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COMPENDIUM

OP

HUMAN & COMPARATIVE

PATHOLOGICAL ANATOMY,

LONDON :
PRINTKI) BY R. CLAY, URHAD STREF.T HILL

A

COMPENDIUM

OF

HUMAN & COMPARATIVE

PATHOLOGICAL ANATOMY.

BY

ADOLPH WILHELM OTTO, M. D.

ROYAI, MEDICAL COUNSELLOK IN THE MEDICAL COLLEGE OF SILESIA, ORDINARY PROFESSOR OF
MEDICINE IN THE UNIVERSITY AND MEDICO-CHIRURGICAL ACADEMY AT BRESLAU,

&c. &c. &c.

Cranslatetr from ti^e (German, toit^ atrlrittonal TSTotes atilr IKeferenres,

BY

JOHN F. SOUTH,

LECTURER ON ANATOMY AT ST. THOMAS'S HOSPITAL.

LONDON :
B. FELLOWES, LUDGATE STREET.

1831.

TRANSLATOR'S PREFACE.

I FEEL no need of apologizing to the Profession for the
translation of a work, the value of which I am convinced will
be fully appreciated by every reader into whose hands it may
chance to come. The importance of the subject on which it
treats, the advantage of shewing at one view what has been
already done in pathology, and the facility it renders to the
student of classing such additional facts as he may meet with
in his reading or experience, require no comment ; and,
as such, I trust it will be found no mean help in professional
inquiry.

The additional references given by the author in his
Appendix I have incorporated in the body of the work, as he
proposed; and to these I have added further references and
notices of cases which have come within my own knowledge,
all of which are bracketed and marked T. to prevent confusion.

As to the minor share I have borne bv the translation, I
have to beg the reader's indulgence if, in my endeavour to

Vlll TRANSLATORS PREFACE.

render the author's views in, as nearly as possible, his
own language, I may seem to have made my translation
too literal. Occasionally I have encountered much diffi-
culty in finding suitable expressions; and for one word which
the author frequently employs I can find no equivalent, and
have been compelled to adopt the term loosening, which
certainly does not give the full meaning of the term he makes
use of, which implies that kind of separation of fibres produced
by shaking up a bag of feathers, or by scribbling wool : where-
ever, therefore, the term loosem?ig is used, it must be under-
stood as employed in this sense.

JOHN F. SOUTH.

Octohei- 10, 1831.

PREFACE.

My Manual of Pathological Anatomy having been out of
print several years, I was anxious to publish a second edition;
but I found that, in the meanwhile, there had been not merely
a great change in the science about which I purposed writing,
but also my own views upon the subject were so much al-
tered, that I rather preferred writing a new book to improving
the old one. Hence originates the present work, the first
volume of which I recommend to the kind consideration of
the honoured reader ; and in consequence of having a different
publisher, has the new title been employed.

I have but little to say with reference to the plan and
arrangement of the book. My own experience, and the
advice of well-informed friends, have convinced me that the
arrangement commonly employed in Anatomy, would also
best suit Pathological Anatomy ; but that it was advisable to
premise the special pathology by a General Part, which should
treat of the irregularities in connexion with each other, which
plan I had always hitherto adopted in my Lectures on Pa-
thological Anatomy.

Not forgetting that one principal character of a good book
is its brevity, I set out with this view, as much from principle
as from inclination, and have endeavoured, wherever explana-
tion was necessary, to supply it in the Notes, to which I must
therefore refer in all matters of doubt. A Compendium should,
on no account, treat subjects circumstantially, but merely
note them ; and in lectures, the teacher may very easily spin
out, according to his pleasure, the short threads herein
provided.

In order that the book might serve for private study and
reference, I thought' it advisable to add a more copious list

X PREFACE.

of Pathological Literature. The latter I have arranged, as
far as I could, with much time and labour, in a chronological
order, so as at once to exhibit, to a certain extent, a history
of the science ; and the influence which the various prevalent
theories in medicine have had in the treatment of the several
chapters, will not escape the attentive reader.

I very much regret that the literary notices are not more
perfect, but especially the Dutch and Italian, to which I
have had no opportunity of referring : be it, however, kindly
remembered, that I live on the eastern borders of Germany,
and could hardly employ any other than my own single
library. Further, I have in part purposely not cited the in-
numerable isolated observations of the younger practitioners,
which have been published in both German and foreign
periodicals, as they are often neither interesting nor correct
anatomical observations. I have also but rarely employed
the copious literary references contained in VoigteVs Hand-
buch der Pathologischen Anatomic, because I found them
very unsatisfactory. I have, instead, commonly referred to
preparations in the Anatomical Collection at Breslau, which
has been done for the sake of my auditors ; and the addition
to my Catalogue, which will shortly appear, will more fully
announce the nine thousand preparations in this collection.

I must, however, observe, that the printing of the work
commenced two years ago, but that a severe illness, with an
accumulation of official engagements, have prevented its more
rapid progress, by which several additions, required to make
the work useful, are now added in an Appendix.

The Pathological Anatomy of Craigie, Andral, and Lob-
steitiy unfortunately reached me so late, that I could not
make use of them ; however, they will certainly be used in
the second and last volume, which, I hope, will very soon
follow the firsi.

Dreshu, Sept. 182^. A. W. OTTO.

CONTENTS.

Introduction

Page
1

FIRST, OR GENERAL PART.

First Section

Second Section
Third Section
Fourth Section
Fifth Section
Sixth Section

Of the Vices of Animal Organization in

general . 13

Of Vices relating to Number .... 18

Of Vices relating to Size ..... 21

Of Vices relating to Form 27

Of Vices relating to Position .... 28

Of Vices relating to Connexion ... 31

Seventh Section . Of Vices relating to Colour .... 33

Eighth Section . Of Vices relating to Consistence ... 38

Ninth Section . Of Vices relating to Continuity ... 39

Tenth Section . Of Vices relating to Texture .... 41

Eleventh Section. Of Vices relating to Contents .... 73

SECOND, OR PARTICULAR PART.

FIRST BOOK.
OF THE PARTICULAR ORGANS, OR THE ORGANIC SYSTEMS.

Twelfth Section . Of Cellular or Mucous Tissue . . 90

Thirteenth Section. Of Cellular Membranes .... 95

First Chapter . Of Serous Membranes 96

Second Chapter . Of Mucous Membranes .... 99

Third Chapter . Of External Skin 103

xu

CONTENTS.

Page

Fourteenth Section . Of Horny Tissue 110

First Chapter . Of the External and Internal Cuticle 114

Second Chapter . Of the Nails and Hoofs . . . . 116

Third Chapter . Of Hair and Feathers 120

Fifteenth Section. Of the Bony System 125

First Chapter . Of Bones in general ih.

Second Chapter . Of Bones in particular 157

A.— Of the Bones of the Head ib.

B.— Of the Bones of the Trunk 194

C. — Of the Bones of the Upper Extremities . . . 216

D. — Of the Bones of the Lower Extremities . . . 220

Sixteenth Section . Of the Cartilaginous System . . . 225
Seventeenth Section. Of the Fibrous System in general,

and of the Joints in particular . 229

Eighteenth Section . Of the Muscular System .... 243

Nineteenth Section. Of the Vascular System .... 253

First Chapter . Of the Pericardium ib.

Second Chapter . Of the Heart 260

Third Chapter . Of the Arteries 294

Fourth Chapter . Of the Veins 335

Fifth Chapter . Of the Lymphatic Vessels and Glands 355

Twentieth Section . Of the Nervous System .... 363

First Chapter . Of the Brain ib.

A. — Of the Membranes of the Brain ib.

B.— Of the Brain itself 385

Second Chaj^ter . Of the Spinal Marrow 423

A. — Of the Membranes of the Spinal Marrow . . ib

B.— Of the Spinal Marrow itself 428

Third Chapter . Of the Nerves 439

INTRODUCTION.

Anatomy, or the science of the structure of organic bodies,
is divided into two principal parts, according as it treats either
of healthy and regular, or of diseased and irregular structure ;
the former is briefly called Anatomy, Normal or Physiological
Anatomy ; the latter. Pathological, Morbid, or Practical
Medical^ Anatomy.

The very nature of the subject prevents our setting distinct
limits to Pathological Anatomy. For as during life no
direct boundary can be drawn between health and disease, so
also does the healthy and regular structure of organized bodies
merge so imperceptibly and in so many different ways into the
diseased and irregular, that normal and abnormal or patholo-
gical anatomy cannot be strictly separated from each other,
just so intimately and firmly is pathological anatomy con-
nected with pathology, symptomatology, and surgery, that a
strict distinction between them might be difficult. In conse-
quence of the close connexion of these sciences with patholo-
gical anatomy arises the necessity of making oneself master of
them for the purpose of learning and prosecuting it with
advantage. But hefore all, a very intimate knowledge, per-
fected by practice, not merely of the coarser, but especially of
the more delicate structure of cwrganic bodies, that is, a know-
ledge of human and comparative anatomy, is necessary for the
study of pathological anatomy ^

{1) Morgagni praef. ad lib. IV. Epistolar, dc sed. et caiu. morbor,
(2) lb, praef. ad lib. I.

B

2 Introductio}},

As, however, man forms but one link in the cliain of organic
beings, so, for the perfection of pathological anatomy, nothing
would operate more advantageously, than the investigation of
the diseased structure of the other organic bodies, and par-
ticularly those of animals. As soon as we have collected a
considerable number of such observations, we may expect,
in a general view of the vices of structure in organic bodies,
to penetrate deeper into their nature and causes. Even
now whilst pathological anatomy, in comparison with most
other medical sciences, is only in its infancy, its utility is
traced in almost all the branches of medicine ; it is the
common and absolute source of all,^ but particularly of
anatomy, physiology, and pathology.*

Hence is the intimate knowledge of pathological anatomy
equally indispensable, both to the practical physician, the
medical jurist and the surgeon, and if subsequently this be
more studied as a comparative science, for the veterinary
physician also.

Pathological anatomy has only in later times been pursued
successfully, although in the earliest periods,^ and some hun-
dred years before Galen, human bodies had been examined in
Egypt "^ in order to ascertain the seat and causes of disease.
In the beginning of the sixteenth century, the first work on
pathological anatomy was written by Antonio Benivieni at
Florence. When in this century, the love of anatomy revived,

(3) Morgagni proef. ad lib, I— V. Gerh. Jndr. Muller Progr. de utilitate ana-
tomise practical Gies. 1753. Pauls Grduwen Oratio de anatomiae pathologicse
utilitate et necessitate. Groning. 1771.

Ladeveze et Monfalcon De I'influence de I'anatomie pathologique sur le
progres de la medecine, etc. in Journ. complem. du Diction, des So. medic. T. XI.
p. 193—215. T. XIV. p. 289 et T. XV. p. 98. Bayle Considerations genferales
sur les secours quel'anatoniie pathologique peut fournir ^ la Medecine ; v. Artie.
Anatomie pathologique, in Diet, des Scienc. medicales, T. II. p. 61—78. Lobstein
in Journ. complementaire du Dictionnaire des Sciences medicales. Paris, 1818.
T. II. p. 3—23.

Bousquet Quelques reflexions sur I'anatomie pathologique, consid^r^e dans ses
rapports avec la Science des maladies, in Journ. complem. du Diet, des Sc.
medical. T. VII. p. 289—303.

J. Smith D. de utilitate morborum naturam cadaveribus sectis explorandi.
Edinb. 1812.

/.. Pachii Intorno la necessity dello studio dell' Anatomia patolosica. Lucca.
1828.

(4) F. A. Stiinner D. exh. meletemata quaedam generalia in patholoffiam.
Svo. Dorpati, 1814.

Oijs. — Not merely local diseases, but fevers and nervous diseases are likewise
connected with pathological anatomy, as undoubtedly many of these have
organic changes for their cause, and all have them, though perhaps transiently,
as an effect.

(5) The Writings of llippocrales.
(T)) Plinius Nat. Hist. I. XIX. c. 8.

Iniroduction, 3

and the science was ardently pursued by Fallopius, Vesalius,
and EusTACHius with most briUiant success ; individual obser-
vations of interest in pathological anatomy were occasionally
made, and pathological examinations were frequently instituted
both in this and in the subsequent century. But the deficiency
of the necessary ancillary sciences, and the superstition and
prejudice at that time prevailing, prevented the speedy progress
of this science. Bonetus and Mangetus, towards the end
of the seventeenth century, collected the single, and in some
measure, important observations made before their time, and
endeavoured to arrange them, though not very successfully. It
was only in the eighteenth century that pathological anatomy
began to advance rapidly, especially by the extraordinary labour
of MoRGAGNi, who must be considered as the founder of this
science, by the rich and instructive collections of anatomico-
pathological preparations of Hove, Rau, Ruysch, Walter
VAN Doeveren, Vater, Walter, the Meckels, the Monros,
the Sandiforts, and the Hunters, which were further added
to by LoBSTEiN, Loder, and others, as well as by the excel-
lent contributions and works of later, and in some instances
still living, anatomists.^

The pathological anatomy of animals has been relatively,
as yet, but little investigated, and needs, as well as com-
parative pathology, further attention. It arises indeed from
the circumstance, that only of late comparative anatomy has
began to be studied with ardour ; that anatomists and patho-
logists rarely possess sufficient zoological and zoomedical
knowledge, whilst the veterinary physicians, on the other hand,
have as rarely sufficient knowledge of physiology and patho-
logy, and further that the rarity of most animals much in-
creases the difficulty of anatomico-pathological examinations.
Animals are also subject to much fewer diseases than man
living in a civilized state,^ and those only of them which he
appropriates to himself, and about which he evinces the greatest
concern, are most frequently subject to diseases.

Besides the numerous and important contributions to patho-
logical anatomy, which are found dispersed in the writings of

(7) A short view of the History of Pathological Anatomy is given by Morgagni,
praef. ad lib. II. Hecker Magazin fur die pathol. Anat. and Physiol. Altona,
1796, Voigtel, p. 3. and P. Raycr Sommaire d'une histoire abregee de I'Ana-
tomie pathologique. 8vo. Paris, 1818.

(8) G. E, Stahl D. de frequentia morborum in corpore huniano prae brutis.
4to. 1695.

Don Bern. Doiit'mgttez Rosainz Porque son mas frequentes las enfermedades
en los racionales que en los brutos ? &c. Mem. Acad, de la R. Soc. de Sevilla
T. V. p. 191. (Why are diseases more common in man than in brutes?)

b2

4 Introduction.

anatomists, physiologists/ and pliysicians, the best general
works, either exclusively or preeminently, relating to patho-
logical anatomy, are the following:^"

Anton. Benivenius De abditis nonnuUis ac mirandis morborum
et sanationum causis. 4to. Florent. 1507.

*Jo. Jacob Chiffletius, Singulares tarn ex curationibus quam
Cadavenim sectionibus observationes. 12mo. Paris, 1612.

*T. CoRBEUS Patliologia sive Morborum et AfFectuum omnium
praeter naturam qui Corpus Humanum invadere solent enumeratio.
12mo. Francof. 1G16.

*J. RioLANUS, (filius) Encheiridium Anatomicum et Pathologi-
cum in quo ex naturali Constitutione Partium Recessus a naturali
Statu demonstratur. 8vo. Lugd. Batav\ 1649.

*GuALT. Charleton, M.D. Exercitationes Pathologicae novis
Anatomicoi-um inventis sedulo inquiruntur. 4to. London. 1661.

Th. Kerckringii Spicilegium anatomicum, continens observa-
tionum anatomicarum rariarum centuriam unam, etc. 4to. Amstel.
1670.

Th. Bartholinus De anatom. practica ex cadaveribus morbosis
adornanda consilium. 4to. Hafniae, 1674.

Theophili Boneti Prodromus anatomise practicae. 8vo.
Genevae, 1675.

Ejusd. Sepulchre turn anatomicum s. anatomia practica ex cada-
veribus morbo denatis. Vol. II. fol. Genev. 1679. Mangeti,
Vol. III. fol. Lugdun. 1700.

Gregorii Horstii Specimen anatomise practicae. Francof. 1678.

Steph. Blancardi Anatomia practica rationalis, s. rariorum cada-
venim morbis denatorum anatomica inspectio. 12mo. Amstel. 1688.

*Jac. Am. Long, D. de Differentia inter Hominum morbos com
brutis communes. 4to. Alt. 1689.

Bibliotbeca anatomica illustrata et aucta. Digesserunt Daniel
Clericus et J. J. Mangetus. Vol. II. fol. Genev. 1699.

H. BiDLoo Exercitationum anatomico - chirurgicarum Decades
duc-e. 4to. c. tab. Lugd. B. 1708.

Jo. Salzmanni Specimen anatomise curiosae et utUis. 4to.
Argent. 1709.

(9) Viz. Holler, Blumenbach, J. Hunter, Pinel, BlcJiat, and many others.

(10) Compare Baldinf^er Neues Magazin fiir Aerzte, Leipzig, 1799. Vol. IX.
Part I. p. 87, and Vol. XVI. Part VI. p. 481. Hecker, The Manuals of Ludwig,
Conradi, Voigtel, and Conshruch, as well as Heusinger System der Histologie,
Vol. I. Part I. p. 50— 103.

• All the authorities marked thus ♦ are additional. — Trayislator.

Introduciion. B

Jo. Mauritii Hoffmanni Disquisitio corporis humani anato-
mico-pathologica rationibus et observationibus veterum et recen-
tiorum singular! studio collectis, confirmata. 4to. Altdorf. 1713.

Ph. Conr. Fabrizii Idea anatomiae practicse. 8vo. Wetzlar, 1741.

F. Barrere Observations anatomiques tirees de I'ouverture des
cadavres. 4to. Perpignan, 1751. 2d ed. enlarged, with engravings.
4to. 1753.

*C.N. Jenty, M.D. a Course of Anatomico-Physiological Lec-
tures on the Human Structure and Animal CEconomy, &c. and
Pathological Observations, deduced from the Dissection of Morbid
Bodies. Including whatever is most valuable in the Works of all
the eminent Professors on these subjects. 3 vols. 8vo. London,
1751—65.

Albini Variae annotationes anatomico - pathologicse in Lam-
brecht's Oblectationes et observationes anatomicae. Francof. 1751.

J. D. Metzger Observationes nonnuUae anatomico - pathologicae
c. Epicrisi. Regiom. 1757.

Pet. Camper Demonstrationes anatomico ~ pathologicse. fol.
Lib. I. etll. Amstelod. 1760—62.

Jo. BaptistjE Morgagni De sedibus et causis morborum per
anatomen indagatis. Vol. II. fol. Venet. 1761. — fol. Patav.
1767. — Vol. II. 4to. Amstel. 1768. — Ebroduni in Helvet. ex
edit. TissoTi, 1799. Vol. III. 4to. Translated into German by
KoENiGSDOERFER. 5 vols. 8vo. Altcub. 1771. Edid. J. Radius.
Lips. 1828.

* Samuel Clossy, Of some Diseases of the parts of the Human
Body, chiefly taken from the Dissections of Morbid Bodies. 8vo.
London. 1763.

Alb. v. Haller Opera minora. 4to. Laus. 1762 — 68. Vol. III.
and Opuscula pathologica. 8vo. Laus. 1768.

Rich. Browne Cheston, Pathological Inquiries and Observations
in Surgery from the dissection of morbid bodies. 4to. Glocester, 1766.
Pathologische Untersuchungen und Beobachtungen in d. W. A. K.
durch Zergliederung krankhafter Leichname ; nebst cimen An-
hange von 12 versch. Wahmehmungen v. J. C. F. Scherf. 8vo,
Gotha, 1780.

JoH. Lieutaud Historia anatomico-medica, sistens numerosissima
cadaverum humanorum extispicia, quibus in apricum venit genuina
morborum sedes. Edit, ab Ant. Portal. Vol, II. 4to, Paris, 1767.
recudi curavit, correxit et suppl. complet. J. Chr. Fr. Schlegel.
Vol. II. 8vo. maj. Longosaliss. 1786 — 87.

Ed. Sandifort Observationes anatomico-pathologicae. Vol. IV.
c. fig. 4to. Lugd. B. 1777—80.

Chr. Fr. Ludwigii Prunse lineae anatomise pathologicae. 8\o,
Lips. 1785.

6 Introduction.

VicQ d'AzYR Artie. Anatomie pathologique, in the Encyclopedic
methodique. 1789.

Chr. Fr. Ludwigii De quanindam segritudinum h. c. sedibus et
causis, tabulis 16, meditat. nonn. illustr. fol. Lips. 1798.

Matthew Baillie, The morbid anatomy of some of the most
important parts of the Human Body. 8vo. 5th edition. London,
1818. Translated from the 1st edition into German, with additions,
by S. Tn. Soemmerring. 8vo. Berlin, 1794. and the Appendix,
with the 5th edition, translated by Dr. C. Hohnbaum, and with
additional remarks by S. Th. v. Soemmerring. 8vo. Berlin, 1820.
— translated also into Italian by Zannini, and into French by

GUERBOIS.

Ih. Series of Engi-avings, accompanied with Explanations,
which are intended to illustrate the morbid anatomy of some of the
most important parts of the human body. 2d ed. 4to. London, 1812.

Ih. The morbid anatomy and other works of the late, by
J. Wardrop. 2 vols. 8vo. Lond. 1827.

Georg. Christoph Conradi Handbuch der pathologischen Ana-
tomie. 8vo. Hannov. 1799.

J. C. Flachsland Observationesanatomico-pathologicae. Rastad.
1800. c. tab. aen.

Spry Ueber die Anatomie des kranken K<5rpers v. Friese Annalen
der neusten britt. A. K. u. W. A. K. Bd. I. St. I. 1801.

C. Bell, A System of Dissection, explaining the anatomy of the
human body, the manner of displaying the parts, and their varieties
in disease, fol. Edinb. 1798.

*/6. Engravings of specimens of morbid parts in the Author's
collection, fol. London, 1813.

V. Malaga RNE Ricordi della Anatomia chirurgica raccolti.
2 tom. 8vo. Padova, 1801 — 2.

G. DupuYTREN Propositions sur quelques points d'anatomie, de
physiologic et d'anatomie pathologique. Paris, 1803.

A. R. Vetter Aphorismen aus der pathologischen Anatomie.
Wien. 1803.

G. H. Thilow Beschreibung anatomisch-pathologischen Gegen-
stiinde durch Wachspraparate und Kupfer versinnlicht, nebst ver-
schiedenen Anmerkungen. Bd. I. L. I. Gotha, 1804.

Prost Medecinc eclairee par I'observation et I'ouverture des corps.
2 tom. 8vo. Paris, 1804.

Portal Cours d' Anatomic m^dicale, ou elemens de I'anatomie
de I'homme avec des remarques physiologiques et les resultats des
observations sur le siege et la nature des maladies d'apres I'ouverture
des Corps. 5 tom. 8vo. Paris, 1804.

Introduction. 7

F. G. VoiGTEL Handbuch der pathologischen Anatomie. Mit
Zusatzen von P. F. Meckel. 3 bde. 8vo. Halle, 1804 — 5.

C. J. Kellethout Sectiones cadaverum pathologicae. Lugd.
Batav. 1805.

Flor. Caldani Osservazioni anatomico-patologiche. Memoria I.
in Memor. di Matemat. e di Fisica della Societ. Italian. T. XII.
P. II. Modena, 1806.

Pit. Fr. Meckel Journal fiir anatomische Varietiiten, feinere und
pathologische Anatomie. 8vo. Bd. I. H. I. m. k. Halle, 1805.

*F. I. V. Broussais Histoire des Phlegmasies on inflammations
chroniques. 2 torn. 8vo. Paris, 1808 — 1816.

JoH. Fr. Meckel Handbuch der pathologischen Anatomie, Bd. I.
Bd. II. Abth. 1 und 2. 8vo. Leipzig, 1812—18.

J. M. D. Herold D. exh. Observata quaedam ad corp. hum. par-
tium structuram et conditionem abnormem. 8vo. Marburg. 1812.

Alex. Monro, jun. Outlines of the Anatomy of the Human
Body in its sound and diseased state. 8vo. Edin. 1812. 3 vols,
and 1 vol. engravings.

JoH. Fr. Blumenbach De anomalis et vitiosis quibusam nisus
formativi aberrationibus commentatio. 4to. c. duob. tab. sen. Got-
ting. 1813.

*Kelcii Beitrage zur patholog. Anatomie. Berl. 1813.

J. Farre, Pathological Researches in Medicine and Surgery. 8vo.
London, 1814.

A. F. Fowe D. s. animadversiones in anatomiam pathologicam.
8vo. Berol. 1815.

GoTTFR. Fleischmann LeiclieuofFnungen. 8vo. Erlangen, 1815.

*J. W. Francis, M.D. Cases of Morbid Anatomy. 4to. New-
York, 1815.

C. H. Parry, Elements of Pathology and Therapeutics, illus-
trated by numerous Cases and Dissections. Vol. I. 8vo. Lond.
1816.

Jean Cruveilhier Essai sur I'Anatomie pathologique en gene-
ral et sur les transformations et productions organiques en parti-
culier. 2 tom. 8vo. Paris, 1816.

Ih. Medecine eclairee par I'Anatomie et la Physiologic patho-
logique. 8vo. Cah. I. Paris, 1821.

Ih, Anatomie pathologique du corps humain, ou descriptions
avec figures lithographiees des di verses alterations morbides, dont
le corps humain est susceptible, fol. Liv. I. to X. Paris, 1828 —
1831.

A. W. Otto Seltene Beobachtungen zur Anatomie, Physiologic
und Pathologic gehorig. 4to. m. k. Ites. Heft. Breslau, 1816,

8 Introduction.

2tes Heft. Berlin, 1824. (Also under the title, Neue seltene Beo-
bacht.)

John Howship, Practical Observations in Surgery and Morbid
Anatomy illustrated by cases, wdth Dissections and Engravings. 8vo.
Lond. 1816. Translated into German by Schulze. 8vo. Hal-
berst. 1819.

J. F. Meckel Tabulae anatomico - pathologicae, modos omnes,
quibus partium corp. hum. forma externa atque interna a norma
recedit, exhibentes. fol. Fasc. I. — IV. Lips. 1817 — 26.

Rob. Allan, A System of pathological and operative Surgery,
founded on Anatomy, illustrated by Drawings of diseased Structure
and Plans of Operations. 3 vols. 8vo. Edinburgh, 1819 — 24.

J. B. Palletta Exercitationes pathologicae. c. tab. aen. 4to. maj.
Mediol. 1820. P. II. Mediolani, 1827.

Consbruch's Taschenbuch der pathologischen Anatomic fiir
praktische Aerzte und Wundarzte. 8vo. Leipz. 1820.

P. J. Wassermann D. de mutationibus pathologicis primitivarum
in organismo humano fonnationum. 8vo. Padua, 1820. v. Disser-
tazioni inaugurali d'argomento medico-clinico publicate nell' J. R.
University di Padova. 8vo. Padova, 1821.

Fr. Nasse Leichenoffiiungen, Ite Reihe. 8vo. Bonn, 1821.

L. Cerutti Pathologisch-anatomisches Museum, enthaltend eine
Darstellung der vorziiglichsten krankhaften Yeranderungen und
Bildungsfehler der Organe des menschlichen Korpers u. s. w. Bd. I.
Heft I. und II. 4to. Leipz. 1821— 24.

H. F. Jsenflamm Anatomische Untersuchungen. 8vo. Erlang.
1822.

Tacheron Recherches anatomico-pathologiques sur la Medecine
pratique, etc. 3 tom. 8vo. Paris, 1823.

PoiLROux Nouvelles Recherches sur les maladies chroniques et
principalement sur les affections organiques et les maladies h^re-
ditaires. 8vo. Paris, 1823.

Xav. Bichat Anatomic pathologique, ed. par Boisseau. 8vo.
Paris, 1825. Translated into German, with Notes, by Pestel.
8vo. Leipz. 1826.

Heusinger Berichte von der Konigl. anthropotomischen Anstalt
uz Wiirzburg. Iter Bericht. 4to. m. k. Wiirzburg, 1826.

Louis Memoires, ou Recherches anatomico-pathologiques. 8vo.
Paris, 1826.

Repertoire general d'anatomie et de physiologic pathologiques et
clinique chirurgicale, ou Recueil de memoires et d'observations sur
la chirurgie et sur I'anatomie ct la physiologic consider^es dans
les tissus sains et les tissus malades. 8 tom. 4to. with lithog. plates.
Paris, 1826. An almost complete system of Pathological Anatomy is

Introduction, 9

given in three Essays, by Merat, in Diction, de Scienc. m^dicales :
Lesions organiques, Vol. XXVII. p. 485 ; Lesions physiques des
prganes, Vol. XXXVIII. p. 138; and Lesions organiques des
tissus, Vol. LV. p. 210.

Laennec Note sur I'anatomie pathologique in Joum. de Medec.
Chir. et Pharm. par Corvisart, Leroux, etc. T. IX. p. 360,
and his Essay, Anatomic pathologique in Diction, des Sc. medic.
Vol. 11. p. 46.

Spitta Die Leichenoffiiung in Beziehung auf Pathologic u. Dia-
gnostik. Stendal, 1826.

Berard D. sur plusieurs points d' Anatomic pathologique. Paris,
1826.

RiBEs De I'anatomie pathologique consideree dans ses vrais rap-
ports avec la science des maladies. T. I. 8vo. Paris, 1828.

*L. C. Roche and L. I. Sanson Nouveaux Elemens de Patho-
logic Medico Chirurgicale. 5 vols. 8vo. Paris, 1828.

Craigie, Elements of general and pathological Anatomy adapted
to the present State of Knowledge in that Science. 8vo. Edinb.
1828.

R. Bright, Reports of Medical Cases, selected with a view of illus-
trating the Symptoms and Cure of Diseases by a reference to morbid
Anatomy. 4to. with 16 coloured engravings. London, 1827.

J. R. Farre, Journal of morbid Anatomy, or Researches, etc.
London. Vol. I. 4to. with engravings. 1828.

Baron, Delineations of the Origin and Progress of various Changes
of Structure which occur in Man and some of the inferior Animals,
etc, 4to. with engravings. London, 1828.

G. Andral Precis d' Anatomic pathologique. 3 torn. 8vo. Paris,
1829.

J. F. LoBSTEiN Traite d'Anatomie pathologique. T. I. Paris,
1829.

*W. Money, A Vade-Mecum of Morbid Anatomy. 8vo. Lon-
don, 1831.

*Clocquet Pathologic Chirurgicale. Plan et Methode qu'il con-
vient de suivre dans renseignement de cette science. 4to. Paris,
1831.

Descriptions of Anatomical Collections which are of import-
ance to Pathological Anatomy,

RuYSCHii Thesaurus anatomicus I. — X. 4to. c. fig. aen. Am-
stelod. 1701—16.

Ejusd. Curae posteriores sea Thesaurus omnium maximus.

1 0 Introduction,

8vo. Amstelod. 1724. Curse renovatae, etc. 4to. Amstel. 1728.
(in operibus.)

Vatert Museum anatomicum proprium. 4to. c. tab. aen.
Helmst. 1750.

Ed. Sandifort Museum anatomicum Academiae Lugduno-Batav.
T. I. with 9 plates. T. II. with 127 plates, fol. Lugd. Bat. 1793.

KoEHLER Beschreibung der physiologischen und pathologischen
Praparate, welche in der Sammlung des Herm Hofrath Loder ent-
halten sind. Svo. Abth. I. Jena 1794.

Museum anatomicum Boltenianum. 8vo. Hamb. 1796.

J. G. Walters Anatomisches Museum, beschrieben von F. A.
Walter. 2 thl. 4to. "v\dth plates. Berlin, 1796.

Ejusd. Museum anatomicum, etc. venale ofFert. Svo. Berol.
1802.

Ejusd. ^Museum anatomicum, etc. 4to. Berolini, 1805.

F. B. Osiander Epigrammata in complures Musei anatomici res.
Svo. Getting. 1807. Ih. enlarged. 1814.

Biermayer Museum anatomico-pathologicum Nosocomii univer-
salis Vindobonensis. Svo. Vindob. 1816.

Catalogue of the Museum of Heaviside. London, 1818.

Burdacii Berichte von der Konigl. anatomischen Anstalt zu Ko-
nigsberg. Iter bis 6ter Bericht. Svo. Leipzig, 1818 — 1823.

Seidel Index Musei anatomici Kiliensis. Kiliae, 1818.

Cerutti Beschreibung der pathologischen Praparate des anato-
mischen Theaters zu Leipzig. Svo. Leipzig, 1819.

Fanzago Memorie sopra alcuni pezzi morbosi conservati nel
gabinetto patologico dell' J. R. Universita di Padova. 4to. with
engravings. Padova, 1820.

Lobstein Compte rendu k la Faculte de Medecine de Strasbourg
sur r^tat actuel de son Museum anatomique, suivi du catalogue des
objets qu'il renferme. Svo. Strasbourg, 1820.

Ejusd. Compte rendu etc. sur les travaux anatomiques exe-
cutes a I'amphitheatre pendant les annees 1821 — 1823. Svo. Stras-
bourg, 1824.

Loder Index pra3paratorum, aliarumque rerum ad anatomen
spectantium, quae in Museo Univ. Mosquensis servantur. Svo.
Mosquae, 1823. Edit, altera cmendata et aucta. Mosquae, 1826.

A. K. Hesselbach Beschreibung der pathologischen Praparate,
welche in der Konigl. anatomischen Anstalt zu Wiirzburg aufbe-
wahrt werden. Svo. Giessen, 1824.

A. W. Otto Ver/eichniss dor nnatomischcn Praparaten sammlung
des Konigl. Anatoinic-Instituts zu Brcslau. Svo. Breslau, 1826.

Introduction, 1 1

Bleuland Descriptio Musei anatomici academise Rheno-Trajec-
tince. 4to. maj. Traj. ad Rhen. 1826.

Ih. Icones anatomico - pathologicae partium corporis humani,
quae in descriptione Musei Acad. Rheno-Trajectinse inveniuntur.
4to. Fasc. I. & II. Traj. ad Rh. 1827.

Sandifort Museum anatomicum academiae Lugduno-Batavse.
Vol. III. descriptum a Ger. Sandifort. fol. Lugd. Batav. 1827.

*J.Lasky, General Account of the Hunterian Museum, Glasgow.
8vo. Glasgow, 1813.

*Catalogue of the Hunterian Collection in the Museum of the
Royal College of Surgeons in London. 4to. Parts I. to V. Lon-
don, 1830—31.

*Thomas Hodgkin, M. D. A Catalogue of the Preparations
in the Anatomical Museum of Guy's Hospital. 8vo. London,
1830.

Principal Works on the Pathological Anatomij of the Loiver

Animals,

*M. Paulet Recherches Historiques et Physiques sur les Mala-
dies Epizootiques. 2 vols. 8vo. Paris, \11b,

*C. BouGELAT Memoires sur les Maladies contagieuses de
Betail. 4to. Paris, 1776.

* J AMES Clark, First Lines of Veterinary Physiology and Pa-
thology, 1 vol. 8vo. Edin. 1788—1806.

A. G. Camper's Abhandlung von den Krankheiten, die sowohl
den Menschen als Thieren eigen sind. Deutsch von Herbell. 2te
aufl. 8vo. Lingen, 1794.

E. L. W. Nebel De nosologia brutorum cum hominum morbis
comparata. 8vo. Giessae, 1798.

*D. Blaine, Anatomy of the Horse, accompanied with Re-
marks, Physiological, Pathological, Chirurgical, and Natural. Il-
lustrated with tables. 8vo. London, 1799.

*/6. Canine Pathology. 8vo. London, 1800—1817.

*7&. The Outlines of the Veterinary Art ; or, the Principles of
Medicine, as applied to a Knowledge of the Structure, Functions,
and Economy, of the Horse, the Ox, the Sheep, and the Dog,
and to a more scientific and successful Manner of treating their
various Diseases. 2 vols. 8vo. London, 1802 — 1816.

12 Inirochiction.

*D. Blaine, A Domestic Treatise on the Diseases of Horses
and Dogs. 12mo. London, 1803—1810.

Bergmann D. s. primas lineas pathologiog comparatae. 8vo.
Gotting. 1804.

C. A. RuDOLPHi Bemerkungen aus dem Gebiet der Naturge-
schichte, Medizin und Thierarzneikunde, auf einer Reise durch
einen Theil von Deutschland, Holland und Frankreich gesammelt.

2 thle. 8vo. Berlin, 1804-5.

*Temminck Histoire Natnrelle Generale des Pigeons et des
Gallinaces. 3 vols. 8vo. with plates. Amsterdam, 1813.

*Reich Belekung fur den Landman iiber die Rindviel seuche,
1814.

*J. R. Johnson, Treatise on the Medicinal Leech, with Re-
marks upon the Diseases, &c. of Leeches. 8vo. London, 1816.

*Further Observations, &c. 8vo. London.

*M.DupuY Del'afFection tuberculeuse, vulgarement appelee Morve
Pulmonic, Gourme, Farcin, Fausse Gourme, Pommeliere, Phthisic
du Singe, du Chat, du Chien, et des Oiseaux domestiques, comparee
a I'affection hydatideuse, ou pourriture, du Mouton, du Lapin, du
Lievre, et a la ladrerie du Cochon. 8vo. Paris, 1817.

Gandolphi Cenni di confronto tra le malattie dell' Uomo e dei
Brutti in Opusc. scientif. Tom. I. Fasc. VI. 4to. p. 357 —
372. Bologna, 1817.

K. E. Schwab Materialien zu einer pathologischen Anatomie
der Hausthicre. Iter Bericht. 8vo. Miinchen, 1817.

MuNDiGL Comparativ physiol. und nosolog. Ansichten von den
Krankheiten des Menschen und der vorziiglichsten Hausthicre u. s. w.
8vo. Miinchen, 1818.

Greve Erfahrungen und Beobachtungen iiber die Krankheiten
der Hausthicre im Vergleich mit den Krankheiten der Menschen.
Bd. I. und II. Oldenburg, 1818—21.

*W. Percival, Elementary Lectures on the Veterinary Art.

3 vols. 8vo. London, 1823.

O. J. W. Remer D. exh. Pathologiae comparatae Specimen. 8vo.
Vratisl. 1825.

*H. Burger Die veterinair Diagnostik oder die Kunst, die innem
und aussem Krankheiten unserer Hausthicre zu erkennen und von
einander zu unterscheiden. fol. Berlin, 1830.

*Flourens Sur quelques Maladies des Oiseaux, in the Memoires
de I'Acad. Royale des Sciences. Tom. X. p. G07, for 1831.

FIRST,

OR

GENERAL P A R T.

FIRST SECTION.
Of the Vices of Animal Organization in general,

§ 1.

i HE essence of all deviation from the healthy organic con-
dition of animal bodies, is either the disturbance of their

NORMAL NUTRITIVE ACTIVITY IN QUANTITY OR QUALITY, Or
the MECHANICAL SEPARATION OF THE NATURAL CONNEXION

OF THEIR PARTS, whence again are necessarily produced
changes of the nutritive activity.

§ 2.
The Vices of both kinds must, if they can be generally
recognised, relate to the sensible physical peculiarities of
animal bodies, viz. to number, size, form, position, con-
nexion, COLOUR, consistence, CONTINUITY, TEXTURE, and

contents, according to which we shall therefore consider
them. The chemical peculiarities naturally belong to patho-
logical chemistry, on which account, pathological anatomy
excludes generally from its sphere the animal fluids, and only
concerns itself incidentally with the more important fluids, in
reference to their quantity, colour, and consistence.

§ 3.
Very rarely is a part of the body found deficient only in one
of the above-mentioned physical properties — but very commonly
in several at the same time, which often act alternately as cause

14 Vices of Animal Organiisation, [Part I.

and effect. Thus, for instance, vices of form and position, not
unfrequently produce those of texture, colour, consistence,
&c., nay, by stoppage of the juices, give rise to coagulations
and formations of extraneous bodies ; more frequently the
morbid texture of a part induces a change also of form, size,
and position.

§ 4.

According to the period, at which vices of the animal
organization occur, are they distinguished into the congenital,
vitia congenita, and those at a period subsequent to birth, the
ACQViRED, vitia acqmsita;^ the former are for the most part
vices of form and position, whereas the latter, because they
occur at a period, in which the proportional size of the part is
more or less perfectly completed, seem to refer more to the
texture of the part.

(1) This division is of little value, as the period of its origin is less im-
portant, than the cause and nature of the vice ; and at a later period the two
kinds are often not at all to he distinguished. Still the Congenital Vices are often
more closely connected with the life of the whole, and are more difficult to cure
than the Acquired Vices ; for example — coalescence of the fingers.

§5.

According to their causal relations, are all organic vices
ORIGINAL malformations, vitia primce conformationis,^ that is,
arising out of a variation of the formative impulse, in the first
stage of the animal organism, or of that of its single parts ;
or they are produced by mechanical causes, lesions and
WOUNDS, Icesiones et vulnera ; or finally, they are occasioned by
DISEASES, LOCAL or ORGANIC, morbi locales, disorganiza-
tions, &c.

(1) J. Tr. Blunmibachii De anomalis et vitiosis quihusdam nisus formativi
aberrationihus commentatio. 4to. with plates. Gotting. 1813, 8vo. Leyden,
1821. — Suringar D. de nisu formativo ejusque errorihus.

§ 6.
Such malformations, if they be trifling and not injurious
to the individual in which they occur, we call sports of
NATURE, lusus uatiirce,^ or varieties of formation, varie-
tates ; if they mar the external appearance, deformities,
defonnitates, titrpidines ; — if they be strange, considerable, and
striking, we name them monstrosities, monstrositates, and
the individual so circumstanced a monster, monstrum — finally,
such malformations as are so merely at a later period of life,
whilst at an early period they belong to the normal form,
which arise as it were out of a staying, at an early stage of

Sect. I.] Vices of Animal Organization. 15

formation, of the gradual development of the whole body or of
a part of it, and consequently are incomplete developments, are
called RETARDED FORMATIONS, evolutiones retardatce.^ These
are usually congenital, they may however occur also at a later
period. To the retarded formations belong for the most
part the distant resemblances which human monsters sometimes
bear to animals ; however, on closer comparison, the sup-
posed resemblances greatly disappear, or are merely accidental,
occurring always with reference to single parts alone and with
great difference in the remaining parts. Still less has the
brute monster any real resemblance^ to the higher form of
man ; we can always distinguish in each monster, by a more
exact examination, the class, kind, and species to which the
malformed animal belongs ; and the same laws of formation
which prevail in the normal series of animals, are active in the
abnormal, prevent an endless deviation,* and are the ground of
the great resemblance of many monsters.

(1) Timmermami D. de notandis circa naturae lusus in machina liumana. 4to.
Rintel. 1765. — Jnsfeldt D. de lusibus naturae. 4to. L. B. 1772. Ottens D. de
lusibus naturae naturam illustrantibus. Harderov. 1799. \_Fortun. Liceto De
monstrorum natura, causis et difFerentiis. Libri duo, with engravings. 4to.
Patav. 1634. — J. Hofer Observ. Monst. human, in Acta Helvet. Vol. III. p. 373.
4to. Basil, 1751 — 1767. — Vine Malacarne De'Mostri Umani, de caratteri fonda-
mentali su cui se ne potrebbe stabilire la classificazione, e delle Indicazione che
presentano nel Parto 4to. — lb. Osservazioni anatomiche in conferma d'una pro-
posizione circa I'origine de'Mostri. 4to. Modena, 1805. — J. M. de la Sarthe
Description des principales Monstruosites dans Thomme et dans les animaux
pr^cedee d'un discours sur la physiologic et la classification des Monstres, with
coloured engravings, fol. Paris, 1808.]

(2) Harvey De generatione. Amstel. 1662. p. 300. — Wolff in N. Comm. Petro}).
T. XYU.—Reil Archiv f. die Physiol. Vol. IX. p. 63, G'i.—Meckel Handbuch
der pathologischen anatomic. Vol. I. p. 48 — 61. — Mansfeld in MeckeVs Archiv f.
Anat. und Phisiol. 1826. No. I. p. 9Q. von Walther in his and Graefe's Journal
f. Chir. Vol. II. p. 4.

(3) Blumenbach, p. 6.

(4) S. Th. V. Sommerring Abbildungen und Beschreibungen einiger Miss-
geburten, etc. fol. Mainz, 1791. p. 38. § 91. — Geoffroy- Saint-Hilaire Philoso-
phic anatomique, T. II. des monstruosites humaines. 8vo. Paris, 1822. p. 101.

§7.

No class of animals is free from malformations, lesions, and
disorganizations ; but each of them, and frequently even single
orders, families, and kinds, are very differently affected by them
according to the peculiarities of their organization, kind of
life, &c. There are malformations and organic diseases which
belong only to certain kinds,^ or are particularly frequent in
them.^ It sometimes even happens that the morbid direction
of the formative impulse, accidentally excited in the parents, is
so permanent and innate, that several young born at the same
time are similarly malformed,^ or that the young of several

16 Vices of Ani7)ial Organization. [Part I.

successive births are subjected to similar malformations or
disorganizations.* Mechanical causes affecting the mother,
can also produce a change in several of the children subse-
quently born.^

(1) /. Hunter, Observations on certain parts of the Animal Economy. 2d
edition. 4to. London, 1792. p. 75.

The siren-formation and cancer are peculiar to man ; — to cats, the elongation
of the hind feet, with contemporaneous shortening of the tail ; — to cattle, the
upward curvature of the ribs ; — to snails, the inverted winding and separation of
their volutes (cornu copiae) &c.

(2) For instance, the proboscis in cyclopic swine, the supernumerary feet in
cattle, the shortening of the face in carp, &c. ; — ruptures in man ; inflammation,
dropsies more frequent in one kind than another.

(3) For example, two children with hydrencephalus and curvature of the
extremities, v. Walter Museum anatomicum, 4to. 1805, p. 123, No. 818. — Four
dogs, with defective fore feet and with the hare fissure (hare lip), v. Aucante in
Roux's Journal de Medecine, Vol. XXXII. p. 14. — Two monstrous swine in the
Breslau Museum, No. 2981 and 2982. — Three rattle snakes, with double heads.
V. Mitchell in the American Journal of Science and Arts, 1825, Oct. p. 48.
All ten pigs of one sow were littered without eyes, in the neighbourhood of
Breslau.

(4) Meckel has collected many cases, Handb. der pathol. anat. Vol. I. p. 15.
Three brothers and sisters with shortening of the right thigh, v. Schreger Chir.
versusche. Vol. II. — Three brothers and sisters with deficient brain, v. Penada
Saggio d'osservazioni e memorie, etc. Padua, 1793. — Seven children of the same
parents were affected with hydrencephalus. v. Ralph in London Medic. Reposit.
Sept. 1824. — Four brothers and sisters died of cancer of the eye. v. Lerche in
Verm. Abhandl. a. d. G. d. Heilk. von einer Gesell. prakt. Aerzte, Petersb.
Part I. 1821, No. 14. — I know a case of three brothers and sisters without
an eye-ball, and another case of umbilical rupture in several brothers and
sisters.

(5) A woman who had in the back part of the pelvis a pointed bony tumour,
bore four children, each of whom had a deep indentation, and an unossified spot
on the forehead, v. Fratik in Textor's Neuem Chiron. Vol. I. Part II. p. 2G1.

§ 8.
Very frequently is the irregular form transmitted from the
parents to their children and grandchildren/ and even be-
comes permanently hereditary ; even the more peculiar Vices of
the parents, whether Congenital, or Acquired from disease,
are sometimes inherited for many generations ; ^ we find this
especially the case with reference to the extremities,^ and it
gives rise in brutes to particular varieties.* Even intentional
dismemberments may easily become hereditary/

(1) For example, the habitus apoplecticus and phthisicus.

(2) To wit, the thick joints of rickety parents, fissured nose in dogs, an
exostosis on the head of a bull. v. RudolphVs Bemerkungen aus d. Geb. d.
Naturgesch. u. s. w. 8vo. Berlin, 1804, Vol. I. p. 75. — The goitre, wolf's and
hare lip. v. Irew. N. Act. N. C. I. p. 415, and Amia in IlartenkeiVs Med. chir.
Zeitung, 1805, Vol. IV. p. 212; — the hypospady, or termination of the
urethra beneath the glans penis, v. Heuermann med. Bcob. Vol. II. p. 234, &c.

(3) For example, six fingers and toes, or jimction of them, occur in whole
families; the short great toe is liereditary in all of us; further, club-feet, spavin,
capped heels, diseased hoofs; for some instances in man, v. 0//o Selt. Bcob,
P;irt I. \o. 22, )). 00.

Sect. I.] Vices of Animal Organization. 17

(4) In the American short-legged sheep, in swine with one hoof and witli
three, dogs with wolf's claws, fowls with five or six toes.

(5) For instance, in man, the circumcised prepuce ; in dogs and horses, the
shortened ears and tails. [To this belong the crooked-tailed cats, of which an
account is given by G. Bennett, in London Med. Gazette, Vol. VIII. p. 332.
1831, On a peculiar formation of the tail in the Malay and Manilla cats. T.]

§9.

The disposition towards this or that kind of irregularity also
varies according to the difference of sex, age, climate, mode
OF LIVING, &c. The FEMALE BODY, for instance, is more
subject to malformations, softening of the bones, spurious forma-
tions, especially fatty tumours, cancer, femoral rupture, &c.
thaa the male body, which, on the other hand, is more
frequently affected with aneurysms, inguinal ruptures, and,
on account of the mode of living, with mechanical lesions.
Each AGE, CLIMATE, and occupation has its peculiar dis-
eases^ which often alter the organization. Domestic animals
are also more frequently subject to pathological states than
the wild of the same species ; viz. to malformations which
are the more common, the more artificially the animals are
influenced by man.^ Still the reason why our domestic
animals produce monsters in so much greater proportion than
others, appears to rest either on the particular operation of
man upon certain animals, or on their particular condition.^
Even the artificial hatching of eggs is said frequently to
produce deformed chickens.'^

(1) Almost all foreign animals which have died in menageries, have pre-
sented to me the appearance of scrofula, diseases of bone, and a morbid state of
the viscera. \_A. Wilson, M. D. Some Observations relating to the influence of
climate on vegetables and animal bodies. 8vo. London. 17&0. — M. Roulin, M.D.
Inquiries respecting certain changes observed to have taken place in domestic
animals transported from the old to the new world, in Jamieson's Journal, new
series. Vol. VII. p. 326. Svo. Edinb. T.]

(2) Among beasts, in the domestic animals of this class ; among birds, in the
domestic fowls and pet birds; and among fishes, in the carp and gold fish.
\^F. Cuvier, on the domestication of mammiferous animals, in Jamieson's Journal,
new ser. Vol. IV. p. 60, 292. Svo. Edinb. T.]

(3) For example, oxen and sheep, much more commonly than swine, goats,
and particularly horses ; cats more frequently than dogs, &c.

(4) With deficient limbs, v. Shaw, On the nature and treatment of the
distortions to which the Spine, &c. Svo. p. 39. London. 1823. — Gerson and
Julius Magaz. d. ausland. Lit. d. ges. Heilk. 1824. luli u. Aug. p. 91. —
Geoffroy- Saint- Hilaire in Memoirs du Museum d'Hist. nat. Vol. XIII.

§ 10.

Finally, particular regions and parts of the animal body
present great variety in the proportionate frequency of their
congenital or acquired vices. The left side, usually the
weaker, although not from malformation, is however affected
by organic disease more frequently than the right;' the right

18 Vices relating to Number, [Part I.

half of the brain alone makes an exception to this rule, in
consequence of the stronger flow of blood through it.^ The
irregularly increased number of parts is more common in
the upper half of the body ; on the contrary, in the lower,
consolidation is most frequent. The upper extremities are
more subject to variety in the blood-vessels ; the lower extre-
mities more to diseases, to wit, ulceration. Those organs
which are situated nearest to the heart are subject to many
diseases, on account of the strong circulation in them ; whilst
those farther distant are disposed to other diseases, depending
on a weaker circulation. Finally, the heart, the blood-
vessels, the digestive, urinary, and sexual organs, are more
frequently subject to vicious formations than the nervous
system, the organs of sense, of respiration, &c.^

(1) Du Pui Diss, de homine dextro et sinistro, Lugd. Batav. 1780, reprinted
in SchlegeVs Thes. pathol. therap. Fasc. I. No. 1. — Monteggia De morbis symme-
tricis et asymmetricis in Fasc. pathologicis, No. 1. Mediol. 1789. — Courmette in
the Journ. de Medecine, p. 85. — Isenflamm in his and Rosenmiiller's Beitr. f. die
Zergliederungskunst, Vol. I. Part I. No. 2. — Osiander in Abhandl. der phys. med.
Soc. zu Erlangen, Vol. I. p. 331. — Ardieu Considerat. anat. et physiol. sur la
ligne mediane, qui divise le corps en deux moities symmetriques. Strasb. 1812. —
Mehlis Comment, de morbis hominis dextri et sinistri. 4to. Gbtt. 1818. — Hemsing
D. de privilegio lateris dextri in corpore humano. Groening. 1822. — Kopp
Ueber die Verschiedenheit zwischen der rechten und liuken Seite beim
Menschen, besonders im krankhaften Zustande, in Hufeland's Journal d. prakt.
Heilk. Febr. 1827, p. 3. (Is the left side in brutes also more frequently affected
than the right?)

(2) This is the case, at least according to my own experience, as I have found
likewise the lungs, kidneys, testicles, and ovaries more frequently diseased on
the left than on the right side, though some writers maintain the reverse.

(3) For the rest moreover, all parts belonging to a particular system have a
disposition to the same diseases, which was first noticed by Bichat ; compare
also Hohnhavm iiber das Fortschreiten des Krankheitsprocesses, insbesondere
der Entzxindung u. s. w. 8vo. Hildburghausen, 1826, p. 52 — 299.

SECOND SECTION.

Of Vices relating to Number,

§ 11.

These naturally arise out of the diminution or increase
of the normal number of animal parts ; still, however, both
of these abnormal conditions occur not unfrequently in the
same individual, so that whilst in one part a deficient for-
mation is observed, in another it is seen in excess.*

Sect. II.] Vices relating to Numher, 19

(1) For example, monsters with prominent deficiency exhibit perhaps a
supernumerary finger or toe ; and double monsters perhaps a deficiency in
some one part. To the latter observations those cases in some measure belong,
in which, of twins or triplings one only is found very deficiently formed ; [of
which an instance is given by J. Warner, in Phil. Trans. Vol. LX. 1770, in which
a woman was delivered of a live child of full growth, together with a very small
foetus, which had no visible connexion with the placenta, but was squeezed flat,
and seemed shrivelled, but not at all putrid. In the Mus. Coll. Surg. Lond. is
a similar very beautiful instance in a twin abortion of six months ; one of the
embryons had attained its perfect size, whilst the other docs not exceed half an
inch in its total length, and,. like Warner's case, is not in the least connected to
the placenta, but near its edge attached to the chorion ; it was at first mistaken
for a hydatid. T.]

§ 12.

The COMPLETE DEFICIENCY, defectiis, of a particular part,
or the diminished number of such organs as are multiplicate,
is very frequent. We distinguish the original from the
ACQUIRED DEFECT ; the former is observed chiefly in respect
to every part of an animal body, without the conformation of
the remaining parts being necessarily disturbed by it; ^ although,
indeed, we observe oftentimes, in this respect, certain sym-
pathetic proportions between certain organs.^ Frequently the
external form of the body is tolerably regular, whilst one
or other of the internal parts are wanting. Again, some
organs are more frequently wanting than others,^ and some-
times so many at once, that, instead of a foetus, merely a
head, or an extremity, or nothing more than an unseemly
lump of flesh, is produced ; still, however, of the general
systems, the external skin and cellular tissue, and, perhaps,
also the nervous and vascular systems, are never wholly
deficient. As in the first stage of the embryon, almost all
organs are as yet wanting, so does this want of parts prin-
cipally belong to retarded formations.

A peculiar kind of numerical diminution of some parts
arises out of the original consolidation of two similar, usually
separate organs, into one.*

(1) Compare below, Monstraper defectum. — The comparison of the deficiency
of parts, with the possibility of preserving life, is of considerable interest to
physiology.

(2) Thus, for instance, generally, though not always, the peripheral parts of
a system are deficient at tlie same time with its central, v. Mayer, p. 228, and
Meckel, p. 3i0, in Archiv f. Anat. und Physiol. 1826, No. II. ; the heart com-
monly with the head ; the renal glands frequently with deficient brain ; the
extei'nal organs of generation with deficient lower extremities, &c.

(3) For example, the brain, urinary and genital organs, much more frequently
than the heart, the liver, or intestinal canal ; the deficiency of the upper half of
the body is not quite rare ; that of the lower half, with complete formation of the
upper, is unheard of, &c.

(4) Compare §30.

c2

^0 Vices relating to Number. [Part I.

§13.

The ACQUIRED DEFICIENCY of Certain limbs or parts arises
either from mechanical causes or from disorganization. To
the first cause belong the accidental or intentional mutilations/
viz. amputations, extirpations, &c., which are sometimes very
similar to the original defective formations ; — to the latter we
refer the rare total wasting of single organs by increased
absorption, and the more frequent destruction by ulceration,
mortification, &c.

(1) The subsequently reproduced parts of inferior animals, occasionally pre-
sent a diminished number of their component parts ; for instance, the feet of
salamanders have fewer toes. v. SpaUanzani's Physical and Mathematical
Treatises, p. 62.

§14.

The IRREGULAR MULTIPLICATION of the parts of a body
is also frequently observed;^ in the higher classes of animals
it is always congenital, whereas in the lower classes it also
occurs subsequently, and can sometimes be even artificially
produced.^ The degree of multiplicity ascends from the re-
duplication of single parts only in manifold degrees up to
that of almost the whole body,^ but extends only in very rare
cases beyond the doubling of the normal number.^ The fre-
quency of reduplication also varies very much in the several
parts of the body.^ The superabundant parts are in general
connected with the similar normal parts, yet there are also
exceptions to this law.*^

Finally, it is proper to distinguish from the real multiplicity
of organs, that which is only a seeming increase owing to the
congenital division of an organ into two halves or into several
smaller pieces, and which belongs rather to Vices of Form.'

(1) Meckel De duplicitate monstrosa commentarius, fol. Halae, 1815, with
eight engravings. — Brisohet in Archives g^n6rales de Medecine, Paris, Dec.
1823. — J. C. L. Barkow Commentatio Anatomico Physiolog. de Monstris dupli-
cibus, 4to. Leipzig, 1828, with engravings.

(2) The reproduced fore feet of salamanders acquire occasionally five toes
instead of four, v. Platteretti, in Opusc. scelti di Milano, Vol. XXVII. p. 26,
note. In lizards we can, by a particular injury of the tail, easily occasion the
production of a second ; the reproduced claws of a crab have occasionally a
sui)ernumerary finger, (claw) &c.

(3) Compare below, Monstra per excessum.

(4) There are a few examples of monsters with three heads, three tails, three
thumbs on the claw of a crab, &c.

(5) Accessory intestines and organs of sense, for example, are much more
rare than a multiplicity of the extremities and their parts.

(6) For instance, the bronchi of accessory lungs opened in one instance into
the stomach, v. Otto Sell. Beob. Part I. p. 15.

(7) Compare § 23.

Sect. III.] ^1

THIRD SECTION.

Of Vices relating to Size,

§15.

Vices of this kind deviate from the normal bulk in two ways,
that is, by diminution and by enlargement ; they may be, further,
either original or produced at a later period, but in many cases
it is difficult to distinguish between the two;^ finally, they may
exist only at the time when they are observed.

(1) \_Changeux Sur les Nains et sur les Geants, Journ. de Physique, Vol. XIII.
p. 167. T.]

§16.

The ORIGINAL IRREGULAR DIMINUTIVENESS, maguitudo ini-

minuta, seu parvitas genuina, may affect the whole body or
only particular parts; consequently it is either general or
LOCAL. The first we call dwarfishness, microsomia^ and
the beings so circumstanced dwarfs, pumiliones, nani pyg-
mcei} Such individuals are either born very small or grow
but little at a subsequent period. Sometimes dwarfishness
is hereditary, or affects many brothers and sisters,^* especially
twins and triplings ; and this not unfrequently occurs in
animals, especially the domestic.^

(1) Compare G. Fr. J'dger Vergleichung einiger durch Fettigkeit oder kolos-
sale Bildungausgezeichneter Kinder und EiNiGER Zwerge, 8vo. Stuttgart, 1821.
— Plouquet Repertor. Art. Pygmaeus. — Virey Histoire naturelle du genre hu-
main, 2d edit. Vol. II. p. 265. — Reuss Repertor. Commentat. Vol. I. p. 104, and
Vol. X. p. 44 and 299. — Wunsch Unterhaltungen liber den Menschen, 2d edit.
Vol. I. p. 319. — The oberamtsactuarius Joseph Hoedle, ofEndingen, is 30 inches
high ; Elizabeth Ralph, of Devonshire, was, in her twenty- first year, only 2 feet
10 inches high, and 20 pounds in weight, &c. There are said to have been
adults of 18 and even 16 inches height. [The smallest authentic case is that of
Madlle. Crachami, whose skeleton is in the Museum of the Royal College of
Surgeons, No. 7 of the Osteological Series, and measures exactly 20 inches in
height; but Mr. Clift informs me that when exhibited, she was said to be only 18
inches, which must of course have been incorrect. She died in her tenth year, in
the summer of 1824, at London, v. Catalogue of the Mus. Roy. Coll. Surg, in
Lond. There is also in the College Museum, a painting of the Corsican fairy,
which measures 2 feet 7^ inches high. She was exhibited in London about the
same time as Byrne, v. Section 20, note 2. Among Mr. Hunter's papers there
is a memorandum, unfortunately without name or date, of " A little dwarf woman,
at Norwich, 34 inches in height," which is believed, by Mr. Clift, to refer to this
painting. And it goes on to state, that she cohabited " with a great fellow she
called her husband," and became pregnant. She went her full time, but as might
have been expected, from the smallness of the pelvis, the labour was difficult,
and it was necessary to open the child's head ; after which, the delivery was
effected. The child measured 22 inches; "so that," says the writer of the
memorandum, " if it could have stood upright in utero, it would have risen above

22 Vices relating to Si^c. [Part I.

its mother's head." The woman died four hours after delivery. Boruwlaski,
the celebrated Polish dwarf, measured 39 inches in height when thirty years
old. He was, till very lately, if not at present,'living at Durham. T.]

(]*) [It is remarkable, that of the six children of which Boruwlaski's father's
family consisted, they were born alternately short and tall ; — the eldest son was
3 feet 6 inches, and lived to sixty years of age ; the second, 5 feet 10, and died
at twenty-six years; Boruwlaski himself was the third; the fourth and sixth
were of the common height ; but a daughter, who was the fifth child, measured
only 2 feet 2 inches, and died at twenty- two. T.]

(2) Especially the case in dogs ; I have likewise seen it in horses and goats.

§17.

The irregular diminutiveness is more frequently but par-
tial, so that particular organs only do not acquire their
proper size, and are therefore disproportioned to the rest of
the body: thus the head,' the trunk, or, finally, the extre-
mities'* may be too small in proportion to the other parts.
Such malproportions occur frequently in giants and dwarfs.
In monsters, the enlargement of a particular part is fre-
quently effected as it were at the expense of other parts ; the
accessory parts in double monsters, as well as the reproduced
parts in animals, as the tails of lizards and serpents are
usually too small, and so remain. General weakness, lame-
ness, and continued pressure,^ diminished flow of the juices,
&c. not unfrequently retard the growth. Often, together with
the natural size of the other parts, the whole systems are back-
ward in their development, and either remain small or are
developed at an unusually late period ; this is most commonly
observed in the sexual parts,^ more rarely in the respiratory
organs, and least frequently in the vascular and bony systems.*

In hollow organs, and especially in certain canals, an irre-
gular NARROWING, and even complete imperviousness, is
often the consequence of deficient development ; the latter is
called, especially if it affect the mouths of such canals, con-
genital CLOSURE, atresia congenita, which, as it is always
observed in the early stage of foetal existence, in new-born
infants has been found as an irregular appearance in all the
openings of the body.

(1) A remarkable instance given by Hell D. de concretione digitorum,
8vo. Laiidsh. 1820, with figures.

(1*) [A very good instance of disproportionate limbs, was a man, who, some
years ago, might have been seen on Blackfriars' Bridge, sitting in a little chair,
making pens, and from his habits, known as Drunken Andrew (the King of the
lieggars). He was altogether of small make, sare his head, which was that of
an adult; but his lower extremities did not exceed those of a cliild of four years
nUl, and were not cai)able of su])porting his weight ; he was, therefore, obliged
to wheel his little cliair al)out on crutclies. T.]

(2) For example, the small feet of the Chinese.

(•">) With which also the ])ubic hair, and in man the beard and larynx — in
woimu the breasts usually sympathize. In the male sex I have seen smallness

Sect. III.] Vices relating to Size, 23

of the genitals most frequently occasioned by onanism ; a remarkable example
of impeded development from caries, and of quick maturity after amputation
of the diseased member, is given by Martini in Rusfs Magaz. d, ges. Heilk.
Vol. XIX. Part III. p. 590. Complete development of the whole body and of
the genital organs from pressure on the medulla oblongata is described by
Lenhoss in the Medic. Jahrb. d. K. K. Oesterreich. Staates. N. F. Vol. III.
Part I. p. 96.

(4) Most frequently, hov^rever, with respect to the teeth,

§18.

The ACQUIRED DIMINUTIVENESS differs in this respect from
the original, that parts which are already developed and of
their natural size, as it were, retrograde and diminish ; this
can but seldom occur generally, and can then, in the higher
animals, whose bodies by means of the skeleton possess a
certain permanent proportion, only affect the soft parts, ^ which,
deprived more or less of their interstitial, fatty, gelatinous
and serous parts, exhibit a morbid dryness, leanness, and
WASTING, macies, macor, marasmus, tabes or atrophia uni-
versalis,^ The diminution is more frequently only local or
in one system, and then is called wasting, atropJiia or tabes
partialis, also ariduraf it is either merely the consequence
of diminished nutrition,^* or it is also connected at the same
time with degeneration of the tissue, particularly often with
hardening and ossification. Almost every part of the body,
even the hardest parts, as the bones and cartilages, are subject
to wasting, which may arise from manifold causes ; but espe-
cially from external or internal pressure, from tearing, from
the contraction or closing up of the nutrient blood vessels,
from palsy of the nerves, from long continued rest,^** and from
inflammation, and in rare cases attains such a degree, that the
parts affected by it entirely disappear.'^ If wasting occur in
the hollow organs, their sides become unnaturally thin, and
sometimes so weak, that they can no longer resist the force
which expands them.

(1) Sometimes, however, the whole body becomes somewhat shorter and
smaller by wasting of the intervertebral ligaments, of the articular cartilages,
and even of the bones. Injuries, also, may, without the cause being recognized
at the time, diminish the size of the body; thus I know a man, who, by
fracture of both thighbones, has become about four inches shorter, without being
otherwise deformed. The shrivelling of animals, as the mollusca, belongs rather
to emaciation than to the present subject.

(2) Perhaps more correctly Oligotrophia. A striking example of this is the
so called ' living skeleton,' Claude Ambroise Seurat, who, on account of his
extreme leanness, has been exhibited for money, v. Froriep's Notizen, Vol. XL
No. 20, p. 313, with a figure. The emaciation is greatest in diseases of the
digestive organs ; on the other hand, it is occasionally not consequent on ulcera-
tion and other diseases of the urinary organs, of the breast, cancer of the
rectum, &c. Compare Pemberton's Practical Treatise on various diseases of the
abdomen, p. 186. Compare Art. Atrophia in Plouquet's Repertorium.

^ Vices relating to Size. [Part I.

(3) Nurnberger D. de atrophia partial!, s. de ariduris. 4to. Wittenb. 1792.

(3*) [A remarkable instance of wasting from this cause occurred several years
since, when a part of Dover cliff fell down, by which a pig, known to have
weighed, just before the accident, eight score, or 160 pounds, was buried. The
animal remained entombed during one hundred and sixty days, when, as the
workmen were clearing away the rubbish, they thought they heard a weak moan,
and directing their labours in the direction of the noise, soon met with the pig,
the life of which had been preserved by a piece of the cliif having lodged over
its stye ; during this time it had had no food, beyond perhaps the litter and
biting the chalk, on which its teeth marks were visible, and the water which
had run through the cliff. When taken out, it weighed only two score, or 40
pounds. T.]

(3**) [There is a fine specimen of this state of the thigh bone in the Mus.
Coll. Surg. Lond. No. 448, in which the body of the bone does not exceed |ths
of an inch in diameter, but the cause is not known. There is also a similar
instance in the Mus. Lond. Univers. of the upper arm bone. T.]

(4) For instance, the chrystalline lens after depression ; the testicles in
syphilitic persons.

§ 19.

A peculiar form of morbid diminution is the contraction
OF canals and cavities, strictura, coarctaiio, produced by
the contractility existing in almost all animal tissues, and
often much increased by morbid irritants;^ — by deficiency
of expansile power ; ^ — by thickening of the walls of the canal f
— by external pressure, &c. The highest degree of narrowing
is the MORBID CLOSURE, atresia morbosa, which, however, is
much more rare than the congenital.

(1) For example, by stones in the biliary and urinary bladder.

(2) Thus, blood-vessels and excretory ducts which convey no fluids, con-
tract themselves in consequence, — the intestinal canal below the foecal fistula, —
articular cavities after dislocation, — the sockets after extraction of the teeth, — all
bony canals when the vessels or nerves passing through them disappear, even
the cavities of the orbits and chest, when their contents collapse.

(3) Frequently in the alimentary canal and urethra.

§20.

To the excessive smallness is opposed the irregular mag-
nitude, magnitudo aiicta, which may be either original or
ACQUIRED subsequently. The former is not unfrequently
general, affecting the whole body, for children may be born
unusually large and strong,' or during youth, they may have
an unnaturally active growth,^' and thus attain a size which
remarkably exceeds the ordinary bulk. This is called
giantism, macrosomia, magnitudo giganiea^ and individuals
so affected are called giants, hojnines prcegrandes, gigantes,^
This giantism occurs also, though not so commonly in brutes.''*
In many instances irregular magnitude is united with unusual
fatness,^ not unfrequently, also, a premature puberty, and

Sect. III.] Vices relating to Sii^e. 25

development of the whole body;* the latter, however, also
occurs without irregular enlargement.^

The PARTIAL and original irregular magnitude is also not
unfrequently consequent on too great nutrition of certain parts
of the body, and occurs most frequently in such monsters
as have defective formation in other parts.^

(1) Compare below the foetus.

(1*) [A very remarkable instance of precocious development is given in Phil.
Trans. Vol. XLIII. 1745, by Rev. Mr. Almon and Mr. Dawkes, of a boy, aged
three years and one month, who was 3 feet 11 inches high. But a more
remarkable instance is Philip Howorth, of whom an account is given by Mr.
White, Surgeon to the Westminster Hospital, in Med. tlhir. Trans. Vol. I.
p. 276, who arrived at premature puberty between two and three years old, and
at three years measured 3 feet 2 inches in height. Mr. White has kindly in-
formed me that he arrived at 5 feet, his full height, at the end of six years ;
he is now alive, and twenty- two years old, is married, and has one child, a girl,
and follows the occupation of a ladies' shoemaker. His appearance does not
differ from that which persons of the same period of life possess ; that is, no
marks of premature old age, either by grey hairs, or the countenance. T.]

(2) Compare Plouquet Repertorium Art. Gigas. — Reuss Repertor. Commentat.
Vol. I. p. 101, and Vol. X. p. 4)2.-^ JVunsch Unterhaltungen iiber den Menschen,
2d edit. — Firey Histoire naturelle du genre humain, 2d edit. Vol. II. p. 257.
The greatest size in man appears to be 8 feet 1 — 2. [Charles Byrne, commonly
called the Irish Giant, was twenty- two years old at the time of his death, in
1783; he measured, when dead, 8 feet 4 inches; neither of his family were of
extraordinary size. His skeleton is in the Hunterian Collection, Mus. Royal
Coll. Surg. Lond. and measures 7 feet 8f inches in height. T,]

(2*) [Mr. Clift mentioned to me, that about twenty-five years ago he had seen
a horse 20 hands high, which was exhibited in Piccadilly. T.]

(3) G. F. J'dger Vergleichung einiger durch Fettigkeit oder kolossale Bildung
ausgezeichneter Kinder und einiger Zwerge. 8vo. Stuttgart, 1821. — [Meckel
Handb. derpathol. Anat. Vol. II. Part II. p. 121. — Diez, in the Russ. Sammlung
f. Naturwissenchaft und Heilkunst, Vol. II. Part II. p. 243, describes two very
fat children of the same parents.

(4) Mecltel Vol. II. Part I. p. 2. — J'dger. — Reuss Vol. X. p. 298. — Later cases
are described, by Harless Rhein. Jahrb. der Medic, und Chir. Vol. I. Part II. —
Ulrich in the same, Vol. II. Part II. p. 194. — v. Lenhossek ind. medic. Jahrb. d.
K. K. Oester. Staates. Vol. VI. Part III. — Breschet in Journ. general de Medec.
No. 291, Feb. 1821.— /.F. South in London med. chir. Transact. Vol. XIL
Part I. p. 76. — Descuret in Nouv. Journ. de Medecine, Vol. VII. p. 100. — v.
Duchamp Maladies de la croissance. Paris, 1823. — D'Outrepont Gemeinsame
deutsh. Zeitschr. f. Geburtskunde. Vol. I. Part I. p. 151. — Diefenbach, in Meckel's
Archiv f. die Anat. u. Physiol. 1827, No. 3, p. 367. — Huf eland's Journal, Sept.
1827, p. 124.

(5) For example, in the silk worms, Bombyx Mori, which occasionally, after
. the fourth casting of the skin, and previous to spinning, change into moths,

which retain considerable resemblance to the grub, and thus at once present an
instance of premature development and retarded formation, v. Muller Decou-
verte d'un papillon k tete de chenille (Phalaena Vinula) in the Memoir present.
Vol. VI. p. 508. — Majoli in the Giornale di fisica, etc. del regno Italico, 1813,
Vol. V. p. 399. Compare MeckleVs D. Archiv. f. d. physiol. Vol. II. p. 542.

§21.

The ACQUIRED MAGNITUDE appears as a general condition
of the animal body, only in the form of excessive and morbid

26 Vices relating to Size, [Part L

collections of lymph, jelly, and fat in the tissues of the body,
polysarcia, obesitas, pinguetudo, corptdentia nimia^ by which,
often the circumference and weight of the body, both in man
and animals, is extraordinarily increased.'^ The abnormal
enlargement of single parts is also very frequent, it occurs
without or with, which last is much the more frequent,
MORBID texture; the former is the consequence either of
an excessive local nutrition, liypertrophia, arising from in-
creased local vital activity, when, for example, one viscus
undertakes the office of another,^ or of itself is much over-
exerted,* or there is too great deposition of fat in particular
spots. ^ The enlargement of particular parts united
WITH CHANGE OF TEXTURE, is produccd vcry frequently, and
in manifold ways, by morbid turgescence and expansion of
the vessels of an organ, inflammatory tumours, pliysconia,
iiiforctiiSi obstruction^ by actual change of the internal tissue,
by the formation of tumours, &c. From this kind of irregular
enlargement, is in its nature, the morbid extension of
HOLLOW organs, extentio, very different, as in the latter the
walls are usually unable, from cotemporaneous relaxation,
relaxatio, and thinning, extenuatio, nay, sometimes even from
thickening,' to withstand the extending force of the contained
fluids, and are thus not unfrequently disposed to burst. Often-
times, also, such partial extensions of canals are the consequence
of strictures of the same organ at other spots ; lastly, there is
one particular form of enlargement which appertains here, viz.
the stretching or expansion, expansio^ of solid parts, ^ by
mechanical tearing, and by tumours.

(1) Quelmaz D. de pinguedine ejusque sede tarn secundum quam praeter natu-
ram constituta. 4to Lips. 1748. — Jansen Pinguedinis animalis consideratio
physiol. et patliolog. 8vo. L. B. 178 i. — Reusslng D. de pinguedine sana et
morbosa. lenae, 1791. — Se/fert D. phys. patliol. de pinguedine. Gryph. 1794. —
Clark D. de pinguedine. Ediiib. 1797. — Lorry Adliandl. iiber das Fett in dem
menschl. Kbrper, liber dessen Eigenschaften und Felilei-, etc. translated from the
French by Lindeviann. 8vo. Berlin, 1797. — Dandouville D. sur I'obesite. 4to.
Paris, 1811. — Dupuyiren in Journ. de Medec. Vol. XII. p. 262. — Marcnse D. de
obesitate nimia. 8vo. Bcrol. 1819. — Mnciari, in Giorn. della Soc. med. chir. di
Parma, Vol. IX. j). 168. — Many instances in Rcuss^ Vol. XIV. p. 181—183. —
Amputations of the larger limbs, and castration, are frequently causes of unnatural
fatness. — Adiposis, Diet, des Sc. mcdicales, article Obesite, Corpulence, Graisse.

(2) The most striking example is the London butcher, Falstalf, who died in
his thirty-second year, and weighed 800 pounds. [I believe the most authentic
cases, however, are those of Edward Bright, of Maiden, who weighed 584 pounds,
and died at twenty-nine years of age; and Daniel Lambert, of Leicester, who
weighed 739 pounds, atul died at forty years.

(3) The spleen for the liver, and the reverse — one kidney for the other, &c.

(4) The thickening of particular muscles which have been much exercised,
the muscular coats of hollow organs, from obstructed evacuation of their con-
tents, &c.

(.5) For example, on the neck and face of anencej)halous monsters, fi-om great

Sect. IV.] Vices relating to Form. 27

flow of blood into the carotis facialis, with diminution or closure of the carotis
cerebralis — in the belly — in the spermatic cord (the so called liparocele,) — in the
cellular tissue under the skin, (compare below lipomata,) — near cancerous
tumours, &c.

(6) Rezia De viscerum, quam dicunt obstructione cum molis incremento in ej.
Specimen observationum anatom. et pathologicar. Ticini, 1784, and Venedig,
1802. — Rubini in Memorie di Matem. e. Fisica di Verona, Vol. VII. in WeigeVs
Italian. Biblioth. Vol. IV. p. 33. — Cassan in Memoir, de la Soc. medic, d'emu-
lation. An. V. p. 68. — Infarctus and obstructio are also called, particularly by
the older writers, vices of the intestines.

(7) For example, the heart in active aneurysms, and the womb, in case of
tumours in its cavity.

(8) For instance, artificial elongation of the lobes of the ear, of the hips, of
the labra, by the introduction of foreign bodies ; — expansion of membranes,
tendons, muscles, by tumours.

FOURTH SECTION.

Of Vices relating to Form.

The VICES OF FORM, MALFORMATIONS, deformitates,formc6
alienee,^ are likewise either original or acquired — general or
local — simple or compound, that is, connected with changes of
another kind. General deformity is very rare ; on the con-
trary, partial deformity is very frequent and in endless variety,
according to the individual parts in which it occurs.^

(1) Maisonnabe Recueil d'observationes sur les difFormit^s dont le corps hu-
raain est susceptible a toutes 6poques de la vie et surtout ce qui se rapporte en
g^n^ral a la Mecanique et aux instrumens employes en chirurgie, avec fig.
Paris, 1825. As ditFerence of figure in a minor degree is the character of all
organic bodies, we can here regard the higher degrees only.

(2) It will be therefore treated of specially under these subjects.

§23.

The principal species of malformation are: first, the simple,
in which a part is too long, too broad, too round, too angular,
&c. ; then that which arises from vice of number, followed very
naturally by vices of conformation, which originate in the
division of an elsewhere single organ into two or more parts,
often improperly accounted true duplications; sometimes the
organ is not entirely divided, but merely marked by a deep
cleft, or if it be a hollow viscus, divided more or less perfectly,
sometimes by a stricture, sometimes by an internal partition.
This division of an organ into several parts is often a kind of

28 Vices relating to Position. [Part I.

retarded formation, and as such, is frequently exhibited in the
bony system, by the nonconsoHdation of the original bony
germs, in the lobular form of the kidneys, ^s in the embryon,
and in the womb by its division into two horns ; so also on
the muscles, tendons, nerves, blood-vessels, and some of the
viscera, we frequently observe their abnormal division into
more or less distinct parts.

§24.

There are still other kinds of vices of conformation, in
which the size of individual organs is unnatural, and conse-
quently there is a want of symmetry and proportion ; further,
those depending on altered position and connexion of
PARTS for instance, ruptures, prolapses, and those which are
conjoined with change of texture, as contractions, tumours,
excrescences, dropsies, &c., — finally, such as are consecutive to
mechanical injuries, viz. amputations, extirpations, divisions,
scars, ligatures, &c. The most frequently occurring deformities
are produced by vices of the bony system which draw the
soft structure after them; to these belong curvatures, incur-
rationes, curviturce, of the neck, the back, and the long bones,
— DISTORTIONS, distortiones^^ of the spine, of the feet, for
instance, club-hands, and club-feet, — dislocations, liixationes
— unnatural joints — the shortening or oblique direction of
united fractures, &c.

(1) On Congenital distortion, v. Bourquenod, in Annal. de la Soc. de
M6dec. de Montpellier, Vol. I. Part I, p. 182. — Devilher Diss, sur I'entorse.
Paris, 181 2. — Matthias praes. Red D. diversis morborum localium formis ad con-
tracturae genus revocandis. 8vo. Berol. 1811. — Joerg Ueber die Verkriim-
mungen des menschl. Korpers, etc. 4to. Leipzig, 1816, with six copper-
plates.

FIFTH SECTION.
Of Vices relating to Position,

§25.

Unnatural position, situs alienus, perversus, dislocation
is never general, as all parts of the body cannot be
affected by it, but only partial. It may be either original
or acquired ; but in the more advanced periods of life we
cannot distinguish the two kinds with certainty. To the first

Sect. V.] Vices relating to Position, 29

species belong especially the lateral transposition or mis-
placement of the organs contained in the thoracic and abdo-
minal cavities/ so that the parts ordinarily lying on the left,
are placed on the right, and those on the right, on the left
side. This irregularity is sometimes found merely in one or
several organs, now and then only in the viscera of the chest,
or in those of the belly ;^ but most commonly in the parts
contained in both those cavities,^ and usually without dis-
turbance of the health. Not unfrequently certain parts are
situated either too high or too low, as original or acquired
conditions ; viz. the heart in the belly, the kidneys in the
pelvis, &c., or the abdominal viscera in phrenic hernia in the
chest, the testicles, at an advanced age, in the belly, &c.
Should the viscera become too weighty, or the parts by which
they are supported too lax, they sink down, according to the
laws of gravitation, oftentimes very low. In other cases, one
portion of a hollow organ is received into another, intus-
susception, intussusceptio. They are often thrust out of
their proper place, either by curvatures of the body, by col-
lection of fluids, or by tumours, and even squeeze themselves
out of their proper cavity, if morbidly swollen, as is the case
with the eye-ball, tongue, and the articular ends of bones.

(1) Situs Mutatus^ Transpositio, Inversio Viscerum, also /Inastrophe.

(2) See examples in the description of the thorax and abdomen.

(3) il/(e^a;^er Pr. de translocatione viscerum. Regiom. 1797. Many old examples
in Holler, Opera min. Vol. III. p. 16. note 9. — Morand Hist, de I'Acad. roy.
des So. 1688, p. 44. — Bertrand s. Cattieri o. m. XVII. — Hoffmann Cardianastr.
Lips. 1771. — Mohrenheim Wiener Beitriige. Vol. II. p. 305. — Sampson, in Phil.
Transact. Vol. IX. No. 107, p. 746. — Gauteron Mem. de Montpellier. I. Hist,
p. 110. and VIII.— 5^0// Rat. medendi. I. ^.290. — Holt in Phil. Transac.
Vol. XXII. No. 225, p. 999.. — Sandifort Observ. anat. pathol. lib. I. cap. 2,
p. 39 ; lib. IV. cap. 6, p. 5^—60.— Baillie in Lond. med. Journ. 1789. Vol. X.
Part II. No. 6. — Lentin Beitr. zur ausiib. Arzneiw. Vol. II. p. 76. — Roemer
Sylloge Opusc. Ital. Fasc. I. — Hufeland Journal. Vol. XXII. p. 110. — v. Siehold
Sammlung chir. Beobacht. Vol. II. p. 331. — Auhertm in Journ. de Medec.
Vol. LXV. p. 408. — Bichat Sur la Vie et la Mort. — Jacob in Journ. de
Medec. cont. Sept. 1811. p. 214. — Larrey Mem. de Chir. milit. Vol. I.
Paris, 1812. — Beclard in Bullet, de la Soc. m^dic. d'emulation, Dec. 1816.
p. 328, and Bullet, de la Soc. philomat. 1817. — Herhold\. Thomson's Annals of
Philos. July, 1819, p. 55. (to which belong two unpublished plates, for which I
am indebted to the author.) — Nacquart and Piorry in Journ. g^ner. de Med.
Vol. LXXII. p. 48. — Omer in Observat. des Sc. medic. Marz, 1 822. — Ullersperger
pathol. anat. Beschreib. zweier Missgeburten. p. 44. Wiirzburg, 1822. — Wetzler
s. Berliner Nachrichten v. Staats-u. gelehrten Sachen. No. 2. 1817. — Remsay
in Medic. Repository, New York, new ser. Vol. IV. Part II. 1817. — Heger
praes. Emmert D. de in versa corp. hum. structura. Tubing. 1816. — Desrouelles
in Bull, de la Soc. medic, d'emulation, Fevr. 1821, p. 41. — Bryan in Transact,
of the Associat. of Irish Physic. Vol. IV. No. 14. — Douglas Fox in Lond. med.
and surg. Journ. June, 1824. — Doubled in Archiv. general, de Medec. Dec.
1824. — Scoutetfen v. v. Froriep's Notizen, Vol. VI. No. 8, p. 128. — N'dgele in d.
Heidelb. klin. Annalen. Vol. I. Part IV. p. 507. — Sue in Auserl. Abhandl. der
Akademie d. Winsensch. zu Paris iibers. von Beer. Leipz. 1754. Vol. IT.

so Vices relating to Position, [Part I.

p. 31o. — J. F. Meckel D. de cordis conditionibus abnormibus. 4to. Haloe, 1802.
Tab, I. Fig. 4. — G. Gamage in New-England Journ. of Medec. and Surgery,
Vol. IV. p. 224—246.-3/^ Selt. Beob. Part II. p. \73.—Rose in London med.
and physic. Journ. Oct. 1826. — Baro7i in Medic, chir. Trans. 1827. Vol. III. p. 153.
— S.rre in Archives gen^rales de Medecine, 1827. Vol. XVI. and in Nouvelle
Bibliotheque inedicale, December, 1827. — F. G. Wette D. de situ viscerura
inverso. (in one instance.) 8vo. Berol. 1827. — Moncreiffin Edinb. med. and surg.
Journal, No. 9o, April, 1827, p. 440. — Barhieux in Annales de la med.
physiol. Paris, 1828. I have seen since a case of an adult man in the
Anatomico-pathological Museum at Vienna, No. 1800 ; and also found a
similar instance in a brewer's servant, aet. 45. v. No. 8870, of the Breslau
Museum. I know no instance of it in animals.

§26.

Two particular, and as frequent as important, forms of
dislocation are, ruptures, hernicE, and prolapses, jrrolapsus.
In the former, one or more of the viscera pass either partially
or completely from their proper cavity into an unnatural sac
or bag ; ^ in the latter, a viscus wholly or partially protrudes,
without its investing membrane, through an original aperture,
and is then either simply protruded, or at the same time
inverted, inversio. Finally, the altered position of parts
in ruptures and prolapses is to be distinguished from original
or accidental misplacement, propemlentia, evisceratio, of the
viscera, consequent on separation of the parieties of the
cavities in which they are otherwise contained, either congenital,
or dependent on ruptures and wounds.

(1) The so-called internal hernias are strangulations; the diaphragmatic
hernia, however, with the exception of those which have a sac, belong to the
original or accidental misplacement, evisceratio.

§27.

When certain parts have, at one period, an actual progres-
sive motion, or are supposed to continue it, their unnatural
situation has been named deviation, aberration, deviatio,
aberratio. To this, for instance, belong the descent of the
testicles under the crural arch, or into the perinaeum, and
the anomalous course of the vessels.

§28.

Finally, the position of parts may be so far irregular, that
although not out of their usual place, tliey may have an ab-
normal direction, dircclio perversa, ohliguitas, &c., so that
their axis is changed. These vices are observed in several
viscera, viz. in the eye, heart, stomach, kidneys, and womb,
indeed, even in the bones; thus, for example, the teeth are

Sect. VI.] Vices relating to Connexion. 31

placed sometimes obliquely, sometimes transversely, and some-
times even turned round. ^

(1) [In the Mus. Coll. Surg. Lond. there is one specimen of an incisive tooth,
the crown of which protrudes into the nose. T.]

SIXTH SECTION.
Of Vices relating to Connexion,

§29.

Vices of connexion, vitia nexus, may consist in the dimi-
nution or entire suspension, and in the increase of the natural
connexion and contiguity of a part with those in its neigh-
bourhood. To the FORMER KIND belong the non-attach-
ment of a part, in consequence of defective formation, for
instance, of the intestines, from absence of the mesentery;
the REMOVAL of two viscera fi'om each other dependent on
laxity of the cellular and membranous parts by which they
are connected; the separation, diastasis, of two immovably
connected bones from each other, and the removal of the
articular ends of two bones from each other, dislocation,
luxatio, as it is called.

§30.

The irregular increased connexion of two organs may be
either original or acquired; the first is especially noticed in the
congenital coalescence^ of two or more parts into one
common part, which assumes more or less the trace of dupli-
cation. As the abnormally consolidated parts have at their
commencement, either sprung from a common centre, or are so
close that they touch each other, so it may be explained how
partly the confused activity of development in the organ itself,
partly deficiency of room, and in fine partly the want of power
to separate in the parts otherwise interposed, may produce
such consolidated formations. As instances of these, may be
given the consolidation of two neighbouring vertebrae, ribs,
muscles, the fingers and toes, the two kidneys and the renal
glands ; cyclopy, in which both eyes, the front of the brain,
and sometimes also the two nostrils, are seen running into one ;
next, the imperfect development of the lower part of the face,
in which the ears, the muscles, the salivary glands and ducts of

32 Vices relating to Connexio7i, [Part I.

both sides are found consolidated; further, the cloacal form-
ation/ as it is called, which is produced by the union of the
lower part of the urinary, generative, and alimentary organs
into one common cavity, similar to, although sufficiently distinct
from the cloaca of animals ; and lastly, the most perfect degree
of coalescence in the human subject, the syren formation, in
which even the whole of the lower extremities are united into
one common limb.

(1) Meckel iiber die Verschmelzungsbildungen in his Archiv. f. Anat. und
Physiol, 1826, No. II. p. 238.

(2) Handbuch der pathol. Anatomie. Vol. I. p. 698.

§31.

Much more frequent than the original abnormally increased
connexion of different organs, is that which is acquired, the
agglutination, or coalescence, concretio,^ arising from the
effusion of fibrine consequent on inflammation. Sometimes
this occurs merely locally between neighbouring parts, at other
times more generally between many parts ; it can affect all parts
of the body, and can be produced artificially by the approxi-
mation of sore surfaces. The coalescence is either close and
intimate, so that the parts are every where in contact, or it is
looser, so that newly formed fibres and bands connect the
organs. The coalescence can occur also in a single organ, if
it be hollow, and agglutinate one side of the canal with the
other, as in the blood-vessels ; sometimes also the excretory ducts
of secreting organs, the alimentary canal, &c. are seen closed,
atresia morbosa. If two otherwise movable bones become
united, it is called a stiff joint, anchylosis,'^

(1) Bergen D. de coalitu viscerum. Francof. 1736. — Ilchenslreit D. de
partium coalescentia morbosa. Lips. 1738. — Haller's Diss. pr. VI. No. 209. —
Orell D. de viscerum nexibus insolitis. Helmst, 1743. — Reil D. de concretion-
ibus organorum morbosis. Halae, 1795. — Cruveilhier Essai sur I'anatomie
pathologique en general. 8vo. Paris, 1816. Vol. I. p. 142 — 181. — Plouquet
Repertor. Art. Viscer. Coalitus. Compare below Inflammatio Exsudativa.

(2) Compare Fifteenth Section, On the Bones.

Sect. VII.] 33

SEVENTH SECTION.
Of Vices relating to Colour,

§32.

The IRREGULAR COLOURING of animal parts is very fre-
quently conjoined with vices of texture, and may then consist,
as in scirrhus, in the change into fat, in ossifications, &c. in
diminution of colouring ; or as in inflammations, caries, cancer,
mortification, &c., in the deepening of colour, and frequently
also in an entirely different colouring. But this abnormal
colouring can also occur without any, or at least without any
visible vice of texture, and then for the most part depends
upon change in quantity or quality of the colouring fluids
found in the organs, and especially of the blood.

§33.

First, as to what concerns diminished colouring : this is itself
sometimes original ; thus a particular part does not possess the
proper degree of colour belonging to it, and remains pale as in
the embryon,^ such is one kind of retarded formation ; yet,
however, deficiency of texture is usually connected with this
state. To this belongs, also, the more common state of
ALBINOISM, leuccethiopia, leucopathia^ alhinoismus^ which
occurs both in man and animals, in which the skin, the
hair, and the eyes, are found unnaturally pale ; this morbid
state is sometimes hereditary in man, but more frequently in
animals, and in the latter, then produces distinct varieties.^

(1) For instance, the muscles, the intestines, &c.

(2) Among beasts, albinos are observed in the monkeys, mole, bear, badger,
polecat, marten, fox, dog, beaver, rat, mouse, squirrel, rabbit, hamster, opossum,
horse, swine, elephant, deer, roebuck, goat, cattle, buffalo, dromedary, and among
very many birds. [ T. Trail, On Albinos in Nicholson's Journal. London. 8vo.
No. 19, p. 81. T.]

(3.) For instance, the white horse, the silky hare, the white mouse.

§34.

Unnatural paleness is more generally an acquired diseased
state, a change of colour or bleaching, and is especially
produced by a diminution of the blood generally, and of
its cruor in particular, on which account it is the usual
attendant of long continued disease, of cachexia, and especially
of consumption and dropsy.^ To this place also we refer the
more local change of colour, viz. in the skin of coloured
persons, the change to grey and white of the hairs ^* and

D

34 Vices relating to Colour. [Part I

fccithers, the bleaching of dark eyes, &c. ; the cause of this
bleaching of the above-named parts is found in the diminution
or total removal of the colouring matter. The frequent loss of
colour in the mucous membrane of the mouth, and of the
alimentary canal after poisoning with the concentrated acids
and with tartar emetic/ is also worthy of notice.

(1.) Very frequently also in animals, to wit, in diseased fishes. [The Anemia
of Andral. v. his Precis d'Anatomie Pathologique, Vol. I, p. 74. The paleness
of the body after severe or repeated haemorrhage arises from the same cause,
viz. diminution of the blood generally, and of its cruor in particular. Butchers
are therefore accustomed to bleed their calves, for the purpose of rendering the
veal whiter. T.]

(1*) \^W.P. Dewces, A singular case of alteration of the colour of the hair
during parturition, in which all in front of the coronal suture changed com-
pletely white in the course of an hour, in consequence of alarm. On the following
day it was much less white, and in four or five days its usual colour had returned.
V. Philadelphia Medical Museum, edited by Dr. Cox. Vol. III. p. 219, 1807. T.]

(2) I have seen it more than once after poisoning by sulphuric acid, and the
very white colour of the mucous membrane is by no means merely dependent on
thickening and relaxing of the epithelium.

§35.

The abnormally increased colour of an organ, or the
DEEPENING OF ITS COLOUR, depends in some cases, and espe-
cially in muscles originally pale, upon hypertrophy ; but most
commonly on the gorging of a part with blood, which has
been augmented in it by congestion and stagnation, stasis ;
this is very often observed in the lungs, the liver, the spleen, and
the mucous membrane of the alimentary canal.* Sometimes it
happens that the congested blood is itself unnaturally deep
coloured, and thus doubly deepens the colour of the part in
which it is collected ; this is especially the case after suffocation,
apoplexy, poisoning with narcotic substances, and hydro-
cyanic acid, adynamic fevers, and especially in the blue
disease.' A red or bluish colour is often observed in cer-
tain parts of the body, produced by congestion of blood in
the most delicate vessels, for instance, death spots, lividitas,
nigror, siigillationes spurice, the form, extent, and colour of
which are very variable, according to circumstances; further,
we notice similar red and dusky spots on the internal
parts, arising from the same causes, as on the intestines, and
more especially on their mucous coat ; and the dusky colouring
of those parts into which, if they be lowest, the blood sinks
according to the laws of gravitation ;^ such spots are produced,
even sometime after death, on the putrefaction and thawing of
frozen corpses.

(♦) [Some ft'W years back, I saw a very remarkable instance of this gorging
with blood, in the mucous membrane of the stomach of a man who had fallen
dead in the .street, and was brought into St. Thomas's Hospital. The whole

Sect. VII.] Vices relating to Colour. 36

internal surface of the stomach was of a bright red colour, and looked like velvet
there were no other morbid appearances, nor vvas any history of his previous life
obtained. T.]

(1) A good engraving of a person affected with the blue disease is to be found
in the Chirurg. Kupfertafeln. VVeimer, 1820. PI. 53— 55.

(2) In the common position on the back, also in the soft structures on the side
of the spine, in the hinder part of the lungs and liver, as well as those parti? of
the small intestines which lie in the lesser pelvis.

§ 36.

From this kind of dusky spots we must distinguish other
similar colourings which originate in the percolation of the
darker juices after death ; thus we sometimes observe in persons
who have died of inflammation of the lungs accompanied with
their adhesion to the pleura, large livid or violet-coloured spots
on the chest ; on the stomach there are seen dusky red spots,
where it is in contact with the blood-gorged liver and spleen.
The large venous trunks filled with blood often colour the
neighbouring parts,^ and the gall-bladder very frequently tinges
a part of the adjacent stomach and duodenum with its bile.
Sometimes, also, the naturally pale surfaces immediately in
contact with the blood become equally red, for instance, the
inner surface of the heart, the great arterial trunks, the rectum
in piles ; a peculiar change in the blood seems to be the cause
of this colouring.

(1) We easily distinguish these spots by the neighbouring causes, and because
the external surface of the organ merely is coloured, or the colouring, if it have
penetrated deeper, still diminishes gradually.

§37.

A particular kind of deeper colouring is also produced by
EXTRAVASATION, eccJiymosis, ecchyinomay effusio, suffusioy
sugillatioy either under the skin, or more deeply, but which
differs from the above described similar spots, as it is produced
by the actual effusion of blood from the vessels into the
cellular membrane of the part. This usually accompanies
a BRUISE, contusio ; but it is not unfrequently consequent on
severe strains of a part, on suckling in delicate skinned women,
on great muscular exertions, on coughing, vomiting, and on
many diseases, especially scurvy, petechial fevers, the morbus
haemorrhagicus of Werlhof, &c. These extravasations are
at first blackish or blue, and distinctly circumscribed, but by
degrees become more extended, as it were, fade, and by little
and little assume a violet, greenish and yellow colour.^

(1) Importance of distinguishing these spots from inflammatory redness.
§§ 35—37.

D 2

36 Vices relating to Colour, [Part I.

§38.

Further, the irregular colouring of animal bodies is often
caused by the reception of various extraneous colouring
matters into the body. This is observed almost generally in
the lower animals, especially in the parasitic, when living on dif-
ferent kinds of food ;^ also locally, as the consequence of various
medicines and poisons ;^* thus the bones of men, beasts and
birds, are more or less reddened by food of a red colour.^ The
taking of rhubarb often tinges light parts yellow; hydrocyanic
acid renders many organs bluish or greenish ; nitrate of silver,^
quack medicines, of which the composition is unknown,* and
other medicines,^ often render the skin blackish.

(1) For instance, the aphis, the louse, fresh oysters, &c.

(1*) [/. Ingenhousz, Some further considerations on the influence of the
vegetable kingdom on the animal creation, in Phil. Trans. Vol. LXXXII. p. 426.]

(2) This also occurs in wild animals ; for example, in the water rat, of which
I have seen one instance. \_H. Baker, On the eftects of the Opuntia or Prickly
Pear, and of the Indigo Plant, in colouring the juices of living animals, in
Phil. Trans. Vol. L. p. 29(3. — Gibson, On the effect of Madder Root on the Bones
of Animals. Manchest. Mem. new ser. Vol. I. p. 146. T.]

(3) Swediauer in Fonrcroti La M6decine eclairee par les Sc. physiques.
Vol. I. p. Z^2.—A}bers in Medic, chir. Transact. Vol. VII. Part I. p. 284;
and Roget, ib. p. 290. — Butini De usu interno praeparationum argenti. Gonf
181 <5. — Baillie s. N. Samnd. auserl. Abhandl. z. Gebr. pr. Aerzte. Vol. IX.
Part III. p. 379. — Wedemeyer in Rtist's and Casper's Krit. Repertorium.
Vol. XIX. Part III. p. 454.

(4) A secret of my grandfather's on my mother's side, Dr. Weigel, of Stralsund,
produced, in some instances, to my own knowledge, a general dark colour of the skin.

(5) Transiently after the use of sulphur and quicksilver, by which a kind of
.^THiops is formed, v. Rigby, in London Medical Repository, Jan. 1817.

§39.

Finally, we oftentimes observe some peculiar colouring matter
or pigment* spontaneously produced in animal bodies, and
colouring certain parts more or less completely; such is the
case in jaundice, icterus, and in melanosis. In the former dis-
ease there is formed in the body a yellow animal extractive
or colouring matter, which has great similarity to the pigment
of the bile, and tinges almost all the solid and fluid parts of
the body more or less yellow and dusky, however, so that many
of the systems assume a yellow colour more frequently than
others.^ Diseases of the liver, asthenic fevers, as the plague,
the American yellow fever,^* typhus fever, &c., are commonly
attended with jaundice ; the same also occurs in animals, but
much less frequently. In melanosis,^ on the contrary, a deep
brown or more frequently a blackish tinted pigment is mor-
bidly produced, which occurs sometimes generally, sometimes
to a limited extent; in the former, it is either mingled with
the particular excretions, as the urine, the perspiration, the

Sect. VII.] Vices relating to Colour. 37

mucus from the lungs, in certain cases also, perhaps (in the
matter evacuated) in Melrena,^ or the black disease of Hip-
pocrates, and colours them blackish ; or it may be deposited as a
fluid or semi-coagulated mucus on the expanded surface of
serous membranes, particularly the peritoneum and pleura." In
the confined state the black pigment is found accumulated
either in the otherwise healthy substance of an organ, espe-
cially of the skin, of the lungs, of the bronchial glands,
&c., or it may accompany the various vices of texture, as
mortification, particularly of the dry kind, false membranes,
soft swellings, scirrhus, cancer, medullary sarcoma, and most
commonly, at least in animals, tubercular swellings.^

(1) G. Jaeger Ueber das Vorkommen von Kolile in menschl. Gallensteinen,
nebst einigen Bemerkungen iiber Verkoblung 'organischer Korper uberhaupt,
in Meckel's Arcbiv f. d. Physiol. Vol. VI. p. 485. — Heusinger Untersuchungen
iiber die anomalc Kohlen uud Pigmentbildung in dem menschlichen Korper,
mit besonderer Beziehung auf Melanosen, u. s. w. Eisenach, 1823. — A. Retzius
in Svenska Lakare-Pallskapets Handlingar. Vol. X.

(2) The skin, the cellular tissue and muscles, for instance, more commonly
than bone and cartilage; most rarely the nervous system. — The Kirrhonose
of Lobstein (v. his papers in the Zeitschrift f. Physiol, of Tiedemann and
G. R. and L. C. Trcviranus, Vol. II. Part I. p. 79, and in Re})ertoire gen. d'Anat.
et de Physiol, pathol. Paris, 1826, Vol. I. Part I. p. 141). A yellow colouring
of the serous membranes and nervous medulla in the fcetus I have also occa-
sionally observed, but have considered it not actually different from the jaundice.

(2*) [Pamei Observations sur la fievre jaune. 4to. Pr»ris, 1820. T.]

(3) Dupuytren appears to have first drawn attention to this disease, v. Journ.
de Medec. de Corvisart, Vol. X. p. 89 — dQ. — Bayle, in Recherchcs sur la Phthisie
pulmonaire, Paris, 1810, Obs. XX. and XXI. ; and Laennec, in Journ. de Medec.
de Corvisart, Vol. IX. p. 368, first employed the name, Melanose, and distin-
guished thereby, especially, a kind ofsarcom; on Melanosis in general, compare
Laennec de 1' auscultation mediate, etc. 8vo. Paris, 1819, Vol. I. p. 299. —
Breschet in Magendies Journ. de Physiol, exp^rim. Vol. I. No. 4. p. 354. — Merat in
the Journ. des Sc. medicales. Vol. XXXII. Art. Melanose, p. 183. — Heusinger.
— Noack Comment, de Melanosi cum in homiuibus tum in equis obveniente, etc.
4to. c. trib. tab. sen. Lips, et Paris, 1826. — Savenco Tentamen pathologico-ana-
tomicum de Melanosi. Petropoli, 1825. — Schier D. de morbo quodam maculoso,
quem Melanosin recentiores appellant. 8vo. Berol. 1826. — {^Graves M.D. Clin.
Observ. in Dublin Hosp. Reports. Vol. IV. p. 69. 8vo. Dublin. — G. Breschet
Considerations sur une alteration organique appelee Degenerescence Noire,
Melanose, Cancer, Melane, etc. 8vo. Paris, 1821. — B. Travers, Observations on
the local diseases called Malignant, in Med. Chir. Trans. Vol. XV. p. 195. T.]

(3*) J. Cheyne, M. D. Case of Melaena in Dublin Hosp. Rep. Vol. I.
p. 259, 1817 ; a remarkable instance, in which the production of the secretion
peculiar to this disease, alternated with increased activity in the serous mem-
branes.— A, Portal Observations sur la nature et sur le traitement du Melaena
in Mem. de la Societ. d'Emulat. Vol. II. p. 167.

(4) Melanosis membranacea in Merat and Noack.

(5) See the Tenth Section, On Vices of Texture.

38 [Part I.

EIGHTH SECTION.

Of Vices relating to Consistence.

§40.

The irregularities of animal parts with reference to their
SOLIDITY, CONSISTENCE, consistentio,^ i. e. the normal degree
of the intimate connexion of their elementary parts, origi-
nate in the vices of solidity and power of cohesion; there-
fore, whatever disturbs these, diminishes or increases the
power of an organ to resist mechanical influences. The dif-
ference of consistence, according to age and individuality, the
latter of which the antients distinguished by the terms fibra
LAXA, MOLLIS and DENSA, RiGiDA, &c., do not bcloug here ;
but such changes of consistence as are produced by morbid
activity of nourishment, disproportion of the fluid to the solid
parts, and especially by vices of texture. Only in few instances
are the vices of texture not perceptible in irregular consistence,
although they are in fact always present.

(1) Meckeinan^h. d. pathol. Anat. Vol. II. Part. II. p. 6.

§41.

The DIMINUTION of CONSISTENCE, Or the MORBID SOFT-
NESS, LAXITY, PULPINESS, molUties, laxitas, marcor, &c., is
most frequently the consequence of irritation and inflamma-
tion, under which both the thickness and power of cohesion,
as well as the texture of an organ, are changed. Diminished
consistence, therefore, is not merely the concomitant of suppu-
ration and mortification, but also of the less distinguishable
changes of nourishment in quality and quantity occurring with
and after irritation and inflammation. Whatever produces re-
laxation of the tissue, be it an increased influx of the juices, for
instance, as in dropsy of the organ, or a morbidly increased
internal absorption, produces softness or pulpiness, from which
the hardest and toughest parts, as the bony, cartilaginous and
horny tissues, do not escape, wdiich is most striking on ac-
count of their opposite state. Sometimes the morbid softening,
it appears, is connected with peculiar proportions of mixture, and
so great, that the parts affected are converted into an actual inor-
ganic pultacoous mass, for instance, the brain and spinal marrow,
and especially the stomach and neighbouring parts, in the so
called softening of the stomach ; but in other cases, the con-
sistence of a part is considerably diminished without any ob-

Sect. IX.] Fices relating to Contimiity. 39

servable vice of mixture or texture. This is most frequently
found in the brain and in the muscles.

§42.

The opposite state or the unnaturally increased con-
sistence of a part, the morbid hardness, rigidity, indaratio,
rigiditas, &c., arises from the increased compactness and
power of cohesion in the part, which may originate either in
the mere unnatural contraction of the animal tissues and the
diminution of the part ; in the diminution of the juices and
the augmentation of the solid and especially earthy parts ; in
the effusion of more or less coagulated fluids into the parenchy-
matous structure of the part, for instance, in the induration,
induratio, consequent on inflammation ; and finally, in those
peculiar changes which can neither be reckoned as vices of
mixture or structure, although, perhaps, they really are so ;
to the latter kind belong a peculiar kind of solidity and dry-
ness of the muscles and of the brain.

NINTH SECTION.

Of Vices relating to Continuity.

§43.

Vices of consistence very naturally lead to those of con-
tinuity, which consist in the breaking up, in the actual
separation of the intimate connexion of an organ,
solutio continuitatis , If the power of resistance in an animal
tissue be diminished, then even a relatively moderate mecha-
nical power will act in proportion too strongly, and produce
a separation of the intimate composition of a part ; but more
frequently this is also efi'ected by the actual operation of
external causes, even where the normal degree of consistence
exists. The first more properly belongs here, the last rather
to surgery.

§44.

The breach of continuity of a part may be either original
or acquired. To the former belong the not unfrequcnt

40 Vices relating to Continuity. [Part I.

CLEFTS OF THE FRONT AND BACK OF THE BODY, in the mesilll

perpendicular line ;^ these are perhaps in part retarded forma-
tions, but more commonly the consequence of early morbid
distension of the walls of the cavities, from the too early
development and size of the parts therein contained, from
dropsies, &c. They occur also in different degrees, so that
the organs found in the cavities of the body are either entirely
exposed, or rather are covered by their investing membranes,
which are then much thinned, and occasionally expanded like
bags, and even found torn.^ In this manner are observed clefts
of the spine, of the skull, of the lips and palate, of the breast,
belly, and front of the pelvis, either alone or several of them
at the same time.

(1) MeckeVs Haudbuch der pathol. Anatom. Vol. I. p. 93. — The particular
kinds will be treated of in the separate organs.

(2) It is incorrect, when these thin membranes are described as mere dura
mater, peritoneum, &c. as the common integuments always exist at the same time,
although indeed they are very thin.

§45.

The ACQUIRED vices of continuity are more frequent;
they are the consequence of mechanical causes, and are
commonly called lesions, Icesiones, To these belong the
recent divisions of continuity by mechanical penetrating vio-
lence, i. e. WOUNDS, vulnera, to wit, both the simple, as cuts,
chops and stabs, and the complicated, as contused, gunshot
wounds, burns, &c.; further, partial or complete lacerations
and ruptures, dilaceratiOf rujitura, of parts violently extended
or shaken ;^ and, lastly, fractures of bones, fracturca
ossiiim. Similar lesions now and then occur without any
external violence, especially in the vices of consistence, from
mechanical causes existing in the body itself, for instance,
fractures of bones and ruptures of tendons by the action of
the muscles, the bursting of cavities, from their too great dis-
tension by the fluids which they contain, &c.

(1) For instance, of the internal viscera without wounds of the sides of their
inclosing cavities — remarkable transmission of concussion from distant parts. —
Janson Essai sur Ics ruptures dcs tissus et des organcs du corps humain. 4to.
Paris, 1813.

Lastly, we must here also mention that spontaneous and
morbid separation of parts from the general organism which
occurs, not from violence, but consequent on their irregular
nourishment or total decay, viz. the shedding of the cuticle, the
hair, the nails, horny excrescences, the teeth, the separation of

Sect. X.] Vices relating to Texture. 41

mortified parts, indeed of whole limbs destroyed by mortifica-
tion, the drying up and falling off of supernumerary parts in
monsters,^ and the throwing off of polyps, and growths of
other kind, which have separated themselves completely from
the parts out of which they had grown.

(1) I possess a full grown goose, yet alive, of which the greater portion of the
hind part of the body is double ; two supernumerary feet dried up to the heel,
and fell off.

TENTH SECTION.

Of Vices relating to Texture,

§47.

As in healthy animal bodies their component parts are
in a continual state of change and growth, so must we na-
turally expect this should occur still more in many dis-
eases, and easily amount to a perceptible change of the
tissues. Hence, then, vices of texture or degenerations
OF THE TISSUE, vitia texturcB, desorganisationes,^ are very
common, and in regard to their cause, in most intimate con-
nexion with the already mentioned vices of size, form, colour,
and consistence.

(1) Dumas Sur les transformations des organes in Sedillot Journ. gener. Vol.
XXIII — XXV. — Laennec in Corvisart, etc. Journ. de Medec. Vol. XL p. 360,
and in Diet, des Sc. med. Vol. II. Art. Anatomie pathologique. — Bugayski D. de
part. Corp. hum. solidar. simil. aberrationibus. 4to. Berlin, 1813. — Cruveilhier
Essai sur I'anatomie pathologique en general, et sur les transformations et pro-
ductions organiques en particulier, 2 vols. 8vo. Paris, 1826. — Meckel Handb. der
pathol. Anatomie. Vol. II. Part II. — Heusinger System der Histologic. Parti,
p. 87 — 103, 4to. Eisenach, 1822, and in the first Berichte von der konigl.
anthropotomischen Anstalt zu Wiirzburg, p. 1 — 41. 4to. 1826. — Boulland in
R^vue m6dic. Franjaise et etrangere, etc. Sept. Paris, 1825.

§48.

All degenerations of the animal tissue are either conversion
of the normal into an abnormal substance, as morbid meta-
morphoses, iransformationes, degenerationes, or entirely
new formations, in their stead ; or specially substances not
previously existing, spurious formations, pseudoplasmata,
pseudorganisationes ; or, finally, a mixed state of the
changed and new formations.^ We often find many kinds of

4^ Vices relat'mg to Texture. [Part I.

morbid changes and spurious formations existing together, and
the diseased part a diversified compound of the extraneous
tissue, which is so circumstanced, that the newly presented
morbid substance perforates the original tissue, and is deposited
between its fibres and layers, or is more or less distinctly
defined ; the latter is especially the case with the spurious forma-
tions, which, lying in their proper bed, are attached as it were
by roots to the diseased organ, but sometimes are connected
extensively with its surface, or still distinctly circumscribed
in it, and even enclosed in their proper surrounding membrane
or bag, and merely displace by their position the original sub-
stance, or produce its absorption by pressure.

(1) The diagnosis of this state, as well as of its various kinds, is often very
difficult and even impossible ; much which appears to be a mere change of the
tissue is a new formation; thus, many cartilaginations and ossifications by
which the loose extraneous body is enclosed in fine plates of normal tissue ;
further, the apparent conversion of a muscle into fat, whilst the muscular fibres
exist pale and wasted, but at the same time the fat deposited between them is
also lost ; the spurious formations are also often at first very similar to each other,
but these, at a subsequent period, vary from each other according to the difference
of the organ to which they are attached. One kind also frequently runs into
another.

§49.

All the parts of an animal body are subject to vices of
texture, however, not in a similar degree ; some indeed are
more subject to morbid metamorphosis; others, for example the
skin, mucous membrane, and glandular organs, rather incline
to spurious formations. Hence also many arise from age,
inasmuch as disorganizations generally appear to occur less
frequently in the earlier than in the later periods of life ; but
almost every age has its peculiar or more common vice of
texture/

(1) For example, in childhood, tubercles; in later life, cancer and ossification.

§50.

According to the nature of a partj a certain though very
obscure change both in quantity and quality of the activity of
nutrition, must be considered as the next cause of the vicious
condition of its tissue ; but this again, especially, is derived
from the defective development of the organism, from the
termination of activity in a part, or from certain diseases.
From the first cause arises the retarded formation of the
TISSUE, in which a part remains in the same state as during
foetal existence;' from the second, the so called receding
FORMATION of the uo luorc used tissue, which, in such
cases, is not merely diminished, but frequently at the same

Sect. X.] Vices relating to Texture, ^

time again resolves itself into the original pre-existing cellular
tissue;- finally, fi:om the third cause, viz. from various diseases,
but especially from morbid irritation and inflammation, whence
arise by far the greater number of vices of texture.

(1) Thus we find the bones cartilaginous, the tendons soft, the muscles jelly-
like ; some of the viscera, as thin membranous bags, filled with mucous-like
fluid, &c. Restored parts sometimes exhibit a very imperfect texture ; thus, for
instance, I find in lizards, of whicii the tail had been broken off'two years before,
and had perfectly recovered its normal length and thickness, that the caudal
vertebrae^were still cartilaginous, and the muscles less fibrous and tough than usual.

(2) For example, muscles, blood-vessels, glands, and their excretory ducts,
nerves, tendons, &c.

§51.

Morbid irritation, irritatio morbosa, may be either gene-
ral, as in fevers, or more commonly only local ; it has also
various degrees, in the higher of which, for instance catarrh,
it approaches to inflammation. It has in many cases, when it
attacks the lymphatics and veins, an increased resorption ;
more commonly, when it acts upon the arteries, an increased
flow of blood passes to the irritated part, which therefore, after
death, appears turgid, reddened, and as it were injected, and
easily changes the quantity and quality of the secreted sub-
stances. Thus does morbid irritation lay, not merely the
foundation for new and extraneous chemical operations, for
coagulations, for partitions, but also produces the various
diseased collections which are so often met with in dead sub-
jects. To this belong the presence of various kinds of gases,
which doubtless arise not unfrequently from putrefaction,
between the membranes of the brain, in the cavities of the
brain, in the bags of the lungs, in the pericardium, in the
belly, in the urinary bladder, in the womb, in the heart and
blood-vessels, in the parenchyma of the intestines and in
the cellular membrane ; ^ further, the collection of water in
almost every part, especially in the cellular tissue and in the
serous membranes which line the cavities, whereby the different
kinds of the common dropsies are produced : then the increase
of mucous-like, gelatinous, or rather albuminous masses,
which are observed particularly in the mucous membranes
spread over the cavities or canals of the body ; and finally, the
pouring out of blood, either pure or mingled with water, which
escapes not from ruptured vessels, but actually exudes from the
extreme branches of arteries, and indeed has been found in
all the cavities of the body.^

(1) On all these parts have I observed collections of air, and partially several
times. J. Halliday, D. de Pneumatosi. Edinb. 1806. — Briere in Nouv. Biblioth.
Fevr. et Mars, 1826.

44 Vices relating to Texture, [Part !•

(2) It appears to me to be more frequent in the intestinal canal, in the peri-
cardium, and the ventricles of the brain, where I have found it, as also in the
thorax and abdominal cavities, more than once ; also in the horse, deer, and dog.

§ 52.
The most frequent cause of vice of texture is inflam-
mation, inflammatio, phlegmasia ;^ here, however, only
belong its essential symptoms, redness and swelling. The
INFLAM.MATORY BLUSH, riibor inflammatorius, depends on an
unusual quantity of blood,^* essentially changed in its com-
position, contained in the inflamed part, partly indeed in the
larger and smaller sanguiferous vessels, partly also in those
extreme branches of the arteries which commonly convey no red
blood {vasa- decolor a), and lastly, in part in the cellular tissue
surrounding the arteries, in which it frequently appears exuding
under the form of numerous small red spots. Under high de-
grees of inflammation, new small vessels are probably produced
from the eflTused blood, which subsequently innosculate with
the original vessels. During life, the blood-vessels of inflamed
parts, usually at the commencement, exhibit a quicker motion,
as well as a slight narrowing of their calibre, dependent on the
degree of excitement operating on them ; but the stream of
blood gradually becomes slower, and at last entirely ceases, in
most of the vessels, which then also expand, and are stopped
up with the globules of cruor which they contain ; some of
these are dissolved in the fluid part of the blood, and so enter
the vasa decolor a. In the latter stages of inflammation, and
as it runs on into other morbid states, the inflammatory blush
is changed in various ways, especially by the solution and
mingling of the globules of the blood; it is also visibly
diminished in many organs after death. ^ The inflammatory
SWELLING, tumor inflammatorius, which is regularly accom-
panied with distinct tension, turgor, depends for the most
part both on the extension of many small blood-vessels, and
on the simultaneous, often very great eflusion of blood, fluid
fibrous matter, and lymph into the tissue of the inflamed
organs. After death, the inflammatory swelling subsides on
account of the cessation of the living tension, and perhaps also
on account of the activity of absorption, which the lymphatic
vessels and veins both possess for a longer time, and if then
felt, it is found less tense.

(]) I'acca L. de inflammationis morbosnp, qune in hum. corp. fit, natura, causis,
eftcctihus et curatione. 8vo. Flor. 17(55. — BrambiUa Chir. prakt. Abhandl. von
der Plilcgmonc und ihren Ausgangcn, aus d. Ital. 2 Tide. 8vo. Wien,
1773 — 7.>. — J. Hunter, Treatise on the Hlood, Inflammation, and Gun-shot
Wounds. 4to. London, 1795. — Burns, Dissertation on Inflammation. 2 vols. 8vo.
(JIasrrow, 1800. — Broussais Hist, dcs Phlegmasics, ou Inflammations chroniijues.
Paris, 1802, 2 vols. 8vo. ; 1th edit. 3 vols. 182(). — iV/vx/ Aper9U sur les phe-

Sect. X.] Vices relating to Texture, 4^5

nom^nes generaux de rinflammation, consid6res dans les differens systemes.
8vo. Paris. An. XI. — Jolly Phlegmasies des organes parencliymateux. 4to.
Paris, 1812. — J. Tiiomson, Lectures on Inflammation, &c. Edinburgh, 1813. —
Dzondi De inflammatione Aphorismor. 8vo. lib. I, Halffi, 1814. — Gruithuisen
Theorie der Entziindung, in der Salzb. medic, chir. Zeitg. Vol. II. p. 129. 1816.
(v. also ib. Vol. II. p. 298, IS 11. ) — Dohlhof D. de phlegmone. 8vo. Halae,
1819. — Philip, An experimental inquiry into the laws of the Vital Functions.
8vo. 2d edit. Lond. 1818. — Nickol in Lond. med. Repository, Vol. XVI.
Aug. 1821. — James, Observations on some of the general principles and on the
particular nature and treatment of the different species of Inflammation, &c.
8vo. Lond. 1821. — C.E.Lucas, M. D. On the Principles of Inflammation.
8vo. Lond. 1821. — Scholefield D. de theoria inflammationis. Edinb. 1822. — ■
Waring D. de inflammatione. Edinb. 1823. — Sparer D. de inflammatione, morbo
animalium et vegetabilium. 8vo. Dorpati Livonor. 1824. — Koenig D. s. eK^eri-
menta quaedam circa sanguinis inflammatorii et sani qualitatem diversam instituta.
4to. Bonnae, 1824. — Prus De I'irritation et de la Phlegmasie, etc. 8vo. Paris,
1825. — Koch D. de observationibus nonnullis microscopicis sanguinis cursum et
inflammationem spect. etc. 8vo. Berol. 1825. — Burdach D. observat. nonnuUae
microsc. inflammationem spectantes. 8vo. Regiom. 1825. — Black, A short
Inquiry into the capillary Circulation of the Blood, with a comparative View of
the more intimate nature of Inflammation, &c. 8vo. London, 1825. — Gendrin
Histoire anatomique des inflammations. 8vo. Paris. 1826. — Kaltenbrunner 'Ex-
perimenta circa statum sanguinis et vasorum in inflammatione. 4to. c. tab. novem.
Monachii, 1826. — Hohnbaum Ueber das Fortschreiten des Krankheitsprocesses,
insbesondere der Entziindung, etc. 8vo. Hildburghausen, 1 826. v. — As to Litera-
ture, Scavini, Precis historique de la doctrine de I'inflammation depuis Hippocrate
jusq'a nos jours. 8vo. Turin, 1811. — Meier Versuch einer krit. Geschichte der
Entziindung. Iter Thl. 8vo. Berlin, 1812. v. Plouquet Repertor. Art. Inflam-
matio. — Reuss Repertorium Commentat. T. XIV. p. 21. — G'dllner D. de in-
flammatione. 8vo. Halae, 1821. — A. Goldoni Sulla inflammazione, trattato
diviso in tre parti. Part I, Modena, 1825. — Gisbert van Beers D. de texturae
organorum per inflammationem mutatione. Bonnae, 1826. — Bargen D. de in-
flammatione ejusque theoi'iis. 8vo. Berol. 1827. — Wede7neyer Untersuchungen
iiber den Kreislauf des Blutes. Hanover, 1828. — /. Syme in Edinb. med. and
surg. Journ. No. 97, Octob. 1828. — J. Scott, Surgical Observations on the
treatment of chronic Inflammation. London, 1828. — /. Brown, Medical Essays
on Fever, Inflammation, &c. London, 1828. — Kilpper D. de inflammatione et
praesertim de puris generatione. 8vo. Berol. 1828. — M. Naumann Zur Lehre v.
der Entziindung. Bonn, 1828. — Gendrin Histoire Anatomique des Inflam-
mations. 2 vols. 8vo. Paris, 1822. — Dzondi Pathologiae inflammationis syste-
matum corp. hum. succincta adumbratio. Halae, 1829.

(1*) [The Hyperemie Sthenique of Andral, which however is not merely
confined to inflammation, although then more enduring ; but in every state in
which, from irritation, more blood is sent to a part than usual, as in blushing, &c.
V. his Precis Anat. Path. Vol. I. p. 12. T.]

(2) It is very important to distinguish the inflammatory redness from the
above described red colouring (Seventh Section) ; most difficult, and sometimes
even impossible, is the certain distinction of the redness produced by milder
degrees of inflammation from the injection produced by violent irritation, or
from congestion. The examination with a lens, and observation of the con-
sistence of the part, afford, in such cases, the best results. Compare Boulland
in Revue medicale Franp. et ^trangere. Mai, 1825.

§ 53.

Inflammation attacks all parts of animal bodies/ but in very
different degrees of frequency, thus, the cellular tissue, the
common integuments, the serous and mucous membranes, the
intestines, and among these, especially such as have an

40 Vices relating to Texture, [Part I.

abundance of cellular tissue and vessels, as the lungs ; then
the muscles, great vessels, nerves, are most usually affected
with the consequences of inflammation, whilst the tendons,
ligaments, cartilages, and bones, are least so. In general
external parts are more frequently affected by inflammation,
than internal ; further, it may be confined merely to a single
spot, or many parts may be affected by it at one and the same
time, even the whole limb ; now it attacks merely the surface
or investiture of a part, as the erysipelatous inflammation,
injiammatio erysipelacea, or at the same time it penetrates
into the deeper parts, and into the parenchyma of the intes-
tines as PHLEGMONOUS INFLAMMATION, plilegmone. It is
uncommonly varied, in proportion as the parts affected have
a different structure ; thus the redness and swelling are much
greater in the organs abundantly supplied with vascular and
cellular tissue, than in the reverse ; the duration and termi-
nation of inflammation is therefore also very different. Inflam-
mation also varies exceedingly, according to the difference of
age and constitution;^ next according, to the variety of the
morbid causes, in proportion as they are internal, dynamic,
chemical, or lastly, mechanical ;^ finally, in reference, to the
character of the disease itself, it may be either a common or
SIMPLE, or a SPECIFIC INFLAMMATION.* Here also we must
make particular mention, on account of their importance, of the
OCCULT or HIDDEN INFLAMMATIONS, SO Called, which are
seated especially in the intestines of the three great cavities of
the body, and during life often exhibit no distinct or deter-
minate symptoms. They occur both in men and animals,
accompanying especially the true or sporadic fevers, many
exanthematous diseases, hydrophobia, and very frequently, in
the puriform consumption, in the intestines of the belly.^

(1) The horny system is usually excepted, although many kinds of horny
softenings and excrescences on the frog of the horse's foot, (bleym), and the
swellings of the bulb and pith of the hair, must be analogous to inflammation in
other organs.

(2) There certainly does occur an inflammation of a peculiar kind in debilitated
bodies, but no asthenic inflammation, as this disease is always an increased
local vital activity; — neither do I know a chronic inflammation continuing
for months or years ; for that which is so considered is either irritation or dis-
position to inflammation, or the inflammation subsiding in one spot succes-
sively affects the others in disorganized, and especially in indurated parts.

(3) As the inflammation produced by vvounds, contusions, frost, burns, cor-
rosion with aquafortis, differs from the common spontaneous inflammation.

(4) For example, rheumatic, arthritic, scrofulous, syphilitic, carcinomatous,
anthracic, &c.

(5) 1 have often seen the most decided marks of inflammation and incipient
suppuration in the bodies of such persons as have died of sporadic and con-
tagious typhus, as well as in animals which have been affected with similar
poisons ; in two instances also in men who had been destroyed by the small-pox ;

Sect. X.] Vices relating to Texture, 4f

often also in sheep which had been attacked with pockenkrankeit, but much
more frequently the signs of inflammation are entirely wanting, and when they
are present, they are equally to be considered as merely the consequence and not
the cause of such diseases. The common reddening of particular viscera in
persons who have died of adynamic fevers, which Broussais and Tommassini have
considered as a sign of inflammation, is not in the least so, but the consequence
of mere irritation, congestion, obstruction, &c. The most important writings on
this subject are, Stoll Ratio medendi, Vol. VII. p. 73. — Wieyiholt D. de inflamma-
tionibus occultis viscerum. Gott. 1772. — Meyer D. de inflammationibus laten-
tibus generatim, etc. Frankf. 1785. — Meckel D. ilubia quaedam circa
inflammationes occultas in febribus putridis. Halae, 1788. — Reyland Abhand-
lung von verborgenen und langwierigen Entziindungen. 8vo. Wien, 1790. —
Hartmami D. de inflammatione, praesertim occultarum natura in genere.
Gotting. 1796. — Nietsch Ueber verborgene Entziindungen und die daraus ent-
springenden bedeutenden korperl. Uebel. 8vo. Frankf. 1819. — Collineau : Peut
on mettre en doute I'existence des fievres essentielles? etc. Svo. Paris, 1823.
— Gendrin Recherches sur la nature et les causes prochaines des fievres. Svo.
Paris, 1823. — Dujes Essai phys. pathol. sur la nature de la fievre, de I'in-
flammation et des principales neuroses. 2 vols. 8vo. Paris, 1823. — Laso
Coleccion de inspecciones anatomicas relativas a la fiebre amarilla. 4to. Cadiz,
1821. — Medic, Geschichte des gelben Fiebers, etc. aus dem Franz, von Liman.
Svo. Berlin, 1824. — J. Wendt Die alte Lehre von den verborgenen Entziindun-
gen durch neuere Beobachtungen bestatigt. 8vo. Breslau, 1824. — Caffin Traite
analytique des maladies dites fievres essentielles. Svo. Paris, 1824. — Castel
Refutation de la Doctrine medicale de M. Broussais, etc. Svo. Paris, 1824. —
Bailly Trait^ anat. pathol. des fievres intermittentes simples et pernicieuses, etc.
Paris, 1825. — Boisseau Pyretologie physiologique, etc. Paris, 1824. — Gilbert
Memoire: Existe-t-il toujours des traces d'inflammations dans les visceres ab-
dominaux apres des fievres putrides etmalignes? etc. Svo. Paris, 1825. — On
this question, v. Vacquie in Journ. compl. du Diet, des Sc. medicales, Nov. 1825. —
Chauffard Traite sur les fievres pretendues essentielles, etc. Svo. Paris, 1825. —
Bouilland Trait^ clinque et experimental des fievres dites essentielles. Svo. Paris,
1826. — Upon the internal false inflammations, v. L. E. Polidoro in Omodei's
Annali univers. di Medicina, Vol. XXXVJII. Ap. 1826, (against Broussais.)

§54.

If the inflammation abate without the occurrence of its
essential phenomena, the blood congested in the delicate
vessels is dispersed; the vessels themselves resume their
normal number, and revert to their former calibre, the tissues
gorged with blood again become emptied of it, and in a
word, the normal condition of the tissue is restored : this is
called RESOLUTION, resolutio. Should it not terminate thus
happily, the inflammation is followed by the critical effusion

OF VARIOUS FLUIDS, SUPPURATION, SOFTENING, HARDENING,
MORTIFICATION, and VARIOUS SPURIOUS FORMATIONS, all of

which must be here separately treated of.

§55.

As to the morbidly secreted fluids,^ they may be produced
now from the expanded surface of the organ, and in the
CAVITY receiving them, or they may be poured out in the
parenchyma of the part itself ; — in the former, they give

4*8 Vices relating to Texture, [Part I.

rise to the collection of fluids, partly of the same kind as
in morbid irritation, viz. gaseous, lymph-like,^ mucous, and
bloody f partly peculiar, as fibrous matter and pus. The
first, called plastic lymph, Jibrina, lympha coagulabilis,*^
is poured out in a fluid form under certain inflammations,
therefore named inflammationes exsudativce, and adhcesivce,^ in
greater or less quantity, and then forms, if mingled with much
serum, a turbid milky fluid containing flakes and fibres ; but
if it be pure, an homogeneous, thickish, rather yellowish fluid,
not convertible into pus, which soon becomes solid, still
harder, fibrous or membrane-like, and finally organized,^ and
assumes the name of plastic coagula, or false membranes.^
These plastic coagula are the cause of the adhesion of
organs with each other,^ are partly threadlike and shaggy
processes, partly true membranes completely enveloping the
parts. If such coagula be formed on the expanded surface
of canals lined with mucous membrane, as in the windpipe,
the alimentary canal, the urinary and generative parts, they
frequently assume the shape of the tubes, and produce solid
cylinders, which have the form of the canal itself, as if formed
by it, and are frequently thrown ofll

(1) Wendelstedt D. de cognatione et differentia inter inflammationem et pro-
ftuvia. Marburg, 1809.

(2) In acute dropsy.

(3) fVeiskircher D. de similitudine, quae plurimas inter haemorrhagias naturales
verasque inflammationes intercedit, harumque natura et sede. Hal. 1771. v.
Weiz N. Ausziige. Vol. IV. p. 115.

(4) Dowler, On the products of acute inflammation, in Med. Chir. Trans. Vol.
XII. p. 86.

(5) John Hmiter On the Blood, Inflammation, and Gun-shot Wounds

(G) That is called cellular, and is furnished with vessels which are partly new,
partly elongations from the original neighbouring vessels. Whether they pos-
sess also nervous fibres, is undecided. Upon the accidental formation of vessels
in pseudo membranes, v. Berard U. sur plusieurs points d'anatomie pathologique.
No. 4. Paris, 1826.

(7) Portal Memoires sur la nature et le traitcment de plusieures maladies.
8vo. Paris, 1800. Vol. III. and in Memoires de I'lnstitut. Nat. de France,
1807, Vol. VIII. Part II. p. 67. — Clams Progr. de partibus pseudorganicis.
etc. Lips. 1805, — Nepple D. sur les fausscs membranes et les adh^rences.
Paris, 1812. — Villerme Essai sur les fausses membranes. 4to. Paris, 1814. —
Cruveilhier Transformations et productions lamineuses in essai sur I'anatomie
pathologique. Vol. I. p. 142, with plates. — On the chemical composition of these
membranes, v. Lassaigne in the Journal de Chimie Med. Part I. p. 68. — Junge D.
de pscudo-plasmatum in c. h. obviorum natura et indole. 4to. Erlangen, 1822.

(8) Compare above, § 31.

§56.

The secretion of fibrous matter is also the means which
nature employs in the reunion, reimio^ of the divided parts of
bodies, as well as for the restoration, reproduction of parts
destroyed by injuries, tumours, and gangrene.^ In the former,

Sect. X.] Vices relating to Texture, 49

the fluid fibrous matter of the blood is poured out as a thin layer
between the wounded surfaces, at first glues them together,
by ADHESION or per primmn mtentionem, and subsequently
heals them, when the exuded layer becomes organized and con-
tains new blood-vessels, which open into the vessels of the
wounded surfaces ; in a similar way also can soft and hard parts,
which have been completely separated from the body, and even
a part of a foreign organism, be made to adhere. In cases
of restoration there may also be formed on the wound, from
the eiFused fibrous matter, little, soft, reddish, and cornlike
congelations, called granulations or fleshy funguses,^
which run together with the adjoining membrane into a kind
of skin, are converted into cellular tissue, possess many fine
blood-vessels, and whilst recent, continue to produce fleshy
substances uniting in layers, until the cavity is filled up and
the divided parts are united, upon which, then, finally a
new skin is produced; this at first is very vascular and
red, but gradually becomes white, expanded, often also some-
what thicker, or descends and becomes at the same time
tendinous, and is called a scar, cicatrix, I'he granu-
lations may rise too luxuriantly above the surface of the
neighbouring parts, and are then very spongy and easily bleed,
whence arises their name proud flesh, caro luxurinns,
fangosay hy per sar costs.

(1) TagUacozzi De curtorum chirurgia per insitionem. Venet. 1597. — Fahre
Mem. de I'Acad. de Chir. Vol. IV. p. 74. — Louis p. 106. — Bezoet D. de modo,
quo natura solutum reintegr. 4to. L. B. 1763, in Sandiforf s Thosaur. Diss.
Vol. III. p. 149. — EytfUg De Consolidatione vulneriim cum deperditione sub-
stantiae. Argent. 1770. — Murray Comm. de reintegratione part. corp. animal.
4to. Getting. 1781. — Haeherh Beantwortung de Preisfrage, welche geschnittene
und gehauene Wunden sollen durch Vereinigung und welche durch Eiterung.
geheilt werden? 8vo. Wien, 1781. — Domeier D. de viribus naturae medicatricis
in reparandis et coadunandis partibus corp. human, abscissis. Gcitt. 1784. — ■
Hahn D. de regeneratione partium mollium in vulnere. 4to. Giitt. 1787. — /.
Moore, On the process of nature in the healing of Wounds. Lond. 1789. — White,
On the Regeneration of Animal Substances, in Mem. of the Soc. of Manchester,
Vol I. — Hoorn De iis, quae in partibus membri, proesertim osseis, amputatione
vulnerati, notanda sunt. L. B. 1803. — Baronio DiigW Innesti animali. 8vo.
Milano. 1804. — Eggers Von der Wiedererzeugung. 8vo. Leipz. 1821. — E. A.
Cams D. de vi naturae medicatrice in formandis cicatricibus. Part I. 8vo. Lips,
1822. — Suringar Comm. med. de modo, quo natura versatur in restituendo omni.
quod in corp. hum. solutum est. 4to. L. B. 1823. — IVies/nann De coalitu par-
tium a reliquo corpore prorsus disjunctarum Comm. etc. c. tab. aen. 4to.
Lips. 1824. — Paul Comm. physiol. chir. de vulneribus sanandis, in certam. liter,
praem. ornata. 4to. Getting. 1825. cum duob. tab. aen. — SalfelderD. de reunione
partium corp. hum. elementarium. 8vo. Jenae, 1826. — Fr. Paul Comm. phys.
chir. de vulneribus sanandis, etc. 4to. Goett. 1825, c. duob. tab sen. — \_J. C. Carpue,
An account of two successful Operations for restoring a lost Nose from the in-
teguments of the forehead, with historical and physiological observations on the
nasal operation, including descriptions of the Indian and Italian methods. 4to.
Lond. 1816. — C. F. Graeft De rhinoplastice seu arte curtum nasum ad vivum
restituendi commentatio. Latine edidit J.F. C. Hecker, 4to. Berol. 1818. T.]

£

50 Vices relating to Texture. [Part 1.

^ (2) Gerardin Essai sur les phlogoses sarcopee ct osteopee on l' inflammation
consider^e dans sus deux seules terminaisons le sarcose et I'osteose. 4to. Paris,
1S23.

§57.

Suppuration, supptiratio, injosis^ pyogenia^ is the secre-
tion,^ produced by inflammation, of a peculiar fluid, viz. mat-
ter, pus^' a yellowish, bland, pappy or ointment-like substance,
which especially consists of many little globules and serum,^
and, according to the difference of the organs by which it is
secreted, and the characters of the preceding inflammation,
presents manifold differences in reference to its consistence,
colour and composition/ The pus is often mixed with
blood, mucus, mortified and thrown off* animal fibres, and
contains in consumption even little worms ;^ should it be
very watery, ill coloured, disagreeable, and pungent, it is then
called ichor, sanies. Pus can be secreted either from irri-
tated and inflamed surfaces, particularly from mucous mem-
branes, without abrasion or erosion of their surface ; or there
may exist at the same time with suppuration, a more or less
important loss of substance from absorption, viz. ulceration,
ulceratio,^ In the latter case, the pus-secreting and eroded
spot is either open on the external or internal surface of the
body, and then called an ulcer, ulcus^ or it is deeply con-
cealed under the investing membranes of the body and of the
particular organ itself, forming a cavity filled with matter, an
ABSCESS, abscessus, apostema,^ which may vary much in size
and form, and by the subsequent effusion of fibrous matter, is
lined with a smooth mucous-like membrane, still, however,
secreting matter. Only in rare cases are such abscesses cured
by the absorption of the matter which they contain; more
usually they make their way outwards, although sometimes also
inwards, break, and allow the matter to escape, till the cavities
are filled up by granulation. Should the abscess be situated
deeply, and the passages by which the matter proceeds to the
surface be narrow, long, and lined with a membrane resembling
mucous membrane and secreting lymph,'' such passages are then
called SINUSES or fistulas, fisiulce ; and these may also con-
nect two or more abscesses with each other. If the sides of the
abscess be destroyed, and various lateral outlets or sinuosities
be produced, then the matter is poured into the surrounding
cellular tissue; still, however, we sometimes find abscesses
without any outlet, particularly if the tissue of the part be very
tough, and the inflammation not active. All parts of the body
have not the same disposition to suppuration, nor run thereinto
with equal quickness after inflammation -^^ vascular and cellular

Sect. X.] Vices relating to Texture, 51

parts, as the mucous membranes, the common integuments,
the cellular tissue, the muscles, and the parenchyma of the
viscera, suppurate much more easily than the non vascular
parts, as cartilage, bones, and the fibrous organs.

(1) Old writers erroneously imagined that pus consisted of a resolution of
the fibrous and fluid parts of the animal body. — Morgan Puopoiesis s. Tentamen
med. de puris confectione. Edinb. 1703.

(2) Compare Ploiiqiiet Repertorium Art. Pus. Salmuth D. de diagnosi
puris. Goett. 1783. — Brugmanns D. de Pyogenia, sive mediis, quibus natura
utitur in creando pure. Groiiig. 1785. — Nicolai Theoret. und prakt. Abhandlung
iiber Entzilndung und Eiterung. Jena, 1736. — Quesnay Traite de la suppuration.
12mo. Paris, 1770. — Home, On the properties of Pus. 8vo. London, 1789; and
also in Phil. Transact. 1819. p. 1 — 11. — Pearsoyi, on the same. Part II. p. 294 —
317. 1810. — Hq^warin D. sententia de suppurationis natura. 8vo. Erlang. 1818. —
Microscopische Untersuchungen Uber die Bildung des Eiters von KaUenhrunner
in Heusinger's Zeitschrift f. organ. Physik. Vol. I. Part III. p. 314. — Fr. Petgold
D. de diagnosi puris. Kil. 1327. — A. Pramann D. de puris indole et genesi. 8vo.
Berol. U2^.~lAndral, Vol. I. p. 388. T.]

(3) On the distinction and difference between pus and mucus, compare
Darwin, Experiments establishing a criterion between mucilaginous and purulent
matter, Lichfield, 1780. — Grasmeyer Abhandlung von dem Eiter, und den
Mitteln ihn von alien andern Feuchtigkeiten zu unterschciden. 8vo. Gott.
1790. — Waldmann D. disquisitiones de discrimine inter pus et pituitam. Mar-
burg, 1807. — Rizzetii in Mem. de Turin, Vol. II. and III. — Rossi and Micheloiti,
on the same, Vol. III. p. 109.— Brande in Phil. Transact. 1809, p. 373.— v.
Paula Gruithuisen Naturhist. Untersuchung iiber den Unterschied zwischen Eiter
und Schleim durch das Mikroskop. 4to. Miinchen, 1809, with engr. — Pearson. —
Klaproth's Chem. Worterbuch, Vol. II. p. 45, 46. — Goebel in Schweigger u.
Meinecke's N. Journ. f. Chemie und Physik. Vol. IV. Part IV. p. 'iOS.—Koch
D. de observationibus nonnullis microscopicis sanguinis cursum et inflamma-
tionem spectantibus, atque de suppuratione, adjecta analysi puris chemica. 8vo.
Berol. 1825. The best means of distinguishing them is, in my opinion, the
microscope.

(4) Daucher D, INIomenta circa variam puris indolem in variis corporis hum.
partibus suppuratis. Wurzburg, 1804. — Calliscn's System der neueren Chirurgie.
Copenhagen, 1822. p. 55d. note.

(5) Rogers in London medic. Journ.

(6) /. Hunter, Inflammatio suppurativa. — A. Cooper, Lectures on the Prin-
ciples and Practice of Surgery, by Tyrrell. — De Morm D. Considerations generales
sur r erosion. Paris. 1806.

(7) There is great difference in ulcers, according to their seat and specific
character ; — if an ulcer be not covered, the pus hardens and forms a scab, crusta.
— B. Bell, A Treatise on the Theory and Management of Ulcers. 8vo. Edinb.
1778. — Bertrandi Theoret. und prakt. Abhandlung von den Geschwiiren, aus d.
Ital. 8vo. Erfurt, 1790. — Weber Allgem. Helkologie, oder nosolog. therapeut.
Darstellung der Geschwiire. Berlin, 1792. — Hebenstre'it, Zusatze zu Bell's
Abhandlung von d. Geschwiiren. Leipzig, 1793. — Underwood, Surgical Tracts
on Ulcers, &c. 8vo. 1799. — Rust Helkologie, oder iiber die Natur, Erkenntniss
und Heilung der Geschwure. 2 vols. 8vo. Wien, 1811. \_Andral, Vol. I. p. 189. T,]

(8) Severinus De recondita abscessuum natura. 4to. Francof. 1643, and 4to.
Lugd. Batav. 1724. — DavldU eher die Eitergeschwiilste, u. s. w. in Prix de I'Acad.
de Chir. Vol. IV. p. 119. — Clare Ueber die Eitergeschwiilste, aus d. Engl, in d.
Samml. f. Wundarzte. Part IV. p. 127—143, N. Samml. Part I. p. 64—88.—
Dm i^oi Cogitata quaedam de abscessibus. Jense, 1798. — Dupny de Saint- Julie
M^moire sur les A bees ou Tumeurs purulents en general. — There is great diffe-
rence in abscesses ; the peculiar kinds are Boil, Carbuncle, Lymph-abscess,
Pest-boil, &c.

E 2

52 Vices relating to Texture. [Part 1.

(9) nilermS m Roux' Journ. de Medec. July, 1815, p. 242— 2G1. v.
Meeker s Arcliiv. f. d. Physiol. Vol. II. p. 471. [Jndral, Vol. I. p. 252. T.]

(10) In many cases the suppuration takes place very quickly; earliest, and
even after a few hours, in the mucous membrane.

§58.

If the morbid effusion which is consequent on inflammation
occur not on the surface of the affected organ but in its inte-
rior structure, vices of consistence, with other distinct
CHANGES OF TEXTURE, and softcning as well as hardening,
will be easily excited, from this cause as well as from the more
active change of substance produced by inflammation.^ The
SOFTENING and LOOSENING, emoUitio, mollities^ of inflamed
tissues appears to arise thus: when a considerable quantity
of serum is poured out into the parenchyma of a part and
loosens it, the hard parts at the same time also are removed by
absorption, or their cohesion is diminished. However, it
appears that there must be sometimes also an unknown che-
mical process acting to explain the softening. We observe
this softening and loosening occur with and after inflammation
in all the systems and parts of animal bodies ; it is especially
frequent and distinct in the brain, spinal marrow, and spleen ;
then also in the muco-serous and synovial membranes f but
it is not unfrequently observed in the hardest parts, as the
tendons, ligaments, aponeuroses, cartilages, the horny sub-
stances, and even in the bones. The degree and kind of
softening and loosening is in other respects subjected to many
varieties, dependent partly on the texture of the organ, partly
on the character of the inflammation itself; especially the
so called acute inflammations, which cause the softening of
the tissue ; these may in rare cases be so violent, that the
diseased part is resolved into a kind of jelly or pap, in which
we cannot observe the least trace of an earlier existing or-
ganization.

(1) Compare ahove, the Eighth Section, on Vices of Consistence, without distinct
vice of texture. But it is a question, whether many of these are not produced
by morbid irritation and inflammation. This, in my opinion, is by no means
doubtful, as relates to watery cancer, noma, and the so-called putrescence of
the womb. It is still more the case as regards softening of the stomach ; but it
is disputed, as in metastatic abscesses, traces of inflammation are often indistinct
both in life and death ; notwithstanding that these must necessarily be present,
although in a very trifling degree. Gisbert van Beers D. de tenturae organorum
per inflammationem mutatione. Bonnae, 1825.

(2) Hesse Ueber die Erweichung der Gewebe und Organe desmenschl. Korpers.
Svo. Leipzig, 1827.— [//m/ra/ Precis d'Anat. Path. Vol. I. p. 214. T.]

(3) The relaxation of such membranes, as well as the unusual easy sepa-
ration of the various membranes from each other ; to wit, in the alimentary
canal, is one of the most certain signs of existing inflammation.

Sect. X.] Vices relating to Texture, 53

§59.

In HARDENING, induratio,^ the fluid poured into the tissue
of the diseased part under inflammation is more or less
coagulated, mingled with the normal elementary parts of the
organ, and consolidated into a firm mass. The substances
effiised are fibrous matter, and sometimes also albumen ; in
proportion as both are coagulated in a greater or less degree,
and retain the animal fluid enclosed in them, or have been
deprived of it by previous absorption, is the degree of harden-
ing very different, till at length the effused and coagulated
substance becomes organized, that is, assumes the character of
cellular tissue, forms meshes, plates, fibres, &c., acquires small
blood-vessels, and has now become a permanent part of the
tissue. The more often inflammatory irritation recurs in an
already hardened part, the greater becomes the degree of
induration, which, in itself, also naturally varies, both accord-
ing to the difference of the usual consistence of the organ
attacked, as well as to the difference of the character of the
inflammation ; thus, especially, if inflammation occur in torpid
or debilitated parts, it assumes this termination. Thickening
and hardening of a part is also not unfrequently produced
by long continued pressure. Should they be membranes
which have become thickened and hardened, they remain
mostly thick, and become opake, although they had been previ-
ously transparent ; has a part, in its healthy state, a loose and
soft texture, it can be rendered by the hardening as firm and
tough as the liver, a vice which, when occurring in the lungs,
has been named hepatisatio.^ If with hardening already set
up in the cellular tissue, we find, accompanying inflammation,
an increased flow of blood, and increased redness, this con-
dition is called the red hardening, induratio rubra :^ but on
the contrary, if the inflammation have entirely subsided, and
the quantity of blood and redness in the diseased parts are
diminished, owing to the compression and adhesion of the
vessels, then such is called white hardening, induratio
alhaJ^ The latter not unfrequently becomes so exceedingly
hard, that the indurated parts assume a true sinewy appear-
ance, nay, even actually run into bone.

(1) HoernigkT). de induratione parti um praematura. Lips. 1750. — HallerVr.
de induratis corp. hum. partibus. Goett. 1753. — Bayle in Corvisart, etc. Journ.
de M^dec. s. Edinb. med. and surg. Journ. Vol. II. Part VIII. No. 2. — Wenzel
Ueber die Induration und das Geschwiir in indurirten Theilen. 8vo. Mainz.
1815. — V. Walther in Graefe's, and v. Walther's ionvn. der Cbir. Vol. V. Part II.
p. 196. [G. Jndral, Precis d'Anat. Patb. Vol. I. p. 199. T.]

(2) Morgagni De sedib. et caus. niorbor. Ep. XXI. 2, 17, 19, 27.

(3) This is, however, divisible, and easily resoluble by suppuration ; we com-

54 Vices relating to Texture, [Part I.

mouly observe it in the neighbourhood of ulcers and abscesses, but sometimes
also the parenchyma of a whole intestine is affected by it.

(4) To these belong, for example, the callous edges of many ulcers, the
so-called cold swelling, the hardening and swelling of the almonds of the
uvula from repeated attacks of inflammation, and the hardening in many organs ;
which, by the old practitioners, were improperly termed scirrhi. This kind of
hardening must not be confounded with the equal whitish scirrhous and tuber-
cular hardening.

§60.

Morbid ossification, ossificatio sea osteogenesis prce-
ternaturalis^ presents indeed very different degrees of harden-
ing, but in general less than that of the ordinary bones, so
that the diseased mass is but in a cartilaginous, (cartilagina-
TiON,) fibro-cartilaginous or horny-like pliable state. ^* In other
cases the proportion of earth to the animal parts is more
favourable, and the morbid growth has the accidental com-
position, consistence, and, in rarer cases, also the structure of
true bones. If the earth be in still greater quantity, the mass
more solid, gypsum-like, creaking when cut, and without
any trace of organization, we properly call this disease pe-
trifaction, petrificatioJ^ Repeated inflammation, rickets,
tubercular disease, syphilis, gout, and all the diseases by
which an increased absorption of the earth of bones is pro-
duced, or the bony earth is removed, contrary to law,
from one part and morbidly deposited in another, must be
considered as the principal causes of morbid ossification. A
general or local debility of the living power seems always
to precede ossification ; it therefore occurs at a later period
of life, and although it may be found in almost all the systems
and parts of animal bodies, yet it occurs most frequently
in the torpid parts of the organism.^ A general and uniform
penetration of the normal substance of an organ with bony
accretion,^ or a true conversion of the tissue, rarely occurs ;
more frequently is the extraneous matter collected merely
on single spots, and more loosely connected with the normal
tissue,^ is then of very different forms, viz. as numerous
isolated specks, as drops of cartilaginous and bony sub-
stance running as it were out of each other, and coagulated, as
larger or smaller thin plates,^ or as more roundish, thicker, but
often also as angular and unequal pieces, &c.^ We also see
not unfrequently in the cavities of the joints, in the mucous
bags, in diseased synovial bags, in the vaginal membrane of
the testicles, also in the pericardium, in the membranes of the
chest and belly, one or several loose, mostly roundish
cartilages, or bony and stone-like concretions, which
in the l)eginning, always, and also commonly in later years,

Sect. X.] Vices relating to Texture, 55

are attached by threads or necks, and seem to be contained
in a kind of bag, of which the neck is subsequently ruptured.^

(1) Salzmann D. de ossificatione praeternaturali. Argent. 1720. — Schacher Pr.
observ. circa materiam ossificationis praeter naturam factae. Lips. 1726. v.
Nailer's Coll. Diss, Part VI. No. 205. — Fater D. de osteogenia naturali et
praeternaturali. Viteb. 1726. v. Hallej's Coll. Diss. Part VI. No. 206.— Fa^er
D. de ossificatione praeternaturali. Viteb. 1728, — de Halter, Pr. de ossificatione,
ut vocant praeternaturali. Gott. 1749, and Element. Physiol. Vol. VIII. Part II.
p. 78. — Hoernigk 1. c. — Konigl, Vetenskaps Academiens Handlinger, Vol. XI.
p. 12. — Sandifort in Observat. anat. patbol. lib. III. cap. II. p. 42. — van Heekeren
D. de osteogenesi praeternaturali. 4to. Lugd. Batav. 1797, with engr. — Penada
in Saggio di osservazioni, etc. P. II. p. 36. Padua, 1800. — Meckel Handb. d.
pathol. anat. Vol. II. Part II. p. 160. ■ — [L. V. Brugnatelli Litologia Umana,
Ossia Ricerche chimiche e mediche sulle Sostanze petrose che si formano in
diverse parti del corpo umano, etc. fol. Pavia, 1819. T.] — Cruveilhier, P. II.
p. 1. — Gerardin Essai sur les phlogoses sarcopee et osteop^e, ou I'inflammation
consideree dans ses deux seules terminaisons, la sarcose et I'ost^ose. 4to. Paris,
1828. — /2a?/er in Archives generales de Medecine, March and April, 1823. —
Concerning the chemical analysis, v. D?mca7i, jun. in Edinb. med. and surg.
Journ. Vol. I. p. 407. — JohnChem. Tabellen des Thierreichs. fol. p. 60. Berl.
3 814. — [/. B. Boyer De Suppuratione et curatione inflammationis per suppu-
rationem tcrminandae. 8vo. Monsp. 1766. — ytndral Precis d'Anat. Path. Vol. I.
p. 388. T.]

(1*) [G.Andral, Precis d'Anat. Pathol. Vol. I. p. 275. T.]

(2) The earth which is collected in morbid ossification, is in general phosphate
of lime; but in gouty concretions. Tophi make an exception to this, as
they consist of urate of soda. Tennant first discovered this. v. John, p. 5d. —
Wollaston and Fourcroy confirmed it. Not unfrequently, such earths are poured
out in great quantities in tbe lu'ine, sweat, ulcers, spittle, &c. We also some-
times find it collected as a whitish thickish pap, as a viscid chalk in the thyroid
and bronchial glands, under the inner coat of the arteries, and in other places.

(3) For instance, Ciirtilage, fibrous parts, cellular tissue, serous membranes,
glands which have been emaciated or destroyed by disease, arteries, encysted
tumours, dead hydatids, sarcom, even the dead child, with its membranes, if it
have been retained for a long time in the mother's womb ; — in many instances,
this ossification is a fortunate effect of the healing process. It appears, in
general, to occur more frequently in the male than in the female organism.

(4) Perhaps only in cartilage and in tendinous parts.

(5) In these cases we are accustomed to distinguish the morbid formations by
the names concrementa ossea, lapidea, &c. ; if they lie very loosely, they form the
transition to stones, which have no organic connexion with the body.

(6) Thus it appears most frequently in and between the membranes, and then
sometimes produces a kind of hard crust around an organ.

(7) These lie usually in the parenchyma of an organ, and in the loose cellular
tissue, although sometimes not far distant from the surface of membranes ; for
example, of the peritoneum, the pleura, and the inner surface of the dura
mater, &c. and then, by their sharpness and irregularity, irritate the neighbour-
ing organs. Here also belong the very common, and oftentimes very large, fibro-
cartilaginous tumours in the substance of the womb.

(8) Laennec in Diet, des Sc. medical, Vol. IV. p. 123. — Cassan in Archiv.
general de Medec. May, 1826. — Wardrop in Edinb. med. and surg. Journ.
Vol. IX. p. 14. — Fuhrmann D. de tumoribus cysticis humorem synoviae similem
et corpuscula cartilaginea continentibus. Jente, 1822. — Compare the several
parts in Cruveilhier in Archiv. general de Medec. Jan. 1824.

§61.

The most unfavourable termination of inflammation is
MORTIFICATION, gtingrccna, sphacelus^ sideratio, mortification

56 Vices relating to Texture, [Part I.

which is the gradual destruction of the vital activity, and the
actual death of the aftected part. A higher degree of inflam-
mation which puts an end to the living power of an organ, or
a moderate, sometimes scarcely perceptible, inflammation con-
nected wdth a high degree of general or local weakness, are
the causes of mortification.^ So also do the parts most distant
from the heart, as the toes and fingers, and certain parts
endowed with little vitality, as the scrotum, the bones and
tendinous parts, morbid growths, &c. run more readily into
mortification than others. The condition of the mortified
organs is very different according to the degree, the exciting
causes, and the character of the disease, as well as the difference
of the organic texture.^ The transition of inflammation into
mortification, or the lower degree of this disease, is called in
the strictest sense garigrcena, moist, acute, inflammatory,
or HOT MORTIFICATION ;^ but the highest degree of mortifica-
tion, or actual destruction of a part, and the mortification which
occurs without distinct preceding inflammation, we are accus-
tomed to call sphacelus, dry, chronic, idiopathic, and
COLD mortification. In the former, the red colour of the
impeded blood is changed to yellowish brown, the diseased
part itself, although at first a red blush had extended over it,
becomes purply red, discoloured, lead-coloured, and at last
blackish ; vesicles rise filled with ichor, and the skin, together
with the subjacent parts, becomes more or less deeply dis-
coloured, broken up, and destroyed. In sphacelus, on the
contrary, the violent inflammatory blush is absent, the diseased
part becomes gradually black, shrinks together, and often dries
up like a mummy. To the latter kind also belongs, senile
mortification, gangrcena senilis, gangrcena ex seiiio, me-
lasma,^ which especially first attacks the toes and fingers, often
extends further, and for the most part seems to be produced
by vices of the heart and arteries, especially by the ossification
of their smaller branches. We must also notice as particular
forms of mortification, carbuncle, black-vesicle, or malig-
nant BUBO, carhunculus, anthrax, pustula maligna,^ vespajus,
PLAGUE-BUBO, &c. similar diseases, in which, by endemic,
epidemic, or frequently even contagious influence, as mortifi-
cation of the spleen, and plague, one or many malignant
inflammatory swellings are produced on the external and
internal parts of men and beasts, birds, and even fish, which
run on to mortification ; and lastly, the so called w^atery
cancer, noma, cancer aquosus, cheilocace^ a malignant
tumour rapidly spreading and running into gangrenous cor-
ruption and jclly-Hke sohition, which occurs, especially, on the
lips and checks of children.

Sect. X.] Vices relating to Texture, 57

(1) Compare with reference to Literature, Reuss Repertor. commentat.
Vol. XIII. p. 3()5 — 383. — Ploucquet Repertor. Art. Gangraena & Spha-
celus. — Maitland D. de gangraena. Edinb. 1775. — [jP. Quesnay Traite de la
Gangrene. 8vo. Paris, 1749. — Vic d'Jyr Suite des observations sur les con-
cretions animal, in Hist, de la Soc. Roy. de Med. 4to. Vol. IV. p. 279.
Paris, 1779 — 98. . T.] — Himly Abhandl. iiber den Brand der weichen und
harten Theile. 8vo. Gott. 1800. — Neumann Abhandl. vom Brande und Heils-
methode desselben. 4to. Wien, 1801. — Leslie D. de gangra&na contagiosa,
Edinb. 1804. — Johnston D. de gangraena contagiosa nosocomiali. Edinb. 1805. —
Heffter Doctrinae de gangraena brevis expositio. Lips. 1807. — Lassus Pathol,
chir. Edinb. 1809, Vol. I. — Liesching D. de gangraena. 4to. Gott. 1811. —
Thomson, Lectures on Inflammation, &c. 8vo. Edinb. 1813. — Brugmann
Den Hospitalbrand. — J. Delpech Mem sur la complication des Plaies et des
Ulc^res connue sous le nom de Pourriture d'Hopital. 8vo. Paris, 1815. —
Gerson Ueber den Hospitalbrand, etc. 8vo. Hamb. 1817. — Ericson praes.
Akerman Observationes circa gangraenam. 4to. Upsal. 1817. — Hilsont). de
gangraena nosocomiali. Edinb. 1818. — Brauer Observat. quaedam de gangraena
nosocomiali. 4to. Lips. 1820. — Henzschel D. de gangrsenae atque sphaceli
natura, indole et curatione. 4to. Lips. 1821. — Gregory D. de gangraena
nosocomiali. Edinb, 1822. — Arnold D. de gangraena. Landishut. 8vo. 1823. —
JHancke Ueber den heissen und kalten Brand, etc. Einladungsprogramm. 8vo.
Breslau, 1826. — Renard Ueber hospitalband. Mainz, 1815. — Dussaussoy
Dissertation et observations sur la gangrene des hopitaux, etc. Lyons, 1807. —
C. P. Hilsenberg D. de ffangfrena nosocomiali. 8vo. Berol. 1828.

(2) Old age, scarlet fever, measles, and erysipelas dispose to mortification;
so also syphilis, the mercurial disease, the contagion of typhus, &c. It very
commonly arises from burns, or severe cold ; further, from the cessation of
the circulation in a part ; also from ligature, compression, or stoppage of the
large blood-vessels; very commonly also from continued pressure of very tight
ligatures, from the pressure of a tourniquet in the cure of aneurism ; from con-
tinued lying on a part; hence the wounds produced by lying, decubitus,
on the sacrum, edges of the hip bones, the blade bones, and heels, in long con-
tinued illness, with great weakness of the living powers. Aneurism of the heart,
and large vessels, sometimes cause mortification of the limbs.

(2*) [An instance of mortification of the cheek, consequent on hooping cough
in a child, has lately occurred in St. Thomas's Hospital. She died in nineteen
days from the commencement of the attack. T.]

(3) For example, soft juicy parts are much more easily destroyed by mor-
tification than hard parts, as tendon, cartilage, and bone ; in the latter, this
disease is named necrosis.

(4) Boyer, in his Treatise on Surgical Diseases, Vol. I. improperly calls the
mortification, which does not penetrate beyond the skin and subjacent cellular
tissue, GANGR^NA, and that which penetrates deeper into the flesh, and to the
bones, sphacelus.

(5) Pott Obs. on the mortification of the toes and feet in Chir. Works. 8vo.
Vol. III. Lond. 1791.— Cooper, in Phil. Transact. Vol. XXIII. p. 1195; Vol.
XXIV. p. 1970. — Thomson, p. 537. — Hodgson, Treatise on the diseases of arteries
and veins, &c. p. 65. 8vo. Lond. 1815. — Utmer in der Dresdner Zeitschrift f.
Natur-und Heilkunde. Vol. II. Part II. — Weinech D. de gangraena senili. 8vo.
Halae, 1821. I have seen a man, about thirty years of age, who had lost by this
disease all his toes and fingers, his ears, and a part of his heels. I have seen
this disease sometimes produced by vices of the heart. The mortification which
arises, after living on blighted corn, is very similar, v. Dodard in Journ. des
Savans. 1676. — Noel in Mem. de I'Academ. des. Sc. 1710. — [In the Medical
Museum, 1763, Vol. I. p. 442, a very interesting history is given, by Dr. Wool-
laston, of a whole family, who were all affected with mortification of the legs, in
consequence, it was believed, of eating bread made with bad corn, (it being then,
1762, a time of great scarcity;) and also, that the mother and her six children
were all affected within three days, and the father in a fortnight after. T.]
Langius Descriptio morborum ex esu clavorum secalinorum Campaniae. Lucern,

58 Vices relathig to Texture. [Part I.

1817. — Pessier in Mem. de la Soc. royal de Medec. Vol. I. and II. — Prescott,
On the natural Histoi'y and medicinal Effects of the Secale cornutum, or Ergot.
London, ISlo. See the observations on Raphany. — [Raphany, or Kriebel-
krankheit, as the Germans call it, is a disease produced, it is believed, by eating
the bastard radish. T.]

(6) We find in the midst of carbuncle, a viscous mortified core, the skin also
covering it is at the beginning, perforated by ulceration like a sieve, and some-
times many holes are formed near each other, like a wasp's nest, whence the term
vespajus is applied to it. Compare Guidetti and Malvani in Journ. general de
Medec. No. 294.— jPosfirooAe in Edinb. med. and surg. Journ. Jan. 1821. — A'o/j;;
gives a good plate of carbuncle in the Jahrb. der Staatsarzneik. Jahrg. VI. 1813,
p. 96. — Very many authors in Ploucquet Repertor. Art. Antln-ax. — Callise?is
System Chirurgiae hodiei'nae. 2 vols. 8vo. Hafn. 1824. — Hoffmann D. de
Anthrace. 8vo. Halae, 1820. — Hoffmann in Rust's Magazin f. d. ges. Heilk,
Vol. XXI. Part I. p. 70. — Erdviann Annales Scholae clin. Dorpartensis,
1818—20, and in Horn's Archiv f. medic. Erfahr. 1822, Jan. Febr. p. 182.—
Hoffmann der ^Milzbrand oder contagiose Carfunkel der Menschen u. s. w. 8vo.
Stuttgart, 1827. — Pagliati Sopra un vastissimo Antrace, memoria teoretico-
practica. Messina, 1821. — Kralin D. de pustula maligna. 8vo. Berol. 1826. —
Helbich D. de carbunculo polonico, Berol. 1827. — L. Schrader Uebcr die natur
des Milzbrandes der Thiere des Milzbrandcarbunkcls bei den Menschen, &c.
8vo. Magdeburg, 1828. — C. F. Schroeder Ueber die schwarze Blatter in Rust's
Magazin, Vol. XXIX. Part II. p. 236.

(7) EyseUiis D. de nomis. Erf. 1701. — van Swieten Comm. in Boerhav. Aphor.
Vol. I. p.i749 — 766. Vol. IV. p. 746. — Bierchen Abhandl. von den wahren
Ivcnnzeichen des Krebsschadens. Gtitt. 1775. — deMezam Act. Reg. Soc. med.
Hafn. Vol. II. No. 7. — Thomassen a Thuessink in Geneeslcond. Magazyn. Vol. III.
Part III. No. 13. — Pittschaft m HufelamVs 3 owvn. A. ^YVL\^t.Ylei\k. 1821. Part
VI. p. 14. — Klaatsch ib. Jan. and Feb. 1823. — Reimann D. de nomate, etc.
8vo. Berol. 1824. — E. Thompson, On the gangrenous erosion of young children,
in Loud. Med. and Phys. Journ. June, 1827. — A. L. Richter Der Wasserkrebs
der Kinder, a monograph, with two plates. BerL 1828.

§62.

A remarkable consequence of mortification which does not
prove mortal, is the separation of the dead part from
THE rest of the ORGANISM.^ This is effected by a fresh
inflammatory swelling of the living parts, whilst the dead fall
together, are distinctly bounded by an ulcerated groove, at
first well marked by a white line, and subsequently by eleva-
tion of the skin and by suppuration. The skin and cellular
membrane separate first, next the muscles, nerves, and vessels,
the latter of which are found partly plugged by coagulated
blood, partly closed by active adhesive inflammation, and there-
fore no blood escapes — and at last, the tendons and bones also,
so that sometimes the whole limb is thrown off spontaneously.^
If the bones, cartilages, and tendons, be only partially
destroyed, layers of greater or less thickness separate from
their surface, exfoliation, exfoliatio, which retain the form
of the part ; in the soft formations, however, this occurs very
seldom, and is only observed in parts composed of several layers
or coats.' In rare instances also, cancerous tumours, sarcoms,

Sect. X.] Vices relating to Texture, &§

polyps, and other growths, are separated by mortification, and
even entirely cured/

(1) Compare § 46.

(2) Ploucquet Repertor. Art. Necrosis ; also Aepli in HufelancTs Journ. d.
prakt. Heilk. Vol. XXV. Part III. p. 136.— Spring f eld Nov. Act. Acad. Nat.
Cur. Vol. III. p. 4!64!.—Gignoux in Mem. de I'Acad. Chir. Mem. Vol. V.
p. 778. — Pyaloux, Ibid. Vol. II. p. 477. — Butschka in Badischen Annalen f.
d. gesammte Heilkunde, Jahrg. II. Part I. p. 1 10 ; also both legs at the hip joint,
— Noel. — Both arms at the elbow joint, v. Mem de Paris, An. 1703. M^m. p. 41.
Most frequently the foot at the calf. Two instances of this kind have been given
hy A. Cooper, Principles and practice of Surgery, edited by Tyrrel, Vol. I. p. 216
and 226 ; and another by Bleuland in Genees-natuur-en Huishoud-kundig Ka-
binet van Foegen van Engelen, Part II.

(3) So also large pieces are lost by mortification, from the mucous membrane
of the alimentary canal, or of the urinary organs.

(4) See several instances in Cruveilhier Essai sur I'Anatomie Pathol. Vol. I.
p. 127. I have, a short time since, observed a complete spontaneous separation,
by mortification, of a large sarcom from the shoulder; after some time, however,
it was reproduced.

^63.

The last kind of vice of texture, which occurs in conse-
quence of inflammation or a similar state, depending on a
greater degree of plasticity, is not, as the already mentioned
vices, a morbid change of the normal part of the organism,

but the FORMATION OF NEW SUBSTANCES EITHER NOT pre-
viously existing at this particular spot, or generally
NOT IN the body, wliich are called spurious formations,
pseudoplasmata,pseudorganisationes,^ and as they also usually
produce local swellings, must be numbered among tumours,
tumores, pliymata.^ Some of these spurious formations are
accurately separated from the normal parts, are of a non-
malignant character, and with reference to their texture,
sometimes in a measure resemble the natural tissue^ — others
are less defined, have a disposition to seize upon and destroy
the neighbouring parts, are at first hard, but gradually soften,
are all more or less of a malignant kind, and in their texture
have but little resemblance to the natural tissues. To the
former kind belong the encysted swelling, to the latter
tubercles, sarcoma, and cancer, all of which must be here
particularly treated of.

(1) v. Clarus, Cruveilhier, Junge, Sect. 55, note 7. — von Olfers de Vegetativis et
animatis corporibus in corporibus animatis reperiundis Comment. 8vo. Vol. I.
Berolini, 1816. — Casper Zur Lehre von den Afterorganisationen in Hani's
Archiv f. med. Erfahr. 1821. Nov. Dec. p. 385. — Heusinger first Bericht von
d. konigl. anthropotomischen Anstalt zu Wiirsburg. 4to. 1826. p. 9. ff". —
Ritgen Pathologic u. Therapie der Afterbildungen. Berl. 1828, and in v. Graefe
and V. WaUher's Journal f. Chir. u. Augenheilk. 1828. Vol. XI. Part I. p. 1.
Part II. p. 181 — 229. Part III. p. 405. — Me?/er Untersuchungen uber die
Natur parasitischer Geschwiilste im Mensch. Korper, etc. 8vo. Berl. 1828. —
[^ndral, Vol. I. p. 478. T.]

60 Vices relating to Texture, [Part I.

(2) Rcuss Repertor. Comment, Vol. XV. p. 25, If. — Plouqnei Repert. Art.
Tumor. — Sevennus de recondita abscessum natura. 4to. Francorf. 1613. —
de Sauvages D. Theoria tumorum. Monsp. 1753. — Astruc Traite des tumeurs et
des ulceres, Paris, 1759. translated into German by Ru.mpelt. Leipz. 1761. with
remarks and additions by Hehenstreit. 3d edit. 1805. 2 Parts. — B ertrandi Ahhsjidl.
V, d. chir. Operation. 8vo. Nizza, 1763. — Opere. Svo. Turin, 1786. Vol. I. II. —
Abhandl. von den Geschwiilsten. deutsch von Spohr. 8vo. with plates. Leipz. 1788.
van Gesscher Proeve over de voornaaniste langduurige Gezwellen. Svo. Amst.
1767. — Plevk Novum systema tumorum, etc. 8vo. Vienn. 1767. — J. Bell The
principles of Surgery, as they relate to wounds, ulcers, 8:c. 4 vols. Svo. Lon-
don.— Ahemethy, Surg. Observat. &c. Lond. 1804. — lb. Surgical Observations on
tumours and on lumbar abscess. 2 vols. Svo. London, 1827. — Pelletan in
Clinique chirurgicale, etc. Vol. T. Paris, 1810. — Cm«(?, in Edinb. med. and surg.
Journ. Vol. IX. p. 409. — Baron, An inquiry illustrating the nature of tuber-
culated Accretions of serous membranes, and the origin of Tubercles and tumors
in different textures of the body. Svo. London, 1819.

(3) The resemblance of such spurious formations to healthy parts and tissues
of the body, which especially Laennee, in Journ. de Medec. par Corvisart, etc.
Vol. IX., Pluviose ; and in Diet, des Scienc. medical, Vol. II. p. 46 — 61.;
Fleischmann, in Leichenoffnungen, Erlangen, 1815, p. Ill, and many others,
have pointed out, is however but little in an anatomical view, as will be seen in
the following observations.

§64.

The ENCYSTED or BAGLIKE TUMOURS, tumores ci/stici,
tunicatif cystides, liipice,^ are equally common spm'ious forma-
tions both in men and animals, originate one or more at a time
in almost all parts of the body, in consequence either of a
general disposition, or of mechanical causes ; still, however, their
especial seat is in the cellular membrane beneath the skin.
They are composed of an external perfectly closed cyst, which
secretes the substances contained within,^ and may be of a
very different thickness and texture. Sometimes it is extremely
thin, and merely resembles condensed cellular tissue ; in
other cases it is firmer, and has some similarity to serous,^
fibrous, or mucous membranes ; it may also consist of many
layers, has naturally but few and small blood-vessels and often
none at all, in which latter case it seems nourished merely by
absorption. Usually these encysted tumours lie loosely in the
surrounding cellular membrane, although they are sometimes
more firmly connected to the neighbouring parts, if by their
pressure they have given rise to inflammatory irritation ; mostly
they present a roundish, smooth, though sometimes also, if
lying between unyielding parts, a more compressed form, and
an endless variation of size, acquiring a diameter even of several
feet, which sometimes remains the same for a long period, at
other times increases more or less quickly. They rarely
disperse of themselves ; if artificially emptied, they soon fill
again; should they be only partially removed, they soon
attain their former size; sometimes, if they be much irri-
tated, they run into fungous, cancerous destruction; the

Sect. X.] Vices relating to Texture, %\

cysts frequently become bony, and then cease to grow. The
contents of these encysted tumours differ very much ; as a
general rule, however, they always consist of inorganic, fatty,
or lymph-like fluids. If they contain animal fat, they are
called LARDY or fatty tumours, lipoma, steatoma;^ if they
contain a clearish serous fluid, and the bag itself is no
where attached, but loosely enclosed in the tissue of the organ,
in the cavities of the body, or in their own more common
capsules, they are called hydatids, hydatides ;^ should the
fluids be similar, whilst the sacs are firmly attached, as other
encysted tumours, they obtain the name hygroma, tumor
serosus, lymphaticus, cysiis serosa, hydrops saccatus, S^c, ;''
if they contain a thicker substance similar to the lubricating
fluid of joints, they are called synovial tumours, tumores
synoviales, or ganglia;^ finally, if the contents be more or
less coagulated and granular, such are called granular
TUMOURS, atheroma, or honey-like tumours, meliceris,^ &c.
We not unfrequently find also besides the substances already
mentioned, hairs,^ pieces of bone, and teeth ^*^ in encysted
tumours.

(1) Compare Reus Repertor. Comment. Vol. XV. p. 29. — de Plouquct
Repert. Art. Tumor cysticus. — Littrem Mem. de Paris, A. 1709. Hist. p. 22. —
Lafaye'm Mem de la Soc. de Med. pr. de Montpellier, Vol. XXXII. p. 340. —
Slevogt D. de tumoribus tunicatis, Jan. 1719. — Salzmann D. de quibusdam tumo-
ribus tunicatis externis, Argent. 1719, in Halleri Coll. Diss. chir. Vol. V.
No. 150. — Fitzgerald D. de tumoribus tunicatis. Monsp. 1733. — Gouraigne D.
de tum. tunic. 4to. Monsp. 1733. — Heister D. de. tumor, cyst, singularibus.
Helmst. 1744. — Rey Traite de tumeurs encystes. 8vo. Bruxell. 1752. —
Girard Lupiologie, ou Trait^ des tumeurs connues sous le nom de loupes. Paris,
1775. — Chopari Essaie sur les loupes, in Prix de 1' Acad, de chir. 4to. Vol. IV. —
Chambon Memoires sur les loupes. lb. — Pohl D. de tumorum tunicatorum
genesi. Lips. 1778. — Klose D. de tumor, cyst. Duisb. 1790. — Loder D. de tumor,
cyst. Jenae, 1791. — Jacobsen D. de tumor, cystic. 4to. Jense, 1792. —
Abernethy. — Boudet Essaie sur les loupes. 4to. Strasb. 1806. — Akerman, resp.
Ekelund D. de tumore cystico. Ups. 1817. — Munch D. s. animadversiones
nonnuU. de tumor, cyst. etc. Wirceb. 1818, with plates. — A. Cooper and Trovers,
Surgical Essays, in Two Parts. — v. Walther in his and Graefe's Journ. d. Chir.
u. Augenh. Vol. IV. Part HI. p. 379 — 399. — Fuhrmann D. s. varior. auctor.
observata de tumor, cysticis, etc. Jenae, 1822. — Sckaefer D. quaedem de tumor,
cyst. 4to. Lips. 1825. — Bricheteau in Diet, des Sc. medic. Art. Kyste. Vol.
XXVI. p. 13. — Manfalcon, ib. Art. Lupia. Vol. XXIX. p. 76. — Adam's Opinion,
who considers all encysted tumours as inferior animals, as hydatids, v. On the
cancerous breast. London, 1801. \_E. Bisset, M. D. Observations on lymphatic
and encysted tumours, in Medic. Comment. Vol. IX. p. 244. — Andral, Precis,
Vol. I. p. 242, &c. — Thos. Hodgkin, M. D. On the anatomical characters of some
adventitious structures, in med. chir. Trans. Vol. XV. p. 272. T.] I have
seen several in the horse, cattle, dogs. At Alfort, one from a horse weighing
fifty pounds ; moles, and the swellings on the elbows of horses, are very often
encysted ; Rigot Ueber die Balgbildung in den Thieren. Recueil de Medec.
veterin. par Girard T. V. April, 1825. p. 169. — Delpech in Chir. clinique de
Montpellier, Vol. II. Paris, 1828. (Twenty-third Observation.)

(2) In this respect they differ from the false encysted tumours, which are

62 Vices relating to Texture, [Part I.

formed by exsudative inflammation around eflused fluids, as the blood, and
around extraneous substances remaining in the body, and neither grow nor
secrete. I however know one such instance, in which, besides the hard extra-
neous body, lymph also was contained in such sac. Compare Cruveilhier Essaie
sur I'Anat pathol. Vol. I. p. 202, ff.

(3j Bichat first observed this in his Anat. Gener. Vol. I. p. 103. Paris, 1801 ;
they, however, always want the principal character of serous membranes, viz.
that they are circumscribed within.

(4) These are the most common and the largest of all encysted tumours, and
occur especially on the trunk, and on parts which are naturally fat: — frequently
is the fat contained within them similar to the common fat of the body ; often-
times, however, it is very different, more like oil or lard ; or very hard, being
mixed with adipocire and coagulated albumen. Fatty tumours have always,
according to my observations, a cyst, often indeed very delicate ; but one kind,
which is to be considered more as a disease of the skin, and forms in it some-
times very numerous knots and swellings, appears to have no distinct bag, but is
only surrounded by thickened cellular tissue. For example, the cases in Ludwlg
Hist, pathol. singularis cutis turpitud. fol. with plates. Lips. 1793. v. Walther
Ueber die angebornen Fetthautgeschweilste, etc. fol. with plates. Landshut, 1813.
— Renard'm the Salzb. Med. Chir. Zeit. No. 41, p. 251. 1815. (The case was
hereditary.) Concerning the lipomata lying under the skin, which are situated
in the subcutaneous mucous bags, v. Schreger de Bursis mucosis subcutaneis.
fol. p. 12. Erlang, 1825. — Willudovius s. Remer in Iliifelavd's Journ. der
prakt Heilk. Sept. 1819. — I have seen also a similar case in a hospital here.
Perhaps here also belongs the case related by Jlibert, in his Nosologie
Naturelle, Vok I. pi. 17. — Fatty tumours also not unfrequently depend from
narrow necks, of which the roots are very deeply imbedded. For instance,
Cruveilhier, \o\. I. p. 197. — Kohhusch Corara.chxx. s. exstirpationem steatomatis
in pelvis cavitate radicantis. 4to. c. tab. aen. Lips. 1826. I have seen several
similar. On fatty tumours, compare the literature in Reuss Repert. Vol. XV.
p. 26 and 34. — de Plouqnct Art. Steatoma ; and further, the individual
parts of the body ; there are some novel remarkable instances ; in Weidmann
Annotatio de steatomatibus additis quinque fiouris in sere ductis. 4to. Mogun-
tiaci, \U7.~Brennecke in Allg. med. Annal. Oct. 1811 , p. 930 (25 Pf.)—
Rohers Medic. Repository, 1816. Hufeland's Journ. 1816, Part VIIL p. 12,
with engravings, — (hanging down from the breast to the knees, and 3 feet 3
inches long.) — B.v. Siehold in Chiron. Vol. L No. 3, p. 671. — Dorsey in
Transact, of the American philos. Soc. Philad. 1818, new ser. Vol. I.
(3 feet 9 inches in circumference, 25lbs.) — Berndt in Rust's Magazin fiir die ges.
Heilk. Vol. XIIL Part L p. 160. (22 lbs.) — Hille in the Dresdner Zeitschr. f.
Natur-u. Heilk. "\'ol. IL Part IL p. 255. — A. Cooper, in med. chir. Transact.
^'ol. XL Part IL p. 440. (1 J yards in circumference, 37 lbs.) — Compare Rusfs
Magaz. Vol. XII. Part I. p. 204. two plates-— A'^cm in Graefe and v. Walther Journ.
f. Chir. Vol. I. p. 106. Berl. 1820.(3 feet 1 inch long, 27f lbs.)-P/«. d'Oser-
nyanszky D. s. steatomatis insignis adumbrationem. 4to. c. tab. Regiomonti,
1821, (on the fore arm). — Dagorn Observations chirurg. sur une jeune fille,
qui portait sur le tronc huit loupes. 8vo. witli plates. Paris, 1822. — Compare
Cm//// Pathol, anat. Mus. Vol. I. Part IV. p. 33. Taf. XX—XXUl.—Liston,
in Edinb. med. and surg. Journ. No. 77, October, 1823. (445lbs.) — Portalupi
Storia ragionata dell' enorme tumore del Nob. Sign. Luigi Tedeschi, etc. 8vo,
Venez. 1823, (52 lbs.) — Otto Verzeichniss d. anat. Priiparatsammlung zu Breslau
8vo. 1826. No. 2085—2099.

(5) Also Dead Hydatids, as distinguished from the living, which belong to
the intestinal worms ; — Akephalocystes of Laennec, Bullet, de la Faculte de Medec.
1805, chap. 10. — These are spheroidal smooth bodies, varying in size from that of
a millet seed to an orange, and are especially contained in bags, either singly, or
in many thousands ; their membranes are white, mostly transparent, entirely
deficient of vessels, more or less thick, consisting at least of two, and often of
several layers ; their fluid is usually thin and clear, sometimes, however, turbid,
and mingled with lymphatic coagulations : they also often contain within them

Sect. X.] Vices relating to Texture. 63

little hyilatids, which either swim in the fluid, or sprout from the internal surface
of the large liydatid. Compare as to Literature, Reuss Repert. Comment. Vol.
XIII. p. 480. — de Plouquet Repert. Art. Hydatis, and on the individual parts.
Hunter, in Transact, of a Soc. for the improv. of med. and chir. Knowledge.
Vol. I. p. 34. London, 1793. — Feit Einige Bemerk. iiber die Entstehung der
Hydatiden, in Reirs Archiv. f. die Physiol. Vol. TI. p. 486. — Rudolphi Ento-
zoorum s. verm, intestinal, hist. nat. Amstel. 1808 — 10, 2 vols. 8vo. in several
passages. — Ludersen Dis de hydatidibus. 4to. with a plate. Giitt. 1808. — Himly
in his and Hufeland's Journ. der prakt. Heilk. Dec. 1809, p. 140. — ^. Monro,
An Essay upon the Hydatids of the human body. 8vo. Edinb. 1811. — Meckel
Handb. d. pathol. Anat. Vol. II. Part II. p. 394. — Foshroke in Lond. med.
Repository, Vol. XXI. No. 122 — 125. — Baron, an Inquiry, illustr. the nature
of tuberculated accretions of serous membranes, &c. 8vo. Lond. 1819. —
J. Carlevarius D. de hydatidum origine et mutationibus successivis. 8vo.
Savona, 1825. — Encysted tumours, containing hydatids are often enormously
large, particularly in the belly ; for some examples of such cysts in the general
cellular tissue of the body, v. Reuss and Plouquet. — Janin in Sedillot Recueil
period. Vol. XXIII. p. 254. — Bisset \n Dzmcaw med. Comment. Dec. I. Vol. IX.
p. 244. — Baird, in Edinb. med. and surg, Journ. July, 1821. — Otto Verzeichn.
der Bresl. anat. Praparatensammlung. No. 2077 and 2078. They are not unfre-
quently discharged in various ways, — they also ulcerate, v. de Plouquet Art.
hydatis ex ulcere. — Bisset. — /. Carlevarini D. de hydatidum origine et muta-
tionibus successivis. 8vo. Paris, 1825. — Opinion of the older writers on the
origin of dropsy from rupture of hydatids.

(6) Reuss Reporter. Comment. Vol. XIII. p. 547. — de Plouquet Repertor.
Art. Hydrops cysticus et hydatidosus. — Salzmann D. de tumoribus quibusdam,
serosis externis. Argentor, 1719. — Morgagni De sed. et cans, morbor. Epist.
XXXVIII. p. QS, seq. — Cruveilliier Essay sur I'anat. pathol. Vol. I. p. 256 — 296. —
Meckel Hand, der pathol. Anat, Vol. II. Part II. p. 144—158. They occur
most frequently, and are largest in the belly. Compare the several places.

(7) As they are really situated in the neighbourhood of joints and tendons, so
are they mostly diseases of the mucous bags (bursae mucosae vaginales, vesiculares
subcutaneae). Compare those in Cruveilhler, Vol. I. p. 296 and 303. Meckel,
Vol. VIII. Part II. p. 15. — Fuhrmann D. s. varior. auctor. observata de tumoribus
cysticis humorem synoviae similem et corpuscula cartilaginea continentibus.
Jenae, 1822.

(8) Schmidt D. de atheromate manu curato. Halae, 1798. — Reuss Repertor.
Comment. Vol. XV. p. 33, 34. — de Plouquet Art. Atheroma et Meliceris. [This
secretion is considered by Andral, Vol. I. p. 440, to be merely a variety of
Laennec's * matiere colloide.' T.]

(9) Generally, in fatty tumours, the hair resembles the normal hair of
animals; as wool in sheep, feathers in birds. — de Plouquet Repertor. Art. Pilus
in insolitis locis. — Meckel Ueber regelwidrige Haar-und Zahnbildung in the
Archiv f. d. Physiol. Vol. I. p. 519 ff. and Handb. d. pathol. Anat. Vol. II.
Part II. p. 270. — Cruveilliier, Vol. II. p. 166 and 181. — Hoffmann in Ephem.
N. C. Dec. II. A. V. p. 433. Ann. Ylll.— lVepfer Paeon et Pythag. Ann. XI.

p. 53. — Hunter s. Baillie, in Phil. Transact. Vol. LXXIX. p. 77. Malpiirhi

Opera posth. p. 95. — Ruyscli Thes. anat. Vol. VI. Tab. VI. fig, 5 and 6. — Recent
Observations are in the American medic. Recorder. Philad. Vol. I. No. 3. —
/i . Cooper and Travers, Surgic. Essays, P. II. — Delpech Precis des maladies
reputees chirurg. Vol. III. p. 412. — Zethermann in Hufelaiid's and Hi7nly's Journ.
d. prakt. Heilk. July, 1811, p. 121. — Bricheteau in Journ. compl. du Diet, des
Sc. medic. Vol. XV. p. 298. — Denis in Journ. de Med. Chir. et Pharm. milit.
par Biron et Fournier, Vol. II. p. 357. — Tainturier ih. Vol. XI. p. 271. —
Bobillier ih. p. 273 ; from a horse ; v. RudolphVs Bemerkungen auf einer
Reise u. s. w. Parti, p, 80. Berlin, 1804. — In the Hunterian Museum at
London, I saw two encysted tumours completely full of hair, from a cow ; also
another similar one under the skin of the head in a calf. — Otto Seltene Boebacht.
Part II. p. 159. — v. Bresl. Mus., No. 388. — Three steatomes, with feathers
from a goose and hen, ih. No. 2096 — 2098. Encysted tumours, with

6i Vices relating io Texinre. [Part I.

hair, were described in BarlhoUnus Cent I. Hist:. 100. — Acta Hafn. Vol. II.
p. 40. — Memoir de. I'Acad. 1731, p. 450, &c.
(10) Meckel. Compare the several places.

Still more common and also more malignant than the
encysted, are scrofulous tumours, tubercles and lumps,
scrofulce, tubercnla, nodi, strimice,^ a disease which is
sometimes congenital, but is especially common in children,
though frequent also in manhood, even in later years also
under certain forms, and first originates in inflammatory and
dyscracic irritation. The essential character of this proteus-
like disease is the formation of an inorganized, transparent,
crumbling substance, consisting principally of albumen and
animal lime," which, excepting the horny structures, is found
deposited in all the systems and parts of the body, often in
many of them at once and in great quantity.^ The form of the
spurious formation produced by the scrofulous disease is very
various ; commonly indeed it produces on the parenchyma of
an organ, more or less numerous, little, roundish, greyish white
bodies, which at first are transparent, but gradually become
opake; sometimes they are more flat and irregular little ex-
cresences, of the same substance however, upon the surface of
serous and mucous membranes ; whilst, in other instances, the
scrofulous matter is deposited in the cellular tissue of very
different parts in undefined masses, and then produces a whitish
hardening, devoid of vessels, which must not be confounded
with that arising from inflammation or scirrhus ;* lastly, we not
unfrequently And the scrofulous matter contained in distinct
bags^ composed of cellular tissue. These various forms of
scrofula have this general property, that at first they are small,
hard, and contain but little lime, that by degrees they increase
very much, usually become soft in the middle, and then contain
a yellowish-white, crumbling matter, containing more lime,
similar to new cheese. At this period the tubercles and the
surrounding cellular tissue usually run on to inflammation'' and
suppuration;^ sometimes, however, the scrofulous matter is
removed by absorption, or the diseased structure is as it were
destroyed by ossification. Not frequently from scrofula and its
complication with other diseases, arise the various tumours,*^
which even in certain cases, produce a gradual transition into
sarcoma and carsinoma.

The tubercular disease is very common in animals, particu-
larly in domestic and foreign animals retained in captivity ;"
thus are the glanders, malignant tubercle, farcy, and
the mclmwsis tuherculosa of the liorse, the g lander-like

Sect. X.] Vices reletting to Texture, Q5

DISEASES of sheep and cattle, a kind of murrain among dogs,
the TUBERCULAR DISEASES in Cattle, horses, and dogs, and
other diseases, if they be not the same disease as scrofula,
are still more nearly allied to it.

(1) Rcuss Repert. Comment. Vol. XIV. p. 423 ff. Vol. XV. p. 45.- de Ploii-
quet Repertor. Art. Scrophula. — Diet, des Science medical. Art. Scrophules. —
Bayle in Journ. de Med. Chir. et Pharm. p^ Corvisart, etc. Vol. VI. p. 3 ;
Vol. IX. p. 285, et 427 ; Vol. X. p. 32. — Lambe, Inquiry into the origin, &c.
of Scrofula, Consumption, Cancer, &c. 8vo. London, 1805. — Robertson D.
de Scrophula. Edinb. 1809. — Russel, A treatise on Scrofula. Edinb. 1808. —
Baume Traite sur le vice Scrophuleux. 8vo. Paris, 1808. — Rogers D. de
Scrophula. Edinb. 1810. — Armstrong, Essay on Scrofula, &c. 8vo. London,
1812. — Newsom D. de Scrophula. Edinb. 1814. — Henning, A critical inquiry
into the pathology of Scrofula. 8vo. Lond. 1815. — Carrnichael, W. Goodlad, A
practical essay on the diseases of the vessels and glands of the absorbent system.
8vo. Lond. 1814. — Le Pelleticr Traite complet sur la maladie scrofuleuse et les
dilFerents varietes qu'elle peut oftrir, etc. 8vo. Paris, 1818. — Baron, An inquiry
illustr. the nature of tuberculated accretions of serous membranes, and the origin
of Tubercles and Tumours in different textures of the body. •8vo. Lond. 1819, and
Illustrations of the inquiry respecting tuberculous diseases. 8vo. with 5 plates.
Lond. 1822. — Farre on Scrofula. 8vo. Lond. 1820. — E. A. Lloyd, A treatise on
Scrofula, describing the morbid alterations it produces in the structure of all the
different parts of the body, &c. London, 1821. — Sleyer D. de morbo scrofuloso in-
primis adultorum. 4to. Lips. 1821. — A'ct/r/Ze D. de Scrophula. Edinb. 1821. — Orr
D. de Scrophula. Edinb. 1821. — MacJter Ueber die Ursachen und das Wesen
der Scrofelkrankheit, u. s.w. 8vo. Wien, 1821. — Adelson D. s. casum singularem
morbi tuberosi. 4to. with plates. Gott. 1822. — Home, D. de Scrophula.
Edinb. 1823. — Alison, Observations on the pathology of scrofulous Diseases, &c.
Edinb. 1820. — JbercromMe in Transact, of the med. chir. Soc. of Edinb. Vol. I.
p. 682, 1824; V. also Freudenberg D. de tuberculorum in hepate et pulmonibus
causis atquae cura. 4to Bonnas, 1824, and Laennec De I'auscultation mediate, etc.
Vol. I. p. 9. 8vo. Paris, 1819. — v. Opinions oi Morgagni (de sedib. et caus. mor-
bor. lib. III. Epist. XXXVIII. p. 35.) Adam and Baron, that tubercles consist
of burst hydatids. — Hartmann D. de tuberculorum praeternatm'alium natura et
origine. Halae, 1826. — Lombard Essai sur les tubercules. 4to. Paris, 1827. —
John Baron, Delineations of the origin and progress of various changes of struc-
ture, &c. 4to. with plates. London, 1828. — Alison in Transactions of the Med.
Chir. Soc. of Edinb. Vol. III. p. 1. 1828.

(2) According to Abercrombie, the secretion of albumen into the glands con-
stitutes the disease, the same substance also produces tubercles in the lungs ;
but in the belly they contain a mucous-like extractive matter.

(3) I have many times observed in children, also in adults, and in monkeys,
that there was scarcely a part free from tubercles.

(4) The peculiar scrofulous matter which can be squeezed out by violent pres-
sure, may be often distinguished with certainty ; besides there is wanting the
coagulated fibrine and sinewy fibres of inflammatory and scirrhous hardening.

(5) These bags are formed merely of loose cellular tissue compressed together,
and are very different from encysted tumours ; the thick tough cysts which we
sometimes find around scrofulous Vomicae in the lungs and scrofulous glands,
are produced partly by exsudative inflammation, partly in the latter instance by
nothing more than the outer not yet dissolved substance of the organs.

(6) On these points, notice particularly Thompson, Lectures on Inflammation,
and Burns, Dissertation on Inflammation, Vol. II. I could never discover vessels
in tubercles, but I have very frequently seen them surrounded by a very red
and vascular layer of the organ containing them.

(7) Most of the glandular suppurations, the common suppurative consump-
tion of the lungs, and the various kinds of Phthisis Abdominalis belong here.

(8) Starli D. s. scrofulorum naturam praes. steatomatosarum, causu rariori

r

66 Vices Relating to Texture. [Part I.

adjecto et tabul. sen. illustrato. 4to. Jenae, 1803. — Hehr^aril Essai sur les
tumeurs scrophuleuses, etc. 8vo. Paris, 1803. — Crt/i'^r^ D. de tumoribus scro-
phulosis. Edinb. 1804. — Hamilton, Observations on Scropbulous Swellings in
Edinb. nied. and surg. Journ. Vol. V. p. 363. — Alihert Description des maladies
de la peau. p. 228. (scrophule cancereuse) PI. 48. — AdeJson, Vol. I. and II.

(9) Dupuy De I'afFection tuberculeuse, vulgairement appellee Morve Pul-
monic, Gourme, Farcin, fausse Gourme, Pommeli^re, Phthisic du singe, du chat,
du chien, et dcs oieaux domestiques. 8vo. Paris, 1817. According to him
it occurs in the horse, cattle, sheep, swine, monkeys, dogs, cats, rabbits, hares,
fowls, turkies ; I have found it not merely in these, but also in the lemur, lion,
coati mondi, wolf, seal, rat, guinea-pig, deer, roe, antelope, eagle, pheasant, and
many domestic birds. — \_H. Biirgpr, Veterinaire Diagnostik, p. 14, 3, 30. fol.
Berl. 1830. T.]

^66.

A third and very important kind of spurious formation is the
FLESHY TUMOUR or SARCOM, sarcoma, sarcosis,^ which accord-
ing to the difference of the tissue in which it is seated, the
degree of its development, and its compHcation, assumes a
series of various forms and textures, of which the general
characters are principally negative, have moreover a near
resemblance to llesh," and a structure consisting of cellular
tissue and albuminous-like fluids. Some are as malignant
as cancer, with which they have otherwise many resem-
blances ; but all, and even the most favourable of them,
must be removed by chemical or mechanical means, in order
that they should not become hurtful to the organism ; all have
a disposition, even though artificially removed, to be repro-
duced, and a morbid disposition to their growth is not, in
most instances, to be mistaken. According to their form
and consistence, they are now fleshy excrescences, excres-
ceniice carnoscB^ — now funguses, fungi, or polyps, polypi —
or SARCOMATOUS SWELLINGS, sarcomata, in the strictest sense,
without always being accompanied with definite characters.
As vices of the external skin, here belong the various fleshy
EXCRESCENCES, the FIG-LIKE WARTS, condylomata,^ the com-
mon FLESHY GROW^THS ou the uosc and generative organs, &c. ;
as vices of the mucous membrane, the epulis and polyps ; in the
bony system osteosarcom ; m the fibrous organs, funguses,
fungi; in the vascular system, the fleshy growths on the

INTERIOR of the HEART AND OF THE BLOOD-VESSELS, but

particularly in the loose and })arenchymatous cellular tissue,
the true sarcom." The latter usually produce tumours of a
tolerable size, mostly roundish, although sometimes uneven,
hilly, and extending by roots as it were among the neighbour-
ing parts ; always, however, bounded by a fine investing mem-
brane or a layer of cellular tissue, whilst the tissue in which they
grow is not connected with them, but only perforated or de-

Sect. X.] Vices relating to Texture. 67

stroyed by pressure. Their mass is at first toughish and close,
mostly of a greyish red, although sometimes of a darker colour,
and consists of much fine and soft cellular tissue, into which
a more or less solid albuminous fluid is deposited, either
loosely or in little sacs. They are not unfrequently divided
into greater or less lobes, by processes of membrane, but
are always connected immediately or by a kind of neck ; they
also contain small or large bags filled with fluid lymph, and
may also be accompanied with hydatids and tubercular forma-
tions ; their blood-vessels are at first few and small. From
this firm, and at the same time, quiet state, in which they
either do not increase at all, or only after a very long period,
often, indeed, remaining so for many years, ^ they run spon-
taneously, or, if irritated, into an inflammatory excitement,
increase then very quickly, become soft, acquire more blood-
vessfels, especially veins, and according to their situation take
a very different course. Should they be found, indeed, in the
intestines, they rarely burst externally, but increase to an
astonishingly large size, and destroy by pressure on other organs,
and by a peculiar weakening of the living activity ; but should
they lie under the common integuments, they destroy it by
distension, break outwardly, and produce large fungous swell-
ings, bleeding easily, and secreting lymph, which partly mortify
and are thrown off, but are soon reproduced; lastly, if they
have their seat in the tissue beneath the mucous membranes,
they first elevate, and then perforating them, form on their
open surface similar fungous tumours, which are called polyps,
polypi,^ and assume various colour, consistence, and form ;
the last are usually disposed to form cavities, in which they
grow, although by their increased size, they destroy and
extend themselves into the surrounding parts. Sarcoms and
polyps are very rare in animals, and the former appear to exist
but as sarcomatous growths on the testicles of some beasts.

(1) Reuss Repertor. Comment. Vol. XIII. p. 103. Art. Excresc. — de Plouquet
Repertor. Art. Sarcoma. — Grashuys Exercitatio medico-chir. de scirrho et car-
cinomate, in qua etiam fungi et sarcomata pertractantur, 8vo. Amstel. 1741. — •
Be Gorier D. d. sarcomate. Harderowyck. 1761. — Bertrandi Opere publ. dai
Penchienati e Brugnone. Turin, 1786. p. 189. — Abernethy, Surgical Observa-
tions, &c. London, 1804. — Meckel Handb. d. patliol. Anat. Vol. II. p. 291.
— Among the ancients, observations on sarcoma are mostly treated of under
the name of Scirrhus. — Abernethy divides Sarcoma into S. commune, S. vasculo-
sum, S. adiposum, S. pancreaticum, S. mastoideum, S. mammarium, S. tuber-
culosum, S. medullare, and S. carcinomatosum ; of these, I have described the
fatty sarcom among encysted tumours, as Lipoma ; the tubercular sarcom, at
§ 65, and the carsinomatous sarcom, at § 68, as cancer. Of the other kinds,
the medullary sarcom is only to be distinguished in some degree, although it
also corresponds, by its gradual transition, with the common sarcom ; but the
pancreatic and mammary sarcom of Abernethy have not the least resemblance

F 2

68 Pices relating to Texture. [Part I.

to the parts to which they are likened, and also gradually run into the usual
sarcom. Sometimes all these kinds are found in one tumour. In Ahernethy's
private museum, at St. Bartholomew's Hospital, London, I could distinguish no
particular kinds.

(2) Not of flesh, anatomically speaking, i.e. of muscle, but of flesh generally,
soft parts, i. e. muscle, cellular tissue, skin, fat, and vessels together.

(3) Fici, Mariscae, etc. Compare Wtrnher D. de condylomatibus. Berol. 1826.
— B. I'ossen D. de condylomatibus venereis, 8vo, Borol. 1827.

(4) Besides those which I have recently had the opportunity of mentioning, I
have observed and examined three sarcoms as large as the head ; two on the
thigh bone, the third on the left hip, and all three in males.

(5) One woman I knew who, for more than thirty years after she had a
scirriuis removed from her breast, had a sarcom in her thigh, which, imder more
proper treatment, increased but little, and is still unbroken, although it has
already several times seemed as if it would break.

(6) Comp. Reuss Art. Excrescentia polyposa. — De Plouquet Art. Polypus. —
Portal in M^moire sur la nature et le ti-aitement de plusieures maladies. 8vo.
Vol. III. Paris, 1800. — v. Heckcr Annalen der ges. Medicin, etc. Vol. II.
Part IV. No. 1. — Eichhom D. de polypis. Gott. 1804. — A. Mo?iro, On the
Anatomy of the Human Gullet, etc. Edinb. 1811. — Meckel, p. 304. — Crnveilhier
Essai sur I'anat. pathol. Vol. I. p. 388. — Polyps are not the loose ends of
deeply situated sarcoms, into which they immediately run, as may be easily
seen in the womb, as well also as in other parts. For instance, Otto Selt.
Beob. Part II. No. 85, pi. 4, fig. 3 ; very properly may be here compared,
Palletta in Exerc. pathol. Cap. I. and II. p. 2 and 9; some polyps with sarcoms ;
all polyps from mucous membranes originate in the subjacent cellular tissue,
or in the periosteum ; even subsequently we can trace their firm roots to these
parts. The division of polyps into tendinous, fleshy and mucous, arises
merely from the situations in which they are observed; if the mucous mem-
brane be perforated, then they usually have only one narrow necklike root,
sometimes two ; hence they differ from the fungus of the mucous membrane,
which consists only of the flocculence and growth of this membrane, and usually
has a broad base.

§67.

The MEDULLARY SARCOM, sarcoDia medullare^ is distin-
guished from the common sarcom by certain pecuharities of
structure and progress, as, according to circumstances, a more
or less distinct degeneration ; it is, however, more mahgnant
than the common sarcom, usually proceeds more quickly; if
removed, it returns more readily ; occurs in almost all parts
of the body both primarily and secondarily, and especially
in youth. From the very onset it is softer than the common
sarcom, feels very elastic, and commonly so, as it contains
fluids, and consists of a tolerably homogeneous, whitish, and
softish mass, at first sight similar to the brain of children,
cooked fish-spawn, or clotted cream ; it also, at the same
time, contains albumen, and is perforated in different directions
by soft cellular tissue or membrane, by few, and for the most
part, large veins, and frequently by more or less coagulated
blood or its fibrine. When it bursts and forms a fungus, it
presents many blood-vessels, especially veins, and secretes a
yellowish green lymph ; sometimes tlie fungus separates in

Sect. X.] Vices relating to Texture. 69

large pieces. Not unfrequently is the medullary sarcom con-
nected with MELANOSE, in consequence of which, as well as by
the addition of the clotted blood, the original white substance
of the tumour is coloured, either completely or partially, yel-
lowish, dusky-red, brown, and dusky-black. Sometimes also,
medullary sarcom is accompanied with hydatids,^ scrofula,^
polyps,* osteosarcom,^ &c., and seems to have an indistinct
causal relation to these. True medullary sarcom does not
appear to exist in animals, for under the terms melanosis
tuberculosa, tubercula nigra, charhon, and morilles, of the
French,^ &c. especially in horses, the disease is as it were
intermediate between tubercles and medullary fungus, whilst
particularly upon the vent and about the generative organs,
although also on other parts of the body, in the cellular tissue
and in the skin, tumours arise which are roundish, gibbous,
increase to the size of eggs, penetrate the neighbouring
tissues, break also by ulceration, and consist of an external
delicate, cellular envelope, and similar internal partitions,
into which a fluid, mostly pap-like, but sometimes a clotted and
firm mass is effused, which especially consists of fibrous
matter, albumen, and black pigment. Sometimes these tumours
approximate in character to the encysted, but never are they
so malignant as medullary fungus.

(I) Also BLOODY FUNGUS, fungus hcematodes, f. medullaris, medullary fun-
gus, SOFT CANCER, CARCINOMA, spongoid inflammation, burns, fishspawn-like
TUMOUR, Monro's, — Melanosis, Cancer melanoticus of the French, Encephaloide of
Laennec, &c. There is no difference in the nature of medullary and bloody fungus,
both frequently occur in the same tumour, and run imperceptibly into each
other ; a bloody fungus, if it be removed, returns again as a medullary fungus,
and vice versci ; the so-named bloody fungus arises out of medullary fungus, from
efflision of fibrous matter and blood into its cellular tissue.* The best writings
on medullary sarcom are. Burns Dissertations on Inflammations, Vol. II. p. 302,
spongoid inflamm. — Hey, Practical observations on Surgery. Lond. 1803 ;
fungus haematodes. — Laennec in Bulletin de I'ecole de Medec, 1800 ; in Diet, des
Sc. medic. Art. Anat. pathol. Vol. II. and Art. Encephaloides, Vol. XII.
p. 165. — Wat-drop, Observations on fungus haematodes, or soft cancer, &c. Edinb.
1809, with plates. — Abernethy. — Maunoir M^moire sur les fongus meduUaire, et
hematode. 8vo. Paris et Geneve. — Breschet in Diet, des Sc. m6d. Vol. XX.
p. 126, Art. Fungus haematodes, and ib. Considerations sur une alteration
organique appellee degen^rescence noire, melanose, cancer, melan^, etc. 4to.
Paris, 1821, with a plate; also in Magendie's Journ. de Phys. experimentale,
Vol. I. No. 4. Oct. 1821. p. 354. — von Walther in his and Graefe's Journ.
d. Chir. u. Augenh. Vol, V. Part II. p. 189. — Langenbeck in his N. Biblioth,
f. d. Chir. u. Ophthalm. Vol. III. Part IV. No. 4. — Schrieider D. de fungo
haematode. 4to. Berol. 1821, with plates. — Truckmuller D. de fungo haematode
et medullari. 8vo. Landish. 1821. — Wagner D. de fungo medullari. 8vo.
Vratisl. 1823. — Redlich D. de fungo medullari. 8vo. Regiomont. — Hasse D.
de fungo medullari. 4to. Berol. 1823, with lithographs. — Calliot D. Essai sur
I'enc^phaloide ou fongus medullaire. Strasb. — Gunther Analecta ad anato-
miam fungi medullaris. 8vo. Lips. 1824. — v. Amnion Beitrage zur Erkenntniss
nd Bchandlung des bis jetzt unheilbar gebliebenen fungus iiiEMATODEs. 8vo,

70 Vices relating to Texture, [Part I.

Leipz. 1825, with six lithographs. — Savetiko Tentamen pathol. anat. de Melanosi.
4to. Petropoli, 1825. — Fawdington, A case of Melanosis, with general observations
on the Pathology of this interesting disease. 8vo. Lond. 1826, with two plates. —
J. Casper D. de fungo medullari quaedam. Svo. Berol. 1826. — Of the many indivi-
dual cases, only some more important are here mentioned. — Bidloo Op. omnia
Dec. I. Exerc. 8. Dec. II. Exerc. I. Taf I. in the inguinal region. — Cases re-
corded by Wardrop, Earle, Lawrence, and Langstaff, in Med. chir. Transact.
Vol. III. VIII. IX. — Mahissiere, v. Giorn. della Soc. med. chir. di Parma,
Vol. VI. p. 300, in Journ. de Medec. contin. Vol. XVI. p. 359, on the back. —
Fine in Sedillol Journ. de Medec. Vol. XLV. p. 34 and 151, — M'Kechnie in
Edinb. med. and surg. Journ. Vol. VII. p. 168, 1811. — Brilckmannin Horn's
Archiv f. med. Erfahr. July, 1811, p. 71, on the face. — Roiven in New England
Journ. of Med. and Surg. No. IV. Oct. Boston, 1814, with plates, on the arm. —
Fanzago in Memorie sopra alcuni pezzi morbosi. Fasc. I. p. 65. Padov. 1820,
pi. 4, on the leg. — ACClellan in the American medic. Recorder, Vol. V.
No. 4. Oct. New- York, 1822, on the neck. — Wedemeycr in Rust's Magazin f. d.
ges. Heilk. Vol. XIII. Part 1. on the breast, the arm, and foot. — Gerson and Julius
Magazin der ausl. Lit. d. ges. Heilk. Sept. and Oct. 1823, p. 197, on the wrist.
— Halliday in Medical Intelligencer, No. 43 and 46, June and Sept. 1823. —
Rhades in Horn's Archiv f. d. med. Erfahr. Nov. and Dec. 1823, p. 489, on the
thigh. — Allan, System of pathol. and operat. Surgery, Vol. I. p. 264, note, on
the hip; Archives generales de Medec, Vol. IV. Feb. 1824. — Salomon in
Petersburg, vermischte Abhandl. a. d. Gebiete d. Heilkunde, Part III. Leipz.
1825. — Velpeau in Revue m^dic. franc, et etrang. Vol. I. p. 217 and 343, with
plates, in the left armpit. — Nicolai in Rust's Magazin. Vol. XX. Part III. p. 540.
Otto Verzeichniss der anat. Praparatensammlung. No. 2102 — 2106, p. 30.
Breslau, 1826. — I have lately observed one case on the shoulder. — Alibert, in his
Nosologic naturelle. Vol. I. p. 336, pi. B, gives a good engraving of medullary
sarcom on the shoulder. — Arnold D. de fungo medullari. Vratisl. 1822. — W.
Cullen and R. Carswell on Melanosis, in Edinb. med and surg. Journal, Jan.
1827. — Meycn Untersuchungen iiber die Natur parasit. Geschwiilste im menschl.
Korper, insbesond. iiber den Mark und Blutschwamm. Berl. 1828. — Kastagtie
D. de fungo medullari. 8vo. Kil. 1828. — 0. Zimmermann D. de melanosi. Svo.
1828, with plates. — Fr. Kerksig D. de fungo medullari. Halae, 1828.

* [According to AndraVs account of bloody fungus, or, as it has recently been
named, " tissu erectile accidentel," this does not seem to be really the case; in
true fungus hoematodes the little vessels seem to vegetate, (ils semblent comme
vegeter,) and form tumours supported by cellular tissue ; the vessels increase,
and ])roduce a structure very closely resembling that of the spleen, the blood is
stayed in the little areolas thus produced, and in the veins, with which they freely
communicate, and products, by its variable quantity, rapid change in the consis-
tence, colour and form of the tumour ; and, if it bm-st, severe haemorrhage occurs.
But out of this vascular development there often arise lesions of nutrition and
secretion ; and hence we often find, commingled with this vascular base, fibrous,
scirrhous, purulent, melanotic and other morbid productions ; all of which
arc generally included under the term fungus haematodes. Andral, Vol. I.
p. 176—179. T.]

(2) Adams, Baron, v. Hydatids.

(3) Palletta Exerc. pathol. etc. — Panizza Annotazioni anat. chir. sul fungo
luidollare dell' occhio. t'ol. Pavia, 1821. — Wedemeyer. — Freudcnberg D. de
tuberc. in hepate et pulm. causis atijuecura. p. 16. Bonnie, 1824, — Proudfoot
in Edinb. med and surg. Journal, April, 1826. — Otto Selt. Beob. Part II.
No. 56.

(4) V. Waltlier, and myself one case.

(5) M'ClMan and Rhades.

(6) The preparations which I saw in the veterinary cabinet at Alfort were
marked Morilles and Poireaux ; sometimes the black pigment is also wanting,
(compare above, § 39,) and the tumours have then a whitish or Hesli coloured aj)-
pearance ; tliis is the case, according to the verbal observation of Godine, especially
in nudes, and most commonly it occurs in white or grey horses, in rare cases in

Sect. X.] Vices relating to Texture, 71

roan, dun, and spotted horses ; v. Henon in Gohier, p. 328 ; even in dark-coloured
horses, v. Flandriu Instruct, et Observat. sur les maladies des animaux domes-
tiques par Chabert, Flandrin et Hiizard. Vol. IV. p. 298. Paris, 1822. Some-
times the disposition thereto seems to be hereditary. — v. Brugnone. — Dietrichs
Gestiits-und Ziichtungskunde. p. 580. Berlin, 1824. — Besides the horse, it
has also been seen in the ass, the mule, dog, rabbit, cat, rat, mouse and white
spoonbill ; I have also found it in the stag ; v. Otto's Verzeichniss der anat.
Praparatensammlung zu Breslau, No. 2108 ; on these tumours, v. Brugnone von
der Zucht der Pferde, Esel. u. s. w. a. d. Ital. von FecJmer, p. 61. Prag. 1790. —
Fiborg Veterinair-Sellskabets Skrifter. D. II. III. p. 398, 484, under the title
TUBERCULA NIGRA ; GoMer in Compte rendu des travaux de I'^cole r-et^rinaire
de Lyon. 1811, and M^m. et Observat. sur la chir. et la medic. v6t6rin. Vol. I.
Lyon, 1813. — Breschet. — W. Cullen and Rob. Carswell in Transact, of the med.
chir. Soc. of Edinb. 1824, Vol. I. No. 13. — Noack Comment, vet. med. de
Melanosi cum in hominibus turn in equis obveniente, etc. 4to. Lips, et Paris,
1826, with three plates.

§68.

There now remains only to treat of the last and most
malignant kind of spurious formations, cancer, scirrhtis,
carcinoma^ or cancer,^ a disease which, distinguished at a
general, often even at a first glance, and commonly originating
in a strong hereditary disposition, occurs usually only in the
middle and later stages of life.^ It commences with scirrhus,
a knob, or large tumour, which is separated from the neigh-
bouring healthy parts f usually single, and but rarely occurring
in many parts at once, distinguished by its hardness, cold-
ness, insensibility, whiteness, and weight, contains few or
hardly any red blood-vessels, and presents, as a characteristic
symptom, a great quantity of tendinous or cartilaginous fibres
or plates, which pass either from the centre in a radiated form
to the circumference, or decussate, and lie irregularly upon
each other, and contain between them an inorganic jelly-like,
albuminous, or half-coagulated fluid, mostly transparent and
light coloured, but sometimes also turbid and yellow, or
brownish, in greater or less quantity.'' Such scirrhus, early or
later, runs into an inflammatory state, in consequence of which
it relaxes, softens mostly in the centre, becomes more hilly,
infects the neighbouring tissue, and often attains a considerable
size. It sometimes also contains several large bags full of
lymph, has but few arteries, but at its commencement many
large varicose veins, is commonly surrounded by much hard
yellow fat, and presents in its interior, one or more ulcerated
spots ; in this state it is called hidden cancer, cancer
occultus. The skin lying over the tumour is gradually con-
nected with it, becomes wrinkled, knotty, discoloured, and
even bluish-red, or lead-coloured, and ultimately breaks with
eflusion of much lymph. Now is the disease called open
ganger, cancer apertus^" and becomes a ^malignant ulcer,

72 Vices relating to Texture. [Part I.

with a hard base and circumference, secretes a very foul
and specific copious corroding ichor, has its surrounding
edge jagged, destroys the neighbouring parts much more
in circumference than in depth, and often produces a growing,
easily bleeding fungus, secreting ichor/ Cancer occurs
originally only in the external skin, in which case, instead
of a true scirrhus, a malignant wart, a cartilaginous callosity,
or a hard blackish varix precedes it ; in the inner or mucous
membrane, particularly in the mouth, throat, stomach, intes-
tines, larynx, and mouth of the womb; next, particularly
in the conglomerate, and lastly, very rarely in the lymphatic
glands;^ but it occurs secondarily in almost all organs.^
True cancer is only curable in its first stage, by the total
removal of the diseased structure, for the occasional production
of a thin spreading skin upon the sore does not bound its
malignancy, and the peculiar dryness and scarring of cancer,
which is sometimes observed, is not less deadly f however,
a few cancerous tumours have been destroyed and cured by
mortification.^*' Cancer never occurs in animals."

(1) Compare Reuss Repertor. Comment. Art. Carcinoma, Vol. XII. p. 217 —
235 ; Scirrhus, Vol. XIV. p. 405 ; Tumor cancrosus. Vol. XV. p. 28; Tumor
scirrhosus, Vol. XV. p. 43. — de Plouqiiet Repert Art. Cai*cinoma et Scirrhus. —
*.V. Cooper, First lines of Surgery — Cancer; also Hill, Cases of Surgery, par-
ticularly of Cancer, &c. 8vo. Edinb. 1772. — Hopkins D. de Scirrho et Carcino-
mate. Edinb. 1777. — Bierchtn introedes-tal om kaerftskaders, skrophuloese
och veneriske Svers, etc. Stockh. 1778. — Jaenisch vom Krebs und dessen
Ileilart. Svo. Leipz. 1784, — Camper Sammtl. kleine Schriften deutch von
Herbell. Vol. III. p. 156. Leipz. — Abernethy. — Lacombe Propositions sur le
cancer. Paris, 1805. — Ross D. de carcinomate. Edinb. 1805. — Home, Obser-
vations on Cancer, connected with histories of the disease. Svo. London, 1805.
— GilUchan D. de carcinomate. Edinb. 1809. — Akerman resp. Toppelins D. in
carcinoma observationes. 4to. Upsal, 1811. — Skipton D. de carcinomate. Edinb.
1814. — Wentzel Ueber die Induration und das Geschwiir an indurirten Theilen.
Svo. Mainz, 1815. — Bmimann Ueber den Krebs u. s. w. Svo. Leipz. 1817. —
Westring Erafhr. iiber die Heilung der Krebsgeschwiire. a. d. Schwed. mit Zus.
von K. Sprengel. Svo. Halae, 1817. — Young, Minutes of cases of Cancer and of
cancerous tendency, &c. Vol. II. Svo. London, 181G — 18. — Rouzet Recherches
et observations sur le cancer. Svo. Paris, 1818. — Wolfers D. de scirrho
et carcinomate. Svo. Gcitt. 1820, — Scarpa in Memorie dell' J. R. Istituto del'
Regno Lombard. Vol.11, p. 123—153. Venet. 1821, and Sullo Scirro e sul
Cancro Memorie. 4to. Mailand, 1822. with a plate.— /''arre. An Essay on Cancer.
London, 1822, — Wernecke D. Nonnulla de cancro, Svo. Berol. 1823. — Roth
I), de Scirrho et carcinomate. Svo. Berol. 1823. — v. Walther in his and
Gracfe's Journal d. Chir, and Augenh, Vol, V. Part II. p. 196. — Rambach
J), de scirrho cjusque decursu. Svo. Berol, 1824. — tmn fry and Schrage in
Handel, van het Genootsch, Servandis Civibus, D, IV. p. 1 — 207. — Vorslmayin
V. u. S. Verhandeling over den Ranker. Svo. Utrecht. 1824. — Graham, Ob-
servations on Cancer, comprising numerous cases of cancer in the breast, hip,
and face, &c. London, 1824, — Velpeau Exposition d'un cas remarquable de
maladie cancereuse, Svo. Paris, 1825. — Costin in Archives gen6r, de Medec.
June, July, and Aug. 1826. — Boedecker I), de scirrho et carcinomate. Berol.
1S26. — Ileusinger Erster Bericht von der anthro])otom Anstalt /u Wiirzburg.
p. 27 — 33. 4to. 1826. — [/^. PeyriUte, Dissertation on Cancerous Diseases, trans-

Sect. XL] Vices relating to Contents. 73

lated from the Latin, with Notes. 8vo. London, 1777. — Ledran M^moire de
plusieurs observations sur le Cancer, in Mem. de I'Acad. Roy. de Chirur.
Vol. VIL p. 223. — M. Akenside, Observations on Cancer, in Med. Trans, of Coll.
of Phys. Vol. L p. 45. — C. T.Johnson, Practical Essay on Cancer. 8vo. London,
1810. — Howard, Practical Observations on Cancer. 8vo. Lond. 1811. T.]

(2) Wardrop, p. 176, however, saw it in a boy of twelve years old, and Home
in a man of fifteen years.

(3) A kind of cyst is said sometimes to be fomid surrounding it. I could
never see it.

(4) According to the difference of organization of the parts affected with
cancer, is the tumour of more or less loose texture, the jelly more abundant,
fluid or thicker, and coloured, &c. ; the appearance of the scirrhus also varies
somewhat ; hence arises the observation, not founded in fact, of scirrhus lar-
dosus, hydatidosus, nodulosus, tuberculosus, &c. and the opinion o{ Hunter, Adams,
axidi Baron, that cancer consists of broken-down hydatids. [According to AndraVs
view, cancer is not a distinct alteration, but only the ulceration, which, after
a certain period, occurs in all lesions, either of nutrition or secretion. Vol. I.
p. 501. T.]

(5) It is to be understood that the disease is also so called when it occurs in
internal parts.

(G) Himly in his and Huf eland'* s Journ. der prakt. Heilk. 1809, Part XIL
p. 126, once found in a closed cancer a perfectly formed fungus growth. I have
twice found similar small ones.

(7) Scarpa denies this; however, Klein, chir. Bemerkungen, 8vo. Stuttg.
1801, p. 262 ; Home, p. 161 ; Wardrop, p. 175, note; and von Waltlier, have seen
instances ; I have also at this moment an opportunity of seeing such a case in
an inguinal gland of an old woman of eighty.

(8) I am very doubtful, if malignant ulcers, badly treated swellings, &c., are
actually converted into cancers; even noli me tangere and cancer scroti are
only malignant ulcers, but not true cancer ; in secondary cancer several parts
are not unfrequently affected at once.

(9) Pouteaa Qiuvres posthumes. Vol. L p. 164. — Bayle and Cayol in Diet,
des Sc. medic. Vol. IIL p. 555. — Nicod in Bulletin de la Facvdte, etc. No. 1.
1810.

(10) Bayle din^ Cayol. — Garneri v. Bulletin des Sc. m^dic. par la Soc. medic.
d'Emulation, Dec. 1810 and Sept. 1811. — Richerand Nosographie chirurgic.
2d edit. Part I. p. 387. — Cruveilhier Essai sur I'anat. pathol. Part L p. 127.

(11) Camper Abhandlung von den Krankheiten, die sowohl den Menschen als
Thieren eigen sind etc. ; deutsch von Herbell. 2te Aufl. p. 48. § 7. 8vo. Lingen,
1794. To cancer of the sole in the horse, of the ear in dogs, scirrhus of the
cow's udder, this name does not apply, v. Greve Erfahrungen und Beobach-
tungen iiber die Krankheiten der Hausthiere, in Vergleich mit den Krank-
heiten der Menschen, Part II. p. 65. 8vo. Oldenburg, 1821.

ELEVENTH SECTION.

OJ' Vices relating to Contents.

§69.

The last object of pathological anatomy is the consideration
of VICIOUS CONTENTS, 01' the presence of extraneous sub-
stances {corpora ^;e/'d?gmia^) which have no organic

74 Vices relating to Contents, [Part I.

CONNEXION WITH THE ANIMAL BODY. Thcse may be intro-
duced into the body from without, either accidentally or
intentionally, or they may be here situated owing to a morbid
activity of formation, and an irregular chemical action. Although
they are not parts of the animal body, yet we must here treat
of them, in so far as they are partly the consequence and the
certain sign of a morbid condition existing during life ; partly,
and by no means seldom, as they produce very many diseases,
as the highest irritation, inflammation, suppuration, tumours,
plugging up of canals, mechanical injuries, and even complete
destruction of individual parts. But these extraneous bodies
are sometimes living, as animals and plants ; sometimes

DEAD, as STONES, EARTHS, SALTS, and the VARIOUS SUB-
STANCES, partly natural, partly artificial, which have
entered into the body.

(1) Reuss Repertor. Comment. Art. Peregrinorum in corpus humanum In-
gestio, llemora, Expulsio, Vol. XIV. p. 294 — 322. — de Plouquet Repertor. Art.
Acus, Bufo, Dejectio, Lacerta, Peregrina, Vermes, Vomitus, etc. ; and the
several parts below. — Schmidt D. de corporum heterogcneorum in plantis anima-
libusque genesi. 4to. Berlin, 1825.

§70.

The ANIMALS,^ which we very frequently find unnaturally
situated in and upon animal bodies, are either such as get into
them accidentally, but can remain and even support their ex-
istence there a long while, or such as, according to their nature,
remain in the body for a certain period of their life, hospites, or
always, incolce^ find in it their necessary protection and food,
and are, therefore, called parasitic animals, animalia para-
sitica et entozoa. The following are the principal animals
which we meet with in and upon the bodies of men and
animals, according to the zoological scale :^

I. To the class of amphibia belong here toads, frogs, and
especially salamanders, which being accidentally swallowed,
are discharged alive by vomiting, or going to stool. ^

TI. Of the MOLLUSCA we have snails, coclilecu, and slugs,
VumtceSy which, if they have been swallowed fresh, are passed
by the mouth and the vent.

III. Among the Crustacea there are some which, as they
have very soft coverings, live for protection or for other pur-
poses even in the double-valved muscles, viz. in the pinna,
and the sea muscle, mytilusy more rarely in the oyster, as
it appears, without much inconveniencing the animals in which
they are contained ; this is j^arlicularly the case with the genus
pinnoflicres, palcanioiv' also, and the young cancer mcenaSy

Sect. XL] Vices relating to Contents, 75

portunus puber^ galathea strigosay &c. The genus phronima
prefers animals of the genera beroe, pyrosoma, and medusa
for its habitation ; and we find also little Crustacea, parti-
cularly of the branchiopodous order, in the gills of fishes and
mollusca.^ Certain Crustacea actually live like parasites on
other animals, and nourish themselves from their juices ; here,
too, belong the v^hale louse, cyamus, which is more com-
monly found in the skin of the cetacea, although met with
also in some fishes ; the sea louse, cymotlioa^ Fabr. which
is found sometimes also under the skin'^ of many fishes and
of some other sea animals ; the genus bopyms, the species of
which are found at the lateral edges of the shell of the crab
kind, palcemon; and, lastly, from the entomostracous order
we have the calygus, which live on the soft spots in the skin,
the palate,^ and other parts of fish ; the argulus, which is
found in the stickleback, gasterosteiis, and in the spawn of
frogs ; the ceo ops and dichelestium, which are found on the
gills of the tunny and the sturgeon ; and, finally, the different
kinds of lerncRa,^ which introduce themselves into the jaws,
lips, fins, and other soft parts of many sea and fresh-water
fishes.^*

IV. Of the class insecta,^" there are also some found
in the body, either as eggs, larvae, or perfect insects, which
remaining there for a shorter or a longer time, excite often a
very considerable degree of inconvenience, and may be got rid
of whilst alive. Thus we frequently see insects of very different
kinds proceeding out of the ear, the nose, or more commonly
from the mouth and vent. For instance, water palmers
and woodlice, asellus, armadillo, porcellio, millipedes,
scolopendra, julus, many chafers, cock-roaches, blatta,
EARWIGS, forficula, CATERPILLARS, and especially the magots
or larvae of dipterous insects, viz. of crane-flies, tipula, and
particularly of flies, musca ; the latter occur very commonly
in unadhering wounds and in foul ulcers of men and animals.
Sometimes insects remain so long and in so great number that
we might notice their propagation in the extraneous organism.**
Certain insects instinctively and continually deposit their eggs
in and upon the bodies of other animals, where their larvae may
find shelter and food. To these belong the gadfly kind,
oestrus, Lin., of which some, as the cestrus humanus of Ame-
rica, ce. bovis, also in deer, goats and camels, ce. afitilopa',
cc. tarandi, and ce. cuniculusy in hares and rabbits in America,
deposit their eggs beneath the skin by means of their ovipo-
sitor, where the larvae called bots become developed, and
produce large tumours, till they pierce and creep out of the

76 Vices relating to Contents, [Part I.

skin; but other kinds, as the oe. ovis, also found in goats,
chamois and deer, and the oe. trompe, in rein deer, deposit
their eggs in the nostrils, whence the larvae make their way
into the frontal sinuses; lastly, there are some, as the oe,
equiy oe, licemorrhoidalis^ oe. veterinus, &c. which deposit their
eggs on the skin and lips of horses, whence, by the animal
licking itself, they are conveyed into the stomach, to which the
larvae attach themselves, till they pass out by the vent.
Hereto also belong many insects which deposit their eggs in
other perfect insects, ^^ or in the larvae of insects, ^^ or in the
eggs of insects,^^ in which the larvae remain till their perfect
development, and partially destroy the internal organs of the
animals which they inhabit.

Finally, there are many insects which we call parasitic or
ANIMAL iNSECTS,^^ bccause they always or generally live upon
and in other animals, on the juices of which they feed, and
even bury themselves deeply in them. To these belong, first,
of the ARACHNID ORDER, the MITES, acarus, holetra of Herm.,
and indeed the subgenera, gamasiis,^^ cheyletus, uropoda^^
sarcopteSy^ the ticks, ixodes^'^ argus^"^ caris^^ leptus^^
acldijsia^'^ atoma or tromhidium and ocypete ;^^ then of the
INSECTS, in a more confined sense, of the apterous order,
Aptera, the inallopJiaga, carnivorous or pellivorous
insects of Nitzsch, pediculi, Linn., namely, the orders p/ii-
lopterus^'" trichodectes,'^'^ liotheum^'^ and gyropus,^^ and the
sucking animal insects, as the louse kind, pediculus,^^
and flea, ^9w/^a%-'**' and then also the double-winged insects,
Dijjtera, the genera carnus,^^ the forest fly, hippohosca^^
nictynhla,^^ and hraula.^^

V. Of the worms or annelida, here belong the leech
kind, hiriido, certain species of which, now and then, are
accidentally situated on and in the body, remain there for
some time, and give rise to numerous affections ;^^ but others,
as the parasites, live upon turtle and fish,^*' the gordius aqua-
ticus, which has been vomited up;" next the nereids, nereis,
which frequently perforate the shells of mollusca;^^ the nemertes
borlasli, a sea-worm, which buries itself with its head in the
anomia, and lastly, especially the intestinal worms, vermes
intestinales,^'^ which live in the interior of men and almost all
classes of animals, often increase there spontaneously in very
great quantities, although they also often propagate in us, and
are more or less hurtful. This order of worms comprehends
the following kinds: the thread worms,^'^ filari a, which are
met with in the cellular membrane, the cavities of the body,
and sometimes also in the intestines of men, beasts, birds,

Sect. XI.] Vices relaling to Contents. '?7

amphibia, and fishes, and even of insects ; trichosoma or
capUlaria, hairy-bodied worms, especially in the alimentary
canal of birds; tricocepJialus, hairy-headed worms", in the
larger intestines of men and beasts, and also of amphibia;
oxyuris, a small kind in the intestinal canal of beasts ;^^
cucuUanus, hooded worms, in the intestinal canal and belly
of fishes, and perhaps also of some amphibia ; spiropteraj^^ in
the alimentary canal of man, and in many other parts of
vertebral animals, sometimes forming knots of worms ; p)hysa-
loptera, in the alimentary canal of beasts, birds, and amphibia ;
strongylus,^^ in the intestinal canal, the kidneys, the air-tube,
and many other parts in men, and animals of the first four
classes ; ascaris, round worm,"'^ a very numerous kind which
are found, especially in the alimentary canal, from man down-
wards to insects; ophiostoma,'^^ in the alimentary canal of
beasts and fishes ; and lastly, liorhynchiis,'^^* a little kind found
in the alimentary canal of beasts and fishes.

VI. We find many of the class zoophyta living as
parasitic in and upon other animals, and one particular order,
zoophyta parasitica,^^ appear to be formed there. To these
belong first, the family acanthocephala, with the peculiar but
very numerous kind echinorhynchus ^^^ which by means of their
hook-like proboscis pierce into the alimentary canal of beasts,
birds, amphibia, and fishes; then the family trematoda^ which
have openings or sucking points, by which they stick upon
other animals, although they cannot perforate them ; " these
embrace the monostoma kind, which are found in the alimen-
tary canal of a few beasts and amphibia, and of many birds and
fishes; the amphistoma, in the alimentary canal of birds, but
not so frequently in beasts and amphibia ; distoma,^^ of which
very many species are found, especially in birds and fishes,
more rarely in beasts and amphibia, one even in crabs, in the
most dissimilar parts, although especially in the alimentary
canal and the biliary system ; pantastoma, in the different
organs of certain beasts and a few amphibia ; polystoma,^^ in
men, some amphibia, and on fish, in various parts ; tristoma,
Cuv. or phylline^ Oken, on the gills and external skin of
some fishes ; axine of Abildgaard, on the gills of the garpike ;
cyclocotyla mihi,^'^ on the skin of the garpike, and phceni-
curus imrius, or vertumnus iethydicola,^^ externally on the
tethys ; further, the family of the bandshaped zoophytes,
cestoidea, containing the genera caryophyllcEus, of which the
only species is found in the alimentary canal of many fishes ;
scolex, also but one species in the alimentary canal and belly
of fishes and in the sepia dilopodia ; gymnorhynchus^ of which

78 Vices relating to Co?itents. [Part I.

a peculiar kind is found in the flesh of the brama raji f*
tetrarki/nc/ius, of which a few species are found in different
parts of the sea turtles, fishes, and also of the cuttle fish, which
they seem able to perforate ; ligala, which kind are found in
an imperfect state in the belly of many fishes, but in a more
perfect state in the alimentary canal of animals living on fish,
viz. in seals and sea-birds, and they are besides remarkable,
as they perforate the living fish ; " tricenophorus, of which the
only species lives in the intestines of many fishes ; botrice-
phaluSf TAPE woRM,^° in the intestines of man, seals, birds,
and fishes, and lastly, the tcenia, chain worm," a very com-
mon kind living in the intestines of men, beasts, birds,
amphibia, and fishes. Finally, the family of cyst worms,
cystica,^^ consisting of the genera antJiocephalus,^'^ which is
found in some southern fishes ; cysticercus,^^ peculiar to men
and beasts; coemirus, in the brain of sheep, antelopes, and
cattle, affected with the gid, and echinococcus ^^ which occurs
in men, monkeys, and some of the cloven-footed animals.

(1) V. Baer Beitriige zur Kenntniss der niedern Thiere in Nov. Act. N. Cur.
Vol. XIII. Part II. p. 525. — S. Mitchill in Francis and Beck's New- York
medic, and physical Journ. ; and compare Redi Osservazioni intorno agli ani-
mali viventi die si trovano negli animali viventi. 4to. Firenze, 1684, with
plates. — P. S. Pallas Diss, de infestis viventibus intra viventia. 4to. Lugd. Batav.
1760 ; recus. in Eduard Sandifort Thesauri Diss. Vol. I. p. 247. 4to. Roterod..
1768. — C. A. RudolpM Entozoorum s. Vermium intestinalium historia naturalis.
Vol. II. 8vo. Amstel. 1808 — 10; also upon insects and other animals. — de
Olfers De vegetativis et animatis corporibus in corporibus animatis reperiundis
Commentarius. Pars I. 8vo. Berol. 1816. — Virey Menioire sur les Insectes
parasites de I'homme et de divers animaux, ou les entozoaires; in Journ compl.
du Diet, des Sc. medic. Vol. XIV. p. 193. — \_M. Block Trait6 de la Generation
des Vers des Intestins, translated from the German. 8vo. Strasbourg. 1788. —
Booymerts De Vermibus crebrioribus intestinorum humanorum. Lovan. 1770. —
R. Hooper, M. D., Observations on human intestinal Worms, being an attempt
at their arrangement, with plates, in Mem. of Med. Soc. of London, Vol. V.
p. 224. T.]

(2) I prefer this, because we do not know indeed, of the many parasites
living on aquatic animals, whether they do not live sometimes by themselves, or
whether the different species of the same kind, as leeches, support themselves in
very different ways.

(3) Passing over the fabulous accounts of moles, cats, mice, chickens, and
fish, which have been engendered in the bodies of men, and evacuated, there
are however observations on amphibia which have been evacuated alive, not to
be rejected as valueless, on account of the great tenacity of life in these animals;
probably, however, a prudent scepticism with regard to them is very wholesome ;
but of the batrachial animals there have occurred some instances worthy of
credit. — Schenk, in Harless Ilhein. Jahrb. fiir Medic, u. Chir. Vol. VII. Part
III. p. 138, gives a recent instance of a salamander; in the Bresl. Mus.
No. 2542, is found a hufo variabilis, which, according to the evidence of a very
circumspect and credible physician, was passed by stool. — Spence, in Edinb.
med. and surg. Journ. Vol. IX. (a living salamander by stool.) — On one hundred
live lizards, v. Beobacht u. Abhandl. von den ostreich. Aerzten. Vol. I. p. 155.
1819. [F. R. Ziiiuffcri Lacertus Aquaticus apuella quadam per alvum redditus,
in Acta Helvet. Vol. F. p. 22. T.]

Sect. XL] Vices relating to Contents. 7jE^

(4) A fresh instance in RusVs Magazin fiir die ges. Heilkunde, Vol. XIX.
Part III. p. 509. — Eyting in Hufeland's Journ. d. prakt. Heilk. April, 1822,
p. 16.

(5) For instance, Palcemon pinnophylax mihi. v. Otto Conspectus animalium
quorundum maritimorum nondum editor. 4to. Pars I. p. 12. Vratisl. 1821.
[Pinnotheres veterum, Mus. Roy. Coll. Surg. No. 293, in the shells of pinnae and
oysters ; P.pisum, No. 294, J. B. in the shells of mytili and modioli. T.]

(6) I have seen these often also in sea fish ; viz. once in Blennius Phycis, in
the gills of which were attached a great number of animals of the Praniza kind,
p. 13, under the word Mesosoma, — Nicothoe astaci in the gills of the lobster, and
the female of the Oniscus thoracicus of Montague, under the shell of the Callia-
nassa subterranea.

(7) To wit, Cymothoa hopyroides. v. Lesueur in Bulletin des Sc. par la Soc.
philom. p. 45. 1814.

(8) To wit, C aligns minimus on the palate of the Perca Lahrax. v. Otto, p. 14.

(9) Although some lernaeae are very similar in form to worms, it however
seems to me best to include them here, although this remarkable, little known
race, may certainly be divided into many genera. [^LerntBu pectoralis, Mus.
Roy. Coll. Surg. No. 284, from the pectoral fins of a haddock; Dichelestium
sturionis, No. 285, from the gills of the sturgeon ; Lernaopenna exoceti, No. 285 A,
from the back of the flying-fish ; L. — No, 286, from fin of a diodon 1 L. —
No. 286 A, from the cornea of the Greenland shark ; Lerntea, No, 287, from the
margin of the anus of a small squalus ; L. Spratti, No. 287 A, and 287 B, from the
sprat. T.]

(9*) [Here also may be added of theCiRRiPEDA the following : — Cineras hunteri,
Mus. Roy. Coll. Surg, No. 265, on the tail of the hydrophis bicolor; Tuhicinella
balcenarum, No. 279, Mus. Roy. Coll, Surg, in the skin of whales ; Coronula
diadema, No. 280 — 282 A, in same ; Balamis glacial is, No, 282 B, on the spine of
a dog fish ; No. 282 C, on the arcturus tuberculatus ; Acasta, No. 282 E, on a
sponge. T.]

(10) Heise D. d. insectorum noxio effectu in corpus humanum. 4to. Halae,
1757. — A. Ascona degl' insetti nocivi all'uomo, alle bestie, all'agricoltura, etc.
Milano. \%2^.—Rudolplii, Vol. I. p, 131, 161. and 513. — Reriss Repertor. Com-
ment. Vol. I. p. 377, and Vol. XIV. p. 294, ft: and p. 3 1 8.— Je Plouqnet and Virey.—
Several inapplicable, but one particularly apposite case, is related by Yule, in
Edinb, Phil. Journ, No. 25, p. 72, July, 1825. I myself know some authentic cases
of the Meloe majalis, caterpillars and fly maggots which were vomited ; in refe-
rence to the latter, we must make strict inquiry ; thus, I have seen fly maggots,
said to have been vomited, produced from uncleanliness of the spitting-pot, and
similar animals, said to be voided by stool, from the filthiness of a padded close-
stool. [Observations sur des Chenilles expuls^es vivantes de I'estomae et des
intestines d'un homme, in Journ. de phys. Vol. IX. p. 230. T.]

(11) Acrel in Nov. Act. Soc. Upsaliensis. Vol. VI. p. 98. — Osiander's Denk-
wiirdigkeiten, Vol. I. Parti, p. 1. Part II. p. 424. — Pickel in Transact, of the
Association of Irish Physicians, 1824. Vol. IV. and V. No, 22 and 23 ; above 340
larvae pupae, and perfect animals of the Blaps mortisaga, passed by stool, and
by vomiting above 700 similar animals, Tenebrio molitor, and thousands of the
larvae of flies. [Larvae of the Curculio and Scaraheeus, discharged by the urethra,
frequently for the space of six weeks, W. Henry, Edinb, Med. and Surg. Journ.
Vol. VTI. p. 146. Similar larvae were also in one case vomited, and in another
passed by stool ; case related by T. Bateman, v, Edinb, Med. and Surg, Journ
Vol, VII. p. 41. I have before me specimens of the Dermesies Murinus, both in
the larval and perfect state, which were passed per anum. Three hexapod larvae,
voided by stool, v, Jessop in Phil, Trans. Vol, X, p, 391, are considered hy Kirhy
as belonging to the Dermestes, Fab. or Byrrhus, Lin. Probably also those men-
tioned by Chichester in a case of Hsematemesis, in Edinb. Med. and Phys. Journ.
Vol. VII. p. 326, belonged to this genus, perhaps are D. Lardarius ; but his
account is very unsatisfactory ; he says that many hundreds were vomited and
passed per anum. Mention is made in Kirhy and Spence's Entomology, Vol. I.
p. 140, of the larva of an insect probably belonging to the Tipulidcn, which was

80 Vices relating to Contents, [Part I.

passed by the urethra. In Lemprlere, On the diseases of the Army in Jamaica,
Vol. II. p. 182, is mentioned the case of a lady who died in consequence of the
larvae of some species of Muscidee making their way from the cavity of the nose in
which their eggs had been deposited, through the crybriform plate of the ethmoid
bone into the brain. There is also a horrible case mentioned in Kirby and Speiice,
\o\. I. p. 138, in which a man, who was accustomed to place his superabvmdant
food within his shirt, and next to his skin, having been taken ill and laid down
in a field on a very hot day, the meat soon became putrid, flies were attracted to
it, and deposited their eggs not only in it, but also in the body of the man himself,
who, being found some little time after, was so eaten by the maggots that he died
in a few hours. — Elophilus Pendulus, in the larval state, was found in the stomach
of a woman, v. Bonnet (Euvres d'histoire naturelle et de philosophic. Vol. X.
p. 144. 8vo. Neufchatel, 1779. T.]

(12) To wit, Xtnos and Sty lops, under the abdominal plate of wasps, and
Andrena ; Cleptes coccorum, Fabr. on the coccus kind, Cryptus aphidiim, Fabr.
on the vine fretters; Conops rnfipes in the Bombtts lapidar'ms and terrestris ;
Conops ferrug'mea in Apis meUifica.

(13) For instance, in t\\e Diploleparia, Nees, or Ciniptera, Latr., in the larvae of
the gall fly ; the genus Foenus in the larvae of bees ; all Ichnenmonides in caterpillars
and other larvae ; the Musca farvariim in caterpillars.

(14) Some species of the genus Chalcis, and some Ichnenmonides gemini.

(15) Redi Esperienze intorno alia generazione degP Insetti. 4to. Firenze,
1788. 5th edition, lat. Amstel 1671, 1G86, 1712. — de Geer Memoires
pour servir h I'histoire des Insectes. 7 vols. 4to. Stockh. 1752 — 78. — Hermann
Memoire apterologique. fol. Strasb. 1804. — A^27:^sc7i Die Familien und Gattungen
der Thierinsecten, insecta epizoica, als Prodromus einer Naturgeschichte
derselben, in Germar and Zinlcen Magazin der Entomologie. Vol. III. p. 2Glft'.

(16) The G. marginatns in the diseased skin of men, even in the brain and
eye-ball; also in swallow's nests; other kinds on mammalia and birds. Here,
perhaps, the observations oi Bory de St.- Vincent, v. Rapport des trav. de I'Acad.
des Sc. pour I'an 1823, p. 42, with engravings. — lb. Sur un nouveau genre
d'Acaridiens sorti du corps d'une femme, in Annal. des Sc. naturell. Vol. XV.
p. 125. Oct. 1828. [^Gammasus gymnoptornm, Mus. Roy. Coll. Surg. No. 370 B,
in a humble-bee; G. coleoptratorum, No. 370 C, in a cetonia; Cellularia hassani
in cellular tissue of gannet, Montagu, in Wern. Trans. Vol. I. p. 191. T.]

(17) Especially on chafers.

(18) Here Snrcoptes, or A cams siro, or Scabiei, in the itch pustules of men;
also in those of horses, dogs, cats, and on birds, &c. such animals occur.

(19) Especially /. ricinns, the dog-tick, and reticulatus, which live upon hair,
hut commonly bury tliemselvcs deeply in the skin of dog.s, oxen, horses, and
other quadrupeds. I found them also in the hare, even in the tortoise, and
sometimes they multiply astonishingly ; both occur also on men ; also in Nor-
way, /. sanguisugus, in America, 1. nigra, in Egypt. /. eegypticus. \^Ixodes ricinus,
No. 373, Mus. Roy. Coll. Surg, in dogs and cattle; I. spJendens, No. 373 A,
from a tiger, and 373 B, from a tapir ; 373 C, from the perineum and vulva of a
rhinoceros; 374, from an iguana. T.]

(20) Upon pigeons.

(21) Upon bats.

(22) To wit, the Leplus autumnalis, which lives on grass, &c., and buries itself
in the human skin, where it produces painful itching.

(23) Under the wings of the Diliscus marginalis. v. /Indouin in Bullet, des Sc.
par la Soc. ])hilom. 1822, p. 12. Drawings in Diet, classique d'histoire nat.
Paris, 1822.

(24) The two latter kinds from insects.

(25) Subgenera are Docophorus, Nirmus, Lipeurus and Gonioides, all of which
occur as parasitic in birds.

(26) On mammalia, viz. the dog, cat, sheep, goat, oxen, &c.

(27) The Subgenera are Colpocephalum, Menopon, Trinoton, Ettreum, Ltemobo-
thrion and Physostomum, entirely in birds.

(28) Two species of these from Cavia Cobaya.

Sect. XI.] Vices relating to Contents, 81

(29) In man, the following species occur : — Pedic. capitis, head-louse ; Ped.
vestimenti, clothes-louse ; Ped. tahescentium, Ped. nigritarum and Ped. pubis, crab-
louse ; — cattle, swine, and deer have also their peculiar lice. In diseased m6n,
lice are seen in the skin in pustules (even in the inner parts?); — often in
astonishing quantity, and produce the so-called lousy disease, Phthiriasis v. Plou-
quet Repert. Art. Phthiriasis. — Hufe land J our n. d. prakt. Heilk. 1813. Part III.
p. 122 — 127. — Rust in Bremser Ueber lebende Wiirmer in lebenden Menschen.
p. 54, 55. 4to. Wien, 1819. — ^/i Comm. de Phthiriasi. 4to. BonnsB, 1824; with
good drawings, and apposite observations. — Sichel D. Historiae Phthiriasis in-
ternae verae fragmentum. Berol. 1825. — Harder in Petersb. verraischt. Ab-
handlungen a. d. Gebiete d. Heilk. Part II. p. 207. Petersb. 1823. — lb. and
Mailer in the same. Part III. p. 254. Petersb. 1825, (in gouty persons). —
According to Kirby, the supposed lice in pustules of the skin are acari, therefore
he calls the disease Acariasis. [^Pediculi, Mus. Roy. Coll. Surg. No. 375 — 381,
from man, swine, turkey, dove, and crane. T.]

(30) For instance, the common flea, Ptilex irritans, and the chigoe, Pulex
penetrans, which, in America, buries itself deeply in the human skin, and pro-
duces very malignant and even fatal consequences ; in beasts and birds other
kinds, besides the common flea, occur.

(31) Carnus hemapterus, on starlings.

(32) The Subgenera are Ornithomyia on birds; Normomyia, especially on
mammalia ; Lipoptena upon stags and roes ; Melophila, for instance, the sheep-
tick, M. ovina.

(33) On bats.

(34) The Br. cocca on the honey-bee.

(35) Not unfrequently in the throats of men, in the nostrils of horses, and on
the naked parts of the heads of water-birds.

(36) To wit, H. branchiata, H. piseium, and H. muricata, H. sturionis, H. hip~
poglossi, &c. in the gills of crabs. [Lacretelle in Gazette de Sante, Feb. 1828.
Death by suffocation in a soldier who had swallowed a leech in drinking water ;
it was found in the right ventricle of the larynx. — Vanderbach in Journ. Univ.
Haematemesis, for fifteen days after swallowing a leech in drinking water ; the
animal found its way into the pharynx, whence it was then pulled out alive by
the patient. T.]

(37) Deglaud in Rec. d. trav. de la Soc. de Lille. 1820, p. 22. Lille, 1823.
p. 166. V. LeveillS in d. Ann. de la Soc. Linn. Paris, May, 1825. p. 132.

(38) They appear to do this by a corroding juice, which dissolves the lime ;
in consequence, the mollusca fill up the hole with a peculiar yellow indissoluble
animal substance.

(39) Under this head I understand the true intestinal worms, i. e. Ru~
dolphi's Entozoa nematoidea, or Cuvier's Cavitaires, which, according to my
opinion, are not to be separated from the Annelida. Concerning the intestinal
worms in general, v. Block Abhandlung von der Erzeugung der Einge-
weidewiirmer und den Mitteln wider dieselben. 4to. Berlin, 1782, with ten
plates. — Goeze Versuch einer Naturgeschichte der Eingeweidewiirmer thierischer
Korper. 4to. Leipz. 1782, with forty- four plates. Erster Nachtrag zur Natur-
geschichte der Eingeweidewiirmer von Goeze, mit Zus. u. Anmerk. von Zeder.
4to. Leipz. 1800, with six plates. — Zeder Anleitung zur Naturgeschichte der
Eingeweidewiirmer. 8vo. Bamberg, 1803, with four plates. -^ Rudolphi above,
and Entozoorum Synopsis cui accedunt Mantissa duplex et Indices locupletis-
simi. 8vo. Berol. 1819, with three plates. — Bremser Ueber lebende Wurmer in
Lebenden Menschen u. s. w. 4to. Wien, 1819, with four plates. — 76. Icones
Helminthum systema Rudolphii entozoologicum illustrantes. fol. Fasc. I — III.
Vienn. 1824. — C. Fischer, D. de entozois. Svo. Viennae, 1822. — Gerardi de Vos
Disqu. med. de entozois humanis in Belgio repertis, &c. 8vo. Traj. ad Rhen.
1828. — Cre/jZm Observationes de Entozois. P. I. Svo. Gryphisw. 1825, with plates.
— Fr. S. Leukart Versuch einer naturgemassen Eintheilung der Helminthen.
Svo. Heidelb. 1827, and Handb. der Helminthologie in naturhist u. medic.
Hinsichtzu Vorlesungen. Heidelb. 1827, with plates. — ./. C. Zenker Parasitae
Corp. hum. internae v. vermes intestinales hominis. Lips, 1827. — C. B. C.Martius

G

82 Vices relating to Contents. [Part I.

D. de vermibus in corpore humano. Wurceb. 1828. — Creplin Novae obser-
vationes de Entozois. Berol. 1829, with two plates.

(40) In men occur the skin-worm, guinea-worm, &c. F. medinensis in the
tropical regions of Africa and Asia, especially on the feet, often occasioning
much inconvenience, bore through the skin, and may then be drawn out.
J, DuncaTi, D. de Filaria medinensi s. Gordio medinensi. Edinb. 1821. —
Kennedy and Smyttan, v. Gerson and Julius Magazin d. ausl. Lit. d. ges. Heilk.
1825, Sept. and Oct. p. 242. It is doubtful whether it was the Filaria bronchialis
or Hamularia lymphatica, which Treutler found in the neighbourhood of the
bronchia of a man. — [Filaria, No 167 — 173, in Mus. Roy. Coll. Surg.; among
which F. gracilis in a cyst close to the trachea of simia satyrus, between pleura
costalis and pulmonalis in sim. capucinus ; F. papillosa, behind peritoneum and
pleiura, and in trabhea and globe of the eye in the horse ; F. macropi majoris,
a doubtful specimen, marked, ' Worms found alive within the capsular ligament
of the knee-joint of the kangaroo ;' F. apis terrestris, doubtful, in the abdomen
of the humble-bee. — Paioti, Cases of guinea-worm, with Obs. in Edinb. med.
and surg. Journ. Vol. XI. p. 151. — Filaria in the belly of a spider, v. Vicat, in
Lond. med. and surg. Journ. Vol. XXXIX. p. 478. T.]

(41) In man the Trichocephalus dispar : other kinds in cattle, sheep, dogs,
and swine. — [Trichocephali, No. 173 — 174, in Mus. Roy. Coll. Surg. — T. dispar
in coecum of man, which was ' perforated as it were by a number of pinholes ;'
T. depressiusculus ? in coecum of dog and fox. T.]

(42) Bremser here includes also the Oxyiiris vermicularis of men, according
to Rudolphi an Ascaris ; in the horse. Ox. curvula.

(43) It is doubtful whether the Spiroptera liominis is in the human bladder.
[There is, however, a specimen of S.hominis, No. 174, Mus. Roy. Coll. Surg, on
the bladder of a man ; for Lawrence's account of which, v. Med. Chir. Trans.
Vol. II. p. 382. T.]

(44) In men, the Strnngylus gigas in the urinary organs ; the same in many
beasts; the Sfr. armatus is common in horses. — \_Strongyli, No. 175 — 180", in
Mus. Roy. Coll. Surg. — .S". armatus, in aneurysms of mesenteric artery in horse
and ass ; S. gigas, two specimens in man, a third in the racoon, all from
the kidneys, rarely in other parts ; aS*. filaria, in bronchi of sheep ; S. iuflexus,
in pulmonary artery of porpes ; S, minor, irom. tympanum, eustachian tube and
venous sinuses of the base of the brain ; ^S". criniformis, from intestines of badger ;
*S', vulturis, in a vulture. T.]

(45) In men, the Jscaris lumbricoides and ver7nicularis ; the former occurs also
in swine, cattle, horses and asses, and was found also in man, in a popliteal aneu-
rysm, as well as in abscesses on the spine, v. Otto Seh. Beob. Part II. p. 41.
No. 17. — Felpeau in Archiv. general, de Medec. Vol. VII. March. [Ascarides,
No. 181 — 189, in Mus. Roy. Coll. Surg. — A. lumhricoides, from small intestines
of man, and intestines of sus, bos, equus, and asinus ; A. marginata, from small
intestines of dog; A. vermicalaris, from large intestines of man ; A. spiculigera,
from (tsophagus and proventriculus of cormorant; A. testudinis terrestris, from
rectum of land tortoise ; A.pythonis, doubtful species from stomach of a python ;
Case of ascarides, found in biliary ducts of a child, in Med. and Phys. Journ.
Vol. XV. p. 28. — W. Heberden, Observations on ascarides, in Med. Trans. Coll.
Phys. Vol. I. p. 45. — A. lumhricoides ? from the cellular tissue of the belly, v.
M. Willius in Act. Helvet. Vol. I. p. 73 ; from the cellular tissue of the arm,
D. C. E. Berdot in ib. Vol. VII. p. 177. T.]

(46) A still doubtful kind which occurs in the stomach of men is the Oph.
Pouterii, v. //. Cloquet in Nouv. Journ de Med., ('hir. ct Pharm. Vol. XIII.
Feb.

(46*) \_Liorhrynchi, No, 189, in Mus. Roy. Coll. Surg. L. gracilescens, in the
stomach of the great seal, in Mus. Roy. Coll. Surg. T.]

(47) That is, Rudolphi' s last four orders of intestinal worms, Cuvier's Paren-
chymateux, and some parasites of this class living on animals ; we may divide
them into Zoophyta cntozoa and extozoa.

(48) The largest and most common kind is the Ech. gigas from tame and wild
swine. — \VestrumhCoTMx\ent.Ae Helminthibusacanthocephalis. fol. Hanov. 1821.

Sect. XL] Vices relating to Contents. 83

with three plates. — [Echinorhynchi, No. 190 — 194, Mus. Roy. Coll. Surg. — E.
porrigens, from intestines of whalebone whale ; E. halanocephaliis, two specimens
from the intestines of balaena rostratus; E. filicollis, two specimens from the
intestines of eider duck. T.]

(49) For instance, the Distomaferox bores itself pits in the intestine, v. Goexe
p. 177. pi. 15, fig. \.—lDistomata, No. 196—202, in Mus. Roy. Coll. Surg.— Z).
hepaticum, from the liver and gall-bladder of man and sheep ; D. variegatum,
from gall-bladder of wolf fish ; D. lineare, three specimens from the windpipe of
the common fowl and partridge. This animal is the cause of the disease called
the ' gapes ' in chicken. D. hydrojohidis, doubtful, from the ovarium of the
watersnake. T.]

(49*) [^Amphistomata, No. 164"^ — 195, Mus. Roy. Coll. Surg. — A. conicum, two
specimens from the first stomach of the rein deer ; A. scdetriquetrum, from small
intestines, ccecum and colon of beaver. T.]

(50) In man, in the gall-bladder, the Distoma hepaticum ; the same in the liver
and alimentary canal of many mammalia, viz. the horse, cow, sheep, goat and
swine ; most commonly in the sheep, the liver of which is thereby very fre-
quently knotted. Some Distomata make the transition to the Trematodoa
extozoa, as they are found in the gills of fishes, and externally on the skin.
\_Fasciola trachea, in chickens and young turkeys. — Wiesentha in Med. and phys.
Journ. Vol.11, p. 204; also in young partridges and pheasants, Montagu in
Werner. Trans. Vol. I. p. 194—198. T.]

(51) Pol. pinguicola was found by Treutler on a human ovary; the Pol.
venarum, which he also found in a burst tibial vein, seems to me only a Pla-
naria ; — the Pol. duplicatum on the gills of the tunny, on account of its habitat,
makes also the transition to the following kinds.

(52) Ottom Nov. Act. Acad. Nat. Cur. Vol. XI. Part II. p. 300, pi. 41, f. 2.

(53) Rudolphi Entozoorum Synopsis, p. 573. — Otto, p. 294. pi. 41, f. 1.

(54) I also found it in three instances of this fish in Nizza and Naples.

{55) Goeze engraves on plate 16, a Ligula, which had bored its way out of the
spine of a fish. \_Ligida, No. 203, Mus. Roy. Coll. Surg. — L, cyprini, from the
abdominal cavity of a carp, perhaps C. Brama. T.]

{55*) \_Trmnophorus, No. 203% Mus. Roy. Coll. Surg. — T. nodulosus, from the
stomach of the haddock. T.]

{5Q) In the intestinal canal of man occurs the Bothryorpehalus latus, otherwise
called Tania lata, in a remarkable manner, especially only in Switzerland and
Russia — now and then in France ; in Germany, Holland and England, but very
rarely; hardly ever in the dead body. iBothryocephali, No. 204 — -206«*, Mus.
Roy. Coll. Surg. — B. latus, three specimens from intestines of a Swiss girl ;
B. punctatus, from stomach and intestines of a turbot ; B. rnacrocephalus, from
stomach of a greenland dove ; B. pythonis, from intestines of a species of
Python. T.]

(57) In man the Tania solium, Lin., which however is also sometimes found not
singly, but numerous, especially in Germany, Holland, England and the East;
also, though rarely, occurs in spawn ; it is then easily distinguished, as it
attaches itself to the orifices of the ovaries on the edge of the organ, whilst the
Bothryocephalus latus attaches itself to the surface. The head extremity is in both
very thin and threadlike ; the hinder joints of the T. solium, which are often shed
singly, and which we formerly erroneously called flat worms ; Tcenia occur in
all our domestic animals, except swine. [^TcBnice, No. 207 — 222, Mus. Roy. Coll.
Surg. — T. denticidata, three specimens from the intestines of the genus Bos ; T.
plicaia, from the small intestines of a horse ; T. perfoliata, from the colon and
ccecum of a horse ; T. anthocephala, from the rectum of the great seal ; T. ompha-
lides, from the intestines of the short-tailed field mouse ; T. pusilla, from the
common mouse and rat; T. solium, four specimens from the small intestines of
man ; T. marginata, from the intestines of a wolf; T. serrata, three specimens
from the small intestines of dogs ; T. crassicollis, three specimens from the small
intestines of a common cat. — T. sollda of Gmelin, in cellular tissue of gasterosteus
aculeatus, v. F. L. Dick, in Thomson's Annals of Philosophy, Vol. VII. p. 106.
T.]

q2

84 Vices relating to Contents. [Part I.

(58) Called also living hydatids ; and it is well to distinguish them from the
dead hydatids above described, § 64, to which they form the transition.

(59) H.floriceps, Cuvier's. [A/ithocephalus, No. 222% Mus. Roy. Coll. Surg. —
A. macrourus, from the genus sparus. T.]

(60) In man, in the brain, heart, but especially in the muscles, the Cyst,
cellulosa ; also in monkeys, and particularly common in swine ; in most other
domestic animals the Cyst. tenuicolUs ; in the horse Cyst, fistularis. l_Cysticerci,
No. 222^ — 227, Mus. Roy. Coll. Surg. — C. fasiolaris, two specimens from livers
of mouse and rat ; C. tenuicolUs, three specimens from the pleura and peritoneum
of ruminant animals and sow; C. celliilosiis, two specimens in the heart of hog.
C. tenuicolUs ? Mus. Roy. Coll. Surg. No. 593, from the urethra, v. J. C. Letsom,
Mem. of Med. Soc of Lond. Vol. II. p. 32 ; also F. B.'Fimiey, ih. p. 516. T.]

60* \^Coenuri, No. 228 — 229, Mus. Roy. Coll. Surg. — C. cerehralis, two speci-
mens from the brain of giddy sheep. T.]

(61) The species are the Ech. hominis, Ech. simice, and Ech. veterinorum ; the
latter in swine, sheep, oxen and camels. Upon the Ech. hominis, v. Bremser in
Meckel's D. Archiv f. d. Physiol. Vol. VI. p. 292.

§71.

The existence of vegetable substances, producta pJiy-
toidea, is much more rai'e and restricted in Hvin^ animal
bodies, than the animals already noticed ; and here only be-
long the formation of mould, bz/ssits, and of funguses,
fungus, which rarely occur in foul wounds,^ and on dirty,
moist parts of the skin,^ and such as are disposed to mois-
ture from lying still, consisting of confervi, oscillatoria, tangae,
spongiae, tremelli, &c., which are not unfrequently seen on
the old or diseased skins of many animals living in sea or
fresh water; for instance, of fish, particularly the carp, of the
mollusca, the Crustacea, and the water chafers, &;c.

(1) It usually occurs in foul bandages, but sometimes also in the wound
itself. I agree with Jaeger, Vol. II. p. 354, and with Rudolphi, in his Grundriss
der Physiol. Vol. I. p. 292, 8vo. Berl. 1821, that we must entirely doubt the
assertions as to the production of mould in living animals, respecting which, v.
Thayer Verschimmelung, Mucedo in lebenden Thiere in Meckel's D. Archiv. f.
Physiol. Vol. I. p. 310. — Heusinger De metamorphosi rostri pici et dege-
neratione mucosis in organismo animali vivente Progr. Jenae, 1821. — On the
growth of vegetables on living animal bodies, v. Mitchill in Silliman's Journ.
Vol. XII. No. I. p. 21, March, 1827. — Neue Beobachtungen iiber Schimmel-
bildung am lebentlen Kiirper. v. Theile in Heusinger's Zeitschrift. f. organ.
Physik.' Vol. I. Part III. p. 331.

(2) For example, after severe corrosive sweat mushrooms upon the vertebras
between the hairs, v. Memoire della Soc. med. di Bologna, Vol. I. p. 350.
Harless in his and Hufelatid's Journ. d. prakt. Heilk. Nov. 1815, p. 118.

§72.

The first and most important kind of dead extraneous
substances found in the animal body, are stones, calculiy^
so named from their hardness, composition, and inorganic
form. But the stone formation, lithiasisy is the product
of a morbid mixture of the animal fluids, and of a changed

Sect. XL] Vices relating to Contents. 85

dynamic influence of the solid parts containing it; hence in
advanced age, and in the male sex/ in which dyscracice and the
production of earth are frequent, it is more common than in
young persons and in females ; it is also very generally con-
nected with other dyscracic diseases, viz. gout,^ hemorrhoids,*
so also in children with rickets and scrofula; climate
and the mode of life also appear to have great influence
on the production of stone. Stones very frequently occur
in animals, and are found in great quantity in beasts, birds,
amphibia, and fishes, and even in invertebral animals ;* in
animals, however, they vary very considerably with respect
to their frequency, inasmuch as they are very common in
some kinds, whilst in others they are rarely seen at all.^ As
to the locality in which stones are formed, almost all parts
of animal bodies seem disposed to this formation, although
some parts are more especially so ; thus we observe the stony
deposit in the membranous system, in the organs of sense,
and in the brain, in all cavities lined with serous membranes,
very commonly in the alimentary canal and its adjuncts, as
the salivary organs, the tonsils, the liver, &c., in the organs
of respiration, circulation, and generation, but more especially
in the urinary organs and the neighbouring parts, where the
urine is in a morbid state. Not unfrequently are such stones
produced in the body, voided by the natural openings, or by
abscesses in very different parts. The number, size, colour,
form and hardness of such stones vary without end, partly
depending upon the localities in which they are formed ; most
of them are roundish and tolerably smooth, sometimes, how-
ever, they are also rough, angular, beset with points, so that
they excite mechanical irritation ; in other cases they stop up
the canals of the body, or may be prejudicial in many other
ways. They are also very different in structure ; some consist
of a close homogeneous mass, others are as it were chemical
deposits, that is, incrustations of extraneous bodies which have
remained some time in the organism, and are often hidden
in them like kernels,' or frequently as concentric layers : in
other instances they assume a more crystallized form, or consist
of crystallized and uncrystallized layers alternately. Some-
times the earth and salts of which the stone is usually formed
are not compounded into a stone, but are either collected
in the body, as sand, dust or small crystals,^ or are passed
in large quantity with the urine, spittle, perspiration and
ulceration,^ &;c.

(1) Reuss Repertor. Comment. Art. Calculus, Vol. XII. p. 156 — 216. — de
Plouquet Repertor. Art. Calculus. — Walther^s Anatom. Museum. Vol. I, 4to.

86 Vices rekit'wg to Contents. [Part I.

Berlin, 1796, with engrav. Fourcroy Sur le nombre, la nature et les caractdres
distinctifs des diiferens materiaux, qui forment les calculs, les bezoards et les
diverses concretions des animaux, in the Annal. du Museum d'hist. natur.
Vol. I. p. 93. 1802, with engrav. — Marcet, An Essay on the chemical history
and medical treatment of calculous disorders. London, 1817. — Bremmer D. de
calculis corporis humani propriis. Edinb. 1818. — Brugnatelli Lithologia umana,
ossia ricerche chimiche e mediche sulle sostanze petrose, che si formano in diverse
parti del corpo umano, etc. fol. Pavia, 1819, with engrav. — Henry, On urinary
and other morbid concretions in Medic, chir. Transact. Lond. 1819. Vol. X.
p. 410; and in Thomson's Annals of Philos. Febr. 1820. p. 10. — Foelkel D.
de formatione concrementorum calculosorum corp. hum. 8vo. Vratislav. 1822. —
[ProM^ on the nature and treatment of Gravel, Calculus, &c. 2d ed. 8vo. Lond.
1825. — C. Sciidamore, on the nature and cure of Rheumatism. 8vo. Lond.
1827. — ^. Fourcroy Observations sur les Calcules Urinaires de la vessie de
I'homme, in the Mem. de la Soc. Med. de I'Emulation, Vol. II. p. 63. T.]
Compare above, §60, and different places. — On animal stones, compare
particularly Ficq d'Azyr Observations sur les concretions animales in Hist, et
Mem de la Soc. Roy. de Medec. A. 1779. H. p. 204. A. 1780 et 1781. H.
p. 279. — de Lens in Sedillot Rec. period, de la Soc. de Medec. de Paris, Vol. XLV.
p. 3. — Pelletier fils et Doxihle par Lens, ib. p. 129. — Fourcroy. — Rudolphi
Uebersicht der bisher bei den Wirbelthieren gefundenen Steine, in the Abhandl.
der Berl. Akademie. p. 171. Berlin, 1816. — Suckow Ueber die steinartigen Con-
cremente der Wirbelthiere, mit bes. Riicksicht auf die Haus-und landwirth-
schaftlichen Thiere, in the Badischen Annalen fiir die ges. Heilk. Jahrg. I.
Part II. p. 7. with engravings. [Gaitskell, On the intestinal calculi of horses,
in Med. Facts and Obs. Vol. IV. p. 31. T.]

(2) Ste'mmann D. de causis, cur frcquentius viri prae foeminis calculosi fiant.
Argentor. 1750.

(3) Compare de Plouqiiet Repert. Athritis et Calculus. Heim D. de origine
calculi in viis urinariis, quatenus est arthritidis efFectus. Halae, 1772. — Murray
D. de cognatione inter arthritidem et calculum. Gott. 1767, in Opusc. med.
Vol. L Gbtt. 1785. — Forbes, Treatise upon gravel and upon gout, &c. 8vo.
London, 1793. — Wollastov, On gouty and urinary concretions. 8vo. London,
1796. — Moore, On gouty concretions or chalk-stones. Med. chir. Trans. Vol. II.
p. 112. — Poth Bestimmung der Gicht und ihr Verhaltnis zum Rheumatismus
und zu der Steinki-ankheit. 8vo. Speier, 1825.

(4) /llberti D. de haemorrhoidum consensu cum calculo et podagra. Halae, 1720.

(5) To these especially belong the Pearls of bivalve muscles, which are formed
partly as a growth on the inner surface of the shell, especially after wounds, and
also in the flesh of the animal itself; indeed they can be artificially produced by
introducing small portions of the muscle shell. Oriental pearls are derived from
the AvicuLA Margaritifera, especially from the Persian Gulf; the German
from the Mya Margaritifera; they may also be obtained from many other
shells, viz. from the Haliotis tuberculata, Mytilus edulis, Anomia Ephippium,
Spondylus Gaedaropus, Area Noae, Anomia Caepa, Pecten Jacobaeus, Barbula
pUcata, etc. v. Poll Testacea utriusque Siciliae. Vol. I. Introductio. Cap. IV.
p. 18. — Floerke Repertorium, Vol. I. Part III. No. 20. — Gray, in Annals of
Philosophy, Jan. 1825, p. 27. — Ev. Home, ib. June, 1826, p. 452. — Stones may be
produced even in insects ; thus I found a gallstone in a crab, and a stone in the
stomach of the Dytiscus Marginatus, in Otto Verzeichniss der anat. Priipa-
ratensammlung zu Breslau. No. 4126 and 4220.

(6) In vegetable more commonly than in animal feeders ; very frequently in
the horse ; not very rare in the dog ; in the cat, as far as I know, it has not
been observed, &c.

(7) Such incrustations appear not merely in the intestinal canal and bladder,
but also in the organ of hearing, in the nose, in the salivary ducts, in the air-
tube, in the vagina, &c.

(8) I have twice found little crystalline bodies in tumours ; for instance, in
sarcoms. — Ilowship's Observations on the healthy and diseased formation of Bone,
p. 176; found similar in morbid masses of fat, sea salt in wounds. — v. Angeli Sale

Sect. XI.] Vices relating to Contents, 87

marine uscito della piaga di un piede, etc. 8vo. Imola, 1819. — v. Nuovi Com-
mentar. Medicina, Juli, 2820.

(9) For instance, in one case, more bone than the weight of the whole body,
[v. Richter's Spec. Therap. Vol. IV. p. 551. T.]

§73.
Lastly, we frequently find, both in men and animals, dead

EXTRANEOUS SUBSTANCES, WHICH HAVE BEEN INTRODUCED
ACCIDENTALLY OR PURPOSELY FROM WITHOUT, either through

the natural openings of the body, as the ears, nose, mouth,
fundament, and urethra, or by violence, viz. by gunshot, stabs,
&c., into other parts of the body. These extraneous substances
are of the most varied kinds, viz. bones, fish bones, muscle
and crab shells, hair, kernels, nutshells, seeds,^ bits of wood,
thorns, straw, ears of corn, money, nails, rings, the points of
daggers and swords, needles and bullets especially, pieces of
tobacco pipe, case knives, forks, pieces of cloth, glass, and
a thousand other things. It is remarkable that such bodies will
remain for a considerable length of time, indeed even during
the whole life, without producing any injury or inconvenience
to the person ; this is especially the case if a plastic bag has
been formed around, so as to isolate them from the rest of the
body.^ Often are they after a long time coughed up or
sneezed out, or if they be in the alimentary canal, are some-
times easily passed by vomiting or by stool. In other instances
they produce very serious and even fatal consequences, as the
perforation of important parts, inflammation and suppuration,
stoppage of the alimentary canal;"* if in the air-tube, to suffo-
cation or consumption; they give rise, as has been already
observed, to stones, of which they form the kernels; bullets,
small shot, pieces of cloth, &c., sticking in deep wounds,
prevent union, and irritate the nerves f bodies capable of
swelling, as beans and peas, grow and violently distend narrow
parts, as, for instance, the nostril and the auditory, passage,
&c. Frequently, extraneous bodies travel very far in the
body,* partly according to the laws of gravitation, partly
according to the various motions of the parts, then appear
at entirely different parts, often perforate, especially if they
be pointed, many parts, and so sometimes get into those canals
which open externally, or into the skin, and so become dis-
charged; frequently, also, are they discharged by abscess,^
and from bones by exfoliation: such wanderings we have
most frequently seen in needles" and ears of corn.^

More than once quicksilver, which had been taken or rubbed
in as an oxydule or an oxyd, has been observed to recompose
itself in the body, and after remaining for a long time, to be

88 Vices relating to Contents , [Part I.

discharged as pure quicksilver/ through the skin/ or with the
urine/" &c.

(1) They also penetrate the body through the skin; thus, the very pointed
seeds of the stipa pennata and capillata, which not only in Portugal,
Greece, and Barbary, very much annoy the cattle, but in Hungary are fatal
to the flocks of sheep, v. Raspail in the Annales des Sc. Naturelles, Sept. 1826.
p. 82.

(2) I have found such many times ; for instance, around a needle, around
shots. Compare Otto Verzeichniss der anatom. Praparatensammlung zu Breslau,
No. 2124 and 2125 ; the first is the sac described by Benedict, around six bits of
metal and lead which had been shot in ten years previously, v. Graefe's and
Walther's Journ. d. Chir. u. Augenh. Vol. V. Part I. p. 12. — [G. Arnott, a piece
of iron which remained encysted in the arm for fourteen years, Med. Chir. Trans.
Vol. XIII. p. 281. T.]

(2*) [A very remarkable instance of a man occasionally swallowing case-
knives, which sometimes were vomited up, sometimes passed by stool, related by
A. Marcet, in Med. Chir. Trans. Vol. XII. p. 52. Some of these, however, were
retained for ten years, and the patient died of the consequent irritation. But it is
very remarkable, that although the point of one of the knives retained had
passed through the side of the rectum, there was no extravasation of foeculent
matter into the cavity of the peritoneum. T].

(3) For instance, pain in the face from a piece of porcelain sticking in the
integuments during fourteen years. Jiffreys v. Froriep's Notizen, 1823, No. 83,
p. 271.

(4) Remarkable examples of such wanderings are to be seen in Haller,
Element. Physiol. Vol. I. p. 15. — Schwed. Abhandl. libers, v. Kaestner, Vol.
XXXIV. v. Siebold's Chiron. Vol. I. Part III. No. 9. p. 10.— Doering's Journ.
f. d. neuste. Holland, med. u. naturhist. Lit. Vol. I. Part IV. No. 2. [A needle
found in the heart of a sheep, in Mem. de I'Acad. de Dijon, Vol. I. p. 107. —
Ledran Observations sur des Epingles avallees et trouves a diverses partres du
corps sous la peau, in Mem. de I'Acad. Roy. de Chirurg. Vol. III. p. 91. T.]

(5) Many instances in de Plouqiict, Art, Apostema ; — two pieces of iron forks
which were swallowed came out of the belly by ulceration, v. Sonderland in
Harless N. Jarhb. d. deutsch. Medic, u. Chir. Vol. VII. Part III. p. 155,
with engravings, Vol. X. Part III. p. 127. — A seton needle, which had been
stuck into the uterus for the purpose of producing abortion, escaped from the
belly by ulceration after seventy-nine days. — Crouzit in Archiv. general, de
Medec. Sept. 1823.

(G) Compare de Plouquct, Art. Acus, besides Westring in Kgl. Svenska
Vet. Akadem. Handlingar, 1810. Part II. (vomited.) — Hall, ib. (passed by
stool.) — Wagner in Rust's Magazin. Vol. XVII. Part III. p. 556, (by vomiting,
from the upper eyelid into the neck.) — Bouzel in Hufeland's Journ. d. prakt.
Heilk. Nov. 1815, p. 112, (needles which had been swallowed came out at the
feet.) — Alibert Nosologic naturelle. Part I. Gen. 2. Heterorexia (1500
needles, which had been swallowed at various times, passed through the
skin in the urinary bladder and vagina.) — Biermaycr Museum anat. pathol. No.
205, (a needle which had been swallowed, in the psoas muscle.) — Lobstein Compte
rendu sur les travaux anatomiques, etc. 8vo. Strasburg, 1824, p. 42, (swal-
lowed needles in many parts of the belly. — Tourtual in Hufeland's Journ. der
prakt. llcilk. Feb. 1823, p. 110, (in the upper arm of a child.) — Villars in
M<^'moirs de la Soc. des Sc. de Strasbourg, 1823, Vol. II. p. 292, (300 needles
and 50 pins, which had been swallowed, were removed by incision ; — a second
case was fatal.) — B'uchner in Henke's Zeitschr. f, d. Staatsarzneikunde, 1823.
Part IV. No. 14, (344 needles.) Diction, des Sc. medical. Vol. VII. p. 65. —
Durct aus d. Journ. univers. des Sc. medical, in Horn's Archiv f. d. med.
Erfahrung, Jan. and Feb. 1825, \t. 173, (needles which had been stuck into the
skin passed by stool). — Herholdt Obsorvatio de aftectibus morbosis Havniensis,
ciii pluriina; acus e variis corporis partibus oxciscX' et cxtractai sunt. Havniae,
1822. Although the needles, as Herholdt has subsequently ascertained, were

Sect. XL] Vices relating to Contents, 89

purposely introduced, the case is still interesting on account of the length of
time they remained under the skin. I have myself seen, in the Friederich
Hospital at Copenhagen, in another girl, needles which had been swallowed, cut
out of the skin. — \_F. Bush, a knife lodged in the back above thirty years, after
which time it excited irritation, and was removed by excision, in Med. Chir.
Trans. Vol. II. p. 102. T.]

(7) Plovquet, Art. Apostema. Spica. — Reuss, Vol. XIV. p. 321. — Holier Elem.
Phys. Vol. I. p. 15. — Mirandolle van Ghert in v. Siebold's Chiron. Vol. I. Part
III. No. X. (escaped after ten years from the chest). — Bottomley in London
medic, chir. and Pharm. Repository, March, 1814, Vol. I. — Marikowski in
Huf eland's Journ. d. prakt. Heilk. 1821. — Bally in Revue m^dicale franc,
et etrang. Vol. II. April, 1825, (ears of grass which had been swallowed, were
thrown out by the lungs and kidneys.) In the Lazaretto of St. Anna, at Briinn,
I saw an ear of corn which had protruded in the lumbar region. In a person I
knew, I saw several portions of barley-corns which had been swallowed, thrown
out two years after from the neck. — [A pin, which had been swallowed by
a woman, extracted fifteen months after, covered with oxalate of lime, from the
urethra, v. /. F. Jones, in Mitchill and Miller's Med. Repos. Vol. V. p. 236.
Now- York. T.]

(8) Particularly common on and in the bones, in the cavity of the skull, in the
brain, in the cartilages of the larynx, about joints, &c. Compare Fallopius De
morbo gallico. Cap. 76 and 78 ; Fernelius De luis vener. curat. Cap. 7,
lin. 15; Four croy in Journ. d. Erfindungen. Part XL. p. 92; Jutenreith Fhy-
siologie. Vol. I. p. 265 ; Otto Selt Beobacht. Part II. p. 36 ; and many old
observations, v. de Plouquet Repert. Art. Mercurius.

(9) BarthoUnus Hist. anat. Cent. I. Hist. 7. — Memoirs of the medic. Soc.of
London, Vol. V. 1799. — Bruckmaim in //orn'.<f Archiv f. d. medic. Erfahr. 1810.
Vol. II. Part II. p. 252. — Ekl Bericht iiber die Ergebnisse im chir. Clinicum
zu Landstrut. 1826.

(10) Hochstetter Observ. med. Dec. III. cas. 4. — RhodiusCent. III. Obs. 37. —
\^Dr. Mead also states, that he found pure mercury in a vein. T.J

SECOND,

OR

PARTICULAR PART.

FIRST BOOK

OF THE PARTICULAR ORGANS, OR THE ORGANIC SYSTEMS.

TWELFTH SECTION.
O/" Cellular or Mucous Tissue,^

§74.

The quantity of cellular tissue in animal bodies is found
sometimes irregularly diminished, sometimes irregularly in-
creased, according to the variation of individual or morbid
formation ; the former inasmuch as certain individuals are
naturally devoid of cellular tissue, or in which it has either
generally or locally wasted, in consequence of disease or
pressure ; the latter also partly as an individual condition
of man or animals, partly as a morbid grow^th, since it is not
merely the foundation of all spurious formations, as encysted,
scrofulous, sarcomatous, and cancerous tumours, as well as the
so-called proud flesh, caro luxurians\ in wounds, but also
supplies, either for a considerable time or permanently, the
place of parts which are deficient either as original vices or as
the consequence of injuries and diseases.^ The cellular tissue
is often merely seemingly increased, when it is very much
loosened.

(1) Pohl Progr. de morbis contextus cellulosi in genere. Lipsiae, 1765. —
Thiirry An in celluloso textu frequentius morbi et morboruni inutationes, in
Halleri Coll. Disp. ad morb. bist. etc. Vol. VII. p. 855. — Lclpold D. de morbis
teJae cellulosae. Erlang. 1782.

(2) If tbe viscera be congenitally deficient, the cellular tissue often occupies
their ])lace ; viz. in the orbit, in the chest in acephala; in the pelvis, in imper-
fect or entirely deficient formation of the pelvic organs.

Sect. XII.] Of Cellular or Mucous Tissue. 91

§75.

Just as variable is the consistence of the cellular tissue.
Sometimes we observe as a permanent individual condition,
its unusual laxity or extensibility, or on the contrary its
too great tenacity and solidity; more frequently the
MORBID CHANGE of coHsistcnce in the cellular tissue is, espe-
cially if it be very loose and moist, abnormally lax and
EXTENSILE, 01 if it be compressed, and have been deprived by
various diseases of its semifluid state, and have been con-
solidated into fibres and leaves, it is found unnaturally solid
and TOUGH.

§ 76.

Among the peculiar diseases of the cellular tissue, its very
frequent inflammation, inflammatlo telce cellulosce, or com-
mon phlogosis^ with its consequences, deserves first to be
mentioned ; this especially attacks the cellular tissue beneath
the skin, is often very wide-spreading, and easily runs into
large abscesses and sinuses, or even into mortification.^
The cellular tissue is very frequently swollen and hardened
in consequence of the inflammatory effusion of albuminous and
gelatinous fluids into it ; to these belong many gouty, scrofulous,
and other hard swellings, the thick foot, the often recurring,
imperfectly cured erysipelas — the swelling in pellagra, in
elephantiasis, the mallenders in horses, &c. ; then the white
swelling of the thigh, phlegmasia alba dolens,^ a white,
chronic, expanded, hot, very painful swelling of the thigh in
lying-in women; indeed also in rare cases even in young
women* and men,^ and also attacking the arms;^ and espe-
cially that peculiar induration of the cellular tissue,
induratio telce cellulosce, scleremia, scleroma, &c.,^ which
particularly occurs in new-born children, and results from vices
of circulation and respiration;^ it is also observed in very rare
cases, in later years, even in adults, and only on particular parts
of the body.''

(1) Compare above, § 52. — Neumann D. de inflammatione telae mucosae. Berol.
\%2Q.—Pmili in Rust's Magaz. f. d. ges. Heilk. 1828. Vol. XXVII. p. 127.—
\_A, J. Testa De cellulosae telae affectibus, in Rcemer Dissert. Med. Ital. 8vo.
note. — Z). Craigie, Elem. of gen. and pathol. Anat. p. 33. 8vo. Edinb. 1828. T.]

(2) Many cases of far-spreading diffused inflammation of the cellular tissue
consequent on blood-letting, wounds in dissection, &c. are related by A. Duncan,
jun. in the Trans, of the Med. chir. Soc. of Edinburgh, Vol. I. 1824, No. 21 ;
and Scott, in the Edinb. Med. Surg. Journ. Vol. XXIV. p. 225. [Also
^.jrra«;er5, on Constitutional irritation. 8vo. London, 1826, p. 223. T.] — Inflam-
mation of the cellular tissue with sinuses from the foot to the trunk, v. Bailey, in
Lond. Med. Repos. March, 1826. — Inflammation and suppuration of the cellular

92 Of Cellular or Mucous Tissue, [Part I L

tissue sometimes occur simultaneously in many parts of the body, which has
been named Necrosis tel^ celi^ulos.e ; v. Creutzwieser in Rust's Magaz.
f. d. ges. Heilk. Vol. XXII. Part II. p. 33S.— Otto Selt. Beob. Part II. p. 41.

(3) Zinn in Comment. Soc. reg. scient. Getting. Vol. II. p. 364. — White on
the swelling of the lower extremities in pregnant women. 8vo. Lond. 1803. —
Sankey in Edinb. med. and surg. Journ. Vol. X. p. 401. — Casjoer Commentarius
de Phlegmatia alba dolente. 8vo. Halae, 1819. — Velpeau in Archiv. Gener. de
Medec. Vol. VI. p. 221. Pfeiffer D. de. phi. a. d. quaedam, adnexa hujus morbi
historia. 8vo. Marburg. 1825. — Struve Comm.de Phi. a. d. quindecim observa-
tiones practicas continens.- 8vo. Tubing. 1825. — Renter D. de Phi. a. d. 8vo.
Berol. 1826. — Sellheim D. de Phlegmasia dolente. 8vo. Dorpat. 1826. — de
Hubschmann D. de Phlegmasia serosa. 8vo. Mitav. 1825. — James Mann in
Medical Communications of the Massachusetts medical Society, Vol. II. p. 1.
Boston, 1813. — Freyberg D. s. Annotationes quasdam in phlcgmatiam albam
sic dictam dolentem. 8vo. Halae, 1820. — Grimm D. quaedam de phlegmasiae
albae dolentis pathologia. 8vo. Berol. 1826. — Goldmann, v. Ammon and Feist in
der gemeinsamen deutschen Zeitschrift fiir Geburtskunde, Vol. II. Part II. —
Bohr V. Siebold's Journal fur Geburtshiilfe, Vol. VII. Part. II. p. ^20.— Hugh
Fraser and Lizars in Edinb. med. and surg. Journ. January, 1827. — 0. Fr.
Schumann D. s. Phlegmatiae albas puerperarum dolentis observationem, adjectis
nonnullis animadversionibus in ejusdem naturam. 4to. Jenae, 1828. — Friclte
Annalen der chirurg. Abtheilung des allgem. Krankenhauses zu Hamburg,
1826, Vol. I. p. 88. This disease is sometimes the consequence of stoppage or
adhesion of the veins. — \_Robert Lee, M.D. Two very excellent papers on Phlegm.
Dolens, showing it to originate in inflammation of the iliac and femoral veins, in
Med. Chir. Trans. Vol. XV. p. 132 and 369.— W. Lawrence, Case of Phlegm.
Dolens from inflammation of veins in the lower extremity, ib. Vol. XVI. p. 58.
T.]

(4) Hazeltine in med. papers communicated to the Mussachusetts Med. Soc.
Vol. III. p. 1. Boston, 1819.

(5) Davies in Lond. Medical Repository and Review, July 1825. — Francis in
New- York Medical and Physical Journ. No. 1. — Strtive. — [Case of Phlegm. Dol.
in a phthisical boy, is given by T. H. Holberton, in Med. Chir. Trans. Vol. XVI.
p. 63. T.]

(6) Francis.

(7) Reiiss Repertor. Comment, and de Plouquet Repertor. Art. Tela cellulosa.
— Carus Ueber die Zellgewebsverhartung neugeborner Kinder in Hufeland's
Journ. Vol. XLII. Part II. p. 110. — Schdnberg D. de induratione telae cellu-
losse in neonatis. Gott. 1808. — Wies7ier D. de tela cellulari infantum indurata.
8vo. Berol. 1816.— G. Jaeger in Harless Rhein. Jahrb. fiir Medic, u. Chir. Vol. III.
Part II. p. 42, and Harless in same, p. 85. — Alibert Nosologic naturelle. Vol. I.
p. 494. — Liberali in Nuovi Commentarj di Medicina e di Chirugia, 1818, p. 337.
— Breschet in Bulletin de la Soc. d'Emulat. de Paris. Avril, 1822. — Carmiriati
and Palletta in OmodeVs Annali universali di Medicina. Vol. XXVIII. — Leger.
Considerations sur I'endurcissement du tissu cellulaire chcz les nouveau-nes.
4to. Paris, 1823. — Sudoffsky D. de telae cellulosac induratione. 8vo. Dorpati L.
1824. — BarmannD. de tel. cell. ind. Berol. 1823, in a boy of six years. — Michaelis
De ind. telae cellul. recens nator. Commentatio. 8vo. Kiliac, 1825. — Denis
Recherches d' Anatomic et de Pliysiologie pathologiques sur plusieurs Maladies
des Enfans nouveau-nes, p. 145. 8vo. Paris, 1826. — Palletta in Omodie's Annali,
etc. Vol. XXXV. Luglio — Settem. 1825. — liillard in Archiv. g^'ueralesde M^dec.
Vol. XIII. p. 204. Feb. 1827- — Banmgarten D. de induratione textus cellulosi
neonatorum. 8vo. Hala', 1821. — P. Fleischhammer D. de scleremate. 8vo.
Berol. lS28.—[Andral Precis d'Anat pathol. Vol. I. p. 201. T.]

(8) According to Denis, it arises in connexion with inflammation of the
stomach and intestines. — [D. Craigie, p. 45. — Andral, Vol. II. Part II. p. 577.

T.] ...

(9) Es])ccially in the cheeks, in the pubic region, and on the extremities;

in chihircn, ])articularly such as are fat, there is observed at the time of teething,
and continuing for many months, a hard swelling in the checks. A similar

Sect. XII.] Of Cellular or Mucous Tissue, 93

hardening of the cellular tissue, connected with too great production of fat, has
already been observed as a rare disease in one foetus, v. Otto, Selt. Beob.
Part II. p. 166. tab. 4. f. 3.

§ 77.

We frequently observe irregularities in respect to the con-
tents of the cellular tissue, inasmuch as, not only are the
fluids usually found, viz. the fat and the serum, irregular, but
entirely extraneous substances are also contained in it.
As to the FAT, it is not merely found in very small quantity in
great nieagreness, and in too great quantity in morbid fatness,
adiposis, in every part, or only in certain parts in the cellular
tissue,^ but it also often deviates in colour, composition, and
consistence : thus it may be too pale, or too dark, reddish,
merely discoloured, and not unfrequently in cachetic persons,
too soft, jelly-like and smeary ; but in other cases, on the con-
trary, it is found too hard, horny, and even like wax. Similar
vices are also observed in the serum of the cellular tissue,
which may be entirely deficient, in great general, or local
meagreness and dryness of the body ; but it is more frequently
in too great quantity in the cellular tissue, anasarca, leuco-
phlegmasia,^ or in particular places, oedema,^ for instance,
especially in the eyelids, the scrotum, the pudenda of women,
the hands and feet. Often is the serum discoloured ; thus, it
is yellowish in jaundice, in yellow fever,* in typhus, in diseases
of cattle, viz. in mortification of the spleen, &c. ; turbid and
milky in the so-called milk change, and if it be mingled
with pus ; reddish with blood, &c. The serum frequently
varies in reference to its consistence ; thus, on account of the
decay of animal substance, it is too watery, as in dropsy ; or by
the unnatural mixture of albumen and fibrous matter, it even
becomes as thick as jelly. To the very extraneous productions
in the cellular tissue belong those of air and of animal
gases, by which airy and windy tumours, pneumatosis,
emphysema,^ are produced, which most commonly originate in
the escape of air from the respiratory organs into the cellular
tissue on the neck and breast, consequent on penetrating
wounds of the lungs, broken ribs, contusions, violent strains,
as in delivery, violent coughing, &c., and these often extend
very far, indeed almost over the whole of the body.^* We,
however, also observe these airy swellings in the cellular tissue
in other parts of the body, viz. after convulsions and fevers,
under the skin of the head, of the joints, and among the
muscles — in the arm-pit after the reduction of dislocated arms ;
without suspicion of any putrefaction between the membranes
of the alimentary canal, the gall-bladder, &c.^ Effusions of

94 Of Cellular or Mucous Tissue, [Part II.

BLOOD INTO THE CELLULAR TISSUE, sugUlatiOf effusioy ecchy-
mosiSf'' are very frequently found. If internal abscesses burst,
the PUS escapes into the neighbouring cellular tissue, and by
apertures in the urinary passages, the urine also, which
often extends very far in the cellular tissue of the back, in the
pelvis, and beneath the muscles of the belly, even up to the
breast. We also find various kinds of gases and fluids in the
cellular tissue in consequence of the great penetrability of ani-
mal membranes. Further, parasitic animals, viz. acari or
mites, larvae of the oestrus, Jilarice, and cysticerci,^ are found in
every part of the cellular membrane of man and animals ; next,
not unfrequently bony and stony concretions ; and lastly,
many dead extraneous substances, which are conveyed
from without into the organism, remain in the cellular tissue
often for a long time without any apparent injury, and often,
even travel about to a very great extent.

(1) Compare above, § 18, in which, however, it is also to be observed that
organic diseases of the brain and heart rarely induce consequent wasting;
further, § 20 and § 2L Grune D. de sana et morbosa pinguedinis in corpora
secretione. 8vo. Berol. 1826. Alibert^\n his Nosologic Naturelle, Vol. I. p. 490,
pi. A, gives an engraving of a very fat boy of twelve years old. An instance of
the cure of a case of very large adiposis is given by v. Graefe in Journ. fiir Chir.
und Augenheilk, Vol. IX. Part III. p. 367, with f.n engraving. [Dr. Cheyne also,
who, when thirty-five years of age, weighed 448 pounds, by proper management,
reduced his weight to 280 pounds, and lived to the age of seventy- three.
A. P. Cooper's Lectures, MSS. T.] Compare also the articles ObesiU, Corpu-
lence and Graisse in the Diet, des Sciences Medic. — G. M'Crake D. de pingue et
pinguitudine. Edinb. 1805. [There is in the Mus. St. Thomas's Hosp. a piece
of fat from the abdomen of a woman, which is about four inches thick. T.]

(2) Breschet Recherches sur les hydropisies actives en general, et sur I'hydro-
pisie active du tissu cellulaire en particulier. Diss, inaug. 4 to. Paris, 1812.
Compare above, § 51 and § 55. In brutes Anasarca is less frequent than
in man, although often to be observed in monkeys, sheep, calves, dogs, and in
poultry ; the opposite state of the fat and serum is also very interesting, as when
the one is unnaturally increased, the other appears to be decreased.

(3) In nervous and gastric diseases, particularly in hypochondriac and
hysterical persons, there sometimes occur suddenly tumours of very different
size, which, after a few hours or days, or at death, immediately subside, and are
produced by effusion of Serum. (Edema not unfrequently occurs as the con-
sequence of the obstructed reflux of blood, owing to compression or adhesion of
the veins,

(4) De I'etat anatomique de la peau et du tissu cellulaire dans la fi^vre
jaune, &c. by Desmoulins, in Magendie's Journ. de Physiol, experim. Vol. III.
No. 3, p. 255.

(5) J. P. Frank de curand. hom. morb. Epitom. lib. VI. de Retentionibus. —
Waitz D. de emphysematc. 4to. Lips. 1803. — Ilehenstreit D. de emphysemate.
Lips. 1803. — Halliday de Pneumatosi D. Edinb. 1806, and Observations on
Emphysema in Edinb. med. and surg. Journ. Vol. IV. p. 351. — Verdeyen Essai
sur TEmphyseme, etc. Paris, 1809. — Cheyne D. de Emphysemate. Edinb. 1820.
v. also Vidal Essai sur le gaz animal considere dans les maladies, etc. Marseille,
1H09. V. Sedillvt Journ. Vol. XXXV. p. 422. — Also in animals, esjjecially in
birds, eni])liysema occurs, [of which No. 599, Mus. Roy. Coll. Surg, ia an ex-
ample. T.J

Sect. XIII.] Of Cellular Membranes, 95

(5*) [I once saw a case of emphysema of the face, in consequence of fracture
of the outer table of the frontal sinuses and the escape of air from the nose. T.]

(6) Compare above, § 51.

(7) V. § 37.

(8) Compare above, § 70.

THIRTEENTH SECTION.

Of Cellular Membranes,

§78.

The animal membranes which either entirely or for the
most part are composed of cellular tissue, are, in reference
to their vices and diseases, so closely connected with the
cellular tissue, that what has been already said in the pre-
ceding section generally applies to them. We, therefore,
here merely premise that these membranes can as little be

ENTIRELY WANTING AS THE CELLULAR TISSUE IN GENERAL,

since the circumscription of the external extent of the or-
ganism, as well as the internal organic separations, necessarily
depend upon them, and that they can by no means always
EXHIBIT those REMARKABLE VARIETIES which they show in
a higher development of the organism. They still, indeed,
sometimes retain for a longer period, that is, as a retarded
formation, that indeterminate character which they possess in
the early stage of foetal existence ; or they appear often, even
in adults, in spurious formations, especially in encysted tumours,
not less indistinct, so that it is difficult to distinguish whether
it be a serous, a mucous, or a skinny membrane. The cel-
lular membranes also, when subsequently diseased, become so
changed, that they are mutually converted into each other;
so that for instance the external skin, in violent and con-
tinued extension, by which the vessels, nerves and glands
in it disappear, assumes the appearance of a serous mem-
brane; in other cases, by loosening, expansion and exclusion
from the air, it resembles a mucous membrane,^ and on the
contrary a mucous membrane unnaturally subjected to the in-
fluence of air, assumes not unfrequently the nature of skin,^ as
is the case in protrusion of the rectum and of the vagina.

As the cellular membranes stand in close formal connexion
with the systems and organs to which they as essential parts
belong, so it will be in part better to treat of them together;

96 Of Serous Membranes, [Part II.

and we shall, therefore, at present, only consider the more
common of them, namely, the serous and mucous membranes,
and the external skin.

(1) Hebriard Memoire sur I'analogie qui existe entre les syst^mes muqueux
et dermoide in Mem. de la Soc. medic. d'Emulat. Vol. VIII. Part I. \^Andral
Precis d'Anat. Path. Vol. I. p. 263. T.]

(2) In monsters with extensive congenital clefts, of which the cavities are
lined with mucous and serous membranes, I have several times seen these
membranes too thick and firm, and very nearly approximating to leather in
appearance.

First Chapter.
Of Serous Membranes,^

§79.

Entire deficiency of the serous membranes can only
occur in such imperfect monsters as have neither the larger
cavities of the body nor even the cavities of the joints formed,
with both of which these membranes necessarily and simulta-
neously exist. More commonly they are absent only at certain
parts, viz. the pleura, the pericardium, a portion of the me-
sentery, some of the mucous bags, &c. ; they also sometimes
at a later period degenerate by resolution into cellular tissue,
viz. in unreduced dislocations, in anchylosis after smashing of
the mucous bags, &c. Sometimes, also, we observe in them
EXCESS OF FORMATION, iuasmuch as irregular processes and
sacs of serous membrane are occasionally found congenital,
whilst at every period of life serous membranes can be pro-
duced, and always are produced, when there is formed in the
body a permanent and perfectly closed cavity, as for instance,
in new joints and encysted tumours.

(1) To which also, on account of the similarity of their texture, the synovial
membranes and mucous bags belong. On the diseases of the latter compare Koch
D. de niorbis bursarum tendinum mucosarnm, 4to. Lips. 1790; and Unter-
suchung des natiirl. Baues und der Krankheiten der Schleimbeutel, 8vo.
Niirnb. 1795. — Jlerwig D. de morbis bursarum mucosarum. 4to. Gbtt. 1795.

§80.

The SIZE and form of serous membranes, as they
merely Hne the interior of cavities, depend entirely on them,
and are therefore subject to many deviations; wherefore we

Sect. XIII.] Of Serous Memhranes, 97

must only remember that they possess a considerable ex-
tensibility, and often become expanded, together with the
other parts of the walls of the cavities, into large sacs. Also,
in reference to connexion, they sometimes present irregu-
larities, as, in the non-existent separation of the several cavities
of the body, the usually distinct serous membranes run into
each other.^ Breach of continuity does not often occur
in them, on account of their great pliancy; to this, however,
belong dislocations with rupture of the articular capsule, and
the rupture of the serous membranes alone, especially of a
hernial sac, is sometimes observed consequent on external in-
jury or very violent extension. Irregularities as to colour
are not very rare, as, for instance, in dropsy they become dim,
cloudy, and too white ; in other instances, on account of the
excessive filling of the vascular tissue lying beneath, they are
as it were injected, spotted, even more or less red; in high
degrees of jaundice they appear yellow; in mortification and
melanosis, blackish, &c. ; in rare instances also we have ob-
served petechial spots upon them.

(1) To wit, the pericardium may run into the pleura; these into the perito-
neum ; this larger bag, in consequence of the imperfect closing of the abdominal
ring, into the external process of the peritoneum (tunica vaginalis testis) ; mucous
bags as congenital vices, or as consequent on friction, into the neighbouring
articular cavities, &c.

§81.

Among the vices of texture of serous membranes must be
mentioned, before all other, their inflammation,^ which is
very frequently idiopathic, in consequence of mechanical and
other causes, particularly when they are brought in contact
with atmospheric air ; not unfrequently is it also sympathetic
and metastatic in eruptive diseases, in gout, puerperal fever ;
sometimes has an acute, sometimes a chronic course, and
creeping along as it were by degrees, can extend itself very
widely. This inflammation rarely runs into true suppura-
moN^ and MORTIFICATION,^ but is especially disposed to the
exudation of serum and fibrous substance, from the latter
of which are very frequently produced on the open surface of
serous membranes, plastic concrements, which assume the
form of fibres, bands, cells, and false membranes, and very
commonly effect close or loose adhesions of the outer
and inner surfaces of serous membranes. We often find the
serous membranes thickened in consequence of the inflam-
matory state, and indeed either loosened and cedematous,
or more frequently hardened, and not rarely cartilaginous
and bony in certain spots. A more common morbid state of

H

.^

98 Of Serous Membranes. [Part if

the serous membranes in man and animals is the deposition
of SCROFULOUS MATTER in them, and the formation of the
so-called tubercles;* more rare are exanthematous pus-
tules and KNOTS, tumours attached by thin necks,

ENCYSTED FORMATIONS, FUNGOUS and SARCOMATOUS EXCRE-
SCENCES.^ Hydatids, on the contrary, are often found on
the serous membranes of man and animals, either singly or
in large cysts.

(1) Latralle D. sur I'inflammation du sysfeme sereux. Paris, 1802. — Sauceur
D. sur les inflammations des systemes sereux et du systdme synovial. Paris, 1812. —
As serous membranes possess no blood-vessels, the seat of inflammation is, in the
strictest sense, rather in the adjacent layer of cellular tissue, and on the surface of
the organs covered with serous membrane, than in the serous membrane itself.
These, however, participate in the disease. — Moffait D. sur les Phlegmasies des
membranes synoviales des articulations. Paris, 1810. — Flormann resp. Lorich D.
de signis inflammationis membranai-um serosarum. 4to. Lund. 1812. — Chomel
D. sur le Rheum atisme. Paris, 1813. — Villcrajid de la Fosse D. sur Rheumatisme.
Paris, 1815. — Roche Phlegmasies du svsteme flbro-sereux des articulations. 4to.
Paris, 1819.— [Andral, Vol. L p. 281. ' T.]

(2) The disposition to malignant ulceration in mucous bags which are opened
and exposed to atmospheric air is very remarkable, it can even give rise to
fungous growths.

(3) This never occurs singly and primarily in the serous membranes, but
only secondarily, and simultaneously in the neighbouring organs.

(4) An Inquiry, illustrating the nature of tuberculated accretions of serous
membranes and the origin of tubercles and tumours in different textures of the
body, by John Baron. 8vo. London, 1819, with plates.

(.5) Zink Reflexions et observations sur les fongus des membranes sereuses,
in Journ. coiji})!. du Diet, des So. M6d. Vol. XXL p. 24.

§ 82.

The CONTENTS of the cavities formed by serous membranes
also vary considerably from the rule; we observe, indeed,
sometimes air, as consequent on an exhalation which has
occurred during life — next, pus and blood, ^ collected in them,
and very frequently water, of which the quantity, colour,
consistence, and composition varies remarkably,^ and produces
large swellings of the head, chest, belly, scrotum, the cap-
sules of joints, and the so-called ganglia.^ The latter are
partly tumours of the mucous sheaths and bags {bmsarum
mucosarum vaginaliuni, vesicalinm and subcutanearum) partly
new formations, that is, serous cysts ; they sometimes acquire
a large size, and when of long standing, are often very hard, as
the secretion contained in them becomes thick, albuminous,
and jelly-like, even cartilaginous, and not rarely coagulated into
little LOOSE cartilages which are of various forms, and often
in great quantity.* Similar loose cartilages, although in
other respects mostly fibro-cartilage, and even bony in their
centre or bony throughout, are not unfrequently found in other

Sect. XIII.] Of Mucous Membranes, 99

serous and synovial cavities ; they seem always to be formed in
the above-mentioned tumours with necks of these membranes,
and are therefore often found hanging by long fine threads,
which at a later period are broken.^

(1) Compare above, § 51.

(2) John Chemische Tabellen des Thierreichs, p. 42 — 44. fol. Berlin, 1814.
— Schreger fluidorum corp. animal, chemise nosologicae specimen, p. 16 — 24.
Erlang, 1 800. — Marcet, A Chemical account of various Dropsical Fluids, in Med.
chir. Trans. Vol.11, p. 342. — Berzelius, ib. Vol. III. p. 251. — Bostock, ib.
Vol. IV. p. 52. — Annals of Medicine, Vol. VI. p. 126, &c. The water is some-
times clear, at other times turbid, milky, yellow, merging to greenish, brownish,
reddish, from the mixture of blood, often quite thin, or rather thickish, like
white of egg ; sometimes it is so acrid, that pustules on the hands are produced
by it, &c.

(3) Juncker D. de gangliis generatim consideratis. Halae, 1740. — Eller in
den Schr. der Berl. Akademie d. Wissench. p. 108. 1746. — de Biichner D. de
gangliis. Halae, 1748. — Vinckler D. de ganglio. Budae, 1783. — de ReimerD. de
ganglio. Duisburg, 1796. — Assalin Considerations sur les tumeurs des bourses
ou capsules muqueuses du genou. Strasburg, 1803. — J. Clocquet in Archives
generales de Medecine, Vol. IV. Paris, Feb. 1824. A case of a very large
ganglion under the knee, where, as well as on the hand and on the tendo achillis,
it is most common, is given by Sitchet in Journ. compl. du Diet, des Sc. Medicales,
Vol. XI. Cap. 43. Ganglions most generally originate in blows, pressure,
violent extension, &c. although also from internal causes, particularly gout,
rheumatism, scrofula, and painters' colic. Ganglions are also very common in
the tendinous sheaths of the flexor muscles of horses, and are called windgalls.
In asses and mules they also occur, though rarely ; but in other animals they
have not been observed within my knowledge.

(4) Albinus in Annot. academ. lib. VII. c. 15. — Monro, Description of all
the bursoe mucosae of the human body. fol. Edinb. 1788, translated into Ger-
man, with notes, by Rosenmuller. p. hQ. fol. Leipz. 1799, pi. 15. — Wedekind in
the Annalen der Wetterauischen Gesellschaft f. d. ges. Naturkunde. Vol. I.
Part I. No. 4. — Abernethy, Surgical observations. — Beauchene in Journ. de
Medec. Chir. et Pharm. Oct. 1813. Vol. XXVIII. p. 137.— Clocquet.— Cruveil-
hier, Kystes contenant de petits corps blancs, in Essai sur I'anat. patholog.
Vol. I. p. 306, relates ten cases from Dupuytren, Pelletan, Patissier, &c. — I saw
at Mr. fVardrop's, in London, fifty such cartilages from a ganglion on the back
of the hand, and above one hundred roundish pieces and little linseed-like
cartilages in the Museum of Ch. Bell. — C. M. Fuhrmann D. s. variorum auctorum
observata de tumoribus cysticis humorem synoviae similem et corpuscula cartila-
ginea continentibus. Jenae, 1822.

(5) V. more particularly below, in several places. — Compare Laennec, Art.
Cartilages accidentelles in Diet, des Scienc. medicales. Vol. IV. p. 123 ;
Meckel Handb. der pathol. Anatomie. Vol. II. Part II. p. 198 — 214 ; Cassan
Notes sur les concretions dites albumineuses, in Archives generales de Mede-
cine, May, 1826.

Second Chapter.
Of Mucous Membranes,

As the MUCOUS membranes form the internal boundaries of
animal bodies, they can only be wanting, when the organs

H 2

100 Of Mucous Membranes, [Part II.

which they line do not exist; their partial deficiency can
only be acquired and not long continued. The excess of
FORMATION of the mucous membrane occurs but rarely ; we
must here include the congenital irregular length of some of
the mucous folds, also the congenital closing of the mucous
canals at their usually open extremities, or at other parts by
cross bands ; unnatural mucous membranes are also formed
in all irregular cavities and canals, which, like the normal
mucous membranes, are connected with the surface of the
body, or tend to represent them at certain spots, as in abscesses
and fistulas ; finally, the mucous membranes are commonly
REPRODUCED, if they have been destroyed, either of the usual
kind, or somewhat changed, as by a cicatrix.^

(1) The reproduction of mucous membrane does not appear to me to be
doubtful, as it is not an unfrequent occurrence, for instance, in the mouth, the
nose, and the vagina ; in the alimentary canal it appears also to be reproduced,
although generally somewhat changed ; at least I have seen newly produced
skin on certain spots of an intestine which has been affected by ulceration in
dysentery, although without true villi, yet villous-like, and it may be said
further, with little mucous glands, [In examining the body of the late M.
Beclard, who had some years previously been affected with gastric disease, sup-
posed to be chronic inflammation, there was found in the lesser curvature of
the stomach, a cicatrized ulcer, about the size of a sixpence, with a flat surface,
and traversed by a solid cellular band, on each side of which were two lacunaa
formed by peritoneum ; the margins were neither red nor swollen, and the rest
of the stomach was sound. — v. C. Billard De la membrane muqueuse gastro
intestinale. T.j

§84.

Mucous membranes assume, together with the canals which
they line, the most varied form and size, as they contract
themselves, even to the closing of their canal, and on the
contrary are capable of great extension ; sometimes they
alone are expanded, and project like bladders through clefts in
the surrounding parts. ^ Their thickness as an individual
formation varies exceedingly, and is often very much dimi-
nished, either locally or generally, by excessive extension and
atrophy, as well as increased to a great extent by hypertrophy,
and still more by disease. The colour is frequently irregular,
sometimes it is too pale in the atrophic state of the membrane ;
white from the effect of sulphuric acid ; frequently red in the
most various shades and extent, as a consequence of irritation,
congestion, effusion of blood on tlie surface, and inflammation;^
and in consequence of the latter disease, sometimes also brown,
slate-coloured, and in the mortified state and melanotic de-
posits, even blackish ; the mucous membrane may also some-
times be irregularly coloured by food, drink, and medicines
containing pigment.^ Rupture of the mucous membrane,

Sect. XIII.] Of Mucous Membranes. 101

merely from violent extension, is very rare, more commonly it
is wounded by sharp bodies thrust into it, especially in the
alimentary and urinary canals.

(1) For instance, in the air- tube, the alimentary canal, the urinary bladder, &c.

(2) The redness is sometimes produced merely by certain large vessels filled
with blood, as if they were injected; in other cases it appears in little spots, in
others streaky, speckled, or as it were washed, &c.

(3) V. further below, in the alimentary oanal.

§ 85.

We observe, not unfrequently with reference to their diseases,
a great sympathy in the mucous membranes of different parts
with each other, and particularly also with the external skin ;
thus they are often found affected altogether more or less by
exanthematous diseases, by continued fevers, &c., and vices of
TEXTURE are very common in them. The latter, as is gene-
rally the case, so also here, frequently, arise from inflamma-
tion of the mucous membrane, which has a peculiar cha-
racter, is called inflammatio catarrhaliSy and shows itself
in lower degrees of the disease by moderate redness, swell-
ing, and increased secretion of the mucous fluid ; in higher
degrees by more excessive redness and swelling, connected
with dryness, or with great disposition to the effusion of fibrous
matter. This produces the plastic spots of various kinds,*
or gives rise to adhesions of the mucous membranes to each
other, and so to the closing up of their canals. Inflammation
of the mucous membrane has often consequent to it, soften-
ing, SPONGY LOOSENING, CEDEMA, FLABBINESS, and FOLDS ; in

other cases swelling, with infiltration of coagulable lymph,
consequent thickening and hardening, even of a cartila-
ginous character,^ in all which states a speedy coalescence,
and even imperviousness of the canals lined by the mucous
membrane, is readily produced. The higher, more phlegmonous
degree of inflammation, not unfrequently runs into suppura-
tion and mortification, in the latter of which, large pieces
of the mucous membrane are sometimes separated from the
adjoining parts, and thrown off. Ossification of the mucous
membrane alone does not appear to occur.^

(1) Compare § 55. — Thrush, Jpthce, are a peculiar kind of such false mem-
branes which occur in the mouth, gullet, and stomach, and are situated on or
beneath the epitlielium of the mucous membrane, and have very various form
and colour. — Lelut Memories sur le muquet, in Repertoire general d'anat. et de
physiol. pathol. Vol. III. Part I. p. 145. — \_G. Macilwain, Surgical observations
on the more important diseases of the mucous canals of the body. 8vo. Lond.
1830. T.]

(2) Here also belong the changes which affect the mucous membrane of pro-
truded parts, v. above, § 78.— [v. Andral Precis d' Anat. Path. Vol. I. p. 266. T.]

102 Of Mucous Membranes, [Part II.

(3) The few instances of ossification mentioned by writers appear to me either
to have their seat in the cellular tissue investing the mucous membrane, or to
be an earthy deposit on their expanded surface, and in the mucous glands. It
has not been my luck to find true ossification of this membrane, nor to see it in
any collection, and this great analogy with the external skin induces one to
believe in the want of this vice of texture.

§ 86.

Among the compound vices of texture of the mucous mem-
brane must be first named, especially, the exanthematous
DISEASES not unfrequently observed in many parts, as the
BRAN-LIKE SCALING of their epithelium, the various kinds of
SPOTS, KNOTS, PUSTULES, VESICLES, and cveu the true pocks,
&c. ; further, the varices and degenerations of the blood-
vessels found in them, then the great development, exten-
sion, SUPPURATION, which occur in the mucous glands
contained in them, especially in chronic catarrh and mucous
fevers; finally also, a number of spurious formations. To
these belong the hairs, which in rare cases are produced upon
them, hydatids, the more rare peculiar encysted tumours,
tubercles, fungous growths, and the polyps, which
are very common on many places, as well as the sarcomatous
tumours allied to them, and finally, scirrhus and cancer,
which particularly afiect those parts of the mucous membrane
in which there are many mucous glands.

§87.

The CONTENTS of the mucous membrane lining cavities also
present irregularities. To these especially belong the peculiar
SECRETIONS OF GAS, Varying in quality and quantity, and of
WATER, which can sometimes be retained for a long while in
certain regions in the morbid interlacing of the muscular parts
surrounding mucous membrane ; further, of mucus, which is fre-
quently collected in incredible quantijty, sometimes thickish and
viscous, like frog spawn or white of egg, even forming tubes,
but in other instances, has a purulent appearance, and indeed
in the alimentary canal is not unfrequently mixed with the
various morbid excretions, and coloured by them; then of
blood, which not unfrequently may be equally poured out
upon the mucous membrane without rupture of the larger
vessels, in inflammatory, hemorrhoidal, and other conditions
of the membrane; finally, of earthy' and saline substances
of various kinds, which are found upon them either in a fluid
form, or coagulated and formed into incrustations and stones,
which are produced in the canals of the mucous membrane
especially. Intestinal worms are also very commonly

Sect. XIII.] Of External Skin, 103

produced, both in man and animals, in the cavities formed of
mucous membrane, and where they open externally, we find
also various other animals and dead extraneous sub-
stances.

(1) I knpw one person, in whom, during an atonic attack of gout, the whole
mouth, thrdat, and gullet were largely covered with a whitish mucus, which,
when dried on blotting paper, left behind a large quantity of phosphate of
lime.

Third Chapter.
Of External Sldn.^

§88.

As no organic body can exist without a covering, so defi-
ciency OF THE external SKIN CAN NEVER EXIST AS A VICE

OF FORMATION : but it is so much the more common as an
acquired vice, since large patches of skin are often destroyed
by suppuration, mortification, burns, &c. The formation of
the skin is, however, frequently seen imperfect, so far, as that
in man and animals it is often found at the time of birth as
thin and transparent, on certain spots, as in the youngest
embryon, and then, in consequence of its simultaneous con-
nexion with the subjacent membranes, it appears at first sight
to be really deficient. This is most common in hemicephaly,
spina biftda, and the clefts on the front of the body, in which
internal pressure prevents the evolution of the skin.^

On the contrary, we sometimes also observe an excessive
FORMATION OF SKIN, in which are seen, on certain parts, as
congenital vices both in man and animals, unnatural processes
OF SKIN ; and as acquired vices, encysted tumours, especi-
ally those which are internally beset with hair, are frequently
formed of a membrane very analogous to the cutis. ^ The
skin is also very easily reproduced,^ after having been destroyed
by disease or operation ; but at such spots it generally becomes
changed, viz. is thin, expanded, at first red, but subsequently
white from poverty of vessels, has neither hair nor sebaceous
glands, and is then called a scar, cicatrix,^

(1) PlenTc Doctrina de morbis cutaneis. Vindob. 1770. — Lorry De morbis
cutaneis. Paris, 1777. — Jackson, Observations on the diseases of the skin. —
Schmidt Cutis morbi ex materiae animalis mixtura et forma mutatis cognoscendi
D. Halae, 1799. — Willan's Description and treatment of cutaneous diseases.
4to. Lond. 1798. — Alibert Description des maladies de la peau observees a

lot Of External Skin, [Part 1 1 .

I'hopital Saint-Louis, etc. fol. Paris, 1806 — 182G, with plartes.— Safewan, Practi-
cal synopsis of Cutaneous Diseases, according to the arrangement of Dr. Willan,
illustrated by a coloured plate. 3d edit. London, 1813; and Delineations of
the Cutaneous Diseases, &c. 4to. London, 1814 — 18 IG. — Nushard Skizze einer
Dermato-Pathologie. 8vo. Prag. 1816. — Bergmann die Krankheiten der Haut,
der Haare und Nagel am menschl. Kdrper. 8vo. Leipz. 1824. — Klaatsch Tabel-
larische Uebersicht der Hautkrankheiten nach Willan's System, fol. Berlin,
1824. — Plumbe A practical treatise on Diseases of Skin, &c. 8vo. London,
1824. — Rayer Traite th^orique et pratique des maladies de la peau, etc. Paris,
1826, with an atlas. — v. de Ploiiquet Repertor. Cutis morbi. iCraigie's Elements,
p. 604. T.]

(2) I have already observed, in the above cases, that the common integu-
ments covering the other membranous sacs are not deficient, but only thinned ;
and this will be found to be conlirmed subsequently by a host of cases ; I have
always endeavoured to distinguish the thinned skin from the subjacent fibrous or
serous membranes, and often also to separate them. — Compare my Monstror.
sex humanor. anat. et physiol. disquis. p. 12. — Selt. Beob. Parti, p. 26. —
Handb. der pathol. Anatomic. 1st edit. p. 152.

(3) For instance, my Selt. Beob. Part IL p. 159.

(4) I once saw the skin of the whole belly from the navel, of the penis and
testicles, and a part of that of the thigh, soon reproduced, after having been
destroyed by gangrene, consequent on a syphilitic bubo.

(5) Compare § 56. — From the appearance of the scar, we can sometimes
distinguish the character of the preceding vilceration of the skin, whether it had
been a scrofulous, syphilitic, or variolous ulcer which had given rise to the
scai% &c.

§89.

The EXTENT, THICKNESS, and FORM^ of the skin is subject
to great variety. Sometimes it is found congenitally so nar-
row, as to produce strictures and deep indentations;^ it
is more frequently narrowed and shortened in consequence of
a diseased state, especially in the destruction of burnt parts,
tumours, and wounds, with loss of substance, so that it
restricts the motions of a part. Oftentimes the skin is too
wide, withered, and wrinkled, sometimes to a very great
extent;^ in many cachectic diseases;* and when it has been
previously very much expanded by tumours, this is especially
the case. The extensibility of the skin is very great,
particularly if it have been long in taking place. With great
extension there also occurs thinning of the skin, and some-
times to such extent that it becomes quite smooth, shining,
transparent, and similar to a serous membrane, and then not
unfrequently bursts. Not less common is also the thicken-
ing of the skin in consequence of various diseases, for instance,
badly cured erysipelas, elephantiasis, &c. in consequence of
which it can be thickened to a quarter of an inch. There is
also commonly found at the same time, hardness, which,
however, may exist without any thickening, and is occasionally
so great, that the skin ])ecomes as dry and firm as tanned
leather or parchment, not unfrequently breaks and produces
cracks, rhagades ; the skin is also found in many men, for

Sect. XIII.] Of External Skin, 105

instance, sometimes in barren women, naturally too hard and
rough. The contrary vice of consistence, viz. the softening
and LOOSENING of the skin, occurs in many diseases, on parts
vi^hich have been long deprived of the influence of air and have
continued moist, in habitual sweating, and on the hands of
little children, who are accustomed to suck them, &c.^

(1) Many muscles alter the form of their shell to that of the body, on which
they fasten themselves.

(2) I have twice observed deep circular strictures on the thigh and leg of
new born children. One such case has been described by Cornelison in the
Medical Repository of Original Essays and Intelligence, New York, 1817,
new ser. Vol. IV. Part II.

(3) One young man could draw the skin of the neck and shoulder over the
whole face. v. Tidpius Observ. medic, p. 100. Amstel, 1672.

(4) For instance, the disease Cosz, in the country of Nogays, between the
Black and Caspian seas.

(5) A few remarkable cases of softening and dissolution are communicated
and drawn by Heusinger in the first Bericht. von der anthropotomischen Anstalt
zu Wiirtzburg, p. 34. fF. plate 3. Similar strong development of the papillae of
the skin have been often noticed in elephantiasis, under the thickened cuticle.

§ 90.

The colour' of the skin presents very many variations

from the normal state, which are usually situated only in the

upper layer of the cutis itself, although in rare cases in the

cuticle also at the same time ; these are sometimes general,

sometimes only local. Too great whiteness of the skin

occurs originally and often hereditarily in leuc^thiopy, or

ALRiNOiSM of men and animals,^ and rarely as a bleaching in

the coloured nations;^ the yellow colour, as a morbid state

in JAUNDICE, icterus;*^ the red colour, particularly in high

inflammation, and in the eruptive diseases, although also

without these. ^ There is observed further in Europeans a

BROWNISH,'' in rarer instances a leaden,^ more commonly a

BLUISH,® and even a blackish^ state of the skin, partly as the

consequence of a morbid state, partly from certain colouring

substances.^'' We also not unfrequently observe upon the skin,

SPOTS of various colour, number, size, and form; for instance,

Europeans with the skin entirely white, yellow, red, brown,

and blackish; coloured nations, on the contrary, with light

spots. ^' Here belong also sun-blisterings, ephdides ;

freckles, lentigines, cloasmata ; the blackish spots in old

PERSONS, melasmata ;^^ then the bluish and dark spots which

arise from congestion or from actual effusion of blood in and

beneath the tissue of the skin, as death spots, sugillations,

petechiae, scorbutic spots, &c. ; '^ and finally, the various spots

in which, at the same time, the skin is morbidly changed. In

animals also, we sometimes observe morbid spots on the skin,

106 Of Ejcternal Skin. [Part IL

particularly in the murrain among swine, sheep, fishes with-
out scales, viz. eels, even in crabs, silkworms, &c.

(1) Blandus De maculis corporis. 4to. Roniae, \o^^. — Fr. Hoffmann D. de
morbis cum colore cutis depravato. Halae, 1714. — Bose De mutato per morbum
colore Corp. Lips. 1785. — Blumenhach De generis humani varietate nativa.
p. 150. edit, tertia. Gotting. 1795. flf.

(2) Compare § 33. Btumenbach, § 78, p. 274, and in Comment. Sec. Reg.
Scient. Getting. Vol. VII. p. 29, and in the Medic. Bibliothek. Vol. II.
p. 537. — G. T. L. Sachs Historia natur. duorum leiicsetliiopum auctoris ipsius et
sororis ejus. 8vo. Solisbaci, 1812, accompanied with observations by Schlegel in
Neuen Materialien fur die Staatsarzneivviss. "N'ol, III, p. 1 — 148. — Mansfeld
Ueber das Wesen der Leukopathie oder des Albinoismus, nebst Beschreibung
eines in Braunschweig lebenden Albinos. 4to. Braunschweig, 1 822, with a plate. —
A» Rctzius Bericht liber zwei schwedische Albinos, nebst Bemerkungen iiber die
Pigmentbildung in Svenska L'dkare- S,'dshkapets Handlingar. \o\. X. — Description
of an Albino which was born at Gorlitz, by Dr. Bauenistein, in Neuen Lausitzer
Magazin. Vol. V. Part III. Gorlitz, 182(j. v. also § 33, note 2. — [</. R. Cox,
an account of an Albino, in a note to which, Jefferson's account of three Albino
negro women in the same family, in Cox's Philadelph. Med. Mus. Vol. I. p. 151.
— /. Vaiighan, account of two Albinos, in Ih. Vol. II. p. 285. T.]

(3) Partly in congenial climates, partly in disease, v. Blumenhach, p. ICiO and
IGl, and in Foigfs Magazin, Vol. V. p. 368. Recent instances of bleaching in
the negro, are given by Fisher in Mem. of the Soc. of Manchester. Vol. V. Part I.
p. 314. — Hamilton in Edinburgh, Med. chir. Trans. 1824, No. 22. — Dwiqht,
Travels in New-England and New- York. — Another case in the Norfolk Beacon. —
Bleaching of Americans is described by Dwight and Knight in Transact, of the
physico-medical Soc. of New York. Vol. I. 1817.

(4) v. § 39. — Desmoulins De I'etat anatomique de la peau et du tissu cellulaire
dans la fievre jaune, etc. in Magendie's Journ. de Physiol, experim. Vol. III.
No. 3. p. 255.

(5) For instance, a red negress. Marcgravii Brasil. p. 12.

(6) Frank's Kleine Schriften medic.-prakt. Inhalts, a. d. Lat. v. Eyerel, p. 274.
8vo. Leipz. 1810. — Johnson in London med. chir. Transact. Vol. XIII. Part I.;
sometimes also in jaundice.

(7) Hagedorn Hist. med. phys. Cent. III. Hist. 56.

(8) Especially in the blue disease, cyanosis: from grief, Farde.au in Fournier's
Recueil de Memoires de Medicine, Chir. et Pharmac. militaires. Vol. VIII. p. 237.

(9) Occurring especially in pregnancy and in disturbed menstruation ; not
unfrequently in several })arts. v. Albinus De sede et causa color, aethiop. p. 9. —
Holler's Elem. Physiol. Vol. V. p. 18. — Blumenhach De gen. hum. var. nativ. —
Heusinger Untersuchungen iiber die anomale Kohlen-und Pigmentbildung,
u. s. w. p. 58, Eisenach, 1823. — On the leg of a dropsical person, Wurfbain Misc.
Acad. N, C, Dec. II. Ann. V, p. 325 ; — on the face, Cassini Mem. de Paris, 1702.
Hist, p, 29.— Yonge in Phil, Trans. 1709, p, 424 and 432.— CViowzc/ Bullet, de la
Facult, de Med, et de la Soc, de Paris, 1814, p, 113, — Goodwin in iSedillot's
Recueil period, dc la Soc. de Med. de Paris. Vol. XL VI. p. 339. — from the
breast to the knee downwards. Rugieri Storia ragionata di una Donna avente
gran parte del corpo coperta di pile et pelle negro. 8vo. Vened, 1815. — Wells,
Two Essays, &c. and an Account of a Female of the white race of mankind, part
of whose skin resembles that of a negro, 8vo, Edinb, 1819, — Parsons in Philos.
Transact. Vol. LIII, — General black colouring is noticed in Ludwig Epistol. ad
Hallerum script. Vol. I, p. 393, — Strack, Observat. de febrib. intermitt. p. 194.
8vo. Off'enb. 1785. — Leske auserl. Abhandl. Vol. I. p. 1. — Chomel in Journ.
gener. de Med, Chir. et Pharm, Vol. XXX. Jun. in Bulletin. — Bernstein in
Salzb. medic, chir. Zeitung, 1813, Vol. IV. No. 87. p. 143; and in Kleinen
nu'dic. Aufsittzen. Frankf. 1814. — Pascalism Medic. Repository, New York, 1817,
Vol. IV, Part IV, — Rostan in Leroux Journ. de Med. Chir, et Pharm, Vol. XL.
Nov. and Dccbr. — Bulletin dc la Soc. dc la I'acultd* dc Medec. 1817, No. IX.

Sect. XIII.] Of External Skin. 107

and X. — [^Chamseru in Hist, de la Soc. Roy. de M^d. Vol. IV. p. 264, mentions
the case of a child born with a violet- coloured skin, which gradually darkened to
nearly black, on the lips, cheeks, tongue, interior of the mouth, and ends of the
fingers ; at the same time, the white of the eyes, and the irides more especially,
became violet-coloured. The child was eight years old when the account of the
case was given. T.]

(10) Compare § 38. Baillie also observed two instances of black colouring of
the skin from continued internal use of the Argentum Nitratum. v. N. Samml.
auserl Abhandl. z. Gebr. prakt Aerzte. Vol. IX. Part III p. 379. — Many muscles,
viz. oysters, pUcatula, anomice, halani, &c. change the colour of their shells to that
of the bodies on which they are fastened, v. Defrance in the Annales des Sciences
Naturelles. Vol. I. p. 16.

(11) The scars of coloured nations are at first lighter, but subsequently they
become as dark as the original skin. — [Pied negro, v. Morgan, in Amer. Phil.
Trans. Vol. II. p. 392. T.]

(12) Bruchmann in Horn's Archiv f. medic. Erfahrung. Vol. II. Part II. p. 247.

(13) I know a lady who has a weak chest, in whom oftentimes sundry large
skin spots, of a beautiful cerulean blue, appear on the extremities, without the
slightest cause, and when she is in perfect health; after several hours they
gradually subside.

§91.

Among the vices of texture in the skin, inflammation,
dermatitis f must be first mentioned, which is usually designated
by the name of St. Anthony's fire, erysipelas,^ and can
exhibit very different degrees and peculiarities. In the higher
degree of inflammation, the skin is not only adherent to the
parts beneath, but also to the external surface of other parts of
the skin with which it is in contact.^ This inflammation
frequently runs into suppuration, in consequence of which,
ulcers of the skin occur; these indeed present a very different
appearance, according as they arise from external or internal
causes, and in the latter case are, for instance, either of a
syphilitic, scrofulous, or gouty nature.^ Thickening and
HARDENING of the skin are also a very usual consequence of
inflammation, which sometimes attains a very high degree, but
never runs into true ossification, a condition which never
occurs in the skin.* On the contrary, the skin is very subject
to mortification, in consequence of which large patches of it
are destroyed. The skin also undergoes various kinds of
degenerations in man and animals, in the eruptive dis-
eases, both in the exanthematous and impetiginous, in which
are produced the various kinds of spots, elevations, knots,
pustules, bladders, scabs, chaps, &c. The texture of the skin
is also sometimes more extensively changed in scrofula,
syphilis, pellagra,** radesyge, in eastern and western
LEPRA, which may occur on almost all animals ; so also may it
be congenital in various ways, in the so-called mothers' marks,
nred materni,^ which, however, do not seem to occur in animals.
The sebaceous follicles, cryptce sebaccce, found in the skin,

108 Of External Skin, [Part 1 1 .

also not unfrequently appear somewhat diseased; thus they
often become enlarged, especially in atrophic children, in
whom the sebaceous matter is collected in too great quantity
and hardness, and appears at the mouth of the follicle as a
black spot, and may be squeezed out in form of a maggot,
MAGGOTS, comedones, as they are called; boils, furunculi^
hard, very painful circumscribed tumours, in which are produced
a viscid kernel or core, are usually seated in the sebaceous
follicles, although they appear sometimes to be formed also in
the cellular tissue of the skin. Hair has been once found in a
boil.' Sometimes calcareous concretions^ are formed in the
sebaceous follicles. To the more distinct and important vices
of texture of the skin belong encysted tumours,^* which may
be developed, if small, in the cellular tissue of the skin itself;
the FATTY TUMOURS are the most common;^ sometimes horny
SUBSTANCES present themselves in a kind of bag of skin. Various
FUNGOUS and sarcomatous growths occur not unfrequently
on the skin, as excrescences, condylomata, the yaws and
piANS,^" certain scrofulous growths,^^ the frequent sarco-
matous GROWTHS on the nose, and above all medullary
SARCOM, which is not unfrequently seated in the skin, and the
malignant warts and gibbous tumours,^^ which run into
TRUE CANCER OF THE SKIN. In auimals, of which the skin is
consolidated into scales, crusts, &c., these often exhibit various
diseases, thus curvings, abrasions, perforations, and wounds
of different kinds ;^^ growths, to which also especially belong,
the brilliant pearls found on the inside of bivalve shells, &c.

(1) The lowest degree we commonly call also erythema; the highest, ery-
sipelas phlegmonodes. Erysipelas is most common on the face and on the feet ;
its occurrence after operations is dangerous, and it resembles the state of the skin
in scarlet fever. Inflammation of the skin frequently arises from wounds, blis-
ters, burns, frost-bites, insect stings, from pressure in consequence of lying down,
decubitus, &c. The galling or abrasion, intertrigo, of very fat persons and new-
born children also belongs here, as well as in beasts, the so-called ignis sacer,
ferus, sylvestris, persicus, St. Antonii, &c.

(2) For example, especially the fingers and toes after burns : in one instance,
the fore-arm adhered to the lip. — Cruveilhier Essai sur I'Anatom. pathol. Vol. I.
p, 181, the heel with the tuberosity of the ischium. — Otto Vcrz. d. anat. Pra-
paratensammlung. No. 2902. — The adhesion of separate parts to each other is
pretty fre(iuent, and with the investing membranes of the foetus. Observe in
these the importance of the ready union of the skin for operative surgery.

(3) Compare § 57. — Here belong especially watery cancer, the corroding spots,
herpes exedens, chimney-sweepers' cancer, and other malignant ulcerations of the
skin.

(4) The bony concretion in the Cabinet d'Ecolc de Medicine at Paris, which,
according to the description, was produced in the skin of a young girl of
eighteen; I found, on a closer investigation, in the year 1818, to be rather fat,
almost like adipocire.

(1*) [Pellagra or the Lombard evil; the scherlievo, radesyge, spedalsked,
liktraa, or the Northern evil ; mal di rosa of the Asturias, and a cutaneous

Sect. XIII.] Of External Skin . 109

disease prevalent in Crim Tartary, are all considered, by Craigie, as probable
varieties of the same morbid action, v. his Elem, p. 640. He also gives the
following authorities. — On the Pellagra, v. N. X. Jansen de Pellagra. Ludg.1787 ;
Holland, M. D. in Med. Chir. Trans. Vol. VIII. p. 317 ; on Radesyge, Morbus
quem Kadesyge vocant, etc. Commentatio Auct. Fred. Hoist, M. D. Christianse,
1817 ; Geographische Nosologic von Fr. Schnuner, M. D. ; on mal di rosa,
Thiery Observations de Physique et Medec. Vol. II. Chap. VI. ; on Scherlievo,
Annali de Medicina ; for Crim Tartary diseases, the travels of Falk, Guldenstudty
and Pallas. T.]

(5.) Reuss De nsevis maternis. v. Repertor. Commentat. Vol. X. p. 268, and
Vol. XII. p. 332. — de Plouquet Repertor. Art. Naevus. — Wienhold Sieben Vorle-
sungen iiber die Entstehung der Missgeburten. Bremen, 1807. — Krause Ab-
handlung von den Muttermalern. Leipz. 1758. — Jouar d Des monstruosites et
bizarreries de la nature, etc. Paris, 1806. — A good plate of a mother's mark is
to be found in Aliberfs Nosologic Naturelle, Vol. I. pi. E, p. 350. — Another
kind in Walther, Ueber die angebornen FetthautgeschwUlste und andre Bil-
dungsfehler. fol. Landshut, 1814. — J, Wardrop, in London Medic. Chir. Trans.
Vol. IX. Part I. — One kind of mother's mark is near akin to angiectasy,
described in the vascular system. — No. 2877, of Bresl. Mus. exhibits a mother's
mark affecting the back of the head, the neck, and the whole of the upper part
of the back. — [/. S. Elsholz Anthropometria et Doctrina Naevorum. 4to. Pat.
1654. — P. P/j2ne/Za Libri tres Naevorum. 12mo. Antw. 1632. T.]

(6) Astruc Traite des Tumeurs, I. — Staid D. de abscessu etfurunculo. Halae,
1714. — Berlin D. de furunculo. Giitt. 1797. — Helm's Erfahrungen iiber die
Furunkeln in Horn's Archiv f. Medic. Erfahr. Vol. VII. Part I. and II. —
Ritter in Graafe's and v. Walther' s J ourn. of Chir. Vol. III. Parti, p. 81.

(7) Gilibert Adversar. med. pract. p. 140. Lyon, 1791.

(8) Foigtel, Hand, der pathol. Anat. Vol. I. p. 85, describes a few very in-
teresting cases from Meckel's collection. Also in the sebaceous follicles of brutes
concretions are sometimes formed, viz. the so-called stags' tears, in stags, which
even become bony. v. Eph. N. C. Dec. II. Ann. IX. Observ. 15, p. 45.

(8*) [The only kind of encysted tumours which occurs in the skin is, accord-
ing to Craigie, the meliceris ; v. his Elements, &c. p. 644. T.]

(9) Compare § 64.

(10) Good plates in Alihert, pi. 35 and 36. — Ludwig Histor. pathologica sin-
gularis cutis turpitudinis Reinhardi. fol. Lips. 1793, with engravings.

(11) For example, in Adelson, D. s. casum singularem morbi tuberosi, etc. 4to.
Gbtt. 1822, with two engravings. A peculiar kind of fungous growth on the
tip of the finger was observed by Boerhave, De morb. nervor. p. 282, and Stiebel
Kleine Beitrage zur Heilwissenschaft, p. 111. 8vo. Frankf. a. M. 1823.

(12) Alibert gives good plates of such ulcers under the name of Scrophule
CANCEREUSE ; further, in the Nosologie Naturelle, Vol. I. p. 548, pi. H,
and p. 554, pi, K.

(13) If mollusca be penetrated by boring muscles and worms, they do not
close the opening with lime, but with a yellowish insoluble animal substance.

§92.

Parasitic animals^ are very often produced in and upon
the skin of man and animals ; extraneous bodies also remain
there either permanently or for a long time.^ Frequently also
there is noticed some peculiarity in reference to the secre-
tion FROM THE SKIN, thus the PERSPIRATION/'' is produccd only
at certain parts, on one half of the body, acrid and corroding,
or stinking, containing urine,^^ unusually sour, or discoloured,
reddish, yellow, green, bluish,^ *^ even blackish'*^ — too thick,
clammy, milk-like, &c. ;^^ further, bloody-sweat,^ '^ and the ex-

1' » »■ I' . .iH" ii^iw

no Of Homy Tissue, [Part II.

cretion of the menstrual fluid through the skin ; the secretion
OF EARTHY AND SALINE MATTER, especially in gouty persons;^
even the exudation of pure quicksilver, through the skin.*

(1) Compare § 70.

(2) For instance, gunpowder, which has been burnt in, and colouring matter
used in tattooing.

(2») [/. Jhernethy, Surgical and Physiological Essays, Part II. An Essay
on the nature of the matter perspired and absorbed by the skin. T.j

(2'») H. HaJford, Urinous smell in the perspiration, v. Med. Trans. Coll. Phys.
Vol. VI. p. 389.

(2*=) [An instance of blue sweat is mentioned in Southwell's Medical Essays,
Vol. in. p. 53. T.]

(2*^) [A case of back sweat is mentioned in a paper, ' De morbo quodam
sudoribus urinisque nigerrimis insigni,' in Comment. Bonoens. Vol. VI. p. 60. T.]

(2«) Jahn, Oily perspiration in general emphysema, Magaz. f. d. Gesammt.
Heilk. Vol. XXVIIL p. 59.

(2^) [Bloody sweat is mentioned by Blainville in his Cours de Physiol.
Gen. et Comp. Vol. III. p. 57. Paris, 1830, as occurring under severe mental
excitement, and in the disease called Diapedese, but he considers that " il
n'y a pas une veritable transpiration, mais qui consititue plut6t une hemorrhagic
par exhalation, comme celle que Ton observe a la surface de la membrane
pituitaire." A very curious case of this disease is mentioned by Samuel du Gard,
in Phil. Trans. Vol. IX. No. 109, p. 193. A child about three months old
began to bleed from the nose, ears, and back of the head ; in three days that
from the nose and ears subsided ; upon which the blood flowed more violently
from the head, and streamed down to some distance. She bled also from the
shoulders and waist, also at the shoulders, bends of the arms, hands, and toes.
She died in six days from the commencement of the attack, and there appeared
in those places where the blood came, little holes like the pricking of a
needle. T.]

(3) Albrecht in Miscell. Acad. N. C. Dec. II. Ann. 1690, p. l^^.—PauUini in
App. Misc. N. C. Dec. II. Ann. V. Obs. 85. — BartJwlinus Hist. anat. rar. Hafn.
1651, Cent. I, Obs. 34, Vol. II. p. i)o. — Medicinisches Wochenblatt von Muller
und Hoffmann, 1787, No. 10.— Hlchter Specielle Therapie, Vol. VI. p. 551. —
Compare de Plouquet Repertor. Calculus in sudore. According to Dandalo, the
sweat of gouty persons contains uric acid ; thus the concretion might be urate
of soda.

(4) Memoir of the medical Soc. of London, 1799. Vol. V. — Br'uclcmann in
Horn's Archiv f. med. Erfahr. 1810, Vol. II. Part II. p. 252.—Biet in Kopp's
Aerztl. Bemerkungen, veranlasst durch eine Reise, u. s. w. p. 116. 8vo. Frankf.
a. M. 1825.

FOURTEENTH SECTION.

Of Horn// Jlssue.^

§93.

The already mentioned vices of the skin lead very naturally
to those of the horn-like parts which are most intimately
connected with it, to wit, of the cuticle, of the epithelium^ the
variou.s kinds of callosities, horny warts, scales, and
shells of animals, the horny beaks, nails, talons, claws,

Sect. XIV.] Of Horny Tissue. Ill

HOOFS, true horns, so far as they do not belong to the
bony system, the hairs, bristles, spines, feathers, &c.
As these parts are all composed of the same substance, viz.
horn; they have also the same vices, some only of them there-
fore will, on account of their various peculiarities, be treated of
more at length below.

(1) Rudolphi Ueber Hornbildungin den Abhandlungen der kbnigl. Akademie
der Wissenschaften in Berlin, aus den Jahren, 1814 — 1815, p. 175. Berlin,
1818. — J. F. Meckel, Hornbildungen im Allgemeinen und insbesondere an der
menschlichen Eichel, im D. Archiv fUr die Physiol .Vol. I. p. 298.

§94.

The ENTIRE WANT of the horny system cannot naturally
occur throughout its whole extent ; the partial deficiency,
however, exists not unfrequently both as a congenital and
acquired state, and may attack almost all the several parts
of this system.^ Deficient formation of the horny tissue is
often connected with debility of the skin, as well as of the
whole body ; sometimes also, however, with peculiarity of race.
The opposite vice, viz. excess of formation of the horny
TISSUE,^ is commonly observed, and almost in every kind of
variety; to this especially belong the existence of irregular
HORNS and warts upon the skin. The former, the cormia
cutanea,^ are usually composed of a kind of encysted tumour,
sometimes also in consequence of blows, pressure, wounds,
burns, &c., frequently even without any distinct cause, but as
mere growths of the cuticle ; they occur on all parts of the
body, although most commonly on the head ; in old women,
especially, they attain oftentimes an uncommon size and firm-
ness, and are periodically thrown off and again renewed;
sometimes several exist at the same time, or one is cleft in two,
&c. In animals we also notice them, particularly in horses
and sheep, and even in birds. ^ Warts, verruca^,^ are little,
mostly roundish, though sometimes also flat, pedicular, thread-
like, or on the contrary, gibbous horny swellings, more or less
deeply attached to the skin, which, in man and animals, are
either separate and scattered, or in masses, and connected with
other malformations of the skin, as for instance, with mothers'
marks,^ or they are observed covering entire parts,'' even inclu-
ding almost the whole body. The latter occurs in the so-called
PORCUPINE-MEN, or in the highest degree of icthyosis cornea,
and in part appears to be hereditary.'' If the horny tissue be
destroyed on any particular part, it is reproduced naturally
and WITHOUT difficulty, as soon as the separated skin has
been reproduced ; still the reproductive power is not the same
in all horny parts ; thus, the cuticle is always reproduced, the

112 Of Horny Tissue, [Part 1 1 .

hair with more difficulty, the nails with still more, &c. The
opinion* that horny parts, viz. the hair and nails, grow after
death, is founded on false accounts.

(1) I have more rarely observed, for instance, the deficiency of the horny
excrescences, or chestnuts as they are called, on the insides of the legs of
the horse, the size of which also varies very much. Their absence in the horse
and mule is described by Havemajin Anleitung zur Bcurtheilung des aussern
Pferdes, p. 194, 3d edit. Hannov. 1822; and Greve Bruchstiicke zur ver-
gleichenden Anatomic und Physiologic, p. 38. Svo. Oldenburg, 1818.

(2) Plenck Lehre von den Hautkrankheiten, a. d. Lat. p. 141. Svo. Leipz.
1789. — Piccinelli Memoria sull' origine e cura di quelle escrescenze impro-
priamente chiamate corna umane. Svo. Bergamo, 1816. — Meckel in Handb.
der pathol. Anat. Vol. II. p. 276. ff. — Er7ist D. de corneis hum. corp. excres-
centiis, quarum generali brevique notitiae singularis casus de hominis cujusdam
corneis excrescentiis adjectus est. 4to. Berol. 1819. — Many similar cases have
been collected by Plouquet, Repertorium, Art. Corn, hominum. — Other instances
are Maiinagetia and Defkarding in Misc. Acad. N. C. Dec. I. Ann. I. p. 103;
Dec. III. Ann. V. and VI. App. 148. — Lanzoni Misc. Acad. N. C. Dec. III.
Ann. IV. p. 152, on the forehead of a boy. — Lauchmund ih. 1673 and 74. p. 239,
Dec. III. Ann. III. App. p. 109, on the top of the foot. — Koenig ib. Dec, II.
Ann. X. 1691, p. 208, on the great toe. — Gcguelin s. Sedillot Rec. periodique de
la Soc. de MMec. de Paris. Vol. LIV. p. 96, on the back of the head. — Rochefort
in Mem. de I'Acad. de Chir. Vol. III. Hist. p. 7, on the loins. — Majorat in
Gazette salutaive de Bouillon. 1788. v. Hujeland's Annalen. Vol. 1. p. 447,
No. 109, on the forehead. — Culdaiii m Mem. di Verona. "N'ol. XVI. p. 127, on
the head. — Rigal in Diet, des Sc. medical. Vol. IV. p. 251, on the breast-
bone and on the tuberosity of the ischium. — AUbert, ib. two horns on the back
of the head. — Otto Selt. Beob. Part I. p. 109, on the back of the hand.— ^^r-
trajid in Archives generales de Medecine, August 1824, on the head. — v. Pl'on-
tiies in v. Froriep' s Notizen, 1824, No. 135, p. 33, with plates, on the head ; other
cases, ib. — Pensa in Giornale medico Neapolitano, Settembre, 1825 ; v. Froriep,
Vol. XVI. p. 89, one on the head, the other on the back. Vol. VIII. p. 112.
Description and engraving of knobby growths on the hands and feet of Lorenz
RufF by Behrends, translated by Dr. TV. Soemmerring, fol. p. 10. Frankf. a M.
1825, two cases on the head. — A. Cooper, in his and Trailers' Surg. Essays,
Part II. pi. S. fig. 8 and 9. — Wiesenthal in New England Journ. of Medic, and
Surgery. Boston, 1819, on the breast. — Ansiaux Clinique chirurgicale. Liege,
1816, on the forehead. — Medical Repository, New- York, 1819, n. series.
Vol. V. Part I. on the head, very large and divided. I have seen two twisted
horns, several inches long, from the head of a woman, in the Museum of Ck.
Bell in London ; another from the head in the Museum of St. Thomas's Hos-
pital, London ; another 2|^ inches long, and as thick as one's finger, from the
back of the head, in the Ashmolcan Museum at Oxford. Concerning horns on
the glans penis, v. Penis. — [^/c d' Azyr Observation sur une corne humaine, in
Hist, de la Soc. Roy. de Meil. Vol. V. p. 294. — E. Home, Observations on cer-
tain horny excrescences of the human body, in which are given Mr. Hunter's
notions respecting the production of such excrescences, v. Phil. Trans.
Vol. LXXXI. p. 95. T.J

(3) Malpighi found a horn hanging on the neck of an ox. v. Phil. Trans.
1684, p. 601. In oxen, especially in those of southern countries, the horns are
not unfrequently attached merely by skin ; in the llunterian Museum, London,
I saw a misshapen horny growth from the forehead of an ox, and a similar one
in the Anat. Mus. at Oxford, hollow, an inch and a half in length, and an inch in
diameter at the base. [/. Parsons, M.D. On a sheep shewn alive to the Royal
Soc. in Nov. 1754, liaving a monstrous horn growing from his throat, &c.
which weighed twenty-six pounds. Phil. Trans. \'ol. XLIX. p. 183. T.] A
very large born from the side of a sheep, v. Museum regium Danicura
Olig. Jacobai, p. 6, engraved in Valentin's amphith. zootomicum, p. 130;

Sect. XIV.] Of Horny Tissue. 113

on the same place I found a smaller one, about four inches long. v. Otto
Selt. Beob. Part I. p. 109. In the horse they have been several times observed,
for instance, Commerc. litter. 1739, p. 212. — Mannagetta. — Acta phys. med.
N. C. Vol. VII. p. 289, — a spiral shaped, as if turned, long, hornlike growth on
the beak of a canary bird, v. Bemerkungen iiber einen monstrbsen Kanarienvogel,
U.S. w. 4to. Hamburg, 1780, with engravings. I have also seen similar growths
on the beak of a partridge ; an enormously large horny growth on the pelvis of
a dove is described and figured by Rudolphi, p. 183.

(4) Compare Reuss Repertor. Commentat. Vol. XII. p. 334. — de Plouquet
Repert. Art. Verruca. — We loosely distinguish warts from their form and
consistence Verruca vulgaris s. topica ; V. pensilis s. Acrochordum ; V. sessilis
s. Porrum, s. Myrmecia ; V. filiformis 5 V. rhagadoidea, &c. ; the Verrucae
carneae, madidse, the Mariscse, &c. do not belong here, but to the sarcomatous
formations of the skin.

(5) I have seen this several times ; amongst others, in a boy in the Albergo
de' Poveri, at Genoa, who had a mother's mark affecting the neck, the left side
of the breast, and the greater part of the back, covered with black hair, and with
horny warts and points.

(6) To this belongs, for instance, the so-called Leontiasis corniculata of
Sauvages, Nosologia methodica, Part II. p. 417, tab. 3, in which he includes
Ash's case, in the Phil. Trans. No. 176. To this belongs the case observed by
Behrends and W. Soemmerring. v. above, note 2.

(7) Machin, in Philos. Transact. 1731, No. 424, p. 2d9. — Baker, ih. 1755,
Vol. XLIX. Part I, p. 21. — r«7esm5 Ausfuhrliche Beschreibung und Abbildung
der beiden sogenannten Stachelschweinmenschen, u. s. w. fol. Altenburg,
1802.— Bunivain Mem. de Turin, 1809—1810, p. 364— 403.— ^.scawm in Journ.
de Medec. etc. Vol. IV. p. 216. — Lauth Memoires sur les freres Lambert, etc., in
the Memoires de la Soc. des Sc. de Strasbourg, 1811, Vol. I. p. 327. ■ — Stalpart
van der Wiel describes a similar disease in Obs. rar. Cent. II. Obs. 35. — Martin,
in Medic, chir. Trans. Vol. IX. Part I. p. 52. v. Cerutti Pathol, anat. Mu-
seum. Part II. pi. 7. 8vo. Leipz, 1822, hereditary. — Mansfeldt Beschreibung
einer Ichthyosis cornea spinosa partialis am Bauche eines Kindes, in Archiv f.
medic. ]Erfahrung von Horn, Nasse, Hencke and Wagner, July and Aug. 1823,
p. 1, with engravings. — Lohstein Compte rendu, etc. Part CXXXIX.
No. 1071, describes, from the Strasburg Museum, a child entirely covered with
warts. The case described by Ernst, although more confined, also belongs
here. — HaskeVs Ichthyosis cornea, v. New-England Journ. of Med. and Surg,
Vol. VIII. No. 1, p. 1, Boston, 1819, v. Salzburger medic.-chir. Zeitung,
1820, Vol. II. No. 38, p. 178, appears to belong rather to Leontiasis.

(8) To wit, Schubert Ahndungen einer allgemeinen Geschichte des Lebens,
Vol. II. Part I. p. 63. Leipz. 1806-7. — Cams Versuch einer Darstejlung des
J^ervensy stems, p. 39. 4to. Leipz. 1814.

§95.

On account of the simplicity and similarity of the horny
tissue, it is not surprising that it is subject to but few
DISEASES. Among these must be enumerated the change
OF COLOUR in deficient nutrition and in actual death ; the
DISCOLORATION which is sometimes only seeming, as parts
composed of horn, if they be thickened, become dusky ; some-
times there is an actual discoloration, as the morbid pigment
produced in bodies is deposited in it; or colouring matter
applied accidentally or purposely to the skin, hair, nails, &c.,
easily colours the horny substance in various ways. Further,

114 Of External and Internal Cuticle, [Part I L

the VICES OF CONSISTENCE, in which the horny tissue some-
times, in a manner recalHng the inflammation of the other tissues
of animal bodies,^ is very materially softened, swollen, and
full of moisture ; sometimes is irregularly dry, rough, and
broken, whence are frequently produced vices of continuity,
which show themselves as clefts, exfoliations, &c.

(1) Compare above, § 53, note 1.

First Chapter.
Of the External and Internal Cuticle?

§ 96.

The cuticle exhibits very great variation from its natural
thickness,^ either original or acquired, in the development of
the body ; thus it is sometimes unusually delicate and thin,
but more frequently too thick ; the latter sometimes occurs
simultaneously throughout the whole skin in barren and mas-
culine-made women. Such irregularities are more usually the
consequence of diseases ; many scars, the healing edges of
cancerous swellings, &c. are indeed overspread with a thin
external skin, which is usually so fine, that a smarting sen-
sation of the skin is the consequence.^ Very frequently we
observe, in consequence of diseases of the skin, especially of
the inflammatory kind, an increased deposition of layers on the
inner surface of the cuticle,^ whereby it sometimes acquires
a very considerable thickness, even that of an inch,^ as well as
growths of many kinds ; most frequently the thickening occurs
on particular spots in consequence of friction, pressure, &c.,
and is then named callosity, callus, tyloma;'^ and on the
feet, especially on the toes, where like a pointed nail it buries
itself deeply in the subjacent skin, whilst its upper surface
is broad and projecting, and is then called a corn, a horny
SUBSTANCE, clavus, gemnrsG, helosJ Vices of thickness are
usually connected with vice of consistence; thus, for
instance, we observe the skin on parts which are moist, in the
neighbourhood of ulcers, beneath plasters, at parts where there
is habitual perspiration, &c. irregularly soft, and on the contrary,
also under many conditions, especially at the same time with
thickening, too hard, dry, rough, so that it presents, clefts,
r/iagadcs, inequalities and growths of various kinds, and

Sect. XIV.] Of External and Internal Cuticle, 115

both looks and feels like the bark of a tree;® this is especially
the case in syphilis, icthyosis, elephantiasis, &c. The
COLOUR of the cuticle is sometimes irregular, inasmuch as
generally it not merely participates in the discoloration of the
cutis, but also of itself assumes an unnatural colour,^ and can
very frequently be coloured in different ways, by the intro-
duction of colouring matter, accidentally or purposely ; ^^ lastly,
the cuticle commonly exhibits vices of continuity, thus it is
either separated from the subjacent cutis by contusions, by the
operation of blisters, and by many diseases, especially pem-
phigus, and is elevated in form of larger or smaller bladders
filled with blood, lymph, and pus, or it is separated without
forming any such bladders, in shape of bran, scales, even of
entire sleeves, stockings, &c. This commonly occurs after
eruptive diseases, for instance, erysipelas, small-pox, scarlet-
fever, icthyosis ; " is even periodical ; the consequence of
poison,^^ and the like. In animals we also observe this
desquamation ;^^ and such of them as are naturally subjected
to a change of skin at certain periods, as snakes, lizards,
insects, viz. silkworms,^* exhibit indeed many irregularities
with reference to these changes. In rare cases the internal
cuticle or epithelium, has been observed to scale off, to wit, in
the intestinal canal of a badger ^^ and of a mangy dog.^^

(1) Leidenfrost D, de epidermidis humanse natura et morbis. Duisburg. 1785.
V. Opusc. Vol. IV. No. III. Compare the writers on diseases of the skin. Con-
cerning diseases of the epithelium, v. Lelut, in Repert. gen. d'Anat. et de
Physiol, pathol. Vol. III. Part II. p. 161. 1827.

(2) This appears also to be the case with the epithelium.

(3) Osthoff in v. Siebold's Chiron. Vol. II. p. 505.

(4) I have seen this also occur in the epithelium of the mouth and gullet after
scalding with boiling water and sulphuric acid. Probably also, in Ash's case, the
air-tube was thickened by external horny growth of the epithelium, as W. Soem-
merring rightly imagines, p. 10.

(5) In one instance was the skin of the foot and hand so thick, v. Gardane^
in Gazette de Sante, 1773, p. 23.

(6) Leeuwenhoek in Philos. Transactions, 1722, p. 156. — Lordat in Sedillot
Recueil period de la Soc. de Medec. de Paris. Vol. XXII. p. 427. — Nurnherger
D. de cuticula e frictione comprimente callosa. Viteb. 1789. In animals, not
unfrequently from the pressure of the harness ; for instance, on the neck of oxen.
Clavus boum Columella. Vol. VI. p. 14.

(7) Wedel D. de clavo pedis. Jenae, 1675. — Camerarius D. de Gemursa
Pliniana, clavi pedis maligniori specie. Tub. 1722. — Lochner De clavi in pedibus
maligna specie, etc. in Ephem. A. N. C. Cent. I and II. p. 419. — van der Haar
Berigt om exter-oogen in Verhandl. van bet Maatsch. te Haarlem. D. XIII,
Part I. p. 605. — J. Wardrop, in Med.-chir. Trans. Voh V. p. 129. — Lion, Com-
plete Treatise upon spinse pedum. 8vo. London, 1802, with engravings. —
[D. Low, Chiropodologia, or a scientific inquiry into the causes of corns, warts,
&c. 8vo. London, 1785. — A. Car/zVe, Observations on the nature of corns,
and the means of removing them, in Med. Facts and Observations, Vpl. VII.
p. 29. T.]

(8) Vater Pr. de cuticula pueri 15 annorum, cutis rhinocerotis aut corticis
arboris instar incrassata, quotannis decidua. Viteb. 1735. In a calf without

i2

116 Of Nails and Hoofs. [Part 1 1

hair, all the skin was covered with scales, v. Fresier in den Mem. de I'Acad.
1722, p. 21. In negroes, the cuticle on the sole of the foot is often thickened
and burst from the heat of the soil. v. Mercurialis De decoriatione, p. m. 103. —
Blumenbach De generis hum. varietate nativa. p. 246, note 6.

(9) To wit, the blackish tinge in a new-born child, which, after three weeks, is
lost in the black colour of the cuticle. Bernstein in der Salzb. medic, chir.
Zeitung, 1813, No. 87, p. 143.

(10) We observe the hands of dyers, the colouring of the cuticle from poul-
tices, plasters, from steeping in a solution of lapis infernalis, the accidental
colouring of the skin of many nations with carthamus tinctorius, bixa orellana,
&c.

(11) In my younger days, I had once to treat a person with this disease,
in whose bed I found, every morning, three pints of such scales.

(12) For instance, ai'senic. — de Haen Rat. Med. Part X. p. 2. § 7.

(13) In many diseases. Camels sometimes lose the whole sole of the foot in
wet ground. — Pallas Neue Nordische Beitriige. Vol. II. p. 160. [It has also
occurred, that after the operation of nerving horses, proposed by 5lr. Sewell,
and often attended with success, the hoof has been thrown off. T.]

(14) Bergmann Primae lineae anat. comparat. p. 27.

(15) 7?urfo//)Ai Anat. physiol. Abhandl. p. 46.

(16) Hedwig in Isenflain's and Rosenmuller' s Beitragen, Vol. II. p. 54.

Second Chapter.
Of the Nails and Hoofs.^

§ 97.

In rare cases the nails are wanting originally;^ this
especially occurs in the imperfect development of super-
numerary fingers and toes. Sometimes also a greater
NUMBER of nails is seen, so that one finger or toe exhibits,
with other traces of duplication, even two nails ; it is said that
many Chinese have two nails on the little toe.^ Their size,
thickness, and form, is often irregular;* thus are they found
congenitally too small and too thin, or become so in later
years, as the consequence of deficient nutrition, as in paralytic
persons ; in horses a hoof may be too narrow, the so-called

NARROW-HEELED HOOF, SO also is the SHRINKING and CON-
TRACTION of the hoof, not an unfrequent vice. Often we
find the contrary, viz. the increase of the nail with thickening,
very great elongation, claw-like curving,^ &;c. This sometimes
occurs simultaneously with the increase of other horny organs,*
although it may also occur alone; it is often caused by incessant
cutting and rubbing ; and is not unfrequently seen in animals.'
Irregular enlargement of the nail, and pressure causes its
jjjoN VERSION INTO FLESH." Frequently also are nails con-

Sect. XIV.] Of Nails and Hoofs, 1 \1

genitally malformed ; to this especially belongs the consoli-
dation of two, three, and four nails on connected fingers and
toes.^ In many diseases, the form of the nail also is changed;
thus, for instance, in the blue disease, the entire tips of the
fingers and toes become unusually large, broad, and curved ; ^'^
in consumption they become curved and arched in a peculiar
way, either in the early or very last stage of the disease ; ^^ in
lepra, mishapen,^^ &c. Newly produced nails are also fre-
quently very much malformed.

(1) Plempius De affectibus capilloruin et unguium. 4to. Sorau. 1662. —
Werner D. de unguibus humanis, varioque modo, quo possunt corrumpi. Lips.
1773. — Niirnberger Meletemata super digitorum unguibus. 4to. Wittenb.
1786. — Blech Tractatio de mutationibus unguium morbosis. 4to. Berol. 1816,
with engravings. — Ozanan in Annales cliniques de Montpellier, Juillet, 1822.
— Royer Collard in Repert. general d'Anatom. et de Physiol, pathol. Vol. II.
p. 199, pi. 6 and 7. — Bergmann Die Krankheiten der Haut, der Haare, und
Nagel. 8vo. Leipz. 1824. — Coleman, Observations on the structure, economy,
and diseases of the foot of the horse, Vol. I. and II. 4to. London, 1801 and
1802. Compare also Camper, on the best form of the shoe, and Wardrop,
an account of some diseases of the toes and fingers, &c. in Med. chir. Transact.
Vol. V. p. 129, and the writings of the Chiropedists. — A. Cooper, in Lond. med.
and phys. Journ. April, 1827. [_M. Hall, Commentaries on some of the more
important diseases of females. 8vo. London, 1827. T.]

(2) For instance, in a monster in the Museum at Berlin; on all the toes in
a monster in the Bresl. Mus. v. Otto Verzeichniss der anat. Praparatensamm-
lung. No. 2888.

(3) iVew/^q^ Gesandtschaft an den tartarischen Chan, u. s. w. p. 263.

(4) Franck de Franckenaii D. de unguibus monstrosis, etc. Hafniae, 1716. —
Rouhault Observation anatomique sur des ongles monstrueux in Mem. de Paris.
A. 1719. Hist. p. 38.

(5) Old examples in de Plouquet Repertorium Art. Unguis ; Haller Elem.
Physiol. Vol. V. p. 30. — in Blech. — A case, Henning, in Horn's Archiv f. med.
Erfahrung, 1823, Septbr. u. Octbr. p. 205. fig. 2 and 3. — Lion gives several plates
of very ill-formed nails, pi. 1 and 2 ; I have also seen several very large. In
the Bresl. Mus. in a monster, No. 2888, is a part of the left hand very long and
clawlike. In the Museum at Freyburg, I saw all the nails of one hand remark-
ably large. \_Lncke in Phil. Trans. Vol. XIX. p. 594. Nails on most of the
fingers and toes four inches long, and other horny growths on the back of the
hands, in a boy of twenty years old. — R. Wroe. Case of a boy in which, within
a twelvemonth, the nails of the left hand grew to the length of two inches,
" with great quicks or roots under the nails," which were painful when cut, but
not otherwise ; subsequently they grew on the fingers of the right hand ; on both
hands they seemed to acquire their full growth in twelve months, then fell oif
without pain, and were reproduced. It is further mentioned that *' he was mise-
rably overspread with leprosy," probably ichthyosis, v. Phil. Trans. Vol. XXIV.
p. 1899. In the Museum at St. Thomas's Hospital there are two nails about
two laches in length, very much curved, and extending far beyond the ends of
the fingers, and I remember it used to be mentioned at the lecture that they
were so extremely sensitive, that any attempt at cutting them was attended with
severe pain, but I have no further history of them. In Cruvelhier, Anatomic
Pathologique, fol. Part VII. plate 6, Maladies de la peau (productions cornees),
fig. 2 and 2', have a very near resemblance to those just mentioned, but at pre-
sent no account is given of them. T.]

(6) Mtisaus D. de unguibus monstrosis. Hafn. 1716, with fig. — Locke in Philos.
Transact. No. 230. — Haskell.m New England Journ. of Medicine and Surgery,
Vol. VIII. No. 1. Boston, 1819.— ^s/i Phil. Transact. No. IIG.—Behrends and
W, Soemmerring, pi. 2 — 4.

118 Of Nails and Hoofs. . [Part II.

(7) In wild animals which are confined, I have several times observed elonga-
tion and deformity of the claws — in dogs it is sometimes the cause of lameness.
V. Blaine On the Diseases of Dogs. — In oxen I have seen it several times;
a short time since I possessed two ox feet, in which the hooflets were four inches
long, and completely cylindrical; — in the horse there is very frequently mal-
formation of the hoof, as flat-hoof, bound-hoof, brittle-hoof, pomet-foot, ass-hoof,
&c. ; in domestic birds the monstrous elongation of the claws is very common.

(8) Compare especially Roger CoUard.

(9) The monsters. No. 2906 and 2917, of the Bresl. Mus. exhibit such nails, the
latter a common nail for the fingers of the right hand ; cases of this kind were
also noticed by v. Walther Ueber die angebornen Fetthautgeschwiil-ste und andre
Bildungsfehlcr, p. 31. fol. Landshut, 1814. I saw a consolidation of the four
outer nails of both hands of a remarkable thief in the Anatomical Museum at
Freyburg. Something similar occurs in the undivided hoofs of pigs, v. Otto
Selt. Beob. Part II. p. 83. I have since procured the skeleton of a pig of this
kind for the Museum, No. 4652, and saw in the Veterinary School at Stockholm,
three full-grown swine with the same deformity.

(10) Blech, fig. 5 and 6.

(11) lb. fig. 1 and 2.

(12) Schmidt Diss, de leprosa, unguibus monstrosis praedita. Ultraj. 1696.

§98.

The COLOUR of the nails is not unfrequently irregular, thus
in many diseases they lose their gloss, reddish colour, and
natural transparency; or white streaks, seline, are produced
in consequence of partial or deficient nourishment ; they even
become entirely white, which has been once observed in a
paralytic person ; ^ sometimes the normal white streak, lunula^
is deficient ; in jaundice they assume a yellow colour ; some-
times yellow and red streaks are produced, as in the hoof of a
horse afiected with the so-called corns ; they appear dusky
and BLUISH in the blue disease, in suffocation, after bruises,
in which blood is collected beneath them; they have been
seen blackish in some diseases.^ The nails are also easily
coloured either accidentally or purposely in various ways, for
instance, yellow, brown, and even black, in baths containing
iron and sulphur,^ reddish in baths of red madder ; in dyers,
tanners, hat-makers, they are often deeply coloured, and many
nations have the custom of colouring their nails."

(1) Loder Medic, chir. Bcobactungen, Vol. I. Svo. Weimer, 1794.

(2) Barlholimis Acta Hafn. I. Obs. 32. — Jackson. — d'OiUrcpont in Reil's
Archiv f. d. Thysiol. Vol. IV. p. 472. — I have also seen it so twice in typhus
fever.

(3) Wailz in Ilufeland's Journ. d. prakt. Heilk. Vol. XVI. Part II. p. 22.

(4) For instance, in the east, red with the Lawsonia inennis.

§99.

We frequently find the consistence and texture of the
nails morbidly changed, either alone or generally together with
similar changes in the cuticle. Spots, lepra, syphilis, gout,

Sect. XIV.] Of Nails and Hoofs. 1 19

polish plait, tabes, as well as the handling of sharp instru-
ments by handicraft men, operate on them most frequently and
prejudicially ; we also observe them diseased in insane people.*
The substance of the nail itself is sometimes softened,
LOOSENED, SOAKED IN BLOOD,^ more frequently it is very dry,
ROUGH, and harsh, splits,^ and scales off in plates. The
nails not unfrequently dry up, and are thrown off either alone,
or together with the skin. Often also are they changed more
or less by ulceration of the soft substance lying beneath and
around them, are covered with proud flesh, pterygium unguium,
and are partially separated or completely thrown off'; this is
especially the case in whitloe or felon, panaritium,^ in the
so-called canker of the sole in horses,^ and in the spo-
radic and epizootic diseases of the claws. Finally, we
observe many variations in reference to the favourable
reproductive power of the nails ; thus it produces in sharp
wounds, divisions of the hoof, &c. puffy scars projecting
much externally or even internally ; or if the nails have
entirely been shed, they are either not reproduced or indeed
only on foreign parts ; for instance, after partial or complete loss
of the finger, they are reproduced on the second or first joint,
and even on the fore extremity of the metacarpus;^ on the
latter part they have been observed also as vices of structure in
imperfect fingers,^ as well also as congenital on the inside of
the forefinger.^

( 1 ) Blech gives an engraving of it, fig. 3 and 4.

(2) This at least is the case with the hoof of the horse in corns ; perhaps
also the case in the human subject given by Nees in HufelaniTs Journ. d. prakt.
Heilk. Vol. XVL Part II. p. 183, belongs here.

(3) Not very unfrequent on the hoofs of horses and oxen, and in the former
known by the name of cracked hoof, sandcrack, cleft hoof, broken hoof, &c.
Compare Schwab Materialien zu einer pathologischen Anatomic der Hausthiere.
1st Part, p. 26. 8vo. Miinchen, 1815. The sandcrack arises usually mechanically
from false quittor, whereby the hoof is entirely thrown off at the coronet.

(4) Called also Panaris, Onychia, Paronychia. Acrel in Svenska Vetensk. Acad.
Handl. A. 1754, p. 271. — van Amstel D. de paronychia. Lugd. Bat. 1758. — Sue
D. de panaritio. Paris, 1772 ; and in Memoir, de la Soc. medicale d'emulation,
Vol. II. p. 284. — Focke D. de paronychia. Gott. 1786. — Melchior D. de pana-
ritio. Duisb. 1789. — Flajani Osservazioni pratiche sopra — il panereccio. Roma,
1791. — Eggel D. de panaritio. Erfurt, 1792. — Barfoth D. de panaritio. Lund.
1800. — Vogt D. de paronychia. Viteb. 1803. — Cyvoet D. sur le Panaris. Paris,
\%Q1 .— Wardrop.

(5) To abscesses of the nails belong also the quittor and thrush of veteri-
nary physicians.

(6) Pechlin Observat. L. II. Obs. 42. — Tulpius Observat. medic. L. IV.
c. LVI. p. 370. — Foigtel Handb. derpathol. Anatomic, Vol. I. p. 86. — Marechal
de Rougeres in Journ. de Medec. Vol. XXVII. p. 177. — Ormancey in Journ. de
Medec. continue, Vol. XVII. p. 218.

(7) Bartholinus Hist. anat. Vol. I. p. 241.

(8) Jb. 240.

120 [Part II.

Third Chapter.

Of Hair ^ and Feathers.

§ 100.

The formation of hair and feathers is not unfrequently seen
DEFICIENT, in consequence of general weakness of the body,
or of a certain pecuharity of race ; here belong entire defi-
ciency of these parts, which has been observed as a congenital
formation in man,^ and animals;^ mere local deficiency,*
retarded putting forth of the hair, either generally or
locally, and finally, the too sparing growth of the hair.^
More commonly are the hairs deficient generally or locally,
when, as is the fashion with many people, they have been care-
fully pulled out and removed by aquafortis, or have fallen out
from disease ; ^ the latter is very common on the head, and is
even hereditary^ and endemic.^ The opposite vice also, viz.
excess in the formation of hair and feathers, not
unfrequently occurs, in so far as the growth of hair on the
whole body, or only on certain parts ^ is too great ; it is also
observed on very unusual situations,^" or uncommonly early,"
and even in advanced age.^^

(1) Jouhert De aflfectibus pilorum et cutis, praesertim capitis. 8vo. Lyon, 1577.
— Ampsing Hortus adfectionum capillos et pilos corp. hum. infestantium. 4to.
Rostock, 1G23. — Fort. Plempius De affectibus capillorum et unguium. Lovan.
1661. — Meibom D. de pilis eorumque morbis. Helmst. 1704. — Salwick D. de
morbis pilorum. Frib. 1777. — Pfaff D- de varietatibus pilorum naturalibus et
proeternaturalibus. 4to. liaise. 1799. — Wolfart Bemerk. Uber die krankhafte
\'eranderung der llaare, in Asklepieion, 1811, No. 41, p. 674. — Wedemeyer
Com. historiam patbologicam pilorum corporis humani sistens. 4to. Gotting.
1812. — van der Burch D. de integumentis connnunibus, pilis ac pilorum varieta-
tibus. L. B. 1814. — Meckel Ueber regelwidrige Haar-und Zahnbildungen, in
Archiv fur die Physiologic, Vol. I. p. 519. — JSgidi D. de pilorum anatomia,
physiologia, pathologia et therapia. 8vo. Berol. 1819. — Buck D. de pilis
eorumque morbis. 8vo. Halse, 1819. — Dergmann die Krankheiten der Haut,
der Haare und Nagel. 8vo. Leipz. 1824. — BenvemUi De naturali et morbosa
pilorum oeconomia. 8vo. Patav. 1825. — Vogel Von der diagnostischen Wiirde
der Haare, in Jlecker's literar. Annalen der ges Heilkunde, 1825, Novbr. u.
Decbr. — Blummeiier Adhandlung iiber das menschliche Haupthaar, in histor.
anatom. physiol. pathologisch und therapeut. Hinsicht. 8vo. Berlin, 1826.

(2) Heister in Ephem. Acad. N.Cur. Cent. I. and II. p. 431. — Dcmz \n Stark's
Archiv f. d. Geburtshiilfe, Vol. IV. p. 684, in two adult Jews who never had
teeth. — Augustht in WolfarVs Asklepieion, 1812, Miirz, p. 281. — Wells in
Transact, of the Soc. med. and chir. knowledge. Vol. II. p. 264. [In 1811 there
was a man, aged twenty years, employed at the Courier newspaper office,
London, who had not any hair upon the head, eyebrows, eyelids, nor chin, and
was said to have had none on the pubes. T.]

(3) For instance, tlie known races of horses and dogs without hair ; a rabbit,
V. Allg. Hist der Natur. Part VII. Vol. II. p. 238. No. 1415; a cai,Gudtard
Memoircs. Vol. II. p. 17. — I also once possessed a full grown goat, entirely bare

Sect. XIV.] Of Hair and Feathers, 121

from birth ; it also occurs in birds, I knew, for instance, a kind of doves
entirely featherless, which so continued to be produced through many genera-
tions.— Otto Verzeichn. d. anat. Praparatensammlung, No. 2132. — Schleep
describes an unfledged canary bird in the N. Annalen der Wetterauischen
Gesellschaft, Vol. I. Part I. p. 180.

(4) For example, bare spots in the beard ; in one case also on the head in the
region of the fontanel, v. Misc. N. Cur. Dec. I. Ann. VI. Obs. 74.

(5) For example, in weakly persons, in eunuchs.

(6) Pilorum defluvium, Alopecia, Madarosis, Calvities, upon the head also called
Area, Ovum and Ophiasis, is the consequence of great weakness, therefore also
of many acute and chronic diseases, of lying-in, of grief, of fear, of many exan-
thematous diseases, especially the itch, of poisoning by arsenic, &c. ; in animals
also, falling off of the hair occurs ; viz. among domestic animals, especially in
horses, sheep, and swine. I observed it also in a stag which I still possess ; it is
common in parrots, and other domesticated birds.

(7) Mangili sulla calvezza ereditaria, inGiorn. della Soc. med. chir. di Parma.
Vol. VIII. p. 57.

(8) In Barbary, according to Leo Africanus Descriptio Africae, Lib. I. p. 85.

(9) For example, in the beard of sterile women; compare Hippocrates
ETTiSvfiiuv, Lib. VI. Sect. YIIl. — Haller Elem. Physiol. Vol. V. p. 32.— rfe
Plouquet Repertor. Barba mulierum. — Reuss Repert. Comment. Vol. X. p. 205.
— Curiositaten der phys. liter, artist, histor. Vor-und Mitwelt. Vol. I. Part I.
Weimar, 1811. — I have myself seen many, both alive and in engravings. Too
great length of hair of the head, so that it reaches the ground, Bruckmann in
Horn's Archiv fiir medic. Erfahrung, 1811, Vol. II. p. 69; the pubic hair in a
woman an ell and a half long; v. Collect. Acad. Vol. III. p. 168; a mon-
strously long tail in a horse in the Royal Cabinet of Natural History at Dresden ;
frequently very long manes in horses; monstrous strange feathers in many
kinds of domestic birds ; individual very long feathers in birds, &c.

(10) In anencephalous monsters, the hair of the head descends to the eye-
brows and root of the nose, and if the spine be, at the same time, cleft, also
along its edges ; stiff hairs on the upper end of acephalous monsters ; upon the
navel, Osiander Denkwiirdigkeiten a. d. Geburtshiilfe, Vol. II. Part II. p. 406;
a hairy stripe upon the back, Gilihert Samml. prakt. Beobact. iibers. v. Hehen-
streit, Leipz. 1772, p. 5Q ; especially on warts and mothers' marks, viz. Rosen-
muller in his and Isenflamm's Beitr. f. d. Zergliederungskunst, Vol. II. No. 1.
p. 106, pi. 2, fig. 2, upon almost the whole back, besides many other examples;
from the breast and shoulders down to the knees, Ruggieri Storia ragionata di
una Donna, avente gran parte del corpo coperta di pile et pelle nero. 8vo.
Venez. 1815; with which are also several other instances; v. Walther Ueber
die angebornen Fetthautgeschwulste, u. s. w. fol. Landshut, 1814, pi. 1 and 2;
upon hair in encysted tumours, compare § 64, note 9 ; upon hair in the other
internal parts, the same.

(11) Compare § 20, note 4 ; in a girl four years and nine months old, there
were strong pubic hairs, Cookson in Medic, and Phys. Journ. Sedillot Journ.
gener. de Medec. Vol. XLVII. p. 101.

(12) Schurich De calvo post triginta annorum decursum comato. Misc. Acad.
N. Cur. Dec. III. Ann. 7 and 8, p. 191. — Observations sur des cheveux et deux
dents revenus a un homme de 70 ans, in Mem. de Paris. An. 1703. Hist,
p. 37.

§ 101.

Sometimes also the form of the hair varies ; thus we notice
it irregularly thin and fine, for instance, as a kind of lanugo
on the skin in adult albinoes ; but it is more frequently too
thick and stiff; it is often found unequally thick, thus in
different places thinner and thicker, here and there knotted,
when broken, for instance on the hands, on the parts of hernia,

12^ Of Hair a7id Feathers. [Part II.

&c. ; human hairs are sometimes cleft at the end like bristles,
dicophyia. Animals which have the hair otherwise smooth,
present it, as an exception, curled ; ^ we also find the direction
of the hair and feathers irregular in other respects, for instance,
in trichiasis of the eye-lashes, on the head taking unusual
turns ; certain feathers twisted, &c. Feathers are produced
without barbs, especially in one variety of fowls ; on the con-
trary, there are also double hairs and feathers, sometimes two
or several spring out of a single root ; ^ the feathers of very
old female birds even assume the form of those of the
male, &c.^

(1) A horse with curly hair is engraved in Geoff roy and F. Cuvier's Mammi-
f(§res, Liv. 32. I saw three horses in the Cabinet of Natural History, in the
University and in the Veterinary School at Vienna, with all the hair curly ; in a
peculiar kind of fowl, the feathers are not unfrequently seen crisped and bent
up ; I knew a lady, who lost her long smooth hair, which became short and
curly ; the hair sometimes crisps only during disease, viz. under an attack of
gout in the head. v. American Medical Recorder, p. 277.

(2) I have myself noticed such hair ; I have also seen a double feather from
a goose and from a partridge, v. Oito Verzeichniss d. anat. Praparatensamml.
No. 6069. — Hanotv also saw a double wing feather in a goose, v. his Selten-
heiten der Natur. Vol. III. p. 114; in many birds remarkable double feathers
belong to their natural structure.

(3) For instance, the long band-like feathers of the cock ; old hens of the
Meleagris Gallopavo sometimes have a hairy tuft on the breast like the males.
V. ^ec/w/eira Naturgeschichte Deutschl. Vol. III. p. 116.

§ 102.

The COLOUR of the hair and feathers is still more frequently
irregular ; this is not uncommonly observed as a congenital
or ORIGINAL, and even as an hereditary state ; to it belongs
the unusually light or entire white colour of hair and
feathers which we observe, especially, in albinoes among men
and animals, although also without this known vice in the
eyes.^ Sometimes the colour of hair and feathers is only
white at certain parts, and the body merely spotted.^ We
also notice other various colours,^ as well as the remarkable
variation of the colour of the hair in man on various parts of
the body. The change of colour in hair and feathers is more
fi-equently acquired and produced in later years from disease,
food, old age ; here is to be observed the bleaching of the hair,
and its greyness, canities^ which occurs in later age, and also
earlier under weakening influences, even in rare cases is sudden,
sometimes also only local ; * we see besides, though rarely, the
outer half of the hair become white, whilst that nearest the
root remains black. ^ Much more seldom is the deepening of
the colour of the hair and feathers which we have however
seen in man® and animals.^ We observe also other colours;
thus, for example, in a woman with blond hair, so often as she

Sect. XIV.] Of Hair and Feathers, 123

had fever it became reddish/ Parrots, it is said, in a diseased
state, become not white but yellow ; also the same colour still
remaining, diiferent shades in it are produced.'^ We have
frequently seen hen birds assume in old age the colour and
form of the plumage of the male/" Finally, it is known, that
the hair can either accidentally or purposely ^^ be rendered
black, violet, blue, and green, by various pigments.

(1) Several instances are mentioned of men born with grey hairs ; I myself
knew a young man, who from his birth had so much white beneath his black
hair, that it appeared grey ; among mammalia the white colour has been seen as
an irregularity in the ape, shrew, mole, marten, (of both the latter there are
instances in the Bresl. Mus. of Natural History,) polecat, seal, fox, rat, the
several kinds of mice, the squirrel, hare, elephant, horse, camel, stag, fallow
deer, and buffalo ; among birds we often see white ravens and crows, (one such
I possessed alive for a long time,) sparrows, larks, finches, linnets, buntings,
swallows, &c. ; a white Corvus Cornix and Monedula, Garrulus glandarius, Ampelis
garrulus, Turdus iliacus, pilaris and musicus, Hirundo rustica, three examples,
Alauda arvensis, Motacilla flava, Fringilla domestica and montana, exist in Bresl.
Zoological Museum; many instances have been collected by Tiedemann in his
Zoologie, Vol. III. p. 304. Compare Gunther's Gedanken iiber die ganz
weissen Vogel, welche von anders gefarbten Eltern anatomisch erzeugt werden,
im Naturforscher, Part I. p. 54. — Zorn Einwendungen gegen Gmither's Hypo-
these, und JValch von der anomalischen weissen Farbe der A ogel, ib. Part IV.
p. 128 and 135. — A white song-thrush and a similar cross-bill are described in
Meyer's Zeitschrift fUr das Forst-und Jagdwesen in Baiern. 2ter Jahrg. Miin-
chen, 1814.

(2) For instance, stags with a white spot, v. Wildungen Taschenbuch f. Forst-
und Jagdfreunde f. die Jahre, 1809 — 1812, Marburg, with an engraving. I
saw a similar stag, and one with a much larger white spot on the neck, in the
Royal Saxon Zoological Garden at Moritzburgh ; a white-thighed roebuck, v.
Gatterer and Laurop, Annalen der Forst - und Jagdwissenchaft, Darmstadt,
1811. 1st vol. White spots on birds are not uncommon ; in Bresl. Mus. a crow
and a song-thrush exhibit them.

(3) Red hair in dark nations, fox-red elephants, a light bay-coloured marten,
and an iron-grey roebuck, in Bresl. Mus.

(4) For instance, only on one side of the head. I knew a young officer, in
the midst of whose black hair was one completely white lock ; in horses, several
white spots, from pressure of the harness, are very common ; black fowls, when
very old, have often white spots, v. Schroter in den Berlin, Mannigfaltig-
keiten, Jahrg. II. p. 168.

(5) Destris in Journ. gener. de Medec. Vol. LXIX. p. 213, Nov. 1819. — ffe
Plouquet Repertor. Art. Capillorum Denigratio.

(6) Bruley in Sedilot Rec. period, de la Soc. de Sante de Paris, Vol. IV.
p. 290. — J. Sinclair, The code of health and longevity, 4 vols. 8vo. Edinb. 1807.
Instead of falling out, light hair will become dark, as I have myself noticed.
V. Diet, des Sciences M6dicales, Vol. IV. p. 17.

(7) For instance, stags becoming black, v. Sylvari, etc. von Laurop and Fischer.
No. 5. Marburg, 1813. — I saw a completely black mus arvalis, in the museum
of Professor Schinz, at Zurich. Birds which are confined, as bulfinches, cross-
bills, goldfinches, often become darker. Compare Giinther, Gedanken iiber die
Entstehung der anomalischen schwarzen Farbe verschiedner sonst anders
gefarbter Vogel im Naturforscher, Vol. II. p. 1. [Larks in confinement, fed
upon hempsecd, will become black, as also other birds. T.]

(8) Isouard in Journ. compl. du Diet, des Sc. medic. Vol. V. p. 39 ; in one
other instance, instead of blond-hair falling off, it became red. v. Diet, des Sc.
Medic. Vol. IV. p. 7.

(9) Le Vaillant v. RudolpMs Bemerkungen auf einer Reise u. s. w. Part I.

124 Of Hair and Feathers. [Part II."

p. 235 ; it is however said, that the little green parrot, from Surat, becomes
quite white in old age. v. Turpin, Hist de Siam, Vol. I. p. 321. I possess one,
probably very old, PsHtacus dominiceusis, which was first bright red, then marked
with dark red spots, and at last almost entirely of a deep purple colour ; but the
tips of the wings remained bluish-green. In Bresl. Mus. there is a wild Anas
boschus, of which the whole under parts have a beautiful purple-coloured plumage.

(10) /. Hunter, in Phil. Trans. Vol. LXX. p. 527; and in his Obs. on certain
parts of the Animal Economy, p. 75. 4to. 2d edit. London, 1792. — Blumenhach,
in his Institut. Physiol, p. 550; and in De anomalis et vitiosis quibusdam nisus
formativi aberrationibus Commentatio. 4to. G ott. \^\^. — Tiedemann Zoologie,
Vol. III. p. 306. — Kob D. de mutatione sexus. p. 11. 8vo. Berol. 1823. —
Butler, in Memoirs of the Wernerian Nat. Hist. Soc. Vol. III. p. 188. — hid.
Geoffroy- Saint- Hillaire in Memoires du Museum, Vol. XII. p. 220, and in
Annales dcs Sc. Naturelles, Vol. VII. p. 336, March, 1826. This has been also
observed in the Phasianus colchicus, nycthemerus, pictus and gallus, in the Mehagris
Gallopavo, Tetrao Perdrix, Columba, Otis tarda, Platatea, Anas, in the Ampelides,
in some species of Fringilla, Motacilla erythacus, and in Sturnus vulgaris.

(11) In persons of light hair, who work in metal, it is found green and blue.

§ 103.

The vices of consistence and structure are, as might be
expected from the simple structure of the hair, but few. To these
belong first, the irregular dryness and stiffness of the hair,
which arise indeed from a diminution in the quantity of the fatty
and lymph-like moisture contained in it, and run on either to
the dryness and shedding of the hair already mentioned, or to
splitting and breaking;^ then the opposite vice, or softening,

loosening, VERY GREAT MOISTURE, and ACTIVITY OF SECRE-
TION in the hairs and feathers.^ We observe these frequently
in scald head, tinea, in the rot in pigs, and especially in
POLISH PLAIT, /;/ica j^olonica, trichoma, cirrhagra,^ &c. The
latter disease occurs spontaneously, but is endemic and even
hereditary in Poland, and consists of a peculiar entangling and
matting of the hairs, which are swollen at their roots and are
more or less soft, and secrete a kind of viscous lymph, by
which the hair of the head, the beard, or hair of the pubes,
forms various cap-like or plaited masses. The same disease
occurs also in animals.''

(1) E. 11. Weber in MeelceVs Archiv f. Anat. und Phys. 1827, No. 11, p. 222.

(2) In many diseases of the horse, oxen, and sheep, we find the hair too soft.
v. Vollst. Handb. der Vieharzneikunst von Chabert, Flandrin, and Huzard.
Vol. II. p. 186. Berlin, 1801.

(3) v. the writers in de Plouquet Repertor. and Reuss Repert. Comment. Art.
Plica polonica ; the most important and recent cases, in Ilaller Disp. med. pract.
Vol. I. — Vicat M6n. sur la Plicjuc polonaise. Lausan. 1775. — de la Fontaine
Chir. med. Abhandl. 8vo. Breslau, 1792, with seven plates.— /Je/ewr/s D. de
(Uibio j)lica' j)olonica' inter morbos loco. Francof. 1801. — Wolfram Versuch iiber
die hijchst wahrscheinl. Ursachen dcs Weichselzopfes. 8vo. Breslau, 1801'. —
,/. F. A. Schlegel Ueber die Ursachen des Wcichselzopfes der Menschen und
Thiere. 8vo. Jena, 1806, with engravings; and in Materialien f. die Staatsarz-
neiwissenschaft. Vol. VI. ; and in Neuen Materialien u. s. w. Vol. II. No. 22,
with drawings. — Walter I), de pi. p. Marb. 1808. — Ge7nhitdci D. de singulari
pilorum vegetatione morbosa, etc. Erfurt, 1808. — Chromy Neustc Wahrneh-

Sect. XV.] Of Bones in General, 125

mungen iiber die Krankheit des Weichselzopfes u. s. w. 8vo. Krakau, 1809. —
V, Ruhmfeld Neuste Geschichte des Weichselzopfes. 8vo. Freiberg, 1813. —
/. Frank, Memoirs sur I'origine et la nature de la plique polonaise. Vilna,
1814. — Hecker Gedanken iiber die Natur u. Ursachen des Weichselzopfes. 8vo.
Gotha, 1819. — Szklarski D. de trichomate. 8vo. Berol. 1823. — Goullon D. de
plica polonica. 8vo. Berol. 1824. — v. Steinkohl der Weichselzopf in Deutsch-
land. 4to. Hadamar, 1824, with one plate. — /. Schlesinger D. de trichomate.
8vo. Berol. 1827. — Compare also Larrey's Med. chir. Denkwiirdigkeiten,
and Alibert Maladies de la Peau, p. 25 — 48, pi. 6 — 10. — Leschenault de la Tour
on the Polish plait in India, in Memoires du Museum d'hist. nat. Vol. IX.
p. 245. — [Article Trichoma in Diet, des Sciences Medic. — de Carro on Plica
polonica in Med. chir. Rev. Vol. XIII. p. xxx. — Defour, Case of plica polonica,
in Lond. Med and Phys. Journ. Vol. XVI. p. 235. T.] The opinions held by
the ancients concerning the blood contained in the hair, in plica polonica,
has been treated of lately by IJen7iing, v. Horn's Archiv f. medic. Erfahr. Sept.
and Oct. 1823, p. 201. Many cases of plica are found in Bresl. Mus. v. Otto
Verzeichn. No. 3998 — 4013. Even the chemical composition of the hair is so
changed in this disease, that it dissolves in boiling.

(4) For instance, in horses in North Germany. Greve Erfahr, u. Beobach-
tungen iiber die Krankheiten der Hausthiere u. s.w. p. 112. Oldenberg, 1818 ;
in oxen, dogs, and foxes.

FIFTEENTH SECTION.

Of the Bony System,

First Chapter.
Of Bones in GeneraV

§ 104.

The formation and perfection of the bony system,
in man and animals, is subject to various interruptions both
as to time and degree, sometimes accompanied with imperfect
development of the whole organism, sometimes merely with
that of the skeleton alone. In rare cases, not the least trace
of bone^ has been found in monsters; more commonly the
deposition of lime in the cartilaginous nidus of the skeleton is,
alone, either entirely or partially deficient, and the latter there-
fore in a high degree imperfect ; this is most generally the case
in congenital rickets;^ although also after birth the perfection
of the bones is sometimes very much disturbed by debility,
disease and pressure ; * so that for instance, at the period of
manhood, the skeleton is still that of a child, and the epiphyses
still remain unattached to the bodies of the bones ;^ the
sessamoid bones continue cartilaginous, &c.

126 Of Bones in General, [Part II.

(1) Compare <fe P/om^mc^ Repertor. Art Os. — Courtial et Petit Description
exacte des Os, etc. 12mo. Paris, Leyde, 1709. — Herissant in Mem. de Paris.
A. 1758. Mem. p. 419. — Boerhaave Abhandl. vom Krebs und Krankheiten der
Knochen. Fr. 1765. — Schaarschmidt's Kurzur Unterricht von den Krankheiten
der Knochen. 8vo. Berlin, 1768. — Ficq-d^Azyr\n Hist, et Mem. de la Soc. R.
de Medec. A. 1779. Hist. p. 224. — Bbttcher Abhand. von den Krankheiten
der Knochen, Knorpel und Sehnen. 8vo. Dessau u. Konings. 1781-93.
3 parts, and Konigs. 1795. — A. Bonn Descriptio thesauri ossium morbosorum
Hoviani. 4to. Amstel. 1783. — Bertrandi Ueber die Knochenkrankheiten, a. d.
Ital. von Spohr. 8vo. Leips. u. Dresd. 1792. — Clossins Ueber die Krankheiten
der Knochen. 8vo. Tubingen, 1798. — F. Malacame Auctuar. observationum et
iconum ad osteologiam et osteopathologiam Ltuhigii et ScarptB. Patavii, 1801. —
{van Heckerens und DyVs) Vermischte Beitrage zur Beforderung der Kenntniss
und Behandlung der Knochenkrankheiten. Part II. 8vo. Bresl. 1803. —
Boyer Le9ons sur les maladies des os. 2 vols. 8vo. Paris, 1803, translated by
M. Farrel, 2 \o\s. 8vo. London, 1807. — Vidler in Wolfarfs Asklepieion, June,
1812. — /. Howship, in Medio-chirurgical Tranactions, 1817, Vol. VIII.
Part I. p. 57—107. — Rodati in Praeparationes osseas musei pathologici
animadversion es in Opuscul. scientif. Fasc. XII. p. 362, Bologna, 1818. —
Ribes in Bull, de la Facul. de M^dec. Vol. VI. p. 299. Compare Meckel's D.
Archiv f. d. Physiol. Vol. VI. p. 446. — Jam. Wilson, Lectures on the Struct, and
Physiol, of the parts composing the Skeleton, and on the Diseases of the Bones
and Joints. 8vo. London, 1820. — Caspari Physiol, pathol. Abhandl. Uber die
Entstehung der Knockenkrankheiten in v. Graefe's and v. Walther's Journ.
f. Chir. u. Augenhk, Vol. V. Part I. p. 44. — v. Walther Ueber Krankheiten
fossiler Thierknochen, Vol. VIII. Part I. p. 1 — 16. — Cumin, in Edinh. med. and
surgic. Journ. No. 82, Jan. 1825. — Good plates of diseased bones are given by
Cheselden, Osteographia, or anatomy of the bones, fol. London, 1733. — Bonn
Tabulae ossium morbosorum. fol. Fasc. I — III. Amstel. 1785-88. — Ed, Sandifort,
Museum anat. Vol. II. tab. 1 — 103. — Ludwigii Icones anatom. pathol. Lips.
1798, tab. 3 — 14, &c. [C. Havers, Osteologia Nova, or some new observations of
the bones and the parts belonging to them. 8vo. London, 1691. — Hernauld,
Dissertation sur les maladies des os. 12mo. Paris, 1726. — G. Bribosia, De morbis
ossium. Givot. 1777. — Walker, Cases and remarks relative to diseases of the
bones, in Med. Trans, of Coll. of Phys. Vol. III. p. 25. — A Fasciculus, containing
nine lithographic anatomical drawings, from preparations in the Museum of the
Medical Department at Chatham, fol. London, 1824. T.]

(2) In a monstrous calf, Camper Abhandl. von den Krankheiten, die sowohl
den Menschen als Thieren eigen sind u. s. w. 2d edit. p. 23, note. — Blandin
Philos. Transact. 1787, Vol. LXXL Part I. p. 363.— G. Vrolick Verhandeling
over de zonderlige Misvorming eener Vrucht, u. s. w. ; and Memoires sur quelques
interessants d' Anatomic et de Physiologic, trad, par Fallot. 4to. Amsterd. 1822.

(3) Glisson, De rhachitide, etc. London, 1650. — Bidloo Opera omnia, p. 191. —
Klein D. s. casum rhachitidis congenitae, etc. 4to. Strasb. 1763 ; and in Nov.
Actis N, Cur. Vol. I. p. 146. — Pinel in la Medecine eclairee par les Sc. physiques,
VoJ. I. p. 111. — Bordenave in Mem de Mathem. et de Phys. Vol. IV. p. 545. —
uoemmerring Abbildungen und Beschreib. einiger Missgeburtcn. p. 30, plate 11. —
Henke Neue medic, chir. Anmerkungen. Part II. p. 58. Berlin, 1772. — Otto Selt
Beob. Part I. p. 1, pi. 1, fig. 1. — Verzeichniss der anat. Priiparatensammlung,
No. 2905 and 3012. — Romberg D. de rhachitide congenita. Berol. 1817, with
engravings, — J. F. Meckel Anat. physiol. Bcobacht, u. Untcrsuchungen, p, 1.
Halle, U22.—Rathke in Meckel's D. Archiv, Vol, VII. p, ^M.—Sartorius Rhachi-
tidis congenitae Observationes. 4to, Lips. 1826, with three engravings. — v. Loder
Index Praeparatorum, etc. Mosquae, 1823. 8vo. Sect. II. D. — I saw a similar
fcL'tus in the Anat. Museum at Strasburg, at Naegele's in Heidelberg and at
V. Soemmerring's ; I have also seen this disease several times in new-born calves ;
V, Ilerzberg D. Monstri vitulini descriptio anatomica. 4to. Berol. 1825, with
engravings.

(4) Especially in dropsy of the head,

(5) In a man of twenty-five years old. See Rudolphi Bemerkungen auf einer

Sect. XV.] Of Bones in General. 127

reise, u.s. w. Part I. p. 140, which case I also saw with Dr. de Reimer at the
Hague. I have also observed in some men of twenty- two, and in one of twenty-
three years, the separation of all the epiphyses, and the same also in the skeleton
of a man of twenty-seven years, in the hospital St. Francisci at Naples,

§ 105.
The opposite vice also, viz. the too great activity in

REFERENCE TO THE FORMATION OF BONE, hyperostosis,

occurs, though much more rarely, and in like manner some-
times as to time alone, sometimes as to degree. To the
former kind belongs the premature perfection and hardening of
all or only of some bones, so that, for example, the bones of a
newly born child are too full of lime, and therefore very
frangible ; further, the very early closing of the fontanels, the
consolidation of the bones of the skull, of the two halves of
the lower jaw and of the epiphyses, at a much too early
period ; the very early cutting of the teeth, &c. In the latter
kind we must include the possible excessive production of
bony matter which may occur at any period of life, and in rare
cases is exhibited throughout almost the whole skeleton, but
more frequently is only local, and consists in the morbid thick-
ening, enlargement or growth of the bones. We also often
observe, that the earth of the bones taken up from some
diseased parts of the skeleton, is deposited more freely on
other parts.

§ 106.

The NUMBER of the bones forming the skeleton is not
unfrequently subject to variation, which, if we exclude the
mechanical or morbid separation of individual bones, is
always naturally original. It is to be recollected that in
deficient or excessive formation of single parts, their bones are
deficient or supernumerary ; but even in the external apparently
normal formation of a part, the number of bones sometimes
varies, thus some are deficient or superfluous;^ this most
frequently appears to be the case with reference to the teeth,
the vertebrae, and the ribs ; the number of the sesamoid bones^
also varies uncommonly, as they are often entirely or partially
wanting ; in rare cases there are two or three to one joint, or
they are also found in entirely unusual situations.^ The
number of the bones is apparently not less increased by the
permanent separation of the single pieces of a bone, and by
the sutural and interstitial bones.*

(1) Compare further below the separate bones.

(2) /. Fr. Crell de ossibus sesamoideis. Helmst. 1746. — Berlin Traite d'osteo-
logie, Vol. IV. p. 231.— Haller Element. Physiol. Vol. IV. p. 500.—Blumenbach
Osteologie.

128 Of Bones 171 General, [Part I L

(3) For instance, on the outer four fingers and toes, on the front joints of the
fingers and toes, on the articular processes of the thigh hone, on the wrist, the
spine, the forehead, v. Burchard D. de pecuHari osse sesamoideo ad os frontale
reperto, 4to. Rostock, 1742, on the elbow joint, v. Chenal Observ. botanicae,
§ 28. 4to. Basil, 1766; and Soemmerring\oxa Bau des menschl. Korpers. Vol. I.
p. 425, &c.

(4) See further on.

§ 107.

The SIZE of bones is subject to various deviations from the
general law. Only in dwarfs^ and giants/ is the normal
MASS OF THE vi^HOLE SKELETON changed: a vice which otherwise
occurs merely in reference to single bones or individual
regions of the skeleton, may be congenital as well as
ACQUIRED, and not unfi'equently produces great disproportion
and want of symmetry in the skeleton. The frequency of such
vices is not to be wondered at, as the bones, in spite of their
hardness, are of all organs the most changeable. The too
SMALL SIZE of single bones is frequently congenital ; thus,
for instance, we find in malformed children, the skull, the
face, the chest, the limbs too small, and the latter even only on
one side,^ &c. Individual parts of the skeleton frequently
remain undeveloped^ from different causes during youth ;
lastly, well-formed bones may in later life distinctly diminish
in size, which is called consumption of bone, tabes ossium;^
a phenomenon produced by disturbed nutrition, and the con-
tractile power which belongs to bones. Sometimes we observe
this consumption in the bones of whole limbs after lameness,
dislocations, &c. ; it is more commonly local, especially from
long continued pressure ;^ so that in the latter case, without any
erosion^ of the bone, it diminishes at a particular spot, a pit is
formed, and indeed in flat bones, it wastes even to the peri-
osteum, and holes are produced. Here also belong the
narrowing and diminution of the cavities and canals of bones
which occur every where, and often in a very high degree, if
the expansile power be lost or entirely consumed.^ The
opposite vice, or the irregular size of certain bones or
REGIONS of the SKELETON, is, in moustcrs with disproportion
of parts, sometimes congenital, so also when in original
deficiency of individual bones, the neighbouring bones occupy
their place;'' more frequently it is acquired, and is then the
consequence of hypertrophy in certain parts of the skeleton,
of mechanical extension,'" or lastly and most frequently of vice
of texture, which increases either many bones at the same time
or only single ones, and thus produces bony tumours, tumores
ossiiuN.^^ This morbid enlargement has generally reference
only to the breadth and thickness of a bone, but very rarely to

Sect. XV.] Of Bones in GeneraL 120'

its longitudinal proportions.^^ On account of the strength of
the bony tissue, it is very natural that morbid swellings in
bones should be more permanent than in soft parts, and if
they acquire a certain size, they are never again entirely lost.

(1) Skeletons of dwarfs are found in many collections.

(2) Schoenberg Ueber das Skelet des grossen Anton (now at Marburg) im Maga-
zin der naturf. Freunde zu Berlin, 1810, Jahrg. IV. p. 236. — Degg in Phil.
Transact, 1727, p. 363. — Zitterland D. de duorum sceletorum praegrandium
rationibus. 8vo. Berol. 1815. — The skeleton of the Irishman, Patrick O'Brien, in
the Hunterian Museum at London, is seven feet eight inches and a half high,
and his thigh bone is about as tall as the Polish dwarf Borulawski. Gigantic and
dwarfish skeletons exhibit frequent disproportions of the several regions ; this
occurs also in animals, for example, in a dwarf horse. Neergard Beitr. zur vergl.
Anat., Thierarzneikunde und Naturgeschichte, p. 28, pi. 1. Gbtt. 1807.

(3) I have observed this several times. Compare Breschet in Med. Trans.
Vol. IX. 1818, p. 433.

(4) Compare several instances in the upper extremities : Otto Seltene Beobacht,
Vol. II. p. 32, No. 11, on the lower extremities: Lohste'm Compte rendu sur
les travaux anatomiques pendant 1822-23, p. 30, 8vo. Strasb. 1824; the feet
of the Chinese women, from long continued pressure, &c.

(5) Lehmann D. de Tabe ossium. 4to. Lips. 1821, with engravings. — Sebastian
Ueber die Knochenscwindsucht, in Huf eland's Journ, p. 3, July, 1821.

(6) For instance, from tumours of all kinds, from the head of a dislocated
bone, from water and hydatids in the skull, from external mechanical causes, &c.

(7) Of this further on.

(8) Thus, for instance, do the orbits, the alveolar cavities, the openings in the
base of the skull, the articular cavities, and even the chest, become narrowed.

(9) For instance, the upper jaw, when the nasal and lachrymal bones are defi-
cient; the parietal in deficient frontal bone.

(10) To wit, the bones of the skull from dropsy of the brain, the acetabulum,
from enlargement of the head of the thigh bone, &c.

(11) Roberg D. de ossibus tuberosis. Upsal. 1717. v. Haller Coll. Disp.
chir. IV. No. 122, — Heister D. de ossium tumoribus. Helmst. 1740. — Matani de
osseis tumoribus. 8vo. Pisa, 1763.

(12) An instance of this kind occurring on the shin bone of a boy is known to
me ; compare Trendelenburg prses. Florman D. de longitudine femoris ancta, sine
praevia luxatione. 4to. Lund. 1812, on the last joint of the finger. — Portal
Cours d' Anatomic medicale. Vol. I. p. 14.

§ 108.

Not less common are the vices of form in bones,^ v^^hich
may be congenital as vrell as acquired. To these belong
the various forms corresponding to the external contour of
mishapen bodies which the bones so often present, for instance,
in the anencephala, the cyclops, the monsters with clefts of the
face, chest, and spine, with deformed extremities, with defi-
ciency, excess, and consolidation of parts ; then a great number
of more minute variations of form in certain bones, not indicated
by the general form of the body, which not unfrequently, like
many of the foregoing, are retarded formations ; further,
such deformities as arise from pernicious fashions and customs,
for instance, pressure of the head, pressure from stays, small
shoes, certain positions of the body ; the vices of form caused

K

130 Of Bones in General. [Part II.

by tumours, dislocations, and badly united fractures ; and lastly,
especially the obliquity, contortion, and curvature of the
skeleton, sometimes congenital, but more frequently produced
by disease, which are remarkably frequent in the spine and
extremities,^ and are sometimes followed by very decided and
general malformation of the body/

(1) E. Sandifort De ossibus, diverse modo a solita conformatione abludentibus
in Observ. anat pathol. L. III. cap. 10, and L. IV. cap. 10. — van Doeveren
observationes osteologicae, varies naturae lusus in ossibus humanor. corpor.
exhib. in Observ. acad. specim. Lug. Bat. 1765. — RosenmiiUer D. de singularibus
et nativis ossium corp. hum. varietatibus. 4to. Lips. 1804, with engravings. —
Fesmer praes. Rudolphi D. anat. seu Observationes osteologicae. Berol. 1812,
with two engravings.

(2) On the upper extremities however much more rare than on the lower.

(3) Good plates of such skeletons are given in Sandifort Museum anat. Vol. II.
pi. 1 — 5. — Rodati in Opusc. scientif. Bologna. 1817. Fasc. V, pi. 11, 12. —
Copeland, On the symptoms and treatment of diseased spine. Svo. Lond. 1815. —
Striking examples are given by Vrolick Memoires sur quelques sujets interessants
d'anatomie et de physiologie. trad, du Hollandais par i-'a/^^ 4to. Amsterd. 1822.
— Compare Otto Verzeichniss der anat. Praparatensammlung, No. 3019 — 3025.

§ 109.

The irregular connexion of bones with each other, and
often their position^ also, is tolerably frequent; their con-
nexion may be either in a slight degree or entirely destroyed,
or it may be too firm ; both occur in bones which are immov-
ably and movably connected, and may be observed both as
congenital and occurring at a later period of life. To the
DIMINISHED CONNEXION belong the not unfrequent CONGENITAL
CLEFTS of the face, spine, chest, and pelvis; the separation in
youth, osteodiastasis,^ of immovably connected bones, still,
however continuing in adults, which is produced in the skull
by water, effusion of blood, tumours, &c., in the face, especially
by polyps, and sometimes in the pelvis by relaxation of the
ligaments and extension from within ; and lastly, the naturally
more common dislocation, luxatio,^. in which the normally
connected articular ends of two or more bones are, by me-
chanical extension or tearing of the ligaments, separated from
each other, partially, luxatio incompleta, subluxation or entirely,
luxatio completa. If dislocation arise from internal causes,
as from swelling of the articular end of a bone or from other
diseases of joints, this we call spontaneous dislocation,
luxatio spontanea;^ in animals it does not appear to take
place. If the dislocated bones be not replaced, they acquire,
wliilst their original articular cavity in the other bone is gradu-
ally wasting away, a new connexion, either with the edge, or
with more distant i)arts of the same bone, or with another distinct
bone ; which partly by absorption, partly by deposition of bone,

Sect. XV.] Of Bones in General. 131

and the adaptation thus effected by opposite means as well as
by the production of articular ligaments, often becomes, in time,
a tolerably good new joint,^ which in a certain degree
restores the use of the limb. The irregular close con-
nexion may partly affect such bones as are immovably con-
nected with each other, this is called consolidation of bones,
concretio ossium,^ or it may, as a more distinct and important
vice, affect two bones movably connected, the consolidation
OF JOINTS, anchylosis, ankylosis? This vice is very common
in man and animals,^ and if it have attained only a trifling
extent, and there still remain some motion in the joint, it is

called STIFFNESS OF THE JOINT, Or FALSE, IMPERFECT ANCHY-
LOSIS, rigiditas articulorwn, anchylosis spuria, incompleta ;
but if it be complete, then it is anchylosis vera ; consolidation
of the articular surfaces with each other, ossification of the
articular ligaments, and the irregular deposition of bone in and
about the joint, are the next causes of anchylosis.^ Sometimes
this is a congenital vice ; ^^ it rarely occurs in youth, more
frequently in more advanced age ; in rare instances it occurs in
almost all the joints of the body at once.^^ Some instances are
also given, in which anchylosed joints having been separated
by violence, have again become movable. ^^

(1) Dislocatio, especially in dislocations ; the most remarkable instance 1 have
seen was in the Anatomical Museum at Vienna, No. 297 ; the dislocated head of
the right upper arm bone is thrust between the second and third ribs almost two
inches into the chest, and remained there many years, until it had become soft.

(2) Many examples in PlouqueVs Repertor. Art. Ossis Diastasis. — Lvdwig's
Program, de diastasi, Leipzig, 1620, includes several dissertations. — If the dia-
stasis occur in youth and be long continued, the intermass of the bones expand ; —
if this be not the case it is usually torn.

(3) Hamherger D. de luxationibus et subluxationibus. Jen. 1746. — Henkel
Abhandlung von Beinbriichenund Verrenkungen. 8vo. Berlin, 1759. — Bordenave
D. de luxationibus. Paris, 1764. — Poit, Remarks on Fractures and Dislocations.
8vo. Lond. 1768. — Aitkefi Ueber Beinbriiche und Verrenkungen mit Anmerk.
von Reich. 8vo. Niirnb. 1793. — Bernstein Ueber Verrenkungen und Beinbriiche.
8vo. Jena, 1802. 2d edit. Jena, 1818. — Laemmerhirt Taschenbuch iiber Bein-
briiche und Verrenkungen. Berlin, 1806. — Caspari Anat. chir. Darstellung der
Verrenkungen, u. s. w. 8vo. Leipz. 1821. — A. Cooper, A treatise on Dislocations
and on fractures of the joints. 4to. Lond. 1822, with plates. — J. M. Cunningham,
A synoptical chart of the various Dislocations to which the human frame is sub-
jected. Lond. 1827.

(4) Jtincker D. de causis luxationum internis. Halae, 1761. — Rust Arthrokako-
logie, oder iiber die Verrenkungen durch innere Bedingung und iiber die
Anwendung des Gliiheisens. 4to. Wien, 1817, with plates.

(5) Howship in Medico-chir. Transact. Vol. IIL Part IL 1817: und prak-
tische Beobachtungen aus der Wundarzneikunst und Krankheitszergliederungs-
kunde; ubers. v. Schulze, p. 435, 8vo. Halberstadt, 1819, plate 6, fig. 5, plate 7
and 8. — A. Cooper and Travers, Surgical Essays, Part I. — Warren in New England
Journ. of Medicine and Surgery, Boston, 1814, April, with drawings. — Todd in
Dublin Hospital Reports and Communications in Medicine and Surgery,
Vol. IIL Dublin, 1822. — Hesselbach Beschreibung der pathol. Praparate zu
Wiirzburg, No. 85 — 91, and 684. Otto Verzeichniss der anat. Priiparatensamm-

K 2

132 Of Bones in General, [Part II.

lung, No. 3440, 3442, 3443, 3492, and several others. — C. M. Geisler D, de
Pseudarthrosi a luxatione proficiscente in genera. 8vo. Berol, 1827.

(6) Here belong, for instance, the early, or even congenital consolidation of
the bones of the skull, of tlie nose, of the two halves of the lower jaw, of the
epiphyses with the diaphyses, the teeth with their sockets, &c.

(7) Muller D. de Ancylosi L. B. 1707. v. Haller Coll. Disp. chir. Vol. IV.
No. 120. — de Biichner D. de Ancylosi. Erford. 1743. — Paul D. de Ancylosi.
Argentor. 1774. — van de Wynsperse Dissertationes med. chir. de Ancylosi. L. B.
1785, with figures. — van Doeveren D, de Ancylosi. L. B. 1783. — Murray, resp.
Leffler D. de Ancylosi. Upsal. 1797. — Rudolphi Schwed. Annalen. Part I.
p. 132. — Jamain Diss, sur I'ancylose. 4to. Paris, 1806. — Carmichael, in Edinb.
med. and surg. Journ. Vol. V. p. 185.

(8) For instance, on the spine of horses, mules, asses, and oxen ; in spavin
and grease of horses; on the knee of a monkey ; and not rarely on the joints of
wild beasts and birds which have been i.ijured ; to wit, in wolves, No. 3575 and
3576, in a bird, No. 3594 of Bresl. Mus. I also saw one on the heel-joint of a
young kangaroo.

(9) Gout, osteomalacy, caries, fracture and injuries in the neighbourhood of a
joint, most commonly produce anchylosis ; also the long- continued rest of a
limb ; for instance, the Indian Fakirs, who, foi' penance, do not move a joint for
a whole year, often suffer anchylosis.

(10) I have seen this several times in monsters of men, sheep and oxen, espe-
cially on the spine and ribs; on the knee of a new-born child, Veatman in Lond.
med. and phys. Journ. Nov. 1824 ; on the spine of calves and lambs. No. 3032,
3034, 3324, of Bresl. Mus. ; in a calf, H. Jaeger in MeckeVs Archiv f. Anatomie
und Physiol. 1826, No. 1, p. 79.

(11) Cohnnhus de re anatomica L. XV. p. 485. —B. Connor, de Stupendo
ossium coalitu. Oxon. 1695; and in Philos. Transact. 1695, p. 21. — Deslandes in
Mem. de I'Academie des Sc. 1716, in a child. — Smith, Naturalis historia
Hiberniae comitatuum. Dublin, 1744. — i^aa^/er Observationes medical incisione
cadaverum illustratae, 1763, p. 80. — Gentleman's Magazine, Sept. 1787. —
lianisuy Philos. Transact, abridg. Vol. IX. p. 24, with an engraving of the
skeleton which is in the museum at Trinity College, Dublin. The skeleton of
Jeffs, in the Hunterian Museum, at London, is similar; and there are two ske-
letons in the Cabinet d'Ecole de Medecine of Paris; compare hereon Percy,
Bulletin de la Soc. philomath. Ann. X. p. 93 ; and in Shlillot Rec. period,
de la Soc. de Medec. de Paris, Vol. XIII. p. 352. — Gaslellier, ib. Vol. LIV.
p. 380, and Frank Ileise nach Paris, London, u. s. w. p. 127; — Grahner :
Maraschin in Omodei' s AnnaVi universali di Medicina, Vol. XXXII. Oct. 1824;
almost complete anchylosis in a skeleton in the Anatomical Museum at Berlin,
v. Walter Anat. Mus. Vol. II. No. 463, p. 77.

(12) Job. von Meek'ren Observat. Cap. LXIV. p. 297 ; in such the consolida-
tion was probably only slight.

§ 110.
The natural colour^ of bones deviates variously, in the
altered component proportions of the jelly, fat, blood, and
lime found in them ; if the latter be in excess and the former
diminished, the bone appears too white, thus in certain forms
of gout it is IVORY-LIKE,^ in necrosis often white as chalk ;
should the bones be very fat and deficient in lime, they are
sometimes completely transparent,^ more frequently very yel-
low ; inflamed, scorbutic, and rickety bones when examined
recently are more or less red, but after some time mostly
ciiir.YLsH; in the not rare morbid effusion of blood into the
diploe of bones, they are spotted of a deep red or bluish

Sect. XV.] Of Bones in General. 133

COLOUR-/ carious ^nd necrotic bones are often discoloured
BROWNISH and even black : the bones are irregularly coloured
in rare cases, by pigments morbidly produced in the body ;
for instance, yellow in jaundice,* and blackish in mela-
NOSE ; ^ in one instance, blue on the upper surface of exfoliated
portions of bone;' but this is more frequently produced by
extraneous colouring matter, thus yellow from carrots,^ red
from madder^* and galium aparine, dusky or blackish, if
preparations of peruvian bark, oak bark, rhatany, nitrate
of silver,^ be applied on bare bones, &c. ; also after death
the bones easily assume an extraneous colour, as a dark
brown or BLACKISH colour from putrefaction and lying in
black earth, a reddish from ochrous earth, and a greenish
colour from that impregnated with oxyds of copper/"

(1) H. F. Isenflamm Ueber die Verschiedenheit der Knochenfarbe als Diss.
Dorpat, 1809, enlarged on in his Anatomisclien Untersuchungen. 8vo. Erlang.
1822 p. 3—45.

(2) I have several times found this. Compare also v. Sommerring Ueber die
Gichtknochen in Blumenhach' s medicin. Bibliothek, Vol. III. Part III. p. 508.

(3) Otto Verzeichniss der anat. Praparatensammlung, No. 3020.

(4) I have several times found such spots on the bones of the skull and of the
pelvis ; on others also, however, which have a thinner shell. Compare Ver-
zeichniss der anat. Praparatensammlung, No. 3119 and 3120.

(5) Lieutaud Hist. anat. medica. Vol. I. L. I. Observ. 817. — J. Andree, Con-
siderations on bilious diseases, &c. London, 1790. — Stoerck Ann. medic. I.
p. 150. — Stoll Ratio medendi, iibers. von Fahri. Vol. III. Part II. p. 148. —
Wrisherg Descript. Embryon, p. 6. — v. Soemmerring Vom Bau des menschlichen
Kiirpers. 2d edit. Part L p. 7. — Isenflamm, p. 29. — I have also seen this several
times, especially in icterus neonatorum.

(6) Howe and Alison in Transact, of the med. chir. Soc. Edinburgh, Vol. I.
1824, No. 13.

(7) Menegazzi in Brera's Giornale di Medic, prat. Part I. p. 1.

(8) In Geese. Frankische Sammlungen, u. s. w. Part II. p. 11.

(8*) [De coloratis Animalium quorundam vivorum ossibus, in Comm. Bo-
noens, Vol. II. p. 129. — M. Bazani De ossium colorandorum artificio per
radicem rubiae, ih. Part II. p. 124. T.]

(9) As to the intentional or accidental colouring of the teeth, see further, on
the teeth.

(10) V. No. 817 and 818 in Bresl. Mus.

§111.

As to vices of consistence of bone, these are regularly
the consequence of vices of texture and indeed of inflammatory
loosening or thickening; this however is not always distin-
guishable, and in other cases also the vices of consistence, in
reality, appear only to depend on the change of nutrition or the
proportions of mixture of the fluid with the earthy parts ; here,
therefore, we must speak of them generally. The diminished
consistence of bones appears in a double form, viz. as soften-
ing and as brittleness. The former, moUities or rachitis
ossiuniy in a greater degree also called osteomalacia^ mala-
costeon, osteosarcosis ^^ is produced to a less extent in bones,

134 Of Bojies in Ge)wral. [Part II.

by the long-continued rest of a joint ; but more commonly is it a
symptom of rickets and scrofula, in which, besides the dispro-
portion of the phosphoric acid to the lime sometimes observed, the
latter especially is very much diminished, and contrariwise the
quantity of jelly very much increased; such bones are therefore
more or less flexible, and are easily bent and mishapen, partly
by the actual weight of the body, and partly by the operation
of the muscles. Rickety bones especially, according to the
increase of their vessels and the expansion of their cells with
jelly, become swollen, of a bloody-red colour, and therefore
in different degi'ees too deeply reddened. This rickety soften-
ing is sometimes congenital;^ but it usually only occurs in
the early period of youth, in man and animals.^ The softening
of bone which occurs in adults and old people^ is more malig-
nant and greater, and is found in the whole skeleton, or only
in certain parts ; this is especially called osteomalacia y rachitis
adultorum and senilis; it is much more common in the female than
in the male sex, and often occurs from scrofula, in animals from
the kindred diseases, tubercles, glanders, farcy,^ &c. ; further,
from rheumatism, gout, syphilis, scurvy, mercurial disease, and
in rare cases from onanism,*^ diabetes,^ and lepra ;^ not less does
almost every inflammation of the bony tissue produce this
softening at its commencement. The other kind of diminished
consistence of bone is that brittleness, marcor, and glass-
like FRANGiBiLiTY, fragiUtas vitrettf fractura spontanea^
arising therefrom, which in rare cases is merely the result of
diminished elasticity, and increased deposition of lime, but on
the contrary, is more frequently produced by loss of the lime
and jelly of the bone, and not unusually to such extent, that
the mere weight of the body, and slight muscular exertion
break the bone.^* In rare instances this vice is congenital, or
occurring very early in youth, generally it takes place only in
advanced age ; it also occurs sometimes in animals.^" The
irregular increased consistence of bones, which in and of
itself is no vice, depends always on thickening of the tissue,
and had therefore better be treated of among changes of
structure.

(1) ReiLxs Repertor. Comment. Vol. XIV. p. 255. — de. Phnquet Repertor. Art.
Ossis MoUities ; almost all the writers on Rachitis. — J. C. Plank D. s. morbum
osteosarcoseos singular! casu illustratum. 4to. Tubing. 1711, with figs. — Navier
Observations sur le ramollissenicnt des os. Paris, \75r). — Lu(lwig Pr. Observat.
in cadavere, cujus ossa emollita crant. Lips. 1757. — Boehmer D. de ossium
moUitie ex laesione vi.scerum. Ilahe, ]7()3. — Fries D. de emoUitione ossium.
Argentor. 1775. — J. C. Plank De osteosarcosi commentat. 8vo. Tubing. 1782,
with ])latcs. — Eckmnm) (pncs. ArreU) D. dcscriptionem et casus aliquot osteo-
malaciai s. U])sal. 1788. — Conradi D, de osteomalacia. 4to. Gott. 179f). — Metzf^er
D. de osteomalacia. Regiomont. 1797. — /fewar^/ RamoUissement remarquable des

Sect. XV.] Of Bones in General. 135

OS du tronc d'une femme. 8vo. Majence, 1804, with fig.—Fleichmann in den
Abhandl. der phys. medic. Societat zu Erlangen, Vol. I. No. 1. — Monteggia in
Sedillot Rec. period, de la Soc. de Med. de Paris, Vol. LXI. p. 75. — Jurine in
Journ. de Medec. 1810, Dec. p. 499. — Keller D. de ossium emollitione morbosa,
&c. L. B. 181(). — Some remarkable cases of general osteomalacy are described by
Morand Histoire de la maladie singuliere et de I'Examen du cadavre d'une femme
(Supiot) devenue tout a fait contrefaite par un ramollissement general des os.
Paris, 1752. — Hosty, An account on the case of A. E. Queriot, &c. Philos.
Transact. 1753, Vol. XLVIII. p. 26.~H. Thomson in Med. Observat. and
Inquiris. Vol. V. p. 259. — GoocVs Chir. Works. Vol. II. 1792. p. 395—399.
— Vrolick Memoires sur quelques sujets interessans d'Anatomie et de Physiologie
trad, du Hollandais par Fallot. 4to. Amsterd. 1822. — /. Howship in Transact,
of the med. chir. Society of Edinburgh, 1826. Vol. II. — [^Astruc de Morbis vene-
reis. Lib. IV. c. 4. — Tauvry in Mem. de I'Acad. Roy. Paris, 1700, a case of a
girl whose bones were as soft as wax, and bent every time she was moved ; the
teeth, however, still retained their original hai'dness. — I recollect a boy of seven
or eight years old, who was brought into St, Thomas's Hospital, some years ago,
having fallen down and bent the fore arm, about its middle, nearly to a right
angle; slight extension straitened it, and he did well. T.]

(2) Compare above, § 104, note 2.

(3) To wit, I have observed it in puppies, calves, lambs, and young monkeys ;
examples of the monkey, dog, and porcupine are given by Sandifort, Mus. Anat.
Vol. III. p. 275, No. 908, 909. — /. Amesbury, Observations on the nature and
treatment of fractures of the upper third of the thighbone, and of fractures of
long standing, &c., with engravings. London, 1828. — Many instances of spon-
taneously cured fractures and wounds of bone are given by Sandifort^ Mus. Anat.
Vol. III. p. 202, and in the Recueil period, de la Soc. de M^dec. de Paris,
Vol. LXVI. p. 249. I have also observed them more rarely on the mycetes
fuscus, didelphis Azarae, bradypus didactylus, herpestes ichneumon, and on
a frog.

(4) J. P. Frank Delect, opusculor. Vol. II. p. 304. — Biermayer Musaeum anat.
pathol. No. 440. p. 74. I saw an instance of osteomalacia in a woman of eighty
years old, in the Anatomical Museum at Bonn, Imperfect fractures have been
observed by Lisfranc. v. Revue med. franp. et etrang. 1827. Vol. X. Miscellen.

(5) I found it in the horse, ox, sheep, dog, cat, rat, in very many monkeys,
and in one polar bear ; in birds this disease appears to me more rare. Compare
Dupuy De I'afFection tuberculeuse. 8vo, Paris, 1817. p. 50 and 265 — 268. —
Laubender Theoret. prakt. Handbuch der Thierheilk, Vol. IV. p. 112. Erfurt,
1812. — In the mule and sheep, Robertson Vollst. Werk iiber die Pferdewis-
senschaft, herausg. von Mogalla. Vol. II. p. 235. Breslau, 1800. — In a lioness.
Ephem. N. C. Ann, 1671. Obs. 5, p. 6.

(6) I have seen one case of this kind in the Anat. pathol. Mus. at Vienna.

(7) Po^inPhil. Trans. 1753, ^o. ^59.— Lisfranc.

(8) I saw one example on the hand in the anatomical collection of Dr. Pattison,
at Glasgow.

(9) Fragility of bones may also be produced by the above-mentioned diseases
operating very injuriously upon the bony system. — Waldschmidt D. de fracturis
ossium sine violenta causa externa. Kilon. 1721. — Nicod D. sur la fragility des os.
Paris, 1S07. —Villermd in Journ. de Medec. de Leroux, Vol. XXXVII. p. 331,—
Many instances in Reiiss Repert. Comment. Vol. XIV. p. 254. — de Plouquet Re-
pertor. Art. Ossis Fragilitas ; also Medic. Observ. and Inquiries, Vol. V. — Smith,
in Lond. Medic. Repository, Vol. IV. Sept. — Chevalier in Journ. de M^dec. 1810,
Oct. p. 276. — The Medical Repository by Mitchill, Pascalis, and Akerly, new
series. Vol. I. New- York, 1812 and 1813. — Hutchinson in Lond. Med. Reposit.
April, 1815. — Gastellier in Leroux Journ. de Medec. Chir. et Pharm. Vol.
XXXIII. Juill. 1815.— i/ame in Journ. gen. de Medec. 1819. Vol. LXV. No.
272, p. 90. — Nicod in Annuaire medic, chir. des Hopitaux et Hospices civiles
de Paris, p. 494. Paris, \%\9.^Kriiger-Hausen in v. Graefe's and v. Walther's
Journ. f. Chir. Vol, III. Part IV. p. 647. — Bergmann in Nasse's Zeitschrift fiir
die Antlu'opologie, 1823. Part II. p. 413. — Wkitelaw Ainslie on Elephantiasis,

136 Of Bones in General. [Part II.

in Trans, of Roy. Asiat. Soc. Vol. I. Part II. p. 282. London, 1826.— 0«o Selt.
Beobacht. Vol.1, No. 40, p. 81, and Verzeichniss der anat. Praparatensammlung,
No. 3019. At Breslau the disease is very common in consequence of scrofula,
syphilis, and cancer ; Ekstrom observed it following Radesyge. v. Ars. Berattelse
om Svenska Lakare-Sallskapets Arbeten. Stockh. 1825.

(9*) [J. Pringle in Phil. Trans. Vol. XLVIII. p. 406, mentions a woman of
thirty-one, whose leg was broken merely in walking ; no callus (it is said, per-
haps more properly, no lime,) was generated, and soon after the lime was
removed from all the bones, which, after death, could be cut without turning the
edge of a knife. T.]

(10) Duptiy. — G/grfi/^c^ Abhandlung iiber eine seltene Art des Knockenbruchs
bei dem Rindviche u. s. w. Berlin, 1737. I have observed a great degree of
brittleness in several monkeys, in a hyaena, a two-year old lioness, in some
dogs, stags, and roes.

§112.

To the above described vices, those of continuity in a
single bone naturally follow. These are produced partly by
the more or less deep penetration of sharp instruments, and
are therefore called wounds of bone, vulnera ossium ;^ partly
they arise from various other mechanical causes operating
either externally or within the body itself,^ and are then called
FRACTURES OF BONES, fracturce ossium.^ The latter are
IMPERFECT, fracturcB incompletce,^ if the natural connexion of a
bone is only partially broken, as in fissure of BO^Y.,Jlssura,
and the cracking of bones which are not very brittle ; or as usual,
COMPLETE FRACTURE, fracturcB completcE^ in which the bone
is completely divided into two or more pieces. Such fracture
is either simple, simplex,^ or compound, to which also belongs
the SPLITTING, or crushing of the hone yfractur a comminuta ;
further, according to its direction, it is oblique, fr. obliquay
which is the most common, transverse, ^r. transversa,^ lon-
gitudinal, fr. longitudinaliSf'' or lastly, irregular, fr.
irregularis.

(1) Heister D. de vulneribus ossium rite curandis. Helmst. 1753. in HaUer's
Diss. chir. IV. No. 123. — P. G. van Hoorn D. de iis, quae in partibus membri,
praesertim osseis, amputatione vulneratis, notanda sunt. L. B. \%OZ.~Hennen,
Principles of Military Surgery. 8vo. Edinb. 1829.^ — Diet. d. Sc. m^dic. Art.
Plaic. p. 83. Here belong piercing and perforating stab, cut, and gunshot
wounds, amputations, trepannings, sawings off, chisellings, &c. ; sometimes also
in adults a piece of bone is cut off' smooth without splintering.

(2) From violent muscular exertion ; this is especially the case with the olech
ranon, the knee-cap, and the heelbone, although also with long and other bones;
horses break even the lower jaw in biting, the dorsal vertebrae in drawing, &c.
Compare Nicod Diss. Essai sur la contraction musculaire comme cause de la
fracture. Paris, 1807.

(3) Pott, Remarks on fractures and dislocations. 8vo. Lond. 1768. — Jitkeu,
On fractures and luxations. 8vo. Lond. 1790. — Bernstein Ueber Verrenkungen
und Beinbriiche. 8vo. Jena, 1819. — A. Cooper, Treatise on dislocations and on
fractures of the joints. 4to. Lond. 1823, witli engraving. — ,7. Jmesbury, On the
nature and treatment of Fractures, &c. 8vo. Lond. 1828. — Richter Ilandbuch
der Lehre von den liriichen und Verrenkungen der Knochen, 8vo. Berlin,
1827, with many lithographic plates. — Pautalcon Bivz\)eheT die verschicdenen

Sect. XV.] Of Bones in GeneroL 137

Knochenbriiche der Hausthiere, besonders der Pferde, u. s. w. 8vo. Tubing.
1824. — /. Peterka Griindlicbe und kurzgefasste Darstellung von verschiedenen
Arten Knochenbriichen und Hufkrankbeiten unserer Haus-und Nutzthiere.
Svo. Prag. 1827, witb four lithographic plates.

(4) Boyer, in his Traite des maladies chirurgicales, Vol. III. p. 19, very incor-
rectly disclaims incomplete fractures ; they occur not merely in morbid and in
young bones, which have little lime, but also in the healthy bones of adults. In a
boy, six years old, affected with the blue disease, I found, after a fall, both fore-arms
imperfectly broken ; so also the radius of a lion. No. 3577, a fibula. No. 3890, in
Bresl. Mus., the breast-bone of an adult, several skull-bones of newly born
children, and of the stag and roe kinds ; also in adults, the internal table will
snap oif whilst the external remains uninjured. Other instances are in HegnauU
in Journ. de Medec. Vol. XXVI. p. 159. — Cheselden, Anatomy of the human
body, observed an imperfect fracture in the ribs of children ; and on the ribs
and cubit of grown up persons it was seen by Chaussier Recueil de Memoires,
etc. 8vo. Paris, 1824, p. 447, note; on the fibula by Campaignac, v. von Froriep's
Notizen, 1826, No. 321, p. 207. Compare also Barton in American medical
Recorder, Vol. IV. p. 1, Philadelphia, Jan. 1821; on the vihs hy Marjolin, v.
Archives general, Mai, 1827.

(5) J. Dunlap D. de fracturis simplicibus. Edinb. 1823.

(6) Transverse fracture of the knee-cap is not rare, (see below) ; next of
the shoulder-blade, which I have seen in several collections. Compare also
Allan, System of pathological and operative Surgery, Vol. II. p. 61 ; on the
breast -bone. Otto Verzeichniss, No. 3474, and Haugk D. s. observat. de fractura
sterni et vertebrarum. 4to. Lips. 1816, with plates. — Chaussier e-xhihited such
a breast-bone to the Academy at Paris, on the 8th of May, 1826; Bonn and
Camper have also noticed it in the body of cylindrical bones ; to transverse
fracture belongs also the breaking off of the epiphyses ; v. G. Ch. Reichel D. de
epiphysiumab ossium diaphysi deductione. Lips. 1759, with figs. — Instances are
given by Champion and J. Cloquet, v.Laitrent in Journ. compl. au Diet, des Sc. med.
Paris, 1818. Vol. I. p. 317 — 226. — Julia Fontenelle in Archiv. gener. de Medec.
Vol. IX. Octobr. lS25.—Baumetz, v. von Froriep's Notizen, Vol. VI. No. 6, p. 96.

(7) Improperly do Petit, Boyer and others disallow this ; it has been several
times observed, especially after shot wounds. Compare Hoffmann D. de ossium
cylindricorum fissura. 4to. Lips. 1764, with figs. — Eccard Epistola de ossium
cylindricorum fissura longitudinali. Lips. 1784. — Duverney Traits des maladies
des OS. Vol. I. p. 167. — LeveilU Nouvelle doctrine chirurgicale. Vol. II. p. 158.
— S. Cooper, Surgical Dictionary, Art Amputation. — I have seen such fracture
of the knee-cap, No. 3908, in Bresl. Mus., and of the hip-bone of a horse in
the Veterinary School of Copenhagen. — Lisfranc.

§113.

To the consideration of the broken connexion of a single
bone is very naturally consequent, that of its reunion, reunio,^
as well as the reproduction, regeneratio sen reproduction of
such bony parts as have been lost by injuries or diseases, for
instance, caries and mortification. Both have alike many
resemblances with the similar processes in soft parts, and with
the original production of bone. The reunion of the divided
bony parts is effected by the effusion of a mass which glues
the edges of the wound together, gradually becomes organized
and ossified, that is, by adhesion or per primam intentionem,
which is effected in somewhat longer period than in the soft
parts, on account of the peculiarities of the bones ; thus, then,
in part, pieces of bone which have been completely divided by

138 Of Bofies in General. [Part II.

sharp instruments are very commonly healed ;'' in part, fractures
of bone are easily united by callus.^ In the latter instance
the following is the process : soon after the fracture has
occurred, blood and coagulated lymph is poured out in greater
or less quantity from the ends of the broken bone, from its
periosteal and medullary membrane, as well as from the neigh-
bouring somewhat injured soft parts, which glue all the affected
parts together and produce the so-called callous swelling, which
at first is jelly-like, soft, and reddish, gradually becomes har-
der, and as it were cartilaginous and paler. Whilst the torn
original periosteum is absorbed, there is formed a new one
around the callous swelling, which is connected with the
healthy periosteum on the ends of the bone as well as with the
other surrounding soft parts, and, together with the whole callus,
contains blood-vessels on all sides, whence lime is deposited,
and the callus gradually converted into several hard bones. The
ossification usually takes place first externally, although some-
times also earlier on other parts, and as the mass interposed
between the two ends of the bone becomes ossified, if it be a
tubular bone, the medullary cavity is at the same time divided
into two parts, which division, however, is at a later period again
done away with by absorption. As the broken ends of the
bone are usually at the same time rather soft, and have been
deprived of their angles and points by absorption, and not un-
frequently the primary splinters of the bone surrounded by callus
during the cure, and again become living,^ so at last do the old
and new bone assimilate, and the original form is again tolerably
reproduced. In a similar way, is a bone from which the
middle portion has been removed, as also two distinct bones
from which the articular ends have been artificially cut off,
united." This natural process of uniting broken bones may,
however, be disturbed in various ways ;^ for instance, by
suppuration and mortification in complicated fractures, by great
debility, by syphilis, scurvy, rickets, osteomalacia, pregnancy,
suckling, improper position of the broken bones, and their
frequent motion.'* In such cases either a too large and mishapen
mass of callus, callus luxiirians, is thrown out,^ or the callus is
formed in too small quantity, and does not become hard, so
that one part of the bone remains movable upon the
OTHER, or the ends of the bones become cicatrized, and a new
JOINT is produced between them," in which we sometimes find
plates of cartilage, articular ligaments, and synovial membrane,
as in the normal joints. The processes of bone also which are
broken within the capsular ligament, do not appear to heal by
bony substance but only by ligamentous bands.'"

SficT. XV.] Of Bones 171 General, 139

(1) Compare above, § 5Q, and the writings of the surgeons. A good plate is
given by Bonn^ Tabulae ossium morbosorum, II. fig. 1. — van der Leeuw D.
de ossium vulneratorum etfractorum consolidatione. Groening, 1785. — Howship,
on the morbid appearances and structure of bones, in Med. Chir. Trans. Vol. X.
p. 176. —M. J. Weber in Nov. Actis Acad. W. Cur. Vol. II. Part II. p. 709,
pi. 60—64.

(2) Compare § 56. — Reuss Repert. Comment. Vol. X. p. 41. Vol. XIV.
p. 260.— de Plouquet Repert. Art. Ossis. Regeneratio. — M. Troja De Novorum
ossium in integris aut maximis ob morbos deperditionibus regeneratione expe-
rimenta, Lutet. 1775; and Osservazioni ed esperimenti suUe ossa, in supple-
mento ad un opera sulla regenerazione delle ossa, etc. 4to. Napoli, 1814, with
engravings. — Koeler Experimenta circa regenerationem ossium. Goett. 1786. —
Blumenhach in Richter's Chir. Bibliothek. Vol. VI. p. 107. — Maret in Memoirs
de Dijon, Vol. II. p. 85. — Baronio Delia regenerazione delle ossa in Memor.
della Soc. Italiana, Vol. IV. p. 430. — LeveilU in M^moire de Physiologie et
de Chirurgie pratique par Scarpa et LeveilU. Mem. 4. Paris, 1804. — Osthoff \n
V. Slebold's Chiron. II. p. 539. — Bouillancy in Journ. General de M6dec.
Aout, 1807. — Eggers Von der Wiedervereinigung. Wiirz. 1821. — Charmeil
Recherches sur les Metastases, suivies de nouvelles experiences sur la regene-
ration des OS. Metz. 1821, with engravings. — Eschholz D. de ossium genesi et
regeneratione. 8vo. Berol. 1823, with engravings. — Meding D. de regeneratione
ossium per experimenta illustrata. 4to. Lips. 1825, with engravings; and in the
Dresdner Zeitschrift f. Natur-und Heilkunde, Vol. III. Part III. p. 305. — Knox
inEdinb. Med. and Surg. Journ. June, 1822, and Vol. XVIII. p. 62, April,
1823. — Kortum D. prop, experimenta et observationes circa regenerationem
ossium. 4to, Berol. 1824, with lithographic plates. — Ernst D. de regeneratione
ossium in genere, etc. 8vo. Bonnae, 1824. — M. Troja Neue Beobachtungen iiber
die Knochen, translated by y. Schoenberg. 4to. Erlangen,1828. — [A good example
of adhesion by the first intention in bones, is given in the Lancet, 1828-29,
p. 401, in a case of vertical division of the whole finger by a chaff'-knife, which
was perfectly cured in twenty-eight days. T.]

(3) For instance, the phalanges removed from the fingers, and large pieces of
bone from the skull, No. 8250 of Bresl. Mus. ; further, the pieces sawn otF by
the trepan, v. No. 3195, in my Verzeichniss, u. s. w.

(4) Reuss Repertor. Comment. Vol. X. p. 363. — de Plouquet Repertor. Art.
Callus.— Diet, des Sc. m^dicales, Vol. XXXVIII. p. 416. — Muller D. m. chir.
de callo ossium. 4to. Norimb. 1707. — Bajer D. de callo ossium. Norimb.
1807. — Boehmer Pr. de callo ossium e rubiae tinctorum radicis pastu infectorum.
Lips. 1752, and Pr. de ossium callo. Lips. 1758. — Detlef D. ossium calli
generationem, etc. Getting. 1753. — Delins D. Cicatrix et callus idea nutritionis.
Erlang. 1755. — Bordenave in Fougeroux M^m sur les os. Paris, 1760. — Haller
Op. minor, II. p. 460 and 478. — Marigues D. phys. et chir. sur la for-
mation du cal dans les fractures. Paris, 1783. — Bo7in and Marigues phys. und
chir. Abhandlung iiber die Natur und Erzeugung des Callus iiberhaupt und
insbesondere von den Fehlern und Unfdrmlichkeiten desselben bei Beinbriichen.
Svo. Leipz. 1786. — Macdonald D. de necrosi ac callo. Edinb. 1799. — Wood in
Memoirs of the Literary and philos. Soc, of Manchester, Series II. Vol. III.
1819. — Breschet These. Recherches historiques et experimental es sur la formation
du Cal. 4to. Paris, 1819. — Expose de la doctrine de Dapuytren sur le Cal, par
Sanson in Journ. univ. des Sc. m^dic. Vol. XX. p. 131. Paris, 1820. — J. H.
Reypens Commentatio ad quaestionem ab ordine medicorum propositam : Quae-
ritur ut exponantur variae doctorum virorum sententiae de origine et natura
Calli ossium ; dein observatis in homine, nee minus experimentis in animalibus
institutis, probabilior inferatur theoria ossium fractorum coalitus ; quae praemio
ornata est. 4to. Lovani 1823, with twenty experiments. — Scarpa Abhandlung
iiber die Knochenexpansion und iiber die callus nach Frakturen a. d. Lat. 4to.
Weimar, 1828. — [P. Camper., Observationes circa callum ossium fractorum. T.]

(5) Breschet and Villerm6 in Magendie's Journ. de Physiol, experim. Vol. I.
No. 2, April, 1821, p. 116.— Howship, p, 89 and 97, pi. 10, fig. 6.

(6) H. Park, Account of a new method of treating diseases of the joints of the

140 Of Bones in General [Part II.

knee and elbow. Lond. 1783; Cases of the excision of carious joints, by
H. Park and P. F. Moreau, with Observations by Jiffray. Glasgow, 1806. —
Wachter D. de articul. exstiratione. Grbningae, 1810. — Devov^ D. sur I'utilite de
la resection des os dans les membres- Paris, 1812. — Roux De la resection de
portions d'os malades, etc. Paris, 1812. — Rowland, A case of an ununited
fracture of the thigh, cured by sawing off the ends of the bone, in New. cliir.
Transact. Vol. II. No. 5, — Crampton, in the Dublin Hospital Reports, &c. 1827,
Vol. IV. — \_Roux, on removal of diseased joints, in Revue Medic. — /. Syme, Cases
of excision of elbow and knee joints, v. Edinb. Med. and Surg. Journ. April,
1830. T.]

(7) Callisen De variis formationis calli impedimentis in Collect. Soc. med.
Havn. Vol. II. No. 21, p. 189.

(7*) [A good instance of ununited fracture of the thigh bone from this cause,
is related by Somm4, in Med. Chir. Trans. Vol. XVI. p. '66. T.]

(8) Metzger D. de callo luxuriante. Regiom. 1793. Good plates are given
in Liidwig de quarundam agriter. c. h. sed. et cans. tab. 10, tig. 1 and 2. — ■
Heckeren D. de osteogenesi praeternaturali. L. B. 1797, fig. 1 and 2. It must
be remembered that we are not now talking of callus in the same sense as the
older writers.

(9) de Plouquet KeTpertor. Articulatio succedanea. — Salzmann D. de articu-
lationibus quae fracturis ossium superveniunt. 4to. Argent. 1718. — Gras in
Journ. g^ner. de Med. chir. et Pharm. August. Paris, 1800. — Reisseisen and
Langenheck, in the Neuen Bibliothek f. Chir. Part I. p. 81, fF — Home, in
Transact, of a Society for the impr. of med. and chir. Knowl. Vol. I. p. 233,
gives several instances. — PaUetta Exercit. pathologicae, Vol. I. p. 58. — Flormami
resp. Nerman D. de articulationibus sic dictis accidentalibus, fracturas ossium
interdum subsequentibus. 8vo. Lundae, 1821. — Schwoerer D. de cans, et struc-
tura Pseudarthrosium, etc. 8vo. Friburg. 1822. — Mitsching D. de articulatione
spuria et nova eam curandi methodo. 8vo. Halae, 1822. — Sclmster D. de
articulatione praeternaturali. 8vo. Landshut. 1822. — M. Troschel D. pseudar-
throsi. Svo. Berol. 1826, with a plate. They are not unfrequent in animals.
I have seen them in dogs, cats, a fox, and several birds. — Greve, Erfahr. und
Beobacht, iiber die Krankheiten der Hausthiere, Vol. II. p. 3, found an unnatural
joint in a hare. Compare my Verseichniss der Breslauer Praparatensammlung,
No. 2149, 2150, 2321, 2322, 3589, 3590. —J. Tenon, Observation Anatomique
sur une articulation singuliere dans un chat formee par la nature, in Mem. de
Paris, 1760, Hist. p. 50.

(10) Callisen Annot. circa callum ossium in Act. Soc. med. Hafn. Vol. I.
No. 26, p. 312. — A. Cooper, On Dislocations and Fractures, &c. Lond. 1822, and
his Observations on fractures of the Neck of the Thigh-bone, &c. Lond. 1823. —
Compare below, the thigh-bone and knee-cap.

§114. ,

Partly in a similar manner occurs also the reproduction,
regeneratio, of a bone. If part of it be destroyed by wounds
or mortification, the reproduction occurs as in soft parts by
granulation/ whilst in the newly produced tissue lime is also
gradually and freely deposited.^* The bone usually forms at such
part a more or less thick and deep cicatrix ; in rare cases this
rises even above the surface of the bone. The unattached
ends of bone produced by amputation become smooth, rounded,
and narrowed by absorption and contraction, and are always
closed by a new mass of bone.^ Should the bony parts have
been destroyed by necrosis, there is poured out a mass very
similar to callus, which, by expelling the hard dead piece>

Sect. XV.] Of Bones in General, 141

becomes homogeneous with the healthy bone, and thus the lost
bone is completely replaced.^ In such manner large pieces of
bone, and even whole bones, have been seen to be reproduced ;*
this, however, especially applies to hard and thick bones, as
the spongy bones cannot be thus restored, but are cured by
granulation and cicatrization with large deposit of lime in the
bony tissue/

(1) Compare above, § 56. The reason why holes in the skull, made by the
trepan, are closed with greater difficulty, is the want of blood vessels, both as the
outer and inner membranes of the bone are removed. — \_Craigie seems to doubt
whether these apertures are ever filled up. He admits, with reservation, Weid-
tnann's case, pi, 12 ; but thinks that the cases seen by Russell, who states that the
solid matter *' possessed all the qualities of solid bone," rather resemble the
reproduction after fracture than that after necrosis, v. his Elements, p. 568. T.]

(1*) [These granulations, often, however, have so strong a tendency to ossify,
that it becomes a considerable inconvenience, i. e. they form higher than the sur-
face of the bone in general, which prominence prevents the process of cica-
trization. John Hunter, MSS. Lectures on Surgery. T.]

(2) Fan Hoorn D. de iis, quae in partibus membri praesertim osseis, ampu-
tatione vulneratis, notanda sunt, p. 36. L. B. 1803. — In rare instances, the
uniting bony mass is poured out in too large quantity, and forms mishapen
projections. In a hare, the foot of which had been shot off, a paw-like bony
mass served as a foot. C'etoit une espece de jambe de bois, dont la nature seule
avait fait les frais ; Morand in I'Histoir. de I'Acad, des Sc. de Paris, 1770, p. 30.

(3) Compare the particular observations on necrosis.

(4) V. the writings of surgeons. — Voigtel Hanb, der pathol. Anatomie, Vol. L
p. 199 — 209. — de Plouquet Repertor. Ossis regeneratio, &c.

(5) Compare Bauer Ueber das geringe Wiedererzeugungsvermogen der
schwammigen Knocken, in Heidelberger klinischen Annalen, Vol III. Part I.

§ 115.

On account of their peculiar structure and composition, the
VICES OF TEXTURE of boucs differ very remarkably from those
of soft parts, but, like them, are they also specially produced by
the inflammatory state. The periosteum, as an essential part
of living bone, not only participates in these vices of texture,
if at all important, but is, when primarily affected, also often
the cause of them. Inflammation of bone, ostitis, inflam-
matio ossium^ attacks, indeed, all bones, but especially those
which are very vascular, as young bones, the bodies of the
vertebrae, the articular extremities of long bones, the bones
of the hands and feet, &c.,^* and arises partly from external,*
partly from internal causes, especially from scrofula, syphilis,
rheumatism, gout, and metastasis in fevers and eruptive
diseases. Inflammation can exist at the same time in the
whole bone, or locally, only in the periosteum,^ periostitis^
or in the so-called medullary membrane ; and in the latter
case, according to the strength of the bony tissue, it is con-
fined for a long time to the external or internal layers of
the bone, although it occasionally attacks more or less the

H2 Of Bo/ies in General. .^ [Part II.

whole tissue, especially in the spongy bones. Should this
be the case, the bone becomes swollen,^ and exhibits in its
substance, as well as in the periosteum and medullary mem-
brane, a great quantity of blood-vessels, and thereby becomes
somewhat and in rare cases remarkably red. The cells and
canals in the bony tissue increase in size, are irregular, run
together in part by the absorption of their walls, and are filled
with blood and jelly, so that the fine membranes by which they
are lined are found distinctly thickened. The proportion of
lime in the bone is more or less diminished according to
the intensity and duration of the inflammation. We find the
periosteum thickened and relaxed ; ^ this is especially the case,
if the inflammation of the bone arises from it, and if it have
been long provoked by disease of the neighbouring soft parts.
In such cases the surface of the bone generally exhibits an
oftentimes very material roughness and porousness.^*

(1) G/oA's D. de ossium inflammationibus. L. B. 1728. v. Nailer's Bih\. chir.
Vol. II. p. 198. — Fr. Hoffmann de infl. oss. Halae, 1737. — Scrinci D. de ossium
natura, horumque inflamniatione in genere, etc. Pragae, 1743. — Wallerian
Lectiones curiosae de morbis ex ossium inflammatione ortis. Regiom. 1764. —
Nebel Pr. de oss. inflammationibus. Giessae, 1778. — Flormann D. de infl. ossium.
Lund. 1799. — Soeminerring de morbis vasorum absorbentibus, p. 164. — Tornero in
Memor. Acad, de la R. Soc. de Sevilla, Vol. III. p. 131. — Victorino, ib. Vol. V.
p. 62. — Schramm D. de oss. inflam. Altdorf. 1805. — Naumann D. de ostitide.
4to. Lips. 1818. — Hale Comm. de oss. inflam. 8vo. Goett. 1821. — Howship,
On the morbid appearances and structure of bone, in the Med. chir. Trans.
Vol. X. p. 176. — Goetz D. de ostitide. 8vo. Landshuti, 1822.

(1*) [Soft bones, and the soft parts of hard bones, are more subject to inflam-
mation than others. /. Hunter, MSS. T.]

(2) Cold, but especially mechanical influences on the bone itself, or upon
the neighbouring soft parts, as muscles, synovial membranes, &c. from which the
inflammation extends itself further.

(3) With reference to idiopathic inflammation of the periosteum, compare
especially. Ph. Crampton, in Dublin hospital reports and communications, &c.
Vol.1, p. 337 — 397. — Bradley Tylor mentions a remarkable instance of fatal
periostitis in the American Medic. Recorder. Vol. II. No. 1. Philadelphia,
1819. — Meiselhach D. de periostei inflammatione. 8vo. Halae, 1824.

(4) All the bony tumours, which are indeed sometimes very obscure, may
be produced by an inflammatory state ; the kind of loosening and swelling
varies considerably. Compare the following §§.

(.'3) It has been once seen half an inch thick, upon the skull, after an injury,
v. Trye in Med. Communic. Vol. II. London, 1790. I have seen it in tumours,
with growth of bone even an inch thick. — [The periosteum becomes very easy of
separation after inflammation, if the ossifying disposition does not take place.
J. Hunter, MSS. T.]

(5*) [Ossific inflammation is distinguishable after death by the loss of shape.
J. Hunter, MSS. T.j

§ no.

To the terminations of inflammation of bones, which when
found in a distinct degree, is rarely cured by resolution,
belong especially suppuration of bone, ulceration and

Sect. XV.] OJ Bones in General. 143

MORTIFICATION, curies.^ This disease is very similar to the
ulceration of soft parts, and, like it, varies much according to
the causes giving rise to it,^ of age, of the parts attacked, &c. ;
but it always consists in a greater or less destruction and dis-
colouring of the bone, with secretion of pus.^ Young and
spongy bones largely supplied with vessels most commonly
become carious.^* In many cases, in consequence of the
destruction of the neighbouring fleshy parts, and of the parts
surrounding the articular extremities,* the periosteum and the
upper surface of the bone become first destroyed, caries
externa; more commonly the disease commences in the inte-
rior of the bone, caries centralis^' then sometimes forms a
circumscribed abscess, osteoapostema^ and frequently one or
several sinuses, osseous fistulas, make their way to the
surface of the bone.^* A peculiar and very malignant form
of bony mortification is the so-called p^darthrocacy, spina
ventosa^ pcedarthrocace.^ The characteristic of this disease
is a malignant bony tumour originating from within, with very
great swelling of the diseased bone, and often accompanied
with a disposition to deposit lime in the neighbourhood of the
tumour, in form of points or spines. The latter, however, is
not always the case, and the bone forms not unfrequently, in
spina ventosa, a large bladder-like, tolerably smooth enlarge-
ment, without any bony increment. In the interior of this
spina ventosa we find a very loose bony tissue with spongy
cellular tissue, abscesses, and sinuses, and not rarely also
cavities filled with lymph and blood. The spina ventosa
attacks hard and thick as well as spongy bones ;^* it affects, in
children, the articular ends of bones which are swollen by
rickets, the so-called double joints, and thus we are led to call
it especially paedarthrocacy.

(1) Compare de Plouquet Repertor. Ossis Caries. — Reuss Repert. Comm.
Vol. XII. p. 236. — Heinze D. de carie ossium. Gryph. 1751. — Fitzgerald D. de
carr. oss. Monspel. 1752. — Rauschert D. de c. o. L. B. 1706 ; in Haller's Bibl.
chir. Vol. TI. p. 422. — Nicolai .D. de c. o. in genere. Jen. 1762. — [C Barberis
De ossium carie. 4to. Monsp. 1775. T.] — Ferrand D. de c. o. Paris, 1765. —
Piderit Geschichte eines sehr merkwUrdigen Beinfrasses. 8vo. Kassel, 1781.
— Ulmann D. s. ossium cariem. Marb. 1795. — Delzeules D. sur la necrose et
la carie. 8vo. Paris, 1802. — Levret D. sur la carie. 4to. Paris, 1805. — Jua7i
D. sur la carie. 4to. Paris, 1806. — Walter, D. de carie. Helmst. 1807. —
Louis D. de carie vera. Erlang. 1807. — Mariglier D. de carie. 4to. Paris,
1811. — Wissmarm Observationes de rite cognoscendis et curandis nuda-
tione, carie et necrosi ossium. 8vo. Halae, 1820. — Schmoelzl D. de ossium
carie. Landshut. 1823. — Wehmeyer D. de ossium carie. 8vo. Rostock, 1826. —
In animals, caries is much more rare than in man; the scrofulous, however,
occurs in confined animals, and caries in the spine of horses, from poll evil,
saddle-gall, ulcer on the croup. Compare No. 3246, 3351, 3520, 3521, 3788,
3789, of the Breslau Museum. — A cured caries on the skull of a monkey,
v. Sandifort, Mus. Anat. Vol. III. p. 276, No. 919.

144 Of Bones in General. [Part II.

(2) For instance, the caries from mechanical causes, the malignant caries from
internal causes, the scorbutic, scrofulous, syphilitic, the corroding from pox,
the cancerous, &c.

(3) This is usually at first, though not always, thin, ichorous, very stinking,
mingled with broken up bony fragments, and, according to the greater quantity
of salts, especially phosphates, which it contains, blackening a silver sound.

(3*) [Suppuration does not so often take place in bone as in soft parts, be-
cause when it does take place the etFects are so very serious. Although suppu-
ration sometimes takes place in the substance of bones, yet the periosteum of
bones being more liable to inflammation, more frequently suppurates, and the
bone becomes aflfected in this way. J. Hunter, MSS. T.]

(4) Compare Eclc D. de carie articulorum externa cum interna comparata.
8vo. Berol. 1818, with engravings.

(5) Compare especially. Rust Arthrokakologie, oder iiber die Verrenkungen
durch innere Bedingung und uber die Anwendung des Gliiheisens. 4to. Wien,
1817, with eight engravings.

(5*) [Bones are not very liable to suppuration, performing many operations
without this process. /. Hunter, MSS. T.]

(6) Also Ventositas spina, Arthrocace, Teredo, and falsely Bony Cancer. Much
confusion occurs in writers, with reference to spina ventosa. Many cases of
morbus coxarius, of tumor albus, &c., belong here. — N. Massa, Epist. medic.
4to. p. 108, Venet. 1550, first used the name spina ventosa. — The older writers,
de Plouquet Repert. Art. Paedarthrocace, and Reuss Repert. Comment. Vol. XIV.
p. 261 — 2G3. — Hemmer D. de spina ventosa. Hafniae, 1595. — Augustin D. de
Spina ventosa ossium. 4to. Halae, 1794, with four plates. — G. Ghioni Memoria
sopra la detta Spina ventosa. 8vo. Parma, 1798. — Lagresie Observations sur
I'amputation de la cuisse, necessitee par le spina ventosa du tibia et du peron^,
etc. 8vo. Paris, Ann. VII. — Houzelot D. sur les maladies du systeme lympha-
tico-sanguins des os, connues sous les dilFerens noms de Paedarthrocace, de spina
ventosa, d'osteosarcome, ou de carnifications des os. 4to. Paris, 1804. — Fan-
denzaude D. sur le spina ventosa. 4to. Paris, 1805. — Suchchardt Annotata
quaedam de spina ventosa, etc. 8vo. Marburgi, 1817. — Haenel D. de spina
ventosa. 4to. Lips. 1823, with plates. — Stark, Prog. Historia morbi ossium faciei
memoratu digna, cum nonnullis adnotationibus in spinum ventosam et exostosin
Contin. I. 4to. Jenae, 1827. — Good engravings in Sandifort's Mus. anat.
tab. 89, fig. 1 — 3; tab. 320, 321, 424 — 474. In animals, spina ventosa occurs
not very rarely, especially in the jaws of oxen and horses, and in their feet. v.
No. 3106, 3168, 3868, of the Bresl. Mus. in the tip of the tail of monkeys, of the
coati mondi, of a camelion. No. 4859, &c. — Stark, &c. Continuatio, II. Prog. —
R. Kraner D. de pancreatitide. 4to. Jenae, 1828. — [J. Pandolplimus De ventosi-
tatis spinae saevissimo morbo. 12mo. Norimb. 1674. — //. Meer De spina ventosa.
4to. Duisb. ad Rhen. 1729. T.]

(7) Severinus Tractatus de paedarthrocace, etc. in de recondita abscessuum
natura, p. 335. L. B. 1724. — Fausius D. de paedarthrocace. Heidelberg. 1657. —
Chun D. de paedarthrocace. Marburg. 1697. — Schmidt D. de paedarthrocace.
L. B. 1721. — Nehel D. de P. Heidelb. 1745. — Rosenhlad D. s. casum paedarthro-
caces. Lund. 1777. — [More recently, F. Freind, who placed the primary
action in the marrow, which becoming diseased and enlarged, separates the
outer lamella, and distends the periosteum with pjKU and swelling. — Monro
primus Cheseldev, and others, held the same opinion. — Bromfield thought it
an abscess in the marrow ; v. his Surgical Observations and Cases, Vol. II.
p. 20 — 22. 8vo. London, 1737; and Warner, that it originated in the marrow
and vessels; v. his Cases in Surgery, p. 322. 8vo. London, 1760. — Richerand
considers spina ventosa as a variety of osteosarcoma, and that it is the simple
scrofulous swelling of the articular extremities of the phalanges, the mem-
brane lining the spongy cells of which becoming thick, inflamed, ulcerated,
and ])uttincT forth more or less abundant vegetations. Further, that it does
not difi'cr from su])purating exostosis or caries, except in the excessive
swelling of the bony substance and the enormous size which the articular
extremities of bones acquire; v. his Nosographie Chirurgicalc, Vol. III.

Sect. XV.] Of Bones i7i General, 145

p. 120. 8vo. Paris, 1815. — Scarpa holds the same opinion; v. his work De
Anatome et Pathologia Ossium, p. 76 — 78. T.]

(7*) [This is denied by Craigie ; he says, that " Spina ventosa never occurs
in a bone with a distinct medullary canal, unless at the epiphyses where the
structure is cancellated." And that the true agent of the process is the vascular
medullary web, especially of the epiphyses; v. his Elements, p. 568 — 572. T.]

§117.

Another common consequence of inflammation is mortifi-
cation OF BONE, necrosis, osteonecrosis, osteogangrena,^
answering to the gangrene of soft parts, but proportionally
more frequent and of a more favourable kind than that. Mor-
tification of bone may indeed occur in all parts of the skeleton,
although it especially attacks the hard bones, ^ and is always
succeeded by a separation, exfoliatio^ of the dead portions
of bone from the living.^* According to the state of the bone
attacked as well as the causal proportions, mortification of bone
exhibits various differences. If a part of the body be completely
aflTected by gangrene, the bones found therein become dead,
spongy, light, frangible, and of a blackish brown colour.* In
other cases, when scorbutic ulceration and hospital gangrene
render the bones in the neighbourhood necrotic, so with
similar discoloration they become softer and more soluble ; in
the common cases of necrosis, on the contrary, the dead bone
is dry, rough, very deficient in jelly, frequently porous, or
as it were, externally corroded, and mostly snow white, but
more rarely coloured by a blackish or brown pigment evolved
in the body itself. Often is the necrosis connected with
caries, or it is the consequence as well as the cause of
the latter ; in fracture also single portions of bone not unfre-
quently become necrotic, and are separated and thrown off by
exfoliation.^ Mortification sometimes occurs only in certain
layers of bone, for instance, the external, necrosis externa,
superficialis , or the internal, Jiecrosis interna, centralis ; some-
times the whole mass, necrosis totalis. The first usually arises
from the exposure, denudatio, of bone, in consequence of the
morbid destruction of the neighbouring fleshy parts, &c., and
attacks a greater or less portion of the outer table of the bone,
which, when it is separated, is thrown off" by ulceration, and
replaced by granulation.^* The necrosis interna occurs almost
only in tubular and round bones, ^ the necrosis totalis, on the
contrary, in all solid bones. The latter kind of bony mortifi-
cation, especially in tubular bones,^ exhibits the remarkable
phenomenon, that before the dead piece of bone has been
separated from the living part, there is poured out between
the inflamed periosteum and dead bone a jelly-like mass, which

L

146 Of Bones in General, [Part II.

gradually hardens and becomes ossified, surrounds, like a
sheath, vagina sen capsula sequesfralis, the necrotic bone,
which is then called a sequester, sequestrum;^ at first is con-
nected with it, subsequently separates from it, and is then lined
internally by a delicate medullary membrane. In the midst of
these bony sheaths are one or several holes, foramina grandia of
Troja, cloaccB^ of Weidmann, which running into the already
existing sinuses of the soft parts, produce an outlet for the
continually absorbed and diminished sequestrum, as well as for
the secreted lymph and pus, and when this is effected, they
become gradually closed up. In the necrosis interna, the
process is exactly the same ; but in this case, the jelly-like
substance poured out beneath the periosteum is only connected
with the remaining living circumference of the bone, which, in
many cases, swells simultaneously, and becomes softish.
Both in necrosis totalis and interna, as well as in the externa,
if the dead piece of bone be of some thickness, the medullary
cavity in tubular bones is usually closed up,^" at least for a
time, by the deposition of bony matter.

(1) By the ancients in part, Caries sicca; Louis, in Mem. de I'Acad. de Chir.
Vol. V. first distinguished this disease by the name Necrosis. — de Plouquet
Repert. Art. Ossis Necrosis. — Reuss Repert. Comm. Vol. XII. p. 246, and the
above-mentioned writers, § 113, note 2 ; especially Troja, Knox, Meding and
Cor turn ; — Robert, ^xxs. C^o/jar? De necrosi ossium Theses. Paris, 1776. — David
Observations sur une maladie, connue sous le nom de Necrosis. Paris, 1782.
— Hirsch, praes. Metzger D. de necrosi ossium. Regiomonti, 1791. — Weidmann
De Necrosi ossium. fol. Francof. a. M. 1793, with engravings; and ih. Ueber den
Missbrauch des gliihenden Eisens um brandige Knochenstiicke abzusondern,
a. d. Lat. von Jos. und A^. IVenzel, 4to. Frankf. a. M. 1801, with eight plates. —
Russel, A practical Essay on a certain disease of the bones, termed Necrosis,
Edinb. and London, 1794, with six plates. — Macdonnld D. de Necrosi ac Callo.
Edinb. 1799. — Himly Abhandlung iiber den Brand der harten und weichen
Theile. Svo. Gotting. 1800. — Deleuze D. sur la necrose et la carie. Svo. Paris,
1802. — Birgelmann De necrosi ossium. Rudolst. 1804. — Beclard in Bullet, de
la Fac. de M^dec. de Paris, 1815, p. 427. — Whately, Practical observations on
necrosis of the tibia. London, 181J. — Blaise Essai sur la necrose. 4to. Paris,
1815. — Lannes \). sur la necrose en general. 4to. Paris, 1815. — Cullerier
Observations sur des necroses du crane, etc. in Annuaire med. chir. des
Hopit. et llosp. Paris, 1819, p. 437. — Wissmann D. s. observationes de rite
cognosccndis et curandis nudationc, carie et necrosi ossium. Halae, 1820. —
Hennen D. de ossium necrosi. Edinb. 1821. — Kleemann D. de ossium necrosi.
Svo. Berol. 1821. — Flecchia Sulla necrosi e sopra un raro osseo processo, in
Otnodci's Annali univers. di Medic. 1821, Vol. XVII. — Borgh Ite Verhandling
over de necrosis gevolget van eenige Waarnemingcn. 8vo. Groeningen, 1822,
with plates. — Weigleiu D. de necrosi. 8vo. W'ien. 1824. — J. Russel in Trans,
of the med. chir. Soc. of Edinb. 1824. No. 3. — Richter Die necrose, pathol. und
tlierapeut. gcwiirdigt. 8vo. Berlin, 1826, and in v. Graefe's and r. Walther's Journ.
f. Chir. Vol. VII. andWU.— Rudolph I), de necrosi. Svo. Berol. 1827.—/*.
Hindenmcht Ueber die Erkentniss und die Beliandl. des Knockenbrandes. Svo.
Wiirzb. 1827.

(2) Especially the shin, upper arm, and thigh-bones, the extremities of which
it however spares ; the lower jaw, and in syphilitic persons, the llat skull-bones.
[Uard bones and hard parts of soft bones are found to exfoliate most readily,

Sect. XV.] Of Bones in GeneraL 147

this depending on the hard becoming dead most readily, from the fewer vessels
in them ; so that it is almost impossible to lay a hard bone bare without exfolia-
tion being the consequence. J. Hunter, MSS. T.]

(3) Scaling, when sometimes the separate layers of the bones are thrown off
like leaves. — Exfoliatio sensibilis and insensibilis, if the smaller pieces of bone
thrown off are entirely absorbed or evacuated with the pus. — Reiiss Repert.
Comment. Vol. XIV. p. 251. — Boulay D. sur I'exfoliation des os. 4to. Paris,
1814. — Menegazzi, in Brera's Giorn. di Med. prat. Vol. I. Part I. gives a very
remarkable instance of exfoliation on several parts.

(3*) [When a piece of bone becomes dead, it nevertheless adheres to the
living part by attraction of cohesion, but it acts as an extraneous body would
do, by stimulating it. In consequence of this stimulus, the surrounding living
bone becomes inflamed and more vascular than before, the surrounding parts
also inflame, and often take on the ossific disposition to a great extent; the
earthy part of the bone is next absorbed, but the dead bone still adheres to the
living by the animal substance of the bone ; the next process then is the absorp-
tion of this animal substance ; the absorption begins at the circumference and is
continued to the centre ; next the granulations arise (beginning at the circum-
ference before it is entirely absorbed at the centre) from the living surface
between the living and the dead bone, and the latter is pushed off. J. Hmiter.
MSS. T.]

(4) So that the whole limb may be separated. Compare § 62, note 2. A
rare instance of loss of the thigh-bone is given by Desessartz in M^m. de I'lnstit.
nat, Ann. IV. Vol. I. — In the Anatomical Museum of the Joseph Academy at
Vienna, I saw four such feet, and a fifth in the Anat. Mus. of the University
there.

(5) The so-called secondary splinters.

(5*) [The dead bone is sometimes confined by the granulations extending over
the edges of it and becoming ossified; if the parts so circumstanced are left to
themselves, the same process will happen as in cases of other extraneous bodies,
&c. the pressure producing ulceration. J. Hunter, MSS. T.]

(6) Weidmann, De necrosi ossium, p. 94, however, gives an instance of it
on the hip-bone.

(7) Among the flat bones this kind of regeneration has been only observed in
the blade-bone. v. further, § 140; the necrotic bones of the skull, as they are
generally reproduced, effect this by granulations from the edges and from the
dura mater. No instance of the round bones is known, except the heel-
bone belonging to the Museum at Kiel, in which, however, the containing vagina
aequestralis appears to be the shell of the old bone. Compare Seidel Index Musei
anatomici Kiliensis. 4to. Kiliae, 1818. No. 27, p. 22.

(8) Sc. Os. — The size and form of such sequestra vary exceedingly ; some-
times they form a complete tube, sometimes merely a part ; in internal necrosis
both their surfaces are rough, but in complete necrosis the external is usually
smooth.

(9) Usually we find only single cloacae, but Kohler saw sixteen ; v. Experi-
menta circa regenerationem ossium. No. 146, p. 45 ; on a tibia in the Anato-
mical Museum at Griefswald, I counted as many as thirty cloacae. Disputes
upon the cause of their origin. According to Meding and Cortunij birds seem to
form no cloacae.

(10) Here belongs also the case described by Munk of Rosenschold, which is
not very well known to me ; v. D. resp. Rabben, de formatione novi ossis in
cavamine tibiae, exemplo comprobata. 4to. Lund. 1814.

§118.

Besides caries and mortification of bone which are the most
common consequences of bony inflammation, the latter particu-
larly, if it take on the chronic form and depend upon certain
dyscracies and general diseases, produces some very striking

L 2

148 Of Bones in GefieraL [Part II.

vices of texture. To these belong erosion, increased depo-
sition OF lime, and the cancerous kind of bony dis-
eases.

First, as to erosion, erosio, 'Avaj^pwmg,^ this is a partial
destruction of a bone by increased absorption, which is of an
inflammatory nature, and is often very distinctly produced by
the increased activity of the numerous veins of the bone. It
differs from caries, to which it often otherwise is very similar, in
being unaccompanied by suppuration, and usually also without
discoloration ; from tabes ossium, on the contrary, by its in-
flammatory nature, and inasmuch as it not merely attacks the
diploe, but also the external table of the bone. The erosion
then is sometimes internal, sometimes external; the former
is commonly the consequence of scrofula proiracta, syphilis,
cancer, and other general cachexiae, in which oftentimes a
morbid irritation and inflammatory condition of the bone is
produced ; the lime is then gradually removed, the diploe more
or less destroyed,^ and the bones, often quite soft, are mostly in
the commencement filled with hard marrow, in which, as in the
remaining bony substance, are seen many expanded tortuous
veins. If the weakness of the organism increase, so that at
last the jelly and hard fat of the bone are consumed, in their
place is deposited lymph, which is often bloody, or a thinnish
fluid-like marrow, and thus the brittleness of the bone, fragi-
litas vitrea, is produced. In rare cases this internal erosion
arises from the morbid activity of the blood-vessels, and there
is found, instead of the absorbed bony tissue, a greater or less
collection of blood, mostly coagulated, but sometimes also fluid,
which partially destroys, but always very much expands, the
outer walls of the bone, and thus produces true bloody tu-
mours, tumores sangtiinei, of bones. In most instances this
disease is, as it were, a varicosity of the bone, and we then
find at death, a thin half-coagulated blood collected in the cells
of the bony tumour and in the veins, which are here and there
enlarged and knotty.^ More rarely are these bloody swellings
of bone of an aneurysmal nature, present during life some
pulsation, and in their interior, the coagulated fibrous part of
the blood partially mingled with cruor in large cells and cavi-
ties, and the distinct termination of a quantity of fine arterial
branches in the cells.' Just as common as the internal is the
external erosion, which originates in a certain inflammatory
irritation of the surface of the bone from disease of the soft
parts and periosteum lying upon it, but especially from con-
tinued pressure, from eflused blood, ^ and tumours of various
kinds, more particularly aneurysmal, fungous, and scrofulous

Sect. XV.] Of Bones in General, 149

tumours, which run into softening on the surface of the bone.
At first the bone is more or less rough, often marked with deep
hues, the indentations of the expanded blood-vessels, or perfo-
rated at several points, as if it were absorbed ; the outer walls
of the bone are gradually destroyed, together with more or
less of the diploe; and flat bones, for instance, the bones of
the skull, and the breast bone, are not unfrequently completely
perforated.

(1) It is commonly held by some persons to be the same as consumption of
bone, tahes ossium, (compare § 107,) and is besides often very similar to, and
even connected with it, although I think it may be distinguished not improperly
from that disease. In reference to its literature, v. above, § 107, note 5 ; Scarpa
in D. Memoir, de la Soc. Roy. de Med. 1780 and 81, Vol. IV. first distinguished
the erosion in aneurysm from caries ; Cumin first employed the word anabrosis
in the Edinb. med. and surgical Journ. 1825.

(2) In the long tubular bones, the shell only remains, hardly a line thick ;
Saillant in Histoire de la Soc. Roy. de Medecine, 1786, p. 98, call, t\\\s gouttc
medullaire. Compare Lohsiein Compte rendu, &c. p. 26 ; many such prepara-
tions are found in the Bresl. Anat. Mus. I have several times seen on the
flat bones of the skull, pelvis, and shoulder-blades roundish pits, closed on both
sides merely with periosteum, and containing a thin jelly ; v. my Verzeichniss,
u. s. w. No.'3522, 3649, 3925.— Selt. Beob. Part II. p. 11, No. 4 ; a good en-
graving is given by Cppeland in his Observations on the symptoms and treat-
ment of diseased Spine. 8vo. London, 1815.

(3) To these belong in part Bayer's tumears fongueuses sanguines accidcntelles.
v. Traite des maladies chirurgicales. 2d edit. Paris, 1818, Vol. II. p. 318. —
Fahriz Hildanus Observat. Cent. II, Obs. 35, p. 110, — Else, Medic. Observat. and
Enquiries. Vol. III. p. 169. Lond. 1769. — Perc. Pott, Chirurgical Works. — Lassus
Pathol, chirurg. Vol. I. p. 489. — Pelletan Clinique chirurg. Vol. II. p. 14,
Obs. 3. — Breschet Sur des tumeurs sanguines, etc. in Repert. gen. d'Anatom. et
de Phys. pathol. 1826. Vol. II. No. 4, p. 263. Several of the preceding obser-
vations, however, describe cases of osteosarcom, in which much blood is found
in the tumour. I have seen two cases of this kind in the lower jaw and on
the shin-bone.

(4) Pearson Medic. Communicat. Vol. XI. p. 95, Lond. 1790. — Scarpa SuU,
Aneurysma. Obs. 10. — Lallemand in Repert. gen. d'Anat. et de Phys. patlio-
logiques, 1826, Vol. 11. No. 4, p. 253. — Breschet^ p. 280, in which are described
three cases horn Dupuytren's practice. Simultaneously also with osteosarcom we
find small aneurysms; v. my Selt. Beob. Part II, p. 30, — Scarpa, p. 103.

(5) Hu7iter in Med. and Surg. Observations and Inquiries, &c. Vol. I. —
Thomas in Edinb. med. Comment. Vol. VI. p. 75.

§119.

The INCREASED DEPOSITION OF BONY MATTER, hyperostosis^

consequent on the inflamed state of bones, appears under a two-
fold form, viz. as internal and external. The former
indeed, in a milder degree, is the usual and best consequence
even of the least important inflammation of bone, which on
account of its hardness, does not appear capable of being
resolved in a similar manner to inflammation of soft parts.
The necessary consequence of this deposition of bony mat-
ter in the diploe is naturally, increased weight and soli-
dity of the bones. The more frequently the inflammatory

150 Of Bones in General, [Part II.

condition recurs, or in other cases the longer the morbid irritation
favours the deposition of hme, the more is the weight and sohdity
increased ; so that such bones not unfrequently assume an ivory-
like state, and if they be tubular, their medullary cavities are also
filled with bony substance.^ This bony deposition, however, is
always favourable, and is not, as to its consequences, to be com-
pared with the induration of soft parts ; it is on the contrary a kind
of cure for many diseases of bone, or at least an attempt thereat.
We therefore often find a bone consolidated in the neighbour-
hood of caries and spina ventosa; frequently the venereal
disease,^ and malignant gout, produce great weight and solidity of
the bones ; sometimes also the looseness of bone from rickets,
or other ill-defined and mixed morbid causes, are as it were
cured by the increased deposition of lime, and thus distinct
bony tumours, with accompanying unnatural solidity, density,
and weight, are produced. We most commonly observe this
latter disease, which in a more restricted sense we call hyper-
ostosis, on the head,'' although sometimes also on other bones,
and even on several parts of the skeleton at the same time/
More frequent than on the interior, is the deposition of lime
on THE SURFACE OF THE BONE, or the EXTERNAL hyperos-
tosis; for the most part also, as is natural, is it more injurious
in its consequences than the former. The inflammatory states
of the periosteum, and the outer table of the bone, produced
partly by mechanical, and partly by internal causes,*^ are the
usual origins of this disease. Sometimes the lime is deposited
in the loosened periosteum, which then becomes cartilaginous
and bony, in leaf-like patches,^ or it assumes the form of flat-
tened rounded tumours of cartilage, gummata^ or of nodes,
nodi. If the superfluous bony mass be situated on the bone
itself, we call it, when it forms a local and defined prominence,
a BONY TUMOUR, exontos'is^ but if it be very large and less
distinctly defined, a bony growth, luxuratio ossium; the
bony tumours which occur in cavities, for instance, in the
skull, the orbit, the pelvis, the joints, we distinguish by the
name cnostosis ; sometimes in the skull an exostosis is pro-
duced simultaneously on the external and internal surface.
The bones of the skull, as well as the tubular bones, and of
these, the thigh and shin bone, most commonly present exos-
tosis; next them perhaps, the vertebrae and the pelvis; still
however they can be produced on any bone,'" and in rare cases
on many parts of the skeleton sinmltaneously.^' They are also
frequently found in great number in the neighbourhood of bony
parts which have been affected with long-continued caries'^ and
spina ventosa.'^ Their foim and size assume an endless

Sect. XV.] Of Bones in General. 151

variety ; we observe them flat, globular, gibbous, tooth-like,
styliform, broken as it were at both ends and arched in the
middle,^* sometimes they attain the size of a child's head, and
even that of man. But even more considerably does the
texture of these bony tumours vary ; frequently are they of a
mixed structure; they assume, however, three principal forms:
they consist indeed often of a more or less close, even ivory-like
healthy bony mass, which as it were exudes from the surface
of the bone, and there coagulates ;^^ in this case the outer layer
of the bone only appears slightly changed in its structure ; the
spiny and tooth-like exostoses also, as in spina ventosa,
appear to be very hard and close. In other instances, from the
loosened surface of the bone, innumerable delicate bony fibres,
standing close to each other in a perpendicular or oblique
direction, shoot up in the inflamed and spongy-like loosened
periosteum ; these bony fibres are of the length of an inch or
thereabout, are harder and closer at their base, and at their
further end soft and cartilaginous, and penetrate into the
cellular tissue of the loosened periosteum, which still remaining
externally unbroken, dips deeply inwards between the bony
fibres, surrounding them like sheaths. Lastly, in other cases,
by the partial expansion of the bone from within, the con-
tained exostosis has its interior loose, cellular, very vascular,
and its cavities filled with very different substances, which
vary in consistence from lymph to soft cartilage ; large tumours
of this kind are particularly common in the lower jaw,^® and
still more in the bones of the hand,*' containing a light coloured
jelly in mixed cells of bony fibres and cartilaginous mem-
branes. These cellular exostoses become larger than the other
kinds, easily inflame, and run into suppuration, or are con-
verted, by increase of the cellular tissue of their cells and
loosening of the periosteum, into large tumours, the base of
which consists of thread-like, tooth-like, or leaf-like bony
masses. Very hard and close exostoses are in rare instances
separated by necrosis.*^

(1) Nesse-Hill Sur les maladies des os par secretion superflue, &c. in Journ.
de Medec. continue. Vol. VI. p. 122.

(2) van der Haarm Verhandelingen van het Maatsch. te Haarlem. Decl. XV.
Boyer, Traits de malad. chir. Vol. III. p. 547, properly considers this to occur
but rarely. Compare Pitet in Bulletin de la Societe de M^dec. An. XIII. and
XIV. Several instances occur in the Bresl. Mus; v. my Verzeichniss, u. s. w.
No. 3510, 3514. — Lobste'in Compte rendu, &c. p. 25.

(3) Brugmanns in van Maanen D. de absorptione solidorum, etc. p. 93. My
Verzeichniss, No. 167, 3091, 3092.

(4) Malpighi Op. posth. ed. Lond. 1697, p. 49, from the collection of the
Duke of Modena. — Ribelt in Mem. present. Vol. II. p. 336, (it weighed eight
pounds and half an ounce;) a skull which Jussieu possessed at Paris, described
and engraved in the Oryctologie par MM. les Sav. de Londres et Montpellier,

152 Of Bones in General, [Part II.

1755, by Jadelct Description analom, d'une tete humaine extraordinaire, etc.
8vo. Paris, 1799, with engravings. — Jourdaln Ixdaie des depots dans le sinus;
Maxillaire et des Caries, etc. 12mo. Paris, 1761. — Selt. Beob. u.s.w. Vol.11, p. 1,
No. 1. — //o- Einige anatomische Beob. u.s.w. p. 10, Prag. 1821, pi. 2 and 3. — von
Soemmerring in Ballenstedf s and Ki tiger's Archiv fiir die neuesten Entdeckungen
aus der Urwelt. Vol. III. Part I. p. 25. — Spurzheim possessed a similar skull ;
V. Km an Anat. Untersuchungen iiber das neunte Nervenpaar. p. 133, note 10.
I saw a similar skull in tlie Cabinet of Natural History at Darmstadt, {Bojanus
has described it in v. Froriep's Notizen, Sept. 1826, Vol. XV. No. 9, p. 129.)
in Brookes's collection in London, in VroJidcs at Amsterdam, at Copenhagen
in the Surgical Academy, in the Anat. Pathol. Mus. at Vienna (when fresh
almost seven pounds in weight,) and the commencement of this disease on a
skull in Prof. Huth's at Frankfort, aftei'wards at Charkow {v. Soemmerring^ s
mention of this case was probably derived from my verbal explanation,)
and died at Dorpat. Sometimes it occurs only on certain parts of the skull, v.
Sandifort^s Mus. Anat. Vol. II. plate 13, fig 3, 4, 5. — v. Soemmerring mentions
such a case in his collection. — v. Loder of a parietal bone ; v. Index praeparator.
Part II. p. 9. I also saw this disease on the forehead of a child with a large
tumour on the upper jaw, of an osteosarcomatous nature, in the Museum at
Freyburg in Brisgow.

(5) Oh almost all the bones of one man ; Noel in Roux Journ. de Medec. 1779.
Maerz. p. 225. — Saucirotte in JVlemor. de I'lnstitut nat. Scienc. physic. Vol. II.
p. 114. In Soemmerring' s collection I saw this disease on two fowls, and also in
tbe Anat. Mus. at Bonn, in the skeleton of a hen ; perhaps also here belong the
fowls' bones described by Sandifort, Mus. Anat. Vol. III. p. 275, No 911 — 915.

(6) Especially syphilis, gout, and mixed cachexias, which are distinguished
with difficulty.

(7) Ossification of the Periosteum is indeed a rare disease, though I
have seen it several times on the bony stump after amputation, and also on other
parts ; sometimes the outer layer only is ossified, and then forms a rough thin
bony plate, running parallel to, but at about half a line's distance from, the
bone itself, and which is only attached to it at certain parts by bony fibres ; I
once saw this on the outer surface of the hip-bone. Upon ossification of the
periosteum, v. J. Howship, in Med. Chir. Trans. Vol. VIII. p. 70. — Boyer m
Archives generales de Medecine, Nov. 1823.

(8) Boyer, Traite des maladies chirug. 2d edit. Vol. III. p. 564, calls it
Periostosis.

(9) Bidloo De exostosi in Op. omn. p. 202, tab. 2. Lug. Bat. 1715. — Juncker
praes. Ludwig D. de exostosibus. 4to. Halae, 1756. — Houstet in Mem de I'Acad.
de Chir. Vol. III. No. 7, p. ViQ.—Saldana D. de Exostosi. Traj. ad Rh. 1762.—
Allan i)raes. Dumont De exostosi. Theses anat. chir. 4to. Paris, 1770. — Delort
praes. Sue De exostosi. 4to. Paris, 1774. — Fayolle De exostosi Monspel. 1774. —
Sigwart D. exostosis exemplo rariori illustrata. Tubing. 1781. — Morgagni De sed.
et cans, morbor. Ep. L. Art. 56, et seq. — Ramonet D. sur les exostoses. 8vo. Paris.
An. XI. — Milliere D. sur les exostoses. 4to. Paris, 1814. — CuUerier in Diet, des
Sc. medic. Art. Exostose, Vol. XIV. p. 218. — Howship, p. 55. — J. Cooper on
exostosis in his and Traverses Surgic. Essays, Vol. I. 2d edit. 1818. — B(til D. de
ossium luxuriatione. 4to. Berol. 1820, with lithographic engravings. — Busch in
Petersb. vermischten Abhandl. u.s.w. Part I. }). 61, pi. 2- Petersb. 1821. —
Westberg in Svenska Lakare-Sallska])ets Ilandlingar. Vol. IX. 1823. — Gibson in
Philadelphia Journ. of the medical and physical Sciences, ed. by Chapman. Vol. II.
No. 1, p. 121. — Starck ; v. § 116, note 6. — Sandifort gives good engravings of
exostosis in his Mus. Anat. tab. 87, 88, 102. — In brutes exostoses are not un-
common; to wit, on the spine in horses, on the foot in spavin and ringbone:
the latter disease is sometimes hereditary and congenital; — all the progeny of
a bull with an exostosis on the head liad this vice. See Rndolphi Bemerkungcn
auf eiuer Reise, u. s. w. Vol. I. j). 75 ; — Boyer describes, at p. 600, a case of
hereditary exostosis in the human subject.

(10) Gibson thought it did not occur on the hand and finger bones; this how-
ever is incorrect, for many such instances have been seen; note 17. — In Bresl.

Sect. XV.] Of Bones in General. 153

Mus. there is (No. 8090) an exostosis on the first phalanx of a finger, as big as
a walnut, hard and close — I have seen a somewhat smaller one on a phalanx of
a finger in the Anat. Mus. at Freyburg.

(11) Compare, for instance, several of the above described cases, § 109,
note 11, in general anchylosis; further Trafve7ifeldt, in Ars. Berattelsa om
Svenska Lakare Sallskapets Arbeten. p. 14. Stockh. 1815. — Ekstrom, ih. 1826. —
I saw two very striking instances in the Anat. Pathol. Mus. at Vienna, and in
the Anat. Mus. at Strasburg. Meckel, in his Pathol. Anat. Vol. II. Part I.
p. 274, has described large fibrous exostoses on the skull and pelvis of an in-
dividual.

(12) In the Anat. Mus. at Zurich I saw several exostoses as big as one's fist,
oh the thigh and shin bone in the neighbourhood of caries.

(13) Cumin calls it caries ossificans.

(14) For instance, my Verzeichn. No. 3854.

(15) Cooper's periosteal and cartilaginous exostosis, as it is between the
periosteum and bone, is at first formed of a cartilaginous mass.

(16) A case of this kind has, without any reason, been named Hydrexostosis ;
see Noack D. de hydrexostosi et haematexostosi. 8vo. Vratisl. 1824.

(17) They usually occur in children, especially in those of a rickety dispo-
sition, sometimes however also in adults ; in both cases, often from mechanical
influence, they often exist for ten or twenty years without actual inconvenience
beyond their size and weight. — Bidloo Op. omnia, p. 205, with engravings.
Plate I. — Mery in Mem. de I'Acad. des Sc. 1720, p. 447, tab. 12— 15.— Ze^fm
in Loder's Journ. f. Chir. Vol. I. p. m.— Meckel Pathol. Anat. Vol. II. Part I.
p. 272. — Dupuytren in Dipt, des Sc. medic. Vol. XXXIII. p. 8. — von Klein in
V. Graefe's and v WaltJier's Journ. f. Chir. Vol. III. Part III. p. 403, pi. 3, fig. 4.
— Souvestre in Journ compl. du Diet, des Sc. m^dic. Vol. VI. p. 276. — Thurn in
Harless Rhein. Jahrb. fur Med. u. Chir. Vol. VI. Part I. p. l99.—Edholm and
GadeUus in Svenska Lakare- Sallsk. Handl. Vol. I. Part II. p. 100 ff". and p. 109
(the latter case on the foot) ; — Wahlherg, ib. Vol. III. p. 127, pi. 2. — Bail, p. 16,
fig. 4. — Ilesselhach Beschreib. der pathol. Priiparate zu Wurzburg. p. 307,
No. 127, 128, 481.— Myself in Selt. Beob. Part II. p. 22, No. 10, tab. 1,
fig. 1. — I lately saw a boy, about ten years old, on whose left hand and foot there
were many and large gibbous swellings of this kind.

(18) Boyer, Vol. III. p. 554. In the Anat. Mus. of Meckel, at Halle, I saw
an ivory-like exostosis, as large as one's fist, which had spontaneously dropped
from the nostrils of a horse.

§ 120.

The last and most malignant kind of vice of texture in bones,
is the BONE FLESHY SWELLING, or BONY CANCER, osteosarcoma,
osteosteatoma, fungus, and cancer ossium} as it is called.
This disease, so far as the structure of bone permits, resembles
the sarcomatous and carsinomatous diseases of soft parts in
their various and varying forms, together with their distinct
morbid disposition,^ their easy recurrence, their existence in
the middle and later periods of life, and their common malig-
nity. Sometimes external mechanical influences operate as
occasional causes for the production of osteosarcom. This
disease most usually occurs on the bones of the head, of the
pelvis, and in the long tubular bones : but in animals it is as
rarely seen as cancer in the soft parts. The original seat of
the disease is usually the internal bony tissue, and the perios-
teum at first extends unchanged over the bony tumour;

154 Of Bones in General. [Part II.

although in rare cases, tumours and fungosities of similar
character are primarily produced in the periosteum.^ With
regard to the structure of the osteosarcom, this is somewhat
different, according as the bone is more delicate and spongy,*
and as the disease assumes more the form of sarcom, medullary
sarcom, or cancer ; in general however, the tumour at first
consists (although afterwards the bone be more or less softened
and swollen) of a tolerably homogeneous, greyish-white, un-
vascular mass, intermixed with bony points, which almost
resembles cartilage, and consists of a quantity of sinewy
fibres, more or less firmly consolidated with albumen. The
tissue gradually becomes loosened, and forms cells of a greater
or less size, which are filled with a light-coloured jelly ; an
inflammatory excitement now takes place in the swelling, the
thin cellular tissue which lines the cells becomes thickened,
and secretes a mishapen mass consisting of albumen, which is
sometimes hard, sometimes soft and resembles brain, or there
is produced within them a cellular tissue richly loaded with
albumen; the blood-vessels also gradually enlarge in the
periosteum, as well also as in the interior of the swelling,
and small or large cavities are commonly formed, which in
rare cases are filled with arterial, but more usually with venous
blood,^ and into the brain-like substance blood is also efiused.
At the same time innumerable bony fibres or plates commonly
project from the interior of the bone outwards, and perforate
the tumour in various directions, which becoming softer and
larger, is finally united at certain spots with the much ex-
panded fleshy and membranous parts lying upon it, per-
forates these, and allows the escape of a more or less growing
fungus.

( 1 ) Also exostosis fungosa, carnosa, carcinomatosa, &c. There is a great con-
fusion among authors, especially about this disease, as spina ventosa, and
particularly cellular exostosis, is often confounded Avith osteosarcom. With
reference to single cases, v. du Plouquet Repertor. Art. Osteosteatoma; also the
old observations of Severinus de Abscondita abscessuum natura, L. B. 1724,
p. 207, with engravings. — Diwerney in Abhandl. viber Knochenkrankheitcn. —
Ainyaud in Phil. Transact. 1708, j). 170, &c. — Hunderlinark praes. Tittmann D.
s. osteostcatomatis casum rariorem. Lips. 1757. — Hemnann D. de osteostea-
toniate. 4to. Li])s, 17fi7, witli coloured plates. — A. Murray, D. de osteostea-
tomate. Upsal, 1780. — Gruner D. Ilistoria osteostcatomatis feliciter curati.
Jena3, 1781. — Ludwig Icones anat. pathol. tab. 1, fig. 1. tab. 2, f. on the
pelvis. — Howship, p. 04-. — Rust Magazin f. die gesammte Heilk. Vol. I. Part I.
p. 60, tab. 1, on the upper arm. — Myself in Selt. Beob, Vol. I. p. 83, No. 41,
tab. 2, on the upper arm, and ih. Vol. II. p. 23, if. — Bang in Actis nov. reg.
Soc. med. Vol. J. No. 8, Ilavniens. 1818, on the pelvis. — Behr in Recueil do
Mem. de M6d. Chir. et Pharm. niilit. par Fournier-Dcscay. Vol. XII. No. 10,
on the arm. — v. JValther in his and v. Graefe's Journ. der Chir. &c. Vol. V.
Part II. p. 283, on the hand and shin-bone. — Weslrhig in Svcnska Lakarc-
Siillskap. llandlingar. Vol. IX. p. 13(i, on the pelvis and shin-bone. — C^tting

Sect. XV.] Of Bones in General. 155

in Med. Chir. Transact. Vol. II. No. 24, on the upper arm. — Gibson in Chapman's
Philad. Journ. of med. and physical Science, Vol. III. No. 1 . — Bmjer Trait6 des
Malad. chir. 2d edit. Vol. III. p. 600, on the thigh and pelvis. — Baldy in
FothergiWs Lond. med. phys. Journ. Vol. XL. Nov. 1818, on the upper arm bone. —
Cerutti Beschreib. der pathol. Praparate des anat. Theat. zu Leips. No. 332,
p. 68, on the upper arm bone. — Pech Osteosarcoma, ejusque speciei insignis
descriptio, etc. 4to. Wirceb. 1819, with three engravings, on the face. — Car-
michaelin Irish Transact, of the Association, &c. Vol. 111. Dublin, 1820, with
engravings, on the thigh. — Williams in Lond. med. Repository, Vol. XVII.
No. 99, p. 204, March, 1822, on the shin bone. — Dictel D. de osteosteatomate.
4to. Lips. 1822, with three engravings, on the thigh. — Lohstcin Compte rendu,
etc. p. 32, Strasb. 1824, on the splint and shin bone, also the chemical analy-
sis of the tumour. — Crampton in Dublin Hospital Reports, Vol. IV. p. 537. —
Kolsck Ein Fall vom Knochenkrebs, nebst einigen Bemerkungen. Inaugural
dissertation. 8vo. Wiirzb. 1826, with one engraving. — Graff in v. Graefe's
and V. Walther's Journ. d. Chir. Vol. X. Part I. p. 76, pi. 2, fig 4 and 5, on the
skull. — On osteosarcom of the jaws and their joints, see those parts. — Koschate
Observationes nonnullae circa Osteosarcoseos naturam et indolem adnexis tribus
hujus morbi historiis. 8vo. Vratisl. 1826. — J. F. Bonfils Description succinte
d'une Maladie grave et rare de la partie superieur de I'humerus, etc. Nancy,
1817, with engravings. — K. E. Donat D. de fractura cum Osteomalacia fun-
goque carnosa complicata, ex medulla tibiae exeunte. Halae, 1828.

(2) Compare my Selt. Beob. Vol. II. p. 23. — Gibson, in which on several parts
at the same time, or recurring and connected with a cancerous state of other
parts ; Pott in Phil. Transact. No. 459. — Voigtel Pathol. Anat. Vol. I.
p. 127. — Meckel Pathol. Anat. Vol. II. Part I. p. 274, fF. — Heymann in Harless
Rhein. Jahrb. Vol. II, Part I. p. 74. — M'Clellan in Americ. medic. Recorder.
Vol. V. No. 4. New- York, Oct. 1822. — v. Walther. — Salomon mY erra. Abhandl.
a. d. Gebiete der Heilk. 3d edit. p. 237. Petersb. 1825. — Bonfils in Journ. gen.
de Medec. 8vo. 1826.

(3) Sometimes as large roundish loosely attached swellings, more rarely as
fungous growths, &c. v. Walther in der Salzb. med. chir. Zeitung, p. 185. Feb.
1813, on the collar bone of a woman with fungus of the dura mater; sometimes
large sarcoms in the soft structures adhere to the neighbouring periosteum of a
bone, and seem then to spring from it. — Voigtel, p. 124, improperly considers
the periosteum as the usual seat of osteosarcom.

(4) In this the structure of the tumour is, from the commencement, more
loose and cellular.

(5) From these large varicose cavities, the blood starts sometimes in great
quantity during operations, v. Rust and myself.

§ 1^1.

Finally, we observe also vices of the contents of bones.
To these first belong the morbid changes of the marrow ; ^
this in cachetic men and animals is even entirely deficient, or at
least it exists only in small quantity ; in other instances, on the
contrary, it is too abundant, and pervades the usually dry bony
parts. Its consistence varies not less from its natural condi-
tion, it is sometimes too hard, tallow-like, and even resembling
waxy fat ; but more commonly it is too thin and too much
mingled with lymph. The latter is especially the case in
rickets, scurvy, dropsy, and other cachexias. The marrow
also exhibits numerous deviations in respect to colour, so that
it may be too pale and completely white, or too deep yellow^

156 Of Bones in General. [Part II.

reddened by a large admixture of blood ; and in carious and
mortified bones, sometimes grey and discoloured.

Dropsy, of such kind as is met with in soft parts, cannot
occur on account of the firm texture of the bone ; ^ however, we
sometimes find in dropsical persons, that the bony cells, in-
stead of containing fat, are filled throughout with lymph -like
fluid, and in rare cases, in dropsical children newly born, we
observe a turbid serum efflised between the bones and their
investing periosteum ; ^ there have been also observed in some
instances in the cavities of the tubular bones, watery blad-
ders, or hydatids;* pus and ichor often fill the spongy
tissue of inflamed and carious bones ; more rarely we find that
blood is poured out in their cellular tissue,^ without any distinct
change of structure in the bones ; we more frequently observe,
in the swellings of the heads of new-born children, or after con-
tusions, &c., if the periosteum be partially separated from the
bone, blood effused between them. Lastly, in the bones we
sometimes meet with entirely extraneous bodies, which have
entered from the surface, for instance, mercury,^ which in
various forms has been taken up by the skin or by the
mouth, and received into the body ; sulphur in labourers
in sulphur mines ;^ and especially shot, which are generally
thrown out by caries or mortification, but sometimes remain,
and are firmly connected to the bone for a long time, and even
throughout life.^

(1) Mofffwow Tentamen de medulla morbis, 8vo. Paris Ann. III.

(2) The disease described by v. Wy in Heelkundig. MengelstofF, Vol. II.
Part I. 1785, under the name Ilydrosteon, does not appear to belong to this, but
to rickety loosening.

(3) I have seen three or four dead born, though never putrid dropsical
children. — A similar instance, with loss of the epiphyses, was seen by Clouquet,
V. Leroux Journ. d. Med. chir. et Pharm. Vol. XXXIX. Aug.

(4) In a bony swelling, Keate, in Lond. med. chir. Transact. Vol. V. ; and
A. Cooper, which latter preparation I saw in the Museum at St. Thomas's Hos-
pital, London; in the cavity of the tibia, CuUer'ierm Corvisart^s Journ. de Medec.
Vol. XII. p. 125, Aout, 1806. — Webster in New-England Journ. of Med. and
Surgery, Vol. VIII. Boston, 1809. — A preparation of this kind is in the Hun-
terian Museum at Glasgow ; and another, viz. a long watery cyst in the thigh-
bone of an ox, in the Hunterian Museum in London, No. 521 of the patholog.
series. — Many hydatids were found in the tibia, by IVickhum, in London med. and
physic. Journ. Jan. 1827, j). 530. [Tiierc is a preparation in the Mus. at St.
Tliomas's lIos])ital of hydatids in the spinal column; they are situated in the
bodies of the eleventh and twelfth dorsal vertebra?, the greater part of which,
together with the intervertebral substance, are absorbed ; and the cavity thus
formed communicates on the left side with a large bag full of hydatids, which
resembles an inci})ient psoas abscess, and the spine is at this point curved for-
wards, as in scrofulous caries. It seems impossible to determine whether the
hydatids were first formed in the bony, or in the ligamento-cartilaginous
intervertel)ral substance ; of that, lunvever, between the two vertebra', there is
not the least trace, but the remainder of the bodies are tilled with the little
watery cysts. T.]

Sect. XV.] Of the Bones of the Head, 157

(5) I have seen this a few times on the skull bones of an adult, accompanying
organic vice of the brain, v. Selt. Beobacht. Vol. II. p. 92, No. 3119, of Bresl.
Mus. ; in the skulls of birds which have been poisoned with opium, belladonna,
and spirits, v. Cuvier s. Annales des Sc. naturelles, Vol, 1 1, p. 428.

(6) V. Fricke Annalen des Hamburger Krankenhauses, u. s. w. Vol. I,
p. 106. — de Plonquet Art. Mercurius, also Lieutaud Hist. anat. med. L. III.
Sect. VIII. Obs. 558— 562.— 5oMefi Sepulchret. anat. Vol. I. Obs. 114, p. 64.—
Hufeland's Journ. f. pr. Heilk. 1821, — Isenflamm in Augustin's Neueste Ent-
deckungen, u, s, w. 1800, p. 375. — Lohsiein Compte rendu, etc. p. 27. — Myself
in Selt. Beob. Part II. No. 13, p, 36, — I also have observed a third instance.
V. Verzeich. der anat. Praparatensammlung, u. s. w. No. 3019.

(7) Reil in van Mons Journ. de Chim. Vol. II. p. 105; compare John's Chem.
Tabellen des Thierreichs, p. 44.

(8) Compare surgical writers, and de Plouquet Repertor. Art. Peregrina. — Gott,
gel. Anzeiger, 1269, p, 202, a bullet 5d years in the skull. There are several
instances in Isenfiamrn Anatom. Untersuchungen, 8vo. p. 36. Erlang. 1822 — Eck
D. de carie articulor. externa, p. 82. Berol. 1818, — Grossheim in v. Graefe's and
V. Wallher's Journ. f Chir. Vol. X. Part I. p. 142, pi. 3, fig. 123. — Sandifort
Mus. anat. Vol. III. p, 201, No. 336, a piece of lead in the collar-bone. On
balls in elephant's teeth, v. the Teeth, In animals, enclosed balls and gun-
shots are not uncommon, I have found them in wolves, No. 3576 of Bresl,
Mus. ; in foxes, hares, and in the wing-bones of birds.

Second Chapter.
Of the Bones in Particular.

A. OF THE BONES OF THE HEAD.'

§ 122.

In human monsters and in those of animals, the skull is
frequently very deficient ; this especially occurs in the anen-
cephalous, of which the entire upper part of the skull is apt
to be wanting.^ But even in a well-formed skull, the number
of bony pieces composing it often varies remarkably, inasmuch
as, either certain bones, as a vice of formation, are deficient,
and their place supplied by others which have become enlarged,
or on the contrary, supernumerary bones exist in the different
kinds of duplicature of the head. The number of bony pieces
in the skull are most usually increased by the congenital
SEPARATION of many bones into several pieces,^ and by the
suTURAL BONES, ossa suturariim^ The latter most commonly
in the lambdoidal, next in the coronal and squamous suture, vary
in number from one to some hundreds ; sometimes they are
very symmetrical ; and in more rare cases, are produced only on
the outer or inner table of the bone. A single large bone of

158 Of the Bones of the Head, [Part IIv

this kind occupying the place of the great fontanel, is called a
FONTANEL bone/ Dropsy of the brain, rickets, and cretinism,''
are the most usual causes of sutural bones. The skull fre-
quently varies in reference to its size; thus we sometimes
find it remarkably small, in monsters with imperfectly
formed heads,'' as well also as in congenital hernia cerebri ;
also in idiots,® and epileptic persons ° it is frequently too small
in consequence of imperfect development of the brain, or of the
too early closing of the sutures. The opposite vice, or the
IRREGULAR ENLARGEMENT of the skull, is morc commou ; we
observe this both in man and animals, in a less degree, as a
peculiar and often hereditary disposition, but in a greater
degree, as consequent on the hypertrophy of the brain often
accompanying rickets, and particularly as the effect of the
internal dropsy of the head; in the latter case the skull often
attains a most enormous size.^*' The shape of the skull also
frequently differs from the normal form, being found irregularly
long, broad, flat, even angular, round, and particularly un-
symmetrical.^^ Such deformities are sometimes congenital,
in consequence of the irregularly formed pelvis of the mother,
or of early diseases of the embryon, which have acted on the
head; more frequently they occur after birth from deficient
and irregular development of the brain,^' from the early closing
of some of the sutures, whereby the widening of the skull is
prevented at this, and on the other hand, increased at other
parts ; in rickets, by which especially the front and back of the
head are apt to be projected ; by dropsy of the brain, which at
the same time unequally expands the skull and depresses its
base ; by softening of the bones, in which that part of the
base of the skull which is supported on the spinal column,
is gradually thrust into the cavity ; " by palsy of one half
of the head, hemicrany, the facial pain of Fothergill, and
tinea, in consequence of which the skull frequently becomes
atrophic, and awry, &c.^* The skulls of epileptic, idiotic,^^
insane ^° persons and cretins,^^ are frequently very much mal-
formed. Sometimes the irregular shape of the skull depends
upon mechanical causes, either indeed purposed or accidental,'**
as by indentation of the skull during labour, by falls, blows,
&c., various and often very distinct impressions and irregu-
larities '■' are produced. The skull is frequently irregular in
its thickness, thus it may sometimes be found too thin, some-
times too thick; the former generally occurs especially in
dropsy of the head in man and animals, and sometimes to such
a degree, that the bones of the skull are as thin as paper and
transparent ; this general thinning of the skull also occurs in

Sect. XV.] Of the Bones of the Head. 159

consequence of wasting of the diploe in very old persons, and
more rarely also in young people without any assignable
cause. ^*' Oftentimes certain spots only are so thin,^^ particularly
when pressure has been continued on them for a long time.
Very naturally connected with the irregular thinness of the
skull, is that state in which it is not only very thin, but
even partially unossified and merely membranous ; in some
cases this occurs to a great extent, more commonly only
at certain spots, especially in dropsy of the head, rickets, and
cretins. ^^ The opposite vice, the abnormal thickness of the
skull,^' is still more common, especially in persons who are
much subject to congestion in the head, also for instance, in
insane people,^* and often attains such extent, that the bones
of the skull become half an inch, or a whole inch thick ; in
this state, the structure of the bones is sometimes perfectly
healthy, in other cases, especially in ricketty people, spongy,
and light ; in some instances, however, thick and heavy, almost
like ivory. ^^ Sometimes the skull is only so thick and tuber-
cular at certain places. ^^ This leads us to the bony growths,"
which we observe produced not merely on the outer or inner
surface of the skull, but sometimes on both sides, and occa-
sionally acquiring a very great size ; in animals, such exostoses
are frequently observed.^^ In epileptic and insane, and even
in other persons not unfrequently, processes are found on the
interior of the skull which are very prominent and sharp." As
to the CONNEXION of the separate bones of the skull, there is
great deviation from the general rule, arising from diminution,
increased strength, and irregular mass of their composition.
The first vice exhibits itself in the long continued or permanent
existence of such sutures which, as the frontal suture, and
some sutures in animals, are naturally consolidated at an early
period, and in the unusual congenital separation of certain
bones of the skull into many pieces ; ^^ further, it is very com-
mon in dropsy of the head, in which congeni tally or sometimes
soon after birth, the bones of the head are more or less further
apart from each other ; this happens in more rare cases only in
a single suture. Such broad membranous interspaces, some-
times in later years, become so filled up with a quantity of little
sutural bones, that some and even all the sutures appear at
once double.^^ Oftentimes we observe bones which have been
for a long while united, separated from each other at their
sutures,^^ by violent flow of blood to the brain, as well also as
by collections of water, and tumours, &c. The other vice, the
too firm connexion or anchylosis of the bones of the skull, is
much more common, it occurs especially in the sagittal suture,

160 Of the Bones of the Head. [Part II.

although also not rarely on other, and even on all the
sutures of the skull at the same time ; sometimes it exists only
on the outer or inner surface, whilst on the opposite side the
suture is still distinct, and can then only be properly considered
as morbid, if it be observed previous to birth ^^ or before the
perfect development of the head.^* Finally, the sutures of the
head often appear so far irregular, as that they run obliquely or
tortuously, have too few or too many, too small or too large
teeth,^' in some places are widened,^'' or become seam-like."
The CONTINUITY of the bones of the skull is frequently
destroyed by mechanical influences; to these belong, the in-
cised, penetrating,^^ and shot wounds, the splitting of the
external and internal tables of the skull, the clefts or fissures,
fissurce^^ which in consequence of the brittleness of the bones
of the head often are very extensive and very numerous, some-
times run into the sutures and divide them, although not unfre-
quently their course is stopped by them ; fissures occur either
at the spot on which the blow is received or at some distance
from it, producing co7itrafissurce ; fractures of bone with the
loss of one or several pieces ; the more or less deep indenta-
tions, impressiones, or depressions, depressiones, of the bony
pieces connected with fracture, and the openings artificially made
by the trephine, which are but rarely again filled up with
bone. Similar apertures in the skull to those purposely made by
the trephine, occur also not rarely from other causes," viz.
those which are congenital in hernia cerebri and dropsy of the
brain, further, such as occur in caries, necrosis,^^ and by the
erosion of encysted and scrofulous tumours,''^ fungus of the dura
mater, aneurysm,''^ &c. Lastly, we must here mention the
so-called yi/w^//5 cranii;^^ this is a sarcom or medullary sarcom
of the bones of the skull, in which a distinct tumour is pro-
duced often only on the external surface, or also at the same
time on the internal surface, and sometimes becomes pretty
large ; it may run at last into a spongy growth. It usually
occurs on the top of the skull, although also sometimes on
its base, and then protrudes outwards through the usual open-
ings at this part.'^

(1) Krehel D. de anatomia patholoo;ica ossium cay)itis. 8vo. Ilalae, 1823.—
Bctrachtungen u])or die Ursachcn uiul \'erschiedcnliciten der IMissbildungen
des Schadels und des Riickgiathes bcim Foetus von Dugds in Revue medicale
francaise et etranf^ere. Vol. X. p. 358.

(2) Good engravinf^s in E. Saiidifort Anatome infantis cerebro destituti.
L. B. 1784, and in IMus. anat. \'ol. II. tab. 35, fig. 2 — 5. — Geoffroy Anat. pbilo-
sopliiquc. Vol. I. Paris. 1822, pi. 1 — 3.— J. /•'. Meckel Descript. nionstror.
nonnullor. 4to. Lips. 1820, tab. 1.

(3) Generally the bony gernis do jiot grow; sometimes also there is an ano-
malous growth.

Sect. XV.] Of the Bones of the Head. 161

(4) Intermedial bones, Ossa Wormiana, O. triquetra, &c. ; v. Bertin Traite
d'Ost^ologie, Vol. II. p. 470 ; Monro in Edinb. med. Essays. Vol. V. No. 16,
pi. 2. — Sanclifort in Observ. anat. pathol. Lib. III. cap. 9, tab, 9, and Lib. IV.
cap. 10, p. 136. — Blumenbach's Geschichte der Knoclien. — Meckel Patbol. Anat.
Vol. I. p. 313. — Rottboll in Skrif. det kiobenhavnske Selsk. Nye Samml. Deel I.
p. 249. — Jung Animadversiones quaedam de ossibus generatim et in specie de
ossibus rapbogeminantibus, quae vulgo ossa suturarum dicuntur. 4to. Basil.
1827, with figs. — My Verzeicbniss, &c. No. 183 — 225; in animals, intermedial
bones are very rare, even in extensive water in the head. — Loder, Anat. Handb.
Part I. p. 46, in note, mentions two instances of intermedial bones in monkeys.
— Wiedemann Archiv, u. s. w. Vol. III. Part II. in an ant-eater. — Greve Bruch-
stiicke vergl. Anat. und Physiol, p. 10, Oldenb. 1818, in hares, rabbits, and
dogs ; — in lambs, my Selt. Beob. Vol. I. p. 39. — G. Jdger in Meckel's Archiv f.
Anat. und Phys. 1826, p. 72.

(5) Lachmund in Misc. Nat. Cur. 1675 and 1676, p. 241. — StaheUn Obs. botan.
anat. in Haller s CoW. disp. anat. Vol. VI. p. 671, with tigs. — vari Doeveren Spec,
observat. acad. p. 189, pi. 7, fig. 1 — 3, two cases. — Sandifort Observ. anat.
pathol. Vol. III. tab. 9, fig. 3 — 7. — Hebenstreit De rarior. quibusdam ossium
momentis, p. 5. Lips. 1740. My Verzeicbniss der anat. Priiparatensammlung,
No. 184 — 186, 8034. There is also (No. 4566,) in the skull of an ateles paniscus
a fontanel bone, of which I have also seen a beautiful instance in the Anat.
Mus. of the Joseph Academy at Vienna, a similar instance in the Anat. Mus.
at Zurich, and at Strasburg, and two examples in the Anat. Mus. at Heidelberg.

(6) A very remarkable instance is mentioned by Prochaska Disq. anat. phys.
organismic. h. 4to. Viennae, 1822, tab. 8—10. p. 177.

(7) Curtius De monstro humano. L. B. 1762. — Gilibert Advers. med. pract.
Lucubratio anat. de foetu acephalo, p. 122. My Verzeicbniss, &c. No. 3044.

(8) Hippocrates early considered microcephalia as the cause of idiotcy. —
/. E. Greding Sammtliche medicinische Schriften, herausgegeben von C. W.
Greding. Greiz, 1790. — Georget de la Folie. Paris, 1820, p. 478. — Spia-zheim,
Observations on the deranged manifestations of the mind, or insanity. 8vo.
London, 1817. — Esquirol in Diet, des Sc. m^dicales. Vol. XXIII. p. 521, and
in Pathologie und Therapie der Seelenstiirungen, deutsch von Hille, p. 515. 8vo.
Leipz. 1827. — A very remarkable instance is given by Blumenbach De anomalis
et vitiosis quibusdam nisus formativi aberrationibus Comment. 4to. Gott. 1813.
tab. 2, p. 17. — Smallness, depression, and obliquity of the forehead in an
idiotic child of two years old. — My Verzeicbniss, &c. No. 3016.

(9) My Selt. Beob. Part I. p. 72.

(10) Good engravings are given by Gall Anat. et Physiol, du Systeme nerveux
en general, etc. PL 21—24. — Sandifort Mus. anat. Vol. IL tab. 6—12. —
Rudolphi in Abhandl. der Akademie der Wiss. zu Berlin, 1827, pi. 3 — 5.
— Baillie, Engravings of morbid Anat. Fasc. X. pi. 3, fig. 1. — Monro's Outlines
of the Anatomy, &c. pi. 21. — Klein Kurze Beschreibung einiger seltenen Was-
serkbpfe. 4to. Stuttg. 1819, tab. 1 and 2. — Great increase of the size of the
skull is described in the Gazette de Sante, 1817. v. Rusfs Magazin f. d. ges.
Heilk. Vol. IV. Part I. p. 187, (2 feet 3 inches in circumference ; I saw this
person in the Charite at Lyons.) — Valentin in Journ. de Medec. Chir. et Pharm.
Paris, Octob. 1816, (circumference 26^ inches.) — Ehrlich Chir. auf Reisen
gemachte Beobacht. Leipz. 1795. Vol. I. (in CruikihanFs collection 2 feet
5 inches in circumference.) — In New England Journ. of Med. and Surgery,
Vol. IV. No. 1. Jan. 1815, p. 21, (circumference 2| feet.) — Lobstein Compte
rendu, etc. 1824, p. 62, No. 36, (circumference 2 feet 3 inches.) — /. P. Horn
Bemerk. und Erfahr. iiber einige Gegenstande der prakt, Geburtshiilfe. 8vo.
Wien, 1826, tab. 1, (circumference in a new-born child 21 inches.) — Himly vn.
Gbtt. gel. Anzeigen, 1827, No. 69, p. 681, (33^ inches, Calenberg measure, in
circumference.) — My Verzeicbniss, No. 3089 and 3090. — Kolder Beschreibung
der physiol. u. pathol. Praparate. — Loder, p. 103, No. 365, described by
Kaltschmied Pr. de hydrocephalo interno rarae magnitudinis in Mettelhauser
D. de via chyle ab intestinis ad sanguinem. Jense, 1752, with plates, (33 inches in
circumference.) — A drawing of Himly's case is given by E. A. W. Himlty

M

1 62 Of the Bones of the Head. [Part 1 1 .

Darstellung des Dualismus am normalen und abnormen menschl. Korper.
Hanover, 1829, p. 21, pi. 5 and 6. — Among animals the skull is frequently
very much expanded by dropsy, in the horse, ox, (of which there are two very
large. No. 8059 and 8060, besides three less large in the Bresl. Mus.) and sheep,
rarely in other mammalia, and never in birds. — [There is in the Mus. at Guy's
Hospital, the skull of a hydrocephalic man, who lived to the age of twenty-nine
years, whose skull measured 33^ inches in circumference. — Also at St. Thomas's
Mus., the skull of a child of about two years, which measured 29 inches. T.]

(11) Compare my Verzeichniss, &c. No. 163,164, 210, 3057—3063, 3068,
and 804'6. — Hesselhach Beschreibung der pathol. Praparate zu Wiirzburg. p. 3.
— On obliquity of the skull compare Loschge de scelete hom. symmetrico, p. 41.
— Meckel anat. phys. Beobacht. und Untersuch. p. 247. 8vo. Halae, 1822 —
Sandifort, Vol. II. pi. 8 and 9. — Kohler Beschreib. der anat. und physiol. Pra-
parate, etc. p. 134. — The obliquity of the skull, in many cetaceous animals, is
natural to them. A peculiar deformity of the skull, viz. a very large bony cyst
with a large cavity on the temple, occurs in fowls, geese, ducks, pigeons, and
canary birds; v. Borellus Hist, et observat. rarior. ed. 1656, p. 154. — Stobaeus
in Act. literar. Speciae 7730, Vol. III. p. 53. — Pallas Spicil. IV. p. 22. — Sandi-
fort Mus. anat. Vol. I. p. 806. — Blumenbach, p. 19, tab. 1. fig. 2 and 3. — IDupre,

Phil. Trans. 1699, p. 372. — In the skull of a female child, a native of Van
Dieman's Land, No. 99, Mus. Roy. Coll. Surg., there is great projection in the
central part of the parietal bone, giving an angular form to the head. T.]

(12) In the Anat. Mus. at Bonn, I saw a skull, on account of the imperfect
formation of which, the left half of the cerebellum was very flat in that region. —
M. J. Weber, Specimen malse conformationis encephali capitis et pelvis viri.
4to. Bonnae, 1828, with lithog. tab.

(13) I have seen this not unfrequently. Compare Verzeichniss der Breslauer
anat. Praparatensammlung, No. 163 — 165. I have also seen it in some cretin
skulls.

(14) My Selt. Beob. Part I. p. 74, No. 32. An instance from face-ache in
Blumenbach' s Geschichte u. Beschreibung der Knochen. 2d edit. p. 29, note f. —
Gall Anat. et Physiol, du Systeme nerveux, etc. with figures, pi. 53, a skull, the
left half of which had become atrophic from abscesses in the optic beds.

(15) Frequently is the skull not merely too small, but also otherwise abnor-
mally formed, thus the forehead too small and too inclined, &c. v. Gall, pi. 18 —
2029. — Reil in his and Hoffbauer's Beitr zur Beforderung der psychischen Cur-
methode, Vol. II. Part I. — Esquirol in Diet, des Sc. medic. Art. Demonomanie,
Vol. VIII. p. 294, tab. 1 — 4. and Pathol, und Therapie der Seelenstorungen,
p. 315. — Georget De la Folie. p. 478. Paris, 1820. — Wittwerck D. de varia hum.
cranii forma. 4to. Berol, 1825, with two engravings. But especially Blumenbach
De anomalis et vitiosis quibusdam nisus formativi aberrationibus Comment,
p. 17, pi. 2.

(16) For instance, unsymmetrical, compressed laterally, with a high vertex ;
internally with strong development, &c. — Pinel 'Recherches anatomiques sur
les vices de conformation du crane des ali6nes in Bull, de la Soc. philomath.
Ann. IV. Vol. II. p. 103, 109. — Georget, p. 480. — My Selt. Beob. p. 72,
No. 31. — Romberg Untersuchung irrer Personen, in the Zeitschrift fur psychische
Aertze, 1822. Part I. p. 124, and in the Zeitschrift fiir die Aiuhropologie von
Nas.se, 1828, Part III. p. 195. — Esquirol Pathologie und Therapie der Seelenstor-
ungen, u.s.w. p. 483.

(17) Generally very broad, often as broad as long, shallow from above to
below, the base of the skull often uplifted in the middle, &c. Compare Acker-
mann Uebcr die Cretinen, &c. 8vo. Gotha, 1790. — Foder6 Essai sur le goitre et
le cretinisme. 8vo. Turin, 1792, 2d edit. Paris, Ann. VIII. — Michaelis in
Blumenbach'' s medic. Biblioth. Ricordi della anatomia chirurgica, etc. Padova,
1801. — Wenzel Ueber den Cretinismus. Wien, 1802. — Iphoff D. de Cretinismo.
Viteberg. ISOI^.— Reeve in Philos. Transact. 1808. Part I. No. 7, p. Ill, pi. 2
and 3. — Prochaska Disquis. anat. phys. organismi, etc. p. 177, tab. 8 — 10.
Vienna?, 1812, and in Physiologic. 2d edit. 1820. Abschnitt VI. — Andrea
D. qunodam de Cretinismo. 4to. Berol. 1814, with engravings. — Osiander in

Sect. XV.] Of the Bones of the Head. 163

Gott. gel. Anzeig. 1817, PartCXXXII. — /pAo/en der Cretinismus, philosophiscli
und medicinisch iintersucht. 2 Theile. 8vo. Dresd. 1817, tab. 5. — Sensburg Der
Cretinismus, mit besonderer Riicksicht auf dessen Erscheinung in Untermain-
und Rezatkreise. Wiirzb. 1825. — T. H. Wilke D. de Cretinismo. 4to. Berol.
1828, with two engravings.

(18) For instance, of a very elongated form in a Scythian people on the Maeotic
lake. V. Hippocrates Op. omnia, ed. Kiihn, Vol. I. Lips. 1825. L. de aere, locis
et aquis, p. 551. — Pressing back of the forehead in the Caribbees and Americans
from Colombia river, v. Blumenhach decas cranior. divers, gent. Dec. I. tab. 10,
and Dec. II. tab. 20. — Lawrence, Lectures on Physiology, Zoology, and the
natural History of Man. London, 1822, pi. 11. — Mitchill in New- York Repo-
sitory, April, 1821. — Pressure from above, as in the Chocktaws and old Peru-
vians. V. Blumenhach, Dec. I, tab. 9. — [A deep broad transverse groove from
pressure, passing over the vertex, as in the skulls of the people of Nootka Sound,
in the Anat. Mus. at Christchurch, Oxford. — Three Peruvian skulls in the Mus.
Roy. Coll. Surg. No. 63, 64, Q5 ; but especially the former, resemble the skulls
of the Caribs, in the great depression of the forehead, but in these it is considered
a natural formation. T.]

(19) The ancients distinguish eS^o, sedes seu vestigium, — ^kkottt], excisio, —
Sta/coTT^, prsecisio, — a.TroaKeTrapvKr/j.os, dedolatio, OXaais and ivdXaffis, etc. ; some-
times it is congenital ; when subsequent, is always connected with fracture ;
sometimes only the outer table and diploe are depressed ; in other cases, the whole
bone deeply so, without great injury, v. de Plouquet Repertor. Art. Cranii
Depressio. — Crull D. de depressione cranii. Jenae, 1808. — Stalp. van der Wiel
Observat. rarior. p. 27. Leidae, 1727. — Isenflamm' s Anat. Untersuchungen,
p. \2^.— Klein \n Graefe's Journ. f. die Chir. Vol. III. p. 226. —My Seltene
Beobachtungen. I. p. 75, No. 33. — Home in Philos. Transact. 1814, Part II.
p. 469. — Congenital indentation observed by Sandifort, Vol. II. tab. 34. — Frank
in Textor*s Neuem Chiron. Vol. I. Part II. p. 261. — [A few years since, a child,
about three years old, was admitted into St. Thomas's Hospital, with a depression
on the upper and back part of the parietal bone, caused by a fall, which was
nearly large enough to hold a dessert spoon. No symptoms occurred, and as
there was no external wound, it could not be perfectly decided, but it was believed
to be a mere indentation without fracture. T]

(20) My Verzeichniss der Breslauer Praparatensammlung, No. 3065, 3076,
and 3169.

(21) To wit, from external encysted tumours, from internally enlarged
pacchionic glands, very expanded blood-vessels, watery bags, as in the gid of
sheep, &c.

(22) I have indeed seen this in twenty monsters, of men, horses, oxen, and
sheep, mostly accompanied with traces of dropsy of the head and general dropsy,
although sometimes also without. — For instance, in two children, v. Verzeichniss,
&c. No. 3079, 3080 ; and in a third, which was born without eyes, and with
monstrosity of the extremities; in an almost full-grown man, No. 3081; in a
child with sarcom on the head, v. Seltene Beobachtungen, II. p. 1661. As
such openings, however, sometimes become ossified at a later period, so also on the
contrary, may membranous parts of the skull be produced at a late period,
especially in dropsy of the head, in the gid in sheep, from absorption, &c. A
woman who had exostosis in the pelvis, was delivered of four children, in which
there was an unossified indentation on the forehead, v. Frank. — In Osiander's
collection at Gottingen, I saw the skull of a bitch membranous in several spots,
and she had produced similar puppies. Instances of such membranous patches
on the skull are given by Feirac and Portal sur Rhachitisme ; Bidloo Opera
omnia, p. 191, tab. 3. L. B. 1715. — Sandifort Obs. anat. pathol. L. III.
cap. 10, p. 132 and 137, and Mus. anat. Vol. II. p. 16, tab. 34. — Stark
Neues Archiv f. die Geburtshiilfe, Vol. I. p. 422. — Loffler, ib. p. 428,
note. — Osiander Beobacht. und Abhandl. u. s. w. p. 223. 1787. — Baillie,
Engravings, Fasc. VIII. pi. 3, fig. 2. — Howship, Practical Observations in
Surgery, p. 33, from a fall. -— Palletta Exercit. patholog. I. p. 127. —
Hesselbach Beschreibung der patholog. Praparaten zu Wurzburgh. p. 8. No. 652.

m2

164 Of the Bones of the Head. [Part II.

Gall, pi. 49. — Cerutti Beschreibiing der pathol. Praparate des anat. Mus. zu
Leipzig, No. 761. In a Cretin, v. Prochaska, &c. — Sometimes the fontanels
remain open for a long: time, even througliout life. v. Casp. Bauhini Theatr.
p. 280. — Lachmund in Miscell. Acad. Nat. Cur. lG7o — 1676, p. 240, in a man
twenty-three years old. — Nil Rosen resp. Sidre7i de Ossibus calvariaB. Upsal,
1746. — Ma?/er Beschreibung des ganzen mencshl. Kbrpers. Vol. II. p. 63 ; in a
woman of some twenty years old I have also seen this, as also an open fontanel
in a monstrous sheep, v. Selt Beob. I. No. 9, p. 30, the great fontanel remains
long open as a peculiarity in some kinds of sheep, which are called heath sheep.
We also sometimes see it in pug dogs. v. Greve Bruchstiicke zur vergl.
Anatomic und Physiologic, p. 1. Oldenburgh, 1828, in the various kinds of
birds with large cells ; the bony cell is frequently ossified imperfectly.

(23) Morgagni De sedib. et cans, morbor. Ep. III. p. 2, IV. p. 15, XIV.
p. 35, XXVII. p. 2, LX. p. 12. — Albimis Index suppellect. anat. Raviani.
No. 27, 29, p. 4. — Sandifort Mus. anat. Vol. II. tab. 13. — Voigtel Pathol, anat.
Vol. I. p. 272. — Monro, Outlines of Anatomy, pi. 12. — Biermayer Museum anat.
pathol. No. 221, 317, 563. — Hollberg in Ars-Berattelse om Svenska Sallskapets
Arbeten, of Coriander, Stockh. 1818, in a child twenty months old. — JVendt in
V. Froriep's Notizen, No. 65, p. 327, on the back of the head, probably from
muscular exertion. — My Verzeichniss, &c. No. 3093 — 3097, 3115. — In
animals, a morbid thickening of the skull is very rare, excepting such as are
scrofulous, in which I have seen it several times.

(24) Thickening of the skull occurs in insane persons, and it is so much greater
as it is farther back. — Greding found the skull too thick in 151 out of 196 indi-
viduals.— Georget, p. 480, found it l-20th too thick in 480 out of 500 such
skulls. V. also Esquirol. — Gall thought the skull was too thick and ivory like in
all suicides, which however is by no means generally the case.

(25) Compare above § 119, note 4.

(26) I saw a skull of this kind in the Surgical Academy at Copenhagen, and
there is a sim.ilar one in Bresl. Mus.

(27) Caspart D. de exostosi cranii rariore. Argentor. 1730 ; and in Haller's
Coll. Diss. chir. I. No. 4. — Mogling in Eph. Acad. N. C. Cent. V. and VI.
p. 221. — Muller D. de febre biliosa, subjuncta observatione exostoseos in cranio
reperta?. Argentor. 1782. — Tarin in Act. Nat. Cur. Vol. VIII. p. 251. — Baillie,
Engraxings, Fasc. X. pi. 1, fig. 2. — Kohler, p. 29, No. 100, a very large internal
one. — Rbmhild D. continens nonnulla de exostosibus in olla capitis. 8vo. Goett.
1808, with engravings, from Blumenhach' s Collection, engraved and described in
/. P. Frank's Opuscula posthuma. p. 102, tab. 4 — 6. 8vo. Viennae, 1824. —
Prochaska Disquisitio anat. physiol. organism!, etc. tab. 6 and 7. 1822. — I saw
a remarkable case in the Cabinet d'ecole de M6decine at Paris, it is engraved in
the Diet, des Sc. medic. Vol. XXXV. p. 26, pi. 3. — Hartmann in Rust's
Magazin f. die ges. Heilk. Vol. III. Parti, p. 19. — Hesselbach, No. 371. —
Wittwerck. — My Verzeichniss, &c. No. 3100 — 3147. — Injuries of the skull
are sometimes cured by exostosis, to wit, Sandifort Mus. anat. Vol. II. tab. 19. —
Myself, No. 3106, 3108.

(28) Especially in the cavity of the skull of oxen. v. Vallisneri De Animalium
cerebris ut vulgo creditum est, lapidesccntibus in Op. I. p. 80. — Soemmerring
Anhang zu Baillie, p. 180, engraved in Rheineck Medic, u. chir. Beobacht.
iiber die einfache Methode, des Serten-Blasensteinschnittes, pi. 3, fig. 21. 8vo.
Berl. 1815. — G. Moreschi, v. Zscliokke's Miscellen f. die Neueste Weltkunde,
No. 92. 1809.— Ephem. N. C. Dec. I. Ann. I. Obs. 26, p. 92. — Th. Bartholini,
Epist. VIII. Cent. III. and VI.; and Histor. med. Obs. XCI. p. 357. — Giroin
Annuare de la Soc. de Medic, du Depart, de TEure, 1810, p. 90. — Dohizensky
de Negroponte in Miss. Acad. N. C. Dec. I. Ann. I. 1670, p. 289. Ann. 11.
App. p. 8. — Duverncy m Mem. de Paris, 1703. Hist. p. 26. Mem. p. 261. —
Jin ron in M<5moir. de Paris, 1753. Hist. p. 134. — Pitschel Anat. chir. Anmcr-
kungon, Dresden, 1784, now in the Anat. Mus. of the Academy of Surgery at
Dresden. My Selt. Beob. I. p. 79, tab. 1, fig. 3. — Simson, An Inquiry how far
the vital and animal actions, &c. p. 259. 8vo. Edinb. 1752, with engravings. —
Sandifort Mus. anatom. Vol. HI. No. 650, ]). 392. — I saw a similar exostosis in

Sect. XV.] Of the Bones of the Head, 1G5

the Imperial Museum of Florence ; and another in the collection of Sommerring. —
I saw a large exostosis on the skull of a roe, in the collection of Schinz, at
Zurich; on the skull of a fowl, v. Nat. Cur. Observ. med. phys. Cent. III. and
IV. Obs. 96, p. 257; on the skull of an epileptic canary-bird, — Goldfuss.

(29) Boerhavii Prael. de morbor. nervor I. p. 141. — Fordyce De Hemicrania
§ 33. — Plainer De vi corporis in memor. I. p. 31. — Greding, p. 32. — The London
medic. Repository by JSwrrozi^^ and Thomson, Jan. 1817.- — My Selt. Beob. I. p. 72,
No. 31, Verzeichniss, &c. No. 233, 234, 236, 238, 240, 242, 243, 3064, 3067,
3109, and 3110,

(30) Of which, in the several bones.

(31) Several examples in SandiforL Voigtel, Pathol. Anat. Vol. I. p. 286. —
My Verzeichniss, &c. No. 187—190.

(32) Many instances in de Plouquet Repertor. Art. Cranii suturae, Cephalaea,
Hydrops capitis, Sutura, &c. Such a case of diastasis from dropsy of the head,
in a boy of seven years, is found in the works of M, Baillie ed. Wardrop. Lond.
1825. Vol.1, first described in Medical Transact. Vol. IV. 1813.— My Selt.
Beob. II. p. 95, No. 42; Verzeichniss der anat. Praparatensammlung, No. 3120.

(33) A too perfect state of the sutures and the fontanels, for the most part, or
completely closed, is not very unfrequent in newly born children ; v. Osiander
Annalen der Entbindungslehranstalt zu Gott. 1800, p. 27. — Bnsch in Stark's N.
Archiv fur Geburtshiilfe. II. p. 96. — Jorg Handb. der Kinderkrankheiten.
Leipz. 1826, p. 315, § 316. I have seen several such instances, also complete
ossification of single sutures in human and brute monsters, to wit, No. 3012,
3047, 3052, 8056, 8226, 8227.

(34) Lentin in Blumenbach's Medic. Biblioth, Vol. III. p. 525, (all the
sutures in a boy six years old.) — Desessarz in Mem. de I'lnstit. nation, des Sc.
Vol. I. p. 234, (all the sutures in a boy twelve years old,) individual sutures are
pretty frequently seen closed.

{35) v. my Verzeichniss der anat. Praparatensammlung, p. 4 — 6, in which
such varieties exist, for instance, No. 179 — 182, 209, 214, 226—229.

(36) To wit, a kind of middle fontanel in the sagittal suture, v. Stein's
geburtshiilf. Wahrnehmungen I. p. 345. — Meckel Anat. physiol. Beobacht. und
Untersuchungen, p. 3 and 50. Halse, 1822. I have also found it twice.

(37) In Zo(/feT's Cabinet, v. Xo/ifer, p. 50, No. 171.

(38) A good engraving of a large half-united incised wound, in Sandifort Mus.
anat. Vol. II. pi. 19. — A remarkable injury of the skull, which a suicide effected
on his forehead with an axe, I have described in my Selt. Beob. II. p. 14. v.
Verzeichniss des Museums, No. 3183, in which occur, from No. 3169 to 3195,
many instances of injuries of the skull ; of the congenital, v. below, in the foetus.
Pieces of the skull which have been cut off" obliquely are sometimes healed with
some loss of substance; for instance, Sandifort, Vol. II. tab. 20. fig. 1 ; a case
in Bresl. Mus. No. 8250, and some cases in the Anat. Mus. of the Joseph Acad,
at Vienna. [There is in the Museum at St. Thomas's Hospital, a fine instance
of union of a portion of the parietal bone about the size of a half-crown, which
had been struck off'by a sabre. T.]

(39) Fissures of the skull sometimes do not heal for a very long time; such
cases are described by Duverneij in Mem. de I'Academie de Chirurgie. Vol. I. —
Stanley in Medic, chir. Transact. Vol. VIII. p. 24, pi. 1. — Eltze D. de fracturis
baseos cranii cognoscendis quaedam. 8vo. Berol. 1826. — Good engravings of
fissures are given by Sandifort, Mus. anat. II. pi. 17 and 18.

(40) V. my Verzeichniss, &c. No. 3122, 3124, 3128 — 3131, 3164.— ^ow^«/br^
gives good engravings of such holes in his Mus. anat. II. pi. 20 — 24, 26, 27.

(41) James Russet, Some observations of a peculiar affection, to which the bones
of the cranium are liable, in Transact, of the medico-chir. Soc. of Edinb. 1824,
No. 3. — Cullerier Observations des necroses du crane produites par la syphilis
in Annuaire med. chir. sur des Hopitaux et Hospices civiles de Paris, 1819,
p. 437. [A Fasciculus containing nine lithographic anatomical drawings, &c.
pi. 7. fig. 1. T.]

(42) Palletta De tuberculis ossivoris in Exercit. pathol. I. p. 93—104.

(43) Le Clerc Maladies des Os, etc. v. Mailer's Biblioth. chir. I. p. 469.—-

166 Of the Bones of the Head, [Part II.

Pelletan Clinique chirurgicale, Vol. II. fig. 1. — Rickter in v. Froriep's Notizen,
Feb. 1822, No. 24, p. 29.— Krimer in v. Gr'dfe's and v. Walther's Journ. f. d.
Chir. 1827. Vol. X. Part IV. p. 587. — In a case related by Flint in New-
England Journ. of Medic, and Surgery, new series, Vol. IV. April, 1820, a
bloody tumour sprung through an opening on the occiput connected with the
sinus transversus. I have also before me a similar case in a boy of five
years old.

(44) Crell resp. Kaufmann D. de Tumore capitis fungoso post cariem cranii
exorto. Helmst. 1743, cum icone, in Haller's Coll. Diss. chir. I. No. 3. — Sandifort
Exercit. academ. Lib. II. p. 40, tab. 3. — Museum anat. Vol. I. p. 152. Vol. II.
p. 142, tab. 13, fig. 6 — 9. — v. Siebold in Arnemann^ s Magazin fiir die Wundarz-
neiwiss. Gott. 1797, Vol. T. Part IV. p. 389, with engravings. — Cheston Browne
in Philos. Transact. 1780, Vol. LXX. p. 323, with engravings. — Baillie En-
gravings, Fasc. X. pi. 5. fig. 1. — Home, Transact, for the improvement of Med.
and Surg. Knowledge. Lond. 1812, Vol. III. tab. 2.— v. Walther in his and
V. Grdfe's Journ. f. Chir. Vol. I. Part I. p. 55. — Ficker, ib. Vol. II. Part II.
p. 219. — Calliot Diss, sur I'encephaloides ou fongus medullaire. Strasb. p. 25,
Obs. vi. — Wishart in Edinb. Med. and Surgical Journ. July, 1822, p. 393.
Schneider Diss, de fungo haematode. 4to Berol. 1821, with engravings. — Eck
in V. Grdfe's and v. Walther' s Journ. f. Chir. Vol. V. Part I. p. 105. — My Selt.
Beob. 11. p. 82; No. 2133, of Bresl. Mus. — Seerig Comm. nonnuUa de fungi
duraematris origine etdiagnosi, tab. 1. Vratisl. 1825. — Hesselbach Beschreib. der
pathol. Praparate zu Wiirzburg, p. 63, No. 642. — Schwarzschild D. de fungis,
capitis et durae matris. 4to. Heidelb. 1825, with four lithographs. — Salomon in
Petersb. vermischt. Abhandl. III. 1825, ^. 237 . — Schindler in Rusfs Magazin
f. d. ges. Heilk. 1827, Vol. XXV. Part II. p. 267.— G. Sandifort Mus. Anat.
Vol. III. p. 158, No. 127. — C. Graff in v. Griife and v. Walther' s Journal der
chir. Vol. X. Part I. No. 4. — Weffer. — Abercrombie Pathological and practical
researches on diseases of the brain and spinal cord. 8vo. Edinb. 1828. — A. G.
Rhodius D. casum singularem de amaurosi cranii osteosarcomate efiecta. 4to
Berol. 1 829, with engravings, (on the right side of the sphenoid bone ; ) Eber-
maier Ueber den Schwamm der schedel knocken und die schwammartigen
Auswiichse der harten Hirnhaut. 4to. Dusseld 1829, with 10 lithographic
plates.

(45) Landmann Comm. pathol. anat. exh. morbum cerebri oculique singu-
larem, 4to. Lips. 1820, with three engravings. — Myself, p. 86, No. 2356, of the
Bresl. Mus.

§ \2S.

Sometimes the frontal bone is entirely deficient, and its
place supplied by the elongated parietal bones/ the frontal
portion of this bone is very commonly deficient in anencepha-
lous monsters, and its orbitar portion, as in dropsy of the head,
is short and depressed backwards. In hydrencephalous chil-
dren and insane persons, the frontal portion is oftentimes very
much inclined backwards, whilst in dropsy of the head and
rickets it is usually very prominent and much expanded.
The frontal suture remains, in men, especially with broad
foreheads, partially or entirely, often for a long time, or
even permanently, unconsolidated,'* whilst on the contrary
in those animals, in which it regularly remains open, its
consolidation is sometimes observed.^ In rare cases the
frontal suture does not proceed straight to the sagittal.^ The
crista frontalis has been seen remarkably prominent,* and the

Sect. XV.] Of the Bones of the Head. 167

nasal spine abnormally enlarged.^ The frontal sinuses
frequently present variations;^ in rare cases indeed both are
wanting/ or there is but one, or they are unusually small ;
they become contracted by disease, or are completely filled by
bony substance.^ On the contrary, we sometimes find them
unusually large, both as congenital formations,^ and as conse-
quent on morbid extension.^'' They are often much destroyed
by caries, particularly in syphilis, and glanders in horses,
&c. Not unfrequently there arise from the frontal bone, horns
and ANTLERS, which are irregular. Sometimes these are entirely
deficient, and such deficiency becomes hereditary and charac-
teristic of a peculiar race;" more rarely but one horn or antler
is deficient ; ^^ or in cattle, there is only the tip of the corniferous
process, so that the distorted horn is merely attached to the skin.
On the contrary, we observe also too many horns, for instance,
in sheep,^^ goats,^* in the antilope saiga,^^ the deer-kind,^° and
oxen ; ^^ also the females of the deer and roe kind which are
naturally hornless, possess antlers, especially in old age ; these,
however, always remain smaller than the normal horns of the
male.^^ Frequently do the form of the horns and antlers^*
vary, inasmuch as they are observed in sickly deer and roes too
small,^'' become curved in animals which are otherwise healthy,
or are merely malformed in various ways.^"* Vices of texture,
similar to those of other bones, also attack the bony core of
horns and antlers ; we observe them deficient of lime, and
therefore spongy, light, and fi-angible ; ^^ too full of lime, and
therefore too solid and heavy, and studded on their surface with
increasing exostoses. ^^ The bony core inflames, is more or
less destroyed by caries,^^ and even separated from the horny
covering. In rarer instances we observe in deer and roes,
instead of the deficient antler, or upon it, a large or small
quantity of soft movable swellings, often attached to a neck,
which for the most part consist externally of fine hairs, but
within of a cartilaginous substance. In sporting language, such
roe is called a roe-king.^* When great violence is applied to
the horns, they break, sometimes only one of them, or they
even actually break off, which in oxen usually occurs close to
the head.

(1) Bonnet, Medic, septentr. collat. Vol. I. p. 19.

(1*) [It was remarked by Dr. Leach and others, who have seen the collection
of crania in the catacombs at Paris, that the frontal suture remained unobli-
terated in at lease one of eleven skulls. — CUft in catal. of Mus. Roy. Coll. Surg.
Part in. p. 7. T.]

(2) For instance, in sheep ; v. my Selt. Beob. I. No. 10, p. 31. No. 11, p. 34,
and No. 12, p. 39. Congenital consolidation of the frontal suture has also been
noticed in the human subject ; v. my Selt. Beob. I. p. 5 ; — Sandifort Mus. Anat.
Vol. III. p. 99. No. 687.

168 Of the Bones of the Head, [Part II.

(3) My Verzeichniss, No. 179.

(4) In one instance as a long sickle-shaped bony plate, about a third of an
inch broad. Blumenbach Geschichte und Beschriebung der knocken. 2d eilit. p.
114, note 1.

(o) Siebergundi in Harless Rhein. Westphal. Jahrb. Vol. II. Part II. No. 2.

(6) Range praes. Ziegler D. de morbis praecipuis sinuum ossis frontis, etc.
4to. Rintel. 1750. — [Fe/g-e D. de morbis sinuum frontalium, etc. 4to. Gbtt. 1786.

(7) Morgagni De sed. etcaus. morb. Lib. V. Epis. LXIII. Art. 13. Blumenbach,
p. Ill, note 1, saj's that their development is prevented by water in the head,
and rickets, which I have also seen several times. Prochaska, Disquis. anat. phys.
organismi corp. hum. tab. 8, also mentions the same from cretinism.

(8) Horn in his Archiv fiir die medic. Erfahrung. 1815. Part III. p. 552.

(9) My Verzeichniss, &c. No. 170 and 3226.

(10) Not merely is its anterior wall then protruded, like a bladdej:, but some-
times the internal also very remarkably, so that the brain is compressed ; for
instance, Horn, 1815, Part V. p. 854. I once saw the right frontal sinus in a
young roe much expanded by a scrofulous swelling. Selt. Beob. Part I. p. 78.
No. 35, Museum, No. 2361.

(11) It is well known that there are unhorned varieties of oxen, sheep, and
goats. A bull, which was accidentally without horns, implanted this vice upon all
its male progeny, and thus gave rise to the now common race of oxen in Para-
guay. V. Azara's Reise nach Siidamerika, p. 161. Berl. 1810. — A cow, which had
lost the left horn by suppuration, subsequently produced three calves, which had
merely a claw-like horny scale on that side instead of a horn. See Thaer in the
Moegliner Annalen, 1822, Vol. X. p. 154. — In the forests of Erbach were
observed, for several years, stags which in the first year had no antlers, and
subsequently merely prickers ; see Wildungen Taschenbuch, 1802, p. 73. In rare
cases also the horns are wanting in buffaloes ; v. Cuvier Ossemens fossiles,
Vol. IV. p. 123. Plate 10. fig. 7—9.

(12) Anaxagoras dissected, in the time of Pericles, the head of a ram with but
a single horn, Plutarch; in the antilope saiga sometimes there is only a single
horn. Linn^. System, anat. ed. GmeUn, Vol. I. p. 185. — At Mr. Klinkenberg's,
apothecary at Utrctcht, I saw the skull of a roe with but one antler, and that on
the right side. If a stag or roebuck be castrated only on one side, on that side
no antler is reproduced.

(13) Such a ram is sketched in the Ecarts de la Nature, tab. 18. Sturm in
Viehrassen, Jena, 1819, Part II. pi. 6. — A similar one exists in Bresl. Mus.
No. 3223. In Iceland sheep we find as many as eight horns, also in other sheep
five horns; for instance, Radzcynski Historia Poloniae animalium, Vol. II. p. 464,
U2:)on Ovis polycerata. v. Linn6 Ammoen. acad. Vol. IV. p. 174.

(14) Skulls of goats with four horns are not very uncommon ; there are three
of them in Bresl. Mus. No. 3222, 4672, 8217.

(15) Linn^.

(16) Double antlers and supernumerary shoots are not uncommon in stags
and roes. Nov. Acta N. Cur. Vol. I. Obs. 39. p. 148. — Aelian Animal, Lib. XI.
cap. 36. In Bresl. Mus. there are the double antlers of two roes. No. 3211,
3212. I saw, in the Ashmolean Museum, at Oxford, the skull of a roe with a
third horn in the middle and in front of the other two ; and in tlie Museum of
Natural History at Copenhagen a skull of an elk, in which the left antler is
doul)le. [No. 272, Mus. Roy. Coll. Surg, a double horn in a goat. T.]

(17) An instance of three horns is given by Radzci/nski ; a similar one may
be seen at Madrid. [No. 271, Mus. Roy. Coll. Surg, is a remarkable instance
of a third horn in a cow, growing from the centre of the forehead, between the
eyes; it arises by a broad base, tlie greatest diameter of which is 9^ inches; it
forms an elevated crest, extending forwards as far as the extremity of the nose,
is hollow or concave on its inferior surface, and composed of a loose fibrous
structure. T.]

(18) Of hinds with horns there are many exam])les in Anglica Normaimica a
veteribus scri})ta ex bibiiotbcca G. ('aindeni, Inucrnr'nnw, Cambria?. Francof.
1603, p. 821. — Ephcm. N. Cur. Ann. IX and X. Obs. 88, p. 225, and Dec. II.

Sect. XV.] Of the Bones of the Head. 169

Ann. 11. Obs. 98, p. 247.-6=. E. Stahl De cornu cervi deciduo. Halse, 1699. —
Scheuchzer in Leopoldi D. de alee. Basil. 1700. — Valmnnt de Bomaine in Journ. de
Physique, Vol. VI. p. 501. — Ridinger Abbild. seltener Thiere Tab. 79. — Jam.
Hoij in Transact, of the Linnean Society, Vol. II. p. 356 — v. Wildungen Tas-
chenbuch fiir Furst-und Jagdfreunde. 1800, p. 14. — Gr. Mellin, ib. 1805, p. 13.
— In roes this is noticed in Eph. N. Cur. Dec. II. Ann. VI. Obs. 192, p. 367. —
V. Wildungen, 1801, p. 178. — I saw an antler of this kind in the Zootomical
Cabinet at Paris, and three examples are to be found in Bresl. Mus. No. 3217 —
3219 ; in a fourth instance. No. 4668. the animal was even with young. Com-
pare Selt. Beob. Part I. No. 30, p. 71. [No. 16, Mus. Roy. Coll. Surg, is an
instance of an old roe hind, which had horns, the longer of which did not
exceed three inches. And in the note accompanying this, Lord Egremont
states that it is not uncommon to see imperfectly formed horns in the roebuck,
stag, and fallow deer which are old and past their prime. T.J

(19) There is a rich collection of malformed antlers in the hunting castle of
Moritzburg, at Dresden. Compare Allgem. Historie der Natur. Vol. II.
Part III. p. 88, 109, 134. Vol. I. Part VIII. p. 127.— Of a reindeer. Vol. II.
Part VI. p. 80. — Ridinger, pi. 81, and in Blatter rarer monstroser Hirsche. fol.
Augsb. 1740. — V. Wildungen Jagdkalender 1799, pi. 3, and Taschenbuch fiir
Forst-und Jagdfreunde, 1809— 1812.— My Verzeichniss, No. 3202—3221.

(20) Such distorted roe horns have given rise to the fable of hares with horns.
(20*) [Horns sometimes grow parallel to each other, become firmly united

throughout their whole length, producing the appearance of a single horn ; a
good example of which is seen in the Ovis Ammon, No. 1043. in Mus. Roy.
Coll. Surg. T ]

(21) I kept a stag for twelve years, which at two years old I had castrated,
it put up yearly, when it shed its coat, new long prickers, which were mostly
covered with velvet, and were so brittle that the stag never attempted to but
with them, but if angered, used his fore feet as weapons. [This is a remarkable
exception to the fact usually noted, that animals which have deciduous horns,
never shed them after castration ; there are several instances of such permanent
horns in stags, in the Mus. Roy. Coll. Surg. And further to shew the intimate
connexion between the growth of horns and the generative functions, it has been
observed that if a stag have its horn broken during its growth, the animal is for
that year impotent. T.]

(22) Allgem. Historie der Natur. Vol. II. Part III. p. 87, No. 587.— My
Verzeichniss, No. 3202.

(23) Cotton Tufts in the Memoirs of the American Academy of Arts and
Sciences, Vol. I. Boston, 1785, and in the London Med. Journ. Vol. VII.
Part III. p. 305, 1786.

(24) Schmucker Fasciculus admirandorum naturae. Strasb. 1697, p. 5, No. 4.
— Rudolphi, Bemerkungen — auf einer Reise, u.s.w. Part I. p. 71. Part II. p. 200,
describes one such from the Cabinet of Natural History at Vienna, and another
at Brunswick. — Osiander Epigramiifiata in diversas res musei sui anatomici.
2d edit. Gott. 1814, p. 155, pi. 6.— My Selt. Beob. II. p. 10, of a female roe;
I however possessed for a short time the head of a male roe, of which one of the
horns sent off a somewhat longish bottle-like process; the head of the so called
roe-king is found also in the Anat. Mus. at Berlin.

§ 124.

The PARIETAL BONES are very frequently deficient, either
entirely or partially in anencephalous monsters; they are,
however, occasionally missed in natural foetuses.^ In rare
cases they are divided by an irregular transverse suture into an
upper and lower-half; ^ we have, however, seen the suture in
one instance run partially verticaP and diagonal.* Its form

1 70 Of the Bones of the Head. [Part 1 1 .

participates in almost all the changes of the skull, so that it is
sometimes found unequal, oblique, remarkably large in watery
head, &c. We sometimes observe the groove for the longi-
tudinal sinus, not in the middle beneath the sagittal suture,
but running along only one of the parietal bones ; the edges of
this groove are also seen very prominent, like a kind of bony
sickle. Frequently very deep pits are found, indeed even
bladder-like depressions from the so-called pacchionic glands ; ^
sometimes the parietal holes, foramina parietalia^ are very
large/ If in the bloody tumours of the heads of new-born
infants, the effused blood remain for any length of time upon
the parietal bones, on that spot is the external table easily
destroyed.^ Finally, the parietal bones, on account of their
position, are especially subjected to injuries;^ this applies to
animals with the prominent crista longitudinalis, also especially
in that part, which therefore very frequently exhibits bendings
and fractures.^

(1) Loffler in Stark's Neuem Archiv fur die Geburtshiilfe, Vol. I. p. 422 ; and
Stark, ib. p. 423, note.

(2) Winslow in Turin Osteographie, p. 16, pi. 5. — van Doeveren Observ. academ.
p. 195. — Murray resp. Schulzen Descriptio foetus hydrocephalo interno correpti.
Upsal. 1797. Compare RudolpMs Schwed. Annalen, Vol. I. Part I. p. 119, —
Meckel relates one case from the collection of Gotthard, and two of his own.
Handbuch der pathol. Anatomic, Vol. I. p. 337. — Hesselbach Beschreibung der
pathol. Praparate eu Wurzburg, p. 3. No. 43. — von Sommerring in I'iedemann' s
and G. R. and Chr. L. Treviranus Zeitschrift fiir Physiologie, Vol. II. Part I.
p. 1, pi. 1 and 2. The suture sometimes does not pass completely through.
V. AurivilUus resp. Ekmark de hydrocephalo 45 annorum. Upsal. 1763. In
Sandifort Thes. diss. Vol. II.

(3) AurivilUus.

(4) Hesselbach.

(5) My Verzeichniss, No. 3082.

(6) Jancke De foraminibus calvarioe eorumque usu. Lips. 1762. — Lohstein D.
de nervis durae matris. Argentor. 1772, Tab. 1, fig. 6. — My Verzeichniss,
No. 3083, 3084.

(7) Michaelis in Loder's Journ. f. d. Chir. Vol. 11. Part IV. p. 657, improperly
considered the bloody swelling as an original disease of the bone ; v. below, on
the Head. Cases of such bony erosions are found in Palleila Exercit. pathol.
4to. Milan. 1820, p. 123. — Hesselbach, p. 145, No. 289. — My Verzeichniss,
'i^o. ^\22. — Schwarz in v. Siebold's Journ. f. Geburtshulfe, 1828, Vol. VI.
Part II. p. 439.

(8) Schneider D. de vulneribus sincipitis. Viteb. 1653. — Kahl D. de fracturis
ossis bregmatis. Lips. 1776.

(9) I saw a fossil hyaena's skull in Soemmer ring's Museum, in which the longi-
tudinal crest had been almost entirely broken off and reunited. On the skull of
a hyaena striata, No. 4608, in Brcsl. Mus. it is very much curved ; in dogs I
have several times seen it indented, and with united fractures ; also curved, in
the nasua rufa.

§ 125,

The OCCIPITAL BONE,^ in anencephalous and hydrencephalous
monsters is often very deficient at its upper part ; in the latter
case we frequently find in it only one single hole of greater or

Sect. XV.] Of the Bones of the Head. 171

less size ; in both kinds of monsters we find the occipital bone
pressed much backwards and downwards ; still, however, after
birth the squamous part of the bone is very much driven out
by dropsy of the brain ; as well also in persons with heavy
heads, especially if connected with softening of the bones,
the under part of the bones is very much thrust up into the
cavity of the skull ;^ sometimes the pressure is so great that
we find on the occipital bone a deep impression answering to
the first cervical vertebra.^ We very frequently find the sepa-
rate bony pieces, of which in the foetus the squamous part of
the occipital bone is composed, ununited at a later period, and
therefore large distinct pieces lie in and upon the lambdoidal
suture,* or the bone is divided by a transverse^ or more rarely
by a perpendicular^ suture. The occipital spine is sometimes
unusually large ; the articular processes jut out too much and
are too deeply articulated, or are too flat, and at the same time
sunk in, oblique,^ unequal, divided into two surfaces, &c. ; in
rare cases we find near the articular processes on one or both
sides, some which are accessory, that is, processes which are
articulated with the atlas. ^ Oftentimes we find the occipital
hole malformed, viz. too narrow, too wide, oblique,^ or in
idiots unusually wide and directed backwards, &c. In horses
and cattle we find caries of the occipital bone from pressure of
tumours in the neck, poll evil, talpa,^^

(1) Schneider D. de osse occipitis, ejusdem vitiis et vulneribus. Viteb. 1653.

(2) I have seen this several times in osteomalacy and in rickets ; it also often
occurs in the skulls of cretins.

(3) For instance, my Verzeichniss, No. 165, 168.

(4) Compare the Catalogue of Bresl. Mus. No. 194, 208, 211, 217, 225, &c.

(5) Etcstachius, tab. 46, fig. 8. — Albinus De sceleto, p. 131. — Albrecht in Nov.
Act. Nat. Cur. Vol. IV. Obs. 13, p. 70. Vol I. fig. 7. — Bruns Observat. anat.
et chir. med. Getting. 1760. rev. in Sandifort's Thesaurus Diss. Vol. III. p. 65. —
Schreiber in Nov. Comm. Acad. Petropol. Vol. III. p. 395, pi. 9. — Blumenbach
Geschichte der Knochen. Part II. p. 186, note c. — Rudolphi Schwed.
Annalen. Vol. I. Part I. p. 119, note. — Meckel Handb. d. pathol. Anatomie.
I. p. 320. — Kelch, Beitr. z. pathol. Anat. p. 2. No. 2. — Bleuland Descript. Mus.
anat. p. 226. No. 1177; one instance in Bresl. Mus. No. 202; in the anat.
pathol. Museum at Vienna, and in the anat. Museum at Heidelberg. Deep
notches on either side are common.

(6) Vesalius De corp. hum. fabrica. Lib. I. cap. 6, p. 26, the edition by Albin ;
Reisel in Eph. Nat. Cur. Dec. II. Ann. II. p. 274. A notch often remains for a
long while above in the lambdoidal angle.

(7) In long-continued wry neck the whole base of the occipital bone is often
awry. v. Bleuland, p. 238. No. 1241.

(8) Sandifort Exercit. acad. Vol. I. p. 10. — Mus. anat. Vol. II. plate 14,
fig. 31. — Leveling Observat. anat. rarior, p. 134, tab. 5, fig. 2 (hardly more than
facettes on the occipital bone, and the tubercles on the Atlas; — Meckel Dedupli-
citate monstrosa, p. 24, in D. Archiv f. d. Physiol. Vol. I. p. 644, pi. 6, fig. 37 ;
and in Anat. physiol. Beobacht. und Untersuchungen, p. 178. — Tesmer praes. Ru-
dolphi D. Observat. osteol. Berol. 1812, with plates ; three cases, in Bresl. Mus,
No. 166, 167, S292. — G. Sandifort Mus. anat. Vol. III. p. 289, No. 987.—

1 72 Of the Bones of the Head, [Part II.

Knape also possesses such a skuU. v. Schuple De luxatione spontanea atlantis et
epistrophei, p. 21, in note. 4to. Berol. 1816.

(9) I have seen several instances of this, also some in brutes ; to wit, Selt.
Beob. I. No. 10 and 11 ; since that time several more ; five instances are related
by Meckel in his Anat. phys. Beobact. p. 173.

(10) I have seen instances of this at Alfort, and large exostoses, from similar
causes, on the skull of a horse in the veterinary school at Stockholm.

§126.

The TEMPORAL BONES also exhibit many vices of formation ;
to these bdong the partial deficiency of the squamous portion
in anencephalous monsters, their exceeding smallness, approxi-
mation to each other, consolidation and deficient formation in
monsters with imperfect face, particularly with cyclopy and
want of the lower jaw ; ^ further, the division of the squamous
portion into many pieces f its lengthening forwards, so that it
joins itself with the frontal bone ;^ deficient formation of the
zygomatic process/ &c. In anencephalous monsters, and in
watery heads, owing to the lateral extension of the head, the
petrous bones, instead of being sloped, are completely trans-
verse, and in the latter disease the petrous bone and squamous
portion are more or less pressed upon each other/ In rarer
cases the groove for the transverse sinus in the temporal bone
is deficient;^ the edge of the petrous bone sometimes in insane
persons projects as a cutting bony plate ;^ the carotid canal
becomes narrowed, in consequence of the smallness and
obliteration of the carotid artery, and is even found completely
closed;^ the styloid process is remarkably large and be-
comes bony;° the glenoid cavity is naturally wanting at the
same time with absence of the lower jaw, and in gouty persons
is entirely bereft of its cartilage ; frequently surrounded with
tophus ; a new articular cavity has been once found produced
after dislocation of the lower jaw.^° In rare cases we find in
man, unusual openings and canals in the temporal bone for
veins, which run out from the transverse sinus. ^^ The tem-
poral bones are frequently found carious ^^ in consequence of
primary diseases of the ear, of abscesses of the brain, which
burst here, from metastasis, from superjacent tumours, &c.;
we have also once seen a very large exostosis on each temporal
bone." As to those parts of the temporal bone which belong
to the ORGANS OF HEARING, we find them as a rare congenital
condition malformed in various ways, that is, as in the small
foetal state, deficient in certain parts, consolidated together, &c.
We observe the bony passage of the ear, in congenital closure
and deficient development, sometimes very short and narrow,
and it is also said to be compressed in later years, in such
persons as liave lost their back teeth. ^' The drum is in rare

34

Sect. XV,] Of the Bones of the Head. 173

cases too small," malformed, with consolidation of both auditory-
organs, also in deaf and dumb persons ; ^^ on the contrary, too
large and very frequently rough and broken down by caries.
The auditory bones, in rare cases, are alP^ congenitally wanting,
occasionally only some of them, viz. the hammer and the anvil,^^
or merely, the hammer ^^ or the anvil ;^° sometimes we notice
supernumerary auditory bones in man and animals ; ^^ in other
cases they are too small, ^^ too large,^^ malformed in various
ways,^^ united with each other and with the neighbouring
parts,^^ lost from suppuration, separated by dropsy of the
head, &c.^*' The parts of the bony labyrinth also are, in rare
cases, very much malformed, particularly in deaf and dumb
persons ; ^^ we have also seen the round and oval holes wanting
at the same time,^^ or merely the round ^^ hole, or the oval hole,^**
or the latter too narrow ;^^ the cochlea has a turn too little,^^ or
it is too small, so that the promontory in the drum is defi
cient;^^ in one deaf and dumb person the semicircular canals^
merely, were wanting, in an otherwise perfect ear, &c.

(1) I have noticed this in a great number of human and other animal mon-
sters. Compare further down on the Ear. — E. H. Weber has lately described a
few instances of consolidation of the organ of hearing, in the Zeitchrift f. Phy-
siologie by Tiedemann, H. R. and L. C. Treviranus, Vol. II. Part II. p. 305,
pi. 15. — A skull of this kind is described in Sandiforfs Mus. Anat. Vol. III.
p. 293, No. 1004.

(2) Meckel Handb. der pathol. Anatomie, Vol, I. p. 339. — I have similar
instances before me. — Kelch, Beitrage zur pathol. Anat. No. 4, saw the mamil-
lary parts divided from the squamous by a suture.

(3) Chizeau in Roux Journ de M^dec. Dec. 1772.

(4) In a cretin it was so short as to form no zygomatic arch. v. Prochaska
Disquis. Anat. phys. organismi c. h. tab. 8. — Deficiency of the zygomatic arch,
in consequence of congenital tumour in this region. My Selt, Beobacht. II.
p. 162.

(5) Blumenhach, p. 151, note 1.

(G) The Review of Rosenmuller De singularibus et nativis ossium c. h. varleta-
tibus, in the Ergangungsblattern zur Hall. allg. Litt. Zeitung, 1813. No. 101.

(7) J. E. Gredhig Sammtliche medic. Schriften, u s.w. p. 293. — My Selt. Beob.
I. p. 73. No. 3—74. No. 7.

(8) So narrow, that it would hardly admit a pig's bristle, v. Tode Medic,
chirur. Biblioth. Vol. X. p. 407 ; entirely closed in a preparation in the Anat.
Mus. at Dresden.

(9) So that it could easily be broken. — Blumenhach, p. 139, Note n, had one
which was an inch and a half Paris measure ; in No. 144, &c. almost two inches;
in No. 245, even three inches long; two inches, and two inches and a half
long, V. Sandiforfs Mus. Anat. Vol. III. p. 289, No. 988 and 989. [There is
a very remarkable skull in the Mus. at St. Thomas's Hospital, in which the
styloid processes are of great length, and each has articulated on its point a bone
which occupies the place of the stylohyoideal ligament, and joins the tongue-
bone, which is thus connected by bone to the skull, as in many animals. T.]

(10) a Loder Index Prseparator. Absch. X.\.—Sandifort, No. 594, p. 283. —
[There is another instance in the skull of a New Zealander, No. 78, Mus. Roy.
Coll. Surg. T.]

(11) My Selt. Beob. II. p. Q9, No. 31. b. — There can be no question that
this variation of structure, so important to practical surgery, is, in most mam-^

174 Of the Bones of the Head. [Part II.

malia, connected with tlie existence of the canalis venosus. v. De Animalium
quorundam, per hyemem dormientium, vasis cephalicis et aure interna in Nov.
Actis phys. med. Acad. N. C. Vol. XIII. F. I.

(12) Morgagni Epist. anat. XIV. — Mohrenheim Beobacht. verschied. chir.
Vorfiille, I. p. 98. — Memoir de I'Acad. de Paris, 1754, p. 63. — A.Duncan, in
Medic. Commentaries, II. p. 286. — Schuhmacher Medic, chir. Bemerkungen,
I. p. 301. — Weidmann Ueber den Missbrauch des gliihenden Eisens, pl. 5 and 6. —
Palletta Exerc. pathol. p. 2. — Brodie, in Transact, of a Soc. for the Improv. of
med. and chir. Knowledge, Vol. III. p. 106. — Parkinson in London medic.
Repository, Jan. 1817. — O'Brien, in Transact, of the Association, &c. Dublin,
1818. Voi U.— Thiele'm Rust's Magazin f. d. ges. Heilkunde, Vol. II. Parti,
p. 164. — Starke, ih. Vol. II. Part II. p. 311, the pus escaped through the fora-
men mastoideum. — Rust, Vol. IV. Part I. p. 197. — Neumann in Hufeland's
Journ. No. 2, p. 6. July, 1824, the pus escaped through the glasserian fissure
in the articular cavity for the lower jaw ; and lb. No. 12, p. 14, from an adjacent
steatom. — Duncan, jun. in Edinb. med. and surg. Journ. July, 1821, Vol. XVII.
in three instances. — Itard Traite des malad. de I'orielle, etc. p. 70. — Dorn in
Hufeland's Journ. 1822, Part II. p. 76. — Lallemand Recherches anatomico
pathologiques sur I'Encephale et ses dependance. 8vo. Paris, 1824 — 1829. —
Raikem in Repert. gen^r. d' Anatomic et de Phys. pathol. Vol. I. No. II.
p. 295.— My Selt. Beob. II. p. 96.— Verzeichniss, No. 3225— 3231. — Kim7nel
praes. Birkholz D. observatio anat. pathol. de canali carotico carie syphilitica
exeso. 4to. Lips. 1805, with engravings. — ffo/sHn Magazin for Naturvidenska-
bere. Parti. Christiania, 1825. — Martin, in Journ. de Medec. Vol. XXX.
p. 453.— G. Sandifort Mus. anat. Vol. III. No. 927, p. 278.

(13) Petit found one hard and like ivory, of the size of a melon.

(14) Larrey in the Journ. Compl. du Diet, des Sc. Medic. Vol. XIII. p. 308.

(15) Rudolphi found it very much diminished, and the pyramid especially
wasted in a man. Physiologie II. p. 148, note 2. — I have found it very small in
several cyclopic monsters, v. my Selt. Beob. I. No. 12.

(16) Rudolphi.

(17) I have also found this simultaneous with deficient face ; since then, in
some imperfect auditory organs in animal monsters.

(18) Caldani Ep. ad Hallerum, Vol. VI. p. 142. — Scarpa De structura fenestrae
rotundae auris, etc. p. 84. Mutin, 1772.

(19) My Selt. Beob. 1. No. 10 and 11.

(20) Boneti Sepulchretum anat. Lib. I. p. 19. Obs. 4. — Marin. Mersennus Epist.
ad Beverwyk De calculo, p. 80.

(21) Cassebohni Tractat. VI. de aure humana. Halae, 1734, p. 55. Teich-
77i« i/er Vindiciae quorundam inventor, meorum anat. Jenae, 1727. rev. in Haller^s
Disp. Anat. Vol. IV. — Eastach tab. 7, fig. 3, (in a dog.) — Adair in Cowper
Myotomia reformata. fol. London, 1694, p. 70, fig. 9. — In a preparation be-
longing to Professor Romer, at Vienna, there is a Jong cylindrical intermediate
bone between the malleus and incus, which are separated from each other.

(22) In a deaf and dumb child, three times too small, Bailly v. Boneti Sepul-
chretum, Vol. I. p. 19, Obs. 4, § 3.

(23) Cotunni De aquaeductibus auris humani. Neap. 1760. § 72, concomitant
with a closed fenestra rotunda.

(21) Haller Elem. Physiol. Vol. V. p. 209, 213.— Rudolphi, p. 128, note.—
The stapes has been seen with only one leg, or without any opening in it. —
Comparetti Obs. anat. de aure interna comparata. p. 24, Obs. 13. 4to. Patav.
178f), in two cases. — Cassebohm Tractat. sextus do aure monst. hum. tab. 6,
fig. 18. Ilalfp, 1735, — Ticdcmaiin in Meckel's D. Archiv fiir d. Physiologie,
Vol. V. Part III. p. 349. — In other instances one leg of the stapes does not
reach its base. Ldsecke Obs. anat. cliir. p. 15. 4to. Berol. 1754. — Rudolphi in
Tesmer D. s. Observat. osteologicas. tab 1, fig. 15. 4to. Berol. 1812. — An exostosis
on an incus, v. Hesselbach Beschreib. der pathol. Praparate zu Wiirsburg.
No. 370.

(25) Valsalva T>c aure humana. Caj). II. §10, j). 52. — In consolidation of
bntli organs of hearing, several of the small bones are also at the same time, in

Sect. XV.] Of the Bones of the Head. 175

many instances, anchylosed together, v. My Selt. Beob. I. No. 10 and 11, and
since then in several more cases.

(26) Blumenbach Geschichte und Beschreibung der Knochen. 2d edit. p. 151,
note 1.

(27) Mundini Comment. Bonon. Vol. VI. Anatomia surdi nati. p. 422

(28) Roederer Descr. foetus par. in Comm. Soc. Getting. IV.

(29) Roederer.

(30) Cotunni. — I also saw the same at Romer's, in a preparation from a deaf
and dumb boy.

(31) My Selt. Beob. I. No. 12.

(32) Mundini.

(33) In the case of Romer's at Vienna.

(34) Miirer Ccmm. de causis cophoseos surdomutorum indagatu difficilibus.
Haffn. 1825.

§ 1^7.

The SPHENOID BONE presents numerous varieties in reference
to its form, which partly depend on the size of the fossa
basilaris ; in cyclopic, anencephalous, and dropsical-headed
embryons, it is commonly not only very much malformed, but
also perforated and divided in its body, perhaps in consequence
of the water bursting out^ from the cavity of the head at this
part. The depth and width of the Turkish saddle varies very
considerably, and often becomes very much enlarged by swell-
ing of the cerebral appendage, (pituitory gland) as well as by
dropsy of the head.^ We frequently find the body of the
sphenoid bone, as well also as other parts of it, softened, rough,
and broken up.^ The sphenoidal sinus in rare cases is indeed
completely deficient, or it is very small and undeveloped ; to
this belongs that state, in which it is filled by a kind of diploe ; *
often it varies in having a partition ; sometimes we observe it
communicating by openings with the skull ; ^ at other times
it is unusually distended by diseases, and its roof raised like a
bladder towards the cavity of the skull. ^ If the optic nerve
waste in man and animals, the optic hole in the sphenoid bone
becomes distinctly narrowed.^

(1) My Selt. Beob. I. p. 41, fF. — Klinkosch Pr. quo anatomen partus capite
monstroso proponit. 4to. Prag. 1766, rec. in Diss. med. select. Pragens. Vol. I.
No. 12, p. \^9.—Beclard in Bulletin de la Facult. de Medec. Vol. III. p. 292,
note 9.

(2)1 have myself observed this several times, I also saw in the Pathological
Mus. at Vienna, a large bladder-like elevation of the Turkish saddle, from indu-
ration and hydatids in the pituitary gland.

(3) Especially in epileptic persons ; v. Jos. Wenzel Beobacht. iiber den
Hirnanhang fallsiichtiger Personen. 4to Mainz, 1810. — My Selt. Beob. I.
No. 31, p. 72; at the same time in several individuals; I also once found the
sphenoid bone excessively soft in a syphilitic person. It is often very much
destroyed by tumours in the skull and orbit, by large nasal polyps, &c. ; also
at the same time with part of the petrous bone. — Monro's Morbid anatomy of
the human gullet, stomach, and intestines, &c. Cap. III. sec. 7. — Klein in v.
Griife and v. fValther's Journ. f. die Chir. Vol. III. Part IV. p. 621. — My Selt.
Beob. II. p. 92, No. 39. — A syphilitic caries of the body of the sphenoid bone

176 Of the Bones of the Head, [Part II.

is engraved in SandiforCs Mus. Anat. II. tab. 20, fig.. 2. — A necrotic destruction
in Weidmaim Ueber den Missbrauch des glubenden Eisens. pi. 3 and 4.

(4) Compare Blumenbach, § 69, p. 170 ; I bave sometimes seen it deficient.

(5) Haller Icones Fasc. IV. Tab, narium intern. Vol. II. — KeJch Beitrage zur
patbol. Anatomic, No. 7.

(6) In a sypbilitic person I once saw it expanded to tbe size of a walnut, in
consequence of the purulent fluid contained in it, — Horn saw it very much
expanded towards tbe cavity of the skull in an epileptic person, v. Arcbiv f. d.
Medic. Erfahr. 1815, Part V, p. 8o4. In professor Fithusen's Collection at
Copenhagen, I saw the skull of a person forty years old, deformed since child-
hood by the uncommon expansion of tbe occiput ; between the inner and outer
tables of the occipital bone is a hollow space an inch and a half deep, which is
connected by the pars basilaris with the sphenoidal sinus ; the clivus and Turkish
saddle are by the expansion of the sinus very much elevated,

(7) V. Sommerring saw this in a horse and in a squirrel, v. Blumenbach, p. 38,
note z.

§ 128.

The ETHMOID BONE is not unfrequently very defective
in monsters with imperfect or entirely deficient face, and
merely consists of the crybriform plate, which is found mem-
branous, cartilaginous, and imperforate.^ In other cases, and
indeed commonly in anencephalous monsters, we find large
holes instead of the crybriform plate, through which probably
the water has burst out from the cavity of the skull ; ^ also at
a later period the crybriform plate appears sometimes to be
partially destroyed, in which case, water, pus, or blood, per-
colate from the skull through the nose.^ In congenital
rupture of the brain into the nose, the ethmoid bone must be
very imperfectly formed; sometimes the crybriform plate lies
unusually deep.* The ethmoid bone also exhibits various
irregularities in other respects, viz. an oblique partition, too few
and small, or morbidly large cells, the paper-like bones en-
tirely or for the most deficient,^ or divided by a suture into two
portions,*^ &c. Finally, the ethmoid bone is very often com-
pletely or partially destroyed by nasal polyps, by scrofulous
tumours, syphilitic caries, and mechanical injuries.

ri) My Selt Beob. I. p. 31 and 34.

(2) Osiander Series observat. de homine quomodo fiat et formetur, read on
the 3d of September, 1814, in the Gbttinger Socieat der Wissenschaft ; my
Sclt. Beob. p, 44.

(3) Burdach Beitrage zur nahern Kenntniss des Gehirns, u. s. w. Leipz.
Vol. I. p. 288, and Vom Baue und Leben des Gehirns, Vol. III. p. 80. — Aher-
cromhle Pathol, and pract, researches on the diseases of the brain and spinal
cord. 2d edit. 8vo, Kdinb. 1829,

(4) I have seen this in several persons with watery heads, and in epileptic
patients, ])robably produced by the ])rcssure of the water.

(5) Kelch, No. 6.— Meckel Pathol. Anatomic, Vol, I, p. 345.

{()) Hiinaidd Mem. de TAcad. des Sc. 1740, p. 527. — Meckel. I have also some
Buch instances before me.

Sect. XV.] Of the Bones of the Head, 177

§ 129.

The BONES OF THE FACE taken collectively, present not
unfrequently the most manifold variation in reference to num-
ber, form, connexion, &c. as they naturally take the most
remarkable part in the different malformations of the face.
Sometimes in monsters, no trace of bones of the face is
observed in the bony capsule enveloping the brain;' next there is
formed in certain cyclops only an imperfect orbit, as a rudiment
of the face, beneath which it develops itself always more and
more gradually, from the frame-work of the upper jaw, with or
without a lower jaw. The entire deficiency or unusual small-
ness of the orbits and of the bony nostrils, the partial consoli-
dation of both lateral halves of the face in cyclopy, the mostly
very remarkable smallness of the frame-work of the upper jaw
in monsters with deficient lower jaw and similar vices, produce
very naturally a great deformity in the bones of the face.
Sometimes the upper jaw is monstrously short, although perfect
in its particular parts ; to this belongs, for instance, the de-
formity occurring in the so-called pug-nosed carp.^ In rare
cases the upper jaw is thus short in animals on account of defi-
ciency of the intermaxillary bones. ^ To these imperfect
formations of the bony face, is opposed the excess of forma-
tion in these parts, which we observe in double monsters,
with two more or less perfectly formed faces on one head,'^ as
also in malformed embryons with monstrously large frame-work
of the jaws.^ Great deformity of the bony face occurs also in
congenital clefts, which, as in hare-lip and wolf's-mouth,
affect only the upper jaw and palate bones, which parts are more
or less separated from each other ; but in rare cases the cleft
also extends from the margin of the jaw into the cavity of the
orbits, ears, and skull. *^ Frequently the symmetry of the two
halves of the bony face is disturbed, and the face becomes more
OR LESS AWRY;^ this malformation is sometimes original;^ more
frequently it is produced by mechanical injuries, and by palsy,
eruptions, face-ache, &c. on one side, also by the early loss of
the teeth on one side, or unusual increase of the incisive teeth of
gnawing animals. In such cases the upper and lower jaws are
commonly found bent back on different sides, and more or less
crooked.^ Great malformations and destruction of the bones
of the face arise from various diseases of the face, especially
from tumours in the orbits, nostrils, and mouth, which easily
force asunder or destroy the bones. Finally, we observe not
very seldom the various fractures of the bones of the face, ev^n
although the injury has not operated immediately on them, but

,N

178 Of the Bones of the Head, [Part II.

on the skull. ^" We must not confound small fissures with
irregular sutures or with sutural bones/^ which although more
rarely than in the skull, occur also in the bones of the face.

(1) For instance, No. 2949—2951, 3044, 8021, of Bresl. Mus.

(2) Mayer's Vorstellungen allerhand Thiere, Vol. I. pi. 8. — -Voigt in Magazin
fiir die Naturkunde, Vol. III. p. 515. — In Silesia they are not rare ; v. my Selt.
Beob. I. p. 51, tab. 1, fig. 2, and Verzeichniss der Breslauer Sammlung.
No. 3009, 3048 — 50. In the collection formerly belonging to Minkwitz (now at
Warsaw) I saw two pug-nosed carp and three skulls of the same ; sometimes
are the parts of the mouth extended into a kind of proboscis ; v. de Reaumur in
Memoir, de I'Academ. des Sc. 1747, p. 58. — Hamberger de cyprino monstroso
rostrato. Jenae, 1748.

(3) In two sheep, v. my Selt. Beob. I. p. 31. No. 10, p. 34. No. 11. — In a
dog, in Sandifort's Mus. Anat. Vol. III. p. 375, No. 533.

(4) The least extensive degree of duplication is seen in a calf's skull, of
which the snout is too broad ; and above, between the intermaxillary bones, are
two other accessory bones ; as also in the lower jaw, a middle piece, which sup-
ports three incisive teeth. Sandifort Mus. Anat. Vol. III. p. 295, No. 1012.

(5) At Alfort and Paris, I saw the skull of a horse, the front jaw of which pro-
jected far before the hinder.

(6) Klein Monstror. quorundam descript. p. 5. Stuttg. 1793. — van Doeveren
Obs. acad. Cap. II. p. 46, tab. 5, — Meckel Handb. der pathol. Anatomic, I.
p. 523, in a calf, even into the ear. — Nicati, Spec, de labii leporini congeniti
natura et origine, Utrecht, 1822, gives an instance of a cleft which passed from
the mouth to the eye, from Vrolik's collection. — I have seen a similar case, v. my
Selt. Beob. I. p. 19.

(7) In the Veterinary School at Stockholm, I saw in the skull of a young horse,
the whole upper jaw remarkably bent to one side. I have the same before me,
in the skull of a doe. No. 8225, In both instances the cause is unknown.
There is also one example from the duck, in Bresl. Mus. No. 3238. There is a
remarkable variety of the duck, the anas adunca, or curvirostra, in which the
whole bill is strongly bent downwards. An instance of a goose is to be found in
the Eph. Nat. Cur. Dec. I. Ann. IV. and V. Obs. 181, p. 226; and in Bresl.
Mus. No. 2319.

(8) Especially in double monsters, v. my Selt. Beob. Part I. No. 10 — 13 ; in
a double-headed calf. No. 3032, in Bresl. Mus. — Wirtensohn D. duorum mon-
strorum duplicium humanor. descriptio anat. p. 6, tab. 1. 4to. Berol. 1825.
However, also, in single monsters, v. Ullersperger Pathol, anat. Beschreib. sweier
Missgeburten. p. 44 and 45, fig. 2. 8vo. WUrzburg, 1822.

(9) This especially occurs in birds; for instance, in the crow and lark. v.
Rudolphi Bemerkungen auf einer Reise, Vol. I. p. 94. — I have also found it in
fowls, and in a crow, v. No. 2320, 3240, and 8066. — And I saw it on both heads
of a monstrous dove, in the Zootomical Museum at Paris. — In a young turkey.
V. Sandifort' s Mus. Anat. I. p. 306, No. 36. — [In Mus. Roy. Coll. Surg. No. 2,
the mandibles decussate in a fetal chick, like those of the crossbill. T.J

(10) J. Clocquet Memoire sur les fractures par contrecoup de la machoire
superieure. 8vo. Paris, 1820, with an engraving. — [J. Ahernethij, in his Lectures
on Anatomy, &c. mentions a case in which the bones of the face were torn off
from the skull, at the transverse suture, and left hanging merely by the optic
nerves. T.]

(11) For instance, between the frontal and nasal bones, v. Meckel VdiihoX.
Anat. Vol. I. p. Si6.—BSclard in the Bulletin do la Facult. de Medec. Vol. III.
Ann. IX. p. 292. — I have some instances before me; viz. No. 165, 177, 191,
203, and 244, of Bresl. Mus.; between the nasal bones, Meckel D. Archiv.
f. d. Physiol. Vol. VII. p. 107; between the palate bones, lb. p. 154; between
the lower end of the lachrymal bone and the upper jaw, viz. No. 204, in Bresl.
Mus.

S ECT. XV.] Of the Bones of the Head. 1 79

§ 130.

The UPPER JAW BONES are either entirely or merely partially
deficient in monsters with imperfect development of the face,
or finally, they are but unusually small and malformed. Among
their malformations, the most common is the clefts present in
hare-lip and wolf's-mouth, which runs through the edge of the
jaw either on one or both sides, where the intermaxillary are
naturally connected with the upper jaw bones, and in the
palate prevents, either only on one or on both sides, the junc-
tion of the palatine process with the nasal partition. Should
the cleft be large, the palatine portion of the upper jaw-bone is
sometimes entirely deficient. In rare cases the palatine pro-
cesses are so long, that they form the palatine spur. The
nasal processes, with deficient nasal bones, are so large that they
supply their place ; the front part of the same forms externally
even a deep fork ; ^ that part also of the nasal process which
surrounds the lachrymal sac, forms in many skulls a particular
piece of bone.^ The alveolar process differs unusually in
form, according as the teeth are absent or present, is large or
small, straight or oblique. Sometimes instead of one infra-
orbitar hole, there are two, three, and even four.* The
maxillary sinus is either entirely wanting or very small,
according to the imperfect development of the bones ; still,
how^ever, although these are perfect, the cavities may be very
much diminished or even entirely destroyed by great contrac-
tion of the bones ; ^ in one syphilitic patient, both cavities were
at the same time filled up with a loose bony cellular tissue,
very plentifully supplied with fat ; ° more frequently we see it
very much enlarged and expanded like a bladder, with pus ^* and
water, with polyps, &c. The upper jaw bones are most fre-
quently, of all the bones of the face, subject to diseases which
more or less destroy them ; for instance, to erosion and breaking
up by polyps in the nasal and maxillary cavities,^ to caries,^ to
spina ventosa,^ to exostosis,^" to osteosarcom ; ^^ more rarely
to necrosis.^^ In the animals which have the upper jaw
covered with a horny skin, that sometimes presents a mor-
bid appearance, viz. irregular enlargement,^^ clefts, swell-
ings,^* &c.

(1) A good engraving of a skull, with a wolf 's- jaw, is given in Sandifort's
Mus. Anat. tab. 35, fig. 1. — Paletta Exercit. Pathol. I. fig. 3. — In the double
hare-lip, the middle of the edge of the jaw often projects very much, is
oblique, &c. — [/. Rand, Observations on the double hare-lip in Trans, of Lond.
Med. Soc. Vol. I. p. 159. T.]

(2) This may give rise to a peculiarity in the operation for fistula lachrymalis.
V. Bromfield, Chirurgical Observat. and Cases, Vol. I. p. 341.

(3) Rosenmuller Partium externar. occuli hum. inprimis organor. lacrym.
descriptio Anat. p. 57. 4to. Lips. 1797.

N ^

1 80 Of the Bones of the Head. [Part 1 1 .

(4) Important from the division of the infra-orbitar nerve in face-ache.

(5) I, at least, have seen it in several cases.

(6) I have observed this.

(6*) [Sometimes abscess of the antrum causes absorption of the front of the
superior maxillary bone, producing a tumour on the face, v. T. Bell Anatomy,
Physiology, and Diseases of the Teeth. T.]

(7) For instance, No, 3236 and 3237, of Bresl. Mus. — A good engraving is
given in Sandifort Mus. Anat. No. 2, tab. 30 — 33. [Some examples also in the
Mus. at St. Thomas's Hospital. T.]

(8) Especially on the palate, in syphilitic ozaena, on the edges of the alveolar
cavities, in dental fistulas ; more rarely from noma, of which, however, I have
seen two instances in the Pathological Museum at Vienna, v. Sandifort Mus.
Anat. Vol. III. p. 266, No. 855. — A case of carious destruction of the upper
jaw, with restoration, is given by Krimer in v. Graefe and v. Walther's Journ. f.
Chir. 1827, Vol. X. Part IV. p. 606. — Several instances from caries, in Bresl.
Mus. No. 3252, 3253, 3256, 3258. — Carious destruction of the upper mandible of
a lark, is described by Rathke, in Meckel's Archiv f. die Pbysiol. Vol. VII.
p. 497. — A good engraving of caries is given in Sandlforfs Mus. Anat. Vol. II.
tab. 28, fig. 1 and 2.

(9) Hardly more rare in man than in animals, and especially in oxen, v. No.
3168 in Bresl. Mus. ; also in horses and swine, of which I have seen an instance
in the Anatom. Mus. at Utrecht.

(10) Bottcher Abhandlung von den Krankheiten der Knochen, u. s. w. Vol.
III. p. 170.— ^ii^^ner in Nov. Act. Acad. Nat. Cur. Vol. V. p. 71. Vol. VI.
p. 27. — Weber in Museum der Heilkunde, Vol. II. p. 192. — il/o^^we Chirur-
gische Novellen, u. s. w. No. 7. — Vialet in Bulletin de I'Ecole de Medec. etc.
Ann. XIII. p. 27. — Breschet in Bulletin de la Fac. de Medec. de Paris, 1815,
p. 332. — Howship, Pract. Observat. in Surgery and morbid Anatomy, 1816. —
Rust in his Magazin. Vol. I. Part I. p. 71, tab. 2. — Fox, Natural History and
Diseases of the human Teeth. Lond. 1814. — My Verzeichniss, &c. No. 3254
and 3255.— Diet, des Sc. medicales. Vol. XXXV. p. 25, tab. 1 and 2. -[T. Bell,
Anatomy, Physiology, and Diseases of the Teeth, p. 173. T.] — In a bul-
lock, V, Rndolphi Bemerkungen auf einer Reise, u. s. w. Vol I. p. 75. — On the
skull of a hippopotamus, in Bresl. Mus., there is one large cellular exostosis on
the upper maxillary, lachrymal, and zygomatic bones ; a second smaller on the
intermaxillary bones, and a third, on the zygomatic process of the temporal bone.
[There is in the Mus. at St. Thomas's Hospital, a remarkably fine specimen of
exostosis on the right side of the upper jaw, as large as an orange, oh the front of
the face, filling up the maxillary and part of the sphenoidal sinus, the latter of
which is much enlarged by its pressure ; the tumour extends into the right orbit,
backward into the temporal pit, and including the right alveolar process posterior
to the second bicuspid tooth, and the right half of the bony palate. — In another
instance, an exostosis, as large as a hen's egg, projects from the infra orbitar pit
on each side, they fill up the maxillary sinuses and nostrils, and protrude back-
wards into the temporal pits, and upwards into the orbits. In the left orbit there
is also a second exostosis, as large as a walnut, which arises from the orbitar
plate of the frontal bone. In consequence of the necessary diminution of the
cavity of the orbit, the eye-ball had been thrust upwards and outwards, and by
its pressure, expanded and thinned the superciliary ridge and outer angular pro-
cess of the frontal bone very considerably. The subject of the latter case was a
fishwoman,who dropped in a fit of apoplexy at the hospital gate. T.]

(11) Becker praes. Siehold D. de insolito maxillae superioris turaore aliisque
ejusdem morbis. Herbipol. 1776. — HowsJap, pi. 1, fig, 3. — Klein in Rhein. Jahrb.
von Harless, Vol. V. Part II. p. 42, with engravings. — Terwey in Rust's Magazin,
Vol. III. Part II. p. 221, tab. 2.— Becker in Rmt, Vol. XXI. Part II,
p. 218. — Pech Osteosarcoma ejusque spcciei insignis descriptio, etc. Wirceb.
1819, with three engravings. — Giorgi in Omedeis Annali universali di Medicina.
Jan. 1827. — My Selt. Bool). 11. p. 6, No. 2 ; p, 11, No. 10.— Verzeichniss, No.
3164, 3165, 2134. — In the Anat. Mus. at Freyburgh, I saw on the upper jaw of
a child, a large sarcomatous swelling, as big as its head. v. on the nose.

Sect. XV.] Of the Bones of the Head. 181

(12) Also in animals. — I saw, for instance, in the Zoolog. Mus. at Lund, a
walrus, with a large necrosis and exfoliation of the alveolar cavity of one
tusk.

(13) At Paris and Alfort, I saw the upper mandible of a hen and of a jay,
extremely long, curved, and cleft at the point. In rapacious birds and parrots,
which are confined, it easily becomes monstrously long. — Schioter found the upper
mandible very much enlarged, elongated, and warty, in one partridge ; and in
another, the upper mandible converted into a large horn-like knob, curved
upwards, besides having horny warts on it. v, Archiv f. Zoologie and Zootomie,
Vol. V. No. 7.

(14) V. Bemerkungen viber einen monstriisen Canarienvogl, u.s.w. 4to.
Hamb. 1780, with engravings. — In the Zool. Mus. at Paris, I saw two large
ones on a partridge. — A sparrow with a spiral horn on the bill, v. Sandifort
Mus. Anat. Vol. III. p. 372, No. 511.

§ 131.
The small bones of the face connected with the upper jaw-
participate with it in its variations from the normal form.
Thus we find, for instance, the palate bones, in wolf's-
mouth, not connected with each other, and more or less deficient
in reference to their palatine portion. In rare cases the palate
bones do not touch if the palatine point be formed of the elon-
gated upper jaw bones. In congenital closure of the hinder
opening of the nostrils, the palatine bones are very much de-
formed. They are frequently destroyed by polyps of the nose
and throat as well as by syphilitic ulcers. In monsters, with
deficient formation of the face, the malar bone is some-
times consolidated,^ sometimes also it has been found
divided into two halves by an irregular suture.^ The nasal
BONES are sometimes, as a congenital formation, entirely
wanting,^ and are then replaced by the enlarged nasal processes
of the upper jaw bones.* In many cases there is originally
but one nasal bone,^ in other cases there are two, remarkably
small, unequal, oblique, arched, consolidated together,'^ divided
into two or more pieces, &c. ; in horses, we observe them not
rarely pressed in from pressure of the cavesson, even absorbed,
so that the openings are merely closed with skin.^ Frequently
are they more or less destroyed by syphilitic caries, polypous
and scrofulous tumours in the nostrils, and more rarely in
animals, by glanders and farcy.^ The lachrymal bones are
sometimes entirely deficient, and their place is then supplied by
the nasal process of the upper jaw-bone.^ They are fre-
quently very small, or lie so far backwards, as not to assist
in forming the lachrymal canal, ^° the groove in them for which
presents also many differences. In diseases of the lachrymal
sac, in nasal polyps, &c. the lachrymal bones are easily
destroyed.

(1) Viz. in No. 3045 and 8226 in Bresl. Mus.

(2) Sandifort Observ. anat. pathol. L. III. p. 9, fig. 7. — v. Sbmmerring Lehre
von den Knochen und Knorpeln. 2d edit. p. 218.

182 Of the Bones of the Head. [Part II.

(3) Rohff'in M6m. de I'Academie des Sc. de Berlin, 1761. — Marrigues in Mem.
de Mathem. pres. a I'Acad. des Sc. IV.

(4) Sandifort, L. III. Cap. X. p. 130. L. IV. Cap. X. p. 136.— Mus. anat.
Vol. I. p. 167, No. 101. — Kohler Beschreibung der phys. und pathol. Praparate.
No. 417, p. 124 ; No. 540, p. 140. — I have seen an instance of it on the skull of
a man from Nootka Sound, in Prof. Mayer's Collection at Bonn. In two in-
stances, No. 7080 and 8039, of Bresl. Mus. the left nasal bone does not reach the
frontal, but its place is supplied by the broad nasal process of the upper maxil-
lary bone. In cyclopic monsters, which have a proboscis instead of a nose, the
upper maxillary bones often lie close to each other, and the distorted nasal bones
at the root of the trunk, over the orbits.

(5) As a little loose roundish bony germ, in No. 3047 and 8226, in Bresl. Mus.

(6) Entirely or partially, not unfrequently both ; for instance, No. 67, 70, 100,
115, 144, 151, 164, 169, 170, 188, 195, 215, 237, 689, 3175, 3251, 3360, 7068,
7075 and 7130, Bresl. Mus.

(7) In a dog, No. 3245, in same.

(8) Licht D. de praecipuis viarum lacrymalium morbis. fig. 1. Argentor.
1776. — Sandifort Obs. anat. pathol. L. III. C. X. p. 128. L. IV. C. X.
p. 137. — Meckel Handb. d. pathol. Anat. Vol. I. p. 345.— On a skull, No. 171,
in Bresl. Mus. the left lachrymal bone is entirely wanting, and the right so
small, that it does not contribute to the formation of the lachrymal pit.

(9) Metzger Curat, chirurg. quae ad fistulam lacrymal. hucusque fuere adhibita,
historia critica. p. 66. Monast. 1772.

(10) On No. 8062, the crista longitudinalis is very strongly developed.

§ 132.

The LOWER JAW is not unfrequently, as a congenital forma-
tion, entirely deficient, even although the upper jaw exists.^
In other similar cases there is only found a shapeless rudi-
ment,^ this sometimes lies on the neck without any connexion
to the skull. ^ Oftentimes is the lower jaw normally formed,
but varies in reference to its size and figure ; thus, for instance,
we find it too small, and indeed too short as well as too small ; *
on the other hand also unnaturally large, and this is sometimes
in proportion to a short upper jaw, sometimes in reference to
its own proportions only ;^ finally, it is often bent, and indeed
particularly upwards, when the upper jaw is monstrously
small, or in deformity of the whole face to one and the same
side with the upper jaw, or to the opposite side to that with
which it is then curved. In rare cases we notice also irregular
divisions of the lower jaw,*^ in which, as is well known, there
occurs one or two little bony germs in the suture between the
two halves of the lower jaw-bone.^ The form of the lower jaw
of man and animals, is often very remarkably changed by the
loss of some or all of the teeth ; the condyle varies very much
in reference to its size, direction, and arching ; not unfrequently
is its cartilaginous covering destroyed and rubbed offV we
find it also covered with gouty tophus;" the internal mental
spine is in rare cases unusually long;'" in the skull of a Botocudan
there was found a deep pit before and above the chin, in
consequence of the pressure of the wood worn in the lip,^^ &c.

Sect. XV.] Of the Bones of the Head. 183

Vices of connexion also occur in the lower jaw, as we find
it dislocated, completely or incompletely on one or both sides ;
but even in man before birth, and in animals in which the two
halves of the lower jaw remain usually separate, we observe
their uncommonly late consolidation with each other,^^ with
the temporal bones, ^^ and even with the edge of the upper jaw-
bone.^* The continuity of this bone is easily broken, on ac-
count of its peculiar form, by external violence, especially by
drawing teeth, indeed even by violent biting. ^^ Among the
diseases which frequently attack the lower jaw, are especially
to be mentioned, caries,^*^ and necrosis, to which easily follow
the reproduction of the lost parts ; further, loosening, spina
ventosa,^^ bony tumours/^ and especially osteosarcom.^^

(1) Schuharth, Comment, de maxillae inferioris monstrosa parvitate et defectu,
Francof. ad Viadr. 4to. 1819, with two engravings, describes several instances
in man and animals. — Kerkringius Opera omnia anatomica, Obs, 60, p. 122.
L. B. 1717. — Themelius Comm. med. qua nutritione foetus, etc. Lips, I7f')l, and
in Fasc. Diss. anat. medic, recus. Amstel. 1764, p. 125, in a sheep. — Halleri
Opusc. pathol. Venet. 1775, Obs. 58, p. 145, in a sheep. — Speer D. de Cyclopia.
Halae, 1819.— My Selt. Beob. II. p. 168.— G*. J'dger in Meckel's Archiv f. Anat.
und Physiol. 1826, p. 64, in a foetus of cervus axis and in a lamb. — lb. 1828, No, 1,
p. 71, in a lamb. — UUersperger Pathol, anat. Beschreibung zweier Missgeburten.
8vo. Wiirzburg, 1822, p. 39, fig. 2. — Weber Ueber die Verschmelzung der beiden
Gehororgane in d. Zeitschrift f. Physiologic von Tiedemann and G. R. and
L. C. Treviranus, Vol. II. Part II. p. 309, in a calf. — My Verzeichniss, &c.
No. 2953— 2956, 3013, 3047; also No. 8022, 8069, 8226, of Bresl. Mus., all
three from sheep.

(2) Meckel Handb. der pathol. Anatomie, Vol. I. p. 523, in a calf. — Schuharth^
Jager, in a lamb.

(3) My Selt. Beob. I. No. 12, p. 38.

(4) I have seen several men and animals with this vice. — Also, in the Anat.
Mus. of the University at Vienna, a child, with hare-lip, very small eyes, and
very short lower jaw. — In the Anat. Mus. at Heidelberg, a dog, with a short
lower jaw, and a monstrous short foot. — A child, on account of the shortness of
the lower jaw, could not suck. v. Moschner Conspectus partuum in lechodochio
Pragensi, etc. Pragae, 1826, p. 109. — I saw it shorter than the tongue, in a hen
in the Zootom. Cabin, at Paris. — [In the Mus. Roy. Coll. Surg. No. 304, a pre-
ternaturally short lower jaw, in a yovmg red deer (cervus dama), in consequence
of which, the animal was starved, from not being able to press the udder in its
attempts to suck. — A short account is given by Lord Egremont, who presented
the animal to the College, in which it is mentioned, that this malformation was
always found in the white varieties of his red deer, and that they never lived
more than a day or two, for the reason assigned above. T.]

(5) By the French, called Menton de Galoche, in the Milanese Geppa, in England
Underhung; is often connected with stammering and weakness of intellect, v.
Palletta Exercit. pathol. I. p. 142. — Catalan Memoire Rapport, et Obs. sur I'ap-
pareil propre a corriger la diiformite, qui consiste dans le chevauchement de la
machoire inferieure en avant de la superieure, difformite vulgairement nommee
Menton de Galoche. 8vo. Paris, 1826, with drawings. — Kohler, Beschreibung der
anat. Praparate, u.s. w. No. 17 1, p. 50, mentions a human lower jaw, three
inches broad. — Some remarkably large and heavy skulls, I saw in the Anat. Mus.
at Florence and Bologna. — A very long hinder jaw in a mule at Alfort. — In
birds in confinement which cannot wear out the beak, viz. the parrot, I have
often seen the horny covering of the lower mandible uncommonly long ; in a

184 Of the Bones of the Heath [Part II.

lark, with injured upper mandible, the lower grew uncommonly, v. Rathke in
MeckeVs D. Archiv f. d. Physolog. Vol. VII. p. 497.

(6) Eyssonius, De ossibus infantis, p. 49, observed a division of the lateral parts
of the horizontal branch ; — divided in a fowl, v. note 4. — The whole length
divided in a full grown sparrow, in the Anat. Mus. of the Surgical Academy at
Dresden.

(7) Ruysch Thesaur. anat. V. No. 4, p. 45. — Meckel Anat. phys. Beobach-
tungen und Untersuchungen, p. 21. Halle, 1822. — His Deutsches Archiv f die
Physiol. Vol. VII. p. 107- — 1 found a similar intermediate bone in No. 3012,
and some of the same in No. 8031 in Bresl. jNIus.

(8) Leidenfrost in Weseiier D. de susurm auriam. 4to. Duisb.1785.

(9) My Verseichniss, &c. No. 3270, 3271.

(10) In No. 788, Bresl. Mus., is the spina mentalis interna, almost half an
inch long, thick, and cylindrical. — Compare Howshlp.

(11) In the Anat. jNIus. at the university of Vienna ; I did not, however, see
it in other Botocudan skulls.

(12) Kerkring Spicil. anat. p. 65, tab. 8. — Ruysch Catalogus Musei. p. 187. —
Morgagni De sed. et caus. morbor. Epist. XLVIII. Art. 50. — Meckel Anat. phys.
Beobacht. und Unters. p. 69. — My Selt. Beob. I. p. 6, partially united ; in dogs
I have found the lower jaw sometimes united.

(13) Eustachius De dentibus C. XXVIII. p. 92. — Columbus De re anato-
mica. Lib. XV. p. 484. — Schenk Observat. medic. Basil. 1584. Obs. 405, p. 441.
— O'Connor De stupendo ossium coalitu, p. 4, Oxon. 1695. — P'llfyn Beschryving
der Beenderen. p. 218. — Bonks and Solander saw such a skull at Madeira, v.
Ilawkesworth, An account of Voyages, &c. Vol. III. — Satidifort 'Exerc. acadero.
Vol. II. C. 5, tab. 5 and 6.— Observat. anat. pathol. Lib. I. C. 7, p. 102. —
Mus. anat. Vol. I. p. 149; Vol. II. tab. 16, p. 384, 603; Vol. III. p. 234,
No. 615, 616. V. a Loder, Index. — Kohler, No. 1, p. 3. — Renard of Mayence
possessed such a skull, which has been described by Guleite. — Jam. Snell, in
Medic. Repository, Feb. 1825, new series. Vol. III. in a child; one case in
Bresl. Mus. No 3262. — Howship. — Tarlra in Journ. de Medec. contin. Vol. XI.
p. 182. — Rudtorffer Anhang zur Abhandl. iiber die Operation der Briiche. No. 9.
— Holscher in his translation oi Brodles Diseases of joints, p. 334, note.

(14) Rust in his Magazin f d. ges. Heilk. Vol. I. Part II. p. 226. — In a carp.
— Hamherger De cyprino monstroso rostrato. Jenae, 1748.

(15) In a rabid horse in the Museum at Alfort ; the possibility of fracture
at the symphysis is doubtful, according to Boyer, Delpcch, and others ; it has,
however, been once seen, v. Chollct in Journ. gen. de Medecinc. Vol. LXVI.
No. 266, Jan. 1819, p. 80. — Two instances of fracture in Bresl. Mus. No. 3275
and 3276. — A false joint after fracture, v. Horeau in Journ. de Medec. contin.
Vol. X. p. 195. — Dubois- Fauconin Journ. gen. de Medec. Vol. XXXIII. p. 86.

(16) In man and animals it is very common from diseases of the teeth,
scrofulous and carsinomatous destruction of the neighbouring glands, of the
lower lip, &c. v. No. 3264, 3265, 3268, 3274, of Bresl. Mus.— In a child fatal
hemorrhage occurred from caries of the lower jaw, and ulceration of the artcria
maxillaris inferior. Edinb. Med. and Surg. Journ. Jan. 1824; v. also Fenner
Ueber caries des unterkiefers in the Bibliothek for Laeger, Sfc. Kjobcnhavn,
Vol. IV. \%\Z.—Sandifort Mus. Anat. II. tab. 23, fig. 2 ; tab. 28, fig. 3—5, gives
some good plates ; he also describes caries of the lower jaw, in consequence of
cancer of the lip, v. Vol. III. p. 246, No. 714 — 717, and in consequence of
noma, p. 266, No. 852 and 853 ; there is also a remarkable case of caries on
account of development of hair in tlie lower jaw, p. 280, No. 933. — Caries in
the lower jaw of a dog. v. Sai/difart, III. p. 185, No. 242.

(17) Particularly common in horses ; I have seen several examples of it in
the collections of dificrent veterinary schools, viz. Alfort, Berlin, Munich; one
case in Bresl. Mus. No. 3166'; a similar one from an ox, No. 3167. v. Rudolphi
Bemerkungcn auf einer Reise, u. s. w. I. p. 75. — Grcve ICrfahr. und Beobacht.
iiber die Krankhciten der Ilausihiere. II. p. 3. — Of a pig at Utrecht. — Bleuland
resp. Ueijiiavii Spicilcg. observat. anatoui. de Hyiina. ]). 12. 4t(), Bcrol. 1811. —
lu a marmot in r. SOmmerrin^ s Museunj.

Sect. XV.] Of the Bones of the Head. 185

(18) Mosque Chirurgische Novellen, u. s. w. No. 10. — My Verzeichniss, &c.
No. 3266, 3269. — In the veterinary school at Stockholm, I saw an exostosis,
as big as a walnut, with a neck, from a horse.

(19) Crernouas in Mem. de I'Academ. de chir. Vol. V. Mem. p. 350. — Borde-
nave, ib. p. 338. — Morelot, ib. p. 352. — Quittenbaum D. de memorabili quodara
maxillae inferioris fungo scrofuloso. fol. Hannov. 1818, with two engravings. —
Crowfoot in Edinburgh Med and Surg. Journ. 1825, Oct. — Cusack and Crampton
An account of such tumours removed from parts of the lower jaw in several
cases ; v. Dublin Hospital Reports and Communications in Medicine and
Surgery, Vol. IV. 1827. — Oudetm Archives general, de Medec. Jan. 1826, three
instances by Mott, and one communicated by Clellan, v. d. Busch in Lav genbeck' s
N. Biblioth. f. d. Chir. und Ophthalm, 1827, Vol. IV. Part III. p. 417, ib.
p. 532, with the editor's additions.— G. Sandifort Mus. anat. Vol. III. p. 285,
No. 971, p. 348, No. 300.

§ 133.

The TEETH ^ are subject to very many irregular formations
and diseases, as they are not merely affected alone, but parti-
cipate also more or less readily in the diseases affecting the
organization of the face.^ The number of the teeth does not
unfrequently vary from that which is normal, inasmuch as in
man and in animals, sometimes several,^ at other times all ^ are
deficient, as a vice of formation, sometimes also on the contrary
there are supernumerary^ teeth, two and even three rows;^
the additional number depends most commonly on the con-
tinuance of the milk teeth. ^ We observe many irregularities
with respect to the period of cutting and changing the
TEETH ; in weakly and especially rickety children, the teeth
are sometimes either all or some of them cut very late,* or in
irregular order,^ and even their change is very much retarded ;
in rare cases we observe, even in old people, several teeth still
to be produced;*" on the contrary, we notice the too great
activity in reference to the formation of the teeth, as they may
have been cut before birth,** or very soon after, *^ may be
changed too early and too frequently ; ^^ also in very rare cases,
when parts of the jaw have been destroyed by caries, necrosis,
&c. new teeth are produced in the newly formed bone;** so
also in a false direction of the formative power, the teeth
present themselves not unfrequently in other places than the
jaws,*** indeed even in encysted tumours.*^ The teeth frequently
vary from what is natural in reference to size and form ; we
thus find not merely the supernumerary, but even some other
or all the teeth remarkably undeveloped and small, in conse-
quence of early pressure, rickets, &c. ; the normal teeth are
also distinctly diminished in consequence of the wearing away *°
and rubbing down *^ of their crowns. Just as frequent is the
original irregular size of certain teeth, in consequence of which
deformity, displacement and retarded cutting of other teeth is
easily produced, as well as the later increase of such teeth as

1 86 Of the Bones of the Head. [Part 1 1 .

have not been retarded in their growth by counter-pressure
and rubbing down ; such teeth often attain an uncommon
length, often curve up and penetrate into the neighbouring
parts, for instance, into the palate, nose, orbit, and even into
the brain. ^* Often also without any increase, the form of the
teeth varies in numerous ways, in which case the crown is
deformed,^' the number, length, direction, and curving of the
roots varies much,-" the whole teeth are curved,-^ they present
congenital tumours covered with enameP" {denies proliferi),
and the surface of the teeth is uneven, owing to congenital
unequal deposition of the enamel. ^^ We very frequently observe
in rickety persons, and such as have small jaws, the position
and DIRECTION of the teeth irregular;^* they stand obliquely,"
are more or less turned round on their axis,-'^ horizontal," and
even completely turned round ;^^ in all these cases the teeth
remain frequently for a long time or throughout life hidden in
the jaws,"^ they stand unevenly in the edge of the jaw, and are
huddled together, and in irregular rows,^*^ or they protrude
inwards and outwards on the alveolar edges of the jaws,^^ in
the upper maxillary sinus,^^ in the nostrils,^^ externally on the
upper jaw,^* on the coronoid process,^^ on the outside,^*^ and on
the chin" of the lower jaw, &c. Not fewer are the variations
respecting the connexion of the teeth ; thus, in rare cases, we
find some of the teeth sticking^** only in the gums, and without
roots or alveolar cavities, or in monsters with deficient forma-
tion of the jaws or duplicity of the mouth, some teeth entirely
loose or covered by a thin membrane and hanging to the skinny
parts of the opening of the mouth ; ^^ many teeth have uncom-
monly small roots and alveoli, and easily fall out;" this we
especially see in the teeth shed by old persons. But perfectly
formed teeth are sometimes also, some or all of them, lost and
shed unusually early,^^ partly owing to imperfect nourishment/^
and rapid absorption of their roots" and alveoli, partly in con-
sequence of a morbid state of the jaw, whereby their connexion
with each other is dissolved.'* The opposite state, viz. the
too close connexion of the teeth with the jaws arises partly
from swelling of their roots, but often from their consolidation
with the alveoli; we also find in not very rare cases, two" or
even more teeth, ^" more or less consolidated at their crowns,
roots, or completely gi'own together throughout.**'* The colour
of the teeth also presents many vices ; to these belong the
diflfbrent shades of the white colour and lustre which is pro-
duced by disease and disposition to it; thus we find the
teeth bluish white in tlie dis})oyition to consumption and
rickets ; like transparent horn in the hereditary disposition to

Sect. XV.] Of the Bones of the Head. 1 87

herpes/' &c. Meat, drink, medicines, and the Hke, often colour
the teeth more or less brownish and blackish ; *^ diseased teeth
usually become discoloured, yellowish, greyish, even black,
brown, as in caries. Very frequently the discolouration of the
teeth arises from tartar, commonly so called, that is, a mass
composed of phosphate of lime and a small quantity of animal
matter, which envelopes the teeth more or less completely,
attaches itself more or less firmly, assumes a greyish, greenish,
brownish, blackish, and even metallic shining colour,^^ and is
often deposited in great quantity on the teeth. ^" As to vices of
CONSISTENCE, wc find the teeth naturally either too soft and
friable, or they become morbidly so ; the latter vice occurs
commonly in a greater or less degree on the roots,^^ and
internally carious teeth, but seldom it is found in the whole
tooth ; " in other cases the substance of the tooth is too hard,
and brittle like glass, and therefore in consequence of sudden
changes of cold and heat, as well as in biting, &c. fissures,
clefts, and actual fractures, easily occur, which can only again
be united at the lower part of the tooth. ^^ Not less are the
teeth subject to many vices of texture, notwithstanding the
hardness and similarity of their substance ; to these belong
inflammation^* and its consequences, as softening and absorp-
tion" of the fangs, the swelling,^^ which rarely attacks the
whole tooth, but usually only the roots, exostosis," and lastly,
especially caries,^^ which is so usual in man, and also in ani-
mals, viz. horses, cattle, house-dogs, &c. Lastly, in very rare
instances we meet with extraneous bodies in the teeth, for
instance, hydatids in the cavity of a carious tooth,^^ worms
commonly so called, that is, the larvae of insects and infusory
animals,*^" and in the tusks of elephants, especially bullets," and
in one instance the point of a spear,*^^ both of which had per-
forated the tooth in its young and soft state.

(1) V. de Plouquet Repertor. Art. Dens, and Diet, des Sc. medicales.
Vol. VIII, Art. Dent — Fr. Hoffmann D. de dentibus eorumque morbis. 4to
Halae, 1698, in Operib. VI. — Pf aff Ahhandl. von den Zabnen und deren Krank-
heiten, Berlin, 1756. — Berdmore, A Treatise on the disorders and deformities
of the Teeth and Gums. Lond. 1770. — Plenk De morbis dentium ac gingivarum.
Vindob. 1778. — Jackson D. de physiologia et pathologia dentium. Edinb. 1778.
Jourdan Traite des maladies et des operations chirurgicales de la bouche. 2 Vols.
Paris, 1778. — /. Hunter, The natural history of the Teeth, their structure and
various diseases. 4to. London, 1771. — Walkey, On the diseases of the Teeth, &c.
1793. — Bring Observationes in hodiernam de dentibus praccipue doctrinam.
Lundae, 1793. — Hirsch Prakt. Bemerkungen iiber die Zahne und einige Krank-
heiten derselben. Jena, 1796. — Ettmuller Medic. chii\ Abhandl. iib. die Krankh.
der Zahne, u. s. w. Leipz. 1798. — Paldamus D. de dentium morbis. 4to. Halae,
1799. — Hirschfeld Prakt. Bemerkungen iiber die Zahne, u. s. w. Gotha, 1801. —
Skinner, A treatise on the human Teeth, concisely explaining their structure and
cause of disease and decay. New York, 1801. — Fox, the history and treatment

1 88 Of the Bones of the Head. [Part 1 1 .

of the diseases of the Teeth, Gums, &c. Lend. 1806; and the natural history and
diseases of the human Teeth. Lond. 1814. — Gariot Traite des maladies de la
houche, etc. Paris, 1805. — Jourdan et Maggiolo ]\lanuel de I'art du Dentiste, etc.
Nancy, 1807. — Laforgue Th^orie et pratique de I'art du dentiste, etc. 2d edit.
Paris, 1810. — Duvnl, many single treatises in French Medical Annuals, and on
the diseases of the teeth in animals, in Bulletin de I'ecole de Medec. et de la
Society de Paris, 1811, p. 118. — Gallette Anat. phys. und chir. Beobachtungen
iiber die Krankheiten der Ziihne. Mainz, 1813. — K'onig Ueber die Ziihne der
Thiere und die Krankheiten derselben, u. s. w. Wien, 1820. — Ringelmann Der
Organismus des ^Nlundes, besonders der Zahne, deren Krankheiten, u. s.w.
Niirnberg, 1823. — On the variations of the teeth, v. Sommt rriiig vom Baue des
menschl. Korpers. 2d edit. Vol. I. p. 268, § 236, and Rudolphi resp. Tesmer D.
s. Observat. osteologicas. 4to. Berol. 1812, with two engravings. — [K. Blake,
An Essay on the structure and formation of the teeth in man, and various
animals. 8vo. Dublin, 1801. — T. Bell, On the Anatomy, Physiology, and Dis-
eases of the Teeth. 8vo. with plates. London, 1829. T.]

(2) Rickets, scrofula, scurvy, syphilis, herpes, and gout operate very prejudi-
cially on the development and state of the teeth.

(3) Pretty frequently are two of the upper incisives wanting; I have seen
this in two living persons ; and in No. 3301, 804-4, and 8045 of the Bresl. Mus.
the wise teeth are frequently deficient ; once the incisive and cuspid, v. Misc.
Nat. Cur. Dec. II. Ann. VI. Obs. 122 ; an incisive tooth in a horse, v. Rudolphi
Anat. Physiol. Abhandl. Berlin, 1802, p. 148; several back teeth in a dog,
Allg. Hist, der Natur. Vol. VII. Part II. p. 235, No. 1396 ; in sheep sometimes
one or other of the back teeth is wanting ; so also in stallions and geldings, and
in one instance even the tushes. [In the skull of a New Hollander, No. 100
Cat. Mus. Roy. Coll. Surg, the second temporary grinders were formed as per-
manent grinders, and therefore there are only two bicuspids. — Two skulls from
Van Dieman's Land, No. 97 and 98, Cat. Mus. Roy. Coll. Surg, have but three
lower incisives, which are so close as to preclude the probability of the deficient
tooth having been previously extracted. It is also further remarkable that in
both the symphysis divides the middle alveolar cavity. T.]

(4) Borelli Hist, et Observ. med. phys. rar. Cent. II. Obs. 41. — Danx in
Siark's Archiv f. d. Geburtshiilfe, Vol. IV. p. 684, in two brothers.

(5) G. Thomson, Observations on supernumerary teeth, in Edinb. Med.
Essays. Vol. V. Part I. p. 222. — Dubois- Faucon in Jouru. gen de Med. de Chir.
et de Pharm. par Scdillot, Mai, Vol. XXXII. p. 73.— Eph. Nat. Cur. Cent. I.
and II. Obs. 107. — Five incisive teeth, PloUijuet D. aetates human, earumque jura,
p. 8, Tubing. 1778. — Two instances in the Berlin Museum, v. Tesmer Praes.
Rudolphi D. Observat. osteol. p. 6. — Two instances are mentioned by Sommerring,
p. 269 ; I have also recently seen it in a girl of twelve years old, and on the
skull of an adult; six incisive teeth above, v. G. Sandifort Mus. Anat. Vol. III.
p. 288, No. 983. — [Five incisive teeth in the lower jaw. v. T. Bell, Anatomy,
Physiology, and Diseases of the Teeth, p. 102. 8vo. London, 1829. T.]
— Supernumerary teeth are mentioned in Courtois Grundl. u. auf Erfah-
rung gestiitztc Untersuchung der Beschaffenheit und Krankheiten der Ziihne,
a. d. Franz, p. 163. Gotha, 1778. — It is interesting that the negro has
mostly six back teeth, v. Gavard Osteologie, p. 354. — Sommerring. — Concerning
the difference in bodily form of the negro from the European, § 30, (now at
Vienna;) 1 also lately saw a second skull in the Museum of v. Sommerring. —
The supernumerary teeth are sometimes imperfect and small, v. Albinus Annot.
acad. I. p. 52 and 53, tab. 4, fig. 2 and 3. — Cerulti Beschreibung der patholo-
gischen Pr'aparate, u. s. w. No. 585. — Rudolphi, p. 7, tab. 1, fig. 13. — in horses
they are not unfrequently in the palate, and called wolf's- teeth, dentes lui)ini. —
Rudolphi Anat. ))liys. Abhandl. j). 147, found thein also in the walrus; in mares
the tuslies sometimes exist; at Alfort I saw the front jaw of a horse with nine
tutting teeth ; Rudolphi found five of these in the siniia paniscus. v. Anat. phys.
Abliandl. p. 145. — In the narwhal two tusks, v. Blumenhuch Handbuch der natur-
gcschiclite, on the monodon narwhal. — Jlhers Icones ad illust. Anat. comp.
Vol. I. J). 9, where arc given nine plates of Jiuch .skull, and also a tenth from a

Sect. XV.] Of the Bones of the Head 189

similar skull, which he gives from «. Froreip's Sammlung ; I saw a skull of this
kind in /. Brookes' s Museum, London ; and also in the Veterinary School and
Museum of natural history at Copenhagen.

(6) Several instances in Haller Elem. phys. Vol. VI. p. 29. — Columbus De re
anatomica. L. XV. — Courtois. — In my youth, I knew a young man who had
two rows of teeth in both jaws.

(7) In a dog, the cuspid teeth, v. No. 3311 of the Verzeich. des Bresl. Mus,
In an adult, I found a molar of the first set still remaining. — Here also belongs
the milk tooth of a man of thirty-seven years of age, described by Block Med.
Bemerk. p. 19. — Cerutti Bescreib. der pathol. Praparate, No. 567.

(8) I have known several instances of children, from two to three years of age,
who had not cut a tooth. In one case they were first cut at thirteen years,
V. Misc. Nat. Cur. Dec. III. Ann. VI. and VII. Obs. 183. — A very rickety girl,
nine years old, at Neurode, had but one tooth in both jaws. — Three instances of
want of one cuspid tooth, at the seventh year, are related in Wichmann Ideen
zur Diagnostik, p. 82. — A rickety child, of ten years of age, in the Bresl. Mus.
had only the first eleven teeth, viz. seven incisive and four back teeth.

(9) For instance, the back earlier than the front teeth, v. Fischer's Beitrage
zur Arzneiwissenchaft, 1776. Part I. p. 80.

(10) Several instances in Reuss Repertor. Comment. Vol. X. p. 54. — Sera
dentium eruptio. — Doubois-Faucon^\xv\e^ dents tardives in S^dillot's ^ec^^^rioA.
de la Soc. de Medec. de Paris, Vol. XIII. May, p. 73, such teeth have always
small sockets. — Ysabeau in Journ. de Medec. Vol. XXV. 1766, gives instances
in persons of eighty, ninety-two, and even one hundred and twenty years of
age. — V. Sommerring, p. 270. — Pentzius in Rust's Magazin f. d. ges. Heilk. Vol.
XXII. Part III. p. 596, in a man of seventy-five years of age. — Deficiency of
room, or irregular position, is often the cause of this. In many cases also there
is a second change.

(11) Haller Elem. Physiol, Vol. VI. p. 19. — Girardi Oratio de re anatom.
p. 27, note c. 8vo. Parmae, 1781. — Baudelocque Entbindungskunst. 2d edit.
Vol. I. p. 222. — V. Sommerring, p. 269. — Louis XIV. was known to have been
born with teeth, v. de Plouquet Repertor. Dentes praecoces.

(12) A boy with premature puberty, had, in the first year, nine teeth in the
upper, but none in the lower jaw. — South, in Lond. Med. Chir. Trans. 1822.
Vol. XII. p. 1.

(13) Gehler Progr. de dentitione tertia. 4to. Lips. 1786. — v. Haller, Vol. VIII.
p. 22. — Albinus Knnot. AcdidL. L. I. tab. 4, fig.3. — Hunter, ^.^5. — Gavard OsteoXogie,
p. 354. — Med. and Phil. Comment. Vol. III. and VIII. — Simmons, in Med. Obs.
and Inq. Vol. III. p. 118. — Ducks in Verhandelingen te Haarlem, Vol. XVI.
D. II. p. 327. — Hinze Kleine Aufsatze aus dem Gebiete der Medicin, Chirurgie
mid Geburtshiilfe. Breslau, 1826. — v. Froriep's Notizen, Vol. VIII. No. IX.
p. 138. — The Armenian, Saas Oglou, had two new back teeth at the age of a
hundred, a third in his hundred and twenty-first year.

(14) Fardeau v. Gerson and Julius Magaz. f d. ausland Litt. Vol. II. p. 486. —
Harder, in Petersb. verm. Abhandl. a. d. Geb. d. Heilk. 1823. Vol. II. p. 207.—
Krimer in v. Grdfe and v. Walther's Journ. f. Chirurg. 1827. Vol. X. Part IV.
p. 606.

(14*) [In Mus. Roy. Coll. Surg., No. 269, a lamb, in which two well formed
incisive teeth project between the angle of the jaw and the external auditory
passage on one side of the neck, and on the other side a single incisive tooth
only. T.]

(15) Meckel Ueber regelwidrige Haar und Zahnbildung in his Archiv. f. d.
Physiol. Vol. I. Part IV. p. 519. — Compare the several parts below.

(16) Not merely may the roots of the teeth become atrophic, but even the
crowns may waste. — I saw this very distinctly in the Anat. Mus. at Lund, in the
incisive teeth of a very old horse, which had become exceedingly small, v.
Duval Memoirs sur I'atrophie des dents, v. Bulletin de la Facult. de Medec, etc.
p. 7. 1812.

(17) The crown is sometimes almost worn down to the neck, without the cavity
oi the tooth being -opened, as a peculiar kind of bony deposit takes place in it v.

190 Of the Bones of the Head, [Part 1 1.

Duval Memoire sur I'usure des dents, p. 6, 1810; and Prochask a De decremento
dentium in Annot. Academ. Fasc. I. p. 5, tab. 1. \_T. Bell, p. 188, mentions a
case in which the incisive teeth were so worn down, that when the jaws were shut
there was an interspace of near a quarter of an inch ; the cavities, however, were
saved from exposure by the deposit of new bony matter, solid and hard, but so
transparent, that nothing but examination by actual contact could convince an
observer that they were closed. T.]

(18) I have seen this several times, in the hare, rabbit, catsquirrel, hamster,
rat, and mouse, v. No. 3297 — 3300, of Bresl. Mus. — I lately had two similar
hares. — Moreau de la Sarthe gives, in his fourteenth plate, an engraving of a rat
with a very long and curved incisive tooth. — TImnberg, a hare's skull, in the
Miincher Akadem. Denkchriften, Vol. IX. — Cheselden, a similar case in a wild
boar. — The upper tusk of a babyroussa penetrated by its point into the brain.
V. Lobstein Compte rendu, etc. No, 265, p. 71. Strasburg, 1824. — Two instances
of rats. V. von Froriep's Notizen, Vol. IV. No. 701, p. 8, and Vol. XI. No. 2,
p. 20. — In the last case noticed by Devergie, the tooth had passed through the
posterior opening of the nostril into the nose, then again through the upper jaw
into the mouth, and again up to the orbit. — I saw in the Anat. Mus. at Lund, a
horse's mouth, in which a tooth of the lower jaw had grown high up into a hole
in the upper. — In elephants, not unfrequently are the tusks curved and spiral-
shaped. [In Mus. Roy. Coll. Surg, is an example. No. 12, of perforation of the
palate of a dog, in consequence of unnatural situation and length of a lower
cuspid tooth on the right side. No. 516, an upper incisive tooth of a rat,
which, from want of apposition, has formed one perfect circle and the segment of
another. — Similar elongation, and from the same cause, in rabbits, No. 547 — 549,
&c. ; in the latter the secondary incisive teeth are also much elongated. T.]

(19) Compressed, awry, &c. — An incisive tooth in the Bresl. Mus. No.
3279, has a roundish and flat crown. — The crowns of the back teeth in dogs,
which, for several generations back, have fed principally on vegetable food, lose
the points, and produce the flat crown as an hereditary deformity. The palate
teeth often vary very much in form ; for instance, their crowns are pointed and
conical. — Cerutti, No. 582, 3282, and 3283, Bresl. Mus.; cauliflower-shaped, v.
Soemmerring, p. 272 ; tulip-shaped, Cerutti, No. 581; the front molar teeth in
adults have four, the hinder five and six tubercles, fitc.

(20) Incisive teeth with two fangs, Rudolphi, tab.!, fig. 1 and 3 ; and No.
.3285,8130, Bresl. Mus. — Cuspid teeth with two fangs, Rudolphi, tab. 1, fig. 4
and 5. — Cerutti, No. 573, 574. — No. 3285, with three fangs, v. Fauchart Der
Zahnarzt, tab. 27, fig. 13 ; the third and fourth molar, with but one fang, (one
instance in Bresl. Mus.) or with five or six fangs, v. Rudolphi, tab. 1, fig. 6. —
Frequently we find them hooked, curved, much diverging, connected at the
points, and enclosing a portion of the jaw, the roots very long, &c. No. 3278,
3288, 3292, 3302, 8127, 8133, of my Verzeichniss.

(21) For instance, an incisive tooth bent at an acute angle, and its point
directed outwards. No. 3307, of my Verzeichniss.— ^The tusks of the elephant are
often curved and spiral. — Incisive teeth, which are very projecting and curved ;
as also the persons so provided and called Brand, v. Mercurialis Variorum
lect L. VI. C. XIII. [An instance of this kind is No. 615, Mus. Roy. Coll.
Surg., in which an elephant's tusk is spirally wreathed, or twisted from the
bottom to the top with three circumvolutions, standing between two straight
lines; it is also furrowed longitudinally, and parallel to the axis of the tooth.
V. Crew's Mus. Reg. Soc. p. 31. London, 1681. No. 712, Mus. Roy. Coll. Surg,
exhibits the cuspid tooth of a hij)popotamus unusually curved. T.]

(22) They usually occur singly, on the neck or crown of the back teeth, rarely
several at once, and on the front teeth, for instance, three on one cuspid tooth.
v. Lemaire in Journ. de Medec. par Leroux Vol. XXXVI. p. 254. — Denies
proliferi, are described by Alhinus Annot. Acad. Vol. I. pi. 4, fig. 3 and 4, —
V. Sommerring, p. 275. — Fox, Natural history and diseases of human teeth,
tab. 13, fig. 1 — 8. — Rudolphi resp. Tesiner, p. 10, tab. 1, fig. 7 — 9. — Meckel
Tabul.'K anat. pathol. Fasc. III. p. 1, tab. 17, fig. 1. — Several instances are found
in the Leipzig, anatom. Mus. — I have found several such teeth, v. No. 3287,

Sect. XV.] Of the Bones of the Head, 191

8131, 8132, with two excrescences, and 8250. — Ccrutti Beschreib. der pathol.
praparate, No. 565.

(23) Erosion of the teeth, in Bunon Experiences et demonstrations, etc,
Paris, 1746; and in Mahon Le Dentiste observateur. Paris. Ann. VI. — Atrophie
in Duval, p. 7, 1812.

(24) Dubois- Faucon De dentium vitiose positorum curatione; Theses ana-
tomico-chirurgicse. 4to. Paris, 1775.

(25) As resemblances to animals, the teeth very sloping as in cretins; also in
pug dogs, uncommonly sloping ; further, from the protrusion of the tongue.

(26) In Bresl. Mus. v. my Verzeichniss, &c. No. 3308.

(27) V. Sommcrring, p. 272 and 278. — Dubois-Faucon in S^dillofs Jour. gen. de
Medec. Vol. XXXII. May. — Powell- Blackett, in London medical Repository,
June, 1821. Vol. XV. No. 90, p. 456, with engravings, v. my Verzeichniss,
No. 3305, 3308, and 8249.

(28) Albinus Annot. Academ. L. I. C. XIII. tab. 4. fig. 1, the cuspid teeth
in the nasal process of the upper jaw. — Sandifort Observat. anat. pathol. L. III.
tab. 10, fig. 1.— Meckel, tab. 17, fig. 7.

(29) V. my Verzeichniss, No. 3302, 3303, 3306, 8062.— Such teeth not un-
frequently give rise to bony fistulas. [No. 144 and 145, Mus. Roy. Coll. Surg. ;
in these the right upper cuspid tooth is formed so high in the jaw, that it cannot
reach the gum. T.]

(30) For instance, the first molar before the cuspid, Miel in Leroux Journ. de
Medec. Vol. XL. p. 88. — Meckel, tab. 17, fig. 2 — The first molar in the place of
the outer incisive tooth, and that in its place, Miel. — In a wild boar, the first
right incisive tooth of the lower jaw in its middle, and the tusk opposite, v.
Allg. Historic der Natur. Vol. VII. Part II. p. 232, No. 1384.

(31) Borelhis, Cent. II. Obs. 81. — Erndiel in Actis N. C. Vol. IL Obs. 113,
p. 262. — Schenk Observat. L. I. No. 411. — v. Sommerring, p. 272. — Meckel, tab. 17,
fig. Q.—Hirsch p. 74. — Tode Medic. Journal. Vol. II. Part IV. p. 21.— Schmidt
in «. ^ze&oW* Samml. selt. und auserl. chir. Abhandl. Vol. III. 1812. Part XXII.
My Verzeichniss, No. 3282, 3283, ^ZOi.— Albinus, p. 53, tab. 4, fig. 3.— Cerutti,
No. 580 — 582. — In the horse, not unfrequently wolf's-teeth, dentes lupini.

(32) Fauchard in Mem. de I'Acad. de Chir. Vol. V. Mem. 257. — In Anat.
Mus. of University at Copenhagen, I saw caries of the bones of the face produced
by a molar tooth, which, with its crown outwards, had penetrated the left maxil-
lary antrum ; also the fangs of the bicuspid and front molai's, sometimes pene-
trate the maxillary sinus, v. Berlin Osteologie, Vol. II. p. 309. — Portal Comp.
d' Anatomic medical. Vol. I. p. 210, note 2. — My Verzeichniss, No. 3278 ; there
are, in the Bresl. Mus. No. 8128, two teeth, as it were absorbed, which had
been drawn out of the maxillary cavity.

(33) In the Anat. Mus. at Lund, I saw an upper jaw, in which an incisive
tooth was breaking into the nostril. — Compare Cerutti. [No. 143, Mus. Roy.
Coll. Surg, the crown of the right upper bicuspis projecting upwards and
inwards into the right nostril. T.]

(34) Albinus, p. 53.

(35) Sandifort, p. 138, tab. X. fig. 5.

(36) Tesmer, praes. Rudolphi, tab. 1, fig. 14.

(37) Sandifort.

(38) Hunter, p. 8. [In Mus. Roy. Coll. Surg. No. 1059, is a lower molar
tooth, formed only in the gum, and unconnected with the jaw. T.]

(39) I found this several times in monstrous sheep and calves, v. my Verzeich-
niss, No. 2322, 2323, 2949; further. No. 8021, lb. Mus.—Schliipfer, in a calf, in
Schweitz. naturwissenchaftl. Anzeiger. No. 1. July, 1819.

(40) Dubois-Faucon in S^dillofs Journ. gen. de M6d. de Chir. et Pharm.
Vol. XXXII. May.

(41) In diseases of cattle the teeth not unfrequently become loose, especially
in oxen and sheep; in an epidemic scabious exanthematous disease which
affected the cats in Holland in the year 1796, their teeth fell out.

(42) This appears to be the case, as when the second or permanent teeth are
shed by a process similar to that which causes the shedding of the horns of stags,

192 Of the Bones of the Head. [Part II.

viz. the closing of the nutritive canals in their roots which secrete the bony
substance, the destructiou of the vessels and nerves, and thus also of the life of
tlie tooth. I have seen this in several teeth ; v. Pearsons in New-England Journ.
of Medic, and Sui^. new series, Vol. IV. Jan. 1820.

(43) Duval in Bulletin de la Faculte de Medec. 1811, No. 7—12.

(44) From inflammation, swelling, and suppuration of the internal membrane
of the socket, by which the tooth is more or less pushed out and loosened ; from
destruction of the gums, gumboil, caries, osteosarcom of the jaw, from glossocele,
&c. It is self-evident that they may be loosened by mechanical influence of
various kinds ; an imperfect loosening of this kind, we call, though improperly,
dislocation of the teeth.

(45) V. Haller Elem. Physiol. Vol. VI. p. 29. — de Plouquet Art. Dentis Con-
tinuitas. — Gavard Osteologie. p. 338. — Laveran in S^dillot Journ. de M^dec.
Vol. XXIX. p. 192. — Courtois,-^. 156. — v. Sommerring, p. 273. — Hirsch, p. 77. —
Serre Praktische Darstellung aller Operationen der Zahnarzneikunst. Berlin,
1804, p. 208, tab. 21. fig 1 and 2. — Fleischmaiin in Abhandlungen der physik.
medic. Societat zu Erlangen. Vol. I. p. 31, tab. 1, fig. 3 and 4. — Tesmer Praes.
Rudolphi, p. 9, tab. 1. fig. 11 and 12. — I saw in a student here two incisive teeth
grown together by their crowns ; two back teeth with their roots united ; v. my
Verzeichniss, No, 3280, 3281, 3284. — From a cow, v. Cerutti Beschreibung der
pathol. Praparate d. anat. Theat. zu Leipzig, No. 586, from man. No. 575, 578.

(46) V. Haller, who as well as Rhodigius Lection, antiqu, Basil. 1517, L. II.
C. XXXIII. p. 78, gives doubtful instances of union of all the teeth. I lately had
three incisive teeth of a child united at their roots, No. 8129 of the collection. —
Oudet found on each side of the lower jaw a large unequal tumour, covered here
and there with enamel, which seemed to arise from consolidation of the incisive
and cuspid teeth ; v. N. Journ. de Medec. Feb. 1821, p. 245. [No. 146, Mus.
Roy. Coll. Surg, a molar tooth of the upper jaw anchylosed to that adjoining,
which is inverted. T.]

(46*) In the Mus. Roy. Coll. Surg. No. 265, a double human incisor. —
No. 266, two tusks of a young elephant growing ft-om the same side of the jaw,
closely united throughout, and the cavities containing the pulps communicating
lateraUy. T.]

(47) Duval in Leroux Journ. de M^d. Chir. et Pharm. Vol. XXXIII. July
and August.

(48) To wit, smoking tobacco, chewing betel, the use of sugar of lead. v.
Sajctorph'm Act. R. Soc. Med. Havn. Vol. III. p. 96. — From sulphur baths,
Waiz in Hnfelund's Journ. d. prakt. Heilk. Vol. XVI. Part II. p. 33. It is well
known that many nations colour their teeth artificially ; tooth tinctures con-
taining mineral acids easily colour the teeth dusky.

(49) The black glazing of the hind teeth of oxen, sheep, and goats takes place
especially in such animals as feed on dry and rooty fodder; the metallic glazing,
like bronze, gold, &c. is often produced from the use of water containing iron.
In coppersmiths the teeth are sometimes coloured green, and little particles of
metal mingle with the tartar.

(50) Especially in persons with weak digestion, in rickety people, in those
which are generally affected by lithiasis ; sometimes in uncleanly persons
several or all the teeth are united together with tartar, or it surrounds the whole
tooth and forms a large tumour, v. Duval Le dentiste de la jeunesse. Paris,
1804. I have found many such instances, for example, one as large as a walnut,
v. my Verzeichniss, No. 3294, 3295. — Cerutti, No. 566, 571.— Sand if art Mus.
Anat. Vol. III. p. 297, No. 1031.— [Tbere is in the Mus. at St. Thomas's Hos-
pital, a piece of tartar as large as a hen's egg. T.]

(51) Blumenbach's Horny substance of the teeth.

(52) In general osteomalacy the teeth usually remain hard, although there
are exceptions to this rule ; for instance, tbe case by Veirac Abhandlung iiber
die Rbacbitis, u. 6. w. p. 54 and 83, Stendal, 1794. — henflamm Vcrsuch cinger
prakt. Anmerkungen iiber die Knochen, p. 427. — A tooth resembling cartilage
was found by Kruuss in Mis. Acad. N. Cur. 1697, p. 619. — le Blanc Precis des
Operations. \o\. I. p. 18,

Sect. XV.] Of the Boties of the Head, 193

(53) Jourdam Essai sur la formation des dents. Paris, 1766. — Duval in
Recueil periodique, etc. Vol. XIII. p. 275, and in Bulletin de la Faculty de
M^dec. 1811, July, p. 115 ; Sept. p. 161.

(54) Plouquet D. Primae lineae Odontitidis, s. inflammationis ipsorum dentium.
4to. Tiibin. 1794. — It easily arises out of scrofulous, syphilitic, and gouty
causes. — [A very excellent instance of abscess in the bony body of a molar tooth
is given by T. Bell, in Med. Chir. Trans. Vol. X. p. 38. — Chuny, the elephant,
which, a few years ago, was destroyed at Exeter Change, in consequence of his
ungovernable violence, arising as was then supposed from sexual excitement,
was found, when the bones were macerated, to have been labouring under inflam-
mation of the tusk, probably its pulp, as in the socket was found a quart or two
of pus, and on the tusk itself some bony deposit, and an indentation, perhaps
produced when the tusk was recently formed, by a blow with a shovel, which had
been given him a year or two before, when very unruly. T.]

{55) Duval in Bulletin de la Faculte de M^decine, 1811, p. 204.

{56) v. Duval, 1811, No. 7 — 12. — Many instances in Bresl. Mus. viz.
No. 3290, 3291, 8126.— Cem^/, No. 550—553, 559. -in Blumenbach's collection
I saw the back tooth of an animal, which, excepting the root, was completely
expanded into a large bony tumour. — Meckel has figured a similar case of a
human tooth; v. tab. 17, fig. 8 — 10. — Howship, Pract. Observat. &c. — Oudet in
N. Journ. de Medecine, 1821, Fevr. p. 245.

(57) Small exostoses on the fangs are not uncommon ; v. above, note 22.

(58) Kuchler D. de ulceribus dentium fistulosis. 4to. Lips. 1733. — Rengel-

mami De ossium morbis, eormnque, in specie dentium, carie. Arnstadt, 1805. —

Duval in Bulletin de la Faculty de Medec. 1809, p. 104, and 1810, No. 6, p. 86.

— Lavagna Esperienze e Rillessioni sopra la cari de denti umani. 8vo. Genua,

1812. — Caries also occurs in rare cases in teetli which have not been cut, as well

also as in that part of the tooth covered by the gum. — [Perhaps here belongs the

case of a large tumour of the lower jaw, with an abscess in the neck, occasioned

by supernumerary teeth, related by Whately, in Medical Facts, Vol. VIII.

p. 173. — The term caries is objected to by T. Bell, in his Anatomy, &c. of the

Teeth, p. 118 ; and he prefers calling it gangrene, as it "has not the slightest

analogy to true caries of bone." — /. Hunter also, in his Natural History of the

Teeth, had previously stated that it was " such a decay as would appear to

deserve the name of mortification ;" though he considers that there is something

more than this. T.]

(59) Ileuermann Bemerkungen, u. s. w. I. p. 302.

(60) V. de Plouquet Repert. Art. Dens. Vermiculi. — Cerutti, No. 563. —
Kremser in Horn's Archiv f. medic. Erfahrung. July and Aug. 1821.

(61) Daubenton in Buffon, Vol, XI. p. 161. — Gallandat Over de Olyphants
Tanden im Verhandelingen der Genootsh. te Vliessingen, Vol. IX. p. 352. — ■
Bonn in Descr. Thesauri Hoviani. p. 146. — Blumenhach Handb. der vergl.
Anatomic. 2d edit. p. 44, in notes. — G. Cuvierm Diet, des Sc. medic. Vol. VIII.
p. 328. — Isenflumm Anat. Untersuchungen, u. s. w. p. 37. — Several examples are
given by von Gothe zur Naturwissenschaft, Vol. II. Part I. p. 7. — One example
from V. Grdfe's Sammlung. — Dr. Grossheim in v. Grdfe and v. Walther's Journ.
f. d. Chir. Vol. X. Part I. p. 152, pi, 3, fig. 4, and one example of a small bullet
in Bresl. Mus. v. my Verzeichniss, No. 3296.

(62) Combe in Philos. Trans. 1811, Part I. p. 165.

§ 134.

The TONGUE-BONE, as being an appendage to the skull, must
also be mentioned here. In monsters with deficient or very
small tongues, this bone is sometimes completely wanting, or
in the imperfect development of the neighbouring parts it exists
only as a rudiment, and at the time of birth remains entirely
cartilaginous. Sometimes in otherwise well-formed tongue-

o

194 Of the Bones of the Head, [Part II.

bones certain parts are wanting, viz. once, one of the horns. ^
On the contrary, we also see the tongue-bone ossified too
early ;^ in double monsters we find one made up of two tongue-
bones consolidated together.^ The size and form of this bone
varies remarkably ; in many cases we find it proportionally too
small ; in other cases very large and broad ; the direction,
curving, and length of the great horns, is not rarely unequal
on the two sides, ^ the small horns also are unequal. The
connexion of the several pieces is sometimes irregular, thus the
large and small horns are anchylosed to the middle piece ; ^
the fastening of the tongue-bone to the skull is sometimes
found too firm.*^ We observe dislocations^ and fractures^ of
this bone in consequence of external violence, as well also as
greater or less destruction from caries,^ as a primary and
secondary affection.

(1) Leveling Anat. des Menschen, 1794, p. 167.

(2) Loschge Progr. de symmetria corp, human. Erlangen, 1793, p. 65.

(3) For example, my Selt. Beob, I. p. 14.

(4) V. Soemmerring Vom Baue des menschl, Korpers, 2d edit. Vol. I. p. 281.
— Several instances are also found in Bresl. Mus. — In a few cases of stuttering
persons, the tongue-bone was developed more on one side than the other. — v.
Sevres Anat. du Cerveau, Vol. II. chap. 4, p. 233.

(5) Loschge, already in a child a fortnight old.

(6) Inasmuch as the connecting ligament becomes more or less bony; I have
some instances of its almost complete ossification before me ; in a horse the
tongue-bone was in one instance completely anchylosed with the styloid
process.

(7) Valsalva De aure humana in Oper. Venet. Ausg. p. 35. — Molinelli in
Comment. Bonon. Vol. V. Part I. p. 90; Part II. p. 1. — Cederschjold in Ars-
Beriittelse om Svenska Lakare-Sallskapets Arbeten. Stockh. 1818.

(8) For instance, in persons who have been hanged. — Cerutti, No. 804.

(9) Tode Med. Journ. Vol. III. Part II. p. 43. — Biermayer Mus. anat. path.
No. 545.

B. OF THE BONES OF THE TRUNK.

§135.

The SPINE,' being the first and most important part of the
skeleton, is entirely wanting only in rare cases, and in the
most imperfect monsters ; ^ its formation is more commonly de-
ficient only at certain parts ; thus in the acephalous monsters,
there is usually wanting, together with the head, more or less of
the spine, according as the neck, breast, and even part of the
belly are deficient in these monsters. Very generally we find in
monsters with ancncephaly, the vertebrae of the neck in part
imperfectly formed, in part one or many of them wanting;^ in

Sect. XV.] Of the Bones of the Trunk. 195

very rare cases also, of otherwise well-formed persons, we miss
one of the cervical vertebrae.* In monsters with cleft and curva-
ture of the spine,^ although with bodies otherwise well formed,
several of the dorsal and lumbar vertebrae are deficient ;*' some-
times the hinder extremity of the spine is imperfectly developed,
so that it is either entirely or partially wanting, or the number
of the sacral and coccygeal bones is diminished.^ Very much
more rare is the actual increased number of the pieces of the
spine ; it is but trifling, however, as we never notice more
than one superfluous vertebra ; thus, we observe in very rare
instances eight cervical vertebrae,^ more commonly thirteen
dorsal,^ and six lumbar^" vertebrae in man ; sometimes also the
sacrum" and the coccyx^^ have a vertebra too many. In very
many instances we observe vices of size and form in the
vertebrae ; in monsters with anencephaly, hydrencephalocele,
dropsy of the head, as well as with curvature and cleft of the
spine, the vertebrae are sometimes very imperfectly formed,
consolidated, but half, unusually narrow, &c. ; ^^ not unfre-
quently the spine is in them, as also in adults, remarkably short
in proportion to the other parts of the body ; there has been
once observed, in an otherwise well-made child, one dorsal
vertebra only half formed,^* and on the lumbar vertebra of an
adult, an articular process with half of the arch deficient ; " in
an adult cow the eleventh and twelfth dorsal vertebrae were
partially double, each having two spinous processes ; ^^ the
sixth cervical vertebra of a man was found spiral-shaped ; ^^ in
rare cases there occur productions on the first vertebra, which
are articulated with the occipital bone ;^^ the form of the first
vertebra is, however, besides, frequently very variable ; ^^ the
lowest cervical vertebra has also a second hole in its transverse
process for an accessory vertebral artery ; the last dorsal
vertebra assumes the form of a lumbar ; ^° the spinous processes
especially of the dorsal vertebrae, are frequently very much
arched; on the lumbar vertebrae sometimes occur very long
transverse processes,^^ also not uncommonly there are on them,
in man, large jjrocessus accessorii ; the sacrum exhibits very
many varieties in reference to its length, breadth, and curva-
ture, not unusually is its upper false vertebra, even in adults,
completely separate from the following, either on one or both
surfaces, or it assumes on one side more or less completely the
form of a lumbar vertebra ; ^^ the vertebrae in the reproduced tails
of lizards are never normally formed, and the processes are
mostly deficient ; ^^ sometimes the form of the spinal canal is
irregular,^* and the size of the holes in the vertebrae varying.
A malformation of the spine of man and animals, as common

o 2

196 Of the Bones of the Trunk. [Part II.

as it is great, is the cleft spine, sjnna bifida, hydrorrhachia,
or hydrorrhacJns,-" in which, as an original vice, on account
of the collection of water in the spinal canal, at a very early
period, the vertebrae are more or less cleft, and stayed in their
development. In rare instances we see only a single little
irregular opening on the hinder surface of the spine,-*^ or
more commonly the arched part of the vertebra is not closed,
more or less open, pressed forwards, and entirely wanting,
or in the highest degree even the bodies of the vertebrae are
cleft;" sometimes also the transverse and articular processes,
as well as part of the body of the vertebra, are deficient.-^
The cleaving of the spine usually occurs at one part of the
column, and most commonly in the lumbar and dorsal regions,
if it be not at the same time connected with anencephaly and
hydrencephaly, with which commonly the cervical region is
simultaneously cleft; it is least frequent in the neck. In many
instances is the whole spine cleft and open from top to bot-
tom,^^ it has also been seen cleft in two places at the same
time ;^° and in one instance it still remained in an adult male.^^
But even without any dropsy in the spinal canal, we sometimes
observe in the atlas and in the sacrum, that the hinder arched
part has not closed, but that a gap is formed ; indeed in an
adult cretin, the spinous processes of all the dorsal vertebrae
still remained thus cleft.^' Some also have thought they
found an imperfect union of the original bony pieces in other
parts of the vertebrae.^^ The spine frequently presents as a
congenital state,^^ but more commonly as the consequence of
diseases and injurious practices,^^ irregular bendings and
CURVATURES, sinuoi dorsaUs distortio, curvatura^^ of which
there are given four principal kinds, viz. the posterior curva-
ture, the HUMP-BACK, gihbositas, kyphosis,^'' the lateral curva-
ture, skoliosis sen ohstipitas,^^ the curvature forwards, or in
animals, downwards, sinking back, lordosis,^'^ and lastly, the
REVOLVING SPINE, votatio spiucc,^'^ In many instances several
of these kinds occur in the same spine at once. In animals
also curvatures of the spine are not infrequent. ^^

Concerning vices of connexion of the spinal column, to
these belong, dislocations of the vertebr^,^^ which on
account of the firm connexion of these bones with each other,
is, proportionally, rarely produced by mechanical, more fre-
quently from internal causes, especially between the first two
vertebrae ; ^^ as also the opposite vice, viz. the too firm and
constrained connexion of the vertebrae, and the actual
consolidation of their joints, ankylosis.^^ The latter vice
is not rarely congenital,'" especially in connexion with cleft

Sect. XV.] Of the Bones of the Trunk. 197

and curved spine, but it more frequently occurs at a subsequent
period, particularly in the curvature of the back in old persons,
and as a most fortunate occurrence after spondylarthrocacy
and caries ; in animals also, especially in such as often have
the back mucli strained, as in horses and asses, anchylosis of
the vertebrae is by no means rare.'"' The consolidation is pro-
duced sometimes by ossification of the joint ligaments, and
sometimes by true soldering together of the articular surfaces,
sometimes by irregular bony growths ; it commonly affects only
individual joints, or few vertebrae, more seldom almost the
whole spine. *^ Fractures of the VERTEBRiE,'^^ on account
of the simultaneous strength and suppleness of the spine, are
proportionally rare, and mostly fatal at an earlier or later
period; they are, however, in individual cases, cured by
callus,*^ or the formation of a newjoint.^*^

Finally, of the vices of texture which occur in the
bones of the spine, we must especially mention, on account of
its frequency and malignity, the scrofulous inflammation
OF THE VERTEBRA, spondylartJiTocace^"^ which very often
gives rise to hump-back and to caries,^^ especially of the
bodies of the vertebrae ; this latter disease, as well as erosion
of the vertebras, which is not to be confounded with it, often
arises from other causes, viz. mechanical influence on the
sacrum from decubitus, often from scrofulous tumours running
into suppuration, from melanosis, and from lymphatic swell-
ings,^^ lumbar abscesses,^"^ aneurysms, ^^ &c. ;"* in animals also
caries is not rare.^*' Finally, inflammation of the spine and its
periosteum give rise in many cases to spina ventosa, and to
large exostoses."

(1) Franck Oratio de vertebralis columnae in morbis dignitate in Delect.
Opuscul. Vol. IX. No. L Paviae, 1791. — van Gesscher Ueber Entstellungen des
Riickgrathes und Schenkelbeines, a. d. Holland. 8vo. Getting. 1793. — Guyenet
D. sur quelques maladies, qui afFectent la colonne vertebrale. Montpell. 1809. —
Demussy Histoire de quelques affections de la colonne vertebrale. Svo. Paris,
1812. — J. Gordon D. de morbo vertebrarum. Edinb. 1813. — Copeland, Obser-
vations on the diseased Spine. 8vo. London, 1815. — T. Sheldrake, A treatise on
diseased Spine and distorted Spine, with cases to illustrate the success of a new
method of cure. London, 1816. — Simpson, C. de Spina dorsi vitiosa. Edinb.
1821. — Lloyd, A treatise on the nature and treatment of Scrofula, describing its
connexion with the diseases of the Spine, Joints, Eyes, Glands, &c. London,
1821. — Ck. Bell, Observations on the Injuries of the Spine, and of the Thigh-
bone, &c. London, 1824, with nine plates. — Cunow D. de morbis columnae
vertebralis. 8vo. Halae, 1825. — C. WenzelXJ eher die Krankheiten am Riick-
grathe. gr. fol. Bamberg, 1825, with eight engravings. — Duges in Revue medicale
francaise et ^trangere. Vol. X. p. 353. — Harrison in FothergiWs medical and
physic. Journ. Vol. XLV. Feb. and Pathological and Practical Observations on
Spinal Diseases, illustrated with cases and engravings ; also an Inquiry into the
origin and cure of distorted limbs. Svo. London, 1827, with fifteen plates.

(2) Compare above § 104, note 2. — In an acephalous monster, which merely
consisted of pelvis and lower extremities, the sacral and coccygeal bones, together

198 Of the Bones of the TrimL [Part II.

with all trace of the spine, were deficient, v. Bovn in Verhand. van et Genoot-
schap ter bevordering der Heelkunde. Amsterd. D. III. p. 124. — A similar case
of its total deficiency in another acephalous monster, v. Clark in Phil. Transact.
1793, p. 154.

(3) Holler Opera minora. Vol. III. p. 14, v. the Vertebrae. — My Monstror.
sex humanor. anat. et phys. disquisitio, Francof. ad V. p. 7, 13, 14, twice but
four, once only three vertebrae ; and Selt. Beob. Part I. No. 9, in a double monster
from a sheep, in the neck but six vertebrae. — I have, however, since seen it in
many anencephalous monsters. — In the Cabinet of Nat. Hist, at Stuttgart, I saw
only two cervical vertebrae in one such monster. — Several instances of deficient
individual vertebrae are given in Meckel Descriptio monstror. nonnullor, etc.
p. 10, 19, 26. Lips. \^2Q. — liathke in Meckel D. Archiv f. d. Phys. Vol. VII.
p. 490, only six cervical vertebrae. — Detharding in Nov. Act. Phys. med. Vol. X.
Part II. p. 706, merely the rudiment of an atlas and epistropheus; also in
hydrencephalocele. v. Burkart D. de monstro humano notabili, Friburgi Brisg.
1825, p. 15, but five cervical vertebrae.

(4) Columbus De re anat. p. 2Qo.—Cullen, Practice of Physic, Vol. III. § 1107,
saw this in a family disposed to apoplexy, even hereditai'ily. — I have lately seen
a case of this very kind in an adult man. v. No. 8852 of Bresl. Mus.

(5) Malacarne in Mem. della Soc. Ital. XII. p. 164. — Meckel Handb. d.
pathol. Anat. Vol. I. p. 201.

(6) For instance, two skeletons, with eleven dorsal, but six lumbar vertebrae, in
the Anat. Mus. at Kiel. — In oxen, only twelve dorsal vertebrae, v. Pilger Handb.
der Veterinar-Wissensch. Vol. I. p. 502. — In the horse, but five lumbar vertebrae.
V. Pilgery p. 494, note. — Allg. Hist, der Natur. Vol.11. Part II. p. 189. —
Rudolphi Bemerk. auf einer Reise. Part I. p. 37.

(7) In a calf, most of the lumbar, and all the sacral, and coccygeal ver-
tebrae were wanting, and the lower extremities were attached by ligament to the
first lumbar vertebra, v. Savdifort Mus. anat. Vol. III. No. 1009, p. 294. — In
another calf, No. 1060, ih. only the hind part of the sacrum, and all the coccygeal
vertebrae ; instead of the sacrum and coccyx, there has been seen merely a
single small bony germ. v. Friedlieb Monstrosi foetus descriptio atque delineatio.
4to. Altonae, 1803, p. 33, tab. 4 and 6, on children, with congenital large
encysted tumours on the back. — The evolution of the lower part of the spine is
sometimes retarded, v. my Selt. Beob. Vol. II. p. 165. — In No. 2903, Bresl.
l\Ius. the coccyx is wanting entu-ely. — The pelvis in man has rarely but four, and
the coccyx frequently but three pieces. — Often in animal monsters, the whole
tail is either deficient, or uncommonly short. — This is seen hereditary in the
horse, dog, and the peculiar race of tailless fowls. — In domestic animals, how-
ever, the normal number of pieces in the tail varies ; thus, in the horse, from
thirteen to twenty-four; in oxen, from sixteen to eighteen; in sheep, from
sixteen to twenty, &c.

(8) Eustach'ius Ossium examen, p. 210. — Columbus, p. 484. — Palfyn Anat. Vol.
II. p. 100. — Leveling Ohserv. anat. rarior. Fasc. I. C. III. — Ackermami Ueber
die korperliche Verschiedenheit des Mannes vom Weibe, p. 49, note k. v.
Meckel De duplicitate monstrosa, p. 27. To a certain degree also belongs here
the case quoted under note 16 below.

(9) Morgagni De sed. et cans. morb. L. I. Epist. V. note 6. — Bohmer Observat.
anat. Fasc. I. praef. p. 5. — Fabricius Animndv. vnr. argument!. Hehnst. 1783,
p. 9. — van Doeveren S])ec. observ. acad, p. 201. — Meckel, p. 25 and 28. — One
case in my Selt. Beob. I. p. 70; and Vcrzeiclmiss, No. 3312, in which there is
a mistake, there not being six lumbar, but thirteen dorsal vertebra\ — In Anat.
Mus. zu Kiel, there is also a skeleton, with tliirtcon dorsal vertebraB. — In
animals, a dorsal vertebra too many. — In a horse at Hanover, there are nineteen
dorsal vertebrae. — Rudolphi, I. p. 74. — In an ox. v. Pilger, p. 502.

(10) V. Blumenbach (Jeschichte und Beschreib. d. Knochen, 2d. edit. p. 309. —
llesselbach Beschreib. d. pathol. PrJiparate zu Wiirzburg, No. 651, p. 12. —
In two sheep, a supernumerary lumbar vcrtcljra. v. Rudolphi, I. p. 37.

(11) van Doeveren, p. 206. — Jlbinus Annot. acad. lib. IV. C. XI. de esse
^acro. — Sandifort Mus. anat. Vol. I. p. 87, No. 352; p. 176, No. 162 and

Sect. XV.] Of the Bones of the Trunk, 199

177; No. 163; compare Blumenbach, p. 316. — Some instances also in Bresl.
Mus.

(12) As it appears more frequently in women, v. von Sommerring, Vom Bane des
menschl. Korpers. 2d edit. I. p. 360. — I have also some instances before me.
If the observations about men with tails are to be believed, the coccygeal vertebrae
must have been much increased or very long.

(13) I have seen this in a great number of monsters, especially in the
Anencephalous. v. D. Monstror. sex humanor. anat. et phys. disquisitio ; Selt.
Beob. I. p. 20, and since in several more. — Meckel Handb. der pathol. Anatomic,
Vol. I. p. 382, and Descript. monstror. nonnullor, p. 10, 19, 26, 36. — Seerig D.
de hydroencephaloceles specimine eximio, p. 12. 4to. Vratisl. 1822.

(14) On No. 3018 in Bresl. Mus. v. my Selt. Beob. II. p. 15.

(15) Rosenmuller D. de singularibus et nativis ossium c. h varietatibus, p. 58.

(16) I saw this in the Veterinary School at Munich, the cow had super-
numerary feet on this part, and, according to the account, she had also an udder
here ; the lumbar vertebrae exhibited a spina bifida ; the spinous processes of the
dorsal vertebrae were not at all cleft, but actually double.

(17) It formed two turns with two spinous processes, and on each side two
transverse processes. I saw this very remarkable piece in the Anat. Mus, of the
Joseph Academy, at Vienna.

(18) Leveling Observat. anat. rar. p. 134, tab. 5, fig. 1. — Sandifort Mus. anat.
Vol. II. tab. 14, fig. 3, V. § 125, note 7.

(19) Compare v. Sommerring, p. 312, § 284. — I have frequently found it, as it
were, squeezed flat, in water of the head, and rickets. — A similar atlas is described
by Kelch Beitrage zur pathol. Anatomie, No. VIII.

(20) Only on one side in an ass. v. Allgem. Historic der Natur. Vol. II. Part
II. p. 219.

(21) I have seen this several times; — in many cases they are so large on the
fifth lumbar vertebra, that the vertebra is locked between the hip bones, and in-
deed resembles the first false vertebra of the sacrum, v. Kelch, No. X.— On the
first lumbar vertebra of two horses, in the Veterinary School, at Stockholm, I
saw the transverse processes almost as long as the last rib, formed also like it,
with a cartilage at the extremity, not however movable.

(22) This seems to occur only in men.

(23) I have this in No. 8160 of Bresl. Mus. before me. — In the Anat. Mus. at
Prague, I also saw the skeleton of a lizard, which had lived for three years after
breaking off" the tail, without the new vertebrae becoming ossified, or having
processes.

(24) To wit, too narrow or too wide, compressed, completed at an early period,
so that there is no hole in the sacrum. — I have seen the latter in children with
cleft spine. — Stoll Ratio medendi. — Mokrenheim's Beobactungen, u.s.w. Vol. I.
p. 174.

(25) Reuss Repertor. Comment. Vol. XIII. p. 570. — de Plouquet Repertor.
Art. Hydrops spinas. — Hochstetter D. de Spina bifida. Altdorf. 1703. — Titsingh
Heelkundige Verhandeling over de tegen-natuurlyke Sply tinge de Rugge-graat.
Svo. Amsterd. 1782, with four engravings. — Vijllhoorn Noodig Denkbeeld van
Spin. bif. 8vo. Amsterd. 1732, with an engraving ; and Tweede Vertoog over het
ongemakvan de Spin. bif. u.s.w. Amsterd. 1733, — Plainer Vxogr. de Sp. bif.
Lips. 173i.— Gild D. de Sp. bif. Viennse, 1754. v. Mailer's Diss, pract. VII.
note 253. — Murray D. Sp. bif. ex mala ossium conformatione initia, Goetting.
1779. V. Opusc. II. note 5.— CappelD. Ae S^.hiL Helmst. 1793.— Meckel D. de
hydrorrhachia. Halae, 1795. — Batter D. de hydrorrhachitide. Erford. 1798. —
Bodin D. de Sp. bif. v. Journ, de Medec. continue. Vol. III. p. 148. — Fleischmann
De vitiis congenitis circa thoracem et abdomen, p, 9. Erlangae, 1 810. — /. F. Meckel
Handb. der Pathol. Anat. Vol. I. p. 356. — Forster D. de Sp. bif. Svo. Berol.
1820.—^. F. Moeckel Comm. de Hydrorrhachitide. Svo. Lips, 1822, with
engravings. — Compare No. 3313 — 3319.

(26) Ruysch Observ. anat. chir. Obs. 36. — Acrell in Schwed. Abhandlung.
Vol. X. p. 291.

(27) 7'w//3m.s Observ. med. p. 230. — Wepfer in Ephem. Nat. Cur. Dec. I. Ann.

200 Of the Bones of the Trunk. [Part II.

III. Obs. 129, p. 222.—Jiugdenm Philos. Transact. Vol. XXXVI. NoAlO.—Sah-
mami in Orthii D. de quibusdam tumor, tunicat. ext, recus. in Haller's Coll. Diss,
med. chir. Vol. V. § 3, p. 411. — Camerarius, ih. § 4. — Fleischmann. — LaUemand
Observat. patholog. p. 32. Paris, 1818. — Meckel Anat. phys. Beobaclit. und
Untersucbungen. p. 90, 9G. — v. Loder Index praeparator. Abscbn. Part II.
No. 3313 of Bresl. Mus. seem to belong here ; also No. 3318.

(28) In a calf, I saw the cleft entirely on the right side of the spine, so that
the right half of the vertebrae was entirely wanting, while the left half, both of
the bodies and arches, were perfect, v. my Verzeichniss, No. 3318.

(29) Several examples in Bresl. Mus. v. Fielitz in Richter's Chir. Biblioth.
Vol. IX. p. 185. — IIoi)i in Memoir de Dijon, Vol. II. p. 105. — Bidloo Opera
omnia. L. B. 1715, pi. 4, fig. 1 and 2, from the first vertebra even into the
sacrum. — Palletta Exercit. pathol. I. fig. 11. — Pottho/D. Descriptio casus raris-
simi spinae bifidae totalis. Berol. 1828.

(30) Camper Ueber die Natur und Ursachen der versch. Wassersuchten. v.
Samml. auserl. Abhandl. f. prakt. Aerzte. Vol. X. p. 448.

(31) J. P. Frank Delectus opusculor. medicor. Vol. II. p. 33, in the note. —
Perhaps here belongs, as a less degree, the case engraved by Sandifort Mus. Anat.
Vol. II. tab. 45, fig. 1 — 3, in which the cavity of the sacrum of an adult man
was, at one spot, remarkably enlarged, and its sides expanded.

(32) Prochaska Disquis. anat. phys. organ, c. h. tab. 9, fig. 2.

(33) Bichat Anatomic descriptive. Vol. I. p. 133 ; the arch of a lumbar vertebra
movably connected with its body, was seen by Heiland, in Ephem. Nat. Cur.
Dec. III. Ann. VII. p. 278, and Rosenmiiller, p. 57 ; — a transverse process joined
to its vertebra. — Ungebauer Epistola osteologica de ossium trunci genesi, p. 257,
Lips. 1739, and twice in Rosenmiiller, p. 58. — A movable spinous process on
the sacrum, in Ilehenstreit de rarior. quibusdam ossium momentis, p. 7. Lips.
1740. — On the point of the spinous process of the seventh cervical vertebra,
there was a roundish bone articulated, almost as large as a hazel nut, v. Ketch,
No. 9 ; and a similar bone on one lumbar vertebra, v. Schulze in Commercio
Noric. 1731, No. V. p. 33. Perhaps, in both cases, there were sessamoid bones.
Compare below, note 48.

(34) For instance, in monsters with anencephaly, and hydrencephaly, very
often in the neck ; in man and animals with cleft spine, with lateral excen-
tration ; in many double monsters, very common in calves, &c.

(35) Especially in softening of bone, erosion, inflammation, and ulceration of
the vertebrae, and the intervertebral substance, from muscular weakness, neg-
ligent carriage, and various mechanical causes, as tight lacing.

(3(>) Compare above, note 1. — Jones, Essay on Crookedness or distortions of
the Spine. 8vo. Lond. 1788. — Palletta Beobachtungen iiber die mit Liihmung
verbundene Kriimmung des Riickgraths, a. d. Ital. 8vo. Tubing. 1795. — Portal
Observations sur la nature et le traitement du Rhachitisme, ou des courbures de
la colonne vertebrale et de celles des extremit^s. 8vo. Paris, 1798. — Wilkinson,
Physiol, and philosophical Essays on the distortions of the Spine. 8vo. Lond.
1798. — jEar/e, Observations on the cure of curved Spine, &c. Svo. Lond. 1803. —
Frolich resp. Meyer D. de curvatura spina' dorsi cum paralysi extrcmitatum infe-
riorum. 4to. Upsal. 1804. — Feller De s])inae dorsi incurvationibus, etc. Svo.
Norimb. 1807, with figures. — Jo/vr Ueber die Vcrkriimmungcn des menschlichen
Korpers und die Ileilart dersclben. 4to. Leipz. 181G, with engravings. —
Macartnei/y Observations on the Curvatures of the Sjjine. 4to. Dublin, 1817. —
Penncld D. de spina incurva. Edinb. 1818. — Malsch D. de nova machina
Graefiana, etc. nee non disquisitio dcformitatum istarum. 4to. Berol. 1818. —
(7/iOM/rt«f Decas pelvium spinarunuiue deformatarum. 4to. Lips. 1818. — Decas
secund. Lips. 1820. — Hashach D. de distortionibus columnae vertebralis in
genere. Svo. Marburg. 1820. — Ward, Practical Observations on Distortions of
the Spine, Chest, and Limbs, &c. Svo. London, 1822. — ./. Shaw, On the Nature
and Treatment of tlie Distortions to whicii tlie Spine and the Bones of the Chest
are subject, &c. Svo. London, 1823, illustrated by j)lates in folio ; and further,
Observations on the lateral or serj)entine Curvature of the Spine, Sic. Svo.
Fiondon, 1825. — • Dods, Pathological Observations on the rotated or contorted

Sect. XV.] Of the Bones of the Trunk. 201

Spine, commonly called lateral Curvature, &c. 8vo. London, 1824. — Jarroldy An
inquiry into the causes of the Curvatures of the Spine, &c. Svo. London, 1824,
with engravings. — Strauss D. de Spinae vertebralis curvaturis cum statu para-
lytico junctis. 8vo. Marburg. 1824. — Bampfield, An Essay on Curvatures and
diseases of the Spine, including all the forms of spinal distortions, &c. Svo.
London, 1824. 2d edit. 1826. — Maisonable Recueil d'observations sur les
difFormites dontle corps humain est susceptible, etc. Paris, 1825. — Good plates
in Walter's Museum anatomicum. — Sandifort Mus. anat. Vol. II. tab. 36, 37,
41 — 43, 50 — 61, and Wenzel. — Many beautiful examples in Bresl. Mus. No.
3017—3025, 3329—3348.

(37) Gibber, Gibbus, Cyrtoma, &c. — Reuss Repertor. Comm. Vol. XIII.
p. 383. — de Plouquet Repertor. Art. Gibbus, etc.— Wedel D. de gibbere. Jenae,
1684. — Crell Pr. sectio puellae gibbosae. Helmst. 1745 ; and in Act. Acad.
Nat. Cur. Vol. IX. p. 229. — de Haller Pr. Gibbi descriptio. Goett. 1749.—
Coopmann D. de Cyphosi. Franequer. 1770. — Donner D. de gibbositate.
Goett. 1785.

(38) a Roy Com. de Scoliosi. 4to. L. B. 1774. — Reynders D. de scoliosi
ejusque causis et sanatione observatione et propriis experinientis confirmata,
Groening. 1787. — Pape D. de Scoliosi ejusque casu rariore. 4to. Regiomont.
1808. — Here also belongs wry-neck, which, if it occur in early youth, often pro
duces consequent obliquity of the vertebrae.

(39) G. TV. Wedel De Lordosi in Misc. Acad. Nat. Cur. Dec. II. Ann. V.
p. 445.

(40) This kind rarely occurs as a congenital disposition in man, and only in a
minor degree. — More frequently in animals, especially in calves, and is then
sometimes so great, that the spine can be twisted round once or twice on its
axis. — I have seen this several times, v. my Verzeichniss, No. 3034. — Blumenthal
D. de monstroso vituli sceleto. 8vo. Regiom. 1 826, with lithographic tables.

(41) Much more rarely however than in man ; and this, besides other causes,
on account of the horizontal position of the spine. — On distortions in animals, v.
Camper Von den Krankheiten, die sowohl den Menschen als Thieren eigin sind.
p. 28. 2d edit. — It has been found in monkeys, dogs, &c. v. Voigtel Handb, der
pathol. Anat. B. I. p. 316 ; in the hare, pig, horse, and ass, especially the sinking
back ; although also other kinds, for instance, great lateral curving. — Rudolphi
Bemerkungen, u.s.w. Vol. I. p. 74. — A humpback, v. Neergaard Beitrage zur
vergl. Anatomic, u.s.w. p. 37, tab. 1. Gbtt. 1807. — In oxen, v. my Verzeichniss,
No. 3032, 3034, 3317, 3318.— In lambs, of which I have several examples, v. No.
3323 and 3324. — In birds, viz. fowls and geese; of the latter, there are two in-
stances in Bresl. Mus. — Examples in Bresl. Mus. No. 3038 and 3039. —
Even in fishes, v. Camper. — Bergmann Primae linese pathologiae comparatae,
p. 30, (in Perca fluviatilis). — Bleuland Descriptio Musei anat. No. 2569,
p. 407, (in Pleuronnectes Flesus). — G. Sandifort Mus. anat. Vol. III. p. 276,
No. 916 and 917.

(42) V. Reuss Repertorium. Comment. Vol. XIV. p. 113. — de Plouquet Art.
Vertebrarum Luxatio. — Columbus, Valsalva, Morgagni, Heister, Mauchart, Tahar-
ranus, Palletta, Schack, Cooper, &c. maintain that dislocation from external
causes can never occur without simultaneous fracture ; others properly admit
them, at least subluxations ; viz. Rust in Arthrokakologie, and Boyer, (between
the atlas and epistropheus.) — Ch. Bell describes and engraves several dislocations ;
a dislocation of the fifth cervical vertebra is described by Thillaye in Leroux
Journ. de Medec. 1816, p. 35. Bulletin de la Faculty, p. 26. — Of the seventh
cervical by Gaitskell in the London medical Repository, April, 1821, Vol. XV.
p. 282. — Edinburgh Med. and Surg. Journ. July, 1819. — Of the fourth cervical,
\>y Lawrence m the Lancet, Vol. XI. p. 749. — v. Deggeller Diss, de luxatione
vertebrarum. Altdorf. 1707. — Mauchart Pr. de luxatione nuchae. Tubing. 1747.
Cuenotte D. s. casum subluxationis vertebrae dorsi cum fractura complicatae, etc.
Svo. Argentor, 1761. — Murray D. de spinae dorsi luxationibus. Upsal. 1780. —
Ludwig De luxatione vertebrarum colli a medico forensi circumspecte disqui-
renda. Lips. 1787. — Sommerr'mg Bemerkungen Uber Verrenkung und Bruch
d€s Ruckgraths. Svo. Berlin, 1793. — A good collection of cases are given by

202 Of the Bones of the Trunk. [Part 1 1 .

Casper in Rust's Magazin f. d. gesammte Heilk, Vol. XIV. p. 433. — Several
also are found in v. Grdfe and v. Wal/her's Journ. f. Chir. Vol. III. Part II.
p. 197. — /. F. L. Ranch D. de vertebrarum cervicalium luxatione. 8vo. Berol.
1828, (of the fifth and sixth.) — [Dislocation between the last dorsal and first
lumbar vertebra, v. Med. Gazette, Vol. III. p. 651. — Dislocations of the
vertebrae from each otlier without fracture, are, as far as I am aware, extremely
uncommon. T.] Imperfect dislocations in the horse, of which Havemann has
spoken, are observed by Lebel. — v. Recueil de Medec. veterinaire. Vol. II,
Sept. 1825.

(13) Especially from inflammatory swelling of the vertebrae, caries, destruc-
tion of the ligaments, exostosis, &c. it is most common on the first two vertebrae;
it has been also observed by Daubeulon v. Allg. Historie der Natur, Vol. II.
Part I. p. 68, No. 200.— Duverneij Maladies des Os. II. p. VSl.—Saudifort Mus.
anat Vol. I. p. 143; Vol. II. tab. 14 and 15 ; Vol. III. p. 384, ^o. 603.— Rust's
Magazin f. d, gesammte Heilk. Vol. XII. Part II. p. 413. — Bauer in Tiibinger
Blattern, Vol. I, No. 2, p. 154. — Schupke De luxatione spontanea atlantis et
epistrophei. 4to. Berol. 1816, with one engraving. — Schrog D. de luxatione
vertebrarum spontanea. 4to. Lips. 1817. — de Wagner D. de luxatione capitis
spontanea. 8vo. Dorpati, 1822, with engravings. — Shaw. — Rosenthal Abhandl.
aus dem Gebiete der Anat. Physiol, und Pathologie. 8vo. Berlin, 1824, p. 141,
pi. 9. — /. Cloqnet in Archives generales de M^dec. Jan. 1824, p. 143. — I myself
have seen this three times; v. Selt. Beob. I. p. 80, and Verzeichniss, No. 3361
— 3363. — Berlin Traite d'osteologie, Vol. III. p. 61. — O/Z/u/t-r Traite de la moelle
epinidre et de ses maladies, &c. 2 vols. 8vo. 2d edit. Paris, 1827. — C. A. Parry.

(44) Compare above § 109, note 7. — de Plouquet Repertor Vertebrar. Ancylosis,
and roig'el Handb. der pathol. Anat. p. 227, if. — It frequently occurs on all the
vertebral regions, viz. between the atlas and occipital bone, between that and the
second vertebra, or between all three; hereto belong almost all the cases men-
tioned in the last note ; further, Gotz Diss, de morbor. ligamentor. Halae, 1798,
p. 32. — Kelch No. 8. — I have twice found it, viz. No. 3360 ; I saw several instances
in the Mus. of Brookes at London ; in Savdifori's at Leyden ; two cases in the Mus.
])athologicum at Vienna ; three cases in the Anatom. Museum at Heidelberg ; an
anchylosis of the second verteln'a with the occipital bone in destruction of the
front arch of the atlas was seen by J. Cloquef. — In a horse, Viborg'in ^'cterinair-
Selsk Skrifter. Vol. III. p. 479, &c. — Anchylosis of several or all the cervical
vertebrae, v. Bacheracht D. sur le Scorbut, § 40. — Alhrecht in Act. phys. med.
Vol. VIII. Obs. 124, p. 452. — My Verzeichniss, No. 3363, and a similar case
in Broolces's Mus. — Sometimes the cervical vertebrae are anchyloscd also in very
early existing collum obstipum. — Anchylosis of the dorsal and lumbar portions
of the spine are very common ; also the consolidation of the sacrum with the last
lumbar vertebra, and with the coccyx; so also are anchyloses of tlie false ver-
tebrae not rare. v. Sandifort Mus. anat. Vol. II. pi. 38 — 44, and my Verzeichniss,
No. 3365—3373.

(45) I have found this in several human monsters, also in calves and sheep.
V. Verzeichniss, No. 3032, 3034, 3321, 8016.— In a calf, G. Sandifort Mus.
anat. \'ol. III. p. 291-, No. 1009, 1010. — In a monstrous stag, G. J'dger in
MeckeVs Archiv f. Anat. und Physiol. 1826, No. 1. p. 65 and 66.

(46) On ancliylosis of the vertebrae in the horse, v. Albrccht in Nov. Actis
Acad. N. C. Vol. VIII. p. 452.— Complete anchylosis of all the dorsal and
lumbar vertebrae in two horses was found by Greve Erfahr. und Beobachtungen
iiber die Krankheiten der Hausthiere, Vol. 1 1, p. 3. —Instances of anchylosis in
horses, v. Sandifort \o\. III. p. 213, No. 689— 701.— My Verzeichniss, No. 3374
—3381.— In an ass, PiJger Handbuc-h der Veter. Wiss. Vol. II. p. 1824.— Allg.
Historic der Natur. Vol. II. Part II. ]). 223, No. 436. — In a sheep, of which I
saw an example at Alfort. — In a boa constrictor. — Sandifort, p. 21'3, No. 703.

(47) Com])are § 109, note. 11. — G. Sandifort Mus. anat. Vol. III. p. 236,
No. 639. — An anchylosis of all the vertebrae, but only on the right side, after
rljcumatism, was seen bv ./. Cloqnet, v. Archives generales de M^dec. April,
1S23. \R. Connor^ in Phil. Trans. Vol. XIX. p. 21, gives an account of a spine,
" the ligaments of which were so perfectly bony, and their articulations so

Sect. XV.] Of the Bones of the Trunk. 203

effaced, that they really made but one uniform continuous bone. On sawing
through them it was found that the ossification extended two lines deep, and
the rest of the surfaces of the bodies were ununited as usual." There is in the
Mus. Roy. Coll. Surg. No. 310, one example; and in the Mus. at St. Thomas's
Hospital, another of anchylosis of the first vertebra with the occipital bone ;
and in the latter collection another of the first and second cervical vertebrae,
both of which are, I believe, extremely rare. T.]

(48) Ludwig Pr. de Paraplegia e fractura vertebrarum colli. Lipsiae, 1767. —
V. Sommerring Bemerkungen iiber Verrenkung und Bruch des Rlickgraths.
Berlin, 1793. — Haugk D. de fractura sterni et vertebrarum. 4to. Lips. 1816. —
Casper in Ritsfs Magazin f d. ges. Heilk. Vol. XIV. p. 433. — J. Cooper Lectures
by Tyrrel, Vol. IL p. 6. [Among the cases related in which, is a most re-
markable one of transverse fracture of the atlas, without displacement, which
occurred to Mr. Cline, sen. in which, when the head was depressed or elevated,
the atlas was displaced from the epistrophea, the dentiform process of which,
together with the broken piece of the atlas connected with it, was then thrust
against the spinal marrow ; the child lived twelve months after the accident. T.]

(49) Ephem. Nat. Cur. Dec. IL Ann. VL Obs. 142 ; and ib. Cent. L Obs. 1 ;
van de Wynpersse D. de Ancylosi, p. 21, tab. 1, fig. 4. — Sandifort Mus. anat.
Vol. IL tab. 40. fig. 6 and 7, (after a gun-shot, the bullet grew in,) and Vol. III.
p. 201, No. 340. — [In Mus. Roy. Coll. Surg, there is a very fine instance of a
ball lodged in the vertebral canal ; it rests in the front of the arch of the eleventh
dorsal on the right side, and has become slightly embedded ; its surface is rough,
as if corroded, v. further for this in the Spinal Marrow. T.] — One case of united
fracture of the spine I saw in Museum of Brookes, and in Hunterian Museum
at London. [The preparation here alluded to, is a beautiful example of united
fracture of the twelfth dorsal vertebra through the body and arch, in consequence
of the man having been bent double by the falling in of a gravel pit. There is
not very much displacement, and a broad band of bony deposit passes across the
injured vertebra, connecting it with the lower edge of the superjacent vertebra
on the left, and with the subjacent one on the right side, to which it is more
firmly connected than to the upper. The man lived for twelve months after the
accident. There is a specimen at St. Thomas's, in which there is a ligamentous
union in one of the common cases, in which the fractured upper edge of the body
of the lower vertebra had been carried forward with the displaced upper
vertebra. T.] — Two instances are mentioned by Richerand Nosographie chirur-
gicale, and a case by J. Cloquet in von Froriep's Notizen. Octob. 1826, No. 322,
p. 221. — A case of united fracture of the sacrum is engraved in Sandifort,
Vol. II. tab. 45, fig. 5—7.

(50) Compare my Selt. Beob. II. p. 15, No. 7, and Verzeichniss, No. 6,
3321, and 3322, all three cases on the lumbar vertebrae ; the arches were articu-
lated on the bodies. — Howship, Practical Observations in Surgery and morbid
Anatomy. Lond. 1816, 101st case. — Shaw, On the Nature and Treatment of
Distortions, also relates one instance. The cases related above, at note 33, by
Heiland, RosenmuUer, Ungebauer, and Hebenstreit belong, in my opinion, here, and
not to vices of formation. — Lisfranc in Journ. g^n. de Medec. Vol. XCVIII.
March, lS27.—Jefferys in Lond. Med. and. Phys. Journ. July, 1826.

(51) Here belongs also the so-called Morbus Pottii, in which, at the same
time, swelling of some vertebrae, distortion, and mostly lameness of the lower
extremities, are connected with inflammation ; the spondylarthrocacy especially
affects the bodies of the vertebrae, particularly in the cervical and dorsal portions
of the spine. Compare, on this disease especially. Pott, Remarks on that kind
of palsy of the lower limbs which is frequently found to accompany a curvature
of the spine, in Chir. Works, Vol. III. p. 349. Lond. 1779. — Palletta Anatom.
pathol. Beobachtungen iiber die mit Lahmung verbundene Kriimmung des
Rlickgraths. Tiibin. 1794. — Rust Arthrokakologie, u. s. w. — Schroder D. de
Spondylarthrocace. Svo. Halae, 1827. — I saw a case of morbus pottii in an old
man. v. Selt. Beob. II. p. 17, and Verzeichniss, No. 3363.

(52) Hunauld D. an ah ictu, lapsu, nisuque quandoque vertebrarum caries,
Paris, 1742. — Balk]\ir\. Beobachtung iiber Beinfrass der Riickenwirbel in Mur-

204 Of the Bones of the Trunk, [Part II.

sinnas Journal. Vol. I. p. 49. — Joffrion D. sur la carie des vertebrcs et les abces
par congestion, qui en sont frequemment un etfet. Svo. Paris, 1801. — Fievei D.
sur la carie de la colonne vertebrale. Strasb. 1802. — Ducasse D. sur la carie
du corps des vertebres. Paris, 1807. — Blackburn D. de spinae carie. Edinb.
1822. — Caries on the first two vertebrae after spondylarthrocacy is not rare;
instances are given in Reil Fieberlehre, Vol. II. § 102. — Rust in the Salzb. med.
chir. Zeitung. 1813, Vol. III. p. 108 ; and in his Magaz. f. d. ges. Heilk. Vol. I.
Part II. p. 213 ; and an engraving of it in the Arthrokakologie, pi. 5 and 6. —
Biermaijer Museum anat. pathol. No. 227 and 382. — Raimann in Medic. Jahrb.
der ostreich. Monarchic. "\'ol. III. No. 1, p. 43. — Schallgruher in der Wiener
Literatur-Zeit. 1813, Part III. — Schupke, with engravings. — Carious destruction
of the first two cervical vertebrae from venereal ulceration of the spine, so that
the spinal marrow, with its membranes, was exposed from the mouth, v.
Tiibinger Blatter, Vol. II. Part II. p. 135. — Carious exfoliation of the greater
part of the body of the second cervical vertebra cured, was seen by /. Syme, v.
Edinb. med. and surg. Journ. April, 1826. — Caries of the sacrum, Biermayer
No. 107, 234, and 544. — Sandifort, Vol. II. tab. 44, fig. 4. — My Verzeichniss,
No. 340G, 3408. — Caries and erosion of the sacrum consequent on concubitus
analis, v. my Verzeichniss, No. 3404. — lb. No. 3351 — 3358 several instances of
caries on the vertebral column. — [An instance of syphylitic caries of the denti-
form process of the second vertebra occurred several years since in St. Thomas's
Hospital, which so much destroyed it that the mere weight of the head broke it,
and the woman was killed by pressure upon the spinal cord. T.]

(53) On the transverse processes of the four lower cervical vertebrae. —
Palletta Exercit. pathol. Vol. I. p. 62. — On the lumbar vertebrae Biermayer,
No. 370. — I have described several instances of this kind in my Selt. Beob.
Part II. No. 33. — A case of caries in consequence of scrofulous suppuration of
the throat, v. my Verzeichniss, No. 3352.

(54) Knackstedt Medic, chir. Beob. No. 54:.—SeUe N. Beitrage II. p. 102.—
Ilowship^ 100 and 101st cases. — Several instances in the Strasburgh Museum.
Compare Kilian Anat. Untersuchungen iiber das 9th Hirnnervenpaar, p. 121. —
A psoas abscess connected with the vertebral canal, v. /. Jackson in New-
England Journ. of Med. and Surg. Vol. V. No. 1, Jan, 1816. — Two psoas
abscesses connected with each other through the spine, observed by Mllroy,
communicated by Lizars in Edinb. Medical and Surg. Journ. July, 1825. —
In such lumbar abscesses, with caries of the spine, ascarides in very rare cases
have been found; v. my Selt. Beob. II. p. 41, and Velpeau in Archives gen.
de Medecine, Vol. VII. Uixrc\\.— Sandifort, Vol. III. p. 262, No. 839—844.

{bo) The destruction of the vertebrae seems to take place, as Scarpa has
very admirably shewn, usually from increased absorption, although in rare
cases, if the morbid irritation produce inflammation in the bones; also from
caries, of which I have an instance. Scarpa himself describes such cases ; v. his
Sull'Aneurisma reflessioni ed osservazioni anatomico chirurgiche. fol. Pav.
1804, translated by Wisharf, Svo. Edinb. ISOS.—Ayrer Ueber Pulsadergcsch-
wiilste, u. s. w. Giittingen, 1800, p. 16.—Eck De carie articulorum externa. 8vo.
Berol, 1818, Tp. 4:7 .—Cerutti Beschreibung der pathol. Praparate zu Leipzig,
No. 743, &c.

{'')5*) [In the Mus. at St. Thomas's Hospital, there are two fine instances
of cancerous afTection of the spine, which were concomitant with cancer
of tlie breast. In one instance, the cellular structure of the bodies of the
vertebra? is so comi)letely destroyed, that tliey have been crushed by their own
weight. In the other, there are distinct scirrhous tubercles, and the disease docs
not seem to have proceeded so far as in the former case. T.]

(56) For instance, in oxen and horses on the first cervical vertebra from
poll-evil ; v. my Verzeichniss, No. 3351. I saw similar instances on the atlas of
two horses in the \'eterinary College, London, and at Stockholm.— On the
si)inous processes of the withers of horses, from neglected saddle-gall, on the
caudal vertebra- from tail-evil, of which I have seen instances in the veterinary
schools at Berlin, \ ieima, and Alfort, and not tuifriquently on the tip of the
tail in monkeys, makis, coatimondis, marsupial animals, ike. in confinement.

Sect. XV.] Of the Bones of the TrunJc, 205

(57) I saw, in the Collection of the Joseph Academy at Vienna, a remarkable
fungous exostosis of the spine, in consequence of a blow, projecting into the chest;
a lesser one on the lumbar vertebra, (called osteosteatoma,) is found in Sandi-
fort Mus. Anat. Vol. I. p. 188 ; Vol. II. tab. 59 and 60. — I have a smaller one
on the last lumbar vertebra, v. Verzeichniss, No. 3386. — A bony growth on
the neck of a dog. v. Viborg in Veterinair-Selsk. Skrifter, Vol. III. p. 493. —
Spina ventosa on the lumbar vertebrae of a pig, at Alfort. — Spina ventosa and
exostosis are frequent on the tip of the tail in long-tailed monkeys, marsupial
animals, coatis, &c. — I found a spina ventosa on some caudal vertebrae of a
camelion ; v. Verzeichniss, No. 4859. — Also large exostoses on some spinous
processes in Lepidopus Peronii and Sparus erythrinus, v. No. 4899 and 4905, —
An exostosis as large as a hen's egg on the spine of Gadus iEglefinus at Kiel.
V. Seidel Index Musei anat. Kiliens. p. 28, No. 21. — A large exostosis on the
side of the tail of a fish, v. Sandifort, Vol. III. p. 243, No. 702; and on two
vertebrae of a boa constrictor, No. 703.

§ 136.

The RIBS exhibit many variations in reference to their usual
NUMBER;^ thus they are wanting, for instance, in human and
animal monsters with imperfect development of the upper half
of the body, with deficient skull, with cleft breast and spine,
congenital curvings, &c. usually also at the same time with defi-
cient, imperfect, and consolidated dorsal vertebrae, or of them-
selves several ribs are alone absent ; ^ the absence of one or •
other ribs, however, occurs also in otherwise well-formed men
and animals, without absence of one vertebra.^ On the con-
trary, we find also on one or both sides, one rib too many,*
and sometimes indeed when there is a dorsal vertebra too
many, or the first lumbar supports a rib ; ^ sometimes, in rare
.cases, from the seventh cervical vertebra springs a rib, either
terminating loosely or connected with the breast-bone, or with
the first normal rib.'^

The SIZE and form of the ribs also deviate in various ways ;
we find them, either as a congenital or acquired state, irregularly
SHORT,^ of DIFFERENT LENGTHS^ ou the two sidcs ; ncxt, as
it were, the commencement of duplicity, unusually thick,'
BROAD," and MORE OR LESS DIVIDED at their front ends;" lastly,
frequently arched in a greater or less degree. ^^ If the
dislocated head of the upper arm-bone remain long upon the
ribs, then a pit is formed upon them. We also sometimes
observe irregularities with respect to connexion ; thus on
account of cleft spine, we observe the heads of the ribs lying
in front of the bodies of the vertebrae, and touching those of
the opposite side ; " frequently is the attachment of the front
ends of the true ribs deficient, inasmuch as, they are either not
connected with their cartilages, or they are not connected by
them to the breast-bone, or the cartilages are entirely defi-
cient ; ^* the first rib is even connected by a true capsular joint
with its cartilage ; ^^ two ribs have, in rare cases, but one com-

206 Of the Bones of the Trunk, [Part II.

moil cartilage ; ^° sometimes instead of seven, only six, or even
eight ribs are joined to the breast-bone;^" we have also seen
in one disease the costal cartilages separated from the ribs,'^
and in one instance, a costal cartilage dislocated. ^^ The
ribs are not unfrequently anchyiosed at their hinder ends, partly
with the vertebrae, '" partly irregidarly connected with each
other, in so far as that, as an original or acquired formation,
they have as it were been consolidated,"^ or by particular pro-
cesses," or wing-like projections from their edges, jointed with
the neighbouring ribs, or grown together. ^^

Vices of consistence in the ribs are also to be mentioned
here ; we find not merely in rickets, but also often in epilepsy,
and idiots, that they are very soft, and bending like fish-
bones.-* The opposite vices are also found, that is, the too
great brittleness and frangibility of the ribs, especially in long-
continued disease of the lungs, in cancer of the breast, &c. ; in
which the cartilages of the ribs frequently participate, as, on
account of the increased deposit of lime, they lose their elas-
ticity and flexibility, sometimes on their interior, but more fre-
quently on their external surface.^^ In consequence of this
brittleness of the ribs, their otherwise great disposition to
FRACTURE "° is vcry much increased, which, if the motion of the
broken parts be not entirely prevented, easily unite out of
shape, or with unnatural joints ;-^ the latter has many times
been found congenital. ^^

Of the VICES OF texture of the ribs, we must here
notice their frequent erosion and destruction by aneurysms
in the cavity of the chest,^^ from caries in consequence of
carsinoma of the chest, from consumption^" and empyema;
and lastly, exostoses,^^ which are observed in rare instances
on the ribs.

(1) F. J. Hnnauld in Mem. de Paris, 1740, p. 377, — v. Sommerring Vom Baue
des menschl, Kcirpers. 2d edit. Vol. L p. 339, § 384. Variations of the ribs.

(2) In anencephalous monsters the upper vertebrae which exist do not
support any rib ; in many children with anencephaly, hydrencephaly, spina
bifida, &c. I saw, simultaneously with deficiency or consolidation of the
vertebra?, deficient ribs on one or both sides ; for instance, the five lower on the
left side, in No. 2929. — v. Scerig D. de hydrencephaloceles spccimine cximio,
p. 12. 4-to. Vratisl. 1824,— TV/ec/.W, Handb. dcr i)athol. Anat. Vol.1, p. 201,
found in an anencephalous monster only eioht dorsal vertebi-cTe and ])airs of ribs.
— Morgagiii, Ep. an. mcd. XLVIII. note 50, saw in a monster without a skull, on
the right side only eleven ril)s ; in a monstrous calf, on each side only four ribs ;
v. G. Samlifort Mus. anat. Vol. III. p. 29o, No. 1010. — In a child with spina
bifida, only ten ribs; v. Seidel Index Musci anat. Kiliensis, p. 2, No. 12.

(3) Tlie twelfth rib is frequently wantin;>; on one or both sides ; for instance,
Bolinier Obs. anat. rar. Fasc. I. Pntf. ]). vi. No. 2. — In two skeletons in Kiel Mus.
v. Seidel, No. 3 and G. — In one case I saw the eleventh rib wanting, with the
left half of the spine, v. Selt Heob. I. p. 15, Vcrzeichniss, No. 3018. — In an
adult man, the third, fourth, and fifth ribs were wanting on the left side, as a

Sect. XV.] Of the Bones of the Trunk. 207

vice of formation, v. Lallemand in Epheraerides m^dicales de Montpellier,
Vol. I. Fevr. 1826. — Several instances in Voigtel Handb. der pathol. Anat.
Vol. I. p. 324.

(4) Compare Meckel De duplicitate monstrosa, p. 28. — Voigtel.

(5) Bertin Osteologie, Vol. III. p. 142. — Bohmer, Fasc. I. Praef. p. vi. No. 3. — ■
van Doeveren Spec. Obs. academ. p. 199 and 201. — Hunauld, p. 536.—Ih(ysch
Diluc. velc obs., Cap. 4, Obs. 1, — v. Haller in Boerhaave's Prselect. ac. Vol. V.
Part I. p. 74. — Morgagni Epist. V. p. 6, 10. — Gemmil Medic. Essays and Obs.
Vol. V. Part I. p. 336.— Acta med. Berolin. Dec. I. Vol. IX. p. 58. N.— Five
instances in Meckel, p. 30. — A case at Moscow, v. Loder Index Praeparatorum. —
A case in Bresl. Mus. — Nineteen pairs of ribs in a horse at Hanover, v.
Rudolphi Bemerkungen, u. s. w. Vol. I. p. 74. — In the Veterinary School at
Stockholm I saw in an ass, on one side of the first lumbar vertebra, a supernu-
merary rib full seven inches long.

(6) Bertin. — Bohmer, No. 2. — Leveling Observ. anat. rar. p. 145, tab. 5, fig.
3 — 5. — Meckel found this only on one side in an adult, v. his Archiv. f. d.
Physiol. Vol. I. p. 6. — I have seen two instances, v. my Verzeichniss, No. 14
and 3011. — T saw a third in the Anat. Mus. at Christiana, in an adult ; the ribs
go one side as far as the middle in the one, but on the other to the breast-
bone ; and a fourth, at the Joseph Academy at Vienna, from an adult woman ;
the supernumerary ribs do not reach the breast-bone, PotthoffD. s. descriptionem
casus rarissimi spinam bifidam totalem exhibentes. Berol. 1827, p. 11.

(7) And therefore the chest either completely or partially too narrow ; I
have several times found this congenital, especially in children with abdominal
cleft and undeveloped lungs, also in some monstrous calves, v. my Selt. Beob.
I. p. 6, and Verzeichniss, No. 3012. — Fleischmann De vitiis congenitis circa
thoracem et abdomen, p. 7. — Also in later years we find the malproportion of
the chest to the other parts of the body frequent, especially in consumptive
persons. — Frequently the last rib is very short.

(8) I saw this most remarkably in a lateral cleft of the chest, v. Fleischmann,
p. 6, § 5, tab. 1, fig. 2. — I also have seen it several times as a vice subsequently
originating in diseases of the chest, as the chest conforms itself to the form of the
viscera it contains ; if therefore one lung have not its proper bulk on account of
tubercles, hepatization, compression, &c., so is the chest not properly developed
on that side. In a child which had for a long while laboured under empyema
of the left side, I saw the chest distinctly compressed on that side. — Similar
cases are described by Malmstrom Praes. Florman De insolita costarum depres-
sione, etc. 4to. Lundae, 1807. — Sommer in v. Griife and v. Walther's J ourn. f. d.
Chir. Vol. VII. Part IV. p. 605.—Celloez in Journ. de Medecine, Vol. XVIII.
p. 161. — Laennec Sur 1' auscultation immediate, etc. — In other cases is the one
half of the chest very much enlarged by prominence and expansion of the ribs,
as well as distortion of the spine, from the collection of water or pus in one of
the pleura ; here also I have some examples. — Pitcairn in Med. chir. Trans, of
Edinb. Vol. II. 1826, describes a case of this kind in progress.

(9) For example, in a case which I have described in my Selt. Beob. I. p. 6.
— Sometimes there are only single ribs so thick ; to wit, the seventh, in No. 2929,
of Bresl. Mus. v. Seerig. — Or with other thinness merely the anterior end of the
rib very thick, v. Fleischmann, § 6.

(10) Sometimes we find this only on one, sometimes on several at once,
especially if the fore extremity of the rib be cleft. — In v. Soemmering' s Museum
there is a rib an inch and a half broad, v. his work Vom Baue des mensch-
lichen kbrpers. 2d edit. Vol. I. p. 340.

(11) Albinus Adnot. acad. L. II. c. 13, tab. 7, fig. 8. — Histoire royale de
Medec. k Paris, 1779, pi. 3, fig. 5. — van Doeveren Spec. Observ. acad. No, 13,
p. 2QZ.—SandiJort Mus. anat. Vol. II. tab. 49, fig 3; Vol. III. p. 289, No. 991.
— Walter's Anat. Mus. p. 185, No. 681 — 684. — Meckel, p. 29, mentions several
such in his collection. — I have also found this formation seven times, v. Selt.
Beob. I. p. 71, and Verzeichniss, No. 3445 — 3451. — Kelch describes a case in
Beitr. zu pathol. Anatomie, No. 12. This cleft occurs, as it appears, only on
the true ribs; also in animals, for instance, in cattle, v. Sandifort, Vol. III.

208 Of the Bones of the Trunh [Part II.

p. 289, No. 995, and p. 295, No. 1010 ; in the latter case another rib expanded
into three extremities, as Berlin also observed in the human rib in the last
described case.

(12) Very common, and in very different kinds, especially with distortion of
the spine; in consequence of pressure from bandaging and lacing, v. von Sommer-
ring Ueber die Wirkungen der Schniirbriiste, 8vo, 2d edit. Berlin, 1793. — In
monstrous sheep and calves, I have seen not merely the ribs unnaturally straight,
but even bent inwards; to wit, in No. 3028 of my Verzeichniss. The distortion of
the ribs, with that of the back and left chest, is peculiar to some races of cattle. —
I have met with such an instance, v. my Verzeichniss, No. 3034. — Sandifort^
Vol. III. p. 295. No. 1011. — Cerufti s. fVeese De cordisectonia, p. 40. Bcrol.
1818. — I have seen this in two calves in the Veterinary School at Berlin.

(13) I saw this in the Anat. Mus. at Zurich.

(14) Especially in monsters with prolapse of the thoracic and abdominal vis-
cera, though also in others; compare MecAe/ Handb. der pathol. anat. Vol.1,
p. 93. ff. — Sand'ifort in Obs. anat. pathol. L. III. C. I. p. 16, describes a case,
in which the greater number of ribs, of both sides, were not connected with the
breast-bone; only the upper four ribs of ilie left side were joined to the breast-
bone, Kelch, No. 18. — In a child with frenic hernia, I found the cartilages of the
first three ribs not connected with the breast-bone. v. No. 2899 of my Verzeich-
niss. — In an adult there is another similar case, v. Fallot in the Journ. de
Med. chir. et pharm. Nov. 1S13. Vol. XXVIII.

(15) I found such a case on the right side in an old man. It was found on
both sides by Heusinger. v. Meckel's deutsch. Archiv. f. d. Physiol. Vol. VI.
p. 541, pi. 5, fig. 4 and 5.

(16) Cheselden, Osteographia, pi. 17, fig. 2. — J Ibhius Ar\i\ot. acad. Vol. VII.
L. II. p. 8.—G. Sandifort Mus. anat. Vol. III. p. 352, No. 312.

(17) I have found some examples of both vices.

(18) Stoll Ratio Medendi, Vol. \'II. p. 1052.— I have found the cartilage of
the second rib separated from the breast-bone by abscess, v. No. 3472 of my
Verzeichniss.

(19) Martin, in Journ. d. Medec. Vol. LIV. p. 328.

(20) Engravings of it are to be found in Sandifort, Mus. Anat. Vol. II. pi.
41 — 13, 47. — Several examples are in Bresl. Mus.; it is very frequent in dis-
tortion of the back. — In a horse, Sandifort, Vol. III. p. 243, No. 700.

(21) Compare Volgtel, p. 230. — KaUschmidt Progr. de costis duabus primis
veris in dextro pucllae latere per interpositam substantiam osseam coha^i'cntibus.
Jenffi, 1767. — Many instances in de Plouquet Ilepertoi'. Art. Costar. symphisis. —
Sandifort has many examples, and one very remarkable case, in which four ribs
are completely united from behind to before. Vol. III. p. 289. No. 993. The
same in two calves, No. 1000 and 1011. — Meckel noticed congenital consoli-
dation in several cases; Handb. der pathol. anat. Vol. I. p. 201, 211. — Rathke, in
Meckel's D. Archiv f. d. Physiol. Vol. VIII. p. 4^9, describes a congenital con-
solidation of almost all the ribs on one side. — In Saxtorph's Collection, at Copen-
hagen, I saw a skeleton of a child with deficiency of skull and cleft spine, in
which all the ribs of both sides were consolidated in the middle. — I found this
consolidation on three ribs, in No. 2929. v. Seerlg D. de hydrencephalocclis
specimine eximio, p. 12. 4to. Vratisl. 1824. — Further, in my Verzeichniss,
No. 3453.

(22) Morgagiii De .sed. et caus. morb. Ep. XLVIII. note 50. — LevellngOhs,crv.
anat. rar. p. 153, tab. 5, fig. d.— Sandifort Mus. anat. Vol. I. p. 180, 197, 198;
Vol. 1 1, p. 48, tab. 47, fig. (i and 7. — Roscnmuller De singul. et nativ. ossium c. h.
varietatibus, p. 55. — Kelch, No. XIII. — In a pig, Blumenbach Geschichte und
Beschreibung der Knochen. 2d edit. p. 352.

(23) Of this I have several examples; and })robably No. 3452 of my Verzeichniss
belongs here. — In one case these leaf-like processes were joined by a suture.
V. Sandifort, Vol. III. p. 289, No. 992.

(24) Greding's Sammtl. medic. Schriftcn, I. p. 333.

(25) Extensive ossification of the cartilages of the ribs, especially in the form
of little bony plates and scales in the membrane of the cartilages, I found

Sect. XV.] Of the Bones of the Trunk, 209

common, particularly in consumption, and also in tubercular disease. It has
also been seen in animals ; for example, in a horse, v. G. Sandifort Mus. anat.
Vol. III. p. 288, No. 982.

(26) Viole Diss, de costarum fractura. Paris, 1788. — Vacca Berlinghieri
M^moire sur les fractures des cotes, in Mem. de la Soc. medic, d'emulation.
Ann. III. p. 151.

(27) Sandifort Ohs. anat. pathol. L. III. C. X. p. 135. — va7i Doeveren Specim.
obs. acad. Cap. XIII. p. 204. — Some of the fractures of the ribs of horses, oxen,
and sheep, related by G. Sandifort, Mus. anat. Vol. III. p. 185, ff. No. 243—246,
249 — 252. p. 381, No. 580, belong here. One example in an ox, in the Stras-
burg Mus. V. Kilian Anatom. Untersuchungen iiber das neunte Hirnnervenpaar,
p. 136.

(28) Meckel Beitrage zur vergl. Anatomic, Vol. I. Part II. p. 138. — I once
found this in some ribs of a monstrous calf, and of a monstrous sheep, No. 3028
of my Verzeichniss.

(29) Ruysch Observat. XXXVII. — Morgagni De sed. et caus. morbor. Epist.
XVII. p. 25 ; Epist. XXIII. p. 25 ; Epist. XXVI. p. 5. — Walter Anatom.
Mus. Vol. II. p. 103, No. 560; p. 114, No. 561; p. 121, ^o. 5Q'i. — Baillie,
Morbid Anatomy. — I have found it thrice, v. below, on Aneurysm. — Janin in
Bulletin de la Soc. medic, d'emulat. July, 1817. — Salomon in Petersburg, ver-
mischt. Abhandl. 1825, p. 164.

(30) Bleuland Icones anat. pathol. Fasc. II. pi. 8.

(31 A remarkable exostosis attached to the ribs and breast-bone of a horse,
measuring seven inches in every diameter, I saw at Alfort ; it is, probably, the
same which Grognier, in Journ. de Medec. contin. Dec. 1810, p. 505, described.
— Ekstrom found a cartilaginous exostosis, weighing several pounds, which
included six ribs. v. Ars. Berattelse om Svenska Lakare-Sallskapets Arbeten.
Stockholm, 1826.

§ 137.

The BREAST-BONE is somctimes entirely wanting, or is
often very imperfectly formed in monsters with acephaly and
prolapse of the viscera of the chest and belly. In the latter
it is also frequently cleft throughout its whole length, or only
at the upper, middle, or lower part.^ We, however, miss in
rare cases, without prolapse of the viscera of the chest, and
when the common integuments are undivided, the whole or
part of the breast-bone; or it is found cleft.^ The lowest
degree of this formation is in the common perfect division of
the point of the breast-bone ; ^ not unfrequently there is a hole
in the lower part of the breast-bone ; * the bony kernels lying
together in pairs, and their often long-continued existence in
that state,^ and the too late and too incomplete ossification
of the breast-bone.

Variations as to size and form occur very frequently in the
breast-bone," sometimes to a remarkable degree; thus, for
instance, we see it remarkably short,' small, or on the
contrary, very long,^ broad,^ bent inwards, unusually arched
and projecting, or arched and malformed in other directions.^"

As to VICES OF CONNEXION, wc obscrvc in the later period
of youth, and even in manhood, that the original bony kernels
remain unconsolidated. There is a kind of articular motion

210 Of the Bones of the Trunk, [Part II.

between the handle and the body of the breast-bone, which has
been observed not merely in very narrow-chested children/^
but sometimes even in adults. ^^ Frequent is the opposite vice,
the complete immobility of the breast-bone, in consequence of
anchylosis of its pieces. ^^ Once there was found an un-
natural ligament on the breast-bone.^*

We must mention among the vices of consistence, imper-
fect fractures or cracking of the breast-bone, and its complete
fractures, ^^ which appear not rarely as distinct longitudinal and
transverse fractures. One longitudinal fracture of this bone
remained ununited through life.^*^

Lastly, as to vices of texture in the breast-bone ; here
especially must be mentioned the not unfrequent rickety and
INFLAMMATORY POROUSNESS, and LOOSENESS,^' the frcqucnt
erosion and perforation, of the breast-bone by aneurysms
of the arch of the aorta, ^^ caries, ^^ which not unfrequently
arises from scrofulous glands and from abscesses within the
anterior mediastinum, and as a more rare condition, spina
ventosa,^*^ exostoses,^^ and osteosarcom.^^

(1) V. Wiedemami Ueber das fehlende Brustbein. Braunschw. 1794. — Meckel
Ueber Spaltungen der vorderen Korperflache, v. Handb. der patliol. Anat. Vol. I.
Sect. II. p. 93. — Fleischmann De vitiis congenitis circa thoraceni et abdomen,
p. 1, tab. 1. — My Sell. Beob. I. p. 64. — In a child with a large umbilical rup-
ture ; I have however since seen cleft of the breast-bone in three human
monsters, and in one monstrous calf ; in another calf both halves of the breast-
bone with their ribs were curved back on the spine, v. Scmdiforf Mus. Anat.
Vol. III. p. 295, No. 1011.— No. 3034 of Bresl. Mus. is similar.— An instance
of deficient formation of the breast-bone, with prolapse of the heart, is described
by Chaussier in the Bullet, de la fac. de Med. de Paris.

(2) Ficker Beitrage zur Arzneiwiss, Part I. p. 76. — Wiedemann. — v. Som-
merring Vom Baue des menschlichen Korpers. 2d edit. Vol. I. p. 347, note 5. —
Chaussier. in a man of twenty-seven years, there was only the manubrium
present. — Deficiency of the lower part of the breast-bone in a young person,
v. G. Sandifort, Vol. III. p. 393, No. 662.—CuUerier in Journ. gen. de M^dec.
No. 292, saw it divided to the lowest extremity in a woman of thirty-one ye.*....
In a calf with two supernumerary feet on the' breast, the sternum is completely
divided or remarkably doubled, without any ribs between, v. No. 3031 of my
Verzeichniss.

(3) I have found these clefts very wide in several children with umbilical or
ventral ruptures; in many instances, instead of a cleft there have been one,
more rarely two holes in the ensi form cartilage.

(4) I have four examples before me ; in one case, where the lower part of the
breast-bone was wanting, I found in the middle very broad part, consisting of
several pieces, a hole covered with membrane, v. Samiifort Mus. Anat. Vol. III.
p. 898, note 662.

(5) Two symmetrical bony germs, close to each other, in the handle of the
breast-bone. v. Meckel in Beitrjigen zur vergl. Anat. Vol. II. Part I. p. 145,
pi. 1, fig. 8. Ilandb. der pathol. Anat. Vol. I. p. 115 ; and myself in one case,
v. Selt. Beob. I. p. 7. — I have seen tbcse bony germs lying synunetrically in
pairs in the middle pieces in four young skeletons, and indeed even in two boys
nearly sixteen years, v. No. 7 and 8 of my W'rzeichniss.

(6) Eustarhiits in Ossium examen, p. 197 and Tab. anatoni. tab. 47, fig. 18 — 21.

Sect. XV.] Of the Bones of the Trunk, 2X1

— Albinus Icon, ossium Foetus, p. 75 — 95. — Sandifort Mus. anat. Vol. I. p. 179,
No. 191—193, 196; Vol. II. tab. 46.-— The cartilaginous tip of the breast-bone
particularly also varies in respect to size and form.

(7) In children with cleft of the belly, large umbilical rupture, and in other
cases in which the chest, in proportion to the belly, is not properly formed ; I
saw the latter once, as it were, with remarkable breadtli, in a child with rachitis
congenita, v. my Selt. Beob. I. p. 6. It sometimes appears very short, if the
point of the cartilage be either deficient or very small.

(8) In one monster it reached to the symphysis pubis, with which it was
connected by cartilage, v. Marrigues in the Mem. de Mathem. pres. k I'Acad.
des Sc. Vol. IV. — Sometimes the ensiform cartilage alone is remarkably long,
reaching down to the navel.

(9) Blumenbach, Geschichte und Beschreib. d. Knochen. 2d edit. p. 365,
note 1, mentions a breast-bone in his collection nearly as broad as the hand;
several are before me almost as broad at the lower part. — In a double monster
with two spines, but only one chest and breast-bone, the latter as a trace of
duplication is very broad, and consists of a double row of bony kernels, v.
No. 3028 of my Verzeichniss.

(10) It is often very much curved, especially outwards, as consequent on
deficient development of the chest, of rachitis, distortion of the spine, and
mechanical influence. Compare vari dem Bosch Anatomia systematis respira-
tioni inservientis pathologica, p. Q5. 4to. Haarlem, 1801. — Biermayer Museum
anat. pathol. No. 99 and 457.— My Verzeichniss, No. 3022, 3331, 3332, 3335,
3465, and 3466. — To these belong the projecting or hawk breast of horses ;
the chest of birds is frequently distorted. I have seen this in fowls, pigeons,
geese, ducks, guinea-hens, heath-cocks, and a buzzard. Sometimes the ensiform
cartilage is strongly bent from internal or external disease, v. Codronchius Dc
morbo novo s. prolapsu cartilaginis mucronatae, in his work De morbis, qui
Imolae vulgati sunt. 4to. Bonon. 1603. — Septalius De morbis ex mucronata
cartilagine evenientibus. 8vo. Mediol. 1632. — Pico Histor. natur. Brasil. p. 36.
— Troschel De morbis ex alieno situ partium abdominis. Francof § 28. a. V.
1754. — The breast-bone was uncommonly twisted and deformed, as a vice of
formation, in an adult, v. Fallot in Journ. de M6d. Chir. et Pharm. Nov.
1813, Vol. XXVIII.

(11) Blumejibach, p. 367, note m.

(12) Beauehene Observation sur une sorte d' articulation contre-nature^ entre
les deux premieres pieces du Sternum in Sidillot Rec. period, de la Soc. de
Medec. de Paris, Vol. XXXIII. p. 287. — Heusinger in Meckel's D. Archiv fiir die
Physiologic, Vol. VI. p. 541, tab. 5, fig. 4 and 5. — In diseases of respiration ; — I
have also once found it in a man who died of asthma.

(13) I have found this several times. — Many such instances are given by
Sandifort Mus. anat. Vol. I. No. 186—189; Vol. II. tab. 46 ; Vol. III. p. 237,
No. 640—642, 646—650.

(14) Kelch, No. 11, p. 8 ; it lay loosely on the external surface of the breast-
bone, and descended from a transverse ridge between the insertion of the third
pair of costal cartilages, down to the ensiform cartilage, and to the sixth
pair.

(15) Busnel D. de fractura sterni. Paris, 1761. — Sahatier Memoire sur la
fracture du sternum in Mem. de I'Institut. nation, de Paris. Sc. Mathem. et Phys.
Vol. II. Mem. p. 115. — Fr. Haugk D. de fractura sterni et vertebrarum. 4to.
Lips. 18 16. — Compare several cases in de Plouquet Repertor, — A case of longi-
tudinal fracture in Diet, des Sc. medical. Vol. LII. p. 576. — Two cases of
transverse fracture from muscular action were observed by Chaussier. v. Revue
medicale, 1827. Vol. IV. p. 260. — A third in Cruveilhier. — I have found one case,
v. No. 3474 of my Verzeichniss. — A remarkable union of a fracture in a fowl,
described by Tilesius in Mem. de I'Academ. des Sc. de Petersburg. Vol. VI.
p. 44.- — A transverse fracture from violent exertion in labour, v. Compte et Martin
m Revue Medic, franc, et etrang. Nov. 1827. Vol. IV. with engravings.

(16) Meyer Samml. medic. Beobachtungen, p. 714.

(17) I have seen several instances of both. — Cases of inflammatory swelling

p 2

^\2 Of the Bones of the Trunk. [Part II.

are described by Howship, Pract. Observat. in Surgery and morbid Anatomy,
case 51 — 53.

(18) Verhriigge D. de aneurysmate, etc. L. B. 1773, tab. 1 and 4. — Frank De
cur. horn. morb. L. V. 2. p. 40. — Baillie, Morbid Anatomy. — Breschet in Journ.

de M^d. Cbir. et Pharm. 1813. Vol. XXVI. p. 365. 1 have found it four

times. V. Selt. Beob. II. p. 64. — Verzeichniss, No. 2257 and 2258 ; and since
two cases. — Heisler D. rariorem atque memoratu dignissimam aneurysmatis aortae
sternum perforantis historiam exbibens. Landshut. 1817. — Sandifort Mus. anat.
Vol. III. p. 347, No. 288.

(19) V. Reuss Repertor. Comment. Vol. XII. p. 243. — de Plouquet Repertor.
Sterni Apostema. — Biermayer Mus. anat. pathol. No. 143, from Syphilis. —
Lohstein Compte rendu, etc. Strasb. 1824, p. 63, No. 51 and 52. — Sandifort
Mus. anat. Vol. I. p. 178, No. 184, 185; Vol. III. p. 207, No. 381; p. 347,
No. 288. — I have found three cases, v. my Verzeichniss, No. 3471 — 3473. — In
rare instances, the breast-bone is entirely destroyed, and the opening in the
chest filled up by adherence of the opposite ribs. v. Schenk Obs. med. L. II. Obs.
171 and 172, p. 367. — Gazette salutaire de Bouillon. 1789. v. Hufeland's Neuste
Annalen der franz. A. Wiss. Vol. I. p. 420.

(20) An instance from the Strasburgh Mus. is mentioned by Kilian Anat.
Untersuchungen iiber das neunte Hirnnervenpaar, p. 136. — A very striking
instance in a hen in the Anat. Mus. of the University at Vienna.

(21) Lobstein, No. 53; and a case in a horse at Alfort. v. above, § 136,
note 31.

(22) Sandifort, p. 349, No. 301. — v. Gr'dfe, liter Jahresbericht iiber das
klinische chir. und augenarztl. Institut. Berlin, 1827, p. 18. [In the Mus.
St. Thomas's Hospital there is a preparation of scirrhous tubercles in the ster-
num; and from the same person tubercles of the like kind in the thigh bone,
wbich was fractured merely in rising in bed, consequent on the absorption of the
shell of the bone. T.]

§ 138.

The PELVIS ^ is, in rare cases of different kinds of monsters,
found partially deficient ; thus we miss the sacrum together
with the coccyx,^ or a part of the lateral pelvic bones in
absence of one lower extremity,^ in the cleft pelvis," and in the
syren formation ; in the latter case we frequently observe the
lateral parts of the pelvis consolidated, whereby the pelvis
itself is closed at its lower part, unossified, and more or less
malformed.^ On the contrary, in monsters, we frequently notice
the pelvis in various ways either ^ completely or partially
DOUBLE, and as it were, two united into one.

The SIZE and form^ of the pelvis is very often, as an ori-
ginal or acquired vice, irregular; thus it varies in reference to its
breadth in both directions from the normal mass ; it may be too
narrow,' or too wide;" it is variously formed as to its particular
diameters, its cavity, direction, and inclination ; and sometimes
in consequence of softening of the bones, it is found awry
and crooked in very many ways.° Even in adults the form of
the pelvis is sometimes very distinctly altered by osteomalacy,^"
fractures, dislocations, &c. The pelvis is also frequently
irregular as to its articular cavities ; not merely, as might
be su])posed, in deficiency of the lower extremities, but even

Sect. XV.] Of the Bones of the Trunk. 213

when they exist, these cavities are entirely wanting ;^^ or in
monsters with consolidated lower extremities, they are not
double, but form only a single cavity, placed at the under and
fore part of the pelvis, and may be too flat, too narrow, too
deep and wide, oval, triangular, and malformed in other ways ;^^
the acetabula indeed are often very much altered and even
much widened in later life by various diseases ; ^^ should the
dislocated head of a thigh bone remain unreduced, the original
socket becomes narrowed and flattened by absorption and con-
traction, or by being filled up with cartilaginous and bony
substance, and in its stead a pit and a more or less perfect new
socket is formed, where the head of the bone rests. ^"^

The CONNEXION of the bones of the pelvis with each other
also sometimes exhibits certain irregularities ; to these belong,
the late consolidation of the hip, haunch, and share-bones with
each other in weakly persons ; ^^ the crest of the hip-bone with
itself; ^^ the want of junction of the share-bones in congenital
protrusion of the bladder ;^^ sometimes also great mobility on
the sacro-iliac joint; the rare complete relaxation, ^^ or rupture
of the pelvic ligaments, whence dislocation of the lateral bones
arise ; " and lastly, the ossification of these ligaments ; conse-
quent to which is the true anchylosis of the ilium with the
sacrum,^*' or more rarely of both the pubic bones. ^^

Vices of continuity or fractures of the pelvic
BONES,^^ naturally and very easily occur, not merely in conse-
quence of external violence, but also from difficult labour, and
even from violent muscular exertion, and are not unusually
united pretty much out of shape, on account of the difficulty of
fixing them with bandages.

Among the vices of texture which affect the pelvis,
deserve to be particularly mentioned, partly on account of their
frequency, partly on account of their connexion with mid-
wifery, the SOFTENING, SWELLING, AND FRANGIBILITY of the

bones of the pelvis produced by rickets, scrofula, gout, syphilis,
&c. ; next, caries and spina ventosa, which here not only
easily arise from the same causes as in other bones, but
frequently also from lumbar abscess, decubitus, cancer of the
rectum, and especially from diseases of the hip-joint, and also
coxarthrocacy ; and lastly, exostosis ^^ and osteosarcom,^*
both of which are here as frequent as they are large.

eve

(1) Jordens De vitiis pelvis muliebr. rat. partus. 4to. Erlang. 1787. — C/..„
Von den Krankheiten des weiblichen Beckens. 4to. Berlin, 1795, with eleven
engravings.

(2) G. Sandifort Mus. anat. Vol. III. p. 294, No. 1009, in a calf; the hind
legs with the ossa innominata attached to the last lumbar vertebra. In another
case, only the posterior part of the" sacrum with the tail, ib. No. 1010. —Bonn in

2H Of the Bones of the Trunk, [Part 1 1.

Verhandel. van het Genootschap ter bevordering der Heelkunde. Amsterd.
D. III. p. 124', in an acephalous monster. — Myself in a syren monster, No. 3015
in Bresl. Mus.

(3) I have found this a few times in men and animals ; viz. in No. 2902 of
my Verzeichniss. — In a full-grown pig, with deficient right hind leg, I found the
right half of the pelvis very small, and the ischium entirely wanting, v. No,
3027. — Sajctorph, Gesammte Schriften von Scheel, I. p. 314, Copenhagen, 1823,
missed the hip-bone at the same time with a lower extremity. — Frolick M^moires
sur quelques sujets interessans d'Anatom. et de Physiol, trad, par Fallot. 4to.
Amsterd. 1822, pi. 3, fig. 1 and 2. — Hensinger in his Zeitchrift f. die organische.
Physik. Feb. 1828. Vol. II. Part II. p. 208.

(4) Warivick in Philos. Transact. Vol. XLII. No. 464, p. 152, IF. ; and
le Sage, in Roux Journ. de M6dec. Vol. XXXV. 1788, p. 221, flf. missed the
pubic bone.

(5) See below, in the extremities, the observations on the syren formation ;
in No. 2903 Bresl. Mus., the coccyx is deficient, and the outlet of the pelvis
almost closed.

(()) B'uchner resp. Schiffert D. de difficultate pariendi ex mala conformatione
pelvis. Halae, 1756. — Thierry D. de partu difficili a mala conformatione pelvis.
Argentor. 1764. — Choulant Decas pelvium spinarumque deformatarum. 4to.
Lips. 1818; and Decas secunda, adjectis nonnullis adnotationibus. 4to. Lips.
1820. — K. W. Schwabe D. de pelvi ejusque deformationibus. 4to. Jenae, 1828. —
According to /. M. Weber, the form of the pelvis is always in reference to that of
the head in malformed skeletons, which I have, however, not found constant, v.
Nov. Act. Phys. Med. Acad. Nat. Cur. Vol. XI. Part II. p. 411, pi. 1 ; and Spe-
cimen malae conformationis encephali, capitis et pelvis viri. 4to, Bonnae, 1828.

(7) It seems to me that the size of the pelvis, equally with the skull, the
chest, &c. generally depends on the viscera it contains; in the higher degree
especially, which originates in deficient development of the generative organs. I
have thus found in two adult women the generative organs of the size of those of
a child of ten years old, and the pelvis at the same time remarkably small. A
similar case was recently shown to me by Professor Lauth, of Strasburg. Also in
monsters with deficiency of the rectum, or of various kinds of retarded forma-
tions in the generative organs and lower extremities, I have seen the pelvis very
small. I have also found the ilium and ischium sometimes in anchylosis, unre-
duced dislocations, and lameness of one lower extremity, very much wasted.

(8) Ebennaier D. de nimia pelvis muliebris amplitudine, ejusque in gravidi-
tatem et partum influxu. 8vo. Goett. 1797. — In congenital prolapse of the bladder
the pelvis is usually very spacious, especially too broad.

(9) Compare my Verzeichniss, No. 3019—3025, 3383— 3425 ;— in No. 3020
and 3025 are the pubic bones compressed laterally and closely, and project like
a fold ; — in No. 3023 the projection of the junction of the left ilium and os pubis
is so great, that there seems to be formed two upper apertures to the pelvis.
Descriptions and engravings of very mishapen pelves are given by Sandifort in
Museum anat. — Walter in Mus. anat, Kohler, Voigtel, &c. — In distortion of the
spine the form of the pelvis is usually affected, especially in scoliosis. — [In the
Mus. Roy. Coll. Surg. No. 623, is a cast of a female pelvis, in which the upper
aperture of the pelvis is only an inch wide between the pubes and sacrum. T.]

(10) de Fremery De mutationibus figurae pelvis, pnesertim iis, quae ex emol-
litione ossium oriuntur. Lugd. Batav. 1793. — Wood in Bradley's med. and phys.
Journ. 1801, No. 32. — vou Siebold's Journ. f. Geburtshiilfe, Vol. III. Part II.
1821. — Those cases are more rare in which a too narrow pelvis expands, v. Rust's
Magaz, f. d. gesammte Ileilkunde. 1825. — [No. 624, Mus. Roy. Coll. Surg,
is a cast of a female pelvis distorted in consequence of moUitus ossium, in which
the pubic bones are compressed and project forwards, and the acetabula are on
the front of the pelvis. T.]

(11) They are wanting on one side, as causes of congenital lameness, v. Schreger
chir. Versuche, Vol. 11; their entire absence, or mere rudimentary state, was
noticed by Diipuiflren in Rcpcrt. gen. d'Anat. et dc Physiol, pathol. Vol. 1 1, sect. 3,
]>. 150.

Sect. XV.] Of the Bones of the Trunk* 215

(12) Palletta Exercit. de claudicadone congenita, L. B. 1787, and Exercit.
pathol. Vol. I. p. 64 — 92. — Prochaska found the acetabula in a cretin very wide,
flat and mishapen. v. Disquis. Anat. phys. organ, c. h. tab. 11, fig. 1. Sometimes
we find, without disease, a hole in the bottom of the acetabulum merely filled by
membrane.

(13) I have described in my Selt. Beob. II. p. 9, No. 9, a remarkable case,
viz. a great projection of the bottom of the acetabula on both sides, like a bladder,
into the pelvis, v. Verzeichn. No. 342r5. Not unfrequently the acetabulum appears
deeper than it should be, in which case its fibro-cartilaginous edge is ossified, or
bony matter of some kind is deposited around the edge of the cavity. — [No. 198,
Mus. Roy. Coll. Surg, is a fine example of ulceration of the acetabulum, by
which an aperture was made through its centre into the pelvis. T.]

(14) Sandi/ort Mus. Anat. Vol. II. tab. 64 — 68. — Palletta Exercit. path. 1
fig. 11, engraves an os innominatum, with three pits, on which at different
times the head of the thigh-bone was seen. — Loder Index praeparat. II. sect. A,
describes a new acetabulum above the crest of the right pubic bone ; and the
reviewer in Rust and Gaspares Krit. Repert. Vol. XV. Part III. p. 432, mentions
a similar case in the midwifery school at Bamberg. — Good engravings of such
new acetabula are given in Cooper and Traverses Surgical Essays, Part I. Three
cases are found in Bresl. Mus. v. my Verzeichn. No. 3440 — 3442 and 3443. —
Tenon, in Mem. de Paris, 1770, Hist., p. 54, describes a rare similar instance in
a horse.

(15) Not even in the seventeenth year ; de Fremeryy p. 14.

(16) I have seen this a few times in rickety persons, some twenty years old.

(17) Compare the writers on congenital prolapse of the bladder, below, on the
Bladder. The pubic bones are often distinctly separated from each other, in adults,
to one-third of an inch ; they are generally connected by a small tendinous band.
At present we have only Walter's observations on the non-union of the pubes
without prolapse of the bladder, v. De dissectione Synchondroseos ossium pubis
in partu difficili, p. 22. Berol. 1782.

(18) We find the old disputes and opinions about the existence of such laxity
of the pelvic ligaments, especially in Michel De utilitate Synchondrotomiae pubis
in partu difficili, p. 4 and 5. Lug. Bat. 1781 ; and de Plouquet Repert. Art. Pelvis
Discessus. — Instances of separation of the pubic joint in natural labour are noted
by Eickelberg in Rusfs Magazin. f. d. ges. Heilk. Vol. XVII. Part III. p. 550,
and Nicholson in the Transact, of Physicians in Ireland. Vol. IV. 1824. — More
remarkable are the instances in which in children the bones of the pelvis were
very movable ; such were observed by Deventer. — Alix Observat, chirurgica,
Fasc. III. p. 60. — Palletta, p. 89. — In a woman the pelvis was so movable every
time she became pregnant, that she was unable to stand, v. Frank in Textor's
Neuem Chiron. Vol. I. Part II. p. 261.

(19) Enaux in Nouv. Memoires de I'Academie de Dijon, Vol. VIII. No. 6,
1784, sect. I. — Louis in Memoires de I'Acad. de Chir. Vol. IV. — Creve, p. 137.
— I have seen one instance of subluxation, v. my Verzeichniss, No. 3417. —
— The so-called dislocation of the os coccygis is more probably fracture.

(20) Many such cases are collected by Creve, p. 164. — Individual cases de-
scribed by JJesgranges in Anc. Journ. de Medec. Vol. LXVIII. p. 85. — Lamorier
in Memoires de Montpellier, Vol. II. Mem. p. 243. — Sandifort, Mus. anat. Vol. I.
No. 217—232, 242, 246; Vol. II. tab. 61— 63; Vol. III. p. 219, No. 459;
p. 223, No. 492; p. 237, No. (i5\—G5Q; p. 385, No. 605.— Seven instances
are described by Bleuland Descr. Mus. anat. p. 257, No. 1390-1396. — Engravings
are also given by Sandifort from C. 0. Wagner D. de ancylosi ossium pelvis. 4to
Heidelb. 1818 ; and Weidmann D. de comparatione inter sectionem caesaream et
dissectionem cartilaginis et ligamentorum pubis. Wirceburgi, 1779, tab. 2,
fig. 1. — I have found sacro-iliac anchylosis six times, v. No. 3387, 3410, 3414.
[No 308, and 309, Mus. Roy. Coll. Surg, are examples of anchylosis at the
sacro-iliac joint. — There are also some examples in the Mus. at St. Thomas's
Hospital. T.] — It also occurs unnaturally in mammalia, especially in horses,
asses, and oxen.

(21) This is often doubted, though improperly. Instances are given in

216 Of the Bones of the Ujyper Extremities, [Part II.

Sandifort, Vol. I. p. 190, No. 21G ; Vol. II. tab. 63 ; Vol. III. p. 238, No. 657
—^^'d; p. 385, No. 607 and QQ%.—WaWier, p. U.—Kohler Beschreib. der
Praparate des Hrn. Loder, p. 11, and Loder's Index Praeparator. — I saw one
case in Anat. Museum at Heidelberg, and another in Meckel's Museum. — Older
cases in Creve, p. 168, and pi. 11. — Also in those animals in which anchylosis
of the pubis is not normal, it occurs as an exception, viz. in monkeys, many
kinds of dogs, &c.

(22) Maret Sur les fractures des os du bassin in Memoires de Dijon, Vol. 11.
p. 85. — Creve D. de fractura ossium pubis. Mogunt 1792 ; and on fracture of
the pelvic bones, in his treatise Von den Krankheiten des weibl. Beckens,
p. 13— 18. —Saudifort, Vol. I. p. 178, No. 182; Vol. II. tab. 45, fig. 5—7,
(a fracture of the sacrum united at an angle,) tab. 63, Vol. III. p. 199,
No. 331 ; p. 204, No. 358. Compare No. 3416, 3430, 3431, my Verzeichniss. —
In horses, fractures of the pelvis occur from muscular exertion, v. Alters in
Salzburg, medic, chir. Zeitung, 1808, I. p. 233. — I saw a similar case in the
veterinary scliool at Copenhagen ; a fractured pelvis of a horse, united, in
the veterinary school at Dresden ; and a human pelvis, fractured in difficult
labour, at the Hospital of St. Anna, at Briinn. — In rare cases iractures of the
pelvis occur, in which the head of the thigh-bone passes through the acetabulum.
V. Lawson in Edinb. Med. Com. II. Dec. III. p. 28.

(23) van Doeveren Specim. observ. acad. Cap. XII. p. 177. — Stark in Baldinger's
Neuem Magazin. Vol. VI. p. 73. — van Heekeeren De osteogenesi praeternaturali.
L. B. 1797, fig. 4. — Murray in neue Samml. der auserless und neuesten Abhandl.
fiir Wundiirzte, Vol. II. p. 79. — Wichert D. de excrescentiis praeternaturalibus
ex interior! pelvis muliebris superficie, etc. 4to. Gott. 1797. — Autenrieth resp.
Silber D. de viribus naturae medicatricibus in situm fcetuum iniquum. Tiibing.
1799, p. Zl.— Sandifort Mus. anat. Vol. II. tab. 62. — Duretm Bulletin de I'Ecole
de Medecine et de la Soc. de Paris, 1810, p. 148. — Bail D. de ossium luxuria-
tione. 4to. Berol. 1820, fig. 1. — von Persy n D. de exostosium atque osteosteato-
matum pelvis muliebris influxu in partum. 8vo. Berol. 1821.— i^mHA:. — I have
found several, v. No. 3386, 3387, 3393, 3403, 3405, 3428, 3429, my Verzeichniss,
and one as big as the fist, and hard, deep in the pelvis of a very rickety boy. —
Exostosis on the pelvis in the region of acetabulum is very common in
coxarthrocacy, dislocations, fractures of the neck of the thigh-bone, and gouty
afiections of these parts, v. engravings of them in Sandifort Mus. anat. Vol. II.
tab. 67 — 74, 79. — Also in animals exostoses occur on the pelvis. — I have seen
several on the ilium in horses. — One weighing three pounds on the pelvis of an
ox. V. Pilger's Handbuch der Veterin. Wissensch. Vol. II. p. 1819. — Exos-
tosis around the carious acetabulum of a pig. v. Sandifort, Vol. III. p. 241,
No. 681. — In the same animal I have found exostosis on the spine of the
ischium, and many small ones on the pubic bone and acetabulum in a kangaroo.

(24) Herrmann D. de osteosteatomate. Lips. 1767, p. 23. — Boyer Traite des
maladies chirurgicales. Vol. III. p. 594. — Pascal in Graperon's Bulletin des
Scienc. medical. Vol. II. p. 265. — Bang in Actis Regiae Societ. med. Havniensis.
Vol. V. No, 8, 1818, (above twenty pounds weight.) —Biermayer Mus. anat. pathol.
No. 153, (four pounds, in a child.) — Sandifort Mus. anat. Vol. III. p. 286,
No. 972; p. 349, No. 302—305; p. 391, No. 641.— At Saxtorph's,n\ Copen-
hagen, I saw one so large that it almost filled the whole pelvis.

C. — OF THE BONES OF THE UPPER EXTREMITIES.

§ 139.

The COLLAR-BONES ai'C occasionally wanting together with
the blade-bones in monsters which have no upper extremities;
they are, however, missed in rare instances, entirely' or partially,"

Sect. XV.] Of the Bones of the Upi^er Extremities. 217

although the latter exist. They vary exceedingly in length,
thickness, flexibility, &c. ; thus in imperfect evolution of the
chest, they are often very short, very thick and broad, too thin
in atrophy of the arms,^ too straight in deficiency of the upper
extremities, and in women who have worn stays from their
youth,* and the like. Dislocations** of the collar-bone even
on the blade-bone are rare, still more so on the breast-bone ;
as also are anchyloses;^ but fractures® are very common
even merely from muscular exertion.'

Vices of texture occur proportionally but rarely on the
collar-bones ; however, rickety expansion, erosion from aneu-
rysm, caries, necrosis, and osteosarcom,^ have been observed.

(1) In Acephala. \. Henkel Neue Bemerk. 1st. Samml. p. 60. — Meckel
Abhandl. aus der mensch. und vergl. Anat. p. 165 and 173. — In children with
cleft breast, v. Mem. de Paris, 1760, p. 58.

(2) I have a few times seen the inner extremity wanting in cleft chest, as
also the outer, in absence of the upper extremities. — In an adult the outer
fourth of it was hereditarily wanting, and was attached by a little thin process
to the coracoid process, v. Martin in Roux Journ. de Med. Vol. XXIII. p. 458. —
In a cretin the outer half of both were deficient, and their place supplied by
ligament, v. Prochaska Disquis. anatom. phys. organ, c. h. expl. tab. 8.

(3) V. Selt. Beob. II. p. 32.

(4) Sabatier Tr. d'Anat. Vol. I. p. 172.

(4*) [In the course of the last spring, I saw a dislocation of the sternal end of
the clavicle behind the sternum, in a man, which did well. T.]

(5) I know no instance of its occurrence at the sternal extremity ; at the
scapula many are related, v. Kohler Beschreibung der phys. und pathol. Pra-
parate, u.s.w., p. 11, No. 39. — Sandifort Mus. anat. Vol. III. p. 239, No. 660.

(6) Ph. Wilhelm Ueber den Bruch des Schliisselbeins. 8vo. Wiirzburg, 1827,
with engravings.

(7) Churchill in the Lond. medic. Repository, April, 1822, p. 289.

(8) Kulrmis resp. Mohring D. de exostosi steatomatode claviculae ejusque felici
sectione. 4to. Gedan. 1732. — von Grdfe in llten Jahresbericht des klin. chir.
Instituts. Berlin, 1827, p. 18. — [Avery excellent case of osteosarcoma of the
clavicle, in which this bone was removed by Mott, of New- York, is given in
Med. Gazette, Vol. III. p. 405. T.]

§ 140.

In imperfect development of the upper extremities we notice,
in rare cases, the blade-bone deficiently formed, some-
times it is too small, too narrow, or cartilaginous, and terminat-
ing in a round tubercle instead of an articular cavity, &c. In
imperfectly formed upper extremities its form is also sometimes
irregular ; thus we find it cleft, as a congenital formation ; ^
imperfectly ossified;^ its hinder edge sometimes straight,
sometimes more rounded ; and especially in rickety softening,
more or less curved.^ The point of the spinous process
(acromion) is sometimes a distinct and even movable piece.*
If the posterior ligament be ossified, we find a hole instead of
the semilunar notch in the upper edge of the blade-bone.

^18 Of the Bones of the Upper Extremities. [Part II.

If the dislocated upper-arm-bone be not replaced, the form of the
original socket is changed, and at that part of the bone on which
the dislocated head rests, a kind of new socket is produced/
Anchylosis of the blade-bone with the upper-arm is very rare.*^
Fractures,' on account of the exposed position of the blade-
bone, are not very unfrequent, and especially the complete
transverse fracture ; ^ such fractures generally unite perfectly
well ; shot and other wounds however remain open for a long
while,^ or if there be a fracture and it do not unite, an unna-
tural joint is produced. *°

Among the vices of texture, which occur in proportion but
rarely, in the blade-bones, we must particularly mention scro-
fulous enlargement, and caries ; ^^ still more rare is the partial
destruction by aneurysm ^^ and superjacent encysted tumours ;
necrosis with reproduction,^^ exostosis,^* and osteosarcom.^*

(1) Hochst'ddter D. de spina bifida. Altdorf, 1703.

(2) Thilow Beschreib. anat. pathol. Gegenstande. Vol. I. No. 6. — Cerutti
Beschreibung der pathol. Praparate zu Leipzig, No. 484 and 485.

(3) I have also seen this in a lioness, v. Verzeichniss, No. 3482 and 3483.

(4) V. Sommerring Vom Baue des menschl. Korpers. 2d edit. Vol. I. p. 414. —
I have found this also, v. Verzeichniss, No. 2150. — Sandifort Mus. anat. Vol. I.
p. 222, No. 541.

(5) Sandifort Mus. anat. Vol. II. pi. 99; Vol. III. p. 212, No. 419— 424 ;
p. 383, No. 593 ; p. 384, No. 598 and 599. v. my Verzeichniss, No. 3492. —
Loseke Observ. anat. chir. p. 11. — [Mus. Roy. Coll. Surg. No. 436. T.]

(6) Allg. Historic der Natur. Vol. II. p. 68, No. 201. — /taiier in Hist, de la
Societe de Medec. 1779. — Kohler, p. 11, No. 40. — fValter Mus. anat. II. p. 70,
No. 445.— G. Sandifort Mus. anat. Vol. III. p. 239, No. 661 and 662. — I have
seen a similar case in a living person. — [No. 296 and 297 Mus. Roy. Coll. Surg,
in both of which the humerus has become anchylosed to the scapula, by ossi-
fication of the capsular ligament; but the articular surfaces have not taken on the
ossific inflammation. Both specimens are from a feline animal, but of what genus
is not known. T.]

(7) Adoue D. de fractura Scapulae. 4to. Paris, 1787. — Fogt Anat. physiol.
chirur. Abhandlung eines sehr seltenen Bruches zweier Schulterblatter und des
rechten Schliisselbeins. 4to. Leipzig, 1800.

(8) I saw a recent instance of this disease in a man, in consequence of a blow,
and a united transverse fracture in the Mus. Pathol, at Vienna. — A united frac-
ture of the shoulder-blade is described by Lobsiein Compte rendu, etc. Strasb.
1824, p. 64, No. 78. — I found a similar instance of this kind in a wolf. v. No.
3490 of my Verzeichniss.

(9) Sandifort Mus. anat. Vol. III. p. 186, No. 247 and 248 ; p. 101, No. 338.—
A hole made by trepanning in a horse at Alfort, is not entirely closed, v. Rudolphi
Bemerkungen auf einer reise, Part II. p. 5Q.

(10) Fluriudnnn resp. Nennan D. de articulationibus sic dictis accidentalibus.
8vo. Lund. 1821, p. 8.

(11) In scrofulous and syphilitic persons, in diseases of joints, &c. No.
34S4— 3487, 3489 ; Sandifort Mus. anat. Vol. II. tab. 99, fig. 5 and 6.

(12) Prom an aneurysm of the art. subscapularis, v. Liston, in Edinb. med.
and surg. Journ. Jan. 1820.

(13) Chopart resp. Robert De necrosi ossium theses. Paris, 1776, p. 7. — An
instance in a horse at Alfort. v. Rudolphi, p. 35 ; the engraving of it in Edinb.
ined. and surg. Journ. April, 1823, p. 217, fig. 1 and 3. — A similar case in the
Veterinary School at Berlin, v. Kortuvi 1). cxperinicnta ct observationcs circa
rcgencrationcm ossium. 4to. Berol. 1821, p. 8, fig. 1 and 2.

Sect. XV.] Of the Bones of the Upper Extremities, 219

(14) A fungous exostosis. Bondin in Lond. med. and phys. Journ. Vol.
XLVI. August, 1821. — A large one on the shoulder-blade and collar-bone,
Kbhler, p. 11, No. 39. — A cauliflower-like one, Lohstein, No. 79. Compare No.
3488 and 3489 of my Verzeichn. — In a horse, around a trephine aperture, at
Alfort. V. Rudolphi, p. 56.

(15) Heymann in Rust's Magazin f. die ges. Heilkunde. Vol. XIX. Part III.
p. 505.

§141.

As to the OTHER BONES OF THE UPPER EXTREMITIES, they

as well as the last mentioned are often deficiently formed in
very different degrees ; in many cases, in the little rudiment of
the upper limb, we find only a more or less imperfect piece of
the upper-arm-bone, or this may be wanting at the same time
with the fore-arm, and the hand articulated with the blade-bone,^
or if only the fore-arm be deficient, with the extremity of the upper
arm ;^ frequently also are the bones of the fore-arm deficient,
inasmuch as there is only one of them present, to which the
imperfect hand is attached ; or if that be deficient, it terminates
short and pointed : ^ the bones of the hand are frequently defi-
ciently formed, and owing to the want of all or individual
fingers, they are consoKdated or shortened. Without, however,
any external deformity of the hand, one of the bones in the
metacarpus may be missed.* We find also, on the contrary,
SUPERNUMERARY BONES ou the forc extremities, and then not
merely with excessive number of the fingers, but also with
otherwise well-formed joints ; for instance, in the metacarpus,^
a phalanx too many on the fingers(?),° unusual sessamoid bones
at the elbow joint,^ &c.

The FORM of the bones of the upper extremities varies not
merely as to their different formal vices, in numerous ways,
from what is regular,^ but is also frequently changed by diseases ;
for instance, in imperfect growth of certain regions,^ in arms
lamed ^^ and curved by rickets, in club-hands, from disloca-
tion," &c.

Vices of connexion, both dislocations and anchylosis,^^
as well as fractures ^^ and wounds, are naturally very com-
mon in the bones of the upper extremities of man ; in animals
also similar vices are not unfrequent.^*

Vices of texture, of the most different kinds, very fre-
quently occur in the fore extremities both of man and animals,

as RICKETY enlargement, CARIES, SPINA VENTOSA,^^ NE-
CROSIS, EXOSTOSIS, and osteosarcom.

(1) Dumeril in Bulletin de la Soc. philom. Vol. III. p. 122. — I have seen a
similar case. v. No. 2894, my Verz.

(2) Flachsland Obs. anat. pathol. Rastad, 1800, p. 44. — Palleita Exercit.
pathol, I. p. 139, fig. 9. — Hesselbach Beschreib. der pathol. Priiparate zu Wiirz-
hurg, p. 13, No. 71 and 72.

220 Of the Bones of the Lower Extremities:, [Part II.

(3) Of all these vices I have instances before me. — Absence of the radius is
not rare when there is no thumb, and in bending inward of the hand. I have
seen this four times. — Similar cases are given by Wiedemann in Isenflamm's and
/?ose7?7nfi//<T'jf Beitragen zur Zergliederungskunst. Vol. I. Part I. p. 42; and
Flcischmann in LeichenotFnungen, p. 259, No. 92. — Compare the difterent miU-
formations further on, and the observations on the extremities in particular.

(!•) Sandifort Observat. anat. pathol. L. 111. C. X. p. loG.

(o) Salzmaiin Decas Observat. anat. Argentor. 1725, p. 3, rev. in HuUeri
Coll. Diss. anat. — Nine carpal bones in man. v. Vol. VI. p. 69. — Sandifort. —
In the horse, ten bones instead of seven in the carpus, v. Pilger Handbuch der
^ eterin-Wiss. Vol. II. p. 527. — On a rana temporaria, a supernumerary carpal
bone, v. Cams Von den Urtheilen des Knochen-und Schalengeriistes. fol.
Leipzig, 1828, p. 133, § 590.

(()) Columbus De re anatomica, p. 485.

(7) A large one on the olecranon. Chenal Obscrv. botan. 4to. Basil. 17G6,
§ 28 ; and Rosenmuller D. de sing, et rar. oss. c. h. variet. p. 62. — One on the
point of the coronoid process, v. von Sbmmerring Vom Baue des Menschl. Kbr-
pers. 2d edit. Vol. I. p. 425.

(8) As a rare example, I have once seen the bicipital groove wanting on the
upper-arm-bone, with deficiency of the long head of the M. biceps cubiti. —
Less rare is the communication between the anterior and posterior pits at the
lower part of the bone.

(9) For instance, the fore-arm, on account of disease in youth, v. No. 3503
and 3504 of my Verzeichn.

(10) I have described a good instance in my Selt. Beob. II, p. 32, and
Verzeich. No. 3502.

(11) The form of the head of the upper arm varies much, especially if it be
dislocated ; in which case it is, as it were, compressed and flattened.

(12) Many instances of it in Bresl. Mus. No. 3572 — 3574.

(13) The lesser fractures are easily overlooked; to wit, that of the olecranon.
On this fracture, v. de Plouqiiet's Repertor. Art. Olecranon ; also Camper and
Jlcock, See. § 142, note 8. — Btzion D. de fractura olccrani. 4to. Paris, 1786;
and Feiler Ueber don Bruch des Olecranums, nebst einer neuen Methode
denselben zu heilen. 8vo. Sulzbach, 1811. — On fracture of the processus coro-
noideus, v. SchreheVnis D. de fracturis in genere et de fracturae cubiti natura ct
curatione. Basil. 1602. — Combes Brassard Sulla frattura del' apofisi coronoide del
cubito. Montauban. 1811. — Kuhnhoh in Ephemerides medicalesde Montpellier.
March, 1826. — Several instances of united fracture of the bones of the arm, in
Bresl. Mus. No. 3577—3593.

(14) Especially anchyloses in the horse. — On the skeleton of a monkey, in the
Zoot. Mus. at Paris, between the fore-arm and carpus. — In a wolf, v. my
Verzeichn. No. 3575 and 3576. — In a bird, No. 3594. — At Alfort, I saw, in
a dog, in dislocation, a new articular pit formed on the ol^ecranon, for the humerus.

(15) I have recently seen some remarkable cases in the Mus. Anat. Pathol, at
Vienna ; viz. on the lower end of the ulna, a spina ventosa, as big as an ostrich
egg ; and two cases on the end of the radius, as big as the head of a child two
years old . — It also occurs in animals ; thus 1 found it on the ulna of a horse, on
the metacarpal and pastern bones of an ox, at Alfort. — On the great wing-bone
of a parrot, in the Mus. oi' Sandifort. v. liudolphi, Part I. p. 131.

D. — OF THE BONES OF THE LOWER EXTREMITIES.

§142.

The bones of the lower extremity, hke those of the upper,
are found congcnitally deficient, inasmuch as they may be

Sect. XV.] Of the Bones of the Lower Extremities. 221

altogether wanting, or only imperfectly developed in certain
regions.^ But they have this peculiarity, that, in the syren-
like monsters, there exists a greater or less degree of con-
solidation ; the frame-work of two extremities indeed is found,
which are merely connected below at the feet alone, or at the
knees, or there may be only the frame-work of one lower
extremity, in which case, however, by the greater breadth and
duplicity of the articular surfaces we can distinguish the con-
solidation of the two ; at the same time all the bones may be
so turned round upon their axis, that the parts usually in front
are situated behind.^

The opposite vice, or the excessive number of bones in a
more or less double lower extremity is at once shown by its
external form.

The SIZE and form of the bones in the lower extremities
frequently appear irregular; to these belong especially, the
disproportionate shortness or length of the bones of the thigh
and leg, or only in one of these regions ; their occasional
unequal length in the two extremities ; the articular extremities
very often rendered too broad in rickets, and as it were dis-
located ; the crookedness of the long bones, which is no where
else so common and so great, partly congenital, partly pro-
duced especially by rickets ; the malformation of the bones of
the foot, in club-foot,^ and from wearing too small shoes ; and
the partially congenital,* partially acquired ^ varying forms of
the upper end of the thigh-bone.

Vices of connexion and continuity which originate in
the form and use of the bones of the lower extremity are very
common. To the former belong the displacement of the
metatarsal bones in club-foot, dislocations ° from external
and internal causes, and anchylosis ;'' to the latter, the various
fractures, of which those of the neck of the thigh-bone ^
and the knee-cap,^ usually exhibit much difficulty of union
by callus.''*

Vices of texture occur in the bones of the lower extremi-
ties in man still more frequently than in those of the upper,
which may indeed arise from their more active employment,
and the more ready influence of injurious causes upon them ;
to these especially belong, the rickety inflammatory
swelling of the small bones, as the knee-cap and the bones of
the feet, as well as the articular ends of the tubular bones ;
caries, which especially in morbus coxarius,^" and in the bones
of the knee joint,^^ is as common as it is dangerous ; spina
VENTOSA, which often produces very large swellings, especially
on the thigh and shin-bones ; ^^ necrosis which occurs particU'

222 Of the Bones of the Lowe?' Extremities, [Part 11.

larly on the shin-bone and often on the thigh ;^^ the common
BONY growths/* and deposition of gouty tophus, osteo-
sarcoma^ &c.

(1) V, below in the extremiries ; a mere rudiment of the thigh-bone has
been seen several times — in the case described by Dumeril : although there was
on each side a rudiment of the thigh-bone, consisting merely of the head and
trocanters, the single bone which formed the leg was not attached to it, but arti-
culated with the inferior anterior spinous process of the ilium. In another case
there was merely a single bone between the pelvis and the foot. v. Dumas Principes
de Physiologic, Vol. III. p. 163. — Sometimes the foot is directly attached to the
pelvis, V. Bouchard, Eph. Nat. Cur. Dec. I. Ann. III. c. 12; or to the lower
extremity of the thigh-bone, v. Flaclcslayid, &c. ; at the same time with the outer
toe in one instance was the fibula wanting, except a small portion of its lower
end, V. Meckel, Handb. der pathol. Anat. Vol. I. p. 750. — In another case of the
foot there were only the hinder three tarsal bones present, v. ib. p. 751, &c. —
In a syren monster I missed the knee-cap at the knee-joint, v. Monstror. sex
humanor. anat. et phys. disquisitio, p. 40. [In the Mus. Roy. Coll. Surg., No. 105,
a foetus, in which both the lower extremities are deficient, and the trunk ter-
minated in a rounded stump about two inches long, with a depression in it
resembling an anus. — No. 106 of the same collection, a foetus, in which there is a
slight projection from the back of the sacrum, like a rudiment of an extremity.
Unfortunately neither of these preparations are dissected, so that no further
account can be given. T.]

(2) Compare below in the extremities.

(3) lb.

(4) In the syren monsters with but a single thigh-bone, the neck is wanting,
and the head is attached on the extreme end of the bone. In a cretin, the neck
was wanting, and the malformed head was attached much lower down. v. P?o-
chaska Disquis. anat. physiol. organ, c. h. explicatio. tab. 8, and engraving,
tab. 11, fig. 2. — We observe the head of the thigh-bone variously malformed,
sometimes in congenital lameness ; otherwise also, however, v. Palletta Exercit.
de claudicatione congenita. L. B. 1787, § 82, and Exercit. pathol. Vol. I. —
In rare instances the pit on the head of the thigh-bone for the round ligament
is deficient, v. Genga Anatomia chirurgica, 8vo. Rom. 1687, p. 124. — Nicolai
proes. Salzmann Decas Observat. anatom. Argent. 1725, p. 10., abbreviated
in Haller's Select. Diss. Vol. VI. p. 694. — Caldani Institut. anat. Vol. I. p. 145,
and Palletta Exercit. pathol. Vol. I. p. 65. — Bonn Thesaurus ossium morbos.
No. 22, 43, 47. — Sandifort Observat. anat. pathol. L. III. c. 10, and Mus. anat.
Vol. I. p. 203, No. 271 ; Vol. II. tab. 77, fig. 1 and 2.—Prochaska.-i:\\e pit and
ligament are, however, sometimes destroyed also by disease, viz. gout. v. Som-
merring Vom Baue des menschl. Kbrpers. 2d edit. Vol. I. p. 482, and in
Blumenbach's medic. Bibliothek. Vol. III.

(5) For instance, after dislocation, in which the head and neck of the thigh-
bone are often very much changed ; thus the former becomes flattened, the latter
often shortened and distorted ; after gouty afiections, and other inflammatory
forms of disease, both sometimes become much swollen and mishapen; beautiful
delineations of both vices are given in Sandifort' s Museum anat. Vol. II.
tab. 65 — 74. — Compare B. Bell, Remarks on interstitial Absorption of the Neck
of the Thigh-bone. Lond. 1824.

(6) Among dislocations from mechanical causes, that of the foot is the most
frequent ; among the spontaneous, that of the hip in coxarthrocacy ; upon
congenital dislocation of the hip-joint, v. Dupinjtrcn in Repertoire general
d'Anatomie, etc. Vol. II. p. 151, pi. 4. — Sometimes also merely the knee-cap is
dislocated, v. le Facher Theses de variis patella? luxationibus. Paris, 1761 ;
it then rubs fot itself a chase at some other part of the thigh-bone. v. Ver-
zeichmiss. No. 3882. — Moreau in S^dillol's Rec. period de la Soc. de Medec.
Vol. LXIV. p. 79; tlie so-called strain in the wliirlbone, or stiffle strain in the
thigh of the horse, is a true dislocation of the patella.

Sect. XV.] Of the Bones of the Lower Extremities. 22d

(7) Imperfect anchylosis of the hip-joint is not rare; there are several
instances in the Bresl. Mus. viz. No. 3425, 3436—3439; Allg. Historic der
Natur. 2terTheil, p. 72. No. 222— 225. —Sandif or t Mus. anat. Vol. II. tab. 69,
tig. 1 and 2, tab. 72 — 74. — More rare is perfect anchylosis, v. Hildanus in Op.
p. 882. — rfe Haen Rat. medend. Vol. I. p. 360. — Allgem. Historic der Natur.
Part II. p. 24, No. 226, 230, tab. 3. — van der Wynpersse D. de ancylosi, p. 41,
§ 3S.—Kohler, p. 14, No. 56—62. — Walter, Mus. anatom. Vol. II. p. 71, No.
446; and Sandifort, Vol. II. tab. 75 and 76; Vol. III. p. 240, No. 671,
instances are mentioned. — It has also been found in a horse at Hanover, v.
Eudolphi Bemerkungen auf einer Reise, u. s. w. Vol. I. p. 77. — The anchylosis
of the thigh-bone, with the shin-bone, the splint-bone, and knee-cap, altogether,
or singly, is not uncommon, v. No. 3440, 3883 — 3885 of my Verzeichn. — Still
more frequently does it occur between the shin and splint bones, at the ankle
joint, and between the bones of the foot. v. No. 3886 — 3889 of Bresl. Mus. —
[Among the preparations of anchylosis, in the Mus. St. Thomas's Hospital,
there are several fine specimens of this disease in almost every joint ; among
them is one very interesting case of tibro-cartilaginous anchylosis in the knee-
joint of a child ; and a bony anchylosis of the knee-joint, by which all the three
bones are connected, but in a very remarkable manner, the leg being bent for-
wards at a right angle upon the thigh. T.] — On the foot of the horse, it is
especially in ring-bone and spavin not unfrequent. — [In Mus. St. Thomas's
Hospital, there is a cast of a simple dislocation of the head of the tibia upon the
thigh-bone, in which the tibia is thrown backwards : a very rare accident. T.]
(8) Salzmann D. de curatione ossis femoris rariore, frequentiore colli fractura.
Argentor, 1723, rev. in Mailer's Coll, Diss. chir. IV. No. 145. — Bordenave D. de
fractura colli femoris. Paris, 1771. — Ludwlg Pr. de fractura colli femoris. Lips.
1755, in Haller, No. 146. — Haase Pr.de fractura colli ossis femoris cum luxatione
capitis ejusdem ossis conjuncta. Lips. 1801. — Richerand Dissert, sur les fractures
du col de femur, etc. Paris, Ann. VII. — Gerard, Memoires sur les fractures du
col de femur. Gand. 1805. — Hagedorn, Abhandl. iiber den Bruch des Schenkel-
beinhalses. 8vo. Leipz. 1808. — ilfe?/«- D. observationes circa fracturam colli ossis
femoris. Gryphisw. 1810. — The fracture usually heals only by a mass of liga-
ment, not by bony substance. — A. Cooper, in his and B. Traverses Surgical Essays,
Vol. II. 2d edit. Lond. 1820, pi. 1 — 3 ; and in his treatise on Dislocations and on
Fractures of the Joints, Lond. 1823, and in Observations on the Fracture of the
Neck of the Thigh-bone, &c. 4to. Lond.1823, with plates, first held that this fracture
was not united by callus, but by a ligamentous mass. — Colles, in Dublin Hospital
Reports, &c. Vol. II. Dublin, 1818, found this confirmed in nine cases. Similar is
the opinion of C Bell, in Observations on the Injuries of the Spine and of the Thigh-
bone, &c. 4to. Lond. 1824, with plates ; /. Wilson, On the Structure and Physio-
logy of the Skeleton, Lond. 1820, p. 243, and H. Mayo in London med. and phys.
Journ. Decbr. 1826. — The opposite opinion is held by Earle in Practical Obser-
vations in Surgery, Lond. 1823 ; London med. and surg. Journ. by Macleod and
Bacot, Vol. L. October, 1823, though without mentioning cases of union. A rare
notice of such cure is given by Liston in Edinb. med. and surg. Journ. April, 1820. —
van Houte D. de collo femoris intra ligamentum capsulare fracto et rite sanato.
8vo. Amstelod. 1824, with engravings. — Dzondi, De colligendo, conservando, dis-
ponendo et inspiciendo Museo anat. pathol. 8vo. Halae, 1825, p. 13, had seen
cases of this kind in Leyden and Brunswick ; an instance is described by Beghie
in Edinb. Journ. of med. Sciences, Jan. 1826 ; several instances by G. Sandiforty
Mus. anat. Vol. III. p. 206, No. 379 and 380, p. 346, No. 273; incipient cure,
p. 204, No. 359. I saw a case of this kind in the Anat. Mus. at Dresden, and if
I be not mistaken also in Soe^nmerring's Museum ; the cases I have observed.
No. 2147, 2148, 3892—3895, and 3925, in Bresl. Mus., exhibit no callous union.
I have, however, once seen the neck of the thigh-bone penetrating, as it were, and
driven into the cavity of the bone itself, as was observed by Dessault several
times, and engraved by Sandifort, Vol. II. tab. 78, fig. 4 — 7. — [This is by no means
an uncommon accident ; there are several specimens of it in the Mus. at St.
Thomas's ; and among others, one sent by Roux, as an instance of fractured
neck of the thigh-bone united by bone from which it is quite distinct. — The

224 Of the Bones of the Lower Extreynities. [Part II.

fractured neck of the thigh-bone of English surgeons being always within the
capsular ligament. T.] — An ununited fracture of the neck of the thigh-bone in a
young stag is mentioned by Sandijort, Vol. III. p. 34G, No. 272. — /. yimesbury,
Observations on the nature and treatment of fractures of the upper third of the
thigh-bone, and of fractures of long standing. 8vo. London, 1828, with plates.
— Instances of cure of fractured neck of the thigh-bone by callus are related
by Laiigstaffe in Med. Chir. Trans. Vol. XIII. Part II. p. 487, London, 1827.—
G. Sandijort in Niewe Verhandelingen dereeste Klasse vanhet K. Needer-
landsche Institut van Vetenschappen. Amsterd. 1827, Vol. I. No. 1, two
instances; and Brulatour. in Revue med. franc, et etrang. Dec. 1827, Vol. IV.
p. 398. — [A case of fracture of the neck of the thigh-bone united by bone
occurred to Swan, and is to be seen at the Mus. Roy. Coll. Surg. — Another case
occurred to Stanley, and is, I believe, in the Mus. at St. Bartholomew's Hospital.
— A third to Chorhy, of Leeds. T.]

(9) V. de Plouquet Repertor. Art. Patella. — Meihomius de patellae esse, ejusque
laesionibus et curatione. Frank. 1697 ; Langguth D. de fractura patellae genu.
Viteb. 1745. — Koole D. de patellae fractura. Franequer, 1761. — Allough D. de
patellae transversa fractura. Paris, 1775. — Deidier De patellae transversa fractura.
Paris, 1775, — P. Camper D. de fractura patellae et olecrani. 4to. Franequ. 1754,
and Hagae Comit. 1789. — Sheldon, An essay on the fracture of the Patella or Knee-
pan. Lond. 1789. — Hierbuur D. de fractura patellae. Franequer, 1790. — Buirer in
V. Siehold's Chiron. Vol. III. Part I. p. 64. — Keller De ossium emollitione morbosa,
de perfracti genuum orbis sanationis rarioris causa, etc. L. B. 1816. — Linon D. de
fractura rotulae. L. B. 1816. — Fielding, A case of transverse Fracture of the
Patella, in which perfect osseous union was procured. 8vo. Lond. 1822. — de Zutter
D. de rotulae fractura et curativa methodo. 4to. Gandae, 1823. — Alcock, Practical
Observations on fracture of the Patella and of the Olecranon. 8vo. Lond. 1823.
Fest D. de fractura patellae. 4to. Berol. 1827. — Ortalli D. de fr. pat. 8vo.
Berol. 1827. — Callisen, in Actis reg. Soc. med. Havn. Vol. I. p. 307 ; and
A. Cooper, are of opinion that the transverse fracture of the knee-cap, which
usually originates in muscular exertion, is never cured by callus, although many
instances are given, besides the several cases of the above authors, by Lallement.
V. in Boyer Trait6 des malad. chir. Vol. III. p. 355, pi. 3 and 5. — Wilson,
p. 24!0.—Langenbeck in D. N. Bibliothek f. d. Chir. und Ophthalm. Vol. III.
Part I. — Rodati in Opusc. scientif. Fasc. XII. p. 377, after comminuted
fracture. — Bleuland Descriptio. Mus. anat. p. 275, No. 1519. — I have also seen
one instance in W. Hunter's Mus., and another in the Anat. Mus. at Prague. —
I once found a piece of the outer edge of the knee-cap well united, after a per-
pendicular fracture, v. No. 3908 of my Verzeichniss.

(9*) [Some few years back there was, in the Mus. at Thomas's, a very
remarkable instance of fracture of the tibia ununited, in which the fibula, which
had remained perfect, increased exceedingly in size, and performed the office of
the tibia in supporting the body. It has unfortunately disappeared. T.]

(10) Compare below, § 150.

(11) /. Russell, upon Diseases of the Knee-joint.

(12) Compare above, § 116.

(13) T. Whately, Practical Observations on Necrosis of the Tibia, &c. 8vo.
Lond. 1815, with an engraving.

(14) Compare above, § 119.

(15) Rare on the smaller bones. For instance, on the inside of a knee-cap. —
G. Sandi/ort Mus. anat. Vol. III. p. 141, No. 4, on the first phalanx of the
thuuib. — £/ir/»a7j« Compte rendu, etc. Strasburg. 1827. p. 60, No. 418, b.

Sect. XVT.] 225

SIXTEENTH SECTION.
O/* the Cartilaginous System.^

§ 143.

Although the cartilages in different parts of the body,
especially as they have greater or less commixture of tendinous
fibres, (fibro-cartilage,) exhibit very important differences of
structure ; they however all agree in this, that they exhibit vices
of formation as rarely as morbid destruction, and that they pos-
sess also the consequent power to withstand, for a long while,
those morbid influences which oftentimes completely destroy the
neighbouring parts. As cartilage is formed very early in the
embryon, so do we easily comprehend why its actual congenital
DEFICIENCY is uot Otherwise observed than when the parts of
which it forms the base, are entirely deficient or are very
imperfectly developed ; ^ in the latter case the cartilage is not
properly formed, but is soft and like membrane, as in the young
embryon.^

Just as rarely do we observe supernumerary cartilages ; to
these belong certain little cartilaginous pieces, which we
observe now and then in the external ear, the nose, the larynx,
besides those which are usual ; the fibro-cartilaginous mass
sometimes formed in dislocations, as well as the thin carti-
laginous plates which often show themselves in the new joints
on the ends of broken bones ; and lastly, the various extraneous
isolated bodies which are composed of cartilage or fibro-carti-
lage, which we meet with as a congenital,'' or more frequently
as a morbid condition in various organs.^

The SIZE and form of cartilage rarely deviates, except when
the whole organ, in which it is found, appears malformed ; still
we find now and then even one of the costal cartilages irregu-
larly formed; the cartilaginous rings on the air tube vary
uncommonly in their form, are crooked ; the menisci in disease
are diminished, rubbed through, &c. The latter also sometimes
vary as to their natural position, if from mechanical violence
their connexion with the neighbouring parts be disturbed.''

Not less permanent is their colour, so that often they
retain their whiteness and gloss in the midst of ulcerated and
mortified parts; we however find them, as exceptions, in certain
cases of greater destruction, opake, dull, and yellowish grey ;
also in the morbid deposition of lime, they lose their bluish,
transparent colour; in the severer degrees of jaundice, they

Q

226 Of the Cartilaginous System, [Part II.

have been in one instance seen yellow ; ^ lastly, in diseases of
young persons, although never red, still, on account of their
somewhat increased vascularity, they appear at times pale-
yellow.^

Vices of continuity naturally do not often occur in carti-
lages, on account of their great elasticity; we observe, however,
in the firmest of them, viz. the cartilages of the larynx and
ribs, even in the cartilages of the ear, the nose, and the air-
tube, especially if by morbid increase of the lime contained
in them, their frangibility is increased, very often frac-
tures, which have been observed to unite in the costal carti-
lages only by a bony callus in form of scales or rings ; ^ those
however which are ever so small, as incised wounds of carti-
lages, unite indeed, but are merely joined by cellular tissue ;
loss of substance appears to be replaced no otherwise than by
cellular tissue,^"

(1) Bottcher Abhandlung von den Krankheiten der Knochen, Knorpel und
Sehnen. 3 Theile. 8vo. Konigsb. 1796. — Autenrieth resp. Bdrver D. de gra-
vioribus quibusdam cartilaginum mutationibus. 8vo. Tubing. 1798. — Cruveilhier
Observations sur les cartilages diarthrodiaux et les maladies des articulations
diarthrodiales ; in Archives g^nerales de Medecine, Vol. IV. p. 161.

(2) The fibrous cartilages in the joints are, however, in very rare instances,
deficient. At least I once could not find, in a perfect syren monster, the semi-
lunar cartilages in the knee-joint ; once in a monster with imperfect formation
of the face, the meniscus of the maxillary joint ; and a few times in new-born
children with club hands, the cartilago intermedia triangularis in the wrist-
joint. — That single or several cartilages of the ribs are deficient, has been already
observed above, v. § 136, note 14.

(3) For example, in the ears, the eye-lids, the nose, the air-tube, &c,

*^ (4) Once in a new-born child, I found an irregular-shaped, angular, tolerably
large piece of cartilage, situated beneath the skin of the neck, upon the sterno-
mastoid muscle. — Another child had, in the inside of the upper eyelid, a tolerably
large swelling, which consisted of firm cartilage, and was closely attached by a
neck to the interior of the orbit. — In a sheep, I have found a few times, between
the ear and the jaw, as a rudiment of a second mouth, a process principally com-
posed of cartilage, with a canal leading inwards, v. No. 2322 and 2323.

(f5) For instance, in the synovial cavities and the serous membranes, in the
womb, the ovaries, in encysted tumours, &c.

(6) Hesselbach once found a triangular meniscus in the wrist-joint, torn from
the ulna, and perforated in consequence of the friction at its base. v. Vollst.
Anleitungzur Zergliederungskunde. Vol.1. Part II. p. 37, note. 4to. Arnstadt,
1806. — I once found in a strong man, after a severe strain, the external
semilunar cartilage of the knee-joint situated in a cyst-like extension of the
ca])sule, and torn through at its anterior extremity.

(7) Stoll Ratio Medendi. — Slorck\s Annus medicus, I. p. 150.

(8) This must not be confounded with the great redness exhibited in the
cartilages of young people and animals, from maceration or soaking in water,
which Btrzelius states to arise from the oxide of iron contained in them.

(9) Lohstein Rapports sur les travaux executes k I'amphith^atre d' Anatomic.
Strasb. 1805, p. 11. — Magendie and Desoer have also observed this. v. Cruveilhier
Essai sur 1' Anat. pathol. Part II. p. 9. — Greve saw it in the cartilages of three of
the false ribs of a horse.

(10) On account of the small number of blood-vessels in cartilage, this is not
to be wondered at. — In such injuries also, the membrane of the cartilage, from

Sect. XVI.] Of the Cartilaginous System, ^^7

which it especially seems to derive its support, is commonly destroyed, and thus
the first step to regeneration is removed. If Laennec, in the Diet, des Scienc.
Medic. Vol. IV. p. 129, consider the several thin spots of cartilage on the arti-
cular ends of bones to be newly produced cartilage, he is certainly mistaken ; it
is much rather the destruction of the cartilage.

§ 144.

Lastly, concerning vices of texture in cartilage, inflam-
mation in this tissue is so indistinct, that it has been entirely
denied.^ We must not however exclude them from several
vices of texture which are known as the usual consequences of
inflammation, and occur also in cartilage ; sometimes even slight
traces of inflammation itself have been observed. To the latter
belong, for instance, swelling of cartilage, inflammatory injection
of the vessels in cartilaginous membranes, viz. of the larynx and
costal cartilages, as well as in the interior of the cartilage, and
particularly of fibro-cartilage, and the pale-reddish and even
rosy-red colour which cartilage, and especially fibro-cartilage,
sometimes exhibits ; although compared with other organs, these
signs of inflammation are always very indistinct and their course
very tedious.^ Inflammation of cartilage hardly ever runs into
true ULCERATION with formation of pus ; it only occurs when
a previous conversion of the cartilage into bone has taken place.
The usual consequence of inflammation is the softening and

DESTRUCTION OF THE CARTILAGE BY MORBID ABSORPTION ; it

is then found not merely porous and crumbling, but even con-
verted into a greasy or jelly-like fluid, usually greyish, but
sometimes also coloured;^ or partially and generally withered,
or finally more or less eroded ; so that it is sometimes seen
having many small pits and holes, sometimes lost in many
single fibres, separated from each other and standing perpen-
dicularly upon the articular ends of the bones. In such way
is not unfrequently a meniscus, and the cartilaginous plate
which overspreads a bone, entirely destroyed ; in which case
the ends of the bones, if anchylosis do not ensue, assume a thick
and very rough bony covering, in consequence of the existing
inflammation, which, in the motions of the joint, is gradually
rubbed down, polished, and assumes a very similar appearance
to ivory;* this is sometimes observed in gouty persons. More
rarely, after destruction of the cartilaginous covering of the
articular surfaces, is the bony matter deposited more largely
and unequally, and thus a hilly surface is produced.^

As inflammation of cartilage is of so indistinct and chronic a
nature, mortification and necrosis are also very rare in this
system ; it has, however, been many times observed, that large
or small pieces of cartilage, separated from the surface or lying
in mortified soft parts, have exfoliated, that the cartilaginous

Q 2

228 Of the Cartilaginous Syste^n. [Part II.

coverings of the articular ends of bones have been lost, indeed
that even the whole of large cartilages, for instance, of the ribs
and larynx, have been thrown off in malignant ulceration.

The last, and indeed not uncommon consequence of inflam-
mation is OSSIFICATION, to whicli, however, all the cartilages
have not a similar disposition; thus, for instance, in the carti-
laginous tip of the breast-bone, the cartilages of the ribs and
larynx, it is very common and extensive ; more rarely, how-
ever, and imperfectly, the fibro-cartilages of the wind-pipe, the
edgings of articular cavities, and the interarticular cartilages;
still less in frequency and extent, those of the eyelids, ears,
and nose ; and the cartilaginous covering of the articular ends
of bone, and the pulleys for tendons are perhaps never ossified.
This ossification of the cartilaginous system, is distinctly pre-
ceded by an increased absorption of the jelly, and a greater
vascular development, somewhat similar to the normal ossi-
fication of cartilage, so that the genuine cartilage then assumes
a more fibrous appearance ; and about the cornlike deposi-
tion of lime, little arterial nets are observed. In rare cases,
especially in the cartilages of the ribs, the lime is deposited
only in the membrane of the cartilage, whence these are
merely surrounded by a kind of bony shell or rind. Cartilages
morbidly converted into bone are equally subject to all the
diseases which can afiect normal bone.

(1) Autenrieth reviewed by Dorner. — Russell, A treatise on the Morbid affec-
tions of the Knee-joint. 8vo. Lond. 1802. — Scott, On diseases of the Joints.
Lond. 1828.

(2) //. Maijo, in Lond. Medic. Chir. Trans. Vol. IX. Part I. speaks indeed of
a transient inflammation and ulceration of the cartilages of the knee-joint, which
commonly terminate in anchylosis of the joint. We, however, readily see that
this is not properly expressed.

(3) We see this as a primary state, particularly common on the fibrous carti-
lage between the vertebrae, of which especially mention is made by PaUetta, in
his Exercit. pathol. Vol. I. p. 104 — 108; and by Brodie, in his Diseases of
Joints. — I have also, several times, satisfied myself, that the destruction of the
spine may originally spring from the intervertebral substanfce ; but I have never
found su))puration, except at the same time the bones and the neighbouring
cellular tissue were inflamed. Sometimes in the intervertebral mass, and once
also in the cartilage of a rib, more or less large roundish cavities, closed by mem-
brane, which were filled with a brown reddish ichor, containing albumen.

(4) Herzius D. de crepitu ossium. Giessa?, 1701. — Leidcvfrost in Wesener D.
de susurru aurium. 4to. Duisb. 1785. — v. Sommerring's Abhandlung iiber Gicht-
knochcn in B lumen back's Medic. Bibliothek. Vol. III. Part III. p. 493 ; and
De morbis vasor. absorbent, p. 30. — J. Wenzel D. de ossium arthriticorum
indole. 8vo. Mogunt. 1791. — Cruveilhier ; and in Nouv. Biblioth. medicale.
Jan. 1827, p. 79. — The latter observed this vice in the jaws, shoulder, and hip-
joint; also in the horse. — I have found it not merely on the same spots, l)ut also
in the elljow-joint, between the radius and ulna, and especially in the knee joint,
of which proofs may be found in the Bresl. Mus.

(/)) I have instances of this before me ; whether it is of a similar nature
with the gouty tophus to be subsequently treated of, I know not ; however, in
rare cases, it becomes so great as to give rise to dislocations.

Sect. XVIL] 229

SEVENTEENTH SECTION.

Of the Fibrous System in General, and of the Joints in

Particular ^

§ 145.

The various membranous and ligamentous parts which we
include in the fibrous system, exhibit numerous peculiarities,
dependent on their position, connexion, and more minute
variety of texture ; in reference to the frequency and kind of
their organic vices, however, they naturally agree with each
other in many morbid phenomena, and especially in this, that,
with the exception of the periosteum, perhaps, which is very
vascular, and by its connexion with the bones more thereto
disposed, these parts exhibit proportionally less disorganiza-
tion, and this only after a long time and very indistinctly, on
account of their lower vitality.

(1) Rhases Liber de morbis articulorum in Op. Widmann D. de genuum
structura, eorumque morbis. Helmst. 1744. — Curtmann D. morborum articu-
lationis ac symphysis brevis aetiologia ac diagnosis. Giessse, 1797. — Bacheracht
D. de morbis ligamentorum. L. B. 1750. — Park, On the Diseases of the Joints,
etc. Lond. 1783. — Gotz D. de morbis ligamentorum ex materise animalis mixtura
et structura mutata cognoscendis. Halae, 1798, with two engravings. — /. Russel,
On the morbid affection of the Knee-joint. 8vo. Lond. 1802. — B. N. Schreger
Chirurgische Versuche, Vol. IL No. 4. Niirnberg, 1818. — Brodie Pathological
and surgical observations on diseases of the Joints. 8vo. Lond. 1818, with
engravings. — Wilson, Lectures on the Structure and Physiol, of the parts
comp. the Skeleton, and on the Diseases of the Bones and Joints. 8vo. Lond.
1820. — Lloyd, A treatise on the nature and treatment of Scrofula, describing
its connexion with diseases of the Spine, Joints, &c. London, 1821. —
W. F. Gniest D. de morbis articulorum. Halae, 1826. — F. A. G. Geiss D. de
morbis articulorum accuratius distinguendis et aptius curandis. 8vo. Halae, 1826.

§ 146.
First, concerning the vices of number, size, and form in
this system ; these are in general but seldom observed, and
especially as congenital. Thus, for instance, the fibrous mem-
branes investing the different viscera, the muscles, synovial
membranes, &c. are only deficient when those parts are
wanting ; the ligament-fibrous parts are also very constant
in their formation, although a fibrous band has been occa-
sionally missed at a joint, or a whole ligament,^ and par-
ticularly a tendon from a muscle. Sometimes indeed the
capsules of joints, viz. those of the shoulder, the hip and knee,
are so far imperfectly formed, that there are more or less
large gaps in them, by which they are connected with the
neighbouring mucous bags. Rarely also is increased number
of fibrous parts observed without duplicature of such organs

230 Of the Fibrous System^ and Joints. [Part II.

as they belong to, and then almost only in reference to tendons
and individual bundles of fibres of joints ; here, however, also
belong the capsular ligaments constantly existing in irregular
joints, which are sometimes formed after dislocations and
fractures.^

The fibrous parts frequently vary in respect to their thick-
ness and SIZE ; thus we find them, in some instances, congeni-
tally, remarkably thin, and as in the early state of foetal
existence, but little tendinous;^ in other cases wasted and relaxed
on account of disease, for instance, in lamed joints. Irregular
THICKNESS is mostly a morbid state. Frequently also are
certain parts of this system too short or narrow; to these
belong the congenital strictures w^hich occur in the
aponeuroses of the upper and lower extremities, to such extent,
that the subjacent soft parts are retarded in their development ;
the relative narrowness, and consequent tension which arise
in such aponeuroses, when pus, blood, &c. is effused in
them, or the muscles are swollen by inflammation ; the liga-
ments very short on one side in contortions of the limbs and
spine, both congenital, and when acquired during youth,* and
finally, the morbid contractions, contractiircBf of certain
fibrous parts, viz. tendons and ligaments, which mostly arise
from inflammatory irritation after too great extension, cramp,
&c. Just as frequently does the opposite vice, or irregular
SIZE and width, occur in such fibrous parts as surround other
organs or cavities, and to as great extent, as they are capable
of expanding in consequence of a power long operating on
them ; we find this not merely in swellings of the bones, of the
spleen, the kidneys, &c. of which the fibrous membranes
increase in equal proportion ; but also the sclerotic coat of the
eye, the dura-mater of the brain, the articular capsules, &c.
are often very much expanded by collections of fluid, and then
usually at the same time attenuated. Such expansion is fre-
quently seen only at one spot, so that bag-like elongations
are then formed.^ The bundle-like articular ligaments nearest
the articular capsules are also sometimes, in diminished tone,
distinctly elongated, and give rise to dislocations.^

Mere vices of form very rarely occur in the fibrous system
itself; to these belong, now and then, certain varying forms of
isolated ligaments, unusual expansion in the articular ligaments,
in the broad tendons of the abdominal muscles, in other tendons,
and the like.

(1) This especially applies to the lif^amentuni teres at the hip-joint, which, in
Bome cases as an orifrinal formation, hut more frequently in consequence of ruj)-
tnro, suppuration and ahsorj)tion, does not exist. Compare ahove, § 14-2,
note 4, and Tioch, in M6m. do Montpellier, Vol. II. p. 354. — I myself have

Sect. XVII.] Of the Fibrous System^ and Joints. 231

twice missed it in syren monsters, and oftener in diseased hip-joints, especially
those affected with gout ; if the semilunar cartilage in the knee-joint, or the
meniscus in the wrist be wanting, their ligaments also naturally do not exist, v.
§ 143, note 2.

(2) Compare § 109, note 5, and § 113, note 9. — Howship imagines that the
formation of a new joint takes place only in those dislocations in which the
capsular membrane, wherein the new bony matter is deposited, is not torn ; this,
however, is by no means the case, for after lacerations, tolerably perfect new
joints are formed, as I have sometimes seen, and as the case described by

Warren proves, in which the slit in the old capsule of the shoulder-joint re-
mained, although at the same time there existed a new capsule with synovial
membrane. It however requires a long time before the new capsule, which was
at first cellular, becomes of a fibrous nature, which in false joints arising after
fractures is very much furthered by motion, as Villerme's experiments on dogs
have proved, v. Revue medicale, historique et philosophique. Paris, 1821,
Vol. V. p. 68 — 75. — In a rabbit the new capsule was formed from the untorn but
thickened periosteum of the thigh-bone. v. Howship. — An engraving of a false
joint in the upper-arm is given by Delpech in his Chirurgie clinique de Mont-
pellier. Vol. I. — Observations and engravings of similar joints in the thigh-bone
and fore-arm are given by Kuhnholtz in the Journ. compl. du Diet des Scienc.
med. Vol. III. p. 289.— An Indian at New- York was obliged to move himself
forward by means of a large wooden ball, as he had double joints in both the
upper and lower extremities, v. Tilloch Philos. Magaz. and Journ. No. 278,
June, 1821.

(3) As it were, merely cellular, membranous-like. — I have seen this a few
times in malformed eye-balls, and in the aponeuroses and articular ligaments of
imperfect extremities.

(4) Very common in club-hands and feet, wry-neck, and other distortions, in
which cases I have found it common in man, and often also in calves and lambs.
Compare further the writers on club-feet. — Murray Foetus hydrocephalo interno
corrupti descriptio. Upsal, 1797. — Rudolphi, Swedische Annalen, Vol. I. p. 123,
found it on a foot. — Morgagni, De sed. et caus. morbor. Epist. LXIII. p. 19,
found in an old woman one lateral ligament of the dentiform process of the
second vertebra much longer and thicker than the other.

(5) For instance, on the dura-mater in hernia cerebri and hydrencephalocele.
— We sometimes find in horses, on the hock and pastern joints, tumours full
of synovia, which originate in a partial extension of the articular capsule, v.
Rohlwes Magaz. f. die Thierarzneikunde, Vol. I. Abhandlung von den Gallen. —
[They are named by farriers, according to their situation, windgall, when about
the fetlock ; bogspavin, on the inside of the hock ; thoroughpin, on the upper
and back part of the hock ; capulet, or capped-hock, on the point of the hock ;
and capped-elbow, on the point of the elbow. T.] — I have once noticed on the
outside of the knee-joint in a man a bag-like expansion, in which, after a severe
strain, probably, the external semilunar cartilage, partially torn through, was
thrown. — Aneurysmal and varicose expansions of some parts of their fibrous
membrane occur on the cellular bodies of the spine, &c.

(6) There are some persons whose ligaments are naturally so loose and long
that they can bend some of their limbs in a contrary direction ; thus, for
instance, the finger and the thumb especially can be bent so much backwards as
to touch the back of the hand. In a case of lameness and great atrophy of the
left arm, I found the capsule of the shoulder joint very loose and long, so that
the head of the upper-arm-bone hung very low and loose, v. Selt. Beob. II.
p. 32, No. 11. — An interesting example of such looseness of several ligaments,
giving rise to dislocations, is mentioned by Gotz, p. 32.

§147.

The normal colouring of fibrous parts is rarely entirely,
although in different vices of texture variously changed ; this
occurs also sometimes without any other distinct morbid

232 Of the Fibrous System^ and Joints. [Part II.

change, and indeed from the deposit of animal pigment; to
these belong, that in jaundice, as well as the colour but seldom
occurring, and more or less yellow, and still more seldom brown
or blackish, in melanosis/ In the negro fowls, all the fibrous
membranes and ligaments are hereditarily of a blackish colour.^

(1) I once found several single black spots on the fibrous membrane of the
air-tube; also a few times brownish or blackish spots upon the dura-mater,
without distinct vice of texture.

(2) Chapotin Topographic medicale de I'lsle de France, p. 31. — Pallas Zoogra-
phia Rosso- Asiatica. Vol. II. p. 90. 4to. Petrop. 1811. — Temminck Histoire
naturelle des Pigeons et des Gallinaces. 8vo. Vol. II. p. 253 and 256. Amsterd.
1813. — Rudolphi Grundriss der Physiologic, Vol. I. § 77, note 1.

§ 148.

Vices of continuity in this system are sometimes pro-
duced by preceding atrophy or marcor, and by extension
gradually increased to bursting, but more frequently by sudden
and actual violence. To the latter belong, various wounds
with and without loss of substance, the perfect and imperfect
rupture of tendons^ and tendinous sheaths, which originate not
unfrequently in violent muscular exertion, and the rupture of
ligaments arising mostly from external violence, which occurs
as a usual condition in dislocations from external causes;^
whilst in dislocations from internal causes, as arthrocacy,
collections of water and pus in joints, swelling of the liga-
ments, cartilage, and the fatty masses in joints, exostosis,^ &c.
the ligaments are only more or less expanded ; although the
latter occur as an exception also in dislocation from external
causes, especially in imperfect dislocation without any rupture.

Although simple incised wounds of fibrous organs seem to heal
easily and quickly, this, liowever, is by no means the case with
other of their injuries, especially in those with loss of sub-
stance, as almost all fibrous parts possess but very confined
or even no reproductive power ; and commonly wounds and loss
of substance in them are only healed and replaced by cellular
tissue, which gradually becomes tougher, but seldom actually
tendinous. Hence, for instance, ruptured ligaments heal but
slowly and imperfectly, so that consequently the reproduced
synovial membrane and the new cellular tissue are ruptured by
less violence, and the head of the bone is again protruded
through the old aperture.* The difficulty of reproduction is
not, however, equally great in all parts of the fibrous system, as
when tendons have been destroyed by suppuration or me-
chanical violence, they sometimes appear to be not only actu-
ally reproduced,^ but even the periosteum itself is also easily
and quickly restored.

Sect. XVI L] Of the Fibrous System^ and Joints, S33

(1) Compare /2eM55 Repertor. Comment. Vol. X. p. 63, de ruptura tendinum. —
de Plouquet Repertor. Art, Tendo. — Very frequently the tendo Achillis. v. Kulmus
D. de tendine Achillis disrupto, etc. Gendan. 1760. — Delauriere D. sur la solu-
tion de continuity du tendon d'Achille, produite par la contraction musculaire.
Paris, 1809. — Oehlers D. tendinis Achillis disrupti felicissimae sanationis, etc.
8vo. Kiliae, 1819.— A case of imperfect rupture of the tendo Achillis is given by
Ehrmann Compte rendu des travaux anatomiques. Strasb. 1827, p. 22. Kelch,
Beitrage zur pathol. Anatom. No. 16, found, in a very old dislocation of the
upper-arm-bone, the long tendon of the M. biceps torn ; an instance of rupture
of the ligament of the patella is given in the Lond. Med. Repos. Sept. 1825. —
Ruptures of tendons also occur in animals, viz. the perforating flexor tendon of
the foot in a horse, v. Greve Erfahr. und Beob. iiber die Krankheiten der
Hausthiere, Vol. II. p. 5. — C. Fr. Hoffendahl D. de tendinis Achillis ruptura et
conglutinatione. 4to. Berol. 1826, with plates.

(2) Compare the observations above quoted, § 109, note 3 and 4 ; also
A. Bonn, Comment, de humero luxato. 4to. L. B. and Amstel. 1782, with en-
gravings.— Todd's account of a recent dislocation of the hip-joint, in Dublin
Hosp. Rep. and Commun. in Med. and Surg. Vol. III. Dublin, 1822. —
Warren. — Sometimes merely one lateral, or only an internal ligament, as the
round ligament of the hip is torn, whilst the capsule of the joint remains un-
injured ; the latter was observed by Hesselbach, Vollst. Anleitung* zur Zerglie-
derungskunde. Vol. I. Part II. p. 57. — W. Wallace in Dublin Transactions
of the Association of Physicians, Vol. V. 1826.

(3) Spangenherg relates an instance in the translation of Bayer's work on the
diseases of bones. Vol. II. p. 197. Leipz. 1804. — Nees observed a spontaneous
dislocation from the deposition of gouty tophus in a joint, v. Hufeland's Journ.
der prakt. Heilk. Vol. XVI. Part II. p. 180.

(4) I have seen dislocations several months and even years old, in which the
original rupture of the articular capsule was still very distinct, and merely closed
within by synovial membrane, and without by a little and soft cellular tissue. In
a lady of my acquaintance, who some twenty years since dislocated the humerus,
the bone was readily dislocated at every violent elevation, but was as easily
reduced. Hence also old dislocations are sometimes perfectly replaced ; for in-
stance, the head of the thigh-bone, even after five years, v. Cornish in Lond.
Med. Repos. p. 200. March, 1822.

(5) A most remarkable instance of this is related by Baronio, in which the
whole tendo Achillis was reproduced, v. WeigeVs Italien. medic, chir. Bibliothek.
Vol. IV. Part I. p. 47. — Experiments on the reproduction of this tendon are
related by Lee Fearn in Medical Recorder, quarterly series, No, 39, Vol, XII.
No. 1.

§ 149.

Inflammation/ as the common cause of vice of texture
in fibrous parts, deserves first to be noticed. This is in
general not very fi:equent ; but in parts of this system which
are very vascular, as the periosteum, the articular ligaments,
and the dura-mater, it is by no means unfrequent, and is some-
times produced by mechanical causes, as contusions, ruptures,^
vv^ounds, occasionally by stabs, &c., sometimes by general
diseases communicated to them, and among these especially,
gout, rheumatism, syphilis, and scrofula. The inflammation
of fibrous parts rarely assumes an acute character, as is, how-
ever, sometimes the case in gout and rheumatism ; its course
is usually more tedious, and all the phenomena so indistinct,
that they are often overlooked. According as the degree of

2S4f Of the Fibrous S?/stem, and Joints, [Part II.

the inflammation and the state of the fibrous parts varies, so
do v/e find the redness and swelling in a greater or less
degree ; sometimes indeed we observe the parts, as it were,
merely injected, or with more or less large and numerous red
streaks or undefined spots ; in other cases they are more
generally reddened, and not uncommonly of a rose-red colour ;
the latter is especially the case, if they come in contact with
the air, as may be best seen in trepanning and in amputa-
tion through joints ; in many cases also the colour of the
inflamed parts is more or less yellowish, and if they have
naturally a tendinous glistening, that is also in general com-
pletely lost, and in chronic or often repeated inflammation and
their consequences, the fibrous organs are sometimes also
found discoloured in various ways, viz. grey, brownish, and
even blackish.

The swelling is commonly but trifling; if the inflamma-
tion continue longer, or it recur often without complete resolu-
tion, the fibrous organs also swell very much, and we then
find the fibrous structure more or less wasted, their boundaries
with the neighbouring as well as with the inflammatory parts,
not distinct, and either a jelly-like fluid poured out into the
swollen cellular tissue, or the latter converted rather into a soft,
reddish kind of substance.

Should the degree of inflammation be very high, it runs,
although tediously and moderately, into suppuration, in
which the fibrous parts are eaten through, and more or less
destroyed.

(1) Huhn D. de rite cognoscenda et curanda systematis fibrosi inflammatione.
8vo. Halae, 1820. — Rayer, in Archives gen^rales de Medecine, March and
April, 1823.

(2) For example, in sprains and dislocations of joints, distortio.

§ 150.

Concerning the inflamed state of joints in particular,
this indeed in many cases has its original seat in their
fibrous and fibro-cartilaginous parts,^ however more frequently
in their lining membrane, the synovial,^ which like all serous
membranes easily inflames ; it is just as easily affected by
mechanical causes as by gout, rheumatism, syphilis, metastasis,
&c., and is then found more or less swollen, reddened, and
softened.^ If the inflammation be not resolved, then there is
consequent either increased secretion into the joint especially of
fibrous matter, which not rarely produces anchylosis, or there
is more usually suppuration. Not less frequently does arti-
cular inflammation and destruction originate in the bones,
of which the articular extremities, partly from injuries, partly

Sect. XVII.] Of the Fibrous System, and Joints, 2S5

in an especial manner from scrofulous diseases, and other
internal causes, inflame ; and internal caries, caries articulorum
interna seu centralis,'^ a kind of paedarthrocacy, is produced.
But should the disease have its original seat in the bones or
synovial membrane, sometimes also are the fibrous, fibro-
cartilaginous, and even the bony parts of the joint themselves co-
affected; this is also the case where the morbid causes operate so
violently upon the joint, that all the parts are simultaneously
attacked with inflammation, as we not unfrequently find the case
after violent bruises, penetrating wounds, fractures of bones,
which extend into joints, &c. In all these cases there arises
either an acute and distinctly progressive general inflamma-
tion OF THE JOINT, artlirophlegmone, to which articular
anchylosis, abscess, caries, caries externa,^ &;c. are consequent ;
or a more chronic, and in its origin a more undecided state of
inflammation, mostly produced by scrofula and rheumatism,
which, according to the variety of its symptoms, seat and
consequences, is named morbus coxarius, luxatio spontanea,
claudicatio congenita, fungus articulorum, arthrocace, hip

DISEASE, SPONTANEOUS LAMENESS, ARTICULAR FUNGUS;'' but

it is essentially always the same disease, of which the following
are the most remarkable symptoms : the joint is, more or less,
sometimes very remarkably swollen, less movable than in the
healthy state, and always to a certain degree bent ; the tumour
itself is at certain parts hard, firm, elastic, in other parts
as it were doughy, and unsteady ; the common integuments,
even to the last stage, when sinuses are formed, remain un-
changed, though occasionally somewhat varicose and underlaid
with hard fat; the muscles which surround the joint often
appear pale, and together with the neighbouring cellular tissue,
infiltrated with lymph; the articular ligaments more or less
swollen, hardened, although loosened in some spots, dull,
often without any distinct fibres, and often consolidated with
the neighbouring cellular tissue ; whitish, here and there dis-
coloured, generally converted into an unvascular mass, in
which are observed at different parts several little cavities filled
with lymph, jelly-like fluid, or ichorous pus ; the internal
articular ligaments, the menisci, the cartilaginous layers on the
articular extremities, and the synovial membrane are entirely
or partially destroyed ; the bone becomes affected primarily or
secondarily in a greater or less degree, is either swollen,
softened, inflamed, and becoming carious from within, or it is
but little swollen and tolerably hard, but superficially eroded
or destroyed by caries, by which in general, especially if the
heads of the joint are swollen, and even without that, dislo-

236 Of the Fibrous System, and Joints. [Part II.

cated ; we find also in young individuals the epiphyses some-
times lost at their diaphyses ; in the articular cavity itself, we
observe at first a large quantity of thickish, albuminous-like,
often pale-reddish-coloured synovia, and in later stages of the
disease, if the suppuration have more or less destroyed the joint,
a thinnish, often very foul-smelling pus mixed with blood,
cartilage, and cartilaginous fragments, and the so-called arti-
cular mass of fat sometimes increased, filling up entirely or
partially the cavity of the joint. ^ In animals, fungus of the
joint and spontaneous lameness occur but rarely.®

(1) I think I have also observed this very satisfactorily in several cases.

(2) L. Moffait Recherches sur les Phlegmasies des membranes synovial
des articulations. Paris, 1810. — Smiveur de la Villeraye These sur les inflammations
du systeme sereux et du systeme synovial. 4to. Paris, 1812. — Chomel D. sur le
Rheumatisme. Paris, 1813. — Valleraud de la Fosse, D. sur le Rheumatisme. Paris,
1815. — Roche Sur les Phlegmasies du systeme fibro-sereux des articulations. 4to.
Paris, 1819.

(3) Brodie, c. 3, has found the synovial membrane frequently converted into a
light brownish pultaceous mass, from J to J^ an inch thick. I have also found
this several times ; but it seems to me that this extraneous mass is rather putrid
bloody sediment mingled with fibrous matter, than a conversion of the mucous
membrane, of which however I find at the same time, here and there, distinct
traces.

(4) According to Rust.

(5) Eck D. de carie articulorum externa cum interna comparata. Svo. Berol.
1818, with engravings.

(6) By the English, according to Wisemann's Chirurg. L. IV. c. 4, White
Swell mg ; from the difference of its seat, also Coxarthrocace, GonnrtJirocace,
Omarthrocnce, Olecranarihrocace, Spondylarthrocace, &c. — Here also belong the
cases described by the ancients under the names Pcedarthrocace, Abscessus articu-
laris. — J. II. Slevogt resp. Wucherer D. de tumoribus artuum fungosis. Jenae,
1715. — A. Monro primus, On the White Swellings of the joints, in Edinb. Med.
Essays and Observat, Vol. IV. p. 242. — Th. Simpson, History of a White Swelling
of the knee, ib. p. 246. — Detharding resp. Becker D. de fungo articulorum.
Rostock, 1743. — Enckelmami D. de fungo articulor. 4to. Argent. 1749. — Reimarus
D. de tumore ligamentorum circa articulos, fungo articulorum dicto. Leid. 1757.

— Cartheuser D. de fungo articulor. Francof. 1769. — Sidrhi resp. Bockler D. de
tumore articulor. fungoso. Upsal. 1769. — B. Bell, A treatise on the theory and
management of ulcers, with a dissertation on White Swellings of the joints, &c.
Edinb. 1778. — Muller D. de fungo articulor. Gott. 1780. — P. Camper Over het
mankgaan in Haarlem. Vevhandelingen, Vol. VII. Part I. p. 452, and in
Kleinern Schriften, deutsch von Ilerbell, Vol. I. Part II. p. 108. — Palletta Ex-
ercitatio de claiidicatione congenita. L. B. 1787, and Exercit. pathol. I. p. 30

— 58. — J'dger Bcitrage zur Erlauterung der Entstehungsursachen und der
Heilarten des (iliedschwammes. Frankf. 1789. — Storr D. de fungo articulari.
Tubing. 1792. — Fahsel D. de fungo articulor. Gott. 1792. — Ford, Observations
on the disease on the liij)-joint, to which are added some remarks on White
Swelling of the knee, &c. London, 1794 ; second edit, by Copeland. 8vo. London,
1810. — Oemler I), de fungo articuli, etc. Jena?, 1797. — Dylius D. de claudica-
tione. 4to. L. B. 1798.—./. Ilewson D. de morbo coxario. Edinb. 1798.— Klcffel
D. de fungo articulor. Hala>, 1798. — Krcysig 1). de fungo articulari. Viteb.
1799. — Munck af Rosen sckold D. de morbo articuli coxae. 4to. Lund, 1799; and
in K. Svcnska Vctensk. Akademiens nya. Handlingar, 1802, Part I. p. 57. —
Bernstein D. de fungo articulor. Jena', 1801. — J. Jlerdman, on White Swelling
of the joints, &c. 8vo. Edinb. 1802. — J. Itus.scl, Treatise on the morbid affec-
tions of the Kncc-Joint. Edinb. 1802. — Pulous Observations et Idees relatives

Sect. XVII.] Of the Fibrous System, and Joints, 2tf7

aux tumeurs blanches des articulations. 8vo. Paris, 1802. — Berends D. de fungo
articulor. Francof. 1804. — Franck D. de morbo coxario. Marburg. 1804. —
Vecrhelc De morbo coxario seu de tumore albo articuli coxo-femoralis. 4to.
Paris, 1806. — J. A. Albers and Picker Gekronte Preisschrift iiber das sogenannte
freiwillige Hinken der Kinder. 4to. Wien, 1807. — Crowther, Practical observa-
tions on the disease of the joints, commonly called White Swelling, &c. London,
1808. — Wirth D. de coxalgia. Wirceb. 1809. — Krause De claudicatione Comm.
med. chir. 4to. Lips. 1809. — Pundt D. de fungo articuli. Gc3tt. 1809. — J.
Watts D. de morbo coxario. Edinb. 1809. — Browne D. de morbo coxario.
Edinb. 1813. — Gordon D. de tumore albido. Edinb. 1815. — Baier D.
de fungo articulor. 8vo. Wirceburg. 1816. — Volpi Saggio di osservazioni
medico- chirurgiche. Vol. III. No. 4. Pavia, 1816. — R. M. Davis D. de morbo
coxario. Edinb. 1816. — Rust Arthrokakologie, oder iiber die Verrenkung durch
innere Bedingung und iiber die AnwendungdesGliiheisens. 4to. Wien, 1817, with
eight engravings. — P. Fairhairn D. de mordo coxario. Edinb. 1819. — Leube
Adnotationes ad coxarthrocacen. 8vo. Tubing. 1821. — C. L. Lehmann D. de
coxarthrocace. 8vo. Berol. 1821. — Juiignickel D. de tumore albo. 8vo. Berol.
1824. — Reisick Abhandlung iiber die Coxalgie. 8vo. Prag. 1824. — Margot Mem.
sur les tumeurs blanches des articulations, in Archives generates de Medecine,
May, 1826. — Lehmann Tumoris genu albi et Gonarthrocaces adumbratio patho-
logica. 8vo. Rostock. 1826. — Ruhstrat Abhandlung iiber die weisse Kniegesch-
vvulst. 8vo. Gott. 1826. — H. P. Z'ohrer Monographie der weissen Geschwulstam
Kniegelenke, u. s. w. Wien, 1828. — Sprengel in Rust's Magaz. f. d. ges. Heilk.
Vol. IX. Part II. p. 302, has well described a few cases of White Swelling in
the knee ; and Nicolai also in the same work. Vol. XXII. Part I. p. 3. — Compare
above, § 135, 138, and 142. — In very rare instances, congenital spontaneous dis-
ease of the hip-joint has been observed, v. Hippocrates De articulis, Sect. VI.
p. 819. — Alhers relates three instances of it; perhaps also the cases of conge-
nital dislocation of the head of the thigh-bone mentioned by Dupmjtren may
be referred here, at least that in which the round ligament was very much
elongated, v. Repertorie general d' Anatomic et de Physiologic pathologiques,
etc. Vol. II. Part III. p. 150.

(7) I have made use of this description, after numerous observations on
individual cases, and the proofs of it are partly to be found in Bresl. Mus. v.
No. 2152—2154, 3407, 3408, 3432—3435, 3440, 3442, 3443, 3489, 3684—
3693, &c.

(8) I have found examples in the hip-joint in two monkeys, one nasua rufa,
and one adult female kangaroo. Perhaps also here belongs the diseased hip-
•oint of a pig, mentioned by Sandifort Mus. Anat. III. p. 241, No. 681, 682.

§ 151.

Another termination of inflammation in the fibrous system
is ossification/ which is especially very common in many
parts of this system, viz. the Hgaments and the dura-mater ;
less frequently in the periosteum/ the tendons/ the fibrous
membrane of the spleen, and but seldom in the other fibrous
structures ; it shows also a very diflferent degree of production, as
sometimes only the fibro-cartilaginous base of bone is deposited
in form of plates or flat roundish swellings,* more frequently
true phosphate of lime is deposited, sometimes as distinct spots
and kernels of bone surrounded with vascular circlets, some-
times in form of splinters, sometimes, lastly, throughout and
equally in the fibrous tissue. Should the articular ligaments,
which are then usually shortened, be found in this state, there
ensues either stiffness of the joint, rigiditas articulorum,

238 Of the Fibrous System, and Joints, [Part II.

anchylosis incompleta seu spuria, or actual anchylosis,
anchylosis veraJ' Both vices occur commonly in man and even
in animals, when an earthy mass, less resembling bone than
gypsum or chalk, gouty tophus,^ as it is called, consisting
especially of urate of soda, is, in gouty persons, deposited in
the ligaments, in the neighbouring aponeuroses, and perios-
teum of one or several joints, at first in a soft, but subsequently
in a hard state, and often in great quantity.

(1) Compare especially Boyer in Archiv. gener. de Medec. March and
April, 1823.

(2) V. above, § 119.

(3) I have seen only a few instances in man. — A good example on almost all
the tendons of the lower extremities is described by Veslingius Observ. Anat.
Epist. posth. XV. — Other instances in Bartholinus De diaphvagmatis strnctnra
nov. Paris, 1676. — Booerhaave Praelect. ad instit. Medic, edit. Halleri. Goett.
1739, § 4:78.— He uermayin Physiologie, Vol. III. p. 162. — Whether the disease
described by Sauvages in his Nosol. Method. Vol. I. p. 530, under the name
Catochus, and by Macbride in his Introd. med. theor. et pract. med. Traj.
1774, as sarcostosis, in which the entire limb was said to be converted into bone,
belongs here, or whether it was ossification of the aponeurosis, it is very
difficult to determine, as they, and indeed that related by Henry, in Philos.
Trans. 1759, Vol. LI. p. 89; Vol. LII. Parti, p. 143, are very doubtful.—
Walter also found lime deposited between the tendons of the fore-arm, in a gouty
person, v. his Mus. Anat. Vol. I. p. 144, No. 289.— In animals, ossification of
the tendons is more frequently observed ; for instance, in the horse, v. Schwab
Materialen zur pathol. Anat. der Hausthiere, Iste Liefer, p. 49. - In the Cape
jerboa, and other quadrupeds, which always spring from their hind limbs.
V. Cuvier Lemons d'Anat. Comp. Vol. I. p. 115. — I found the lendo Achillis
ossified in a dipus ; very frequently in birds, especially of the gallinaceous kind,
in the legs ; and, before all others, in cranes, v. Rudolphi Physiol. Vol. I. p. 85,
§ 88, note. — I have observed the same in the peacock, guinea-fowl, partridge,
crax pauxi. No. 3931 of Bresl. Mus. and in an ossifrage eagle.

(4) Here partly belong the gummata in the periosteum, the fibro-cartilaginous
spots on capsular membranes especially in the hip-joint, the frequent cartila-
ginous plates in the fibrous membrane of the spleen, in the tendons of the
smaller muscles, &c.

(5) Compare above, § 109. — Also without anchylosis, those ligaments which
connect two immovable bones naturally become ossified ; for instance, the pro-
per ligaments of the blade-bone, the lig. tuberoso and spinoso-sacrum, &c. —
Greve saw a large lime-like deposit in the nuchal ligament of a horse, v. his
Erfahr. und Beob. Ubcr die Krankheiten der Hausthiere, Vol. II. p. 4.

(6) Gouty deposits occur not merely on the joints of the extremities, but
even in the jaw. v. No. 3270, 3271, and 8360, of Bresl. Mus. — On the joints of
the spine, &c.— Sometimes they become very large; I have seen them as large
and larger tban a walnut. In many instances they give rise to spontaneous
dislocation. — v. Lieutaud Ilistoria anat. medica. Vol. \\\. p. 90, Obs. 230 and
232.— AVc5 in Hufeland's Journ. der prakt. Hcilk. Vol. XVI. Part II. p. 180. —
On gouty deposits, compare § 72, note 3. — Also Contuli De lapidibus podagrae et
chiragrae in corp. hum. i)roductis. Rom, 1679. — Born De arthritide nodosa.
Leid. 1699. — van Priesteren D. calculorum genesis et convenientia cum tophis
podagricis. L. B. 1788. — Jdger D. acidum phosplioricum morbor. quorundam
caussam proponens. Stuttgart, 1793. — A remarkable instance of to})bus in the
ligaments, tendons, and aponeurosis about a joint, is described by Lobstein in
Compte rendu sur les travaux anatomiques, etc. Strasb. 1824, p. 16. — Another by
van der liounMesch Eene scheidkundige outleding van den Jichtkalk in Bydragen
tot de naturkundige \Vcten.schai)pen. Anjsterd. 1826, D. I. No. 2, p. 127. —
Tejinanl's and Wullastons o])inion that it is not phosijhate of lime, but phosphate

Sect. XVII.] Of the Fibrous System^ and Joints. ^39

of soda, is confirmed by Fourcroy and Vmiquelin in Anal, du Mus. d'hist.
nat. Vol. I. p. 93; Vol. II. p. 201 ; Vol. IV. p. 329, and in Fourcroy' s Syst. de
conn. chym. Vol. X. p. 265. — Vogel in Bulletin de Pharm. No. 12, p. 568,
&c. — In many instances gouty concretions contain no urate of soda, but phos-
phate of lime. — John in Meckel's Archiv fiir die Physiol. Vol. I. Part IV. p. 513.
— Gouty tophus also occurs in animals, though much more rarely ; viz. in fowls
and hawks, on the joints of the toes. v. Aldrovandi Ornithol. Vol. I. p. 456. —
Tiedemann Zoologie, Vol. II. p. 165.

§ \52.

A very rare termination of the inflammation of fibrous parts
is MORTIFICATION ;^ it occurs primarily and distinctly, but is
always rare, perhaps only in such parts of the system as are
proportionally tolerably supplied with blood-vessels, viz. the
periosteum and the dura-mater ; in the other fibrous organs, for
instance, the tendons, articular ligaments, aponeuroses, &c., it
has generally only been primarily observed, when they have
been completely laid bare by wounds and ulcers, and exposed
to the air, in which case they are destroyed and exfoliate,
together with the surface of the bones and cartilages.^ In
connexion with other parts, the fibrous system, as is understood,
is often attacked with mortification ; so that, for instance, in
a mortified foot, the tendons, aponeuroses, &c. together with
the other soft parts, become gangrenous ; anthrax also easily
extends itself from the neighbouring to fibrous parts. ^ In
mortified limbs, the articular ligaments are also attacked, so
that hence sometimes arises the spontaneous loss of a hmb.''

(1) Neither brownish nor blackish coloured fibrous parts are, for that reason,
gangrenous ; because sometimes from morbid irritation alone there is a deposit
of black pigment. Compare § 147.

(2) Remarkable instances of exfoliation of the tendo Achillis are described by
Baronio, and by Acrel, v. Chirurg. Vorfalle, Vol. II. p. 380. This is not unfre-
quently the case in the finger inwhitloe. — [In the Mus. at St. Thomas's Hospital,
there is a tendon on one of the flexors, which had sloughed out, in consequence
of injury to the finger. T.]

(3) Lavernet in Journ. de Medec. contin. Vol. II. p. 248, describes a case of
destruction of several tendons by an anthrax.

(4) Compare § 62.

§153.

As to SPURIOUS FORMATIONS, thcsc are but rarely observed
in the fibrous system. There exist, for instance, but few
examples of encysted tumours^ in this tissue, if we do not
reckon those bursal tumours which occur on the articular cap-
sules, and partly between the tendinous fibres of the aponeuroses,
and especially on the elbow-joint, and knee-cap, which have
their origin in the mucous bags there placed. Just as rare are
the TUBERCULAR FORMATIONS in and on fibrous parts ; deposits
of scrofulous matter, however, occur here and there in the

240 Of the Fibrous Si/stem, and Joints. [Part II.

tissue of the dura-mater and the periosteum.^ We more fre-
quently find FUNGOUS AND SARCOMATOUS SWELLINGS In the

fibrous organs, to which belong the already described sarcom
of the periosteum/ the fungus of the dura-mater hereafter to
be mentioned, the very rare fungous growths on the tendons,*
and the sarcom observed sometimes in and upon the arti-
cular ligaments, which indeed occasionally approaches the
character of medullary saixom.^ Cancer does not occur
primarily in the fibrous system, but it equally attacks it se-
condarily.®

(1) In the Strasburg Mus. there is an encysted tumour on the tendon of the
flexor muscle of the finger, v. Ehrmann Compte rendu des travaux anatomiques,
etc. Strasburg, 1827, p. 22, No. 428, des IVIusei.

(2) I have myself found them on these parts.

(3) Compare § 120.

(4) Dzondi observed them on the extensor muscles of eight fingers, v.
Beitr'age zur Vervollkommung der Heilkunde. Ister Theil. Halle, 1816.

(5) I have three or four thues found in very old and large white swellings, so
called, between the layers of the much- thickened articular ligaments, and the
aponeurosis of the knee, several roundish tumours, which, in their nature, very
nearly approximate to medullary sarcom. — Burns, Dissertation on inflammation,
Vol. II. p. 311, describes an instance of fungus haematodes in the hip-joint;
and Langenheck, one of medullary sarcom in the knee-joint, v. Neue Bibliothek
f. Chir. und Augenheilkunde.

(6) In a carcinoma of an inguinal gland, I have found the ligamentum
fallopii, and the neighbouring tendons of the abdominal muscles, partly
destroyed.

§ 154.
Lastly, we observe the contents of the cavities formed by
fibrous membranes not unfrequently irregular. To these be-
long partly, the morJ)id collections of water, jelly-like fluid,^
pus, blood, &c. in the aponeurotic sheaths surrounding and
separating the muscles, as, not merely does the joint-fluid,
stjnovia^ vary exceedingly, but even extraneous substances occur
in the articular cavities. Thus we find the synovia deficient
in respect to quantity, inasmuch as it is sometimes in so small
quantity, that hence ensues a kind of stiffness, friction, and even
a creaking of the joint; or it is much more commonly found in
too great quantity. The latter is most generally the case in all
inflammatory states of the synovial membrane, but it occurs
without any distinct inflammation, especially in the knee-joint
in rheumatic, rickety, and syphilitic patients, &c., sometimes to
such degree that the joint is occasionally more or less swollen
at the weaker parts, its use prevented, and itself even dislo-
cated ; this always local disease we distinguish by the name
DROPSY OF A JOINT, hydrops articuloru7n, hydrarthiis, meli-
ceria.^ The colour and consistence of the synovia are also
often abnormal, and we observe it then muddy, reddish, too
watery or too albuminous, similar to half-coagulated jelly, &c.

Sect. XVI L] Of the Fibrous System, and Joints. 241

To the extraneous substances which we sometimes observe
in joints, belongs quicksilver/ which is however very rare ;
rarely also blood, which is effused into joints in injuries of
various kinds ;^ more frequently pus, which is produced either
from a high inflammatory state of the synovial membrane, and
of the bony cartilages and ligaments forming the joint in the
articular cavity itself, or it may have made its way into the
joint from without ;° and lastly, unusual loose cartila-
ginous CONCRETIONS, which have not unfrequently been
observed to grow on the inner or expanded surface of the
synovial membrane, into club-like or necked appendages;^
these at first are attached by thin threads, but when these are
broken, they lie loosely in the joint, are at first soft, then
mostly cartilaginous, sometimes however merely cartilaginous
within, or are entirely bony ; are usually round, but in some
cases also flattened and angular, and very variable in size and
number.^

(1) Very commonly in acute rheumatism.

(2) /, A. Cdmmerer prses. Haase D. de unguine articulari ejusque vitiis. 4to.
Lips. 1774.

(3) Fahr ictus Hildaniis De ichore et meliceria acri Celsi, sive Hydarthro, v.
Op. p. 83L — M. Hoffmann D. de meliceria s. articulorum laesorum inundatione.
Altd. 1650. — Charislus D. de meliceria Celsi. Regiom. 1726. — Haffner Yon
der Gelenkwassersucht. Freiburg, v. Welz N. Auszuge. Vol. V. p. 129. — Brown
D. de hydarthro. Edinb. 1798. — Savarin-Marestan D. sur les hydropisies arti-
culaires, etc Svo. Pai'is, 1803. — Sanders D. de hydarthro. Edinb. 1809. —
Taaks D. de hydrope articulationum. 8vo. Berlin, 1815. — Russel, Chap. VI. —
An instance of water in the knee-joint is described by BohilUer in Recueil de
Memoires de Med. Chir. et Pharm. militaire par Fournier, Vol. XI. p. 300. —
In a rickety boy, four years old, I once saw dropsy of the joints, both of the foot
and hand, as also of the membrana capsularis carpi communis. — In the horse,
hydrarthus is not rare. v. Rohlwes Magaz. f. d. Thier arz neikunde, Vol. I. — Of
windgalls, v. Greve Erfahr und Beob. iiber die Krankheiten der Hausthiere,
Vol, I. p. 85.

(4) Several instances in LieutaudH\s,tox\s. anatomico medica, Vol. III. p. 9d.

(5) Compare Russel, Chap. V. — Hey, Practical Observations in Surgery,
p. 354.

(6) Abscesses in the neighbouring soft parts easily penetrate into the cavities
of the hip and knee, when the mucous bags there situated are connected by an
aperture with the joint, either from being rubbed through, or as an original vice
of formation. I have seen some such instances in both the above-mentioned
joints. In one ease, v. my Selt. Beob. Part II. No. 17, p. 42, a lumbar abscess
had burst into the hip-joint. I have also since seen another such case. Rustj
too, describes a similar instance, in his Magaz. f. d. ges. Heilkunde. Vol. I.
Part I. p. 46.

(7) Compare above, § 81. — Cases in which these processes with necks were
very numerous are described by A. Bonn, in Thesauro ossium morbosor. Hovi-
ano. No. 75 ; and by Gotz D. de morbis ligamentorum, tab. 1. — BohilUer in
Recueil de Med. Chir. et Pharm. milit. par Fournier, Vol. XI. p. 300; all three
in the knee-joint. I have lately observed a very great quantity of them in
the diseased hip-joint of a gouty person ; we usually find at the same time
much viscous synovia in the joint.

(8) The disease is also called mures in genu; by Swediaur, arthroncus tuber-
culosus. Such cartilages are not to be confounded with little exostoses and

R

^42 Of the Fibrous System^ and Joints. [Part II,

gouty tophus, which have been broken off. They most commonly occur in the
knee, although also in other joints. — Amhr. Par^ CEnvres, Livr. XXI. Chap. 15,
p. 772. — Marcellus Donatus De histor. med. mirab. L. IV. c. 30 (in the hip). —
Pechlin Observat. physico-med. Obs. 38, p. 306. — Henkel Med. und chirur.
Anmerk. Part HI. p. 7; Part V. p. 26 (several). — Monro prim, in Edinb. med.
Essays, Vol. IV. No. 19, p. 244.— 5msow, ib. No. 20, p. l^iQ.—Rcimarus D. de
tumore ligamentorum circa articulos, etc. Leyd. 1757. — Morgagni De sedibus et
caus. morbor. Epist L. LVII. 14 (some twenty in the knee; in other instances
he also observed them in the knuckles). — -v. Haller Progr. de induratione in
c. h. partibus, § 5, and in Elem. Physiol. Vol. VI. p. 9 (above twenty in the
maxillary joint). — Bromjield, Observations, I. p. 330 ; II. p. 76. — Theden'Seue
Bemerk. und Erfahrungen zur Bereicherung der Wundarzneikunst, 17S2,
Vol. I. Sect. 17, p. 99. — Cheston Pathological Inquiries and Observations in
Surgery, &c. — Crulkshank in Edinb. medic. Comment. Vol. IV. p. 342. —
Ford, in Medical Observations and Inquiries, Vol. V. No. 30, p. 329 (of the size
of a chestnut). — Loffler Beitrage zur Wundarzneikunde, Part I. (in the elbow-
joint). — Warner in Philosoph. Transact. 17<56, p. 452, — Coley in Medico-chir.
Transact. Vol. V. p. 76 (in the elbow-joint as large as a nux vomica). — Mohrenheim
Beobachtungen verschiedener chir. Vorfalle, Vol. II. — Home, in Transact, of a
Society for the Improv. of medic, and chir. Knowledge, p. 229 (one instance of
three pieces; another, in which the cartilage was nearly as large as the patella; and
a third, in which thirty or forty of such little cartilaginous bodies were produced
in a false joint). — Sulzerm. lUchter^s Chir. Bibliothek. Vol. VIII. p. 492. — Desault
in Journ. de Chir. Vol. II. No. 45. Similar instances observed hy Hewit, Middle-
ton, Gooch, Sahatier; and B. Bell found them in the joints of the foot ; they were
found also in those of the hand. v. Boyer Traite des Maladies chirurgicales.
Vol. IV. p. 434. — Heilmuiin D. de corporibus juxta articulos mobilibus. Wiirceb.
1796. — Munro, a Description of all the Bursae, &c. fol. Edinb. 1788. — Bichat
Anat. Gen. (in the capsular membrane of the pisiform-bone). — Champigny D. sur
les corps etrangers, qui se forment dans les articulations. 8vo. Paris, 1803. —
Abernethy, Surgical Observations, &c. Lond. 1804, p. 253, found one hundred
in one joint as large as shot. — Laennec, in Diet. des. Sc. medical. Vol. IV. p. 123,
Art. Cartilages accidentelles, found thi^m also in the joint between the head of
the tibia and fibula, and mentions, on the authority of Bichat, that they were
observed in the thumb. — Sauter in v. SiebohVs Chiron. Vol. II. p. 359, with
plates. — Larrey in Nouv. Bulletin de la Soc. philomath. 1810, Vol. II. p. 182;
and in Memoir, de Chir. militair. Vol. II. p. 421. — Laxzari in Giornale della
Soc. med. chir. di Parma. Vol. I. p. 198. — Wardrop in Edinb. med. and surgic.
Journ. Vol. IX. p. 14. — Clark in Med. chir. Transact, of Lond. Vol. V. No. 4,
p. 67 (in one case three). — Hey, Practical Observations in Surgery. Lond. 1814,
Cap. VII. (an instance in the elbow-joint). — Williams, in London medical Re-
pository, March, 1815. (The mother and grandmother of the boy had had the
same disease). — B. G. Schreger Beobachtungen ~und Bemerk. iiber die bewegli-
chen Concremente in den Gclenken und ihre Exstirpation. 4to. Erlangen,
1815. — Blackett, in London medical Repository, May, 18l6. — Russel, On the
Morbid affections of the Knee-joint. (They were sometimes covered with a
delicate membrane, which, in rare instances, was freely supplied with blood-
vessels).— Ceruiti Beschi'cibung der pathol. Priiparate des anat. Mus. zu Leipzig,
1819, No. 646. — Buhle D. de arthroncis tuberculosis. 8vo. Ilalop, 1823 (two
instances in the knee, a third in the shoulder). — Blenland Dcscriptio Musei
anat. 1826, p. 293, No. 1663 (attached in tlie elbow-joint.) — Wcdemeyer in
V. Griife's and v. Walther's Journ. der Chir. 1826, Vol. IX. Part l.— Cassan Note
sur les concretions dites albumineuses, in Archives gencrales de Medecine,
Mai, 1826. — Ekstrom in Am. Beriittelse om Svenska Lakare-Siillskapets Arbcten
Lemnad af Ekstrom. Stockh. 1826 (as large as a bitter almond, after some time
a still larger must have been removed). — Cruveilhier in Nouv. Biblioth. medic.
Janv. 1827, p. 79. — G. Sandifort Museum nnatomicum. Vol. IIL j). 298, No.
1040 and 1011 (partly porous). — //. ./. K'nlilcr I), de corporibus alienis in arti-
culis obviis. 8vo. Berol. 1827. —In the llunterian Museum, London, 1 saw
several such cartilages, among which, one almost as large as the knee-cap

Sect. XVI II.] Of the Muscular Si/stem. 24^3

(v. Home), and a diseased knee-joint, which was internally covered with car-
tilaginous growths, and with several large cartilages suspended by necks.
Further, in the Anat. Mus. of the Surgical Academy at Copenhagen, a few large
cartilages, removed from the knee-joint by operation ; and a large irregular
cartilaginous concretion from the knee, in the Anat. Mus. at Rostock. I have
described three such instances in my Selt. Beob. Part II, p. 37, No. 14, the first
of which consists of a large loose flat bone from the knee ; the second, of a little
cartilage from the elbow ; and the third, of two bones hanging by threads to the
knee. I have since twice found in the elbow-joint a little loose cartilage, v. my
Verzeichn. No. 2159, 2161—2163, and 8446, of the Bresl. Mus.

EIGHTEENTH SECTION.

Of the Muscular System.

§ 155.

Among the different vices of the muscular system^ are its
so-called varieties/ and especially such as refer to number,
v^^hich are the most common ; rarely, however, is there a true
morbid condition, that is, the cause of impeded or disturbed
muscular activity. The latter, however, is the case, if in
monsters the muscles of the whole body, or of certain regions,
have not been developed from their original jelly-like cellular
base into true muscles, or are entirely deficient ; this has been
observed in some instances throughout the whole body ; ^ more
frequently at certain parts. ^ The congenital deficiency of
certain muscles, or parts of them, without actual hindrance of
the power of motion, is very common; thus the zygomaticus
minor, one sternothyreoideus, stylohyoideus, styloglossus, one
scalenus, the sternocostalis, one or both pyrarnidales abdo-
minis, the hiterspinales cerricis, the palmaris lojigus, one
lumhricalis, the extensor proprius, and the flexor of the little
finger, one or other tendon of the flexor and extensor of the
fingers, the psoas minor, the upper gemellus, the plantaris, the
peroneus tertius, and single heads of the flexor and extensor
of the toes are deficient.^ More rarely is there deficiency of all
or some of the muscles of the eyes,® of the levator labii supe-
rioris proprius, the zygomaticus major, the geniohyoideus,
both stylopharyngei, the omohyoideus, the long head of the
biceps brachii,^ the whole anterior half of the deltoideus^ the
pronator quadratus, the middle portion of the serratus anticus
major, of the lower gemellus, the pyriformis,^ the quadratus
femoris, the short head of the biceps femor is, &c.

The opposite vice, or excess of number in the muscles, is
not less frequent, and occurs sometimes in many parts of the

R 2

244 Of the Muscular System. [Part II.

body at once.^*^ The increased number commonly arises from
the stronger development and division of the normal muscles ;
thus, for instance, we observe the ohViquus oculi superior, and
the ahducens^^ the retrahentes auris, the risorius santoriniy
depressor alee narium, stylolnjoideus, stylopharyngeus , genio-
hyoideus, omohyoideus, stcrnoliyoideus, the sternocleido-
mastoideuSy splenius capitis, rectus capitis j^osticus major,
rectus capitis lateralis, the scaleni, interspinales, intercostales ,
cucullares, pectorales, the suhclavius, biceps braehii, bra-
chialis internus, pronator teres and quadratus, supinator
brevis, extensor radialis brevis, the flexores and extensores of
the fingers, the lumbricales, the pyramidales and recti abdo-
minis, the glutcei, the pyramidalis, the adductores femoris,
the sartorius, biceps femoris, popliteus, peroneus brevis, the ex-
tensores dind Jlexores of the toes, &c. double or even manifold.
The normal number is also increased, although much more
rarely, by entirely unusual muscles ; to these belong, viz. the
anomalus faciei, cephalopharyngeus, a muscle between the
occipital bone and the transverse process of the second cervical
vertebra, another between the transverse process of the sixth,
and the collar-bone, a capsularis humeri, the sternalis bruto-
rum, the extensores breves of the fingers, a very remarkable
muscle on the under and outer part of the hinder surface of the
tibia, &c. In many instances normally formed muscles send off
unusual heads or tendons, for example, the omohyoideus, a
head to the sternothyreoideus ; the digastrici maxillae, a head
which connects them with each other and binds them to the
transversus menti ; the sternocleidomastoideus, a slip to the
angle of the lower jaw ; a long process from the levator anguli
scapulae, which loses itself between the shoulder-blade and the
spine ; from the serratus posticus superior, a portion to the
transverse process of the first vertebra ; fi'om the pectoralis
major, a fleshy or tendinous portion to the latissimus dorsi,
which can easily compress the axillary vessels and nerves, or
processes to the skin of the arm-pit, to the tendon of the
coraco brachialis, to the biceps braehii, &c. ; a slip to the
latissimus dorsi, to the processus coracoideus, or to the occi-
pital bone ; a slip of the deltoideus, to the infraspinatus, or
inner edge of the shoulder-blade; the ulnaris externus, a tendon
to the fifth finger, the Jlexor digitoru?n communis profundus, a
head to the condylus flexorius ; the biceps femoris, a slip to
the tendo Achillis, &c.

(1) Isevjlamm D. de musculorum ))athologia. 4to. Erlanjr, 1774. — de Schafl-
hammer D. de morhis fibnc muscularis ex materiel animalis mixtura mutata
cognoscendis. 4to. Hala-, 1799, with engravings; and in ReU*s Archiv f. d.

Sect. XVIII.] Of the Muscular System. 245

Physiol. Vol. IV. p. 222. — Rodati in praeparationes myo-pathologicas Musei
Bononiensis animadversiones in Opusc. scientific. Fasc. XVIII. p. 397.

(2) G. de la Faye Observat. anat. sur des muscles surnumeraires in Mem. de
Paris, 1736, Hist. p. 59; B. S. Albini Annot. acad. Lib. IV.— VI.— ^. K. Boer-
haave Observatio anatomica musculi in pectore praeternaturalis et varii in diversis
corporibus inventi in N. Comment. Acad. Petropol. Vol. II. Hist. p. 23, Mem.
p. 257. — Bohrner Observat. anat. rarior. Fasc. I. in Praefat. p. 6, Fasc. II. in Praefat.
p. 5. — Sandifort Exercit. academ. L. I. c. 6, L. II. c. 6. — Hildehrand Bemerkung
einer merkwiirdigen Varietat am Nervo musculo-cutaneo und einiger Muskelva-
rietaten in Blumenbach's Medic. Biblioth. Vol. III. Part I. p. 176.— He ymann
Varietates praec. c. hum. muscul. Traj. ad Viadr. 1784. — Brugnone, Observations
myologiques in Memoires de Turin. Sc. Phys. et Mathem. Vol. VII. p. 157. —
Rosenmuller D. de nonnullis muse. c. h. variet. Lips. 1804. — Zagorshy in Mem. de
I'Acad. de Petersb. Vol. I. 1809. — Flelschmann in d. Abhandl. der physical, medic.
Societat zu Erlangen. Vol. I. No. I. 1810. — Daille praes. Tiedemann D. anat. non-
nuUas musculor. varietates exhibens. 8vo. Landshuti, 1813. — Kelch Beitrage zur
pathol. Anatom. No. 20 — 36. — Gantzer praes. Rudolphi D. anat. musculor. varietat.
sistens. 8vo. Berol. 1813. — Sels praes. Rudolphi D. anat. musculor. varietat. 8vo.
Berol. lS15.—Moser in Meckel's Archiv f. Physiol. Vol. VII. p. 224.— My Selt.
Beob. Part I. p. 89, Part II. p. 39.—/. F. Meckel in Zmaw D. de ano contra
naturam. Halae, 1822, p. 34, and in his Archiv f. d. Physiol. Vol. VIII. p. 585.—
Compare also the anatomical Manuals of Mayer, Sommerring and Meckel.

(3) In an acephalous monster in Meckel's collection. \.de Schallhammer, p. 27. —
V. Lenhosseck, in the Medic. Jahrbuch d. K. K. oesterr. Staates, Vol. V. Part IV.
instead of muscles, a fatty mass in a malformed child. Hardly any trace of
muscle in a very mishapen monster was observed by Pcschier, as mentioned by
Locker- Bather, in Hecker's litter, annal. d. g. Heilk. 1828, Aug. p. 406 ; I also
found jelly instead of muscle in a human monster.

(4) J. G. Salzmann D. s. plurium pedis musculor. defectum. Argent. 1754. —
von Bergen D. de plurium musculorum femoris defectu. Franc, ad Viadr. 1734. —
Commerc. liter. Nor. 1739, p. 22 (on the right lower extremity). — v. Haller. Op.
minor, Vol. III. p. 33, remarks, from the observations of Winslow and Ruysch,
that in supernumerary limbs, fat is sometimes found instead of muscle ; this was
also seen by C. C. F. Jdger, Ueber die Natur und Behandlung der krankhaften
Schwache des menschl. Organismus. Stuttg. 1807, p. 227. I have also noticed it
four or five times in birds and calves ; in a foetus in Meckel's collection all the
muscles of the thigh are deficient, v. Thamm D. de genitalium sexus sequioris
varietatibus. Halae, 1799, p. 24, fig. 1 (all the muscles of the right lower extre-
mity wanting) Breschet in Medic, chir. Transact. Vol. IX. 1818, p. 433. —
Palletta saw, in two cases, lameness produced by deficiency of the m. gastrocnemii
and tendo Achilles, v. Exercit. pathol. I. p. 151. — G. Jdger saw several muscles
very imperfectly formed in a monstrous calf. v. in Meckel's Archiv f. Anat. and
Physiol. 1826, No. 1, p. 79. — Similar cases are described by Clarke in Philos.
Transact. 1793, Part II. — Frolik in Verhandel. van het k. Instit. 2. aflev. p. 29,
and in a lamb on the hind legs. — Schroder van der Kolk Observ. anat. pathol. et
pract. argumenti. Fasc. I. Amsterd. 1826, p. 9. — It is self evident that in im-
perfect formation of individual parts of the body their muscles must be deficient;
thus in extensive spina bifida almost all the muscles of the back ; in thoracic and
abdominal clefts, as well also as in large umbilical ruptures, the muscles are often
deficient. In four monsters, with deficiency of the radius and thumb, all the
muscles naturally situated on the radius were absent. If an entire part of an
extremity be wanting, the muscles lying on the superjacent limb, which would
have moved it, are generally very imperfect.

(5) I have missed the just-named muscles several times.

(6) Klinkosch, Progr. quo sect, et demonstrat. indicit, &c. 4to. Pragae, 1766,
missed all of them. Several in squinting persons, v. Wrisberg, Dotting, gel. Anz.
1781. p. 683.

(7) My Selt. Beob. Part I. p. 89, Part II. p. 39.

(8)1 have lately seen this in a subject which exhibited many other varieties in
tlie muscles.

246 OJ the Muscular System. [Part II.

(9) I have missed this once, in which case the m. gemellus superior was very
large.

(10) Instances of this kind are described by Tiedemann in Meckel's Archiv fur
Physiol. Vol. IV. p. 412; Meckel, ib. Vol. V. p. 115. I once saw in a subject
seven supernumeraiy muscles, viz. on the arm, an additional head to the biceps,
an anomalus faciei on each side, a double styloglossus, a sternalis brutorum, and
on the thigh an anomalous muscle from the heel to the gastrocnemius.

(11) Alhinus Histor. musculor. horn. p. 167. — Zagoisky,

§ 156.

The SIZE and form of the muscles depend in general on
that of the skeleton, so that in its vices of form the muscles
are found to vary very much.^ Still, however, we observe these
circumstances alone without the bones being malformed; thus
we find them, congeni tally, too long or too short, too broad or
too narrow, too thick or too thin, unsymmetrical, &c.^ More
frequently their form varies as an acquired vice ; to these
belong the morbid contractions, contracturce^ arising espe-
cially in consequence of inflammatory and convulsive condi-
tions, the shrinking of muscles* in consequence of diminished
nourishment in cachetic patients, general or local in lame
people, or in limbs which have been long unused from other
causes, or if long-continued pressure have acted on the muscles,
as in wens, abdominal dropsy, and swellings of various kinds ;
in such instances, thick muscles become, generally when they
are simultaneously expanded, often as thin as membrane :
further, the opposite vice or morbid increase from hypertrophy^"
and the various kinds of swellings connected with vice of
texture, as well as extension of length and breadth occurring
in relaxation, which, when also the extensile causes, as
tumours, collections of water, dislocations of bone, &c. cease
to operate, often distinctly remain for a long time.

(1) For instance, on imperfectly developed limbs, very small. In crookedly
united fractures of bone, in distortions. — A description and engraving of some
cases of the latter kind, in rickety persons, is given by Rodati, p. 397, pi. 18.

(2) The platysma myoides, instead of being flat, has been seen thick and
roundish, and extending up to the occipital bone. v. Zagorsky, p. 357. — I have
several times found, in new-born children and animals, some of the limbs too
much arched or distorted, in consequence of the unnatural shortness of certain
muscles. — In congenital wry-neck, as well as in club-hand and foot, this is
generally the case.

(3) lieuss Repertorium Comment. Vol. XII. p. 284. — Crausius D. de contrac-
tura. Jenae, 1687. — Vater D. de contracturis- Witeb. 1696. — Schwab D. de
contractura. Leyd. 1701. — Prietto D. de contractura. Budae, 1703. — Matthias
praes. Reil D. de diversis morborum localium formis ad contractura,' genus revo-
candis. 8vo. Berol. 1811. Compare § 21, note 1.

(1) After the bite of the Ceylon leech, malignant ulceration and great wasting
of tlie muscles are said to arise, v. Tytles in Transact, of the Med. and Phys.
Soc. of Calcutta. 8vo. Vol. I. 1828.

(5) Compare above, § 21, note 4.

Sect. XVIII.] Of the Muscular System. 217

§ 157.
The POSITION and connexion of muscles vary in rare cases
from what is regular ; this may be as well a congenital as
an acquired vice. The former is the case when certain muscles
have unusual points of origin and attachment; thus we find,
for instance, the flexing muscles on the limbs sometimes irre-
gularly deeply attached, and the extension of the part conse-
quently very confined ; ^ in deficient formation of the extre-
mities, the tendons of the muscles of the terminal pieces are
frequently connected with each other; in deficiency of the
lower jaw, we find the masseter and maxillary muscles of the
cheeks of both sides running into each other ; ^ in the complete
and sometimes also in the incomplete cleft belly, the tendinous
membranes of the abdominal muscles are not connected at the
white line ; the bi venter maxillcs has been seen attached not
to the chin, but to the lateral part of the jaw ; ^ the omohyoi-
deiis not arising from the tongue-bone, but from the second
vertebra,* and the stylo glossus from the pterygoideus internus;^
the sternocleido7nastoideuSf by means of the sternalis hrutorum
running into the rectus abdominis f* all the scaleni attached to
the first and none to the second rib ; the biceps bracJiu not
fixed to the fore- arm, but only belonging to the upper-arm/
&c. To the acquired vices of situation and form, belong the
various dislocations of individual or several muscles which
may be produced by tumours of difi^erent kinds, but especially
by bony tumours and dislocations of bones ; and without these
in consequence of unnatural motions, and the rupture of their
retaining ligaments and the aponeuroses surrounding them.^

(1) I have occasionally seen this in human, but more frequently in animal
monsters, especially in calves and sheep.

(2) I have seen this formation in two human monsters, and in six monstrous
sheep.

(3) Plainer D. de musculo digastrico maxillae inferioris. Lips. 1737, p. 14,
tab. 1.

(4) Rudolphi resp. Sels, p. 4.

(5) Moser, p. 226.

(6)1 have also once seen this.

(7) Petit in Mem. de I'Acad. des Sciences. 1733, p. 21,

(8) Compare de Plouquet Repertor. Art. Musculor. Dislocatio. — Pouteau Ver-
mischte Schriften. Dresden, 1764. — De la luxation des Muscles in Fillers
et Capelle Journal de la Societe de Sante et d'histor. natur. de Bordeaux.
Vol. I. p. 120; and Coffiniere Observations sur la luxation des muscles, ih.
p. 138. — Ximenes in Memor. Acad, de la R. Soc. de Sevilla, Vol. VI. p. 108. —
Richter's Chir. Bibliothek, Vol. VII. p. 344.— C. F. Ludwig De Diastasi. No. III.
Myodiastasis. Lips. 1821.

§158. .

The usual red colour of the muscles not unfrequently
varies from the normal in both ways, and is naturally, though

248 Of the Muscular System 4 [Part II.

not always, proportioned to the quantity and state of the cruor
contained in the blood. The muscles are therefore, in all
those diseases in which the quantity of blood and its contained
cruor are greatly diminished, much paler than usual ; thus in
almost all cachexias of man and animals, as lameness, dropsy,
wasting, in rickets, tubercular disease, &c. ; further, in indivi-
dual parts more or less used, as in wry-neck, club-foot, and
anchylosis, in which the muscles are in a state of inactivity,
they often become very pale and white, appear almost similar to
the breast muscles of fowls ; and on the contrary, muscles which
are more used are often very pale from bleeding ; also in several
changes of texture, as in their conversion into fat, in induration
from inflammation, and in scirrhus, the colour of the muscles
becomes unnaturally light. The opposite vice, or the too
great redness and colour of the muscles, is not less common ;
thus, for instance, they are very red naturally in all persons
who are hanged, drunk, stiffled, destroyed by narcotic poi-
sons, &c. on account of the great congestion of blood ; further,
in all inflammatory diseases of men and animals, in consumption,
&c., dark or purple-red; also bluish-red in typhus and many
plague-like diseases of man and animals, especially in yellow
fever ^ and mortification of the spleen ; also in the blue disease,
they are sometimes dusky-red,^ and in scorbutic persons, of a
soot-like dark colour. In other cases, we find them coloured
yellow or brownish-red, and if depositions of blood or destruc-
tion from mortification occur, they then become dark-brown
and blackish.

(1) Laso Colleccion de inspecciones anatoinicas relativas a la fiebre amarilla.
4 to. Cadiz, 1824.

(2) I have seen this in two instances.

§ 159.
The CONSISTENCE of muscles also varies exceedingly. We
find it diminished in many cachetic diseases, particularly in
long continued and general dropsies ; in the continued rest of a
part, especially in paralytic limbs, in cholera morbus^^ in putrid
fever, plague of every kind, mortification of the spleen, &c. ;^* also
in the glanders of horses and in tubercular diseases, the mus-
cles are often very flabby, withered, and soft; so again in hunted
animals, and such as are killed by lightning ; finally, it must
be understood that they often exhibit much diminished con-
sistence together with the changes of texture. The opposite
vice, or too great solidity, firmness, and dryness of the mus-
cles, is not merely the consequence of vice of texture, but
occurs also without it, in rare cases, in a high degree,
sometimes locally, in muscles which have been contracted

Sect. XVIII.] Of the Muscular System, 249

and compressed for a long time, and sometimes generally;
they have been thus found extremely dry/ once in a hydro-
phobic patient, and once in an idiot, dark, bloodless, very hard
and as dry as cured flesh. ^

Vices of consistence occasionally give rise to vices of
CONTINUITY,* which, however, are more commonly the conse-
quence of mechanical violence. To the latter belong, not
merely the various flesh-wounds, the violent rupture of mus-
cles,^ the separation of their connexion by suppuration, &c. ;
but also the more rare separation of the fleshy fibres by
substances penetrating them,^ and the spontaneous rupture of
individual muscles by violent exertion.^

In all these cases is the perfect or imperfect division of con-
nexion, and the consequent loss of substance repaired by a
reddish jelly-like substance being poured out, which at first is
converted into a vascular and reddish cellular tissue, subse-
quently becomes compressed, lighter in colour, solid and
devoid of vessels, produces the union of the two divided por-
tions, and thus the use of the muscle is perfectly restored ;
in man and animals,^ however, this structure does not consist
of true muscular substance.^

(1) Davy s. Neue Sammlung auserl. Abhandl. zum Gebrauche prakt. Aerzte
Vol. VI. Part II. p. 302.

(1*) [A remarkable instance of the softening of the muscles in a person who
had painters' colic, is mentioned by Z)e/<oen, Ratio medendi ; and another person,
similarly circumstanced, is stated by Barthez, to have had the firmness of the
muscles restored, when the paralysis subsided, v. Andral Precis. d'Anat. Path.
Vol. I. p. 220. T.]

(2) Morgagni De sedib. et caus. morbor. Epist. VIII. Art. 30.

(3) My Selt. Beob. I. p. 92. — An interesting case of hardening, without vice
of texture, is noticed by Isenflamm. v. Versuch iiber die Muskeln, § 159.

(4) For instance, rupture of the heart, the womb, the bladder, &c. from
softening of their fleshy parts.

(5) I have in a few cases, of persons who have been run over, or who have
fallen down dead, observed some of the muscles torn. This occurs also in violent
pressure of the air from explosion of gunpowder, &c. If parts of the extremities
be lacerated by mills, or other machinery, the tendons are sometimes torn out
above the common point of separation, even up to the heads of the muscles, as I
have seen in one instance. — [In one instance, I saw the upper portion of the
rectus abdominis ruptured by the shaft of a cart, without injury to the common
integuments : a ventral rupture was the consequence. T.]

(6) In the alimentary canal, the urinary bladder, and the arteries, the in-
ternal membrane protrudes between the divided muscular fibres. The same also
occurs in the abdominal muscles in ruptures, and in very fat persons.

(7) Compare de Plouquet Repertor. Art. Musculor. Ruptura et Dislocatio
fibrarum ; and Retiss Repertor. Comment. Vol. XIV. p. 387 ; also Janson D. sur
Ics ruptures des tissus et des organes du corps humain. 4to. Paris, 1813. —
Fleischmann Leichenoffhungen. Erlangen, 1815, p. 211. — In a person struck by
lightning, v. Ouvrard in Nouv. Journ. de Medec. Chir. et Pharm. Paris, Dec.
1822. — Larrey Mem. de Chir. milit Vol. III., the rectus abdominis in tetanus. —
//. F. Isenflamm Anditom. Untersuchungen, 1822, p. 173. — Roulin Du mecanisme
des ruptures musculaires in Magendie Journ. de Physiol, experim. Vol. I. No. 3,
p. 295. — Chaussier llecueil dc Memoires, Consultations et Rapports sur divers

2C)0 Of the Muscular System, [Part II.

objets de Medecine legale, p. 402. 8vo. Paris, 1824. — Richerand Grundriss
der neuern Wundarzneikunst, a. d. Fr, v. RohU. Vol. VIII. Leipz. 1824. —
Martin in Rusf s Magaz. f. d. ges. Heilk. Vol. XIX. p. 590. — Borjer Traite des
Maladies chirurgicales. 8vo. Paris, 1822—1826, Vol. XI. Chap. 3, the right M.
rectus after vomiting. — Flaubert in Repertoire g^ner. d'Anat. et de Physiologic
pathologiques, 1827, Vol. III. Part I. p. 124, ruptm-e of the pyriformis, of the
gcmelli, and of the quadratus femoris, caused by dislocation of the hip outwards
or inwards. — I consider the case of Kelch, No. 37, which has been often
observed, to have taken place after death, as in it all the marks which accom-
pany rupture during life, viz. effusion of blood and inflammation, were absent. —
I have once seen after spasm, the omohyoideus torn ; and a few times also, other
muscles, v. Selt. Beob. I. p. 92. Verz. No. 2175.

(8) It is well known, that in the lower animals, muscular fibres also are
reproduced in regenerated parts. How^ever, I find that in the reproduced tails of
lizards, the muscles still remain, for many years, more imperfect than the original.

(9) Compare the notices given above, § 5i^, note 1 ; also Kleemann D. s.
quaedam circa productionem partium corp. hum. Halae, 1786. — Sclmell praes.
Autenrieth D. de natura reunionis musculorum vulnei'atorum. Tubing. 1804. —
F. Paul Comm. physiol. chir. de vulneribus sanandis, in certam. lit. praem. ornata.
4to. Gott. 1825, with two engravings.

§ 160.

Among the vices of texture of the muscular system,
INFLAMMATION, mijositis^ ai'ises very generally both from
internal and external causes ; so also its usual consequence,
SUPPURATION, which, according to the difference of its causal
proportions, its seat and extent, assumes the most varying
forms ;^ and gangrene, which often destroys very large masses
of flesh. Softening of the muscles, in consequence of inflam-
mation or uncertain proportions of mixture, is much less com-
mon; it occurs in the muscular coats of the alimentary canal and
urinary bladder at the same time, with softening of the other
coats of the aforesaid parts, and in softening of the stomach
secondarily in the diaphragm ; it occurs in the muscles of the
lips and cheeks in watery cancer, and even in the large
muscles, and sometimes attains such an extent, that a muscle
is converted either entirely or partially into a slimy, purulent,
bloody, jelly-like, pappy, or fungous mass. The conver-
sion OF muscles into true fat^ is more frequent, by which
ultimately the fibrous structure of the part is entirely destroy-
ed ; this vice occurs especially on the lower extremities,*
particulary in the gastrocnemii, in anchylosis and other diseases
of the knee-joint ; so also in fot people, there is frequent
paleness of the muscular fibres by the simultaneous deposition
of fat in the muscular tissue. The consistence of the mus-
cles in this disease, as naturally as frequently, though not
always, diminishes their size. Hardening of the muscles,
with change of their tissue, is always the consequence of
inflammation, and the exudations thereby produced into their
interior, and often occurs as well in the voluntary as in the

Sect. XVIIL] Of the Muscular System, 251

involuntary muscles, and in very different degrees ; usually
also with some swelling. Should this state be longer con-
tinued, and the hardening become more distinct, then the
muscles become whitish, entirely lose their usual texture, and
assume a leathery and even tendinous or cartilaginous appear-
ance/ The OSSIFICATION of muscles, that is, the actual con-
version of muscular fibre into bony substance, does not appear
to occur ;^* although frequently, and especially in old and
gouty persons, we observe bony and stony concrements,
which, however, are always seated merely in the cellular tissue
between the muscles, and appear in very different number,
size, and form/ Spurious productions are extremely un-
common in the muscular system ; to these belong, tubercles,
which sometimes occur in the involuntary and more rarely in
the voluntary muscles ; ' further, lipoma,^ and other tumours,^
for example, medullary sarcom, which usually render the
neighbouring parts gangrenous,^" and scirrhus, which attacks
the muscular system but only secondarily, and changes it into
a solid, whitish fibrous substance, which subsequently runs into
malignant ulceration.

(1) de Plouquet D. de myositide et nevritide. Tubing. 1790. — A very confined
motion may easily occur, in consequence of inflammation of muscles, their adhe-
sion with each other, with the aponeurosis and with the skin.

(2) I have described two cases of a peculiar kind of suppuration in muscles,
in my Selt. Beob. Part II. p. 40, The most important kind is psoitis, on
account of its frequency and consequences, of which we must speak further, when
on the abdominal and pelvic cavities.

(3) Myodemia oi Lobsfein. v. Compte rendu, etc. Strasb. 1820, p. 32. — [Stea-
tosis oi Cragie. v. his Elements, p. 498. T.]

(4) I have never seen the true conversion of muscle into fat, as has Lobstein,
in any other parts than on the extremities. It is, however, said to occur in
other parts, and even to take place in all the muscles at once. v. Saillmit
Memoire sur la Maladie de veuve Melin. Paris, 1776. — Several instances of
this disease have been collected by cle Plouquet, in his Repertorium, and by Reuss,
in his Repert. Comment. Vol. XIV. p. 170.

(5)1 have seen the latter in the foot of a man, who was destroyed by elephan-
tiasis. V. No. 2168 of my Verzeich. — In a child, of which the skin had become
remarkably hard, the muscles also participated in the hardness, v. Baillie's
Works, edited by Wardrop. 2 vols. 8vo. London, 1825. Vol. I. — [^«rfra/ saw,
in one instance, the sterno mastoid muscle converted, throughout its whole
extent, into a fibrous structure, exactly similar to its own lower tendon, Vol. I.
p. 275. T.]

(5*) \_Tavernier in Andral Prec. d. Anat. Vol. II. Part II. p. 571, gives an
account of ossification of the diaphragm to the extent of three inches by three
inches and a half, in which he states, that no trace either of muscular or fibrous
structure existed at that part; and concludes, "Dans ce cas il semblc evident
que le diaphragme lui meme etait le siege de la transformation cartilagineuse et
osseuse. T.]

(6) Sometimes they are remarkably large ; to wit, as long as the finger, v.
Phil. Trans. 1741, No. 461. — I saw a similar concretion at RudolphVs, on the
thigh. I once found a large one, two inches long, and above an inch broad,
upon the diaphragm, v. my Selt. Beob. Part I. p. 93. — I have frequently found
smaller ones. — Cerutti, in his Beschreib. der pathoL praparate zu Leipzig, relates

252 Of the Muscular System. [Part II.

several, No. 639 — 6 14. — Tledemann found in the body of a gouty person, white,
stone-like, roundish concretions, principally consisting of phosphate of lime, in
most of the muscles, especially in those of the extremities, v. von Froriep's No-
tizen, No. 4, p. 64. Aug. 1821. — Meckel found in a newly-born rickety child,
a little hard bony concretion in the left M. levator scapulae, v. Anat. Physiol.
Beob. und Untersuch. p. 22. Halle, 1822. — 1 once saw a congenital large
angular piece of cartilage, in the M. sternomastoideus of a boy. The case related
by IV. Henry, in which the muscles and tendons of a young man were said to
be converted into bone, is certainly improperly related. — [In Mus. Roy. Coll.
Surg. No. 53 i, is a remarkable case of extensive ossitication, some of which cer-
tainly appear to be conversion of the muscles into bone ; thus, one large mass
occupies the place of the deltoid, joins the clavicle, scapula, and humerus together ;
another, that of the supra spinatus ; a third, attaches the scapulae of both sides to
the spine, and the angle of the scapula on the right side to the humerus, taking
the course of the teres major and latissimus, and many others below ; but
one especially joins the pelvis to the right thigh, in the exact situation of the
long-head of the triceps adductor femoris. T.]

(7) In scrofulous monkeys, I have seen a few times tubercles in the muscles
of the neck, also in those of the thigh. I once also found a large tubercle on
the sternomastoid muscle of a girl. — Laennec also found tubercles, v. his work,
De I'auscultation mediate.

(8) de Schallhammer, fig. 11.

(9) Haller Opera Minora, Vol. III. p. 286, of an undefined character in the
M. masseter.

(10) Will. Chevalier, General observations of morbid tumours, in which the
muscular structure is attacked, &c. in London Med. and Phys. Journ. Vol. LV.
p. 95, with engravings.

§161.

Lastly, we find also extraneous and unnatural sub-
stances in the muscles, and especially fluids, as water in
dropsy, by which the fibres are sometimes widely separated from
each other, and the muscle similar to a sponge filled with water ;
jelly-like fluid, which seems to be pom'ed out in and upon
the muscles in acute rheumatism ; a yellowish lymph-like
FLUID, which, in mortification of the spleen in animals, is often
poured out between the skin and the flesh, sometimes also
between and in the muscles ; not unfrequently blood and pus,
in manifold different proportions ; further, parasitic animals,'
as the lernece, which in fishes penetrate through the skin,
sometimes into the muscles ; fly-maggots, which occur in
foul sores, and their surrounding fleshy parts in man and
animals ; the hydrachna concharum, in the flesh of freshwater
muscles ; the gamasus marginatus and pulex penetrans which
sometimes insinuate themselves through the skin into the
adjacent muscles ; and lastly, the several kinds of intestinal
worms, ^/aWa, distoma^ ligula and cysticercuSy or measles
in pigs.^ Finally, we must here also mention, dead extra-
neous BODIES, as needles, fish bones, balls, &c. which may
remain sometimes for a longer or shorter period in the
muscles.*

( 1 ) Compare above, § 70.

Sect. XIX.] Of the Pericardium, ^53

(2) For instance, Distoma isostomum and cirrigerum in the flesh of crabs,
even in the claws, and D. duplicatum in the foot of the anodonta. v. von Bar
in Nov. Act. Nat. Cur. Vol. XIII. Part II. p. 553 and 559.

(3) I found the cysticercus cellulosse throughout almost every winter in
one or several subjects, sometimes numerous, at other times but few ; but I
never saw cysticerci in the muscles of the head. Perhaps these animals give rise
to the formation of the very rare, little, thick-coated, tough cysts filled with fluid.
V. my Selt. Beob. Part I. p. 93.

(4) Compare above, § 73.

NINETEENTH SECTION.
Of the Vascular System.

First Chapter.
Of the Pericardium.

§ 162.

The vices of formation which the pericardium but rarely
presents,^ are mostly in close connexion with those of the heart
itself, to which it merely serves as an investing membrane, and
a mean of attachment. The pericardium, therefore, is not only
always completely deficient if the heart be wanting, but com-
monly also if the heart be exterior to the chest ; ^ yet some-
times it is either wholly^ or partially* wanting, although the
heart exists and is situated within the chest.

The SIZE and form of the pericardium depends partly on
that of the heart, partly on that of the chest, and of the
neighbouring soft parts. Sometimes it is found very large,
if in monsters it contain two hearts, or more commonly if it be
MORBIDLY DISTENDED, as in swclliugs of the heart and of the
origin of the aorta, as well as in collections of fluid or of air
in it. Very rarely the extension is so great at a particular
spot, that a diverticulum is produced.^ In many instances,
especially in monsters, it is found, at the time of birth, as
imperfectly developed and thin as in the early stage of foetal
existence ; in other cases, it is observed unnaturally thin at a
later period, in consequence of atrophy. The opposite vice,
viz. the TOO great thickness, is much more frequent, which,
however, seems to occur only in disease.

(1) M. Hoffmann D. de pericardio. Altd. 1690. — Luther D. de pericardii,
pulmonuni ct partium genitalium anomaliis. Kil. 1704. — A. B. Heimann D. de

254 Of the Pericardium, [Part II..

pericardio sano et morboso. Leid. 1729. — Compare the treatises on the diseases
of the lieart.

(2) To this rule I have seen a few exceptions. — In the Anat. Mus. at Berlin,
a case of protruding heart appears to possess a pericardium. — The same was
observed by Bock. v. CenittVs Pathol, anat. Museum, Vol. I. Part III. p. 45. —
Cerutti in Meckel's Archiv fiir Anat. und Physiol. 1828. No. II. p. 194. — When
the heart rests in the belly, sometimes the under part of the pericardium is
wanting, as I have seen several times, — Observed also by Rosenthal Abhandl.
a. d. Gebiete d. Anat. Physiol, und Patholog. p. 148. 8vo. Berlin, 1824.

(3) On removal of the breast-bone, the heart lies quite exposed, with the left
lung in a common cavity, and derives its serous covering from the left pleura. —
For the most numerous observations of deficient pericardium, compare de Plouquet
Repertor. Art. Pericardium deficiens : though not all, as Halle?; De corp. hum.
fabr. L. IV. Sect. 1, § 23, erroneously maintains, were real adhesions of the
pericardium with the heart, although in the following cases there appears to
have been an actual deficiency : Cohnnhus De re anat. L. XV. p. 489. — Rartho-
linus Hist. anat. Cent. IV. No. 20 ; Epist. p. 406. — Baillie in Philos. Transact.
1740 and 1741, No. 46 ; and in another case, in Transact, of a Society for the
improvement of med. and chir. knowledge, London, 1793, Art. 6, with an
engraving. Appendix, p. 2, — Dinkier in Sandifor-t's Natuur-en geneeskundige
Bibliothek. Vol. I. p. 661. — Joh. G. Walter Museum anatom. No. 668, —
Compare Henkel D. de pericardio deficiente, Berol, 1818. — My Monstros. sex
humanor, anat. et physiol. disquisitio. 4to, Francof, ad Viadr. 1811, p. 16; and
since then in another case. — Petersb. vermischte Abhandl. aus dem Gebiete der
Heilkunde, 1st Part, 1821, p, 230. — Wolf in Rust's Magazin fiir die gesammte
Heilk. Vol. XXIII. Part II. p, 333, — GotthoffD. s. descriptionem casus rarissimi
spinam bifidam totalem — exhibentis. 4to. Berol, 1827, p. 7.

(4) This, on account of the oblique situation of the heart, seems to occur only
on the left side ; a portion of the heart then lies sometimes in the left pleura,
sometimes, on the contrary, one lobe of the lung in the cavity of the pericardium.
Similar cases are described in my Selt. Beob, Part II. No. 18, p. 44. — Since
then a second similar case occurred in the Bresl. Mus. No. 2874. — Breschet in
Repertoire gen. d'Anat. et de Physiol, pathol. 1826, Vol. I, Part I, p, 212.—
./, F. Meckel Descriptio monstror. nonnuUor. 4to, Lips. 1S26, p, 12.

(5) I saw a similar instance in the Anat. pathol. Mus. at Vienna, which is
large, and only connected with the pericardium by a narrow aperture.

§ 1G3.

The pericardium sometimes also presents numerous varieties
in reference to position and attachment, inasmuch as, in
rare instances, it is not only placed with the heart too high or
too low, even in the belly, ^ or exterior to the chest,^ whilst the
heart still retains its perpendicular position in the middle ;
so in the congenital situation of that organ to the right side, it
also lies too much to the right ; but it further deviates in a
peculiar manner as concerns the common degree of its attach-
ment to the diaphragm.^

The COLOUR of tlie pericardium is but seldom irregular, and
it may be either too pale, dull, or slightly reddened in many
diseases ; also in suppuration, mortification, &c. in the cavities
of the mediastina it is variously discoloured, even black,* and,
in the severer forms of jaundice, yellow.'* Sometimes its in-
ternal surface is marked with large red-brown spots from the
blood transuding through the right auricle.

Sect. XIX.] Of the Pericardium. 255

(1)1 remarked this several times, particularly in large umbilical hernia.

(2) Compare § 162, note 2.

(3) Compare my Selt. Beob. Part I. p. 94. — Sometimes in equal size of the
heart the diameter of the point of attachment is only one and a half, often also
four inches. The first vice forms the transition to the more unattached position
of the pericardium in mammalia.

(4) Stoerck Annus I. p. 108.

(5) Stoll Ratio medendi.

§ 164.

The CONSISTENCE of the pericardium, which is sometimes
considerably lessened by disease, and may also be increased,
falls but very seldom under consideration, on account of its pro-
tected position and its pliancy. In a few instances it has been
seen torn by external violence, not by any thing piercing it,
but merely by concussion ;^ more frequently however, it is in-
jured by bullets, pointed instruments, broken ribs, and pointed
substances which have been swallowed ; and it has been
marked by cicatrices,^ the consequence of such wounds as
have not been mortal. It is very remarkable, that in some few
instances the pericardium is found as dry as if it had been long
exposed to the air ; ^ and this has even sometimes been observed
in cases of hydrophobia, both in man and animals.*

(1) Boimti Sepulchret. Lib. IV. Sect. 3, Obs. 27. — Danz in Stark's Archiv.
Vol. III. Part III. No. 2. — In a healthy young man, the heart completely
burst the pericardium, without any injury to the chest, in consequence of a
blow on the breast from the wadding of a small cannon ; in a morbid examination
at the Med. Coll, of Silesia.

(2) de Hautesierk Recueil d' Observations de Medecine. Paris, 1772, Vol. II.
p. (JOO. — Bongon V. R^ist and Casper Krit. Repert. f. d. ges. Heilkunde, Vol. VI.
Part III. p. 474. — Compare the cases of cured wounds of the heart, related by
surgeons.

(3) Boerhaave's Pathological treatises on the Heart, in the Sammlung auserles.
Abhandl. prakt. Aerzte, Vol. IX. p. 495. — Hunter, Sdmmerring, and Baillie's
Morbid Anatomy. — I once found it in an asthmatic person as dry as parchment,
only on the left side.

(4) Capivacci Practic. L. VII. c. 12, p. 1085.^ — Brechtford v. Acta med. Havn.
Vol. V. Obs. 144, 1677.—Taury in Mem. de I'Acad. de Paris, 1699, p. 55.~
Gherardini Samml. fiir prakt. Aerzte, Vol. XV. p. 96. — Andry Untersuchungen
iiber die Wuth nach dem Bisse toiler Thiere. Leipz. 1785. — Ferriar Medical
Facts and Experiments. Vol. I. London, 1791.

§ 165.

Among the vices of texture of the pericardium, its in-
flammation, pericarditis,^ is the most important. This dis-
ease, according to the diversity of its causes,^ its acute or
chronic course, its degree and extent, exhibits many varieties ;
it, however, always shows itself by tumefaction, loosening, and
more or less redness. A morbid exudation of lymph-like
fluid and fibrous substance on the inner surface of the peri-
cardium is the usual consequence of inflammation of that
membrane. From the fibrous substance are produced false

256 Of the Pericardium. [Part II.

membranes, bands, flakes, fibres, &c., which are either simple,
more or less thick, even double, and in time become organized ;
they are situated either merely upon the inner surface of
the pericardium or upon the surface of the heart also,
and then cause either a general or local, a close or loose
CONNEXION^ of the pericardium with the heart. Less fre-
quently such efflision occurs on the external surface of the
pericardium, and then produces its adhesion with the breast-
bone, the mediastina, the gullet, &c. Pericarditis seldom
runs on to suppuration; but wdien this happens, one or
more ulcerated spots* are found, sometimes externally, but
more usually internally. Inflammation of the pericardium
probably never terminates of itself and without gangrenous
destruction of the neighbouring parts, in mortification.
After chronic pericarditis the pericardium more commonly
becomes thickened, either generally or in particular spots ; '
becomes hard, leathery, and even cartilaginous ; *^ and more
rarely ossified in patches.

(1) Lemazurier D. sur la pericardite. 4to. Paris, 1810. — Petrenz D. de peri-
carditidis pathologia. 4to. Lipsiensis, 1822. — Tacheron Recherches anat. pathol.
Vol. III. p. 226. Paris, 1823. — /. ^hercrombie in Transactions of the medic,
chirurg. Soc. of Edinb. 1824, No. 1. — Andral j\xn. in Mdmoires de la Soc.
medicale d' Emulation de Paris, "\'ol. IX. No. 14, 1826. — Louis in Revue medi-
cale fran^aise et etrang^re, Paris, 1824, Jan. to March; and in Memoires,
ou Recherches anat. pathol. p. 253. 8vo Paris, 1826. — Adams in Dublin
Hospital Reports and Communications, &c. 1827, Vol. IV. No. 19. — Good
engravings, by /. G. Walter Sur les maladies du Cceur in Nouv. Memoir, de
I'Academ. des Sc. a Berlin, 1785, tab. 4; and Bleidand Icones anat. pathol.
4to. Traj. ad Rhen. 1826, tab. 1 and 2. — Stiehel Monographiae carditidis et
pericarditidis acutae, epistola dedicatoria et praefatio. 4to. Francof. ad Moen.
1828.

(2) For instance, from mechanical causes, from catching cold, metastasis of
gout, rheumatism, hydrophobia, &c.

(3) It is not unfrequently so general and so firm, that the pericardium seems
to be entirely wanting ; often it resembles cellular tissue, ligaments, threads, &c,
— Pohl Progr. de pericardio cordi adhaerente ejusque motum turbante. Lips.
1775. — Nebel Progr. de pericardio cum corde concreto. Giess. 1778. — [In the
Mus. at St. Thomas's Hospital, there is a fine specimen of complete adhesion of
the close and investing portions of the pericardium, which, from its appearance,
has evidently existed for a considerable time. T,]

(4) Hilscher et Schmiedel D. de exulceratione pericardii et cord, exemplo illus-
trata. Jenae, 174:2:— Lieutaud Histor. anat. med. 4to. p. 210. — Meckel Mem.
de Berlin, 1756, Vol. XII. p. 31.— Stoll Rat. med. VII. p. 172.— ran Doeveren
Specim. observat. acad. Cap. V. — Senac de Corde, L. VI. cap. 2. — Slorck Aiuuis
medicus sccundus, p. 92. — Chamhon de Moniaux Merkvv. Krankengcschichten
und Leichenberichtc. Leipz. n9\.—B'iennayer Mus. anat. pathol. No. 434. —
I have myself once seen scrofulous suppuration of the anterior wall of the heart.
[The assertion of the author, that suppuration of the pericardium never occurs
without ulceration, is not correct. — BailUe once found the pericardium highly
inflamed, and containing a quart of pus, but without ulceration. — In the Mus. at
St. Thomas's Hospital, there is a case of sujjpuration of the pericardium, which
protruded at the j)it of the stomach, and bciiiu: mistaken for abscess of the liver,
was tapped ; what was the immediate result I do not know. T.]

(5) I have found this several times from two-twelfths to thrrc-twclfihs of nn

Sect. XIX.] Of the Pericardium. 257

inch thick, and in one here and there half an inch. Good instances of thick-
ening are given hy Boerhaave, Vol. IX. p. 498. — Senac, p. 72. — Morgagrn De sed.
et causs. morbor. Ep. XVIII. p. 34 ; XX. 20, 35 ; XXII. 10; XLIII. 17;
XLV. 16 ; LI 1 1. 29.— Portal Cours d'Anat. mM. III. p. 24.— It was found nine
lines thick, and with two suppurating, and one gypsum-like tumour, by Rochoux
V. Journ. gen. de Med. et chir. Vol. XXIX. Feb. 1814, Bulletin, p. 33. — Fibrous
degeneration of the pericardium, many lines thick, &c. v, Bidoisfils, in Archiv.
gener. de M^dec. Decbr. 1823. — Elliotson, Diseases of the heart, fig.

(6) Morgagni, Ep. XXII. p. 10. — Boerhaave. — Riolanus Anthropographia,
L. III. c. 12. — Haufes'ierlc Recueil d'Observations, Vol. II. p. 583. — Saviardin
Journ. des Savans, 1691. — Testa; — very thick and cartilaginous, v. Peterb. ver-
mischte Abhandl. a. d. Gebiete der Heilk. Iste Samml. p. 232, 1821. — I have
observed several remarkable cases.

(7) Ossification occurs, sometimes in the fibrous, sometimes in the serous,
layer. — Instances are related by Haller Addenda ad Elem. Physiol, p. 128.
— Senac Traite des Maladies du Cceur. L. VI. c. 2. — Saviard Observat. chir, I.
LV. p. 25. — Aurivillius in Nov. Art. Upsal. Vol. I. p. 101. — Walter Oh%ex v. anat.
p. 63, and Anat. Mus. Vol. I. p. 148, 149, 297. — Pasia Ep. de cordis polypo.
p. 75, — Prost Medecine eclairee par I'overture des corps. I. p. 140. — Payer in
Archiv. general, de Medec. March and April, 1823. — Abercrombie, in Trans, of
Med. Chir. Soc. of Edinb. No. 1. — Adams. — A large piece of bone was once found
in the pericardium, which had been driven in from the breast-bone by a shot a
long while before, v. Rust's Magazin f. d. ges. Heilk. Vol. XVI. Part I. p. 185.

§ 166.

To the other vices of texture, which either are not, or at
least not distinctly, consequences of inflammation of the peri-
cardium, belong the too great deposition of fat on the external
surface and between the layers of the pericardium, which pro-
duces sometimes a narrowing of the cavity of the chest, and
especially an injurious pressure upon the heart and great
vessels ;^ next hydatids,^ which are occasionally observed
situate both on the inside and outside of the pericardium
both in man and beasts ; then a peculiar kind of peduncular
GROWTHS, peculiar to serous membranes, is found on its inner
surface,^ in which, although very rarely in this membrane,
cartilaginous or osseous masses present themselves, which, if
the connecting pedicle be ruptured, are found loose in the
pericardium ; true encysted tumours,* and, finally, tuber-
cular^ and sarcomatous'^ swellings, which are all merely
spurious formations, are here very seldom met with.

(1) Boneti Sepulchret. anat. Lib. II. sect. 11, obs. 16. — Senac, p. Q9. — Godart,
in Journ. de Medec, 1761, May, Vol XIV. p. ^Q\.— Morgagni, Epist. XIX. § 7. —
Meckel Mem. de I'Acad. de Berlin, 1756, p. 79. — /. v. Bergen., in Act, soc. med.
Havn. Vol. I. p. 247. — Testa. — Parry, Inquiry into the symptoms and causes of
the syncope anginosa. Lond. 1801. — Black, in Mem. of the Med. Soc, of London,
Vol. VI. p. 45, — Kreysig Von den Krankheiten des Herzens, Vol, III. p. 124. —
I{or7i, in Archiv f. d, Med. Erfahr. Vol. Ill, Part I. p. 58, found a steatomatus
pericardium three inches thick. Such fatty deposits on the pericardium have
been improperly considered as possible causes of angina pectoris, v. Fothergill,
Med. obs, and Inq, Vol, V. p. 246.— fFa//, in Med, Mem, Vol. III. p. 13.—
Schramm Comm. pathol. de angina pectoris, p, 17, &c. — In many of the above
described cases the disease killed suddenly. I have seen a few such cases, in one

S

258 Of the Pericardium, [Part II.

of which the pericardium had become remarkably narrow, and in meagreness of
other parts of the body I have found very much fat in the pericardium.

(2) Rolfinck, Epitome method, cognosc. c. h. affect, p. 164. — Boneti Sepulchret.
L. II. Sect. VIII. Obs. 6, L. III. Sect. XXI. Obs. 21, § 14. Sect. XXXVII.
Obs. 3, § 12. — Heuermann Physiologic, Vol. I. p. 202. — Richter Deutsche Biblioth.
Vol. IV. p. 239. — Stembuch De taenia hydatigena, 1802, p. 5. — Bernhardi Ob-
servat. circa ingentem cordis tumorem. 8vo. Regiomonti, 1826, p. 22. — Here
also perhaps belongs the case of a cyst filled with lymph in a monkey, v. Galenns
De loc. affect. L. V. c. 2.

(3) Compare § 81. I have found this twice, and in the one case, at the same
time with loose cartilages, v. my Verzeichn. No. 2183 and 2184.

(4) Tlie case related by Lancisius de Aneurysm. L. I. propos. 5, seems to belong
here. — Senac, Vol. II. p. 340, found a meliceris.— Por/a/ Cours d'Anatomie medi-
cale. Vol. III. p. 23.

(5)1 have twice found this, once in a child and once in a monkey. — Lucht-
mann's Samml. auserles. Abhandl. Vol. XVII. p. 210. — BaiUie found two or three
such tubercles, one of which was as large as a walnut ; he also found two tubercles
as big as hazelnuts on the side of the heart, v. his works, edited by Wardrop,
Vol. I. London. — Macmichael in London med. and phys. Journ. Aug. 1826. —
Perhaps we may here include the cases mentioned by Zacutus Prax. adm. L. II.
Observ. 137. — Galenns, in a fowl. — Dionis, v. Lieutaud hist. anat. med. Vol. II.
p. 271. — Boiirru in Hist, de I'Acad. de Paris, 1763, p. 35. — Haller Op. minor.
Vol. III. p. 365.— Nov. Comm. Petropol. v. Foigtel Path. Anat. L. II. p. 220.
C. Be^/, System of Dissection, &c. Edinb. fol. 1798. — Laennec De I'auscultation
mediate. Vol. II. p. 397. Paris, 1819 ; also in an ox. — Musgrave, in Phil. Transact.
1685. p. 860.

(6) In a case of medullary sarcoma in the posterior mediastinum not only was
the posterior part of the pericardium affected, but even perforated by it. In an
old woman, whose arm was amputated on account of fungus haematodes, medullary
sarcom was found on the pericardium and heart, v. Gerson and Julius Magaz. der
ausliind. Literatur d. g. Heilk. 1823, Sept. Oct. p. 199.

§167.

Finally, as to the vices of contents, we must first notice the
collections of gaseous and lymph-like fluids which are mostly
the product of morbid irritation or of an inflammatory condition ;
the collection of air^ in the pericardium is not often observed
without existing decomposition ; but sometimes, however, it
is observed in such degree that the membrane appears inflated.
The collection of water or dropsy of the pericardium,
hydrops pericardii, hydropericardion,'^ is much more com-
mon. It is generally found accompanying dropsy in other
parts, but rarely alone, and varies considerably with respect
to the quantity, colour, and consistence of the collected fluid.^
In inflammation of the pericardium and its consequences, dis-
tinct extravasations of plastic lymph or fibrin e are fre-
quently seen on the heart, which float in the greater or less
quantity of water in the form of flakes and lumps ; or, on the
contrary, if it be coagulated into cells, the water is contained in
them; or, finally, becomes thicker, and assumes the appear-
ance of a pus-like substance.^ If ulcers are found on the
pericardium or heart, true pus* is seen on the former, which,
however, in rare cases makes its way from the neighbouring

Sect. XIX.] Of the Pericardium. ^59

parts^ into the pericardium/ as it can in like manner make its
way out of the pericardium. When the heart or the blood-vessels
are injured, or burst within the pericardium, that membrane is
naturally found more or less filled with fluid or coagulated
BLOOD f still we sometimes find in the pericardium bloody
water or actual blood, without any other cause than mere
transudation.^ Sometimes blood is poured out between
the layers of the pericardium, and forms larger bladders of
blood,^** or smaller petechial spots.^^ Fibro cartilaginous^^
and sTONY^^ concretions are very rarely observed loose in
the cavity of the pericardium; these very probably have had
their origin in peduncular tumours, which had been subse-
quently broken oflT.^"^ Lastly, in the pericardium of beasts,
ENTOZOA have been found. ^'

(1) Compare § 51. — HoUerius de morb. int. L. I. c. 29, p. 129. — Hercules a
Saxonia Prael. pract. C. 1, p. 2. — Bartholin, v. Lieutaud Hist. anat. med. sect. 1,
Obs. 1672. — Ballonius paradigmata, No. 96. — Senac, L. VI. c. 3. — One case in
Med. Chir. Rev. 1&25.—Briere in Nouv. Bibliotb. Febr. and March, 1826.— In
my Selt. Beob. some good instances.

(2) See for single cases in de Plouquet Rcpert. Art. Hj'drops pericardii, and
Reuss Repertor. Comment. Vol. XIII. p. 561. — Schellhammer D. de aqua pericardii.
1694. — Fr.Floffmann vesTp. GiatzD. de hydrope pericardii rarissimo. Halse,1697. —
Mercker D. de hydrocardia. Ultraj. 1711. — Westring in K. Svenska Vetensk.
Acad. Nya Handl. 1790, Vol. XL p. 292. — Landvoigt D. de hydrope pericardii
dignoscendo. Halae, 1798. — Heinecke D. de hydrope pericardii. Erford, 1799. —
Modes D. Essai sur I'hydropisie du pericarde. Paris, 1808. — In rare cases we find
the water between the layers of the pericardium itself v. Portal, Vol. III. p. 11,
note 2. — Morgagni, Epist. XVI. p. 44 ; XXV. p. 16 ; and Portal, p. 28, have impro-
perly asserted that dropsy of the pericardium may arise from ruptured hydatids.

(3) The quantity varies from some spoonfuls to two or three pints, v. Frank,
p. 243. — Corvisart Sur les Maladies et les lesions organiques de coeur. 8vo.
Paris, 1806 ; translated by Hebb, London, 1813. — [In a case of hydrops pericardii,
related by Wood, in London Med. and phys. Journ. Vol. LXI. p. 406, two quarts
of lymph were effused. T.] The colour is sometimes light and clear, more
frequently yellow or brownish, even reddish, viz. commonly in bilious and putrid
fevers ; milky in metastasis of the milk in lying-in women, &c. The consistence
is often very mucous, albuminous-like, &c. A moderate quantity of water in the
pericardium does not necessarily lead to the conclusion, that disease existed
during life, since here, as in other serous cavities, it is often first effused in
the very moment of death.

(4) Compare § 55. The coagulum lying loosely in the pericardium, improperly
called polypus by Hohnbaum, v. Heidelberger klinische Annalen, Vol. I. Part III.
p. 414, undoubtedly belongs here. [According to Elliotson, On Diseases of the
Heart, p. 8, the quantity of serum effused in acute pericarditis is far less in propor-
tion to the fibrine than in pleurisy, rarely amounting to a pint : on the contrary,
in chronic disease the fibrine, if any, is thin and soft. T.]

(5) The older and even more modern authors often confound pus with puri-
form coagulable lymph, therefore their observations are not to be relied on.
Compare the cases described at § 165, note 4. — A. Monro, in his description of
all the bursae mucosae, &c. Edinburgh, 1788, p. 41, states, that after an injury
with a red-hot iron, he found five ounces of pus in the pericardium.

(6) For instance, from abscess of the liver, through the diaphragm ; Nov. Acta,
Nat. Cur. Vol. VIII. Obs. 9, and v. Siebold Samml. chir. Beobachtungen Vol. I.
p. 248. — Chaussier in Bulletin de la Faculte de Medecine, 1811, No. 5, p. 98.

S 2

2G0 Of the Heart. [Part IT.

In Philadelphia medical Journal. — I once found in an abscess in the anterior
mediastinum some pus penetrating through a delicate fistulous orifice into the
pericardium.

(7) From abscess between the ribs. v. Sabatier in Memoires de I'lnstitut de
France, Sciences mathem. et physiques, 1S07, p. 104. — Fahricius in Harless
Rhein. Jahrb. der Med. und Chir. Vol. I. Part I. p. 156.

(8) Tolerably frequent in rupture of the heart, and of aneurysmal bags in
the aorta ; more rarely in bursting of the arteria innominata. — Meyer in Oesterr.
medic. Jahrbiicher, Vol. V. Part III. p. 61, the coronary veins, v. Commercium
Litt A. 1732, Hebd. 41, No. 4. — Acta Nat. Cur. Vol. II. Obs. 107, Vol. V.
Obs. 37.— riridet, v. HaUer Bibl. chir. II. p. 103.— Hedlund in Svenska Lii-
kare-Sallskapets Handlingar, Vol. III. p. 181, on the v. cavae and pulmonal.
V. Morgagni, Epist. XX\'I. 27, 28. — SyJ Aufsiitze und Beobachtungen, Vol. IV.
p. 34. — Portal, v. Auserlesene Abhandlungen, Vol. XII. p. 724. — DouhJeday in
Medical Observat. and Inquir. Vol. V. p. 144. — Wright in ibid. Vol. VII. No. 1,
on one side of the vena cava. v. Sahmann D. de morte subita ex sanguine in
pericardium effuso. Argentor. 1731. — Sometimes the openings from the blood-
vessels into the heart ai'e very small, viz. in two instances before noted in my
Selt. Beob. Vol. II. p. 60 and QQ. — ViUesavoye, v. Frankische Sammlungen,
Vol. II. Part II. p. 312. — Ariwtt in London med. and phys. Journ. — Abercromble
in Transact, of the med. chir. Society of Edinb. Vol. I., &c.

(9) Compare §51. — Lieutaud, Vol. II. Obs. 659. — Vater in Miscell. Nat.
Cur. Dec. III. Ann. IX. p. 293. — Bnder Observ. med. incisionibus illustratae,
1762. Observat. 1. in Sandifort Thesaur. Diss. Vol. III. ; de Haen Ratio
Medendi, Vol. IX. cap. 1, § 6. — Thomson in Medical Observat. and Inquiries.
Lond. 1771, Vol. IV. — Hooper in Mem. of the med. Societ. of London, Vol. I.
No. 18. — Alston in Med. Essays and Observat. by a Soc. in Edinb. Vol. V.
Part II. p. QQ^.— Testa, p. 294.— My Selt. Beob. Vol. I. p. 95, and a few times
since, among others also in a stag. — Hufeland and Harless Journ. d. prakt.
Heilk. 1815, Part I. Jan. p. 85. — Fitzpatrick in London Med. Repos. 1822,
April, p. 295.— Copland, ib. p. 298.

(10) Morgagni Epist. XXIII. 23. — de la Faye in Hist, de I'Acad. dc Paris,
1735, p. 20, 21.

(11) Stoll, Ratio medendi. In a man who died of asthma I observed some
little effusions of blood between the layers of the pericardium. Do the cysts
observed by Wrisberg in his Comment, med. physiol. anat. et obstet. arg. Vol. I.
No. 4, belong here ?

(12) My Selt. Beob. Part II. No, 19, p. 45, and Verzeichn. No. 2184.

(13) Lanzoni in Miscell. Nat. Cur. Dec. III. Ann. VII. and VIII. 1699 and
1700, Obs. 75, p. 129, three stones.

(14) Compare above, § 82.

(15) Especially in pigs, the echinococcus veterinorum Rud. — In the pericar-
dium of the mya pictorum, and various kinds of anodonta, the aspidogaster
conchicola. v. Baer in Nov. Act. Cur. Vol. XIII. Part II. p. 527.

Second Chapter.
Of the Heart.

§ 168.

The DISEASES of the heart/ both those which are congenital
and those which are acquired, are not of rare occurrence.
The former, or vices of formation, depend partly on the earliest

Sect. XIX.] Of the Ht art. 261

form and structure of the heart itself, and are true retarded
formations ; the latter are oftentimes the consequence of re-
curring sympathetic irritation, which, in passionate men,
arises from the brain, in others, often also from the respi-
ratory or the digestive organs. Therefore, diseases of the
heart are more common in the male sex, in elderly persons,
and perhaps also in criminals, and in diseases of the mind -^
sometimes mechanical causes, and among these, especially
in the malformation of the chest and of the spine, and even
hereditary disposition also,^ give rise to them.

(1) C.a Vega De cordis et thoracis afFectibus in de arte medendi. fol. Lugd.
B. 1564. — C. Bruno De corde et ejus vitiis. 4to. Basil. 1580. — RyffT). de afFec-
tibus cordis. Basil. 1584. — Rud'tus De naturali et morbosa cordis constitutione.
4to. Venet. 1600. — Montaguana Consilia de segritudinibus cordis i. Op. select,
fol. Francof. 1604. — Albertini De affectibus cordis. L. III. 4to. Cesena, 1648. —
A. Bulgetius De afFectionibus cordis. 4to. Patav. 1657. — ab Hartenfels Pr. de
corde, ejusque atiectibus. Erford. 1697. — Barbeyrac D. nouvelles sur les ma-
ladies de la poitrine, du coeur, etc. 8vo. Amstel. 1731. — J. F. Meckel Sur les
maladies du coeur in Mem. de I'Acad. des Sc. de Berlin. 1775, p. 56; 1776,
p. 31. — Juncker and Bockmann D. cordis morbos proprios in tabula exhibens. 4to.
Halae, 1763. — Spaventi D. de frequentioribus cordis, majorumque vasorum
morbis internis. Vienn. 1772. — Senac Traite de la structure du coeur et de ses
malad. Par. 1749; ed. Portal. 4to. Vol. II. Par. 1778.—//. Boerhaave in
Genees-Natuur-en Huishoudkundig Kabinet. door /. Foegen van Engelen. Leid.
1779. Deel. I. p. 562. — de Petraglia De cordis afFectionibus syntagma. 8vo. Romae,
1779. — /. G. Walter Sur les maladies du Cceur in Nouv. Mem. de Berlin. 1785,
Mem. p. 57. — Reil Analecta ad historiam cordis pathologicam. 4to. Halae,
1790. — J. F. Meckel De cordis conditionibus abnormibus. 4to. Halse, 1802 ; and
in KeiVs Archiv f'iir Physiologic, Vol. VI. p. 549. — Cablrau-Cahannes Aperpu sur
quelques afFections organiques du coeur, etc. 8vo. Paris, 1805. — F. Zidiuni De
quibusdam cordis afFectionibus. 4to. Brix. 1805. — le Heris.se Propositions sur
les afFections organiques du cceur. 4to. Paris, 1806. — Corvisart Essai sur les
maladies et les lesions du coeur et des gros vaisseaux. Paris, 1806, 1812, and
1818. — Coutelle D. Essais sur quelques causes de maladies du coeur. Paris,
1808. — Hornier D. de morborum cordis diagnosi. Gbtt. 1809. — Warren, Cases
of organic Diseases of the Heart, with Dissections, and some remarks intended
to point out the distinctive symptoms of these diseases. Boston, 1809. — Allan
Burns, Observations on some of the most frequent and important Diseases of
the Heart, &c. Edinb. 1809. — Testa Delle malattie del cuore, loro cagioni,
specie, segni e cura. Vol. III. Bologna, 1810, 1811. — Pelletan Mem. sur quel-
ques maladies et vices de conformation du coeur in Clinique chirurgicale,
Paris, 1810, Vol. III. — Grassal D. sur quelques afFections organiques du coeur.
4to. Paris, 1810. — Sandberg D. de vitiis cordis. Edinb. 1813. — Farre, Patholo-
gical Researches in Medecine, Essay I, on malformations of the human heart,
illustrated by numerous cases and 5 plates, containing 14 figures. 8vo. Lond.
1814. — J. Gorgham, On organic Diseases of the Heart, with Dissections, in
New England Journ. of Medic, and Surgery. Boston, 1814. Vol. III. Jan. —
F. L. Kreysig Die Krankheiten des Herzens, systematisch bearbeitet, u.s. w.
Vol. III. Berlin, 1814.— 1816.— /. F.Meckel Tab. anat. pathol. Fasc. I. Cor. fol.
Lips. 1817. — G. Foster D. de organicis vitiis cordis. Edinb. 1819. — Lneck D.
Adumbratio morborum cordis generalis. 8vo. Berol. 1819. — Mayer Berichte
iiber organische Fehler des Herzens under grbsseren Blutgefasse in d. Oestreich.
medic. Jahrb. Vol. V. Part III. 1819, p. 59. — Laenncc De 1' auscultation mediate,
ou traite de diagnostic des maladies des Poumons et du Coeur. Vol. II. Par.
1819 and 1826. — Wetzler Ueber Krankheiten des Herzens und der Arterien in his
Beitragen zur thcoret. u. prakt. Mcdicin. V^ol. I. Part I. and II. Mainz, 1820^

262 Of the Heart, [Part II.

J. A. Walter D. de variis cordis afFectibus. Haloe, 1821. — Reeder, Practical
treatise on the inflammatory, organic, and sympathetic Diseases of the Heart.
Lond. 1821. — J. Whitsed D. de fabrica cordis vitiosa. Edinb. 1823. — Wedemeyer
in Rusfs Magazin f. d. ges Heilk. Vol. XIII. Part II. p. 177. — Abercrombie,
Contributions to the pathology of the heart, in Transact, of the medico- chir.
So, of Edinb. 1824, Vol. I. p. I.— M. A. Petit Essai sur la Medecine du Coeur,
etc. second edit, Lyon, 1824. — Bert in Traite des maladies du coeur et des gros
vaisseaux, redige par BouiUnud. Paris, 1824, with six engravings. — Burger
Diagnostik der Herzkrankheiten. Berlin, 1825. — C. H. Parry, Collections
from the unpublished medical writings, Vol. II. p. 129. Lond. 1825. — R. Adams
in Dublin hospital Reports and Communicat. 1827. Vol. IV. No, 19. — Faber in
Hufelaiid's Journ. d. prakt. Heilk. Aug. 1827, p. 3. — Stadelmeyer D. de morbis
cordis organicis observationes quaedam. 8vo. Wirceb. 1827. — /. Brown, Med.
Essays on fever, inflammation, rheumatism, diseases of the heart, &c. 8vo,
London, 1828. — Many single cases in de Plouqiiet Repertor. Art. Cordis morbi;
in Reuss Repertor. Comment. Vol. X. p. 87, Vol. XII. p. 304, and in the perio-
dicals, [Andral in Precis d'Anat. Pathol. Vol. II. p. 275, Maladies du Coeur. —
,7. Elliotsoji, On the recent improvements in the art of distinguishing the various
Diseases of the Heart, fol. plates. London, 1830. T.]

(2) Compare J. E. Greding's Sammtl. medic. Schriften, edited by C. W.
Greding. Graiz. 1790. Vol. II. — Nasse in Archiv f. medic. Erfahr. von Horn,
Nasse, and Henke, 1817, July and August. — Weber in Nasse' s Zeitschrift
f. Psychische Aerzte, 1820. Vol. II. p. 396. — Diseases of the heart, however,
according to Georget Sur la folie, p. 496, Paris, 1820, are rare in insane per-
sons, which is confirmed by my experience.

(3) Several instances are given by Laiicisi De aneurysm. L. II. Prop. 47,
p. 74; and by Testa, p. 45, Frank, Abernethy, &c.— I knew a woman who died
of disease of the heart, in the prime of life, having had two daughters affected
with disease of the heart, one grand-child the subject of the blue disease, and
another, which from youth, had a violently pulsating heart.

§ 169.

The DEFICIENCY OF THE HEART, okardia, is observed,
although not as a constant, yet as a common and regular
phenomenon in headless monsters, even when they possess
the chest and neck of the trunk.^ In other embryons with
heads there exist but few instances of deficiency of the heart.'"^
The opposite vice, or double heart, is, in double monsters
with a single chest, naturally not uncommon, particularly if the
upper part of the body be double. The degree of duplication
is therefore very different, since the heart common to two
bodies is very large, or sends off double vessels, or is even
itself double ;^ or in the higher grades, two distinct hearts may
be contained in one pericardium, or each may be enclosed in
its own proper membrane, and more or less removed from each
other. Cases very rarely occur in which, in a single body, the
heart has been found double, either in certain parts,* or en-
tirely.* The latter has been several times noticed in birds.*'

(1) J.F. Meckel Ilandbuch dor pathol. Anatomic, Vol. I. p. 162. — F. Tiede-
viami Anatomic der kopflosen Missgcburten. fol. Landshut, 1813, p. G9, § 75. —
liidard M^moire .sur le.s fa'tus acephalcs. 8vo. Paris, 1818; and in Leronx
Journ. de Medec. 1815 and 1816. — E. Elben D. de acephalis s monstris corde
carentibus, p. 84. 4to, Berol. 1821, with 22 lithogr. tab. — The two last
authors believe that the heart is always wanting in acephala. - Jagon/.f/, however,

Sect. XIX.] Of the Heart. 26

'^

found a rudiment of it. v. Nov. Acta. Petropol. Vol. XV. 1806, p. 45, ff.; and
Vallisneri in Malpighi Op. posthuma. fol. Lond. 1697, p. 87. — Katzky in Act.
Medicor. Berol. Vol. IX. p. 61. 8vo. Berol. 1721 ; and Gilihert Adversaria
med. pract. Jyudg. 1791, p. 132, a true heart. There is also in the Anat. Mus.
at Berlin, according to an excellent communication of Rudolphi's, an acephalous
monster with a heart.

(2) Marrigues in Mem. de Math^m. pres. a I'Acad. des Sc. Vol. IV. p. 123. —
Daniel Samml. med. Gutachten. Leipz. 1776, p. 276. — Brodie in Phil. Transact.
1809, p. 161 ; and in Edinb. med. and surg. Journ. Vol. VI. p. 191. — Lawrence
in Med. chir. Transact. Vol. V.

(3) A heart with four auricles, and four ventricles, v. Fetter's Aphorismen
aus der pathol. Anat. p. 108. — In a calf, there was a third smaller one near the left
ventricle. Lictzau Hist, trium monstrorum. Regiomonti, 1825, p. 9. — In a goose,
three ventricles, v. Ephem. N. C. Dec. I. Aim. IX. and X. Obs. 108 ; Dec. II.
Ann. VIII. Obs. 114, Schol. p. 251, — /. F. Meckel Tab. anat. path. Fasc. I.
Vol. II. fig. 1, describes a heart, from the right ventricle of which two aortas
arose. Similar cases are described by Haller, Opera minor. Vol. III. tab. 16. —
Walter Observat. anat. tab. 4, fig 3 and 4. — I have also seen a similar case.

(4) Kerhring Spicil. anat. Obs. 69, p. 139, 642, the right ventricle double,
with two pulmonary arteries.

(5) Compare several doubtful cases in de Plouquet Repertor. Art. Cor. duplex. —
Winslow in Mem. de I'Acad. de Paris, 1743, p. 462. — Coulomb CEuvr. med. chir.
Lyon, 1798. s. ReiVs Archiv, Vol. IV. p. 213. — Chaussierm Bulletin de la Facult.
de Medec. de Paris, 1816 ; in /. F. Meckel's D. Archiv, Vol. II. p. 137. — In a
dog. V. PauUini Cynograph. cur. p. 43. — In a rat. v. Boerhaave, p. 491.

(6) For instance, in fowls, v. Ephem. Nat. Cur. Cent. VIII. Obs. 8 ; and
Littre in Mem. de Paris, 1700, p. 32. — In partridges, v. d'Ahoville in American
Philos. Transact. Vol. II. p. 330. — In pigeons, v. Barzellotti in Nuovo Giornale
de' Letterati. Vol. I. No. 1. Pisa, 1822. — In geese, v. Sbmmerring addenda to
Baillie, p. 27, note 51 ; and J. F. Meckel Comm. de duplicit. monstrosa, p. 54.
fol. 1815.— Ephem. Acad. Nat. Cur. Dec. I. Ann. IX and X. Obs. 108, p. 267.

§170.

The heart varies, not unfrequently, considerably from its
usual and proportionate size in both directions, not only as
consequent on original formation, but also more frequently
from disease ; such disproportionate size of the heart to the
whole body appears even to be hereditary. The irregular
SMALLNESs of the heart is sometimes congenital, and is then pro-
bably connected in some cases with other vicious formations
of that organ.' Sometimes this smallness is connected with
general weakness and imperfect development;^ although, in-
deed, often not distinctly marked.^ The acquired smallness
of the heart, the consequence of disease, consumption, or
ATROPHY,^ is very different from the state just described. This
vice is rarely produced by external pressure or narrowed
space, stenocardia;^ but is more usually caused by defective
nourishment of the whole body,'' or of the heart alone, espe-
cially after inflammation, softening, &c., and is, since the
consumption takes place principally in the muscular substance
of the heart, connected naturally with the more or less con-
siderable THINNING OF THE WALLS of the heart.' Sometimes
this smallness of the heart is only a seeming diminution, in

264 Of the HearL [Part II.

consequence of the vioient contraction of the muscle itself, con-
tinued even after death/

(1)1 have found it exceedingly small in a dozen instances, in monsters, or
newly-born children otherwise well-formed, together with other vices, as holes in
the partition of the ventricles, closure of the venous aperture of the right ven-
tricle, but especially in unnatural position of the heart, and in frenic ruptures ;
in the latter, indeed, there has been irregular pressure upon the heart. Other
observers have also frequently noticed the same. Also in double monsters, in
which two hearts are placed in one chest, it is not unfrequent for one of them to
be remarkably small.

(2) Kerkr'nig Spicil. anat p. 43. — Mem. de I'Acad. des Sciences de Paris,
1712. - Lieulaud, Vol. II. p. 147, Obs. 4:53.—Morgagni, Epist. XVII. p. 12.—
Chavasse in Lond. Med. Journ. 17S6, p. 409. — Kreysig, Vol. II. Part II.
p. 468, &C.- — I have twice found in grown-up persons, and in a weakly girl,
whose generative organs were almost those of a child, the heart remarkably
small. V. No. 2186 and 2187 of my Verzeich. ; in which, under No. 2188 and
2189, other cases of still further diminution are related. — In tame birds, the
heart is proportionally less large and muscular than in wild ones of the same
species, v. Tiedemann's Zoologie, Vol. II. p. 571.

(3) Many cases of very small hearts, in grown up persons, are loosely men-
tioned by Lieutaud, p. 146 ; and in de Plouquet Art. Cor. parvum. — In a man of
fifty years it was not larger than in a child of four years, v. Wedemeyer in Rust's
Magaz. f. d. ges. Heilk. Vol. XIII. p. 190. — Biermayer Mus. Anat. Pathol.
No. 381.

(4) Compare Testa, § 4, No. 15.— Kreysig, Vol. II. Part I. p. 326. — - Fetter,
in his Aphorismcn aus der pathol. Anatomie, p. 101, note, seems to consider,
improperly, the small size of the heart as a congenital vice.

(5) Brera Delia stenocardia, malattica volgarmente conosciuta sotte il nome di
Angina pectoris. Verona, 1810. — I have occasionally found the heart, when it
has been much confined by collection of fat in the pericardium, by hardened
lungs, tumours in the mediastina, and by elevation of the diaphragm, not merely
very small, but compressed as it were into an angular shape. Compare note 1. —
A heart which had been diminished in size by a fatty swelling, is described by
Meckel Mem. de I'Acad. des Sc. Berlin, 1755, p. 82. — In an uncommon collec-
tion of water in the belly, which very much compressed the heart. Testa, p. 255,
found it extremely small. — Kreysig, Vol. III. p. 124, found it small in a case of
lardaceous growth in the mediastina.

(6) Hence not unfrequently arises the diminution of the heart, in a small
degree, in wasting diseases, although by no means so common and rapid as in
other muscles, as Morgagni, Epist. LXX. p. 5, has observed. This arises from
the want of cellular tissue between the muscular bundles.

(7) The walls of the heart are so thin, that they are merely membranous,
especially when the muscular fibres are very pale. Here belong also the case of
a person who died of a long-continued sickness, in whom no heart was found,
but in its stead merely a membrane, v. Telesiiis De rer. nat. L. V. c. 28. — Schenck
Observat. L. II. p. 272. — If a really small heart be fleshy, hard and red, I
consider it as a vice of formation ; if it be, notwithstanding, at the same time,
thin and dried up, pale or hardened, I then consider it as a wasting atrophia.

(8) I have seen this repeatedly, particularly in deaths from accident, and in
those who have died of tetanus ; also once in a person who died suddenly from
a stab in the heart. — Tesfa, p. MS, cites an interesting case, in which a man
struggled uncommonly when executed, and on dissection, the heart was dis-
covered very small, from its being most strongly contracted ; therefore Portal,
Vol. III. p. 88, and Kreysig, Vol. II. Part 11. p. 469, very properly warn us
against these easily to be avoided errors.

§ ni.

The opposite vice, or irregular enlargement of thp
heart, is but rarely a congenital disease,^ usually it is acquired,

Sect. XIX.] Of the Heart. 2Q5

in consequence of the mode of living, or of certain diseases, in
which the heart can attain very considerably more than its
usual size.^ This enlargement appears, first, in the otherwise
normal state of the heart, as the mere thickening of its walls,
that is, as an increase of bulk, or hypertrophy of the fleshy
substance, which arises from increased excitement, in a manner
analogous to other muscles ;^ and, secondly, as the morbid
EXPANSION OF THE CAVITIES OF THE HEART, aneurysina
cordis, cardieurysma, cardieciasis, &c.* This latter is usually
divided into the active and the passive, the former of which
consists in the expansion of the cavities of the heart, with
simultaneous thickening and increased hardness of its walls ;
the latter in expansion of the cavities, with thinning, relaxation,
and extension of the walls of the heart. The active aneurysm,
which properly does not deserve the title aneurysm, if com-
pared with the so-named disease of arteries, occurs most
commonly on the left side, especially in the ventricle, but
more rarely on the right side ; the passive, on the contrary, is
usually seated on the right side of the heart, and particularly
in the right auricle. Both forms of aneurysm are frequently
met with in the same individual, and but rarely is the whole
heart affected with one or other species of the disease alone.
The expansion of the cavities is naturally greater in the passive
than in the active aneurysm, and the whole cavity generally
participates equally in it; more rarely is one single circum-
scribed spot affected, which is then distended in a bag-like
form, and connected with the cavity of the heart by an
aperture between the ruptured or separated muscular fibres.^

(1) In new-born children of similar size, we sometimes find a striking dif-
ference in the size of the heart, and the whole of its blood-vessels, as it is
usually larger in wide, than in narrow-chested children ; often also are the hearts
of new-born children affected with the blue disease, proportionably very large.

(2) Even double and more of the usual size and weight. Compare Lieufaud,
Vol.11, p. 129 — 146. — de Plouquet Repertor. Art. Cor. magnum. — Keuss
Repertor. Comment, Vol. X. p. 92 ; Vol. XII. p. 304; for instance, as large as
the heart of an ox. — Lancisius Von den verschiedenen pliitzl. Tod-esarten. Vol. IT.
^. \?jO.—Morgagm Ep. XVII. p. 21 ; XVIII. 28; LIII. ^.—Wildbergm the
Abhandl. der Erlanger phys. med. Soc. I. No. 16. — Gustavus Adolphus's heart
weighed 25 ounces. — Hearts of two or three pounds were found by Chambert, in
Journ. de Med. cont. July, 1810, p. 5. — Fritze in Horn's Archiv f. prakt. Medic.
Vol. III. p. 298. — I once found a heart which weighed two pounds and ten
ounces. — Boeck D. de statu quodam cordis abnormi. 8vo. Berol. 1818, with
plates, &c.

(3) Fef/er Aphorismen aus derpathol. Anatomie, p. d9. — Bertin. — Legallois
Observation sur une maladie du cceur par hypersarcose, ou par exces de la sub-
stance musculaire, etc. in Bulletin de la Faculte de Med. de Paris. Ann. XI II.
p. 69. — Several cases of hypersarcosis of the heart are given by Lallemand in
Archiv. generales de Medec. Aug. 1824. — Rousseau compares the hypertrophy
of the heart in active aneurysm, with the development of the muscular substance
of the uterus in pregnancy, v. Recueil de Memoir, de Med. Chir. et Pharm.

266 OftJw Heart. [Part II.

milit. par Fournier, Vol. X. p. 366. — [Hypertrophy, when partial, is more com-
mon in the left ventricle than elsewhere, and in the ventricular partition more
frequently than in the other parts. — Hypertrophy of the auricles are rare. v.
Andral, Vol. II. p. 284, 285. T.]

(4) Compare Renss Repertor. Comment. Vol. X. p. 92 ; Vol. XV. p. 200. —
de Plouquet Repertor. Art. Cordis Aneurysma. — Lieutaud. — Morgagni De sed. et
caus. morb. in several parts. — Lancisius De motu cordis et aneurysmatibus. fol.
Rom.1728. — il/a^rt»i De aneurysmaticis praecordiorum morbis. Francof. 1766; and
in Lauih Scriptor. latinor. de aneurysmat. collatio. — Hiefinger D. s. histor.
hydropis pectoris cum aneurysmate cordis. Viennae, 1770. — Michaelis D. aneu-
rysmatum cordis disquisitio anatom. med., observatione quadani illustrata.
Halae, 1785. — A. Ramsay, Anatomy of the Heart, Cranium, and Brain. 2d edit.
Edinb. 1803, remarks, that enlargement of the aortic chamber is very common
in warm climates. — Lesage D. sur les aneurysmes du Coeur et des gros vaisseaux.
4to. Paris, 1803, with five plates. —Co?-i'isar; first employed the terms Aneurysma
activum and passivum ; Matani, Morgagni, and Berlin, had however previously
remarked on their distinctions. — Flormarm De aneurysmate cordis. P. I. resp.
Hjerstedt, P. II. resp. Engestrom, P. III. resp. Pramherg. 4to. Lond, 1812.
— M6m. du Mus. d'hist. natur. 1818. Vol. IV. p. 62. — Rostan very frequently
found aneurysms of the heart in asthmatic persons, v. L' Asthma des vieillards
est-il une affection nerveuse ? 8vo. Par. 1818. — FoderS in Journ. compl. du
Diet, des Sc. m^dic. Vol. VIII. p. 309; Vol. IX. p. 97. —Portal in Journ.
universel des Sc. medic. Vol. VIII. p. 5. — ^rcrcy^ D. de cordis aneurysmate,
Edinb. 1822. — I have described several instances in my Selt. Beobacht. Part I.
p. 86, — Verzeichniss, No. 2190 — 2200. — Engravings of aneurysms of the heart
are given by /. F. Meckel Tab. anat. pathol. Fasc. I. tab. 3, 4, and 6. — Dundas
V. Allgem. Medic. Annalen, 1811, p. 702. — Portal Sur les aneurysmes du coeur,
etc. in Mem. du Mus. d'histoire nat, 1818, Vol. IV. p. 62. — H. B. Smitz D. de
aneurysmate cordis. 4to Gandavi, 1827. — Aneurysmal hearts have also been ob-
served in animals; viz. in horses affected with palpitation of the heart. — [The
term. Aneurysm of the heart, is objected to by Andral, Vol. II. p. 282, as not
indicating the real circumstances of the disease. T.]

(5) J. G. Waller, Mem. de I'Acad. des Sc. de Berl. 1785, p. 5o, tab. 4, fig. 1 ;
and Mus., No. 675, as steatoma cordis; although M. Boas D. de cordis aneurys-
mate rarissimo, 8vo. Berol. 1826, with engravings, has shown it to be an aneurysm
of this kind. — Baillie, Morbid anatomy, and Scries of Engravings, p. 15, pi. 3,
fig. 1. — Ja/niiiii Anatomia pathologica di M. Bailie. Vol. I. p. 27, No. 17 and 18.
Venezia, 1819. — Corvisart, p. 269, Obs. 42. — Berard D. sur plusieurs points
d'anatomie pathologique et de pathologic, Paris, 1826 ; and in Archiv. general,
de Medec. Vol. XI. March, 1826, two cases. — Cruveilhier in Nouv. Biblioth.
med. April, 1827. — Bielt Histoire de la maladie de Talma, in Repertoire
g<5neral d' Anatom. et de Physiol, pathol, etc. Vol. III. Part I. p. 214. — Breschet
Sur I'aneurysme faux consecutif du Coeur, etc. — lb. Vol. III. Part II. p. 183,
contains one case from Dance, and another, and pi. 6 and 7, engravings of such
hearts; all these cases occurred in the left ventricle, and answer, in a certain
degree, to aneurysma s})urium of the arteries. An eleventh case, in the right
auricle, is mentioned by C. R. Bernhardt, D. obscrvatio circa ingentem cordis tu-
morem. 8vo. Regiomonti, 1826, with a wood-cut. — \_Johnso7i\s Med. chir.
Review, for .July, 1829, gives a case of aneurysm of the left ventricle protruding
into the auricle. — In the Mus. St. Thomas's Hosp. there are three specimens of
aneurysm of the heart, two of which are in the posterior part of tiie loft ventricle;
one of them is nearly as large as the heart itself, and its walls are principally
formed of the thickened pericardium, containing thick layers of coagulable lymph;
the other is the case related by Dr. Elliotson, p. 29, in which there is also a
tumour as large as a pigeon's egg, with several smaller in the right ventricle ;
the third is an aneurysm of the sinus of the left auricle, also mentioned by
Dr. E., ]). 29. He gives engravings of both the latter in his work. — According
to a memoir of Reyi/aud, in Journ. bebdom. de M6dec. Vol. XI. the lining
membrane of the heart, said by Breschet to be ruptured, merely distended, as in
true primitive aneurysm. T.]

Sect. XIX.] Of the Heart, 267

§ 172,

The just-mentioned partial enlargements of the heart natu-
rally lead us to consider the vices of form in this organ.
These are usually congenital, and may affect both the ex-
ternal and INTERNAL form. The former are frequently con-
nected with the latter, and are often necessarily consequent
upon them;^ still, however, vices of the external form alone
are not infrequent,^ since, both in infants and adults, the heart
has been noticed, for instance, too globular,^ flattened,^ very
long and pointed,^ very broad and blunt,^ deeply indented at
the tip,^ unsymmetrical,^ crooked,^ with processes and deep
indentations of the auricles,^" &c. The irregular internal form
and arrangement of the heart, as it depends partly on the
development of the organ itself, and is merely a retardation
of it, is not merely more common, but more important,^^ as the
circulation of the blood is usually so irregular that the
continuance of life for any length of time after birth is pre-
vented, or at least rendered very difficult; and in both cases a
morbid condition is presented by the mingling together of the
arterial with the venous blood, which has been named, from its
most remarkable symptom, the blue disease, morbus ccerulens,
cyanosis, cyanopathia,^'^

(1) In the greater number of instances, the hearts of persons affected with
the blue disease are also externally malformed, not to mention examples of still
more imperfect formations of the heart, I have found the heart also, in a great
number of such cases, most commonly too broad and blunt ; for example, No.
2896, 2929, 2930, 2899, 8011, 8012, in Bresl. Mus. and in many others.— Also
in many animal monsters.

(2) Sometimes the fault appears to lie in an irregular position, or narrowed space.

(3) K. Blegnij Zodiacus Ann. XL Jan. Obs. 4. — Kohler Beshreib. der Loder-
schen Samml. No. 1037. — I found it once in a child with anencephaly and
abdominal cleft, almost spheroidal, No. 8016, of the Museum.

(4) Stalpart van der Wiel Observat. rar. med. anat. L. B. 1687. Cent. I.
Obs. 37. — Kulmus in Actis Lips. Ann. 1727. — I have found it likewise occasion-
ally in dropsical people, also in a monster, v. Selt. Beob. Part I. p. 8.

(5) For instance, if the pericardium be deficient at its base, the point of the
heart lies between the lobes of the liver, v. Selt. Beob. Part I. p. 64 ; and fre-
quently since. — Very much elongated, in which case its apex adhered to the
head. — Cerutti Rar. monstr. descript. anat. 4to. Lips. 1827. — Very pointed when
one of the ventricles does not reach the point, &c.

(6) Not unfrequently.

(7) Bartholinus Histor. anat. Cent. I. Hist. 67 ; Vol. I. p. 117. — /. F. Meckel
Pathol. Anat. Vol. I. p. 469. — Kelch Beitrage zur pathol. Anat. p. 81, No 57. —
BurkhardtD.de monstro humano notabili. 8vo. Frib. 1825. — My Verzeichniss,
No. 2201. — J. Meckel in J. F. Meckel's Archiv f. Anat. u. Physiol, 1828.
No. 2, p. 153.

(8) In which case one or other ventricle is too small.

(9) Morgagni Epist. LX. p. 8.

(10) de Haen Ratio medendi. Vol. IX. p. 39. Viennae, 1764.— £. d' Alton D.
cyanopathiae specie, p. 15, Bonn, 1824.

(11) The resemblance which such malformed human hearts are said to have
to those of the lower animals, for example, insects, crabs, molusca, fish, and

268 Of the Heart. [Part II.

amphibious animals, is to me not conclusive. Setting aside the number of
cavities and holes in the partitions of the heart, I have never been able to dis-
cover the smallest or most remote similarity with any one heart of an animal.
How different, for example, is the heart of a child affected with the blue disease
with the opening insepto of the heart of a tortoise with the other form, the
several auricles, the loose but at the same time spongy structure of the walls of
the heart ; the other valves, the pale and soft muscles, &c. ? It is remarkable
that this kind of vice of structure is, against all rule, more common in the male
than in the female sex.

(12) Seller Pr. de raorbo cceruleo. Viteb. 1805. — Schuler D. de morbo cceruleo.
8vo. (Enipont, 1810. — A'a^se in ReiVs Archiv f. d. Physiol. Vol. X. p. 213.— In
a supplement to the translation of Bums on Diseases of the heart, and a col-
lection of twelve cases, in Horn's, Nasse's, and Henke's Archiv fiir medic.
Erfahrung. Nov. and Dec. 1817. — Kdmvierer D. de morb. ccerul. Hala^, 1811. —
J. F. Meckel Handbuch der pathol, Anat. Vol. I. p. 419, fF. ; and in D. Archiv
f. d. Physiol. Vol. I, p. 221, with a table of seventy-seven separate observations,
— Toiler D. de morbor. coerul. Gott. 1812. — Haase D. de morb. ccerul. 4to. Lips.
1813, with engravings. — Kwiatkowski D. aetiologiam morbi ccerulei amplificans.
8vo. Vilnae, 1815. — Hein D. de istis cordis deformation, quae sanguinem venosum
cum arterioso misceri permittunt, 4to. Gott. 1816, with a table of more than
seventy-one cases. — C. de Hartmannn D. de cyanosi ejusque cura. Viennae, 1817.
— Cherrier D. sur la maladie bleue, etc. Paris, 1820. — Marx D. morbi cosrul.
exemplum memorabile. 8vo. Berol. 1820. — Zimmermunn D. de morb. cceruleo.
Svo. Berol, 1822, (without a case of his own.) — Peters D. s. relationem depuero,
morbo cceruleo laborante. 4to. Kiliae, 1822. — Horner D. de Cyanosi. 4to.
Monachii, 1823. — Louis Observations suivies de quelques considerations sur la
communication des cavites droites avec les cavites gaudies du Coeur in Archiv.
gener. de IMedec. Nov. 1823, and in M^moires ou Recherchcs anat. pathol.
p. 301, Paris, 1826. (with some of his own cases.) — Gintrac Observations et
Recherches sur la Cyanose ou maladie bleue. Paris, first as a Diss. 1814, sub-
sequently enlarged. 8vo. 1824. (three cases of his own, and a collection of fifty-
three others.) — Ramberg D. de corde vasisque majoribus eorundem ratione normali
in animantibus et abnormi in homine, 8vo. Berol. 1824, with engravings. — E.
(T Alton D. de cyanopathiae specie ex invicem permutata arteria? pulmonalis
atque aortai origine, 4to. Bonnae, 1824, with engravings. — Meinccke D. de
cyanosi. 8vo. Berol. 1825. — Lewes D. de morbo cceruleo. Svo. Berol. 1826. —
Fr. Ermel D. de cyanosi. 4to. Lips. 1827. — As to individual cases, v. the tables
of Meckel, Hain, and Gintrac, the latter of which I have not unfortunately at
hand. — Gallois Bulletin de la Faculte de Medecine de Paris, 1809, p. 133.
— Pelletan Clinique chirurgicale. Vol. III. Paris, 1810. — Tupper in London
Medical and Physical Journal, Vol. III. p. 497. — Jackson, ib. No. 198,
p. 100, Aug. 1815; and in New-England Journ. of Med. and Surg. Vol. III.
p. IGl, \%\^. — Ribes in Corvisart and Leroux Journ. de Medec. Vol. XXXIV.
p. 421, 1815. — Thomson in Ebinb. Med. and Surg. Journ. Vol. XII. p. 3. —
Dorsey in New-England Journ. of Med. and Surg. Vol. I. p. 69, 1812. — Young
in Journal of Science and Arts of the Royal Institution, London, 1816, Vol. I.
Art. 3, with engravings. — Howship, Practical Observations in Surgery and
morbid Anatomy, Cases 57 — 59, 1816. — Kreysig Die Kranklicitcn des Ilerzens.
Part III. p. 104, witli engravings. — R, Thuxter in New-England Journal of
Medicine and Surg. Vol. V. Boston, 1816. — Creveld in Hufilaiurs ioxxrniA d.
pr. Ileilk. p. 74. Dccemb. 1816. — Delondre in S^dilloVs Journ. de M^dec.
Vol. LX. p. 38. — Wistar s. Gott. gclchrte Anzeigen, p. 1767, 1818. — Nordblad in
Ars-Berattelse om Svenska Lakare-Siillskapets Arbeten of Carlander. Stockh.
1816. — Seidel Index Musei anatom. Kiliensis. p. 61, Kiliae, 1818. — Marechal in
Journ. gen. de Medec. Vol. LXIX. p. 354, Dec. 1819. — Thibert and Fouquier in
Bulletin de la Faculte de Medec. Vol. VI. ]). 355 — Olivry in Journ. gen. de
Medec. Vol. LXXIII. p. 1 1'5. — Hcsselbc.ch IJcriclit von der kcinigl. anat. Anstalt
zu Wiirzburg, 1820, and Beschrcib. der pathol. Priiparate zu Wiirzburg. j). 201.
No. 511 ; p. 202, No. 610. Gicsscn, 1821. — Nasse LcichenoHnungen, p. liiCi,
Iste Reihc. \%2\.— Gregory in Med. chir. Transact. Vol. XI. p. 29G, 1821.—

Sect. XIX.] Of the Heart. 2G9

Olory in Repertorio Med. chir. per I'anno 1821, Turino. — Bock in Ceruttis
Pathol, anat. Museum, Vol.1. Part III. p. 37. — Holmsted in London med.
Repository, Vol. XVII. p. 455, June, 1822. — SchaUgruher Abhandl. im Fache
der Gerichtsarzneikunde, p. 55 — 76. Gratz, 1823. — Rust's Magazin f. d. ges.
Heilk. Vol. XVIII. p. 346. — Hesse D. Monstri bicipitis descriptio anat. p. 20.
Berol. 1823.— C. Perkins in New- York Med. and Phys. Journ. Vol. II. p. 444. —
Holmers in Transact, of Med. chir. Soc. of Edinb. Vol. I. No. 11. 1824. —
Tiedemann in d. Zeitschrift f. Physiologic, Vol. I. Part I. p. Ill, pi. 7, fig. g. —
Coates in Cliafmann's Philadelphia Journal of the Med, and Physic. Sc. Vol. IX.
No. 17, Nov. 1824. — Rosenstiel D. monstri duplicis rarissimi descriptio anato-
mica. p. 12. Berol. 1824. — Wirtensohn Duor. monstror. duplic. humanor. descr.
anat. p. 13, tab. 2. Berol. 1825. — Hall and Vrolik in Praktisch Tijdschrift voor
de Geneeskonde. Part II. 1825. — Burkart D. de monstro humano notabili. 8vo.
Friburof, 1825. — Ahercromhie in Trans, of Med. Chir. Soc. of Edinb. Vol.1.
p. 1. — J.F.Meckel Descript. monstr. nonnull. p. 11, 21, 31, 59. 4to. Lips.
1826. — Breschet in Repert. g^n. d'Anat. etc. Vol. II. p. 12, \7.—Huf eland's
Journ. d. prakt. Heilk. p. 133. Feb. 1826. — Delmas in Eph^mer. med. de
Montpell, Vol. I. Jan. 1^26.— Ullrich in Rust's Magaz. Vol. XXII. p. 502.—
Mauran in Philadelphia Journ. Vol. XIV. p. 253. — Dujes in Journ. gdn. de
Med. Vol. CI. p. 88. — Mayer in v. Grdfe's and v. Walther's Journ. der Chir.
Vol. X. p. 44, pi. 2, fig. 1. — Knup in Harless Rhein-Westphal. Jahrb. d. Med.
und Chir. Vol. IV. Part I. No. 8. — One case in Archives gen. de Medecine,
Sept. 1827. — Cerutti Rarior. monstri. descript. anat. 4to. Lips. 1827, with en-
gravings.— Staupa Anweisung zu gerichtl. und pathol. Untersuchungen menschl.
Leichname. p. 164, note xx. Wien, 1827. — Cogoreux in Revue medic, franc,
et etrang. Vol. I. and II. 1827. — Wittcke in Hnfeland's and Osann's Journ. d.
prakt. Heilk, April, 1828 — R. K. Hoffmann in New-York Med. and Phys. Journ.
Vol. VI. p. 25Q. — Basedow in Hufeland's Journ. p. 78, July, 1828.— My Selt.
Beob. Vol. I. p. 16, 64; Vol. II. No. 21, p. 49, 102; since in No. 2203—2207,
2896, 2899, 2929, 2944, my Verzeichniss, and in No. 8011—8014, 8020, besides
in several monstrous cattle and sheep. — Legallois observed one case in a rabbit.
Vol. XII. p. 122, V. Bulletin de la Soc. de Medec. 1809, p. 99.— Compare Reil's
Archiv. B. and Meckel's Descript. monstror. nonnullor. p. 50, in a pig. — R. K^iox,
in Edinb. med. and surg. Journ. 1815, Vol. II, p. 57, — Alihert Nosologic Natu-
relle, 1817, Vol. I. p. 344. — Bonnissentj Obet, and Pinel, in Revue M^dic.
Vol. VI. p. 175, Oct. 1821. — Lallemand in Rech. anat. pathol. sur I'Encephale,
Vol. II. p. 7, Paris, 1823. — Crziveilhier Anat. Pathol. Part I. pi. 6.

§ 173.

These malformations of the heart vary considerably in
degree. As the lowest kind we must notice that rudimentary
formation of the heart in which it appears as a mere fleshy
mass without any cavity;^ as a longish solid mass, from which
the vessels arise ; ^ or as a mere expanded vascular trunk.^
To these, follow the heart with a very imperfect muscular
structure, containing a single valveless cavity, with a very
imperfect trace of an auricle ; ^ then such hearts as are occa-
sionally formed with but a single ventricle and auricle, with
a corresponding vascular trunk,^ succeeded by those which,
having merely a single ventricle, are furnished with an auricle,
more or less perfectly divided by a partition into two cavities,
whence the venous and arterial trunks simultaneously arise,
either confounded together or distinctly divided.^ More per-
fect and more common are those formations of the heart, in

270 Of the Heart. [Part II.

which, either by the increased capacity of the ventricle, or by
the gradual development of the partition, merely open at a
single point,' the division into two ventricles is completed,^
of which, sometimes the right,^ at other times the left alone, ^'^
is small and imperfect. Lastly, we frequently meet with those
hearts which are irregular in their normal structure, merely
so far as that the peculiar foetal blood-passages remain mor-
bidly open, so that either both the oval hole, and the arterious
duct,^^ or only the former,^' or the latter alone,^^ are found un-
closed. In diving mammalia, viz. the otter, the seal-kind, the
beaver, the desman, and the cetaceous animals, we find the
oval hole or the arterious duct generally, though not always
open, but still much more frequently than in other beasts.^*
We also occasionally meet with, in the human subject, one or
more tolerably distinct apertures in the oval pit, continuing to
a later period of life without any consequent diseased con-
dition ;^^ it however appears that, by no means infrequently,
is the already closed oval hole again morbidly opened, and
with it, as it were, a recurrence to the foetal state. ^°

(1) Misc. Nat. Cur. Dec. II. Ann. II. Sect. 143 ; Dec. III. Ann. II. Sect. 9.
— Vesllngii Syntagma Anatomicum, p. 150. — In a large fat pig, with accom-
panying small size of the liver and spleen, the heart was found not bigger than a
small cherry, attached by a thin neck in the pericardium, and without-auricles
and blood-vessels, v. Fahnestock in American Medical Recorder, Vol. VI. April,
1823.

(2) Zagorsktj Nov. Act. Petropol, Vol. XV. p. 478. 1806.

(3) In many headless monsters.

(4) Roederer Foetus parasitici descriptio in Comment. Soc. Getting. Vol. IV.
p. 125.

(5) Wilson in Phil. Trans. 1798, Part II. p. 346.— F«rre, p. 2.—Mauran and
Brescfiei, p. 17.

(6) Standert in Phil. Trans. 1805. — Tiedemann's Zoologie, Vol. I. p. 177. —
Chemineaii in M6m. de I'Acad. des Sc. 1699, Hist, p. 43, — Lawrence in Farre,
p. 31. — Fleischmann, p. 193. — Pozzis in Senac. — Hartmann and Staupa. — Manran.
—My Selt. Beob. Part I. p. 16.— Wolf in Kreysig, Vol. III. p. 200.— Rosenstiel,
p. 12.— Breschet, p. 12.

(7) Usually we find an opening more or less large in the upper part of the
partition ; and over it the aorta springing out of botli ventricles. In rare cases,
however, is this hole further downwards towards the apex, or it is even manifold.
The first instance was found by Meckel, v. Jieil's Archiv. Vol. IX. p. 442, and
Tab. anat. Fasc. I, tab. 1, fig. 2; Gregory ; — and myself in a monstrous calf — the
latter, J. F.Meckel Descrij)tio monstror. nonnullor, p. 11. — Kreysig, \o\. III.
p. 104; and myself. No. 2899; in all three cases two openings; in one case
even three, v. Hodgson in Farre, p. 19.

(8) Such holes in the upper part of the partition were observed by Slenson,
Men/, Sandlfort, Hunter, J. F. Meckel in three cases, Farre in three cases,
Langstajf, Ring, Jbernetky, Obet, Frochaska, Meyer, Cooper, Tiedemann, Richcrand,
Nevin, Pulteney, Cruiksliank, Corvisarl, Caillloi, Duret, Huet, Lawrence and Haase.
V, ./, F. Meckel's and Ilayn's tables. — Further, Pelletan, Tapper, Jackson, Ribes,
Creveld, Thoxter, Dorscy, Delondre, Seidel, Marechal, Olivry, Hessellmch, Nasse,
Gregory, Olory, Bock, Ilolmsted, llonicr, Srliallgniher, Perkins, Ilolniers, Biirkart,
Meckel in six cases, liujeland, Gallois, Ilowsliip, y/bcrcrombie, Louis, Obs. 10,
Hoffmann, Basedow, Knox, Gintrac, p. 164, and myself in twelve cases, viz. Selt.

Sect. XIX.] Of the Heart. 271

Beob. Vol. I. p. 64 ; Vol. II. p. 50, 102.— In No. 2203—2207, 2896 (with a
valve,) 2899, 2929, 8011, 8013, 8014, 8020.— In an anencephalic as well as in a
calf and sheep monster. — In very rare cases such holes appear also capable of
arising later through disease, for instance, in abscess, lacerations, &c. — Hereto
belongs a case which I saw in the Anat. Mus. at Strasburg, and the case of
Thibert and Fouquier.

(9) For example, Marechal, Holmers, Beckhai/s, Schuler, Kreysig, Vol. III. p. 104.
—My Selt. Beob. Part I. p. 64; Part 11. p. 50; and in No. 8020 of the Bresl.
Mus. — Hereto belongs, in a certain degree, also the case observed by Ahercrombie,
in which the upper part of the right ventricle of the heart by adhesion of its
walls was separated, and produced a small cavity.

(10) This was found by Mery, Meckel, in two cases, Corvisart, Farre, in two
cases, Louis, Obs. 4, Ramberg, Rust, and Hesselbach.

(11) For instance, in the cases by Langstaff, Jurine, Spry, Seller, Burns, and
one by Farre. — Wolf in Kreysig, Vol. III. p. 200. — Marechal.

(12) Hodgson, Hunter, English, Lawrence, Schuler, Nevin, Haase, Jurine, Sandi-
fort, Meckel, Tacconi, Morgagni, Nordblad, Farre, in two cases Meyer, Green,

Corvisart, Hesselbach, Seller, Delmas, Ulrich, Hoffmann, Basedow. — Moreou de la
Sarthe Fragmens pour servir a I'histoii-e de la Medecine en France, p. 45. 1812.
— Kreysig, Vol. III. p. 104, with an engraving. — Knox, Allbert, Gintrac, p. 164.
Cherrier, Bonnissent, Obet, Plnel, and Lallemand.

(13) Fabricius Hildanus Op. omnia. Ep. XLV. p. 992. — Brendel in Ephem.
Nat. Cur. Cent. IV. Obs. 166. — Hunter and Jurine found it open but narrow.
English, Obet, liicherand. Spry, Seller, Marechal, Burns, Thoxter and Delmas saw it
wider.

(14) /. F. Meckel has collected such cases in his edition of Cuvler's Comp. Anat.
Vol. IV. p. 37, note ; in his Beitragen zur vergl. Anatomie, Vol. II. Part I.
p. 15, and in his Pathol. Anat. Vol. I. p. 447. — Blumeyibnch Handbuch der vergl.
Anatomie, p. 543. — I have hitherto found the oval hole open in three seals, and
also in the alca torda in Tiedemann^s anat, Mus. — The oval hole open in a young
delphinus phocoena. v. Elchwald in M^m. de I'Academ. des. Sc. de Petersb.
Vol. IX. p. 431.

(15) Compare J. F. Meckel's Pathol. Anat. Vol. I. p. 447.— We usually find
the aperture obliquely upwards, sometimes downwards, and in number even as
many as a dozen. In the Anat. pathol. Mus. at Vienna I saw the heart of a
young man with an open oval hole, and a second also, separated from it by a
thick column of flesh. Two oval holes were found by Vieussens Du Cceur,
p. 53. — Breschet and Hoffmann. — I have very often found in adults, who had never
complained of any affection of the heart, openings in the partition of the auricle
of the thickness of a finger. Similar cases have been often described; compare
Reuss Repertor. Comment. Vol. X. p. 39, and de Plouquet Repert. Art. Cor. and
Biel D. de foraminis ovalis et ductus arteriosi mutationibus. 4to. Berol. 1827,
with engravings.

(16) Lentlllus, Eph. Nat. Cur. Cent. VII. VIII. Obs. 62, was the first who
adopted the idea of the reopening of the oval hole. — Tacconi, in Comment.
Bonon. leads to this from a case. — Abernethy, in Phil. Transact. 1798, P. I.
believed that this was the case in affection of the lungs ; also Meckel, p. 465, is
not disinclined to adopt this opinion. I myself have endeavoured to ground it
upon fourteen cases, v. my Selt. Beob. Part I. p. 97, and Part II. p. 5^. And
since then I have observed more cases which speak to that point. Also Gintrac
and A. Retzlus, v. Ars. Berattelse om Svenska Lakare-Sallskapets Arbeten
lemnad af Ekstrom Stockh. 1826, are of this opinion. — Single obs. which appear
to me to countenance it are Schrader Obs. an. med. Dec. I. Obs. 4, p. Q5. —
Brendel, Ephem. N. C. Cent. IV. Obs. 166.—Sandifort, Obs. anat. pathol. L. IV.
cap. 6. — Thomson in Edinb. med. and surg. Journal, No. 46, Jan. 1826, No. 2. — ■
Thibert, Fouquier, and Young. — Bolllaud in Nouv. Journ. de Med. Vol. VI.
p. 23. — Corvisart, 2d edit. p. 290. — Retzlus. — Hesselbach, p. 205, No. 620.—
Compare Pasquallni Memorie sulla frequente apertura del foramine ovale rinve-
nuta nei cadaveri dei tisici. 8vo. Roma, 1827.

272 Of the Heart. [Part II.

§ 174.

Though several of the just described vices of formation, for
instance, the open state of the oval hole, and simultaneously
with it, the perforation of the ventricular partition, are often
present in the same heart, we also find still other malformations
of various kinds associated with them. To these belong, for
instance, the imperforate state of the venous orifice of
the right^ or left^ ventricle, which is of very rare occurrence ;
and no less rare the narrowed or closed state of the
ARTERIAL APERTURE of the left veutricle,^ and the very com-
mon NARROWING Or PERFECT CLOSURE OF THE ARTERIAL

ORIFICE of the right ventricle, viz. the origin of the pulmonary
artery.* Very frequently also we observe, either alone or in
connexion with other vicious formations, an irregular arrange-
ment of the ARTERIES AND VEINS arising from the heart, in
consequence of which, the arterial and venous blood become
mixed, or the change of the latter into the former is prevented.^
The VALVES of the heart also not unfrequently present con-
genital vices*' of formation; thus for instance, the valve of
THE OVAL HOLE is often entirely deficient, and especially, if
in persons affected with the blue disease, the aperture be very
large ;^ or it is too small, and not adherent at one or more
points of its edge ; sometimes it is perforated, sometimes very
thin, double,^ and differing variously in position and form.^
The EUSTACHIAN VALVE commouly, though not always, has
a certain relation to the oval hole, so that it appears to be
large, if in the later periods of life that aperture is found
open ; ^° frequently it is entirely deficient, and not merely in
after life, when it is often very small, thin, perforated, and lost
in net-work, and fibres, but even in young persons;" some-
times it is so large that it occupies the place of the deficient
thebesian valve, and covers the orifice ^of the coronary vein ;
even its position varies in certain cases. ^^ It has been already
observed that the thebesian valve is often wanting,^-^ but it
also deviates considerably in size, form, and position ; " and
is also found double and manifold.'^ The tricuspid*^ and
BICUSPID*^ valves are also deficient, simultaneously with other
malformations of the heart, or they are imperfectly developed
and mishapen. In rare instances the semilunar valves, both
of the aorta and of the pulmonary artery, were not found,'* or
only as a single valve.'" And equally rare is the existence in
the former^'' or in the latter'^' of only two valves; or on the
contrary, both in the pulmonary artery,^' and the aorta," four,
and even five" semilunar valves; they are also seen cleft, and
of unequal size. In a single instance an uiuiatural valve has

S ECT. X I X .] Of the Heart, 273

been observed on the orifice of a pulmonary vein, in the left
auricle of the heart. ^^

(1) Kreysig, Vol. III. p. 106. — Myself in a human monster, No. 8012, and in
a double lamb. No. 8020 of the Bresl. Mus.

(2) My Selt. Beob. Part I. p. 16. — Respecting the morbid narrowing of this
and other openings of the heart, I shall treat when I speak of the vices of texture.

(3) A case in Corvisart, Rust, Ramberg, &c.

(4) This was found by Stenson, La7igst<tff, Chemineau, Hodgson, Hunter, Schulcr,
Fleischmnnn, Farre (several times), Howship, Nevin. Ring, Abernethy, Cailliot, Obet,
Meyer, Cooper, Haasse, Sandifort, Huet^ Pulteney, Tacconi, Morgogni, Seller,
Schallgruher, Hall and Vrolick, Delmas, Meckel, and myself, v. Selt. Beobacht.
Part 11. p. 102, and in the monsters, No. 8012 and 8020 in Bresl. Mus. This
vice consists sometimes in a mere narrowing of the arteries; in other cases the
opening is through an oblique partition, but only slightly perforated in the middle,
through the adherent or entirely closed semilunar valve ; although this is by no
means always the case in the blue disease, inasmuch as the arteries of the lungs
have commonly their normal width ; they are even irregularly wide, as the cases
of Farre, Richerand, Lawrence, Corvisart, Meckel, Young, Hufeland, and LaUemayid,
will show.

(5) See further down in the several blood-vessels.

(6) Of the acquired deformity of the same we shall speak further on.

(7) Plancus, V. Morgagni, Ep. XLVIII. 62. — Delmas, Hodgson, English, Law-
rence, Ulrich, &c.

(8) Vieussens Du Coeur, p. 53. — There were two foramina ovalia.

(9) Haller Elem. Physiol. Vol. VIII. p. 379.—Kilian Ueber den Kreislauf des
Blutes im Kinde, u. s. w. 4to. Karlsruhe, 1826.

(10) Compare /. F. Meckel Pathol. Anat. Vol. I. p. 455 fF.

(11) I have found this myself often, viz. in monsters, No. 8012 and 8014 of the
Bresl. Mus.

(12) Kilian, pi. 3 and 4.

(13) Meckel resp. Lindner D. de lymphat. vasor. systemate. Halae, 1787, p. 2. —
I have missed the valvula thebesii three times, viz. in an adult and in two mon-
sters. No. 8013 and 8014 in the Bresl. Mus.; also in the case of D' Alton it was
wanting. — If the left upper vena cava open into the coronary vein, then the
valve also is sometimes wanting. This I observed, for instance, in a monster,
No. 8020 of Bresl. Mus.

(14) In such rare cases, in which the coronary vein empties itself in the left
auricle, the valve very naturally cannot be in the right, but only in the left
auricle.

(15) Sommerring Vom Baue des menschl. Korpers, Vol. IV. p. 427.

(16) It is wanting always when the venous opening of the right ventricle is
closed, and sometimes when the aorta springs up very far to the right, by which
its development is retarded, and it can only partially exist, as I have myself
found several times. In two cases I found it consisting of four pieces, as was
also seen by Hesselbach. v. Beschreib. der pathol. Praparate, p. 201, No. 541..

(17) In closed ostium venosum of the left ventricle, although also without it;
for example, /. F. Meckel, Descriptio monstror. nonnullor, p. 11. It was vex^
deformed in the case in Rust.

(18) For example, Wichert, Descriptio monstri duplicati. 8vo. Dorpat, 18^,
p. 24, 26. — Wirtensohn D. duorum monstror. duplic. humanor. descriptio anat.
p. 24, 4to. Berol. 1825.

(19) For example, when it is closed at its origin, or sometimes only very
narrow ; so that in the blue disease, in the pulmonary artery commonly, instead
of the three valves, there is only a membranous ring, with a narrow opening in
the middle, as mentioned above, v. note 4.

(20) Littre in Mem de Paris, 1713, p. 22 and 29.--Baillie, Engravings of
morbid Anat. pi. 2, fig. 5. — /. F. Meckel Handb. der pathol. Anat. Vol. I. p. 436,
and Tab. anat. pathol. Fasc. I. tab. 1, fig. 1 ; and myself in three cases, v. Selt.

T

274 Of the Heart. [Part II.

Beob. Part II. p. 67. In a monster, No, 2896 of my Verzeichn, and in a mon-
strous calf, with cleft palate, monstrously short legs, &c.

(21) Walther Observat. anat. p. 9, tab, 4, fig. 3. — Sandijort Observ. anat. pathol.
Lib. I. tab. 3, fig. 4 and 5, Lib. III. tab. 4, fig. 3. — J. F. Meckel De corde abnorm.
Vol. II. fig. 2 and 3, and Tab. anat. path, Fasc. I, tab. 2, fig. 5 and 6. — Farre,
fig. 12.— Palois in Bullet, de la Soc, de Medec. de Paris, 1809, Vol. IV. p. 226.—
Cailliot, ib. 1807. p, 21. — Ilesselbach Beschreib. der pathol. Praparate, p. 201,
No. 541, and myself in two monsters. No. 8011 and 8013 of Bresl. Mus.

(22) Petschke, v. Holier Coll. Disp. anat. Vol. VI. p. 774. — Morgagni,
Epist. XXXIV. 15. — J. F. Meckel De cord, abnorm, tab. 2, fig. 1, and Tab. anat,
path. Fasc. I. tab. 2, fig, 2 — 4. — Penada Saggio terzo d'osserv. e memor. med.
anat. Padova, 1803, No. 3.

(23) Kclch Beitrage zur pathol. anat. p. 81, No. 58.

(24) In an aorta at first single, but very soon after divided, v. Malacarne
Osservazione in Chirurgia, Torino, 1788, Part III. p. 119.

(25) Kelch, No. 59.

§175.

The POSITION of the heart is not unfrequently found irregu-
lar/ both as a congenital and as an acquired vice. The first
kind presents very many variations and gradual transitions into
each other, but which may generally be referred to two forms,

viz. IRREGULAR POSITION WITHIN and WITHOUT THE CHEST.

To the former belong, the very rare position of the heart too
much to the left side,^ next, the more usual, and in very
different degrees, situation of the heart to the right side, which
is not merely observed in the transposition of all the viscera of
the chest," but sometimes even of the heart alone ; * next follows,
the transition thereto in the direct or vertical position of the
heart,* or its transverse position,*^ in which the point is turned,
now to the right and now to the left side, and often even up-
wards, and the heart itself also often placed lower ; finally, some
instances of the too high situation of the heart, especially
in connexion with imperfect development of the cavity of the
chest, in reference to its longitudinal diameter, are observed.
The second kind of irregular position of the heart, in which
case it is situated externally to the chest, is either its partial or
entire concealment in the belly,'^ or in its more or less complete
prolapse, when the anterior surface of the body is deficient,
propendentia^ hernia cordis^ &c.^ In this prolapse the heart
may protrude either alone,^ or in connexion with other thoracic
and abdominal viscera,^" at the neck or in absence of the breast-
bone and through congenital holes and clefts of that bone,
either higher or lower upon the breast, or close under the
point of the breast-bone and at the top of the belly. Should
the heart in such cases be uncovered by the sacciform ex-
panded walls of the chest or belly, but lying completely free
on the exterior, it will in rare instances adhere to other
parts of the body.''

Sect. XIX.] Of the Heart. 275

(1) Dislocatio seu ectopia cordis; compare de Plouquet Repertor. Dislocatio
cordis. — Haller Elem. Physiol. Vol. I. p. 303. — Zedler D. de situ cordis abnormi
cum historia morbi singularis hue spectante. 4to. Vratisl. 1817. — Breschet
M^moire sur I'ectopie de I'appareil de la circulation et particuli^rement sur celle
du coeur. 4to. Paris, 1826, with three plates ; and in Repertoire general d'Anat.
et de Physiol, patholog. &c. Vol. II. p. 1.

(2) In congenital frenic ruptures on the right side, of which I have found
two examples, viz. No. 2874 and 8015 of the Bresl. Mus.

(3) Compare above, § 25, and below, on the cavity of the chest.

(4) Reuss Repertor. Comment. Vol. X. p. 90 and 91. We here also find
different degrees, in so far as sometimes the point or the whole heart is turned
towards the right, and sometimes turned completely to the right side. Examples
hereof are given by Riolanus Anthropographia, L. III. cap. 12. — BarthoUnus
Histor. anat. 1747, Cent. II. Hist. 25. — Fr. Hoffmann D. Cardianastrophe admi-
randa, etc. Lips. 1761.— van Doeheln in Act. Acad. N. C. Vol. IV. Obs. 132,
p. 505. — Buxtorf in Act. Helvet. Vol. VII. p. 101. — Mery, v. dtc Hamel Hist,
acad. reg. Scient. L. III. c. 2. — Walter in Nouv. Memoir, de I'Acad. des Sc. de
Berlin, 1775, p. 139. — Abhandl. der Josephsakademie, Vol. I. p. 286. — Delamare
in Journ. de Medec. Vol. XXXIII. p. 510. — 7'a«^mi Wisseuschaftl. Werke. Pisa,
1812. — Barton in American medic. Recorder. Vol. IV. No. 2. Philadelphia, 1821.
— I have found three instances, v. Selt. Beob. Part I. p. 95 ; Part II. p. 47 ; and
Verzeichness der anat. Praparatensammlung, No. 2186 — Breschet, p. 10, pi. 1,
found this four times ; the heart, in congenital ruptures of the diaphragm, is
commonly forced to the right side by the pressure of the protruded bowels ; also,
in the blue disease, the heart lies sometimes on the right side. v. Testa, Haase,
Seidel, and § 172, note 11. — Breschet, p. 12,

(5) Sand/fort Obs. anat. pathol. L. IV. cap. 6, p. 55. — My Selt. Beob. Part I.
p. 16. — d' Alton De de cyanopathiae specie, etc. 4to. Bonnae, 1824. — Breschet, p. 17.

(6) Acta Nat. Cur. Vol. X. p. 17. — Abhandlungen der Josephsakademie,
Vol. I. p. 265.-~Caillot.—J. F. Meckel Archiv f. Anat. u. Physiol. 1826, No. 1,
p. 41. — My Selt. Beob. Part II. p. 48, in a monster, No. 8013 of Bresl. Mus., on
account cf depression from umbilical rupture. — Torres found the heart with the
point turned somewhat upwards, v. Mem. de Math6m. et de Phys. Vol. I.
p. 136 ; and in Phil. Transact. 1741, p. 776.

(7) Miscell. Nat. Cur. Dec. II. Ann. VI. Obs. 232 ; Ann. VIII. Obs. 114.—
BarthoUnus Hist. Anat. 1747, Cent. III. Hist. 32. — Boerhaave, v. Samml. auserl.
Abhandl. Vol. IX. p. 491, in a rat. — Ramel in Journ. de M^dec. Vol. XLIX.
1778, May, p. 4:23.— Desciiamp in Journ. g^n. de Med. Vol. XXVI. p. 276, in the
region of the left kidney. — Fetter Aphorismen aus der pathol. Anat. p. 108,
note. — Foii^tel Fragmenta sem. obstetr. Hal. 1792, p. 77, tab. 5. — Lenhosseck in
Oestr. medic. Jahrb. Vol. VI. Part II.

(8) Also ectopia cordis in a strict sense; for instance, in Fleischmann De vitiis
congenitis circa thoracem et abdomen. 4to. Erlangae, 1810. — C. Weese D. de
cordis ectopia. Berol. 1818, with six engravings. — H. J. Haan D. de ectopia
cordis casu illustrata. 4to. Bonnae, 1825, with two lithogr. plates. — Compare on
this kind of false position of the heart, J. F. Meckel Handb. der pathol. Anat.
Vol.1, p. 97, ff.

(9) Acta Hafn. Vol. I. No. 110.— Eph. N. C. Ann. VI. and VII. Obs. 232.—
Philos. Transact. No. 461. — Martinez Observatio rara de corde in monstroso in-
fantulo, etc. Madriti, 1723. v. Haller Disput. anat. select. Vol. II. p. 973. —
Morand in Mem. de I'Acad. des. Sc. 1760. Hist. p. 47. — Buttner Anat. Anmerk.
4to. Kiinigsberg, 1752, with engravings, in a child born alive, with the heart
prolapsed ; and Anat. Wahrnehmungen. Kbnigsb. 1768, p. 36, with plates. —
Sandifort in Act. Helvet. Vol. VII. p. 59. — Vauhonnais Mem. de I'Acad. des Sc.
1712. Hist. p. 89. — Weher, or especially Manchart, v. Baldinger's Magazin
f. Aerzte, 1776, Part VI. p. 510. — Gilibert Adversaria med. pract. Lugd. 1791,
p. 132. — Prochaska Adnot. academ. Fasc. III. p. 172. — Malacarne in Lezioni
academiche. II. VIII. p. 12. Fasc. III. V. — Chaussier Note sur une hernie
congeniale du Coeur, in Bulletin de la Faculte de med. de Paris, 1814, p. 93.—
Herold in Slarh's Archiv f. die Geburtshulfe. Vol. I. Part 1. p. 31.— Haan Medic.

T 2

276 Of the Heart, [Part II.

Jahrb. des ostr. Staates. Vol. V. Part II. p. 68. — Cerutti Rarioris monstri, in
museo anatomico Lipsiensi adversati descriptio anat. 4to, Lips. 1827, with two
engravings, v. Meckel's Archiv f. Anat. und Phys. 1828, No. 2, p. 192. — Mende
in Nov. Act. phys. med. Acad. caes. L. C. Vol. XI. Part II. p. 445, tab. 5Z,
fig. 2, in a foetus six or seven weeks old ; also, though rarely in animals, viz.
in dogs and calves, v. Journ. des Savans, 1668, No. 3, 1681 and 166, in two
cats. V. Regis i OMvn. des Savans, 1681, p. 166. Paris. — In a sheep on the neck,
v. IVeese, p. 8, tab. 1 ; as a transition to this malformation is to be attributed
the very loose position of the heart in deficient breast-bone, with undivided
common integument. — Cordis situs patulus, in Fleisclimann, p. 15. Compare
§ U7.—Lund Schwedische Abhandl. Vol. XXIV. p. 248.— The same in a dove,
de la Chevalleraye. v. Mem. de I'Acad. des Sc. 1740, p. 586 and 595.

(10) Compare below, on thoracic and abdominal clefts. — In large congenital
ventral ruptures, which often include the under part of the chest, we frequently
find the heart then situated in the upper part of the sack, in the scrobiculus
cordis above the diaphragm ; but if the diaphragm be imperfectly developed,
and in rare cases, even when it is properly formed, we find the heart in the belly
itself, and mostly in the neighbourhood of the liver. Instances of this kind are
found in Chabelard Mem, de I'Acad. des Sc. 1746, Hist. p. 67. — Wahlbom in
Abhandl. der k. schwed. Acad, der Wissensch. 1767, Vol. XXVI. p. 82. —
Sandifort in Act. Helvet. Vol. VII. p. 86. — Buttner Anat.Wahrnehmungen, p. 121.
— Wilson,\n Philos.Transact. 1798, Part II. p.346. — Voigtel Fragm.semiol. obstetr.
Halae, 1792, tab. 5, p. 77 ; compare /. F. Meckel De cord, condit. abnorm. p. 6. — •
Fleisclimann, p. 2, 17, 24, tab. 1, fig. 1. — Bock in Cerutti' s Pathol, anat. Mus.
Vol. I. Part III. p. 37, pi. 16 and 17. Leipz. 1^22.— Herrmann in Salzb. med.
chir. Zeitung, 1822, Vol. IV. p. 95. — Lenhosseck in Medic. Jahrb. des. k. ostr.
Staates, Vol. VI. Part II.— My Selt. Beob. Part I. p. 64.— Verzeichn. No. 2883
and 8016 of Bresl. Mus. — Also once in a monstrous calf. — In two instances it
was found by Cerutti. v. Weese, p. 40, § 60. — The division of ectopia into pec-
toralis and ventralis, to which Breschet adds cephalica, appears to me by no
means applicable, as all these forms gradually run into each other ; at all events,
we must then assume an e. collaris of which a case is described by Lachmund,
in Ephem. N. C. Dec. I. Ann. III. Obs. 103, p. 166; that of von Hammer, v.
Commerc. lit. Noric. 1737, Hebd. X. p. 74, tab. 1, fig. 1. — One in a sheep, v.
Weese, p. 8, pi. 1. — And a case by Breschet, p. 44, in which the heart was raised
upon the front of the neck, from the ramus of the lower jaw to the tongue, with
which it was connected.

(11) For example, by a thick plastic thread with the navel-string, v. Haauy
fig. 1. — With the spine on the palate, &c. v. Breschet, p. 45, pi. 2. — With the
fore part of the face. v. Bonfils and Brescfiet, p. 48, pi. 3.

§176.

So again the heart may be irregularly situated after birth,
and at every period of life, from causes originating either in
itself or in the parts by which it is surrounded. To the former
belong an unusual general enlargement or partial swelling of
the heart, in consequence of which it is, as it were, dragged
down out of its natural place ; and the accompanying increased
weight, whereby, if at the same time the parts supporting it
are weakened, the heart sinks down in a remarkable manner,
and carries with it the diaphragm in a bottle-like form ; this
sinking down of the heart has been called its prolapse, pro-
lapsus,^ Large tumours lying on the upper part of the heart,
especially aneurysms of the aortic arch, may also depress it.'
The heart is also commonly displaced in other vices occurring

Sect. XIX.] Of the Heart, ^77

in the chest ; to these belong, curvatures of the spine, of the
ribs, and breast-bone, large tumours connected with increased
consistence of the lungs,^ collections of water,* plastic lymph,
and pus,^ blood,® and even air'' in one of the pleurae, in con-
sequence of which the heart is gradually thrust in the opposite
direction ; again, all kinds, of tumours, as large exostoses,'
aneurysms,^ adipose and sarcomatous swellings,^*' &c. and also
from the intestines of the belly rising up into the chest through
rupture of the diaphragm." Finally, also, the heart may be
thrust upwards into the neck, and in various other directions,
by pressure of the abdominal viscera; large dropsies of the
belly, tumours of the liver, spleen, of the stomach and other
organs, ^^ sometimes produce the same effect. ^^*

(1) Lmcisi De aneurysmatibus, L. II. Propos. 52, p. 81; and De mortibus
subitaneis, p. 136. — Morgagni Epist. auat. XV. note 53; and De sed. et caus.
morb. Epist. XVII. p. 25 — 28. — Leidenfrost Exereit. d« hernia et prolapsu
cordis humani. Duisb. 1778; and Opusc. phys. chem. et med. Lemgo, 1797,
Vol.1, p. 3. — Testa, p. 174. — Single observations in Pachioni Op. Edit. 4to,
—Fel Plater Observat. L. III. p. 636.—Senac Traite du Coeur. L. IV. Ch. VIII.
No. 4, p. 178. — Zuliani De quibusdam cordis adfect. Obs. 2 — 4.

(2) Morgagni De sed. et caus. morbor. Ep. XVII. p. 25. — I have observed
this twice.

(3) I have found this several times ; — in one case, where a very large hard car-
tilaginous bag, surrounding a vomica, existed in the left lung, the heart beat for
upwards of a year only on the right side, and lay there also, as seen on dissection.
Compare my Selt. Beob. I. p. ^5 ; II. p. U.—Senac, L. IV. Ch. IX. § 7, p. 429.—
Acta med. Berol. Dec. I. Vol. VII. p. 98. — Schmidt, v. Hnfeland's Journ.
Vol. XXV. p. 189. — E. J'dger D. de hepatitide et phtbisi, etc., — in viro, cui cor
in dextro latere pulsabat. Tubing. 1780. — Schwarz Praes. Mai D. paradoxum
asthma cum corde e situnaturali deturbato. 4to. Heidelb. 1803. — Abercrombie, in
Transact, of the med. chir. Soc. of Edinb. 1824, Vol. I. two cases. — Also from
emphysema of the lungs, v. Laennec De rauscultation mediate. Vol. II. p. 336,
Paris, 1810.

(4) Harless and Ritter's N. Journ. d. ausland. med. chir. Lit. Vol. VI. p. 148. —
A watery bag containing fifteen pints, v. Sammlung fiir pract. Aerzte, B. XXIII.
p. 538.

(5) Most frequently is the heart pressed to the right side by a large collection
of puriform plastic lymph in the left pleura. — Klinz in Abhandlungen der
Josephsakademie, Vol. I. p. 273. — Sommerring De morb. vasor, lymphaticor.
p. 139. — Friese Archiv der pract. Heilk. f. Schlesien, Vol. III. Part III.
No. 6. — Larrey Mem. de Chir. Milit. &c. Paris, 1812. — Rust's Magazin. Vol. V.
p. 165. — Zedler. — Howship, Practical observations, Case 64. — Ficker in Harless
Rhein. Jahrb. f. Med. und Chir. Vol. IV. p. 34. — I have seen this several times.

(6) From a bag filled with blood, v. Plenciz Acta et Observ. Med. p. 162.

(7) Laennec.

(8) Compare above, § 136, note 31 ; and § 137, note 21 and 22.

(9) Werdermann in Mursinna's N. Journ. f. d. Chir. Vol. I. p. 188. — I observed
a similar case in an old woman, with very large aneurysm of the aorta, close to
the diaphragm, by which the heart and left lung were thrust upwards and to the
right.

(10) For instance, Boerhaave Opera omnia. Hagae Com. 1738, p. 3. — Meckel in
Mem. de I'Acad. de Berlin, 1759, p. 44, 45, and 86. — lb. De conditione cord,
abnorm. p. 6. — Corden, in Mem. of the Med. Soc. of London, Vol. VI. p. 122. —
Mac in Huf eland's Journ. Vol. XIX. Part I. p. 112. — Horn, N. Archiv f. medicin.
Erfahrung, Vol. III. Part I. No. 3. — Corvisart in Leroux Journ. de Medec. cont.
Vol. II. p. 14. — Lallemend in lb. p. 24.

278 Of the Heart. [P art 1 1 .

(11) Very common in congenital frenic hernia, very rare when occurring sub-
sequently ; for instance, after a sword wound, through which the stomach was
thrust up into the left cavity of the chest, v. Sennert Practica, L. II. Part II.
cap. 15, p. 703. Lugd. Bat. 1650. — Mobius Fundam. med. Physiol. C. X.

(12) Even the ovaria. v. Kelch in Hitf eland' s Journ. d. pr. Heilk. Vol. XXV.
I have twice seen it thrust obliquely upwards by large hydatid cysts in the belly.
It is well known that Brera believed that angina pectoris arose from the heart
being thrust out of its place by swelling of the liver, v. Brera Delia Stenocardia,
malattia volgarmente conosciuta sotto il nome di angina pectoris. Verona,
1810; and in Giornale di medicina practica, 1814, p. 1 — 26. — Jos. Averandi
D. de angina pectoris, ejusque praecipua specie, Stenocardia, ih. January, 1816.

(12*) [ W. Stokes, in Med. Gazette, Vol. \'I II. p. 560, mentions a case, in which
the heart was thrust (by the blow of a water-wheel) from its natural position on
the left, to the right side, between the sixth and seventh ribs, on which side it
pulsates. The patient still lives, but the narrator of the case has no doubt of
the fact. T.]

Sometimes also the colour of the heart is irregular; this is
very commonly the case in cachetic and especially in dropsical
persons; and it is not pale merely on the external surface, but
also in the muscular substance itself; a similar lighter or darker
YELLOW colour is seen in fat hearts; in hypertrophy as well as
in inflammation the heart is coloured too red ; hearts which
are afiected with softening, suppuration, mortification, or other
vice of texture, are spotted sometimes grey, light, or
DARK-BROWN, and even blackish. One or more white
SPECKS of different degrees of size are frequently observed on
the heart ; they are produced by a trifling degree of inflamma-
tion, which causes thickening and opacity of the membrane of
the heart, and are more commonly present on the right than
on the left ventricle, and on the auricle ; ^ petechi^e have
also been noticed on the heart.^ In a very few instances the
surface of the heart itself is also reddened throughout, by the
transudation of the blood ;^ and lastly, I have once seen it
tinged with green in a case of poison.^

(1) Morgagni, Epist. III. p. 26. — Baillie's Morbid Anatomy, p. 20. — I have
occasionally seen them also on the auricles, on the left ventricle, and even on the
venae cava?, so far as they are in the pericardium.

(2) Stall's Ratio medendi. — Fairbami, in Transact, of the med. chir. Soc. of
Edinb. \'ol. II. p. 157, found, in one case of purpura hemorrhagica, eflusions of
blood under the inner coat of the heart, and in the muscular substance ; a
similar case I observed in a person who died of the febris petechialis. — I also
found it in a person killed by fire-damp ; and in a child which died of the
whooping-cough ; also in one case in violent inflammation of the heart, on insu-
lated places, under its outer membrane, there were small extravasations of
blood.

(3) Compare § 36. — Laennec De Tauscultation mediate, Vol. II. p. 353. — And
I found this often, without suspicion of inflammation. Sometimes also even the
coagulated blood transudes from the riglit auricle through its parietes, and
colours them throughout of a brown red colour.

(4) I found this once in a child poisonctl by stramonium seeds.

Sect. XIX.] Of the Heart. 279

§ 178.

No less does the consistence of the heart vary considerably
in consequence of vice of texture. But it is also not unfrequently
unnaturally relaxed, soft and easily broken down,^ without any
distinct vice of structure, but merely consequent on atrophy or
some unknown proportion of composition ; so also very fat
hearts are always flabby and soft ; violent exertion appears, as
in other muscles, to render the heart easily broken down ;
thus, for instance, it is found very weak in hunted deer.^ The
opposite vice, or abnormal firmness of the heart, though we do
not here include inflammatory hardening, is most common in
hypertrophy of the heart ; it is also sometimes merely a seem-
ing hardening, in consequence of the muscles of the heart
having become unusually contracted in death.

(1) In persons who have died suddenly, and without any distinct cause, we
sometimes find the heart very lax and bloodless, v. Chevalier in Med. Chir.
Trans. Vol. I. p. 157.

(2) According to Senac. Compare § 159.

§179.

Rupture of the heart, ruptura cordis, cardiorrhexis,^ is
usually the consequence of the already described diminished
consistence of this organ ; as also ulcerative erosion, great aneu-
rysmal expansion with thinning of the walls, and obstruction of
the flow of blood through the openings of the heart or of the
neighbouring large vessels. Not unfrequently, however, we
observe in apparently healthy hearts, bursting in consequence
of superabundant influx of blood,^ violent emotions and external
violence, not penetrating but merely producing concussion.
Most frequently the left ventricle is found torn, the right ^ less
so, and the auricles least of all; in some instances also, we
observe numerous cracks at the same time or only rupture of the
septum,* of some of the fleshy columns and tendons,^ but prin-
cipally of the valves of the heart.^ Wounds of the heart which
arise not merely from penetrating incisions, stabs, and gun-
shots, but also from splinters of fractured breast-bone and ribs,^
are indeed, if they be considerable and pierce the cavities,
usually immediately fatal ; still they are sometimes also fatal
after a longer time f they, however, occasionally heal, so that
subsequently we observe the scars of the wounds.'' That such
scars, however, can also be produced by ulcers which have
healed, and hydatids^" which have been destroyed, is self-
evident.

(1) Sahmann D. de subitanea morte a sanguine in pericardium efFuso. Argentor.
1731, in Nailer's Coll. Diss. pr. Vol. II. No. 67. — Mummsseyi D. de corde rupto.
Lips. 1764, with engravings. — Murray resp. Tengmalm D. de corde rupto. 4to

280 Of the Heart. [Part II.

Upsal. 1788. — A. Olmi Memoria di una morte repentina, cagionata della rottura
del cuore. Svo, Firenze, 1803. — Pohl De ruptura cordis. 4to. Lips. 1808, with
engravings. — Brera Di una straordinaria rottura di cuore. Verona, 1808. — Rostcin
Memoire sur les ruptures du coeur, in Journ. gen. de Medec. p. 72, July 1820.
— As to single observations, v. Reuss Repertor. Comment. \o\. XIV. p. 384. —
de Plouquet Repert. Art. Cor ruptum. Dictionn. des Sc. medical. Vol. XLIX.
p. 212. — Chavasse in London Med. Journ. 178G, Part III. — Buchholz Beitrage
zur gerichtlichen Arzneigelahrtheit, Vol. III. p. 192, (a tear in the right ven-
tricle of an apoplectic person.) — Ferrus, Laennec, Bland, L. and /. A.Rochoux. v.
Breschet in Repertoire general. Vol. III. Part II. p. 203. — Three instances in
Testa, p. 391. — Salzburger Med. chir. Zeitung, 1814, No. 40, p. 239, (from an
ulcer.)— iJ/o// in Transact, of the Phys. Med. Soc. of New- York, Vol. I. 1817,
(as a consequence of ulceration.) — AsdruhaU in Nuovi commentarj di Med. etdi
Chir. Padova, 1818, (in one case.) — Akermatin in Svenska Lakare-Sallskapets
Handlingar, 1818. Vol. V. p. 221, (a gangrenous spot.) — BetuUn, ih. p. 225,
(after ulceration.) — Petersb. vermischte Abhandl. aus dem Geb. der Heilk
1821. Erste Samml. p. 231, (the brother of this man died in a similar way.) —
Rudolphi Physiologie, Vol. T. p. 90. — Ashburner,v. von Froriep's Notizen, 1823,
No. 82, p. 253, (both ventricles.)— Nouv. Biblioth. Med. Vol. I. No. 3, p. 1823,
(both ventricles.) — Archives generales de M^dec. Vol. IV. Part IV. 1821'. —
Bayle in Revue medicale, July, 1824, (the diseased person died after fourteen
hours.) — Carrier and Baron in Journ. compl. du Diet, des Sc. med. Oct. 1824.
— Edinb. med. chir. Transact, v. Horn's Archiv, Jan. and Feb. 1824, p. 143, (with
suppuration.) — Hcsselhach Beschreibung der pathol. Priiparate, u. s. w. p. 321,
No. 369. — Thomas in London Med. and Phys. Journ. Vol. LI 1 1, p. 193, March,
1825, (the right ventricle in a boy of fourteen years old, with erosion.) — ZieJil in
JIarless Rhein. Westp. Jahrb. VoL III. Part III. p. 9, (on the right ventricle.) —
Charpentier in Journ. gen. de Med. May, 1S2(). — Berard D. sur plusieurs points
d'anatomie pathologique. No. 2, Paris, 1826, (from a fall.) — Ahercrombie in
Transactions of tlie Med. Chir. Soc, of Edinb. 1824, Vol. I. (two cases.) —
ZechincUi in Omode'i Annali universali di Medicina, Vol. XXXVII. Feb. 1826.
— Myself in four cases, v. Sclt. Beob. Part II. p. 59, and Verzeichniss, No. 2245
and 2216. — More recently, two instances are mentioned in the account of morbid
examinations of the Bresl. Med. Coll. in one of which there was a burst
aneurysm of the left auricle in a girl of fourteen. — \_Bignardi, Rupture of the
left ventricle, the substance of the heart about the aperture soft. v. Annali
Univers. di Medic. Jan. 1829. T.]

(2) For instance, in the plague. Quesnai des fi^vres, Vol. 11. p. 448, and
Traite des causes, des accidens et de la cure de la peste. Vol. I. p. 201. — In epi-
leptic cases, v. Johnston Med. Bermerk. und Untersuchungen, Vol. II. p. 201. —
Several in anger and trouble, viz. Philip V. on hearing of the loss of the battle
of Placenza. — Zimmermann von der Erfahrung, Vol. II. p. 449. — Sometimes
during coitus, v. Morgagni, Ep. XXVI. p. 13, ^nd Voter De mortis subitaneae
non vulgaris caussis ct remediis, Vitcb. 1723, and in Misc. Nat. Cur. Dec. III.
Ann. IX. Obs. 164. — In straining on going to stool, George II. of England,
v. NklioUs in Philos. Transact. Vol. II. Part I, p. 265. — In hydrophobia in a
pig, in the veterinary school at Alfort. — Compare Rudolphi Bemerk. auf einer
reise, u. s. w. Vol. II. p. 62.

(3) This does not occur in those cases in which the heart is burst from exter-
nal violence, as the right ventricle is then more commonly torn, on account of
its being more exposed and more easily struck.

(4) Breslauer Sammlungcn, May, 1723, p. 560.

(5) Marat in Journ. de Medec. continue, \o\. VI. p. 587. — Corvisart, -p. 257.
— Adams in Dublin Ilosi)ital Reports and (Communications, Vol. IV. 1827,
No. 19. — [Andral, Precis, &c. Vol. II. ]>. 305, speaks of perforations in the
nuiscular substance of the heart, by wiiich the l)lood is brought in direct contact
with the close portion of the pericardium without rupture of that membrane,
and mentions a case at the Acad, Roy. do Medec. in which the posterior ])art of
(he left ventrich' exhibits five such perforations without any surrounding
boftening. — Bouillaud mentions lupture of the flcsliy columns of the tricuspid

Sect. XIX.] Of the Heart, 281

valve in a phthisical girl who had severe attacks of coughing, v. Andral Pr6cis,
&c. Vol. II. p. 307. T.]

(6) Compare Haller Elem. Physiol. I. p. 339. — Mummssen, p. 37. — Sandifort
Obs. anat. pathol. L. I. c. I. p. 24 and 53. — Meckel in Mem. de I'Acad. des Sc.
de Berlin, 1755. — BaiUie, Morbid Anatomy, p. 32, and an engraving of it at
pi. 2, fig. 5. — In an asthmatic person I once saw the tricuspid valve with a hole
in it ; once also one of the semilunar valves of the pulmonary artery obliquely
cleft and jagged in its upper edge. The flask-like expansions which, in some
instances, we observe in some of the valves, very much dispose to such tearings.
— Morand, Hist, de I'Acad. Roy. des Sc. 1729, Obs. Anat. 7, found one of the
mitral valves so distended. — [In Mus. St. Thomas's Hospital there is a case of
this flask -like protrusion of the mitral valve into the left auricle, in which there
are three small holes. — Rupture of the tricuspid valve in violent exertion is
mentioned by A. Williams, Med. Gaz. Vol. IV. p. 78. T.]

(7) I have found several cases of this kind in the account of the morbid
examinations of the Breslau Medicinal College ; but very recently I saw in a
man of Ems, who was murdered at Tillendorf, with fracture of the breast-bone
and some of the ribs, the right auricle torn by a splinter of the breast- bone. —
In a horse, v. RoJilwes Magaz. f. d. Thierarzneikunde, Vol. I. p. 311.

(8) Many cases are collected in de Plouquet Repert. Art. Cordis vulnus. —
Kriigelsfein Promptuarium medicinae forensis. Erfurth and Gotha, 1822, Art.
Cordis vulnus. — Alleweireldt D. sur les lesions mecaniques du cceur et des vais-
seaux sanguins, &c. 4to. Paris, 1814. — Alphonse Sanson These : Plaies du coeur.
Paris, 1827. — [Gunshot wound of the right ventricle ; the boy lived two months
and six days ; three shot were found in the cavity of the ventricle, and the right
lung nearly destroyed, v. Randall in Western Journal of Med. and Phys. Sc. —
Left ventricle stabbed with a knife ; patient lived ten days. v. Journ. hebdom,
1828. — In Mus. St. Thomas's Hospital, bayonet wound of left ventricle;
patient died in forty-nine hours. — Dapuy, in Journal de Med. V^terin, 1826,
p. 24, mentions a wound of the right ventricle of the heart of an ox, in which a
piece of iron wire it had swallowed ulcerated through the honeycomb stomach,
diaphragm, pericardium, and into the substance of the heart itself ; it died in
fourteen days. T.]

(9) Ido Wolf Observ. Med. Chir. L. I. No. 21. p. 70. — Durande Mem. sur
I'abus de I'ensevelissement des morts, p. 28, Strasb. 1780. — Rougnon Conside-
rationes pathologico semioticae, &c. p. 7. Vesunt. 1786. — Meier in Baldinger's
Neuem Magaz. Vol. IV. p. 109. — Ollenrot in Schmuclcer' s Vermischten Schriften
Vol. II. p. 127. — Penada Saggi di Padova, Vol. III. Part II. p. 59. — Lentin's
Beitrage. Suppl. B. Leipzig, 1808. — Maussion v. Diet, des Sc. m^d. Vol. IV.
p. 216. — Bougan, v. Rust and Casper's Krit. Repertor. f. d. ges. Heilk. Vol. VI.
Par. III. p. 474. — Moglin in Revue Med. franc, et etrang. Vol. XI. p. 133. —
Two instances in A. Sanson. — Suringar D. de Gallorum chirurgia observationum
Sylloge, L. B. 1827. — Scars have also been found several times on the hearts
of animals.

(10) Morgagni Epist. XXXVIII. 43. — He also saw it in a hare.

§ 180.

Inflammation, with its consequences, must be mentioned
first among the vices of texture in the heart. Inflamma-
tion, inflammatio cordis ^ carditis,^ is not at all an unfrequent
disease of the heart in men^ and animals^ as the consequence
of mechanical influences, of cold, of metastases, of gout and
rheumatism, of eruptive diseases,* of canine madness,^ &c.,
and occurs sometimes in the heart alone, but more frequently
simultaneous with that of the pericardium and pleura, and may
be even epidemic." Oftentimes we observe but a single spot of

282 Of the Heart. [Part II.

the heart inflamed, more frequently the external membrane
alone is rose - coloured, or the muscular substance, is more
or less similarly affected,^ but in rarer cases only the in-
ternal membrane lininoj the cavities of the heart^ is affected.
Should the inflammation of the heart be merely superficial,
there is but an imperfect pouring out of serum and coagulated
lymph in a slight degree, and to little extent, beneath the
membrane,^ hence, consequently, arise the above-mentioned
white spots ; but in higher degrees of inflammation there is
a very decided effusion of a similar substance upon the sur-
face, and even in the cavities of the heart. This effused
fibrous matter renders the surface of the heart both wrinkled
and uneven,**^ with little projections and knots, more frequently
with fibres and net- work of various form, cor mllosum^^^ or it
is produced more largely and more smoothly, so that the heart
and pericardium are lined with a false membrane,^- of a cel-
lular texture filled with serum, the mass occupying the inter-
space between the heart and the pericardium ; or, finally, there
is a more or less extensive and firm adhesion between these
two parts. ^^ Should the eflfusion of fibrous matter occur upon
the internal surface of the heart, it appears capable of pro-
ducing in very rare cases polypous coagula,^* also false

MEMBRANES,^^ ADHESIONS OF THE WALLS OF THE HEART^*^ and

of the VALVES^^ to each other, and to themselves.

(1) de Berger D. de inflammatione cordis. Viteb. 1717. — Gloger D. de iii-
flam. cordis vera. Jenae, 1758. — Nujui D. de carditide spontanea. 4to. Erford,
1788. — Metzger resp. Merzfeldt D. de carditide. Regiomonti, 1789. — Davis,
Inquiry into the symptoms and treatment of Carditis. London, 1808. — Reilcem in
Bulletin de la Fac. de Medec. p. 140. Paris, 1809. — ^wrrow; D. de carditide
acuta. Edinb. 1816. — G. L. Hertzberg De carditide. Parts I. and IL Halae,
1817. — Ilehn Von der hitzigen idiopathischen Herzentziindung in Rust's Magaz.
f. d. ges. Heilk. Vol. VI. p. 343, with one engraving. — Roux Collectanea quae-
dam de carditide cxsudativa. 4to. Lips. 1819, with engravings. — Also under the
title Comment, pathol. anat. de card, exsud. 4to. Lips^ 1820, with col. engrav. —
C. U. J. Iluber D. de carditide, quae epidemice grassavit (!) inter milites anno
1814, in obsidionc castelli Delfzyl, etc. 8vo. Griining. 1819, with engravings. —
Compare Ilarless Rhein. Jahrb. f. Med. und Chir. Vol. VI. p. 1. — Piirhelt De
carditide infantum Comment. 8vo. Lips. 1824. — Glas Ueber Herzentziindung.
Inaugural dissertation. 8vo. Wurzburg, 182G. — KrauseD. de carditide idiopathica
acuta. 8vo. Berol. 182(). — An interesting case of inflammation of the heart,
proved by dissection, is given by Gairdner in Transact, of the Med. chir. Soc.
of Edinb. Vol. II. p. 237. — Stkbel MonographicC carditidis ct pcricarditidis
acutae epistola dedicatoria et prajfatio. 4to. Francof. ad Moen, 1828. — Compare
above. § 1G5, note 1.

(2) Marcus Entwurf ciner speciellen Therapie, Vol. II. § 1273, ft'. — I find
traces of inflammation of the heart not uncommon here (Breslau) especially
among the poorer inhabitants, and in phthisical persons.

(3) I^spccially in horses and dogs ; I but lately lost a Newfoundland dog with
this disease ; in monkeys also I have observed inflammation of the heart occur-
ring with j)eripn(Uinony.

(4) Tanchou On smallpox, v. Edinb. Journ. of Med. Science, Jidy, 1826. —

Sect. XIX.] Of the Heart. '283

Forlani Observat. Dec. No. 5, in repressed itch. I have found it in a child
which died of scarlet fever.

(5) Compare Sprengel in Tesla, p. 246, note 37.

(6) Trecoiirt in Recueil period, d' observations de Med. de chir. et de Pharm.
Paris, 1755, Vol. III. p. ^58.—Huxham Op. phys. med. Lips. 1764, Vol. III.
p. 50—52.—Huher.

(7) I have sometimes found the muscular substance inflamed an inch deep in
the greater part of both ventricles, and on their outer surface.

(8) I have noticed this a fev^r times ; Fetter also saw it. v. Aphorismen aus
der pathol. Anat. p. 98, § 109. — Orfila, after poisoning with white oxyd of
arsenic, v. Archives gen^rales de Med. Feb. 1823. — Tanchou in small-pox.

(9) I have sometimes found between the membrane and the muscular part of
the heart a considerable quantity of lymph poured out, and the heart as it
were cedematous ; in other cases this has been found only on one or some parts.
— Compare Burns, p. 132.

(10) Hence the ancients called such hearts broken up and suppurating.

(11) Cor pilosum, hirsuUim, tomentosum^ etc. v. Bose Pr. s. historiam cordis
villosi, Lips. 1771. — Good engravings are given by Walter Sur les maladies du
cceur, in Mem. de I'Acad. de Berlin, 1785, tab. 4, fig. 1. — Baillie Engravings,
Fasc. I. pi. 1, fig. 1 — 3 ; and Roux, and Bleuland Icon. anat. pathol. Fasc. I.
tab. 1 and 2. — This condition also is not rare in animals ; I have seen it in
horses, in a cow, and a dog.

(12) Sometimes is the heart so concealed thereby that it almost appears de-
ficient, as it is attached to the diaphragm, but upon its upper surface, smoothly
covered with a thick false membrane, between which and the pericardium a
large cavity is found filled with serum.

(13) Pohl Pr. de pericardio cordi adhserente ejusque motum turbante. Lips.
1775. — l<Iehel Pr. de pericardio cum corde concreto. Giess. 1778. — /. C. F.
Muller D. de concretione morbosa cordis cum pericardio, casibus aliquot
illustrata. 8vo. Bonnae, 1825. — A partial congenital adhesion has also been
found. V. /. F. Meckel Anat. Phys. Beob. und Untersuch. p. 87.

(14) Burns, On some of the most frequent and important diseases of the heart,
&c. 8vo. Edinb. 1809. — Corvisart, p. 419, Obs. 56. — Although in the cases here
recited, the spots where the polyps were situated were said to be diseased, and
therefore might have given rise to eftusion during life, I do not, however, com-
prehend why the fibrous matter which is poured out in exudative inflammation
in a fluid form, should not have been washed away by the doubly powerful flow of
blood in inflammation of the heart, and thus its coagulation prevented. I there-
fore think, even in opposition to the grounds laid down by Kreysig, Part I. p. 86,
that I must for the present firmly hold the doubts I have expressed in my Selt.
Beob. Part II. p. 5Q.

(15) Baillie, in his Morbid Anatomy, p. 33, once found the venous valves of
the heart inflamed and covered with a layer of coagulable lymph ; the latter
indeed was deposited only at death, as well as the false membrane which Burns,
p. 206, found in the right auricle, and Corvisart, Obs. 55, p. 419, in the right
ventricle.

(16) /. Ahercromhie found, in a man who had at an earlier period been sub-
ject to dyspnoea and palpitation of the heart, the walls of the right ventricle
increased an inch and a half in thickness at its base. v. Med. chir. Trans, of
Edinb. Vol. I. No. 1, 1824.

(17) Himauld in Mem. de Paris, 1735, Hist. p. 19. — Lieutaud Hist. Anat.
Med. Vol. II. p. 184. — The review on Corvisart in the Hall. Allgem. L. Zeit.
Sept. 1813, No. 219, p. 76. — Kelch Beitrage zur pathol. anat. No. 60.— I have
also sometimes found it, especially with otherwise diseased valves.

§181.

Another consequence of inflammation of the heart is the
frequent formation of ulcers and abscesses on this organ. V

284 Of the Heart, [Part II.

The former are found on the external surface of the heart to
a greater or less extent;^ they however occur, but more rarely
on the inner surface of the cavities of the heart/ and very fre-
quently, in form of slight erosions, on the diseased valves. But
the latter,* which are seated in the substance of the heart itself,
and sometimes attain considerable size, may burst either
externally or internally, and as well as ulceration, produce
perforation and rupture of the walls of the heart/ A high
degree of inflammation will very rarely run on to gangrene,^
which then attacks one part of the heart, and like ulceration,
will give rise to perforations and bursting of that organ.

(1) As the opinions of the older writers are for the most part not to be de-
pended on, because their diagnosis between cardielcosis and inflammatio exuda-
tiva cordis is so imperfect, I refer to Hielscher and Schmiedel D. de ulcerations
pericardii et cordis, exemplo illustrata. 4to. Jenae, 1742 ; as also with reference
to the several observations in de Ploiiquet's Repertorium Art. Cordis apostema,
arrosio, exulceratio, suppuratio and ulcus ; and Lieutaud, Vol. II. p. 161,
Obs. 510— 538.

(2) Malpighi v. Morgagni Epist. XXV. p. 17. — van Doevercn Specimen observ.
acad. L. B. 1765, No. 4, p. 70. — Sandifort Observat. anat. pathol. L. IV. s. x.
p. 109. — Penada Saggi di Padova, Vol. III. Part II. p. 59. — Caldaniin Memorie
di Fisica della Soc. Ital. di Modena, Vol. XII. p. 11. — Desault Cours de Clinique
externe, p. 117. Paris 1804. — Testa p. 233, 239, 241. — Bagatta in Breras
Giornale di Medic, pratica, Vol. III. Part IX. — Cerutti Beschreibung der pathol.
Priiparate, u.s.w. No. 845. [Scrofulous ulcer, No. 307, Mus. Roy. Coll. Surg. T.]

(3) The Landarzt, Part XXXIV. and Ausziige a. d. Tagebuche eines prakt.
Arztes. Berlin, 1791, Part I. last article; Testa, p. 239; Laennec, De I'auscul-
tation mediate. Vol. II. p. 305, contends, although erroneously, that ulceration of
the inner surface is more common than that of the outer.

(4) Beniven'ius Observ. cap. 42. — Columbus de re anat. L. XV. p. 489. — Mor-
gagtii, Epist, XXV. 25. — CruiksJiank, The Anatomy of the absorbing vessels of
the human body. 4to. London, 1786. — G.J'dger in Harless Rhein. Jahrb. Vol II.
p. 146. — Laennec, p. 303. — Neubert in Hufeland's Journ. 1823, Nov. p. 91.
[Jndral, Vol. II. p. 324, an abscess as large as a hazel-nut in the parietes of the
left ventricle, accompanied by, but not communicating with, suppuration in the
pericardium. T.]

(5) Compare § 179, note 1. — Penada. — Walter Mem. de Berlin, 1785. — Mor-
gagni, Epist, XVII. 5, 8; Epist. LXIV. 15. — Journ. de Medec. Aout, 1791.—
Biermayer Museum anat. pathol. No. 374. — H. Cloqnet'in Bulletin de la Faculte
de Medec. de Paris, 1822, p. 219, — Sometimes only the partition of the ventricle
is eaten through, v. Sommerring addend, to Baillie, p. 11. — Testa, p. 244. — Weber
in Nasse's Zeitschr. f. pyschische Aerzte, 1820, p. 396.

(6) Lieutaud, Vol. I. p. 476, Obs. 1618, Vol. II. p. 168, Obs. 539—543
(amongst them three instances in the plague.) — Morand in Mem. de I'Acad. des
Sc. de Paris, 1732, p. 594. — Stoerck Annus medic. II. p. 262. — Getting, gelehrte
Anzeigcn, 1786, PartCXXVIII. p. 1284. — Chambon de Montaux Merkwurd.
Krankengeschichten und Beobachtungen, Leipz. 1791, p. 370. — Johnstone in
Mem. of the med. Soc. of Lond. \'ol, I. and in Medical Essays. Evesham, 1795,
p. 192. — /Ikenside in Phil. Transact, Vol. LI 1 1, p. 353, — IVring in den Abhandl.
der Josej)sakademie, Vol. II. p. 345. — Ganlay Memoire sur la gangrene du Coeur.
Svo. Paris, 1807, and in Journ. de M<^d. Chir. et Pharm. par Corvisart, Leroux
and Boyer, Vol. XIII. i^. 7.— Portal Cours d'Anat. m<:dic. Vol. III. p. 79.—
Testa, p. 245. — Conisart, p. 253. — J. Kennedy, in London medical Repository,
April, ]82t. Vol. XXI. No. 124; — also in horses, v. Journ. de M^d. continue,
I'tbr. 1812, p. 151. — Berth/, Tr;iit6 des maladies du coeur, etc. par Bouillaud,
Paris, 1824, p. 408, improperly considers gangrene of the heart doulKfuI.

Sect. XIX.] Of the Heart. ^^5

§ 182.

Lastly, inflammation also frequently produces in the heart
many changes of tissue, in consequence of which its normal con-
sistence is remarkably altered. To this belongs the loosen-
ing or SOFTENING,^ which, in a minor degree, always accom-
panies the early stages of inflammation, but, in a higher degree,
is so closely connected with the changes of composition and
texture consequent on inflammation, that a general disposition
of the heart to break and tear to pieces is produced ; suppura-
tion and mortification, as might be supposed, are connected
with greater softening of the tissue, although we sometimes
find, without any distinct mortification, a particular spot on the
heart, as it were, rotten, brownish, dryish, and so soft, that
it can readily be torn with the finger or the probe. Quite as
common is the opposite vice or inflammatory hardening of
the heart,^ of which the extent and degree are not less variable.
Sometimes indeed only the external membrane of the heart
is thickened and hardened; or on the contrary, only the
internal coat and the valves composed of it ; or finally, more or
less of the muscular substance of the heart itself, in which
case, either its outer layer may be entirely hardened, or only
certain spots through and through. The degree of this hard-
ening of the heart varies very considerably ; the most common
form is the red hardening, the less frequent the white, which
appears to be confined to certain spots, and sometimes goes so
far that the hardened spots assume a tendinous^ and carti-
laginous-like* character. The highest degree of hardening
occurs in the deposit of earth and bony masses in the
HEART,*^ which however are, in proportion, very seldom found
in the fleshy substance, whereas, ossifications are found, as
frequently as extensively, in and beneath the external coat of
the heart,^ in its fibrous parts,'^ and in the internal coat,^ and
at the same time in the valves.^ Considerable difference is
found to exist with reference to the disposition to ossification
in particular parts of the heart, inasmuch as the ventricles, the
valves on the left side of the heart and the coronary arteries,^"
are more frequently ossified than the auricles, the valves on the
right side,^^ and the veins of the heart; ^^ and we also find that
the deposit of earthy matter is more rare in the venous than in
the arterial valves of the heart. The just-described hardening,
thickening, and ossification of the valves of the heart, frequently
give rise to narrowing of the venous orifices as well as those of
the arteries of the ventricle, especially of the left ; to deficient
motion and shutting up of the valves at these points, and con-

286 Of ike Heart, [Part II.

sequently to the irregular flow of blood, which in its turn be-
comes the cause of many other diseases of the heart."

(1) Portal, Vol. III. p. 80. — Laennec de I'auscviltation mediate, Vol. II.
p. 286. — According to Dundas, the substance of the heart is too soft and pale in
gout and rheumatism.

(2) I found general inflammatory hardening of the heart several times in so
high a degree that its substance was quite firm and elastic. I also saw this in a
cow which had a needle in her heart, and in a dog destroyed by inflammation of
that organ. A few interesting cases of induration of the heart are mentioned by
Testa, p. 234, and by Curvisart, p. 176.

(3) Albertini in Comment. Bonon. 1731, Vol. I. — Scharschmidt Medic, and chir.
Nachrichten Jahrg. III. p. 245. — Morgagni, Ep. XLV. 23. — Tendinous tumours.
V. Guest, Account of an uncommon ossification in the heart in Med. Mus. Lond.
1764, Vol. III. p. 165.

(4) Columbus de re anat. L. XV. — v. Haller Bibl. med. pract. II. p. 125. —
J^esUngius Obs. anat. et Epist. med. XV. — Martenus de Cilano in Act. Acad. Nat.
Curios. Vol. IX. p. 357. — Morgagni, Epist. XXVII. 17. — Beauchampm S^dUlofs
Rec. period. Vol. V. p. 292. — Burns, p. 146 — Corvisart, p. 184, (the point of the
heart.) — Kreysig, Vol. III. p. 173, (the left auricle of the heart.) — I have found
often the outer membrane of the heart, and a part of the subjacent tissue,
changed into a cartilaginous mass of one or two lines thick. Once I also saw the
right auricle of the heart studded externally with small cartilaginous points and
spots. — Laen?}ec, p. 301, § 783, found pretty often cartilaginous plates in the
inner membrane of the left ventricle.

(5) Compare Haller Elem. Physiol. Vol. VIII. Part II. p. 78. — Lieuiaud,
Vol. II. Obs. 556—571. — Reuss Repertor. Comment. Vol. X. p. 94 and 95. —
de Plouqnet Repertor. Art. Cordis ossa. — Striking instances related by Boerhaave
Praelect. ad Inst. § 478, (also the septum.) — Garengeot in Mem. de Paris, 1726,
Hist. p. 24. — Senac Trait6 du Coeur, L. IV. c. 9, No. 5.— Cruwel D. de cordis et
vasorum osteogenesi, etc. Halae, 1765, with engravings. — Mohrenfieim in Wiener
Beitrtigen, Vol. II. p. 212. — Simmons and Watson in Medical Communications,
Vol. I. Lond. 1784, No. 18, p. 228 and 234, engraved in BaiUie^s Engravings,
Fasc. I. tab. 5. — Michaelh Prakt. Bibl. Vol. I. Part I. p. 116, in the Appendix. —
Hagstrom in Svenska L'akare-Sallskapets Handlingar. Vol. I. Part I. p. 52. —
Renauldin in CorvisarCs Journ. de Med. Vol. XL Jan. 1806, p. 259, (the left
ventricle stony internally with stalactic-like chrystals.) Also in animals ossifi-
cations of the heart occur, which I saw at Alfort, on the left auricle in a horse ; and
in the anatomical Museum at Utretcht a considerable ossification on the heart of
a sheep ; the entirely ossified hearts of ducks, which le Meilleur, v. Rovx Journ.
de Med. Vol. XXXI I, p. 411 ; V. Malacarne, delle Osservazioni in Chirurgia,
Part II. Torino, 1784, p. 190; and Michaelis, Medic, prakt. Bibliothek. Vol. I.
Gott. 1785, mention, were really the inferior male larynx; here perhaps belongs
also the whole ossified heart of a goose, which Cruveilhier, Essai sur I'Anat.
Pathol. Vol. II. p. 77, is said to have seen.

(6) Frequently between the adhering pericardium and heart, v. /lurivillius in
Nov. Act. Upsal. Vol. I. No. 15, p. 101. — Crowfoot in Ediub. med. and surg. Journ.
Vol. V. Part XIX. ISio. l. — Krei/sig, Vol. III. ]y. 26S. — Cruveilhier, Vol. IL
p. 22. — LaenneCy Vol. II. p. 402. — Berlin Traite des maladies du canir, p. 262. —
Tacheron Rccherches anat. patholog. Vol. III. p. 257 and 261. — Arch. gen. de med.
Vol. I. p. 521. — Louis Mem. ou Recherch. anat. patliol. p. 298. — Abercroinbic in
Trans, of the med. chir. Soc. of Edinb. Vol. I. 1824, No. 1. — I once found in the
cellular tissue between the heart and j)ericardium many distinct gypsum-like
hard corns. In another case large thin ])oints and ])lates of bone. Ossifica-
tion and stoniness, which more or less dee])Iy penetrate into the tissue of the
heart, are often found on tlic superfices of unadliering hearts, viz. Morgagni
Epist. XXVI 11. 16. — Bordenave in Mem. de I'Acad. des Sc. 1786, p. ii'iy (in part
two inches broad.) — Prost Medecine eclairee par I'observation ct I'ouverturc des
corps. Vol. I. p. 140, Paris, 1804. — Wcbrr in dcr Sal/,l>. med. chir. Zeitung, 1811,
Part 11. p. 80. ( I saw this prej)aration myself, the two bony plates arc almost as

Sect. XIX.] Of the Heart. 287

large as a pair of oyster shells, and like stone.) — Burns, p. 146, (both chambers
resembled calcareous boxes.) — BoecJc D. de statu quodam cordis abnormi.
8vo. Berol, 1818, p. 25 (in the right ventricle.) — Mayer in d. Oestreich. medic.
Jahrb. Vol. V. Part III. p. 80, (almost the whole upper surface) ; one instance
in College of Surgeons in London, v. von Froriep' s Notizen, 1823, No. 84, p. 286
(a bony scale on the left ventricle and right auricle.) — Adams in Dublin Hospital
Reports and Commvmications, Vol. IV. 1827, No. 19 (one above an inch broad
and three lines thick) ; an instance in Berlin Mus. v. Rudolphi Grundriss der
Physiologic, Vol. II. Part II. p. 290, note 1. — I saw in the Anatomical Museum
at Leipzig large ossifications on the right ventricle and auricle.

(7) Most commonly in the fibro-cartilaginous mass which forms the basis of
the chambers of the heart where the bony earth, which is deposited, frequently
assumes the shape of rings of the thickness of a finger, which surround the venous
openings of the ventricle, especially the left ; for example, BarthoUnus Hist.
Anat. Cent. II. Hist. 45, in Pope Urban VIII. a large triangular bone. — Mor-
gagni Epist. XXVII. 2. — Haller Elementa Physiolog. Addenda, p. 129. Soem-
merring^s additions to Baillie's Morbid Anatomy, p. 26, note 49. — ran Heekcren
D. de osteogenesi praeternaturali, Lug. Bat. 1797, p. 120. — Fetter Aphorismen aus
der pathol. Anat. p. 100, § 112. — Corvisart, p. 211. — Howship's Practical Obs. —
Louis, p. 298.— My Selt. Beob. Part I. p. 99, and Verzeichn. No. 2233—2235,
3937, 3938. — The chordae tendinese of the mitral valve are not unfrequently
more or less filled with lime, as I have several times observed. — Boerhaave,
Praelect. ad Instit. L. V. § 478, found them quasi osseas festucas.

(8) I have several times seen little single earthy deposits on the internal coat
of the left ventricle. — Feslhig, Obs. Anat. et Epist. med. 15, saw the left ven-
tricle lined with a cartilaginous crust. — Tilling found one of the carneae columnse
in the left ventricle ossified, v. Hufeland's Journ. Vol. XV. p. 156. — Konig in
Horn's Archiv f. medic. Erfahr. 1825, March and April, p. 292, a scale of bone
in the left auricle ; the upper part converted into fibro-cartilage.

(9) Many cases in Morgagni. — Lieufaud, Vol. II. obs. § 575 — 595. — dePlouqitet
Repert. Art. Cord, palpitatio et Valvularum vitia. — F. Malacarne Discorso sulla
litiasi delie valvule del cuore. 8vo, Torino, 1787. — Lucas De depositionibus
cretaceis intra cordis valvularum arteriarumque substantiam. 4to. Marburg, 1815.
— Hering D. de osteogenesi valvularum cordis. 4to. Lips. 1819, with coloured
engravings. — I often find deposits of lime on the valves of the left side of
the heart, not merely in old men, but also in women, and even in persons who
have not attained the adult period, as it appears almost always connected in a
certain degree with scrofula, which at Breslau is very frequent and malignant.
Aldis also found in a man of eighteen extensive ossification of the valves, v. Edinb.
med. and surg. Journ. Vol. V. Part XX. No. 5. — The lime also frequently forms
strong points on the valves ; or grapelike and roundish processes as big as peas,
or thereabouts. Good engravings of such ossifications are given in Sandifort
Observat. anat. path. Lib. I. — Baillie's Engravings, Fasc. I. fig. 1, 2, 3, 5. —
Hodgson, Engravings intended to illustrate some of the diseases of arteries.
London, 1815, tab. 1. — MeckelTah, anat. path. Fasc. I. tab. 5, fig. 1 — 8. — Hering
also mentions ossification of the aortic valves sometimes occurring in animals. I
have seen it, for example, a few times in horses.

(10) Se7iac, L. IV. c. 10. — Morgagni Epist. XXIV. 16, 17, in which are men-
tioned the observations of the ancients. — Crell et Rheinhold D. de arteria coronaria
instar ossis indurata. Vidob. 1740, — Lentin Beitrage zur ausiib. Arzneiwissench.
Vol. III. p. 113. — Parry, On angina pectoris, Lond. 1799 ; and An Inquiry into
the symptoms and causes of the syncope anginosa, Lond. 1801, holds the opinion
that ossification of the coronary arteries is the cause of angina pectoris. In favour
of this notion are the observations of Sam. Black in Mem. of the med. Soc. of
Lond. 1805, Vol. VI. No. 2. — Ri7ig in Edinb. med. and phys. Journ. No. 95,
p. 9. — Kreysig in Horn's Archiv f. med. Erf. Vol. III. Part I. No. 4, and Krankh.
d. Herz. Vol. II. Part II. p. 532, ft'. Vol. III. p. 289; in which several cases
are collected. — Ritter in Hufeland's 3 onxn. Vol. XX. p. 117. — Burns, p. 157. —
Aiders in Salzb. med. chir. Zeitung, 1815, No. 25, p. 416. — Louyrr- Fillermay,
V. Bulletin de la Faculte de Med. de Paris, 1816, No. 1. — Jurine Memoire sur

288 Of the Heart. [Part II.

I'angine de Poitrine, 8vo. Paris, 1815. — ^c/im^nm Comment, pathol. de angina
pectoris, p. 17. Lips. 1822, with coloured plates. — Faher found this in a man who
had died from difficult respii'ation. v. Hufeland^s Journ. 1827, Aug, p. 79. — We
do not, however, by any means always find them ossified in this disease, v. Testa,
p. 321 ; on the contrary, there is often great ossification of the coronary arteries
without this disease, v. Hodgson, p. 59; my Verzeich. No. 2236, 2237, 3938, —
Howship, p. 64. — Adams.

(11) Bichat, Anatomie generale, maintains that it never occurs, which Adams
supports, though wrongly, as the following examples show: Senac, p. 428, (of the
semilunar valve in two cases). — Morgagni Epist. XIV. 35 (the tricuspid valve) ;
XVII. 12 (semilunar valve) ; XL'N'II. 16 (tricuspid valve) ; several cases col-
lected by Hodgson, On the diseases of arteries and veins, p. 67. — Seiler in Horn's
Neuem Archiv f. med. Urfahr. Vol. II. Part II, (semilunar valve ) — Nevin in
Medical Commentaries by Duncan, Dec. II. Vol. IX. No. 10, p. 325, (semilunar
valve.) — Corvisart, p. 210, § 3. — Horn in his Archiv f. prakt. Medicin. Vol. IV.
p. 296 (tricuspid valve.) — Burns, p. 34, (tricuspid valve.) — Yoting, in Journal of
Science and the Arts, No. I. p. 49, (tricuspid and semilunar valves.) — Hall Jackson
in Corvisart's Journal de jNIed. et Chir. Xoh XIX. p. 468, (tricuspid valve.) —
Cerutti Beschreibung der pathol. Praparate, p. 113, No. 590. — Oierrier D. sur la
maladie bleue, etc. Paris, 1820.— Zowis, p. 318, (tricuspid valve.) — The reviewer
in Gerson and .Jidius Magazin d. ausl. Litt. d, ges. Heilk. Jan. and Febr. 1828,
p. 198. — My Selt. Beob. Part I. p. 98, (semilunar valve) ; since in another case,
on the same place. I also saw at Vienna, in the Pathological Museum, No, 3237,
ossification on the tricuspid valve. — [No. 311 Mus. Roy. Coll. Surg, ossification
of the tricuspid valve. — No. 309, ib. of the bicuspid. — In Mus. St. Thomas's
Hospital, a preparation of the mitral valve ossified. T.]

(12) A case by Bonet, which I cannot again find; another in Ephem. Nat.
Cur. Dec. II. Ann. X. Obs. 175.

(13) Ahemethy, On a diminution of the area of the aperture, by which the left
auricle of the heart communicates with the ventricle of the same side in Medic,
chir. Transact. Vol. I. p. 27, — Corvisart sur les Maladies, etc, du coeur,
p. 204, ff". — Kreysig, Vol. II. Part II. p. 583 — 615. — Beriin says that he has
seen two hundred cases of enlargement, or aneurysm of the heart, with narrowing
of the apertures. — [Elliotso7i, p. 19. T.]

§ 183.

Less distinct are some other textural vices of the substance
of the heart consequent on inflammation, although in many
such instances they may bear at least some resemblance to
those above-mentioned. To these belong the irregular
FATNESS and spurious FORMATIONS of the heart ; the former
appears under two shapes, viz. as a mere enormous deposit of
fat upon the surface of the heart, ^ which is so much in-
creased and so unequal, that the heart itself, especially if
there be much fat deposited at the same time in the mediastina,
suffers from want of space and from pressure ; or secondly,
as a real metamorphosis of the muscular substance, which
is then changed more or less completely into fat, and is
generally at the same time very flabby and thin.^ To the
SPURIOUS FORMATIONS, which are rarely met with in the heart,
belong first many kinds of tumours,' especially steatomes,*
HYDATIDS, and other watery cysts,'* as well as gritty
tumours;' next, tubercles,' and lastly, sarcomatous for-

Sect. XIX.] Of the Heart, 289

MATioNs of various kinds,^ even medullary sarcoma." The
existence of true scirrhus and carcinoma upon the heart is
still doubtful. ^'^

(1) Lieutaud, Vol. II. p. 150, Cor adipe obrutum. Morgagni Epist. III. 20,
XVI. 36, XXVII. 2, XXXV. 18, XLIII. 17, LII. Z^. — Meckel in Mem. de
I'Acad. de Berlin, 1756, p. 79. — v. Bergen in Actis Soc. med. Havn. Vol. I.
p. 247. — Pyl Aufsatze und Beobachtungen aus der gerichtl. Arzneiwissenschaft;
Vol. VII. p. 106, (in a drunkard.) Portal Cours d' Anatomic ni^dicale, Vol. III.
p. 74. — Testa, p. 342. — Foihergill in Lond. medic. Observ. and Inquiries, Vol. V.
p. 233, considers it as giving rise to angina pectoris. — Corvisart, p. 197. —
Laennec, Vol. 11. p. 295. — Schramm^ Comm. patbol. de angina pectoris, Lips.
1822, p. 17, thinks that in the disease described by him there was always great
deposition of fat on the heart, pericardium and omentum. — Wedemeyer. v. Rtist's
Magaz. Vol. XIX. p. 246, 269, often observed in drunkards great fatness of the
heart, with accompanying ossification of the coronary arteries. — I have sometimes
found in old persons the heart so surrounded with fat, although there was otlier-
wise great meagreness, that it became mishapen and gibbous.

(2) Weithreclit. v. Senac Traite de la structure du cceur, etc. L. IV. Ch. IX. 12.
— Edinb. med. and surg. Journ. No. XI. VI. I. Jan. 1806. — Duncan, ibid.
Jan. 1816, No. XLVI. I. found the greater part of the heart converted into a
homogeneous greyish yellow ffitty mass. — -Cruveilheir Essai sur I'Anat. pathol.
Part I. p. 183. — Chardel Monographic des degenerations skirrheuses de I'estomac.
8vo. Paris, 1808, (the left ventricle.) — Dublin Hospital Reports and Commu-
nications, Vol. II. Part II. (in an apopletic person.) — Laennec, De I'auscul-
tation mediate. Vol. II. p. 298, found it merely on the point of the heart. — Ni
AuserL Abhandl. zu Gebrauche f. prakt. Aerzte, Vol. IV. p. 4. — Adams, ibid.
Vol. X. p. 4. — C. zum Tohel D. seu singularem casum degenerationis adiposae
cordis, cum aliis vicinarum partium mutationibus conjunctae, 8vo. Tubing.
1825. — The case related by Simeon in the Hcidolb. Klin. Annalen, Vol. III.
Part II. p. 262, does not belong here, as the narrator mistook the plastic form-
ation on the heart for fat. — I have seen two cases, in which almost the whole
of the heart was converted into fat. v. Verzeichn. No. 2226 and 2227.

(3) Where many of the tumours on the heart observed by the ancients belong
to, cannot be decided, on account of their deficient anatomico-pathological know-
ledge at that period, and the not less defective descriptions therefrom arising.
To these belong, for instance, the observations which Lieutaud, Vol. II. Obs.
544 — 553, has collected ; further, those by Columbus De re anatomica, L. XV.
p. 489, 492, (hard tumours in the substance of the left ventricle as big as an egg.)
— Rhodius Observ. Medic. Cent. III. Obs. 4, (follicle in the right auricle of the
heart.) — Srhenk Observ. L. II. No. 203. — Gantius. v. Boneti sepulchretum Anat.
L. II. Sect. 1, addit. Obs. 2 (several tumours on the base of the heart, one of
them as large as a pigeon's eg^) ; other cases in Bonet, L. II. Sect. VII. Obs.
56, 132, addit. Obs. 9, Sect. 8, Obs. 34; L. III. Sect. 21, addit. Obs. 60.— Pyl
Aufsatze und Beobachtungen, Vol. VI. p. 78 (on the tip, as a gland, as large as
a bean.)

(4) Penada Saggio secondo d'osservazioni e memorie medico-anatomiche. 4to.
Padua, 1800, (in a duck containing feathers.) Whether the case described by
Fleisch in d. Allg. Annalen, 1811, Jul. p. 645, as the conversion of the heart into
a fatlike cartilaginous mass, weighing six pounds, belongs here, must remain
undecided. In the Hunterian Mus. at London I saw a lardaceous tumour on the
tip of the heart of an ox, which contained a bony mass. I also found in a man a
large lardaceous tumour on the right ventricle near the aorta, consisting of a firm
lard-like mass mingled with hydatids, v. my Selt. Beob. Part II. p. 58.

(5) Compare Liidersen D. de hydatidibus Gcitt. 1808, p. 11. — Boneti Sepulchret.
anat. L. III. Sect. 37, Obs. 4, L. N. Sect. 12. Obs. l2.--Morgagm Epist XXI. 4,
Epist. XXV. U.— W. Rutty in Philos. Transact. 1728, ^. 562. — Heuermann
Physiologic, Vol. I. p. 202. — Salzmann in Haller's Disputat. Vol. IV. p. 248. —
Closdus in Baldinger's Magazin, Vol. X. p. 5'\3.— Portal Cours d'anat. medic,

U

290 Of the Heart [Part II.

Vol. III. p. 29, 74 (several on the base of the heart, of which one was the size
of a small hen's egg.)— Testa, p. 64, 67, 277, 278.— J. F. Meckel Tab. anat,
pathol. Fasc. I. Vol. I. tab. 8, (a large hydatid sac on the left ventricle.) — D. Price
in London med. chir. Transact. Vol. XI. Part II. 1821, (in a boy often years old,
who died suddenly, a large single hydatid in the muscular substance.) — Bernhardt
Observatio circa ingentem cordis tumorem, 8vo. Regiom, p. 22, 1826 (an hydatid
externally on the right ventricle.) v. my Verzeichniss, &c. No. 2229. — I saw in
Museum pathologicum at Vienna, No. 664, little hydatids on the upper surface of
the heart, and the engraving of a heart beset with large hydatids at AUlettVs, in
Venice. — J. Abercromhie found a has: containino- two ounces of an albuminous
fluid on the left auricle of a child. — [In the Mus. at St. Thomas's Hospital,
there is a heart with a cyst on its apex, as large as a hen's egg, which was
filled wuth hydatids. T.] — Sometimes we find hydatids attached within the
cavities of the heart, v. Trotter in Medic, and chym. Essays. Lond. 1796, (two
hydatids in the right ventricle of the heart.) — Bupuytren in CorvisarVs Journ. de
Medec. Ann. XI. Brumaire, (several large ones in the right auricle.) I saw a
large hydatid in the right auricle in the Anat. Mus. at Vienna, No. 4040. — In
a man thirty-four years old, who died of struma testis, I saw a large heap of
hydatids on the Eustachian valve, hanging by several threads into the right
ventricle, v. Selt. Beob. Part II. p. 57, tab. 1, fig. 2. — Hydatids have also
been found on the hearts of animals, one as large as an apple on the heart of an
ox. V. BarthoUmis Hist. XXXII. Cent. II. — Privy Councillor Heim, at Berlin,
in an ox, which he was kind enough to communicate to me in a note on BaUlie. —
In a lioness the size of a hazel-nut. v. Eph. Nat. Curios. Dec. I. Ann. II. 1761,
Obs. 5, p. 6.

(6) Walter in Mem. de I'Acad. de Berlin, 1785, p. Q5, tab. 4, fig. 2. — Museum
anat. Part I. p. 163, No. 1086, described and engraved in Arndt D. de tumoribus
cordis tunicatis. 4to. Berol. 1817, with two engravings, (on the point of the heart
of an ox.) — Cruveilheir, Vol. I. p. 301, (a little meliceris of the size of a pea.) I
have seen three cases in the Mus. pathol. at Vienna, viz. a flat gritty tumour in
the substance of the right ventricle of an old woman, and five or six encysted,
the size of hazel-nuts, in the mass of the left ventricle of a young man.

(7) Here perhaps belong Lietitaud, Vol. II. Obs. 545, 546. — Heurnius. v. Boneti
Sepulchretum, L. IV. Sect, I. Obs. 15, § 13. — Fr. von Hilden Observat. chir.
Cent, I. Obs. 51. — Morgagni Epist. LXVIII. 12, (the right auricle of a boy,
fifteen years old, was externally quite beset with it.) — Portal, Vol. III. p. 74. —
Abernethy, Surgical Observations. — Autenrieth in Tiibinger Blatter, Vol. I.
Part II. p. 191. — Spens in Edinb. med. and surg. Journ. 1816, Vol. XH.
p. 194. — Lawrence in Med. chir. Transact. Vol. III. p. 78. — Laennec, Vol.11.
p. 325, in two cases. — Andral and Bayle, in Revue medicale franp. et etrangdre,
Fevrier, 1821, found the heart of a cbild, as it were, enveloped in the tuber-
cular mass. — Macmichael in London med. and phys. Journ. August, 1826. —
Although I have dissected a great number of scrofulous men and animals, I have
never found a tubercle on the heart, and therefore consider them very rare.
[Perhaps the preparation in Mus. St. Thomas's Hospital, mentioned by ElHotson,
p. 32, as having little scrofulous deposits in the walls of the left ventricle,
surrounded by wliite and almost cartilaginous induration, belongs here. T.]

(8) They especially occur in a threefold form ; first, as single little roundish
knots deposited between the layers of the valves of the heart ; then as white
condylomatous growths on the inner surface, and especially on the valves ; and,
lastly, as more or less s})heroidal, smooth, often tolerably large and solid growths,
or true sarcoms. The first kind is very common ; of the second, instances are
given by Lancisi De morbis suhitaneis, Obs. IV. p. 121. — Riviere, v. Boneti
Sepulchretum anat. L. II. Sect. 8, Obs. 24. — Morgagni, Epist. XI. 11. — Sandi-

fort Obs. anat. patliol. L. I. c. 1, p. 31 ; L. III. c. 1, p. 41, tab. 3. — Corvisart,
J). 223, ff". which he considers of a syphilitic nature, as also does Scarpa. — Bertin,
in Bulletin de la Facult6 de Medec. 1812, p. 58, and in Traits des maladies du
ca'ur, p. 232, denies CorvisarVs opinion that it is sy})hilitic. — Testa, p. 314. —
Laennec de 1' Auscultation mediate, \'ol. II. j). 334. — Desrnclles in Revue medic.
Ijistor. et jjhilos. \'ol. IV. j). 305, Paris, 1821. — Wedemeyer in Rust's Magaz.

Sect. XIX.] Of the Iltart. 291

Vol. XIX. Part II. p. 239, in both auricles. — I have often found it both in
syphilitic as well as in many other persons ; sometimes it is very large, grape-
like, in form of a cock's-comb or a cauliflower. I saw a very large grape-like
one on the mitral valve of a syphilitic person in the Mus. pathol. at Vienna,
No. 1020. The third kind is most rare, to which perhaps belong several of the
tumours on the heart described in note 3 above, as well as in the following. —
I'esta, p. 314, found in a person who had been long afflicted with syphilis, the
left auricle so beset externally with this structure, that a second auricle seemed
to have been produced. Sometimes they are attached on the inner surface of the
heart, v. Blancard An?itom\e rar. Cent. I. Obs. 75, p. 158. — Forlani Oh'?,, rar. med.
pract. Dec. I. p. 70 ; Dec. II. p. 10, found a round tumour as large as a hazel-nut
on one of the valves of the heart. — Soewmerring, in his additions to Baillie, p. 21,
note 2, a similar one. — Myself in Selt. Beob. Part I. p. 98, in the right auricle.
— /. F. Meckel Tab. Anat. pathol. Fasc. I. tab. 7, found fifteen such growths,
from the size of a pin's head to that of a hazel-nut, partly within, partly without
the heart. — Nasse found in the left auricle many pyriform growths with necks.
V. his Leichenoffhungen, Ite Reihe, p. 24. — The swellings which Laennec,
p. 346, describes as vegetations globuleuses, appear to be quite different from
these sarcomatous growths ; they are cyst-like projections of the inner coat of
the heart, filled with effused blood, which is sometimes black and coagulated,
sometimes deprived of red pigment, as there is more or less coagulated fibrous
matter ; the smaller are semiglobular, the large more spheroidal, and furnished
with necks. I might compare them with the tumours of serous and synovial
membrane described above, §§ 81 and 154, note 7. — Laennec found them in a
phthisical person in the right ventricle. — I have seen them three times in calves,
especially a remarkably large one on the mitral valve in the left ventricle, v.
Selt. Beob. Part II. p. 53; Verzeichniss, 2228. — There is a similar one in the
right auricle of a calf. No. 8610; and many on different parts in one of the
two hearts of a double calf. No. 8611, of Bresl. Mus. [In Mus. St. Thomas's
Hospital, on the interior of the right auricle of the heart of a man, who had a
sarcomatous growth in the nostrils, there are two similar tubercles, one as large
as a bean, the other as a pea. — Rigacci, fleshy polypus in left ventricle, similar
to sarcoma, with vascular connexions, which were injected with quicksilver, in
Antologia Firenze. T.]

(9) Bartzlcy Observatio singularis fungi medullaris in corde ; praef. Dzoyidi,
8vo. Halae, 1821, with plates, (a large tumour on the fore and upper surface of
the heart.) — Hodgson, v. engraving in Savenko Tentamen anat. pathol. de
Melanosi. 4to. Petropoli, 1825. — Segalas d' Etchepare in Revue Medic, franf. et
etrang. 1825, Vol. IV. p. 247 ; and Nouv. Bullet, des Sc. par la Soc. philom.
May, 1825, in a boy eleven years old. — In a woman who had medullary sarcom
on the fore-arm, there were several such knots on the heart, v. Gerson and
Julius Magaz. d. ausl. Litter, d. ges. Heilk. p. 199, Sept. and Oct. \^2^.-~-Staupa
Anweisung zur gerichtlichen u. pathol. Untersuchung menschl. Leichname,
p. 164. 8vo. Wien, 1827, in an aged man, who had a similar tumour, as large
as one's head, in the pelvis on the right ilium. — Another case I saw in the
pathological Museum at Vienna, No. 4116, of a man with medullary sarcom on
the thigh-bone. There are many such tumours, externally, in the muscular sub-
stance and within the right ventricle.

(10) Carcassone observed a carcinoma on the heart in a girl who had been
long affected with syphilis, v. Hist et Mem. de la Soc. roy. de Medec. 1777 and
1778, Hist. p. 252, Ann. 1786; Hist. p. 320, (there was indeed only one ulcer
with hardening.) — Duchateaii in Journ. de Medec. p. 243, Oct, 1810, a tumour as
large as a pea, in a woman who had many cancerous swellings on the skin and
on other parts. — Rullier. v. Bulletin de la Fac. et de la Soc. de Medec. de Paris,
No. 5, p. 367, 1813, in Journ. de Medec. chir. et Pharm. Vol. XXVII. 1813,
at the same time, with many scirrhi on other parts ; also scirrlms and carcinoma
of the heart. — Dupuytren. v. Cruveilhier, Vol. II. p. 87, (many, above six hundred
carsinomatous tumours.) — Andral and Bayle in Revue m^d. franc, et etrang re,
Feb. 1824, (three cases of carcinoma.) — lb. Nov. 1825, a case is related by
Recamier. — OlHvier De la moelle ^piniere et de ses maladies, p. 262. 8vo. Paris,

u 2

292 0/ the Heart. [Part II.

1824, (a case of cancer.) — Felpeau Exposition d'un cas remarquable de maladie
cancereuse, etc. 8vo. Paris, 1825. — Churchill in London Med. and Phys. Journ.
March, 1827, together with scirrhus and carcinoma of other parts. — The cases
mentioned appear to me to be more properly included in sarcom that in cancer.

§ 184.

Lastly, in the heart numerous remarkable phenomena as
respects its contents are frequently observed. To these, for
instance, belong the entire absence, as well as, contrariwise,
the unusual enormous gorging of blood, the latter of which
indeed appears to be very considerable, especially in the right
side of the heart, in suffocation, apoplexy, in paralysis of the
heart and lungs, as also in persons destroyed by narcotic
poisons : next, we have coagula of blood, which are known
by the name of cardiac polyps ; ^ these are usually only pro-
duced at the time of death, but, in some rare instances, they
may be formed during life in consequence of the greater
plasticity of the blood and the morbid operation of the walls of
the heart upon it, and vary as to size, shape, colour, consist-
ence, &c. without end.^ Occasionally the heart is found
distended with air,^ although there is not the slightest trace
of putrefaction in the body. In rare instances, we observe
parasitic animals,* both on and in the heart, also stones^
lying loose in the cavities of the heart, and even different ex-
traneous SUBSTANCES,^ wliicli, having penetrated by external
violence, have remained here for a considerable space of time.

(1) Pissini Epistola de cordis polyp, App. ad Librum de Diabete. 4to.
Mediol. KiS-i. — Malpighi de polypo cordis, 1(366, in Op. p. 123. — Scheid D.
Quaestionum de polypo cordis ir^vras. Argent. 1689. — Zollihhofer D. de polypo
cordis. Witeb. 1689. — de Berger D. de cordis polypis. Witeb. 1689. — Rossen D.
de polypo cordis. Leidae, 1693. — Alhini D. de polypis. Franc. 1695. — Snell D.
de polypo cordis. Giess. 1702. — de Cruyskerken D. de polypo cordis. Leid.
1705. — Gohl De cordis polypis ex neglectis haemorrhoidibus. Berlin, 1710. —
Beck D. de polypo cordis. Giess. 1718. — Gnez D. de polyposis concretionibus
variorum in pectore morborum causis. Altd. 1726. — Ludolff D. de polypo
cordis. Erford. 1727. — Teichmeyer D. de polypis, in specie cordis. Jense,
1729. — Grateloiip D. de ])olypo cordis. Argent. 1731. — Bochmer D. de prae-
cavenda polyporuiu gcneratione. Halae, 1736, — A. Pasta Epistola de cordis
polypo in diibium revocato. Bergamo, 1739, — Alberti D. de polypo cordis.
Halae, 171-1. — Langguth D. de polypo infantis rhachitici. Viteb, 1744. — Va/ighan,
D, de polypo cordis. Edinb, 1761. — Goetzke Casus medico-practicus de polypo
cordis, etc. Spirae, 1764. — Jos. Pasta De sanguine ct sanguineis concretionibus
per anatomen indagatis et pro causis morborum habitis qua'stiones medicae. 8vo.
Bergam, 1786, — Maincnurt D. de sanguineis lymphaticisque male polypis dictis
concretionibus in corde et in vasis per vitam existentibus, Paris, 1789. —
Tiedemnnn D. de cordis polypis. 8vo, Marb. 1801', Pontin pra*s, /*. Afzelius D. de
cordis polypo. 4to. Upsal. 1805. — Gartner D. path. med. de polypo cordis in specie
infantum. Wiirceb. 1810, with eight engravings. — Flormann Bemerkungen Uber
Polypen im Herzin in Svenska LJikare-Saallskapets llajullingar. Vol. IV.
]). 1()5. Stockh. 1817. — Simon D. de cordis polypo. 8vo. Berol. 1818. — Nasse
zur Kenntniss der Herzpolypen in Hum's Ai'chiv f. medic. Erlahrung, 1818,
July and August, p. 116. — Schmelcher praes. Munz D. de polypis cordis. 8vo.

Sect. XIX.] Of the Heart. 293

Landishuti, 1819. — Dee gen D. de polypis cordis. 8vo. Halap, 1821. — Heinrich
D. de polyporum cordis genuinorum natura et origine. 4to. Jenas, 1828.
A. Meckel Beitrag zur Lehre von der Entsteh. der Ilerzpolypen in /. F. MtckeVs
Archiv f. Anat. u. Physiol. 1828, No. 2, p. 166, tab. 6, fig. 4. — As to single
observations, compare the writers on diseases of the heart; de Plouquet Repert.
Art. Cordis polypus, and Reuss Repert. Comm. Vol. XIII. p. 117; also in
animals, polyps of the heart are not rare.

(2) They occur very frequently on the right side of the heart, on account of
the obstruction which the blood meets with in its passage through the lungs,
although pretty often also on the left side of the heart; their size is sometimes
so considerable, that they become as big as one's fist, and expand the auricle or
ventricle, and if they be also firm, compress the muscular fibres flat. Their form
is also very various, as they are either like membrane, long and thin, thick
at one end and pointed at the other, oval, spheroidal, &c. Their colour varies
from black to pale yellow; tlieir consistence is sometimes that of jelly, or of the
bufty coat of the blood, of the clot of blood, or of fibrous matter coagulated
in different degrees, so that they feel tough, and may be divided into bundles of
fibres or concentric layers, whilst interiorly they are hollow, and contain cruor
or lymph, which is wrongly considered as pus. Sometimes they lie quite loosely,
like balls, even several of them in the cavities of the heart ; but generally they
are attached so firmly to its walls, and penetrate by so many processes between
the fleshy columns, tendinous fibres, valves, and the openings of the small veins
of the heart, that we naturally imagine they arise from the walls of the heart.
Kerlcring, in part, also Senac,Morgagni, but especially Lieutaud, both Pastas, Baillie,
Soemmerring, Bichat, Fetter, and myself, in Selt. Beob. Vol. 11. p. 54, satisfied me
of the contrary ; no one as yet has ascertained cellular tissue and blood-vessels
in them. Hence it appears to me, that Meckel's opinion, v. Handb. der pathol.
Anat. Vol. II. Part II. p. 336, that at first they are firmly attached, but
subsequently are separated, is not probable. — Kreysig thinks that the so-called
true polyps of the heart, or plastic coagula in carditis exsudativa, are secreted
from the internal membrane of the heart, and that such may subsequently
become separated. The former may perhaps be the case in very rare instances.
I have, however, at least, a hundred cases before me, in which the internal
membrane of the heart was never diseased ; so, on the contrary, it may some-
times be inflamed and thickened, without there being any polyps; also, as fat
as I am aware, plastic membranes may sometimes be separated from mucous,
but never from serous membranes, to which class the internal membrane ot the
heart naturally belongs.

(3) Morg^flg/?/, Epist. VIII. p. 23, in a hydrophobic person. — Acta Eruditor.
Lips. 1721. — Chestonin Medic. Observat. and Inquiries, Vol. VI. No. 5. — Nysien
Recherches de Physiologic et de Chimie pathologique, p. 5 and 167. — Nassemsat
Leichenoffriungen, Ite Reihe. p. 138. — I have twice observed this phenomenon.
[/. Barlow, in Med. Chir. Trans. Vol. XV. p. 28, mentions three cases of air in
the right auricle, which had entered through the divided orifices of veins during
operations; one of them his own, and another Dapuytretis, and the third Mott's. T.]

(4) Of the many old observations collected in Phmquefs Repertorium, it is
hardly possible to make use of a single one. Perhaps, however, those men-
tioned by Hnehne in Actis Nat. Cur. Ann. VII. p. 5'd, belong here. We very
rarely find the cysticercus cellulosae in the human heart, v. Budolphi Ento-
zoorum Synopsis, p.546, (once three pieces.) — Duhreuil in Ephemerides m^dicales
de Montpellier, Nov. 1826, in the right auricle. Rarely also in swine, viz. at
Alfort. V. Rudolphi Bemerkungen auf einer Jleise, Vol. II. p. 62; and Dupuy
De I'afiection tuberculeuse, Paris, 1817, p. 267. — Ascarides have several times
been found in the hearts of dogs ; for example, Peysson, in Annales de la Soc. de
M<:d. prat, de Montpellier, Vol. XV. p. 49. v. Journ. de Medoc. continue,
Vol. XI. p. 441.— ZmVm in Memor. della Soc. Ital. Vol. XIV. Part II. p. 152,
(one in the left ventricle.) — Bohe-Moreau in ScdiJlofs Journ. general de Medec.
Vol. XLVII. p. 4. May, 181.3.— O. Fabricins, in Fauna Greenland, p. 272, No.
250, found ascarides in the heart of a living phoca fee ti da, which had been
wounded by a harpoon; and also ophiostoma dispar, Hud. — Paulliuus, in Observ,

294 Of the Arteries. [Part 1 1 .

med. phys. in Eph. Nat. Cur. App. ad. Dec. II. Ann. V. p. 19, found a filaria
on the heart of a duck. — Dnldorf, s. Dansk. Selsk. Skrift. Vol. II. 2. p. 159,
saw an hitestinal worm on the heart of a squalus; in anodonta ventricosa in
the substance, and in the cavities of the heart, distoma duplicatum ; and in palu-
dina vivajjara, &c. in the auricle of tlie heart, cercariae. — von Baer in Nov.
Act. N. C. Vol. XIII. Part II. p. 5o9, 616, and 617. [Abercrombie, in Edin-
burgh Med. Chir. Transact. Vol. I. p. 53, found a cyst in the left auricle, con-
taining others collapsed, in a dark fluid. Andral, Precis, Vol. II. p. 332,
frequently found cysticerci in the hearts of measly pigs ; also, in a patient at La
Charite, he found three vesicles, as large as filberts, in the heart. Elliotson, p. 32,
found in the ventricles of the heart innumerable thin globular cysts, attached by
peduncles. T.]

(5) Compare de Plouquet Repertor. Calculus in corde. These observations
are almost all inapplicable. — Bartholin Hist. anat. Cent. VI. Hist. 93, p. 364,
thought that the stone found in the heart of a stag might have been an encrusted
bullet, which is possible, although such stones arise like phlebolithi, or as in the
necked processes in serous membranes. 5. § 183, note 8, towards the end.

(6) For instance, bullets, which it is probable had penetrated deeper, whilst
the parts behind them had healed : — thus, in a man who had received a shot in
his breast several years before, a flattened bullet was found in the anterior ven-
tricle. V. Penada in Saggi di Padova, Vol. III. Part II. p. 59. — A similar case
described by Maussion, in Diet, des Sciences m^dic. Vol. IV. p. 216; and Boyer,
Traite des maladies chirurgical. Vol. VII. 8vo. Paris. — Edinb. med. and
chirurg. Journ. Vol. V. p. 417. — This has been observed several times in
animals, v. Forwaltner in Misc. Acad. N. Cur. Dec. III. Ann. V. and VI.
Obs. 3, p. 228, (in a stag).— Eph. Nat. Cur. Dec. II. Ann. VI. Obs. 77, in a
dog. — London medical and physical Journal, by FothergiU, Vol. XXXVI.
Nov. 1816, (in an abscess of the substance of the heart of an apparently healthy
deer.) — More frequently nails in cattle. Ann. X. Obs. 171, Schol. p. 313 ;
and especially needles in cows. v. Hoffmann in Ephem. N. C. Cent. IX.
and X. p. 462. — Peyer Parerga, Salzburger medic, chir. Zeitung, 1812, I.
p. 227. — Gebhard in Teiiffel's Magazin f. theoret. und prakt. Thierheilkunde,
Vol. I. Part II.— In my Selt. Beob. Part I. p. 99 ; and Verzeichn. No. 2238. —
Schwab Materialien zur pathol. Anat der Hausthiere, Ite Lief p. 15, a piece
of scissors. — A needle in the heart of a sheep, v. Maret in Memoir, de
Dijon, Part I. Hist. p. 107. — A broken clock-maker's file, which had pene-
trated through the left into the right ventricle, was extracted after twenty-
one days. — Ferrus in Repert. gen. d' Anat. et de Physiol, pathol. Vol. II. Part II.
p. 402, engravings, pi. 8, fig. 1 ; by whom are also mentioned some examples of
bullets, needles, and file points which have been found in the heart.

Third Cpiapter.
Of the Arteries,^

§ 185.
As the circulation of the blood is a necessary condition of the
existence and formation of the organs^ in men and in the higher
animals, there cannot be a complete absence of the blood-
vessels, especially of the arteries; there may, however, be a
partial deficiency in them, but only in proportion to the vices
of the parts for which they were destined.^ If therefore, the
vessels, which according to their proper arrangement supply
an organ with blood, are destroyed, the part becomes dry,

Sect. XIX.] Of the Arteries,

owing to deprivation of its usual supply of blood.* For this
reason also, in the most imperfect monsters, to which especially
many of those which are headless belong, there is always a
vascular system proportioned to their size and extent.^ But
as the normal mass of blood, which is proportioned to the size
and activity of the part, may be conveyed to it in a usual or
unusual manner, as well as by a large vessel, or by many small
ones, so with reference to the number, size, connexion, ramifi-
cations and position of the arteries, we shall find there are
very frequent and diversified varieties,^ the most important
of which will be here treated of.

(1) Faselius D. s. morbos arteriarum, Jenae, 1757. — Langswortk Theoria med.
de arteriar. et venar. in corpore humano adfectionibus, Vol. I. 4to. Prag.
1763. — Alex. Monro, Remarks on the coats of arteries, their diseases, &c. in
Edinb. med. Essays and Observations, Vol.11, p. 264. — Malacarne Osserv.
sopra alcun. arterie nel corpo umano nello stato preternaturale et nello stato
morboso in osserv. in Chirugia, Vol. II. p. 119. Torino, 1784, ff. — Lane D. de
arteriarum morbis, etc. L. B. 1787. — H. Watson, Account of a large aneurysm,
with some introductory reflections on the artery in its diseased state
in Medic. Commun. Vol. I. p. 178. — Freer, Observations on Aneurysm and some
diseases of the arterial system. Birmingham, 1807. — Hodgson, a Treatise on the
diseases of Arteries and Veins, containing the pathology and treatment of aneu-
rysms and v^rounded arteries, &c. 8vo. Lond. 1815; second edition, Lond. 1822;
translated into German by Kohei-wein, with remarks by Kreysig, Hanover, 1819 ;
translated into French by Breschet, with notes. 2 Vols. 8vo. Paris, 1819. —
Engravings to illustrate some of the diseases of the arteries, fol. 1815. — /. F.
Meckel Tabulae anat. pathol. Fasc. II. Vasa. fol. Lips. 1820. — Engelhardt D.
s. succinctam systematis arteriosi pathologiam. 4to. Lips. 1821. — C.H. Ehrmann
Recherches sur la structure les fonctions et les alterations organiques des
art&res, p. 32. 4to. Strasb. 1822. fF.

(2) This appears to me a better mode of expressing it than that o{ A. Serres
in Bullet, de la Soc. med. d'Emulation, Sept. 1821, who finds in malformation
of the vessels, the cause of almost all malformations of the fcetus, especially the
deficiency and excess of parts, though indeed the common origin of deficiency or
excess of parts and their blood-vessels is, as is well known, one and the same
variation in the formative impulse. It appears rather, however, as if the prin-
ciple determining the form arose out of the nervous system.

(3) The observations on deficiency of all blood-vessels in monsters, viz. in an
acephalous monster, v. Schellhammer in Ephem. Nat. Cur. Dec. II. p. 253,
1690, ff. (in the right lower extremity of a child.) v. Chanssier in Bullet, de la
Fac. de Medec. Vol. V. p. 405, are certainly founded in error, since the small
and delicate vessels are overlooked.

(4) Hence sometimes spurious formations are produced and nourished by
absorption ; I have, however, always found small arteries and veins.

(5) In the acephala, of which the heart is notoriously naturally wanting, we
find either merely an umbilical vein dividing like an artery, or the umbilical
arteries also ; sometimes even the aorta and vena cava with several branches ;
even in the most imperfect monsters, which have been described by Vrolik,
Memoires sur quelques sujets inte^rressans d'Anat. et de Physiologic par Fallot,
p. 25 — 64, Amst. 1822 ; and G. Lieber D. Monstri Molse speciem prse se ferentis
descriptio anatomica. 4to. Berol. 1821. — As also in a head born alone, v. Rudolphi
in the Schriften der Acad, der Wiss. zu Berlin f. d. Jahr. 1816 ; and in a mon-
strous goat, which consisted merely of a foot, v. Jgn. Hayn Monstri unicum
pedem referentis descriptio anatomica, 4to. Berol. 1824, arteries and veins
were found.

^96 Of the Arteries, [Part II.

(6) Compare most of tlie writers on the vessels, especially Haller, Mayer,
Sdenimerring, Meckel, furth^^r Timmermami D. de notandis circa naturae in hum.
machina lusus. § oO. Rintel. 1765, SI — Nlcolai D. de directione vasorum in
Haller s Coll. Disput. anat. Vol. II. — Ludwigii Progr. observat. angiol. tradens.
Lips. 17()^. — Sand/fort De notabilioribus vasorum observationibus in Obs. anat.
pathol. L. IV. and VIII. — Loder D. Nonnullie arteriarum varietates. Jenae,
1781. — Penchienati in Mem. de I'Acad. des Sc. de Turin. P. I. 1786. — JVrisberg
Varietatum angiologicarum per XXX. annor. seriem in corp. hum. observatarum.
P. I. Gciett. 1791. — Burns, Observations on some of the most frequent and im-
portant diseases of the heart, and on the unusual origin and distribution of some
of the large arteries of the human body. Edinb. 1809. ~ Zagorslaj in M^m. de
I'Acad. Imp. des Sc. de St. Petersburg, Vol. I. and II ; he also read, on the 30th
of May, 1827, in the Academy : Abnormitas quae ad ortum et numerum quarundam
arteriarum observata. — Koherwehi D. de vasorum decursu adnormi ejusque vi in
omnem valetudinem varia. Viteb. 1810. — Fleischmann in the Abhandl. der
physical, nied. Societat zu Erlangen, Vol. I. and II. — Rijan D. de quarundam
arteriarum in corpore hum. distributione. Edinb. 1812. — My Selt. Beob. Part I.
]). 100 ; Part II, p. 60.— J. F. Meckel Tab. anat. pathol. Fasc. II. Lips. 1820.
— Fr. I'iedemann Tabulee arteriarum corp. hum. Fasc. I — IV. gr. fol. Carlsruhae,
1822. — Schoen D. de nonnullarum arteriarum ortu et decursu abnormi. 8vo.
Halse, 1823.

§ 186.

The trunk of the pulmonary artery is not merely wanting,
if the organs for which it is destined, viz. the lungs, are deficient,
but also not unfrequently when they exist, in cases of unusual
form of the heart, in which case the arteries supplying the
lungs with blood usually arise either as a distinct but later
given off trunk, or else as two vessels from the root of the
aorta;* more rarely from their ascending portion^ or even from
the branches of the aorta.^ Sometimes the trunk of the pul-
monary artery exists, gives off no pulmonary branches, but
runs branchless as the ductus arteriosus into the aorta;* in
other instances the pulmonary artery, otherwise normal, forms
no connexion with the aorta, so that the ductus arteriosus is en-
tirely wanting.^ On the contrary, we observe very rarely a
distinct duplicate of the pulmonary axtery, in this case, for
instance, besides the pulmonary artery, a particular ductus
arteriosus arises from the right ventricle,^ or a second vessel
opens itself into the true pulmonary artery.^ This formation is
followed by those very rare cases in which the lungs, besides
their usual pulmonary artery, are supplied from some other
accessory branches.* More frequently we observe an irregu-
lar origin of the pulmonary artery from the heart, in which, for
instance, it originates not from the upper part, but rather from
the middle of the right ventricle," out of a special little third
part of the heart,*" out of both ventricles at once,*' or from the
left ventricle together with the aorta. *^ In several cases we
see, in the normal entrance of the veins into the heart, a
transposition of the pulmonary artery and aorta, so that this

16

Sect. XIX.] Of the Arteries. 297

springs from the left and that from the right ventricle. ^^
Another vice, which in the blue disease is not uncommon, is
the unnatural narrowing or actual closing up of the pulmonary
artery, either at its origin, or still higher up,^* in which cases
the blood is usually conveyed from the aorta, through the wide
ductus arteriosus to the lungs. ^^ The contrary state, the too
great capacity of the pulmonary artery, is much more rare.
Finally, the division and subsequent course of the pulmonary
artery sometimes varies ; so that from its left branch, a twig is
sent to the left subclavian,^^ from its right branch to the truncus
anonymus^^ from its division, the right subclavian ; " from the
ductus arteriosus, the left subclavian f^ at the separation of
the pulmonary branches, the left subclavian and descending
aorta, or the left carotid, subclavian and descending aorta ;^^
and more frequently besides the pulmonary branches, the
descending aorta merely is given ofF.^^

(1) Such cases were observed by Farre, Wilson, Standert, J. F. Meckel, Seidel,
Beckhaus, Mayer, Cerutti, and myself in three cases, in the above-mentioned
place, § 172, note 11. — Lietzau Hist, trium Monstror. p. 19, 8vo. Regiom, 1825,
in a double sheep.

(2) /. F. Meckel Descriptio monstrorum nonullorum, p. 11.

(3) In a rabbit, from the subclavian, v. Legallois in Bulletin de la Soc. de
Medec. p. 99, 1809. — Compare Rei.rs Archiv. Vol. XII. p. 122. — I also saw in a
double monster an artery from the truncus anonymus pass to the accessory lung.
V. Selt. Beob. Part I. p. 16.

(4) I found it so in a monstrous sheep without lungs, v. my Verzeichniss, 2949.

(5) Such cases were observed by Stenson, Bartholin, Sandifort, Chemineau,
Kreysig, Knox. — Compare § 172, note 11. — Meckel in Reirs Archiv. Vol. IX.
p. 437.— My Selt. Beob. Part I. p. 16, in No. 8025 of Bresl. Mus. and in another
monster, hereafter to be described, with abdominal cleft and hernia cerebri. —
Gamage in New-England Journ. of Med. and Surg. Vol. IV. p. 244.

(6) Wrisherg addend, to Haller's Physiologic, p. 77.

(7) Hall and Vrolik in Praktisch Tydschrift voor de Geneeskunde, Part II.
1825.

(8) For instance, a large branch from the aorta in the region of the sixth
dorsal vertebra for the lobes of the right lung. v. Huher in Act. Helvet.
Vol. VIII. p. 85, a similar twig for the under lobe of the left lung. v. J. F.
Meckel in his Archiv f. d. Physiologic. Vol. VI. p. 454. — Branches from the
frenic arteries for both lungs, v. Mangers in Sidillot Recueil p^riodique,
Vol. XIII. p. 74 ; and in Coi-visart Journ. de Medec. Ann. X. Pluviose. — Or
with very small pulmonary arteries, equally for both lungs from the pericardial
arteries, v. Jacobson in Meckel, Vol. II. p. l34, fF

(9) Hodgson and Leadam in Farre.

(10) Lawrence in Farre, p. 26.

(11) This was observed by Cooper, Farre, Bock, Horner.

(12) Mery in Memoires de Paris, 1700, Hist. p. 54. — Richard K. Hoffmann in
New-York medical and physical Journal, Vol. VI. p. 250. — Mareckal.

(13) Bailiie, Engravings of morbid Anatomy, Fasc. I. pi. 6, fig. 1 and 2. —
Wistar System of Anatomy, Vol. I. Pennsylvania, 1811. — Langst<^ in London
Medical Review, Vol. IV. and in Farre, p. 28. — Farre, p. 29, with plates, fig. 14.
— /. F. Meckel Tabulae anat. pathol. Fasc. II. p. 1 and 2, (in a lamb and a calf,)
and Descriptio monstror. nonullor. p. 21, (in a hemicephalic monster.) — Tiede-
mann in his and G. R. and L. Ch. Treviranus Zeitschrift fiir Physiologic, Vol. I.
Part I. p. Ill, tab. 7, f. g. — E. d' Alton D. de cyanopathiae specie ex invicem

298 Of the Arteries. [Part 1 1 .

permutata arteriae pulmonalis atque aortee origine. 4to. Bonnae, 1824, with
plates. — Jos. Burckart D. de monstro humano notabili. Friburg, 8vo. Brisg. 1825.
— Dug^s in Journ. gener. de Medec. Vol. CI. p. 88.

(14) Farre had a case of his own, and one from Hodgson. The latter saw the
pulmonary artery like a thread. — Narrow only on one side, seen by Pulteney in
Medic. Transactions by the Coll. of Physic, of London, Vol. III. p. 339, 1785. —
And Kreysig Herzkrankheiten, Vol. III. p. 104, with plates. — Basedow, (only a
ligamentous rudiment.) — On closure of their orifices, v. § 174, note 4. — Simple
narrowing of the pulmonary artery often occurs in the blue disease.

(15) V. Hodgson in Farre, Perkins, Beckhaus, Delmas, Breschet, p. 12 ; Mauran.
Cerutti. — Myself in a few instances, v. above, § 172, note 11.

(16) Such cases described by Cooper in Farre, Richerand, Corvisart, Testa, J. F.
Meckel, Hufeland, Lawrence, Young, &c.

(17) Jackson in Lond. Medic, and Physical Journ. Aug. 1815, p. 100 — 102.

(18) Breschet in Repert. general d'Anat. et d. Physiol, pathol. etc. Vol. II.
Cah. I. p. 17, Paris, 1826.

(19) /. F. Meckel Tabul. anat. pathol. Fasc. II. p. 2, (in a calf.)

(20) Relnmann in Nov. Act. Acad. Nat. Cur. Vol. I. p. 302. — KUnkosch Progr.
de anatome foetus capite monstroso. Prag. 1766. — J. F. Meckel Handb. der
pathol. Anat. Vol. II, p. 105. — In other cases the ductus arteriosus opened in
the left subclavia. v. Obet in Bulletin des Scienc. m^dic. par la Soc. med.
d' Emulation, May, 1808. — Rudolphi in Bernhard D. de arteriarum e corde pro-
deuntium aberrationibus. 4to. Berol. 1818.- — Re'mmann in Nov. Act. Acad. Nat.
Cur. Part I. p. ^0% — Sandifort Mus. anat. Vol. I. p. 273 ; Vol. II. tab. 107,
fig. 1 and 2.— Corvisart, 288.

(21) I found the former in a child with frenic rupture, deficiency of a finger,
&c. No. 8025 ; the latter in a double monster of a sheep in one of the hearts.
No. 8020, of Bresl. Mus. — One similar case is described by Seidel, Index Musei
Anat. Kiliensis, p. 61. Kilis, 1818.

(22) For instance, Laiigstaff and Cooper, in two cases. — Farre. — Steidele Samm-
lung chirurg. Beobacht. Vol. II. p. 114. Wien, 1778. — Choulant Epist. gratulat.
ad Pezold, p. 13. The preparation is at Dresden, in the collection of the Medico-
Chirurg. Acad. — Kreysig Krankheiten, Vol. III. p. 104, with engravings. —
Lietzau, p. 19, the right descending aorta in a double sheep.

§187.

The ENTIRE ABSENCE OF THE AORTA wlien the heart is
present, has not yet been satisfactorily observed ; but the par-
tial DEFICIENCY occurs, as when the pulmonary artery gives
off branches of communication to the aortic branches, or forms
the descending aorta, it is very small, and merely gives off' the
branches to the upper half of the body, and even then not
completely.^ In these cases it is sometimes only connected with
the lower aorta by a narrow vessel, and frequently not at all.
Excess of formation is exhibited in its too great size, when
it and the pulmonary artery originate by a single trunk ^ from
the heart, and from an actual duplicity of the same in the
single heart of a double monster. Frequently we find the
origin of THE AORTA irregular in the blue disease, inasmuch as
it is more or less inclined to the right, and then arises, owing to
deficient formation of the septum, from both ventricles,^ or
entirely from the right ventricle ;* sometimes it is unnaturally
NARROW at its commencement,^ or even comfletely closed,*"'

Sect. XIX.] Of the Arteries. 299

and the blood then proceeds from the pulmonary artery
through the wide ductus arteriosus^ In rare cases also the
further course of the aorta is abnormal ; to these belong its
division, and stretching itself in a ring around the air tube/ its
division from the commencement into an upper artery which
merely supplies the head and the arms, and a descending, which
is the proper artery of the lower half of the body ; ^ its course
to the right instead of the left side, inasmuch as it not merely
descends on the right side of the spine, as might naturally be
expected in the usual transposition of the viscera,^** but also
sometimes in the normal position of the intestines, it curves
over the right bronchus, and descending along the right side
of the spine, soon inclines more or less far down towards
the usual orifice in the diaphragm ; ^^ its unconnected and
separated course from the spine, so that it perforates the
diaphragm not behind but near the right of the gullet,^^ and in
a syren-formed monster, once divided in front of the urinary
bladder and uterus into the two iliac arteries ; ^^ and lastly, its
unusual early high division.^*

(1) Compare § 186, note 17—22.

(2) Compare § 186, note 1—3.

(3) This was observed by Stenson, Sandifort, Howship in three cases, Nevin,
Ring, Cailliot, Ohet, Cooper, Hunter, Corvisart, Huet, Pulteney, Lawrence, Farre,
Jacobson, Knox, Haase, Meckel, Tapper, Creveld, Palois, Dorset/, Thoxter, Olivri/,
Gintrac, Gregory, Basedow, in § 172, note 11. — Myself in four cases, v. Selt.
Beob. Part I. p. 64 ; Verzeichn. No. 2203, 2929; and in No. 8011 of Bresl, Mus.

(4) To wit, Abernethy, Farre, p. 37, Fleischmann, Bock, Burkart. — My Selt.
Beob. Part I. p. 16, and Andre, compare § 186, note 13.

(5) Lemaire in Bulletin des Sciences medic. Vol. V. 1810. — J. F. Meckel
Descriptio monstror. nonnullor, p. 11.

(6) Roederer De fcetu parasitico in Comm. Soc. Goetting, Vol. IV. p. 121 and
123 ; in this case they were attached to the heart merely by cellular tissue.

(7) Ramberg D. de corde vasisque majoribus eorundem ratione normali in
animantibus et abnormi in homine, p. 21. 8vo. Berol. 1824, with engravings. —
Rust Magazin f. die ges. Heilkunde, Vol. XV 1 11. Part II. p. 346.

(8) Hommel in Commerc. litter. Vol. II. p. 161, fig. 1 and 2. Norimb. 1737,
(the preparation is at present in the Anat. Mus. at Strasburg.) — Malacame Osser-
vazioni in Chirurgia. Part II. p. 119, fig. 1 and 2. Torino, 1784. — Both cases
are again engraved in /. F. Meckel Tab, anat. pathol. Fasc. II. tab. 9, fig. 3 and 4,
and in Tiedemann Tabul. arteriar. corp. hum. Fasc. I. tab. 4, fig. 6 and 7. — A
third instance was observed by Joseph. Exupere Berlin, v. R. J. Berlin Traite des
maladies du coeur, p. 433.

(9) Haller Elementa Physiol. Vol. II. p. 162, note f, from the Journ. des
Savans, 1668, No. 3, (in a child.) — Klinz Abhandl. der Josephin. medic, chir.
Akademie, Vol. I. p. 271, pi. 6. Wien, 1787.

(10) Not always, however; for instance, not in the cases related hy Douglas
Fox, in Lend. Med. and Phys. Journ. July, 1824 ; it usually descends on the left
side of the spine, but the arteria anonyma arose from the left of its arch.

(11) Cases of this kind have been observed by Klinkosch Progr. de anat. foetus
capite monstr. p. 15. Prag. 1766. — Abernethy, in Philos. Transact. 1793, p. 59. —
Fiorati in Saggi di Padova. Vol.1, p. 69, flf. — Sandifort Mus. anatom. Vol.1.
p. 273 ; Vol. II. tab. 107, fig. 1 and 2. — Cailliot, two cases in Bulletin de I'Ecole
de Med. 1807, p. 24. — Obet in Bulletin des Scienc. medical, par Graperon, Vol. II.

300 Of the Arlerlcs, [Part 1 1 .

p. Q5. ISOS.—Legallois in Bulletin de la Soc. de Medec. 1800, p. 99, (in a rabbit )
J. F. Meckel Handb. der pathol. Anat. Vol.11. Parti, p. 97. — Rudolphi, v.
Beruhard D. de arteriar. e corde prodeunt. aberrationibus. 4to, Berol. 1818,
witli engravings. — Breschet in Repertoire gen. d'Anat. et de Physiol, pathol.
\o\. II. Part I. p. 14. — Myself in my Selt. Beob. Part II. p. 60 ; and Verzeich.
No. 1922. — More rare is the case which I found in a child with frenic rupture, de-
ficient fingers, &c. No. 8025 of Bresl. Mus. ; viz. that the descending aorta, which
arose from the pulmonary artery, after giving off the left art. subclavia, passed
to the right between the gullet and the second dorsal vertebra, and turned again
downwards and to the left to the hole in the diaphragm.

(12) PotthoffX). s. Descriptionem casus rarissimi spinam bifidam totalem exhi-
bentis, p. 9. 4to. Berol. 1827.

(13) Myself, Monstrorum sex humanor. anat, et physiol. disquisitio, p. 38.
Francof. ad Viadr. 1811.

(14) In a few instances, which I have already described in my Selt. Beob.
Part II. p. 71 ; and Verzeichn. No. 1988, it divided about the third or fourth
lumbar vertebra. — Petsche also found it divided early, and the two iliac arteries
connected with each other by a transverse branch, v. Syllog. Observat. anat.
select. § 77 ; rec. in HalJer Coll. Diss. Anat. Vol. VI. p. 781. — It divided very
early, in a case by Wehrde D. anat. pathol. de monstro rariore humano. 8vo.
Halae, 1826. — This vai'iety would partly render impracticable compression of the
aorta in active hemorrhage after birth.

§ 188.
As to the individual branches of the aorta, these present not
a few and somewhat interesting varieties. Thus we find, for
instance, instead of two coronary arteries to the heart, only
one,^ or more frequently three, and even four; or finally, they
have unusual origins, viz. higher up from the aorta,^ and in
one instance from the siihclavia dextra^ 8zc. Very frequently
the number, origin, and course of the great vessels* arising
from the arch of the aorta vary, as in rare cases they originate
from one common short trunk, or more frequently from two,
or finally, still oftener, by a greater number than usual, that is,
by four, five,^ and even six,*^ so that instead of from the hi?io-
9ninata, the right subclavia and carotis arise separately from the
aorta ; or the vertebral arteries, one of the thyroid, one of the
thymic, or the internal mammary, aris^e from the arch of the
aorta. In operative surgery, the most important are, the
origin of a middle inferior thyroid, which arises from the arch of
the aorta, the truncus anonymus or the carotis, and ascends
directly in front of the air-tube to the thyroid-gland;'' the crossing
of one carotis upon the air-tube, as for instance, the left arising
from the innominata, or the right unusually far on the left
side ; and the origin of the right subclavia, from the left side,
in which case it usually proceeds between the spine and the
gullet;" more rarely between the latter and the air-tube," or
still less frequently before'" these to the right arm. In some
instances the right subclavia did not arise so far to the left,
and only lay behind the right'' or behind both'^ carotids at
their division.

Sect. XIX.] Of the Arteries. 301

(1) I have once observed this.

(2) Farre, p. 2, fF.

(3) Mayer in Graefe and v. Walther's Journ. f. d. Chir. Vol. X. p. 44.

(4) Huber De arcus aortse ramis in Actis Helvet. Vol. VIII. p. 68 — 102. —
Walter Mem. de I'Academ. des Scienc. de Berlin, 1785, p. 57, ff. — Tiedemann
resp. /. N. Bayer D. de ramis exarcu aortse prodeuntibus. 4to. Salzb. 1817, with
lith. plates. — Zagorsld, Malacarne, and Fiorati. — Thilow in den Allg. niedic.
Annalen, March, 1817, p. 289. — I have also sometimes observed in anin^ials
varieties respecting these branches.

(5) Ph. Ad. Bohmer De quatuor et quinque ramis ex aorta ascendentibus.
liaise, 1741.

(6) Penada Saggio terzo di Osservazioni patologico-anatomiche. Padova,
1801. — F. Muller, v. MecheVs Handbuch der menschl. Anatomic. Vol. III. p. 84,
note 21, — Tiedemann Tabulse arteriav. Fasc. I. tab. 4, fig. 5.

(7) This anomaly was first described by Neuhauer, Descr. anat. arter. innomi-
natae et thyreoidese imas in Op, Anat. collect, p. 287, note o. — Tiedemann gives a
good engraving of it in his Tab. 3, fig. 11. — I have only found this variety once,
but the origin of the thyreoidea ima below from the truncus anonymus I have
seen twice ; both varieties, as well as the following, are very important in
tracheotomy.

(8) Boknier, fig. 1. — Fahricius Proemticum nonnullas observationes sistens, ad
Diss. J. B. Hoffmanni. Helrast. 1751, p. 10, — Mieg Spic. observat, anat. et bota-
nicar. Basil. 1753, Art, 8. — Loeseche Observat, anat, chir. med. Berol. 1754,
p. 26. — J.F.Meckel, the grandfather, Ep, ad Hall, Vol, III. p. 132, 141,—
Ludwig Progr, observat. angiologicas tradens. Lips. 1764, p. 5. — Pohl Observat.
angiol. de arteriis. Lips. 1773, p. 7. — Neuhauer, § 13. — ^ Murray Abhandlungen
der Schwed, Akademie, Vol. XXX. p. 92.— ScJdeitz, ib. p. 98. — Sandifort Mus.
anatomicum, Vol. II, tab. 106, fig. 2. — Hidme in Soc. of London, 1789, Vol. II.
p. 271, ff. — Autenrieth resp. Pfleiderer D. de dysphagia lusoria, 8vo. Tubing.
1806. — Obet in Bulletin des Sc. medicales, reviewed by Graperov, 1808, Vol. II.
p. Q5, ff. — Koberwein, p. 16, — Herold D. exhib. observationes quasdam ad corp.
hum. part, struct. Marburgi, 1812, p. 7. — Fleischmann Leichendffn. Erlang.
1815, p. 213, — J. F. Meckel Handb. der pathol. Anatomie, Vol.11. Parti,
p. 98; also in a hedge-hog. v. Cuvier Anatomie Compar., Vol. IV. p. 699,
which has been observed by Tiedemann, and Tabul. arteriar. Fasc, I. tab. 2,
fig. 6 ; the engraved case appears to belong here. — G. W.Stedmann, in Edinb.
med. and surg. Journ. Oct. 1823, No. 77, with plates. — Perhaps also Hart, ib.
April, 1826. — Mayer in v. Graefe and v. Walther's Journ. der Chir. Vol. X.
p. 44. — Cerutti Rarior. monstri descript. anat. Lips, 1827. — I have seen these
varieties six times; compare my Selt. Beob. Parti, p. 100 ; Verzeichniss,
No. 1923, 2247, 2248, 8683 of Bresl. Mus. and in two cases not preserved. In
neither case had difficult swallowing occurred, which had already been missed by
Fleischmann and Koberwein, whilst Bay ford, Hvlme, Mo7iro, Autenrieth, and Murray,
have mentioned a peculiar kind of dysphagia (lusoria). This variety is important
in the operation of tying the subclavian artery, because its inner part na-
turally lies deeper, i. e. more backwards. It is interesting, that sometimes the
left subclavian, which, in altered position of the aorta, mostly arises from the
right, passes behind the gullet to the left arm. v. Fiorati Saggi scientifiche di
Padova, Vol I. p. 69, 70; and myself in Selt. Beob. Vok II. p. 61.

(9) Bayford D. de dysphagia lusoria. v. Memoirs of the med, Soc, of London,
Vol. II. 1789, p. 271. — Alex. Monro D. de dysphagia, Edinb. 1797, and in
Outlines of the Anatomy of the human Body, Edinb. 1813, Vol. III. p. 277,
pi. 43. — Zagorsky, Vol. II. p. 318, tab. 2, fig. 7. — Herold D. exhib. observationes
quasdam ad corp. hum. part, struct. Marburgi, 1812. — J. F. Meckel, p. 100. —
Hesselbuch Beschreib. der pathol. Praparate zu Wiirzb. p. 181, No. 604, and
p. 212, No. 587.

(10) Hunauld in Mem. de I'Acad. des. Sc. 1735, Hist. p. 28, No. 7.— Walter
Mem. de I'Acad. des Scienc, de Berlin, 1785, Vol. III. p, 62, tab. 3, fig, 5.

(11) Huber in Actis Helvet, Vol, VIII. p. 75, fig. 3.

(12) Walter, tab. 3, fig. 4.

302 Of the Arteries, [Part 1 1 .

§ 189.

The further course of the arteries originating from the arch
of the aorta is sometimes irregular, in a manner peculiarly
interesting to operative surgery ; thus, the common artery of
THE HEAD, from whicli, in rare cases, large unusual branches
are given off, divides at once,^ very early, ^ or on the contrary,
very late and not distinctly,^ into external and internal branches;
the CEREBRAL CAROTID was in one instance entirely deficient on
one side ;^ in anencephala, the cerebral carotid as well as the
vertebral arteries are mostly very small, thin coated, and even
terminate in blind extremities. The superior thyroid artery
is sometimes wanting on one side, or is not unfrequently
double ; the occipital artery in many cases takes its origin
from the cerebral carotid. The external maxillary
artery is sometimes remarkably small, and its place is then
supplied by the so-much larger transverse facial artery. The
VERTEBRAL ARTERY is uot uufrequeutly very small on one
side and as much larger on the other ; sometimes it is more or
less double, sometimes indeed only at its origin,^ sometimes still
higher up ; it has been seen even three-fold ; '^ not unfrequently
it proceeds superficially on the spine, in order to make its
first entrance into the fifth, fourth, and even the third or
second cervical vertebra; in one instance its upper part was
perforated by the tierviis hijpoglossus.'' The inferior thyroid
ARTERY is sometimes wanting on one side, it arises also double,
or the left and right spring from a common trunk ; ^ sometimes
they lie very loosely; are very uncommonly tortuous, &c. The
internal mammary artery was, in one case, formed of three
parallel descending vessels, of which the outer two were only
connected by a small transverse branch ; " in another case it
gave off a large external branch, which, passed upoa the first
four ribs.^° The artery of the arm varies very frequently
and differently in respect to its course and division ; ^^ in a
practical point of view, the most important anomalies are, that
the artery gives off a vas aberrans, which descends more or
less completely to the elbow-joint, and here terminates either
in the principal trunk or in one of the arteries of the fore-arm;
the artery divides higher than usual, and not unfrequently even
in the arm-pit, into two branches, which lie close by each
other ; and of the two, the abnormal sometimes very superficial,
that is, close beneath the skin, is most frequently the radial,
more rarely the ulnar, or lastly, and the most unusual, the
interosseal artery; the radial artery in very rare instances
is entirely wanting, and then can no pulse be felt on the

Sect. XIX.] Of the Arteries. 303

fore-arm ;^^ it divides too high, in which case, its palmar
branch, taking the direction of the trunk of the radial, gives
rise to mistakes in feeling the pulse,^^ or its dorsal branch runs
down on the fore-arm superficially, and is easily wounded ;
the ULNAR ARTERY, instead of its usual deep course, descends
superficially;^* and finally, the interosseous artery sends
oflf' an anomalous twig on the inside of the fore-arm, which
lying nearer to the skin than itself, runs to the palm of the
hand.

(1) A case of this kind in a monster I have described in my Sclt. Boob.
Part I. p. 16.

(2) Morgagni De sed. et cans, morbor. Epist. XXIX. 20. — Burns, Diseases
of the Heart, p. 327. — Rijan, p. 4. I have seen it a few times divided an inch or
two deeper than common.

(3) Burns, p. 326 and 327.

(4) Tode, Medic, chir. Bibliothek. Vol. X. p. 401.

(5) For instance, with one origin from the aorta ; with another from the left
subclavia. v. Huber in Act. Helvet. Vol. VIII. p. 73. — Henkel's AnmerV.. von
wiedernaturl. Geburten, Part II. p.lO ; with both origins from the right subclavian.
\. J. F. Meckel Handb. der menschl. Anatomic, Vol. III. p. 135.

(6) Viz. two origins from the right subclavian, and a third from the inferior
thyroid ; all three united together between the fourth and fifth cervical vertebrae.
V. J. Meckel in /. F. Meckel's Archiv fiir Anat. und Physiol. 1828, No. 2, p. 170,
tab. 7, fig. 4.

(7) The wax model of it is in the Anatomical Museum of the Joseph Academy
at Vienna.

(8) Burns, p. 331.

(9) I saw this rare preparation in the Anat. Mus. of the Surgical Academy at
Copenhagen.

(10) v. my Selt. Beob. Part II. p. 62, Verzeichn. No. 1931, and once since.
It may be easily seen that this anomaly may, in penetrating wounds of the chest,
fractured ribs, &c. give rise to internal hemorrhage.

(11) C. G. Ludwig Progr. de variantibus arteriae brachialis ramis in aneurys-
matis operatione attendendis. Lips. 1767. — J- F. Meckel Ueber den regelwidrigen
Verlauf der Armpulsadern ; in his D. Archiv f. d. Physiol. Vol. II. p. 117 — 131,
and in Tabul. anat. pathol. Fasc. II. tab. 11. — Fr. Tiedeman Beobachtungen iiber
die hohe Theilung- der Armschlagader in die Speichen-und Ellenbogen-Schla-
gader; in the Denkschriften der Akad. der Wissench. zu MUnchen, Vol. VI.
p. 3, fF. and in Tabul. arteriar. Fasc. II.

(12) I have observed this during life and after death, on both arms of an aged
woman ; from the radial artery there is merely the recurrent and a few little
muscular branches ; the descending trunk is entirely wanting ; hence the inter-
osseal is larger, and gives off the branch to the hand, which is naturally sent from
the radial. Compare No. 8531, Bresl. Mus.

(13) Burns, p. 343, in which he relates an observation of Dr. Baird, according
to which three persons in the same family were subjects of this anomaly.

(14) Tiedemann,Td\i\x\2L Arteriarum, Tab. XVII. fig. 1. — Burns, p. 341, saw it
three times. I have only to the present time seen it once.

§ 190.

Not fewer varieties are exhibited by the arteries arising
FROM THE descending AORTA. Thus wc somctimcs find the
BRONCHIAL arteries vcry much enlarged in persons aflTected
with the blue disease ;^ the origin and course of the intestinal

304 Of the Arteries. [Part II.

and mesenteric arteries vary uncommonly ; in large umbilical
ruptures and protrusion of the abdominal viscera, their arte-
ries are very deficient ; ^ the inferior mesenteric artery
in an otherwise well-formed child was deficient/ and in one
case of high division of the aorta, it arose from the common
iliae artery ; * the arteria omphalo mesaraica, not merely in
new-born children, but even in adults, still remains distinct;^
the renal arteries are very commonly irregular in number
and origin, sometimes there are five instead of two, and in one
instance the arteries of both kidneys arose by a common trunk
from the front of the aorta close to the superior mesenteric,'^
or lastly and more commonly, in congenital abnormal position
of the kidneys, their arteries also arise irregularly, viz. lower
down from the aorta, from the iliaca communis, the hypo-
gastrica, and even the sacralis media^ &c. The pelvic
arteries also vary frequently; to these first belongs, the
umbilical artery, which especially in malformed, although
also frequently in well-formed children, is entirely deficient on
one side,^ or as an approach to such formation, is unusually
small, sometimes has an unnatural origin,'' and in its shrivelled
state, in adults, does not lie close to the abdominal parietes,
but depends loosely in a tolerably broad fold of the perito-
neum/" The irregular course of the pudeitda communis is
also important, as its principal trunk, in some instances, does
not descend between the inferior pelvic ligaments, but along
the urinary bladder and prostate gland, or even through these
to the penis, and may therefore, in the operation for the stone,
be easily wounded in a dangerous manner/^ Not less im-
portant in reference to the operation for crural rupture is the
variety of the ohturatoria ; it arises, in rare cases, beneath the
crural arch from the femoral artery itself, or very frequently
from the epigastrica, or even by one trunk common to it and
the latter from the pelvic artery ;^^ in all these instances it
returns upon the share-bone into the pelvis, and then passes
usually on the outer side of the femoral rupture, although also
in external femoral rupture on the inner side, and sometimes
even curves in front of the neck of the sac. Finally, the
course of the femoral artery and its branches is subject to
numerous varieties, of which the most important are the follow-
ing : the epigastrica f which normally, in external [oblique]
inguinal rupture is on the inner side, and in internal [direct]
inguinal rupture, on the contrary, is on the outer side of the
neck of the sac, and in femoral rupture also ascends to its
outer side, sometimes takes a contrary course, if it arise too low
down from the femoral artery, or as is commonly the case with

Sect. XIX.] Of the Arteries. 305

the obturatoria, or although arising at its usual place, descends
too low ; ^^ the ahdominalis is sometimes double, and so large,
that in wounds of the belly, injury to it is very dangerous ; ^^
the common femoral artery divides sometimes close to the
crural arch, and in rare instances even above the crural arch
into superficial and deep femoral arteries ; ^^ the latter is some-
times, as to size, the principal trunk, so that the perforating
arteries of the thigh are unusually large ; the internal coro-
nary [circumflex] artery arises sometimes so high, that in
the operation for femoral rupture it may be wounded ; ^^ the
SUPERFICIAL femoral ARTERY in onc iustaucc gave off an
uncommon branch, which descended on the inside of the lower
extremity close beneath the skin to the inner condyle ; ^' in
other instances it was double to the tendon of the triceps, so
that two trunks descended parallel to each other ; ^^ this leads
to the unnatural high division into tibial and peroneal arteries,^**
from the popliteal artery a large branch which ascends to
the middle of the thigh, and anastomoses with the perforating
arteries ; ^" lastly, the arteries of the leg also frequently
vary, as the one or the other of them may be either entirely
deficient or very small ;^^ the division into the posterior, tibial,
and peroneal arteries takes place very low down, there is irre-
gular communication between them, or their course is unusual. ^^

(1) I have found this once; also Tiedemann. v. Zeitschrift f. Physiologie.
Vol. I. Part I. p. Ill, IF. — Jacohson v. Meckel's D. Archiv fiir Physiol. Vol. II.
p. 134, and others, observed this.

(2) Potthoff D. s. descriptionem casus rariss. spinam bifidam, totalem, etc,
exhibentis. 4to. Berol, 1827, p. 9, (but one artery instead of the coeliaca, me-
senterica superior and inferior.) I have seen a similar case. — Wehrde D. anat.
pathol. de monstro rariore humano. 8vo. Halae, 182G, (the mesenterica superior,
the sacra media, and the umbilicalis were wanting.)

(3) Flelschmann, v. Leichenofthungen, p. 239, No. 81. — Vic d'Azy?- once missed
the communicating branch of the superior mesenteric artery, v. M^m. de Paris.
Ann. 1776. Mem. p. 702.

(4) Petsche Syll. Obs. rec. in HaUeri Col. Diss. Vol. VI. p. 781.

(5) I have found three times in newly born children that the artery is closed,
but totally distinct from the vein. I have also four.d it in animals, viz. in a full
grown otter and in a cavia aguti. — Heuslnger found it in a full grown foetus.
v. Zeitschrift fur organ Physik. Vol. I. Part III. p. 335.

(6) Portal Cours d' Anatomic m^dicale. Vol. III. p. 290.

(7) I have observed this once on the right and once on the left side. I have
also seen an artery for the left deep seated kidney taking its origin from the right
common iliac.

(8) Only a single umbilical artery, without any account to which side it belongs,
is given in Haller Elem. Physiol. Vol. VII. p. 495. — Hebenstreit resp. Lehmann
Funiculi umbilic. hum. pathol. Lips. 1747 ; and in Mailer's Collect, anat. Vol. V.
p. 682. — Osiander Annalen, Vol. II. p. 80. — Murdoch in Edinb. med. and surg.
Journ. 1821, p. 315. — Windsor, ib. October, 1821. — Rathke in Meckel's D.
Archiv. f. Physiol. Vol. VII, p. 483. — Herrmann in d. Salzburg, med. chir.
Zeitung, 1822, Vol. IV. p. 93, IF. ; the right missed by Breschet, v. Reper-
toire, etc. Vol. II. Cah. I. p. 471. — J. F. Meckel in five cases, v. Descript. mon-

306 Of the Arteries, [Part 1 1 .

stror. nonnullor. Lips. 1826, p. 13, 22, 31, 43; and in Archiv fiir Anat. und
Physiol. 1826, No. 1, p. 37. — Fnher D. duor. monstror. humanor. descript. anat.
4to. Berol. 1827, p. 16. — Hesse D.monsth bicipitis descript. anat. Svo. Berol. 1823,
p. 21. — Bock in CeruttVs Pathol, anat. Museum, Vol. I. Part III. p. 39. — Mende
in Nov. Act. phys. med. Acad. Nat. Cur. Vol. XHI. Part II. 1827, p. 869 ; and
myself in four cases, v. Selt. Beob. Part I, p. 16, and in No. 2903, 8012, and
8013, Bresl. Mus. ; the left missed by Wrisberg Descr. anat. embryon. Obs. 4. —
Sandiforl Obs. anat. pathol. Lib. III. cap. 1, tab. 3, fig. 3, k. — Cants Zur Lehre
von Schwangerschaft und Geburt. Part II. p. 107. — Frdnkel D. de organor.
generat. deformitate rariss. p. 14, 4to. Berol. 1825. — JVehrde D. anat. pathol.
de monstro rariore humano, p. 12. Hala?, 1826. — Mayer in the Zeitschrift fiir
Physiologie of Tiedemann and G. R. and L. Cli. Treviranus, Vol. II. Part I. p. 37 ;
and myself in five cases, viz. in Monstror. sex humanor. anat. et phys. disquisitio,
p. 15. 4to. Francof. 1811, and in No. 2881, 8011, 8015, and 8016, Bresl. Mus.
I have also seen a case belonging here in the Anat. Mus. at Freyburgh. There
appears also, in i-eference to the frequency of this phenomenon, no actual diffe-
rence between the right and left sides. In rare cases both imibilical arteries are
consolidated into one trunk within the cord. v. Henkel Medic, chir. Beobach-
tungen. — FIcischmann Leichenoflhungen, p. 239, No. 82.

(9) For instance, from the iliaca. \. Breschet. — From the aorta ; this is indeed
regular in the syren monsters, v. Hottinger in Misc. Nat. Cur. Dec. III. An. 9. Obs.
233. — A. K. Boerhaave Hist. anat. infantis cujus pars corporis inferior monstrosa.
Petrop. 1754, p. 74; and Hist, altera Petrop. 1757, p. 73. — Rossi D. s. foetus
monstrosi Holmiae nati descript. et delineat. Jenae, 1800, p. 16. — Sachse D. s.
descriptionem infantis monstrosi. Lips. 1803, p. 14. — Dieckerhnff D. de Mono-
podia. Halae, 1819 (in several cases.) — Hesselbach Beschrcibung der jjathol.
Praparate zu Wiirzburg, p. 232. — Behn D. de monopodibus, p. 12. 4to. Berol.
1827. — Myself, v. Monstror. sex humanor. anat. et physiol. Disquis. p. 38, and
in No. 2903 of my Verzeichniss. — This anomaly, however, also occurs without
syren formation, v. Needham De format, fcetu. Cap. IV. — Kerkring Spicil. anat.
Obs. 9, p. 27. — My Selt. Beob. Part I. p. 16. — Herrmanti in d. Salzb. medic,
chir. Zeitung, 1822, Vol. W. p. 95. — In a monstrous calf, with deficient hind-
part of the body, the umbilical arteries arose from the anterior mesenteric.
V. Fingerlmth in Meckel's Archiv fiir Anat. und Physiol. 1826. No. 1. p. 3.

(10) I have observed this twice; Kelch also has seen it once. v. Beitrage zur
pathol. anat. p. 60, No. 47. — There may easily arise from this anomaly an in-
ternal contraction of the intestine.

(11) This variety is so common, that Vcsalias, and other older writers, have
considered it as the usual formation. I have, however, observed it but twice in
adult men. Burns, p. 350, first pointed out the danger of wounding it in the
operation for the stone in man. — Tiedemann Tabulae Arteriar. tab. 30, fig. 2,
has engraved it very satisfactorily. — On account of this anomaly, J. Shaw lost a
patient by hemorrhage, very shortly after operating for the stone, v. Magazin
der ausliind jitterat. der ges. Ileilkunde, Vol. XL p. 349. — Seldom, and perhajjs
only in injuries of the penis, is the origin of the arteria dorsalis penis from
the deej) artery of the thigh important, v. T'ledemaim, tab. 3, fig. ].

(12) I have several times found the varieties just mentioned, and it appears
to me, as also to Hesselbach and Tiedemann, that the external origin of the ob-
turatoria in women is more fretjuent than in men. Good plates of these varieties
are given by Monro in his Morbid Anatomy of the human Gullet, Stomach, and
Intestines. Kdinb. 1811, Tab. 14. — Burns in Edinb. med. and surg. Journ.
Vol. II. p. 273, fig. ].— fl'ardrop, ib. p. 203. — //. A'. Hesselbach Ueber den
Ursprung und Verlauf der untern Bauchdeckenschlagader und der Hiiftbcin-
lochsscldagader. 4to. Bamberg and Wiirzb. 1819, with six plates. — Tiedemann
Tabula' Arteriar. tab. 30, fig. 3 and 4 ; tab. 33, fig. 2—4.

(13) Such cases are described by F. C. Hesselbach in der Salzl). mod. chir.
Zeitung, 1811, No. 62, ]). 186; and in Untersuclumg iiber den llr.s))rung und
das Fortschreiten der Leisten-uiid Sclunkelhriiehe, ]). 17. Wiirzburg, 1815. —
Burns, p. 360. — Beckers D. nu d. de hernia inguinali, p. 316. Paris, 1813. —
//. K. Hesselbach, p. 24, No. 31.

Sect. XIX,] Of the Arteries. 307

(14) Ramsay in Edinb. med. and surg. Journ. Vol. VIII. p. 282, plate 1,
fig. 1. — Burns, p. 361.

(15) The ligature of the superficial femoral artery for aneurysm was without
any good result, because the deep artery arose almost immediately below the
crural arch ; and, therefore, between its origin, and the part at which the
ligature was applied, so small a space remained, that the clot could not with-
stand the flow of the blood, v. Ephem. medic, de Montpellier, Vol. V. p. 61. —
A few good engravings of high division are given by Tiedemann, tab. 33, fig. 2
and 3. — The division above the crural arch was observed by Burns, p. 362, in
four individuals. — Tiedemann once. v. Explicat. Tabular. Arteriar. p. 322,
note a. — I have found it twice, and, indeed, on both sides in each case ; the
high division near the crural arch I have not unfrequently seen.

(16) Burns, p. 362.

(17) Zagorskij, Vol. I. observed this case, interesting physiologically, on
account of the similarity between the arteries and veins of this region.

(18) C. Bell in London med. and physical Journal, August, 1826. — As in this
case the man had popliteal aneurysm, the blood, after the ligature had been
applied, naturally passed by one femoral artery into the sac. — A similar variety
was found by Houston, v. Dublin Hospital Reports and Communications.
Vol. IV. p. 314.

(19) According to Ramsay, p. 283, the division takes place sometimes above
the popliteal muscle, so that of these, the anterior tibial artery proceeding from
it, inclines towards the tibia; in rare cases the division is found as high as the
crural arch. v. Sandifort, Obs. Anat. pathol. Lib. IV. p. 97. — Portal Cours
d'Anatomie Medicale, Vol. III. p. 326.

(20) My Selt. Beob. Part II. p. 62.

(21) According to my observations, this most frequently occurs in the pero-
neal. I have, however, now and then missed the anterior tibial, in which case
the dorsal artery of the foot is formed by the anterior peroneal. I have never
myself seen the posterior tibial deficient.

(22) In one man the anterior tibial lay so superficially, that its pulsation
excited a suspicion of aneurysm ; in one of his children an early similar anomaly
was observed, v. Pelletan Clinique Chirurgicale, Vol. I. p. 101.

§191.

The course of one or several arteries is occasionally so far
irregular that they appear unnaturally curved and tortuous.
In many instances this seems to be congenital/ more frequently
acquired, as in incurvation of the skeleton the neighbouring
arteries participate in this change ;^ or tumours, dislocated
bones, &c. sometimes displace the neighbouring blood-vessels ;
or the arteries in disease of their coats, and consequent dimi-
nished elasticity, become gradually elongated by the stream
of blood, and therefore curved.^ Great difference also exists
in reference to the thickness of the arterial parietes ; thus
frequently they are throughout the whole body congenitally
too THIN, and resemble veins,* or this occurs only in certain
parts ;^ lastly, the arterial membranes are sometimes remark-
ably thinned at a later period, owing to great extension and
atrophy.*' Very frequently also, on the contrary, the arteries
become thickened by disease.

(1) Thus the carotids were once found twisted in the middle like a snail's
shell. V. Morgagni, Epist. XLIX. 18 ; perhaps, also the remarkable serpentine
course of the iliac artery, which I have described, was congenital. — Compare

X 2

308 Of the Arteries, [Part II.

my Selt. Beob. Part IT. p. G3 ; that hotli cases are important in operative sur-
gery requires no furtlier discussion.

(2) For example, in rickety distortion of the lower extremities ; the vertebral
artery in spondylarthrocacy of the first cervical vertebra; the subclavian in
unsymnietry of the shoulders ; but especially the aorta in kyphosis and scoliosis
of the spine below the fifth dorsal vertebra. — A. L. C. Wetzel prses. Hartmann Effi-
cacium gibbositatis in mutandis vasorum directionibus. 4to. Traj. ad Viadr. 1778,
with four engravings. — Vrolik D. anat. pathol. de mutato vasorum sanguiferor.
cursu in scoliosi et cyphosi. 4to. Amstel. 1823, with two plates.— My Verzeichn.
No. 3932 — 3935. — In badly united and distorted fractures of the long tubular
bones, I have seen the vascular trunk of the extremity very much curved.

(3) I have also seen this several times, once in the greatest degree in the
aorta, which was bent at a right angle, and was displaced almost two inches to
the left. Compare my Selt. Beob. Part II. p. (>4, and my Verzeichniss, No. 3936.
— A similar extension of the iliac arteries and aorta was observed by Morgagnt.
V. Epist. XIX. p. 58 ; XXXVII. 30 ; also in the carotid and vertebral arteries,
XLII, 34; LXVII. 11.

(4) Abernethy thus found the aorta and pulmonary artery in a blue child.
V. his Surgical and Physiological Essays. — I have also seen a similar state in
some monsters.

(5) For instance, the carotids and vertebral arteries within the cavity of the
skull in acephaly, hydrencephaly, and congenital water in the head ; further, the
arteries of many spurious growths, particularly the common and medullary
sarcom.

(C) For instance, in limbs which have been paralytic for a long while.

§ 192.

The variation of arteries as to their normal calibre is
found in both directions. First, as to their irregular nar-
rowness, or smallness, this may be equally congenital as
acquired, general or local, and may lead to the complete
closing up and imperviousness of the vessels. We find it indeed
occurring throughout the whole arterial system in relation to
the heart, or with it in reference to the whole body remarkably
narrow, as was once observed in the trunk of the aorta. ^ In
persons affected with the blue disease, the pulmonary artery is
often too narrow or even closed.^ In limbs which have been
long paralytic, the arteries are now and then too narrow, as
also usually the other wasted, hardened, or even inactive
organs, as well also as the arteries below an aneurysmal
tumour. Sometimes we observe only on certain spots a great
narrowing and even imperviousness of the arteries, without
being able to determine, whether it be vice of formation, or
the consequence of disease and mechanical influence ; this
happens not unfrecjuently in the smaller arteries;^ it has been
observed several times even in the aorta.* In other cases the
cause of the narrowing or closing of certain arteries is foreign
to the vessel itself; thus, for instance, when they are compressed
by tumours in their neighbourhood,' or their proper coats are
rendered less transparent by thickening," or lastly, when they
are clogged uj) by cancerous matter,^ &c.

Sect. XIX.] Of the Arteries. 809

(1) Morgagni, Epist. XVIII, p. 2; XXI. ;36' ; XXIII, 4; XXX. 12;
XXXVIII. 34; XLV. 23; LIV. 37; LV. 10; LVI. 10; LXVI. ^. — Meckel
Memoires de Berlin, 1750, p. 163 — 182; 1756, Obs. 17, p. 6J.— I have myself
found several such cases in leucophlegmatic persons. In a large man I once
saw all the arteries not larger than those of a boy twelve years old, at the same
time the heart was very small.

(2) Compare § 174, note, and § 186, note 14 and 15.

(3) Fleischmann found the aorta with its branches, from the diaphragm down-
wards, very narrow, v. LeichenbfFnungen, p. 226, No. 71. — On spontaneous closure
of the arteries, compare Chaussier in Bulletin de la Fac. de Med. et de la Soc.
de Paris, 1818, p. 149. — A remarkable case of spontaneous closure of the right
art. hrachialis, ulnaris, cruralis, poplitea, and tibialis, after severe cold,
was observed by Thomson, v. Hodgson, On diseases of Arteries, &c. — Closure
of the carotids, seen by Petit, v. M^m. de I'Acad. des. Sc. 1765, p. 758. —
Pelletan Clinique chirurgicale. Vol. I. p. 68. — A. Cooper in Med. chir. Transact.
Vol. I. p. 12, tab. 2, fig. 2. — The subclavia and axillaris, Pelletan, p. 77, 80. —
Beauchene in Journ. de Med. Vol. XX. p. 209. — Hodgson, p. 156. — The brachial
artery from its orgin to its division, v. Hihes in Bullet, de la Faculte de Med. de
Paris, 1817, No. 1 — ^.—Rostan in SSdlilot's Recueil period. Vol. LXIV. p. 242.
— The external iliac, Bryant in Edinb. Med. and Surg. Journ. Jan. 1823 — The
popliteal, Ribes. — The anterior tibial in the region of the ankle, v. J.Barclay,
A description of the arteries of the Human Body. p. 263. 8vo. Edinb. 1812.

(4) A very narrow part was found by Paris, v. DessauWs Joui-n. de Chir.
Vol. II. p. 107, (close under the arch of the aorta.) — A. Cooper, Surgical Essays,
Part I. p. 115, (close under the arch of the aorta, death by bursting of the heart.)
— My Selt. Beob. Part II. p. QQ, tab. 1, fig. 3, (close beneath the arch, death
from rupture of the aorta.) — Complete closure of the aorta was noticed by
Graham, and communicated by Bkme in Med. chir. Trans. Vol. V. p. 287, (in
the region of the canalis arteriosus.) — Goodisson's case of obliterated aorta, with
some additional remarks by Crampton in Dublin Hospital Reports, &c. Vol, II.
p. 194, (below the inferior mesenteric artery.) — A. Monro, v. Johnson Med. chir.
Review, new series, No. 12, p. 481, April, 1827, (the abdominal aorta below
an aneurysm.)— y^. Meckel in .7. F. Meckel, s Archiv fiir Anat. und Physiol. 1827,
No. 3, p. 345, pi. 5, fig. 1 and 2, (on the fourth dorsal vertebra.)— [Left carotid
at its origin from the aorta so nai'rowed by a membrane as scarcely to admit a
probe, in a patient of Key's who had aneurysm of the innominata, for which the
carotid was tied ; she died an hour and a half after the operation, v. Med.
Gazette, Vol. VI. p. 702. — The pulmonary artery contracted to the size of the
brachial, v. Elliolson, p. 19. T.]

(5) For example, bronchocele the carotids, aneurysm the neighbouring
arteries; compare Pellatan, A. Cooper, Hodgson, note 3. — In one case, two steo-
matous tumours enclosed the aorta close under its arch. v. Stenzel D. de
Steatomatibus in principio arteriae aortae repertis. Viteb. 1723. — I have several
times seen individual arteries closely compressed by scrofulous, scirrhous, and
encysted tumours, v. Verzeichn. No. 2265.

(6) Compare further below, in vices of texture ; and my Verzeichn. No. 2266
and 2267. — In the late Margrave of Baden-Baden, almost the whole aorta
was filled with lime. v. J. P. Frank Apit. de cur. horn, morbis. Vol. VIII. L. VI.
p. 331.

(7) Velpeau Exposition d'un cas remarquable de la maladie cancereuse avec
obliteration de I'Aorte, etc. 8vo. Paris, 1825. — In a person with carcinomatous
disposition, the aorta was filled from the third lumbar vertebra downwards, and
also the iliac arteries partially, with a firm cylinder of a greyish yellow colour, v.
Churchill, in Lond. Med. and Phys. Journ. new series, Vol. II. No. 9, March, 1827.

§ 193.
The opposite state, that is, a permanent irregular

WIDENING, OR GREAT SIZE OF ARTERIES, is mUch more COIH-

mon, and exhibits Hkewise many variations of grade and

310 Of the Arteries. [Part II.

extent. It occurs in individuals in whom the whole arterial
system is congenitally very large in proportion to the body ;
but this enlargement of arteries is commonly more defined and
occurring at a later period, in which we distinguish the dilata-
tion OF ARTERIES, dilatatio, disfensio arteriarwn, arteriectasis,
and ANEURYSM, aneurysma, although without being always
able to distinguish them accurately from each other. To the
former kind belongs the general enlargement, affecting the dia-
meter of one or several arteries, as it appears sometimes in
hypertrophy of certain parts, but especially in many tumours,
and most distinctly in neighbouring branches after the closing
up or narrowing of the principal trunk ;^ in these cases the
coats of the artery are healthy, and the dilatation of the vessel
appears to be spontaneous and active. Another, is the passive
or morbid form, in which, according to the more or less
abnormal change of its structure, or diminished coherence, the
artery loses its necessary elasticity, and so, being incapable of
opposing the violent passage of the blood, is often very dis-
tinctly expanded, in a greater or less degree ; the latter state
especially occurs in diseases of the lungs, in the trunk of the
pulmonary artery, but more frequently at the origin of the aorta.^
A peculiar form of disease, not however yet, according to its
nature, fully investigated, but which still must be classed
with these, is the extension of the extremities of the
ARTERIES, telangiectasis, angiectasis , aneurysma per anasto-
mosin, hoematoncus, tumears erectiles,^ &c. This is usually
congenital, in form of a mother's mark, more or less large,
elevated and reddish, which earlier or later begins to increase
and develope itself, and indeed sometimes only after a long
period, and even then but slightly; in rarer cases, however,
this disease appears to take place later, spontaneously, or from
some mechanical cause. It especially attacks the skin of the
head, although also in rare cases it affects other parts of the
skin, and perhaps even the interior of the body itself,* and
produces tumours of various size and form, which are easily
dispersed by pressure, but when that is withdrawn, again be-
come filled ; often have a tremulous motion, accompanied with
an internal rushing, a bluish-red colour, and an unequal
surface ; at a later period much blood is repeatedly poured
out from the most projecting parts having burst, and from
anatomical examination, tliey are found to consist of a vast
quantity of the extreme branches of arteries, collected on all
sides, expanded, anastomosing, and disposed in a net-like and
coil-like maimer, of many veins expanded here and there
into cavities, and of a loose cellular tissue.

Sect. XIX.] Of the Arteries. 311

(1) Some striking examples of this kind are given in White, Cases in Surgery,
p. 139, tab. 7. Lond. 1770, (on the arm.) — Deschamp in Mem. pres. a I'lnstitut.
des Sciences, 1805, Vol. I. p. 251, (on the foot.) — Pelletan Clinique chirurgicale,
Vol.1, p. 127, (on the foot.) — A.Cooper in Medico-chir. Transact. Vol.11,
p. 249, and Vol. IV. p. 429. pi. 5, (on the feet.) — Jones, On the process employed
by nature in suppressing the hemorrhage from divided and punctured arteries, &c.
8vo. London, 1810, (experiments on dogs.) The same occurs after closure of
the aorta. — In the Anatom. Mus. at St, Thomas's Hospital, I saw some very
rare preparations of collateral circulation. — In one instance, in wrhich the truncus
anonymus was closed, the right arm received its blood from the left subclavia,
by the much widened communicating inferior thyreoideal arteries, v. William
Darrach, in Philadelphia Journal. — Often in varicose aneurysms, the arteries
which are narrowed above, become widened below the injured part. v. W. Hunter,
Vol. II. — Dorsey and Schottin, &c. § 194, note 6.

(2) On both places I have found it several times very distinctly, and on the
aorta also sometimes unequally, that is, slightly bottle-shaped; compare my
Verzeichn. No. 2250—2253.

(3) In the venereal disease, also cavernous, spongy, bloody fungous tumours, &c.
The disease was first satisfactorily described by John Bell, under the name of
Aueurxjsma per anastomosin. v. Principles of Surgery, Vol.1, p. 456 ; Vol. III.
p. 255. — Griife Angiectasie, ein Beitriig. zur rationelleii Cur. und Erkenntniss der
Gefassausdehnungen. 4to. Leipz. 1808, with plates. — Alibert calls this disease
Hamatoncus ; and distinguishes three kinds: — H. fungoides, II. frambaesia, and
H. tuberosus. v. Nosologic naturelle, Vol.1, p. 334. — v. Walther in his and
V. Gr'dfe's Journ. d. Chir. Vol. V. Part II. p. 231, (five instances on the head,
a sixth on the labia pudendi.) — Some interesting cases are described by Desault
in Journ. de Chir. Vol. II. p. 73, (on the chin.) — Lamorier in Mem. de
la Societe de Montpellier, Vol. 1. p. 245, (on the arm.) — Scarpa Sull' aneurysma,
(in the left arm-pit.) — Pelletan, Vol. I. and Vol. II. p. 59, (on the head.) — Travers
in Medico-chir. Transact. Vol. II. p. 1, (in the orbit.) — Dalrymple, ib. Vol. VI.
p. 110, (in the orbit.) — Ahernethy,^nxgicix\ Observations, p. 224, (besides several
cases on the head, one also in the orbit.) — Boyer, Traite des maladies chir.
Vol, II. p. 2()9, (in the orbit.) — Tartra s. Harles N. Journ. der ausland. med. chir.
Litt. Vol. VII. Part I. (on the head.) — Wardrop Obs. on one species of naevus,
in Med. chir. Transact. Vol. IX. p. 203, ft', (several of his own cases, also a case
by Lawrence, p. 216, on the finger.) — Breschet gives a case of a large telangi-
ectasy on the occiput and neck of a grown-up person, in the Diet, des Sciences
mMicales, Vol. XX, p. 200. Art. Haematoncie. — G. S. Pattison, in American
medical Recorder, New- York, Jan. 1822, Art. 11, (on the face, cured by tying
the carotid.) — Arendt in Journ. f. Militair-Medicin. 8vo. Vol. I. Part I.
p. 75 — 88. Petersb. 1823, with engravings, (on the right side of the head, cured
by tying the carotid.) — Buchner in Harles Rhein. Westphal. Jahrb. de Medic, u.
Chir. Vol. VIII. Part II. p. 123, with plates, (on the forehead of a child.) —
Brosse in Rust's Magazin der ges. Heilk. Vol. VII. Part II. p. 161, (on the right
ear and the surrounding parts, cured by tying the carotid.) — Hodgson, p. 86, (on
the temple.) — Ib. translated into French by Breschet, with several observations
by Dupuytren. — Kreysig observed a case on the point of the fore-finger, v.
Hodgson, p. 97, note 13. — Burns, Anatomy of the Head and Neck, p. 309, 8vo.
Edinb. 1811, tab. 8, fig. 1, (on the face.) — Weese in Rust's Magazin f. die ges
Heilk. Vol. XII. Part II. p. 227, (on the lower eye-lid.) — I once saw a very
remarkable case in a stout countryman on the right side of the face and neck. —
[Aneurysm by anastomosis occupying the middle of the upper lip, the whole
nose, and lower part of the forehead, cured by ligature, v. Liston in Med. Gaz.
Vol. VI. p. 896. — Anastomosing aneurysm extending across the nose from
canthus to canthus, covering the nose to its extremity and reaching on the fore-
head, in a child three months old, the common carotid tied by Mott. Amer.
Journ. of Med. Sc. — Anastomosing aneurysm on the head, with a base of five
inches diameter, and elevation of nearly two inches, cured by tying both primi-
tive carotids, v. R. D. Mussey in American Journ. of Med. Sc. Feb. 1830. T.]

(4) I have my doubts whether the cases described by Meckel in Handb. der

312 Of the Arteries, [Part 1 1 .

pathol. anat. Vol. II. Part I. p. 244, were true telangiectases ; the pulsating spleen,
indeed, of writers is for the most part inflamed spleen, and the similar diseases
occurring in the brain and liver, are, indeed, fungus haematodes, that is, a kind
of medullary sarcoma; lastly, the pulsating tumour described by Bell, p. 471, as
large as an Q^g^ and situated between the vagina and rectum, is not, from the
description, to be received with certainty.

§ 194.

Aneurysm, aneurysmal is an arterial swelling, proportion-
ally more distinct, more perfectly defined, and especially affect-
ing but one side of the arterial trunk. ^ We generally speak of
the following kinds of aneurysm: first, the true or genuine,
aneurysma verum, genuinum^ which consists of a more or
less distinctly sac-like extension of all the coats, of an always
diseased artery; secondly, the mixed aneurysm, aneurysma
mixtum,^ in which the genuine and spurious are confounded
together, and arises from a mechanical or morbid destruction
of the two inner coats of the artery, with sac-like expan-
sion of the outer or cellular coat, as well also as of the adjacent
cellular tissue, and sometimes also of the other membranes
investing the artery; the third, is the false ok spurious
aneurysm, aneurysma spiirimn,^ the essence of which is
grounded in an aperture in all the membranes of an artery,
and the production of a swelling, more or less extensive, from
the effusion of blood into the neighbouring cellular tissue, and
on the limbs into the tendinous sheaths ; lastly, and fourthly,
the varicose aneurysm, aneurysma varicosum, or varix
aneurysmaticus,^ in which, in consequence of wound and the
production of a communication between the artery and vein,
the blood from the former flows into the latter, and produces
a swelling in it. We also distinguish them according to their
situation, as external and internal aneurysm, aneurysma
externum and internum, and thus we commonly designate by
the former title those situated on the limbs, which are also the
most visible ; and by the latter name, those which are mostly
occult on the trunk.

(1) J. li. Stjloaticits, Tract, de aneurysmate. 4to. Vincent. 1595. — v. Holler'' s
Bibl. mcd. j)ract. Vol. II. j). 245. — van Home. Epist. de aneurysmate. 8vo.
Panormi, KiH-. — A. Poll tins Apologia de aneurysmate pnL'tenso, etc. 4to.
Pajiornii, Hi20. — Tit. Bartholinus De antur. 4to. L, li. Kill. — JVcpfcr \). Trtpi
ai/fupvaixaros. Basil. H>5J), — (j. /I. Fahriciu.s I), de A. Basil. 16()7. — Metzacr I),
de A. Tubing. 1G79. — Wedel I), de A. Jcniv, 1669. — Klose I), de tumore aneu-
rysmatico. Leips. 1702. — Alherli I), de A. Hal.T, 1725. — Lancisins De aneu-
rysmatibus. Iloma-', 1728, in Louth's Collect. — HilscherD.de A. Jena?, 1728. —
/•'. N'icholls, Some observations on aneurysms in general, in Philos. Transact.
1728, ]). 410.— ./. /.. Pelil in Mdm. de I'aris, 17;5(). AK-m. p, 241.— ./. /•'. Wnl-
thrr I'r. de A. Lips. 17-58. — von Lieawtu D. de A. vero. Leida*, 1742. —
(iiKittoiii Ilistoriu' (hia* aneurysmatuni, etc. Romu", 1745, and De externis
aneurysmfit. Bom;p, 1772. v. /.rt//^//'.v ('ollect. — H. h'tlot de A. in Qua'slion.
med. XII. Monsp. 1711). — Wellimis D. de aneur. vero pectoris extcrno, hemi-

Sect. XIX.] Of the Arteries. 313

plegiae sobole. Basil. 1750. v. Lnnth^s Collect. — Jrnauld, Observations on
aneurysms. London, 1750. — Matani Animadversiones de aneurysmal, pra-
cordiorum morbis, etc. Florent. 1756. v. LnuW s CoWf^ct. — Fouhert in Memoires
de r Academic de Chir. de Paris. Vol. II. p. 535. — Gihellet D. de A. Argentor.
1757. — Alex. Monro, Remarks on the coats of arteries, their diseases, and parti-
cularly on the formation of an aneurysm, in Edinb. Medic. Essays and Observat.
Vol. II. p. 264. — Donald Monro, Cases of aneurysms, with remarks, in Edinb.
Med. Essays and Observat. Vol. III. 1771. No. XII. p. 187.— Jsmann D. de
aneurysmatibus. Greening, 1773. v. Laulh's Collect. — Verhrugge D. anat. chir.
de A. ; oblata notabile aortae aneurysma divulgandi occasione. L. B. 1773.
V. LautWs Collect. — J. B. Heraud De aneur. externis. Monsp. 1775. — W. Hunter,
The history of an aneurysm of the aorta, with some remarks on aneurysms in
general, in London Medic. Observ. and Inquiries. Vol. I. 1776. p. 323. PI. IV.
fig. 1. Vol. II. p. S90.—Strihel D. de A. Viennse, 1783.— Th. Lauth Scriptor.
latinor. de aneurysmatibus Collectio. 4to. Argentor. 1785, with 15 engravings. —
Penchie7iati Recherches anat. pathol. sur les aneurysmes, etc., in Mem. de
I'Acad. de Turin, 1784-85. Part I. p. 153. — Walter Sur I'aneurysme in N. Mem.
de Berl. 1785, p. 48. — C. Lomhardlni De aneurysmat. praecordior. morbis.
4to. Ticini, 1787. — Witte D. de A. ej usque curatione. Kilon, 1787. — Laue
D. de arteriar. morbis et prsecipue de aneurysmatibus. L. B. 1787. — Scheid
Obs. med. chir. de A. 8vo. Harderovici, 1792. — E. Home, Account of
Mr. Hunter's method of performing the operation for the cure of the popliteal
aneurysm in Transactions of a Society for the Improvement of medical chir.
Knowledge, Vol. I. p. 138, Vol. II. p. 235. 1793 and 18m.—Salmade in Se-
dillot Recueil period, de la Societe de Sant6 de Paris. Vol. III. p. 454. —
Palletta in Giornale di Venezia, 1796, No. 1, p. 24; and mKuhn's and WeigeVs
Ital. medic, chir. Biblioth. Vol. IV. p. 73. — R. Calliot Essay sur I'Aneurysme.
8vo. Paris. Ann. VIII. — AyerXJehex die Pulsadergeschwulste und ihre chirurg.
Behandlung. 8vo. Cutting. 1800, with plates. — Sarazin Considerations sur les
causes generales de I'Aneurysme et de la rupture spontane des vaisseaux san-
guins arteriels, etc. Paris, 1800. — Bejiedix D. A. externum ejusque curatio.
Jenae, 1801. — Briot Essai sur les tumeurs par le sang arteriel. 8vo. Paris,
1802. — Giierin Memoire sur I'Aneurysme in Rec. des Actes de la Soc. de Sante
de Lyon. Vol. II. p. 149, 176. — Maunoir Memoires physiologiques et pratiques
sur I'Aneurysnie et la ligature des arteres. Geneve, 1802, — Richemnd Observa-
tions sur une nouvelle espece d'Aneurysme in Bulletin de la Soc. Philomath,
Ann. III. Vol. II. p. 48. — Larretj Notice sur I'Aneurysme in Bulletin de I'Ecole
de Med. et de la Soc. de Paris, Ann. XIII. p. 116. — Dhigeman^s Verhandeling
over de waare en onwaare Slagaderbreuken. 8vo. Amsterd. 1803. — A. Scarpa
Suir Aneurysma, riflessioni ed osservazioni anatomico-chirurgiche. gr. fol. Pavia,
1804, with plates; with notes and additions, translated into German by Harles.
Zurich, 1808. Text in 4to., with fol. plates, into French, by Delpech. Paris, 1809.
— Sammlungeiniger Abhandlungen von Scarpa, v. Berhnghieri und Uccelli \] ehex
die Pulsadergeschwulste, als Nachtrag zu Harles's Uebersetzung von Scarpa's
Werke a. d. Ital. mit Zutsatzen von W. B. Seller. 8vo. Zurich, 1822. —

Akerman resp. Ahlander Observationes in Aneurysmata D. Upsal. 4to. 1804

Deguise D. sur I'Aneurysme, etc. Paris, 1804. — Popp D. selectiora capita de
Aneurysmatibus. Altdorf, 1805. — Ludwig Progr. Annot. diagnostices chiruro-icae
fragmenta, I. de aneurysmate interno. Lips. 1805. — C. Fr. Hubjicr D. de Aneu-
rysmatibus. Goett. 1807. — Freer, Observations on Aneurysm and some diseases
of the arterial system. 4to. Birmingham, 1807. — Ingelmann praes. Engelhart
D. Aneurysma spurium externum, casu hujus morbi illustratum. 4to. Lund,
1814. — Jacob D. de A. Edinb. 1814. — Aitkin D. de. A. Edinb. 1814!.— Szwenslk
D. de aneurysmatis structura. Halae, 1814, with two engravings. — J. Hiibner
D. de Aneurysmatibus. Viennae, 1815. — J. Hodgson, Treatise on the diseases
of Arteries and Veins, containing the pathology and treatment of Aneurysms and
wounded Arteries. 8vo. Lond. 1815, with plates. — G. A. Spangeiiberg JLxhhrnnfmn
iiber die Pulsadergeschwulste, in //ora'.s Archiv f. d. medic. Erfahrung. 1815
p. 209. — C. D. Kuhln D. de A. externo. 4to. Jenas, 1816. — Hur.st D. de A.'
Edinb. 1817 .—Her rick D. de A. Edinb. 1817.— Frampton D. de A. Edinb'.

314 Of the Arteries, [Part II.

1819. — Huston D. de A. Edinb. 1819. — Manznni in Memorie della Soc. Ital. di
Modena. Vol. XVIII. Mein. di Fisica. No. 12. — A. J. Munzenthaler pra^s.
Munz. D. s. Observationes et annotationes quasdam de aneurysmatibus et pra'c.
veris. 4to. Landishut, 1820, with two ])lates. — Bcathy D. de A. Edinb. 1820. —
C/it'mWer D. Aneurysmatum adumbratio anat. pathol. 8vo. Berol. 1821. — Doring
D. quasdam circa Aneurysmatuni pathogeniam. 8vo. Berol. 1822. — Townsend
I), de A. Edinb. 1822. — J. Shekelton in Dublin Hos{)ital Reports and Com-
munications, 1822, Vol. III. — Boyscn D. de Aneurysmatibus. 4to. Kilis, 1822. —
Gottschalk D. doctrinam hodiernam de aneurysmate exhibente. Trajecti ad Rhen.
1822. — M. S. Levi Saggio teortico-pratico sugli aneurismi intcrni, etc. 8vo.
Venezia, 1822. — Wedemeyer in Rust's Magazin fiir die gesammte Heilkunde,
Vol. XIII. Part II. p. 229. — Pascal/s in New- York medical Repository,
Vol. VII. No. 1. — Casamayor Reflexions et Observations anat. chir. sur I'ancu-
rysme spontane en general et sur celui de I'artere femorale en jiarticulier. 8vo.
Paris, 1825.— J. S. Morizio D. de Aneurysmatibus internis. 8vo. Patavii,
1825. — Fr. Schippang D. de Aneurysmate in genere. 8vo. Berol. 182(). — Desmann
D. de incerta aneurysmatum internorum diagnosi. 4to. Berol. 1827, with lithogr.
plates. — G. Breschet Recherches et Observations sur I'Aneurysme faux con-
secutif du coeur et sur I'Aneurysme vrai des arteres in Repertoire gener.
d' Anatomic et de Physiol, pathol. Paris, 1827, Vol. III. Part II. p. 183. —
Dupuylren Memoire sur les ancurysmes, qui compliquent les fractures et les
plaies d'arnies a feu in Archives generales de Medecine, Juillet, 1828.

(2) In order to obviate the confusion relating to artericctasy and aneurysm,
it seems to me necessary to confine the partial and bag-like extension to the
latter, but the general and simultaneous to the former. The so-called aneu-
rysma verum cylindroidcs of Sauvages may, however, and with propriety, be
called merely an extension of the vessels sensu latiori, in which notion Scarpa
includes only one particular kind of aneurysm.

(3) The first opinion held by Fervelius, Universa Medicina, de extern, corj).
afiect. L. VII. cap. 3, that all aneurysms arose from expansion of the whole
arterial coats, only holds good in certain cases, which Scarpa denies without suffi-
cient grounds. Many cases of true aneurysms have been collected by Harles,
in his translation oi Scarpa, \). 310, If. — J. F. Meckel in Tab. anat. pathol. Ease. II.
p. 10 ; and JIudgsoii, p. 9i; If. — I myself have, up to this time, examined five aneu-
rysms, in which all three coats of the artery were uninjured, but expanded, and
1 have already mentioned them, v. Ilandbuch der pathol. anat. 1st edit. }). 105.
note 42. Selt Beob. Part I. p. 103; Part II. p. G5. It is self-evident, that the
true aneurysms, especially on the aorta, seldom become so large as the mixed and
spurious aneurysms, and easily riui into the latter. In true aneurysm, the exten-
sion of the artery, arteriectasis, usually occurs in all parts of the vessel, and sub-
sequently the artery begins to expand at its weakest })art, in a bag-like form, so
that we may notice a gradual transition, and endless steps, from arteriectasis
to time, mixed, and spurious aneurysm. — Anton Nuck, Operat. et experim. chirurg.
L. B. 1096, p. 97, appears to have been the first who gave an account of the cor-
rect differences between true and spurious aneurysm. [In the Mus. St. Thomas's
Ilosjjital there are two instances of aneurysm by simple dilatation of the aorta,
and two of the carotid artery. T.]

(4) W. Hunter first emj)loyed this term as synonymous with Aneurysma herniani
artcria- sislcns, and showed tbe diverliculuni, or bellying ])rotrusion ol" the inner
coat through an aperture in tbe outer ; as this circuuistance, however, according
to the experiments of John Hunter and E. Home, does not always occur in the
above state, and the few observations thereon by Dubois and Dupuylren, in the
Diet, des Sc. Med. art. Aneurisme; and lireschel, in his translation o( Hodgson,
p. 130; Richeraud Aneurysma aort.e enorme per herniam membrauje interna', in
iiis Nosogr. Chirurg. \'()1. I. p. 71', 1805; and Asklepieion, 1811, No. 71, do uot
hold it to be sufficiently made out ; this distinction is therefore given up by most
persons. — Alex. Monro called a true aneurysm which had l)iu-sl, mixed or con.se-
(Utive. — J'erbrugge, p. 15. § 7, makes use of the terms A. varicosuni anil A.mixtum
indiscriminately. — Morfiagni, in his Advers. Anat. II. Aninmdversiones, XXXI X.
and I''.pist. Anat. XVII. 27, calls common or mixed aneurysm the sacciforme,

Sect. XIX.] Of the Arteries, 315

which title, however, suits true aneurysm. — Scarpa includes A. mixtum with the
spuriuni, because he only admits two arterial coats, and has taken great trouble
to make out the frequency and true nature of this species especially, although
Harvey, Exercit. Anat. de circul. sanguinis, ex editione AlUni, L. B. 1736,
Preface, p. xiv. and cxxix. &c. had already defined it. The aneurysmal sac is
commonly connected with the artery by means of a round, and, more or less,
large aperture ; rarely is this aperture a kind of oblique or ragged slit.

(5) It is known that Galen, Aetius, Fahr ictus, Hildanus, Seunert, Sylvaiicus,
Die/nerbroech, and more recently, especially Palletta, Scarpa, and Burns, derive all
aneurysms from rupture of the arterial coats. — W. Hunter dWi^es A. spurium
into the diffusum and circumscriptum. — Foubert, on the contrary, less correctly,
divides them into A. primitif, answering to the diffusum ; and A. cunsecutif, to the
circumscriptum ; the latter contains the blood in a bag, not belonging to the
artery, formed by coagulation and inflammation ; in A. diffusum, on the contrary,
the blood is poured out loosely into the cellular tissue, and the aponeurotic
sheaths ; both kinds may occur, as is easily perceived, may go through their
stages together, or may run into one another. [In Mus. St. Thomas's Hospital
a case of spurious aneurysm of the femoral artery from a bayonet wound. There
is no attempt at repairing the wound, but around the orifice a sac as large as a
hen's egg, consisting of layers of coagulum ; and close to the artery an aperture,
through which the blood escaped into the cellular tissue of the thigh, which was
enormously swollen. T.]

(G) W. Hunter, who first described the disease, called it aneurysma per anasio-
mosin ; subsequent observations upon it may be found in Guattai/i, Obs. 2
and 4. — Cleghorn, Case of aneurysmal varix in Med. Observat. and Inquiries,
Vol. III. No. 13, p. 110. — White, On the varicose aneurysm, ib. Vol. IV. No. 34. —
Armiger, On varicose aneurysm, ib. No. d5. — Duval De aneurysmate varicoso.
Theses, 8vo. Paris, 1786. — Garneri, v. Bertrandi Oper. post, delle Operaz. chirurg.
Vol. III. p. 208. — A. V. Brambilla Von der blutaderichten Schlagadergeschwulst
(A. venosum) in d. Abhandl. der Josephin. med. chir. Akademie, Vol. I. p. 92. —
f^an Wy Samml. einiger Wahrnehmungen, u.s.w.. No. 1. — Pott, Vol. I. p. 173. —
B. Bell, A System of Surgery, Vol. III. p. 199. — Monteggia Instituzioni chirur-
giche, Vol. I. p. 187. — Park in Medical Facts and Observations, Vol. IV, p. 111. —
Scarpa. — Nouvel in Capelle Journ. de Sante, ct d'hist. nat. de Bordeaux, Vol. III.
p. 107. — Atkinson, v. S. Cooper's Surgical Dictionary. — Chidellain Canella's Giorn.
di Chirurgia pratica. Januar. 1827. — In the above cases the disease occurs after
badly performed blood-letting in the arm, although it occurs in other parts, and
from other causes; for instance, from a stab with a sword in the popliteal artery
and vein, noticed by Larrey at Toulouse, v. Larrey M^moires de Cbir. mil.
Vol. IV. p. 340. The same case is described by Lassus M^decine operatoire.
Vol. II. p. 443. — Sabatier Medecine operatoire, Vol. I. p. 417. — Richerand in
Diet, des Sc. medic. Art. Aneurysme variqueux, and Buyer Traite des Maladies
chirurgicales. Vol. II. p. 177. — On the aorta and vena subclavia by a sword
wound, and on all the veins of the arm by a stab in the armpit, v. Larrey, Vol. IV.
p. 431. — Through a stab in the art. carotis communis, and vena jugularis, ob-
served by Larrey in v. Froriep's Notizen, No. 259, Vol. XII. No. 17, p. 271 ;
and Williaume in Journ. compl. du Diet, des Sciences medicales. Vol. XI. p. 91. —
By small shot in the art. tibialis posterior, v. Dorsey Elements of Surgery,
Vol. II. p. 210, Philadelphia, 1813. — In the thigh by a stab with a red-hot piece
of iron ; and in the knee by a pistol shot. v. Hodgson, p. 514, IF. — On the arm after
injury, v. Richerand Histoire des Progres recens de la Chirurgie, p. 119, 122. —
After wound by small shot. v. PL Adelmann Tractatus anat. chir. de aneurysmate
spurio varicoso. 4to. Wiirceburgi, 1821, with lithographic engravings. After a
contusion between the art. radialis and the vena cephalica. v. K. Schottin merk-
wiirdiger fall von aneurysmatischer Venegeschwulst. 4to. Altenburg, 1822, with
plates. — On the crural artery and vein in the middle of the thigh by a wound
with a knife, v. J. Th. Fleischer D. aneurysmatis varicosi coniplicati historia.
Dor pat, 1822. — Besides other cases, one also in the art. and vena iliac externa,
v. Brodie in London med. and physic. Journ. Feb. 1827.

316 Of the Arteries. [Part II.

§ 195.

The CAUSES which produce aneurysm are of very different
kinds. The most common is a morbid state of the
INNERMOST, and frequently also, at the same time, of the
FIBROUS COAT, by which they lose their elasticity, become soft
and easily ruptured, and are even entirely destroyed.^ Thus is
produced an aneurysmal disposition, which it is clear may,
consequently, produce several aneurysms in the same individual,
sometimes at once, and sometimes consecutively." Old age,
the male sex,^ and several general diseases, especially syphylis
and gout, in which all the internal coats easily lose their elas-
ticity, dispose to aneurysm. Other frequent causes of this
disease are mechanical influences, which render the artery
diseased, or immediately weaken or break up its connexion,
as concussion, rupture, contusion and actual wounds from
sharp instruments, splinters of bone in fracture, &c.; but
especially bleeding.* Lastly, aneurysms may now and then
be spuriously produced by inflammation, suppuration, and
mortification in the neighbourhood of an artery.'*

(1) Compare further on.

(2) Instances given by Morgagni. — Rnijsch Opera Obs. anat. chir. Vol. I.
p. 4. — Matani in Laiith's Collect, p. 290, (innumera dispersa per totum corpus.) —
Donald Monro, on the A. mesenterica superior, interior, renalis, and cruralis. —
^lex. Monro, on both A. inguinales, crurales and jjopliteae. — Arnaitd in Me-
nioire de chirurg. \o\. I. p. 182. — Guattani, p. 158 and 232. — Stoll Hat.
Mcdendi, Vol. I. — Michaelis. v. Loder's Journ. Vol. II. p. (i(\5, (nine pieces on
the arm.) — Sommerring on Baillie, p. 16, note 31. — Guerin, v. Journ, 1. ausliind.
med. chir. Litt. 1802,' October, p. 338, ft". — J.Major Wilson, v. lb. Vol. IH.
p. 1. — Ev. Home, in two cases, v. Neues Journal der ausl. med. chir. Litt.
V'ol. I. Part II. — Baillie in Transact, of a Soc. for the improv. of med. Knowl.
Vol. I. p. 121. — A. Cooper in Med. chir. Transact. Vol. IV. ]^ ^127 .— Warner,
Cases in Surgery, p. 139, (the brachial artery was tied three times, on account
of recurring aneurysm.) — Pelletan CIini{|ue chirurgicale. Vol. II. p. 1, (sixty-
three in one body.) — In two cases of operation for popliteal aneurysm, the patient
died by bursting of aneurysm of the aorta, v. London medical Review, Vol. H.
p. 420 ; and Burns, Diseases of the Heart, p. 261. — Five following each other on
the descending aorta, were seen by Maifcr. v. Jahrb. medic, des Oesterr Staates.
Vol. V. Part III. p. (J2 — Several, O'Reardon in Journ. de Medic, contiinie.
Vol. XVI. p. 482. — Beauchene, ib. 1810, Se])t. p. 209. — Aneurysm on the
aorta, described by Munzerithaler })ra^s. Miiuz, five on the same. — Ulrich in
Uufelaud's Journ. 1823, October, j). 122. — Two on the aorta, Clocqnet in
Revue medicalc franyaise et etrangere. March, 1823; and Ekslroin in Ars.
Berattelse cm Svenska La.kare-Sallska})cts Arbeten. Stockh. 1825. — An aneu-
rysm, first in the left, and then in the right ham, described by Trarers, in Lond.
medic, and ])hys. Journ. \'ol. L\'1II. p. 25. — A man, who had aneurysm in tlie
ham and thigh, died, after operation for it, of aneurysm of the arch of the aorta,
from London medic. Repository. — In tlie iMus. at St. Thomas's Hospital 1 saw
seven aneurysms in one body.

(3) Of sixty-three cases, fifty-six in men and only seven in women, v. Hodgson,
!>. 130.

(4) An aneurysma spuri\nn on the arm, in consetiuence of bleeding, is
describi'd, among otlicrs, l)y Th. liarlholin, in Hist. anat. rar. 1754. C'enf. II.
Hist. IX. — iWo/i«c//i De aneurysmate a laesa brachii arteria. Ito. Bonon. 1750.

Sect. XIX.] Of the Arteries. 317

Mucqidl and Monro, in Edinb. med. Essays and Observations, Vol. II. and III. —
Guattani in Lauth, p. 21G. — Teichmcyer resp. Emmrich D. de stupendo aneu-
rysmate in brachio, etc. Jenae, 1734. — Ludwig Pr. de variantibus arteriae
brachialis ramis in aneurysmatis operatione attendendis. Lips. 1767. — Trew
Aneurysmatis spui'ii post venae basilicae sectionem orti histor. et curatio. 4to.
Norimb. 1769. — Schmucker, v. Vermischte chir. Scbriften. Vol. I. p. 329. Vol. IJ.
p. 165, Vol. III. p. 318.-0^. Acrel Chir. Vorfalle, Vol. l.—Loder Pr. historia
aneurysmatis spurii arteriae brachialis feliciter curati. Jenae, 1795. — Penchienati,
Guerin, and Adams, in Journ. der Ausland. med. chir. Litt. Vol. II. p. 369
and 443. — Cartier and Vimont s. Neues Journ. d. ausl. med. chir. Litt. Vol. II.
Part II. and Vol. VI. Part I. — Gins. Flajavi in Osservazioni e Riflessioni di
Chirurgia, Vol. II. Osserv. VII. — X. and Riflessioni generali, p. 41 — QG. — ■
B. Travers, in London medical and physical Journ. April and July, 1827,
8th case. — A. Cooper's Lectures, Vol. II. p. 78. — Many other cases are collected
in de Plouquet, Art. aneurysma arteriae brachii, and A. spurium. In a case
which I have before me, the injury was cured by compression, as, the man
having died about two months after, I found the hole in the artery still open,
but a little plastic bag at first about the size of a pea, and with thick walls, the
commencement of an A. spurium circumscriptum, situated on the aperture.
[I once saw in a wound by a penknife of the external carotid, close to the origin
of the lingual artery, a similar little bag about as large as a pea, into which the
artery opened. The patient had lived some weeks after the common carotid artery
had been tied for this accident ; but adhesion did not occur at the point on which
the ligature was applied, and he died of hemorrhage, but no blood escaped from
the original wound. T.] — A good engraving of false aneurysm on the arm in
consequence of blood-letting is given in Tiedemaiin Tabulae arteriarum, Fasc. II.
tab. 14. fig. 2.

(5) For instance, after shot wounds. I saw an interesting case of this kind
in one of the students here (Breslau,) who had received a shot through the right
shoulder joint, in consequence of which, half a year after a diffused aneurysm
of the axillary artery took place, wliich, at last, ran into spurious diffuse
aneurysm, and caused death by mortification. Cases of aneurysms on the arm,
arising from mortification, are described by Pecklin D. seu historiam vulneris
thoracici. — Scarpa, Obs. 9.

§ 196.

Aneurysms occur by no means equally frequent in
ALL ARTERIES, but are much more common in the larger than
in the middle-sized and smaller arteries ; they are much less
frequent in the pulmonary artery than in the aorta, and also
more uncommon in the upper than in the lower extremities,
where they moreover often appear spontaneously, while in the
former they originate almost solely from mechanical causes.
Aneurysms, both in men and animals, are observed by far
the most frequently on the aorta^ especially on its arch ;
next on the art. poplitea,^ the art. cruralis, the iliaca^ the
subclavia and axillaris,'^ and the carotis ;^ more rarely are they
on the smaller arteries, viz. the coronaria cordis ^^^ the lesser
BRANCHES of the carotis on the head, as the maxillaris, tem-
poralis^ auricularis, occipitalis,^ &c., on the vertehralis,^ the
mammaria interna,^ the thyreoidea,^'^ on the circumflexa
humeri anterior,^^ the arteries of the fore-arm and
HAND,^^ on an intercostalis,^^ bronchialis,^* on the cceliaca

318 Of the Arteries. [Part II.

and ITS branches/^ the mesenterica superior and inferior,^^
one renalis^^ spermatica interna^^ glutcea^^'^ ischiatica^^^
pudenda,-^ on the arteries of the leg and foot;- and
lastly, also on the pulmonary artery,'^ and on the ductus
arteriosus, "^^

(1) The first observation on aneurysm of the aorta was made by Vesalius.
V. Boneti Sepulchretum anat. Lib. IV. sect. 2. Obs. 2L — Alex. Knips Macoppe
Epist. de aortae aneurysmate et polypo cordis. 8vo. Brixiae. 1731. — //a//er Pr. de
aneurysmate aortae. Goett. 1749. — Matani. — Ed. Sandifort Heel en ontleedkou-
dige Verhandeling over eenen Slagader Breuk in de groote Slagader, etc.
Gravenhage, 17()5 ; Vei-hrugge, Lombard/in, and Burns. — Naegele Epist. ad Th. Fr.
Baltz, Qua hist, et descript. aneurysmatis, quod in aorta abdominali observavit,
continetur, addita tab. aenea. 4to. Heidelb. 1816. — J. N. Heislcr D. rariorem
atque memoratu dignissimam aneurysmatis aortae sternum perforantis historiam
exhibens. Landisliuti, 1817. — Laennec Des ancurysmes de I'aorte in De I'aus-
cultation mediate, 1819, Vol. IL p. 404. — Ehrhardt De aneurysmate aortae
Comment, anat. pathol. 4to. Lips. 1820, with five engravings. — G. Novcrre D.
sur les aneurysmes de I'aorte. 8vo. Paris, 1820. — H. Hartmann D. Observatio
ingentis aortae aneurysmatis. 8vo. Berol. 1828. — Many individual cases are
collected by Verhrugge, Eherhardt, Scarpa, and Harles. — Pncheli Ueber aneurys-
men der bauchaorta in Heidelb. klin. Annal. Vol. III. Part IV. No. 6 (with a
case of his own) ; and Plouquet Repert. — I have nine times observed aneurysm
of the aorta.— Compare my Verz. No. 2254 — 58, 8498, 8690. — In animals also,
aneurysms of the aorta occur, especially on the posterior aorta in horses, of
which I have seen many instances in the collections of the veterinary schools ;
such are described also by Grognier. v. Correspondance sur la conservation et
I'amelioration des animaux domestiques ipa.r Fromage de Feugrd, Vol. II. p. 97. —
CarviUe in Annuaire de la Soc. de Med. du Depart, de I'Eure, 1806, p. 308. —
Jhiznrd in Bulletin de la Fac. de Med. et de la Soc. de Paris, Ann. XIII. p. 45.
— In Sns Tajassu. v. Dauhenton in Allg. historic der natur. Vol. V. Part II. p. 22.
— Edw. Tysot), The anatomy of a pigmy compared with that of a monkey, an
ape, and a man, &c. Loud. 1731 (three behind each other). — Fiverra Nasiia,
from a verbal remark of Ducrotay de BlainvUle. — Good engravings are also given
in Liltre in the Memoires de I'Academ. 11. de Paris, Ann. 1707. — Ruysch Ob-
serv. anat. chir. p. 37. — Haller Opera minor. Vol. III. p. 301, tab. 9. — W. Hunter,
in Medic. Obs. and Inquiries, Vol. I. tab. 4 and 5. — Bayford, lb. Vol. III. pi. 1. —
Walter, in the Memoires de I'Acad. de Berlin, Ann. 1785, p. 5Q, tab. 1 and 2. —
Sandifort Museum anat. Vol. II. — Scarpa, pi. 8, fig. 1, 2; pi. 9, fig. 1, 2; ti-ans-
lated by Harles, ])1. 10, fig. 4, 5. — Baillie, Engravings, Fasc. I. pi. 3, fig. 2. —
Monro, Outlines of the anatomy of the human body, &c., pi. 33 — 35. — Hodgson,
pi. 2.— Meckel Tab. anat. pathol. Fasc. II. pi. 12, 13, 15, &c.

(2) Sabatier D. do poplitis aneurysmate. Paris, 1772. — Massotti D.sull' Aneu-
risma del poplite. Fircnze. 1772. — La Motte D. de poplitis aneurysmate. Paris,
1773. — Aug. Grimn De poplitis aneurysmate. Malta, 1773. — Penchienati Recher-
ches anat. pathol. sur les aneurysmes des arteres crurale et poplitee. Svo. 1786.
— IVindel 1). de aneurysmate, praesertim de illo arteriae popliteae. Goett. 1795. —
Desclianips Observat. et Reflex, sur la ligature des principales arteres, et particul.
sur I'Aneurysme de I'art^re poplitee. 2d edit. Paris, 1797. — J'acca Berlinghieri
Istoria d'un Aneurisma del poplite. — Hutchinson, Letter on popliteal aneurysm.
Svo. London, 1811. The disease is very frequent in coachmen and carriers.

(3) Alefeld D. aneurysmate arteria» cruralis in cartilaginem et os mutato.
Giessae, 1763. — Ad. Murray resp. Arvidsson D. in ancurysmata femoris obser-
vationes. 4to. Upsal. 1781. — Com})are Laulh's Collection. — Hosalc, Case of
aneurysm of the femor.il artery. 8vo. New-York, 1812. — Dawidowicz I), exhibens
casuni aneurysmatis arteriae cruralis. 4to. Itegiom. 1821, with a lithographic
plate. — J. A. L. Casamajor Reflexions et Observations anat. chirurgicales sur
I'aneurysme spontane en g6neral et sur celui de I'artt^re femorale en particulier.

Sect. XIX.] Of the Arteries, 319

4to. Paris, 1825, (he relates forty-six cases of spontaneous or artificial closure of
the art. iiiaca externa and interna.)

(4) A good engraving of an aneurysm in the armpit is given by Dupui/tren in
Repert. gen. d'Anat. et de Physiol, pathol. etc. Vol. I. No. 2, pi. 2. Paris. 1826.
— Sometimes they arise in this region from violent extension in reducing dislo-
cation. V. Pelletan Clinique chirurgicale, Vol, II. p. 95. — Gibson in Philadelphia
Journal by Chapmajin, Vol. VII. No. 1, Nov. 1823. — Flaubert in Repertoire
general d'Anatom. et Physiol.-pathol. Vol. III. Part I. p. 102, 1827.

(5) Both on the carotis communis, and on the externa and interna, a good
engraving of an aneurysm of the carotis is given by Scarpa, pi. 8. fig. 4
and 5. — J. FoseD. de arteriae carotidis aneurysmate. Edinb. 1809. — P. J. Fan-
derhagen D. sur I'Aneurysme de I'artere carotide. Paris, 1815.

(6) Hedlund \n Svenska Lakare-Sallskapets Handlingar, Vol. III. p. 181. —
In a man of forty years old it was fatal by bursting and effusion of blood into
the pericardium.

(7) To wit, on the lingualis. v. Collomb CEuvres med. chir. p. 451. — On the
maxillaris externa, v. GiUbert Adversaria pract. prim. p. 3. — Ant. Petit in Mem.
de Paris, 1765, Hist. p. 38, Mem. p. 480. — It also occurs here in horses. — On
the art. palatina of a horse, v. Schwab Materialien zu einer pathol. Anatomic der
Hausthiex'. p. 3. Ite Lief. Miinchen. 1815, — On the art. nasi externa, v. de Ilaen
Ratio Mendendi. Part IV. p. 11. — On the art. frontalis, v. Acta eruditor.
p. 51, Lipsiens. 1699; and TI/ec/reHn Journ. de Med. Vol. XLVIII. p. 239.— On
the art. temporalis, v. PaUetta. — Scarpa, p. 529; and several instances in dePlouquet
Repertor. — On the auricularis. v. Klaunig in Ephem. Nat. Cur. Cent. III. Ann.
1715. Obs. QQ. — A. Cooper, v. Burns, p. 266. — On the occipitalis, v. Fidtis Fidius
Op. omnia. L. VI. — Fareliaad. v. Journ. d. ausland. med. chir. Litt. 1803,
Vol. I. p. 154. — Mejer D. de aneurysm, occipitali. Wiirceb. 1804. — Pelletan and
Tartra; compare § 193, note 3. — Richter. v. von Froriep's Notiz. No. 24, p. 29, Feb.
1822 (as big as a pigeon's egg.) — Fr. E. Schilbach D. s. casum aneurysm, in capite
virginis sexagenariae rar. 4to Jenae, 1825, with plates. — Dopfer Geschichte eines
Pulsaderbruches auf dem Kopfe in Beobacht. und Abhandl. aus dem Gebiete der
gesammten prakt. Heilk. Vol, V. p. 416, Wien. 1820. I have a case at present
in a living boy, who has water on the head and amaurosis ; the aneurysm, how-
ever, is not on the occipitalis, but the strong pulsating tumour on the back of the
head receives its blood distinctly from the skull, by a small hole in the upper
part of the occipital bone. — On the meningeis. v. J. N. Holtorf Casus aneurysmatis
in capite pueri 11 annorum. Argentorati, 1722. — Roderer De cerebri scirrho,
4to. Gbtt. 1762.—Stoerck v. Lieutand Hist. anat. med. Vol. II. p. 325. Lib. III.
Obs. 5^. — Malacarne Encefalotomia nuova univ. p. 68, Torino, 1780 (as large
as a pigeon's egg.) — Krimer in v. Griife and v. Walther's Journ. d. Chir. Vol. X.
Part IV. p. 587, 1827 (on the meningea media ; the skull was perforated.) — On
the carotis cerebralis, where it appears in the skull ; I have found it twice ; simi-
lar cases were seen by Biumi in Sandifori Thesaur. III. p. 373. — Gilb. Blane, in
Transact, of a Soc. for the improv. of medic, knowl. Vol. II. p. 193, — BailUe's
Morbid anat. &c. p. 468. 5th edit. Lond. 1818. — Chevalier in Journ. univ, des
Sc. medic. Janv. 1828 (on the cerebral arteries.) v. Bell, Anatomy of the human
body. Vol. II. — Hodgson, p. 116, ffl and 177, (in four instances on the basilaris,
and on the anterior cerebri.) — »Se;-re5 Annuaire medico-chirurg. p. 314. — Ollivier
Traite de la moelle epiniere et de ces maladies, &c. 8vo. 2 vols. Paris,
1827. Case 23. — Spurgin in London medic. Repos, June, 1825 (on the cerebralis
arterior.) — On the ophthalmica, v. Desessarz in Auserles. Abhandl. f. prakt.
Aerzte. Vol. XVIII, p. 99, ff". The reason why the thin-coated arteries of the
brain are proportionally found so rarely aneurysmal, depends on their being
soon ruptured at the commencement. [In the Mus. St, Thomas's Hospital
there is a beautiful preparation of aneurysm of the cerebralis media, about the
size of a small pea, which burst and produced apoplexy ; it illustrates extremely
well the preceding observation. T.] I have, however, seen, a few times little
aneurysms of the A, fossae sylvii, of the A, corpus callosum, and once the A,
cercbelli, but not larger than a vetch or a pea. — Chevalier in London Med. and
Phys. Journal, hy Macleod, new series. Vol. LVIII. 1827, — Abercrombie F'dtho-

320 Of the Arteries. [Part 1 1.

logical and practical remarks on diseases of the Brain and Spinal cord. 8vo.
Edinb. 1828.

(8) Hence pressure on the spinal marrow ; one case in Heaviside's Cabinet, v.
Hodgsoyi, p. 116; and Ho wship, Practical Observations in Surgery and morbid
anatomy, p. 59. Lond. 181(>, — Malacarne found, in two instances, aneurysms on
the arteries of the spinal marrow as large as peas.

(9) Sommer in der Petersburger Sammlung f. Naturwissenschaft und Heil-
kunst, Vol. II. Part II. p. 1.

(10) Especially in some cases of struma aneurysmatica, in which the arteries
of the thyroid gland are rather generally enlarged.

(11) Portal, Cours d'Anatomie medicale, Vol. III. p. 236.

(12) On the radialis. v. Fischer in jNIus. der Heilkunde, Vol. II. p. 276. —
On the arteries of the hand. v. Guattani De extern. Aneurysmat. Hist. XXI. —
Becket, Chirurgical Observations. — Hildaniis Centur. III. Obs. 44. — Tulpins
Observ. med. Lib. IV. Obs. 17. — Ranhy in Chirurgical Observations.

(13) 7e« j/5c/t Thesaur. anat. IV. No. 5.— Obs. anat. chir. XXXVIII. — Acta
Eruditor. Lips. 1714, Sept. p. 420. — Vylhoorn in der Holland Uebers. v.
Heisteri Instit. chir.

(14) A.Leprottus in Comment. Bonon. Vol. I. p 345 and 353.

(15) On the coeliaca, v. Guc7-in,\o\.\\. p. 348. — Nenci Observatio de dis-
rupta splenica arteria. Siena. 1786. — [In Museum of St. Thomas's Hospital,
aneurysm of the cceliac artery, which, by its motions against the stomach,
produced vomiting whenever food was taken, and the patient died of conse-
quent starvation. — T.J — Portal, p. 268. — Nysten in the Journ. de Medec. Chir.
et Pharm. Oct 1815. — Isenflamm Anat. Untersuchungen. Erlangen, 1822,
p. 207. — On a twig of the coeliaca. v. Lancisi, p. 64. — On the coronaria ventri-
culi. V. Portal. — Souville in Journ. d. Medec. Vol. L. p. 239. — Dchnas in Annales
de la Soc. de Med. prat, de Montpellier, Vol. VIII. Parti, p. 233, Sept. 1806.—
On the splenica, \. Nenci. — Morgagni, Epist. III. p, 2. — Beaussier in Journ.
de Medec. Vol. XXXII. p. 157. — Staiipa Ansvveisung zur gerichl. und. pathol.
Untersuchungen von menschlichen Leichnamen, p. 186, note. 8vo. Wien, 1827.
I have seen three times little aneurysmal expansions of the splenic artery, which
cannot be confounded with their convolutions.

(16) Donald Monro in Edinburgh Essays, &c. Vol. III. — They not unfrequently
occur in horses and asses in the anterior mesenteric artery, and frequently contain
worms, viz. the strongylus armatus minor, Rudolph, which, as they are often situated
in tubercles in the arterial coats, and render them diseased, in many instances,
are tlie cause of aneurysm. Compare Radolphi Entozoor. v. vermium intestinal,
historia naturalis. Vol. I. p. 437, Vol. II. p. 204, and Synopsis, p. 259. — Groguier
in Journ. de Medec. cont. 1810, Dec. p. 504. — Hodgson, p. 581, ff. with a good
plate, in Engravings intended to illustrate some of the diseases of Arteries,
tab. 8, fig. 2. 4to. Lond. \^\5.— Greve Erfahrungen und Beobachtungcn iiber die
Krankheiten der Hausthiere, Vol. I. p. 105 ; both the latter have not always
worms as the cause of aneurysm. One instance in Bresl. Mus. v. Verzeichniss,
No. 2259.

(17) E])hem. Nat. Curios. Cent. IX. Obs. 59. — Julien in Journ. de M^dec.
Vol. XIII. p. 359. — Donald Monro. — Nenci. — Titius Pr. ancurysmatis arteriae
renalis sinistra? exemplum. Viteb. 1798.

(18) yHhoorn. — Julien. Perhaps also here belongs the case of an aneurysm
on the proper coat of the testicle, v. Bird in Mem. of the med. Soc. of London,
\iA. IV. p. 406. — The situation of an aneurysm on the organs of generation,
which was fatal by bursting, is doubtful, v. Osiander Denkwiirdigkciten, Vol. I.
1). 2. No. 1.

(19) Jo/tn Bell, Principles of Surgery, Vol. I. j). 421. — IV. Stevens in Medic,
chir. Transact. Vol. V. j). 422. [It has recently appeared, however, from the
dissection of this case, v. Owen Med. chir. Trans. Vol. XVI. \). 219, that the
diseased artery was the ischiatica, and not the glutca, as supposed. T.] — Atkinson
ill Medic, and physical Journal, \'ol. XXX VI II. p. 267. — White in American
Journ. of the med. Sciences. Febr. 1828.

(20) Ehrmann Compte rendu, etc. j). 24, Strasburg, 1827.

Sect. XIX.] Of the Arteries. 3^1

(21) B. S. Alhiniis Adnot. acad. L. III. p. 27, after violent extension of a
dislocated limb.

(22) Guattani, p. 162, fF. (on the calf of the leg.) p. 176, Hist. XXII. (on the
top of the foot after blood-letting.) — Ehrlich Chir. Beob. p. 104, (on the tibialis.)
— van Esch Heelkondige Waarneeminge, etc. Gouda. 1772, (also on the tibialis
from mortification.) — Tartra. v. Harles N. Journ. d. ausl. med. chir. Litt.
Vol. VII. Part I. p. 190, ^—Hodgson, p. 438.

(23) Andr. Caesalpin Catoptrices, Lib. VI. cap. 20. — Amhr. Par^. L. I. De
tumoribus. Cap. XXVIII. — Blancard Anat. pract. rat. Cent. II. Obs. 74. —
Fabriz von Hilden Observat. et Cur. chir. Cent. II. Obs. 89. — Eggerdes in Misc.
Acad. N. Cur. Dec. II. Ann. VI. 1687, p. 415. — Several instances are collected
in Morgagni, Epist. XXIV. 36. — Matani De aneurysmat. praecordior. morbis.
p. 145. — Baader Observ. med. incision, cadav. illustr. Frib. 1765. — Bach. v.
Richter's Chir. Bibliothek. Vol. VIII. p. 498. — Eisenschmidt in Schmncker' s
Vermischt. Schriften, Vol.11, p. 241. — /. C, Stark in Abhandlungen der
Erlanger physic, medic. Societat. Vol. I. p. 472. — I saw one instance in the
Anat. Mlis. at Strasburg. Compare Lobstein Compte rendu, etc. p. 35.

(24) Pathol, anat. Atlas zur Erlaut der Geschichte der Kinderkrankh. v.
Billard, Taf. VII. fig. 1.

§197.

Lastly, as to the termination of aneurism, this, if surgical
assistance be not rendered, is necessarily mortal, as the tumour
by continued extension at last bursts, and bleeding ensues.
Should the consistence of the arterial walls be very much
diminished, or the current of blood be very strong, even small
aneurysms burst early. If the diseased artery be situated
apart in one of the great cavities of the body, it usually
at once bursts the surrounding thin serous membrane,
and a fatal gush of blood takes place into the cavity of the
skull, chest, pericardium or peritoneum ;^ if, however, the
aneurysmal sac be directed towards the harder parts, and
consolidated with them, the effusion of blood does not take
place into the great cavities of the body, but by preceding
erosion of the neighbouring bones, membranes, &c., either
externally,^ or into the air tube^ and its branches,* the gullet,^
the stomach,*^ the intestines,'' the urinary bladder,^ even into
the heart and other blood-vessels. ° If the aneurysm occur on
the external parts of the body, then the blood is effused
among the muscles, into the aponeuroses and beneath the skin,
all which parts it greatly expands, and becoming more or
less coagulated, forms a continually increasing tumour, which
at last assumes an inflammatory and gangrenous disposition, and
produces a slough of those parts of the common integuments
which are most distended, upon the immediate or repeated
throwing off of which fatal hemorrhage ensues. It is interest-
ing to observe, how the conservative power of the system strives
to prevent this melancholy termination of the disease : the
fibrous part of the blood being, in the later stages, naturally
deposited in more or less thick and concentric layers within the

Y

32g Of the Arteries. [Part II.

aneurysmal sac, which is thereby remarkably strengthened/"
In rare cases a spontaneous cure is thus effected, in-
asmuch as the aneurysmal sac is entirely filled with fibrous
matter, w^hilst the artery itself remains pervious, or more com-
monly the fibrous matter fills up the whole artery as far as the
last collateral branch. In not less rare cases the spontaneous
CURE of the aneurysm is effected by the aneurysmal sac itself,
which having become enlarged and hard from being filled
with fibrous matter, compresses its artery, and produces ad-
hesion ; or the sac is destroyed by the inflammatory shutting
up of the artery, with simultaneous suppuration and morti-
fication.^^

(1) A. Burns, On some of the most important Diseases of the Heart, p. 258,
first pointed out that the sei'ons membranes, into the cavities of which internal
aneurysms had been effused, were not destroyed like mucous membranes, and
the common integuments by suppuration or mortification, but by bursting. —
Hodgson, p. 8(), confirmed this, as also can I from several cases which have come
before me. — In rare cases the blood of a burst aneurysm of the thoracic aorta does
not empty itself into the chest, but penetrates between the legs of the diaphragm
in the cellular tissue behind the peritoneum, and thence first makes its way through
the peritoneum into the cavity of the belly, v. Richerand Nosogr. chirurg. 2d edit.
\'ol. IV. p. 82. — Scarpa, Sull' Aneurysma, found, on the contrary, an aneurysm
'•f the abdominal aorta, w-hich penetrated into the chest. — Morgagn'i Epist. XL.
p. 29. — Aneurysms near the heart burst soonest, and naturally into the
pericardium. Effusion of blood from aneurysm into the left pleura is common,
but very rarely into the right pleura and mediastinum, v. My SeltBeob. Part II.
p. 65. — Hodgson, p. 481, mentions two cases in which aneurysm of the aorta
burst in the mediastinum and mesentery, and so caused death.

(2) Aneurysms of the arch of the aorta sometimes ascend into the neck, and
may l)e confounded with aneurysm of the carotid and subclavian; most com-
monly, when they do not burst internally, they perforate the breast- bone, the
neighbouring ribs, or the clavicles, dislocate the latter, and form, more or less,
large tumoui's on the front of the chest. Instances are mentioned hy J. Lefaye in
Phil. Trans. 1700, p. 666. — Morgagni De sed. et caus. Morbor. Epist. XXVI. 9.
— Morand in Mem. de Paris, 1721, Hist. p. 30. — Wcltinus D. de aneurys-
mate vero pectoris externo, hemiplegias sobole. 4to. Basil, 1750. v. Lautli's
Collect. — Verhrugge D. de aneurysmate, li. B. 1778, fig. 4. tab. 1 — 6. — Ephem.
Nat. Cur. Cent. V. and VI. Obs. 74:— Ehrlich Chirurg. Beob. p. 93, 95, 96.—
Schreiber in Nov. Comm. Petrop. Vol. III. Hist. p. 36, Mem. p. 401. — We'ikaid
Vermischte medicinische Schriften, Vol. II. No. 6. — Armane in S^dillofs Recueil
period, de la Soc. de Sante de Paris, Vol. X. p. 390. — Compare above § 136,
note 29, and § 137, note 18; also Scarpa in Hist, et Mem. de la Societe de
Med. 1780 and 1781, Hist. 290. — RoseiimuUer in narks' translation of Scarpa,
p. 364. — fiienueijer Mus. anat. ])athoI. p. 94, No. 575. Vindob. 1816. — N. Ileisler
De rariorem atque memoratu dignissimam aneurysmatis aorta' sternum ])erforantis
historiam exhibens. Landish. 1827. — Hodgson, p. 105, case 17. — Laenvec De
I'Auscultation mediate. Vol. II. p. 431. — Cernlti Beschreibung der pathol. PrH-
parate zu Leipzig, No. 286, engraved in Ehrhardt Comm. de aneurysmate aortae,
t;,l^ ,3. — Pfcufer in Horn's Archiv fiir medic. ICrfahrungen, 1824, May and June,
p. 452. — A. Cooper, Lectures on the principles and j)ractice of Surgery Vol. II. j). 31.
— Compare also Lieulaud Hist. anat. med. ed. Schlegel, Vol. II. p. 255, Obs. 796,
805, 810, 8 1 1,814, 816, 823, 824, 827, 830, 831, 832, &c. — Sometimes such tumours
do not burst ext(;rnally, but sink down again, because the aneurysmal sac is more
expanded inwardly. Very rarely such aneurysm, having run into sui)puration,
actually bursts, but it discharges no blood, v. Delortm Nouvelle liiblioth. medic.
^L•ly, 1826. — Aneurysms of the descending aorta frequently destroy the hinder

Sect. XIX.] Of the Arteries. S2?i

part of the ribs and their vertebrae, and protrude through the ribs as larger or
smaller swellings. — Compare de Heyde Observat. med. 8vo. Amstel, 168(), No. 34.
— Noortwyck Obs. de gibbo ab aortae aneurysmate, ad Solani Observ. de pulsu.
8vo. Amstel. 1746. — Walter Sur les maladies du Coeur in d. Nouv. Mem. de
Berlin, 1785. — Lieutaud Hist. anat. med. ed. Schlegel, Vol. II. p. 253, ff. No.
795 and 809.— Horn Archiv f. prakt. Medecin. Vol. IV. p. 290.— Kreysig
Herzkrankheiten, Vol. III. p. 17(>, ff. — Laennec, p. 429, ff. — Ceriitti Beschrei-
bung der pathol. Praparate zu Leipzig. No. 285, engraved in Ehrhardt Comm.
de aneurysmate aortae. Lips. 1820, tab. 4. — Salomon in Petersb. vermischten
Abhandlungen aus dem Gebiete der Heilkunde. 3te Samml. 1825, p. 164,
pi. 2. — ScKoji in Hecker's Litter. Annalen d. ges Heilk. Sept. 1828, p. 10, in two
cases. — A. Cooper, Vol. II. p. 30 — 35, in the latter case the aneurysm was mis-
taken for lumbar abscess. — In the cases of Kreysig and Salomon, the blood pene-
trated even into the spinal canal. — /. Rainy in London Med. and Phys. Journ.
Dec. 1827.

(3) Boneti Sepulchret. anat. L. II, § 5, Obs. 8. — Lieutaud Hist. anat. m^d.
Vol. II. p. 258. Obs. 802. — Hall, in Medical Observations and Inquiries, 1784,
Vol. IV. p. 23. V. Richter's Chir. Biblioth. Vol. IX. p. 37G. — Richerand in
Mem. de la Soc. med. d'Emulat. Ann. IV. p. 345. — Corvisart. — Newbolt in
London medical Repository, March, 1826, Vol. V. No. 27. — Biermayer Museum
anat. patholog. Vindob. 1816, p. 9Q, No. 9Q. — Mandruzzato in Memorie scien-
tifiche e letterarie dell' Ateneo di Treviso. Vol. I. 1817. — Hodgson, p. 134,
case 17. — Mussey in the New- England Journ. of Medic, and Surgery, Vol. VII.
No. 2. Boston, 1818. — Noverre D. sur les Aneurysmes de I'Aorte. Paris, 1820. —
Jndral in Archives general, de Medec. Nov. 1823, p. 466. — Ward in Lon-
don medical Repository, Vol. XXL No. 131. Nov. 1824. — Berlin Traite des
maladies du Coeur, etc. p. 107. — Hisselbach Beschreibung der pathol. Praparate-
zu Wiirzburg, p. 279, No. 550. — Meriadec Laennec in Revue medic, franj. et
etrangere, 1825, Vol. IV. p. 3. — Htmsinger Erster Bericht der anthropotom.
Anstalt zu Wiirzburg, 1826, Pref. p. v. — Schon, in two cases. — A. Cooper,
Vol. II. p. 32. — I also saw engravings of such cases at Venice, at Allietti's.

(4) In the cells of the lungs, v. Pelletan Clinique chirurgicale, Vol, I. p. 89. —
J. O^Reardon in Graperon Bulletin des Sc. medicales, Vol- II. p. 411. — Laennec,
Vol.11, p. 63 and 427. — In the bronchus, y. E. Fritz D. s. Observationem de
aortae aneurysmatis in bronchum ruptura. 4to. Gryphiae, 1817, with engravings;
and Richerand. In the left bronchus, v. Fleury in Ephem. medic, de Montpellier,
VoLVL Nov. 1827.

(5) Saiivages Nosologia methodica, Vol. II. p. 298. — Matani De aneurysmat.
praecordior. morbis. § 62, p. 120. — Lajorgne in Bulletin de la Soc. de M^dec.
p. 154. — App. zum Journ. de Medecine continue, Vol. XIV. — A rmiger in Me-
dico-chir. Transact. Vol.11. No. 21, p. 244. — O'Reardon in Journ. gener. de
Medec. Chir. et Pharni. Dec. 1808; and in Graperon Bulletin des Scienc. medi-
cales. Vol. 11. p. 441. — Dupuytren in Corvisart Sur les Maladies et lesions or-
ganiques du Coeur et des gros vaisseaux. — Berlin v. Bulletin de la Fac. de Medec.
et de la Soc. de Paris, 1812, p. 14. — Raikem and Bouvenot, ib. p. 181. — Bricheteau
in Bulletin de I'Athenee de Medecine de Paris, Dec. 1816. — Copeland, Obser-
vations on the symptoms, &c. of diseased spine. 8vo. London, 1815. — Laennec
De I'Auscultat. med. etc. Vol. II. p. 427, (in three cases.) — Cerutti Beschreibung
der patholog. Praparate zu Leipzig, 1819, p. 156, No.^743. — Becker in Rust's
Magazin f. die gesammte Heilkunde, Vol. XX. Part III. p. 447, with plates. —
Bertin, p. 110. — Proudfoot, in Edinb. med. and surg. Journ. 1824. — Staupa
Anweisungzur gerichtl. und pathol. Untersuchung menschl. Leichname. Wien.
1827, p. 168.* — A case in the London medical and physic. Journal, by Macleod,
Aug. 1827, Vol. L VII I. — Th. Molison, in Transact, of the med. chir. Soc.
of Edinburgh, Vol. III. Part I. p. 173. — Also in animals, viz. in a nasua, from
the verbal communication of de Blainville.

(6) Hodgson, p. 75. — Staupa.

(7) Hodgson, p. 75. — A. Comstock, in Philadelphia Journal, Vol. XIII.
p. 318, with engravings, (an aneurysm of the aorta opened into the flexura
iliaca coli.) — A. Cooper s Lectures, Vol. II. p. 35.

y2

<~>i

24 Of the Arteries, [Part II.

(8) Hodgson, p. 75. — Perhaps also here belongs the case observed by
A. Cooper, Vol. II. p. 36.

(9) For instance, aneurysm of the aorta in the right auricle, v. INIed. chir.
Journ. Vol. VI. p. 617. — Bulletin de la Soc. de M^decine a Paris, 1810, No. 3,
p. 38 ; or in the pulmonary artery, v. TVeUs in Transact, of a Soc. for the
Improv. of med. and chir. Knowledge, Vol. III. p. So. —Suem Bulletin de I'Ecole
de M^dec. et de la Soc. de Paris, 1809, p. 128. — Payan and Zeink in Bulletin de
la Faculte de Medecine, 1819, No. 3, (two cases.) — Journ. de M^dec. continue,
Vol. XXIV. p. 124; and Bulletin de la Faculty, etc. Vol. XVII. p. 16.

(10) Kreysig thinks that the layers of fibrous matter in aneurysmal sacs
originates in effusion from the walls of the artery, v. Herzkrankheiten, Vol. II.
p. 388, and note to Hodgson, p. 124; whilst to me he seems to say, that the
external layers are the firmest ; the innermost are, on the contrary, the weakest,
and that the quantity of fibrous matter collected is by no means proportionate to
the vascular weakness of the vessel, which is often indurated, or very much ex-
panded, and thin arterial coats. — As such coagulum is but rarely found in
angiectasy, and as seldom missed in aneurysm, so the ancients improperly distin-
guished both forms of the disease by the coagula.

(11) Hodgson, p. 100, ff, treats admirably of the spontaneous cure of aneurysm,
and many individual cases in de PloiiqueVs Repertorium Art. Aneurysma, and in
surgical writers. — Some new cases are given by Howship, Practical Observat. in
Surgery and morbid Anatomy, Case 110, (the art. femoralis.) — R.Archer, in
American medical Recorder, hy Eberle, Vol. VI. Art. 3. Philadelphia, October,
1823, (the femoral artery.) — JV. Beach, ih. Jan. 1824, (the art. femoralis,
from cold.) — H. Lyford, in the Lancet, Vol. XII. p. 767, (also the femoral.) —
J. Clocquet in Gazette de Sante, 1825, No. 3, (the right subclavia.) — Many cases
of spontaneous cure of the Art. iliaca externa and interna, are collected by
Casamajor, Reflexions et Observat. anat. chir. sur I'Aneurysme spontanee, etc. 8vo.
Paris, 1825. — An interesting case is described by JV. Darrach, in Philadelphia
Journal, Vol. XIII. p. 115. Compare Magazin der ausliind. Litt. der ges. Heilk.
Sept. and Oct. 1827, p. 338. It was an aneurysm of the arch of the aorta, in
which the truncus anonymus was closed, and the blood flowed from the left sub-
clavia through the much enlarged and anastomosing arteriae thyrooidea? inferiores,
to the right subclavia. [In Mus. St. Thomas's Hospital, a fine example of spon-
taneous cure of aneurysm of the femoralis, by the aneurysmal sac compressing
the artery between itself and the thigh bone ; it is mentioned in Cooper's Lectures
on Surgery, Vol. II. p. 47. T.]

§ 198.

The unnatural widening of vessels and aneurysmal tumours,
naturally lead to the consideration of vices of consistence
AND CONTINUITY in the arterial system. The first arise,
perhaps, in many cases without distinct change of the arterial
tissue, in diminution of elasticity, and in alteration of nourish-
ment; but usually they are consequent on actual change of
texture, as inflanunation and its various terminations. The
DIMINUTION OF CONSISTENCE, with whicli we are alone con-
cerned, is not unfrequently to such extent, that the mere
strong current of blood, or slight stretching or concussion of
an artery, produce gradual extension, or fine cracks, mostly
in the transverse direction of the two internal membranes,
whence arises the first disposition to aneurysm. Sometimes
the disposition to rupture in the arteries is so great, that
SPONTANEOUS TEA RINGS of all tlic coats of tlic artcry occur

Sect. XIX.] Of the Arteries. 325

independent of any of the just-mentioned causes.^ In many
cases also arteries bm'st, if their walls have been weakened
by suppm'ation and mortification. To wounds of arteries
belong ruptures from violent extension/ then cut, thrust, and
contused wounds.^ If in thrust wounds of arteries, which may
occur both in fractures of bones by bony splinters,^ or swallow-
ing pointed bodies,^ the external wound is healed, whilst the
blood continues pouring from the still open wound in the
vessel into the cellular tissue, then it is called a spurious
aneurysm.*' If the wounded vessel be not too large. Nature
stays the hemorrhage, and cures the wounded artery thus, the
vessel itself contracts at its extremity, and often for a con-
siderable distance up, and if, as is usually the case, it lies in
the loose cellular tissue, it retracts,^ whilst the effused and
coagulated blood compresses the end of the artery, and closes
it by an internal plug of blood, thrombus, coagulum internum.
The latter new becomes firmly adherent to the artery, by
subsequent inflammation and pouring out of lymph, which is
thus healed by being closed, usually up to the nearest superior
branch, and is gradually converted into a kind of tendinous-like
band. A similar inflammatory shutting up of arteries occurs
after ligature, in which besides, both the inner coats of the
vessel are transversely divided, by the indentation of the liga-
ture on the part, and thus easily give rise to the curative
effusion of lymph. ^ As to the collateral vessels by which, after
adhesion of an artery, the blood takes its course, it is difficult
to decide whether they be merely vessels which had previously
existed, increased in size, or whether they be partial new pro-
ductions.^ Small cut and thrust wounds, especially if they be
longitudinal, heal in rare instances without closing of the artery
by firm cicatrices ;^*' so also such wounds of arteries, in which
merely the external coat is destroyed, are rendered tough by
the coagulable lymph which is effused. ^^

(1) V. several cases in de Plouquet and Reuss's Repertor. Art. Ruptura Arte-
riarum. — Morgagni, Epist. LIII. 35, 36, (the aorta.) — Bohyi De officio medic,
dupl. Cap. IV. p. 390, (a branch of the carotis.) — Pyl Aufsatze und Beobacht.
aus der gerichtlich. Arzneiw. Vol. IV. Obs. 7 and 8, (the aorta.) — Fogther and
Kausch's Memorabilien der Heilkunde, u. s. w. Vol. III. (the right pulmonary
artery.) — Hodgson, p. 391, (the brachial artery from an accident, of which a
similar ease is mentioned by Saviard, Observ. Chirurg. 7th Observation.) — Bons-
dorf resp. Wegelius D. anatomicam veneficii arsenico peracti investigationem
sistens. Abo. 1817, (the vertebral artery from violent bending backwards of tlie
head.) — [In Mus. St. Thomas's Hospital, the right vertebral artery ruptured in
fracture of the cervical vertebrae. T.] — My Selt. Beob. Part II, p. QQ, (the
aorta.) — Hamilton in London Med. and Phys. Journ. Vol. LVII. p. 506. — Rose^
ib. Vol. LVIII. (the aorta; two other cases of rupture of the aorta are also
mentioned.) — Simpson in Trans, of Med. Chir. Soc. of Edinburgh, 1824, No. 22,
(the pulmonary artery in a child.) — J. Adam in the Trans, of the Med. and Phys.
See. of Calcutta, Vol I. 1827, (in the pulmonary artery.) — It is well known that

S26 Of the Arteries. [Part II.

we often find the arteries of the hrain burst in apoplexy, also branches of the
pulmonary artery in violent coughing. — [A case of rupture of the pulmonary
artery, v. W. Gunn in Edinburgh Med. and SurgicalJourn. 1829. T.]

(2) For example, in dislocations and the extension employed to replace the
bone. V. Petit Traite des maladies des os. Vol. I. p. 179, (the brachial artery.) —
Pelletan Clinique Chirur. Vol. II. p. 95, (the brachial artery.) — Popincl in
Graperon's Bulletin des Sc. Medic. Vol. III. p. 253, (the femoral artery in dislo-
cation at the hip.) — Gibson in Philadelphia Journal, by Chapmann, Vol. VII.
No. 1, Nov. 1823, and the Lancet, Vol. III. p. 90, (the brachial artery.) —
Flaubert in Repertoire gen. d'Anatomie et de physiol. patholog. 1827, Vol. III.
Part I. p. 102, (the brachial artery.) — When the whole limb is torn off, the
arteries bleed proportionally, but little on account of their great extension ;
sometimes they are even stopped by the cellular tissue drawn around them, [A
beautiful instance in the Mus. St. Thomas's Hospital, shewing the mode em-
ployed by nature in sealing up a torn artery, by the drawing over it the surround-
ing cellular tissue, in a man whose thigh was torn off by a cable. T.]

(3) Shot and other contused wounds of arteries are fatal, because often after
eight or more days, when the slough is tlirown off, the artery is opened.

(4) White's Cases in Surgery, p. 141. — Bell, Principles of Surgery, Vol. I.
p. 337, 368. — Pelletan Clinique Chirurgicale, Vol. I. p. 178. — I have had an
opportunity of examining a case in which the coracoid process of the scapula
being shot off, had injured the axillary artery and given rise to a false aneurysm
on the arm.

(5) The aorta was torn by a piece of bone which had been swallowed sticking
in the gullet, v. Lauren in Archives generales de Medec. Oct. 1824.

(G) Compare above, § 194. They occur most frequently in consequence of
bleeding in the arm over the brachial artery; they occur however accidentally
in almost all the arteries, even in the aorta from stabs, v. Guattani De externis
aneurysmat. Hist., p. 26. — Pelletan, Vol. I. p. 92.

(7) Hence arteries, which do not lie in the loose cellular membrane, but
being attached to the bones cannot retract, as the A. meningeal, alveolares,
nutritiae ossium, &c. bleed even for a long time and very much.

(8) Ligatures sometimes produce the closure of an artery in a very short time,
and even if the ligature be again loosened. If the artery be tied at some dis-
tance from the wound, or the aneurism, there is often danger from a collateral
stream of blood, in which case the artery sometimes is only closed at a small
point. The closed wounds of arteries in amputated limbs are often consolidated
so closely with the cellular tissue of the surrounding parts, that it is impossible
to separate them. The most important works on injuries, spontaneous cure, and
ligature of arteries, are Petit M^moire sur la maniere d'arreter les hemorrhages.
I. and II. in Mem. de I'Academie des Sc. de Paris, 1731 and 1732. — Morand Sur
les changemens, qui arrivent aux art^res coupees, etc., ib. 1726. Hist. p. 58.
Mem. p. 321. — Th. Kirldavd, Essay on the method of suppressing hemorrhages
from divided arteries. 8vo. Lond. 1763. — Pouteau Melanges de Chirurgie, 8vo.
Lyon, 1760. — le Comte Resultats de quelques experiences tentees sur plusieurs
animaux, pour faire I'essai de la nouvelle methode de traitor les plaies des ar-
teres in Hist, et Mem. de la Soc. Roy. de M<"dec. 1776, Hist. p. 305. — Callisen
D. de vulneribus arteriarum. Havniae, 1788. — Deschamp Observ. et Reflex, sur
la ligature iles princijjales arltsres blessees et particuli^renient sur TAneurysme
de I'art^re poplitee. 8vo. Paris, 1797. — Mauiioir Memoires })hysiologiques ct
pratiques sur aneurysme et la ligature. Geneve, 1 802. — Jones, A treatise on the
process employed by nature in suppressing the hemorrhage from divided and
punctured arteries, and on the ust; of the ligature. 8vo. Lond. 1806; 2d edit.
1810, witli fifteen ])lat('s. — H. Tiavers in Medic, chirurg. Transact., Vol. IV.
p. 435, and Vol. VI. ]). 632. — W. Lawrence, A ncvv method of tying the arteries,
&c. ib. \o\. VI. ]). 155, and Further observations on the ligature of arteries, ib.
Vol. VIII. Part 1 1, p. 4!>0, — U^clard Heclierches et Experiences sur les IJlessures
des Arteres in Mem. de la Soc. med. d'Emulation, 1816, Part 1 1. )). 569. —
A. Scarpa Memoria stdia legatura della })rineipali arterie degli arti, con una
appendice all'f)pera sull' aneurisma. 4to. Pavia, 1818. — k'accn Hcrlin<:hicri Me-

Sect. XIX.] Of the Arteries. S27

moria sopra I'allacciatura dell' arterie. Pisa, 1819. — Lettere del /4. Scarpa al racca
Berlinghieri sulla legatura delle grosse arterie degli arti e riposta alia midisima di
Vacca Berltnghkri. 8vo. Pisa, 1820. — L Koch D. de praestantissima amputationis
methodo. Landish. 1826, and Ueber die Amputation and die Hinweglassung der
Ligatur der Gei^asse in von Gr'dfe and von Walther's Journ. der Chir. 1827,
Vol. IX. p. 560, — Theoph. Ebel D. de natura medicatrice sicubi arteriae vulneratae
et ligatae fuerint. 4to. Giessae, 1826, with six plates.

(9) From my observations, I believe that both occur. Experiments on the re-
production of blood-vessels are found in Cal. Hillier Parnj, An experimental
inquiry into the nature, cause, and varieties of the pulse, and certain other
properties of the larger arteries in animals with warm blood. Iliust. by en-
gravings. London, 1816. — lb., Additional experiments on the arteries of warm-
blooded animals. London, 1819. — A. E. J. C. Mayer Disquishio de arteriarum
regeneratione. 4to. Bonnae, 1823, with engravings. — G. Salemi, Sull' uso del premi-
arterie. Palermo, 1825. — v. Schonberg Memorie sul ristabilimeno della circola-
zione nella legatura o anche recisione del tronchi delle arterie, con le conchiusioni
immediate, illustrate da esperimenti e disegni. Napol. 1826.' — A. Zhuher Neue
Versuche ariThieren und deren Resultate iiber die Wiedererzeugung der Arterien,
mit beigefugten Bemerkungen dariiber. 8vo. Wien, 1827, with three lithographic
plates.

(10) Scarpa Sull' aneurisma, p. 230. — Hodgson, p. 455 and 467. — CruveiUiiet
Essai sur I'anat. patholog. Vol. I. p. 330, (the cicatrization doubtful.) In one
case I found the little opening in the artery produced by bleeding, still open
after two months, v. No. 8797, Bresl. Mus.

(11) Hunter and Ev. Home in Transact, of a Soc. fjr Improv. of Med. Know-
ledge. Vol. I. p. 144.

§ 199.

Among the vices of texture of arteries, inflammation,
arteriitis,^ deserves, from its frequency and importance, the first
place. This occms, not only especially in all the blood-vessels
of inflamed parts, but also frequently in the arteries alone,
especially in the large ones, as an idiopathic or deuteropathic
disease. We observe it frequently in inflammatory fevers, in the
neighbourhood of local inflammation, in eruptive diseases, in
hydrophobia, gout, rheumatism, syphilis, in mechanical injuries
of arteries,^ &c. ; and in aneurysm and wounds of arteries it is
produced by intentional pressure and ligature, in order to
eflfect the usually consequent adhesion of the vessels. The seat
and degree of this inflammation is subject to numerous varieties.
Most commonly the inner or serous coat of the artery alone
is inflamed, in a greater or less degree, which we distinguish
by its more or less intense red colour, greater softness and
solubility, by its opacity, its loss of lustre, in the larger arteries
by a slight thickening, and especially by a large net-work of
vessels spread over the external surface of their fibrous coat.
This distinct inflammatory state must not be confounded with
the often very similar although generally somewhat dull red
colour of the inner arterial coat, which is observed not very
unfrequently in a peculiai' disposition of the blood to impart
colour, in arteries which are putrid, which have been frozen
and then thawed, as also such as have been dried by the air,

328 Of the Arteries, [Part 1 1 .

in asthenic fevers of men and other animals/ and, lastly, as
consequent on effusion of blood, ecchymosis between the coats
of an artery.* Phlegmonous or general inflammation of all the
coats of an artery is more rare, which we can distinguish, not
merely by the already described signs of inflammation of the
internal coat, but also by swelling, loosening, more easy sepa-
rability, and by greater injection of both the outer arterial
coats.

(1) Morgagni De sed. et caus. morbor. Epist. XXVI. 35 ; Epist. XLIV. 3. —
J. P. Frank Epist. de cur. hom. morb. L. I, § 118. — Schmuck D. de vasorum
sanguiferorum inflammatione. Heidelb. 1793. — Sasse D. de vasor. sanguifero-
rum inflammatione. Halae, 1797. — Portal Cours d'anatomie medicale. Vol. III.
p. 127 (on the aorta.) — Spangenherg Ueb. die Entzundung der Arterien in Horn's
Archiv fiir medic. Erfahrung, 1804, Vol. V. p. 269. — Testa On inflammation
of the aorta, in his Delle Malattie del Cuori, &c. — Patissier in Bulletin de la
Faculty de Medec. de Paris, No. 10, 1815, (heart and large vessels.) — Kreysig
Herzkrankheiten, Vol.11, p. 86, IF; Vol. III. p. 269. — Hodgson, p. 3. — Laennec
De I'auscultation mediate, P. II. p. 353. — W. Sprengel in Rust's Magazin,
Vol. VII. p. 475, (the brachial artery, after injury to the thumb.) — Bard in Re-
vue medicale, Mai, 1820, (almost all the arteries.) — Melt in Annali univers. di
Medic, comp. del Omodei, Vol. XVII. and XVIII. Jan. — Jun. 1821, (all the
arteries and veins.) — Jemina de Monduvi on Aortitis thoracica acuta, ib. 1824.
— Montesanto ib. Vol. XXXVI. No. 5, 1825 (in the aorta, A.innominata, carotis,
and subclavia.) — Bertin Traite des maladies du Cceur, &c. par Bouillaud, Liv. I.
Paris, 1824. — Tanchon v. Edinb. Journ. of medical science, July, 1816; and von
Fro?7>/3'sNotizen, No. 320, p. 183, October,1826. — Bernrd in D.sur plusieurspoints
d'anatomie pathologique. No. 3, Paris, 1826. — R. Bright, Reports of medical
cases, &c. 4to. London, 1827, (three cases.) — Hinterberger in der Medic, chir.
Zeitung, 1828, p. 31, ff, (the aorta in pregnant and lying-in women.) — B. Loca-
telli D. de Angioitide s. de vascularis sanguifei'ae provinciae inflammationibus.
Patav. 1828. — Gendrin Histoire anatom. des inflammations. 2 vols. 8vo.
Paris, 1826. — \_EUiotson on Inflammation of the aorta, in his Diseases of the
Heart, p. 33. T.]

(2) I consider the inflammation of the artery, especially that of its serous mem-
brane, by no means a rare disease ; inasmucli as I have not merely often met with
it in dead bodies, the previous state of which I could know nothing about, but also
several times in diseases which I had previously conducted. In my younger days I
thought I was the subject of aortitis, in consequence of very severe cold, in which
a very distinct and painful pulsation of the aorta, higli fever, and great sensibi-
lity of skin were the symptoms exhibited. — Alsd in animals, I have several times
seen inflammation of the internal coat of the aorta, and of the heart, especially in
horses, and most severe in a young horse, which had a large abscess in the thigh.
In a few instances, of dogs which bad died of hydro})hobia, and in one destroyed
by inflammation of the heart ; and in many foreign animals, wliich frequently die
in menageries, of inflammation of tlie heart. —In children which have been
destroyed by measles and scarlet fever, I have found artcriitis. — Portal, after
measles — Testa, in other eruptive diseases. — Tanchon, in fifty persons who died
under small-pox, S:c. — In syj)hilitic j)ersons who have taken much mercury, and
after catching cold have died of inflanunatory diseases, I have twice found inflam-
mation of the inner-coat of the aorta, and of the larger branches springing from
it — Morgagni, and Epist. XVIII. p. 27; and Testa, have several examples of
artcriitis in j)ersons aftccted with the venereal disease. — Others also have derived
arteriitis from syphilis and the use of mcrciiry ; viz. Lancisi De aneurysmatibus
edit. Lanth, p. 52. — Corvisart, p. 307. — Richerand Nosographie Chirurgicalc,
Vol. IV'. ]). 71. — Hoditsiin, p. 9. — I have even seen, in phthisis, the internal coat of
the pulnionary artery, and of the aorta, inflamed several times; and this once also
in a child, in which the greater part of the skin had been scalded with hot water.

Sect. XIX.] Of the Arteries. 829

(3) Compare above, § 35 and 36, on the redness of the inner-coat of the aorta.
V. Corvisart, p. 334. — Hodgson, p. 7. — Laennec, Chap. XVII. p. 353. — Trousseau
and Rigot, in Archives generales de Medecine, Oct. 1826, and July, 1827.

(4) Compare §37. — Good instances are given by Boerhaave Progr. med.
Vol. I. p. 242 ; and Prsekct. in Instit. Vol. 111. p. 501, No. 827, in a stout ox
and in a hunted bare. — va7i Swieten Comment, in Aphorism. Boerhaavii, p. 171,
in a hunted stag. — Morgagni, Epist. XXVI. p. 13 ; Epist. XXVII. 28, with
rupture of the aorta. — Testa, p. 210, after violent coughing. — I have myself found
such extravasations on the internal coat of arteries in a child which died of
whooping-cough ; in some asthmatic persons ; in one person killed by choke
damp, and in some drunkards and hanged people, on the aorta, and sometimes
also on the larger branches, — Sometimes I have also found the larger arteries, in
amputation, of a bright violet colour, for an inch or two. — I have seen, also in
high degrees of inflammation of the aorta, in a few instances, some little drops
of pale blood between the coats of the arteries. — Laennec found the violet colour
produced by ecchymosis, in those persons especially who had died with severe
struggles.

§200.

A more or less copious effusion of coagulable lymph
is a frequent consequence of arterial inflammation. If this occur
in and between the coats of the artery, there is often consequently
distinct thickening, also an intimate adhesion and consolidation
of the three coats with each other, as has been observed,
for instance, frequently in aneurysmal sacs ; if the exudation
occur on the external surface, the artery adheres more or less
firmly to the neighbouring parts ;^ should it take place on the
internal surface of the artery, it gives rise to obstruction, nar-
rowing, and obliteration or closing of the vessels.^ The latter
is the consequence intended in artificial compression and liga-
ture of arteries, as well as the means whereby Nature herself
cures wounds of arteries, and sometimes even aneurysms.^

(1) For example, aneurysms with the bones, the air-tube, gullet, &c. — Ampu-
tated arteries in the cicatrix with the neighbouring parts. — -In one instance the
axillary artery was torn in reducing a dislocation of the shoulder, in which it
was adherent to the capsule of the joint, v. Gibson in Philadelphia Journ. edited
by Chapmann, Vol. VII. No. 1, Nov. 1823.

(2) I have already described above, § 192, some examples of the spontaneous
obliteration of individual arteries. I have also lately found, in the body of an old
man, the left subclavian artery very much narrowed, without any distinct cause,
but the left carotid completely closed, v. No. 8680, of Bresl. Mus. ; and in
another case the coeliac artery thickened and completely closed, No. 2266, of my
Verzeichn. — Lardner in Edinb. Med. and Surg. Journ. Vol. VIII. Part XXVII.
No. 4, one carotid artery from pressure of a thickened gullet.

(3) Compare § 198.

§S01.

The less frequent terminations of inflammation are suppu-
ration and MORTIFICATION. The former appears to occur
most commonly, in consequence of chronic inflammation on
the innermost coat of hardened arteries, but without the
formation of pus, and is thus rather erosion. In this vice
is often the origin of mixed aneurysms, as well as of rupture of

330 Of the Arteries. [Part II.

arteries. Much more uncommon is the true suppuration of
arteries^ in which the disease is seated, either primarily in the
vessels, or more commonly in the parts immediately adjacent
to the artery ; in hoth cases the artery is easily perforated by
ulceration, and thus gives rise to bleeding,^ unless the existing
inflammation have previously closed the vessel. Mortifica-
tion does not appear to occur primarily in the arterial system,
indeed the tissue of the artery seems to withstand, for a tolera-
bly long time, the sloughing which affects the neighbouring
parts. ^ But if at last the vascular system also runs into
sloughing as well as all the other parts, so consequently
bleeding would be produced, either by the percolation of the
blood towards the softened tissue, even by the incisions often
made into mortified parts, finally, by the spontaneous or
even artificial amputation of the neighbouring mortified parts ;
whilst the arteries, by the inflammation preceding gangrene,
are sometimes stopped up by a plug of coagulated blood,
sometimes are actually adherent and closed.^ But only in
those cases in which a large artery is destroyed on one side
by the mortification of neighbouring ulcers, wounds, &c., is
dangerous hemorrhage to be dreaded.

(1) Morgagni Epist. VI I. 9. — Meckel primus, in Mem. de Berlin, p.lo, 1756. —
V. Nailer Opuscula pathol. Obs. 22, p. <')00. — Weitbrecht in Comment. Acad.
Petropol, Vol. IV. p. 263. — Scarpa Sull'Aneurisma i-cflcssioni, &c. translated by
Wishart, 8vo. Edinb. 1808. — Recamier in Journ. de Med. Cbir. et Pbarm.
Vol. XI. p. 30. — Lobstein Compte rendu a la Faculte de Strasl). 1820, ]>. Ill-,
No. 433, 435 and 437. — I bave several times seen ulceration of the tcmoral artery
from suppuration of the inguinal glands, v. No. 2269, my Verzeichniss. Com-
pare GenJr'm, Vol. II. p. 48. — [In Mus. St. Tliomas's Hospital, there is one
instance of ulceration of the femoral artery from sloughing bubo, and another
from disease of the hip-joint. — Luke, wound of carotid ? from abscess, v. Med,
Gazette, Vol. V. p. 333. T.]

(2) To wit, ulcerous perforation of an aorta not aneurysmal and effusion of
blood into the gullet. \.van Doeveren Observat. anat. pathol. Obs. 1, with engrav.
and Sand/fort Mus. anat. Vol. II. tab. 105 and 106. — Perforation of the gullet
and aorta, in consequence of a piece of money sticking in the former, and effu-
sion of blood into it. v. Martin in La Clinique des Hopitaux et de la Villo,
Vol. I. No. 23, p. 30. — The femoral artei-y. v. Cruikshniik's Anatomy of the
absorbing vessels, &c. 4to. 1786. — The aorta, v. P. Frank I)e cur. horn. morb.
L. V. 2, p. 17. — Fanzago Osservazione di un ulcere nejl' aorta. 4to, Padova,
1816, with engravings; and in Memorie sopra alcuni pezzi morbosi, etc.
Fasc. I. p. 7, tab 1. — liiermaijcr Mus. anat. ))ath()l. No. 477, and Engbcrg and
A. lletzius in Ars. Beriittelse om Svenska L;ikare-Siiliskai)ets Arbeten, lemnad
of Ekstroem, 1825. — The coronary artery of the heart, v. J. Taine in London
Med. Repository, Feb. 1815. — The coronary artery of the stomach, the s])lenic,
and one ))ulm()nary artery, v. Hodgson, j). 11. — The femoral artery, v. li. Tra-
vcrs in London Med. and Physic. Journ. April and July, 1827, in two instances,
and Gibbs,ib. Aug. 1827.

(3) I bave examined the arteries, tliough slightly, in several cases of fatal
mortitication of the uj)per and lower exlremities; and indeed, in one rase, in
wbicli an aneurysma si)uriuni ililliisum was fatal from mortificalion of the arm
and the adjacent half of the thorax, by the closest examination, I could not dis-
cover any injury of the artery.

Sect. XIX.] Of the Arteries, 381

(4) Compare especially J. Thomson's Lectures on Inflammation, &c. Edinb.
1816, p. 352.

§202.

Inflammation of arteries appears to have such consequent
vices of texture as answer to the hardening of the other tissues
in general, but here exhibits many peculiarities. To these
belong the already- mentioned frangibility and dryness of
the arterial coats, especially of the innermost, which is then
found simultaneously lustreless, often also puckered, disco-
loured, and easily separable from the other coats ; further,
there is often very distinct thickening and induration of
the walls of the artery by the effusion of coagulable lymph
into its cellular tissue ; next, the conversion of certain spots into
a cartilaginous substance, and, lastly, ossification.^ The
latter appears under various forms ; thus in rare instances, as
little distinct specks of bone in the previously formed plate
of cartilage, surrounded by a large vascular circle ; or more
commonly as a pap-like substance, sometimes white, some-
times yellow, consisting of phosphate of lime and albumen,
a milky fluid, very similar to fluid lime,^ which gradually be-
comes firmer, leather-like, at last bony; and finally as earthy
or gypsum-like small specks and flakes, not unfrequently ex-
hibiting traces of crystallization. These three kinds of ossi-
fication often occur at once in a large artery, for instance the
aorta, and then at the same time form more or less numerous
isolated or closely approximated irregular bony scales, indeed
even actual unbroken bony cylinders, which prevent the ap-
proximation of a divided artery, and in the application of a
ligature on it, break like a cracked eggshell.^ These ossifica-
tions have their original seat always between the serous and
fibrous coats of the artery, although in their increasing thick-
ness they destroy by pressure and irritation not unfrequently
parts of both coats,'^ so that within they are immediately
washed by the blood, and project into the cavity of the artery
as irregular plates, generally yellow, or as points and pro-
cesses, which is often very much narrowed and even filled
with them.^ Ossification of the arteries is but rarely observed
ill young persons,*^ very frequently, though by no means as a
natural condition, in more advanced age,^ perhaps somewhat
more frequently in men than women, and by no means equally
common in all parts of the body. Thus we observe, for in-
stance, the smaller much more rarely than the larger arteries,
those of the upper less frequently than those of the lower
extremities, — very rarely the pulmonary arteries,*^ the arteries
of the walls of the chest and belly, and perhaps those of the

332 0/ the Arteries. [Part II.

alimentary canal and liver are never ossified ; on the contrary,
commonly the aorta, the angle of the carotids, the arteries of
the pelvis, of the brain, of the thyroid gland, the heart, the
spleen, kidneys, &c. In beasts also we sometimes find ossifica-
tion of certain arteries, although less frequently than in man.^

(1) W. Cowper, On Ossifications or petrifications in the coats of Arteries, &c.
in Philos. Transact. 1705, p. 1970. — Kulmus D. de tendine Achillis disrupto, et
arteriis in osseam naturam conversis. Gedan. 1730. v. Haller's Diss. chir. Vol. V.
No. 153. — Criiwel De cordis et vasorum osteogenesi in viro quadragenario ob-
servata. Halse, 1755, with engravings. — Haller'Elem. Physiol. Vol. VIII. Part II,
p. 80, and Opusc. pathol. Obs. 59. — Morgagni De sed. et caus. morbor. o:i many
parts. V. Index. — Pohl D. de ossificatione vasorum. Lips. 1774. — Malacariie in
Osserv. in Chirm-gia. Vol. II. Torino, 1784. Art. XII. p. 160, K — J. van Heelicren
De osteogenesi prseternaturali. L. B. 1797, p. 116. — Scarpa, Sull' Aneurisma. —
Lohstein Memoire sur les ossifications des arteres in the Mem. de la Soc. des Sc,
Agriculture et Arts de Strasbourg, Vol. I. p. 338, ff'. — Lucae De depositionibus
cretaceis intra cordis valvularum arteriarumque substantiam. 4to. Marburg,
1815, and Accelerandse liter, in universitatibus perfectionis subsidias quasdam
commendat et de ossescentia arteriarum senili quaedam prsefatur. 4to. Marburgi,
1817. — Cruveilhier Essai sur I'Anat. pathol. Vol. II. p. 52, ft". — Hodgson, p. 19.
— Meckel Handb. der pathol. Anatomic, Vol. II. 2, p. 183. — Rosenthal in Horn's
Archiv, June and July, 1818. — Wedemeyer in Rust's Magazin f. d. ges. Heilk.
Vol. XIII. p. 194, ft'. — C. H. Ehrmann Recherches sur la structure, les fonctions
et les alterations organiques des Arteres. 4to. Strasb. 1822, p. 41. — Many in-
stances of complete ossification of the whole aorta, or of almost all the arteries
at once, may be found in Morgagni, and in de Plouqnet's Repertorium, Art. Aortae et
Arteriarum Ossificatio. — A few striking instances of ossified aorta are given by
J. P. Frank Sclbstbiographie, Wien, 1802, p. 57 and 58 ; Salzb. medic, chir.
Zeitung, 1811, Vol. II. p. 185. — Hagslroni in Ars. Berattelse om Svenska Lakare-
Siillskapets Arbeten of Gadelius. Stockh. 1810. — Biermayer Mus. anat. pathol.
No. 458. — The Bresl. Mus. also possesses many remarkable cases. Good plates
are given in Baillie's Engravings, tab. 4, fig. 2, 3. — Hodgson, tab. 1. — J. F. Meckel,
Tab. anat pathol. Fasc. II. tab. 14, fig. 1 — 3, tab. 16. — As these calcareous
deposits increase the friability of the arterial coats, so also do they frequently
give rise to the bursting of arteries, as well as to aneurysm.

(2) INIany writers not quite correctly call this a steatomatou!?, or atheromatous
mass.

(3) The cylindrical ossification of arteries is certainly much more rare than
the scattered or scale-like ; it is, however, by no means so rare as many writers
have supposed. I have no inconsiderable number of such arteries of a middling
and small size, forming bony tubes nearly a foot long, viz. the femoral artery, the
anterior and posterior tibial, the radial, ulnar, &c. I have not found it in the
aorta, although it is sometimes so stift'that it prevents flexion of the body.

(4) The distinction between bony concretion and ossification assumed by
Cruveilheir and IVedemeycr, and following them also by Spitta, m Die Leichcnoff'-
nung in bezug auf Pathologic und Diagnostik, Stendal, 1826, p. 242, is, as is
generally the case, so also liere, on account of the thinness of tlie membranes,
doubly difficult to make out. Itajjpears to me that the original deposition of lime
never takes place in tlie membrane itself, but in the thin layer of cellular tissue
situated on the outside of the serous coat, in which, as in all similar membranes,
there is a very large network of blood-vessels. As the bony scales become
thicker, the subjacent serous membrane is torn, stretched, and at last is entirely de-
stroyed by erosion. The same also aj)i)ears to occur on the external surface with
reference to the muscular coat, the fibres of which are pressed by the bony mass
intruding between them in form of little corns or transverse fibres, are se])arated
from each other, and at last completely wasted ; but they never are actually con-
verted into bone any more tlian other muscles. If the bony scales become still
thicker, the cellular coat itself is rendered atrophic. An actual conversion of

Sect. XIX.] Of the Arteries, SSS

the arterial coats into bone, therefore, according; to my opinion, never occurs.
Oftentimes there are also produced upon the interior of the bony scales already
deposited little deposits, somewhat dittering in colour, more transparent and very
brittle, almost crystaline, the chemical analysis of which is still to be desired.

(5) This in many instances is the cause of gangraena senilis. Compare Kul-
mus.—Morgagni, Epist. LV. 26.—Cowper, Vol. XXII. p. 1195, and Vol. XXIV.
p. 1970. — Naish, ib. Yol XXXI. p. 226. — Ross ignolhj in Journ. de M^dec.
Vol. IX. p. 307 .—Sfeigerthal in Phil. Transact., No. 367 and 369.— w. Mohren-
heim Beitrage zur prakt. Arzneik. Vol. II. p. 214. — Charitius Pr. de arteria crurali
ossea, per oedema, gangraenamque siccam letali. Viteb. 1798. — Thomson^ Lectures
on Inflammation, 1813, p. 537. — Hodgson, p. 41. — Cnweilheir Essai sur I'Anat.
pathol. Vol. II. p. 57. — James, Observation, &c. on Inflammation. Lond. 1821. —
A. Cooper, Lectures, Vol. I. p. 240.

(6) Cowper, No. 299, (in a man of thirty years.) — Bohmer Observ. anat. rarior.
Fasc. I. Praef. p. ix. — Penada Saggiodi Osservaz. Vol. II. p. 22. Padova, 1800. —
Por^aZCoursd' Anat. medic. Vol. III. p. 133, p. 63. — Scarpa. — Fowwg- found the tem-
poral artery of a child, fifteen months old, completely converted into a calcareous
cylinder, v. Hodgson, p. 23. — I once found incipient ossification of the aorta in a
girl of seventeen, v. Selt. Beob. II. p. 66, No. 29.; also a few times ossification
of' the cerebral arteries in people about thirty years old. On the semilunar valves
of the aorta, and in the ductus arteriosus Botalli, ossification occurs not un-
frequently in young persons.

(7) As for instance, Cowper, p. 1970, supposed. According to Baillie. v. Transact,
of a Soc. for the improvement of Med. and Surg. Knowledge, Vol. I. p. 133, it
is in persons of sixty years old more frequent than the healthy state ; and accor-
ding to Bichat, Anat. gen. Vol. II. in every ten persons of sixty years it occurs
in at least seven of them ; according to Lohstein also it is very common in this
class of people. The use of wine, cider and other strong liquors, may in
England and France render the deposition of lime in the arteries proportionally
miore frequent, as it is well known that lithiasis is more common in those countries.
Here, in Silesia, ossification of the arteries is much less frequent, according to
the reports ; even in the West Indies it is said to be still more rare. v. Stevens in
Med. chir. Trans. Vol. V. p. 34. — In persons who have been subject of syphilis,
and are filled with mercury, in gouty people, in those subject to piles, in wine
and brandy drinkers, in gourmands, &c. I find it most common. On the con-
trary I miss it in a great number of very aged persons entirely free from
dyscracies ; so also we hardly ever find it in very old animals. — In many instances
the disposition seems to be hereditary, v. Testa Delle Malattie del cuoro, &c.
3 vols. 8vo. Napoli, 1826; and Kreysig Die Krankheiten des Herzens, Vol. II.
Part I. p. 346. These ossifications do not appear to me to be a mere sign of
deficient vital activity in old age. Their increase also, as Hodgson, p. 23, has justly
observed, is not in proportion to the increase of age ; and, as far as we can add,
as little in morbid disposition of the body to other ossification. It appears to me
much rather the consequence of a peculiar irritation, partly dependent on cli-
mate, partly on dyscracy, originating in climate and mode of living, and the so
frequent creeping inflammation of the serous coat of the arteries.

(8) Bichat improperly denies the existence of ossification in it ; in the blue
disease, however, the deposition of cartilage and lime in the valves of the pul-
monary artery is not unfrequent ; other instances also are given by Riolan and
Vesling. v. Cruveilhier Essai sur I'Anat. pathol. Vol. II. p. 53. — Chomel in Mem.
de Paris, 1707, Hist. p. 26. — Burnet D. de polyposis concretionibus varior. in
pectore morbor. causis. Altd. 1729. — Pohl D. de ossificatione vasor praeterna-
turali. Lips. 1774. — Sandif art Ohserw. anat. pathol. L. I. p. 22. — v. Mohrenheim
Beitrage zur prakt. Arzneik. u. s. w. Vol. II. p. 215. — StoU Ratio Medendi.
Vol. I. p. 200. — Lohstein, No. 434, in Strasburg Museum. — An instance of this
in a young woman who died of consumption, I saw in the Anat. Museum at
Freyburg. — A case in an ox. v. Grimm in Eph. Nat. Cur. Dec. II. Ann. III.
Obs. 38, p. 108.

(9) Grimm in Misc. Acad. Nat. Cur. 1684, Dec. II. Ann. III. p. 108, (in oxen.)
— In the collection of some Veterinary School, I remember having seen slight

oS4f Of the Arteries. [Part II.

ossification on the aorta of horses ; on the coeliac and anterior mesenteric arteries
however they occur principally in the horse. — I once saw in an old monkey
which died of tubercles, yellow earthy spots on the aorta, and in an old otter a
large, prominent, hard pointed bony concretion on the same artery, v. my
Verzeichniss, No. 3957.

§203.

To the most rare vices of texture which have been observed
in the arteries, belong the fungous loosening of their in-
ternal COAT, and the various irregularities and growths
which project into the cavity of the vessels.* If cancer and
medullary sarcom of neighbouring parts approach large arteries,
these also as well as other structures are affected, and then
exhibit tumours of various sizes, especially in their cellular
coat.- The latter is also the especial seat of encysted
tumours,* scrofulous swellings,* and tubercles con-
taining WORMS,^ which in rare instances have been found in
men and brutes. Finally, the arteries also sometimes exhibit
anomalies in respect to their contents, as in many diseases
they, though naturally found empty, contain a considerable
quantity of blood ^ even in their larger trunks, or lymph in a
fluid or coagulated state ;^ in rare cases even worms,^ and loose
stony concretions.^

(1) It is often very difficult to make out what the ancients meant by excres-
cences, tubercles, and pustules; they are in reality the deposits of lime already
mentioned in the last section ; for instance, Morgagnl, Epist. XI. 15 ; XVIII. 8;
XXVII. 28; LXIV. 5 ; but in other cases they appear to be true thicken-
ings and growths from the internal coat ; to w^it, Epist. XXVI. 17 ; XLIV. 3. —
I liavc myself found several times the internal coat loose and fungous-like, in
other instances thick, fleshy, knotty, and hardish. v. also Hodgson^ Sect. IV.
p. 23. — Adelmann found a spot on the interior of the pulmonary artery, thickly
studded with some firmly attached growths of a bluish green colour, and the size
of peas, consisting of a viscid jelly, v. Harles Rhein Jahrb. der Medic, und
Chir. Vol. I. p. 177. — Yellohj found the arteria innominata, the left carotid and
subclavian arteries very much narrowed by growths from their internal coat. v.
Med. chir. Trans. Vol. XII. Part II. p. 5()5, with an engraving. — Hodgson,
p. 18, case third, mentions a growth on the femoral artery, and compares it to
the growths on the valves of the heart ; but it appears to me nothing more than
inflammatory exudation. What was the nature of the pedunculated growth
which Cruickshank found at the origin of the pulmonary artery, and whether it
was situated within or without, I cannot mention, as I cannot find the place. —
V. Soemmer ring's additions to Baillie's Morbid Anat. p. 10, note 35. — Recaimer
once found in the subclavian a polypous-like concretion, with a firmly attached
extremity, v. Laennec De I'auscultation mediate. Vol. II. p. 353.

(2) I have sometimes observed this on the aorta. — In a case mentioned by
Fabriz Hildanus, the aorta and vena cava were so compressed by a scirrhous
tumour that gangrene of the foot took place, v. Saml. Cooper.

(3) For instance, in the coats of the aorta, v. Stenzel D. de steatomatibus in
aorta repertis. Viteb. 1723, and in [Jailer's D. ad morb. hist, et curat, facient.
Vol. II. — Donald Monro in Med. Essays and Observ. Vol. II. Art. 16, p. 237. —
Sand/fort Mus. Anat. Vol. I. No. 11, p. 212. — lieauchene in Bulletin de la Soc.
de M<^'d. App. to the Journ. de Medec. contin. Vol. XI. p. 225. — Corvisart Essai
s\ir les maladies du Cujur, 1806, p. 314. — Two examples of encysted tumours,
as big as walnuts and oranges, 1 saw tipon the aorta of a horse in 'i • Vete-

Sect. XIX.] Of the Veins. S^lj

rinary School at Munich. — Sometimes encysted and other tumours lying close
upon large arteries are mistaken for aneurysms, by the pulsation which they
exhibit. I have seen two such cases, one on the neck and the other on the
thigh. — A similar case is described by Taharrani Observ. Anat. v. Haller's Bibl.
chir. Vol. II. p. 249.

(4) I have occasionally seen scrofulous swellings so close to the carotid and
aorta, that it was impossible to remove them without injury to the external coat
of the vessel. — Perhaps hereto belong the tubercles observed by Sandifort,
Observ. anat. L. IV. Cap. X. p. 109; and Mus. anat. Vol. I. No. IX. p. 242.

(5) viz. On the anterior mesenteric artery of the horse and ass; on the aorta
of a dog. V. ilfor^ffgwe Epist. anatom. Epist. IX. Art. 44 — 4G. Patav. 1764.

(6) The notion that the arteries in death are always emptied of their blood is
incorrect ; it is by no means uncommon to find a large quantity of blood in
them. — 1 have most frequently observed this in persons who have been hanged,
killed by drinking, by fire-damp, after inflammatory and eruptive diseases, in
ossified arteries, and in many corpses, in which I could find no sufficient cause.
Also in hydrophobia and epilepsy, I have found a tolerable quantity of blood in
the arteries.

(7) On these coagula or false polypus, compare § 184. — Also Palin and Knips
Makoppe Epistola de Aortae polypo. 8vo. Brixse, 1731.

(8) Compare § 196, note 16. — Perhaps the bloody mass, in which Rodman
found five living ascarides, (?) was a popliteal aneurysm, v. Edinburgh medic,
and surg. Journ. 1814, Vol. X. Part XXXVII. No. 6; in the pulmonary artery
of the delphinus phocaena, the strongylus inflexus, Rud. has been found some-
times singly, at other times in great numbers. — I found the same in the year
1818, in some porpoises which I dissected at Edinburgh. — They have also been
found by W. Vrolik. v. Bijdragen tot de natuurkundige Wetenschappen, ver-
sameld door raw i/aZ/, W. Irolik en Mulder. 8vo. Deel I. No. 1, p. 77. Amsterd.
1826; and v. Baer, v. Nov. Acta Acad. Nat. Cur. Vol. XIII. Part II. p. 560,
note.

(9) In the Anat. Mus. of the Surgical Academy at Copenhagen, I found a
round stone, as lar^e as a pea, which, according to the account given, was from
the spermatic artery ; probably it is a venous stone. — Eight loose stony concre-
tions have, however, been found in an aneurysmal sac. v. Biermayer Mus. anat.
pathol. p. 101, No. 360, the largest of which is as big as a plum.

Fourth Chapter.
Of the Veins.

§ 204.

The VEINS ^ are said to be completely and entirely wanting
in some monsters ; ^ but generally they exist, even when there
is neither heart nor arteries, in which case the umbilical vein
serving the purpose of an artery divides, and carries the blood
directly to all parts of the body, or a kind of vena cava is
formed, or finally, it goes at once into the principal artery.^'
We not unfrequently observe numerous variations in the veins
as to their origin and course.* The following are the most
important : the coronary vein of the heart opens in the left
instead of the right auricle, either alone,^ or together with the

SS6 Of the Veins, [Part II.

pulmonary artery,*^ and in one instance into the left subclavian
vein ;^ the lesser coronary vein sometimes at once sinks into the
right auricle.^ In imperfect formation of the heart, there arises

BUT ONE INDIVIDUAL DISTINCT VEIN FOR THE W^HOLE BODY/

or the veins of the body and of the lungs already divided spring
from one and the same auricle ; ^^ both vencB cavce are
UNITED INTO A SINGLE VENOUS TRUNK from the right auricle ;^^
the vence cavce, with normal position of the great arteries
of the heart, sink into the left auricle, whilst the pulmonary
veins, on the contrary, proceed to the right. ^^ Several times
has the superior vena cava been found double, whilst
the left jugular and subclavian veins united into a single left
trunk, which commonly proceeded around the base of the
heart in the course of the great coronary vein to the right
auricle, ^^ or in rare cases to the left auricle,^^ or still more
rarely terminated in some other unusual place. '^ The single
BRANCHES of the superioT vena cava, especially the smaller,
as the pericardial, the thymic,^" bronchial, thyroideal, and
superficial veins of the neck, &c. are subject to very nu-
merous variations in their origin and course. The hemi-
azygous vein is sometimes wanting ; ^^ it and the azygous
are double, terminate in the coronary,^® in the vena innomi-
nata,^'^ and oftener in the jugular and subclavian veins of
both sides. ^^ The superficial jugular vein varies very
much, sometimes it is so large that it gives off the greater
number of the superficial veins of the face and skull, and
forms two or more large trunks on the neck ; ^^ the deep
JUGULAR VEIN somctimcs divides itself very early into its two
larger branches ; ^^ the vertebral veins are deficient,^^ or on
the contrary, they are seen double;^* the sinuses of the brain
also, in rare instances, vary from what is regular." Of the
VEINS OF the arm, the subclavian has been once seen double ;^°
the cephalic vein is not unfrequently entirely deficient or ter-
minates at the lower edge of the deltoid muscle ;^^ the median
vein also varies uncommonly, inasmuch as it is not unfre-
quently wanting, is double, and variously connected with the
cephalic and basilic.^* The inferior vena cava has been
several times observed very irregular in reference to its origin
and course ; it sprung, for example, out of the left auricle,^''' or
from the superior vena cava, whilst it took in its further course,
the unusual direction of the azygous and hemiazygous veins f°
or it did not receive the hepatic veins, so that these entered as
a distinct venous trunk into the heart :^^ it was also double or
divided ujmsually high up, '^ its position has also been observed
reversed.^^ Of the branches of the inferior vena cava,

Sect. XIX.] Of the Veins, 337

the emulgent, the capsular, spermatic and pelvic veins, vary
considerably in their origin and number ; the deep veins of
THE LOWER LIMBS are tolerably constant, though the femoral
vein, like the artery, divides sometimes higher, sometimes
lower, and the veins of the leg vary in a similar manner to the
arteries of the same part. The superficial veins of the
lower extremities vary much more commonly; thus, for instance,
the great saphenous vein perforates the femoral sheath at very
different parts, in many instances it is lost in a net-work with-
out forming a trunk, in other instances it forms two distinct
parallel trunks, it also supplies the place of the lesser saphenous,
when, in rare instances, that vessel forms no peculiar trunk,
which sinks into the ham.^* The veins on the foot in which we
bleed are as little determinate in their position and connexion,
as those on the back of the hand, but are subject to many varie-
ties. The PULMONARY VEINS are sometimes branches of the
superior vena cava^^ or arise from the right auricle,^^ or vary in
number, so that they are all connected to one trunk,^^ or merely
on one or both sides to one common trunk ;"^ also five, six, and
even seven pulmonary veins occur,^^ I once found a semilunar
valve at the opening of a pulmonary vein.**^ In headless
monsters the portal vein is always entirely wanting, and the
veins which it usually forms then arise either from the vena
cava, or the umbilical vein ; in rare cases the portal vein does
not terminate in the liver but in the inferior cava}^ The
umbilical vein also sometimes exhibits varieties, thus, for
instance, it is manifold ; ^"^ or it enters the liver at an unusual
part;^^ or it sinks into the vena cava,^^ into one of the
mesenteric veins or into the splenic ; *" sometimes even directly
into the heart.**^ In one instance it connected itself with a
remarkable branch springing out of the right iliac vein.*'
Sometimes it remains open and carrying blood, for a long
time after birth, even in adults.*^ The ductus venosus arantii
is sometimes entirely wanting;*^ the vena omphalo mesaraica
was, in one adult, found open and containing blood. ^^

(1) Compare several of the writers quoted on the arteries at § 185. — de Haller
Pr. de aortse venseque cavae gravioribus quibusdam morbis observationes. Goett.
1749. — Delius Pr. de vena cava plena malorum. Erlang. 1751. — Puchelt Das Ve-
nensystem in seinen krankhaften Verhaltnissen dargestellt. 8vo. Leipz. 1818. —
Gurlt D. anat. pathol. de venarum deformitatibus adnexo vitii rarioris venae cavse
inferioris exemplo. 4to. Vratisl. 1819, with iithogr. plates. — Breschet Recherches
anat. physiol. et pathologiques sur le systeme veineux et specialement sur les
eanaux des Os. Liv. I. p. 6. fol. Paris, 1828-29, with plates. — Stahl D. de vena
portae, porta malorum hypochondriacorum. Halae, 1698. — de Berlholdi D. pri-
mse lineae morborum venae portae. Viennae, 1777.

(2) Schelhammer in Ephem. Acad. Nat. Cur. Dec. II. Ann. IX. 1690, p. 253, ff. ;
and Winslow in Mem. de i'Acad. des Sc. 1740, p. 817, IF. (both in acephalous
monsters.) — Marrigues v. M6m. de Mathem. pr^s. a I'Acad. des Sc. Vol. IV.

Z

338 Of the Veins. [Part II.

p. 123, ff. ; and Sammliingen medicin. Gutachten. Leipz. 1776, p. 276, ff, (in chil-
dren without hearts.)

(3) Compare J. F. Meckel Handb. der pathol. Anatomic, Vol. I. p. 162, ff. —
Tiedemann Anatomie der kopflosen Missgeburten. fol. Landshut, 1813, § 75,
p. 96, ff. — Elben D. de acephalis s. monstris corde carentibus. 4to. Berol. 1821,
p. 108, ff.

(4) J. F. Meckel, Ueber den Verlauf der Arterien und Venen, in his Deutschen
Archiv f. d. Physiologie, Vol. I. p. 285, ff., endeavours to make out the rarity of
venous in comparison with arterial variety ; but I cannot agree with this opinion,
as the number and difference of the varieties are really much greater than are there
mentioned, and the comparison of the variation of the vessels arising from the
aorta, No. 4 — 19, with the single duplication of the superior vena cava, does not
appear to me quite correct, as the branches which arise from the venae innomi-
natae, and the commencement of the thyroideal and subclavian veins, certainly
do not vary less frequently than the arteries which have been named. But as to
the middle and smaller veins, especially the cutaneous, these run into an endless
variety, so that I can boldly assert, of the superior thyroideal, the veins at
the bend of the elbow, and on the back of the hand, they are never, even in a
single person, the same on both sides in the same individual. Two super-
numerary venous trunks (which?) are described hy Meniere s, in Archiv. gener.
de Medec. Vol. XL March, 1826.

(5) .7. F. Meckel Handbuch der Menschl. Anat. Vol. III. p. 67.

(6) Lemaire in Bulletin des Sc. med. 1810, Vol.V. ; there opened two coronary
veins into the pulmonary artery ; in another case, the large coronary vein was
entirely deficient, the middle opened in the left superior cava, and a third, com-
ing from the under part of the heart, terminated in the right auricle, by one
of the thebesian openings, v. Murray, in Svenska Vetensk. Academiens nya.
Handlingar, 1781, Part IV. p. 282.

(7) Le Cat in M^moires de I'Acad. des Sc. 1738, Hist. p. 62.

(8) I found this twice. Murray once saw, in deficiency of the great coronary
vein, a coronary vein open immediately in its stead; v. A. Murray in Svenska
Vetensk. Academ. nya. Handl. 1781, p. 282.

(9) For instance, Roederer in Comm. Soc. Gotting. Vol. VI. p. 125. — Mayer
in V. Graefe and v. JValther's Journal d. Chir. Vol. X. p. 44, ff. — Cerutti
Rarior. monstri, in museo anat. Lipsiensi adservati, descriptio anat. 4to. Lips.
1827.

(10) Standert in Philos. Transact. 1805, Part II. p. 22%.— Meckel Handb. d.
pathol. Anatomie, Vol. II. 1, p. 52, (in a doiible monster.) — Farre Pathol.
Researches, Essay I. Malformations of the human heart, p. 2, Lond. 1814. —
Fleischmann Leichenbffnungen, p. 197. — Maiiran in Philadelphia Journal, Vol.
XIV. p. 253.

(11) Wichert Descript. monstri duplicati. 8vo. Dorpat, 1824, p. 25 and 27.

(12) I observed this in a double human monster, No. 8014 of Bresl. Mus. yet
to be described.

(13) Bartholinus Histor. 84, Cent. II. — Theitne praes. Boehmer D. de con-
fluxu trium cavarum in dextro cordis atrio. 4to. Halae, 1763, with plates; and
Boehmer Observat. anat. rarior. Fasc. I. Praef. p. xii. — A. Murray. — J. F. Meckel,
four cases, v. Handb. der pathol. Anat. Vol. 11. 1. p. 125. — Tabulae anat. pathol.
Fasc. II. tab. 10, fig. 6 and 7; and Archiv f. d. Physiol. Vol. IV. p. 479.—
B6clard in Leroux Journ. de Medecine, Vol. XXXVI. p. 115. — Weese D. de
cordis ectopia. Berol. 1819. p. 30. tab. 6. — Kustner in Bereicherungcn fiir d.
Geburtshiilfe, etc. by Choulant, Ilaase, Kustuer, and Meissner, Vol. I. p. 50,
(this is the same case described by Weese.) — Bock in CerutlVs Pathol, anat. Mus.
Vol. I. Part III. p. 50. — Myself in three instances, v. My Selt. Beob. Vol. 11. j). (id;
and Verzeichniss, No. 2874. — Ilesselhach Beschreibung der pathol. Priiparate
zu Wiirzburg, p. 229. — Wirtensohn D. duor. monstror. duplicium humanor.
(lescri})t. anat. p. 22. 4to. Berol. 1825, — Wehrde D. anat. pathol. de monstro
rariore humano. p. 11. 8vo. Halae, 1826. — Breschet Recherches anat. physiol. et
pathol. sur le Systeme veineux, etc. L. I. p. 2. Paris, 1827.

(14) Breschet in Hc'])ertoirc general d'anat. ct de ))hysio!. ])athol. Vol. 11.

S ECT. X I X .] Of the Veins. 339

p. 12 ; in another case, in the left side of the single auricle, p. 17. — Barhow
Monstra animalium duplicia. Vol. I. p. 16. 4to. Lipsiae, 1828.

(15) For instance, in the right auricle, close to the right upper vena cava. —
V. Hesse D. Monstri bicipitis descriptio anatomica, p. 21, tab. 2. 8vo. Berol.
1823. In another case, both the superior venae cavae joined each other very
shortly before their entrance into the right auricle, but had there two distinct
orifices. — Rosenthal Abhandl. aus dem Gebiete der anatomie, physiologic, und
pathologic, Berlin, 1824, p. 150; or in the inferior vena cava. v. Niemeyer Tt.
singularis in foetu puellari recens editio abnormitatis exemplura. p. 7, 4to.
Halse, 1814.

(16) One thymic vein, as large as a writing- quill, sunk at once into the right
auricle of a child affected with the blue disease, v. Marechal in Journ. general de
medecine. Vol. LXIX. p. 354.

(17) Sommerrivg Vom Bau des menschlichen Korpers. 2d edition. Vol. IV.
p. 470.

(18) Compare Holler Elem. physiol. Vol. III. sect. I, p. 107; and Wrisherg
Observationes anatomicae de vena azyga duplici aliisque hujus venae varietatibus.
Goett. 1778, rev. in Sylloge Diss. p. 127.— I, as well as many others, have
several times found both veins entirely or partially double ; the latter is also
engraved by Mascagni in Vasor. lymphat. c. h. historia et ichnographia, Senis,
1787, pi. 19.

(19) Sylvius Vesani calumniarum depulsio XVII. iu Op. p. 144. — Le Cat
in Memoires de Paris, 1738, Hist. p. 62, (with one branch in the right and the
other in the left auricle.) — Sommerr'mg p. 469 ; the hemiazyga in a cat, in the left
auricle, v. Barkow, Vol. I. p. 115.

(20) The vena azygos in the right subclavian, v. Wrisberg, (by a canal in the
upper lobe of the right lung.) — Breschet, p. 12, ff. 16. I once observed a similar
case in a man. The vena azygos very rarely terminates in the lower vena cava,
within the pericardium, v. Soemmerring, p. 474 ; or in the upper cava, v. Cheselden,
in Phil. Trans. Vol. XXVIIl. No. 337; or in the right vena innominata, v.
Wrisherg, p. 136, and J.F, Meckel Handbuch der menschl. anat. Vol. III. p. 350.
More frequently the vena hemiazyga, instead of going into the vena azygos, empties
itself through the left superior intercostal vein, into the left subclavian, which I
have seen several times, as also have Wrisherg, Fleischmann Leichenoffnungen,
p. 228 ; /. F. Meckel, p. 350. In some of these instances, the vena hemiazyga
has also terminated in the azyga ; the hemiazyga sometimes terminates in the
thyroideal vein. v. Cerutti Beschreibung der Pathol, praparate zu Leipzig, No.
765 and 766. I have also once seen it terminate in the azygous and the left sub-
clavian, at the same time ; in one case, in which the inferior cava extended up-
wards, the hemiazyga terminated in the left vena innominata. v. Wistar.

(21) Lauth Spicilegiura de vena cava superiore, p. 47. 4to. Argentor, 1815.

(22) Cohimhus De re anat. L. XV. p. 487, found it double ; I have seen it a
few times divided below the larynx ; Cerutti observed the same. No. 764^

(23) At the same time in monsters with deficient brain and cleft spine, v. Rossi
in Memoires de Turin, 1800, Vol. VI. p. 18.

(24) Sandifort in Obs. anat. pathol. L. IV. cap. 8, p. 98.

(25) It is said that in one case, one sinus transversus was deficient, v. Lieu-
taud Essai anatomique, p. 385, and one sinus cavernosus. v. Santorinus Observat.
anat. p. 72 ; more frequently the smaller is deficient, or double, even the sinus
falciforrais major has been observed in part double, v. Halhr Elem. physiol.
Vol. IV. p. 147 ; and Vicq d'Azyr, tab. 32. — A remarkable sinus on each side,
from the sinus transversus passing over the petrous bone, and through the
middle cavity of the skull into the orbit, was seen hy Kelch, Beitrage zur pathol.
Anatomie, Berlin, 1813, p. 80, No. 56. — I once found the transverse sinus con-
nected, by an unnatural large hole in the skull, with the external cranial veins,
almost as is regularly the case with mammalia, v. My Selt. Beob. Part II.
p. 69, No. 31, 6.

(26) Morgagni, Epist. LXIX. 2.

(27) In almost every winter, I have seen once or twice the cephalic vein
wanting from the shoulder to the elbow.

Z 2

340 Of the Veins, [Part II-

(28) Sometimes a large venous trunk passes from the median vein between
the cephalic and basilic, some way upwards towards the shoulder, in one or
other or in both of which it terminates.

(29) Ring in Med. and Physic. Journ. Vol. XIII. p. 120. — Lcmaire in Bul-
letin des Scienc. medic. Vol. V. 1810. — Breschet, p. 20, (it passed into the
belly on the left side of the aorta.)

(30) Cheselden in Philos. transact. Vol. XXVIII. No. 337.— £. Wistar, A.
system of anatomy, for the use of students of medicine. Philadelphia, 1811-14.
Vol. II. p. 320. — I saw a similar instance at Professor Jeffray's, at Glasgow,
and myself found a third case. v. Gurlt. p. 20, with a plate, my Selt. Beob.
Part II. p. 67 ; and Verzeichniss, No. 2048. — Herhohlt in Abhandlungen der
k. Akademie zu Kopenhagen, 1818; and in two unpublished plates, very kindly
presented to me, the inferior cava passes from the right side, in spite of the
convolutions of the intestines, and terminates above in the superior cava, which
lies on the leftside. — Weber in Rust's Magazin f. d. ges. Heilk. Vol. XIV. p. 536.
Here, perhaps, belongs also a case of unusual arrangement in the ascending
cava, and the external jugular veins, by W. Horner, in Journ. of the Acad, of
^natural Sciences of Philadelphia. Vol. I. P. II. p. 407, with engravings.

(31) Rothe in Abhandl. der Joseph. Akademie, Vol. I. p. 265, pi. 4, (in
the upper part of the right ventricle, in which there were three valves), re-en-
graved in Meek f I, Tab. anat. pathol. Vol. X. fig. 9 and 10. — Bresehet, p. 14 and
20, (in the first case, the hepatic vein terminated in the left, in the second, in
the right auricle ; an approximation to this formation is, when the hepatic
veins perforate the diaphragm, and empty themselves above it into the inferior
cava.) V. Morgagni V. 0, 9 ; LX. 6. — Huher Observat. aliquot anat. p. 24, Cassell,
1760, rev. in Sandiforf s Thesaur. Vol. I. p. 306. — In the case mentioned in the
preceding note, the hepatic vein passed as a narrow trunk to the right auricle ;
and in the case mentioned by Wistar, as two trunks ; in the cases related by
Weber, however, it was connected with the inferior cava by an unusual branch ;
— in the instances given by Herhohlt, it proceeded in spite of the convolutions
of the intestines into the right atrium.

(32) Petsche Sylloge observ. anat. rev. in Haller's Diss. anat. Vol. VI. No. 77.
Timmermann De notandis circa naturae humanas machinae lusus, p. 54, Duisb.
1750. — Wilde De vena cava duplici ascendente in Commentar. Acad. Petropol.
Vol. XII. p. 262, with an engraving, which is copied in Meckel's Tab. anat. pathol.
Fasc. II. tab. 10, fig. 8. — Lobstein Compte rendu, etc. Strasburg, 1820, No. 469.
(divided from the kidneys downwards.) — A similar case is described by Zagorsky
in Memoires de I'Acad. imp. des Scienc. de Petersbourg, 1822, Vol. VIII, p. 289.
— Meckel in Anat. physiol. Beobachtungen und Untersuchungen, p. 87, and my
Selt. Beob. Part II. p. 70, No. 31. — In a dog. v. Kerckringii Spicilegium anat.
Obs. 29, tab. 11. — As a first step to division of the inferior cava, we sometimes
observe a thin venous trunk, which passes on the left side of the aorta, springs
from the vena iliaca, and usually terminates in the renal, although also in the
cava itself. Such cases were seen by Morgagni, Epist. XLVII. 30. — Paid De
venar. variet. 1773. — Meckel often, v. Handb. der menschlichen Anat. Vol. III.
p. 358, and myself once.

(33) It passes upwards on the left side of the aorta and just close beneath
the (lia])hragm turns to the liver, v. Morgagni Epist. LVI. 31. — //. L. Fianke
in Der Dresdner Zeitschrift fiir Natur-und Heilkunde. Vol. V. Part II. (tiie
])rcparations are to be found in Anat. Mus. of the Chir. Academy of Dresden.)

(34) Which 1 have sometimes seen.

(35) Wilson in Philos. Trans. 1798, Part II. p. Z^Q.— Meckel Tab. anat. pathol.
Fasc. II. tab. 9, fig. 2, (the superior right.) — Breschet, p. 13, (from the double
su})ori()r cava.) — An anastomosis between the su)>erior cava and superior right
pulmonary vein was seen by Winslow in Memoir de I'Academ. R. des Scienc.
1739, p. 113.

(36) yVeese D. de cordis ectopia, p. 29. Berol. 1819, (the right superior.) —
Breschet p. 20, (the right pulmonary vein.)

(37) Lemaire in Hullctin des Sc. medical. \'ol. V. 1820. — Wichert Descriptio
jnousiri cUqjlicali, p. 25. 8vo. Dorpati, 1824.

Sect. XIX.] Of the Veins. S\\

(38) From each lung only one vein was seen to come, by Haller De corp. hum.
part.fabrica.Vol.il. p. 12:31. — Sandifort Observ. anat. pathol. L. IV. cap. 8.
p. 97. — Portal in Mem. de I'Acad. de Scienc. 1771. Hist. p. I^. — Schuler D. de
morbo coeruleo, p. 12. OEnipont. 1810. — J. F. Meckel Handb. der pathol. Anat.
Vol. II. 1, p.l33. — Rust's Magazin f. d. gesam. Heilk. Vol.XVIII. p. 346.— 5oc/c
in CeruttVs Pathol, anat. Museum, Vol. I. Part III. p. 37, IF. — RamhergD. de
corde vasisque majoribus, etc. p. 21. 8vo. Berol. 1824, if. — Myself in a double
monster of a sheep with one heart, v. No. 8020 Bresl, Mus. — Sometimes the
pulmonary veins were connected only on one side in a single trunk, v. Loseke
Obs. anat. chir. med. p. 26. Berol. 1754, (left.) — Sandifort, Lib. III. cap. 1. p. 18,
tab. 6, fig. 4, (left.) — Pohl Observ. angiol. de venis. Lips. p. 11. — J. F. Meckel,
(left.) — Nasse LeichenolFnungen, Ite Reihe, p. 1661. — Delmas in Ephem. medi-
cales de Montpellier, Vol. I. Jan. 1826, (only one right.)

(39) I have several times seen five pulmonary veins, and always three on the
right side ; the same was seen hy Meckel in Mem. de Berlin, 1750, p. 167. — Haller
De Corp. hum. fabr. Vol. II. p. 123. — Portal in Mem. de I'Acad, des Sc. de
Paris, 1771, Hist. p. 74. — /. F. Meckel Handb. der menschl. Anatomic, Vol. III.
p. 370, (in two cases, three pulmonary veins on the right, and, in one instance,
the same on the left. — Six pulmonary veins, of which four were on one side, were
found by Sandifort L. III. 41. IV. 97 ; seven described by Mailer D. exh. syllo-
gen observation, quarund. anatom. Giessae, 1760. v. Foigtel Handb. der pathol.
Anatom. Vol. I. p. 478.

(40) Kelch Beitriige zur pathol. Anatomic, No. 59, p. 81.

(41) Ahernethy in Pliil. Transact. 1793, P. I. p. 59 ; and in W. Saunders, On
the Liver, p. 59, London, 1793. — Lawrence in Med. chir. Transact. 1814,
Vol, V. p. 174; in one case it perforated the diaphragm, and terminated within
the chest, in the inferior cava. v. Huher Observat. anat, p, 34. — [Vena portae
terminating in the vena cava. v. Wilson, in Med. Gazette, Vol. VIII.
p. 443. T.]

(42) Sandifort L. III. p. 33. — In human double monsters, with only a single
navel-string, two umbilical veins are often found, which, sooner or later, though
not always, become united. In double monsters of cattle and sheep, which
regularly possess two umbilical veins, I have often found three, and even four,
within the navel-string.

(43) I have several times seen, especially in children with cleft abdomen,
large umbilical and frenic rupture, with dislocation of the liver, the umbilical
vein entering at the edge and even on the upper surface of the liver. The latter
has also been observed by Breschet. v. Med. chirur. Transactions, 1818, Vol. IX,
p. 433.

(44) Rosenthal Abhandlungen aus dem Gebiete der Anatomic, Physiologic und,
Pathologic, p. 150, Berlin, 1824, (in a foetus, with umbilical rupture in the
inferior cava.) — Littre in Mem. de I'Acad. des Sc. p. 10, 1709, (it principally
formed the inferior cava, perforated the diaphragm distinct from the hepatic
veins, and terminated in the superior cava.) — Weese, p. 22, one branch from it
into the liver, the other into the superior cava.

(45) By one branch into the liver, by the other into the mesenteric vein, v.
Kerkring Spicil. anat. p. 80, Obs. 37. — In the splenic vein. v. Fingerhuth in
Meckel's Archiv fiir Anat. und Physiologic, 1824, No, 1, p. Ill, (in a calf with
deficient abdominal parietes, pelvis and hinder extremities.)

(46) Above the liver, directly in the right auricle, v. Mende in Nov. Actis
phys, med, Acad, N, C, 1821, Vol, XIII. Part II. p. 869, pi. 46.

(47) Serres. v. Archives generales de Medeeine. Dec. 1823.

(48) Kerkring Spicil. anat. p. 21, Obs. 7. —Haller Elem. Physiol. Vol. VI.
p. 483. — M. Hoffmann in Ephem. Acad. N. C. Cent. IX. and X. p, 443, — Potvei
Treatise on the Bile, — My Selt. Beob. Part II. No. 31, p. 71, and Verzeichniss,
No. 2273, (in a man of fifty years, the umbilical artery also was still open.)

(49) Sommerring Vom Bau des menschlichen Kbrpers. 2d edit. Vol. IV.
p. 485. — Kiistner in his and Choulant's, Hase's, and Meissner's Bereicherungen f.
die Geburtshiilfe, u. s.w. Vol, I. p. 52. — As I have myself examined the just-
mentioned foetus, I can confirm this observation. — I have three times besides

342 Of the Veins. [Part II.

seen the ductus venosus deficient in similar cases ; in which, however, the
umbilical vein entered the liver in unnatural situations.

(50) G. Spangenherg in Meckel's D. Archiv f. die Physiologic, Vol. I. p. 87.

§205.

The SIZE and form of the veins, as might be expected from
the great phancy of their walls, are subject to frequent varia-
tions. There are some individuals, in which, as a congenital
and even hereditary peculiarity, the whole system of blood-
vessels, and thus also the veins, is very narrow. In great
deficiency of blood throughout the body, in the diminished
circulation of wounded, paralytic, and indurated parts, in con-
tinued pressure,^ in amputated limbs, &c. the veins are often
very remarkably narrowed. More frequent, however, the
opposite state, or the unnatural enlargement of the veins,
which is sometimes general, sometimes only local, and espe-
cially caused by frequently recurring congestion in a part, by
the various obstructions to the circulation of the blood, for
instance, vices of the heart and lungs, compression or oblitera-
tion of the greater venous trunks,^ &c. as well as by a state
of too great laxity and torpor of the venous coats. In telan-
giectasy, there is a peculiar degeneration of the blood-vessels
connected also with widening of the smaller veins. ^ If the
diseased extension of the veins be continued, partial, and con-
siderable, we give it the name of burst-veins, blood-knots,
variXf cirsns, phlebeurysma,^ &c. This occurs in women,
especially in pregnancy,^ and more frequently than in men;*^
it occurs sometimes throughout the body,^ but most commonly
in the superficial veins of the lower extremities® and lower
part of the belly, in the female generative organs, in the
spermatic cord, in hemorrhoidal disease on the urinary blad-
der and rectum, and on the venous plexuses of the brain.
Sometimes the varices occur simultaneously on several parts
in the same individual, thus they often form on the vena
saphena a prominent series of swellings ; the form of these
vascular swellings, which are often very large, is usually
that of knots, although in many cases, if the veins are simul-
taneously very much elongated, winding like intestines, and
large lobulated or grape-like tumours, which at first are soft
and easily emptied by pressure, but in time become more solid,
whilst their coats are thickened by inflammation, and their
cavities either entirely or partially filled with fibrous matter.
Varices also occur in brutes, although much more rarely than
in man/'' A peculiar kind of venous swelling is the already
described varix ancurysmus^^" or ancurysnia varicosuniy i\\

Sect. XIX.] Of the Vehis, 343

which the extension of the vein is produced by the influx of
the blood from the adjacent wounded artery.

(1) For instance, by aneurysm, which I have a few times seen on the
superior vena cava, once on the v. subclavia, and a few times on the v. cruralis
and poplitea. — Hunter, v. Med. Obs. and Inquir. Vol. I. p. 333, found the
v. cava superior, subclavia, and thyroidea, extensively compressed by an aneu-
rysm.— Similar cases were observed by Corvisart, Sur les Maladies, &c. du
Coeur. — Bertin Traite des Maladies du Cceur, p. 137. — They are not unfre-
quently compressed by tumours of the lymphatic glands ; this was observed by
Bleuland on the superior cava, v. De difficili aut impedita alimentorum depul-
sione, L. B. 1780, and myself twice on the deep thyroid and crural veins;
lastly, tumours of other kinds, as 1 have myself seen, may occasionally compress
the venous trunks.

(2) I have several times observed this to a great extent in diseases of the
lungs and heart, both in the cavae and their large branches, as well also, as
though more rarely, in the pulmonary veins ; also, in the blue disease, I have
several times noticed great expansion of the veins, v. Pozzis, v. Senac Sur la
structure du Coeur. Vol. II. p, 414, fF. — Haase D. de morbo cceruleo. Lips. 1813. —
The expanded jugular veins in many diseases are seen pulsating strongly. —
Comp. Morgagni, Epis. XVIII. p. 9. — If the cavae, or other large veins, are very
much narrowed, or completely closed, the circulation can be restored by the
expansion of the neighbouring small veins. I have twice found this in great
compression of the inferior cava from tumour of the liver ; and in a third case,
in consequence of closure of the superior cava, the v. azyga, hemiazyga, and
mammarise, remarkably large ; the same occurred in the cases of obliteration of
the inferior cava, to be mentioned further on. Whether the enlargement of the
veins in the neighbourhood of cancerous tumours, medullary sarcoma, osteo-
sarcoma, large aneurysms, &c., arises from pressure on the veins, or from disease
in themselves, I do not venture to decide ; I could, however, almost always refer
it to pressure.

(3) Compare above, § 193.

(4) Mancinus Tract, duo, alter de varicibus, alter de reficiendo naso. 8vo.
Francof. 1586. — Rolfink D. de articulor. doloribus, varicibus, etc. Jense, 1637. —
Seger D. de aneurysmate venarum s. varicibus. Basil, 1661. — Fehr in Misc.
Acad. N. C. 1675 and 1676, p. 55 ; 1699 and 1700, App. p. 162.— Miller D. de
varicibus, Altdorf, 1680. — Stammell D. de tumoribus varicosis. Mogunt. 1789. —
Wedel D. de varice. Jenae, 1699. — Pohl D. de varice interno, morborum quorun-
dam causa. Lips. 1785; and /. Coquari D. de varicibus. 4to. Paris, 1786. —
de Plouquet De phlebeurysmate s. varice. Tubing. 1806. — Graefe's Angiektasie.
Leipzig, 1803. — Brodie in Medico-chir. Transact. Vol. VIII. Part I. p. 195. —
Volpi in Saggio di osservazioni, etc. Vol. II. Phil. 1814. — Delpech Traite des
maladies chirurgicales, Vol. III. — Carmichael in Transactions of the Fellows of
College of Physicians in Ireland, Vol. II. p. 345. — Briquet in Archives generales
de Medecine, Vol. VII. Febr. and March, p. 200 and 396.—/. Csorba D. de
Phlebeurysmate, in specie de haemorrhoidibus. 8vo. Pesth. 1817. — Heisterhergic
D. de varicibus. 4to. Lips. 1824.

(5) Haase and Richter D. de gravidarum varicibus. Lipsiae, 1781. — Birkholz D.
de quibusdam gravidarum varicibus. Lipsiae, 1782. — Liitzelberger D. de sympto-
matibus quibusdam gravidarum praecipue de varicibus atque oedemate pedum.
Jenae, 1791. — Brasse D. de varicibus praesertim gravidarum. 4to. Berol. 1819,
with engravings.

(6) In a man of forty years old and in poor health I saw almost all the cutaneous
veins of one lower extremity exceedingly varicose. I have also several times
seen little varices on the vena saphena of men. — Hodgsoti, p. 542, case 51, de-
scribes large varices on the vena saphena of a man.

(7) Besides the already mentioned parts, I have also seen it sometimes on the
veins of the heart in aneurysm, once in the vena cava, once in the orbit as large as
a hazel-nut, and occasionally in the oesophageal veins, although not very large. — von
Siebold found a considerable varix in the orbit, v. Salzb. Med. chir. Zeitung, 1813,

S44 Of the Veins. [Part II.

Vol. II. p. 199. — Frank observed it on the lips, the palate and the cheek, v. De
cur, horn, niorb. L. V. 2. p. 57. — DzomK Lehrb, der Chir. Halle, 1824, p. 395,
saw one as large as a hen's egg in the jugular vein ; they are very rare on the
arm, although Petit, in Traite des maladies chirurgicales, Vol. II. p. 49, has
described a case.

(8) A very beautiful engraving of varicose veins on the thigh is given by
Alihert in his Nosographie Naturelle, Vol. I. pi. 4. — Ghidella, in NuoviCommen-
tarj di Medicina e di Chir. 1819, Vol. III. Part I. gives a very remarkable
instance of the whole v. saphena varicose, and thicker than one's thumb, with
a varicose tumour in the ham : a varicose expansion of the v. saphena con-
founded at its upper extremity with a rupture, is described by J. L. Petit v.
Diet, des Sc. Medic. Vol. XLIX. p. 573.

(9) I have seen it only in the horse in the jugular vein and on the prepuce ; — ■-
a varix as large as a hen's egg was observed on the transverse sinus of the brain
in a horse, v. Journ. gen. de Medec. p. 285, May, 1821.

(10) Compare § 194.

§206.

The great extension to which varicose veins are subjected
sometimes gives rise to bursting of their swellings.^
Various vices of consistence, however, a ssuppuration and
sloughy softening, and in the healthy state of veins, great con-
gestion of blood, violent muscular exertion, ague, &c. also give
rise to spontaneous rupture, which, however, is more
rare than in arteries.^ If it occur in the small and deep-seated
veins, spots and bloody swellings arise, which latter may,
under some circumstances, be mistaken indeed for aneurysm;'
the bursting of larger veins is naturally sometimes fatal.
Sometimes the umbilical vein again opens itself several days
and even weeks after birth, and causes dangerous and mortal
hemorrhage.^ Not very rarely injuries of veins arise from
mechanical injuries not penetrating, but rather by concussion.^
Wounds of veins,° if they be not mortal from effusion of
blood, are readily healed, not merely by closing of the vessels,
but if the wounds are not large, and especially, if they be
longitudinal, even by adhesion and cicatrization, in which they
differ remarkably from those of arteries.

(1) Sometimes with fatal consequences, v. Commerc. Liter. Noric. 1734,
p. 116. — Morgagni Epist. XXVI. 29, (the vena azygos.) — Michaelis in Richtei's
chir. Bihliotbek, Vol. V. p. 123, (the vena jugularis.) — Portal Cours d'Anat.
medic. Vol. III. p. 354, (the subclavia,) p. 373 (the vena azygos.) — Cline v.
Hodgson, p. 538, (the vuna jugularis interna.) — Jmussal and Mural in Revue
m^dic. fran9 et Strang. 1827, Vol. IV. (the vena saphena); compare //a//rr
Elcm. Physinl. Vol. 1. p. 130, note 9; a fatal rupture of a varicose plexus
pam})iniforinis was seen in a youn^ woman by Pleisdutumn.

{2) Spontaneous ruptures of the v. cava observed by /JrettEus De cans, et
sign, morbor. acut. Lib. II. cap. 8. — Laurentius Hist. anat. h. c. Lib, IX.
t]u. 18. — Ilacqulnct v. Eph. N. C. Dec. I. A. 1. Obs. 101. — Puerarhis ad Ihmiet
Thcs. med. Lib. II L ]). 58. — Laucidns De subitan. mort. Obs. ])hys. anat. 5. — •
Funtoni nd Murjjug/iu7n JCpist. Vlil. — Scnnc, I.icutand. v. Portal; in which he
describes two of his own cases. — Ph. liarlliiirniu.s. v. Misc. Acad. N. C. A. i. I()70,
p. 233, 1()71, A))p. Y.2\.—Schci)c.h Observat. Lib. IIL Part IL Obs. 50, 51.—
S. Nebel, ib. 1695 and 1696, p. 120, — L. Bourgeois Obscrv, sur la sterilite, etc.

Sect. XIX.] 0/ the Veins, 345

Lib. I. p. 221, (the inferior.) — de Haen Ratio Medendi, Vol. IV. Part X. pi. I,
§ 3, p. 391. — Salzmann D. morte subita ex sangiiine in pericardium effuso.
Argentor. 1731. — Douhleday in Med. Observat. by a Soc. of Physic, in London,
Vol. V. p. 144. — L. Lovadina Memorie scient. e letter, dell' Ateneo di Treviso,
1817, Vol. L p. 251 (both cavae in mortification on account of an extraneous body
sticking in the gullet. — Nasse Leichenoffnungen, 1st Reihe, p. 85, (the inferior in
the chest.) — J. Kennedy, On Ruptures of the Vena Cava in London medic.
Repository, Vol. XX. Octob. 1823 (with copious i-eferences and two cases of his
own.) — Dommanget in Journ. gen. de Med. Aout. 1824, (the inferior in the chest.) —
Seymour in Lond. med, and phys. Journ. — Larrey, in the Journ. de la Gi-
ronde, in v. Froriep's Notizen, 1827, No. 365, p. 206, (the inferior,) — the inferior
in a horse, v. Grognier in Correspond, veterin. Vol. II. p. 97 ; and in Journ.
de Medec. contin. Dec. 1810, p. 804. — Spontaneous rupture of the pulmonary
veins was seen by Bellini De morb. pector. and Franc. Queye Disp. de
Syncope, C. III. Prop. 2. — Compare Morgagni Epist. XXVI. 27. — Portal Me-
moir, de Paris, 1784. — Compare Auserl. Abhandl. f. prakt. Aerzte. Vol. XII.
p. 724, (the coronary veins of the heart in aneurysms.) ;V. Berlin Traite des
maladies du Cceur. Paris, 1824, p. 417. — The jugular vein. v. Breslauer
Sammlungen, Aug. 1726, p. 254 : and frequently in horses from Moldavia, Wal-
lachia, Tartary, &c. in summer, as I have several times seen. — On the cheek, v.
Haller, note. — The sinuses of the brain, v. London medic. Repository, Vol. V.
Part I. No. 25, (the sinus longitudinalis.) lb. Vol. X. Dec. 1828, (both trans-
verse sinuses.) — Portal, Observat. sur la nature et la traitement de I'Epilepsie.
Svo. Paris, 1827. — Douglas in Edinb. medic. Essays and Observat. Vol. V. Part
1 1, p. 602, an effusion of blood on the occiput caused death, on account of
its connexion by a hole in the skull with the sinus, v. Flint, in New- England
Journal of Medic, and Surgery, new series. Vol. IV. April, 1820. — The veins of
the arm. v. Haller, note 1. — The vena azygos, de Haen, Ratio Medendi,
Vol. IV. Part X. cap. 1, § 3, p. 391, (in cholic.) — The internal iliac vein in a
pregnant woman, v. IV. Blizard, in London medic. Repository, Vol. I. p. 456. —
The veins of the lower extremities, v. Haller, note p — s. — The vena portae.
V. Schenck Observat. L. III. Part II. No. 51. — Rupture of the veins has also
been seen in cold and inflammatory fever, v. Portal, p. 355. \^Andral, Vol. II.
p. 399, rupture of the abdominal cava of an apparently healthy man, in a scuffle,
and death in a few seconds. T.]

(3) Else, Of tumours formed by ruptured veins, sometimes mistaken for aneu-
rysms, in Lond. medic. Observat. and Inquiries, Vol. III. p. 169.

(4) Panaro/MS latrolog. Pentecost. I. Obs. 7. — Po«^, communicated by ^. Cooper,
in Lond. med. chir. Transact. Vol. XII. Part I. 1822. — Lerche in Petersb.
vetmischten Abhandlungen a. d. Gebiete der Heilk. 1823, 2te Samml. p. 208.

(5) Compare Portal. — Some such cases of the superior cava I have known,
from the accounts of morbid examinations. — Rupture of the inferior cava, from
being run over, was seen by Starke, in Rust's Magaz. f. d. ges Heilk. Vol. V.
Part II. p. 323. — One right pulmonary artery, from being run over, without
fracture of bones, v. Rust, Vol. XX. p. 188. — The vena portae, together with the
aorta, v. Pyl Aufsatze und Beob. aus der gerichtl. Arzneiwiss, Vol. IV. case 7,
and 8. — Many effusions have been observed from rupture of veins. — I once
saw a large bloody tumour arise on the calf of the leg, from rupture of a vein in
consequence of a false step. — Hodgson, p. 520, on the same part, in two cases,
from violent cramp.

(6) Autenrieth De vulneratarum venarum sanatione. Tubingen, 1812. —
Ristelhuher Memoires sur les plaies et les ligatures des Veines in Annales de la
Soc. Med. prat, de Montpellier, Vol. XLIII. p. 416; and in Leroux Journ. de
Medec. Vol. XXXIX. p. 3, May, 1817.

§ 207.

Among the vices of texture occurring in the veins,
INFLAMMATION, i^hlehitts,^ and its consequences are the most

346 Of the Veins. [Part II.

important ; this is by no means a rare disease, it arises not
merely from accidental and intentional mechanical injury, as
contusions, stabs, bleeding,^ amputation, ligature, continued
pressure, &c. ; but also from internal causes, for instance,
gangrene, erysipelas,^ cold, various fevers,* especially the
puerperal, scurvy,^ and particularly also in consequence of
irritation propagated from malignant ulcers in the bones and
soft parts ; inflammation of the veins occurs in the veins of the
pelvis and belly,*^ more frequently than in those of the chest,
the neck, and head.^ Inflamed veins appear, according to the
variation of the degree of inflammation, more or less red,
throughout or in spots, the larger especially on the outer sur-
face of their internal coat, and sometimes also in the cellular
tissue, as it were injected, usually also somewhat loosened,
opake, shrivelled, and thickened, so that, now and then, when
cut through, they exhibit, like the arteries, an orifice which does
not collapse ; in this their coats are more easily torn than in
the healthy state. The most common termination of venous
inflammation, is the effusion of coagulable lymph on
their inner surface, in the shape of more or less tough and
adhering bands, false membranes and plugs, whereby the veins
are in a greater or less degree filled, and often completely
stopped up/ Not unfrequently complete obliteration, obli-
teratio, of the veins is produced by this adhesive inflamma-
tion ;° less frequent is the inflammatory eflusion on the external
surface of veins, whereby they are sometimes closely consoli-
dated with the neighbouring arteries, nerves, and other parts.
Inflammation in veins runs on not unfrequently to suppura-
tion,^" in which we see either mere pus of various composition,
colour, and consistence, secreted into the canal of the vein,
from the loosened and, as it were, villous internal coat, or the
walls of the vein are actually broken up, perforated, and even
entirely destroyed. Inflamed varices also often produce malig-
nant ulcers. The highest degree of venous inflammation not
unfrequently runs into mortification, which is rather com-
municated by the neighbouring parts to the veins, although
in mortified limbs, they as well as the arteries are often found
tolerably healthy ; hemorrhage does not then easily arise, as the
preceding inflammation has already stopped up and closed the
veins ; and merely the large veins are opened in particular cases
by the sloughing destruction of the neighbouring parts at one
part, and thus fatal hemorrhage ensues. Lastly, there also
probably occurs an inflammatory state which gives rise to the
very rare conversion of the venous coats into cartilage, or
BONE, or to the deposition of lime^' in them.

Sect. XIX.] Of the Veins, 347

(1) Although well known to the older writers, it was only first circumstantially
treated of by the following authors: John Hunter, in Transactions of a Society
for the Improvement of medical and chirurgical Knowledge, Vol. I. p. 18. —
P. Frank De cur. horn. morb. Lib. V. 2. p. QQ. — Ahemethy, Surgical and
Physiological Essays. — Sasse D. de vasor. sanguiferor. inflammatione. Halae,
1797. — Osiander, Neue DenkwUrdigkeiten, Vol. I. p. 57. Goth. 1799. — Longuet
D. sur I'inflammation des veines. 4to. Paris, 1815. — Carmichael, Observations on
Varix and venous inflammations. — Palletta De inflammatione venarum in Ex-
ercit. pathol. I. p. 20; — Dumbred D. de inflammatione venar. Edinb. 1822. —
B. Travers in his and A. Cooper's Essays. — Bunny D. de inflammatione venar.
Edinb. 1823. — Stan. Czarnowski D. inaug. chir. pract. de Phlebitide. 8vo. Vilna,
1823, (with four of his own cases). — Bresrhei in Journ. compl. du Die. des. Sc.
medical. Vol. II. p. 325. — Schwilgu^ Faits pour servir a Thistoire des inflamma-
tions des veines in Biblioth. medic. Vol. XVI. p. 194. — Bouillaud in Revue
medicale franj. et etrangere, 1825, Vol. II. p. 71 — 92 and 418—434. — Ribes
Memoire sur la phlebite, ib. 1825, Vol. III. Part IV. and VI. — Ferd.
GiUtmann D. de Phlebitide s. inflammatione venarum. 8vo. Berol. 1826. —
H. G. Mende D. med. chir., nonnulla de venar. inflammatione, praesertim
phlebotomiam excipiente, 8vo. Dorpat. 1826, (a fatal case after bleeding.) —
Gendriii Considerations sur les causes de la phlebite et observations surl'inflam-
mation des veines encephaliques in Revue medic. 1826, April and May. —
F. A. Balling Zur Venenentzundung. 8vo. Wiirzb. 1829. — Interesting obser-
vations are related by P. Dionis Cours d' operations de chirurgie, p. 680,
(after bleeding.) — Morgagnl, Epist. LVI. 10. — van Swleten Comment, in H. Boer-
haavii Aphorism. II. § 372, p. 628, ff". — Sherwen in Edinb. medic, commentaries,
Vol. IV. p. 206, (after bleeding.) — Herisse in Journ. de med. chir. et pharm.
Vol. XII. p. 417. — Testa Delia malattie del cuore, &c. (on the vena cava and azy-
gos.) — Dav. Dundas in Med. chir. Trans, (the vena cava.) — J.'Russel in Edinb. med.
and surg. Journ. Jan. 1814, (the vena cava.) — Sprengel in Rust's Magazin f. d.
ges. Heik. Vol. VII. p. 475, (after wound of the thumb.) — Erdmann Annales
scholae clinicse medicae Dorpatensis. Annor. 1818-20, (after bleeding and after
amputation.) — Oldknow in Edinb. med. and surg. Journ. Vol. X. p. 175, (from
ligature.) — Hopfengdrtner in Hufeland's Journ. d. prakt. Heilk. Oct. 1820. — Melt
in Annali univers. di medic, comp. dal Omodei. Vol. XVII. and XVIII. Jan. —
June, 1821, (general.) — Fallot in Journ. compl. du Diet, des Scien. med.
Vol. XXXVII. July, 1821, (general inflammation of the vessels.) — Andr. Dun-
can in Transact, of the med. chir. Soc. of Edinb. Vol. I. 1824, p. 439— 454, and
470 — 642. — Velpeau in Archives generales de medecine, Oct. 1824. — Forbes in
Medic, chir. transact. Vol. VIII. p. 293, (the iliac and femoral veins.) — Guthrie
in London med. and phys. journ, July, 1826, (after amputation.) — Cruveilhier
in Nouv. Bibliotheque, May, 1826, (of the lower extremities.) — Monod in Journ.
univers. des Scien. med. June, 1828, (fatal after bleeding.) — Chapmann in Phila-
delphia Journal, No. 14, p. 322, (fatal after bleeding.) — Hinterberger in med. chir.
Zeitung, 1828, p. 31, (of the inferior cava.) — Fricke Annalen des Hamburger
krankenhauses, 1828, with plates. [/. M. Arnott, On the secondary effects of in-
flammation of the veins, in Med. chir. Trans. Vol. XV. Part I. p. 1. — R. Lee
no Phlegmasia Dolens, ib. p. 132. — Ibid. On inflammation of the veins of the
uterus, Vol. XV. Part II. p. 369. Three excellent papers, containing an
immense number of original and selected cases. Of late, the French have
named inflammation of veins Phlebectasie. v. Briquet Essai sur la phle-
bectasie. T.]

(2) I have twice seen, after blood-letting, fatal inflammation of the veins of
the arm, extending up to the superior vena cava ; this is also not unfrequently
the case in the neck of the horse ; in which there is formed, at the part where
the vein has been opened, a hard, roundish swelling, sometimes secreting
lymph, from which a painful, hard cord may be felt, taking the course of the
vein downwards. [^Arnott, in Medico - chirurgical Transactions, Vol. XV.
Part I., mentions several cases of inflamed veins after bleeding; among which,
obliteration of the basilic and median basilic, p. 16 ; of the cephalic, p. 23 ; of the
median basilic, p. 27. He also saw enormous thickening, with increased vascu-

348 Of the Veins. [Part II.

larity in the jugular vein of a horse, p. 48 ; and mentions another instance seen
by Sims, p. 129. T.]

(3) According to Ribes, the erysipelas is especially seated in the extremities
of the veins, which, however, is difficult to determine.

(4) Bouillaitd goes so far as to consider typhus and putrid fever as inflamma-
tion of the veins, which is certainly incorrect; for I have examined during war
time a hundred cases which have died of typhus, and very seldom seen more than
a slight inflammatory state of the veins. Bouillaud incorrectly esteems as in-
flammatory, the red colouring of the veins which occurs in typhus and putrid
fevers, both in men and animals, which his countrymen, Trousseau and Rigot,
had previously noticed in Archiv. Gen. de ]\I6d. Oct. 1826 and July, 1827;
putrefaction, frost, and air, also operate in reddening the veins of dead bodies.

(5) According to Ribes. I think, however, that that was not true inflamma-
tion, but merely red colouring, which I have observed in the few scorbutic cases
I have seen, even in several patches.

(6) In persons with malignant bony caries, long continued ulcers of the legs,
senile erysipelas, &c. I have very often found the crural vein inflamed ; whilst 1
write, I have a few such cases before me. I have also sometimes seen the veins
inflamed, in the neighbourhood of scrofulous tumours running into suppuration ;
in monkeys, which have died of tubercles, and inflammation of the lungs ; and
in a dog, destroyed by distemper, I liave found the pulmonary vein here and there
inflamed. — \_Lawrence saw inflammation and obstruction of the iliac veins in a
man who died of cancer of the rectum. — v. Lee, On inflammation of the veins of
the uterus, Med. chir. Trans. Vol. XV. Part II. p. 431. — Inflammation of the
veins of the lower extremity excited by malignant ulceration of the cervix uteri.
V. W. Lawrence i\Icd. chir. Trans. Vol. XVI. Part I. p. 58. — Inflammation of the
cava ; both common iliac veins and the whole right femoral vein inflamed, thick-
ened and in parts loaded with adventitious membrane in a case of phthisis, v.
T. H. Holberton, ib. p. 63. T.]

(7) Most seldom, as it appears, in the skull ; I have, however, seen two
instances in the longitudinal sinus ; in the former, after injury of the head and
trepanning ; in the second, in a large abscess of the brain. Other cases have
been given by Abernethy, in Edinb. med. and surg. Journal, July, 1818. — Ribes
in Revue Med. July, 1825, p. 36; and Gendrin, Vol. II. p. 31.

(8) Meckel gives good engravings of it, v. Tab. Anat. Path. Fasc. II. tab. 14,
fig. 6 — 8. As inflammation frequently produces obstruction of the veins, so on
the contrary does it arise, not unfrequently, from pressure and stoppage of the
veins ; hence varices often inflame, and it is sometimes difficult to determine
which is the cause, which the consequence, if simultaneously with phlegmatia
alba dolens, or with long continued, great, partial oedema of a part, the principal
vein is impervious, which I have very often found in the legs. D. Davis, in Med.
Chir. Trans. Vol. XII. Part II. p. 419 — 458, with engravings; and in London
Med. Repos. new series, by Copland, Darwall, and Cotwlly, June and July, 1825,
considers the obstruction of tlie veins of the pelvis, as the cause of phlegmasia
alba dolens, in pregnant women ; as Bouillaud considers it the cause of local
dropsy, v. Archiv. Gen. de Med. July, 1823; May and June, 1824. In rare
cases, these coagula in veins become loosened and detached, and give rise to
dangerous consociuences, especially nervous, v. Ribes. — [/i. Lee, On phlegmasia
dolens, Med. ciiir. Trans. \o\. XV. Part I. p. 132, has shewn by numerous cases,
that inflanunation of the iliac and fenu)ral veins unquestionably gives rise to that
disease. And in Part 1 1, same volume, that the inflanunation connnences in the
uterine branches of the hypogastric, and extends to the iliac and femoral
trunks. T.]

(9) Even the v. cava, especially the inferior. — Compare Rhodius Mantissa
anat. Observ. No. 21, p. 15. — Th. Bariholiuus OI)serv. anat. Cent. II. Hist. 35.
— Bontius de Medic. Indor. Observ. p. 251. — Jthinus Annot. acad. L. VII.
c. 9. — Ilalhr in Opuscul. i)aihol. 01)s. 24. — JVinhler de vasor. lithiasi. I. § 6,
note a. — Baillie in Transact, of a Soc. for Iniprov. of med. Knowl. \'o!. I. p. 127,
))l. 5. — Wilson, ib. Vol. III. p. 65. — f'erfel in (^uatriemc l{api»ort des travaux dc
la Soc. d'Agricult. du Doubs, p. 282, (the superior, from pressure of an aneu-

Sect. XIX.] Of the Veins. 349

rysmal aorta.) — CVme in Scarpa, Siill' Aneurysme, p. 15. — MarjoUn in his Diss.
Paris, 1808, (the superior.) — Knape in Hnfeland's J owrn. der prakt. Heilk. 1813.
Vol. XXXVI. Jan. p. 122. — Deckart D. s. descriptionem concretionis venae
cavae superioris una cum ingente aortse ascendentis aneurysmate, etc. 4to.
Berlin, 1823, with plates. He mentions also, p, 4, a case of ohliteration of the
inferior cava to he found in the Berlin Mus. — My Selt. Beob. Part I. p. Q5, (the
superior in an aneurysm.) — The vena anonyma has been seen closed by the
pressure of an aneurysm. y.Pattison in American medic. Recorder. Philad. 1820,
Vol. III. No. 2. — The jugular vein, Haller in Pr. de aortae venseque cavae gravio-
ribus quibusdam morbis observ. Gbtt. 1749, p. 6 ; and in Opusc. pathol. Obs. 23,
tab. 19. — Simpson in Edinburgh medical Essays, Vol. V. p. 337. — G. Young, v.
Hodgson, p. 533. — Lardner in the Edinburgh med. and surg. Journ. 1811,
Vol. VII. Part XXVII. p. 407 (from considerable thickening of the pharynx.)
I have found the left deep jugular vein closed from the pressure of a large
glandular swelling which surrounded it; and the external vein consequently very
much enlarged. — The sinus falciformis has been seen closed from pressure of a
fungus of the dura-mater three fingers broad. — Palleita Exercit. Pathol. Vol. I.
p. 94. — The sinus transversus. v. Abercromhie. — The iliac vein found obliterated,
by Morga<ini, Epist. LVI. 10 ; twice by Hodgson, p. 530 ; myself once in a large
tumour of the ovarium. — Forbes in Medic, chir. Trans. Lond. 1827, Vol. XIII.
Part II. — I have found the femoral vein adherent five times; once in a large
femoral rupture, once in a scrofulous swelling of the lymphatic glands, and three
times in malignant ulceration and oedema of the leg. Tbe smaller veins are not
unfrequently found impervious. — [In phlegmasia dolens, the common iliac vein
with its subdivisions and the upper part of the femoral resembled a ligamentous
cord, and not distinguishable from the surrounding cellular substance, v. R. Lee
in Med. chir. Trans. Vol. XV. Part I. p. 136. — Also in the same volume, the
following are some of the cases mentioned by Arnoti : Obliteration in basilic and
median basilic, after bleeding, p. 16 ; cephalic obliterated after bleeding, p. 23;
median basihc obliterated after bleeding, p. 27. — Obliteration of the left iliac
vein, by pressure of an encephaloid tumour surrounding it, is mentioned by
Reynaud in Journ. hebdom. de Medec. Vol. II. p. 84 ; and at p. 110 he gives a
case of obliteration of the superior vena cava from pressure of an aneurysm. T.]

(10) Superficial suppuration on the internal surface of the veins is not rare;
sometimes, the vein being closed to a greater distance above and below, by adhe-
sive inflammation, a kind of abscess, or long hollow swelling, is produced ; in
other cases the enlarged veins burst by ulceration, and fatal hemorrhage ensues.
V. Portal Cours d'Anatom. Med. Vol. III. p. 354, (the superior cava near the
auricle.) — Cerwif? Beschreib. der pathol. Prapar. eu Leipz. No. 746, (two lenticu-
lar apertures in the inferior cava.) I have once observed fatal effusion of blood
into the intestine from ruptured vena portae. v. My Verzeichn. No. 2559. —
Rupture of the splenic vein, with fatal effusion of blood into the stomach, has
been observed several times ; I saw one instance of it in the Hunterian Museum
in London, and another in Sand/fort's, at Leyden. — Fatal rupture of the gastro-
epiploic vein has been noticed by Ware in New England Journ. of Med. and
Surg, new series. Vol. IV. July, 1820. — One case of rupture of the gluteal vein,
in psoas abscess, v. Rust's Magaz. f. d. ges. Heilk. Vol. I. p. 48.

(11) Bichat, in his Anat, generale et pathologique, improperly denies the
occurrence of ossification in the veins. Instances of it are related hy Morgagni.
Epist. LXIV. g. — Ruysch Thes. anat. VIII. No. 58. — Salzmann D. de ossificat.
praeternat. p. 27. Argentor. 1720. — Ephem. N. C. Dec. IJ. Ann. X. Obs. 175,
(on the coronary vein of the heart).— ikTii/ra?/ in Act. med. Suec. Upsal. 1783,
Vol. I. p. 3. — Walter Observ. anatom. p. 45. tab. 9. — Meckel v. Sasse D. de
vasor. sanguifer. inflammatione, p. 38, Halae, 1797, (a diseased vein creaked in
cutting.) — Bnillle, Transact, of a Soc. for Improv. of med. Knowledge. Vol. I.
p. 134. — Lobstein, v. Mem. de la Soc. des Sc. Agricult. et Arts de Strasb. Vol. I.
p. 344, note; and Compte rendu sur son Museum anatomique, Strasb. 1820, p. 115.
No. 452 (the vena portae.) — Cruvellhier Essai sur I'Anat, pathol. Vol. II. p. 70. — •
Hip. Clocqiiet in Diet, des Sc. medical. Vol. XXIV. p. 295 (tlie brachial vein.) —
Cerutti No. 855 and 856. — Landgran in Ars Berattelse cm Svenska Lakare-

350 Of the Veins, [Part II.

Siillskapets Arbeten, 1827, p. 31. — I have never myself seen ossification of the
veins ; but I saw, in the Anat. path. Mus. at Vienna, a splenic vein. No. 547, a
vena porta?, No. 2484, the brachial and femoral veins of an old man and woman,
and also, in the Veterinary School at Munich, the preputeal veins of a horse
ossified.

§208.

Spurious formations of several kinds also occur occasionally
in the veins. To these belong, the rare observation of encysted
TUMOURS,^ FATTY SWELLINGS," and HYDATIDS,^ upon and in
them ; the equally uncommon depositions of tubercular
MASSES on their coats in affections of the neighbouring lym-
phatic glands, ' and lastly, sarcomatous tumours,^ which either
originate primarily in them, or extending from the neighbour-
ing parts, perforate the walls of the larger veins and enter into
their cavities.

(1) For instance, in the venae cavae. v. Bresl. Samml. Suppl. II. p. 1C8.

(2) Under the internal coat of the vena portae in a man, who had been affected
with jaundice and cancer of the stomach, v. Honord in Rev. Medic, franf. et
etrang. 1823.

(3) The case of Peyer's, in Misc. Acad. N. C. Dec. II. note 7, 1688, p. 385,
who found a flat hydatid in the vena portte of a pig, appears rather to be a
distoma hepaticum. — Andral, the younger, found in a man, who had many
hydatids in the lungs, also several large hydatids in the pulmonary veins, v.
Bulletin des Sc. par. la Soc. philom. 1823, p. 15. — Mogend'ie's Journ. de Phy-
siologic, Vol. III. No. 1. p. 69 ; and in AyidraVs Clinique medicale, Vol. III.

(4) I have observed this several times in such way, that the scrofulous
matter had penetrated the coats of the vein and filled up its cavity. In other
parts scrofulous ulceration had more or less destroyed the arteries and veins.

(5) In a man who had scirrhus of the stomach, a mass larger than a hazel-
nut was found in the expanded splenic vein. v. Hodgson, p. 524. — A sarcoma-
tous swelling in a girl of nine years old, was attached by a neck to the superior
cava, and filled it up. v. Wolf in RiisVs Magaz. f. d. ges. Heilk. Vol. XIV.
p. 570. — In a person who died of vomiting of blood, a yellow pulpy swelling on
the lesser curvature of the stomach, and a similar one in the vena portse, by which
it was filled, v. Ward in the London Med. Reposit. Vol. XX. Oct. 1823.—
Medullary sarcom penetrated in two cases into the vena cava. v. Velpeau in
Revue Med. franp et etrang. 1825, Vol. I. p. 217—240, and 343— 360.— In the
Anat, pathol. Mus. at Vienna, I saw a large polypous-like growth, with a neck
in the vena cava, behind a similarly diseased liver, No. 2513; and a medullary
sarcom of the inferior cava, No. 3906 ; and a sarcomatous tumour in the superior
cava, No. 41 10 : — lastly, I found a sarcomatous growth, of the size of a hazel-nut,
in the vena cava, near the liver, in a stag, which I had kept for several years.
V. No. 8747 of Bresl. Mus. — A branch of the vena cava had a cancerous-like
appearance, v. Churchill in London med. and phys. Journ. March, 1827.

§ 209.

Lastly, we often observe some irregularities in the veins
with reference to their contents. Thus, as after death the
BLOOT)^ is especially found only in the veins, so any remarkable
peculiarities in it deserve to be first mentioned. It sometimes
varies as well in quantity as in quality; the former shews
itself partly, in the great deficiency of the blood,
atifcmidy which we sometimes observe as a congenital vice

Sect. XIX.] Of the Veins. 351

in imperfect monsters, and is occasionally to such extent, that
we are reminded of the similar state in the early stage of foetal
existence and in the lower animals ; ^ sometimes it is found as
an acquired state, in many cachectic persons, in many fevers,
in severe hemorrhages, in death from hunger:^ partly, in the
TOO GREAT QUANTITY OF BLOOD, polycemia, pletJiora, which
is occasionally observed in somes corpses, viz. in persons affect-
ed with the blue disease, in hydrophobic persons, and brutes.*
Anomalous colour, consistence, and composition, are vices of
QUALITY in the blood, which not unfrequently occur ; thus we
often find it, for instance, too thin and pale after severe loss of
blood, in leucophlegmatic dropsy, tubercular disease, diabetes,^
&c. ; in a person who was destroyed by the poison of prussic
acid contained in nut-water, the blood had a remarkably light-
blue colour;" in inflammation and consumption, it is very
highly red-coloured, and, on account of the great quantity of
coagulable lymph it contains, often firmly coagulated in the
vessels ; we find the blood very deep-coloured, actually black
and very fluid, in the veins of persons affected with the blue
disease, scurvy, jaundice,^ hydrophobia, yellow fever, the fever
of mortified spleen, and carbuncle, in drowning or suspended
respiration from other causes, so also in actual suffocation, and
in men and animals destroyed by poisons ; in melanosis, we
find black flakes and even large clots of black pigment in the
blood ; * occasionally the blood is black and viscous, as though
it were clayey, which has been observed sometimes in yellow
fever,'' mortification of the spleen, &c. In poisoning from
sulphuric acid, the blood in some cases is completely coagulated
in the vessels.^'' The morbid composition of the blood and
the mixture of foreign substances in it, frequently may be
observed without any chemical analysis. ^^ Thus, for instance,
is the quantity of fibrous matter contained in the blood of many
corpses remarkably great or small ; in others, we find the
chyle not intimately mixed with the blood,^^ or yellowish flakes
of albumen in the black uncoagulated blood,^^ or an unusually
large and very readily discernible quantity of fat," especially
in brandy-drinkers/^ &c. Sometimes we find, without its
being the consequence of putrefaction, a greater or less quan-
tity of AIR in the veins, either like bladders mixed with blood,
or alone, which distend them more or less completely ; ^*^ in
many instances the air passes distinctly from without by
apertures in the veins. ^' Pus has been found several times in
the veins, not produced by ulceration of their surface, but by
effusion from neighbouring abscesses, and by absorption into
the veins. ^^ Parasitic animals are also met with in the

S52 Of the Veins. [Part II.

veins. ^^ We very frequently observe vein-stones, phlehoUthi,^^
that is, chalky concretions, deposited in the cavities of the
veins, which occur especially in the veins of the urinary and
generative organs, although sometimes also found in other
parts, and are either little rounded stones composed of con-
centric layers of lime, situated loosely on the wider parts of the
veins, or close calcareous cylinders entirely filling the veins
to a greater or less extent.-^ In a few instances, needles
have been found in a vein.^^

(1) Besler D. de sanguinis contributione secundum et praeternaturam. Altd.
1631. — Sfetierlin D. de morbis ex crasi sanguinis alterata oriundis. Altd. 1682. —
Alhinus D. de pravitate sanguinis. Fr. 1689. — de Sandris De naturali et praeter-
naturali sanguinis statu. 4to. Bonon. 1696. — Relchhelm D. de legitima particu-
laruni sanguinis earumque perturbata mixtura. L. B. 1702. — Riiinus and Boruholt
D. de sanguinis pravitate. Ultraj. 1702.—Br?in)jer D. de mala sanguinis tem-
perie. Groning. 1707. — Otto D. de sanguinis humani constitutione naturali et
praeternaturali, 1735. — W. Hewson Experiments on the Blood, with some re-
markson its morbid appearances, in Phil. Trans. 1770, p. 368. — Gruner D. Pathol,
sanguinis. Jenae, 1791. — J. WhitingD.de sanguine aegrorum. Edinb. 1816. —
van der Kolk Historia sanguinis coagulantis, cum experimentis ad eam illustran-
dam institutis. 8vo. Greening, 1821. — J. Davy, Some observations on the buffy
coat of the Blood, &c. in Phil. Transact. 1822, p. 271.— ^. Stoker Pathol. Obs.
Part I. On Dropsy, Purpura and the Influenza of the latter year, and par-
ticularly on the morbid changes of the blood, &c. 8vo. Dublin, 1823. — Ch.
Scudamore, An Essay on the Blood, comprehending the chief circumstances
which influence its coagulation, the nature of the huffy coat, with a concise
medical view of the state of the blood in diseases, &c. 8vo. London, 1824. —
Koenig D. s. experimenta quaedam circa sanguinis inflammatorii et sani qualita-
tera diversam instituta. 4to. Bonnae, 1824. — Spitta De sanguinis dignitate in
pathologia restituenda, etc. 8vo. llostoch. 1825. — Koch D. de observationibus
nonnullis microscopicis sanguinis cursum et inflammationem spectantibus, etc.
Berol, 1825. — Belhome Beobachtungen iiber das Blut und die crusta inflam-
matoria, u. s. w. in the Revue m^dicale in v. Froriep's Notizen, Vol. \'IL
p. 247. — Heusinger Iter Bericht von der anthropotom. Anstalt. p. 7. 4to.
Wurzburg, 1826. — Leuret Essai Sur I'alteration du sang. These medicale.
4to. Paris, 1826. — Trousseau d^nd Dupuy Experiences sur les alterations du sang,
consider^s comme causes des maladies locales in Archiv. general de M^dec.
June — August, 1826. — Vclpeau Recherches et Observations sur I'alteration du
sang dans les maladies in Revue medicale et Journal de Clinique. June, 1826. —
M. Junkelmann D. de cacochymicis sanguinis indeque oriundis aegritudinibus.
4to. Jenae, 1827. — /• R. Biirkhart Ueber das Blut und das Athmen in physiol.
und allgem. pathol. Hinsicht. Svo. Basel, 1828. — Ribcs in 1' Anatomic pathol.
Vol. Lp. 309. Paris, 1828.

(2) For instance, in the acephala; compare MeckeVs Ilandb. der pathol.
Anatomie, Vol. \. p. 170. — I have, however, observed a similar paucity of
blood in other human and animal monsters, characterized by deficient de-
velopment.

(3) I have seen many bodies which seemed almost bloodless, so that, with
difficulty, we could only find any in the large venous branches ; or, on the con-
trary, very little in the smaller blood-vessels.

(4) We find bodies, in which the quantity of blood is very remarhal)lc, so that
not merely is the heart and larger vessels, but also all the smaller, gorged with
blood, and on the slightest incision tlie blood pours out. — Krugeuberg observed
also this in a person who died of hydr()))hobia, who had been very freely bled. v.
Horn's Archiv f. medic. Erfahrung, 1817, Marcli and April, p. 356.

(5) Also very pale in animals ; for instance, in an ass which died of

Sect. XIX.] Of the Veins, Zt^'^

dropsy of the pericardium, v. Schwab Materialen zu einer pathol. Anatotnie
der Hausthiere. Ite Lief. p. 10. — I have seen it also once very pale in a glan-
dered horse, and in a dog which died of distemper. In diabetic persons,
the blood has often been found chocolate-coloured, and the serum milky, —
Also in new-born infants I and others have found the blood chocolate-coloured.
V. Billard. Traite des enfans nouveaux-nes, &c. 4to. Paris, 1828.

(6) Schneider in Henlie's Zeitschrift fvir die Staatsarzneik, 1825, Part II.
p. 399, fF.

(7) If the blood be coagulated in the vessels, the serum appears very yellow,
which, however, does not arise from the mixture of bile, as Deyeux and Parmen-
tier, and later, Lassaigne, Meissner, and others have shewn. [ W. Stevens, Obser-
vations on the blood in yellow fever, in which there is "a dissolved fluid" in
place of blood as black as ink, and unfit for the purposes of life : A paper read
before the College of Physicians, London, v. London Med. and Phys. Journ.
Vol. LXin. T.]

(8) Bigot found in the veins of a horse a blackish substance as large as a
hazel-nut. v. Lassaigne in Journ. de Chim. med., de Pharm. et de Toxicol, June,
1827, p. 264.

(9) Savaresy De la fievre jaune en general et particulierement de celle qui a
regne a la Martinique, p. 458, Neapel, 1809.

(10) viz. completely in a child, v. Meier in Henlie's Zeitschrift fiir die Staats-
arzneikunde, Vol. X. p. 302. — In the cutaneous vessels only of anembryon, in con-
sequence of the water of the amnion being sour. My Selt. Beob. Part II. p. 152.

(11) In reference to the reception of extraneous substances into the blood,
compare A. C. Mayer Ueber das Einsaugungsvermbgen der Venen des grossen u.
kleinen Kreislaufes in Meeker s Archiv fur Physiol. Vol. III. p. 485. — F. Tiede-
mann and L. Gmelin Versuche iiber die Wege, auf welchen Substanzen aus dem
Magen und Darmkanal ins Blut gelangen. Heidelberg, 1820. — A. H. L. West-
rumh in Meckel's Archiv f. d. Physiologic, Vol. VII. p. 525, and Physiol. Unter-
suchungen iiber die Einsaugungskraft der Venen. Hannover, 1825. — Quick-
silver was found in the blood hy Autenrieth and Zeller. v. ReiV sArchiw. Vol. VIII.
p. 213. — Schuharth in Horn's Archiv, 1823, (in a horse.) — Ekl saw it in the
blood with his naked eye. v. Bericht iiber tiie Ergebnisse im chir. Klinikum zu
Landshuth. 1826. — J. A. Buchner Toxikologie, p. 538, 2d edit. Nurnb. 1827.—
Calson. V. von Froriep's Notizen. Vol. XVI. p. 144. — In a person poisoned with
arsenic it was found in the blood, v, Adelmann in Harles's N. Jahrb. der deutschen
Medicin u. Chir. Vol. I. Part I. — I have very often observed in the blood the
smell of brandy and strong smelling medicines.

(12) In diabetes mellitus. v. Muller D. de diabete praesertim mellito. 8vo.
Goett. 1822. — A white milk-like fluid in the blood of a female ass, which died
soon after birth, found by Moiroud. v. Girard, Vatel, &c. Recueil de Medec.
veterin. May, 1828, p. 233.

(13) In a person who died of yellow fever, v. Fr. Xay. Za^o Colleccion de
inspecciones anatomicas relativas a la fiebre amarilla. 4to. Cadiz, 1821. v. Gerson
and Julius Magazin der ausl. Literatur. Jan. and Feb. 1823, p. 52.

(14) W. Hewson On the Blood, p. 110. Niirnberg, 1780. — Marcet found it in
the serum of a diabetic patient, and Traill in serum of a person affected with
Hepatitis. Compare Hunefeld Physiol. Chemie, Part II. p. 225.— Ray er in the
blood of a person killed by choke - damp. v. Heidelberger Kljn. Annalen,
Vol. IV. Supplementheft, I. p. 160, 1828.

(15) J. Adams in Transact, of the med. and phys. Society of Calcutta, Vol. I.
Calcutta, 1825. v. Taylor's Philos. Magaz. and Journ. Oct. 1826, p. 310. —
Traill, in Edinb. med. and surg. Journ. Vol. XVII. p. 319. — Fauthier and
Bertrand in Archives generales de Medecine, Vol. XV. Sept. 1827. — I myself
have found it twice very distinctly,

(16) Compare especially Morgagni, Epist. V. 17 — 30. — Nysten Recherches
de Physiologic et de Chimie pathologiques. Paris, 1811. — J.Davy in Philos.
Transact. 1823, Part II. — According to Briere v. Nouvelle Biblioth. 1826,
Feb. and March, the air passed from the lungs into the arteries and veins, which,
however, is not to be admitted. — I have found it without any suspicion of

A A

354 Of the Veins. [Part II.

putrefaction. \^Andral, Vol. IT. p. 413, states that he has several times seen the
blood remarkably frothy in some of the veins, or in the cavities of the heart,
without there being any trace of putrefaction in the body ; and seems inclined
to think it takes place before death, but speaks of it with great caution. T.]

(17) After violent blood-letting. — In the blood-vessels of a person whose head
was cut off. V. Testa, in operations on the neck, in which the jugular vein being
injured, the air rushed, with a hissing noise, into the vein. v. Magendie in
Journ. de Physiol. 1821, Vol. I. No. 2. p. 190. — Dupuytren in Archives gene-
rales de Medecine, July, 1824, p. 430; also v. above, § 184, note 3.

(18) Viz. in the inferior cava in abscess of the liver, v. Blancardi Observat.
Cent. II. No. 73. — Ribes. v. Mem. de la Soc. med. d' emulation, V^ol. VIII.
Part II. p. 613. — Velpeau in Archives generales de Medec. 1824, Vol. VI. p. 227.
— Gendrin Hist. Anat. des inflamm. I have also sometimes found pus in the
femoral vein, in ulcers of the leg, without the vein being diseased.

(19) Viz. the strongylus inflexus in the pulmonary veins of a porpoise, v.
W. Vrolik in Bydragen tot de natuurkundige wetenschappen versameld door van
Hall, W. Vrolik en Mulder, D. I. No. 1. p. 77, Amsterd. 1826. — Two strongyli
in the vena azygos of a porpoise, v. von Baer in Nov. Actis Acad. N. C. Vol.
XIII. P. II. p. 560, Nat. — F. J. Schmitz D. de vermibus in circulatione viven-
tibus. 8vo. Berol. 1826, with lithographic tables. The polystoma venarum,
which Treutler, Obs. pathol. anat. p. 23, tab. 4, fig. 1 — 3, found in a vein of the
foot of a man, was, as Rudolphi has remarked, probably a planaria, which had
made its way in.

(20) Realdus Columbus De re anatomica, Lib. XV. p. 491, Svo. Francof. 1593,
(in the hemorrhoidal veins.) — Schenkii Observat. med. rar. L. III. § 2, Obs. 54,
Francof. 1600. — Thorn. Bartholinus Histor. anatom. rarior. Cent. III. Hist. 34,
Vol. II. p. 71, with figs, (in the renai veins.) — Greisel Lapilli cum sanguine e
vena prosilientes in Misc. Acad. Nat. Cur. Dec. I. Ann. I. 1670, p. 163; Ann.

II. 1671, p. 23. — Roesler De calculis in venis mesaraicis, ibid. Dec. I. Ann.

III. 1671, ^. r)2%. — Tulpius Observat. med. L. IV. cap. 22. 4th edit. 8vo.
1672, (in a dorsal vein.) — J. G. Walter Observat. anat. p. 44 and 45. fol. Berol.
1775, (in the veins of the bladder five, and in those of the vagina three, as large
as peas.) — Sommerring Addend, to Baillie, No. 5, p. 191, (on the urinary bladder.) —
Langstaff in Hodgson, p. 522, (three as large as peas on the veins of the uterus.) —
Cruveilhier Essai sur I'Anat. pathol. Vol. II. p. 70, (two instances in the veins
of the bladder ; he also cites cases from Lobstein and Laennec, on the rectum,
bladder, pubic and spermatic veins ; as also from Dupuytren, on the pubic
veins, and Tilorier, on the cutaneous veins of the thigh.) — J. F. Meckel Handb.
der pathol. Anatomic, Vol. II. Parti, p. 190; and Tab. anat. pathol. Fasc. II.
p. 13, pi. 14, fig. 4, 5, (once on the veins of the bladder.) — F. Tiedemann in
Meckel's Archiv fUr die Physiologic, Vol. IV. p. 215, with plates. — Rosenthal in
Horn's Archiv. f. medic. Erfahrung, May and June, 1818, p. 404. — Cerutti Be-
schreibung der pathol. Praparatezu Leipzig, No. 600 and 601, (from the plexus
uterinus and vesioalis.) — Myself on venous stones, in my Selt. Beob. Part II.
p. 72, No. 32; and my Verzeichniss, No. 4284, 4285. I have since also found
them in the veins of the spermatic cord. — Bouillaud in Revue medicale franjaise
et §trangere, April, 1825, (sometimes in old varices of the lower extremities.) —
Ehrmann Compte rendu des travaux anatomiqucs, &c. Strasb. 1827, p. 38,
(thirty-two in the veins of the prostate gland.) — I have found venous stones in
almost all the large anatomical collections ; the largest, however, which I have
seen was the size of a hazel-nut, and from the splenic vein, in the Anat. Mus. at
Strasburgh. — John has given an analysis of them in Schweigger's Journ. f. Chemie
und Physik, Vol. XII. p. 80, and Gmelin in Tiedetnann, according to which, they
consist principally of phosphate and carbonate of lime.

(21) Compare my Selt. Beob. and Verzeichn. No. 4286 and 4287. I also saw
the veins of the large intestines of a horse affected with glanders, and disease of
the bones in the veterinary school at Stockholm ; perhaps also the case of Wal-
ter's,Oh?.er\. Anat. p. 45, tab. 9, above mentioned, in which the crural vein was
filled with a large ])iecc of lime. As to the origin of these phlebolithi, I cannot
agree with Hodgson's opinion, that they pass from without, by a ra])id absorption

Sect. XIX.] Of the Lymphatic Vessels and Glands. 855

of the veins, nor MeckeVs view, that they are produced like encysted tumours ;
but rather adhere to the opinion of Tiedemann, that they are produced from and
in the blood itself, for the reasons which I think I have made clear ; this point
is also supported by the rare observation of Ehrmann, according to which, some of
the phlebolithi were still soft, and appeared to be formed from the fibrous matter
of the blood ; a mode of formation which Cruveilhier had previously noticed.

(22) In one branch of the brachial vein. v. Duverney in Mem. de Paris, 1702,
Hist. p. 25 ; in a vein, Plot, Natural history of Staffordshire, &c. v. Plouquet
Repertor. Art. Vena.

Fifth Chapter.
Of the Lymphatic Vessels and Glands,

§210.

As to the vices of formation and disorganization of the
absorbing system,^ there is, on account of the dehcacy of its
structure, but httle certainly known, and even this especially
appHes to the thoracic duct and the lymphatic glands,
which latter, as coils or congeries of the absorbents, must
be liere considered together with them. As, however, the
lymphatic system is so generally distributed in the bodies of
men and the higher animals, and performs a principal part in the
business of the change of substance in the organism, it is easy
to see that in most general and local diseases it must be
affected, partly idiopathically, partly deuteropathically ; this is
particularly observable in rickets, in tubercular disease in its
widest sense, in syphilis, cancer, and plague. Organic vices
of the absorbent system occur most frequently also in youth,
when the vital activity is at the highest, but most rarely in old
age, when the vegetative process gradually declines.

(1) Lossius D. de glandularum passionibus in genere. Witeb. 1682. — Fr.
Schrader Lympha et glandulae pathologice consideratse. 4to. Helmst. 1686. —
J. Walker D. de glandularum morbis, Edinburgh, 1743. — Russel QCconomia
naturae, in morbis acutis etchronicis glandularum. London, 1755. — Diedrich de
morbis glandularum. Lips. 1759. — Edrn. Darwin, Experiments establishing a
criterion between mucilaginous and purulent matter ; and an account of the
absorbent vessels of animal bodies in some diseases. 8vo. London, 1780. —
J. C. Szomhathy De morbis glandularum secundum aetates. Vien, 1782. — Assa-
lini Essai m;^dical sur les vaisseaux lymphatiques, avec le moyen de prevenir
les effets venimeux des substances venimeuses. 8vo. Turin, 1787. — L. Formey
D. de Systematis absorbentis pathologia. 8vo. Hal. 1788. — Wrisberg in Com-
ment. Soc. Goetting, Vol. IX. Part I. p. 136. — Ludwig D. Physiologorum atque
pathologorum de systemate absorbente recentissima quaedam decreta. Lips.
1789. — Pajol De Morbis vasor. absorbentium in Mem. de la Soc. de M^dec. de
Paris, 1791, Vol. VIL and VIII. — D'Hame Idea pathologiae systematis absor-
bentis. 8vo. Coloniae, 1792.— -Z)e Kming D. de afFectionibus morbosis systematis

A a2

o

56 Of the Lij7nphatic Vessels and Glands. [Part II.

lymphatici. Lugd. Batav. 1793, — S. Th. Sommerring De morbis vasor. absor-
bentium corporis humani. Traj. ad Moen. 1795. — Gilibert Essai sur le systeme
lympbatique dans I'etat de sant^ et de maladie. Paris, 1804. — Alard Histoire
d'une maladie particuliere au systeme lymphatique frequente, etc. 8vo. Paris,
1808, with plates. — Attenhofer Lymphatologie, oder Abhandlungen uber das
l)anphat. system und dessen Leiden. Wien, 1808. — W. Goodlad, A practical
essay on the diseases of the vessels and glands of the absorbent system. 8vo.
London, 1814. — Jndml, fils, Observations sur les maladies du canal thoracique
in Archives generales de m^decine. Dec. 1824. — Reg. Lippi Illustrazioni fisio-
logiche e patologiche del sistema limfatico-chilifero, mediante la scoperta di
un gran numero di communicazioni di esso col venoso. 4to. Firenze, 1825. —
Compare besides the anatomico-physiological writers on the absorbents, and the
greater number of the works on scrofula, quoted at § 65, note 1.

§211.
As to the VARIETIES in this system, they are just as frequent
as in the venous, so that the comparison of the large absorbent
trunks in different individuals, on the right and left side, often
presents great variation in reference to their number and course.
We most frequently observe such variations in the ductus
thoracicus ;^ thus, for instance, it commences higher or lower
in the belly, and also consists of more or less branches, di-
vides at one or more points of its extended course into two or
three branches, is double throughout its whole length,^ divided
merely at the upper part,^ or empties itself at unusual points,*
&c. Sometimes the larger absorbing vessels from the neck
and arms terminate singly in the subclavian veins, so that then
there is no common absorbing trunk on the right side. We
observe it arched, not merely in distortion of the back, but
also as consequent on its elongation in the normal state of the
spine ; sometimes very tortuous, or disturbed from its usual
situation by tumours on the front of the vertebrae, by the
vena cava taking an irregular course,^ &c. The number
and situation of the absorbing glands sometimes varies ; thus
we find on the leg, as well as on the fore-arm, one or several
unusual glands, or in many places, for instance in the groin
and arm-pit, instead of many small, fewer but much larger
glands.

(1) Haller Elem. Physiol. Vol. VII. p. 222, § U. — Sabatier in Memoires de
Paris, 1780. — Juims Bang De variationibus in ductu thoracico visis in Soc. med.
Havn. Collectaneis, Vol. I. p. 82. — Sommerring \'om Baue des menschlichen
Korpers. 2d edit. Part IV. p. 583.

(2) It then usually empties itself into the right subclavian vein, but not always,
and receives all the absorbents, which usually terminate in the lesser ])rincipal
thoracic trunk. — Such cases were seen by A. F. Walther De ductu thoracico
bipartito, etc. 4to. Lips. 1731, rec. in Ilalleri Disp. anat. Vol. I. — le Noble,
Collins, Duvernoy, Winslow, Wium. v. Haller, wlio saw it twice ; further Th.
BarthoVmns Anat. L. B. 1()8(), p. G20. — W. Cruikshanlc's Anatomy of the ab-
sorbing A'essels. — Sommerring, p. 583, note 2, — I have twice found it completely
double, and inth^'d in one instance botb terminated on the left side in the
jugular and subclavian vein ; in tlie other on each side in the subclavian vein.

(3) The thoracic duct not unfrequontly terminates on tlic left side of the neck

Sect. XIX.] Of the Lymphatic Vessels and Glands, 357

by two or three branches ; if it be divided further down, the right branch ter-
minates in the right subclavian. Such cases were observed by Wium, Heuermann,
Felse, Pequet, and Roffink. v. Haller, p. 224. I have also seen the same in a wax
model in the anatomical collection at Upsal.

(4) Not merely in persons with general transposition of the viscera ; but some-
times also in others, it empties itself into the right subclavian vein. — Compare
Haller, p. 223, note 1. — Meckel De vaselymphat. gland, conglob. 4to. Berol. 1757,
p. 19. — Cruikshank, The Anatomy of the absorbent Vessels of the human Body.
4to. Lond. 1786, 2d edit. 1790, p. 152. — Fleischmann Leichenotfnungen, p. 236,
No. 75. — It has also been seen terminating entirely, or only by a single branch,
in the vena azygos ; the former is described by Alhinus. v. Cruikshank^ s Anatomy
of the absorbing Vessels, 4to. London, 1786, and Mascagni Vasorum lympha-
ticorum corporis humani historia et iconographia. fol. Senis, 1787. v. Ludwig,
Vol. III. p. 42. — Of the latter /. C Bohl D. viae lactese corporis humani historia.
Ilegiomont. 1741.

(5) I have sometimes seen it thrust out of its place by exostoses, and in one
case, by the inferior cava passing behind it and the aorta ; the latter is en-
graven by Gurlt, D. de venar. difFormitatibus. 4to. Vratislaviae, 1819. Sometimes
it is very much displaced by aneurysm of the aorta, v. Baijford in Medic. Obs.
and Inquir. Vol. III. p. 18.

§212.

The SIZE of the absorbent vessels varies in the same way as
that of the veins ; thus in many individuals they are all very
small and narrow/ in other instances again they are all propor-
tionally too wide, and more frequently vary from their usual size
only at particular parts of the body, inasmuch as, for example,
in atrophic parts they are very much straightened, or are com-
pressed at certain parts by adjacent swellings, or lastly, and
which occurs more commonly, and is more frequently noticed,
they are remarkably expanded at certain parts, either on ac-
count of the relaxation of their walls, or of mechanical obstruc-
tion to the progress of the lymph, that is, become varicose,
a state to which, in the most restricted sense, we apply the
name cirsus, or absorbent knots. ^ Those hydatids which
are connected with delicate and in part hollow threads, and
are often in rows, for example, in the vascular plexuses of the
cavities of the brain, in hydatid moles, &c., perhaps arise from
varicosity of the absorbent vessels.^ More apparent are the
deviations from normal size in the lymphatic glands, which
appear equally in two states, viz. diminution or wasting, and
still more frequently, in several diseases, as idiopathic or sym-
pathetic, and often very considerable swellings. The too great
extension of the lymphatic vessels may also lead to their con-
sequent RUPTURE OR BURSTING,* whcreby effusions and collec-
tions of lymph occur in the cellular tissue, producing the
LYMPHATIC TUMOUR, tumov lymphaticus,^ so called ; or, if the
thoracic duct be torn, effusion of lymph into the mediastinum,
hydrops lacteus, as it is named.*' Similar effusions of lymph also
occur after wounds' of the larger trunks, the cure of which, on.

S58 Of the Lymjihatic Vessels and Glands, [Part II.

account of this effusion, is sometimes difficult ; but when it
takes place, it is always alone effected by adhesion and closing
of the lymphatic vessels.

(1) For instance in dwarfs, v. Sommerring De morbis vasor. absorb, p. 42.

(2) Many instances of great varicosity of the absorbents are to be found in
Wrisherg, and Cruikshank, and in Sommering, § 22, Vasa absorbentia varicosa. —
I have often observed it in the absoi*bents of the lungs, liver, intestines, pelvis,
and of the lower extremities, either on account of compression or stoppage
in their more superficial trunks and glands. I have a few times found
the thoracic duct compressed by aneurysms of the aorta, or stretched by
their lying beneath it ; the same has been observed by Laennec Journ. de
Medec. cont. Vol. XII. p. 159. — The thoracic duct has been once seen as thick as
the finger, v. Criiikshank, p. 207, pi. 5. 2d edit. — BailUe, in his Morbid Ana-
tomy, p. 108, mentions one nearly as large as the subclavian vein, of which
Sommerring, in his Addenda to Baillie, gives another instance. — According to
Baron these tubercles arise from enlargement and great development of the
lymphatic vessels, or from the formation of little cysts in them. v. Delineations
of the Origin and Progress of various changes of structure, &c. 4to. Lond. 1828,
with plates.

(3) Of this opinion, for example, is Bidloo De hydatidibus in Exercit. anat. chir.
L. B. 1708. — Hufeland Ueber die Natur, Erkenntnissmittel und Heilart der
Skrofelkrankheit. p. 382. Jena, 1795. — Rudolphi resp. Carger De ventriculis
cerebri. Gryphiae, 1786. — Liidersen D. de hydatidibus. Gbtt. 1808, p. 82. — This
kind of hydatids seems to me, in some cases, rather to be connected with the
extremities of the arteries.

(4) It is well known that the older writers erroneously derived consumption
especially, and also scrofula, &c. from rupture of the absorbents.

(5) Plenck Novum systema tumorum, p. 127. Viennae, 1767. — ^. Beinl Von
einer eignen Art Lymphgeschwulst, und der zweckmassigsten Methode dieselbe
zu heilen. 4to. Wien, 1801. — /. A. Schmidt Ueber den Grund der Todtlichkeitder
Lymphgeschwulste, in the Abhandlungen der Josephinischen Akademie, Vol. II.
p. 327, Wien, 1801. — Nyblaus praes. Ackermann D. de tumore lymphatico, Up-
salae, 1807. — Strunk D. de abscessu lymphatico, Goett. 1809. — Rust Abhandlung
von den Lymph, geschwiilsten in Harles's Jahrb. der deutschen Medicin und
Chir. Vol. I. p. 155. Nurnberg, 1814. — Von Walther Ueber die wahre Natur der
Lymphgeschwiilste in his and Gr'dfe's Journal f. Chir. Vol. I. p. 584 — 611. —
Chelius in Textor'*s Neuem Chiron. Vol. I. p. 115 — 125. — G. Zembsch D. de tumore
lymphatico. 8vo. Berol. 1826. — That Walther, and other surgeons of modern
times, have very properly shewn the greater number of lymphatic abscesses to
be no more than ulcers of a peculiar kind does not, according to my opinion,
contradict the existence of lymphatic tumours from the causes here mentioned.

(6) Bassius Observationum Decas II. Observat. VII. — Guiffart in Bartholinus
Opera nov. p. 490.

(7) J. Mays De vulnere vasculi lymphatici in Praxi medico, chirurg. p. 240,
Amstel. 1695. — Jnt. Nuck, De vulneribus vasor. lymphaticor. in Experimentis
chir. L. B. Cap. 28, 1733 ; comp, Sommerring, p. 52, § XXVII. I have known a
few cases of a free flow of lymph from wounds made in opening veins. On
injuries of the thoracic duct, see the writers on medical jurisprudence ; in one such
case, the lymph continued to flow, and produced a fistula, v. Fr. Hoffmann. B.
affectus rarissimus perpetui stillicidii succi nutritii, in Opusc. supp. II. 2.

§213.
Vices of texture in the lymphatic system appear to be
tlie same as those in veins ; but they are naturally less easily
ob.served. Inflammation,' both of the absorbent vessels
and glands, is frequent; the former sometimes take on that state
during life, giving the sensation and appearance of hardish,

Sect. XIX.] Of the Lymphatic Vessels and Glands, 859

painful threads, producing reddish streaks in the skin, and in the
dead body they appear, especially if the inflammation were che-
mical, more or less red, thickened, hardened, knotty, opake,
less elastic, and if it be the ductus thoracicus^ even freely
covered with a net-work of blood-vessels : the latter exhibit
inflammation, especially by great swelling,^ compactness, and
increased redness : commonly also we find the neighbouring
cellular tissue inflamed at the same time. This inflammation
of the lymphatic system is sometimes idiopathic, and is then
very commonly produced in men and animals, partly by local,
mechanical, and chemical irritation, partly by general disease
of this system, viz. by scrofulous and tubercular disease ; in
other cases the inflammation of the absorbent and lymphatic
glands is sympathetic,* metastatic and even critical.^ This
disease rarely runs immediately into suppuration and mor-
tification, but it has rather a disposition to induration,
internal effusion, and consequent obstruction® and adhesion,
whence, subsequently, in part suppuration occurs, which in-
deed is frequently the case in scrofulous swellings produced
by induration and stoppage of the branches of the absorbent
vessels and lymphatic glands f partly oedematous swelling of
those parts from which the reflux of the lymph is prevented;
and, lastly, consumption frequently occurs. Continued pressure
also easily effects adhesion of the absorbent vessels. The
ductus thoracicus has also been several times observed ob-
structed or adherent from coagulated and exuded lymph. ^
Lastly, the inflammatory irritation often gives rise to the con-
version of the tissue of the absorbent vessels and glands into
a cartilaginous mass, and a deposition of lime in their tissue.
The latter is observed but rarely and very partially in the
absorbent vessels f on the contrary, in the lymphatic glands,
especially in the bronchial and mesenteric glands of men and
animals,^^ it occurs frequently and largely, so that oftentimes
they are completely converted into a stony mass.

(1) Here belong the endemic swelling of the legs, of Barbados, v. /. Hendy,
Treatise on the glandular Disease of Barbados, proving it to be seated in the
lymphatic system. London, 1784. /. Rollo, Remarks on the disease lately
described by Br. Hetidy, Sic. London, 1785. — Alard De I'inflammation des
Vaisseux absorbens lymphatiques dermoides et souscutanes, maladie designe
par les auteurs sous les difFerens noms d'Elephantiasis des Arabes, d'CEdeme
dur, de Maladie charnue, de Maladie glandulaire de Barbade, etc. 8vo. 2d edit.
Paris, 1824. Fr. Fedeli De lymphangioitide, ejusque formis diversis. 8vo. Patavii,
1825. — Gendrin Histoire Anatomique des inflammations, 2 vols. Svo. Paris,
1826.

(2) Two cases are found in Andral, and one in Gendrin, p. 70, § 1001.

(3) Panus or Adenophyma.

(4) For instance, — in difficulty of cutting the teeth ; in lying-in women, in
the first secretion of milk in the breast ; in the neighbourhood of many eruptive

360 Of the Lymphatic Vessels and Glands, [Part II.

diseases of the skin, — malignant ulcers ; in syphilis in the unguinal glands ; in
buboes, &c. Compare /. D. Prophet D. de sympathica glandularum inflamma-
tione. 8vo. Halae, 1823.

(5) In typhus fever, and especially in the plague ; although, according to
some authors, the plague boil is not seated in the lymphatic glands, but in the
neighbouring cellular tissue ; compare P. Russell, Treatise of the Plague, 4to.
Loudon, 1791. — Larrey Mem. de Chir. Mil. Paris, 1812. In yellow fever, the
plague bubo, bubones pestilentiales, are said to be very rare. A. Ramsay, how-
ever, found the lymphatic vessels opake, inelastic, widened, and thickened, in a
person who had died of yellow fever, v. Edinburgh medic, andsurg. Journ. 1812,
Vol. VIII. Part IV.

(6) Not every lymphatic gland swollen by inflammation is, as the old writers
thought, rendered impervious, but, on the contrary, rendered wider, as quick-
silver will pass more easily through them than usual ; but in the higher degrees
of inflammation, and its consequences, as also in scrofulous, scirrhous, and other
hardening, the glands are partially or completely obstructed.

(7) Compare § 65.

(8) Cruikshank . — Mascagni Vasor. lymphaticor. corporis humani Historia et
Ichnographia. fol. Senis, 1787. — Assalini Versuch iiber die Krankheiten des
lymphat. Systems, p. 41. — Walter in Mem. de I'Acad. de Berlin, 1786, p. 21. —
Poncy in Saviard's Recueil d' Observations chirurgicales. Observat. 3. — Watson
in Philos. Transact. Vol. L. p. 392. — Astley Cooper in Medical Record and Re-
searches from the papers of a private medical association. Vol. I. London, 1798,
(three cases, in one ulceration and adhesion of the valves.) — Goodlad. — Hopfen-
g'drtner in Hufeland's Journ. d. prakt. Heilk. June, 1817. — Nasse Leichenoff*-
nungen. Ite Reihe, p. 150. — Andral, third observation. — Lobstein Compte rendu
sur les travaux anatomiques, etc. Strasb. 1824, p. 67, No. 131. — Baillie, the works
of, ed. by Wardrop, Loudon, 1825, Vol. I. — Gendrin, p. 70, § 1001.

(9) To wit, Mascagni, p. 30. — Attenhofer.

(10) The glands sometimes contain one or several bony concretions; some-
times they are completely converted into stone, with a smooth surface ; sometimes
they have merely an external bony capsule ; sometimes, finally, the lime in a
state of pap is contained within the gland as in a kind of sac. Among animals I
have found ossification of the glands in monkeys, dogs, sheep and horses.

§ 214.
Among the spurious formations, it appears that the lym-
phatic system, on account of the dehcacy of its structm'e and
the small quantity of cellular tissue therein contained, is not
disposed to the formation of encysted tumours. The lympha-
tic glands, however, to a certain degree, not unfrequently
assume the form of encysted tumours ; thus they become con-
verted by suppuration and absorption into membranous bags
filled with bloody ichor, thin lymph, a secretion containing
lime, &c. The lymphatic system is affected with tubercular
DISEASE the more frequently, as the latter is originally seated
merely in it. The formation of a peculiar substance, similar
to white fresh cheese, is also here the peculiar characteristic
of this disease,' in which the lympliatic vessels often inflame,
thicken, are stopped up with scrofulous matter, and are even
converted into more or less long, thick, hard strings : the
glands first inflame ; subsecjuently, in consc(jucnce of the depo-
sition of scrofulous matter, harden, thicken, become pale, and
at last soften from their centre and run into suppuration. Not

Sect. XIX.] Of the Lymphatic Vessels and Glands, 361

unfrequently in those parts where the glands lie near each
other, as, for instance, in the neck, on the spine and me-
sentery, many of them are converted into one large scrofulous
swelling. Sarcom and cancer^ appear to occur primarily in
the lymphatic system but very rarely; but not unfrequently
secondarily, as the infection from the originally diseased parts
is easily propagated to the neighbouring lymphatic glands
agreeably to the course of the lymph. ^ In medullary sarcom
of the testicle we very frequently observe a similar sympathetic
affection of the lymphatic glands on the spermatic cord, pelvis
and spine, more or less high up, in which case also the ductus
thoracicus frequently becomes at the same time affected.'^

(1) Compare § 65. I have myself observed some instances in which the
thoracic duct, and the lymphatic glands in its neighbourhood, were scrofulous.
Compare my Selt, Beob. Part II. No. 33, p. 76. I have since seen some other
instances. — Older cases may be found in Lieuiaud, Hist. Anat. Med. Vol. II.
p. 243, Obs. 770, 771, 771 a. — A. Cooper, (first and second case.) — Palletta Exercit.
Pathol, p. 109, fig. 4.

(2) Compare § 78, note 7. According to Baron, Delineations of the origin
and progress of various changes of structure, &c. 4to. London, 1828, scirrhus
should in all parts arise from a morbid change of the lymphatic vessels.

(3) To wit, from cancer of the breast in the axillary glands ; of the lips and
salivary glands in those of the neck ; of the alimentary canal in those of the
mesentery, and of the testicle in the pelvic glands, &c. The latter 1 have
also seen in sarcocele.

(4) A. Cooper, (third case.) — Rust in Horn's Archiv f. d. medic. Erfahrung,
1815, p. 731 — 790, (two cases.) — /. Wardrop, Observations on Fungus haema-
todes, Case 21 — 24. — Howship, Practical Observations in Surgery and morbid
Anatomy, Case 94. — Gierl'm Textor's'^QXXQXi Chiron. Vol. I. Part II. p. 273. — ■
Biermmjer Museum anatomico-pathologicum. No. 535. I saw a second inte-
resting case in the same Museum, in 1827, No. 390G. — Breschet in Diction, des
Scienc. medical. Vol. XX. Art. Hematode, p. 196, under the name Carcinome
abdominal. — Keulel in Rust's Magazin f d. ges. Heilkunde, Vol. XVI. p. 226. — •
My Selt. Beob. Part II. p. 76, (since in another case.) — Dickson in Edinb. med.
and surgic. Journ. April, 1825, No. 83. — Zink in Journ. compl. du Diet, des Sc. me-
dicales, Vol. XXI. March, 1825.—Rlssler in Ars Berattelse om Svenska Lakare-
Siillskapets Arbeten, lemnad of Ekstroem. Stockh, 1825. — B. H. Coates in Phila-
delphia Journ. of the med. and phys. Sciences by Chapmann, Vol. IV. No. 2. —
Also in melanosis tuberculosa of the horse, (§ 67), an uninterrupted string of large
swellings between the rump and the termination of the aorta, v. W. Cullen and
R, Carswell in Transact, of the med. chir. Soc. of Edinburgh, 1824, Vol. I. No. 13.

§215.

Lastly, in the lymphatic system we observe vices of con-
tents, inasmuch as, by their absorbing activity, they are
sometimes able to take up extraneous substances. Thus we
find them not unfrequently filled with pus, blood, bile, can-
cerous iciiOR,^ and rendered very distinct by the darker
colour of these fluids. The glands also sometimes assume
an unnatural colour from the matters absorbed; thus, for in-
stance, the glands in the neighbourhood of the liver are often
completely yellow, those in the region of the spleen brownish,

362 Of the Lymphatic Vessels and Glands, [Part II.

and the bronchial glands, especially, blackish from a juice
similar to Indian ink,^ which in previous difficulty of breathing
is often found very dark, aiid deposited in large quantity. We
however find also sometimes, in other parts, single lymphatic
glands or vessels blackish, particularly if melanosis be con-
nected with schirrus and medullary sarcom. Lime has
been several times found in the lymphatic vessels, and some-
times in such quantity that they are completely filled by it. ^
In stonemasons and other persons who breathe much dust,
it appears to be absorbed in the lungs and deposited in the
bronchial glands.* A stone has been once found in the ductus
thoracicusJ' Intestinal worms, viz. filaria hominis bron-
chialis, Rud. have also been found in the absorbent vessels
and lymphatic glands of the neck.^

(1) I have seen this several times, and this cannot offend the surgeons, as
they derive fevers, affections of various kinds, and death from the irritation
excited in the circulation by malignant pus and gangrenous ichor received into
it. Compare the novel and interesting experiments of Velpemi, Gendrin, Leuret,
Trousseau, Ditpuy, Hamont, Rochoux, &c. On the inoculation and injection of
putrid blood and pus.

(2) G. Pearson, On the colouring matter of the black bronchial glands, and
of the black spots of the lungs, in Phil. Trans. 1813. — Nasse in Meckel's Archiv
f. d. Physiol. Vol. II. p. 445.

(3) Portal in Lieutaud, Vol. II. p. 243, Obs. 771 a, (the thoracic duct.) —
Cheston in Phil. Trans. 1780, Vol. LXX. p. 323, 578, (the thoracic duct.)— J. G.
Walter in Mem. de I'Acad. des Sc. of Berlin, 1786 and 1787, p. 21, (the lymphatic
vessels of the small intestines. — Mascagni, p. 29. — Cruikshank, p. 74. — Jssa/ini,
p. 52, (the thoracic duct.) — Goodlad, (the thoracic duct.) — Scarpa, Ou the expan-
sion of bone and callus after fracture, translated into Latin, p. 63, 4to. Weimar,
1828, (tlie absorbents of the lower extremities, in a boy affected with pa'dar-
throcacy.)

(4) Compare Portal Cours d'Anat. Medic. Vol. III. p. 511 ; Vol. V. p. 43. —
Sommerring, p. 45.

(5) J. D. Scherb De calculo in ductu thoracico, 1729 ; reviewed in Halter's
Diss. Pathol.

(6) Trentler in Observ. Pathol. Anat. Auctuar, ad Hclminthologiam hum.
Corp. continentes, p. 10, tab. 2, fig. 3 — 7, Lips. 1793; he calls it Hamularia
lymphatica, and Rudolphi now names it Hamularia subcompressa ; it has, not
however, been seen again in the animal, and therefore may be considered
doubtful.

363

TWENTIETH SECTION,

Of the Nervous System,

First Chapter.
Of the Brain,^

A. — OF THE MEMBRANES OF THE BRAIN.
§ 216.

It is very natural in the close connexion with which the
membranes of the brain stand, on account of their situation
and expansion in reference to the skull and the brain, that
they should participate in almost all the malformations, dis-
eases, and injuries of those organs ; and as, on the one hand
by isolation, they frequently prevent the extension of the
diseases of the brain-case to the brain, and contrariwise of
the brain to the bones, so on the other hand they sometimes
produce mutual infection. Thus we find, for instance, in
congenital as well as acquired malformation of the brain, the
membranes naturally formed on a similar type ; in abnormal
situation of the brain, as in hernia cerebri and hydrencephalo-
cele, the hernial sac is often formed of all the three membranes ;
and in penetrating wounds of the brain, its membranes are
naturally injured with it. In hemicephaly, and often also in
hydrencephalocele, in which more or less of the vault of the
skull is deficient, the two external membranes are more or less
consolidated with the here undeveloped general covering and
fibrous parts, and produce, together with these, the membrane
oftentimes very thin and transparent, which surrounds the
brain. ^ The membranes are very frequently affected sympa-
thetically and secondarily in diseases of the skull and brain,
although they are often the seat of idiopathic and primary
diseases, whereby then especially, congestion, inflammation
with its consequences, and effusion between them of various
kinds of fluids are produced. Those frequent and important dis-
eases which appear to belong especially to the nervous system,
as many fevers, viz. yellow and typhus fever, diseases of the
mind, nostalgia, epilepsy, convulsions, tetanus, delirium tre-
mens ^ cephalalgia, palsy, apoplexy, &c., have often, as either
cause or consequence, vices of the brain as well as of the
cerebral membranes.^

364f Of the Brain. [Part 11.

(1) Jason a Pratis De cerehr. morbis. 8vo. Basil, 1549. — Haller's Bibl. med.
pr. Vol. I. p. 511. — Moniagnana Consil. de aegritudinibus cerebri. Fr. 1604. —
Fr. Hildeshebn Spicilegia de cerebri et capitis morbis internis. Fr. 1612. —
Thorn. Willis Pathologiae cerebri et nervosi generis specimen. Amstelod, 1663. —
Cuminius D. de cerebro ejusque pathologia in genere. Leid. 1684, — J. J. Wepfer
Observationes medico-practicae de atFectibus capitis. Scapb. 1727. — de Biichner
D. de morbis cerebri ex structura ejus anatomica deducendis. Erford, 1741. —
Lazerme De morbis internis capitis. Amstelod, 1748. — Payva Epicrisis de
morbis cerebri et mentis qui extra cerebrum originem ducunt 4to. Rom. 1751. —
Moor Patbologia cerebri. Amstelod, 1754. — Gennari De peculiari structura
cerebri, nonnullisque ejus morbis. Parma, 1782. — Van der Haar Ueber die Be-
schaffenbeit des Gebirns der Nerven und etlicber Krankheiten derselben. a. d.
Holland. Stendal, 1794. — A. Winckelmann D. bist. pathologiae cerebri specimen
primum. Goett. 1803. — Burdach Beitriige zur nahern Kenntniss des Gebirns in
Hinsicht auf Physiologic, Medicin und Chirurgie, 2 parts. Leipzig, 1805 and
1806. — Th. Mills, Of the morbid anatomy of the brain in typhus, or brain-fever,
&c. 2d edit. Dublin, 1818. — Hehreart Observ. sur quelques maladies du cervelet,
du cerveau et de leurs membranes, &c. Paris, 1819. — John Abercrombie, Patholo-
gical and practical researches on Diseases of the Brain, &c. 8vo. Edinb. 1st ed.
1828, 2d 1829. — John Cook, A treatise on Nervous Diseases, Vol. I, on Apoplexy.
Lond. 1820; Vol. II. on Palsy and on Epilepsy. 8vo. Lond. lS23.—Georget De la
Physiologic du Systeme nerveux et specialement du Cerveau ; Recherches sur les
maladies nerveuses en general et en particulier sur le Siege, la Nature et le Traite-
ment de I'Hysterie, de I'Hypochondrie, de I'Epilepsie et de I'Asthme convulsif,
Vol.11. Paris, 1821. — J. Swan, Observations on some points relating to the ana-
tomy, physiology and pathology of the Nervous System. 8vo. Lond. 1 822, with en-
gravings.— J. C. Prichard, A treatise on the diseases of the Nervous System, Parti.
comprising convulsive and maniacal affections, London, 1822. — Craigie, Observa-
tions on the pathological anatomy of the Human Brain, &c. in Edinb. med. and
surg. Journ. Jan. 1823, Vol. XVIII. p. 487; Vol. XIX. ip. 63. — F. Lallemand
Recherches anatomico-pathologiques sur I'encephale et ses dependances, 2 vols.
Paris, 1824-29. — G. F. J. Sahmen die Krankh. des Gehirnes und der Hirnhaute,
pathol. diagnostisch betrachtet, Riga, 1825. — Guerin de Mamers Des irritations
encephaliques et rachidicnnes, &c. Paris, 1825. — Th. Mills, An account of the
morbid appearances exhibited on dissection in various Disorders of the Brain,
&c. Dublin, 1826. — Rob. Hooper, The morbid anatomy of the Human Brain.
4to. London, 1826, with 15 coloured plates. — Raikem Observations sur quelques
maladies de I'encephale et particulierement sur I'inflammation et ramollissement
de cet organe, in Repert. g^n. d'Anat. et de Physiol, pathologique, 1826, Vol. I.
No. 2, p. 271 — 321 ; No. 3, p. 74. — A. L. J. Bayle Traits des maladies du cer-
veau et de ses membranes, Paris, 1826. — J. G. Fourcade Maladies nerveuses des
auteurs rapportees k I'irritation de I'encephale, des nerfs cerebro-rhachidiens et
sj)lanchiques avec ou sans inflammations. Paris, 1826. — /. Sablairoles Recherches
d' Anatomic et de Physiologic pathologiques, relatives ^ la predominance et ^
I'influence des organes digestifs des enfans sur le cerveau. Montpellier, 1826. —
Bompard Consid^irations sur quelques maladies dc rencephale et de ses depen-
dances, &c. Paris, 1827. — A. Monro, The morbid Anatomy of the Brain, Vol. I.
Hydrocephalus. Edinb. 1827. — Compare the writers on insanity, especially
Ilaslam, Observations on Insanity, with practical remarks on the disease, and an
account of the apj)earances on dissection. 8vo. London, 1798. — J.E. Grcding's
Mclancholico-maniacorum et e})ilcpticorum quorundam, in ptochotropheo Wald-
hemiensi defunctorum sectiones in Lndwig's Adversar. med. pract. Lips. 1771,
Vol. IL and III. and Samnitl. medic. Schriften, edited by K. IV. Grcding, 2 vols.
Greiz. 1790 and 1791. — Chiarugi Delia Paz/ia iiigencrc c in specie, con una cen-
turia d'osservazioni. Vol. 111. 8vo. Fircn/e, 1791. — li. Ilofrichtcr D. de locis in
nielancholia .affectis, 8vo. Ilahx*, 1797. — Brian Crowlher, VvAci\c;\\ remarks on
Insanity, to which is added a connnentary on tlie dissection of the brains of maniacs,
iVc. Lond. 181 1. — Andr. Marshall, The morbid Anatomyof the Brain in mania and
hydrophobia, &c. hy S. Sawrey. Lond. 1815. — Spnrzhcim, Observations on the
deranged manifestations of the mind, or insanity. London, 1817, .with cngra-

Sect. XX.] Of the Bram. SQ5

vings. — Georget De la Folic. Paris, 1820. — Falret De rhypochondrie et du
suicide. Paris, 1822. — Buzorini Untersuch. lib. d. kiirperl. Bedingung'. der
versch. Formen von Geisteskrankli. 8vo. Ulm, 1824. — Neumann in Hufeland^s
Journ. d. prakt. Heilk. July, 1824, p. 3—64, (fifty cases.) — PineU fils, Quelques
recherches sur le siege des alterations cer^brales ; and observations thereon by
Bonilluud in Magendie's Journ. de Physiologie, 1826, Vol. VI. No. 1, p. 19. —
Esquirol Allgemeine und specielle Pathologie und Therapie der Seelenstbrungen
deutsch von Hille nebst einem Anhange von Heinroth. Leipz. 1827. On Apoplexy
especially, Morgagni De sed. et causis morbor. Epist. II. — V. — Wepfer Hist, apo-
plecticorum observationibus et scholiis anatomico-medicis illustratse. 4to. Scaphus.
1658, nov. edit, access. Auctuarium historiarum et observationum similium. Sca-
phus. 1675. — Kirkland, Commentary on apoplectic and paralytic affections, &c.
Lond. 1792. — Portal Second Memoire sur I'Apoplexie in his Memoir, sur la nature
et le traitement de plusieurs maladies, Vol. II. No. 10. — Reil and Hausleutner De
locis in apoplexia affectis, 8vo. Halse, 1795. — J. Cheyne, Cases of Apoplexy and
Lethargy, with observations upon the comatose diseases. London, 1822. — Riobe
Observations propres a resoudre cette question : L'Apoplexie dans laquelle il se
fait un epanchement de sang dans le cerveau, est elle susceptible de guerison ?
Paris, 1814. — Rochoux Recherches sur I'Apoplexie. Paris, 1814. — Brkheteau in
Journ. compl. du Diet, des Sc. medicales. Vol. I. p. 129 — 152, and 289 — 317. —
— il/oM/m Traite de I'apoplexie, ou Hemorrhagic cerebrale, etc. Paris, 1819. — <
Serves in Annuaire medico-chir. des hopitaux et hospices civils a Paris, 1819. —
Romberg in Horn's Archiv fur medic. Erfahrung. p. 405 — 447, May and June,
1823. — A. Ziegler Ueber den Schlagfluss in pathologisch anatomischer Hinsicht
in Oken's Isis. Vol. XX. Part X. p. 851. — Compare further. Portal Sur la nature
et le traitement de I'Epilepsie, 8vo. Paris, 1827. — Rob. Manisch, The Anatomy of
Drunkenness. 8vo. Glasgow, 1827, and Barkhausen Beobachtungen iiber den
Sauferwahnsinn oder das Delirium tremens. 8vo. Brem. 1828. — Lastly, also
many authors on Typhus. — Interesting single treatises on the Pathological
Anatomy of the Brain are furnished by Th. Anderson, Pathological Observa-
tions on the Brain, in Transact, of the Soc. of Edinb. Vol. II. p. 17. — R. Powell,
Some cases illustrative of the Pathology of the Brain, in Medical Transactions,
Vol. V. p. 198. — Gilb. Blane in Transact, of the Soc. of Med. and Chir. know-
ledge. Vol. II. p. 192. — Labonardiere, in SedilloVs Recueil period, de la Soc. de
Med. Vol. L. p. 261, 337, m'd. — Rampo7it, ib. Vol. LV. p. 19. — Ever. Home'm
Pbilos. Transact. 1814, Part II. p. 469. — Nasse Zur nahern Kenntniss der organ.
Gehirnkrankheiten in Horn's Archiv f. medic. Erfabrung, May and June, 1821,
p. 375. — Duwcflw, jun. in Edinb. Med. and Surg. Journ. No. 68, July, 1821. —
Collections from the unpublished medical writings of the late C. H. Parry,
Vol. I. p. 274, London, 1825. — Thilow in Pierer's Allgem. medic. Annalen, Nov,
1827, Part XI. p. 1441. — Earle On paraplegia in London Med. and Chir.
Transact. 1827, Vol. XIII. No. 18.

(2) I can, however, almost always separate the continuation of the common
integument from the dura mater as a thin transparent layer resembling the skin
of the young embryon. Compare § 44, note 2.

(3) In no instance do we find greater difficulty than in the brain, in making
the result of dissection agree with the phenomena of disease previously ex-
hibited. We often observe during life the most violent symptoms indicating
affections of the brain, whilst the examination presents either none or very
trivial vice in that organ ; in other instances, on the contrary, we frequently
observe manifold, very extensive and important anomalies in the brain and its
membranes, of which, during life, there was not the least suspicion. It is espe-
cially important here to distinguish correctly which is cause or consequence of
the preceding disease. Violent and repeated irritation of the brain, occurring in
fevers, madness, convulsions, headach, continued drunkenness, &c., and metas-
tatic affections of the brain in neighbouring eruptive diseases, gout, puerperal
fever, &c. easily produce congestion of blood, secretion of air and lymph, and
states similar to those produced by inflammation. The kind of death itself, as
well as the changes to which the body as a corpse is subjected, are here also
worthy of notice.

366 Of the Brain. [Part H.

§ 217.
As to the DURA MATER alone, it is affected indeed with the
same irregularities as other fibrous parts ;^ but it exhibits
many pecuharities dependent principally on its situation and
connexion. Its form and size depend generally on that of
the skull and brain, and according as they are too small, unde-
veloped, too large, half doubled, awi'y, &c. so are they in vari-
ous ways abnormal. Sometimes the falciform process is entirely
or only partially deficient,^ as is also the tentorium.^ Toler-
ably often we observe in the falciform process, especially
towards its lower edge, more or less large openings, in conse-
quence of which both hemispheres of the cerebrum may adhere
to each other. When the two hemispheres of the cerebrum
are unsymmetrical, it is placed awry, and sometimes pushed up-
wards and sidewards by swellings of various kinds. In hydro-
cephalus internus, hernia cerebri, and hydrencephalocele, the
dura mater is sometimes generally or partially expanded to a
great extent,"^ although in both the latter diseases, it is some-
times also perforated by holes, through which the cerebral mem-
branes and the brain itself protrude. The dura mater fre-
quently varies from its normal thickness : thus it appears
atrophic, in parts even entirely absorbed, especially if long-
continued pressure have been made on it ; ^ sometimes and more
frequently it is remarkably and morbidly thickened, so that it
produces indentations in the brain itself." It is remarkable
that it has sometimes been observed, especially in diseases of
the mind and in hydrophobia, unnaturally dry, shrivelled,
AND EVEN PARCHMENT-LIKE.^ Its COLOUR also is somctimcs ir-
regular in men and animals, viz. transparent, grey, more or less
red under inflammation ; in contusion, suppuration, mortification,
and other diseases, sometimes yellow, dusky, bluish, brown-
ish, even blackish ; in jaundice of a yellow colour," and in
melanosis^ spotted with black from the well-known pigment.^

(1) Compare Sect. VII. § 145—154.

(2) This is always the case if tlie cerebrum be undivided ; see further on : if
it be single in front, but divided behind, the falciform process first begins to
appear where the division is, viz. at the coronal suture. The falx, however,
sometimes appears in a well-formed brain to be completely or partially wasted
by absorption. — Garengeot Splanchnologie, Vol. II. p. 211. — Giinz and Sprhigs-

Jeld. v. Burdach Beitrage, Vol. I. p. 87. — Ilaller Op. minora. Vol. III. p. 863.
Obs. 61. — Carlisle, v. Transactions of the Soc. for the im])rovement of med. and
surg. Knowledge, Vol. I. p. 212, (in a woman twenty-nine years old it was
comi)letely absent.) — Alex. Ramsay, Anatomy of the Heart, Cranium, and Brain,
p. 38. iMlinb. 180.3, found it entirely absorbed, and the two halves of the cere-
brum united.

(;3) If in monsters the posterior lobes of the cerebrum are deficient, the
tentorium is also wanting, v. Eller and Iloloff in Hist de I'Acad. des Sc. de
Berlin, 1754, p. 112. In a girl of seventeen years old, who was idiotic and

Sect. XX.] Of the Brain, 367

motionless from birth, the hinder part of the tentorium was deficient, v. Gilbert
in Edinburgh Med. and Surg. Journ. No. 95, April, 1828, (from absorption, as
the dura mater was also very much wasted at the base of the skull.)

(4) I have observed a rare case in a cyclopic pig, No. 2346 of my Verzeichn. ;
here the cavity of the skull communicates with the large orbit by a wide aper-
ture, through which the dura mater projects into it, and there forms at the
hinder part a peculiar space, in which a part of the cerebrum is lodged.

(5) For instance, in tumours of various kinds; most frequently it arises from
granulations of the brain, by which it is thus frequently perforated.

(6) I have seen it half an inch thick at some parts ; which was also observed
by Bo7ietus Sepulchretum anat. Vol I. p. 41, Obs. 82.

(7) Lieutaud, Hist. anat. med. Vol. II. Lib. III. Obs. 3, 16, 76, 165. — Bagliv
De fibra motrice in Op. omn. Lib. I. cap. 5, p. 287. Antwerp, 1715. — Littre
in Mem. de I'Acad. des Scienc. 1705. — Trecourt in Journ. de Medec. Vol. VI.
p. 189. — Shrivelled up and like a half-dried bladder in a man who died of
rupture of the stomach, v. B, Brown, in London med. Repos. 1822, Feb.
Vol. XVII. No, 58, p. 108. This state is indeed a consequence of inflammation.

(8) Stoll, Ratio Medendi, Vol. III. — I have indeed but once seen it pale
yellow, although I have dissected a dozen cases of jaundice ; also in yellow fever
it is found, though rarely, of a yellow colour.

(9) Bonetus. — Gendrin Histoire anatomique des inflammations. 2 vols. Svo.
Paris, 1826. — In an old man I have found a very large spot of a soot-like colour,
without suspicion of mortification.

§218.

The CONNEXION of the dura mater with the skull is often so far
irregular, that it is either too firmly attached, and even perfectly
adherent to certain parts of the brain-case, especially at the top
of the skull, in consequence of previous inflammation; or, on the
contrary, it is only loosely connected with the bones, so that in
opening the head, the skull-cap falls off of itself. Rarely from
internal causes, but more frequently from external concussion,
is a part of the dura mater entirely separated from the skull,^
and then, in consequence of a collection of blood, of fluid or
coagulated lymph, or of pus,^ it is expanded like a bladder;
tumours also of various kinds, as exostoses, sarcoms, cancerous
tumours, &c. which grow from without into the cavity of the
skull, often thrust the dura mater before them.^ Sometimes
also the connexion of the dura mater and the skull is destroyed
by collection of water between them,* and even the two layers
of the membrane itself are in rare cases separated from each
other by water, pus, blood, and tumours.^ Vices of con-
tinuity arise not merely from penetrating, shot, thrust, and
trepan wounds, but also very easily from indented and splin-
tered pieces of the skull. Sometimes the dura mater is torn
by very violent extension from within, as, for instance, in water
of the head.*' As fibrous parts are but imperfectly reproduced,
so is the dura mater also rarely restored after loss of substance ;
but there is usually formed in its stead, at those spots, a thick
cellular tissue, which is closely connected with the newly-
formed bone, or if the bone be not reproduced, it assumes a

368 Of the Brain. [Part II.

fibro-cartilaginous condition, and becomes consolidated into a
common cicatrix with the general integuments, which in many
cases produces only a weak membrane for the brain, and may
therefore be easily burst from internal expansion.^

(1) Sometimes, as I have myself occasionally seen, on the opposite side to that
on which the blow was received.

(2) Pus collects here also in consequence of inflammation, and without ante-
cedent mechanical influence.

(3) Schtjeicler D. de fungo l/.Bmatode. Berol. 1821. — Sclnvarzch'ild D. de fungis
capitis. 4to. Heidelbergae. 1825, with four lithogr. plates. — Sandifort Museum
anatomicum, Vol. III. p. 158, No, 127. — Lisfranc in Nouv. Biblioth. med.
May, 1827. — Abercromhie, (fourth case,) p. 426.

(4) Bonetus Sepulchret. anatom. Lib. I. Sect. II. Obs. 4o, p. 116. — Klinkosch
Progr. quo hydrocephalum foetus rariorem ejusque causam proponit. Pragae, 1773.
— I have occasionally seen in hydropic children the flat bones of the skull com-
pletely separated by water from the dura mater. — Greding saw it in insane
persons, v. Ludwig Adversaria med. pract. Vol. II. p. 469. — P. Frank Epit. de
cur. hom. morbis. VI. 1, p. 161. — Foigtel Handb. Vol. II. p. 9, had also one case.

(5) To wit, from bloody serum, v. /. Paisley in Edinb. medic. Essays, Vol. III.
p. 304 ; from seven ounces of blackish ichorous fluid, v. Biermayer Museum
anat. pathol. No. 94 ; the dura mater was found separated, by coagulated blood,
into two, and even three layers, v. Kil'ian Anat. Untersuchung des 9ten Hirn-
nervenpaares, p. 127 ; and Lobstein Compte rendu sur les travaux anatomiques.
I. p. 56 ; the layer which is lined by the arachnoid coat was separated from it
by pus, V. Vicq D'Azyr in Mem. de Paris, 1781, p. 497.

(6) We frequently find such rents in the cerebral membranes of hemicephalic
monsters ; in extensive hydrocephalus the water escapes by the nostrils, or
penetrates through the sutures of the skull, v. Cavallmi Collezione istorica di
casi chirurg. 4to. Firenzi, \o\. II. — In one instance a large quantity of water
flowed through the nose, and the membranes of the brain subsequently cracked ;
an external dropsical swelling was produced, v. J. BaroTi in Med. chir. Trans.
Vol. III. Part I. No. 3.

(7) The dura mater burst in a violent fit of hooping-cough, seven months after
trepanning, v. E. Stanley, Med. chir. Trans. Vol. III. p. 24. ff.

§ 219.

Vices of texture in the dura mater are of proportionally
rare occurrence. We often indeed see it injected and congested,
when in a state of morbid irritation in fevers of various kinds,
in cephalalgia, convulsions, epilepsy, hydrophobia, in staggers
in the horse, &c., or when the blood is retained in the vessels
of the brain, as occurs in many kinds of death, but especially
in that from suffocation.* True inflammation^ occurs idio-
pathically from internal causes but rarely ; ^ more frequently
from mechanical^ and chemicaP agency, or consecutively to
caries of the skull, inflammation of the ear, suppuration of the
brain, &c. Inflammation of this membrane sometimes proceeds
to the effusion on its outer surface of a false membrane con-
sisting of fibrous matter, and to adhesion with the skull, ^ with
the other cerebral membranes, and even the brain itself;
sometimes to suppuration, in which the pus is found
between its layers, and on its inner or outer surface, and in

Sect. XX.] Of the Brain. 369

the latter case may erode and perforate the skull ;^ sometimes it
runs into gangrene;* sometimes, lastly, into thickening and
INDURATION, the latter of which may even assume the cha-
racter of fibro-cartilage.^ Probably also ossification of the
dura mater arises from inflammatory irritation.^"

(1) On varices of the veins of the dura mater, compare § 205. On aneurism of
the meningeal arteries, § 196, note 7.

(2) Burdach Vom Baue und Leben des Gehirns. Vol. III. p. 18, in which he
applies to this the name of Perimeningitis.

(3) The accounts of its inflammation in yellowr fever, typhus, madness, &c. for
the most part originate in confusion between congestion and inflammation in the
other cerebral membranes. Hooper, pi. 1, gives an engraving of a portion of
inflamed dura mater.

(4) After injuries of the head, not penetrating through the skull ; viz. after
contusion, concussion, cuts, extirpation of tumours, &c. in consequence of the
connexion of the vessels of the pericranium with the dura mater.

(5) After the imprudent use of the moxa, of the actual cautery, of corroding
applications, of blows, in denudation from exposure to atmospheric air ; in the
latter case the inflammation of the dura mater which occurs is often a regene-
rating process. Although also in other persons, yet still more frequently in insane
people, v. Greding, Vol. I. p. 293, Georget De la Folie, p. 486.

(6) I have occasionally found this on several distinct spots ; it always appears
after wounds of the brain.

(7) Such cases are described hy Burserius^ Morand, Brisseau, Pietsch, Marchetti,
Barrere, and Abercromhie. M'Turk, in medical and phys. Journ. April, 1819;
further, Fizeau in Nouv. Journ. de Medecine, Chir. et Pharm. Vol. XI. p. 523,
and Roux, ib. Vol. XII. Sept. 1821; in the latter case, and in that of Alorand,
union occurred after trepanning. Concerning such cranial fistulas, comp,
Marvide in Memoires sur les sujets, proposes pour le prix de I'Academ. royale de
Chir. Vol. IX. 1778, and /Jic/z^er's chirurg. Bibliothek. Vol. IV. Pt. IV. p. 730.

(8) This seems to occur but rarely ; I have never seen them, except in wounds
of the brain which have become gangrenous, in cerebral abscesses, and in caries
of the skull; the melanotic colouring of the dura mater, v. § 217, note 9, cannot
be confounded with gangrene. Sometimes the dead dura mater exfoliates.

(9) To these belong the gummata in syphilitic persons, of which Lieutaud
speaks, Vol, II. p. 372. Lib. III. Obs. 205. It is difficult to determine where the
pustulae miliares, mentioned \>y Lieutaud, Lib. III. Obs. 16, belong; perhaps
they were, at least in one case, purulent cysts. Sometimes fibrous matter is
effused between the two layers of the dura mater, producing swellings which
form for themselves pits in the brain ; viz. Abercromhie, Case 6, p. 47, (half an inch
thick, 5 J inches long, and 2^ inches wide.)

(10) Ossification of the dura mater itself is, according to my observations, as
rare as that on the arachnoid coat lining it is common ; as it is often firmly con-
nected with the dura mater, which, by the pressure of the greater thickness of the
bony concretion, is wasted ; so, in careless examination, it is often improperly
considered as a growth from the dura mater. Calcareous deposits, however, do
occur in the dura mater itself, as I have seen a few times in diseases of the brain,
in which the dura mater was studded with little bony points and flakes ; for
example, in an epileptic person, and in No. 3983 of my Verzeichn. Compare
Albrecht praes. Boehmer 1). de ossificatione durae matris singulari observatione
illustrata. 4to. Halae, 1764. — Poft/ Progr. de dura matre passim ossea facta. 4to.
Lips. 1764. — Felten Casus aliquot memoratu digni ossificationum in membranis
cerebri inventarum, D. Bonnae, 1825, with two lithographic engravings. Com-
pare further on § 224.

§ 220.
Lastly, to the spurious formations, which in rare cases
we observe on the dura mater, belong, first, fatty and

B B

370 Of the Brain, [Part 1 1 .

ENCYSTED TUMOURS, whicli sometimes are found only upon it,
at other times between its layers, and contain even hair :^ next,
SCROFULOUS TUMOURS,^ wliich are found on both sides of the
internal cerebral membrane, as well as between its separate
layers : and, finally, sarcomatous and carcinomatous tu-
mours, some of which, passing fi'om without through the
natural or morbid apertures in the skull, particularly through
the orbits, perforate the dura mater, and produce on it, in
the cavity of the skull, more or less large swellings ;^ others
arise from the bones of the skull, and some from the dura
mater itself. To the latter kind especially belong fungus
of the DURA mater, fungus durce matris.^ This is a sarcom,
and sometimes more closely resembles the so-called fleshy
sarcom, sometimes more the medullary ; it is of various
colour and consistence, according as it belongs to one or
other of these kinds, or is examined in the incipient firm, or
subsequent spongy, fungous, inflammatory, and even suppu-
rative state. Usually we find only one such swelling, some-
times, however, several ;^ at first they are small, but sometimes
attain a very great size ;^ generally they are found on that part
of the dura mater which lines the top of the skull, although
sometimes also on that covering the lateral parts and base of
the skull. If the fungus be situated on the outer surface of the
dura mater, w^hich is its most usual seat,^ it perforates the
skull to a greater or less extent by absorption, and appears
externally on the head ; but should it be placed on the internal
surface, it grows more or less into the cavity of the skull.
We often also find fungus of the dura mater connected with
osteosarcom of the skull, fungus cranii; thus the latter, either
by participation of the dura mater in the disease, or by its
fibres only being separated from each other, grows through
them into the cavity of the skull. ^

(1) For example, an adipose tumour with hair in the substance of the ten-
torium. V. Morgagni Epist. anat. XX. No. 58. — In a new-born child with large
dropsy of the head, No. 2891 of my Verzeichn., I found, situated externally
upon the skull, between the common integument of the head, and the mem-
brane formed by the dura mater and pericranium, many flat adipose swellings,
with much black hair, and surrounded by fine cellular tissue ; one of these
tumours penetrated the dura mater, and was projected inwards in form of
several similar swellings which lay on the dura mater and arachnoid coat ; —
two little fatty tumours, whence sprouted many hairs, were seen on the dura
mater of a man which had been exposed by caries, v. Fricke Annalen der
Chir. Abtheilung des allgemeinen Krankenhauses zu Hamburgh, Part I. 1828,
p. 406. pi. 2.

(2) Lieulaiul, Lib. IIL Obs. 218 a. — BaiUie's Morbid Anatomy, p. 432, and
Sommerring' s Addenda, note 517, and a plate in Bnillie's Engravings, Fasc. X.
pi. 5.— My Selt Beob. Part L p. 108, No. 59; My Verzeichn. No. 2357.— £flr/f,
On paraplegia in Med. Chir. Trans. Vol. XIIL Part. 11. No. 18.

(3) For in«stance, Loder Observatio Anatomise tumoris scirrhosi in basi cranii

Sect. XX.] Of the Brain, S7L

reperti. 4to. Jenae, 17 7 9. -^PJranger D. Historia casus perrari de fungo dursema-
tris, prolapsum atque destructionem oculi bulbi efficiente. Erf. 1801. — A. B. Hertel
D. patholog. anat, de cerebri et meningum tumoribus. 8vo. Berol. 1814, with
plates. — Journal de Medecine continue, Vol. XVI. App. Bulletin, p. 83, (can-
cerous).— Landmann Comment, patbol. anat. exh. morbum cerebri oculique
singularem. 4to. Lips. 1820, with three copper-plates, (according to the account,
a cartilaginous tumour.) — My Selt. Beobachtungen, Part II. p. 86, No. Z6. — My
Verzeichn. No. 2356 (scirrhus of the neck projecting into the cavity of the skull),
p. 88, No. 37. — My Verzeichn. No. 2353, (A medullary- sarcoma of the eye
growing into the cavity of the skull, also described and represented in Benedicts
Handbuch der prakt Augenheilkunde, Vol. II ; and a cancerous tumour of the
eye which grew into the cavity of the skull. — MyVerzeichniss, No.2352.) — Panizza
Annotazioni anat. chir. sul fungo midoUare dell' occhio, &c. fol. Pavia, 1821, with
three plates. — Hasse D de fungo meduUari. 4to. Berol. 1823 (from the orbit.)
See below on the eye.

(4) Compare § 122, note 44. — The authors on Fungus Cranii — Amatus Lusi-
tanus Centur. V. Obs. 8. — Camerarius in Ephem. N. Cur. Dec. II. Ann. VI. 1687,
Obs. 99. — Cattier in Observ. medical. Obs. 15, p. 48. — Pohl in Actis eruditor.
Lips. May, 1736. — Scheler praes. Baldinger D. de Epilepsia et capitis dolore
ex tumore durae matris scirrhoso et carie cranii ortis, p. 8. Jenae, 1771 — Konig
in Ephem. Nat. Cur. Dec. II. Ann. I. No. 167. — Salzmann in Mem. de I'Acad.
de Petersbourg, Vol. III. p. 275. — Watken in Medical Observations and In-
quiries, Vol. V. — Viellard in Journ. de Medecine, Vol. XVIII. p. 533. v. Com-
ment. Lipsiensis, Vol. XIII. p. 257.— Edinburgh medical Commentaries, Vol. II.
p. 286. — Louis Memoires sur les tumeurs fongueuses de la dure mere in Mem.
de I'Acad. de Chir. Vol. V. p. 1. Paris, 1774, in which also cases by Amhr.
Par6, Sievert, Robin, Rey, Legrand, Marrigues, Choppart, Folprecht, Jauchius,
Grima, and Philippe, are related. — Gondange in Memoires de Montpellier,
Vol. I. 1776, Hist. p. Ill (on the base).— ^cre^ Chir. Vorfalle a. d. Schwed.
von A. Murray, Vol. I. p. 40. Gotting. \777.~Steph. de Vigiliis de Crutzenfeld
Biblioth. chirurg. Vol. I. p. 732. Wien, 1781. — Mowro in Medical Trans, published
by the college of Physicians in London, Vol. II. — Ed, Sandifort, compare § 122,
note 44, and Mus. anat. Vol. II. tab. 25. — Baillie, Morbid Anat. p. 433, and Som-
merring, Addenda, note 518. — /. G. Walter Anatom. Museum. 2d part, p. 112.
4to. Berlin, 1796, and Museum anatom. 4to. Berol. 1805, p. 131. — Siebold,
compare § 122, note 44. — Jos. and Carl Wenzel Ueber die schwammigen Auswiichse
auf der aussern Hirnhaut. fol. Mainz, 1811, with six engravings. — M. Baillie
Engravings, p. 219. Fasc. X. pi. 5, fig. 1. — v. Walther in der Salzburger med.
chir. Zeitung, 1813, Febr. p. 185. — Poilroux in Annal. de la Soc. de Medec. de
Montpellier, Vol. XXXIII. p. 139.—Montagnon, ibid. Vol. XXXIV. p. 304.—
Hebreard in Bulletin de la Faculte de M^dec. — Rudolphi, v. Hertel, p. 15. — Horn
Archiv f. medic. Erfahrung, 1815, Part V. p. 838. — Langstaff in Med. chir.
Transact. Vol. II. p. 288. — Biermayer Museum anat. pathol. No. 285. — J. G.
fVolter D. cont. descriptionem tumoris durae matris, cujus substantia cerebro
non dissimilis erat. Duisburg, 1817. — Meckel Handbuch der pathol. Anatomic.
Vol. II. 2. p. 324, fF. (three cases of his own, one on the exterior, two on the
interior of the dura mater.) — Esquirol in Diet, d. Scienc. medical. Vol. VIII.
Art. Demence. p. 201, (at the base, on the clivus.) — Windel D. de fungo durae
matris. 4to. Goett. 1819. — C. B. Tilanus D. de fungoso durse meningis excres-
cente, etc. 4to. Traj. ad Rhen. 1819. — Palletta Exercitat. pathol. Vol.1,
p. 93 — 104. — V. Walther in his and v. Grdfe's Journal f Chir. und Augenheilk.
Vol. I. Part I. Vol. 11. Part II. Vol. V. Part I.— v. Klein, ibid. Vol. III. Part IV.
p. 614. — Galliot, v. § 122, note 44, (fungus cranii and durae matris.) — Kilian Anat.
Untersuchungen iiber das neunte Hirnnervenpaar, p. 127, 4to. Pesth, 1822,
(congenital, in the Museum at Strasburgh.) — Larrey in Revue m^dicale. July,
1822. — Isenflamm Anatom. Untersuchungen, Erlangen, 1822, p. 166. — Wishart.
Compare § 122, note 44. — Weitzenmuller D. de fungo durae matris. 8vo. Gry-
phiae, 1823. — Esquirol in Archiv. gener. de Medec. Dec. 1823, (on the left
temple.) — Revue encyclopedique, August, 1828, (on the right sinus as large as
a walnut.) — Ritterich in Ceruttfs Pathol, anatom. Museum. Vol I. Part IV.

B B 2

372 Of the Brain. [Part II.

p. 5.-^Vingtrin'ier in Archives gen^rales de Medecine, May, 1824, (at the
base of the skull on the bulb of the vein.) — Hesselbach, v. § 122, note 44,
(fungus cranii and durae matris.) — Seerig Comment, nonnulla de fungi durae
matris origine etdiagnosi. 4to. Vratislav. 1825, with three litliographic tables. —
H. Schwarzschild, v. § 122, note 44. — Ch. Mayo, in London medical and physical
Journal, Vol. LVIII. p. 403, (in the right temporal pit.) — Burdach Vom Leben
und Bau des Gehirns. \o\. III. p. 28, § 258. — Hooper, pi. 7. — Churchill, in
London medic, and physic. Journ. March, 1827, (on the inside of the dura
mater). — G. Sandifurt Museum anatomicum. Vol. II L p. 147, No. 39, (a very
large swelling arising from the ala of the sphenoid.) - Rlegling D. quaedam ad
Fungi durae matris pathologiam. 8vo. Berol. 1828. — Ahercrombie (in tentorium)
42d case, p. 41-3, (on the base, large.) — Chelius Ueber den schwammigen Auswuchs
der harten Hirnhaut nach eigenen Erfahrungen. fol. Heidelberg, 1828, with
lithographic plates, and in Diet, des Sciences medicales, Vol. VIII. p. 291,
(on the clivus.) — I have, up to this time, only thrice met with fungus of the
dura mater, one lai-ge and connected with fungus cranii, v. Selt. Beob. Part II.
p. 82, No. 35, engraved in Seerig, tab. I. ; a second small one on the top of the
right orbit, No. 2280, of my Verzeichn.; and a third, also small, and on the
greater falx, No. 2281 of my Verzeichn., engraved in Seerig, pi. 3, fig. 3; all
three attached on the inner surface of the dura mater ; — in the Anat. Mus. at
Strasburg, I saw three cases of fungus of the dura mater in the region of the
longitudinal sinus, two of which were upon the internal surface of the dura
mater.

(5) Two cases were found by Walter and K'ein ; three by Sievert and Volprecht ;
four by Philippe and Meckel ; five by Wenzel and Baillie ; fourteen by Ritterich ;
eighteen by Sandifort ; many by Horn, Rudolphi, Wishart, &c.

(6) For instance, as big as a man's fist, in a case by Burdach and myself; as
large as a goose's egg, in Sandifort's ; as a second head in Grim's.

(7) Wenzel improperly considers that it occurs only on this part.

(8) There has been much disputation concerning the original seat of fungus
durae matris: sometimes it has been ascribed, as by Louis and Wenzel, to
the dura mater ; sometimes, as by Sandifurt, Siebold, and more recently by von
Walther, to the bones of the skull. But, in reality, it may arise in both, and
also in the pericranium; and, as the bones of the skull are only a living organ,
in connexion witli their external and internal periosteum, it must soon, more or
less, comprise all these parts. Osteosarcom of the skull, or fungus cranii, to
which von Walther has recently had the especial merit of drawing the attention,
and fungus durae matris, are therefore merely different, although often simul-
taneously occurring forms of one and the same disease.

§221.

The diseases of the arachnoid and vascular coats of the
brain, which are best treated of together/ are much more
common than those of the dura mater, and naturally in closer
connexion with the diseases of the brain, as that was with
the diseases of the skull. But both these membranes, on
account of their organic connexion with the brain and skull,
are frequently sympathetically affected by their diseases.
The most common pathological phenomena which have been
noticed in them, are morbid irritation,^ and actual in-
flammation, both of which, with their numerous conse-
quences, are observed in their various degrees as the cause
and effect of many diseases.^ In particular, respecting in-
flammation OF THE membranes, meningitis ;* \\\\^'\^ sometimes
an idiopathic and primary disease,* sometimes sympathetic

Sect. XX.] Of the Brain, 373

and SECONDARY, as in injuries of the head, high fevers in men
and animals, erysipelas of the head, many eruptive diseases, in
severe burns,^ in hydrophobia, in gouty, puerperal, and other
metastases, &c. ; further, it is sometimes acute, sometimes rather
CHRONIC, and, lastly, very different in reference to its extent, as
it often affects merely defined spots, merely the part lining the
external or the internal cavities of the brain, and sometimes all
the membranes throughout their whole extent ; most frequently it
occurs on that part of the membranes covering the upper half
of the hemispheres of the cerebrum, more rarely on its base.''
True inflammation of the arachnoid coat alone, arach-
noiditis,^ cannot be distinguished, on account of the deficiency of
blood-vessels in this membrane ; and the redness and injection
vrhich have been observed on it, arise from the inflamed sub-
jacent mucous tissue, and the inflamed vascular coat of the
brain, to which also must be referred, in part, the opacity,
THICKENING, and MILKY COLOUR of the arachuoid membrane,
which have been commonly considered as marks of its inflam-
mation.^ But inflammation of i\\epia mater, which is naturally
the same as inflammation of the surface of the brain, is dis-
tinguished by the usual signs of inflammation."

(1) Because both are cellular membranes, and are perfectly consolidated, not
merely in the coats of the brain, but in general are inseparably vmited in the
greatest part of the circumference of the brain in adults ; and they are always,
however, in organic connexion throughout, by means of fibro-mucous tissue of
various length ; and lastly, because their diseases have similar symptoms, and
generally appear in both at the same time, and of the same kind.

(2) Compare § 51. Great injection of the finer arterial and venous vessels,
is presented by and originates in mere congestion, in which only the veins are
filled; the distinction between morbid irritation and true inflammation is more
difficult, the latter of which terms has been much too often employed by the sup-
porters of Broussais.

(3) Compare § 216, towards the end.

(4) F. Herpin ThSse. Meningitis, ou Inflammation des membranes de I'Ence-
phale. 8vo. Paris, 1803. — Parent-Duchatelet and Marime^Recherchessurl' Inflam-
mation de I'Arachnoide cerebrale et spinale, ou histoire th^orique et pratique de
I'Arachnitis. Svo. Paris, 1821. — Piorry De I'irritation encephalique des enfans,
ou considerations sur les causes, les symptomes, et le traitement de la maladie
designee successivement sous le nom de convulsions internes, d'hydrocephale,
aigue, d'arachnoidite, etc. Svo. Paris, 1823. — A. Cucavaz D. de arachnoite. Svo.
Patav, 1825. — Senn Recherches anatomico-pathologiques sur la meningite aigue
des enfans et ses principales complications. Paris, 1825. — Bayle on Menin-
gitis chronica in Revue medicale, Feb. 1825; and on Meningitis acuta, i&. 1827,
Vol. I. and II. — Tacheron Recherches anat. patholog. sur la m^decine pratique,
Vol. III. p. 4 — 36, Paris, 1823, under the name of Arachnoidite. — Gendrin Hist.
Anatom. des inflammations, 2 vols. Svo. Paris, 1826. — Abercromhie, Path, and
pract. obs. on diseases of the Brain and Spinal Marrow, p. 49.

(5) Perhaps also in phrenitis in men and animals, in many convulsions, in
mad staggers in horses, &c. According to Bayle, a chronic inflammation of
these membranes is the most common cause of disturbance of the mind, with the
exception of congenital idiotcy ; in delirium tremens there is usually meningitis.
v. Barkhausen Beobachtungen iiber den Saiiferwahnsinn, oder das delirium
tremens. Bremen, 1828. The same is also said to be the case in Nostalgia,

374 Of the Brain. [Part II.

Y. Larrey Recueil de M^moires de Chirurgie. Paris, 1827; — also in softening of
the stomach, v. Camerer Versuch iiber die Natur der krankhaften Magenerwei-
chung, Stuttgard, 1828; lastly, also, castration in sheep and fowls often produces
inflammation of the brain and cerebral membranes, v. Faneau Delacour in Journ.
Univers. des Sc. Med. June, 1824.

(6) In a child, who died the third day after having been scalded with hot
water, over almost the whole body, I found distinct meningitis ; Eklund also
found, in three persons who were burnt by the explosion of gunpowder, conges-
tion of blood in the cavity of the skull, v. Ars Berattelse om Svenska Lakare-
Sallskapets Arbeten, lemnad oi Ekstrom. Stockholm, 1827, p. 55.

(7)1 have, however, seen it here also very distinctly several times.

(8) Not arachnitis, as inflammation of the arachnoid coat is called.

(9) It has always appeared so to me, on the closest examination, and I have
found the redness produced by the vessels of the mucous tissue, and the pia
mater, lying beneath the arachnoid ; I do not, however, deny, that in the arach-
noid itself a peculiar state, similar to the inflammation of other parts, may occur ;
at least, thickening, loosening, and deposition of plastic lymph, in its tissue, is a
frequent phenomenon.

(10) As the pia mater, in a healthy state, is also extremely vascular, so we
must not, as is commonly done, take every great injection of it for inflammation.

§ 222.

To the most important anatomico-pathological phenomena
of the cerebral membranes belong the changes which are pro-
duced by morbid irritation and inflammation in relation to
the QUANTITY and quality of the secreted fluids. The
examples are rare in which, without suspicion of putrefaction,
AIR is found between the two layers of the arachnoid coat,
as well as between it and the vascular coat, whereby they are
separated, in bladder-like spots. ^ Or there may be too
little serum, and the membranes therefore appear almost
DRY and shrivelled together. The opposite vice, or an

UNNATURAL COLLECTION OF A WATERY OR LYMPH-LIKE SECRE-
TION, between the membranes and in the ventricles, is very
common. This appears, in many cases, to take place during
the agony of death, and even immediately after death,^ partly
as the product of many diseases and weakness preceding
death. ^ In the so-called serous apoplexy, apoplexia serosa,
palsy and death are commonly produced by pressure of the
serum effused between the membranes of the brain and into
the cavities, although the effusion does not seem to be the
cause of this disease.* Should the quantity of water found
in the cavity of the skull be greater, we call it internal
dropsy of the head, internal watery head, hydroce-
phalus internuSf^ which is again divided into dropsy of the
cerebral membranes, hydrops membranarum cerebri,^ and
dropsy of the ventricles, hydrops ventriculorum cerebri,''
both of which, as is natural, often occur at the same time. In
the former kind, which is much more rare than the latter,
and usually to a less extent, the water is contained in the

Sect. XX.] 0/the Brain. 375

bag of the arachnoid coat, that is, between the outer layer
connected with the dura mater and the inner which envelopes
the brain ; * and the arachnoid then produces, in rare cases, as
a congenital vice, elongated bags, which protrude through
holes in the skull, and have much resemblance to hydrence-
phalocele.^ The water is less frequently contained in closed
bags of the arachnoid coat,^" between it and the vascular mem-
brane, or between the latter and the brain. ^^ But in dropsy
of the ventricles, which is the most common, and the kind
which produces almost all the large watery heads, the water is
collected in the bags of the arachnoid and vascular membranes
which line the cavities of the brain, so that it is either con-
tained in all or the greater number of the cerebral cavities at the
same time, which is most commonly the case, or only in one of
them.^^ The cause of this collection of water in the head is
usually an inflammatory state of the membranes and of the
brain itself, which may produce this effect at every period of
life ; but naturally only in the embryon,^^ and in young children
on account of the yielding of the skull, can lead to a great
eflTusion of water, whilst at a later period, when the skull
cannot be further expanded, there is no room for a large col-
lection of water. From this and other causes, internal dropsy
of the head is sometimes an acute, sometimes a chronic dis-
ease, which in the latter instance sometimes even wears itself out
in riper age,^* and often acquires an enormous size.^^ The efliised
serum is generally quite pale, thin, and clear, although some-
times light brown, turbid, flocculent, containing albumen, and
of a yellowish or red colour from the blood mingled with it.*°

(1) Compare § 51. — Morgagni De sed. et caus. morbor. Epist. IV. 19, 26,
35; V. 17. 19; VIII. 9; IX. 9 ; X. 17 ; XIV. 35 ; XLVIII. 38 ; LIII. 26 ;
LIV. 39, 49; LVII. U.—Halliday D. de pneumatosi. Edinb. ISOG.—Briere in
Nouvelle Biblioth. de Medec. Feb. and March, 1826. — I have several times
seen it without suspicion of putrefaction ; twice in persons who died of tetanus,
as Morgagni in the latter case, and once in a paraplegic person. Compare also
Portal Cours d'Anat. Med. Vol. IV. p. 70, ff.

(2) I have very often found this in persons who had been hanged, drunk, and
in one case of a person destroyed by choke-damp ; several times also in people
who had quickly died from injury of the head. I have met with a quantity of
similar cases in the reports of the morbid examinations at the Royal Medical
College, and have particularly remarked some cases in which great extravasation
of water into the cerebral cavities, and between the membranes, had occurred in
persons destroyed by strangulation and by blows on the head, which was con-
sidered by less experienced practitioners as a morbid state existing previous to
the injury.

(3) To wit, in acute fevers, especially yellow and typhus fever, scarlet fever,
measles with affections of the head, diseases of the mind, nostalgia, epilepsy,
convulsions, tetanus, v. Speranza in Anno clinico-medico. Parma, 1823-24. —
Delirium tremens, hydrophoby, softening of the stomach, asthma, consumption,
rickets, and various cachectic diseases, distemper in dogs, sleepy staggers in
horses, diabetes mellitus. v. von Stosch Versuch einer pathologie und therapie des

376 Of the Brain. [Part II.

diabetes mellitus, p. 103, Berlin, 1828. — Also in drunkards and old people
serum is frequently found between the membranes and in the cavities of the
brain ; this is, however, by no means to be regarded in the latter as an abnormal
condition ; as /. Carson has observed, on the circulation of the blood in the
head, Edinb. med. and surg. Journ. No. 79, 1824, April, p. 261. — The easy
SEPARATION of the vascular membrane from the brain, which is observed in some
bodies, seems to me to originate in the effusion of lymph beneath the pia mater
loosening their connexion. Compare Camerarius D. de apospasmate pise matris.
Tubingae, 1722. — Mechanical causes, however, as concussion, may produce this
loosening.

(4) There is no proportion between the quantity of fluid effused and the
violence of the symptoms prior to death, and the more or less speediness of the
latter ; compare Morgagni De sed. et caus. morb. Lib. I. Epist. IV. : often is the
quantity of fluid much less in this than in other diseases, in which no, or very
indistinct, symptoms of pressure of the brain exist. — Abercrombie, p. 253, a'.so
holds, that extravasation is not the cause but the consequence of apoplexy. —
[Jbercrombie says ' sometimes.' T.] — Probably apoplexy and exudation arise
from one and the same cause.

(5) The INTERNAL, to distinguish it from the external, hydrocephalus extermts
or oedema capitis, in which the water is found between the skull and the external
teguments. As to writers, compare de Plouquet Repertor. Art. Hydrops capitis,
Reuss Repert. Commentat. Vol. XIII. and Dictionnaire des Sciences m^di-
cales, Artie. Hydrocephale, and above, § 122, note 10. — The most valuable of the
modern writers are Murgagfii, Epist. XII. — Kaltschnud Progr. de hydrocephale
interno rars magnitudinis. Jenae, 1752. — Fothergill in Medical Observa-
tions and Inquiries, 1771, Vol. IV. — Klinkosch Pr. de hydrocephalo foetus
rariori ejusque causa. Pra|. 1773, — Ludwig D, de hydrope cerebri puerorum
Lips. 1774. — Odier Memoires sur 1' Hydrocephale interne ou I'Hydropisie des
Ventricules du cerveau in Hist, de la Soc. de Medecine h Paris, 1779, p. 194. —
G. Flajani Osservazioni pratiche sopra i'Amputazione, I'ldrocefalo, etc. Roma,
1791. — Qui)}. Abhandlung iiber die Gehirnwassersucht, Leipz. 1792. — Bader
Geschichte der Wassersucht der Gehirnhohlenoder des Sclilagflusses der Kinder.
Francof. 1794.— Murray resp. Schulzen D. fcetus hydrocephalo interno corrupt!
descriptio. Upsal. 1797. — Kreysig 1l>. dc hydrocephali inliammatorii pathologia.
Viteb. 1800. —J. B. Bott D. de hydrocephalo. Edinb 1800. — Moffat and
Armstrong D. de apoplexia hydrocephalica. Edinb. 1700. — Hopfetigdriner Vn-
tersuchungen iiber die Natur und Behandlung der verschiedenen Arten der
Gehirnwassersucht. Stuttgard, 1802. — Afzelius resp. Rislachi, I). Hydrops ven-
triculorum cerebri historiis morbi et sectionibus cadaverum illustratus. 4to.
Upsal. 1804. — J. Young D. de hydrocephalo interno. Edinb. 1804. — T. Ferris
and E. Sullivan D. de hydrocephalo interno. Edinb. 1805. — J. It. Lucas, D. de
hydrocephalo acuto. Edinb. 1805. — J. and C. Wenzel Bemerkungen iiber die
Hirnwassersucht. 4to. Tubingen, 1806. — P. Lee D. de apoplexia hydrocephalica.
Edinb. 1807. — Bonsfield D. de hydrocephalo acuto. Edinb. l^Ql .—Ralston D. de
hydrocephalo. Edinb. 1808. — M'Creery.. D. de hydrocephalo acuto. Edinb.
1808. — Brown, D. de apoplexia hydrocephalica. Edinb. 1808. — J. Rand, jun.
Observations on the Hydrocephalus internus in Medical Communicat. of the
Massachusetts med. Soc. Vol. I. p. 69. Boston, 1808. — Chcyne, On Hydrocephalus
acutus, or water in the head. 2d edit. Dublin, 1819. — Formey,\on der Was-
sersucht der Geliirnholiien. Berlin, 1810. — Sanders, D. de hydrocejjhalo acuto
interno. Edinb. 1810. — Ferrai and Stormoulh, D. de hydrocephalo acuto. Edinb.
1811. — Autenrieih D. Observat. de hydrocephalo acuto, etc. Tubing. 1811. —
V. Portenschlag- Ledermayer Ueber den Wasserkopf. Wien, 1812. — Lobensiein-
Lobel Die Erkenntniss und Heihuig der Gehirnentziindung, des innern Wasser-
kopfes und der Krampfkrankheiton im kindlichen Alter. Leipzig, 1813. — Golis
Prakt. Abhandl. iiber die vorziiglichsten Krankheiten des kindl. Alters. 1st.
Vol. von der hitzigen Gehirnhohlcnwasscrsucht. 2d Vol. vom innern chron.
Wasserkopfe und den verschiedenen Arten des aussern Wasserkopfes. Wien,

1815 and 1818. 2d edit. Wien, 1821. — J. Ferguson D. de hydrocephalo. Edinb.

1816. — U. Guthrie and /. IVyite D. D. de hydrocephalo acuto. Edinb. 1816. —

Sect. XX.] Of the Brain, 377

Teat, A statement of the early symptoms which lead to the disease termed
water on the brain. 8vo. London, 1815; and an Appendix to the [same, with
cases. London, 1819. — Coindet Memoire siir I'hydrencephale, ou cephalite
interne hydrencephalique. Paris, 1817. — Hecker Antiquitates hydrocephali.
Berol. 1^17 . — Abercroinbie in Edinb. med. and surg. Journ. Vol. XIV. p. 292. —
J.Liglis, D. de hydrocephalo. Edinb. 1817. — J. Squair, D. de hydrocephalo
acuto. Edinb. 1817. — FiUajis, D. de Hydrocephale acuto. Edinb. 1818. —
Bracket Essai sur I'hydrocephalite ou Hydropisie aigue des ventricules du cer-
veau. 8vo. Pai'is, 1818. — de Leon D. de hydrocephalo. Edinb. 1819. — Schiitz D.
de hydrocephalo acuto, 8vo. Halae, 1819. — J. S. Boettger D. de hydrope cerebri.
8vo. Berol. 1819. — Reusch D. de hydrocephalo. 8vo. Berol. 1820. — Moulin Traite
de I'Apoplexie ou hemorrhagie cer^brale, considerations nouvelles surles hydro-
cephales ; description d'une hydropisie cer^brale particuliere aux vieillards.
8vo. Paris, 1819. — Mathey Recherches sur les characteres distinctifs, et sur le
traitement de I'hydrocephale interne in Journ. de Medec. cont. Vol. XL
p. 651. — Ditffin and //. Symes D. D. de hydrocephalo. Edinb. 1821. — Stansfield
D. de hydrocephalo acuto. Edinb. 1821. — Clendinning D. de hydrocephalo acuto.
Edinb. 1821. — Levi D. brevis de Hydroc. tractatio. Berol. 1822. — R. Johnston,
D. de hydrocephalo. Edinb. 1823, — Barry D. de hydrocephalo acuto.
Edinb. 1823. — Campe D. de hydrocephalo acuto. 8vo. Halae, 1823. — ^Ff^jer
D. de hydrocephalo. Wirceb. 1823, s. — Dorrer D. de hydrocephalo chronico
senili. 8vo. Wirceb. 1826. — Mitivie Beobachtungen und Bemerkungen iiber die
hitzige Gehirnhbhlenwassersucht bei den Kindern, nach d. Fr. von G. Wendt.
Leipz. 1823. — A. J. Wenzel D. de hydrocephalo congenito. 8vo. Berol. 1823. —
Ritter Morbi hydrocephali historia. 8vo. Berol. 1824. — Kietis D. de hydro-
cephalo chronico. 8vo. Riga, 1825. — Rabe D. de hydrocephalo ventriculorum
cerebri acuto. 8vo. Berol. 1824. — Fischer D. de hydrocephalo acuto. 8vo.
Berol. 1824. — Bergmann anat. pathol. Untersuchungen iiber Hirnwassersucht in
Nasse's Zeitschrift fiir die Anthropologie, Part I. 1825. — Bamberg D. de
hydrocephalo acuto. 8vo. Berol. 1826. — Ayre, Researches into the nature and
treatment of Dropsy in the brain, chest, abdomen, ovarium, and skin. Lond.
1826. — Duges in Ephemerides medicales de Montpellier, 1826. — Rudolphi Ueber
den Wasserkopf vor der Geburt, in Abhandl. der K. Akad. der Wissenschaften.
Berlin, 1826-7, p. 1, pi. 1, 2, and 6, (in the last plate a beautiful engraving
of the brain.) — E. Ehrenberg D. exh. Hydropis cerebri casum rarissimum.
4to. Berol. 1826, with engravings. — E. W. Otto D. de hydrope cerebri acuto.
4to. Leipz. 1827. — A. Monro, The Morbid anatomy of the Brain, Vol. L Hydro-
cephalus. Edinb. 1827. — Mills in Dublin Transactions of the Association of
Physicians, Vol. V. 1828. — Levrat Aper9us theor. et prat, sur les causes, la nature
et le traitement de 1' Hydrocephale aigUe maladie particuliere du premier age.
Lyons, 1828. — J, Brevis D. de hydrope ventriculorum cerebri acuto. 8vo.
Berol. 1828. — C. Himly Demonstratio hydrocephali humani memorabilis in
Comment. Soc. reg. Scient. Goting. recentior. Vol. VL Class, physic, p. 61 ; and
Langenbeck De cerebro aqua ingenti sacciforme distento, cum nondum perfecto
conferendo, ib. p. 73, pi. 1 — 5, (engravings of the brain.) — Meckel has collected
many individual cases in his Handb. der pathol. Anatoraie, Vol. I. p. 260, fF. —
Burdach Vom Leben und Bau des Gehirns, Vol. III. p. 514. — Some interesting,
or, from their anatomical investigation, very instructive cases are given in
the Edinb. med. and surg. Journ. Vol. II.p. 369.— CVar/f^, Vol.V. p.264; Vol.VIIL
p. 364; Vol. IX. p. 398; Vol. XL p. 453. — Coley in Vol. XIV. p. 401;
Vol. XVII. p. 240, 471 and 510; Vol. XIX. p. 17 3, — Breschet in Magendie's
Journal de Physiol. Vol. L p. 92; Vol. IL p. 269; Vol. IIL p. 241.— Bulletin
de la Faculte de Medec. Vol. VII. p. 332. — Archives generates de Medecine,
July, 1823. — Howship, Pract. observ. in Surgery and morbid Anatomy (twenty-
sixth case, with an engraving of the brain.) — Baxter in Medical Repository, new
series,. New- York, 1817, Vol. IV. Part III. (100 ounces of water in the brain.) —
Tacheron, Vol. III. p. 37 — 59. — Baron in Bulletin de la Societe de MMec.
Vol. IV. p. 432. — Ulrich and Mayer in MeckeVs Archiv f. die Physiologie,
Vol. VI. p. 523, and Vol. VII. p. ^2Z.—Georget in Nouv. Journ. de Medec.
Vol. VII. p. 193. — Seeger in Rust's Magazin, Vol. II. — Kriiger- Hansen in Graefe

378 Of the Brain, [Part II.

and Walther^s Journ. der Chir. Vol. IV. p. 541, (congenital, nineteen inches in
circumference.) — Wetter in Harles's Rhein. Jahrb. fur Med. und Chir. Vol. Ill,
Part III. p. 65. — /. Glover in Chapmann's Philadelphia Journal of the med. and
phys. Sciences, Vol. II. No. 1, (between the membranes.) — Duncan, }nx\. in Trans,
of the raed-chir. Soc. of Edinb. Vol. I. 1824, No. 7, (136 ounces of water in the
arachnoid and in the ventricles, the hemispheres very much separated from each
other.) — Millar aud Robertson, ib. Vol. II. 1826. — PascoU Uebersicht iiber das im
Jahre, 1825-6, in der medic, prakt. Schule zu Inspruck geflogene Heilverfahren,
Inspruck, p. 81, 1827, (the child, aged one year, weighed twenty-five and a half
pounds; its head alone weighed twenty-one pounds.) Internal hydrocephalus
happens frequently among beasts, and often to a great extent in calves, horses
and sheep ; much less frequently in dogs, cats and pigs. Of other animals no
examples are known to me.

(6) Also hydrops cerebri externus, and hydrocephalus internus , in old people,
which dropsy of the ventricles cannot. We may also call it hydrocephalus
meningeus. — Meckel, Handbuch der pathol. anat. Vol. I. p. 264, calls this ex-
ternal dropsy of the head, in contradistinction to dropsy of the ventricles, which,
however, may easily give rise to confusion of ideas. According to Monro, the
water from the ventricles may be effused into the membranes by rupture, which,
however, at least is not in general the case. v. Mo7iro, Observations on the eye,
the ear, and the brain, p. 38. — Even in one case of congenital dropsy of the
brain. No. 2891 of my Verzeichn. in which there was an aperture, no water escaped.

(7) Also hydrops cerebri, hydrops cerebri internus, and hydrocephalus ence-
phalodes. — Gall distinctly pointed out that all the large dropsies of the head
belonged to this kind.

(8) Observations of good cases are given by Wepfer Observat. anat. de
apoplexia. Hist. XIII. and XIV. — Kaltschmid. — Loftie in Medic. Observat. and
Inquiries, Vol. V. No. 13, p. 121. — Wrisberg, v. Salzburg, medic, chir. Zeitung.
Vol. I. 1805, p. 88. — Ilartell, ib. p. 94. — Mier in Samml. auserles Abhandl. zum
Gebr. prakt. Aerzte. Vol. XI. p. 214. — Flajajii, Hufeland, Glover, and Duncan, &c.
In the cases of Kaltschmid, Loftie, Flajani, and Glover, water was found merely
between the skull and the brain ; in the others also at the same time water in the
cavities of the brain. I have several instances of the latter kind; of the former
I have found but two in new-born children.

(9) Penada Saggio d'osservazioni e memorie, etc. 4to. Padua, 1793, (large on
the occiput.) — Textor in Neuen Chir. Vol. I. Part III. p. 469, (on the fontanel,
apparently without connexion with the brain.) — Meckel Descriptio monstrorum
nonnullorum, p. 52, 4to. Lipsiae, 1826. — As in hydrencephalocele the protruded
bag of the brain is sometimes merely membranous, it requires a close examination,
though the watery cyst, which was cured by ligature, might at least in part
belong here. v. E. Thompson in London Medical Repository, Nov. 1824. — In a
monster which had dropsy with an undivided brain. No. 2888, of my Verzeichn.,
the very expanded arachnoid having fallen together, protruded on the temple
through a hole in the dura mater and the membrane of the skull to the general
tegument, and here formed at first sij^ht an encysted tumour ; perhaps water had
been previously contained in it ; the pia mater passed smootlily before the
inner opening, and contributed somewhat, as well as the brain, to the formation
of this tumour.

(10) Metzger Biga Observat. p. 3. — E. Ehrcnberg, p. 16, and an engraving ;
the watery cyst was situated between the other parts of the liemispheres of the
cerebrum. — Meckel Descript. monstr. nonnull. p. 57. 4to. Lipsine, 1826.

(11) Morgagni relates many instances. I myself have also found some,
although in these cases it appears to me that the quantity of water is always but
small. Compare Camerarius.

(12) A. Portal Sur une hydropisie particuli^re dcs vcntricules lateraux du
cerveau, etc. in Mem, de Paris, 1770, p. 210. — In adults I have seen occasionally
water in the lateral ventricles, though never in great quantity. In some children
which had watery heads, I have seen one hemisphere of the brain much more
distended by water than the other, altliough tiicre was water both in it and in the
middle ventricle. In hydrops cerebri hydatidosus the })artial rx})ansion of

Sect. XX.] Of the Brain. 379

one ventricle is naturally more common. — E. Home observed a considerable
quantity of water in the third ventricle, and in the septum lucidum, without there
being any in the lateral ventricles, v. Baillle's Morbid Anatomy, p. 447. — In an
idiot five ounces of water were in one case found in the cavity of the septum
lucidum. V. Vingtri?iier in Revue Medic, franp. et etrang. Vol. VIII. p. 299 —
304, July, 1822.

(13) Chronic water in the head is so frequently congenital that Meckel, Hand-
buch der pathol. Anat. Vol. I. p. 260, allows of no other. I know, however, no
reason why the causes of water in the head should not operate just as much
immediately after as before birth ; and there are really many cases given of water
in the head occurring in healthy children of one, two, or more years old, after
falls, blows, metastases of eruptive diseases, &c. The formation of water in the
head of the foetus is especially important in midwifery, as perforation of the head
is often necessary. Compare Hebenstreit D. de capitonibus. Lips. 1743. v. Haller
Select. Diss. Anat. Vol. VI. — Very small embryons have been seen with water in
the head, viz. Osiander Annalen der Entbindungslehr-anstalt zu Gottingen, Vol. I.
Part II. p. 58, 61, and Handbuch der Entbindungsk. Part II. p. 291, (in em-
bryons two or three months old.) — Rudolphi, tab. 1, fig. 1, (in an embryon about
two months old.) I have a similar case before me, No. 2938. —A description and
plate of a six weeks' old foetus, with water in the head, is given by Meckel De-
scriptio monstr. nonnull. p. 83, pi. 5, fig. 2. 4to. Lips. 1816. — Probably also
here belongs the case by Mende, in Nov. Act. Acad. Nat. Cur. Vol. XI. Part II.
p. 443, pi. 53, fig. 2 ; although the author considered the brain healthy. Some-
times there is a marked disposition to water in the head, as several sisters have
been affected with this disease, v. Portal, Vol. IV. p. 73. — Odier Med. chir.
Abhandl. a. d. Fr. Leipz. 1798.— Recueil period. Vol. VI. p. 289.— P. Frank De
cur. hom. morb. Epitome, Vol. IV. p. 337 ; (five sisters died in their first year of
acute hydrocephalus.) — Goells mentions that in one family three, in another seven
sisters had water in the head. — In another case seven sisters were affected with
this disease, of which only the youngest was cured, v. Rolph in London med.
Repos. Sept. 1824.

(14) Even to the twenty-fourth year, v. Riedlin in Ephem. Nat. Cur. Cent. I.
and II. Obs. 29 ;—Schmtt in Salzburg, med. chir. Zeitung, 1800, Vol. IV. p. 233 ;—
to the twenty-fifth year, v. Howship; — to the twenty-ninth year, v. Michaelis in
Medical Communications, Vol. I. No. 25 ; — to the thirtieth year, v. van Swieten
Commentar. p. 123, § 1217; — Buttner Beschreibung des innern Wasserkopfes
und des ganzen Beinkbrpers einer von ihrer Geburt bis ins 31te Jahr krank
gewesenen Person weiblichen Geschlechts, Konigsb. 1773 ; — Thunherg, v. Reisen
in Afrika und Asien, v. Magazin von neuern Reisebeschreibungen, Vol. IV.
p. 250 ; — to the forty-third year, v. Schneider in Annalen der Wetterauischen
Gesellschaft, Vol. I. No. 24 ; — to the forty-fifth year, v. Aurivillius, resp. Ekmark
De hydrocephalo interno 45 annor. Upsal. 1763, in Sandif or t Thesaurus, Vol. II.
No. 14 ; — to the forty-eighth year, v. Osthoff Kleine Beitrage, Vol. I. No. 4 ;
even to the fifty-third year, v. Gall Anat. et Physiol, du Systeme nerveux en
general, etc., p. 25, with a plate of the brain.

(15) Instances of very large watery heads in new-born children are given in
Marcorel Memoires pres. a I'Academie, Vol. IV. p. 4-58. — Murray. — Stein Ge-
burtshiilfl. Wahrnehmungen, Vol. I. No. 161. — Wrisherg, p. 92, (seven pints of
water, the circumference of the head 30J inches.) — Osiander Annalen der Ent-
bindungsanstalt, Vol. I. Part II. p. 59. — Kriiger- Hansen and Pascoli. — There
is a remarkable case in Bresl. Mus. v. No. 2891, of my Verzeichn., which,
though shrivelled up in spirits, measures even now 19 inches. — Old cases of
large collections of water in the head are collected in Portal, Vol. IV. p. 73. —
In a child a year and a quarter old, the head measured 32 inches round, and
contained fourteen pints and a quarter, v. Schwabischer Merkur, 1807, p. 310. —
In a boy of sixteen years, 31 inches, v. Millar and Robertson. — In another,
seventeen years, 24^ inches, v. Bhimenhach Medic. Biblioth. Vol. III. p. 626,
1788. — In a girl of eighteen, 26f inches, v. Hufeland's Journal, May, 1823,
p. 129. — In the case of Aurivillius, the head contained eighteen pints of water. —
In that of Buttner, twenty pints. — In that mentioned in Ephem. Nat. Cur.

380 Of the Brain. [Part II.

Dec. III. Ann. I., as much as twenty-four pints. The circumference amounted to
29 inches, in a case of Warner's, v. Benj. Gooch, Cases and pract. remarks on
Surger}', Vol. I. p. 37, 29 inches. — In that of Buttner, 30 inches. — In one of
Wrisberg, 30^ inches. — In that of Kalfschmid, 33 inches. — In that of Mackenzie,
Illustrations of Phrenology, Edinb. 1820, p. 24, pi. 6, fig. 3, as much as 36
English inches. — Afonro saw one of 50 inches in cii'cumference. v. Outlines of
the Anatomy of the Hum. Body, Vol. I. p. 361. — I have mentioned above, § 122,
note 10, several good cases. Sometimes the membranes and the brain are so
expanded by the water, that the light may be seen through the head, which I have
often noticed ; or that the membranes have burst and the water been effused be-
neath the external tegument of the head, v. Cavallmi Collezione istorica di casi
chirurgici, Vol.11. 4to. Firenze, 1764; and John Baron in IMedico-chir. Trans.
London, 1817, Vol. VIII. Part I. No. 3; Meckel Anat. physiol. Beobachtungen
und Untersuchungen, Halle, 1821, p. 135; — or it has escaped tlirough the nose,
V. Kaltschmid De nervis opticis in cadavere latis inventis, Jena?, 1752, in
Holler's Disp. pathol. ^'ol. I. p. Zl ^. — John Brron. — Miller and Robertson, (an
aperture was found above, to the right, and before the crista galli.) Perhaps here
also belongs the case in Meckel Descriptio nionstror. nonnullor. p. 57. — It has
been already observed, that tearing of dropsical brains and their membranes is
not rare.

(16) It has been improperly supposed, that the water here secreted in disease
could be chemically distinguished by the coagulation of its contained albumen
with acid and alcohol, from the healthy secretion of the brain, which, however,
is never properly secreted in sufficient quantity for examination. — Yeats,
p. 107. — Analysis of the fluid of watery heads is given by Jordan in Crell's Chem.
aimalen, 1801, Part VII. p. 50 ; Part VIII. p. 115 — Mirabelli and Schreger in
Horkefs Archiv, Vol. I. Part II. p. 256. — Marcet in General views of the com-
position of animal fluids, by Berzelius, p. 55. London, 1812. — Breschet et
Barruel, in Magendie" s i onrn. de Physiol. Vol. I. No. 1. p. d5. — Haldat s. Diet,
des Sc. medical, art. Hydrocephale. — If it have been tapped, which treatment
has been employed as a mean of cure, it easily is reproduced ; compare Lizars
in Edinb. med. and surg. Journ. 1821, Vol. XVII. p. 243 and 471 ; compare
r. Graefe and v. Walther's Journ. d. chir. Vol. IV. Part L p. 140.

§223.

In other cases, especially if the preceding inflammatory irri-
tation have been violent, no distinct watery exudation has been
observed between the cerebral membranes, but a more mucous
and ALBUMINOUS-LIKE STATE,* or a still thicker puriform plas-
tic LYMPH, which overspreads larger or smaller patches of
the membranes, or sometimes forms false membranes.^ If
the plastic lymph be more firmly coagulated, it gives rise to
the various adhesions and unions' of the membranes, to their
very distinct thickening and induration,* as well also as,
probably, to the production of the so-called cerebral
GRANULATIONS or PACCHioNic GLANDS.'* The latter are little
roundish light-coloured corpuscules, of different consistence, and
of the size of grains of millet, hemp, and even of little peas,
which are found in greater or less number very commonly in
the neighbourhood of the longitudinal sinus, although also on
other parts of the arachnoid and vascular membranes, and
not unfrequently, passing outwards from these, they penetrate
through the dura mater itself.

Sect. XX.] Of the Brain. 381

(1) Often, also, in rheumatic affections of the head, in drunkenness, and in
puerperal fever ; sometimes the exudation resembles the buff of the blood in
colour and consistence. Compare Portal, p. 79.

(2) Morgagni, Epist. LI I. 8. — Wrisberg in Haller's Physiologie, note 74. —
Baillie, p. 431, and Sommerring, ibid, note 514. — Baillie gives a plate, in En-
gravings, Fasc. X. p. 215, pi. 4, fig. 1 ; and Hooper, pi. 1. — In a maniac, who
had a very violent attack, a thick false membrane was found. — Biermeyer. v.
Museum anat. pathol. No. 202. — Flormann in Svenska Lakare-Sallskapets
Handlingar, Vol. VI. p. 219, (which covered the whole of the left hemisphere.)
I have found it a few times, but almost always in the temporal region, attached
sometimes moi-e to the dura-materal layer, sometimes more to the cerebral
layer of the arachnoid coat, sometimes between the latter and the vascular
coat; on the latter, it has been several times found by Abercrombie, p. 51, 53,
56—61.

(3) Baillie, p. 245, and Soemmerring consider adhesion of the dura mater with
the other cerebral membranes very rare, and this is, in reality, partially true, if we
compare the arachnoid, in this respect, with the pleura or peritoneum. I
have, however, found such union several times, sometimes fibrous and ligamen-
tous-like, sometimes compact, and in large streaks. In congenital water of the
head, and in tumours within the cavity ot the skull, I have occasionally found
extensive adhesions between the two layers of the arachnoid coat. Not unfre-
quently adhesions of that part of the membrane which lines the cavities of the
brain also occur, as I have seen in diseases of the mind, in tumours, suppu-
ration, and partial dropsy of one ventricle. Compare Morgagni, Epist. I. 14.
IX. 25.— Portal, Vol. IV. p. 91, and Esquirol, in Diet, des Sc. M^d. Vol. VIII.
Art. Demence, who observed adhesion of the membrane lining the lateral
ventricles, in fifty-four mad persons, and also in others who were not insane.

(4) This thickening is often very distinct, and occurs both on the arachnoid
and vascular membrane ; in the former case, the thick membrane passes smoothly
over the convolutions of the brain, in the latter it penetrates into the depres-
sions between them. The membranous lining is also not unfrequently remark-
ably thickened. V. Portal, Vol. IV. p. 91.— Greding found the arachnoid and
pia mater thickened in eighty-six out of a hundred insane people, in eighteen
out of twenty- four melancholic, and in twenty- two out of thirty idiots. Esquirol,
Pinel, Georget, &c., also often found it thickened in diseases of the mind. The
pia mater is often apparently found thickened, on account of turgescence and
rigidity of its vessels, as Neumann has properly observed, who found it but once
actually thickened out of fifty mad people, v. Hufeland' s J ourn. July, 1824. p. 57,
It is natural that the membranes should consequently lose their transparency,
and become whitish or yellowish.

(5) Glandulse Pacchionianae. v. Pacchioni, Op. omn. p. 125, Romae, 1741. —
Granulations cerebrales. v. Bichat Anat. gen. Vol. III. p. 5d. — Portal, Cours
d'Anat. Medec. Vol. IV. p. 10, 44, first pointed them out as somewhat morbid;
then more fully and completely in Wenzel De penitiori structura cerebri. Cap. 1.
— ComTpare Rosenthal in Horn's Archiv, 1818, p. 406 ; he considers them as a
product of the veins. Also in the vascular plexuses of the ventricles they are
not unfrequent; and also, in an epilectic person, Abercrombie, p. 315, found such
a concretion in the vascular plexus, as large as a hazel-nut.

§224.

More rare than the hitherto-mentioned results of morbid irri-
tation and inflammation in the arachnoid membrane of the brain
is ULCERATION, which is however naturally more commonly su-
perficial ulceration of the brain rather than of the just-mentioned
membranes.^ As rare also is the termination in mortification,
which here occurs only secondarily, especially after severe in-
juries, and abscesses of the brain, &c. So much the more

3S2 Of the Brain, [Part 1 1 .

frequent, as consequent on morbid irritation, are found stony
and BONY CONCRETIONS^ in the arachnoid membrane. They
are commonly seen on the external surface of the fold cover-
ing the dura mater, especially in the region of the vertex
and on the falciform process, and often attain a very conside-
rable size. Usually they are flat and splinter-like, although
often tubercular and roundish, so that they penetrate into
depressions of the brain, and even into the skull. They are
very bulky, so that the investing layer of the arachnoid coat
is often much thrust inwards or even entirely absorbed.^ In
rare cases they are produced, as in other serous membranes, in
necked processes or bags, which project from the external layer
into the cavity of the arachnoid coat.* Sometimes also the
cerebral granulations give rise to bony concretions, as lime is
secreted within them.^ The bony concretions between the
arachnoid and vascular coat,^ as well as in that part of it
which lines the cavities of the brain and produces the plexuses,
are more rare and generally smaller.'^

(1) I have seen a few cases, in which, after injury of the head, and suppura-
tion in the ear, the cerebral membranes, which were secondarily inflamed, sup-
purated, without the brain appearing actually to be affected ; in another case,
without this complication, a case of meningitis was connected with a large
collection of pus between the arachnoides and pia mater, at the base of the
brain. A few interesting cases of suppuration are mentioned by Jbercromhie,
p. 58. Case 13 and Case 15, p. 61. On superficial suppuration, v. The Brain. The
cerebral membranes often become yellow, greenish, brown, even blackish from
suppuration and gangrene. We must not confound herewith the yellow colour
which has been seen a few times in jaundice, v. Morgagni Epist. XXVII. 7. —
Buzzi in Italian. Biblioth. Vol. III. Part II. p. 96. — Duhrevil in Ephemerides
medicales de Montpellier, Aug. 1826, (in an embryon three months old.)

(2) Compare § 219, note 10. These bony concretions are very frequently
considered the cause of headache, dizziness, epilepsy, apoplexy, insanity, suicide,
&c. ; but, as I think, cause and effect are here often confounded, as the flow of
blood and morbid irritation, which occur in these diseases, as often give rise to
morbid deposition of lime. Advanced age also appears to me to have no greater
disposition thereto, than, that irritation of the brain more frequently occurs at
that, and especially at a later period of life. I find, therefore, in the bodies of
many old persons brought here for dissection, the formation of bone hardly more
frequent in the cerebral membranes than in middle life, and usually only when
other traces of affections of the head are present at the same time. On the con-
trary, I find large bony concretions also in young people who have died of disease
of the brain ; indeed, I have seen them congenital, to wit, very large in No.
2888 of my Verzeichn. ; several instances of their existence also in children and
young persons, are given by difl'erent writers. I have never found them in
animals, though I have examined so many of their heads ; nor, if I be not
mistaken, are there any examples of them in any collection.

(3) I have found these modifications in various ways, viz. almost three inches
long, and half an inch tiiick ; round, of the size of a hazel-nut, or nutmeg.
Compare No. 2277, 3123, 3975 — 3990 of my Verzeichn. and besides several
interesting cases. In Dr. Locher's coUection at Zurich, I saw a piece of bone,
as big as the palm of the hand, on tlie dura mater. I have never found it on
the tentorium, and therefore consider it very rare, although examples are given.
V. Lietitaud, Part II. p. 324, Lib. III. Obs. 50; some instances in Voigtcl

Sect. XX.] Of the Brain, 383

Handb. der path, anat. Vol. II. p. 26. — Htitchinsoyi in Med. chir. Trans. Vol.11,
p. 113. — Good engravings of such bony concretions are given by Scheid D. de
duobus ossiculis in cerebro humano. Argentorati, 1687. — Baillie, Engravings,
Fasc. X. pi. 4, fig. 2 and 3. — Hooper, The morbid Anatomy of the human Brain,
pi. 5. — According to van der Boon Mesch, these concretions on the arachnoid consist
especially of carbonate of lime; those on the dura mater of phosphate of lime (?)
V. Schroeder van der Kolk Observat. anat. pathol. et pract. argumenti. Fasc. I.
p. 34. Amstelod. 1826.

(4) See my Selt. Beob. Part II. p. 81, and No. 2276 of my Verzeichn.
Compare § 81, 1-54, note 7, &c. — Here also seems to belong Cruveilhier's case.
V. Essai sur I'Anat. path. Vol.11, p. 21 ; and perhaps also that of Fabriclus,
Cent. I. Obs. 81, p. 27, and Gredlng, Vol.11, p. 97.

(5) I myself have never seen this, though several instances are mentioned by
Greding in Ludwig's Adversar. med. pract. Vol. II. Part III. p. 483.

(6) Haller De corp. hum. fabrica. Vol. VIII. p. 33 ; and in Op. minor.
\o\.Ul. ^.ZQZ.— Vicqd'Azyr m Mem. de Paris, 1781, p. 498. — <yanrf«/br;
Observ. anat. pathol. L. III. p. 45. — Cheselden Anat. of the human Body,
p. 221. — Greding in Ludwig's Advers. med. pract. Vol. II. p. 428. — Bichat Ana-
tomic generale, Vol. IV. p. 536. — Meckel Handb. der pathol. Anat. Vol. II.
Part II. p. 206. — I have only found it here twice, v. Verzeichn. No. 3991. —
Hooper, Part V., gives an engraving.

(7) Laennec also found it on the outer surface of the membrane lining the ven-
tricles, but Kerkring and Merklin on the inner, v. Diet, des Sc. Med. Vol. IV.
p. 127. — Less frequently in the plexus choroides. v. Sue Osteologie de Monro, p. 20,
note. — Greding' s Sammtl. medic. Schriften, Vol. I. p. 314. — Sommerring Adden-
da to Baillie, p. 267 and 268. — Walter, Anatom. Museum, Vol. I. p. 155, No.
309. — Chabert, Flandrin, and Huzard Vollstand. Handb. der Vieharzneik. Vol. I.
p. 420. — Powel, in Medical Transactions, Vol. V. p. 234, (earthy concretion.) —
Esquirol in Diet, des Scienc. m^dicales, Vol. VIII. Artie. Demence (a cyst con-
taining lime.) — Asprey in London med. and physic. Journ. (on each side, one as
large as a pea.) — I have also sometimes found earthy and bony concretions in
the plexus.) — Bergmann found, in the plexus of a mad person, about fifty little
crystals, v. Nasse Zeitschrift f. Anthropologic, 1823, Part II. p. 416, and
twenty cases of sand-like formation in the plexus, v. Mende Beob. und Bemer-
kung. aus der Geburtshiilfe und gerichtl. Medic. Vol. III. Gott. 1826.

§^25.

To the more important spurious formations which are
sometimes found in the arachnoid membrane and the external
surface of the vascular membrane of the brain, belong espe-
cially the various kinds of tumours v^^hich easily become in-
jurious by pressure on the brain. These are, first, hydatids^
of different number and size, which in rare cases occur on the
free upper surface of the arachnoid, between it and the vas-
cular membrane, and very commonly and numerously in the
plexuses of the lateral ventricles of the brain ;^ next, a kind

of CYLINDRICAL, Or CLUB-LIKE PROCESSES Or NECKED BAGS,

peculiar to serous membranes, arising from the arachnoid which
lines the dura mater, and containing in their loose extremities
commonly lymphatic concretions, gelatinous, bony, and carti-
laginous matter;^ further, true encysted tumours,'^ and lastly,
not very rarely, tubercles,^ by the breaking up of which

CIRCUMSCRIBED BAGS OF PUS Or ENCYSTED ABSCESSES may

arise on the surface of the brain.

384 Of the Brain, [Part II.

(1) Compare Ludersen D. de hydatidibus. Goett. 1808, p. 10. — Morgagnf
Epist. XII. 6. — LieiiiauJ, Vol. II. p. 310 ; Lib. III. Obs. 4 and 4; a. — Fischer
Hist. Taeniae hydatigenae, § 21, tab. I. — Several examples are collected by
Burdach Beitrage, &c. Vol. II. p. 107 and 287. — I have found tliem a few times,
but am unable to mention any thing certain as to the pathological phenomena. —
Es quirol ioxxnd. a large hydatid in the arachnoid of an insane patient, v. p. 291. —
Were the miliary cysts which Pagenstecher, v. Maries's Neue Rhein. Jahrbiicher
der Medicin und Chirurg. Vol. XII. Part III. p. 1, saw on the arachnoid,
hydatids ?

(2) I found them in persons subject to insanity, epilepsy, headache, &c. ;
also, however, in many others. — We often see many of them attached by fine
threads, or single large ones, which separate the walls of the ventricles from each
other. — A single large hydatid was found by Devau.x in the right lateral ventricle
of a person who died of nostalgia, v. Foumier Recueil de Med. Chir. et Pharm.
Milit. Vol. XI. p. 248. — Rendtorff saw a large hydrops vesicularis in the right
ventricle of a girl eight years old. v. Hufeland's Journ. d. prakt. Heilk. Dec.
1823, p. 46, with a plate. — Headington found a very large hydatid in the left
ventricle, v. Abercromhie, p. 436.

(3) Compare the preceding §, note 5. — I have found this anomaly three
times. — In No. 2276 of my Verzeichn., there were found, besides the large bony
concretions attached by threads, and in sacs with necks, four long appendages,
with little blood-vessels in their necks, and a collection of turbid jelly in their
thicker depending extremities. — No. 2278, from a horse, is similar, in which
there are five appendages, about two inches in length, from which some cylin-
drical processes, similar to those of the gurnards, are produced. — In a third
case, a long roundish tumour, filled with thick yellow jelly, is attached to a thin
stem. — Doubtless, the finger-like appendages mentioned by Lobsfein, Compte
rendu sur les travaux Anatomiques, Strasburg, 1820, p. 50, belong here.

(4) For instance, in the late Duke of Saxe Gotha, one about six inclies long
and three broad upon the right hemisphere, v. Dorl and Ziegler in von Froriep's
Notizen, Vol. X. p. 89. — Esquirol once found a cyst containing fatty matter on
the plexus choroides.

(5) Baillie's Morbid Anatomy, p. 438. — Leveille found in an idiot tubercles
as large as an egg between the dura mater and arachnoidea ; read in the sitting
of the Academy of Medicine, Aug. 10, 1824. — Many smaller tubercles on the
vascular coat of a person who died of paraplegia, v. Eurle on paraplegia, in Med.
chir. Transac. 1827, Vol. XIII. No. 18. — Abercromhie, (seventy-ninth case,)
p. 173. — Tubercles which have their origin in the cerebral membrane frequently
appear to lie on the surface of the brain, of which I shall make mention further
on. I have seen this distinctly in two cases.

§2^6.

Lastly, as to what belongs to vices of contents of the
arachnoid and vascular membrane, it has been already above
noticed, in speaking of the collections of lymphatic secre-
tions to which inflammation of this membrane usually gives
rise. We frequently find between the two layers of the arach-
noid, although also between it and the vascular membrane, a
considerable quantity of pus, which may be here poured out
from ulcers of the membranes, as well also as from the surface
of the brain, and cerebral abscesses which have burst. We
not unfi'equently see in the just-mentioned situations, in in-
juries of the head and in apoplexy, collections of blood, in
very different quantities.' Even pure quicksilver,^ ex-
traneous BODIES which having penetrated from without and

Sect. XX.] Of the Brain. 385

remained here for a long time/ and parasitic animals,* have
been observed in and upon the membranes of the brain.

(1) Little bloody specks have been seen on this membrane in severe menin-
gitis; a few times also petechiae. v. Stoll Ratio Medendi, Part IL p. 406,
in petechial fever. — Wood in a girl who died of purpura, v. vo7i Froriep's Notizen,
Vol. VII L No. 8, p. 127, (according to the report, in the dura mater, also between
it and the lining layer of the arachnoidea.) — Effusions of blood are considerable
in contusions of the cerebral membranes, and rupture of the dura mater, in
which case the blood seems to be collected in a cyst in the arachnoid. In
apoplectic persons also we often find the blood in a cyst of the arachnoid, not
unfrequently between it and the pia mater, as well as beneath the latter. See
further on the brain. — Lobstein, p. 46, found, in two maniacs, the arachnoid
thickened and consisting of several layers, between which blood was effused ; the
brain had also become very much compressed. This seems to be an undescribed
disease.

(2) Af«?-a/^ Observ. chir. Basil. 1691, No. 208. — Panarolus Arcanor. Fasc. II.
— Boneti Sepulchretum anat. Vol. I. p. 64, Obs. 114. — Lieuiaud, Hist. anat.
rued. L. III. Sect. VIII. Obs. 558—562. Compare § 73, note 8.

(3) For instance, bullets, pins. Flajmii found in a Russian, thirty years old,
a needle two inches long in the cavity of the skull, close to the falx. v. Valentin
Voyage medicale en Italic. Nancy, 1822. See below.

(4) The Gamasus marginatus. The worms in the brain described by old
writers are merely threads of plastic lymph, which have been mistaken for them.
It is true that fly maggots may find their way into the cavity of the skull
through badly tended wounds of the head, but this will never occur at the
present time.

B.- — OF THE brain ITSELF.

§ 221,

The brain, together with the rest of the nervous system,
is proportionally subjected to but fevv^ and rare malformations
and diseases; and even those pathological conditions, which
we consider especially grounded in this system, as mental and
nervous diseases, appear but in very rare instances to have
their primary seat in it.^ But so much the more important
are their organic vices, as besides the disturbance of the
peculiar functions of this system, they are frequently, by their
great influence upon the formative and reproductive activity
of the organism, not merely detrimental to life,^ but also, if
they exist previously in the embryon, they have the greatest
influence upon its development, and therefore appear to be
the cause of many vices of formation in the foetus.^

(1) Compare, for instance, the above quoted writers on Diseases of the
Mind, and especially Esquirol in Diet, des Sciences Medic. Vol. VIII. p. 289;
Vol. XXXII. p. 172, and his Therapie der Seelenstorungen, translated into
German by Hille, p. 235 and 483, in which he mentions, that in the examination
of the bodies of 277 insane persons he found but seventy-seven with vices
of the brain ; Pinel (the father) but sixty-eight out of 161. v. Magendie^s Journal
de Physiol. Vol. VI. No. I. p. 50 ; also Georget, De la Folie, did not find
vices of the brain in one half of insane cases. Bayle considers chronic inflam-
mation of the brain as the most frequent cause of diseases of the mind, excepting
.cojigenital idiotcy. Many of the vices of the brain which have been observed

C C

38G Ofthe.Braiji. [Part II.

are certainly only the consequence, and not the cause, of diseases of the mind.
According to Flourens, diseases of the mind, as they are generally the conse-
quence of organic vices, can only be connected with vices of the cerebrum.
According to Casmivieilh and Boucher's Observations in diseases of the Muscular
System, viz. epilepsy and catalepsy, the medullary substance is affected ; but in
the true diseases of the mind the grey substance, v. Briere in Nouv. Biblioth. de
Med. Dec. 1825.

(2) It is known that insane persons rarely become old, and that they are often
affected with consumption.

(3) As the nervous system is, at every period of life, so intimately connected
with the functions of circulation, secretion, and nutrition, so it is well knovv^n to
have in the embryon the greatest influence upon the growth and proportional
form of its several parts. Hence we also see the most varied formation of the
face and the extremities connected with hemicephaly, hydrencephalocele, with
singleness of the brain, spina bifida, &c., as I have already observed in several
parts of my Selt. Beob., and since can confirm by copious collections of recent
observations. And it is very satisfactorily shewn, especially by Tiedeinann in
Beobachtungen iiber die BeschafFenheit des Gehirnesund der Nerven in Missge-
burten. v. Zeitschrift fur Phvsiolog., edited by Tiedemann, G. R. Treviranus^ and
L. C. Treviranus, Vol. I. Part I. p. 56—110; Vol. III. Part I. p. 1—44.

§2^8.

To MALFORMATIONS of the brain belong, especially, the
TOTAL or PARTIAL DEFICIENCY of this organ,^ either when the
vault of the skull is simultaneously deficient, or even when
that exists. To the former state is commonly applied the
name of deficient brain, hemicephaliaj or miencephaliaJ^
In both instances the cause of deficiency is dropsy of the
brain at a very early period, which sometimes continues to
enlarge till it bursts and is discharged, at other times is only
Ynore or less retarded in its external or internal formation.^
In proportion as this disease affects the embryon at an earlier
or later period, must the effect be very different. In hemi-
cephalic monsters the brain is sometimes completely and
entirely wanting, and the base of the skull, which alone
exists, is merely covered with fine membranes, in which the
origin of the cerebral nerves is attached; sometimes we find,
covered with a thin membrane consisting of the common in-
teguments and the dura mater, a larger or smaller rudiment of
brain, occasionally mingled with hydatids, mostly broken to
pieces, fallen together, soft, discoloured, soaked in effused
blood, as it were macerated, and very imperfect in its internal
organization ; * sometimes, lastly, there is a part of the top of
the skull present, but always less arched than natural, and
there is then also a part of tlie brain tolerably normal, whilst
another part lies loosely, and more or less destroyed, as in the
preceding state, is torn or cicatrized. In those embryons,
however, which are not hemicephalic, and are born with the
top of the skull properly arched and even too large, the brain
appears to be sometimes entirely, or for the most part deficient.

Sect. XX.] Of the Brahi. 387

as, on account of the great degree of dropsy, the cerebral
membranes, instead of being filled with brain, are, on the
contrary, filled with water, so that, when, after the evacuation
of the water, the head is opened, its cavity appears empty ;
usually, however, we find in its base more or less of the base
of the brain, as also the anterior columns of the spinal cord,
the cerebral tubercle, pons varolii, limbs, crura cerebri, and
rudiments of the great ganglions, thalami optici and corpora
striata.^ In monsters with deficient face or with very small
skulls, more or less of the fore part of the brain, even the
whole cerebrum, is sometimes wanting, so that merely the
cerebellum, and the oblong marrow, terminating in front in a
rounded form, are present ; ^ or the brain, even if completely
existing, is still so imperfectly developed, that its normal
divisions and internal organs are more or less lost.^ The

DEFICIENCY OF INDIVIDUAL SMALL PARTS OF THE BRAIN, with

the otherwise normal form of the brain and of the face, is
very rare.^ The opposite vice, the excess of number in the
parts of the brain, or the partial duplicity of the brain, is
very common in double monsters, and exhibits the same modi-
fications as the consolidation of the two heads, so that, either
according as the duplicity affects merely the fore or hind part
of the skull, &c., so the brain also is only more or less double
at its fore or hind part, or, when in some heads the cavity of
the skull is double, two brains also are found, of which the
one is sometimes very imperfect on account of the confined
space.'' Very rarely do we find in otherwise single brains,
certain of their parts double or supernumerary.^"

(1) Compare Reuss Repertor. Comment. Vol. X. p. 124 — 126, and p. 279. —
de Plouquet Repertor. Art. Cerebrum deficiens, (the greater number of these cases
relate to hemicephaly.) — Geoffroy Saint- Hilaire in Mem. du Museum d'Histoire
naturelle, Vol. XII. — /. H. Beck Ueber den ursprunglichen Hirnmangel und
iiber die Pathologie und Therapie des Gehirnblutflusses. Niirnberg, 1826, (on
hemicephaly.) — Dujes in Ephemerides medicales de Montpellier, July, 1826,
(on agenesia of the brain and congenital paralysis.) v. Casauvie'ilh in Archives
generates de Medecine, May and July, 1827-

(2) Also called acephalla spuria, acrania, microcephalia, &c. Compare above,
§ 122, and on monsters. — Concerning the state of the brain v. Meckel Handb.
der pathol. Anatomie, Vol. I. p. 195 — 260. — Instead of the name Hemicephali,
for these monsters, B^clard, in Bulletin de la Fac. de Medec, 1815, p. 448, makes
use of the name offKvcpoi, and Meckel, in Anat. physiol. Beob. p. 79, that of
avopo(poi.

(3) The more hemicephalic cases I have examined, the stronger is my convic-
tion of the truth of the view which I took in my Monstror. sex humanor. anat.
et physiol. disquisitio. 4to. Francof. ad V. 1811; and in Selt. Beob. Part I.
p. 41. — Morgagni, Epist. anat. XX. Art. 56, and 57, and De sed. et caus. morbor.
Epist. XII. 5—8. Epist. XLVIII. 50.—Haller Op. min. Vol. III. p. 136.—
Sandifort Anat. Infantis cerebro destituti. L. B. 1784. — Penada Saggio di Osserva-
zioni e Memorie, Vol. II. p. 55, were previously of this opinion, as also Meckel
Handb. der pathol. Anatomie, Vol. I. p. 254, and Anat. physiol. Beobachtun-

C C ^

388 Of the Brain. [Part II.

gen und Untersuchungen. Halae, 1822. — Rudolphi Ueber den Wasserkopf vor der
Geburt. — Tiedemaim, Vol. III. Part I. p. 35, and others, have supported it, both
by their authority and by the grounds and comparisons which they have brought
forward. If the various retarded formations are frequently connected with this
malformation, it shews, as I think, not the originality of deficient brain ; as water
in the head, if it attack the embryon at an early period, may equally have, as a
consequence, retardation of the development. I recently found an embryon six
weeks old, which had hemicephaly, singleness of the brain, which was com-
pressed, discoloured, and two large transverse slits in the parietes of the head.
V. 8821, Bresl. Mus. On account of these slits, adhesion of the hemicephalic
heads with the membranes of the ovum easily occurs, v. Pole in Lond. med. and
phys. Journ. Vol. III. 1800, p. 397 and 497. — Geoffroy Philosophie anatomiq.
p. 155. Paris, 1822. — Cerutti Rarior. monstri in museo anat. Lips, adservati
descriptio anat. 4to. Lips. 1827. — C. E. Rudolphi D. Monstror. trium praeter
naturam cum secundinis coalitor. disquisitio. 4to. Berol. 1829, with plates. I
have also had an opportunity of examining a similar case.

(4) In but very few cases, is there a difference to be observed between the
cortical and medullary substance, but the whole consists rather of grey substance :
if the brain be complete, some of its parts appear tolerably normal, although the
hemispheres of the cerebrum are almost always diseased.

(5) Compare on Water of the l^edidi, Kerkring. v. Lieutaud, Vol. II. Lib. III.
Obs. 332. — Santorini v. Morgagni, Epist. XII. 6. — Bromel in Actis lit. Suecia^,
1725, p. 93, Comment. Soc. Gotting. Vol. IV. p. 113. — Feiler Ueber angeborene
menschliche Missbildungen. Landsh. 1820, p. 5, note. — Beclard in Magendie
Journ. de Physiol. Vol. II. p. 273. — I have myself seen one instance in a human
foetus, and a few of calves and sheep, in which the whole cavity of the skull was
filled with a mere watery cyst, at the bottom of which only was there cerebral
substance. Two imperfect descriptions of total deficiency of the brain in a
boy of ten years old and a newly-born child, are given by Martel in Gazette de
Sante. v. Huf eland's Journal, Octob. 1823, and d'Alquen in Maries' s Rhein.
Westphal. Jahrb. fiir Medic, und Chir. Vol. X. Part I. 1825, p. 77; both cases
seem to be nothing more than a high degree of water in the brain. Breschet
once saw, in a child of three years and a half old, merely a thin membrane filled
with water, instead of the entire outer side of the left hemisphere, v. Archives
generales de Medec. July, 1823.

(6) To wit, Carlisle in Philos. Trans. 1801, Part I. p. 139—144, in a lamb,
of which one ventricle was very large, probably from dropsy. I have seen a
similar case in a lamb, but the cerebellum was only rudimentary.

(7) Bianchi Storia del mostro di due corpi, p. 100, 8vo. Torino, 1748, (the
corpus callosum, septum, fornix, cornua ammonis, pine and plexus choroides were
wanting, the medulla oblongata and pons varolii slightly developed.) — Eller in
M^m. de I'Academie de Berlin, p. 112, 1754, (the brain small, without divisions,
pyramids, olives, the appendix cerebri, and several other parts malformed.) —
Klinkosch Pr. quo anatomen partus capite monstroso proponit. 4to. Prag, 1766,
rev. in Diss. med. select. Pragens. Vol. I. No. 12, p. 199, (most of the inner part,
and also the first six pairs of nerves are deficient.) Malacame in Mem de la Soc.
med. d* Emulation, Paris, 1803, (in a blind child the optic beds were wanting,
together with the eye- balls and optic nerves.) — Rudolphi in Abhandl. der
Berliner Akademie der Wissenschaften fiir das Jahr 1814 — 15, p. 185, Berl.
1815, (with the right eye, the optic bed of the same side was depressed, and
lying loosely on the base, and very much malformed.)

(8) In two idiots, the posterior cornua of the lateral ventricles and the
pes hippocampi were wholly deficient, v. Ch. Hastings in London med. Repos.
Jan. and May, 1817. — In rare cases also merely the latter, which I have seen
in an epileptic patient; Wenzel also sj)eaks of it, De penitiori structura cerebri.
The ])ineal gland is said to have been wanting several times, which is to be
ascribed for the most ))art to its wasting, or even to careless examination.
In rare cases, the acervulus cerebri has been missed. The observations on
congenital absence of the appendage and valve of the brain arc also equally
doubtful.

Sect. XX.] Of the Brain, 389

(9) I have once seen, in a double calf monster, merely the tuber annulare
and the medulla oblongata existing of the cerebellum ; in a double lamb, there
was only the anterior thick and rounded part of the medulla oblongata, v, Barkow
Monstra animalium duplicia. Vol. I. p. 70, 4to. Lips. 1828. — In the Bresl. Mus.
No. 3058 and 8226, are the skulls of two lambs, single in front, but double be-
hind ; in which, on account of the unsymmetry of the skull, the one posterior
half of the brain is much smaller than the other. Sometimes the duplication
of the brain is distinguished merely by the increased size of its anterior or pos-
terior extremity. I thus found, in No. 2907, two cerebella and one cerebrum, of
which the hinder were twice as thick as the front lobes. If there be but a single
cavity in the conjoined skulls of double-headed monsters, the two brains, when
they exist, are sometimes partially consolidated, viz. by the two hemispheres in
a duck. V. Tiedemann, Vol. III. Part I. p. 5, pi. 2, fig. 3 and 4; sometimes
they are separate, and only lie beside each other, as in the cases given by Klein
in Maries's Jahrbiichern der deutsch. Medic, und Chir. Niirnb. 1813, Vol. III.
Part I. p. 17; by Barkow D. de monstris duplicibus verticibus inter se junctis,
4to. Berol. 1821, with plates; and myself in one case. No. 2914of my Verzeichn.

(10) Viz. the pes hippocampi major and the fimbria double. w.Sbmmerring Hirn
und Nervenlehre, p. 42, note 7. — I have twice found a double commissura mollis
of the optic beds. — A double pine. v. Wenzel, pi. 4, fig. 2. — A pair of unnatural
ganglia between the pons varolii and the pyramids, v. Tiedemann, Vol. I. Part I.
p. 73. pi. 6, fig. 1. — Brain sand, acervulus, also in animals, viz. in the fallow-
deer, v. ^emmerring and Nich. Lisignolo D. de lapillis vel prope vel intra glan-
dulam pinealem sitis, p. 10. Moguntiae, 1785. — Greve Bruchstiicke zur vergleich-
enden anatomic und physiologic, p. 23, Oldenburgh, 1818 ; and in a goat,
V. Malacarne Encefalatomia di alcuni quadrupedi, p. 31. Mantov. 1795.

§ 229.

The brain exhibits remarkable variation in its normal
SIZE, both as to smallness and largeness. There are
indeed observed both men and animals, in which the skull and
brain are at birth proportionally too small to the body, in
consequence of previous imperfect development, or do not be-
come so till after birth, since, in their growth, they do not keep
pace with the other parts of the organism. Thus, for instance,
we observe in many idiots the whole brain remarkably small.*
The brain is often generally, though more frequently only
locally, very much diminished by external pressure; thus in
hydrocephalus meningeus, we find, as a congenital state, the
brain sometimes exceedingly small, and lying squeezed up in
the cavity of the skull ; ^ and it is very common, that the brain
is compressed and wasted to a greater or less extent by in-
dentations of the skull, by exostosis, by the expansion of the
frontal and sphenoidal sinuses, by tumours of various kinds, by
thickening of the membranes and collections of lymph, pus, and
blood, between the latter, often to a very great extent;^ even
isolated parts, as the pineal gland and the appendage of the
brain, are then perhaps totally wasted. Just as frequently is
the substance of the brain wasted, if long continued pressure
from within operate upon it, as in dropsy of the ventricles and
tumours in the brain ; indeed, as has been already mentioned

890 Of the Brain. [Part 1 1.

in dropsy of the head, the greatest part of the brain may be in
this way destroyed.* Although the brain, as well as the other
parts of the nervous system, wastes so little in general con-
sumption, it is however generally diminished, both in old
age, and also in certain diseases,^ or more commonly it is
atrophic only at particular parts, as in the cerebellum, in
isolated and ganglionic parts, as in the striated bodies,*^ the
optic beds,^ the quadrigeminal bodies,^ the tubercle of the
brain, the pineal gland,^ and the appendage of the brain, ^'^ &c.
We also find it frequently compressed from mechanical in-
fluences, viz. violent concussion of the brain." Not less com-
mon is the opposite vice, or the irregular large size of the
brain. This is either the consequence of hypertrophy of the
organ, or of a more mechanical extension by the fluids con-
tained within it. The former kind is especially produced in
rickets, and in rare cases may occur even before birth, so that
then the growth of the brain sometimes prevents the formation
of the skull, in the same way as in hemicephaly, and the
cerebrum covered by its membranes rests upon the base of
the skull ; ^^ sometimes only a part of the brain protrudes
through the openings of the skull and forms a hernia cerebri ;^^
sometimes, lastly, the brain merely enlarges the otherwise
normal skull. Frequently, the rickety hypertrophy of the
brain occurs first at birth, and attains often a very great
extent ; " perhaps also brains, which have been much expanded
by dropsy in youth, become subsequently, in rare instances of
this disease, cured by increased deposition of cerebral sub-
stance, and thus retain their morbid size. We therefore
sometimes find in adults brains, otherwise normal, possessing
an unnatural size and weight. ^^ The second kind of enlarge-
ment of the brain occurs most frequently, and to the greatest
extent, from the collection of water in the cavities of the brain,
whereby usually the whole cerebrum, though sometimes also
merely certain parts of it, are very much expanded, more rarely
and in a less degree by dropsy of the substance of tlie brain
itself,'" by determination of blood to the brain and by the depo-
sition of other morbid substances, viz. scrofulous matter, &c.
In many instances, we observe the size of the brain too large
relatively to that of the skull, so that it is compressed within
it, and on the removal of the skull-cap, distinctly expands by
its elasticity.'^ Sometimes the increase of mass and enlarge-
ment is confined to a single part of the brain ; this is usually
connected with vice of texture, and occurs most commonly in
the optic beds, (juadrigeminal bodies, the pineal gland, the
funnel, and cerebral appendage ; '" sometimes, however, one of

Sect. XX.] Of the Brain, 391

the optic beds, or one of the quadrigeminal bodies, is, though
otherwise normal, too large, especially if that on the other side
is atrophic.^''

(1) Hippocrates long since considered microcephaly as the cause of idiotcy. —
Willis Cerebri anatome in Op. omn. p. 14, fig. 4. 4to. Amstel. 1682. — Roederer
De cerebro observ. p. 5. Gbtt. 1758. — Greding in Ludwig's Adversar. Vol. III.
p. 5'^9. — Siehold, v. Journal f. Geburtshiilfe, Vol. I. p. 259— 265, and 272—278.
Sandifort Museum anatomicum, Vol. III. p. 365, No. 443. — Compare the writers
on insanity and cretinism mentioned at § 122, note 15 — 17. — The cerebellum
was found small in a cretin, by V. Malacarne, Sul gozzi e suUa stupidita che in
alcuni paesi gli accompagna. Torino, 1789. — I also once found the brain very
small in an epileptic person, v. Selt. Beob. Part 1. p. 106. — I think that that
form of congenital internal chronic water in the head which Goelis describes,
p. 27 and 51, in which the skull was small, the sutures and fontanels ossified, the
temples too pointed, laterally compressed, &c., belongs here ; and that the small
quantity of water which is occasionally found in the cavities of the brain was
only collected at a later period of life. — I have at least dissected a child of this
kind, in which the phenomena, during life, coincided with those mentioned by
Goelis, but there was no water in the brain. The mere pressure of the too early
closed skull upon the brain produces disposition to disease.

(2) Kaltschmid De hydrocephalo interno, p. 57, Jense, 1752, in Nailer's Disp.
pathol. VII. p. 484. — Mier in Samml. auserl. Abhandl. XI. p. 214, (the brain as
large as a hen's egg, and as firm as a kidney.) — Meckel Ana.t. phys. Beobachtungen
und Untersuchungen, p. 135. Halle, 1822. — Glover in Chapmann's Philadelphia
Journal, Vol. II. No. 1. — I have also seen two cases. Also in hemicephaly,
with undistended, untorn, perfect, but depressed brain, hydrops meningeus seems
to have existed, v. Monstror. sex anat. et physiol. disquisitio, p. 20.

(3) The pressure comes on so gradually, that it may be very great, without pro-
ducing paralysis or disturbance of the mind, as I have observed in a case. v. Selt.
Beob. Partll. p.85. — Great compression of the brain was observed by Walther Salzb.
med. chir. Zeitung, 1813, Feb. p. 185, (fungus cranii.) — Esquirol in Archives
g^n^ralesde Medecine. Dec. 1823, (medullary sarcom of the temporal region ;)
and in Diet, des Sc. medicales, Vol. VIII. p. 291, (a fibrous tumour on the
clivus.) — Hesselbach Beschreibung der pathol. Praparate zu Wiirzburg, p. 63,
No. 642, (fungus cranii, and durae matris.) — Ch. Mayo, in London medical and
physical Journal, Vol. LVIII. p. 408, (medullary sarcom in the right temporal
region.) — G. Sandifort Museum anat. Vol. III. p. 156, No. 127, (fungus cranii.) —
Schindler in Rust's Magazin f. die ges. Heilkunde, 1825, Vol. XXV. Part II.
p. 267, (fungus cranii.) — Lisfranc in Nouvelle Biblioth, m^d. May, 1827, (bloody
fungus.) — Horn's Archiw f. medic. Erfahrung, 1815, p. 854, (expansion of the
frontal and neighbouring sinus.) — Panizza in Annotazioni anat. chir. sul fungo
midollare dell' occhio. Pavia, 1821. — Ward in London medical Repository,
Sept. 1823. — Vingtrinier in Archives generates de Medecine, May, 1824, —
Neumann in Hufeland's Journal, July, 1824, No. 45, p. 46.

(4) This, however, does not appear to be necessarily the case. — I once saw a
case of dropsy of the head examined, in which the bulk of the brain was not in
the least diminished. This is also the case with No. 2891 of my Verzeichn.
Perhaps the morbid irritation of the brain, which produces the secretion of
water, sometimes at first causes an increase of nourishment in the brain. —
Osiander, Annalen, Vol. I. Part II. p. 59, found the brain of a child, which had
water in the head, weighing a pound. — Breschet indeed, in Magendie's Jovirn.
de Physiol, exp^rim. Vol. I. No. 1. p. 95, found it decidedly heavier than the
healthy brain of a child of the same age.

(5)1 have seen this in one case, in idiotcy occurring in later years in conse-
quence of excess. After various fevers and insanity, it is sometimes compressed ;
Savaresy found it diminished in yellow fever, sometimes a sixth of its circum-
ference, V. his work, De la Fievre jaune, p. 158. Neapel, 1809. — In a diabetic
patient, v. Horn Archiv f. med. Erfahrung, Vol. XXII.

392 Of the Brain. [Part II.

(6) Viz. Morgagni, Epist. IX. 20, XI. 11, LX. 4 ; in a person affected with
convulsions the left was very much wasted, v. Wenzel De penitiore cerebri structura,
p. 102 and 136. Biermayer Mas. Anat. pathol. No. 247 ; in an idiot I found both
very flat. Marshall's assertion, that in hemiplegia the corpus striatum of the
other side is always diseased, is not verified by experience.

(7) In long- continued blindness of one eye, one of the optic beds is often wasted,
and generally that on the opposite, though also on the same side. v. SSmmerring
in Hessischen Beitr'agen, Vol. II. IV., in Bliwienbach's Medic. Biblioth. II. 2,
and Nocthig D. de decussat. nervor. optic. Mogunt, 1786. Michaelis Ueber die
Durchkreuzung der Sehnerven. Hallse, 1790. Wenzel De penitiori structura ce-
rebri, p. 115 and 117. Rudolphi in Abhandl. der Akadem. der Wissenschaft. zu
Berlin, 1814 and 1815, p. 195, in two men, a horse, and an ox. I have twice
found the optic beds atrophic on opposite sides, and once both very flat in the
previously mentioned idiot. They were found very small by Ramsay, Anatomy
of the heart, cranium, and brain, p. 45. Edinburgh, 1803. In two insane persons^
both the optic beds were found diminished by Romberg, 1823, in Zeitschrift fiir
die Anthropologic, by Nasse, Part III. p. 214 and 219.

(8) King in Philos. Transact. 1686, No. 185, p. 230. la Peyronie in Mem.
de I'Acad. des Sc. de Paris, p. 208, 1741, (on account of tumour compressing it.)
Blane s. Auserl. Abhandl. z. Gebr. f. prakt. Aerzte, Vol. XX. p. 564 (from a
similar cause.) Swan, Dissertation on the treatment of morbid local affections of
nerves, Chap. 4. London, 1820, once found in a dog, which had the right fore-
leg paralytic, the left corpus quadrigeminum remarkably diminished ; also in
blind persons the corpora quadrigemina participated in the atrophy. Weber
also found the corpora quadrigemina, together with the cerebellum and pons
varolii, smaller on the left side.

(9) Morgagni, Epist. VIII. 12, LXIX. 10, LXX. 5. Wenzel Ueber den Hir-
nanhang fallsuchtiger personen, p. 41, 44, 46, 49, 59, 65. Also in blind
persons and animals it was sometimes found too small, together with the
optic beds.

(10) Morgagni, Epist. III. 6, IV. 19, 26, 35, IX. 20, XII. 2, XXV. 10,
XXXVII. 30, LVII. 14. TVenzel, p. 41, 65, 74, 76. It is frequently seen too
small in water of the head.

(11) Littre in Mem. de I'Acad. de Paris, 1705, p. 54. Morgagni Epist. LI. 9.
Sabatier, v. Orfila Lepons de Medec. legale, 2d edit. Vol. II. p. 447. Schuhmacher
Medic, chir. Bemerk. p. 392. Kopenhagen, 1808. — Lorry Memoires presenteSj
Vol. III. p. 365, (in an experiment on a dog.) — Bamner in Posewitz Journ. f.
Medic. Herborn, 1799, Vol. I. No. 2, (in a living person.) I have dissected
seven persons killed immediately by falling from scaffolds, but have only seen
collapse of the brain in one instance. In no case has it been seen as a certain
mark of concussion.

(12) Hebenstreit De capitonibus rev. in Haller's Coll. Diss. anat. Vol. VI. p. 335,
fig. 3. — Penchienati in M^m. de Turin, Vol. IV. p. 118. — de Sidorowicz D. con-
spectus rerum medicar. Instituti Vindobon. puerperiissolventiumdicati, p. 73, 8vo.
Vienna?, 1826, with an engraving, (the calvaria is deficient, the brain very large^
unequal in its hemispheres, and contains distinctly water in the left half, as
I saw in the Anat. Path. Mus. at Vienna, where the preparation. No. 3744,
is ;) probably the case observed by Mende belongs here, if it be not hydroce-
phalus encephaloidcs. v. Nov. Act. Acad. Nat. Cur. Vol. XL Part II. p. 443,
tab. 53, fig. 2. — Tiedemann, pi. 8 and 9. It is clear, from comparison of several
cases, tliat this condition may be connected with water in the head, and may
run, on the one hand, into hemicephaly, on the other, into hernia cerebri.

(13) Compare §231,

(14) In a child a year old, the brain was so increased, without loss of sub-
stance, that the cavities were diminished, the skull exceedingly expanded, and
all the phenomena of water in the head produced, v. Meckel's Handbuch der
pathol. Anat. Vol. I. p. 298. A similar still stronger case, of a child four
years and a half old, is mentioned by Scontclcn in Archives gtnerales de M6dec.
Vol. Vli. June.

(15) To wit, four or five pounds in weight, and more. v. Ilaller Elem. Physiol.

Sect. XX.] Of the Brain, 393

Vol. IV. p. 10. — Sdmmerring Him- und Nervenlehre, 2d edit. p. 19, $ 24. —
Rudolphi Physiologie, Vol. II. p. 11.

(16) Golis Von der hitzigen Gehirnhbhlen-Wassersucht, 2d edit. p. 212.

(17) I have twice seen this to such extent, that the elasticity of the brain thrust
up the solid calvaria at certain points, by bursting asunder slight fractures ; the
one case occurred in an epileptic patient, v. my Selt. Beob. Part I. p. 106; the
other in a body brought into the anatomical theatre, of which I have no account.
— Fahner*s Beitrage zur prakt. und gerichtl. Arzneikunde. Stendal, 1799. —
Dessessarz, v. Samml. auserles. Abhandl. und Gebr. f, prakt. Aerzte. Vol. XVIII.
p. 9d. — Vering in Nasse's Zeitschrift fiir die psychische Heilk. 1820. In many
cases there seems to arise, in consequence, compression of the brain, and pheno-
mena like those in water of the head. Such were observed by Cheyne, Quin,
and Warren, v. above on Water on the Head, § 222 ; further, Laennec. — Jadelot in
Journ. de Medec. Vol. VI. p. 3. — Mongenoi, ib. Vol. IX. p. 287 and 369.—
Golis. — Scoutelen. — Similar observations on epileptics are made by Portal Obser-
vations sur la nature et traitement de I'Epilepsie. 8vo. Paris, 1827. That in
apoplexy, the brain often, after the removal of the calvaria, expands, by the con-
gestion of blood in that organ, is well known.

(18) As the accounts of organic disease of the pine, and appendage of the
brain, are rarely sufficiently accurate, I shall here give some instances of their
enlargement, so that we may be able to refer to them in the following notes.
The PINE was found morbidly enlarged by Drelincourt in Mangeti Theatr. anat.
L. IV. c. 2, p. 309, (as big as an egg, and stony.) — Morgagni, Epist. I. 14 ;
X. 17 ; XXI. 24 ; XXXVII. 30 ; LIX. 15 ; LXI. 2 ; LXII. 15.—Lieutaud Hist,
anat. med. L. III. Obs. 177, (as large as a walnut;) 210, (four times too large,
and full of pus;) 381, (three times larger than usual.) — Desportes Histoire des
maladies de St. Domingue, Vol. II. p. 209, Paris, 1770, (as large as an egg.)
— Sdmmerring Addenda to Baillie's Morbid Anatomy, p.263, note 561, (sometimes
expanded with water.) — Angeli Osservaz. med. prat, e chirurg. Imola 793, Vol.1,
p. 27, (spongy, stony, filled with yellowish serum.) — Greding Sammtl. medic.
Schriften, u. s. w. Vol. I. p. 318. — Blane, in Transact, of a Society for the
Improvement, &c. London, Vol. II. p. 16, (as large as a nutmeg, and scro-
fulous.)— Meckel D. Archiv f. d. Physiologie, Vol. I. p. 644, with engravings,
pi. 5, fig. 4 and 5, (in a child of nine years old, as large as a middling-sized
nut.) — Tiibinger Blatter, Vol. III. p. 51, (very large, and full of hydatids.) —
I have twice seen it as large as a hazel-nut, and hardened by inflammation ; in
glandered horses it is sometimes swollen, v. Chahert Vom Rotz der Pferde im
Vollstand. Handb. der Vieharzeneikunst von Chahert, Flandrin and Huzardy
Vol. I. p. 370, Berlin, 1798. — The infundibulum is seen much expanded in
dropsy of the ventricles ; in one such case, its canal was so wide in a child as to
admit the finger, v. J. Jeff ray in London medical Repository, 1822, April,
p. 275. — Swelling of the Appendage of the Brain was observed hy Raymond-
Fieussens Novum vasorum corp. human, systema, p. 248, Amstel. 1705. — de Haen
Ratio Medendi. Vol. VI. cap. 6, p. 271. — Leveque-Lasource in S^dillot's Journ.
gen de Med. Vol. XXXVII. p. 36S.— Greding, p. 2%2.—Baillie, Morbid Ana-
tomy, p. 460, 4th, edit. 8vo. London, 1812. — Chaussier Proces verbal de la
distribution des prix des eleves sages femmes de I'hospice de maternite,
1812, p. 107, (in a new-born child, larger than in an adult.) — E. Edholm in
Svenska Lakare-Sallskapets Handlingar, Vol. I. Part I. p. 32 and 41. — HorrCs
Archiv f. med. Erfahrung, 1815, Part III. p. 463, (very large, hard, and
suppurating within.) — Oppert D. de vitiis nervorum organicis, p. 16, Berol.
1815, (very large, and filled with pus.) — Ward in London medical Repository,
Sept. 1823, Vol. XX. p. 217. — Rullier in Archives generates de M6decine,
October, 1823, p. 302, (the size of a small hen's egg.) — P. Rayer Observa-
tions sur les maladies de I'appendice soussphenoidal du cerveau. ibid. Nov.
p. 350, (an inch and a half in diameter.) — Neumann in Hufeland's Journal,
July, 1824, p. 46, No. 45, (in its stead a large steatom.) — Abercrombie, p. 429,
(a case of Powel's ; it was very soft, and five or six times too large ;) and p. 430,
(a case observed by Hay, as big as a walnut.) — Perhaps here also belongs
Pfeuffer's case in Henke's Zeitschrift f. Staatsarzneikunde, 1822, Vol. III. p. 84,

394- Of the Brain. [Part II.

(a large bean-shaped tumour, rising from the Turkish saddle into the brain.) —
In the Anat. path. jMus. at Vienna, I saw an instance of great bladder-like
expansion of the Turkish saddle, in consequence of induration and hydatid
swelling of the appendage of the brain ; I have occasionally found the latter
swollen, and apparently inflamed. I may here remark, that 1 have by no means
found the appendage diseased and swollen by inflammation in idiopathic epi-
lepsy, as J. Wenzel asserts, v. his Beobacht. iiber den Hirnanhang fallsiichtiger
personen, edited by C. Wenzel, 4to. Mainz, 1810; in the review of Wenzel in
the Jenaischen Literat.-Zeitung, I have mentioned this, and subsequently have
confirmed it ; the same was noticed by Kelch Beitrage zur pathol. Anatomic,
p. 103. — Meckel Handb. der menschlichen Anatomie. Vol. III. p. GOO, and
Neumann, p. 62 ; it seems also that the morbid state of the appendage in epi-
lepsy is rather accidental, and may be either cause or consequence of this
disease.

(19) In diseases of the eye the optic beds are also swollen, v. Bohmer Observ.
anat. rarior. Halae, 1766, Obs. 3. — Ford in Med. Comm. Vol. I. 1784. —
Sevres found in several idiots the anterior pair of the quadrigeminal bodies
more developed than the posterior, v. Anatomie du Cerveau, Vol. II. p. 334,
note 1. — Wenzel, De penitiori structura cerebri, p. 125 and 126, also saw the
cerebral ganglia too large.

§ 230.

The FORM of the brain generally answers to that of the

skull, and is therefore as often and as variously irregular as

that organ. The cerebrum especially is found malformed ;

sometimes its length, breadth, or height is generally too great

or too small, sometimes it varies only in particular regions.

Thus, for example, in idiots the front lobes are usually small and

shallow, and both sides of the cerebrum impressed ; in rickety

persons, on the contrary, the front lobes are often very thick,

as the great projection of the forehead already shews ; in many

cretins the brain is flat and broad ; in dropsy of the ventricles

the upper part of the cerebrum especially is much expanded,

whilst the base of the brain remains tolerably natural-sized,

&c. Not unfrequently are the two halves of the brain formed

very unsymmetrically, so that the one of them is generally,

or only in many of its diameters, very much larger than the

other ;^ obliquity of the skull and diseases on one side of the

brain often give rise to this. Tumours of very different kinds

and size produce deep pits in the upper surface of the brain.

Sometimes the brain varies remarkably in reference to its

convolutions and plates ; one kind of deficient development

presents its upper surface completely smooth, or exhibiting

only few and flattened elevations ;- this has been several times

observed in idiots, in whom also the number of plates in the

cerebellum is very much diminished ;^ the convolutions are

frequently destroyed by expansion, especially in dropsy of the

ventricles;* the opposite proportions also occur, although

more rarely, in which the convolutions are small, numerous,

and the clefts unusually deep, so that they almost penetrate

Sect. XX.] Of the Brain. 395

into the ventricles.^ The most remarkable malformation of the
brain is the simplicity of the cerebrum, so that it appears
either entire, or divided only at the fore part. Thus we find
it in all human and animal monsters with cyclopy, and in
those with great and total deficiency of the face, and then
in most cases only the fore part of the cerebrum exists, whilst
its hinder lobes are either very short or entirely wanting, so
that the cerebellum, the quadrigeminal bodies, and even the
optic beds, are seen uncovered, and many of the internal parts,
as the corpus callosum, the fornix, the septum of the ventricles,
and the little commissures of the brain are wanting ;*^ usually
also dropsy of the brain exists, in the early occurrence of
which we may probably seek for the cause of this malformation.'
We also sometimes find the cerebrum undivided in hemice-
phaly ;^ hemicephaly connected with cyclopy,'' and simplicity of
the brain also with malformation of the face, viz. wolf's-mouth,
which probably is congenitally connected with dropsy of the
brain. ^'^ The cerebrum has, however, been seen undivided
without any such malformation." The unnatural simplicity
also sometimes occurs in the interior of the brain, thus in rare
instances the striated body, the optic bed, is completely united
with that of the other side, or the latter unusually connected,
to wit, by two commissures, or by the epithelium, which is
extended from one to the other. The opposite vice is the
absence of the commissures, and the consequent division of
the brain. ^^ Lastly, we sometimes also find certain little por-
tions of the brain varying from their usual form.

(1) A few remarkable instances have been recently published : Rudolphi found
in a child which had neither nose nor right eye, the right side of the brain, on
which also the four first pairs of nerves were deficient, very imperfect, and
different from the left. v. Abhandl. d. Akad. der Wissensch. zu Berlin fiir die
Jahre 1814 and 1815, p. 105, Berlin, 1818, with four engravings. — M. J. Weber
Specimen malae conformationis encephali, capitis et pelvis viri, in Nov. Act.
Acad. Nat. Cur. Vol. XIV. p. 109, tab. 10—14, (the left hemisphere of the
cerebrum is too large, and on the contrary that of the cerebellum much dimi-
nished.) In hemicephaly, hernia cerebri and hydrencephalocele, cyclopy and
internal water of the head, which are merely similar malformations, we often
find a remarkable difference in the form and size of the two hemispheres. In
insane persons also, there is often found great unsymmetry of the brain, v.
Greding Vol. II. p. 525, 5^5, and Vol. III. p. 453. — Esquirol in Diet, des
Scienc. medical. Vol. VIII. Art. Demence, p. 289, fF.

(2) I have seen this several times in monsters ; it has been found in idiots by
Greding. v.Ludwig's Advers. med. pract. Vol, III. p. 613. — Jadelot, in an idiotic
child, in a paper read in the Academie de M^decine, Aug. 10, 1824. — Myself,
in an idiot of two years old. — Fewer convolutions in idiots, v. Desmoulins Anatomic
des systemes nerveux de& animaux a vertebres, Vol. II. p. 605, Paris, 1825. — *
Flattening of the convolutions of the brain in a cretin was seen also by /. C.
Schiffner in Medic. Jahrbuch d. k. k. Oesterr.-Staats, Vol. VI. Part IV. in un-
divided brains ; in cyclopy especially the convolutions are often entirely, or for
the most part, deficient, v. good engravings in Tiedemann.

396 Of the Brain. [Part 1 1 .

(3) Malacarne Neuro-encefalatomia. Pavia, 1791. Compare ReiVs Archiv.
Vol. III. p. 494, (the number of these folds varies from 600 to 700.)

(4) This was first noticed by Hiinauldm Mem. des Sc. de Paris, 1740, p. 375,
and Morgagni Epist, XII. 14.

(5) I have seen this a few times, the skull is always very small in such cases ;
compare my Selt. Beob. Part I. p. 106. — In the Empress Maria Feodorowna
of Russia, all the convolutions were very deep, and distinctly separated from
each other; v. Medic, chir. Zeitung, 1829, Vol. I, p. 110.

(6) Compare, also, many of the older observations which I have mentioned
below on the eye ; a few of my own remarks on the brain of cyclops in my
Selt. Beob. Part I. p. 49, but especially Speer D. de Cyclopia s. unione partium
capitis in statu normali disjunctarum. Halae, 1819. F. Tiedemann Beo-
bachtungen iiber Missbildungen des Gehirns vuid seiner Nerven in der Zeitschrift
fiir Physiologic von Fr. Tiedemann, G. R. and L. C. Trevirmmsy Vol. I. Part I.
p. 5Q — 110; and J. F. Meckel Ueber die Verschmelzungsbildungen in s. Archiv
fiir Anatomic und Physiologie, 1826, No. II. p. 238. In all the cases of cyclopy
which I have examined up to this time, and which will be mentioned in another
part, I have found singleness of the cerebrum in men, beasts, and birds, and
indeed, in No. 2233, 2234, 2344—2346, 2885—2887, 2974, 2977—2980, 2983,
3045, 3046, 8440, 8738, 8740, 8741, 8744, and 8812 of Bresl. Mus. ; and de la
Rue alone has found the brain properly formed in a cyclops, v. Samml. auserles.
Wahrnehmungen, a, d. Arzneikunde, 1763, Vol. VII. p. 295, which is very
doubtful. — Also, in cyclopic monsters, connected with deficient eyes, nose, and
framework of the upper jaw, simplicity of the cerebrum occurs; such cases
were seen by Kl'mkosch Progr. quo anatomen partus capite monstroso proponit,
Prag. 1766, and Diss. med. select. Pragens, Vol. I. No. 12. (deficient eyes,
nose, and malformation of the mouth.) — Osiander Handb. d. Entbindungskunst,
Vol. I. Part II. p. 520, (in deficiency of the eyes, nose, and the existence of a
trunk;) and, myself, in seven cases, viz. No. 2341, 2888, 2950, 3044, 8021,
8068, and 8297 of Bresl. Mus. The reviewer of Tiedemann in the Medic, chir.
Zeitung, 1825, No. 47, p. 408, found simplicity of the brain, in an approach to
cyclopy ; viz. deficient nose, and the existence of a proboscis, together with both
eyes; I have also found like circumstances in a monstrous pig, No. 8812.

(7) Compare my Selt. Beob. Part I. p. 40. In all the cases which I have since
observed and described, I have found either actual dropsy, or the most distinct
traces of it ; the cerebrum commonly forms a semilunar body, sloping backwards,
between which and the cerebellum, a large watery sac is formed of the arachnoidea
and pia mater ; on the base of which the large cerebral ganglia, one or both of the
quadrigeminal bodies, and the entrance to the single cavity of the cerebrum, are
found distinctly filled with water. As this thin sac is usually pretty firmly
attached to the skull, it is torn by opening the head, and may therefore often not
be observed above the water; — this state, however, is distinctly mentioned in
many of the older cases of cyclopy. — J. F. Meckel also observed, in several cases,
the connexion of dropsy of the ventricles with cyclopy. v. Anat. physiol. Beobacht.
und Untcrsuch. p. 145, and Descriptio Monstror. nonnull. p. 83, 4to. Lips. 1826.
In the latter, pi. 5, fig. 2, he has engraved the very rare case of cyclopy in a
hydrocephalic embryon of six weeks old.

(8) My Selt. Beob. Part I. p. 12, 37, 49, and since in a few cases.

(9) Denys Verhandelingen over hct Ampt dcr Vrocd mecster. Leyden. p. 198,
fig. 7 and 8. — Lenhossek in Ilarless Ilhein. Jahrb. Vol. III. Part I. p. 1. A case
in the anatom. Mus. Zuricli, v. Meckel Anat. physiol. Beobachtungen und Unter-
suchungen, p. 102, and Archiv f. Anatomic u. Physiologie, 1826, No. 2, p. 266.—
No. 8742 of Bresl. Mus. is hemicephaly connected with a state bordering on cy-
clopy, and merely a higher degree of that just mentioned, viz. deficient eyes, and
great shortening of the upper jaws.

. (10) Three examples are described and engraved by Tiedemann, p. 72, tab.

i\^ fig, 2 5. I consider it extremely fortiniate, that out of more than a dozen

cases of wolfs- jaw which 1 have examined with great attention, I have only
found in one child, in which however the eyes were at the same time deficient,
the brain undivided, v. my Verzeichn. No. 2888 ; in all the other cases it was

Sect. XX.] Of the Brain. 397

natural, although, ias I have here previously remarked, the olfactory nerves are
often deficient, and the cleft in a few instances less deep, and the falx very
small.

(11) Bianchi Storia del monstro di due corpi, p. 100, Turin, 1750, (in a child
of seven years.) — Whether the case of Carlisle, in Transact, for the Improv, of
med. and chir. Knowledge, Vol. II. p. 212, belongs here, or to adhesion of the
two hemispheres with wasting of the falx, seems to me doubtful.

(12) Deficiency of the corpus callosum was observed by Reil, v. his Archiv fiir
die physiologic. Vol. II. p. 341, — Meckel Handbuch der pathol. Anat. Vol, I.
p. 301. — Wenzel, De penitiori structura cerebri, p. 302, and the review of it in
Wiener allgem. Litt. Zeitung, 1813, No. 39, p. 613, (a few times.) — Cerutti
found merely the posterior part cleft, but describes one case, v. Beschreib. der
pathol. Priiparate zu Leipzig, 1819, No. 829, p. 206. — It has been already men-
tioned, that it may be wanting in singleness of the cerebrum, and in severe
dropsy of the head, from mechanical causes ; a case of the latter kind is described
by Ndgele, in Heidelb. Klin. Annal. Vol. I. Part IV. p. 510. The commissura
mollis of the optic beds is often totally wanting, or there is merely a little
tubercle in its place, v. GrecUng, Sammtl. Schriften, Vol. II. p. 322. The cere-
bellum has also been once seen uncommonly deeply cleft by the falx, v. Plancus
De monstris, Venet. 1749 ; and Kelch once saw the transverse groove so deep, that
the cerebellum seemed to be double, v. Beitrage zur pathol. Anat. No. 43, p. 90.

As the brain is surrounded by the firm skull and almost
completely fills up its cavity, so, naturally, are variations in
reference to its position, in proportion to that of many other
organs, just as rare as that is confined. The vicious position of
the brain, therefore, in the interior of the skull, occurs only with
simultaneous compression and diminution of the organ, inas-
much as tumours of various kinds sometimes distinctly displace
one part of it.^ The change in the position of the brain fre-
quently arises from its protrusion externally through openings
in the skull, vi^hich is called rupture of the brain, hernia
cerebri f encephalocele.^ This may be either congenital or may
arise subsequently. The former seems to consist in a morbid
partial enlargement of the brain, watery rupture of the
BRAIN, ht/drencephalocele, which if not in all, is certainly in
most cases produced by dropsy of the brain, rather than by
a deficient development of the bones of the skull, which is
much rather only a consequence of it.^ According as the
aperture in the skull is larger or smaller, and the protruding
part of the brain and the collection of water is greater or less,
the size and form of the rupture varies.^ Some forms of the
disease gradually run into hemicephaly, as frequently a large
portion of the skull is wanting, and the protruding portion of
brain is covered only by very thin membrane ; in other instances
the opening in the skull is but very small, and the swelling,
consequently, but small or attached to a narrow neck. So
much of the brain is frequently protruded, that but very little
more remains in the cavity of the skull, and the skull is, there-

398 Of the Brain. [Part II.

fore, small and flat ; in rare cases, particularly if the cerebral
rupture be small, the head appears even unnaturally large.
Equally various is the seat of the cerebral rupture ; in by far
the most frequent examples is it found on the back of the
head, as the brain is protruded through the enlarged occi-
pital hole, and the cleft upper cervical vertebra, or through
a hole in the squamous part of the occipital bone, or, lastly,
in the lambdoidal suture ;^ less frequently is the tumour situated
on the top of the head, especially at the great fontanel,"^ more
rarely on the sides of the skull,'^ on the forehead,^ or, most
rarely of all, it penetrates into the nostrils,^ the orbits,^" or
the sphenoidal sinuses, ^^ The rupture of the brain which is
not congenitaP^ thus arises : the brain being expanded by its
own elasticity, or by increased determination of blood, protrudes
through apertures which have been naturally or artificially
made in the skull. This kind is proportionally more rare
than the congenital, and usually also of much less size.

(1) Large exostoses, fungus of the cerebral membranes, &c., thrust one hemi-
spliere with the falx much to the other side. Medullary sarcom in the orbit
which makes its way backwards into the cavity of the skull, and expansion of the
frontal sinuses, remove the anterior lobes of the cerebrum so much from their
natural situation, that they lie where the middle lobes are naturally found. The
hemispheres of the cerebrum were in one case separated by water, four inches
from each other, v. Case of hydrocephalus with bifid brain by yindr. Duncan^ jnn.,
with a description of the malformation, by the late John Gordon, in Transact, of
the med. chir. Soc. of Edinb. 1824, Vol. I.

(2) Le Dran Observat. de Chirurgie, Vol. I. Obs. 1. Paris, 1731, first em-
ployed the term encephalocele. — Ferrand iSIemoircs sur I'encephalocele, ou
hernie du cerveau, in M^m. de I'Acad. de Chir. Vol. V. M^m. p. 60. — Guyenot, ib.
M6m. p. 865. — Corvinus D. de hernia cerebri. Argentor. 1749, in Nailer's Coll.
Diss. anat. Vol. II. p. 330, with a good engraving. — la Motte D. de encephalocele.
Paris, 1763. — Held D. de hernia cerebri. Giessae, 1777. — Salleneuve D. de hernia
cerebri. Argentor. 1781. — Th'iering D. de hernia cerebri. Gott. 1792. — le Roy in
Verhandel. van bet Genotsch. te Antwerpen. D. III. Bl. 252. — Meckel Vom
Hirnbruche in Handb. der pathol. Anatomie, Vol. I. p. 301 ; and in Archiv
f. die Physiologic, Vol. VII. p. 139, fF. — N'dgele Ueber den angeborenen Hirn-
bruch und die Kopfblutgeschwulste Neugeborener in Hnfeland's Journal der
prakt. Heilk. May, 1822, p. 3. — Geoffroy Philosophie anatomique. Paris, 1822,
(in several places.) — Single observations are also noticed in de Plouquet Reperto-
rium, Art. Cerebri Hernia ; and the following writers, J. xian Mehern Observationcs
medic, chirurg. Cap. 7. Amstel. 1682. — Fahricii Ilildani Observ. Cent. VI.
Obs. 17, 18.— Lec/ic/ in Ephem. Acad. Nat. Cur. Dec. II. Ann. II. p. 363. —
Lcutin Observ. med. Fasc. II. p. 71. Cellee, 1770. — Jacoby, v. Lobstcin and
Beyckert D. de nervis durac matris, p. 33. Argentor. 1772. — Deslandes, v.
Journal de M6dec. Vol. XXVI. p. 74. — Saxtorph in Collcctan. Soc. Med. Havn.
Vol. II. p. 280, tab. 5. — L. E. Schneider Cliirurg. Geschichten. Vol. X. p. 10.
Chemnitz, 1785. — Penada in Saggio d'Osscrvazioni e Memorie, Vol. I. p. 15.
Padova, 1793. — Klein Monstror. quor. descriptio. p. 1. Stuttg. 1795. — Teiighil
in Medical Facts and Observations, Vol. VII. No. 23. — Jan. llniirhof in Nieuwe
A^atcrl. Lettercaff. D. I. Part XI. p. 158, with a plate. — Dessault auscrles. chir.
Wabrnehmungen, Vol. VII. p. 26. — Bang Abliandlung. iiber cine Missgeburt,
deren Gebirn in cincm Beutel auf dem Riicken lung, u.s.w. a. d. Dan. von Mendel
Copcnh. and Leipz. 1801.— //m// in Mem. of the Soc. of Manchester, 1802, Vol. V.
P.'u-t II. p. 495. — fValter Museum anat. Berol. 1803, p. 275, No. 1625 and

Sect. XX.] Of the Brain. 399

1626. — Blumenhach Geschichte u. Beschreibung der Knochen, 2d edit. p. 124,
note c. — Stein Geburtshiilfl. Wahrnehmungen, Vol. I. p. 346. Marburg, 1807. —
Osiander in Gutting, gelebrt. Anzeiger, 1812, No. 139. Two cases were observed in
tbe year 1813 by Lallement, and Baltos related in Richerand Nosograpbie cbirurg.
4tb edit. Vol. II. p. 319 ; and a third in a girl of twenty-two, Lallement in
Bulletin de la Soc. de Med. de Paris, Vol. III. p. 351. — BSclard in Bulletin de
la Faculte de Medec. Vol. III. note g. p. 292. — Gistr^n in Svenska Lakare-
Sallskapets Handlingar, Vol. II. Part I. p. 166, 170, with a plate. — Kelch Beitrage
zur patholog. Anatomie, p. 95, No. 67. — Autenrieth in Tiibinger Blattern, Vol. II.
p. 273. — Biermnyer Museum anat. pathol. No. 5, p. 300. — Busch Samml. auserl.
Beobacht. p. 52, pi. 7. Marb. lS17.—Seidel Index Musei anat. Kiliens. 1818,
p. 55. — Earle in Medico-chir. Transact. Vol. VII. p. 427, (four instances, of which
one of darkens ; in the first the puncture was made without injury ; in the second
death occurred immediately on the incision. — Palletta Exercitationes pathologicae.
Vol. I. p. 127, tab. 2. Mediolan. 1820.— Oestreich. medic. Jahrb. Vol. V. Part II.
p. 68. — Textor in his Neuen Chiron. Vol. I. Part III. p. 469. — Isenflamm Anato-
mische Untersuchungen, p. 131. Erlang. 1822. — Schnieber in Rust's Magazin
f. d. ges. Heilk. Vol. XIII. p. 279.— Rathke in Meckel's Archiv f. d. Physiol.
Vol. VII. p. 481, pi. 5. — Seerig D. de hydrencephaloceles specimine eximio, 4to.
Vratislavise, 1822, with lithogr. plates. — Goodeve in Macleod's London med.
and physical Journal. Vol. L. Sept. 1823. — Kolbtnann in v. Siehold's Journ. f.
Geburtshiilfe, Vol. IV. Part I. 1823. — E. Thomson in London medical Repository,
Nov. 1824, (was cured by ligature.) — Hesselbach Beschreib. der pathol. Pra-
parate, p. 196. Wiirzb. 1824. — Martini in Ripertorio medico-chirurgico di
Torino, No. 59, Nov. 1824. — Burkart D. de monstro humano notabili. 8vo.
Triburgi, 1825. — MoscJiner Conspectus partuum in Lechodochio Pragensi cele-
bratorum, p. 109. Pragae, 1826. — Wedemeyer in v. G r of e and v. Watcher's Journ.
d. Chir. 1826, Vol. IX. Part I. (in a man eighteen years old.)'— Merye in Archives
gen de Medec. July, 1827. — Ehrmann in Repert. gen. d'Anatom. et de Physiol,
pathol. Vol. IV. Part I. p. 25.—Hohl D. de Microcephalia, 8vo. Halse, 1827, and in
Niemeyer's Zeitschr. f. Geburtsh. u. prakt. Medic. 1828, Vol. I. Part I. No. 2. —
Bring in Edinb. med. and surg. Journ. Vol. IX. p. 14. — Billard Traite des
Maladies des Enfans nouveaux-nes, &c. 8vo. Paris, 1828. — J. F. Meckel has
described several cases, viz. one in his Pathol. Anatomie, Vol. I. p. 292 ; a second
and third, in two sisters, in D. Archiv f. d. Physiol. Vol. VII. p. 99, ff; and ibid.
p. 143 ; a fourth and, lastly, a fifth in Descriptio monstror. nonnullor. p. 76, in a
calf. Up to this time I have examined twelve cases of hernia cerebri, or hy-
drencephalocele ; one in which the hernial sac was adherent to the membranes
of the ovum, and described by Kustner in Bereicherungen fiir die Geburtshiilfe
und fiir die Physiologie und Parthologie des Weibes und Kindes von Choulant,
Haase, Kiistner, und Meissner, Vol. I. p. 35, Leips. 1821. — The second. No. 2929
of my Verzeichn. described by Seerig. Three other cases I have mentioned in my
Selt. Beob. Part II. p. 157, tab. 3, fig. 3. Compare No. 2928, 2971 and 3088,
of my Verzeichn. The other cases are No. 2903, 3087, 8017, 8227, 8365, (calf),
8441, (calf), and 2346 (cyclopic pig.) I have seen several calves in the museums ;
also Blueland Descript. Musei anat. p. 405, No. 2552 and 2543, has described a
few such cases. The hernia cerebri approximates to partial dislocation of the
brain with large cavities in birds, in which the bony expansion is often imperfectly
ossified. Compare above, § 122, note 11, and my Verzeichn. No. 2286 and 2287;
and also on ectopy of the brain, an observation of Geoffroy St. Hilaire, in Archiv.
gener. de Medec. July, 1827, in which he considers the adhesion of intestines
lying external to their cavities as the principal cause of monstrosity, whilst really
it is always the consequence.

(3) Although, in some cases, perhaps also mere hypertrophy may give rise
to hernia of the brain, yet, naturally, dropsy is its cause ; therefore, almost
all the cases which have been well examined have shewn this : I have also found
it as the cause in all the cases which I myself have observed. In the case
related by Penada, a very considerable quantity of water dribbled from the hernia ;
and, in that of Earle, the water was always reproduced after the hernia was
tapped. The great conformity between hernia cerebri and hemicephaly, and its

400 Of the Brain. [Part II.

gradual transition into the latter, their simultaneous existence, v. Sandifort, Mus»
Anat. pi. 126 ; — the connexion of hernia cerebri with the dropsy, which I find
in No. 2346 of Bresl. Mus. and with large dropsy of the head, as in Meckel's first
case, and No. 2928, which I observed, — no less' support this view. Large drop-
sies of the head sometimes exhibit several membranous spots, extremely thin and
expanded, or actual slits ; in which case, external watery bags are formed, simi-
lar to those in hernia cerebri, v. § 222, notes 9 and 15. In a few rare instances
where the water has escaped, and the brain has seemed to fall together,
cicatrices have been found, v. Meckel, Descriptio monstr. nonnull. p. 57,^and
Billard. The water is, in rare cases, contained merely between the membranes,
which then also merely form the hernia, hydrencephalocele meningea, which Textor
and Thomson have well testified ; more frequently the water is found in one or
both the cavities, which are very much elongated at a particular spot, which,
often, by the extreme thinning of the brain at this part, so that hardly more than
the membranes are distinct, renders it very difficult to be distinguished during life ;
though such thin cerebral sacs, perhaps, will bear the ligature. In rare cases of
hydrencephalocele, the water seems to exist simultaneously in the brain and in
the membranes, as it does in water of the head. As congenital hernia cerebri
always commences before the cranial bones are united, so it is manifest why it is
most frequently seated in the membranous interspace of the skull, though, in
rare cases, it also penetrates between the ununited bones, when, in consequence
of deficient ossification, or absorption from the pressure of dropsy, or of the gid in
sheep, holes are produced. I also see that Dr. E. A. W. Himly, in his Darstellung
des dualismus am normalen u. abnormen menschlichen Korper, u. s. w. Hanover,
1829, thinks he has triumphantly confuted the views put forward in this and
the preceding section, relative to the congenital connexion between water on
the brain, hemicephaly, cyclopy, and hernia cerebri. This is not the place to
controvert the loose statements of the author, and this gentleman will, with the
same propriety, get rid of the many observations here collected, which do not well
suit his dualism, as easily, by a note of interrogation, as he has already done
with one of my observations in this place.

(4) Sometimes it is very large, even larger than all the rest of the head ; in
some cases also it is divided into two halves, by the less yielding falx and sinus,
or by a tendinous band; for example, in Trew's case, v. Comment. Nov. 1738,
p. '^\2.— Thiebault, v. Desault Journ. de Chir. Vol. III. p. 327. — Pemida, B^clard,
Palletta, and Kolbmann, &c. The apparent duplicity of the hernia cerebri is distin-
guished from the actual which has, in a few cases, been seen ; viz. l>y myself, in
its commencement in No. 2771, and its completion in No. 8017, in which it was
divided into two halves. — Martini, Ehrmann, &c. ; — in the case of Billard' $ a
second hernia cerebri seems to have been produced above the cicatrix.

(5) Of twelve cases, I have found six in which the hernia cerebri occurred on
the back of the head, where it has been also seen by Corvinus, Trcw, van Mckern
Fabric. Hildanus, Lechel, Jacoby, (in an adult in whom a part of the longitudinal
sinus lay in the aperture,) Deslandes, Gardner, Tenghil, Dessauli, Bang, Hull, van der
Laar, Siebold, Merye, Penada, Klein, Blunienbach, Gistren, Lallement, Battos, Earle
(in four cases,) Meckel (in three cases,) Isenftamm, Seidel, Ralhke, Thomson,
Moschner, Burkhardt, Kolbmann. I also saw two beautiful examples at Cams' s, at
Dresden. The cause of this frequency of the hernia cerebri in the occiput is
partly, as Meckel, Archiv. f. Physiol. Vol. VII. p. 139, has observed, that this
region of the head of the embryon of itself juts out, partly tliat the occipital
bone consists of several pieces, which become united only at a late period ; and
that the water contained in the posterior horn of the ventricle, in the four cavities
formed by the processes of the dura mater on the occipital bone, may be operated
on by greater power than at other parts, or where it forms ratlier an inclined plane.

(6) Hernia cerebri verticalis in Corvinus. I have met with it here in calves,
in two instances, viz. in No. 3088, 8365 (not directly in the middle, but rather to
the right side ;) further. Held, Schneider, Slein, IValther, Autenrielh, Textor, Bier-
muyer, Hold, and Martini, &c. ; in the latter, there was a hole in both parietal
bones. The cases of Delhardiug and le Dran seem, as A'a^-e/c has very properly
observed, to belong to bloody tumours.

Sect. XX.] Of the Brain, 401

(7) Hernia cerebri lateralis in Corvi7ius. Ferrand in Mem. de 1' Acad, de Chir.
Vol. XIII. p. 102, (on the lateral fontanel.) — Bcdard (right temple.) — Oestreich.
medic. Jahrb. Vol. V, Part II. p. 68, (between the right parietal and temporal
bone,) perhaps the same case which I found in the Anat. path. Mus. at Vienna,
No. 3223. /. F. Meckel, in the former, (between the mastoid process of the
temporal and the articular portion of the occipital,) and the latter (in the right
temporal region.) Billard (in the left temporal region.)

(8) Henckel Samml. medic, u. chir. Anmerkungen, Berl. Vol. Vlt. p. 50. —
Mem. de I'Academ. de Chir. Vol. XV. p. 442. — Saxtorph, Osiander, Bddard,
Kelch, Schneider, and myself in two cases, v. No. 2928 and 8017. I also saw a
similar case in the Anat. path. Mus. at Vienna, No. 1537.

(9) Lycosthenes Chronic. XVI. de prodig. et ostentis. — Richter, v. Getting.
Anzeigen. 1801, p. 441. — Commentat. Soc. Scient. Getting. Vol. XV. p. 81, and
in the medic, chir. Bemerkungen, edited by A. G. Richter, Chap. 5. Berl. 1813.
In Ehrma7in's case the water projected like a bladder in the region of the deficient
nose. — In the Anat. path. Mus. at Vienna I saw a hernia cerebri protruding
through the cribriform plate into the nose.

(10) I have observed this in a cyclopic pig, No. 2346 of my Verzeichn. A
considerable portion of the brain, covered with dura mater, pressed through an
opening in the skull into the single large orbit, and lay there so close to the
large eye-ball that there was a flat pit formed for it at the fore part of the
latter.

(11) Klinkosch Progr. quo anatomen partus capite monstroso proponit, 4to.
Prag. 1766, rev. in Diss. med. select. Pragens, Vol. I. No. 12, p. 199. The
much expanded cerebral appendage of a dropsical brain, covered with dura
mater, penetrated through the body of the sphenoid bone into the nose.
Perhaps an indication of it is the case of Kelch's, who found the cerebral
appendage lying in the sphenoidal sinus, Beitrage zur pathol. Anatomie,
No. 7, p. 5 ; and that of BSclard's, who found a considerable aperture in the
body of the sphenoid of a child with a large hernia cerebri. I refer here to the
cases of cleft of the sphenoid bone which has been sometimes observed in
hemicephaly. v. My Selt. Beob. Part I. p. 46.

(12) Compare the surgical collections and manuals; also several cases in de
Plouquet Repertor. Art. Cerebri hernia. — Fantoni Observat. anat. med. p. 172.
Venet. 1713. — Jamieson in Ingram, Practical Cases and Observations on Surgery,
p. 85, London, 1751, (seven months after fracture of the bones by whooping-
cough). — Don. Monro in Medical Transact. London, 1772, Vol. II. p. 353. —
Ferrand M^moire sur I'encephalocele in Mem. de TAcad. de Chir. Vol. V.
No. 2, p. 60. — Le Roy in Verhandel. van bet Genootsch. — te Antwerpen. D. III.
p. 252.— Edin. med. and Surgic. Journ. Vol. IX. p. 14, and Vol. XII. p. 22.—
Workman in the Medical Repository, 1815, Vol. III. No. 18. — Stanley in
London med. chir. Transact. 1817, Vol. VIII. P. 1, p. 12. — Turner Thackrah
in FothergilVs London medic, and physic. Journ. Vol. XLV. March, (cured by
ligature.) — Jam. Spalding in the New England Journ. of Med. and Surg. Boston,
Jan. 1820, Vol. IX. (cured by repeated excisions.) /. Lipschitz D. Encephalo-
celes acquisitae cum abscessu cerebri observatio. 8vo. Regiom, 1828. It is
vexatious that in several of these and other cases, the observers have not made
sufficient distinction between hernia prolapsus and fungus cerebri.

§ 232.

The brain also varies in numerous ways from its regular
COLOUR \ The brain at its first formation is not divided into
grey and white substance; and this state is observed still re-
maining in new-born children, especially if other deficient de-
velopment exist. In other instances there is a disproportion
of the grey and white substance, so that sometimes the one,
sometimes the other predominates. As the blood contained in

D D

402 Of the Brain. [Part II.

the brain very much conduces to its colouring, so must its
greater diminution, increase or change, most frequently produce
irregular colouring of the brain. Thus we observe in cachectic
persons of different kinds, in those who have been mad for a
long time, &c., the grey substance of the brain, according to
the deficiency of blood, unusually pale, or more frequently,
from the greater quantity of blood, very deeply coloured. The
latter is naturally very often the case in apoplectic, hanged,
drunken persons, &c. ; and occurs in a very high degree, as
the congested venous blood is sometimes simultaneously very
dark, or actually extravasated and mingled with the substance
of the brain, in which cases, dark-red, bluish, or purple-
coloured spots have been observed both in the cortical and
medullary substance. If it be rather arterial blood which is
congested in the brain, for instance, in morbid irritation and
true inflammation, it is coloured too red either generally or
in spots ; still, however, the medullary substance, on account of
its greater whiteness, is but rarely of a very red colour, but
more generally pale or rosy-red, unless there be simultaneous
effusion of blood. If, in severe diseases of the brain, the
blood be decomposed, or the morbid pigment alone be secreted,
the brain not unfrequently appears discoloured in the most
various ways, but also in both substances ; for instance, pale
or dusky-yellow, orange, brown, greyish-green, slate, and even
here and there soot-coloured.^ But it is interesting that in
jaundice, the substance of the brain participates rarely or never
in the yellow colour of the other organs.^

(1) Morgagni in many places. — Billard in Archives gendrales de M^decine,
Yol. IX. Dec. 1825. — LaUemand Recherches Anatomico-pathologiques sur
I'Encephale et sesd^pendances. 8vo. Paris, 1824 — 29.

(2) These are the morbid colours which I have myself observed in various
shades in men and animals. — I have also occasionally seen, in different vices of
texture, although even without these, a deposition of melanotic pigment in
defined patches.

(3) Stoll Ratio Medendi, Vol. III. Part II., maintains the yellow colour of the
brain in jaundice, although it might be merely the membranes and the serum
between them, and not the mass of the brain itself. I have never seen the
nervous mass of the brain coloured in jaundice ; and among the moderns I find
no satisfactory case of it.

§23S.

The consistence of the brain is not unfrequently morbidly
changed, that is, diminished or increased, and even both states
occur simultaneously in difl'erent parts. The diminution of
consistence or softening of the brain, encephalomalacia^^
is observed throughout the brain without suspicion of any
chemical change after death, and seems to be then, as in other
parts, according to their esssential principle, the consequence

Sect. XX.] Of the Brain, 403

of a not well-understood change of the cohesive power, and of
the normal firmness of the organ. It has been found too soft,
for instance, often in malignant adynamic fevers,^ and the various
animal epidemics ; ^ further, in rickets and tubercular disease
of men and animals, in consumption of the lungs, diabetes, and
other similar diseases;* again, in mental diseases,^ but especi-
ally in dropsy of the brain. "^ We, however, observe more
frequently, and also more distinctly, the softening on certain
parts of the brain in consequence of true inflammation, both
primarily and secondarily, which, for example, occurs frequently
around tumours in the brain, or in apoplexy in the neighbour-
hood of extravasated blood.' It is to be observed, that the
consistence of the brain is very much diminished in suppura-
tion and gangrene. Not unfrequent is the opposite state, or
INDURATION OF THE BRAIN,^ which equally occurs either
generally or partially, and in very different degrees. Long
continued or often recurring morbid irritation, certain not satis-
factorily understood chemical changes, and various inflamma-
tory states, seem most commonly to produce irregular hardness
of the brain. This is often so great, that the brain may be very
much handled, without breaking, that it becomes very elastic,
and that it then commonly appears more distinctly fibrous
than usual ; thus it is found not unfrequently in typhus,*' and
especially in chronic and quiet mad persons,^" in many epileptic
persons, cretins,^^ apoplectic patients, and persons long aftected
with head-ach, &c. Sometimes is the induration, especially
the partial, so very great, that it assumes a caseous and cal-
lous, and even a cartilaginous hardness.^^ The consistence of
the brain is also in rare cases diminished by concussion ;^^ also
in poisoning with sulphuric acid.^*

(1) Rostan Recherches sur une maladie, encore inconnue, qui a repu le nom de
RamoUissement du Cerveau. Paris, 1820. — Cruveilhier La Medecine eclairee
par I'anatomie pathologique. Cah. I. Paris, 1821. — Gendrin in Annales
de I'ecole medicale, July, 1823. — Lallemand, first letter, in which he also
quotes Recamier, Bayle, and Catjol. — A. G. Herhst D. de encophalomalaxia.
Haiae, 1825. — Luzzani D. de encophalomalacia. 8vo. Monachii, 1826, — Rostan
Traite elementaire de Diagnostic, etc. Vol. IL Paris, 1827. — Guihert in Revue
medicale, March, 1828. — Many observations are found in Morgagni, Home, &c.,
and collected by Burdach, Vom Baue des Gehirns, Vol. III. p. 534 — 538, to
which many new ones of his own are added.

(2) Viz. 3Iarc, Ant. Jemhm De febre, anno 1783-84, Monteregali epidemica.
V. Brera's Sylloge. Vol. X. p. 218 and 247.

(3) Sagard Von einer besondern Schaafseuche in den Auserleseuen Beitragen
zur Thierarzneikunde, Part I. p. 94.

(4) To wit in a syphilitic person after violent use of mercury, v. Wedemeyer
in Rust's Magazin f. die ges. Heilk. Vol. IX. Part III. p. 549 ; in persons who
had been long subjected to confinement, v. Monro, The morbid Anatomy of the
Brain, Vol. I. p. 35 and 160. — I have seen the brain softened in many men and
animals, who died of cachexise. — Rodet once saw the greater part of the brain

D D 2

404 Of the Brain. [Part II.

softened in a horse, v. Journ. compl. du Diet, des Sciences medicales, Vol. XXIV.
p. 39. — Serres, the cerebellum in a monkey, v. Magcndie's Journ. de Physiologie,
Vol. II. No. 3, p. 265.

(5) Greding in Ludwig's Adversar. Vol.11, p. 533, and Vol. III. p. 662. —
Ilaslam, Observations on Madness and Melancholy, &c. Cases 4, 10, 18, 26, 28,
30, 37. Lond. \%Q9. — Georget De la Folie, p. 488. Paris, U2Q. — Esquirol m
Diet, des Scienc. medical. Vol. VIII. Art. Demence, (in twenty-nine cases the
cerebrum, in seventeen the cerebellum.) — Sometimes in epileptics, v. Portal Sur
la nature et le traitement de I'Epilepsie. — Sometimes also in cretins. — Hertwig
found in at least a hundred horses, affected with sleepy staggers, the brain
very soft, dirty, yellow, and usually fluids in the ventricles, v. Hecker's Liter.
Annal. d. ges. Heilk. May, 1826, p. 5.

(6) In dropsy of the ventricles, the septum, fornix, corpus callosum, and the
substance of the brain around the ventricles, are often resolved into a kind of
jelly or pap; also in the symptomatic water in the ventricles, which occurs in
madness, fever, &c. the mass of the brain is too soft. This is not less the case
in sheep affected with the gid.

(7) Compare the greater number of writers referred to in note 2, as well as
many others cited below, § 235, on apoplexy. In inflammation of the mem-
branes of the brain, we find sometimes merely the outer layer of the brain
softened to an inconsiderable depth, and the same within, if the epithelium of
the ventricles be inflamed. In animals also, inflammatory softening occurs,
especially in mad staggers in the horse.

(8) Morgagjii, Epist. VIII. 2, et seq. Epist. LXI. 8. — Meckel in Mem. de
I'Academie de Berlin, 1766, (also found it specifically lighter.) — Portal Cours
d'Anatomie medicale. Vol. IV. p. 90. — Pinel, fils, Recherches d'anatomie patho-
logique sur I'endurcissement du systeme nerveux, Paris, 1822; and Recherches
sur les causes physiques de I'ali^nation mentale in Magendie's Journ. de Phy-
siologie, 1826, No. 1, p. 44. — Bouillaud Observations et Reflexions sur I'indura-
tion generale de la Substance de Cerveau, consideree comme un des efFets de
I'encephalite generale aigue, in Archives generales de Medecine, Paris, 1825,
August and September. Many individual cases are collected by Burdach,
p. 538, ff. I have seen also a few very remarkable instances, v. Selt. Beob.
Part II. p. 93, on the infundibulum, and more recently in a woman who died of
tetanus, with preceding fixed pain in the head. Some examples of great partial
hardening may be found in Ephem. Acad. Nat. Cur. Dec. III. Ann. IV. p. 148,
(in the cerebellum.) — Morgagni Epist. IX. 25, (the anterior lobe of the right
hemisphere.) — Pyl Aufsatze u. Beobachtungen a. d. gerichtl. Arzneiwissenschaft.
Vol. VII. p. 89, (two-thirds of the right hemisphere.) — Portal Observations sur
la nature et le traitement de I'Apoplexie, p. 144, Paris, 1811. — Meckel D. Archiv
f. Physiologie, Vol. I. Part I. p. 644, (hardening, swelling of the pine.) — Howship's
Practical Observations in surgery and morbid anatomy. Cases 31 and 32, (the
cerebrum.) — Castellier in Journ. de Med. Chir. et Pharm. May, 1815, (cartilagi-
nous in the cerebellum, accompanied with a hole in the occipital bone.) — Hut-
chinson, V. Horn's Archiv 1821, Part I. p. 376, (a hardened spot in the left
hemisphere.) — Monro, (in the anterior lobe of the left hemisphere, and adhering
to the dura mater.) — Bergmann, v. Nasse's Zeitschrift fiir Anthropologic,
p. 415, 2 parts, (both optic beds, in a paralytic and squinting child.) — Wede-
meyer in Rust's Magazin f. d. ges. Heilk. Vol. XIX. Part II. p. 227. — Lallcmand,
2d letter, p. 285, case 30, (a part of the left hemisphere as hard as cheese.) —
Ileusingcr in Zeitschrift fiir organ, physik. April, 1828, Vol. II. Part IV.
p. 382, (tbe valve of the brain cartilaginous, with a layer of fat upon it.) —
Ahercrombie, 2d edit, case 18 (the corpora olivaria, the crus cerebelli, and the
tubercula muinillaria cartilaginous,) and p. 446. — A case oi Anderson's, p. 453,
from Medical Repository, \'ol. III. (hardening of the cerebellum.) Hardening
of tbe infundibulum is described by G. Sandifort in Museum anat. Vol. III.
p. 148, No. 40.

(9) StoU Ratio Medendi, Vol. I. ]>. 185.~C/mmWi de Montaitx Ohscrv. clin.
Pari.s, 1789, Oh^. 29. -- Hudolphi Physiologic, Vol. I. p. 93, (indeed in thirty
bodies from typhus.) In tlie ei)idemic typlius of the years 1809 and 1812-13,

Sect. XX.] Of the Brain. 405

I dissected a great number of bodies which had died of that disease, and found
hardening of the brain, especially in those which died within the first week ; in
many of those which died at a later period, I found great softening. I do not
know whether this is constant. Compare also Gaudet Recherches sur I'endur-
cissement general de I'encephale, considere comme une des causes materielles
des fievres dites ataxiques. Paris, 1825.

(10) Morgngni, Epist. anat. med. VIII. 4 — 18. — Greeting in Ludwig's Adver-
saria, Vol. II. p. 533. — Hunter and BailUe, Morbid anatomy, p. 443. — Sommer-
ring's Addend, to ib. — Plenciz Acta et Observata medica. Prag, 1733, (in a melan-
cholic person.) — Loder in Bucholz's Beitragen zur gerichtlichen Arzneigelahrtheit,
Weimar, 1790, Vol. III. p. 237, (in an idiot.) — Pyl Aufsatze u. Beobachtungen
aus der gerichtl. Arzneiw. Vol. VII. No. 10, (in an idiot.) — Haslam (out of
thirty-seven insane persons, in nine.) — Marshall (of twenty- two, in sixteen cases.)
— Romberg in Horn's Archiv. 1823, Part I. (in several cases.) — ■ Neumann in
Htifeland's Journ. July, 1824, p. 59, (in seven cases.) — Bleuland Descriptio
Musei anatomici. Traj. ad Rh. 4to. 1826, p. 200, No. 997, (in a maniac of
sixty years the brain was discoloured, very hard and dry, and apparently
without blood-vessels.) — Esquirol, (in many cases.) — Pinel, in Magendie's Journ.
de Physiol. 1826, No. I. p. 80, says, that in chronic and incurable insanity, the
brain becomes very hard and fibrous, and the grey substance at the same time
very pale ; I have found this a few times very remarkably in epileptic persons ;
Portal also sometimes found it hardened ; in acute epilepsy this is said to be
always the case. v. Joseph Adams, in Transact, of the Medic. Soc. of London.
1817, Vol. I. Part II. No. 1.

(11) Foderi Traite du Goitre et Cretinisme, &c. Paris, Ann. VIII. It is,
however, by no means constant, as he thinks.

(12) That it has been seen quite dry and crumbling, is indeed either from
confusion with ossification, or it is an exaggeration. What the ancients called
scirrhus, belongs, for the most part, either here or to scrofulous deposition in
the brain. — In two cases I have found the brain very hard, indeed almost all
the small vessels of the brain ossified and stuck into it like pins ; one of these
cases is related in my Selt. Beob. Part II. No. 39, p. 93.

(13) Bayer Traits des Maladies Chirurgicales, Vol. V. chap. 1.

(14) Willudovius found the whole surface of the brain as hard as coagulated
albumen several lines deep, communicated by Remer in Hufeland's Journal, Sept.
1819, p. 61. — I have since had the opportunity of examining a similar case, in
which, though the hardening was somewhat less, it was still merely external, as a
proof of the permeability of the membranes ; the smell also in opening the skull
was sour. I take this opportunity of mentioning that I have several times per-
ceived a strong smell of medicine in opening the skull ; in three instances in
which death was produced by drinking brandy, the brain smelt strongly of spirits,
but in one instance only it appeared to me to be too firm. The smell of spirits
was, in one instance, found in no other part of the body, but only in the cavities
of the brain, v. Rusfs Magazin f. d. ges. Heilk. 1827, Vol. XXV. Part I. p. 125.

§234.

The CONTINUITY of the brain may be, as is well known,
destroyed in various ways by sword, stab, shot wounds, and
CONTUSIONS ; and sometimes the instrument inflicting the injury,
sometimes the compressed and splintered portions of the skull
penetrate into it. Often indeed is a not inconsiderable loss of
SUBSTANCE bomc without loss of life, and even of the usual
functions of this organ. ^ It is interesting, that contusions
and actual tearing^ of the brain sometimes occur, in conse-
quence of injuries of the head which do not penetrate, but
merely jar the head, and that these are found not only

406 Of the Brain. [Part 1 1 .

on the part which is struck, but also in parts which are
distant and opposite.^ Such tearings and divisions of the sub-
stance of the brain occur not unfrequently in apoplectic persons,
from the effusion of blood. Large collections of water in the
ventricles also give rise to tearing of the septum of the ventricles,
the fornix, &c. ; indeed a dropsical brain may even burst on
one side and discharge its water.* Tf the wounds of the brain
are mere cut-and-thrust wounds, they are often healed by
ADHESION ; but if they are connected with loss of substance,
they are healed by granulation, by which the previously lost
substance is gradually restored.^ If the gTanulations be too
great and luxuriant, the morbid mass protrudes through the
aperture in the skull, and forms the so-called fungus of the
B^Kim , fungus cerebri,^

(1) Compare the works on Injuries of the Head and the Surgical Writers
especially. — Ymge Wounds of the Brain proved curable, 12mo. London, 1682. —
Behrens De vulnere cerebri non semper et absolute lethali. Francof. 1733. —
Teuheler praes. de Buchner D, de vulneribus cerebri non semper et absolute
lethalibus. Halae, 1750. — Hennequin D. sur les lesions traumatiques du cerveau
in Diss, souten. ^ I'Ecole de Med. de Paris, An. VIL et VIIL No. 7. — C. G.
Sp'iesshach D. de singularibus quibusdam cerebri cordisque vulneribus. Vratisl.
1812. — Copland Hutchinson, Practical Observations in Surgery, London, 1826,
Treatise 4. — B. Brodie in Medico-chir. Transact. Vol. XIV. London, 1828. —
Many cases have been collected hy Burdach vom Baue und Leben des Gehirns,
Vol. III. p. 501, fF. Compare Arncmann\ex&\xc\\e iiber das Gehirn und Riicken-
mark. Gott. 1787.

(2) Z/7/»2a?m Medicina forensis. Cent. V. case 33. Francof. 1706. — Wilmers,
v. Richter's Chirurg. Biblioth. Vol. V. Part IV. — Henkel Medecin. u. chirurg.
Beobacht. Berl. 1779. Obs. QQ. — OUenrodt in Jrnemann's Magazin f. die
Wundarzneiwissenschaft. Vol. I. Part II. p. 119. — Bernt Beitrage zur gerichtl.
Arzneikunde, Vol. IV. p. 237, (they are said also to occur in epilepsy.) —
j4. Cooper, Lectures on Surgery, edited by Tyrrcl, Vol. I. p. 263.

(3) This, for satisfactory reasons, is much more rare than on the skull.

(l) Compare above, § 222, § 228, and § 231, note 3. — I made one very rare
observation in a child, with large dropsy of the head, and other malformation.
V. my Verzeichn. No. 2891 ; both ventricles were very much expanded with
water, but especially the left ; and the posterior lobe of the brain, on that side,
has, at its outermost extremity, an aperture, nearly three lines in diameter,
roundish, flat, lined with pia mater, passing into the cavity of the ventricle.
The origin of this was a little hard encysted tumour of the arachnoid, lying
loosely in it, which, moving close over the aperture, had prevented the escape
of the water. The brain is No. 8814 of Bresl. Mus.

(5) The loss of substance in the brain, however, in rare cases, is healed with-
out re})roducti<)n, especially if the penetrating piece of bone remain and occupy
tbe i)lace of the depressed brain.

(6) Sand and StoJz D. de fungo Cerebri. Regiom. 1700; rev. in Haller's Coll.
Dis]). chir. Vol. I. No. 9. — Conrad D. de hydrocephalo cum fungo ccrebelli.
Argent. 1778. — C. D. Windcl I), de fungo cerebri ct dura^ matris. Ito. Goett.
1809. — Many cases are collected in de PloiiqucCs Repertor. 7\rt. Cerebri fungus ;
and in liurdach, p. 550. — Compare the works on Surgery. — There is an interest-
ing case described in Lond. med. and physical Journ. p. 369.

Sect. XX.] Of the Brain. 407

§ 2S5.

Among the vices of texture in the brain, which occur
more commonly perhaps on the right side than on the left,
and in hemiplegic persons are found generally on the oppo-
site side to the palsy, inflammation of the brain, encepha-
litis,^ and the irritative and apoplectic changes, so likely
to be confused with it, deserve the first mention, both on
account of their activity and importance. This is partly con-
sequent on external mechanical causes, as actual wounds,
contusion and concussion of the brain, partly from internal
causes, and may be either an idiopathic and secondary disease,
as in many fevers, eruptive diseases, diseases of the ears, and
organic vices of the brain, viz. extravasated blood, tubercles
and tumours of various kinds. Rarely or never is the whole
brain, but usually only a part of it, affected, and the disease is
seated either in the vascular membrane which covers the surface
or lines the cavities of the brain, as well as in the layer of brain
immediately beneath,^ or in the cortical substance, or lastly, in
the larger collections of medullary matter and the interior more
important parts of the brain. A more or less deep red colour of
the substance of the brain extending generally throughout it, or
streaky and spotty, originating not merely in congestion of
certain vessels, but also affecting the whole mass in the diseased
parts ; certain intense red spots, which depend on the effusion
of little portions of blood, and changes of consistence distinctly
morbid, as well as of the neighbouring cerebral substance,^ cha-
racterize inflammation in this organ. Similar, although de-
cidedly different, is the condition of the brain in the morbid
irritation which often accompanies ardent fevers, especially
typhus,* acute eruptive diseases,^ nostalgia,^ epilepsy,^ drunken-
madness," tetanus,^ convulsions, hydrophobia, softening of the
stomach,^" painter's colic,^^ &c.,^^ perhaps even first occurs in
the agony of death ; here also turgescence is seen, and great
and often bright red injection of the brain, but not the general
red colouring, the spot-like effusion of blood, and the change
of consistence.^^ In sanguineous apoplexy, apoplexia san-
guinea,^^ as it occurs spontaneously in fevers attended with
coma, in injuries of the head, in cases of suffocation, &c., we
find either, in rare cases, a stagnation of the blood produced
from mere congestion, in some parts or in the whole of the venous
system of the brain, which exhibits itself even in the external
examination of the brain, as well as in transverse sections by
the spouting out of the blood at distinct points ;^^ or usually
with simultaneous great vascularity of the brain, an actual ex-

408 Of the Brain. [Part II.

TRAVASATiON OF BLOOD at Certain parts. This may be trifling
or very considerable, fluid or coagulated, and sometimes be-
tween the membranes, sometimes under the vascular coat on the
surface of the brain, sometimes in the ventricles,^'' and some-
times, lastly, which is the most common, in the substance of
the brain itself. In the latter case the extravasated blood is
occasionally mingled with the substance of the brain, ^' so that it
appears as it were drenched in blood, or more commonly the
blood is effused in particular cavities,^^ which are sometimes con-
nected with the cavities or surface of the brain by means of
tears. These extravasations of blood in the substance of the
brain occur most frequently in the striated bodies and in the
hemispheres of the cerebrum, much less frequently in the
cerebellum and in the oblong marrow. ^^ The effusion of
blood naturally takes place from the smallest vessels of the
cerebral substance, and those cases are but rare, and mostly
originating in mechanical influence, when the large vessels of
the membranes, of the plexuses, or of the brain itself, have
produced effusion of blood by their rupture.^" If the apo-
plectic attack have not been soon fatal, the effusion of blood
between the membranes or into the cavities, if it be not great,
is either absorbed, or, irritating the brain like an extraneous
body, operates on it and produces various changes, as in-
flammation of the neighbouring cerebral substance, greater or
less, or even pap-like softening of the surrounding parts, yel-
lowish, brownish, and more or less red colouring of the
adjacent substance of the brain. Lastly, also, a false membrane
is often formed by inflammatory exudation, which surrounds
the extravasated blood like a bag or capsule.^^ In the latter
case, in which there is a disposition to cure, a serum is
secreted from the newly-produced sac, by which the blood being
thinned and rendered looser, its absorption is forwarded, and
either a true cicatrix of the diseased part of the brain ensues,
or a little cavity remains, of which the walls are connected by
fibres of loose plastic lymph, and in which is found a little
hard coagulum of discoloured cruor, fibrous matter, coagulated
albumen, or nothing more than a little watery secretion.

(I) Fischer D. de cerebri ejusque membranarum inflamtnatione et suppuratione
occulta, 1781. — van der Belen D. de cerebri ejusque membranarum inflammatione
rt suppurat occulta. Lovan. 1784. — Noelhrn D. de cepbalitide. Erford, 17J)S. —
Constantin D. de Eiicephalitide. Lips. 1800. — Ilaartmarin D. Encepbalitidis
diajj^nosi. Abo. 1802. — Poutin in Vcttenska))S. Jurn. for Lakare ocb Fiiltskiircr,
Vol. I. Part II. p. 7, Stockholm, 1807- — Thorn D. de encophalitide. Giessae,
1810. — Ducriit Essai sur la cephalite ou iriHammation du cerveau. 4to. Paris,
1812. — MalinV). i\ii cnccphalitide. 8vo. llala', 1817. — f^. Furttier D. de variis
Enceplialitides speciebus. 8vo. Landisbuti, 1818. — Blcynie Sur rinilammation
du cerveau. Paris, 1819. — J. II. AUeyne D. de inflammatione longa cerebri.

Sect. XX.] Of the Brain, 409

Edinb. 1822. — BouiUaud Traite clinique et physiologique tie I'encephalite, ou in-
flammation du cerveau et de ses suites, telles que le ramoUissement, la suppuration,
les absces, les tubercules, le squirre, le cancer, etc. 8vo. Paris, 1825. — C. F.
Bellingeri Storia delle Encefalitidi, che furono epidemiche in Torino nell' anno
1824.. Torino, 1825. — Hard Memoire surles phlegmasies cerebrales in Mem. de
I'Acad. de Medec. de Paris, Vol. I. No. 4. 1828. — On inflammation of the brain in
cattle, V. Archiv f. Thierheilk, Vol. IV. Part I. Zurich, 1828. — On secondary
inflammation of the brain, arising from diseases of the ear, v. Lallemand, Vol. II.
p. 233, ff". — Ahercromhie and Itard Trait6 des Maladies de I'oreille. — Upon the
inflammatory state of the appendage of the brain, v. Wenzel Ueber den Hirnan-
hang fallsiichtiger Personen. Mainz, 1810.

(2) Compare §221.

(3) Especially softening, which, if I be not mistaken, was first remarked by
Vetter, in his Aphorismen aus der pathol. Anatomie, p. 31, § 21.

(4) Several of the older writers held inflammation of the brain as the proxi-
mate cause of typhus fever, viz. Willis, Chirac, Werlhof, Silva, Fracassini, Marteau
de Grandvilliers, in Journ. de Medec. 1758, Vol. VIII. p. 275. — Donald Monro ;
more recently, Reil, de Plouquef Expositio Nosologica Typhi. Tiibingen, 1800. —
Constantin, but especially Marcus, in Ephemeriden der Heilkunde, Vol. I. p. 1.
Bamberg, 1811, and ibid, in Roschlaub Ueber den Typhus. Bamberg, 1814. —
H. Clutterbuck, An inquiry into the seat and nature of fever, 2d edit. London,
1825, and the modern French School have supported this view more or less.
The cause of malignant intermittent fever has also been sought for in inflam-
mation of the brain, viz. Forti, Therapeutice speciales ad febres perniciosas,
4to. Francof. et Lipsiae, 1756. — Comparetli, Riscontri medici delle febbri larvate,
periodiche, perniciose, Padua, 1795, and Itard. Opposed to this opinion very
properly are many, viz. Ludwig, Adversaria medico-practica. Vol. I. Part 1.
p. 188. — Hufeland and Himly, Biblioth. der prakt. Heilk. July, 1812, p. 45. —
Horn, Archiv f. medicin. Erfahrung. September, 1812, p. 296 ; March and
April, 1813, p. 317. — Friedreich, Werth der Leichenbffiiungen zur Bestimmung
Typhus sey Hirnentziindung. Wiirzb. 1814.

(5) In small-pox, measles, scarlet- fever, &c., also in sheep-pox, v. Hurtrel
d'Arboval, Trait^ de la clavel6e, etc. Paris, 1822.

(6) Larrey, Recueil de Memoires de Chirurgie. Paris, 1821.

(7) Portal.

(8) J. Frank, Nasse, Abercromhie, also Sutton, on Delirium tremens. — Lind De
delirio tremente sic dicto observationum series ; cum epicrisi de morbi indole ac
natura. Copenh. 1823. — Rob. Macnish, The anatomy of drunkenness. Glasgow,
1827. — Barkhausen, Beobachtungen iiber den Sauferwahnsinn, oder das Delirium
tremens. Bremen, 1828.

(9) Speranza, in Anno clinico-medico. Parma, 1823-4. — E. Blasius, Ueber den
Leichenbefund bei am Tetanus Verstorbenen, in Rust's Magazin f. die ges. Heilk.
1828. Vol. XXVII. Part I. p. 53.

(10) Camerer, Vers, iiber die Natur der krankhaft. Magenerweichung. Stuttg.
1828.

(11) Benj. Palais, Traite pratique sur la colique metallique, etc. Paris, 1825.
— Renauldin, in Journ. compl. du Diet, des Sc. medical. Vol. XXII. p. 297.

(12) According to Faneau-Delacour, as consequent on castration of fowls and
sheep, v. Journ. univ. des Scienc. medical. June, 1824.

(13) But indeed this distinction applies only generally to the just mentioned
diseases, in which, in some cases, there is complication of difierent kinds, and a
gradual transition to true inflammation.

(14) Also haemorrhagia cerebri, apoplexia cerebralis, &c. As to the writers on
this subject, compare Reuss Repertor. Vol. XII. p. 56. — de Plouquet Repertorium,
and Burdach, Vol. III. p. 506, ff. — Wepfer Observationes anat. ex cadaveribus
eorum, quos sustulit apoplexia; nov. edit, access. Auctuarium historiarum et
observationum similium. Scaphus, 1675, and Observat. med. pract. de afFectibus
capitis internis et externis. Scaphus, 1727. — Morgagni, Epist. II., III., and
LX. — J. G. Walter Von den Krankheiten des Bauchfells und dem Schlagfluss,
4to. Berl. 1785. — B. Chandler, An inquiry into the various theories and methods

410 Of the Brain. [Part II.

of cure in Apoplexies and Palsies. 8vo, Cant. 1785. — Zuliani, De apoplexia
praesertim nervea commentarius. Svo. Lipsiae, 1790. — Kirkland a Commentary
on apoplectic and paralytic Affections. London, 1791. — Burdock Die Lehre v.
Schlagfluss u. s. w. Leipz. 1806. — Sander D. de Apoplexia. Goett. 1807. — De de
la Vauterie D. sur I'Apoplexie, consid^ree specialement comme I'effet d'une
phlegmasie de la substance cerebrale. Paris, 1807. — Foder6, De apoplexia
disquisitio. Avenione, 1808. — Portal Observations sur la nature et le traite-
ment de I'apoplexie et sur les moyens de la prevenir. Paris, 1811. — Montain
Traits de I'apoplexie. Paris, 1811. — Cheyne, Cases of Apoplexy and Lethargy,
with Observations upon the comatose Diseases. Lond. 1812. — Riobi^ Observations
propres a resoudre cette question : L'Apoplexie dans laquelle il se fait un
epanchement de sang dans le cerveau, est elle susceptible de guerison ?
Paris, 1814. — Rochoux Recherches sur I'apoplexie. Paris, 1814. — Hopf Versuch
eines Umrisses der Hauptgattungen des Schlagflusses und ihrer Behandlung.
Stuttg. 1817. — Leune De Apoplexia. 8vo. Lips. 1817. — Serres Nouvelle division
des Apoplexies in Annuaire med. chir. des Hopitaux et Hospices civiles de
Paris. 4to. 1817. — Bricheteau in Journ. compl. du Diet, des Scienc. medic.
July, 1819. Vol. I. p. 129—152, and 289— 317.— Mow/m Traite de I'Apoplexie,
ou Hemorrhagie cerebrale, etc. Paris, 1819. — Richelmi\eY%\\c\\ einer. Abhandl.
lib. die Apoplexie u. s. w. a. d. Fr. von E. A. Gr'dfe. Berl. 1821. — Roviberg
\\\ Horn's Archiv, 1823. L — Tacheron Recherches anatomico-pathologiques,
Vol. in. p. 3S6—iS5.—Mertzdorf in Rust's Magazine, Vol. XIV. Part II.—
J. Carson on the circulation of the blood in the head, in Edinb. med. and surg.
Journ. No. 79, p. 258, April, 1824. — Z.aZZe?wa7«c? Recherches Anatomico-patholo-
giques surl'Encephale, &c. 8vo. Paris. 1824-29. — Beck Ueber don urspriinglichen
Hirnmangel und iib. die Pathologic u. Therapie des Gehirnblutflusses. Niirnb.
1826. — L. F. Bravais in Revue medic, franf. et etrang^re. Vol. I. and II. 1827. —
More recently, at Edinburgh, have appeared Dissertations on Apoplexia san-
guinea, by J. Barclay, 1805, Sainsbury, 1809, Prendergast, 1812, Ha7inay^ 1812,
A. Hunter, 1813, Miln, 1814, Bagrie, 1815, Goring, 1816, Burnie, 1818, Bal-
lingall, 1819, Annan, 1820, Walsh, 1820, F. Travers, 1822, M. Baillie, 1823.

(15) Morgagni, Epist. X. 17, 18.

(16) In these cases the vessels of the plexus choroides are usually burst, v.
Morgaqni, Epist. II. 9, 11, 15,22; Epist. III. 11; Epist. LXII. 7; or the blood
extends from the neighbouring cavities filled with blood into the ventricles, by
canals and clefts: here we sometimes find so large a quantity of blood collected,
that the ventricle is very much expanded, or the septum, the fornix, &c., burst.
According to Morgagni, these extravasations occur more frequently on the right
than on the left side; perhaps the flow of blood is stronger there, for which
reason, as has been already mentioned, vices of other kinds are said to be more
common on the right side.

(17) Morgagni, Epist. V. 6, 7. — Lallemand, Letter I.

(18) JVepfer and Morgagni were acquainted with these and their canals into
the ventricles, or up to the surface of the brain. Compare Morgagni, Epist. III.

(19) Several cases of extravasation into the cerebellum are described by Serres
Recherches sur les maladies organiques du ccrvclet in Magendie's Journal de
Physiologic, Vol. II. No. 2, p. 172 ; No. III. p. 249. — I have up to the present
time, among the great number of apoplectic cases which I have examined, found
but twice extravasation in the cerebellum ; the one case I have described in my
Sclt. Beob. Part II. p. 97.

(20) That diminished elasticity which the otherwise thin cerebral arteries
exhibit in disease and old age produces a disposition to tearing, and consequent
extravasation of blood, is well known ; and more recently Bouilhmd, in Mem. de
la Soci^te Medec. d'Enmlation de Paris, Vol. IX. No. 5, 1826, has described a
chronic inflammation of the cerebral vessels as a common cause of apo))lcxy ; but
this is merely a preparatory cause, and many mortal efiusions from blows occur
without any morbid condition of the arteries of the brain, as frequently as that
occurs without any apoj)lexy. A peculiar congestion of blood in the brain, which
in many cases tcrn)inatcs in efi\ision of water, in other cases in extravasation of

Sect. XX.] Of the Brain, 411

blood, or even in both, appears to be the principal cause. It is interesting,
however, that hypertrophy of the left heart, without narrowing of the aorta, as I
have three times observed, gives rise to apoplexy. — Legallois in Bulletin de la
Fac. de Medec. de Paris. Ann. XIII. p. 69. — Bricheteau, p. 17. — LaUemand,
Vol. I. p. 43, 91, &c. — Bursting of aneurysms of the cerebral and meningeal
arteries, (v. above, § 196, note 7 ; and Serves in Archiv. gen. de Med. Vol. XI.
March, 1826; and in Magendie's Journal de Physiol. Vol. VI. p. 82, No. 1,) or of
the sinuses of the brain, (v. above, § 206,) give rise to effusion of blood into the
cavity of the skull. Perhaps stoppage of the sinuses by fibrous matter or suppu-
ration, which has in a few instances been seen, may be enumerated among the
causes of their bursting.

(21) Cheyne considers this as a false membrane surrounding the extravasated
blood ; but Riobe was the true discoverer. Compare farther Rochoux, Raisin Sur les
kystes apoplectiques, in the Journ. gen. de Med. 1820, and Cruveilheir Essai sur
rAnatomie_pathologique, Vol. I. p. 204. — Lobstein, Compte rendu sur les travaux
anatomiques, p. 51, confirms it, as I can also from several of my own observations.

§^36.

Not unfrequently we observe, consequent upon preceding
inflammation of the brain, suppuration of this organ/ either
as a primary or secondary affection. The former commonly
occurs partly from internal causes, and from all those which
could originate in a primary inflammation of the brain, but
especially often in certain scrofulous dispositions ; partly from
external mischief, as concussion and actual wounds of the
brain.^ Secondary suppuration, however, is found in rare
cases in acute fevers, in extravasation of blood, inflamed
tumours of the brain, and caries of the skull ; most frequently,
however, in consequence of inflammatory and suppurative
diseases of the ear.^ The hemispheres of the cerebrum are
most usually the seat of suppuration, although it may be also
observed in most other parts of the brain. In all these cases,
the suppuration appears, either as an open, more or less broad,
ULCER penetrating the outer or inner surface of the organ, or
hidden in the interior of the cerebral substance itself. In the
latter instance, we perceive the pus sometimes poured out in
the substance of the brain, and mingled with it, sometimes in
several spots simultaneously, which are more extensive and
run together, sometimes, lastly, collected into one or several
abscesses. The grey substance with which the pus mingles
appears pale and yellowish, the white substance more distinctly
yellow, or yellowish-green, and almost always more or less soft-
ened ; so also do the parts surrounding the abscesses become
naturally softened, injected, and discoloured in various ways ;
not unfrequently by the inflammatory exudation, is produced a
tolerably firm cyst around the collected pus, a true encysted
ABSCESS, which, however, in other cases appears to arise from
suppuration of an isolated tumour. In rare cases, abscesses
of the brain discharge their pus by bursting or by fistulous

412 Of the Brain, [Part II.

openings into the cavities of the brain, on its surface, and still
further, externally by natural or carious apertures in the skull,
into the nose, the ears,* &c.

(1) Camerarius D. de vomica cerebri. Tiib. 1711. — Bianchi Storia medica d'lin
apostema nel lobo destro del cerebello. Rimini, 1751. — J. Plancus Storia medica
d'un apostema nel cerebello. Rimini, 1752. — Nebcl Pr. de abscessibus cerebri a
causa externa ortis. Heidelb. 1790. — Edinb. med. and surg. Journ. Vol. XVIII.
p. 505 ; many single cases are found in Uonetus, Morgagni, Lieutaud, in de Plouquet's
Repertor., Rcuss Repertor. Comment. Vol. XII. p. 78; Vol. XV. p. 107; in
Home. — Powell in Transact, of the College of Physicians, Vol. V. p. 198. — Bur-
dock, Vol. III. p. 520 — 528. — Lallemand, Letters 2, 3 and 4 ; — in AhercromUe and
in Hooper. — A few instances are related in Horn's Archiv f. medic. Erfahrung.
1813, March and April, p. 238, (in the cerebellum.) — Schallpmher in Allg. med.
Annalen, 1814, August, p. 557, (on the right hemisphere, together with a tumour.)
— le FUs in Rust's Magazin, Vol. V. Part II. p. 235, (in the cerebellum.) —
Laugier in Recueil de Med., Chir. et Pharm. milit. Vol. VIII. 1820, p. 179, (in
the cerebellum.) — Bush in London med. and phys. Journal, 1823, Decemb., (a
large encysted abscess.) — Hamilton in Transact, of the med. chir. Soc. of Edinb.
1824, No. 22. — Dickson in London med. Repository, Oct. 1824, (unexpectedly.) —
Velpeau in Archives generales de M^decine, Vol. VII. Januar. (in the Medulla
oblongata.) — Roloff in Nasse's Zeitschrift fiir die Anthropologic, 1825, Part III.
p. 172, (in one hemisphere without destruction of mental activity.) — A. Cooper's
Lectures by Tyrrel, Vol. I. (several interesting cases.) — Bellmer D. de cerebelli
degenerationibus. 4to. Bonnae, 1825, (in the cerebellum; he also cites similar older
cases.) — Cruveilheir in Nouvelle Bibliotheque, Novemb. 1826, (in the left hemi-
sphere.)— Nasse,\?>2Q, Part III., (in the left hemisphere, without loss of mind.) —
Thilow in Pierer's Allgem. medic. Annalen, 1827, November, p. 1441, — Travers.
V. Magazin der ausland. Liter, d. ges. Heilk. Jan. and Feb. 1828. — F. Jones in
London med. and surg. Journal, 1828, Vol. L. p. 543. — Good engravings are
given in Baillie Engravings, Fasc. X. p. 221, pi. 6. — Hooper ^ pi. 9. — Abscess in
the brain of horses is described in Correspond, veterin. Vol. II. p. 94; by Schwab
Materialien zu einer pathol. Anatomic der Hausthiere, 1st part, p. 9 ; by Dupuy
and Fatel Journ. prat, de Med. veter. Nov. 1827, p. 531.

(2) In such cases the brain is sometimes lost in considerable quantities by sup-
puration. In a youn;:^ man who received a wound with a pitchfork, and was
subsequently trepanned, a pultaceous mass as big as one's fist daily protruded
from the aperture in the latter stage of the disease; after death I found the
wounded hemisphere had suppurated away.

(3) That the diseases of the internal ear are, in many instances, communicated
to the brain, is well known ; but, oftentimes, affections of the ear and brain may
occur simultaneously, and from the same cause. It is difficult to determine this,
as large abscesses of the brain frequently exist for a long while, without either
mental or bodily disturbance ; and this indeed so much the more, as the Otorrhoe
serves the purpose of counter-irritation. In many cases, also, the affection of the
brain seems to be primary, and that of the ear secondary ; compare the following
cases, in which simultaneous su])puration of the internal ear and abscess of the
brain were observed; viz. — Boneius and Lieutaud ; further, Morgagni, Epist. XIV.
3 and 5. — M ogling in Ephem. Nat. Curios. Cent. VI. Obs. 21. — Laubius ib.
Cent. VII. Obs. 401, Cent. VIII. Obs. 2l.—Go7itard in Hist, de I'Acad. des
Scienc. de Paris, 1756. — Ballonius Opera omnia. Vol. I. j). 196, 4to. Gcnev.
\7C)2.—Lehlanc in Journ. de Medec. Vol. XVII. p. ^r^5.—Stoll Praelect. p. 149.—
V. ilfo/i;e«/it'»/j lieobachtungen. \o\. I. p. 98, Wicn 1780. — Schumacher '^ledxc. c\\\r.
Bemerkuiigen. Kopenh. p. 381, 1800. — Portal Cours d'Anat. medic. Vol. IV.
p. 99. — Murray D. Abscessus auris interna; observatio. Upsal. 1796. v. Rudolphi's
Schwed. Annalen. Part I. p. 110. — Sabatier Medecine operatoire, Vol. III. p. 10,
2d edit. 1811. — MeiUcal Coiniucntaries, Vol. II. p. 180. — Frank Interpret, clini-
cne, Vol. I. p. 142. — lirodic in Transact, of a Soc. for Im))rovemcnt, &c. Vol.
III. p. \06.— Rust's Magaz. Vol. II. Part II. p. 311, and Vol. IV. Part I.

Sect. XX.] Of the Brain. 413

p. 197. — Parkinson in London medical Repository, January to' May, 183 7. — O'Brien
in Transact, of King's and Queen's College, Dublin, Vol. II. p. 309. — PaUetia
Exercit. pathol. Vol. I. p. 2. — Hard Traite des maladies de I'oreille et de I'audi-
tion, p. 70. Paris, 1821. — Duncan in Edinb. med. and surg. Journal, Vol. XVII.
p. 331, July, 1821, fourth and fifth case. I have described six instances in my
Selt. Beob. Part II. p. dQ. — Hoist in Magazin fiir Naturvidenskaberne, 1st
Part, Christiania, 1825. — Lallemand, Vol. II. p. 239 and 306. — Ahercromhie, p. 41,
ff. — -ffq^raann Otorrhcea cerebralis primaria in Hay-IBS' s N. Jahrb. der deutsch,
Medic, u. Chir. 2 Supplement, p. 43, 1827.

(4) It is so natural to assume, from analogy with the examples in other parts,
that abscesses in the brain may penetrate the skull by external fistulous openings,
that it is merely respect to Morgagni's opinion, which is not, however, general,
but only meant for his own two cases, which has induced Lallemand to hold the cere-
bral abscesses connected with the caries of the ear always secondary. But that it
may be also primary, Brodie, Hard, and myself in my Selt. Beob. Part II. p. 96,
(before I was aware of the latter's opinion,) and Hoffmann have endeavoured to
show by reasoning and examples. If inflammation of the ear precede that of
the brain, why, on the contrary, should not that of the brain precede that of the ear?
and the rather, as abscesses of the hemispheres descend into the lowest part of
the middle lobes, and here come in contact with the petrous bone, into which the
pus, on account of the thinness of the covering of the semicircular canals and drum,
might easily penetrate ; the effort of all abscesses towards external parts can
hardly find a more favourable outlet. If the abscess be in the cerebellum below
the tentorium, the pus penetrates into the internal auditory passage, or makes its
way out by an aperture behind the ear. v. Hard, p. 254, Obs. 22, and Ahercromhie,
case 3, p. 35. I have already mentioned above, that in suppuration of the cere-
bral membranes, the pus sometimes passes through fistulous openings in the
skull ; the same also occurs in abscesses of the brain at other parts, as well as on
the ear. v. Hill, Cases of Surgery, p. 130. — Pretty, in London Med. Repository,
Vol. XX. Sept. 1823, (through the frontal bone.) — Rosenthal Abhandl. a. d.
Gebiete der anat. physiol. und pathol. Berlin, 1824. — Syme, in Edinb. med.
and surg. Journal, July, 1828, (on the forehead.) — Lithell in Svenska Lakare-
Sallskapets Handlingar, Vol. VII. p. 220, (on the left parietal bone.) — Duncan,
in case sixth, (through the sphenoid and temporal bone.) — Raikem in Repert. gen.
d'Anat. etde Physiol, pathol. Vol. I. No. 2, p. 295, (through the petrous and sphe-
noid bones, and the nose) ; — similar cases to the latter are described by C G. Frank
in Ephem. Nat. Cur. Dec. II. Ann. VI. Obs. 193, (flow of pus from the nose
through a carious sphenoid bone.) — Bartholin Histor. anat. Cent. II. Hist. 34,
Cent. VI. Hist. 13. — Thoner'm Haller's Bibl. med. pract. Vol. III. p. 22. — Lehlanc.
— Sometimes in abscess of the brain the skull is not penetrated, but only eroded.
V. Lieutaud Lib. III. Obs. 1131. — Horn's Archiv f. med. Erfahr. p. 288, March and
April, 1813. A steatoma of the brain, also, by its irritation, gave rise to caries of
the auditory organ, v. Neumann in Hufelaiid's Journal, 1824, p. 14. — Lallemand is
not quite correct, when he says, p. 282, that pus never penetrates any other way
than through the ear. The notion of the priority of abscesses of the brain to the
affections of the ear is also supported, by the fact, that in several of the above-
mentioned cases the disease was a consequence of injury of the head, which had
affected the brain more than the ear.

§ 237.

Proportionally is the brain rarely found mortified,^ and
then almost always from external injury alone, in which having
been bruised, it inflames, and sinks, or when injuries of the
head have been improperly treated. The substance of the
brain is then found dissolved, foetid,^ orange-brown, and even
grey and blackish coloured. Mortification of the brain appears
to arise very rarely from internal causes, and we must take

414 Of the Brain. [Part II.

especial care to distinguish the great softening and deep colour
of the brain from gangrene.^

(1) Lyserus D. de sphacelo cerebri. Lips. 1656.

(2) It is an interesting circumstance, that the brain, without being gan-
grenous, sometimes has a very disagreeable smell, which I have observed in a
few cases, when, upon putrefaction of the brain, the stink was indescribable. —
Similar cases have been observed by Morgagni, Epist. VII. 9 ; XIV. 5. — Greding
Sammtl. Medic. Schrift. Vol. I. p. 306.

(3) I have not yet seen gangrene of the brain from these causes, and I
believe that death would ensue before active inflammation of the brain could run
into gangrene. The observations on gangrene, in the old writers, are therefore
all extremely doubtful, because, till the present time, softening of the brain was
called putrefaction and mortification, and all dark colouring of the brain esteemed
gangrenous. — Even Jhercrombie, if I do not mistake him, considers the proper
softening of the brain as analogous to gangrene.

Another and equally rare vice of texture in the brain, is the
DEPOSITION OF CARTILAGE AND OF LIME in its tissue, and the
consequent production of more or less large and numerous
CARTILAGINOUS, BONY, and STONY CONCRETIONS in it.^ Fre-
quent morbid irritation and chronic inflammation of the brain,
gout, and tubercles in the brain, seem to give rise most com-
monly to this change of texture. The lime is in such cases
found either in very small quantity, scattered about like sand
in one part of the brain, so that it grates when cut through ;
or it is collected in larger quantity at one spot, so that it
assumes a chalky or gypsum-like appearance, and a certain
degree of brittleness ; or lastly, it forms separate bodies of very
different forms, which are deposited in the substance of the
brain, and sometimes even contained in delicate cysts, which,
according to their appearance and solidity, we are accustomed
to call fibro-cartilaginous tumours,^ bony or stony concretions.'
A true ossification of the brain, that is, its conversion into bony
substance, is never found, but it is always rather a removal of
the nervous mass.

(1) The fabulous accounts of the older writers respecting the entire, or
almost entire conversion of the brain of men and animals into bone or stone,
if indeed they are founded on any observation, may perhaps always be referred to
great enostosis of tlie skull. Comp. § 122, note 27 and 28. — Further, Scb. Scarabicii
Historia cerebri bovini in lapidcm mutati. Patav. 1655. — To these belong also
probably the completely stony human brains, in the fossil collection at Lisbon,
v. Domeier in Journ. d. ausliind. med. litcrat. by Huf eland, Schrcger, and Harles,
Vol. I. p. 258.

(2) Compare § 239, note 1.

(3) J. Kentmann De calculis in hominibus. 8vo. Tigur. 1565. — Miscell. Acad.
Nat. Cur. Dec. II. Ann. I. Obs. 32, ]). 76, 1682, (a stony concretion, as large
as a bean, from the brain of a fallow-deer.) — Schelhammcr, ib. p. 332. — Chi\ Vater
De ossiculo in cerebro nato, ib. Dec. 111. Ann. IX. and X. p. 2f)4. — Tyson, in
Phil. Trans. 1697, No, 228, ]). 535, (in the quadrigeminal body.) — Drclincourt in
Maw^c/'j Theatre anat. L. IV. C. II. p. 309, (the pine as large as a hen's egg,

Sect. XX.] Of the Brain, 415

and stony.) — Littre in Mem. de I'Academ. de Paris, 1705, p. 55, (the cerebellum
and part of the medulla oblongata chalky.) — Blegny Zodiac. Gallic. Obs. 14,
p. 87, (a stone, as large as a bean, at the junction of the optic nerves.) — Veratti
in Comment. Bononiens, Vol. II. Parti, p. 184. — Hunauld in Memoir, de
I'Acad. des Sciences de Paris, 1734, p. 44 and 59. — Lieutaud, ih. 1737, p. 51 and
71; and Hist. anat. med. L. III. Obs. 179, p. 56, 4. (on the cerebellum of an
epileptic person, and in the pine.) — Deidier Traite des tumeurs contre nature,
Paris, 1738, p. 351, (in the left striated body.) — Adami D. de causis quibusdam
specialibus apoplexiae, etc. Halae, 1764, (a stone as large as a pigeon's eg^.) —
Compare Meckel in Mem. de Berlin, 1754. — Gredingv. Ludwig's Adversar. med.
pract. Vol. II. p. 448, and Vol. III. p. 658. —de Haen Ratio Medendi, Vol. II.
p. 186, (the infundibulum full of lime.) — Schweikhard Medic, gerichtl. Beobacht.
Vol. III. p. 304. Strasb. 1789, (the hinder part of the hemisphere full of sand.) —
Metzger D. continens bigam Obs. anat. pathol. p. 3. Regiom. 1792, (pons varolii
ossified.) — Mursinna Medic, chir. Beobacht. p. 115. Berl. 1796, (a tumour in the
corpus callosum.) — F.J. Walter Anat. Museum, Vol. I. No. 291. p. 145, — Caldani
Opusc. anat. p. 51. Patav. 1803, (a stone in the optic beds.) — J. and C. Wenzel De
penitiori structura cerebri, p. 104 and 105, (an earthy kernel in the tumour.) —
The Reviev^ers in Leipz. Lit. Zeitg. 1813, No. 25, p. 103, found small grains of
sand in the appendage of the brain. — Hovie, in Philos. Transact. 1814, Part II.
p. 469 — 486, (many earthy substances in the cerebellum and limbs of the brain
in an idiot boy.) — Boyer v. Cruveilhier Essai sur I'Anat. pathol. Vol. II. p. 84. —
Schallgruber Aufs. u. Beobacht. p. 59, Gratz 1816, (grains of sand in a tumour.) —
Prochaska in Oestreich. med. Jahrb. 1819, Vol. V. Part III. p. 83, with plates,
(a large stony concretion.) — Hutchinson, in Med. chir. Transact. Vol. IV.
p. 202, (in a tumour of the brain, fat, cartilage, and bone.) — Nasse in his appendix
to Abercrombie, translated hy De Blois, p. 16, Bonn, 1821, (a tumour in the cere-
bellum, with patches of lime and coagulated lymph alternately.) — Andral in
Magendie's Journ. de physiol. Vol. II. p. 110, (in a consumptive person, a chalky
concretion as large as a pea in the upper part of the left hemisphere. — Tacheron,
Vol. III. p. 380, (a tumour, which grated when cut.) — Neumann in Hufeland's
Journ. July, 1824, p. 28, (stony concretions in the hemisphere under the pia
mater, one of which was almost as large as a pea.) — Rosenthal A\A\a.nd\. a d.
Gebiete der Anatomic, Physiologic u. Pathologic, p. 113. Berl. 1824, (a splinter
of bone in the cerebellum.) — Abr. Berg prses. Weber Observatio tumoris et ossi-
ficationis cerebelli, ossificationem substantiae cerebralis et phaenomena morbi
illustranda. 4to. Lips. 1826. — Bergmanii in Mende Beobacht. u. Bemerk. a. d.
Gebertshiilfe u. gerichtl. Medicin. Vol. III. Gott. 1826, (a tumour in the base of
the left ventricle, consisting of many sandy round bodies and soft substances, as
large as a walnut.) — Hooper, The morbid Anatomy of the human brain, &c.
tab. 12, has engraved a bony tumour from the brain. — In the Bresl. Mus. there
is a large tumour, No. 2295, from the brain, containing earthy matter in many
parts ; and No. 8425, an irregular bony concretion, an inch and a half long,
and almost an inch thick, which was found in macerating a skull, and probably
belonged to a tumour in the brain. — In the Anat. pathol. Mus. at Vienna, I saw
No. 2331 and 2361, two round smooth stones, as large as peas, which had the
appearance of vein-stones, but without any accompanying history. Were they
vein-stones from a sinus ? — I also saw there a very firm brain from an epileptic
person, with extensive ossification in one hemisphere, and a pine, the greater
part of which was stony.

§239.

On account of their frequency as well as their consequences,
SPURIOUS FORMATIONS of various kinds are very important
morbid phenomena in the brain. As they for the most part
produce a mass as solid as the brain, are also frequently sepa-
rated from it by a distinct membranous cyst, indeed even only

416 Of the Brain. [Part II.

embedded in it; they commonly excite, by their irritation,
inflammation, softening, or suppuration in the neighbouring
parts, and then seem, as it were, separated fi'om the other parts
of the brain; we apply to them the but little characteristic
names of nodes, nodi^ cerebral tumours, tumores cere-
hrales^ &c. Although in many cases it is difficult to dis-
tinguish them, as the colour, size, consistence, and texture
vary exceedingly, and they run so gradually into each other,
it seems, however, that they may in general be divided into
encysted tumours, tubercles, and sarcoms. To the former
kind belong the watery bags, hygromata, and hydatids,^
found in the substance of the brain, which either lie tolerably
exposed on the surface, or are found buried in the interior of
the brain, and vary in size from that of millet seed, to that of a
small apple, &c. ; if they be small, sometimes numerous, but if
larger, commonly single. To these hydatids and watery cysts,
are connected the cysts which contain mucous-like, albuminous
and bloody secretions of different consistence ; lastly, true fatty
and gritty tumours which contain fatty and albuminous sub-
stances.^ Tubercular affections of the brain* are common,
not merely in youth, but also in more advanced hfe. The
characteristic tubercular mass is sometimes deposited pretty
regularly in the substance of the brain at one spot, and gives it
a yellowish white and firm character ; sometimes it affects a part
of the brain in a granular and more distinct form; lastly, it
sometimes forms isolated and tolerably large roundish knobs,
which are not unfrequently surrounded by delicate cellular
membranous coverings. The colour and consistence of these
tubercles is very different, as they are observed at first in their
hard, irritated, inflammatory, softened, and even purulent state.''
The sarcom has, either as in the other parts of the body, the
nature of the general or fleshy sarcom, and then consists of a
tissue of cellular substance, minute vessels, cysts, and inor-
ganized albuminous masses, &c., or rather, that of medullary
SARCOM.^ True scirrhus and cancer never occur primarily in
the brain.'

(1) Lieutaudy Vol. II. Lib. III. Obs. 194— 224.— >^. Salomon D. de quibusdam
cerei)ri tumoribus, Edinb. 1810. — A. li. Ilertel D. de cerebri et meningum
tuinoribus, 8vo. Berol. 1814, witb plates, (tbree cases contributed hy Rudolphi.) —
C. E. J. Hammer praes. Rosenmuller D. anat. patbol. s. tumorum morbosorum in
cerebro observationes novas, 4to. Lips. 1817, witb j)latcs. — A^a,v.st' Ueber Gesch-
wiilste im Gebirn, a])pendix to Abercrombie, Patbolojr. and Pract. Remarks on
diseases of tbe Brain and Spinal Marrow, translated into German by de Blots,
Bonn, 1821. — C. L. H. Calow 1). de tumoribus cerebri, 4to. Berol. 182(), witb
plates. — Jiurdacli Vom Baue u. Leben des Gebirns, Vol. III. p. 543 — 550, —
Of tbe numerous individual cases, tbe following are most important: Fel. Plater
Observ. Lib. I. p. 13 and 108.— TJowr// Sepiikbretum anat. L. I. Sect. 1, Obs. 56,63,
Sect. 2, Obs. 53, Sect. 3, Obs. 2\).— Willis De scorbuto, Cap. III. § 4. — /. Harderi

Sect. XX.] Of the Brain, 417

Apiarium, p. 238, Obs. 58, 4to. Basil, 1687, (in the cerebellum and medulla
oblongata.) — Jon. Rhodii Observat. medicar. Cent. I. Observ. 55, Patav. 1757,
(in one ventricle.) — Wagner in Ephem. Acad. Nat. Curiosor. Dec, II. Ann. X,
and ValUsnieri, ib. Cent. VIII. App. p. 72, (in the right ventricle.) — Lancisi De
subit. mort. p. 39, (scirrhus in the medulla oblongata,) and De noxiis paludum
effluviis, L. II. Epist, III. cap. 6, p. 218, (a white, hard, granular-like body in
the cerebellum.) — M^m. de I'Acad. de Scienc. de Paris, 1705, No. 13, (in the
cerebellum and medulla oblongata.) — Santorini Observationes, p. 51. — Fantoni
Opuscula med. et physiol. p. 87 and 202, 4to. Genuae, 1738, (as large as a walnut,
in the brain.) — la Peyronie, ib. 1741, p. 208, (in the fourth ventricle, as large as an
egg.) — Buonav. Perotti in Raccolta d'Opusculi scientifici e fisiologici in Venezia,
Vol. XLVII. 1751, p. 339, (as large as a nut, in the right hemisphere.) — Zinn in
Comment. Soc. reg. Scientiar. Goetting. Vol. II. 1752, (two cases in children.) —
M^m. de I'Acad. des Sc. de Paris, 1754, p. 63, (in the right hemisphere, as large
as a hen's egg.) — Huber Pr. observat. aliquot, anat. Cassellis, 1760, (in a child,
in the medullary substance of one hemisphere.) — Meckel in M^m. de I'Acad. de
Berl. 1754, p. 70, (a scirrhus in the cerebrum,) 1761, p. 61, (in the cerebellum,)
1764, p. 84, (a scirrhus in the left hemisphere.) — Morgagni Epist. LII. 15,
(scirrhus in the cerebellum.) — Roderer Pr. de cerebri scirrho. Goett. 1762. —
Gain in Atti dell' Acad, delle Scienze di Siena, Vol. II. p. 210, (one as large as
a hen's egg, in the right ventricle.) — Haller Opera minora. Vol. III. Obs. 1,
p. 282, (scirrhus cerebelli.) — Marcot in Mem. de la Soc. de Montpellier, Vol. I.
p. 334, Lyon, 1766, (scirrhus.) — Brown Cheston, Pathological Inquiries and
Observations in Surgery, &c. p. 142. 4to. Lond. 1756, (a fungous growth.) —
Forlatii Rarior. obs. med. anat. Vol. I. p. 49, Senis, 1769, (an encysted tumour,
in the left ventricle.) — Baader in Sandiforfs Thesaurus Dissert. Vol. III. p. 38,
(a fatty body as large as a walnut, in the right hemisphere.) — Richter's Chir.
Biblioth. Vol. II. Part I. p. 159. — Desportes in Histoire des maladies de St.
Domingue, Vol. II. p. 209, Paris, 1770, (an encysted tumour, with fat in the pine
as large as an egg.) — Greding in Ludwig's Advers. med. pract. Vol. II. Part II.
p. 492, (large, in the right hemisphere.) — Brisseau in Samml. chir. Bemerkungen,
Vol. I. p. 198, (an encysted tumour as large as a hen's egg, in the cerebellum.) —
Meier in Baldinger^s Magazin, Vol. IV. Part I. p. 1. — Leveling D. de carie cranii
militis quondam venerei. 4to. Ingolst. 1777. — /. Conrad De hydrocephalo cum
fungo cerebelli conjuncto. 4to. Argentor. 1778.' — Schmiicher Samml. vermischt.
chir. Schriften, Vol. I. p. 247, (as large as a nutmeg, in the left ventricle.) —
Baumes inJourn.de Medec. 1791, June. — N asse, in Abercrombie, has collected the
following cases, two of his own ; in one, twenty-one tubercles in the cerebrum ;
and in the other, a tumour in the cerebellum. Further, Reil Memorabil. clinica.
Fasc. III. p. 39, (several tubercles in the cerebrum and cerebellum.) — Blane, in
Transact, of a Soc. for the improvement of medic, and surg. Knowledge
(in the brain and pine). — Wenzel De penitiori struct, cerebri, p. 104, 105.
— Earle in Medic, chir. Transact. Vol. III. p. 59, 1812, (several in the hemi-
spheres in a boy.) — Hutchinson, ibid. Vol. II. p. 113; and Vol. IV. p. 197, (three
cases.) — Powel in Medic. Transact. Vol. V. 219, 234, 241. — Farre in Samml.
auserl. Abhandl. f. prakt. Aerzte. Vol. XXV. p. 21. — Merat in Bulletin de la
Fac. de Medec. de Paris, 1815, No. 4, p. 335, (three cases.) — Cruveilhier Essai
sur I'anat. pathol. Vol. I. p. 300, (encysted tumour in the left hemisphere.) —
Meckel Handb. der pathol. Anatom. Vol. II. Part II. p. 329, (in the left ven-
tricle.)— Rosenmuller in Hammer, p. 17, (in the right hemisphere two as large as
hazel-nuts.) — Bock, ibid. p. 25, (one as large as an egg, in the right hemisphere of
a boy;) p. 28, (scirrhi in the cerebrum andcerebellum of ascrofulous child.) —
Buchanan in Ediub. med. and surg. Journ. Vol. VIII. p. 276. — Steinbuch in
Hufeland's Journal, Aug. 1815, Vol. XLI. Part II. p. 104. — Arvers in Bullet, de
la Fac. de Med. de Paris, 1815, No. I. p. 260. — Chomel in Nouv. Journ.
de Med. March, 1818, p. 1. — Rose in London med. Repos. 1819, No. 61,
p. 12. — Besides the already mentioned cases, Abercrombie has also cited the
following, case 82, p. 175, (an encysted tumour in the cerebellum.) — Latham in
Med, and phys. Journ. July, 1826, (in the cerebellum.) — Planqiie Bibliotheque,
Part III. p. 348, (in the cerebellum, as large as a pigeon's egg.) — Bonillaud

£ £

418 Of the Brain. [Part II.

Traite de I'Encephalite, 1825, (a scirrlius in the right hemisphere.) — Chambers
in Med. and phys. Journ. July, 1826, (in both hemispheres, and in the cere-
bellum.)— CruveUhier in Nouv. Biblioth. de M^dec. Nov. 1825, (a scirrhus in the
right hemisphere.) Hay^ case 14, (the size of a walnut, on the Turkish saddle.)
Colndet Sur I'hydrocephale, p. 98, (a hard tumour on the pons varolii.) — Hay,
case 20, (tumour as large as an orange.) — RocJiozix Sur I'Apoplexie, (a tubercle
as large as a nut, in the cerebellum.) — Bellhy, case 27, (one as large as an egg
between the cerebral membranes in a child.) — BoidUaud, case 32, (many large
scrofulous tumours in a boy in both hemispheres.) — Yelloly in Med. chir.
Transact. I. p. 181, (on the pons varolii and medulla oblongata.) — Rostan
Recherches sur le ramollissement du cerveau. Paris, 1820, (in the right
hemisphere a cancerous-like tumour as big as a turkey's egg^) — Gooch in
ylhcrcrombie, p. 437, (two encysted tumours.) — Edinburgh Journal. Vol. XI.
p. 470, (in the pons varolii.) — Bulletin de la Faculte de M6dec. de Paris,
May, 1816, (as large as a hen's egg, in the left hemisphere.) — Hawhms in Med.
and physical Journal, 1826, (many scrofulous tumours on the cerebrum and
cerebellum.) — Cornell in Medical Repository, Vol. VII. p. 92, (on and in the
cerebellum.) — Hunter, case 40, (as large as a pigeon's egg in the right hemi-
sphere.)— Medico, chir. Transact. Vol. IV. p. 188, (as large as a hen's egg in
the left hemisphere.) — Rostan, case 44, (an egg-shaped tumour in the right
hemisphere.) Some other cases' are : — Salmade in S^dillofs Recueil periodiquc
de la Soc. de M6dec. de Paris. Vol. XXVII. p. 153, (in the left hemisphere.) —
Frihault and Marechal ibid. Vol. XL IV. p. 369, (scirrhus cerebri). — Thomann
Annal. der klinischen Anstalt zu Wiirzburg fiir das Jahr. 1800. Wiirzh. 1803, (on
the pons,) with a plate. — Donald Monro in Medic. Transact. Vol. II. p. 325. —
.7. de Roose in Verhandlingen van het Genootsch. te Antwerpen. D. I. Bl. 109.
Salter in Edinb. med. and surg. Journ. Vol. XI. p. 469, (in the pons.) — Kclck
Beitrage zur pathol. Anatomic, Berl. 1813, No. 64, (on the cerebellum, perhaps
only the flock enlarged) ; No. 66. — Horn in his Archiv f. med. Erfahrung, 1813,
March and April, p. 238, (as large as a pigeon's egg, on the pons.) — Rudolplu, ib.
p. 508, (an encysted tumour in the right hemisphere.) — Edholm in Svenska Llikare-
Siillskapets Handlingar, Vol. I. p. 41, Stockh. 1813, (as large as a walnut, scirrhus
of the gland, pituitaria.) — Schallgruber in Allg. medic. Annalen, 1814, August,
p. 5-37, die Aufs. und Beobachtungen ira Gebiete der Heilkunst. p. 59. Griitz.
1816, (in the right hemisphere.) — E. Home in Philos. Transact. 1814, Part II.
p. 469 — 485; Sect VII. (four cases.) — Zetterstrdm in Svenska Lakare-Sallskapets
Handlingar, 1815, Vol. II. Part II. p. 17 5.— Trafvetifell, ib. p. 191, (in the left
hemisphere, as large as a hen's egg.) — Nysten in Bulletin de la Faculte de Med.
1816, p. 183, (in a child three years old.) — Bicrmayer Museum anat. pathol.
No. 74, (a scirrlnis.) — Cruvcilheir Essai sur I'anatomie patholog. Vol. II. p. 80, (a.
fibro-cartilaginous tumour in the right hemisphere.) — Meckel in Archiv f. d.
Physiol. Vol. III. p. 196, (in both hemispheres fatty and yellowish.) — Wespthal D.
s. descriptionem tumoris in ventriculo cerebri laterali inventi, with illustrative
engravings. 4to. Kiliae, 1817, (in the right ventricle, large.) — Rust Magazin f. d.
gesammte Heilkunde, Vol. V. Part I. p. 165, (encysted tumour.) — Hebreart in
Bulletin de la Fac. de M<^dec. 1817, p. 399, in Annuaire medico-chir. Paris, 1819,
(several cases.) — Cerutti Beschreib. der patholog. Praparate, No. 822, 823, and
827. — Parent- Duchatelet and Martinet Recherches sur I'inflammation de I'arach-
noide. p. 439, 463. Paris, 1821. — Nicl in I'Observateur Proven9al des Scienc.
medicalcs. Vol. II. p. 29, Marseille, 1821, (a medullary swelling as big as one's
fist.) — Ed. Nculey, v. Sammlung auserlescncr Abhandlungen v.um Gebrauch fiir
praktische Aerzte, Vol. XXVII. p. 226. — Mitivie, ib. p. 467. — J. G. Wishart
in Edinburgh medical and surgic. Journal, July, 1822, p. 393. — hard Von den
Krankh. des Gehirns. a. d. Fr. Weimar, 1822, p. 78, (several small scirrhi.) —
liliche in London medical Repository, 1822. — /fiidral in Magendie's Journal
de Physiologic, Vol. II. p. 105. — Pfvuffer in Henke's Zeitschrift f. Staatsar/.nei-
kuiule, 1822, Part III. p. 84, (bean-shaped, lying upon the Turkish saddle,
between the hemispheres.) — Lcbidois in Archives gen6rales de Medec. Paris,
July, 1823, (as large as a hen's egg, in the right hcnjispherc.) — Krukenberg
Jahrbiichcr der ambulator. Klinik zu llallc, 1823, Vol. II. Sect VI. No. 1, (two

Sect. XX.] Of the Brain. 419

cases, in the one as large as a Borsdorf apple, in the right hemisphere.) — Pie-
dagiiel in Magendie's Journ. de Physiol. Vol. III. p. 247, (several large knots.)
— Tacheron Recherches anat. pathologiques, Vol. III. p. 45 and 381, (tubercles
in a child.) — Rezzio in Ripertorio med. chir. di Torino, 1823, (an encysted
tumour.) — Ward, in London med. Repository, September, 1823, Vol. XX.
p. 217, (a tumour projecting from the region of the mucous gland,) and April
and June, 1824, (two instances in the cerebellum.) — OUivier, Trait6 de la moelle
epiniere et de ses maladies, &c. 2 vols. 8vo. Paris, gives several instances of
tumours in the medulla oblongata. — Rosenthal Abhandlungen aus dem Gebiete
der Anatomie, Physiologic, und Pathologic, p. 113, Berlin, 1824, (in two scrofu-
lous children in the cerebellum, and in an adult, in the neighbourhood of the
striated bodies.) — /Te^^e/tec/* Beschreibung. der pathol. prapar. zu Wurzburg,
1824, p. 361, No. 267, 275; p. 398, No. 24^1.— Schneide)- D. de magna quadam
encephali destructione ejusque sequelis, 8vo. Berol. 1823, (three steatomatous
tumours in the left hemisphere.) — Ozanam in Journ. compl. du Diet, des Sc.
Medec. Aug. 1824, (six scirrhous knots, as large as hazel-nuts, on the left
hemisphere, with caries of the skull.) — Ahlherg and A. Retzius in Ars-Berattelse
om Svenska Lakare-Sallskapets Arbeten, lemnad af Echstrom, 1825, (a tumour
as big as a hazel-nut, in the corpus rhomboideum cerebelli.) — Fr. Bellmer D. de
cerebelli degenerationibus, 4to. Bonnae, 1825, (tubercular knots in the cere-
brum and cerebellum in the first case ; and in the third, a knot as large as a
nut in the cerebellum.) — Berg praes. Weber Observatio tumoris et ossificationis
cerebelli, &c. 4to. Lips. 1826. — Bergmann, v. Mende Beob. und Bemerk. a. d.
Geburtshiilfe und gerichtl. Medicin. Vol. III. Gott 1826, (in the left hemi-
sphere, containing earth.) — R. Wade, in London Med. and Physic. Journ. May,
1826, (a hard, lightish brown tumour, as big as an egg, in the left hemisphere.)
— Tiand and Duhreuil in Ephemerides m^dicales de Montpellier, Vol. I. April
1826, (on the left side of the cerebellum, and on the medulla oblongata.) —
R. Hooper, The Morbid Anatomy of the human Brain, &c. pi. 6, 11, 12, and 13.
— Pagenstecher in Harles's N. Rhein. Jahrb. d. Medic, u. Chir. Vol. XII. Part
III. p. 1, (a tumour on the left hemisphere.) — Monro, The morbid anatomy of
the Brain, Vol. I. chap. 5, Edinb. 1827. — de laMotte, in Philadelphia Journ. of
the Med. and Phys. Sciences, Aug. 1827. — Cruveilhier Anatomie pathol. 2 livrais.
pi. 6, (several cases, fatty tumours, also two cases of Dupuytren and Leprestre.) —
Dav. Mayer D. de cerebri tumoribus, 4to. with plates, Berol. 1829. I have
found tumours in the brain eight times, of the scrofulous or steatomatous kind.
Compare Selt. Beob. Part I. p. 107 ; Part II. p. 94. Verzeichn. No. 2295—
2300 ; since then, another case, No. 8502 of Bresl. Mus. viz. several scrofulous
knots in the cerebellum.

(2) On hydatids of the cerebral membranes, compare § 225. — On hygroma and
hydatids in the brain itself, v. Lieutaud, L. III. Sect. 3, Obs. 194. — There are
also instances in Lancisi De subitan. mort. L. I. Cap. 11, p. 35. — Schwencke D,
rari casus explicatio anat. med. Hag. 1737. v. Haller's Coll. Diss. pr. Vol. VII.
No. 260. — Fantoni Opusc. med. et physiol. 1738, p. 22. — Schaarschmidt Medic,
und chir. Nachrichten, Vol. III. p. 363. — Kaltschmid De nervis opticis in
cadavere latis inventis. Jenae, 1752. — Berdot in Actis Helvet. phys. med.
Vol. V. p. 183, (a very large watery cyst.) —^ Goutard in Journ. de Medec.
Vol. IV. p. 132. — Morgagni Epist. Anat. I. 20. — Forlani Obs. med. pract.
Anat. Senis, 1769. — Balme in Journ. de Medec. Vol. XLI. p. 526. — Ht/fe-
land's Journal, Vol. V. p. 813. — Porto^ Cours d'Anatomie Medic. Vol. IV. p. 41,
72. — Pyl Aufsatze und Beobachtungen aus der gerichtl. Arzneiwissenschaft,
Vol. II. p. 37. — Medical Repository, Vol. III. v. Ahercromhie, p. 440,
case 39. — Wenzel Ueber den Hirnanhang fallsUchtiger personen, p. 74. —
Ih. De penitiori structura cerebri, p. 114. — E. Home, first case. — Morrah in
Med. Chir. Trans. Vol. IL ^. 260. — Horn's Archiv. 1815, Part V. p.842.—
Biermayer Museum anat. pathol. No. 247 and 285. — Tubinger Blatter f.
Naturwissenschaft und Arzneikunde, Vol. III. p. 51, (in the pine.) — Heading-
ton in Edinb. med. and surg. Journ. Vol. XV. p. 504. — Morrah in Med. chir.
Trans. Vol. II. p. 262. — Cerutti Beschreibung der pathol. Prapar. No. 822 and
823. — Rostan Recherches sur le ramollissement du cerveau, Cap. 10, p. 166. —

E e2

4^0 Of the Brain. [Part II.

Rentdorf D. de hydatidibus in corp. hum. praesertini in cerebro repertis, p. 36.
8vo. Berol. 1822, with plates. — Romberg in Nasse's Zeitschrift, 1822. Part III.
p. 195. — Neumann in Hufeland's Journal, July, 1824, p. 29. — Jacobi, 1st case, (in
the pons.) — Calcw, 2d case, (in the pons, as large as a hen's egg.) — Bailey in
London medical Repository, Feb. 1826, (one large and several small in the fourth
ventricle.) Hooper, pi. 14. — Nordblad in Ars-'Berdttehe om Svenska Liikare-Sall-
skapets Arbeten, lemnad af Ecksirdm, p. 37. Stockholm, 1827, (on the striated
bodies as large as a bean.) — Abercrombie, p. 175, case 82 ; in Bresl. Mus. there are
two instances, No. 8694, (one as large as a hazel-nut,) and No. 8704, (an encysted
tumour, consisting of fatty substance and hydatids.) — It has been already men-
tioned above, in speaking of apoplexy, that after the absorption of the blood,
cysts are sometimes found filled with serum.

(3) The contents of encysted tumours vary as much in the brain as in those of
other parts ; mucous and albuminous secretions, in various degrees of coagu-
lation, are commonly found in them. Sometimes the albumen is almost
coagulated, deposited in concentric layers, and even mingled with earthy
parts. Often, with the albumen, there is a large quantity of fat mingled, which
is never yellow, but similar to tallow, (stearine, and perhaps also cholesterine,)
light, greyish, and smeary, forming a substance not very dissimilar to brain.
Sometimes these fatty tumours have a silvery or shining white lustre, especially
their cysts, viz. in some cases of Rudolphl, Braun, Parent- Duchatelet, and the
three cases of Cruveilhier's. — T also found, in a tumour of the cerebral membrane,
containing hair, which protruded through an aperture in the hemisphere into
tbe ventricle, its cyst shining like mother-of-pearl, v. § 234, note 4. — /. Veratli
once found, in the lateral ventricle of a woman, a knot of hair as big as a pea,*
mingled with small white granules, (probably fat.) v. Comment. Bononiens.
Vol. II. Part I. p. 184. — The thickness of the cyst varies not less, sometimes
it is very inconsiderable, especially in fatty tumours, and in other cases of car-
tilaginous hardness.

(4) The greater number of tumours of the brain have this character, and
almost all which I have examined in a recent state belong here. — Of the cases
quoted in note 1, those which appear to me maybe properly included here arc those
oi Zinn, Huber, Morgagni, Ep. LII. 15, Haller, Nasse, 1st case, Reil, Blane, Enrle,
Merat, Rosenmuller, Bock, Abercrombie, 1st edit. p. 226, case 1 and 2, Boiiillaud,
Chambers, Hay, Rochon.v, Hawkins, Camell, Powell, Rudolphi s. Hcrtel in two
casete, Horn, 1813, p. 238, Rostan, Mitivie and Deslandes in Parent- Duchatelet,
Piedagnel, Tacheron, Roseyithal, Hesselbach, No. 398, Schneider. — Baillie Morbid
Anatomy, p. 442, under the name of white firm substance. — Sommerring's ad-
denda io Baillie, note 537. — Bellmcr, in 1st case. — Baumes Ueber die Erblich-
keit der Skrofeln u. Beispiele von Skrofeln im Gehirne. v. Hufeland's Neueste
Annalen der franz. A. W. Vol. II. No. XI. p. 73. — Ch. Bell, Anatomy of the
Imman Body, Vol. III. p. 36. — Biermayer Museum anat. pathol. No. 544, (in the
cerebellum.) — Lobstein Compte rendu, etc. p. 51. — Ozanam in Journ. compl. du
Diction, des Scienc. medic. Vol. XIX. p. 189. — Berard in Magendie^s Journ. de
Physiologic, Vol. V. No. 1 and 2, p. 17. — Mitivie Beobacht. und Bemerk. iiber
die hitzige Gehirnhohlenwassersucht. Leipz. 1823, (several cases of his own ; he
considers tubercles not unfrequently the cause of dropsy of the brain.) — Gendrin
Ilecherches sur les tubercles du cerveau et de la moelle epinidre in Annales de
I'ecolc m^dicale. Jan. 1823. — Berlin in Ephemerides m6dicales de Montpellicr,
Vol. I. April, 1826, (in the cerebellum of a boy ten years old.) — Chambers in
London med. and phys. Journ. July, 1826. — Earle in Medico-chir. Transact.
Vol. XIII. Part II. London, 1827. — Huiliicr in Ephem. medic, de Montpellicr,
Vol. VI. Sept. 1828. — Evans in Edinb. medic, and surg. Journal, April, 1828. —
Guibert in Ilevue medic, frany. et etrangere, June, 1828, (in the cerebellum, three
cases.) — Good plates are given in Baillie's Engravings, Ease. X. pi. 7, 227 ; and
in Hooper, \)\. 11 and 12. — Tubercles also occur in animals. — Diipuy De ratl'ec-
tion tid)c'rculeuse, p. 265, Paris, 1817, mentions a tuberculous glandula ])inealis
in a horse. — I saw large tubercles, one of wliich was as big as one's fist, from tl\e
lateral ventricle of a liorsc ; and from oxen in the veterinary school at Munich.
I also once found tubercles in the brain of a monkey.

Sect. XX.] Of the Brain. 4^1

(5) Sometimes they are homogeneous, tough, whitish, and hard ; sometimes
partially or generally soft, running into suppuration ; many of the cerebral ab-
scesses quoted are indeed suppurating tubercles.

(6) Several of the tumours cited in note 1 may belong here ; but to medullary
sarcom especially the following, v. /. Wardrop, Observations on Fungus Haematodes,
or Soft Cancer, &c. p. 30, — 35, 47, 59, 74, 8vo. London, 1809, (several cases simul-
taneous with medullary sarcom of the eye.) — Lerminier Ueber eine carcinomatose
Affection des Gehirnes in Annuaire medico-chir. des Hopitaux, &c. 1819, No. 4,
p. 225. — Rostan, p. 84, Obs. 20, (he calls it cancer.) — Panizza Annotazioni anat.
chir. sul fungo midollare dell' occhio, etc. Pavia, 1828, (in a boy, simultaneous
with medullary fungus of the eye.) — Tacheron, Vol. III. p. 380. — Wedemayer in
Rust's Magazin f. d. ges. Heilk, Vol. XIX. Part II. p. 222, (in the left hemi-
sphere.)— John Hunter, in Medico-chir. Transact. Vol. XIII. Part I. with a
plate, London, 1825, (particularly in the optic couches of a girl of seventeen
years.) — Gregory in London medical and physical Journal, Decbr. 1825. —
Latham in London medical and physical Journal, Vol. LVI. or new series. Vol. I.
July, 1826, (descending from the cerebellum into the spinal canal.) — Pogen-
stecher. — Martin Ware, ibid. Vol. LVI 1 1, p. 502, (with medullary sarcom of the
eye.) — I have described three cases, viz. two in the right hemisphere, and one
.in the appendage, v. My Selt. Beob. Part 11. p. 90, No. 38 and 39 ; Verzeichn.
No. 2291 — 93 ; the former of these is also described by Arnold, D. s. fungi me-
dullars in cerebro invent! exemplum, etc. 8vo. Vratislavise, 1822. — I saw in
the Anat. pathol. Mus. at Vienna, one case of medullary sarcom of the
cerebral appendage.

(7) The numerous cases of scirrhus in the brain arise, as I think, generally
from inflammatory and tubercular indurations, from fibrocartilaginous tumours,
and from sarcoma. They may perhaps occur secondarily from cancer in the orbit,
as well as be communicated from the neck to the brain, although, so far as I
know, this has not been observed.

§ 240.

Lastly, the brain is also sometimes subject to vices of con-
tents, inasmuch as not merely are morbid secretions of dif-
ferent kinds frequently found in the cavities, and in the
substance of the brain, but sometimes also extraneous sub-
stances, first, PARASITIC ANIMALS, viz. MITES, gamastis
marginatus,^ and of the entozoa, in men, monkeys, and pigs,
the cysticercus cellulosce^ Rud. ;^ in sheep, antelopes, and
oxen, the coenurus cerebralis, Rud. f and in rare instances
in man, the eckinococcus hominis, Rud. :* secondly, all
hard substances which have accidentally entered the brain, as
needles, bullets, dagger and sword points, splinters of bone,
&c., which sometinles remain for a long time and even for life,
without inconvenience ^ ; in the latter case, they are often, as in
other parts, enclosed in a plastic bag.

(1) Herrmann Mem. apterologique. fol. Strasb. 1804, Fasc. VI. pi. 6.

(2) They rarely occur in the brain, so that I have never found them ; there
is, however, an old preparation, No. 2304, in the Bresl. Museum, in which
a quantity of cysticerci are loosely embedded in the cortical substance of the brain
beneath the vascular coat. — Compare Rudolplu Entozoorum hist, naturalis u. Sy-
nopsis, p. 180 and 546. — Further, Bremser Ueber lebende Wurmer im lebenden
Menschen. Wien, 1819. — K.Himly, in his and HvfelaruVs Journ. Decemb. 1809,
p. 116, pi. 3. — Hopfcngdrtner, ibid. Vol. LI. Part IV. p. 32. — Romberg in
Nasse's Zeitschrift f. die Anthropologic, 1823, Part III. p. 197. — Rosenthal,

i'22 Of the Brain, [Part I L

p. 114. — Bremser found it in a cercopithecus, p. 237, and Rudolphi Synopsis,
p. 547 ; they are frequently found in pigs. — Flormann found them in a pig,
affected with the gid, not merely on the membranes and in the substance of the
brain, but also twenty of them loose in the right ventricle, v. Kongl. Vet. Acad-
Handlingar, p. 132. Stockholm, 1815.

(3) They are especially frequent in sheep affected with the gid, in the lateral
ventricles ; sometimes also in mad staggers in the fourth ventricle, although
rarely in the substance of the brain. J have recently found such a cyst in the
right hemisphere of the cerebellum, near its external surface. If the cyst be-
come large, or there are two or three of them, the brain is very much expanded,
and the skull itself at the spot absorbed or expanded like a bladder.

(4) I found one in the lateral ventricles of the brain weighing two pounds and
three drachms, in which there were seventy- one echinococci. v. Rentdorf, p. 36. —
Perhaps the case found by Biminll in the Appendix to BailUe's Morbid Anatomy
was similar.

(5) Compare the surgical writers. Interesting cases are found in Boneti Medic,
septentr. collat. Part I. p. 59 (a sword point fourteen years) ; and Biblioth. chir.
Cent. I. Obs. 73, (the point of a poniard five years.) — Zacutus Lusitanus Opera.
Vol. II. L. B. 1657, Prax. med. admirand. Lib. I. p. 2, Obs. 6, (a piece of the
blade of a knife eight years.) — Anel in Mem. de I'Acad. de Chir. Vol. II. p. 131,
(a bullet in the region of the pine some years.) — Quesnay, ih. (a bullet a year.) —
Le Bran Observations de Chirurgie, p. 127. Paris, 1731, (a bullet one year in the
region of the saddle) ; p. 161, (small shot discharged on the thirty- seventh day,
the person recovered.) — Volaire in Journ. de Medec. Vol. XX. 1764, p. 553, (a
bullet two years.) — il/omwc? Opuscules de Chirurgie, Vol. 1. p. 59, Paris, 1768,
(a bullet nine years and a half.) — Brisseau Sammlung. chirurg. Bemerk. Gotha,
1758, Vol. I. p. 171, (a piece of iron which had been thrust in during trephining
made its appearance again after four months.) — Vafer, ib., Vol. II. p. 805, (a
small shot seven weeks.) — Schmucker Samml. vermischt. chir. Schriftwi. Vol. I.
p. 277, Berl. 1785, (a bullet four months.) — Majault in Journ. de Medec.
VoL XLI. p. 82, (the point of an arrow nine years.) — Camperdon in Samml. fiir
Wundiii-zte, Vol. II. p. 112, (a piece of the but of a firelock three months.) —
Sala in Diet, des Sciences medic. Vol. VII. p. 50, (the point of a sword during
the whole life, without inconvenience.) — Paroisse in Opuscules de Chirurgie,
p. 1, Paris, 1806, (a soldier who received a bullet into his head, through the
temple, was cured.) — Langlet in Bulletin de la Faculty de Medecine. Dec, 1810.
p. 233 (a bullet eighteen months.) — Reich in Hufeland's Journal, 1815, (a bullet
nine months). — Fance in Journ. de Med. Chir. et Pharm. milit. par Biron et
Foumier, Paris, 1816, Vol. II. (a bullet a-year after the external wound closed.)
— Zindc, lb., Vol. XII. 1822, p. 221, (a pebble which had been shot seventeen
months.) — Kirby, Dublin hospital Reports, &c. Vol. II. 1818, (a large piece of a
bullet several months). — Utforlig och med ojafagtiga intyganden verificera Berat-
telse, &c. 8vo. Stockholm, 1818, (two screws which had been shot in twenty-one
years and three quarters, without inconvenience.) — Kruger-Hansen in t>. Gr'dfe
and V. Wahher's f. Chir. Vol. III. Part IV. p. 627, (forty large small shot, without
inconvenience.) — Busch in Petersburger Abhandl. a. d. GeJjiete. der Heilkunde,
Part II. 1823, p. 215, (a piece of a gun-stock, the man walked on foot with it
180 wersts, 130 miles.)— «o^e;,s in Med. chir. Trans. Vol. XIII. No. 2, 1827,
(a piece of the stock of a cannon three inches long, and three ounces in weight,
twenty-one days.) — Instances of pins in the brain are mentioned by Portal Cours
d'Anatomic Medic. Vol. IV. p. \Ol.—Manne in Tartra Bullet, des. Sc. Mddic.
Vol. V. p. 317, and Flajani, v. Falent'm Voyage mCxUcal en Italic. Nancy, 1822.

Sect. XX.] 4j.>3

Second Chapter.
Of the Spinal Marroiv}

A. — OF THE MEMBRANES OF THE SPINAL MARROW.

§ 241.

The MEMBRANES OF THE SPINAL MARROW are, as is well
known, the same as those of the brain, and would consequently
require but little particular observation, were it not that in
a pathological view, there are certain peculiarities, which arise
principally from the different proportions of the brain and
spinal marrow to their bony investments,^ as well also as from
the peculiar form, disposition, and structure of the spinal mar-
row. It therefore seems proper to mention only the points in
which they agree with the cerebral membranes, and to dwell
on their peculiarities.

(1) Compare the works quoted at § 216, and the works on diseases of the
spine, § 135. — J. P. Frank Oratio de vertebralis columnae in morbis dignitate.
Paviae, 1791 ; v. Samml. fur prakt. Aerzte, Vol. XV. p. 284. — /. B. Mayer D. de
sano et morboso medullae spinalis statu. 8vo. Vindeb. 1808. — Alex. Demussy
Histoire de quelques affections de la eolonne vertebrale et du prolongement
rhachidien de I'encephale. Paris, 1812. — V. liacchetti Delia struttura, delle fun-
zione e delle malattie della midolla spinale, Milano, 1816. — Asch praes. Meckel
D. de vitiis quibusdam medullae spinalis minus cognitis. 4to. Halae, 1816. —
J. Abercromhie on diseases of the spinal marrow in Edinb. med. and surg. Journ.
Vol. XIV. p. 4:2.— Ollivier Essai sur I'anatomie et les vices de conformation de
la moelle epiniere chez I'homme. Diss, iiiaug. Paris, 1823, and Traite de la
moelle epiniere et de ses maladies, &c. Paris, 1824 and 1827; translated into
German, with additions, by J. Radius. Leipz. 1824. — C. L. Stapf Spec, inaug.
s. conspectum morborum medullae spinalis. 4to. Tubing, 1824. — ^ore^ Affection
de la moelle epiniere. Paris, 1825. — Flutm in Nouvelle Biblioth. 1828, Jan.
and Feb.

(2) It is well known that not merely the arachnoid and vascular coats are
nuich more loosely coimected with the spinal marrow than with the brain ; but
also the dura mater of the spinal cord is not so firmly attached to the bones as
that of the brain. Injuries and diseases of the spinal bones, therefore, are not so
immediately communicated to the membranes of the central nervous system as
in the head; but in the greater mobility of the vertebrae, and on their looser
structure, depend many peculiar morbid effects on the spinal marrow.

§ 2i2.

The SIZE and form of the membranous bags investing the
spinal marrow are in general proportioned to that of the spinal
canal and marrow itself, and may therefore with these be irre-
gular in various ways. The extension which the cerebral

42 !< Of the Spinal Marrow. [Part II.

membranes are subjected to so frequently and to such extent in
water of the head and rupture of the brain, &c., occurs also in the
membranes of the spinal marrow under similar circumstances ;
more rarely however, and of course less extensively, although
it is almost always congenital, as the early closing up of
the spinal canal very much opposes its subsequent formation.
In reference to discoloration ^ and vices of consistence,
the membranes of the spinal marrow resemble those of the
brain, and, as other irregularities, are observed more seldom
on the former than on the latter.^ Vices of continuity
occur distinctly not merely fi'om thrust, cut, and shot wounds,
but also from splinters of bone in fracture of the spine, which,
however, on account of their looser connexion, less frequently
occur than in the membranes of the brain ; they arise also from
violent concussion and extension : the latter occurs particu-
larly in cleft spine. ^

(1) Duhrevil v. Ephemerides medicales de Montpellier, Aug. 1826, found in
an embryon of three months, the arachnoides and pia mater of the brain and
spinal cord yellow.

(2) It appears to me, that this is not only founded on the rare dissection of the
spinal canal, and the difficult examination of the spinal cord ; but that vicious
states of the medulla spinalis are extremely rare : I have myself opened many
spinal canals, and not unfrequently seen them opened, but I have found disorga-
nizations in them proportionally less frequent than in the skull. I have often
merely found morbid effusion of fluid. — Ollivier, p. 77, is also of opinion, that
the spinal cord is one of the least affected organs.

(3) Compare below, on the Spinal Marrow, § 246 and 247.

§243.

Inflammation and its consequences deserve the first notice
among vices of texture in the spinal membranes. Here
also must be distinguished that state of morbid irritation and
congestion which commonly occurs, as in acute fevers, in
many eruptive diseases, hydrophobia, tetanus, epilepsia spi-
nalis f convulsions, paraplegia, &c., from true inflammation,
which, however, occurs also in the same diseases.^ To the
latter applies in general, all that has been said about the several
membranes of the brain ; it is not unfrequently followed by the
effusion of plastic lymph,^ distinct thickening,^ conso-
lidation of the several membranes with each other, and with
the spinal canal;* ulceration, and also mortification. In
rare instances we find, on the arachnoid coat of the spinal
marrow, cartilaginous and bony concretions, which, on
account of the mobility of the spine, are not large, but mostly
small, sometimes appear as numerous scales or leaves, especially
in the region of the back and on its posterior surface.*
Hydatids," tubercular' and sarcomatous tumours" on the
spinal membranes, are still more rare.

Sect. XX.] Of the Spinal Marrow. 4^25

(1) Unpractised anatomists easily mistake the redness which the under
surface of the fibrous coat frequently exhibits, as an indication of inflammation ;
which redness, however, generally arises merely from the numerous veins here
situated, in which, by the position of the corpse on the back, the blood collects
according to the laws of gravitation.

(2) The bodies found in the cerebral membranes, under the name of Pac-
chionic glands, or granulations of the brain, appear to be deficient in the spinal
membranes.

(3) I have found, in a few instances, the dura mater of the spinal marrow
thickened a few lines in spots, from the chronic inflammation arising from caries
of the vertebrae. — Ahercromhie, p. 365, mentions, from the London Med. Obs. and
Inquir. Vol. III. a case of hardening of the spinal membranes ; a less degree
of thickening and opacity in the arachnoid of the spinal marrow, is not un-
frequent.

(4) This adhesion of the dura mater with the spinal canal occurs most com-
monly in spina bifida. I have, however, occasionally seen it at different parts
without this.

(5) I consider it rare, because I have never myself found it, and it is therefore
much more rare than in the cavity of the skull. Examples are given by Mor-
gagni, Epist. XXV. 9, (one as large as a gourd-seed.) — Sommerring addenda to
Baillie, p. 248, note 524, (almost cartilaginous, thickened, chalk-like spots.) —
Chaussier in Bulletin de la Faculte de Medec. Vol. V. p. 154, (bony concretions.)
— Esquirol, ib. p. 426, (in an epileptic patient, many little bony plates.) — Horn
in Archiv f. medicin. Erfahrung. March and April, 1813, p. 237, (many bony
scales in a person who died of tabes dorsalis.) The same case is described and
engraved in Hertel D. de cerebri etmeningum tumoribus. 8vo. Berol. 1811, with
engravings.— J. F. Meckel Handb. der menschlichen Anatomie, Vol. III. p. 603.
— Brayne, in London medical Repository, July, 1820, (in two persons who died
of tetanus.) — Swan, Observations on some points relating to the anatomy, phy-
siology, and pathology of the nervous system, Cap. 7, London, 1822, (cartilagi-
nous spots in one healthy, and another epileptic person.) — Lobstein Compte
rendu, &c. p. 54, (little cartilaginous laminae.) — Ollivier, p. 344, (many pieces
of cartilage in a woman.) — Felpeau in Archives gen^rales de Medecine, Jan.
1825; and in Magendie's Journ. de Physiologie, 1826, No. 2, p. 138, (cartilagi-
nous plates in a paraplegic person.) — Barbier v. Abercrombie, p. 373, I saw
cartilaginous plates on the spinal arachnoid coat, in the museum at St. Thomas's
Hospital, London, in the museum at Pavia, and in the Anat. path. Mus. at
Vienna. The nerves within the spinal canal had a chalky appearance, whilst
situated in an abscess in this region, v. Harrison, in London med. and physical
Journ. May, 1823, Vol. XLIX. — Ollivier, p. 344, also observed little bony con-
cretions on the external surface of the spinal dura mater.

(6) Esquh'ol, p. 426, (many hydatids in a cyst of the arachnoid.) — Chaussier^
in two cases ; in one, between the dura mater and the spinal canal, and in con-
nexion with a large hydatid cyst in the chest and belly; and Proces verbal,
&c. 1807, V. Journal de Medecine continue, Vol. XIV. p. 231 ; and in a note
to the 40th letter of his edition of Morgagni De sed. et caus. morbor. new
edit. Lutet. 1822. — Reydellet in Diet, des Scienc. medic. Vol. XXXIII. p. 564,
(it arose from a tumour connected externally with the spinal canal.) — Miraulty
in Ollivier, p. 360. — In a sheep, v. Fischer in Miscell. Acad. Nat. Cur. Dec. III.
Ann. II. Obs. 53.

(7) Ollivier, p. 345, in two cases. Cases from Bayle, Gendrin, and Harder
are related by Abercrombie, p. 371 ; one case is also described by Serres, in Anat.
comp. du Cerveau, Vol. II. p. 234. — Wittfeld in Horn's Archiv., May and June,
1827, (as large as a bean.)

(8) Knox in London medical Observations and Inquiries, Vol. III. p. 160,
(fungus durse matris.) — P/^^7^pj05 in New medical Journal, Vol. I. p. 144, (medul-
lary sarcom of the membranes and the spinal cord.) — Horn in his Archiv f. medic.
Erfahrung. 1815, Vol. V. p. 838, (a sarcomatous tumour on the dura mater of a
person who died of tabes dorsalis.) — Reid in Transact, of the association of the
King's and Queen's College of Physicians in Ireland, Vol. I. Dublin, 1817, (a

4.26 Of the Spinal Marrow. [Part II.

white mass resembling brain, in a boy who died of tetanus.) — Ollivier, p. 175,
(eighteenth case.) — Velpeau, (a reddish yellow tumour, of the consistence of brain,
compressing the front of the spinal cord between the sixth and third cervical ver-
tebra.— Doiiblis in Mem. de I'Acad. Roy. de Med. de Paris, Vol. I. 1828, No. 2,
(according to the description, cancer between the layers of the arachnoid in the
region of the tenth dorsal vertebra.) — Monod in Nouv. Biblioth. medic. May, 1827,
(a lobular fibrous swelling between the arachnoid and pia mater,

§244.

As FLUIDS of diiferent kinds are found collected between the
cerebral membranes, so is this not unfrequently the case with
the spinal membranes. Of course the morbid contents are
found in the bag formed by the arachnoid membrane ; although
not unfrequently also between it and the vascular membrane,
which is here but loosely connected with it, and also sometimes
between the dura mater of the spinal marrow and the
spinal canal. As to the causal proportions of such extravasa-
tions, that which has been already said in reference to the
cerebral membranes applies to those of the spine ; we are
not, however, to consider all the fluids here collected as the
product of disease of the spinal membranes, as they may de-
scend from the cavity of the skull and even from the cavities of
the brain. ^ Those preceding diseases which commonly are
situated in the spinal marrow, as tetanus, epilepsy, paraplegia,
&c., great injection of the cerebral membranes and other con-
ditions allow us to conclude sometimes with tolerable certainty
on the primary and idiopathic affections of the spinal membranes.
To the irregular contents of these membranes belong, first, col-
lections OF AiR,^ which are in some cases here observed without
any suspicion of putrescence ; next, a large or smaller quantity
of water and lymphatic fluid, a kind of dropsy of the spine,
hydrorrhachisy^ either as an acute or chronic disease ; it may
occur alone, or in connexion with dropsy of the head, and if in
high degree, usually produces palsy by pressure on the spinal
marrow ; then pus, which is here collected either in ulceration
of the spinal marrow and its membranes,* or from the cavity of
the skull,^ from carious vertebrae,^ as well also as effused from
abscesses in the neighbourhood ; ' lastly, also bloody fluid
and PURE BLOOD in a fluid or coagulated form, arising both
from injuries affecting the spine, and from internal causes."

(1) According to Magendic, v. his Journ. de Physiologic, Vol. V. No. 1 and
2, p. 27; Vol.VIL No. 1, p. 1 and (JG ; Vol. VIII. No. 2 and 3, p. 211.

(2) Ollivier, p. 269, calls it Pneuvialorachis,' and gives several instances of
it; also Briere, v. Nouv. Biblioth. Feb. and March, 1826, observed it. 1
have several times found air between tlic spinal membranes, but 1 would not
venture to declare, as the bodies were not quite fresh, that the air was the
product of an exhalation during life.

(•■;) Respecting the peculiar, or commonly only so called dropsy of the s]>inal
canal, or sj)ina bifida, see further on § 216. On dropsical collections in the

Sect. XX.] Of the Spinal Marrow. ^2^11

spine, V. Morgagni Epist. IV. 7, 21, 24, 30; V. 11; X. 13, 17; XL 13, 15;
XV. 6; XXI. 47; XXXVIII. 34; LIV. 49; LXI. 2, &c.—Pet. Frank De
curand. hom. morb. Lib. VI. — Copeland, Observations and symptoms of the
diseased spine, &c. — Itard in Diet. des. Scienc. m^dic. Art. Hydrorrhachis.
Vol. XXII. — Ollivier, p. 248, and Abercromhie, p. 358. In order to show the
collection of water, it is necessary to make a cautious opening of the spinal
canal and skull. I have found this several times in animals ; viz. in monkeys
and dogs, especially in tubercular disease ; in sheep with the gid ; I have also
found, in a stag which I kept for many years, and which at last was attacked
with palsy of the hinder limbs, a considerable quantity of water in the spinal
canal. — [I lately examined the body of a boy who had died of tetanus, and found
four drachms of water in the arachnoid. T.]

(4) In a great number of persons who were bed-ridden, I have found the
spinal membranes inflamed in the sacral region, and much pus collected
between them.

(5) I have observed this in two instances ; also in a man who had suppuration
of the cerebral membranes after injury of the head, and in another man with
cerebral abscess. A similar one to the last is mentioned by Denmark in Med.
Chir. Trans. Vol. V.

(6) So also, in destruction of the spine, originating from intervertebral
disease, as well also as from the bones themselves, pus is frequently effused into
the canal of the spine, and produces paralysis of the lower half of the body, by
pressure on the spinal cord. Similar cases are described by Brodie in Pathol,
and surgical observations on diseases of the Joints. Cap. VI. ; and Velpeau in
Archives generales de Medecine. Vol. VII. March.

(7) I have seen lumbar abscesses occasionally without caries of the lumbar
vertebrae effuse pus into the spinal canal through the intervertebral holes. —
Harrison found one psoas abscess communicating with another on the opposite
side through the vertebrae. Effusion of pus from a psoas abscess into the
vertebral canal is described by /. Jackson in New England Journ. of Med. and
Surgery, Vol. V. Boston, 1816. From a cancerous ulcer, with palsy of the
legs. — Franke in Kausch's Memorabilien der Heilkunde, Staatsarzneikunde und
Thierheilkunde, Vol. III. No. 6. From ulceration of the covering of the sacrum,
Lisfranc v. Heidelberg klinische Annalen, Vol. IV. 1828 ; Supplement, p. 143.
In horses and cattle, inflammatory tumours in the neck, and in horses, ulcers
on the withers, sometimes effuse pus into the spinal canal. Compare § 135,
note 56.

(8) Effusion of blood into the spinal canal appears by no means so rare as is
usually supposed. I have seen it, not merely in four cases in persons who, in
consequence of falling from a great height, were killed by concussion of the
brain and spinal cord, and in a boy who had been struck violently several times
upon the back with a piece of wood; but also frequently in apoplectic, or
hanged persons, in one who died of tetanus, and in children which were destroyed
in difficult delivery. We must however be careful in cases in which the blood is
fluid, and often during the opening the spinal canal, effused from the numerous
gorged veins which are wounded around the spinal marrow, not to mistake it for a
morbid phenomenon. In a boy who had suffered severe concussion of the neck,
ten months after, blood was found in the spinal canal, v. Howship, Practical Ob-
servations on Surgery, &c. case 30 ; in a boy who died of hydrophobia, lumps of
black blood found in the spinal canal, v. A. T. Thomson, Med. Chir. Trans.
Vol, XIII. p. 2, 1827. In apoplexy the blood is sometimes found effused
simultaneously in the skull and spinal canal, of which long since. Bonnet
Sepulchret. Anat. Lib. I. Sect. II. p. 84, and Morgagni, Epist. III. 2; also,
recently, Ollivier, case 32. It also occurs in the apoplexia spinalis, or medul-
laris, in the spinal column alone. — Duverney v. Duhamel in Reg. Scient. Acad,
hist. An. 1G32, Sect. V. Cap. II. p. 2Q^.—Boer]iaave Praelect. ad Institut. §501. —
BreradiwA Harles Ueber die Entziindung des Ruckenmarkes, p. 26, NUrnb. 1814.
— C7<et'a//cr in Medico- chir. Transact. Vol. 11. No. 9. — In a horse from violent
exertion, v. Journ. de Medec. continue, p. 150, Feb. 1811.

428 Of the Spinal Marrow, [Part II.

B. — OF THE SPINAL MARROW ITSELF.

§ 245.

The FORMATION OF THE SPINAL MARROW is Sometimes IM-
PERFECT in a high degree ; for aUhough its total and congenital
absence occurs only in those rare monsters of which the whole
trunk is deficient;^ yet, in acephalous monsters, it is deficient
at the upper part, in proportion to the deficiency of the neck,
breast, and belly ; and in those monsters of which the lower
part of the vertebral column is deficient, so also is there ab-
sence of that part of the spinal cord.^ The spinal marrow, more
commonly, seems to be absent, in which case, it has been
so destroyed and its development so retarded before birth by
dropsy,^ either in itself or its membranes, that there is often only
found a very imperfect rudiment of it, or merely of its coverings.
The opposite vice, or an excess of formation, occurs only in
double monsters, in which, with a double spine, their exists a
double spinal marrow, or the single spinal marrow exhibits, at
its upper or lower extremity, the trace of a corresponding
duplication, according as the duplicity is at the upper or lower
part of the body.*

(1) For instance, monsters consisting merely of a head, or one limb, though
there appears sometimes, even in these, a rudiment of the spinal marrow, as in
the cases oi Rudolph}, read before the Academy of Berlin, June, 1816; — and
J. Hayn D. monstri unicum pedem referentis descriptio anatomica, Berlin,
1824', with engravings; — even in the most shapeless monsters, which appear to
be, as it were, merely a lump of flesh, with few or no intestines, traces of a spinal
cord have been found, to wit, Blandiw Philos. Transact. 1781, Part I. p. 363, and
G. Frolik Memoires sur quelques sujets interessans d' Anatomic et de Physiolo-
gic, 4to. Amsterd. 1822. The account given by Clarke, in Philos. Transact.
1793, Part II. p. 154 — 164, that in an acephalous monster, the spinal marrow and
all the nerves were deficient, probably arose from an imperfect examination.

(2) As in the calves. No. 1009 and 1060, described by G. Sandifurt, Museum
anatomicum, Vol. III. p. 294. If in animals the tail be monstrously deficient,
the extremity of the spinal cord is also wanting. Burdach observed this in a dog.
V. Meckel's Archiv f. Pliysiol. Vol. IV. p. 80, and I have seen it in a dog, a calf,
and a fowl, without the tail bones.

(3) Compare further on.

(4) The spinal cord divides at an angle for the two heads, or the two hinder
limbs, into two equal parts, of which, however, where one head is smaller than the
other, &c., that branch of tlie cord is also smaller. Sometimes the cord is larger,
previous to the point of division, and the indication of division shows itself by a
groove in the central line. Those cases are rare in which, after having divided, the
.sj)inal cord again unites, and sometimes divides anew. v. Barkuw Monstra ani-
mal ium duplicia, etc. Vol. I. pi. 7, fig. 1, 4to. Lips. 1828 ; or in which the lower
end of the spinal cord divided into two has a third, as it were, inserted, v. BarkoWy
fig. 2; or, lastly, when in a double monster, in which both bodies are united by
tiie trunk, the caudal extremity of one spinal cord is imperfectly attached to the
other, V. Tiedemunn in his, and //. B. and L. C. Trcviranus Zeitschrift fiir Physiol.
Vol. in. Part I. pi. 3, fig. 2.

Sect. XX.] Of the Spinal Marrow, 4^

§246.

The spinal marrow deviates, in various ways, from regular
SIZE and form. In general, it corresponds to the length
and form of the spinal column, thus may it be too long, too
short, curved, &c., in proportion to the other parts of the
body; sometimes it is unnaturally thin, either throughout
or only at certain parts. This vice is sometimes original and
congenital, especially in correspondence with monsters with
deficient or distorted heads and limbs ; ^ sometimes a later,
that is, a morbid diminution, a wasting, occurs, as is commonly
the case in dorsal consumption, tabes dorsualis or myeloph-
tisis.^ In the latter case the spinal marrow appears in some
places indented, as it were knotty.^ Sometimes it is to a greater
or less extent very thin, when it is compressed by the neigh-
bouring bones,* by the thickened intervertebral substance, by
bony concretions and thickening of the membranes of the
spinal marrow, by varicose swelling of the veins in the verte-
bral canal, by aneurysm of the vertebral arteries at their exit
from their canals,^ by hydatids, and other swellings,^ and by
fluids efllised in the vertebral canal. The opposite vice, irregular
size, is also sometimes observed, in which case the spinal mar-
row is, congenitally, extremely thick at certain parts,^ or is
morbidly swollen at one part, or lastly, it still remains in new-
born children unnaturally long, as in the early stage of foetal
existence, and extends more or less further down into the
lumbar and even into the sacral region.^ The form of the
spinal marrow is principally and most frequently affected by
DROPSY OF the SPINAL MARROW, JiydrorrhacMs, hydrorrhachia,
which is also called cleft spine, spina bifida, when con-
nected with an open state of the spinal canal. ^ As the time of
the origin of this disease, its extent, complication, and degree
is different, so does also the state of the spinal marrow and its
membranes vary remarkably. Naturally it is a congenital
disease, connected with cleft of the vertebral canal, and is
often naturally complicated with hemicephaly,^" hydrencepha-
locele," and internal dropsy of the head,^^ and is for the most
part very fatal from paralysis ; ^^ in rare cases, however, it
has been seen occurring after birth and even in adults.^*
In the most severe form of the disease, the spinal marrow
is entirely wanting, and we find merely the membranes fallen
together, usually slit at one or more spots, or even more
or less degenerated and adherent to each other, forming some-
times a closed sac filled with lymph. ^^ In the subsequent stages
of this disease we observe also rudiments of the spinal marrow,
little pultaceous masses of medullary substance and blood, or

430 Of the Spinal Marrow. [Part II.

loose and separate nervous bundles, or the anterior columns
running parallel but separate from each other, or the spinal
marrow, as in the early state of the foetus, open behind, broad
and flat, &c. In the milder and more common state of the
disease there is found only on one, or very rarely on two,^^ dis-
tinct spots, a more or less large swelling containing water, some-
times flat, sometimes semilunar or necked, the sides of which
are formed by the expanded spinal membranes, often adherent
and otherwise morbid, which are protruded through the cleft in
one or more vertebrae, and commonly connected with the very
thin and extended common integuments.^^ The watery swelling
is most fi-equently observed in the lumbar region,^^ more rarely
in the sacral,^*' and dorsal, least commonly in the cervical, except
in the case of coexisting hemicephaly or hydrencephalocele, in
which the spina bifida always occurs in the neck, and from this
point protrudes more or less outwards.^^ The seat of the water
is naturally in the spinal marrow itself, which at this part is very
much expanded, broken up, and even entirely destroyed, and
usually exhibits the canal, in its axis, open and expanded up to
the brain; sometimes also the water is contained at the same
time between the membranes of the spinal marrow, or in the
most uncommon cases in them alone, whilst the spinal marrow
itself is observed healthy, or merely compressed." Sometimes
the swelling also contains hydatids. Lastly, dropsy of the
spinal marrow occurs also in rare cases without any external
swelling, and without cleft in the spinal column, so that the
canal in the axis of the spinal marrow, which in man is naturally
closed, becomes more or less widely expanded by the water,
with coexisting increased thickness of the marrow itself,^^ or
the water is poured out only in the substance of the marrow
itself,^^ and one spot of the organ becomes distinctly swollen.

(1) In acephalous monsters, the upper extremity of the spinal cord often ter-
minates, like the spinal column, very thin or pointedly'; with the fore extremities
the upper, with the hind extremities the lower enlargement of the spinal cord is
deficient, and also with deficient limb on that side the enlargement is wanting.
Serresionn^X this in a child, a calf, and a lizard, of which the fore leg was wanting;
and in two children, two cats, and a dog, without hind legs. v. his Anatomic
compar^e du Cerveau dans les quatre classes des animaux vortebres. Vol. I. p. 107,
Paris, 1824. — Tiedemaym, p. 2, saw in a human monster witliout limbs, the spinal
cord too small and thin by about half; — in a similar child. No. 2892 of my Ver-
zeichn., I found it also very thin and without the enlargements. In other mon-
sters with small limbs, it was very slender and without the enlargements; lastly,
in a calf, of which the left fore leg was wanting, and which I had kept alive two
years, the cervical enlargement was perfectly normal on the right, but totally
wanting on the left side. v. No. 2312 of my Verzeichn.

(2) The whole spinal cord is rarely atro])lnc throughout, but usually only a part
of it, viz. the lower extremity. — Compare Schelhammer D. de tabe dorsali, Jena>,
1^>91. — Practical Essay on the Tabes dorsalis, London, ITI^. — Brcndcl D. de
tabe dorsuali, Goett. 1749, and in Opusc. mcd. cur. Wrishcrg, Part II. p. 179,

Sect. XX.] Of the Sjnnal Marrow, 431

Goett. 1769. — Lewis^ Essay upon the tabes dorsalis, London, 1758. — Percy D.
on the lues venerea, gonorrhoea and tabes dorsalis, London, 1787. — de Plonquet
et resp. Williardts D. Exemplum singularis morbi paralytici, Tiibingae, 1806. —
Loewenhard D. de myelophtisi chronica vera et notha, 8vo. Berol. 1812, with
plates. — Chr. v. Weidenbach D. de tabe dorsuali, with plates, Berol. 1817. —
Schesmor D. Tabis dorsualis adumbratio pathologica, 8vo. Berol. 1819, with
plates. — Gossow D. de tabe dorsuali, 8vo. Berol. 1825. — Guil. Horn D. de tabe
dorsuali prselusio, 4to. Berol. 1827; in which, besides the cases of Horn's, the
individual cases of others are very well noted. — Koreff found the spinal cord
extremely thin in a person who died of paralysis, v. Magendie's Journ. de Phy-
siologie, Vol. IV. p. 372, Oct. 1824.

(3) This induced Gall to consider the spinal cord as a kind of ganglionic
chain, v. Weidenbach has engraved a striking example of this kind at the lower
end of the spinal cord. We not unfrequently find, without any disease, the
spinal marrow terminating in one or two knotty tubercles. In a person who
had died in consequence of onanism, the spinal marrow was very much wasted,
and the nervous threads seemed as if unravelled ; the nervous matter in the
nerves of the cauda equina was also at the same time wasted, v. Rust's Magazin
f. d. ges. Heilk. Vol. XXII. Part III. p. 476, with plates.

(4) For instance, if the spine be very much ciu'ved, has exostoses, some of
the vertebrae dislocated, and is swollen or carious, as in spondylarthrocacy, &c.
compare § 135, note 43 and 51. — Further, Dubrevil in Ollivier, p. 192, and C. H.
Parry, (in both cases the origin of the spinal cord was compressed by displace-
ment of the first vertebra.) — Abercrombie, p. 383, relates several similar cases.

(5) Howship, Practical Observations in Surgery and Morbid Anatomv, Lond.
1815, p. 59.

(6) A tumour, originating from the cerebellum, descended into the vertebral
canal behind the spinal cord, to the origin of the sixth cervical nerve, v. Latham
in London Med. and Phys. Journal, new series, Vol. I. July, 1826.

(7) If the neck be very short, the upper enlargement of the spinal cord is
lost in the brachial nerves, and the whole cervical portion is then, as in short-
necked beasts, extremely thick. — Serres once saw in a monster without legs, but
with very powerful arms, the cervical portion of the cord remarkably large.

(8) This is particularly frequent in the case of spina bifida, as I have several
times noticed ; and as many others have also found it, viz. Apinus v. Hochstetter
D. de spina bifida, Altdorf, 1703. — Trew in Commerc. Lit. Norimb. 1741. —
Morgagni, Epist. XII. 16. — Hoin in Mem. de I'Academ. de Dijon, Vol. II.
p. 106. — Hutchinson, in New London med. Journ. 1792, Vol. I. p. 338. —
Graslmys v. Neue Sammlung fiir Wundarzte, Part X. p. 180 — J.F.Meckel
Handb. d. Pathol. Anat. Voh I. p. 354. — Bc'clard in Ollivier, p. 111. — Also,
without cleft spine, viz. in two children without feet, but with tails, it went to
the tail-bones ; and in two cats and a dog without hind legs, but with extremely
long and large tails, the spinal cord was much larger in the lumbar and sacral
region than usual, v. Serres.

(9) Also hydrorrhachitis according to Sauvages Nosolog. meth. 4to. Vol. II.
p. 497. — On the state of the spinal column in this disease, compare § 135, and
also its note 25, in which are quoted several papers on spina bifida. — On the
seat of the water, and the state of the spinal cord, compare Morgagni, Epist. XII.
and Pet. Frank De curand. horn. morb. L. VI. Part I. p. 198, (he divides it into
hydrorrhachia incolumis, and dehiscens, and the latter again into generalis and
partialis, viz. cervicalis, dorsalis, &c.) — Bodin D. sur le spina bifida. Paris, Ann.
IX. p.8. — Terris Considerations g^nerales et observations particuli^res sur le spina
bifida in Journ. gen. de Medec. 1806, Vol. XXVII. p. 162. — Instances of sisters
having spina bifida are mentioned by Orth D. de quibusdam tumoribus tunicatis
ext. in Haller's Coll. Diss. med. chir. Vol. V. p. 412. — Burgius in Ephem. Acad.
Nat. Cur. Dec. II. Ann. VI. Obs. 58. — Henkel Neue med. u. chir. Anmerk.
Part IV. p. 54 ; and Michaelis in Richter's Chir. Biblioth. Vol. XVII. p. 133. —
Of the very numerous cases, the most perfect are in Moeckel De hydror-
rhachitide Commentatio. Lips. 1822. I mention only some of the most remark-
able and novel, viz. Ruysch Obs. anat. chir. Obs. 34 — 36 ; and Thesaur. anat.

iS2 Of the Spinal Marrow, [Part IL

VIII. Part I. No. 2.— Littre in Mem. de I'Acad. desScienc. VOL— Bidloo Exercit.
anat chir. Dec. II. No. 7, with.plates, p. 187, pi. 1 and 2. — Mery, in M6m. de
I'Acad. des Sc. 1712. Obs. anat. 6. — Trew. — Acrel in Svenska Vetensk. Acad.
Handlingar, p. 287, 1748. — Morgag>ii,Ei^ist. XII. 16. — Camper Diss, de hydrope in
Diss. X. Vol. II. ; and Auserl. Abhandl. f. prakt. Aerzte, Vol. XVI. p. 446.— -BoA-
mer Obs. anat. rar. Fasc. II. Praef. p. viii. — Portal in Mem. de I'Acad. des Sc, p. 238,
1770 ; and Cours d'Anat. medic. Vol. II. p. 304. — Sandifort in Obs. anat pathol.
L. III. cap. 1. p. 10; in Obs. anat pr., in Exercit acad. L. II. ; and in Museum
anat. with good engravings, tab. 124:.— Hutchi?ison. — Sieholdin Chir. Tageb. Niirnb.
1792. XXXIX. p. 84, etc. Recent cases in Callisen Systema chir. hodiern.
Vol. II. p. 46, Havn. ISOO.— Oberieitffer in Stark's Neuem Archiv f. d. Geburtsh.
Vol. II. Part IV. p. 624.-^^0// v. Posewitz Journ. f. d. Med. u. Chir. Part I.
Giess. 1802. — B.Bell, in System of Surgery, Vol. V. — Abernethy, Surg, and phy-
siol. Essays, Part I. p. 75. — Okes, An account of spina bifida, with remarks on
the method of treatment proposed by Abernethy, Cambridge, 1810. — Sherwood
in Medic. Repository of original Essays, Vol. I. 1812-13. — Meckel Handb. d.
pathol. Anatomie, Vol. I. p. 355 and 357.—Racchetti. — A. Cooper, in Med. chir.
Transact. Vol. II. p. 324. — Lohenwe'm De monstrosa genitalium deformitate et
spina bifida commentatio in Mem. de I'Academ. imp. des Sc. de Petersb. 1817,
Vol. VI. — Pliny-Hayes, in New England Journal of Medicine and Surgery,
Boston, July, 1817, (in the sacral region.) — Palletta Exercit pathol. Cap. 10. Art.
3, Mediol. 1820. — A'e«ewc?or/ D. de spinas bifidae curatione radicali. Berol. 1820,
with observations by Berndt. — Faced Berlinghieri Storia di una idrorachia. Pavia,
1820.—^. F. A. Foerster D. de spina bifida, 8vo. Berol. 1^20.— Bened. Trompei
V. Omodei's Annali universali di Medicina. Vol. XV. Luglio, 1820; and Locock,
in Edinb. med. and surg. Journ. Vol. XVII. p. 251, (the child lived to six years,
and was punctured several times.) — Brewerton, ib. Vol. XVIII. p. 378, July, 1821,
(a double spina bifida.) — Jukes, in London med. and phys. Journal, p. 106, Feb.
1822, (a very large tumour in a girl of nineteen). — Gittermann in Harles's
Rhein. Jahrbiichern, Vol. V. Part I. p. 4. — Jos. Frank Prax. med. univ. prajcept
Vol. I. Part II. Sect. II. cap. 4. § 16.—Nyblaeus in Abhandl. d. K. Schwedischen
Akademie, 1822, Part II. p. 343. — Carus zur Lehre von Schwangerschaft u.
Geburt Part I. p. 227, 8vo. Leipz. 1822. — Dugh in Revue medicale fran9aise et
etrangere. Paris, April, 1823, p. 370. — Breschet v. Hasper in Hufehmd's Journ.
April, 1823, p. 59. — Urquhart in American medical Recorder, July, 1823. v.
Gerson and Julius Magazin der ausl. Lit Jan. and Feb. 1824, p. 131, (the large
tumour burst, and death ensued,) — Baron in London medical Repository, Vol.
XXI. No. 128, Aug. 1824, (the cyst was several times punctured, but filled
again.) — Lindsay in London medical Repository, January, 1826, (the tumour was
often burst, although the child was thirteen years old.) — Heusinger Berichte von
der anthropotomischen Anstalt zu Wiirzb. 1st Treatise, 1826, p. 50. — Faber
Duor. monstror. humanor. descriptio anatomica. 4to. Berol. 1827, with two en-
gravings.— Potthoff D. s, descriptionem casus rariss. spinam bifidam totalem et
columnam vertebralem antrorsum insigniter curvatam exhibentis. Berol. 1827,
with three engravings. — London medic. Gazette, December, 1827, (cured by punc-
ture.)— E. A. W. Himly Darstellung des Dualismus am normalen und abnormen
menschlichen Korper. p. 191, Hannov. 1829, (as big as a child's head on the
sacrum). I have had three-and-thirty opportunities of examining spina bifida.
v. my Selt Beob. Part I. p. GQ, No. 2313 of my Verzeichn., (in the lumbar region,
cured); No. 2314, (in the lumbar region of a calf); No. 2955, (on the whole
spine of a sheep) ; No. 3314 and 3315, (in the lumbar and sacral regions) ; No.
3316, (sacral region) ; No. 3317 and 3318, (in the lumbar region in two calves);
No. 3319, (on the extremity of the sacrum in a calf) ; No. 8011, (on the rump);
No. 8869, (in the lumbar region) ; of Bresl. Mus. The other cases were con-
nected witli the vices of the brain.

(10) It is well known that half the hemicephalic monsters, both human and
animal, have also s})ina bifida. In the Breslau Collection, such is the case with
twenty-one sucli monsters, viz. No. 2868—2875, 2881—2883, 2967, 2996, 3802,
3003, 3041, 8016, 8017, 8024, 8063, and 8833.

(11) \ iz. Bidlou, in the first case. — Peinida, in Saggio d'osservazioni c nicmorie,

Sect. XX.] Of the Spinal Marrow, ASo

etc. Padova, 1793, T. I. Obs. 1. — van dcr Laar Observ. chirurg. obstetr. anat.
med. L. 15. 1794, No. 3. — Geoffroij Philosophic Anatomique, Vol. I. Paris, 1822.
— Seerig D. de hydrencephaloceles specimine eximio. 4to. Vratisl. 1822, with
engravings, (is No. 2929 of Bresl. Mus.) — Burkart, D. de monstro humane
notabili. 8vo. Friburg, 1825. — Menje^ in Archiv. gener. de Med. July, 1827. —
Potthoff.

(12) Boneti Sepulchret. anat. L. I. Sect. XVI. addend. Obs. 4. — Mayer in
Ephem. N. C. Cent. 1. Obs. 127. — Brunner, ib. Dec. III. Ann. I. Obs. 152 and
1 1. — Murraij, Foetus hydrocephalo interno correpti descriptio. Upsal, 1797. —
Stall Ratio Medendi, Part VII. p. 217. — Morgagni Epist. XI I. 9. — Grewe, v.
Samml. auserles. Abhandl. f. prakt. Aerzte, Vol. VIII. p. 584. — Fielitz m Richtei-' s
Chir. Biblioth. Vol. IX. p. 155. — Portal, Baron, Pliny-Hayes, and Vacch Berliri-
gh'ieri. This connexion is so common, that Acrel has improperly imagined it to be
continual.

(13) There are, however, many instances given of such children living several
years, and even reaching puberty, viz. one of the cases mentioned by Acrel and
Palletta was seventeen years — eighteen, Henderson' s — nineteen, Jukes's — twenty,
in one of Apinus, Hochstetter, Sic. ; Warner's Observations in Surgery, p. 136.
London, 1784, — twenty-eight years witii spontaneous separation by gangrene, in
a case of Camper's — even fifty years, v. Schwagermann, Ontleedheelkund. Verhan-
del. Amst. 1767.

(14) Pet. Frank. Delect. Op. Med. Vol. II. p. 92. Lipsi;e, 1791, (in a man
forty-five years old.) — Reydellet, in Diet, des Sc. Med. Vol. XXXIII. p. 564, (in
an adult from hydatids.)

(15) I have seen this in several hemicephalic monsters — a similar state of the
spinal cord occurs, however, without cleft of the spinal column, v. Mery in Mem.
de I'Acad. des Sc. 1704. p. 29. — Morgagni Epist. anat. XX. p. 5Q. — Anselin in
Journ. de Medec. Vol. XXXV. p. 336. — Saxtorph Gesammelte Schriften u. s. w.
Vol. I. p. 477. 4to. Kopenh. 1803. — G. Lieber D. Monstri molae specimen prae
se ferentis descriptio anatom. 4to. Berol. 1821, with plates, (the brain and spinal
cord were entirely wanting, and there was merely a membranous bag in place of
bone, the lymph contained in which, had either become absoi'bed by remaining in
spirits of wine, or had flowed out during the examination.)

(16) P.Frank De cur. horn. morb. L. VI. Part I. p. 215. — Brcwerton in
Edinb. med. andsurg. Journ. Vol. XVII. p. 378, (two cysts in the lumbar region
lying close to each other, and opening by two apertures into the spinal canal.)

(17) The size of the cleft in the spine varies very considerably; generally
several of the vertebrae are open, more rarely but one, or there is found only a
small round hole in one bone, by which the tumour is connected with the spinal
canal, v. Ruysch, Observat. anat. Chir. Obs. XXXVI. and Acrel. Those cases
are also equally rare, in which, with the bones healthy, the tumour projects be-
tween the vertebrae, v. Mohrenheim and Portal.

(18) In many cases the tumour falls together, as it were cicatrizes, the
skin thickens, inflames, adheres, is discoloured by coagulated blood, &c. — In
other cases it is tense, and varies from the size of a nut to that of a child's head,
or thereabouts, and expands to bursting or mortification.

(19) This arises from the circumstance, that at the period of the usual origin
of this disease, the spinal canal at this part is constantly widened ; and that
in the later origin and situation of the water within the cavity of the arachnoid,
the lower end of the sheath comprises the dura mater.

(20) Although by no means so rare as lltiysch and Morgagni, Epist. XII. 9,
have supposed. Sometimes the tumour includes the lower end of the spinal
canal, which is often deficient at this part. — I have seen this twice, in calves with-
out tails. — van Doeveren also observed it in a calf. v. Specimen Observ. acad. 4to.
L. B. 1765, pi. 4, fig. 2.— Frol/k also saw it in a child, with other malformations.
V. Memoires sur quelques sujets interessans d' Anatomic et de Physiol. Amsterd.
1822, p. 76 and 77, with plates.

(21) The dropsy of the cervical portion of the spinal marrow is then only a pro-
cess from that of the brain, and the degenerated brain is immediately connected
with the destroyed or diseased origin of the spinal marrow, which is sometimes

F F

431 Of the Spinal Marrow. [Part II.

perfectly normal below. In this simultaneous destruction of the cervical portion
of the spinal marrow, whence the nerves of tlie neck arise, lies, according- to my
opinion, the cause of the frequent want, or the extreme shortness of the neck in
hi-micephalic monsters. This is confirmed by tlie fact, that in those hemi-
ccphalics, in which merely the brain, or only the cerebrum, is diseased or
destroyed, the neck is always proportionally long.

(22) Such observations are described by Zwhigcr in Ephem. Acad. N. C.
Cent. VII. Obs. 29. — Lhick in Act. Nat. Cur. Vol. I. Obs. 74. — Huermann
Vermischte Bemerkungen u. Untersuchungen a. d. ausiibend. Arzneiwiss. Vol. I.
p. 304. — Acrel, Palletta, J^acca- Bcrlivghieri and Urquhart.

(23) For instance, Morgagni Adv. anat. VI. Obs. 14, p. 18 ; and Saniorini, ib.,
(as large in an adult as to admit the point of the little finger.) — Portal in M<5m.
de I'Acad. de Sc. 1722, p. 481, (in an adult); and Cours d'Anat. M^d. Vol. IV.
p. G(), (in a new-born child); and p. 118, (in an adult.) — Not merely in
hemicephaly and hydrencephalocele have I found the upper part of the spinal
cord very broad, hollow, and containing water ; hut also in hydrocephalic chil-
dren ; and in two calves with very large dropsical heads, the canal of the spinal
cord was much expanded with water throughout its whole length. — GaWs
observation of two lateral canals in the spinal cord, seems to me not to be
entirely relied on. v. Anat. et physiol. du Systenie ncrveux, p. 51.

(24) P. Frank De cur. hom. morbis. L. VI. Part I. p. 202, observed it twice.
And I once found, in a dropsical person, portions of the spinal marrow swollen,
and cedematous, some inches in length.

§ ^47.

A vicious POSITION of the spinal marrow arises, in rare cases,
from the ah'eacly mentioned hydrorrhachis, so tliat tlie spinal
marrow expanded by the water itself, or compressed by the
collection of water between the membranes, is more or less
protruded through the cleft in the spine, and thus a kind of
RUPTURE OF THE SPINAL MARROW, lievMa medullm spinalis, is
produced.^ Those cases are more rare in wdiich the spinal
marrow deviates a little from its natural position in conse-
quence of morbid destruction of its bony walls. ^ As to colour,
the spinal marrow varies sometimes in a similar manner as the
brain, and in vices of texture it seldom exhibits the natural
colour ; we find it also, but rarely, however, discoloured with-
out change of structure, for instance, yellow in jaundice.^
More frequently is the consistence of the spinal marrow
irregular, inasmuch as it becomes softened, pulpy, even
entirely broken up and mingled with blood,^* generally, or more
commonly only in spots, in consequence of diseases which
destroy its coherence, especially dropsy, suppuration, inflamma-
tion.* Or on the contrary, it becomes too firm and hard ; the
latter we observe in a less degree, and with diminution of the
circumference, in dorsal consumption, with thickening also in
chronic inflammation of the organ. ^ In consequence of the
protected situation of the spinal marrow, diminution of consist-
ence does not give rise to vices of continuity, but these
originate cither in penetrating, cut, and thrust, and especially
in gunshot wounds, or without such wounds in fracture and

Sect. XX.] Of the Spinal Marrow, 435

dislocation of the vertebrae/' as well as also from mere extension
and concussion.' In such cases the marrow sometimes pro-
trudes largely through the opening in the ^;2tt mater. Small
wounds of the spinal marrow may in rare cases even heal.^

(1) For instance, Tulpius in Observ. med. L. III. cap. 29 and 30. — Apinns
in Ephem. Acad. Nat. Cur. Dec. III. Ann. IX. Obs. 180; and Hochstetter. —
Hoin in Memoires de I'Acad. de Dijon, Vol.11. — Sandifort. — Mohrenheim
Beobachtungen verschied. chir. Vorfalle, Vol.1, p. 172. — Palletta. — Moeckel,
fig. 3. — Cams Zur Lehre von Schwangerschaft und Geburt. Part I. p. 227. — 1
have found this dislocation in three instances. — More commonly protrusion of
the spinal nerves is seen, which project far out of the spinal canal, and are lost
on the walls of the tumour. — A few instances also have been found, in which,
through a cleft in the bodies of the vertebrse, a part of the oesophagus had
slipped into the vertebral canal, and displaced the spinal cord. v. Lallemand
Observations pathologiques, p. 29, Paris, 1818, with plates ; and Geoffroy Saitii-
Hilaire in Annales des Sciences naturelles, Vol. XIII. p. 246, March, 1828.

(2) Ferro De carie vertebrarum et medulla spinali libere in abdomine fluc-
tuante historia in Nov. Act. Acad. Nat. Cur. Vol. VIII. p. 123. — Lecat Traits du
mouvement musculaire. Vol. XXII. tab. 3. Bei'l. 1765. — Phillips in New London
medic. Journal, Vol. I. Part II. p. 2. 1792; compare Richfer's Chirurg. Biblioth.
Vol. XV. p. 77.

(3) Lohstein on Kirrhonose in Compte rendu sur les travaux anatomiques,
p. 53, and in Repert. general d'Anat. et de Physiol, etc. Vol. I. No. I. p. 143.
pi. 4. Paris, 1826. Compare above § 39, note 2.

(3*) [Effusion of blood into the centre of the spinal cord opposite the last
dorsal nerves, after violent exertion, death in thirty-seven days. v. Nouv. Bibl.
Med. Nov. 1829. T.]

(4) Ephem. Acad. Nat. Cur. Dec. II. Ann. VI. Obs. 58. — Morgagni, Epist.
LXX. 5, (very soft in a person who died of scirrhus pylori.) — J. P. Frank De
curand. hom. morb. L. II. p. 49, (as suppuration.) — Gautierde Clauhry in Journ.
gen. de Med. par SMillot. Vol. XXXII. June, p. 129. — Portal Cours d'Anat. med.
Vol. IV. p. 116, (in the right half.) — Horn in his Archiv f. medic. Erfahrung.
1815. Part V. p. 838, (pultaceous in a person who died of tabes dorsualis.) —
Esquirol in Leroux Journ. de Medec. 1817, Vol. XXXIX. p. 424, (in many
epileptic persons, especially the lower extremity.) — Dublin Transact, of the
Association of Physicians, Vol. I. p. 1, (two cases which died of tetanus.) —
Georget De la Folic, p. 492. Paris, 1820. — Rostan Recherches sur une maladie
encore peu connue, qui a refu le nom de ramollissement du Cerveau. Paris,
1820, (six examples.) — Pinel in Magendie's Journal de Physiol. Vol. I. No. 1,
p. 54, (in two insane persons, the greater part dissolved.) — RulUer, ib. Vol. III.
No. 2, p. 173. — Harrison in London med. and phys. Journ. Vol. XLIX. May,
1823, (two psoas abscesses communicated with the vertebral canal.) — Ollivier,
cases 43 — 46, 48 and 50. — Sevres in Magendie's Journ. de Physiologic, Vol. V.
No. 3, p. 254; and in Archives generales de Medec. August, 1825, (the anterior
columns of the spinal cord in a paraplegic patient.) — Hertzherg'm Rust's Magazin
f. d. ges. Heilk. Vol. XX. Part I L p. 376, (the lower half.)— AJilherg and
A.Retzius in Ars-Berattelse om Svenska Lakare-Sallskapets Arbeten, lemnad af
Ekstrom, 1825, (in a man who had paralysis without loss of sensation in the feet,
the anterior columns were softened in their lower third.) — Royer Collard, v.
Magendie's Journal de Physiologic, Vol. III. No, 2, p 157, April, 1823, (the
anterior columns of the spinal marrow of a man whose legs had been motionless
and bent up seven years, but in which there was still sensation.) — Louis
Memoires ou Recherches anat. pathol. Paris, 1826, p. 410, (several cases with
caries of the spine.) — Jeffreys in London medical and physical Journal, July,
1826, (three cases of softening after fracture of the vertebrae.) — Fnchs, commu-
nicated hy Locher Balber, in Hecker's Liter. Annalen d. ges. Heilk. Oct. 1826,
p. 244, (pultaceous in two children who died of hydrophobia.) — Vcrivg'in Rust's
Magazin, Vol. XXII. Part II. p. 562, (some time after the injury.) — Thorn.
Malison in Transact, of the med. chir. Soc. of Edinburgh, Vol, HI. Part I. p. 173,

FF S

436 Of the Spiml Marroiv, [Part 1 1 .

(in <i man with aneurysma aortae.) — Gendr'm Histoire Anatomique^les Inflamma-
tions, case IJO. — J'enahhs Dissect. II. p. 9t), quoted hy v. Stosch Versuch einer
Patliologie u. Therapie dcs Diabetes mellitus. 8vo. Berl. 1828, p. 104-, (in a diabetic
person, softened and hardened here and there.) — Xouvelle Biblioth. Aug. 1823,
(with caries and tubercles in the vertebrae.) — Abercrojnbie, case 126 — 129, p. 341
and 316. — I have several times observed softening of the spinal marrow to a high
degree, especially accompanying caries of the spine, although twice also without
it ; the first case was a person atlected with scurvy, who had been very much
chilled in bathing, and became ])araplegic ; the other was a man of whom I could
learn notbing more than that he liad become paraplegic. [I/art in Dublin Hosp.
Rep. Vol. V. p. 522; an abscess in the centre of the spinal marrow of a child
extending throughout the whole dorsal portion. T.] This disease also occurs
in animals, viz. in epizoetics, in the dorsal disease of horses, in tubercular
disease, and from unknown cause, with pai'alysis of the legs. Sugar thus found
it in a disease among sheep, v. Auserles. Beitrage zur Thierarzneik. Vol. I.
p. 49 ; in horses, v. Diipuy in Journ. gen. de M^dec. 1820 ; and in a rabid cow,
Jan. 1821, Vol. LXXV. p. 82. — Compare also Lnllemci7Hl Recherches Anatom.
pathol. sur rEnce])hale et ses Dependances, (extremely distinct in the enlarge-
ments of the spinal marrow, especially in the lower, in horses.) — Greve Erfahr-
ungen und Beobachtungen Uber die Krankhcit. der Hausthiere, Vol.11, p. (3,
(in a horse, to the length of four ells, and as thin as milk.) — Barlhelemy, v.
Arcliives g^n. de Medec. Aug, 1823, (in a rabid horse.) — Bouiey in Recueil de
Medec. veteran. Vol. I. p. 28, (the anterior column of the spinal marrow in a
horse, with palsy of the hind leg.)

(5) The ancients called this in part scirrhus. — Portal, (the cervical portion of
the cord as hard as cartilage.) — Lond. IMed. Obs. and Inq. Vol. III. (in the
Count de Lordat, the cervical portion swollen and hardened.) — Clot Re-
cherches et Observations sur le Spinitis. Montpell. 1820, (the cervical portion
swollen and of cartilaginous firmness.) — Bergamaschi Sulla Mielitide stenica,
&c. Pavia, 1820, (second, fourth, and eighth cases.) — P^elpeau in Revue Medic,
franp. et etrang. Vol. II. p. 247, (the lumbar enlargement like cartilage.) —
In epileptic and insane persons, the spinal cord has been found several times
too hard. \. Esqulrol and Pinel. — Ollivier, p. 304. — Gendr'in, Vol.11, p. 137,
case 150, (hardened and softened in spots.)

(6) On injuries of the s])inal cord and its membranes, I refer to the writers
on surgery and forensic medicine, also to Ollivier and Jbercrombie ; /Iitteurielh
D. Observ. de la-sione medulla? spinalis. Tubinga3,1811.— Pa/.x'//« Exercitationes
pathologicae, p. 231, and Casper Ueber die Verlezzungen des Ruckenmarks und
ihr Lethalitatsverhaltniss in Jiiisf's IMagazin, Vol. XIV. Part III. und besonders
abgedruckt. Berlin, 1823. I have myself seen the s])ina] marrow smashed, iu
three cases, in which workmen had fallen from great heights, and the vertebric of
the neck were broken, and, in one instance, half torn through by a bullet. In the
account of the morbid examinations kej-t at the Breslau Medical College, I have
also found three cases of injury of the spinal marrow, in one of which, a b'.dlct,
})assing through the dorsal jjortion of the s})ine, had torn the spinal cord through ;
in the second, a bullet had torn through one verte1)ral artery, and the whole of
the spinal marrow in the first vertebra; and in the third case, the bullet had so
torn the cord in the lower part of the back, that only one little nervous band
connected the upper and lower portions : in all these cases death ensued either
innnediatcly, or very soon after, but in the latter, the man lived half a year.
Sometimes, iVom a fall or from a blow, 8cc. we find the s])inal cord torn through,
either with or without rupture of the iainil)ranes, v. E. Jlome, Philos. Trans.
1814. — //. Cline, in the case in which he liist removed by operation a j)art of
the broken vertebra. — JIaytvard, in New England Journ. of Medicine and
Surgery, Boston, Jan. 1815, Vol. IV. No. 1, (in the dorsal region, the man
died on the nineteenth day.) — Ruxt, in Magaz. d. ges. Heiik. \ ol. XIII.
Part III. p. 551, (cut through, as it were, by the fracture of several vertebnL».)
— Swan, (ibserv. on the Anatomy, Physioloj.'y, and Pathology of the Nervous
System, (!hap. 8, London, 1822, (fracture of the second dorsal vertebra, with
division of the spinal marrow, fatal on the tburteenth day.) — Jrallacc in Uubliu

Sect. XX.] Of the Spinal Marrow. 43*7

Transactions of the Association of Physicians, Vol. V. 1828, (from a fall out
of window, fracture of the third and fourth dorsal vertebra?, and the extremities
of the spinal marrow, half an inch apart; died on the ninth day.)

(7) It is thought that in partus Agri|)pinus, if the feet are violently pulled,
death often ensues by rupture of the spinal marrow, which is probable, as mid-
wives and bunglers have pulled otF even the head. One person, who behaved
horribly by seizing hold of the neck, tore througji the medulla oblongata without
injuring the bones, v. G. Bonsdorf rosp. IVc^elii/s De anatomicam Veneficii
arsenico peracti investigationem sistens. 4to. Abo, 1817. — By a iall on the head
the spinal marrow was torn from the skull, v. vo?i IValther in his and v. Griife's
Journ. f. Chirurg. Vol.111. Part II. p. 199. — The spinal marrow was torn
through in a child which was run over, although it lived thirteen months after, and
died of the croup, v. C. Bell, Observations on Injuries of the spine, &c. 4to.
London, 1824.

(8) The experiments on animals by Arnemann. v. Versuche uber das Gehirn
und R. M. p. 195, von Frevost, Larrey and Fluuretis. v. Heusbiger's Zeitschrift
fUr die organische Physik. Vol. II. Fart III. gives instances of cicatrization of
wounds of the spinal marrow ; perhaps here also belong the cases of the human
subject mentioned by Morgagni, Epist. LI II. 23, and Buyer Traite des Maladies
ehirurgicales, Vol. VII. p. 9.

§ 248.
Vices of texture of the spinal marrow are generally
similar to those of the brain. In most instances, inflamma-
tion OF the spinal marrow, myelitis,^ which occurs partly
as consequence of injuries and diseases of the vertebrae and their
ligaments, partly as an idiopathic disease, in greater or less
connexion with its membranes, gives rise to them. The seem-
ing apoplectic effusion of blood in the tissue of the spinal
marrow itself, frequently arising from congestion of blood, and
from morbid irritation, must be distinguished from this active
inflammation of the spinal marrow.^ The diseases in v/hich
the spinal marrow exhibits, especially, the traces of existing
irritation and inflammation are, many fevers^ and eruptive
diseases,* hydrophobia,^ painter's colic,'^ epilepsy,^ trismus,^
tetanus,^ St. Vitus's dance,^" &c. The spinal marrow in
such cases often exhibits a rosy-red colour with some dusky
spots and streaks, enlargement of the minute vessels, injection
of its membranes, oftentimes distinct swelling, and always more
or less variation from its usual consistence, namely, hardening
or more commonly softening, or complete dissolution into a
discoloured fluid frequently mingled with blood. More rarely
does the inflammation of the spinal jnarrow appear to run into
true suppuration ;" small abscesses even have been found in
it.^^ Still more unfrequently does gangrenous destruction
occur on the spinal marrow ; never indeed primarily, but only
in defined spots : the deposition of lime on it does not seem
ever to take place. Spurious formations in the spinal
marrow are very uncommon, viz. tumours, tubercles, and
sarcoms.*^ In a few instances, only, have extraneous bodies
been observed to remain for some time in this organ. ^*

438 Of the Spinal Marrow. [Part IL

(1) Called also Rhachialgia, Rhachialgitis, Spin'itis, NotaeomyeUtis, &c. ; and
perhaps most significantly Rhachiomyelitis. v. Galenus Delocis affect. Cap. VI. —
/4Uen Synopsis univ. Med. Part I. p. 165. — J. P. Frank Oratio de vertebralis
columnoB in morbis dignitate. Paviae, 1791, and De curand. horn, morbis.
L. II. § 141, ff. p. 48. — Haefner D, de inflammatione medullae spinalis. Marburg,
1799. — Bergamaschi Osserv. suUa inflammazione della spinale midoUa, &c. 4to.
Pavia, 1810. — Brera Delia Rachialgite cenni patologici in Atti dell' Acadeniia
Italiana di Scienze, Lit e Art., Vol. I. Parti, p. 246, Livorno, 1810; and
Brcra and Harles, Ueber die Entziindung des R. M., from the 2d Vol. of
Maries's Jahrb. de Med. und Chir. abgedruckt. Niirnb. 1814.— A'^zW Sur le Spinitis
in Corvisart's Journ. de Medec. 1812. — Spangetiberg in Horn's Archiv f. med.
Erfahrung. 1813, p. 4. — Macari in Annales de la Soc. de Medec. de Montpellier,
Vol. XX. p. 5. — Rotiander in S%cnska Lakare-Sallskapets Handlingar. Vol. VI.
p. 224, (a case of inflammation of the brain and spinal cord in a man.) — Funk
Die Riickenmarksentziindung, inaugural Treatise, 2d edit. 8vo. Bamberg, 1819,
with additions. Bamberg, 1825. — Klohs D. de myelitide, Hakne, 1820. — Clot Re-
cherches et Observations sur le Spinitis, Montpellier, 1820. — Pinel in Masendie's
Journal de Physiologie, Vol. I. No. I. p. 54. — Nyblcius in Abhandl. der K. Schwed.
Akademie, Jahrg. 1822, Part II. t^. Si3.~Son?ienkalb in der Dresdner Zeitschrift
fur Natur-und Heilkunde, 1823, Vol. III. Part I. p. 65— 110.— Z. fFo// Beobach-
tung einer chronischen Entziindung des R. M. mit ungewbhnlichem Ausgange,
nebst Bemerkungen dariiber. Hamburg, 1824. — Friederich D. de myelitide. 8vo.
Berol. 1825. — Graf De Myelitidis Nosographia. 4to, Regiom, 1823, (with two
cases of his own.) — Machiewitz Observationes de rachialgitide, pneumoniam et
praesertim pleuritidem dorsalem mentiente in Comment. Soc. phys. med. Mos-
quens, Vol. III. Part II. p. 158, Mosquoe, 1825, (three cases.) — A case of in-
flammation of the spinal marrow, with enlargement and softening from rupture
of four nerves of the brachial plexus, is described by Flaubert in Repert. gen.
d'Anat. et de Physiol, pathologiques, Vol. III. Part 1. p. 102, ff"., 1827. — Gassaud
in Journal univ. des Scienc. medic. April, 1828. — Compare also Reydellet in
Diction, des Scienc. medical. Vol. XXXIII. p. 538, Rachetti, Ollivier and
Abercromhie-

(2)1 have twice seen tliis in the cervial region of old persons : in one case the
blood was in little spots in the spinal marrow ; in the other, in a spot where the
marrow was softened and torn, a lump of blood was formed almost as big as a
pea ; in both cases there was also effusion of blood between the membranes, and
the vertebral veins very much expanded. — Home, in Phil. Trans. 1814, found blood
effused within the spinal marrow from external injury. — Ollivier, p. 241. — Jones
saw great injection of the surface of the spinal marrow with diminished sensation.
V. Edinb. med. and surg, Journ. Vol. XXI, p. 81 and 83.

(3) Chaussier, Girard (in oxen and sheep.) Ollivier, p. 375, in the latter. I
myself have seen, in a few cases of typhus, tlie pia mater and adjacent spinal cord
strongly injected ; similar cases are also described by Brera and Rachetti.

(4) I have seen this very distinctly in a person aged twenty-two years, who died
of malignant small-pox.

(5) Matthey in Journ. gen. de Med. Vol. XLIV. p. 279. — Johnson in London
med. chir. Journal and Review, October, 1827. — Clot. — Trolliet Nouv. Traitc de
rage, etc. v. Ollivier, p. 373. — Meniere in Archiv. gdnC'ral. de M^dec. Decemb.
1828. — In oxen and horses, Dupuy and Barthelemy.

(6) Astruc and Sauvages were previously of this opinion, which has been con-
firincd by recent observations, v. B. Palais Trait6 pratique sur la coli(iuc metal-
]i(pK', etc. Paris, 1825, and Renauidin in Journ. Compl. du Diet, des Scienc.
Med. Vol. XXII. p. 247.

(7) Tlie older writers, for instance, Fr. ILijfmanu, had already derived convulsions
from diseases of the spinal marrow, and Harks mentions an epilepsia s])inalis. —
Purhelt also Die individuelle constitution inul ilir l^influss auf die Entstchung
unddcncharakter der Krankheiton, Leij)/. lS23,an epilepsy of the spinal m.'U-row. —
Esr/tiirol, V, Leroux Journ, do Medec. 1817, \'ol. XXXIX. p. 424, frequently found
the spinal marrow in a state of irritation iti epileptic persons. Swan also found
the spinal membranes inflamed in a child who died of convulsions, and adherent

Sect. XX.] Of the Nerves. 439

in a case of epilepsy, v. Observations on some points relating to the anatomy,
physiology, and pathology of the nervous System, London, 1822, Chap. 7.

(8) .7. Thomson found in all the negro children who died of trismus, in Jamaica,
the spinal cord and its membranes inflamed, v. Edinb. med. and surg. Journ.
No. LVII. 1818, Nov. — d'Ouirepo at also found the same in five children, v. Ab-
handl. und Beitrage Geburtshulfl. Jnhalts, Part T. p. 242. Wilrzburg, 1822.

(9) It is well known that heretofore Galen, Willis, Fr. Hoffmann, Burserius, and
subsequently Marcus and many others, derived tetanus from affections of the spinal
marrow ; and indeed, at other times inflammation of the spinal marrow and teta-
nus have been considered identical. Tetanus has been seen to arise after violent
concussion of the spinal cord, v. Stoll Ratio Medendi, Vol. I. p. 298, and .7. P.
Frank, p. 276. Traces of violent irritation and inflammation were found in tetanus
hy Brera Prospetto di risultamenti ottenuti nella clinica medicadell' Universita di
Padova nell' Anno 1816 e 1817. — lieid in Dublin Transact, of the Association of
Physicians, etc. Vol. 1. p. 1, and On the nature and treatment of Tetanus and
Hydrophobia. Dublin, 1817. — Bergamaschi Sulla mielitide stenica, ossia inflam-
mazione della midolla spinale e sul Tetano, loro identity, metodo di cura e ma-
lattie secondarie die ne derivano, Osservazioni. Pavia 1820. — Duncan, jun. in
Edin. med. and surg. Journal, Vol. XVII. p. 332. — Parent- Duchatelet and Martinet
Recherches sur la Meningitis, etc. Paris, 1821. — Speranza in Anno clinico
medico. Parma. 1823-24. — Pelletier in Revue medicale franf. et etrangere, 1827,
Nov. and Decemb. — Blasius in Rust^s Magazin f. die gesammte Heilk. Vol.
XXVII. Part I. p. 53.

(10) /7ar/<?5'5, p. 41, 57, 58.

(11) In a case of paedarthrocacy, I found the pia mater of the spinal cord in-
flamed, thickened and ulcerated at the diseased part ; in fractures of the verte-
brae it has also been seen inflamed and suppurating, v. Jeffreys, in London
med. and phys. Journ. July, 1826. — Destruction of a portion of the spinal
marrow by suppuration in psoas abscess, which had been eflused into the spinal
canal, is related by Jackson, v. Neuc Samml, auserl. Abhandl. z. Gebr. prakt.
Aerzte, Vol. VI. Part III. No. 1. — Spontaneous suppuration was seen hy Brera
in many cases ; it was completely destroyed, together with the seventh dorsal
vertebra, by suppuration in a case oi Heckscher'' s. v. Wolf. p. 142.

(12) Felpeau in Revue medic, frang. et etrang. Vol. II. p. 247, fan abscess
in the right column of the cervical portion of the cord, three inches long and a
couple of lines broad, and a smaller one in tlie left column.) — Gendrin.

(13) Phillips in New London med. Journal, 1792, Vol. I. p. 144, (a medullary
sai'com of the spinal marrow and its membranes.) — Loewenhard D. de myeloph-
thisi chronica vera et notha, 8vo. Berl. 1817, with plates, (a sarcomatous
tumour.) — Cerutli in PathoL anat. Museum, Vol.1. Part II. p. 23, pi. 10,
(a hard yellowish tumour in the cervical portion, as large as a pigeon's egg, indeed
a tubercle.) — Sonnenkalh in Dresdner Zeitschrift fiir Natur-u. Heilk. Vol. III.
Part I. (is the last case.) — Wolf, p. 20, (a large medullary sarcom, which had
projected from without, and formed two tumours on the spine.) — Felpeau in
Archives general, de ?»iedec. 1825, Jan. (a flat yellowish red growth on the
front of the spinal marrow, between the sixth cervical and third dorsal vertebrae.)

(14) The broken point of a dagger was seen by Cuvilliers, and communicated
by Ferrein in Mem. de I'Acad. des Sc. 1743, Obs. 9, Collect, acad. Vol. IX.
in 4to. p. 233. A small shot in the spinal marrow of a bird. v. Ephem. Acad.
Nat. Cur. Dec. II. Ann. X. Obs. 34.

Third Chapter.

Of the Nerves,

§ 249.

The NERVES,^ although generally subjected to few vices of

structure, exhibit no less, in rare cases, varieties in respect to

440 Of the Nerves, [Part II.

their number, origin, course, connexion, &c., of which we shall
here notice the most important. The total want of nerves
never seems to occur in monsters, however imperfect they may
be, as the organs which are formed always possess some nerves.^
Frequently, however, is there a want of single or several
NERVES, as, not merely in monsters of which certain parts are
deficient, the nerves which are naturally appropriated to or are
connected with them are totally or partially missed,^ but even
in those which are present and are imperfectly formed, as iii
deficiency of the mass of muscles of the limbs, the nerves are
deficient.* Most frequently are the anterior nerves of the
BRAIN deficient, and principally indeed in those monsters with
imperfect formation of the nose, the eyes, and the face ; ^ we
also see, especially in such monsters, the olfactory nerves
deficient;*^ this, however, occurs also, in rare instances, in other-
wise well-formed persons.^ The optic nerves stand also in
a similar relation to the eyes, so that when these are entirely
deficient, both optic nerves are also absent ; ^ but if the eye on
one side only be wanting, the nerve on that side is alone defi-
cient,^ and also in cyclopic malformations, according as the
consolidation of both eye-balls varies, so does that of the optic
nerves into one.^" Vices of the third, fourth, and sixth
PAIRS OF NERVES, as wcll also as the first branch of the
fifth pair, are also usually connected with the total want or
the deformity of the eyes.^^ In one cyclopic monster with
nearly total absence of the face, the facial nerve did not
exist. ^- In very imperfect organs of hearing, the auditory
nerve has been missed.^^ Where the tongue has been defi-
cient, there has been noticed not merely deficiency of the
lingual branch of the fifth pair of nerves, but also of
the MUSCULAR lingual nerve. ^* The opposite vice or excess
OF number of the nerves, occurs, when we notice, as is
proper, the uncommon and too early division of a nerve into its
branches, not, however, but with excess of the parts with which
it is connected,*^ and this is then generally to a certain extent
dependent on their form ; thus, for instance, with a supernu-
merary vertebra we have a spinal nerve too many ; a sixth
finger, which is perfectly organized, has also an uncommon
digital nerve, &c. ; in double monsters, of which the head,
belly, or limbs, are simultaneously consolidated of two, we
find in their parts, according as they diiier in the greater or
less degree of their consolidation, the nerves either completely
double or divided, or double and anastomosing at certain
]><>ints, or lastly, double at their origin, but jiassing singly
I'rom their junction.'" Lastly, the number of branches from

Sect. XX.] Of the Nerves. 441

the sympathetic nerve going to different organs, has been, in
diseases of the latter, observed to be diminished or increased. ^^

(1) Of the great number of writers on diseases of the nerves, as they are
generally of little consequence for pathological anatomy, I notice only the
following: — Karl Oppert D. de vitiis nervorum organicis. 4to. Berol. 1815, —
Jos. Swan, A Dissertation on the Treatment of morbid local affections of the
Nerves, London, 1820. — P. /. Descot Dissertation inaugurale sur les affections
locales des nerfs, 4to. Paris, 1822, and since enlarged and published in 8vo.
1825. — On the varieties of the nerves, compare the manuals of Sommerring,
Meckel, A. C. Bock Die Riickenmarksnerven, u. s. w. Leipz. 1827, and DubrevU
in Ephem. Medic, de Montpellier, Vol. V. May, 1827.

(2) Clarke's case of total deficiency of the nervous system, v. Philos. Trans.
1793, Part II. p. 154-164, seems to me not to be relied on; it was probably not
thoroughly dissected.

(3) Deficiency of the nerves is always in causal and connected proportion to
malformation, because the formative principle seems to spring from them ; thus,
for instance, in acephalous monsters, not merely are the nerves of the head and
the upper part of all the nerves, but also the tenth and eleventh pairs, and the
frenic nerves, in rare cases, wanting when there is a distinct chest, lungs, and
diaphragm. The number of spinal nerves depends on the vertebrae ; hence, in
acephalous and hemicephalous monsters with but few cervical vertebrae, in
monsters with imperfect development of the hinder part of the spine, or even in
otherwise perfectly formed men and animals, of which one or other vertebrae is
deficient, one or several pairs of nerves are wanting. In monsters^ of which the
extremities are deficient or imperfect, the deficiency of the limbs is always
connected with that of the nerves ; thus in single fingers and toes, hand and
foot, fore arm and leg, their nerves are also wanting; if the whole limb be
deficient, so also is the brachial and lumbo-sacral plexus, and without any
branches being given off*, except those to the adjacent parts of the trunk ;
lastly, if with deficient arm the region of the shoulder be wanting, or below the
one half of the pelvis, so the above-mentioned nervous plexuses are wanting,
and there proceed from the vertebral holes merely some posterior threads to the
muscles of the neck, and the undermost layer of the muscles of the back. In
the not uncommon human monsters of which the radius of the fore arm and the
thumb are deficient, the radial nerve terminates at the elbow-joint, or passes
down merely as a single thin thread to the back of the hand. In a roe which
had no fore legs, and of which the hind legs were much distorted, the obturator
and crural nerves were wanting ; but the ischiatic was large, v. Serlo D, Monstror.
extremitatibus carentium exempla tria, p. 20. Berol. 1826. Lastly, in syren
monsters sometimes, on the contrary, the ischiatic nerves are wanting, and are
replaced by the anterior nerves.

(4) I have seen a case of this kind in one lower extremity. — Meckel, Hand-
buch der pathol. Anat. Vol. I. p, 173, found neither muscle nor nerve in the
right lower extremity of an acephalous monster. The same was also noticed by
Breschet on the right lower extremity, v. Med. chirurg. Trans, Vol. IX. p. 433,
1818, and by Chaussievy v. Bullet, de la Faculte de Medec. Vol. V. p. 405. — In
a sheep, neither of the hind legs had either muscles or nerves, v. Schroeder van
der Kolk Observat. anatom. pathol. et practici argumenti, Fasc. I, p. 9, Amstel.
1826. In accessory parts of monsters the nerves are frequently wanting ; thus in
a child, from the pit of whose stomach the arms and bones of a parasite,
No. 2913 of Bresl. Mus., were produced, I could find no nerves; and they were
also wanting in a calf, two geese, and several fowls, on the pelves of which

. supernumerary legs were attached ; also in two instances of children with a sixth
finger. — Mayer found in a parasite, on the breast of a child in which there were
arms and bones, no other nerves tlian a delicate thread from the renal plexus.

. V. von Griife and v. Walther's Journ. d. Chir. 1827. Vol. X. Part I. p. 44.

(5) Prochaska found, in a cyclopic child, only the third, seventh, and eighth
])airs of nerves, v. Abhandl. der bohm Gesellschaft. Jahrgang, 1788, p. 230,
Frag. 1789. — Carlisle missed, in a lamb which had no face, not only the cere-

442 .Of the Nerves, [Part 1 1 .

brum, but all the nerves, except the sixth and seventh pairs, v. Phil, Trans.
1801, Part I. p. 139 — \W. In a monstrous sheep without a face, and with a
very small skull, and in which there was merely the hinder part of the brain, I
observed that the first six pairs of nerves were totally wanting; — in a cyclopia
dog, Magendie could not find the anterior five pairs of cerebral nerves, v. Journ.
de Physiol. Vol. I. No. 4, p. 374 ; — and in a cyclopic lamb, Meckel could not
find the first five pairs of nerves, v. Archiv fiir Anatomic u. Physiologic, 1820,
No. 2, p. 263. — Klinkosch found in a child with one eye, without a nose, and
with other deformity of the face, the first six pairs of the nerves deficient,
the external branches of the fifth pair however existed, but the inner were wanting,
v. Progr. quo anatomen partus capite monstroso proponit. 4to. Prag. 176G;
rev. in Diss. med. select. Pragens. Vol. I. No. 12, p. 199. In a child without
lungs, the second, third, fourth, and sixth pairs of nerves were deficient, v.
Malacarne I. Sistemi del ccrpo umano e la reciproca influenza loro indagati,
p. 90, 4to. Padova, 1803. In a child with deficiency of the right eye, the nose,
and other malformation of the face, the first, fourth, and sixth nerves w^ere totally
wanting on the right side. v. Rudolphi in den Abhandlungen der Akademie d.
Wissenschaften in Berlin fiir das Jahr 1814 u. 1815, p. 185. Berlin, 1818. —
Tiedemann saw in a dog, without eyes, the second, third, fourth, and sixth pairs
of nerves wanting, v. Zeitschrift fiir Physiol. Vol. I. Part I. p. 76. In mon-
sters with very imperfect face, with deficient lower jaw, &c., some branches of
the fifth pair are wanting, and also other nerves going to the face.

(fi) This occurs in consequence of the olfactory nerves originating from the
anterior part of the brain, which is often affected with water, and are at first
hollow, and connected with the lateral ventricles. The olfactory nerves are
not merely deficient in all cyclopic monsters which have no nose, or in its stead
a kind of proboscis (I have found this confirmed in above a dozen monsters
wliich I have examined), but also in those monsters which approach to cyclopy,
by the eyes being too closely approximated, &c., v. the review of Tiedemann^
in the Med. Chir. Zeit, 1825, No. 47, p. 408 ; and I have found it in a mon-
strous pig. No. 8812 of Bres. Mus. ; further in other monsters, generally with
distortion of the face, and of the nose in particular, as in two lambs. No. 2950
and 8021 ; also in a child, No. 8297 of this collection; and Sommerrhig, in a
chikl with only a single nostril, and a very small crybriform })late to the ethmoid
bone. V. D. de basi encephali in Ludw'ig's Scriptores neurologici minores. Vol. J I.
p. 4; and also his Addenda to Baillie, p. 263, note 563 ; also sometimes in hemi-
ccphalous monsters, v. my Monstror. sex humanor. anat. et physiol. disquisitio,
Francof. 1811, in the first, second, and, after repeated examination, also in the
fourth case, — Selt. Beob. Part I. p. 13 and 47, and lastly, since that time, in
some other hemicephala of the Bresl. collection. — Pairix Traite sur le cancer et
sur les maladies des voies uterines, in Considerations generales, p. 18. — C. E.
Rudolphi Monstror. trium pra?ter naturam cum secundinis coalitorum disquisitio.
4to. Berol. 1829, with three plates (in three cases.) — Lastly, also, not very rarely
in children with hare-lip and wolf's-mouth, v. Lavagna in Giornale di Medicina
prat, da Brera, 1813, V^ol. IV. Part III. — Tiedejnann, in three cases, v. Zeit-
schrift fiir Physiologic, Vol. I. Part I. p. 72. — Blandin is said to have seen it in
every case of wolfs-mouth, v.ron Froriep's Notizen, Vol. XVI. p. 64, which, how-
ever, is by no means the case, as, in thirteen instances of wolf's-mouth with hare-
lip, only in five was the olfactory nerve wanting, to wit, in No. 2328, 2888, 2891,
2898, and 2939 of my Verzeichn.

(7) Valentin in Eph. Acad. Nat. Cur. Ann. IX. and X. p. 429. — liosonuiiller
Dc nervorum olfactorior. defectu Progr. zu v. Mariius D. de lepra taurica.
Lips. 1816, (there were found instead only two little eminences in the sylvian
])its.) — Rudolphi \. Jilaiiroc/,- 1). de nervorum sensuum defectu, ]). 18, 8vo.
Bcrol. 1828, (the right was entirely wanting, the left rudimentary where it lost
itself in the arachnoides.)

(8) Compare note 5. — P'urther Vicq d' Azyr Mem. de la Soc. de Medec. 1776,
p. 315. — Weuleh; v. Schmidt in Ilimly's and SchmidCs Ophthahnologischcr
Bjbliothek, 1805, Vol. III. Part L p. 170.— O.smnf/rr, Handb. der Kntbindungs-
kunst, 1). 520, Vol. \. Obj. 6, Tiibingen, 1818, (in one kind of cyclops), —

Sect. XX.] Of the Nerves. 443

Lohstein De nervi sympathetici hum. tabrica et usu, p. 53, 4to. Argentor. 1823.
However, also in cyclops with tolerably well-formed eye no optic nerve has been
found, viz. Mery in M^m. de I'Acad. des Sc. 1709. p. 18. — Riviera in BrugnateUVs
Giorn. d. med. Pavia, 1795, Vol. I. p. 225. Even Magendie is said to have
missed it, although the retina existed; one might doubt, that in these cases the
nerve was very thin, and being torn through was overlooked : the absence of the
optic nerve in one kind of cyclops is certain, it is described by Ehrmcmny v.
Repert. gen. d'Anatom. et de Phys. pathol. Vol. IV. Part I. p. 5.

(9) Rudolphi.

(10) There are, indeed, sometimes two optic nerves from the brain, which pass
unnaturally close to each other, without decussating, to the great eye-hall, which
they enter on either side, or they both unite in front in one common nerve for
the single eye ; or, but one nerve arises from the brain, and divides itself ante-
riorly into two branches for the two eye-balls lying in a single orbit, as Rudolphi
saw in two cyclopic pigs. v. Ruben, Descriptio anatomica capitis foetus equini
cyclopici, p. 12, 4to. Berol. 1824, and Meckel, in one cyclopic sheep and
two cyclopic pigs. v. Archiv fiir Anatomie und Physiologic, 1826, No. II.
p. 247 and 248 ; or, and which is most commonly the case, there is only a single
optic nerve from the brain, which, however, is very large at the hinder
part, but passes singly to the brain. I found the latter the case in all the
instances which have come under my observation, and only in No. 2344 was the
optic nerve double at its origin. See, on the formation of the optic nerve in
cyclops, Tiedemann, Meckel, and J. Miiller, Zur vergleichenden Physiologic des
Gesichtssinnes, p. 160. Leipz. 1826.

(11) Compare the cases quoted above at note 5. — In that of Ehrmann's, the
third pair of nerves was, however, said to be present I could not find the fourth
pair in a cyclopic pig. No. 2346, which had all the other nerves except the
olfactory; in a human cyclopic monster the fourth pair was deficient, and the
sixth did not reach the orbit, but was connected merely with the sympathetic
nerve, v. E Her and Roloff, in Hist, de I'Acad. des Sc. de Berlin, p. 112. 1754.

(12) Tiedemann, p. 87.

??(13) I have seen this very rare case in a monstrous sheep, v. my Selt. Beob.
Parti, p. 37. — Valsalva saw a hemicephalic monster which had no auditory
nerve, nor any opening for it in the petrous bone ; it is also curious that two
other children of this woman were deaf. v. Morgagni Epist. XLVIII. 48 ; a
similar case is also described by Lohstein De nervo sympathetico, p. 54, § 69.

(14) Tiedemann. p. 87 and 89.

(15) I have already remarked, at note 4, that accessory parts are not neces-
sarily supplied with nerves.

(16) Several satisfactory cases, and plates of such cases, are given by Darkow,
Monstra animalium duplicia per anatomen indagata, Vol. I. 4to. Leipz. 1828,
who has taken much trouble in examining the nerves. The external examination
of such monsters allows us to speak pretty certainly of their nerves ; the nervi
vagi and s)TTipathici alone sometimes surprise us by their arrangement. In a mon-
ster which was double at the upper part, but single below, with two vertebrae lying
close to each other, but perfectly distinct, the internal sympathetic nerves which
were united beneath had no ganglia, because the spinal nerves on that side were
deficient, v. Gibson in Phil. Trans. 1810, Part I. p. 123. In a janus- faced
monster each face had its proper nerves from the two brains, &c.

(17) LobsieinDe nervi sympathetici hum. fabr. usu et morbis Comm. § 152 —
154. 4to. Paris, 1823. I do not think it probable that there should be an
actual increase or diminution in tlie number of branches, and I hardly need
recall how very difficult such examinations are, and how easily they may be
mistaken.

§ 250,

The NERVES sometimes exhibit variations from their normal
SIZE, which may be either congenital or acquired. The con-
genital IRREGULAR SMALLNESS occurs not unfrcquently, and

44-1 Of the Nerves. [Part II.

is very often connected with morbid softening, colouring, and
structure, and seems to originate oftentimes in the total
absence or great imperfection of the organ to which the nerves
belong.^ In hemicephaly, hydrencephalocele, and internal
dropsy of the head, the cerebral nerves, so long as they remain
within the cavity of the skull, are very thin, as are the spinal
nerves in sjnna bifida at the diseased spot. More frequent is
the ACQUIRED and later occurring diminution, or atrophy of
the nerves, which but rarely, and only in a slight degree, parti-
cipates in the general consumption of the body,^ and appears to
stand in an equally imperfect relation to paralysis ;^ the organs of
sense, however, seem to form an exception, as they waste, shorten,
lengthen, &c., both as cause and consequence of diseases of the
organs of sense;* this has been observed most commonly and
most completely in the optic nerves, of which sometimes only
the part in front of the chiasma, often also the cerebral part of
the nerve on the opposite or upon the same side, or lastly, on
both sides, with or without optic beds and quadrigeminal bodies,
liave been found atrophic/ Not unfrequently wasting of one
or several nerves originates in pressure, arising from swellings
of various kinds at their origins;" so also the nerves within the
skull and the spine are compressed less severely by collections
of water, by abscesses, extravasation of blood, and other causes,
and external to these cavities by various kinds of swellings,
dislocated bones, &c. In many instances the causes of atrophy
in certain nerves are more obscure.^ The opposite vice, the
IRREGULAR INCREASED SIZE OF THE NERVES, is rarely con-
genital,** but usually occurs later in various diseases, as inflam-
mation, dropsy, cancer; in such cases it is naturally confined
to single nerves, but is then sometimes so considerable, that
the nerves exhibit a thickness three or four-fold greater than
usual.^

ts'

(1 ) In a child without eyes, No. 2888 of my Verzeich., I tbuiul the second, third,
fourth, and sixtli jjuirs of nerves, togetlier with tlie first hranch of the fifth pair,
slender, withered, yellowish grey, and almost without nervous matter. In another
monster, No. 82i)7 of tlie Mus., with deficient eyes, nose, and malformed face, the
nerves, from the seventh to the eighth ])air inclusive, were remarkably small. — A
monstrous sheep without a face. No. 8021 of the Mus., with deficient olfactory
nerves, the following seven pairs very thin, and the right optic at the same time
flattened. — A similar lamb. No. 8020, had the olfactory and optic nerves not
thicker than a hair, and without any nervous matter ; the following four pairs
also thin, hut containing sonu^ nervous matter. — In two children, a dog, and
two calves, which were horn with small and very imjK>rfect eyes, I found the optic
nerves, and in part also the optic beds, too small, v. No. 2;)42, 2;)1.'5, '.Vl'.Vl,
3233, 82fi7, 83()3, 83()1-, and 8()03, of Bresl. Mus.— In a cyclopic sheep without
a tongue, I found the fifth, ninth, and twelfth j)airs of nerves very thin. v. my
Sclt. Heob. Part I. p. 37. — In a human monster, No. 2885, the optic nerves
without nervous matter and tubular. — In a monstrous ])ig, with a disj)osition to
cyclopy. No. 8812, the fifth pair was too small; this was also the case with a

Sect. XX,] Of the Nerves. 445

child which had no lower jaw ; and also a similar child, all the lingual nerves.
V. Selt. Beob. Part II. p. 168. — In a similar monstrous sheep, No. 8022, the
third portion of the fifth pair was remarkably small, discoloured, and wanting-
nervous matter. — In some cases of hai'e-li}), and especially No. 2329 and 2896 of
my Verzeich., I found the olfactory nerves too small. — In monsters which are
entirely limbless, or have the limbs too small, the proper nerves to these are too
small, as I have seen in several instances. — Dumeril observed the same in Marco
Catozze, whose limbs, excepting the hands and feet, were deficient, v. Bullet, de
la Soc. philomath. Vol. III. p. 122.

(2) DesmouUns in de Blainville' s Journ. de Physiq. etc. p. 166, Feb. 1821,
especially observes, that the nerves waste merely in the wasting of old persons,
but not in young people ; this is generally correct, although it has appeared to
me, in some cases, as if the nerves, in young persons who had died of tabes, were
sometimes dryer, that is, contained less fat and serum. Whether they were also
thin I could not determine, on account of the great relative variation which
naturally exists in the bulk of the nerves of different individuals. — I have never,
however, found them remarkably thin in such bodies.

(3) In hemiplegic and paraplegic persons, the nerves of the paralytic parts
are very rarely found thinner than in those which can be moved voluntarily. —
Even if the paralysis have existed very long, and have occurred in very early youth,
the nerves are sometimes apparently healthy, v. one such case in my Selt. Beob.
Part II. p. 32. — It however appeared to me, in another case, in which, from
earliest childhood, one leg was shorter and more slender than the other, as if its
nerves were also more slender than those of the healthy foot, as was very natural.
Sometimes also, in tabes dorsalis, the dorsal nerves are somewhat wasted. —
Koreff found, in one such case, the anterior roots of the nerves in a high degree
atrophic, v. Magendie's Journ. de Physiol. Vol. IV. p. 372. Oct. 1824.

(4) The cause is sometimes in the brain and nerves ; sometimes, on the
contrary, on the organs of the senses. In a child which died of water in the
head, the olfactory nerves were too thin, brown, and hard. v. Jeffray in Lon-
don Med. Repos. p. 278, April, 1822.— The auditory nerves have also been seen
atrophic in deaf persons, v. Fr. Hoffmann D. de auditus difficultate, § 12, (in a
dog which was deaf.) — /. Haig1iton/\n^leu\. of the Medic. Soc. of London, 1792,
Vol. III. p. 1. — hard, in a deaf and dumb person, v. Traite des maladies de
I'oreille. Paris, 1821. — In the body of an old woman, I found the left auditory
nerve of a yellow colour, and much thinner than the right. I could not ascer-
tain whether the woman was deaf, though pi'obably she was, as the membrane of
the drum was ossified, and the cavity of the drum and labyrinth filled with a
thick reddish jelly.

(r5) Compare the works on decussation of the optic nerves, and Vrolik in
Memoires sur quelques sujets interessans d'Anat. et de Physiologic, trad, du
HoU. par Fallot, Memoire I. 4to. Amsterd. 1822. — Lieutaud Histor. anat. med.
Lib. III. Obs. 188 — 191, tab. 2, p. 367. — Wasting of the optic portion alone I
have seen in four cases ; — further, Morgagni in several, v. Epist. anat. med. and
De sed. et caus. morbor. Epist. XIII. 9 and 10 ; Epist. II. 30 ; Epist. LXIII. 6. —
Isenflamm Versuch einiger prakt. Anmerkungen iiber die Nerven. Erlang. 1774,
§ 58, p. 170. — Michaelis Ueber die Durchkreuzung der Sehnerven in Grosse's
Magazin zur Naturgeschichte des Menschen, Vol. II. Part I. p. 149; und als
besondere Schrift. Halle, 1790. — JVenzel De penitior. cerebri struct, p. 116, 119,
and 120. — Beer Lehre von den Augenkrankheiten. Vol. II. p. 50. Wien, 1792,
(in all cases, in which one eye was destroyed by inflammation and suppui'ation.) —
Vrolik, p. 14, pi. 2, &c. — On simultaneous atrophy of the cerebral portion of the
nerve of the opposite side, v. Valsalva in Morgagni. — Sommerring and N'dthig De
decussatione nervorum opticorum. Mogunt. 1780, (also several cases of animals.)
— Billmann in Blamenbach' s medic. Biblioth. Vol. II. Part II. p. 391, (in a dog.)
/. G. Walter von der Einsaugung und der Durchkreuzung der Sehnerven,
Berl. 1794, (in three cases.) — Michaelis, (in several cases.) — Ackermann in Bln-
menbach's medic. Biblioth. Vol. III. Part 11.— Rosenthal D. de oculi quibusdam
partibus. Gryphise, 1801, (in a horse and a jackdaw.) — Wenzel, p. 115. — Caldani
Opusc. anat. p. 35, Patav. 1803. — Gallereiix. v. S('dillot's Journ. gen. de Medecine,

416 Of the Nerves. [Part IL

Vol. L. No. 216, p. 880. Aug. 1814. — Ehel and Closdiis, (in horses.) v. Summerring's
Addenda to Baillie, p. 178, note 380. — Magendie in Journ. de Physiol, experim.
Vol. III. No. 4, p. 376, U23.—Rudolphi Grundriss der Physiol. Vol. II. Part I.
p. 220. — I have also seen two cases of this kind, one in a man and the other in
an owl which had heen blinded by a shot in the eye. — Atrophy of the optic nerve on
the same side as the blind eye, throughout its whole length back to the brain, was
seen by Fesalius Decor]}, hum. fabrica. L. IV. c.4. — Co'salpinus, Rolfirick, Cheselden
and Santorimis. v. Morgagni, Epist. XIII. 7. — Heiland in Ephem. Acad. Nat. Cur.
Dec. III. Ann. VII. Obs. 157. — Meckel in nailer's Grundriss der Physiologie,
p. 386.— CftWawi, p. 33 and 36 ; and in Mem. della Soc. Ital. Vol. XII. Part II.
p. 27 ; and my Selt. Beob. Part II. p. 89. — A case in which both portions of the
brain were wasted, in consequence of blindness of one eye, is described by
Weiizel, p. 114. Cases also have been several times observed in which both
eyes were blind, or both optic nerves throughout their whole length, together
with the optic beds, were atrophic, v. Walter, p. 96. — f'rolik, (in a girl of fourteen
years.) — Biennayer Mus. anat. path. p. 134, No. 564. Vindob. 1816; and my
Verzeichn. No. 2350. In one such case it is said, that the optic portion of the
nerve of the eye which was perfect, was atrophic, and that of the blind eye was
natural, v. Magendie's Journ. de Phys. Vol. VIII. No. 1, p. 33. — On this point
there is still much obscurity, and the contrary opinions seem to depend on this,
that the disease originates sometimes from the eye, sometimes from the brain,
and also on one or both sides; that it is sometimes a mere nervous disease,
sometimes an inflammatory state, or disturbed nourishment of the eye ; and that
the course of the disease in men and animals is different. In the former it
appears that the destruction of one eye produces consequent atrophy of the
nerve much later than in beasts and birds, v. Magendie, Vol. III. No. 4, p. 376.
We also perhaps find a difference between man and different animals in refe-
rence to the propagation of the disease to the opposite side.

(6) Otto D. de morbis ab intumescentia et pressione nervorum per foramina
ossium egredientium. Erford. 1799. Wasting of the olfactory nerve, without loss
of smell, was seen by Mery. v. Progrcs de la Medec. 1697. — Loder Progr.
Observatio tumoris scirrhosi in basi cranii reperti. Jenae, 1799, with plates. —
iiommcrr'mg on Baillie, p. 263 ; and Addenda to Baillie, p. 177, note 379. —
JVenzel De penit. cerebri struct, p. 104, (second case.) — J. Ward in London
medical Repository, Vol. XX. p. 217, September, 1823. — J. F. Meckel in D.
Archiv f. d. Physiol. Vol. III. p. 196. — B^clard in Magendie' s Journ. de Physiol.
Vol. V. No. 1 and 2, p. 17; and myself in three cases, v. Selt. Beob. Part II.
p. 89 and 90. Since then also in one case from medullary sarcom of the
eye and nose. Compression of the optic nerve arises from aneurysm of
the carotid arteries near the Turkish saddle, from swelling of the appendage
of the brain, v. Rullier in Archives g6nerales de Medecine, p. 302. October,
1823. From a malformed clinoid process ; v. Sbmvierring' s Addenda to Baillie,
p. 264, and from other tumours. Compare Boneti Sepulchret. anat. Lib. I.
Sect. XVI. Obs. 1, 2, \Q.—Blegny Zodiac. Gallic. Obs. 14, p. 81, (by a bean-
shaped bony concretion.) — Paw Obs. anat. rarior. II. p. 5, (hydatid.) — T. Plater
Observationum, Vol. I. Lib. III. p. 102. Basil, 1641. — Haller Elem. Physiol.
^'ol. IV. p. 297. — Monro Praelect. medicae, &c. p. 27. Lond. ]776.-'~Boehmer
Observ. anat. rar. Fasc. II. Obs. 3. — Sabourant in Prix de Chirurg. XI. p. 96.
Several cases are related by Voigtel, from Wandeler, de JIaen, Ford, and Fcrro, v.
Pathol. Anat. Vol.1, p. 679. — Flor. CahUmi Observat. anatom. Patav. 1803,
with engravings. — Powel in Medic. Transact. Vol. V. — Esquirol in Diet, des Sc.
m6dic. Vol. \'III. p. 291. — Hay in /tbercromhie, p. 430. — J. Ward. — LeveillS,
read at a sitting of the Acad, de M6dec. of Paris, 10th Aug. 1824. — Schneider
1). de magna quadam enco])hali dcstructionc ejusque sequelis. 8vo. Berol. 1824. —
Jlu.st'.s Maga/in f. d. ges. Ileilk. Vol. V. Part. I. p. \C)Ci.—Bhlard.—de la Matte,
in Plula(leli)hia Journal of the medical and physical Sciences, August, 1827. —
Magendie in Journ. de Physiol. Jan. 1828, Vol. VIII. p. 27.— Z>.' Mryrr 1). de
cerebri tumoribus. 4 to. Bcrol. 1829, with engravings. //. y/. G. Jihudius 1). s.
Casum singularem de Amaurosi cranii osteosteatomate effecta. 4to. Berol. 1829,
with i»latc.s. 1 once found in a man who had been affected with amaurosis of

Sect. XX.] Of the Nerves. 447

the right eye, the optic nerve compressed by a scrofulous tumour just before
its entrance into the orbit, v. my Selt. Beob. Part I. p. 108 ; in other cases it
was compressed, together with the nerves following up to the eleventh pair, by a
scirrhous tumour, v. Selt. Beob. Part II. p. 86, or by medullary sarcom of the
appendage of the brain, p. 93. The third, fifth, and sixth nerves were, in one
instance, compressed by a hard tumour, v. Landmann Comm. path, anat, exh.
morbum cerebri oculique singularem. Lips. 1820. The fifth pair was found
atrophic and compressed by tumours, v. Fribault and Marechall in Journ. gener.
de Medec. Vol. XLIV. Aug. 1812, (in a person with face-ache, tic doloureux). —
Desmoulins in Magendie's Journ. de physiol. Vol. V. No. 1 and 2, p. 21 (with loss
of smelling although the olfactory nerve was healthy.) — Hay in Abercrombie,
p. 432, case 20, (the seventh pair was compressed ; the sight and hearing dimi-
nished.) Wasting of the fifth pair, with total destruction of the seventh and eighth,
from a tumour, is described by D. Meyer D. de cerebri tumoribus. 4to. Berol. 1829,
with engravings. In a man with double vision, paralysis of the right side, and
distortion of the left eye towards the nose, the left nervus oculum abducenswas
pressed by a tumour, v. Yelloly in Med. chir. Trans. Vol. I. p. 181. The
seventh pair was compressed at its entrance into the petrous bone by a tumour,
in an old man. v. J. H. Wishart in Edin. med. and surg. Journ. By pus in the
fallopian canal, v. Bellingeri in Annali universali di Medicina, March, 1827.
In one instance a tumour of cartilaginous hardness was situated on the auditory
nerve, v. Sand/fort Obs. anat. path. Lib. I. Chap. IX. p. 117. tab. 8. fig. 5, 6, 7.
The nervus vagus has been seen compressed and wasted several times, v. Cappel
D. de epilepsia e tumore nervo vago inhaerente. Helmst. 1781 (the cerebral end.)
— Biermayer Museum anat. pathol. No. 186, (by an ossified pointed absorbent
gland, situated behind the left lung, tetanus and death.) It and the frenic nerve,
in a person who died with difficulty of breathing, surrounded by tuberculous
glands, and wasted at the lower part, was observed by Andral Nouvelle Biblioth.
med. No. 7, 1826. — Biipuy v. Journ. gen. de Med. p. 5, April, 1821, and Jan. 1825,
imagines that the so-called crib-biting of horses arises from the pressure of
the nervi vagi above the superior laryngeal nerve, and was confirmed in some
cases. Sometimes we find the spinal nerves compressed by tumours ; hence arises
paralysis of the lower extremities from hydatid tumours in the spinal canal, v.
Chaussier in the note to the fortieth letter of his edition of Morgami De sed. et
caus. morbor. Paris, 1822. In a woman with paralysis of one arm and of the
feet, the anterior left roots of the nerves at the lower part of the neck were com-
pressed and wasted by a tumour, v. Valpemi in Magendie^s Journ, de Physiol.
No. II. p. 138, 1826. A tumour in the canal of the spine compressed the anterior
roots of the nerves, and produced imperfect paralysis and violent pain of the
feet. V. Monod in^oxxw. Biblioth. Med. May, 1827. Several instances of com-
pression of the vocal and frenic nerves, and also of the branches of the sympa-
thetic, from tubercles, aneurysm, &c., are described by Lobstein De nervi sym-
pathetici humani fabrica usu et morbis comment. § 145, 147, and 156. 4to,
Paris, 1823, [In Mus, St, Thomas's Hospital a scrofulous tumour in the
dorsal portion of the spinal marrow produced paralysis with loss of sensation in
the lower extremities, T.]

(7) Swan, for instance, found in a man who had taken violent medicines, and at
last was subject to canine hunger, that the oesophageal branches of the tenth pair
were wasted and morbid ; and in consumptive cases the trunks of the nervi vagi
were frequently extremely thin. v. his Observations on some points relating to
the anat, phys, and pathol, of the Nervous System, Chap, II.

(8) As the thickness of the nerves varies exceedingly in different individuals,
the considerable size which appears to have been noticed, viz, in the often-cited
cases of Laumonier in Journ, de M^dec, Vol. XXXVI, p. 259, hardly belong
here. It is an interesting circumstance, however, that the sympathetic nerves
and the ganglia have been found unusually large, as for instance, by Cayre and
Pinel. V. Nouv. Journ. de Medec. Vol. IV. p. 40-45, (in eight cases.) — Romberg
found, in a girl who was an idiot from birth, the nerves in proportion to the
brain very large and firm, but especially the ganglionic system of the belly, very
large, v, Zeitschrift f. die Anthropologie, 1823, Part III. p. 224, — Lobstein De

448 Of the Nerves, [Part II.

nervi sjinpathetici humani fabr. usu et morb. Comment, p. 55, § 70, 4to. Paris,
1823, (in two cases.) — //, Duncan, Reports of the practice in the Clinical Wards,
&c. London, 1819, also found them (three or four) too thick in a diabetic pa-
tient.— In a hemicephalic monster, Meckel found the sympathetic nerve double
its usual size. v. Descrip. monstr. nonnull. 4to. Lips. 1826, p. 21 ; although I
remembered these cases in dissecting idiots and hemicephalic monsters, I have
never observed the size of the ganglionic system such as is stated, nor was it
remarkable ; it also appears that it is not constant.

({)) In a child who died of chronic water in the head, the fourth pair of nerves
was unusually thick and white, and the optic nerves wasted, v. Jeffray^ in Lond.
Med. Repos. p. 278, April, 1822. — In neuralgia and imperfect paralysis, the
nerves have been sometimes seen thickened, not merely in ischias nervosa Co-
tugnii, but also in others, v. Petit in Mem. de Chir. de I'Acad. royale. Vol. I.
p. 90. — CiriUo Prakt. Bemerkungen iib. dier vener. Ki'ankheiten. Leipz. 1790,
p. lot. — C. Wenzel Ueber Induration, u. s. w. p. 50, Mainz, 1815. — Swan, chap.4. —
Serves, in Magendie's Journ. de Physiol. Vol. V. No. 3, p. 233, found in a man,
the right side of whose face was paralytic, the ganglion of the fifth pair swollen,
and the nerves otherwise diseased. In the foot of a man, which was atiected with
elephantiasis, the tibial nerve was uncommonly thickened, irregular, and its
sheath especially swollen, v. Chelius in Heidelberger klin. Annalen. Vol. II.
Part III. p. 359, pi. 2. — In a few cases of old chronic inflammation, thicken-
ing and partial suppuration of the leg, I have seen the ischiatic nerve remark-
ably thickened, and at the same time greyish yellow and semi-transparent; a
very painful enlargement of the nervus tibialis posticus was seen by Barkow
Ueber Nervenanschwellungen in Nov. Act. phys. med. Acad. Nat. Cur. XIV.
and ^. Cooper's Lectures, Vol. I. p. 44. — Thickening of the saphenous nerve
in the neighbourhood of a varicose saphenous vein. v. Gendrin Histoire Anato-
mique des Inflammations, 2 vols. 8vo. Paris, 1826. — Several instances of partial
thickening of the sympathetic nerve are mentioned by Lobstein.

§251.

We but rarely observe important variations as to the form,
POSITION, and ramification in the nerves. Thus, for instance,
occasionally we miss one of the usual roots of the olfactory
NERVE ; it has been found in new-born children, especially in
those having watery heads, as in the young foetus, too thick and
hollow,^ or, in a deaf and dumb person, merely its bulb twice
as thick as in the normal state,^ &c. More frequently do the
origin and course of the optic nerves vary in cyclopic mon-
sters f in these, ^ and in hemicephalic cases,^ the optic nerves
have been noticed completely distinct and without a commissure,
in an otherwise normally formed brain.'' As an approximation
to this state, they have been seen several times, in dropsy of the
brain, as it were torn asunder, and instead of crossing, con-
nected only by a transverse portion of nerve.^ From the point
of decussation, there arose in one instance a pointed medullary
process projecting forwards,* &c. The four following
NERVES of both sides in cyclops run unnaturally close to each
other. The third nerve sometimes varies in reference to its
branching and its twigs to the optic ganglions, thus, for in-
stance, it sends off the long root to it." Among the varieties of
the FIFTH PAIR, the not iuifre(|uently early sei)aration and dis-

Sect. XX. Of the Nerves. 449

tinct course of the frontal, infra orbitar, and maxillary branches,
is important in practice. The outer oculo-muscular nerve
sometimes gives off' the nasal branch instead of the fifth pair.^^
The nerviis reciirrens of the auditory nerve, in abnormal posi-
tion of the neighbouring arteries, sometimes also exhibits an
unnatural course. ^^ The sublingual nerve, in one instance,
passed through the vertebral artery, which was cleft for it.^^
The SPINAL nerves are sometimes subject to variation ; this is
especially the case in the extremities. In one monster, which
wanted the sacrum and coccyx, the ischiatic nerve proceeded
through a large aperture between the fifth lumbar vertebra and
the iliac bone.'^ In deficient formation of the pericardium
the course of the phrenic nerve was found abnormal.^* The
SYMPATHETIC NERVE is also fouud Varying in different ways,
and not rarely curved with the spine, or thrust out of its course
by tumours on the spine. In one instance, owing to the
absence of the lingual branch of the fifth pair, and of the
sublingual nerve, the sympathetic nerve gave off' branches from
the cervical ganglions to the tongue and its muscles. ^^

(1) I have seen this a few times ; in a hemicephalic monster, No. 8016, the
hemispheres were very pointed in front, and reached to the crybriform plate,
extending almost to the olfactory tubercles, as in animals.

(2) A. Meckel in J. F. Meckel's Archiv fur Anat. u. Physiol. 1828, No. II.
p. 169.

(3) Compare § 249, note 10.

(4) 01. Borrich. v. Acta msd. Vol. I. Obs. 93, Havn. I67l.—Litlre in Mem.
del'Acad. des Sc. de Paris, 1717, p. 285.—Albrecht Eph. Acad. Nat. Cur. 1714,
Vol. VII. p. 363, Obs. W2.—Eller and Roloff in Hist, de I'Acad. des Sc. de
Berlin, 1754, p. 112. — Riviera Storia di un Monoculo, etc. p. 12, 8vo. Bologna,
1793. — Ulrich and Heymann in Meckel's D. Archiv f. die Physiolog. Vol. VI.
p. 522. — Ullersperger Pathol, anatom. Beschreibung zweier Missgeburten. 8vo.
Wiirzb. 1822. — Tiedemmm in Zeitschrift fiir Phy.yiologie, Vol. I. Part I. p. 80, etc.

(5) Prochaska Annotat. acad. Fasc. III. p. 175. — Klein Spec, inaug. anat. hist,
Monstror. quorundam descriptio, p. 16, Stuttgard, 1795. — In my Monstror. sex
humanor. anat. et physiolog. disquisitio, p. 8, Francof. ad Viadr. 1811; and
since then in two cases. — Kelch Beitrage zur pathol. Anatomie, p. 85. Berl. 1813.
I have already, in another part of my Selt. Beob. Part I. p. 43, pointed out the
causal connexion of water in the head with this anomaly.

(6) Vesalius De corp. hum. fabr. L. IV. c. 4. — Fabriciiis ah Aquapendente De
Oculo. Part III. cap. 11. — Valverde Anat. del corpo umano. Lib. VII. c. 3. —
Caldani Opuscula anat. p. 40. Patav. 1803.

(7) Os^/jq^ Kleine Beitrage zur Erweiterung des med. Wissensch. p. 146. Duisb.
1804. — Brescliet in Archives generates de M^decine, July, 1823 ; I have found
this occasionally under similar circumstances, and saw one such case with Pro-
fessor Provencal, at Montpellier.

(8) Sommerring and Nothig, fig. 4.

(9) Morgagni Epist. anat. XVI. § 59. - Meckel De quinto pare nervorum, § 48.

(10) V. my Selt. Beobach. Part I. p. 108.

(11) Stedmann, in Edinb. med. and surg. Journal, No. 77, Oct. 1823, saw in a
man whose subclavian artery arose from the arch of the aorta, and passed to the
right arm between the gullet and the spine, the right deficient, and the branches
which supplied the place of the laryngeal arising from the middle of the neck
above. A similar case was observed by Harles, ib. April, 1826. In a man whose

G G

450 Of the Nerves. [Part II.

aorta turned fii*st to the right side, the right nervus recurrens passed under the
arch of that vessel, but the left on the ductus arteriosus Botalli, up to the larynx.
V. Sandifort Mus. Anat Vol. I. p. 273 ; Vol. II. pi. 107, fig. 1 and 2.

(12) I saw a wax model of this case in the Anatomical Museum of the
Josephine Academy at Vienna.

(13) Fried! ieh Monstrosi foetus descriptio atque delhieatio, p. 39. pi. 6. fig. 1.
4to. Altonae, 1803.

(14) In the totally absent pericardium BaUUe saw the left phrenic nerve passing
down close behind the breast-bone. v. Transactions of a Society for the improve-
ment of medical and chirurgical Knowledge, Vol. I. p. 91. — In two cases, v. my
Selt. Beob. Part II. p. 44, and in No. 2874, my Verzeichn. ; with deficiency of the
left side of the pericardium, the left phrenic nerve was curved forwards and to the
right ; a similar case is given by Breschet in Repertoire gen. d' Anat. et de Phy-
siologic pathol. 1826, Vol. I. Call. I. p. 215, pi. 5. — In a child with prolapse
of the heart and deficient pericardium, the phrenic nerves passed on the outer
side of the great vessels, v. Haan, D. de ectopia cordis casu illustrata, p. 13.
4to. Bonnae, 1825.

(15) Lohstein, § QQ, p. 53.

§ 252.

The COLOUR OF the nerves is found irregular in various ways,
and especially occurs in vicious structure. Thus atrophic or
softened nerves usually lose their gloss and whiteness, become
partly opake, grey, or yellowish, or rather greyish-yellow;
contused or inflamed nerves appear more or less red through-
out, or spotted and streaked with red ; in ulcers and in morti-
fied parts, the nerves are usually more or less discoloured ; in
great destruction, viz. in gangrene, in complete atrophy, in
the cancerous-like state especially, we observe them at certain
spots of different shades of brown and rust colour. In jaundice,
they participate very little or not at all in the discoloration.*

(1)1 have occasionally found in new-born children, which had perhaps died a
short time before birth, the medullary part of the brain, spinal cord, and some of
the great nerves, as the ischiatic, here and there of a light yellow colour ; and
Lohstein y p. IGG, § 159, found one child in which the spinal marrow was of a
citron yellow, and the sympathetic nerve of a similar colour, in spots ; upon
Kirrhonose, compare above, § 39, note 2.

§ 25S.

Not less is the consistence of the nerves sometimes
morbidly changed, that is, either decreased or increased ; the
former is the most frequent, and the nerve, instead of being firm
and elastic, becomes soft, withered, shrivelled, easily
TORN, and sometimes as if it had been macerated.* In some
cases, the nervous sheaths exhibit a tolerably normal firmness,
but the several nervous bundles are separated from each other,
and as it were loosened. In other cases, however, the medul-
lary part of the nerve especially is softened, as if it had been
immersed in a solution of kali, so that the discoloured medullary
substance has no fi])res, but runs out from a divided nerve like a
thin ])ulp, like jelly, or even like water. Sometimes at certain

Sect. XX.] Of the Nerves. 451

spots the nerves are entirely deprived of medulla, and the
hollow sheaths alone remain ; such are not unfrequently seen
within the cavity of the skull and spine, in children with
cyclopy, hemicephaly, hydrencephalocele, internal water of
the head, and spina bifida,^ Further, a higher degree of
inflammation seems, as in the brain and spinal marrow, and
also in the nerves, capable of producing a softening and
fluid state of their substance. The opposite vice, or in-
duration, occurs much more rarely in the nerves, and seems
to be especially produced in chronic inflammation by the
deposit of plastic matter in the cellular tissue, which glues
together the separate nervous bundles. Atrophic nerves also
appear to be too dry and hard; sometimes the nervous
sheath only appears to be thickened and too hard. A true
conversion of the nervous substance into cartilage and bone
cannot take place. ^

(1) Atrophic and paralysed nerves, especially the optic, have frequently this
appearance ; the lower extremity of a divided nerve is also withered ; in dropsy
the nerves are sometimes partially too soft. v. Autenrielh, D. observationes in
hydrothoracem virorum, p. 20. Tiib. 1809.

(2) Morgagni, Epist. LIT. 31, had already found the optic nerve of an atrophic
eye so hollow, that when cut through he compared it to an artery. In hemi-
cephalic monsters, I also remarked this very early, and pointed out the con-
nexion of water in the head in reference to the nerves, v. Monstror. sex human,
anatom. et physiol. disquisitio, p. 21, Francof a. V. 1811 ; and since then have
often found it confirmed. More recently I have seen in a cyclopic monster, No.
2885 of Bresl. Mus. one of the optic nerves large, with its sheath very firm,
but when cut through, quite hollow and deficient in nervous matter.

(3) As by bony and stony concretions upon and in the nerves, &c.

§ 254.

Vices of continuity are very common in the nerves, as,
from their extensive distribution, they participate in every
trifling injury ; they are then sometimes cut through, torn
asunder, or only imperfectly separated and contused, tied to-
gether, cut, pierced, &c. If the nerves be stretched gradually,
they often yield remarkably, as in many swellings of joints, in
exopthalmus, &c., without having their functions destroyed ; but
if they be suddenly and violently extended, as by many bony
tumours, by aneurysm, &c., they are more injured, and can even
be torn through without breach of continuity in the neighbour-
ing parts. ^ If the larger nerves be wounded, there sometimes
arise, besides the necessary palsying of the part with which
they are connected, not merely active and continued neuralgia
and sympathetic aflections,^ but also similar organic phenomena,
as in other injured soft parts, viz. swelling, redness, effusion of
coagulable lymph, and union. If a nerve be completely
divided, both its extremities swell, but especially the upper.

452 Of the Nerves. [Part II.

the peripheric part of the nerve becomes thinner, even shghtly
discoloured, and the effused lymph unites both ends into a
more or less large and solid knot, consisting of cellular tissue,
in which, after sometime, some new irregular variously con-
nected nervous threads are produced. In instances of more
considerable loss of substance in a nerve, the ends are either not
united, and cicatrize with a permament swelling, with loss of sen-
sation and motion in the more distant portion ; or if they be but
slightly separated from each other, they may be united by a
newly-produced, but, in that case, thin interposed substance.
In amputated limbs we find the ends of the nerves at first, to a
greater or less extent, swollen, inflamed, spotted or deep red from
the blood effused in their sheaths, but subsequently subsiding
into a greyish, thick, tolerably firm, and not more fibrous-like
knot, from which delicate fibres spring for nerves ; if the end
of a nerve remain bare after amputation, it inflames violently,
and is gradually covered with very sensible granulations. We
not unfrequently observe in the scar, after amputation, several
of the nerves adhering in a loop ; for instance, the upper end of
the nerviis vagus united with the fifth cervical nerve. ^

(1) Flaubert, Mf^moire sur plusieurs cas de luxation, etc. in Repert. g^n.
d'Anat. et de Physiol, pathologiques, 1827, Vol. III. Part I. p. 102, mentions a
case of tearing of the last four nerves of the brachial plexus from the spinal
marrow, in consequence of violent extension in attempting to reduce a dislocation
of the upper arm ; the patient lived eighteen days. — Lohste'm, p. 165, § 158, states
that he has frequently seen the ganglionic nerves in the belly torn by large
tumours.

(2) For instance, if a nerve be included in the ligature applied on artery — if a
nerve be injured in bleeding. — Wardrop saw a case of severe neuralgia subsequent
to puncture of the nerve of one of the fingers, v. Med. Chir. Trans. Vol. XII.
p. 205. Similar symptoms occur from contusion of the popliteal nerve, and the
application of quicksilver to it. v. C. Bell, Surgical Observations, &c. p. 440.
London, 1816. — In another case, the symptoms were so severe after contusion of
the radial nerve, that amputation was required, v. Denmark in London med. chir.
Transact. 1813, Vol. IV. p. 48.

(3) V. /'/oH/e/ii- in Annales des Scienc. naturclles. Vol. XITI. Fevr. 1825, p. 113.
On the union and reproduction of nerves, v. Fontana, Traite sur le Venin de la
Vipere, Vol. II. p. 177. Florence, 1781. — Michaelis, Ueber die Regeneration
der Nerven, a letter to Pet. Camper. Kassel, 1795. — ^Irnemann, Ueber die
Reproduction der Nerven, Giittingen, 1786, and Versuche iiber die Rege-
neration in lebenden Thieren. Vol. 1. Gottingen, 1787, with pi. — Alex. Monro,
Observations on the structure and functions of the nervous system, p. 81, 83.
— Criiihshanli, Experiments on tlie nerves, particularly on their Reproduction,
in Phil. Transact. 1795, Vol. I. p. 177, (he seems to have been the first who
instituted accurate experiments with Hunter.) — Baronio in Memorie di Mate-
matica e Fisica della Soc. Ital. Vol. IV. p. 480. Verona, 1788. — Ilaightonm
Phil. Transact. 1795. Parti. \). \9Q. — Maijcr in ReiVs Archiv f. d. Physiol.
Vol. II. )). 41'9. — van Home De iis, qure in partibus membri pra'sertim osseis
amputatione vulncratis notanda sunt, p. 33. L. I>. 1803. — Swan and Dcscot. —
Bresc/iel in Diet, des Sc. m(''dicales. Vol. V. Art. Cicatrice. — Laneij in Revue
medicale fran^. et etrang. March, 1824, (also coni})resscd,) and in Annal(;s
des Sc. naturelle.s, April, 1827, Vol. X. p. 439. — Prevost in Memoires dc
la Soc. de PhysiipK! it d'llistoire naturelle de Geneve, 1826, Vol. I. — Eksirdm

Sect. XX.] Of the Nerves, 453

and ^e^ziusin Ars-Berattelse om Svenska-Lakare-Sallskapets Arbeten, p. 20,
Stockh. 1827, experiments on the division and reproduction of the nervus
plantaris in horses. \_G. Langstaff, Practical Observations on the healthy and
morbid conditions of stumps, in Med. Chir. Trans. Vol. XVI. p. 128. T.]

^255.

It does not appear remarkable that there should be, from the
great rarity of their organic diseases and from the delicacy of
their structure, great obscurity as to the vices of texture in
THE nerves. Inflammation of nerves, neuritis,^ occurs not
merely in consequence of injuries or exposure, but also spon-
taneously and from internal causes, and is known by swelling,
injection, and more or less extensive redness, with which there
is also usually softening or loosening, as well also as hardening
and thickening of the tissue, sometimes even adhesion to the
neighbouring parts; so that very many of the above de-
scribed vices of colour and consistence in the nerves appear
to be produced, in the greater number of instances, by preced-
ing acute or chronic inflammation. We must, however, dis-
tinguish the accidental colouring of a nerve which arises from
congestion of blood in a part, or from effused blood in the
neighbourhood, from true inflammation.^ Suppuration and
MORTIFICATION do uot appear to arise primarily in the nerves ;
still, however, they are not unfrequently in part ultimately de-
stroyed by these diseases, although they often resist them for a
pretty long while. ^ Various spurious formations frequently occur
in the nerves, to which we usually apply the general name,
NERVOUS SWELLINGS, tumoves tiervorum, neuromata,'^ from their
external appearance, as it is difficult to determine their texture.
These vary exceedingly in number, size, position, and texture ;
usually there is found but one, though sometimes also several,
and even very many in the same individual ; ^ their size varies
from that of a corn of hemp or wheat, to that of a walnut, an
Gggi and in some cases of a small melon ; ^ most commonly they
produce, during life, little and very painful knots in and upon
the membrane of the nerve ; ^ there have been however found
nervous knots on many of the cerebral, spinal, and even on the
ganglionic nerves.^ Finally, as to the structure of these nervous
tumours, they^are usually fatty, encysted, or fibro-cartilaginous,
which are situated in the cellular tissue of the nerves, and tear
asunder and separate from each other several nervous bundles,
which are otherwise healthy: in other instances, there are tuber-
cular or other masses of coagulated albumen attached at a
particular part of the diseased nervous sheath ; in still other
cases the medulla of the nerve appears to be diseased ; this
especially occurs in sarcomatous and cancerous swellings of the

454 Of the Nerves. [Part II.

nerves, in which the whole nerve is here and there swollen,
hardened, knotty, discoloured, and degenerated in a greater or
less degree throughout both its sheath and medulla.^

(1) De P/oz/fj-Me^ D. de myositide et neuritide. 4to. Tubing. 1790. — ^a^se D.de
neuritide. 4to. Halae, 1801. — Home in Trans, of a Soc. for the improvement of
med. and surg. Knowledge, Vol. II. No. 11. — Bettoli in Giorn. della Soc. med.
chir. di Parma, Vol. II. p. 256. — Martinet Memoire sur I'inflammation des Nerfs.
Paris, 1824 ; and in Revue Medic, fran^. et etrang. 1824, Vol. II. p. 329 — 354. —
Dugds Sur la neurite puerperale, etc. ib. Vol. III. p. 157 — 179. — Gendrin Histoire
anatom. des Inflammations. — On the inflammation of nerves in hydrophobia, in the
vicinity of the bitten part, Autenrieth D. de hactenus praetervisa nervorum lustra-
tione in sectionibus hydrophoborum, Tubingen, 1802, has especially treated. —
Brandreth, in Edinb. med. and surg. Journ. April, 1825, No. 83, saw in a case of
hydrophobia, considerable inflammation throughout a large portion of the
nerve. — Hertwig found only in two out of many mad dogs, the nervi vagi and
sympathetici reddened at certain spots, v. Hufeland's Journ. 1828, Supplement,
p. 55. — Reil Ueber Erkenntniss und Cur. der Fieber, Vol. IV. p. 56, found, in a
case of typhus, several of the nerves inflamed, and improperly considered this
accidental complication as the cause of the disease, whilst it was, at the utmost, its
consequence. — Weinhold also found inflammation of the nerves in nervous fever.
V. Kritische Blicke auf das Wesen des Nervenfiebers und seiner Behandlung.
Dresd. 1814. — It is not surprising that acute neuralgiae, viz. tic doloureux, proso-
palgia, ischias nervosa, &c. should be considered as arising from inflammation of
the medullary part and sheaths of the nerves ; this may indeed occur in some
cases, but by no means in all. — Some interesting cases, besides those already
mentioned, are described in Swan and Descot. — Sevres in Magendie's Journ. de
Physiologie, 1825, Vol. V. No. 3, p. 233, (the ganglion gasseri, and the larger
parts of the fifth pair of nerves.) — Ahlberg and Retzius in Ars-Berattelse om
Svenska Lakare-Salskapets Arbeten, lemnad af Ekstrdm, 1826, (the ganglia of
the lumbar nerves.) — Pelletier in Revue medicale franf. et^trangdre, Nov. 1827,
(the ulnar and median nerves in tetanus, after compound fracture of the arm.) —
Lohstein has seen the sympathetic nerves inflamed several times.

(2) Practical anatomists will readily grant how difficult it is to decide, whe-
ther the nervous sheaths and the nervous matter are only apparently or actually
inflamed on account of irritation, congestion, extravasation of blood, &c. I have
only seen actual inflammation of nerve up to this time, in consequence of acci-
dental or intentional injury. — Morgagni once saw, in the axis of the ischiatic
nerve, a long vessel filled with blood, almost a line thick, v. Epist. LXX. 10.

(3) Morgagni, Epist. L. 11 and 55, found, in a popliteal aneurysm, the nerve
here situated almost completely destroyed, which I also have noticed in a similar
case. In a large tumour running into suppuration in the region of the parotid
gland, one part of the facial nerve was completely destroyed, v. Billard in
Archives de Medec. Vol. VI. p. 347.

(4) Spangenberg Ueber Nervenanschwellungen in Horn\s Archiv f. med.
Erfahrung. Vol. V. p. 306. — /tlexarider D. de tumoribus nervorum. 4to. Lugd.
Bat. 1810. — /. L.Aronssohn D. Observations sur les tumeurs dcveloppecs dans l(>s
nerfs. 4to. Strasb. 1822. — Barkow Bemcrkungen iiber die Nervenanschwellungen
in Nov. Act. phys. med. Acad. Nat. Cur. Vol. XIV. Part II. p. 515, pi. 32,
witli engravings. — Some cases, besides those already (juoted in Swan and Descot.
Further Valsalva, v. Morgagni, Epist. L. 15. — Chcsclden Anatomy of the human
Body, p. 256, pi. 28, 1741. —Petit in Memoires de I'Academ. de Chir. Vol. I.
p. 90. — Pet. Camper in Demonstrat. anat. pathol. L. I. Cap. 2. § 5. — van
Gesscher Ueber natur u. Heilart der verschiedenen Arten von Gesciiwiilston.
p. 65. Lei])/,. 1787. — Ev. Home in Transact, of a Soc. for the improvement of med.
and surg. Knowledge, Vol. II. No. 11, ]).152. — IMssct in Mem. of the medic. Soc.
of London, Vol. II L j). 58. — Encycloi)edie metliodiciue de la Chirurgie, Vol, II.
p. 41-2. — /iiV.//rt/ Allgcmeine Anatomic iibcrs. v. Pfaff, Thl. I. Parti, p. 303. —
Marandcl in Bulletin de la Soc. de Medec. App. zum Journ. de Mcdec. continue,

Sect. XX.] Of the Nerves. 455

Vol. XL — Neumann in von Siehold's Samml. chir. Beobachtungen, Vol. I.
p.-5'i, — Mojon and Covercelli, ib. Vol. I. Part III. — Adelmann, ih. Vol. III. p. 177.
— Weinhold Ideen iiber die abnormen Metamorphosen der Highmorsliohle.
Leipz. 1810. — Odier in Manuel de Medecine pratique, p. 278 and 362. Paris and
Geneva, 1811. — Gooch, Cases and practical Remarks in Surgery, Vol.11. —
Ch. Bell, Operative Surgery, Vol. II. p. 161. — Zagorsky in Memoires de Peters-
burg, Vol. III. p. 219. — Rudolphi, v. Oppert. — Sidillot in Journ. general de
Medecine. Aout, 1814, p. 380. — Schiffner in T>exi Oe%\XPAc\\. medic. Jabrbiichern,
Vol. IV. Part IV. p. 77—90 ; and Vol.VI. Part IV. p. 44—54, with engravings,
(very many on several of the cerebral, spinal, and ganglionic nerves of two bro-
thers, who were cretins.) — Heineke D. de mastodynia nervosa. 8vo. Berol. 1821,
with engravings. — Berndt in Rust's Magazin f. d. ges. Heilk. Vol. XIII. Part I.
p. 159. — Wernery in Hufeland's Journ. der prakt. Heilk. May, 1823, p. 107. —
Lohstein de Nervi sympathetici hum. fabr. et morbis, § 157. — Ollivier Ueber das
Riickenmark, u. s. w. d. v. Radius, p. 2. 12mo. Leipz. 1824. Beobachtung 27. —
Hesselbach Beschreibung der pathol. Pr'aparate zu Wurzburg, 1824, p. 361,
No. 274, p. 362, No. 596, 641. — Ehrmann Compte rendu sur les travaux ana-
tomiques, p. 36. Strasb. 1827. — G, Sandifort Museum anatomicum. Vol. HI.
p. 148, No. 41. — Cruveilhier Anatomie pathologique, Livraison, I. Paris, 1828,
pi. 3. — Pring, V. Ahercromhie. — I have, up to the present time, found three
nervous knots, and all of them small, one as large as a date seed on the median
nerve, another as big as a pea, and a third of the size of a vetch seed on a cuta-
neous nerve, v. Verzeich., No. 2317, 2318, and 8853.

(5) To wit, in the cases of Schiffner, Cruveilhier, Barkow. Richerand found a
nerve, forming a whole row of spindle-like swellings, v. Descot, p. 118.

(6) This was found by Dubois in the median nerve, v. Spangenberg. As large
as a hen's eg^ and thereabouts, described by Alexander, Home, Aronssohn, Heineke,
Ehrmann, and Sandifort.

(7) Wood, On painful subcutaneous Tubercle, in Edinb. med. and surg. Journ.
Vol. VIII. p. 283 and 429, and Jaumes D. sur une espece de tumeur squirrheuse
enkystee, attribuee mal-a-propos k une affection des nerfs. Paris, 1828. Both
writers consider that they were not nervous tumours, but fibro-cellular or carti-
laginous tumours, which, surrounded by hardened and thickened cellular tissue,
indented themselves into the nerves ; but I doubt this very much, as in the in-
stances before me, the knots are distinctly situated in the nerves themselves, and
not in the tissue of their coat ; the extreme pain which they give rise to also
opposes this view, as numerous other and large swellings press upon the cuta-
neous nerves, and stretch them, without giving rise to similar symptoms. Obser-
vations on this kind of knot are given by Cheselden, Camper, Bisset, Siebold,
Neumann, Swan, Descot; similar cases are related by Portal Cours d'Anat.
medicale, Vol. IV. p. 247. — Pearson, in Medical Facts and Observations, Vol. VI.
p. 95. — J. Thomson, in Edinb. med. and surg. Journal, Vol. VI 11. p. 289. — New-
bigging, p. 289. — Gillespie, ib. -— Marshall Hall, ib. Vol. XL p. 466. — Windsor,
ib. Vol. XVII. p. 261.— Nicod Nouv. Journ. de Medecine, Nov, 1818.— Cases
of Marjolin, Chaussier., and Fabricio, mentioned by Descot, p. 106. — Jacopi Pros-
petto della Scuola di Chirurgia pratica, Vol. I. cap. 9, Milano, 1813. — Mon~
teggia Instituz. chir. Vol. 11. cap. 14, p. 197. Milano, 1813, &c.

(8) For instance, in the optic nerve of a blind person, a small hard knot,
rather larger than a hemp-seed. v. IShlillot Journ. de Medecine, Vol. L. Aug.
1814, p. 380. — In the fifth nerve, Dupuytren, v. Descot, p. 20; Leveque Las-
source. V. Diet, des Scienc. medic. Art. Cancer. — Weinhold. — Schiffner. — On the
facial nerve, Schiffner, and Wishart in Edinb. med. and surg. Journ. July, 1822.
On the auditory nerve, Schiffner. — On the pneumogastric nerve, Schiffner and
Barkow. — On the recurrent nerve of Willis, Schiffner. — On the brachial nerve,
Cheselden, Petit, Home, Gooch, Delaroche, and Petit Radel, v. Diction, de Chir.
de I'Encyclop. method. Art. Tumeur, Dubois, v. Spangenberg, Alexander, Odier,
Aronssohn, Heineke, Hesselbach, Sandifort, Pring, and myself. — On the dorsal
and lumbar nerves, Ollivier and Schiffner. — On the nerves of the lower extre-
mities, Valsalva, Schiffner, Spangenberg, Dell, Ehrmann, Berndt, Hesselbach, Wer-
nery.— On the abdominal nerves, de Haen, \. Lieutaud Hist. Anat. med. L. 11.

456 Of the Nerves, [Part II.

Sect. 6, Part II. p. 251, Obs. 787; <x\\A Descot, p. 120 and 121.— On the sym-
pathetic nerve and its ganglions, v. Blchat, Lohstein, Hesselbach and Cruveilhier.
(9) This occurs in all the nerves, but most frequently in the optic, which I
have noticed several times. I have, however, once seen it on the ischiatic nerve,
at its origin, and in the suprascapular nerve, which was affected and degenerated
into knots, by an osteosarcom situated in the upper arm ; regarding the latter,
V. my Selt. Beob. Part I. p. 83, pi. 2. I can, after what has been stated above
concerning medullary sarcom, perhaps here notice how incorrect the opinion
is, which considers this as a degeneration of the nervous medulla.

§ 256.

Lastly, we also occasionally observe irregularities in the
nerves as to their contents. Thus the cellular tissue,
which forms the nervous sheaths and connects the several
fibrils of a nerve, is here, as elsewhere, affected with infiltra-
tion OF water, lymph, blood, &c. ; this is most commonly
and distinctly the case in the larger nerves, viz. in the ischiatic,
which has been found not unfrequently dropsical after active
neuralgia, probably depending on chronic inflammation.^ Stony
AND BONY concretions^ havc also been observed in rare cases
on the nervous sheaths and in the cellular tissue of nerves, but
are extraneous to the nervous matter. In a few instances,
there has been observed a peculiar irritation in the nerves,
from extraneous bodies which have accidentally entered
them and remained there for a long period.^

(1) Dom. Cotunni De ischiade nervosa commentarius, Neapol. 1764, reviewed
in SandiforVs Thesaurus, Vol.11. No. 19, p. 403— 4.51. Wien, 1770. Neapol.
1780. Leipzig, 1793. Further, the other works on this disease, on Prosopalgia
and Neuralgia in general.

(2) For instance, on the optic nerve, Blegny Zodiac. Gall. Ann. I. April,
Obs. 14, p. 81. — Cheneau Obs. med. Lib. I. cap. 1, Obs. 2, Lyons, 1673. —
Schurig Lithologia, p. 100, 250. — Walter Observ. anat. p. 42, on the supra-
scapular nerve. — Rudolphi v. Oppert. On a tumour of the first dorsal nerve, v.
Ollimer Trait^ de la Moelle Epini6re, &c. case 27. On the phrenic nerve. Camper
in Syiip De lithotomia. 4to. Amstel. 1761.

(3) A piece of a ball in the radial nerve, v. A. Denmark, in Med. chir. Trans.
Vol. IV. p. 48, for which the arm was amputated. A piece of porcelain remain-
ing in the cheek fourteen years produced tic doloureux, which subsided on
the removal of the extraneous body. v. Jeffreys, in London med. and phys.
Journal.

END OF VOL. I.

R. CLAY, PRINTER, liREAD-STREET-IIILL, CHEAI'SIDE.

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