest and pleasure.— Baltimore. Patriot. Copies may still toe toad of the Fine edition, In one -very large and handsome octavo volume, with twenty-eight beautiful Plates, and two Maps. 
This book, so long and anxiously expected, fully sustains the hopes of the most sanguine and fastidious. It is truly a magnificent work. The type, paper, binding, style, and execution are all of the best and highest character, as are also the maps and engravings. It will do more to elevate the character of our national literature than any work that has appeared for years.— Lady's Book. 
NOTES FROM NINEVEH, and Travels in Mesopotamia, Assyria, and Syria. By the Rev. J. P. Fletcher. In one neat royal 12mo. volume, extra cloth. 
TRAVELS IN SIBERIA, including Excuisions Northward, down the Obi to the Polar Circle, and Southward to the Chinese Frontier. By Adolj-h Exhan. Translated by William D. Cooley. In two handsome vols., royal 12mo., ex. cl. 
HUNGARY AND TRANSYLVANIA, with Remarks on their Condition, Social, Moral, and Political. By John Paget, Esq. In two neat volumes, royal 12mo., extra cloth. 
TURKEY AND ITS DESTINY ; The result of Journeys made in 1847 and 184S, to examine into the State of that Country. By Charles Macfarlane, Esq., Author of " Constantinople in 1828." In two neat vols., royal 12mo., ex. cloth. 
IMPRESSIONS AND EXPERIENCES OF THE WEST INDIES AND NORTH AMERICA IN 1849. By Robert Baird, A. M. In one neat volume, royal 12mo., extra cloth. 
THE WESTERN WORLD; or, Travels in the United States. Exhibiting them in their latest Development—Social, Political, and Industrial. Including a Chapter on California. By Alexander Mackay, Esq. In two neat volumes, royal 12mo., extra cloth. 
SIX MONTHS IN THE GOLD MINES. From a Journal of a Three Years' Residence in Upper and Lower California, during 1847, 1848, and 1S49. By E. Gould Buffum, Esq. In one neat vol., royal 12mo., paper, 50 cents, or ex. cl. 
NARRATIVE OF THE UNITED STATES EXPLORING EXPEDITION. By Charles Wilkes, U. S. N., Commander of the Expedition. In six large volumes, imperial quarto. With several hundred illustrations on steel and wood, and numerous large maps. Price $60. This the same as the edition printed for Congress. As but few have been exposed for sale, those who desire to possess this magnificent monument of the arts of the United Suites, would do well to secure copies without delay. 
EASTERN LIFR, PRESENT AND PAST. By Harriet Martineau. In one large and handsome volume, crown octavo, extra cloth. 


BLANCHARD & LEA'S PUBLICATIONS.— (Miscellaneous.) 
7 
THE ENCYCLOPEDIA AMERICANA; 
A POPULAR DICTIONARY OF ARTS, SCIENCES, LITERATURE, HISTORY, POLITICS, AND BIOGRAPHY. 
In fourteen large octavo volumes of over 600 double-columned pages each. For sale very low, in various styles of binding. 
Some years having elapsed since the original thirteen volumes of the ENCYCLOPAEDIA AMERICANA were published, to bring it up to the present day, with the history of that period, at the request of numerous subscribers, the publishers have issued a 
SUPPLEMENTARY VOLUME (THE FOURTEENTH), 
bringing the work thoroughly up. 
Edited by HENRY YETHAKE, LL. D. 
In one large oclavo volume, of over 650 double-columned pages, which may be had separately, to complete sets. 
MURRAY'S ENCYCLOP/EDIA OF GEOGRAPHY. 
THE ENCYCLOPAEDIA OF GEOGRAPHY, comprising a Complete Description of the Earth, Physical, Statistical, Civil, and Political ; exhibiting its Relation to the Heavenly Bodies, its Physical Structure, The Natural History of each Country, and the Industry, Commerce, Political Institutions, and Civil and Social State of all Nations. By Hugh Murray, F. R. S. E., &c. Assisted in Botany, by Professor Hooker—Zoology, &c, by W. W. Swainson—Astronomy, &c, by Professor Wallace—Geology, &c, by Professor Jameson. Revised, with Additions, by Thomas G. Bradford. The whole brought up, by a Supplement, to 1843. In three large octavo volumes various styles of binding. 
This great work, furnished at a remarkably cheap rate, contains about Nineteen Hundred large Imperial Pages, and is illustrated by Eighty-two small Maps, and a colored Map of the United States, after Tanner's, together with about Eleven Hundred Wood-cuts executed in the best stj le. 
PHILOSOPHY IN SPORT MADE SCIENCE IN EARNEST. In one handsome volume, royal ISmo , crimson cloth, with numerous illustrations. 
ENDLESS AMUSEMENT. A Collection of Four Hundred Entertaining Experiments. In one handsome volume, royal 18mo., with illustrations, crimson cloth. 
MOORE'S MELODIES, SPLENDIDLY ILLUSTRATED. 
IRISH MELODIES. By Thomas Moore, Esq. In one magnificent volume, imperial quarto, with ten large steel plates, by Finden. Handsomely bound in extra cloth, gilt. 
LANGUAGE OF FLOWERS, with illustrative poetry. Eighth edition. In one beautiful volume, royal 18mo., crimson cloth, gilt, with colored plates. 
CAMPBELL'S COMPLETE POETICAL WORKS. Illustrated Edition. One volume crown 8vo., various bindings. 
ROGERS'S POEMS. Illustrated Edition. One volume, royal 8vo., calf gilt. 
KEBLE'S CHRISTIAN YEAR. One vol. 18mo., extra cloth. 
KEBLE'S CHILD'S CHRISTIAN YEAR. One vol. ISmo., cloth. 
POEMS, by Ellis, Currer, and Acton Bell, (Authors of Jane Eyre, &c.) In one 18mo. volume, boards. 
POEMS, by Lucretia Davidson. One vol. royal 12mo., paper or extra cloth. 
POEMS, by Margaret M. Davidson. One vol. royal 12mo., paper or extra cloth. 
SELECTIONS FROM THE WRITINGS OF MRS. DAVIDSON. One vol. ro>al 12mo.. paper or extra cloth. 


8 
BLANCHARD & LEA'S PUBLICATIONS.— (Science.) 
LIBRARY OF ILLUSTRATED SCIENTIFIC WORKS. 
A series of beautifully printed volumes on various branches of science, by the most eminent men in their respective departments. The whole printed in the handsomest style, and profusely embellished in the most efficient manner. No expense hag been or will be spared to render this series worthy of the support of the scientific public, while at the same time it is one of the handsomest specimens of typographical and artistic execution which have appeared in this country. 
DE IiA HECHE'S GEOLOGY— (Just Issued.) 
THE GEOLOGICAL OBSERVER. 
BY SIR HENRY T. DE LA BECHE, C. B., F. R. S., Director-General of the Geological Survey of Great Britain, &c. In one very large and handsome octavo volume. 
WITH OVER THREE HUNDRED WOOD-CUTS. 
We have here presented to us, by one admirably qualified for the task, the most complete compendium of the science of geology ever produced, in which the different facts which fall under the cognizance of this branch of natural science are arranged under the different causes by which they are produced. From the style in which the subject is treated, the work is calculated not only for the use of the professional geologist but for that of the uninitiated reader, who will find in it much curious and interesting information on the changes which the surface of our globe has undergone, and the history of the various striking appearances which it presents Voluminous as the work is, it is not rendered unreadable from its bulk, owing to the judicious subdivision of its contents, and the copious index which is appended.— John Bull. Having had such abundant opportunities, no one could be found so capable of directing the labors of the young geologist, or to aid by his own experience the studies of those who may not have been able to range so extensively over the earth's surface. We strongly recommend Sir Henry De la Beche's book to those who desire to know what has been done, and to learn something of the wide examination which yet lits waiting for the industrious observer.— The Alheneeum. 
KNAPP'S CHEMICAL TECHNOLOGY. 
TECHNOLOGY; or, Chemistry Applied to the Arts and to Manufactures. By Dr. F. Knapp, Professor at the University of Giessen. Edited, with numerous Notes and Additions, by Dr. Edmund Ronalds, and Dr. Thomas Richardson. First American Edition, with Notes and Additions by Prof. Walter R. JohnSon. In two handsome octavo volumes, printed and illustrated in the highest style of art, with about 500 wood engravings. 
The style of excellence in which the first volume was got up is fully preserved in this. The treatises themselves are admirable, and the editing, both by the English and American editors, judicious; so that the work maintains itself as the bestof the series to which it belongs, and worthy the attention of all interested in the arts of which it treats. — Franklin Institute Journal. 
WEISBACH'S MECHANICS. 
PRINCIPLES OF THE MECHANICS OF MACHINERY AND ENGINEERING. By Professor Julius Weisbach. Translated and Edited by Prof. f Gordon, of Glasgow. First American Edition, with Additions by Prof. Walter R. Johnson. In two octavo volumes, beautifully printed, with 9C0 illustrations on wood. 
The most valuable contribution to practical science that has yet appeared in this country. — Alheneeum. Unequalled by anything of the kind yet produced in this country—the most standard book on mechanics, machinery, and engineering now extant: — N. T. Commerrial. J11 every way worthy of being recommended to our readers — Franklin Institute Journal. 


BLANCHARD & LEA'S PUBLICATIONS.— (Science.) 
9 
Mis I* V S TItJl TJEH SCIEJYTIF'MC JLMBIt%£R IT—(Continued.) CARPENTER'S COMPARATIVE PHYSIOLOGY —(Just Issued.) 
PRINCIPLES OF GENERAL AND COMPARATIVE PHYSIOLOGY; intended as an Introduction to the Study of Human Physiology, and as a Guide to the Philosophical Pursuit of Natural History. By William B. Carpenter, M. D., F. R. S., author of " Human Physiology," " Vegetable Physiology," &c. &c. Third improved and enlarged edition. In one very large and handsome octavo volume, with several hundred beautiful illustrations. 
MULLER'S PHYSICS. 
PRINCIPLES OF PHYSICS AND METEOROLOGY. By Professor J. Muller, M. D. Edited, with Additions, by R. Eglesfeld Griffith, M. D. In one large and handsome octavo volume, with 550 wood-cuts and two colored plates. The style in which the volume is published is in the highest degree creditable to the enterprise of the publishers. It comains nearly four hundred engravings executed in a style of extraordinary elegance. We commend the book to general favor. It is the best of its kind we have ever seen.— N. Y. Courier and Enquirer. 
MOHR, REDWOOD, AND PROCTER'S PHARMACY. 
PRACTICAL PHARMACY: Comprising the Arrangements, Apparatus, and Manipulations of the Pharmaceutical Shop and Laboratory. By Francis Mohr, Ph. D., Assessor Pharmacia? of the Royal Prussian College of Medicine, Coblentz ; and Theophilus Redwood, Professor of Pharmacy in the Pharmaceutical Society of Great Britain. Edited, with extensive Additions, by Prof. William Procter, of the Philadelphia College of Pharmacy. In one handsomely printed octavo volume, of 570 pages, with over 500 engravings on wood. 
THE MILLWRIGHT'S GUIDE. 
THE MILLWRIGHT'S AND MILLER'S GUIDE. By Oliver Evans. Eleventh Edition. With Additions and Corrections by the Professor of Mechanics in the Franklin Institute, and a description of an improved Merchant Flour Mill. By C. and O. Evans. In one octavo volume, with numerous engravings. 
HUMAN HEALTH ; or, the Influence of Atmosphere and Locality, Change of Air and Climate, Seasons, Food, Clothing, Bathing, Mineral Springs, Exercise, Sleep, Corporeal and Mental Pursuits, &c. &c., on Healthy Man, constituting Elements of Hygiene. By Robley Dunglison, M D. In one octavo volume. 
THE ANCIENT WORLD; OR, PICTURESQUE SKETCHES OF CREATION. By D. T. Ansted, author of " Elements of Geology," &c. In one neat volume, royal 12mo , with numerous illustrations. 
A NEW THEORY OF LIFE. By S T. Coleridge. Now first published from the original MS. In one small 12mo. volume, cloth. 
ZOOLOGICAL RECREATIONS. By W. T. Broderip, F. R. S. From the second London edition. One volume, royal 12mo., extra cloth. 
AN INTRODUCTION TO ENTOMOLOGY; or, Elements of the Natural History of Insects. By the Rev. Wm. Kir by, and Wm. ''pence, F. R. S. From the sixth Loudon edition. In one large oclavo volume, with plates, plain or colored. 
THE RACES OF MEN; a Fragment. By John Knox. In one royal 12mo. volume, extra cloth. 
AMERICAN ORNITHOLOGY. By Charles Bonaparte,Prince of Canino. In four folio volumes, half bound, with numerous magnificent colored plates. 
LECTURES ON THE PHYSICAL PHENOMENA OF LIVING BEINGS. By Carlo Maueucci. Edited by Jonathan Pereira, M.D. In one royal 12mo. volume, extra cloth, with illustrations. 


10 
BLANCHARD & LEA'S PUBLICATIONS. — (Science.) 
GRAHAM S CHEMISTRY, NEW EDITION. Part I.-(Now Ready.) 
ELEMENTS OF CHEMISTRY; 
INCLUDING THE APPLICATIONS OF THE SCIENCE IN THE ARTS. 
BY THOMAS GRAHAM, F.R.S.,&c, Professor of Chemistry in University College, London, &c. 
Second American, from an entirely Revised and greatly Enlarged English Edition. WITH NUMEROUS WOOD ENGRAVINGS. 
Edited, with Notes, by ROBERT BRIDGES, M. D., Professor of Chemistry in the Philadelphia College of Pharmacy, &c. 
To be completed in Two Parts, forming one very large octavo volume. PART I, now ready, of 430 large pages, with 185 engravings. PART II, preparing for early publication. 
From the Editor's Preface. 
The " Elements of Chemistry," of which a second edition is now presented, attained, on its first appearance, an immediate and deserved reputation. The copious selection of facts from all reliable sources, and their judicious arrangement, render it a safe guide for the beginner, while the clear exposition of theoretical points, and frequent references to special treatises, make it a valuable assistant for the more advanced student. 
From this high character the present edition will in no way detract. The great changes which the science of Chemistry has undergone during the interval have rendered necessary a complete revision of the work, and this has been most thoroughly accomplished by the author. Many portions will therefore be found essentially altered, thereby increasing greatly the size of the work, while the series of illustrations has been entirely changed in style, and nearly doubled in number. 
Under these circumstances but little has been left for the editor. Owing, however, to the appearance of the London edition in parts, some years have elapsed since the first portions were published, and he has therefore found oc casion to introduce the more recent investigations and discoveries in some subjects, as well as to correct such inaccuracies or misprints as. had escaped the author's attention, and to make a few additional references. 
INTRODUCTION TO PRACTICAL CHEMISTRY, including Analysis. By John E. Bowman, M. D. In one neat royal 12ino. volume, extra cloth, with numerous illustrations. DANA ON CORALS. 
ZOOPHYTES AND CORALS. By James D. Dana. In one volume imperial quarto, extra cloth, with wood-cuts. Also, an Atlas to the above, one volume imperial folio, with sixty-one magnificent plates, colored after nature. Bound in half morocco. These splendid volumes form a portion of the publications of the United States Exploring Expedition. As but very few copies have been prepared for sale, and as these are nearly exhausted, all who are desirous of enrichtngtheir libraries with this, the most creditable specimen of American Art and Science as yet issued, will do well to procure copies at once. 
THE ETHNOGRAPHY AND PHILOLOGY OF THE UNITED STATES EXPLORING EXPEDITION. By Horatio Hale. In one large imperial quarto volume, beautifully printed, and strongly bound in extra cloth. 
BARON HUMBOLDT'S LAST WORK. 
ASPECTS OF NATURE IN DIFFERENT LANDS AND DIFFERENT CLIMATES. With Scientific Elucidations. By Alexander Von Humboldt. Translated by Mrs. Sabine. Second American edition. In one handsome volume, large royal 12mo., extra cloth. 
CHEMISTRY OF THE FOUR SEASONS, Spring, Summer, Autumn, and Winter. By Thomas Griffith. In one handsome volume, royal 12mo, extra cloth, with numerous illustrations. 


BLANCHARD & LEA'S PUBLICATIONS.— (Educational Works.) 
11 
A NEW TEXT-BOOK ON NATURAL PHILOSOPHY. 
HANDBOOKS 
OF NATURAL PHILOSOPHY AND ASTRONOMY. 
DIONYSIUS LARDNER, LL. D„ ETC. 
FIRST COURSE:, containing 
Mechanics, Hydrostatics, Hydranlics, Pneumatics, Sound, and Optics. 
In one large royal 12mo. volume of 750 pages, strongly bound in leather, with over 400 wood-cuts, (Just Issued.) 
THE SECOND COURSE, embracing 
HEAT, MAGNETISM, ELECTRICITY, AND GALVANISM, Of about 400 pages, and illustrated with 250 cuts, is just ready. 
THE THIRD COURSE, constituting 
A COMPLETE TREATISE ON ASTRONOMY 
THOROUGHLY ILLUSTRATED, IS IN PREPARATION FOR SPEEDY PUBLICATION. 
The intention of the author has been to prepare a work which should embrace the principles of Natural Philosophy, in their latest state of scientific development, divested of the sbstruseness which renders them unfitted for the younger student, and at the same time illustrated by numerous practicnl applications in every branch of art and science. Dr. Lardner's extensive acquirements in all departments of human knowledge, and his well-known skill in popularizing his subject, have thus enabled him to present a textbook which, though strictly scientific in its groundwork, is yet easily mastered by the student, while calculated to interest the mind, and awaken the attention by showing the importance of the principles discussed, and the manner in which they may be made subservient to the practical purposes of life. To accomplish this still further, the editor has added to each section a series of examples, to be worked out by the learner, thus impressing upon him the practical importance and variety of the results to be obtained from the general laws of nature. The subject is still further simplified by the very large number of illustrative wood-cuts which are scattered through the volume, making plain to the eye what might not readily be grasped by the unassisted mind ; and every care has been taken to render the typographical accuracy of the work what it should be. Although the first portion only has been issued, and that but for a few months, yet it has already been adopted by many academies and colleges of the highest standing and character. A few of the numerous recommendations with which the work has been favored are subjoined. 
From Prof. Millington, Univ. of Mississippi, April 10,1852. 
I am highly pleased with its contents and arrangement. It contains a greater number of every day useful practical facts and examples than I have ever seen noticed in a similar work, and I do not hesitate to say that as a book for teaching I prefer it to any other of the same size and extent that I am acquainted with. During the thirteen years that I was at William and Mary College I had to teach Natural Philosophy, and I should have been very glad to have such a text-book. 
From Edmund Smith, Baltimore, May 19,1652. 
I have a class using it, and think it the best book of the kind with which I am acquainted. 
From Prof. Cleveland, Philadelphia, October 17,1851. 
I feel prepared to say that it is the fullest and most valuable manual upon the subject that has fallen under my notice, and I intend to make it the text-book for the first class in my school. 
From S. Schooler, Hanover Academy, Va.. 
The " Handbooks" seem tome the best popular treatises on their respective subjects with which I am acquainted. Dr. Lardner certainly popularizes science very well, and a good text-book for schools and colleges was not before in existence. 
From Prof. J. S. Henderson, Farmer's College, O., Feb. 16,1852. 
It is an admirable work, and well worthy of public patronage. For clearness and fulness it is unequalled by any that 1 have seen. 


12 
BLANCHARD & LEA'S PUBLICATIONS. -(Educational Works.) 
NEW AND IMPROVED EDITION.—(Now Ready) 
OUTLINES OP ASTRONOMY. 
SIR JOHN F. "VY. HERSCIIEL, F. R. S., &c. 
A NEW AMERICAN FROM THE FOURTH LONDON EDITION. In one very neat crown octavo volume, extra cloth, with six plates and numerous wood-cuts. 
This edition will be found thoroughly brought up to the present state of astronomical science, with the most recent investigations and discoveries fully discussed and explained. 
We now take leave of this remarkable work, which we hold to be, beyond a doubt, the greatest and most remarkable of the works in which the laws of astronomy and the appearance of the heavens are described to those who are not mathematicians nor observers, and recalled to those who are. It is the reward of men who can descend from the advancement of knowledge to care for its diffusion, that their works are essential to all, that they become the manuals of the proficient as well as the text-books of the learner. — Athenmum. There is perhaps no book in the English language on the subject, which, whilst it contains so many of the facts of Astronomy (which it attempts to explain with as little technical language as possible), is so attractive in its style, and so clear and forcible in its illustrations.— Evangelical Review. Probably no book ever written upon any science, embraces within so small a compass an entire epitome of everything known within all its various departments, practical, theoretical, and physical.— Examiner. 
A TREATISE ON ASTRONOMY. 
SIR JOHN F. W. HERSCHEL. Edited by S.C. Walker. In one 12mo. 
volume, half bound, with plates and wood-cuts. 
A TREATISE ON OPTICS 
SIR DAVID BREWSTER, LL. D., F. R. S., &c. 
A NEW EDITION. 
WITH AN APPENDIX, CONTAINING AN ELEMENTARY VIEW OF THE APPLICATION OF ANALYSIS TO REFLECTION AND REFRACTION. BY A. D. BACHE, Superintendent U. S. Coast Survey, &c. In one neat duodecimo volume, half bound, with about 200 illustrations. 
BOLMIR'S FRENCH SERIES. 
New editions of the following works, by A. Bolmar, forming, in connection with " Bolmar's Levizac," a complete series for the acquisition of the French language:— 
A SELECTION OF ONE HUNDRED PERRIN'S FABLES, accompanied by a Key, containing the text, a literal and free translation, arranged in such a manner as to point out the difference between the French and English idiom, &c. In one vol.l2mo. 
A COLLECTION OF COLLOQUIAL PHRASES, on every topic necessary to maintain conversation. Arranged under different heads, with numerous remarks on the peculiar pronunciation and uses of various words; the whole so disposed as considerably to facilitate the acquisition of a correct pronunciation of the French. In one vol. 18mo. 
LES AVENTURES DE TELEMAQUE, PAR FENELON, in one vol. 12mo., accompanied by a Key to the first eight books. In one vol. 12mo., containing, like the Fables, the Text, a literal and free translation, intended as a sequel to the Fables. Either volume sold separately. 
ALL THE FRENCH VERBS, both regular and irregular, in a small volume. 


BLANCHARD & LEA'S PUBLICATIONS.—( Educational Works.) 
13 
ELEMENTS OF NATURAL PHILOSOPHY; 
BEING 
AN EXPERIMENTAL INTRODUCTION TO THE PHYSICAL SCIENCES. Illustrated with over Three Hundred Wood-cuts. 
BY GOLDING BIRD, M.D., Assistant Physician to Guy's Hospital. From the Third London edition. In one neat volume, royal 12mo. 
We are astonished to find that there is Toom in so small a book for even the bare recital of so many subjects. Where everything is treated succinctly, great judgment and much time are needed in making a selection and winnowing the wheat from the chaff Dr. Bird has no need to plead the peculiarity of his position as a shield against criticism, so long as his book continues to be the best epitome in the English language of this wide range of physical subjects.— North American Review, April 1,1851. 
From Prof. John Johnston, Wesleyan Univ., Middlelown. Cl. 
For those desiring as extensive a work, I think it decidedly superior to anything of the kind with which I am acquainted. 
From Prof. R. O. Currey, East Tennessee University. 
I am much gratified in perusing a work which so well, so fully, and so clearly sets forth this branch of the Natural Sciences. For some time I have been desirous of obtaining a substitute for the one now used—one which should embrace the recent discoveries in the sciences, and I can truly say that such a one is afforded in this work of Dr. Bird's. 
From Prof. W. F. Hopkins, Masonic University, Tenn. 
It is just the sort of book I think needed in most colleges, being far above the rank of a mere popular work, and yet not beyond the comprehension of all but the most accomplished mathematicians. 
ELEMENTARY CHEMISTRY; THEORETICAL AND PRACTICAL. 
BY GEORGE FOWNES, Ph.D., Chemical Lecturer in the Middlesex Hospital Medical School, &c. &c. 
WITH NUMEROUS ILLUSTRATIONS. 
Third American, from a late London edition. Edited, with Additions, BY ROBERT BRIDGES, M. D., Professor of General and Pharmaceutical Chemistry in the Philadelphia College of Pharmacy, &c. &c. In one large royal 12mo. volume, of over five hundred pages, with about 180 wood-cuts, sheep or extra cloth. 
The work of Dr. Fownes has long been before the public, and its merits have been fully appreciated as the best text-book on Chemistry now in existence. We do not, of course, place it in a rank superior to the works of Brande, Graham, Turner, Gregory, or Gmelin, but we say that, as a work for students, it is preferable to any of them.—iondon Journal of Medicine. 
We know of no treatise so well calculated to aid the student in becoming familiar with the numerous facts in the science on which it treats, or one better calculated as a text-book for those attending Chemical Lectures. * * * * The best text-book on Chemistry that has issued from our press.— American Med. Journal. 
We know of none within the same limits, which has higher claims to our confidence as a college class-book, both for accuracy of detail and scientific arrangement. — Augusta Med. Journal. 
ELEMENTS OF PHYSICS. 
OR, NATURAL PHILOSOPHY, GENERAL AND MEDICAL. Written for universal use, in plain, or non-technical language By Neill Arnott, M. D. In one octavo volume, with about two hundred illustrations. 2 


14 
BLANCHARD & LEA'S PUBLICATIONS.— (Educational Works.) 
SOMERVILLE'S PHYSICAL GEOGRAPHY. 
PHYSICAL GEOGRAPHY. 
MARY SOMERVILLE. 
SECOND AMERICAN FROM THE SECOND AND REVISED LONDON EDITION. 
WITH AMERICAN NOTES, GLOSSARY, ETC. 
In one neat royal 12mo. volume, extra cloth, of over five hundred and fifty pages. 
The great success of this work, and its introduction into many of our higher schools and academies, have induced the publishers to prepare a new and much improved edition. In addition to the corrections and improvements of the author bestowed on the work in its passage through the press a second time in London, notes have been introduced to adapt it more fully to the physical geography of this country; and a comprehensive glossary has been added, rendering the volume more particularly suited to educational purposes. The amount of these additions may be understood from the fact, that not only has the size of the pages been increased, but the volume itself enlarged by over one hundred and fifty pages. 
Our praise comes lagging in the rear, and is wellnigh superfluous. But we are anxious to recommend to our youth the enlarged method of studying geography which her present work demonstrates to be as captivating as it is instructive. We hold such presents as Mrs. Somerville has bestowed upon the public, to be of incalculable value, disseminating more sound information than all the literary and scientific institutions will accomplish in a whole cycle of their existence. — Blackwood's Magazine. 
From Thomas Sherwin, High School, Boston. 
I hold it in the highest estimation, and am confident that it will prove a very efficient aid in the education of the young, and a source of much interest and instruction to the adult reader. 
From Erastus Everett, High School, New Orleans. 
I have examined it with a good deal of care, and am glad to find that it supplies an important desideratum. The whole work is a masterpiece. Whether we examine the importance of the subjects treated, or the elegant and attractive style in which they are presented, this work leaves nothing to desire. I have introduced it into my school for the use of an advanced class in geography, and they are greatly interested in it. I have no doubt that it will be used in most of our higher seminaries. 
From W. Smyth, Osivego Academy. 
So much important, accurate, and general information I have never seen in a volume of its extent. In fine, 1 believe it to be a work which will soon take a high place in the academies and colleges of America, as well as in the libraries of every individual desirous of accurate information respecting the planet on which we dwell. 1 have recommended it to those connected with the District School Libraries, for which 1 consider it exceedingly well adapted. 
JOHNSTON'S PHYSICAL ATLAS. 
THE PHYSICAL ATLAS 
OF NATURAL PHENOMENA. 
FOR THE USE OF COLLEGES, ACADEMIES, AND FAMILIES. BY ALEXANDER KEITH JOHNSTON, F. R. G. S., F. G. S. 
In one large volume, imperial quarto, handsomely and strongly bound. With twenty-six plates, engraved and colored in the best style. Together with one hundred and twelve pages of Descriptive Letter-press, and a very copious Index. 
A work which should be in every family and every school-room, for consultation and reference. By the ingenious arrangement adopted by the author, it makes clear to the eye every fact and observation relative to the present condition of the earth, arranged under the departments of Geology, Hydrography, Meteorology, and Natural History. The letter-press illustrates this with a body of important information, nowhere else to be found condensed into the same space, while a very full Index renders the whole easy of reference. 


BLANCHARD & LEA'S PUBLICATIONS.— (Educational Works.) 
15 
SCHMITZ AND ZUMPT'S CLASSICAL SERIES. 
Under this title Blanchard & Lea are publishing a series of Latin School- Books, edited by those distinguished scholars and critics, Leonhard Schmitz and C. G. Zumpt. The object of the series is to present a course of accurate texts, revised in accordance with the latest investigations and MSS., and the most approved principles of modern criticism, as well as the necessary elementary books, arranged on the best system of modern instruction. The former are accompanied with notes and illustrations introduced sparingly, avoiding on the one hand the error of overburdening the work with commentary, and on the other that of leaving the student entirely to his own resources. The main object has been to awaken the scholar's mind to a sense of the beauties and peculiarities of his author, to assist him where assistance is necessary, and to lead him to think and to investigate for himself. For this purpose maps and other engravings are given wherever useful, and each author is accompanied with a biographical and critical sketch. The form in which the volumes are printed is neat and convenient, while it admits of their being sold at prices unprecedentedly low, thus placing them within the reach of many to whom the cost of classical works has hitherto proved a bar to this department of education; while the whole series being arranged on one definite and uniform plan, enables the teacher to carry forward his student from the rudiments of the language without the annoyance and interruption caused by the necessity of using textbooks founded on varying and conflicting systems of study. 
CLASSICAL TEXTS PUBLISHED IN THIS SERIES. 
I. CLARIS DE BELLO GALLICO LIBRI IV., 1 vol. royal 18mo., extra cloth, 232 pages, with a Map, price 50 cents. 
II. C.C. SALLUSTII CATILINA ET JUGURTHA, 1 vol. royal 18mo., extra cloth, 168 pages, with a Map, price 50 cents. 
III. P. OVIDII NASONIS CARMINA SELECTA, 1 vol. royal 18mo., extra cloth, 246 pages, price 60 cents. 
IV. P. VIRGILII MARONIS CARMINA, 1 vol. royal 18mo., extra cloth, 438 pages, price 75 cents. 
V. Q. HORATII FLACCI CARMINA EXCERPTA, 1 vol. royal 18mo., extra cloth, 312 pages, price 60 cents. 
VI. Q. CURTII RUFI DE ALEXANDRI MAGNI QUjE SUPERSUNT, 1 vol. royal 18mo., extra cloth, 326 pages, with a Map, price 70 cents. 
VII. T. LIVII PATAVINI HISTORIARUM LIBRI I., II., XXL, XXII., 1 vol. royal 18mo., ex. cloth, 350 pages, with two colored Maps, price 70 cents. 
VIII. M. T. CICERONIS ORATIONES SELECTS XII., 1 vol. royal ISmo., extra cloth, 300 pages, price 60 cents. 
ELEMENTARY WORKS PUBLISHED IN THIS SERIES. 
I. 
A SCHOOL DICTIONARY OF THE LATIN LANGUAGE. By Dr. J. H. Kai.T6CHmidt. In two parts, Latin-English and English-Latin. 
Part I., Latin-English, of nearly 500 pages, strongly bound, price 90 cents. Part II., English-Latin, of about 400 pages, price 75 cents. 
Or the whole complete in one very thick royal 18mo. volume, of nearly 900 closely printed double-columned pages, strongly bound in leather, price only $1 25. 
II. 
GRAMMAR OF THE LATIN LANGUAGE. By Leonhard Schmitz, Ph. D., F. R. S. E., Rector of the High School, Edinburgh, &c. In one handsome volume, royal 18mo., of 318 pages, neatly half bound, price 60 cents. 


16 
BLANCHARD & LEA'S PUBLICATIONS. — (Educational Works.) 
SCHMITZ AND ZUMPT'S CLASSICAL SERIES—Continued. 
III. 
ELEMENTARY GRAMMAR AND EXERCISES. ByDr. Leonhard Schmitz, F. R. S. E., Rector oF the High School, Edinburgh, &c. In one handsome royal 18mo. volume of 246 pages, extra cloth, price 50 cents. (Just Issued.) 
PREPARING FOR SPEEDY PUBLICATION. 
LATIN READING AND EXERCISE BOOK, 1 vol., royal 18mo. A SCHOOL CLASSICAL DICTIONARY, 1 vol., royal 18mo. CORNELIUS NEPOS, with Introduction, Notes, &c, 1 vol., royal 18mo. 
It will thus be seen that this series is now very nearly complete, embracing eight prominent Latin authors, and requiring but two more elementary works to render it sufficient in itself for a thorough course of study, and these latter are now preparing for early publication. During the successive appearance of the volumes, the plan and execution of the whole have been received with marked approbation, and the fact that it supplies a want not hitherto provided for, is evinced by the adoption of these works in a very large number of the best academies and seminaries throughout the country. From among several hundred testimonials with which they have been favored, and which they are every day receiving, the publishers submit a few of the more recent. 
But we cannot forbear commending especially both to instructors and pupils the whole of the series, edited by those accomplished scholars, Drs. Schmitz and Zumpt. Here will be found a set of text-books that combine the excellences so long desired in this class of works. They will not cost the student, by one half at least, that which he must expend for some other editions. And who will not say that this is a consideration worthy of attention 1 For the cheaper our school-books can be made, the more widely will they be circulated and used. Here you will find, too, no useless display of notes and of learning, but in footnotes on each page you have everything necessary to the understanding of the text. The difficult points are sometimes elucidated, and often is the student referred to the places.where he can find light, but not without some effort of his own. We think that the punctuation in these books might be improved; but taken as a whole, they come nearer to the wants of the times than any within our knowledge.—Southern College Review. 
From W. J. Rol/e, Wrentham, Mass., March 22,1852. 
They seem tome the best and the cheapest school editions of the classics that I have yet seen. The notes are all that a teacher could, and all that a student should desire. On classical history and antiquities I think them particularly rich, and the maps add very much to the merjtof the books. Kaltschmidt's Dictionary I adopted as a matter of course. It is so much superior to all the other school dictionaries that no one who has examined it can hesitate to recommend it. 
From Prof. R. N. Newell, Masonic College, Tenn., June 2,1852. 
I can give you no better proof of the value which I set on them than by making use of them in my own classes, and recommending their use in the preparatory department of our institution. I have read them through carefully that 1 might not speak of them without due.examination, and I flatter myself that my opinion is fully borne out by fact, when I pronounce them to be the most useful and the most correct, as well as the cheapest editions of Latin Classics ever introduced in this country. The Latin and English Dictionary contains as much as the student can want in the earlier years of his course ; it contains more than I have ever seen compressed into a book of this kind. It ought 10 be the student's constant companion in his recitations. It has the extraordinary recommendation of being at once portable and comprehensive. 
From Prof. D. Duncan, Randolph Macon College, Va., May 25,1852. 
It is unnecessary for me to say anything respecting the text of Schmitz and Zumpt's scries. The very names of the editors are a sufficient guarantee of their purity. The beauty of the typography, and the judicious selection of notes will insure their use hy every experienced teacher, whilst their cheapness and convenient size will be a sure recommendation to every parent. I think, gentlemen that by the republication of this excellent series you have laid the public under strong obligations to you. We will use them as far as they come into our course, and I will recommend them to our nurnf rous preparatory schools. From the merits above mentioned, they are destined,in my opinion, to supersede most of the editions now in use in our schools. 


BLANCHARD & LEA'S PUBLICATIONS.— (Educational Works.) 
17 
SCHMITZ AND ZUMPT'S CLASSICAL SERIES—Continued. 
From the Rev. L. Van Eokkelen, Principal of St. Timothy's Hall, Md., Feb. 18,1852. Since you commenced the series I have invariably adopted the different works in preference to all others, and I now use them all, with the exception of " Q,. Cunius." 
From W. F. Wyers, New London Academy, Feb. 14,1852. 
I have used no other editions but yours since they made their first appearance, and shall certainly continue to do so. 
Among the various editions of the Latin Classics, Schmitz and Zumpt's series, so far as yet published, are at all times preferred, and students are requested to procure no other.— Announcement of Bethany College, Va. 
Uniform with SCHMITZ AND ZUMPT'S CLASSICAL SERIES. —(Now Ready.) 
THE CLASSICAL MANUAL; 
AN EPITOME OF ANCIENT GEOGRAPHY, GREEK AND ROMAN MYTHOLOGY, ANTIQUITIES, AND CHRONOLOGY. 
CHIEFLY INTENDED FOR THE USE OF SCHOOLS. 
BY JAMES S. S. BAIRD, T. C. D., Assistant Classical Master, King's School, Gloucester. 
In one neat volume, royal 18mo., extra cloth, price Fifty cents. 
This little volume has been prepared to meet the recognized want of an Epitome which, within the compass of a single small volume, should contain the information requisite to elucidate the Greek and Roman authors most commonly read in our schools. The aim of the author has been to embody in it such details as are important or necessary for the junior student, in a form and space capable of rendering them easily mastered and retained, and he has consequently not incumbered it with a mass of learning which, though highly valuable to the advanced student, is merely perplexing to the beginner. In the amount of information presented, and the manner in which it is conveyed, as well as its convenient size and exceedingly low price, it is therefore admirably adapted for the younger classes of our numerous classical schools. 
From Mr. B. F. Stem, Fredericksburg, Va., July 30,1852. 
The Classical Manual I have perused with delight, and shall at once introduce in my school. It is a book that has long been needed, and I know of none where so much varied matter can be found in so small a space. 
'From Mr. C. Hammond, Monson, Mass., Aug. 6, 1852. 
I shall introduce it into my school at once. It is just what we have needed for a long, long lime. 
From Prof. Trimble, Kenyon College, O., Aug. 30,1852. 
It must recommend itself to the teachers in all the classical institutions within the Union, not only on account of its cheapness, but also for its excellent arrangement; and it will be a sine qua non compendious class-book for every studem wishing to enter our colleges. 
From Mr. J. H. Nourse, Washington , Aug. 17, 1852. 
I shall require every classical student to possess a copy of " Baird's Manual." From Mr. W. W. Clarke, Gouverneur Wes. Sem , JV. Y., Aug. 17, 1852. 
I admire it very much for the large amount of classical information so concisely and clearly set forth. It is just the thing for students in their early studies, and has long been a desideratum. 
From Mr. W. S. Bogart, Tallahassee, Fl., Aug. 7, 1852. 
It contains a vast amount of geographical and classical information in a most concise compass, which adapts it equally to the pupil and the advanced student who wishes to review his classical knowledge. 


18 
BLANCHARD & LEA'S PUBLICATIONS.—( Educational Works.) 
A HISTORY Of GREEK CLASSICAL LITERATURE. 
BY THE REV. B. W. BROWNE, M. A., Professor of Classical Literature in King's College, London. In one very neat volume, crown 8vo., extra cloth. 
To be shortly followed by a similar volume on Roman Literature. 
From Prof. J. A. Spencer, New York, March 19, 1852. 
It is an admirable volume, sufficiently full and copious in detail, clear and precise in style, very scholar-like in its execution, genial in its criticism, and altogether displaying a mind well stored with the learning, genius, wisdom, and exquisite taste of the ancient Greeks. It is in advance of everything we have, and it may be considered indispensable to the classical scholar and student. 
From Prof. N. H. Griffin, Williams College, Mass., March 22,1852. 
A valuable compend, embracing in a small compass matter which the student would have to go over much ground to gather for himself. 
From Prof. M. F. Hyde, Burlington College, N. J., Feb. 10,1852. 
This book meets a want that has long been felt of some single work on the subject presenting to the student and general reader, in a popular form, information widely dispersed through a great variety of publications, and nowhere combined into one whole. Mr. Browne's selection of materials is judiciously made, and presented in a perspicuous, elegant, and agreeable manner. 
From Prof. Gessner Harrison, University of Va., Feb. 23,1652. 
I am very favorably impressed with the work from what I have seen of it, and hope to find in it an important help for my class of history. Such a work is very much needed. 
In this field, following the successful assiduity of others, Mr. Browne enters with the relish of an amateur and the skill of a connoisseur, profiting by the labors of his predecessors, and bringing the tested results into the compass of a most valuable book ; one very much to our taste, giving a satisfactory account of the language, the authors, the works which, while Greece herself has passed away, render her name immortal. The history is divided into two periods ; the first extends from the infancy of its literature to the time of the Pisistralidae; the other commences with Simonides, and ends with Aristotle. We commend our author to the favorable regard of professors and teachers.— Metlwdist Quarterly Review, South. 
Mr. Browne's present publication has great merit. His selection of materials is judiciously adapted to the purpose of conveying within a moderate compass some definite idea of the leading characteristics of the great classical authors and their works. * * * * Mr. Browne has the happy art of conveying information in a most agreeable manner. It is impossible to miss his meaning, or be insensible to the charms of nis polished style. Suffice it to say, that he has, in a very readable volume,presented much that is useful to the classical reader. Besides biographical information in reference to all the classical Greek authors, he has furnished critical remarks on their intellectual peculiarities, and an analysis of their works when they are of sufficient importance to deserve it. — London Atlieneeum. 
This book will be of great value to the student.— Examiner. 
G EOG RAPH IA CLASSICA: 
OR, THE APPLICATION OF ANCIENT GEOGRAPHY TO THE CLASSICS. By Samuel Butler, D. D., late Lord Bishop of Litchfield. Revised by his Son. Sixth American, from the last London Edition, with Questions on the Maps, by John Frost, LL. D. In one neat volume, royal 12mo., half bound. 
AN ATLAS OF ANCIENT GEOGRAPHY. 
By Samuel Butler, D. D., late Lord Bishop of Litchfield. In one octavo volume, half bound, containing twenty-one quarto colored Maps, and an accentuated Index. 
ELEMENTS OF UNIVERSAL HISTORY. 
On anew plan; from the Creation of the World to the Congress of Vienna, with a Summary of the Leading Events since that time. By H White. Edited, with a Series of Questions, by John S. Hart, Principal of the Philadelphia High School. In one very large royul 12ino. volume, half bound. 


BLANCHARD & LEA'S PUBLICATIONS.— (Educational Works.) 
19 
NEW AND IMPROVED EDITION—(Now Ready.) 
OUTLINES OF ENGLISH LITERATURE. 
THOMAS B. SHAW. 
Professor of English Literature in the Imperial Alexander Lyceum, St. Petersburg. 
SECOND AMERICAN EDITION. 
WITH A SKETCH OF AMERICAN LITERATURE. 
BY HENRY T. TUCKERMAN, Author of " Characteristics of Literature," " The Optimist," &c. In one large and handsome volume, royal 12mo., extra cloth, of about 500 pages. 
The object of this work is to present to the student a history of the progress of English Literature. To accomplish this, the author has followed its course from the earliest times to the present age, seizing upon the more prominent " Schools of Writing," tracing their causes and effects, and selecting the more celebrated authors as subjects for brief biographical and critical sketches, analyzing their best works, and thus presenting to the student a definite view of the development of the language and literature, with succinct descriptions of those books and men of which no educated person should be ignorant. He has thus not only supplied the acknowledged want of a manual on this subject, but by the liveliness and power of his style, the thorough knowledge he displays of his topic, and the variety of his subjects, he has succeeded in producing a most agreeable reading-book, which will captivate the mind of the scholar, and relieve the monotony of drier studies. This work having attracted much attention, and been introduced into a large number of our best academies and colleges, the publishers, in answering the call for a new edition, have endeavored to render it still more appropriate for the student of this country, by adding to it a sketch of American literature. This has been prepared by Mr. Tuckerman, on the plan adopted by Mr. Shaw, and the volume is again presented with full confidence that it will be found of great utility as a text-book, wherever this subject forms part of the educational course; or as an introduction to a systematic plan of reading. 
From Prof. R. P. Dunn, Brown University, April 22, 1852. 
I had already determined to adopt it as the principal book of reference in my department. This is the first term in which it has been used here ; but from the trial which I have now made of it, I have every reason to congratulate myself on my selection of it us a text-book. 
From the Rev. W. G. T. Shedd, Professor of English Literature in the University of Vt. I take great pleasure in saying that it supplies a want that has long existed of a brief history of English literature, written in the right method and spirit, to serve as an introduction to the critical study of it. I shall recommend the book to my classes. 
From James Shannon, President of Bacon College, Ky. 
I have read about one-ha|f of " Shaw's Outlines," and so far I am more than pleased with the work. I concur with you fully in the opinion that it supplies a want long felt in our higher educational institutes of a critical history of English literature, occupying a reasonable space, and written in a manner to interest and attach the attention of the student. I sincerely desire that it may obtain, as it deserves, an extensive circulation. 
HANDBOOK OF MODERN EUROPEAN LITERATURE. 
British, Danish, Dutch, French, German, Hungarian, Italian, Polish and Russian, Portuguese, Spanish, and Swedish. With a full Biographical and Chronological Index. By Mrs. Foster. In one large royal 12mo. volume, extra cloth. Uniform with " Shaw's Outlines of English Literature." 


20 
BLANCHARD & LEA'S PUBLICATIONS. — (Practical Works.) 
YOUATT AND SKINNER ON THE HORSE. 
THE HORSE. 
WILLIAM YOUATT. 
JI new edition, with numerous Illustrations. 
TOGETHER WITH A GENERAL HISTORY OF THE HORSE ; A DISSERTATION ON THE AMERICAN TROTTING HORSE ; HOW TRAINED AND JOCKEYED } AN ACCOUNT 
OF HIS REMARKABLE PERFORMANCES J AND AN ESSAY ON THE 
ASS AND THE MULE. 
BY J. S. SKINNER, Assistant Postmaster-General, and Editor of the Turf Register. 
This edition of Youatt's well-known and standard work on the Management, Diseases, and Treatmentof the Horse, embodying the valuable additions of Mr. Skinner, has has already obtained such a wide circulation throughout the country, that the Publishers need say nothing to attract to it the attention and confidence of all who keep Horses or are interested in their improvement. 
NOTES ON SHOOTING; OR, HINTS TO SPORTSMEN. 
Comprising the Habits of the Game Birds and Wild Fowl of North America; the Dog, the Gun, the Field, and the Kitchen. By E. J. Lewis, M. D., editor of" Youatt on the Dog," &c. In one handsome volume, royal 12mo., extra cloth, with illustrations. 
YOUATT AND LEWIS ON THE DOG. 
THE DOG. By William Youatl. Edited by E. J. Lewis, M. D. With numerous and beautiful illustrations. In one very handsome volume, crown 8vo., crimson cloth, gilt. 
THE PIG; a Treatise on the Breed, Management, Feeding, and Medical Treatment of Swine. By William Youatt, V. S. In one 12mo. volume, extra cloth, or in neat paper covers, price 50 cents 
EVERY MAN HIS OWN CATTLE DOCTOR. By Francis Clater and William Youatt. Revised by J. S. Skinner. 1 vol. 12mo. 
EVERY MAN HIS OWN FARRIER. By Francis and John Clater. Revised by J. S. Skinner. In one vol. 12mo. 
THE GARDENER'S DICTIONARY. 
A DICTIONARY OF MODERN GARDENING. By G. W. Johnson,Esq. With numerous additions, by. David Landreth. With one hundred and eighty wood-cuts. In one very large royal 12mo. volume, of about 050 double-columned pages. 
This work is now offered at a very low price. 
ACTON'S COOKERY. 
MODERN COOKERY IN ALL ITS BRANCHES, reduced to a System of Easy Practice, for the Use of Private Families ; in a Series of Practical Receipts, all of which are given with the most minute exactness. By Eliza Acton. With numerous woodcut illustrations; to which is added a Table of Weights and Measures. The whole revised, and prepared for American housekeepers, by Mrs. Sarah J. Hale. From the Second London Edition. In one large 12mo. volume. 
MODERN FRENCH COOKERY. By Charles E. Francatelli. In one large octavo volume, extra cloth, with numerous illustrations. 
THE SUGAR PLANTER'S MANUAL. By W. J. Evans. In one neat octavo volume of 268 pages, with cuts and plates. 
THE| DOMESTIC MANAGEMENT OF THE SICK-ROOM, necessary, in aid of medical treatment for the cure of diseases. By A. T. Thomson, M. D. Edited by R. E. Griffith, M. D. In one volume royal 12mo., extra cloth. 
BLANCHARD & LEA also publish Dumerous valuable Medical works, Catalogues of which may be had on application. 


BLANCHARD & LEA'S PUBLICATIONS.— (Educational Works.) 
19 
NEW AND IMPROVED EDITION—(Now Ready.) 
OUTLINES OF ENGLISH LITERATURE. 
THOMAS B. SHAW. 
Professor of English Literature in the Imperial Alexander Lyceum, St. Petersburg. 
SECOND AMERICAN EDITION. 
WITH A SKETCH OF AMERICAN LITERATURE. 
BY HENRY T. TUCKERMAN, Author of " Characteristics of Literature," " The Optimist," &c. In one large and handsome volume, royal 12mo., extra cloth, of about 500 pages. 
The object of this work is to present to the student a history of the progress of English Literature. To accomplish this, the author has followed its course from the earliest times to the present age, seizing upon the more prominent " Schools of Writing," tracing their causes and effects, and selecting the more celebrated authors as subjects for brief biographical and critical sketches, analyzing their best works, and thus presenting to the student a definite view of the development of the language and literature, with succinct descriptions of those books and men of which no educated person should be ignorant. He has thus not only supplied the acknowledged want of a manual on this subject, but by the liveliness and power of his style, the thorough knowledge he displays of his topic, and the variety of his subjects, he has succeeded in producing a most agreeable reading-book, which will captivate the mind of the scholar, and relieve the monotony of drier studies. This work having attracted much attention, and been introduced into a large number of our best academies and colleges, the publishers, in answering the call for a new edition, have endeavored to render it still more appropriate for the student of this country, by adding to it a sketch of American literature. This has been prepared by Mr. Tuckerman, on the plan adopted by Mr. Shaw, and the volume is again presented with full confidence that it will be found of great utility as a text-book, wherever this subject forms part of the educational course; or as an introduction to a systematic plan of reading. 
From Prof. R. P. Dunn, Brown University, April 22, 1852. 
I had already determined to adopt it as the principal book of reference in my department. This is the first term in which it has been used here ; but from the trial which I have now made of it, I have every reason to congratulate myself on my selection of it us a text-book. 
From the Rev. W. G. T. Shedd, Professor of English Literature in the University of Vt. I take great pleasure in saying that it supplies a want that has long existed of a brief history of English literature, written in the right method and spirit, to serve as an introduction to the critical study of it. I shall recommend the book to my classes. 
From James Shannon, President of Bacon College, Ky. 
I have read about one-ha|f of " Shaw's Outlines," and so far I am more than pleased with the work. I concur with you fully in the opinion that it supplies a want long felt in our higher educational institutes of a critical history of English literature, occupying a reasonable space, and written in a manner to interest and attach the attention of the student. I sincerely desire that it may obtain, as it deserves, an extensive circulation. 
HANDBOOK OF MODERN EUROPEAN LITERATURE. 
British, Danish, Dutch, French, German, Hungarian, Italian, Polish and Russian, Portuguese, Spanish, and Swedish. With a full Biographical and Chronological Index. By Mrs. Foster. In one large royal 12mo. volume, extra cloth. Uniform with " Shaw's Outlines of English Literature." 


20 
BLANCHARD & LEA'S PUBLICATIONS. — (Practical Works.) 
YOUATT AND SKINNER ON THE HORSE. 
THE HORSE. 
WILLIAM YOUATT. 
JI new edition, with numerous Illustrations. 
TOGETHER WITH A GENERAL HISTORY OF THE HORSE ; A DISSERTATION ON THE AMERICAN TROTTING HORSE ; HOW TRAINED AND JOCKEYED } AN ACCOUNT 
OF HIS REMARKABLE PERFORMANCES J AND AN ESSAY ON THE 
ASS AND THE MULE. 
BY J. S. SKINNER, Assistant Postmaster-General, and Editor of the Turf Register. 
This edition of Youatt's well-known and standard work on the Management, Diseases, and Treatmentof the Horse, embodying the valuable additions of Mr. Skinner, has has already obtained such a wide circulation throughout the country, that the Publishers need say nothing to attract to it the attention and confidence of all who keep Horses or are interested in their improvement. 
NOTES ON SHOOTING; OR, HINTS TO SPORTSMEN. 
Comprising the Habits of the Game Birds and Wild Fowl of North America; the Dog, the Gun, the Field, and the Kitchen. By E. J. Lewis, M. D., editor of" Youatt on the Dog," &c. In one handsome volume, royal 12mo., extra cloth, with illustrations. 
YOUATT AND LEWIS ON THE DOG. 
THE DOG. By William Youatl. Edited by E. J. Lewis, M. D. With numerous and beautiful illustrations. In one very handsome volume, crown 8vo., crimson cloth, gilt. 
THE PIG; a Treatise on the Breed, Management, Feeding, and Medical Treatment of Swine. By William Youatt, V. S. In one 12mo. volume, extra cloth, or in neat paper covers, price 50 cents 
EVERY MAN HIS OWN CATTLE DOCTOR. By Francis Clater and William Youatt. Revised by J. S. Skinner. 1 vol. 12mo. 
EVERY MAN HIS OWN FARRIER. By Francis and John Clater. Revised by J. S. Skinner. In one vol. 12mo. 
THE GARDENER'S DICTIONARY. 
A DICTIONARY OF MODERN GARDENING. By G. W. Johnson,Esq. With numerous additions, by. David Landreth. With one hundred and eighty wood-cuts. In one very large royal 12mo. volume, of about 050 double-columned pages. 
This work is now offered at a very low price. 
ACTON'S COOKERY. 
MODERN COOKERY IN ALL ITS BRANCHES, reduced to a System of Easy Practice, for the Use of Private Families ; in a Series of Practical Receipts, all of which are given with the most minute exactness. By Eliza Acton. With numerous woodcut illustrations; to which is added a Table of Weights and Measures. The whole revised, and prepared for American housekeepers, by Mrs. Sarah J. Hale. From the Second London Edition. In one large 12mo. volume. 
MODERN FRENCH COOKERY. By Charles E. Francatelli. In one large octavo volume, extra cloth, with numerous illustrations. 
THE SUGAR PLANTER'S MANUAL. By W. J. Evans. In one neat octavo volume of 268 pages, with cuts and plates. 
THE| DOMESTIC MANAGEMENT OF THE SICK-ROOM, necessary, in aid of medical treatment for the cure of diseases. By A. T. Thomson, M. D. Edited by R. E. Griffith, M. D. In one volume royal 12mo., extra cloth. 
BLANCHARD & LEA also publish Dumerous valuable Medical works, Catalogues of which may be had on application.