Digitized by the Internet Archive in 2015 https://archive.org/details/cyclopaediaofan4184todd_0 THE C Y C L O P M D I A ANATOMY and PHYSIOLOGY. VOL. IV,— PART II. S T A W R I 1849-1852 THE CYCLOPAEDIA OF ANATOMY and PHYSIOLOGY. EDITED BY ROBERT B. TODD, M.D. F.R.S. FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS; PHYSICIAN TO KING’S COLLEGE HOSPITAL; AND FORMERLY PROFESSOR OF PHYSIOLOGY AND OF GENERAL AND MORBID ANATOMY IN KING’S COLLEGE, LONDON, ETC. ETC. YOL. IV. — PART II. STA -WRI 1849—1852 15704 LONDON LONGMAN, BROWN, GREEN, LONGMANS, & ROBERTS. ■ -Id To Ad, STATISTICS. 801 In such instances, there is little appearance of any thing morbid beyond the increase of size. The contained blood is usually very dark, and the spleen shares the deepening of colour. By long duration, the capsule of the organ and the fibrous tissues generally, be- come somewhat thickened, but in other re- spects the texture is little altered. In the second class, in which the swelling is pro- bably produced by a peculiar state of the blood ( dyscrasia ), and is certainly associated with a class of blood diseases, the texture of the organ is usually much altered. The size of the spleen is often astonishingly increased, so that it possesses a volume of from 100 to 300 cubic inches, and a weight of 10-20 lbs. The increase includes, besides blood, a considerable quantity of a fibrinous material, the nature of which, and its relations to the healthy organ, are at present little known. The colour and consistence are of every possible gradation ; from greyish to deep brownish red, or from a soft, friable mass, to a dense, firm, and almost fibrous texture. There is a general relation of these changes to the date and duration of the swelling ; thus in acute or recent cases, the organ is usually soft and of a dark colour, while by long continuance, or in chronic diseases, its consistence is greatly increased, and its colour, as well as that of the contained blood, is much paler or greyer than natural. Atrophy of the spleen, or slow and permanent diminution of its size, is much more infrequent than the preceding converse condition. It is associated with similar varieties of colour and consistence. Inflammation of the spleen. — The peritoneal surface of the organ shares in the diseases of this structure generally, and an inflammation of this part of the serous membrane not un- frequently accompanies the enlargements pre- viously mentioned. The exsudation and re- sults are no way peculiar. Concerning in- flammation of the parenchyma of the spleen little can at present be said. The large and numerous veins which it contains are liable to inflammation, the secondary being the more frequent form of phlebitis which affects them. As regards other morbid products, organ- ised and unorganised, the spleen offers no- thing deserving a special notice. Bibliography. — M. Malpighi, De Liene, in Exercitationibus de Yiscerum Structura, Loud. 1GS9. 12. F. Ruysch, De Glandulis, Fibris, Cellu- lisque Lienalibus, Epist. Anat. Quart. Opera omnia. A. V. Leeuwenhoek, Microscopical Observations on the Structure of the Spleen, Phil. Transact. 1706, p. 2305. T. Douglass, Observations on the Glands in the Human Spleen, Phil. Transact. 1714, p. 499. IV. Stuckeley, Of the Spleen, its Description and History, Uses and Diseases, Lond. 1722. B. 8. Albin us, De Liene, in Anotat. Academ. lib. vii. cap. 14. p. 84. De Lasone, Histoire Anatomique de la Rate, Memoires de l’Academ. de Paris, 1754. T. Lieutaud, Observation sur la Grosseur Naturelle de la Rate, Mem. de l’Acad. de Paris, 1788. W. IJew- son, Experimental Inquiries, Lond. 1776 ; et Opus Posthumum, Lugd. Bot., 1786. L. et T. P. Asso- lanti, Reeherches sur la Rate, Paris, 1801. A. Morcs- ehi, Del vero e priraario Uso della Milza nell ’homo VOL. IV. e in tutti gli Animali Vertebrati, Milano, 1803. JBenj. Rush, An Inquiry into the Functions of the Spleen, & c., Philadelphia, 1806. Everard Home, On the Structure and. Uses of the Spleen, Philos. Transact, for 1808, p. 45. ; further Experiments on the Spleen, p. 133. ; Experiments, &c., ibid. 1811. C. F. Heusinger, Ueber den Bau und die Verrichtung der Milz, Eisenach, 1817. F. Tiedemann und L. Gmelin, Versuche iiber die Wege, auf welchen Sub - stanzen aus dem Magen und Darm ini Blut gelan- gen, iiber die Verrichtung der Milz und die gehei- men Hamwege, Heidelberg, 1820. T. Hodgkin, On the Uses of the Spleen, Edinb. Med. and Surg. Journ., 1822, p. 83. Dobson, Lond. Med. and Phys. Journal, 1830, Oct. G. C. Holland, Physiology of the Foetus, Liver, and Spleen, London, 1831. T. Muller, Ueber die Structurder eigenthiimlichen Kiir- perchen in der Milz einiger pflanzenfressender Sau- gethiere, Miill. Arch., 1834. T. C. H. Giesher, Spleno- logie, oder anatomisch-physiologische Untersuchun- gen iiber die Milz, Zurich, 1835. M. T. Evans, Lond. Edinb. and Dubl. Phil. Mag., 1833. FTov. Schwager- Bardeleben, Observationes Microscopicse de Glandu- larum Ductu Excretorio carentium Structura, &c. Berol. 1841. Th. v. Hcssling, Untersuchungen iiber die weissen Korperchen der menschlichen Milz, Regenzburg, 1842. I. Reid, Lond. and Edinb. Monthly Joum., 1843. Apr. Fr. Oesterlen, Beitrage zur Physiologie des gesunden und kranken Orga- nismus, Jena, 1843, pp. 41 — 52. E. Huschke, Lehre von den Eingeweiden und Sinnesorganen, Leipzig, 1844. Schlemm, Berliner Worterbuch der medicin. Wissenschaften, Band xxiii. Th. 435. Ch. Poelmann, Memoire sur la Structure et les Fonctions de la Rate, Annales et Bulletin de la Societe de Medeeine da Gaud, 1846, Dec. C. Handfield Jones, On the Yel- low Corpuscles of the Spleen, Lond. Med. Gazette, 1847, J an. John Simon, On the Thymus Gland, Lond. 1845. A. Kolliker, Ueber den Bau imd die Verrich- tungen der Milz, in Mittheilungen der Ziiricher naturforschenden Gesellschaft, 1847. A. Ecker, Ueber die Veranderungen welche die Blutkorper- chen in der Milz erleiden, in Zeitschrift fur rationelle Medicin, Band vi. 1847. C. B. Heinrich, Die Krank- heiten der Milz, Leipzig, 1847. T. Landis, Beitrage zur Lehre iiber die Verrichtungen der Milz, Zurich, 1847. Gerlach, Ueber die Blutkorperchenhalten- den Zellen der Milz, in Zeitschrift fur rationelle Medicin, Band vii. 1848. T. Bedard, Reeherches experimentales sur les Fonctions de la Rate et sur celles de la Veine Porte, Archives Generates de Me- dicine, Paris, 1848, Oct. Nov. Dec. ( Albert Kolliker.') *■ STATISTICS, MEDICAL. — The Sin- tistical Method; the Numerical Method. La Methode Numerique. — It is to be regretted that the use of numbers in any branch of scientific inquiry should have seemed to need a special name ; for the name has given rise to prejudices and misconceptions which could never have attached to the thing signified. There is no science which has not sooner or later discovered the absolute necessity of re- sorting to figures as measures and standards of comparison ; nor is there any sufficient reason why physiology and medicine should claim an exemption denied to every other branch of human knowledge. On the con- trary, they belong in an especial manner to the class of sciences which may hope to de- rive the greatest benefit from the use of num- * The Editor is indebted to his friend Dr. Brinton, for the translation of the article on the normal anatomy of the spleen from the German MSS. of Professor Kolliker, and for the sketch of the abnor- mal anatomy. 3 F 15704 602 STATISTICS. bers ; and even those persons who are most given to express doubts of the necessity or expediency of resorting to them, find them- selves constrained to sanction by their own practice what they condemn in theory. This is an all-sufficient answer to those who con- tent themselves with objecting in general terms to the employment of numbers in me- dical investigations. As to more minute and detailed objections, these will be found to be anticipated and disarmed by the simple con- sideration that they apply in reality not to the use, but to the abuse of numbers. The time has long gone by, when the absolute dependence of all science on observation and experiment could admit of question or dis- pute ; and, as no one in the present day claims for physiology and medicine any im- munity from the severe conditions which the very nature of things imposes, we are spared those appeals to authority which might for- merly have been required at our hands. The absolute necessity of observation and experi- ment towards the improvement of the science and art of medicine, in the widest acceptation of those terms, may, therefore, be safely taken for granted. The only points upon which any serious difference of opinion or divergence of practice exists, are the degree of care and accuracy which should be brought to bear on individual observations and experiments, the properties which fit single facts to be thrown into groups or classes ; the language which ought to be employed in expressing the ge- neral results of such classifications ; and the number of facts which, being so grouped or classified, may be required to establish a ge- neral proposition, or to furnish an accurate test or trustworthy standard of comparison. The human mind is so constituted, that it looks forward to an occurrence with a con- fidence proportioned to the number of times that it has been previously known to happen. Hence, the universal belief that all living beings will die, and that the sun will rise and set to-morrow ; hence, the somewhat less sanguine expectation that quinine will cure ague, and that vaccination will either pre- vent or modify small-pox ; hence, the little hope we have that a severe attack of Asiatic cholera will terminate favourably, and our absolute despair of the recovery of a patient seized with hydrophobia. In these, and other analogous cases, we have either the expe- rience of all mankind in all times and places, or that of large numbers of men in addition to our own. We do not require that the in- dividual occurrences which have created our confidence, our misgiving, or our despair, should be committed to paper, arranged in columns, and embodied in sums or averages. For practical purposes we are satisfied with our own impressions. But should a doubt be expressed, and supported by a show of reason or experience, whether vaccination possess the virtue generally attributed to it ; should some new preventive measure or mode of treatment be recommended in cholera, as su- perior to other plans previously adopted ; we ask for the specific facts which have seemed to warrant the doubts of the one party, and the recommendation of the other. If these facts are few, we naturally view them with mistrust, and are disposed to attribute them, at the best, to some coincidence ; or if, being more in number, their actual amount is stated in vague and general terms, we as naturally demand the precise figures. We feel instinc- tively, that common and familiar words are altogether wanting in precision ; that they take their meaning from the character of those who use them ; that, in a word, “ the sometimes of the cautious is the often of the sanguine, the always of the empiric, and the never of the sceptic ; while the numbers, 1, 10, 100, 1000, have but one meaning for all mankind.” But this mistrust of vague generalities of expression, is not the only form in which the more cautious and logical spirit of modern times embodies itself. The same misgivings are felt and expressed as to the propriety of committing the facts which are to serve as the materials of our theories to the uncertain keep- ing of the memory. We feel that a science built up of such materials, bears to true science the same sort of relation which tradition bears to history. It may not be destitute of valu- able truths and sound principles, but it must fail in that precision and delicacy of discrimi- nation which forms the peculiar attribute of true science as of true history. The history of medicine abounds with examples of impor- tant principles of treatment, and valuable re- medies discovered solely by the light of experience, based upon the mere recollection of a number of individual occurrences. In this way the efficacy of bark and arsenic in ague, of mercury in syphilis, and of iodide of potassium in certain forms of secondary disease was discovered. Indeed, it may be confidently affirmed that all our knowledge of remedies is traceable to this source ; and it is probable that we shall continue to be indebted to it for all future discoveries of importance. It is the natural method of discovery, and, as such, will necessarily maintain its ground. But a very little reflection will convince us of the utter inadequacy of this method to meet the strict requirements of the science, and the ever-vary- ing exigencies of the art of medicine. We may be able by its aid to sketch the broad out- lines, and mark the salient points of a science, but we cannot hope to fill in the details with all the lights and shadows which go to make up the perfect landscape. Still less can we satisfy ourselves or others as to the real merits of disputed questions by an appeal to un- written or loosely recorded experience. We all feel that there is no solution for our doubts short of an appeal to observations carefully and faithfully recorded, and summed up in the clear and simple language of figures. The use of mercury in syphilis, supplies us with an apt illustration of this truth. An experience, founded upon unrecorded and unnumbered occurrences, first recommended this remedy for the treatment of that disease ; but it would STATISTICS. appear that a counter experience of the same kind was continually leading to its disuse. Thus Morgagni tells us that, when he was quite a young man and went to Bologna, both methods of using mercury, internal and ex- ternal, were so far deserted, that he never saw any physician make use of them, or ever heard of his using them, for the whole space of eight years, during which he studied there.* * * § It would also appear that from the beginning of the sixteenth century up to the present time, there has always been a large number of sur- geons, who have either abandoned the mer- curial treatment altogether, or have restricted the use of the mineral to certain exceptional cases.f In the difference of opinion which prevailed upon this subject, the necessity of submitting the question at issue to the test of figures made itself so strongly felt, that a series of the most elaborate inquiries was undertaken at the instigation of governments, or by private individuals. These inquiries resulted in the collection of nearly 80,000 facts, by means of which the possibility of promptly healing ve- nereal sores without mercury and with but moderate risk of a relapse, or of the occurrence of secondary symptoms, was conclusively esta- blished. J To this same test of figures, all the questions which arise from time to time, as to the relative value of the several remedies recom- mended in the treatment of syphilis are, by common consent, submitted. A most con- vincing proof that the numerical method is, in all cases of doubt and difficulty, the means of solution to which men naturally resort, is af- forded by the treatise of Benjamin Bell, on this very subject, published in the year 1793. § Speaking of the treatment of incipient chancres by caustic, he notices the very important ob- jection, that the cure of the sores was often succeeded by buboes ; and he adds, that for a considerable time he was induced to suppose that the swellings of the glands, which thus take place after the cure of chancres, were more the effect of accident than of the method of treatment, and that they would have oc- curred under whatever management the sores might have been. The frequency, however, of their appearance, led him at last to suspect that he was mistaken, and further observation made it obvious that this was the case. He goes on to observe, “ As experiment alone could determine the question, I was resolved to employ this test. Of the first twenty patients who occurred with incipient chancres, in ten they were destroyed by an immediate and effectual application of lunar caustic, the remedy being employed, according to my usual custom at that time, instantly on my being called ; of the other ten, five were dressed with blue mercurial ointment, and five with common wax ointment. The sores to which caustic * Morgagni’s 58tfi Epistle. t See on this subject, the British and Foreign Medical Beview, vol. v. p. 4. + British and Foreign Medical Beview, vol. v. p. 7. § A Treatise on Gonorrhoea Virulenta, and Lues Venerea. By Benjamin Bell, vol. ii. p. 322. 803 were applied healed much sooner than the others, and next to them the sores that were dressed with mercurial ointment. But of the ten patients to whom caustic was applied, no less than eight had buboes, whilst only one bubo occurred in all the others; and it happened in one of the patients whose chancres had been dressed with mercury. I thought also that buboes appeared to be less frequent from the application of caustic, where mercury had been previously given. This fell within my ob- servation from time to time, with patients who had taken mercury, either of their own'accord or by the advice of others ; and appearing to be of importance, I was resolved to bring it like- wise to the test of experiment, and the result was as follows : of forty-eight patients with chancres in an incipient state, and exactly as they occurred in practice, one half was treated in the manner I have mentioned, by destroy- ing the chancres with caustic immediately on my being desired to see them, while all the others were put under mercury for eight or ten days before the application of caustic. In every other circumstance the method of treat- ment was the same. The difference, however, surprised me exceedingly. Of the twenty-four treated with the immediate application of caustic, twenty were seized with buboes; while only three buboes occurred in an equal number to whom mercury had been previously admin- istered.” The subject of the treatment of syphilis has been selected for illustration on account of the large use which has been made of figures in discussing the relative value of the two modes of treatment; and the extract from the works of Benjamin Bell as a proof that, long anterior to any discussions among me- dical men as to the value of the numerical method and the extent to which it might be applied in the solution of medical questions, men of shrewd common sense were driven to the use of numbers, as the natural and only means of solving difficult questions, and set- ting doubtful or disputed points at rest. Thus much, by way of introduction, the difference of opinion which prevails as to the value of the numerical method seemed to demand. The numerical or statistical method may be defined as the science which prescribes rides for the bringing together of scattered observ- ations, arranging them in classes, testing their sufficiency in point of number, and deducing from them, when so arranged, average and extreme results, fitted by their very condensa- tion to become standards of comparison and data for reasoning. The numerical method*, so defined and * The term, numerical method, will be used throughout this article in preference to the word statistics, or statistical method; for, properly speak- ing, statistics means the science of states (from the German word staat, a state), and is therefore syno- nymous with the terms “ political economy,” “ po- litical science,” “ social science.” The first use of the term statistics has been traced to Achenwal, Professor of History in Gottingen, who, in 174S, published an historical work, in which the phrase scientia statistica occurs for the first time. The use 3 F 2 80-4 STATISTICS. understood, comprises two distinct inquiries, the one relating to the individual facts which form the materials for the calculation of aver- age and extreme values, and the other re- ferring to the averages and extremes them- selves. This natural and convenient division of the subject it is proposed now to adopt. 1 . Of facts considered as the elements of sta- tistical inquiries. — Scientific inquiries are con- versant with two orders of facts : — namely, phenomena of varying intensity, and events brought about by a multitude of causes. The first class of facts enters very largely into the science of physiology ; the last class consti- tutes, though not to the exclusion of the first, the mass of the materials by which the prac- tical sciences of medicine and hygiene are built up. As examples of phenomena of varying inten- sity may be cited the pulse and respiration, the temperature of the body, the secretions of the skin, kidneys, and lungs, the evacuations of the bowels, the weight and stature of the body at different ages, and the muscular de- velopment and power of different nations and classes of persons. These phenomena, care- fully observed and recorded by the aid of the watch, the thermometer, the measure, the balance, and other instruments adapted to special purposes, become so many numerical values, having the same relation to the aver- ages deduced from them, as the more simple events expressed in units bear to the mean results for which they furnish the materials. As an example of an event brought about by a multitude of causes may be mentioned the event of death, governed, as to the age at which it occurs, by original strength or pecu- liarity of constitution, good or bad nursing and management in infancy, sex, occupation and habits of life, climate and place of abode, skilful or unskilful treatment in sickness ; in a word, by the varied influences which make one man to differ physically from another. This is an illustration taken from the science of hygiene. The alternative of death or re- covery from a disease induced by a cause or causes of variable intensity in persons of opposite sex and of different ages, with con- stitutions modified by the several agencies just specified, and submitted to different modes of treatment, is an example from the practice of medicine. Physiology furnishes illustrations of the same kind in those func- tions of the body (such as the cutting of the teeth, and the first appearance and cessation of the catamenia) which are dependent for of numbers as a necessary means of comparison in this work of Achemval, led men to confound the in- strument with tiie science. Dufau, in his Traite de Statistique, incorrectly derives the term statistics from the Latin status. The meaning attached to the words statism and statist, in the writings of poets, essayists, and dramatists, hears out the view just put forward of the proper signification of the term statistics. Mil- ton, for instance, speaks of “ statists and lawyers,” and elsewhere uses the term in the sense of a man haling political power and influence. Ford also uses the word in this latter sense. Soutli speaks of persons who called our religion statism. the period of their occurrence on peculiarity of constitution determined by the combined action of the influences already adverted to. Between these two orders of facts — phe- nomena of varying intensity, and events brought about by a multitude of causes — there is no other difference but that which is apparent on the face of each, namely, that each individual fact, in the one case, is repre- sented by a variable number, while in the other it is a simple unit. If, for example, we count the pulse of several men at the same age, we shall find that each separate observa- tion gives a different number; but, the event of death or recovery in cases of typhus fever will be recorded as a simple unit. In all other respects the two classes of facts closely re- semble each other; for the number of beats peculiar to the pulse of each individual, is as much the result of the concurrent action of several causes, as the event of death or reco- very from fever. The original and acquired constitution, towards the formation of which so many causes must have conspired, deter- mines the number of the pulse in the one case, and influences the event of the disease in the other. The two classes of facts are also equally fitted to supply the elements for the determination of average and extreme values ; for it is obvious that the mean and extreme numbers of the pulse, in males and females respectively, furnish as trustworthy standards of comparison and data for reason- ing, as the average number of men following different occupations who die before any spe- cified period of life, and the greatest age which they respectively attain. From what has been just stated, it will be seen that all the facts which form the mate- rials for our averages, are phenomena or events brought about by the concurrent action of a multitude of causes. The facts or events with which the physiologist and physician are conversant, are remarkable for the mul- tiplicity of the causes which conspire to pro- duce them. The subject of study is the hu- man frame, with its differences of sex, age, and inherited or acquired constitution, acted upon by the variable influences of climate, oc- cupation, and habits of life, and still further modified in disease by the treatment and re- gimen which may happen to be adopted. In consequence of the number and diversity of the influences brought to bear upon it, the human frame presents an object of study only less difficult than the human mind, affected by a like number and variety of moral causes, of which the true nature and force have to be unravelled by multiplied observations on the condition of mankind under different cir- cumstances ; the aggregate of such observ- ations constituting a great part of the science of statistics properly so called, and bearing to the practical science of government the same relation which pathology and therapeutics, based upon large collections of facts, do to the practice of medicine. Now this dependence of the individual facts or events with which physiology and medicine are conversant on the concurrent action of a STATISTICS. 805 multitude of causes, lias been urged as an ob- jection to the introduction of the numerical method into the service of those sciences. It is admitted, that the use of numbers and averages by the astronomer who deals with the more simple relations of matter, such as magnitude and relative position, and by the engineer who avails himself of its more simple properties, such as its hardness, tenacity and elasticity, have contributed to make the science of the one perfect, and the art of the other safe ; but it is contended that the use of num- bers cannot be extended beyond such narrow limits with safety or advantage, and that medi- cine and political economy lie beyond these limits. The actual practiceof mankind, founded upon an instinctive perception of the necessity of employing figures in the service of the phy- sician and statesman, may be fairly alleged as a sufficient answer to this objection ; but a little consideration will serve to show its futility. In the first place, it is self-evident that the exclusion of figures from the service of medi- cine, does not bring about the disuse of those very facts and events which are objected to as unfit to be employed as statistical or numerical elements. The physician will still persist in stating and recording the results of his expe- rience. He will still assert that he has sometimes observed this symptom in a certain disease, that he has often found that remedy beneficial, that he has almost never known such and such a mode of treatment to fail. Those who con- tend for the use of numbers in medicine, merely insist on the necessity of reducing the sometimes, the often , and the almost never to a more correct and intelligible form of expres- sion ; and the}' argue that it is utterly incon- sistent to object to the use of facts as mate- rials or elements of numerical propositions, and yet not to censure the use of these same facts as foundations for loose and inaccurate verbal statements. From this dilemma there is obviously no escape. But, though the ob- jection itself is futile, the misgiving of which it is the exaggerated expression is natural and well founded. It cannot excite surprise that the individual facts or events which own so many concurrent causes should be regarded as requiring, on the part of the observer, a greater degree of care in verifying, recording, collecting, and arranging them than would be necessary in the more simple cases already adduced ; and that both the facts themselves, and the numerical expressions in which they are embodied, should be viewed with a pro- portionate degree of distrust. From this mo- derate and reasonable view of the case, no advocate of the numerical method will be found to dissent. On the contrary, he will seek to strengthen it by giving due promi- nence to each separate ground of misgiving, and by laying down stringent rules for the guidance and governance of the observer. Before proceeding to detail some of these rules, it may be well to advert to a probable, and, indeed, obvious cause, of the distrust with which numerical data are sometimes regarded. Indiscreet advocates of the numerical method have sought to apply the general results of collections of cases expressed in the language of figures to the treatment of individual cases of the same disease, without making allowance for those differences between case and case which confessedly existed in the collections themselves. They have used a general prin- ciple, as if it had been a rigid and unbending rule of action ; forgetting that though, as the experience of assurance offices abundantly tes- tifies, the general results obtained from a large number of individual facts may be safely re- applied to an aggregate of facts of the same nature, they cannot be brought to bear on a single case, or on a small number of cases, without the greatest danger. Each case must be viewed in practice, first as a generality governed by some large law of prognosis, diagnosis, and treatment ; and secondly, as a specialty demanding a careful consideration of all its peculiarities. Among the rules which ought to govern the observer in the collection of facts destined to form the elements of averages, there are some of so simple and obvious a nature as to re- quire no discussion. Such are, the previous preparation of some simple and available form of register, by means of which the several facts may be committed to paper at the very time of observation, so that nothing maybe trusted to the memory ; the careful selection of the facts themselves ; the shaping of the inquiries which may be necessary to elucidate those facts as nearly as may be in the same terms ; the avoidance as much as possible of such leading questions as would be likely to bias the respondent, when the facts in question, like most of the particulars which make up the history of diseases, are dependent upon testi- mony ; and especially the purging of the ob- server’s own mind of prejudices and precon- ceptions in respect of the subject of inquiry. The careful selection of the facts which are to form the materials of our averages is by far the most important of these rules, and one which demands a little further consider- ation. If we consider the facts we are ob- serving in the light of phenomena, or events brought about by a multitude of concurrent causes, it will be obvious that care will re- quire to be exercised, not so much in verify- ing each phenomenon or event as that of which we are in search, as in ascertaining that all the concurrent causes or conditions are, or have been, in operation to bring about that phenomenon or event. The absence of a single cause or condition will vitiate the in- dividual fact, and impair or destroy the value of our average results. A few illustrations will suffice to show what is here intended. We are anxious to determine the true average frequency of the pulse in adult males, in a state of rest, and as free as possible from the influence of all disturbing causes ; but, either from ignorance or oversight, we count it in- differently in every position of the body, and at all times of the day. In this case, our facts cease to be comparable facts ; for it is well 3 r 3 806 STATISTICS. known, that both posture and time of day have a remarkable influence on the number of the pulse. Or, to take another case, we wish to ascertain the influence of some employment upon health (say that of the letter-press printer) ; but we overlook the important fact, that in every printing office, two or three very distinct occupations are carried on, of which the most important are those of the com- positor and pressman. Not being fully aware of this fact, and of the wide difference exist- ing between the two employments, we pro- ceed to extract from some mortuary register the ages at death of printers as a class, calcu- late the average age at death, and then proceed to group the whole class of printers with that large class of occupations carried on in-doors, with little bodily exertion, to which the com- positor alone properly belongs, but from which the pressman is, by the nature of his employment, excluded. In this case, we should have been misled by the common name borne by men following two really dis- tinct occupations, and our facts would again cease to be comparable facts. A third and apt illustration is afforded by the Asiatic cholera. We wish to compare two different remedies or plans of treatment ; but we administer the one remedy, or adopt the one plan, at the onset of the epidemic, and the other during its decline. Here, again, our facts are not comparable facts ; for it is one of the well- known characteristics of this disease, that it is more severe on its first occurrence than during the period of its decline. The same sort of error would be committed, if one remedy were administered in an early, and the other in an advanced, stage of the attacks themselves. The principle which these illus- trations are intended to enforce, is the ne- cessity of selecting, as the elements of the same average, facts strictly comparable, or, in other words, brought about by the same com- bination of causes. Over the intensity with which each cause acts in individual instances, the observer can exercise no control. His province is to ascertain that the same com- bination of causes is at work to bring about each phenomenon or event. If from ignor- ance or oversight he fails in this duty, he im- pairs the value of his facts, and vitiates his inferences in proportion to tiie number and force of the conditions that he has overlooked or omitted. In the observation and collection, therefore, of the individual phenomena or events which are to serve as materials for our average re- sults, the first precaution to be observed is, that those phenomena or events should be strictly comparable as regards the combination of causes by which they are brought about; or, as the French statists express it, we must ensure “ I'invariabilite de I’ensemble des causes jtossibles." The frequent omission of this most necessary precaution has given birth to the dogma of Morgagni — Non numerandee sed per- •pendendee sunt obseivationes — and to the most valid objections urged against the applica- tion of the numerical method in medicine. For the collection, arrangement, and classifi- cation of the facts which are to form the ma- terials of our averages, no concise rules can be laid down. The tabular forms must adapt themselves to the exigencies of each individual inquiry ; and must be more or less complk cated as the subjects of investigation con- sist of few or many particulars. In reporting cases, for instance, and in collecting and analyzing those recorded by others, tabular forms embracing many particulars are re- quired ; and the preparation of such forms demands unusual skill and care.'* The same remarks apply to the collection and classifi- cation of recorded experiences and opinions bearing on particular subjects of inquiry j- ; a numerical summary of authorities favourable and adverse to particular doctrines, consti- tuting what may be not inaptly termed the statistics of opinion. 2. Of the average and extreme results de- duced from observation. — The observer having exercised all due care in the observation of his facts, having grouped together only those events which owned the same combination of antecedents or causes ; and having further correctly performed the work of enumeration, has thus obtained certain average and extreme results, which are to constitute standards of comparison and data for reasoning ; the question naturally arises — are these average and extreme results sound and trustworthy standards and data, or not ; and what are the circumstances which render them the one or the other ? Common sense and experience combine to give an authoritative answer to this question. Our average and extreme re- sults are more or less sound and trustworthy, as the individual facts from which they have been calculated are more or less numerous. Where the facts upon which it is attempted to found a general principle, or to establish a standard of comparison, are very few, we are at once conscious of their insufficiency ; and the more readily when an attempt is made to apply the principle or standard in question to some important practical purpose. A better illus- tration of the futility of such an attempt can scarcely be found than the well-known test of Ploucquet. That author proposed to deter- mine whether or not a child was still-born by referring every doubtful case to a standard of comparison, founded upon three observ- * On this subject the late Dr. Todd, of Brighton, has written a very able work, which may be safely recommended to all who desire to enter upon such complicated investigations. The title of this work is : — The Book of Analysis, or a New Method of Experience, whereby the Induction of the Novum Organon is made easy of Application to Medicine, Physiology, Meteorology, and Natural History ; to Statistics, Political Economy, Metaphysics, and the more complex Departments of Knowledge. By Tweedy John Todd, M.D., of the Royal College of Physicians of London, &c. &c. 1831. f Reference may here be made to a paper pub- lished in the 3rd volume of the Journal of the Statistical Society of London, “ On the best Method of Collecting and Arranging Facts, with a proposed New Plan of Common- Place Book.” By the Author of this Essay. STATISTICS. 807 ations of the relative weight of the lungs and body ; of which three observations, one was made upon the body of an immature infant, so that the subjects of the observations were not strictly comparable. Though Ploucquet, in this procedure, offended against two of the most obvious statistical rules, his test con- tinued to be treated with undeserved respect, till comparatively recent investigations on a larger scale had demonstrated the little re- liance to be placed upon it. The most common attention to the ordinary daily occurrences of life would suffice to caution us against such errors as that into which Ploucquet fell. Coincidencesof the most startling character are constantly happening to put us on our guard against them. One which occurred to the wrriter of this article deserves to be put on record. Two cases of congenital absence of the larger pectoral muscle on the same side of the body, oc- curred, on the same day, among the out- patients of the King’s College Hospital, This defect he has never happened to observe within the wards of that Hospital or else- where, either before or since. A similar coincidence, though of a less striking cha- racter, presented itself in the same institution while the writer was noticing with some care and interest the complexion and physiognomy of patients suffering from pulmonary consump- tion. His own previous experience, in con- formity with the general opinion, had pointed out the fair complexion as that of the great majority of phthisical patients ; but the almost exclusive occurrence for several days together of the olive complexion, among patients labouring under that disease, had almost led him to discard his former opinion and that of the best authorities, and to embrace one which, as farther observation convinced him, would have been erroneous. Games of chance are constantly furnishing striking examples of these coincidences, in the shape of what is familiarly known as a run of good or ill-luck ; the same event, favourable or unfavourable, occurring many times in suc- cession, contrary not only to reasonable ex- pectation, but to the results of unerring cal- culation. On the other hand, the success of the bank, with only a slight calculated chance in its favour, but with a capital sufficiently large to await the inevitable change in the run of luck, vindicates the sufficiency of large numbers of facts. The great annual fluctu- ations, too, which take place in the balance of the receipts and expenditure of assurance offices, but the ultimate safety of their trans- actions, when extending over a long term of years and embracing a large number of in- surances, serve to enforce the same truth. The sufficiency for all practical purposes of large numbers of facts, may also be inferred from the remarkable uniformity observed to take place in the annual summaries of events brought about by the continued operation of the same combination of causes. The annual reports of the Registrar-General supply many illustrations of this principle. The illustration best suited to our present purpose, is one drawn from an event removed, by the very nature of the case, beyond the reach of ex- ternal influences, or only very remotely and indirectly amenable to them ; namely, the proportion of male and female births in suc- cessive years. In the eighth annual report of the Registrar-General (p. lxi.), a table is given, in which the number of males and females born, to every hundred living males and females respectively, is recorded for the seven years 1839-45. If we substitute 100,000 for 100, the table will read thus. Year. Males. Females. Excess of Males. 1839 6,498 6,211 287 1840 6,539 6,250 289 1841 6,580 6,289 291 1842 6,564 6,273 291 1843 6,597 6,305 292 1844 6,676 6,381 295 1845 6,622 6,329 293 The largest excess of male over female births, therefore, in these seven years is 295, anti the least 287, the average being 291; so that the extreme fluctuation amounts to only 8 births in about 6500, or considerably less than 1 in 800 ; while the excess or defect above or below the average of 291 is only 4 births, or less than 1 in 1600. If the causes which determine the births of males and females re- spectively could be assumed to be constant and uniform, these fractional fluctuations would express the divergences due to the insufficiency of the number of observations to express an absolutely true result. The close approximation actually obtained must be held to prove the sufficiency for every prac- tical purpose of results based upon large numbers of observations. Having thus shown, by two opposite ex- amples, the total insufficiency of small num- bers of facts, and the sufficiency, at least for practical purposes, of large numbers of ob- servations, it will be necessary to enter into a more detailed examination of the relative value of numbers of observations intermediate between these two extremes. From what has been already stated, it must be obvious that the degree of confidence to be reposed in results based upon different collections of facts must vary with the num- ber of those facts ; and that, other things being equal, the value of the results must increase with every addition made to that number. But it is only by actual observation, or by mathematical calculations based upon indisputable data, that the precise value of any particular number of facts can be deter- mined. Observation, indeed, is altogether unequal to give more than a vague and general idea of the relative values of small and large collections of facts ; so that we must ulti- mately resort to the mathematics both for authoritative decisions and safe guides. As, however, the large majority of mankind is destitute of that mathematical knowledge and 3 F 4 S03 STATISTICS. training which is essential to the appreciation of mathematical rules, it is desirable to show, by an appeal to the results of actual observ- ation, the increasing value of increasing col- lections of facts, as well as the rate of that increase. For this purpose, it is proposed to make use of some observations collected by the writer of this article. Having had occa- sion, a few years since, to bring together, from the pages of the Peerage and Baronetage, the ages at death of the male members of the En- glish aristocracy, dying 21 years and upwards, to the number of several hundreds, it ap- peared to be a favourable opportunity of test- ing the relative values of large and small numbers of facts, as well as of obtaining a rude approximation to a rule or measure of value. The ages at death, relating, as they do, to members of the same class in society, and taken without selection from the successive obituaries of noble families, constitute a col- lection of strictly comparable facts, well suited to the purpose in view. The following table, which embodies the results of these facts in their bearing on the question before us, has been formed in the following manner: — The several facts were first arranged in groups of 2.3 each ; two successive groups of 25 were then formed into groups of 30 ; the groups of 50, in like manner, into groups of 100, and so on, till the last totals in the table were ob- tained. The greatest and least averages ob- tained from each group of facts were then selected, and, with the range, or difference be- tween them, thrown into a tabular form. Number Average Age at Death. of Facts. Max. Min. Range. 25 69-40 50-64 18-76 50 66-44 55-20 11-24 100 63-70 56-85 6-85 200 62-38 57-61 4-77 400 61-10 58-24 2-86 800 60-84 59-67 1-17 V, J 1600 60-25 Now, if we assume the true average duration of life among the members of the Peerage and Baronetage, who have attained their 21st year to extend to 60 years (being the mean of I COO observations), and, for the sake of simplicity, substitute for the decimals in the table the whole numbers nearest to them in magnitude, it will follow that, in making use of the several groups of observations specified Number of Facts. Error in Excess or Defect. 25 9 , 50 5i 100 34 200 2| 400 14 800 0-i in the first column of the annexed table, we may have the errors in excess or in defect which are enumerated in the second column. These figures, then, represent the extreme error which could have been committed, in this particular case, by relying on 25, 50, 100, 200, 400, and 800 facts respectively. But it must be borne in mind, that this collection of facts is one which, from the very nature of the case, is likely to present a minimum of divergence between the averages deduced from the same number of facts ; for the several obituaries, from which the ages at death are taken, register the deaths of one and the same class, inhabitants of the same country, and split into family groups bearing a close re- semblance to each other. If, instead of a single class, exposed to similar influences, and not admitting of subdivision into smaller classes, we were to take the members of that large section of the community which is ge- nerally known as the upper and middle class, with their numerous subdivisions of employ- ment, and class them by fifties and hundreds, we should encounter a much more consider- able divergence. The results of such a com- parison for the class in question are embodied in the following table. Number Average Age at Death. of Facts. Max. Min. Range. 50 84-44 56-78 27-66 100 76-24 58-25 17-99 200 73-54 61-50 12-04 400 69-78 63-51 6-27 800 68-67 65-07 3-60 1600 67-93 64-84 3-09 3200 66-38 65-82 0-56 V V 6400 66-10 If, as in the former case, we take 66 years to be the true average age attained by the entire middle class, reckoning from 21 years of age, and reduce the range in each case to the nearest whole number, we shall have the following divergences. Number of Facts. Error in Excess or Defect. 50 14 100 9 200 6 400 3 800 2 1600 H 3200 o? In this instance, therefore, though we begin with 50 in place of 25 facts, we obtain a possible error in excess or defect of 14 years in place of 9| years. It must be obvious, then, that the errors to which averages de- duced from any given number of facts are liable, will vary with the nature of those facts ; and that the extent of possible error will bear STATISTICS. 809 a certain proportion to the number of the influences which are brought to bear on each unit of each collection of facts. It must not, however, be forgotten that the figures in these several tables represent only possible errors. It may happen that the first 25 observations brought together may yield an average differing by less than a single unit from the mean of thousands of observations ; and there is always a balance of probability in favour of the average even of a small num- ber of facts approximating more closely to the true average than to the extremes. That this is the case will be evident on the most cursory inspection of the following tables, of which the first is founded upon the facts Average Age at Death. 25 Facts. 72 Groups. 50 Facts. 36 Groups. 100 Facts. 18 Groups. 200 Facts. 9 Groups. 400 Facts. 4 Groups. 800 Facts. 2 Groups. 69 1 G8 0 67 0 66 3 1 65 4 0 64 9 2 1 63 3 3 1 62 3 5 3 3 61 9 6 3 0 3 1 6® 9 4 3 2 0 1 59 8 5 3 3 0 58 6 5 1 1 1 57 5 i 3 56 6 3 55 1 1 54 3 53 1 52 0 51 1 Average Age at Death. 50 Facts. 128 Groups. 100 Facts. 64 Groups. 200 Facts. 32 Groups. 400 Facts. 16 Groups. 800 Facts. 8 Groups. 1600 Facts. 4 Groups. 3200 Facts. 2 Groups. 84 1 83 0 82 0 81 0 80 0 79 0 78 0 77 0 76 1 1 75 1 0 74 4 1 1 73 2 1 0 72 2 1 0 71 5 0 0 70 4 4 0 1 69 7 3 2 0 1 68 13 5 3 1 0 1 67 17 9 4 4 1 0 <6 II 20 13 14 4 2 1 2 65 5 13 2 4 3 2 64 16 6 2 2 1 63 11 1 2 62 10 4 1 61 3 1 1 60 3 0 59 0 0 58 0 1 57 3 810 STATISTICS. relating to the duration of life of the aristo- cracy, and the second on the facts relating to the duration of life of the combined upper and middle classes. For the sake of per- spicuity, the average of all the facts in either table is distinguished by a larger type. These tables speak for themselves. In the first table, for instance, the small number of 25 facts is seen to yield the same average as the total of 1800 facts in no less than 9 in- stances, or one eighth of the whole number ; while in 26 out of 72 instances, or more than one third, the average of 25 facts exceeds or falls short of the average of 1800 facts by only a single unit. In like manner, it ap- pears from the second table, that in 20 cases out of 128, or little less than one sixth, the average of 50 facts coincides with that of 6400 facts; and that in 42 out of 128, or nearly one third, it differs from it only by a single unit. Without entering into a minute examination of the other columns of the two tables, it will suffice to state that the proba- bility in favour of an average of a given num- ber of observations coinciding with the true average increases with the number of observ- ations ; so that we are again brought back to the expediency of collecting large numbers of observations wherever it is practicable so to do. In using small numbers of facts to establish data for reasoning or standards of comparison, we are bound to speak with dif- fidence of their sufficiency, and we ought to regard them rather in the light of probabilities requiring to be strengthened by other pro- babilities, as weak arguments require to be supported by additional reasons, than as, in themselves, worthy of great reliance. Ac- cording to this view of the case, we are not precluded from the use of averages drawn from small numbers of facts. The employ- ment of such averages with this proviso is an absolute scientific necessity ; for in many in- stances we are prevented by causes too nu- merous to specify from bringing together facts by the hundred or the thousand, and yet, were we to reject the smaller numbers as in- admissible, we should be thrown back upon the still more loose and less trustworthy general statements from which it is the pro- vince of statistics to rescue us. An examination of the two foregoing tables, as well as of those which display the extreme variations between the averages derived from the same numbers of facts, will serve to prove the hopelessness of any attempt to establish by observation rules for measuring the rela- tive value of averages derived from different numbers of facts. It must be equally evident that no deductions drawn from observation can enable us to state the actual liability to error of any given number of facts, considered as facts, without reference to their peculiar nature. To determine this liability to error belongs solely to the mathematics. If, on the one hand, observation is unable to supply us with the means of testing the true liability to error of conclusions based on a given number of facts, considered as facts, without reference to their peculiar nature, it must be evident, on the other hand, that ma- thematical formulae deduced from abstract reasoning can only supply us with the means of measuring the value of a given number of facts in this their abstract relation, without taking into account the varying quality of the facts themselves. But as it is of the utmost importance to be able to test the abstract sufficiency of a given number of facts to establish a principle or to supply a sound standard of comparison, it will be necessary to enter at some length into this part of our subject. The facts already adduced, must have abundantly shown that the limits of deviation from a true average result are wider or nar- rower as the number of facts from which the average is drawn is smaller or greater. Many eminent mathematicians, and M. Poisson among the number, have laboured to convert this general principle into an exact numerical expression or formula, applicable as a test of the true value of larger or smaller collections of facts, and as an exact measure of the limits of variation. M. Gavarret, in his work on Medical Statistics, contends successfully for the introduction of these formulae into the service of the medical man ; and adopting the sentiment of Laplace, “ Le systeme tout entier des connaissances humaines se rattache a la theorie des probabilities, ” he insists that medical statistics, or, as we prefer to term it, the Numerical Method, applied to medicine, is nothing more nor less than a special appli- cation of the Calculus of Probabilities, and the Theory of large Numbers ; and that as such it is the most indispensable complement of the experimental method. In other words, he deems it incumbent on the medical man to apply to his numerical results the corrections supplied by the formulae of the pure mathe- matics ; and before he concludes that any number actually obtained by observation is a true representative of a fact or law, to deter- mine whether that number may not be com- prised within the limits of possible variation. M. Gavarret illustrates the necessity of this precaution by applying his mathematical for- mulae to a great variety of results based upon observation ; but he especially insists upon bringing the alleged efficacy of certain modes of treatment to this searching test. The most convenient course to adopt, in reference to these formulae, will be to present the calcula- tions based upon them in tabular forms, and then to apply these calculations to one or two striking examples. The following table presents at one view the possible errors corresponding to average mortalities deduced from different numbers of observations. It is obvious that the table is equally applicable to other contingencies of the same kind, where one of twm events is possible in every instance. The mode of using it will be presently explained and illus- trated. STATISTICS. 811 Tabic of the possible Errors corresponding to Average Mortalities deduced from different Numbers of Observations.* Number of Ob- serva- tions. Average Mor- tality by Observation. Number of Deaths. Number of Re- coveries. Possible Error. Number of Ob- serva- tions. Average Mor- tality by Observation. Number of Deaths. Number of Re- coveries. Possible Error. 25 0-200000 5 20 0-226274 500 0 300000 150 350 0-057965 50 OT 00000 5 45 0-120000 500 0-350000 175 325 0-060333 50 0-200000 10 40 0 160000 50 0-300000 15 35 0 183302 600 0100000 60 540 0 034641 600 0-150000 90 510 0-041231 100 0 '100000 10 90 0-084852 600 0 200000 120 480 0-046188 100 0-150000 15 85 0-100994 600 0-250000 150 450 0-050000 100 0-200000 20 80 0-113136 600 0-300000 180 420 0-052915 100 0-250000 25 75 0-122474 600 0-350000 210 390 0 055077 100 0-300000 30 70 0-129614 100 0-350000 35 65 0-134906 700 o-iocooo 70 630 0 032071 700 0-150000 105 595 0038173 200 o-iooooo 20 180 0 060000 700 0-200000 140 560 0-042762 200 0-150000 30 170 0-071414 700 0-250000 175 525 0-046291 200 0-200000 40 160 0-080000 700 0-300000 210 490 0 048990 200 0-250000 50 150 0 086602 700 0-350000 245 455 0-050990 200 0-300000 60 140 0-091650 200 0-350000 70 130 0-095392 800 0100000 80 720 0-030000 800 0 150000 120 680 0 035707 300 o-iooooo 30 270 0-048990 800 0-200000 160 640 0-040000 300 0-170000 45 255 0 058309 800 0-250000 200 600 0-043301 300 0-200000 60 240 0-065320 800 0-300000 240 560 0 045826 300 0-250000 75 225 0 070711 800 0 350000 280 520 0 047697 300 0 300000 90 210 0-074833 300 0-350000 105 195 0-077889 900 0 100000 90 810 0 028284 900 0-150000 135 7 65 0 033665 400 0-100000 40 360 0 042426 900 0 200000 180 720 0-037712 400 0-150000 60 340 0-050497 900 0-250000 225 675 0 040825 400 0-200000 80 320 0 056568 900 0-300000 270 630 0 043205 400 0-250000 100 300 0-061237 900 0-350000 315 585 0 044969 400 0-300000 120 280 0-064807 400 0 350000 140 260 0-067454 1000 o-iooooo 100 900 0 026833 1000 0 150000 150 850 0 031937 500 0-100000 50 450 0-037947 1000 0 200000 200 800 0-035777 500 01 50000 75 425 0 045167 1000 0-250000 250 750 0-038730 500 0-200000 100 400 0 050596 1000 0-300000 300 700 0 040988 500 0-250000 125 375 0 054772 1000 0-350000 350 650 0-042661 The use of this table will be best explained by an example. Let us suppose that a me- dical man, having, for a long time, adopted a particular course of treatment in a certain malady, has arrived at the following results : 1-20 deaths, 680 recoveries, 800 cases. The average mortality in this case would * This table is an abbreviation of one given at p. 142. of Gavarret’s work, but with additional cal- culations based on the same formula, for the numbers from 25 to 200 inclusive. The formula from which the figures in the column of possible errors have been calculated is, in which m represents the number of times that an event a has happened, n the number of times that an event b has happened, and /u the total number of events : so that m + n = /*; — the average ffe- quency of the events m,as obtained by observation ; and m /2.m.nan( jA /2 .m.n V 2V m W ~~P the limits within which the true average, as corrected by the formula, lies. be or 0-150000 (see the second column of the table for 800 facts and 120 deaths). At first sight the medical observer would ap- pear to be justified in asserting that under li is method of treatment the mortality was at the rate of only 150,000 in 1,000,000 patients, or 15 per cent. But this assertion would be immediately met by the objection that the number of facts is not sufficient to justify this statement, that an average deduced from so small a number as 800 facts can only be re- ceived as an approximation to the truth, and that it requires to be corrected by the aid of the figures in the table. Accordingly, on referring to the column of possible errors corresponding to 800 cases and 120 deaths, we find that the error in ex- cess and defect to which this number of facts is liable, amounts to 0"035707, which error must be added to and taken from the O' 150000, the result of actual observation. It follows, therefore, that the true result must he somewhere between the numbers 0- 1 50000 added to 0-035707, or 0-185707, and 0 150000 dim. by 0-035707, or 0-114293. 8)2 STATISTICS. So that instead of asserting, as we should seem justified in doing, that the mortality under the influence of the treatment adopted amounted to 15 per cent., we could only claim a mortality comprised between the numbers 185,707 and 1 Id, 293 in 1,000,000 cases: or approximatively between the numbers, 19 and 1 1 per cent. Uncorrected observation, therefore, would give, as the result of the treatment adopted, 15 per cent., while corrected observation would give some number between 19 and 11 per cent. The application of the formula given in the note to an actual case will be more instruc- tive than an imaginary example. M. Louis, in his Reclierches sur In Ficvre Typhoide, has attempted to illustrate the treat- ment of typhus fever, by minutely analysing HO cases.' The result was as follows : — Number of deaths (m) 52 Number of recoveries (n) 88 Total - (/a) HO. The mortality in these cases was therefore _y_, or 0 37143 ; and if we were to take this mortality as the strict expression of the re- sults of the treatment adopted, we should shape our proposition as follows: — The mor- tality of typhus fever, under the treatment adopted by M. Louis, amounted to 37, H3 deaths in 100,000 patients ; or, in round numbers, 37 deaths in 100 patients If, now, vve proceed by means of the formula referred to, to determine the possible error at- taching to this proposition (i. 1841, p. 257. 3 K 2 868 TEETH. Fig. 550. Magnified portion of section of incisor of Horse ; c cement, e enamel, d dentine. the tooth, following the sinuous wavings of the lobes of dentine (rf), which diverge from the central pulp-cavity, a. The inflected fold of cement c runs straight for about half a line, and then becomes wavy, the waves rapidly increasing in breadth as they recede from the periphery of the tooth ; the first two, three, or four undulations are simple ; then their contour itself becomes broken by smaller or secondary waves; these become stronger as the fold approaches the centre of the tooth, when it increases in thickness, and finally terminates by a slight dilatation or loop close to the pulp-cavity, from which the free margin of the inflected fold of cement is separated by an extremely thin layer of dentine. The number of the inflected converging folds of dentine is about fifty at the middle of the crown of the tooth figured, but is greater at the base. All the inflected folds of cement at the base of the tooth have the same complicated disposition with increased extent; but, as they approach their termination towards tfie upper part of the tooth, they also gradually diminish in breadth, and consequently penetrate to a less distance into the substance of the tooth. Hence, in such a section as is delineated (fig. 552.), it will be observed that some of the convoluted folds, as those marked cc, extend near to the centre of the tooth ; others, as those marked c , reach only about half-way to the centre ; and those folds, c" , which, to use a geological expression, are “ cropping Tooth of a Labyrintliodon, natural size. out,” penetrate to a very short distance into the dentine, and resemble, in their extent and Fig. 552. Transverse section of tooth of Labyrintliodon. (Magnified.') simplicity, the converging folds of cement in the fangs of the tooth of the Iehthyosnurus. The disposition of the dentine is still more complicated than that of the cement. It con- sists of a slender, central, conical column, excavated by a conical pulp-cavity for a cer- TEETII. 8G9 tain distance from the base of the tooth ; and this column sends radiating outwards, from its circumference, a series of vertical plates, which divide into two once or twice before they terminate at the periphery of the tooth. Each of these diverging and dichotomising plates gives off throughout its course smaller processes, which stand at right angles, or nearly so, to the main plate ; they are gene- rally opposite, but sometimes alternate ; many of the secondary plates or processes, which are given off near the centre of the tooth, also divide into two before they terminate; and their contour is seen, in the transverse section, to partake of all the undulations of the folds of cement which invest and divide the den- tinal plates and processes from each other. The dental pulp-cavity is reduced to a mere line about the upper third of the tooth, but throughout its whole extent fissures radiate from it, corresponding in number with the radiating plates of dentine. Each fissure is continued along the middle of each plate, dividing where this divides, and extending along the middle of each bifurcation and pro- cess to within a short distance of the line of cement. The pulp-fissure commonly dilates into a canal at the origin of the lateral pro- cesses of the radiating plates, before it divides to accompany and penetrate those processes. The main fissures or radiations of the pulp- cavity extend to within a line or half a line of the periphery of the tooth, and suddenly dilate at their terminations into spaces, which, in transverse section, are subcircular, oval, or rally smaller spaces. All these spaces, or canals, in the living tooth, must have been occupied by corresponding processes of the vascular pulp : they constitute so many cen- tres of radiation of the fine calcigerous tubes, which, with their uniting clear substance, constitute the dentine.* An analogous complexity is produced by numerous fissures radiating from a central mass of vaso-dentine, which more or less fills up the pulp-cavity of the seemingly simple conical teeth of the extinct family of fishes which I have called “ Dendrodonts.”f Fig. 553. is one of these fossil teeth, of the natu- Fig. 553. Tooth of a Dendrodus, natural size. ral size ; a a transverse section ; and jig. 554 a reduced view of a portion of the same section, enlarged twenty diameters. Thus magnified, a central pulp-cavity, of pyriform, p : the branches of the radiating relatively small size, and of an irregular lobu- lines, which are continued into the lateral lated form, is discerned, a portion of which secondary plates or processes of the dentinal * Odontography, pp. 195 — 217, pi. 64^, 64b. lamella, likewise dilate into similar, and gene- + H>. p. 171. 3 k 3 870 TEETH. is shown at p; this is immediately surrounded by the transverse sections of large cylindrical medullary, or pulp-canals of different sizes; and, beyond these, there are smaller and more numerous medullary canals, which are pro- cesses of the central pulp-cavity. In the transverse section these processes are seen to be connected together by a net-work of smaller medullary canals belonging to a coarse osseous texture into which the pulp has been converted, and this structure occupies the middle half of the section. All the medullary canals were filled by the opaque matrix. From the circumference of the central net- work, straight medullary fissures radiate at pretty regular intervals to the periphery of the tooth : most of these canals divide once, rarely twice, in their course ; the division taking place sometimes at their origin, in others at different distances from their termi- nations, and the branches diverge slightly as they proceed. Each of the above medullary fissures is continued from a short process of the central structure, which is connected by a concave line with the adjoining process, so that the whole periphery of the transverse section of the central coarse reticulo-medul- lary body of the tooth presents a crenate out- line. From each ray and its primary dicho- tomous divisions, short branches are sent off at brief intervals, generally at right angles with the trunk, or slightly inclined towards the periphery of the tooth. These subdivide into a few short ramifications, like the branches of a shrub, and terminate in irregular and somewhat angular dilatations, simulating leaves, but which resolve themselves into radiating fasciculi of calcigerous tubes. There are from fifteen to twenty-five or thirty- six of these short and small lateral branches on each side of the medullary rays. A third kind of complication is produced by an aggregation of many simple teeth into a single mass. The examples of these truly compound teeth* are most common in the class of Fishes, but the illustration here selected is from the Mammalian class. Each tooth of the Cape Ant-eater ( Oryeteropus ) presents a simple form, is deeply set in the jaw, but without dividing into fangs; its broad and fiat base is porous, like the section of a com- mon cane. The canals to which these pores lead contain processes of a vascular pulp, and are the centres of radiation of as many indc- * In the “ Lemons A’Anatomie Comparde ” of Cuvier, the teeth, in which folds of enamel and cement penetrate the entire substance of the crown, are called “compound:” “Nous appellons ‘dent composee ’ celle dont les differentes substances forment des replis tellement profonds, que dans quelque sens qu'on coupe la dent, on coupe plusieurs fois chacune des substances qui la composent : telles sont, les dents molaires de 1’ Elephant.” The teeth of the “ Labyrinthodonts ” would come under this definition more truly than those of the elephant, although they differ from them in having no enamel ; for a molar of an elephant might be bisected, verti- cally and transversely, without cutting the tissues across more than once. pendent series of dentinal tubules. Each tooth, in fact, consists of a congeries of long and slender prismatic denticles of dentine, which are cemented together by their ossified capsules, the columnar denticles slightly de- creasing in diameter and occasionally bifur- cating as they approach the grinding surface of the tooth. A figure of a longitudinal section of the molar teeth is given in PI. 70, fig. 10. of my “ Odontography,” and a magnified view of a similar section in PI. 77. ; fig. 555. gives a magnified view of a portion of the transverse Fig. 555. Part of transverse section of the tooth of the Oryc- teropus. ( Magnified .) section of the fourth molar, showing c the cement; d the dentine; p the pulp-cavity of the denticles ; and d' a section of one of the denticles just beyond its bifurcation. The pectinated incisors of the flying Lemur of the Indian Islands (G ale opith ecus) are ex- amples of teeth, the crowns of which are composed of denticles consisting of hard den- tine, with a covering of true enamel. The layer of cement over this is too thin to show its characteristic structure, and does not fill up the intervals of the denticles, which stand out as free processes from the base of the crown. Tubular prolongations of the pulp- cavity are continued up the centre of each denticle. Fig. 556. exhibits a longitudinal section, magnified, of this kind of compound tooth; d is the dentine; e the enamel; p the pulp- cavity. The originally detached summits of the crown of the human incisor are homo- logous with these columnar processes, or denticles of the incisor of the Galeopithecus. In the compound molars of the great Afri- can wart-hogs ( Phacochcerus) the columnar denticles are in three rows, and their inter- spaces are filled up by cement : each denticle consists of a slender column of hard dentine inclosed in a thick sheet of enamel, the whole being bound together by the cement ; and the TEETH. 871 denticles, as in the Galeopithecus , blending together into a common base in the fully-de- veloped tooth. Fig. 556. Section of lower incisor of Galeopithecus ( Magnified .) A figure is given of the grinding surface of the third true molar of the Phacochcerus Pal- long diameter of the tooth. When the tooth is bisected vertically and lengthwise, the three substances, d dentine, e enamel, and c cement, Fig. 557. are seen interblended as in Jig. 557., in which p is the common pulp-cavity, and r one of the roots of this complex tooth. A still more complex grinding apparatus is found in certain fishes. The lower pharyngeal bone of the parrot-fish ( Scants *), for ex- ample, supports a dental plate with a tri- Fig. 558. Two of the upper pharyngeal teeth, Scarus. ( Magnified .) lasii, in PL 140,y?g. 4, of my “ Odontography.” titrating surface like that of the compound In the elephant the denticles of the com- molars of the Phacochcerus. The interlocked pound molars are in the form of plates, vertical upper pharyngeals {Jig. 565.) support dental to the grinding surface and tranverse to the * Odontography, pi. 51., fig. 3. 3 k 4 872 TEETH. masses with a grinding surface more like that of the compound molars of the elephant. When a vertical and longitudinal section is made of one of these upper pharyngeal compound teeth, each denticle is seen to be composed, as in fig. 558., of a body of very hard and unvascular dentine d, with a thick sheath of enamel e, the denticles being united together by the cement c, and supported and further united together, and to the pharyngeal bone, by a basal mass of vascular osteo-dentine. Such are some of the prominent features of a field of observation which comparative anatomy opens out to our view ; — such the varied nature, and such the gradation of complexity of the dental tissues, which, up to December 1839*, continued, notwithstanding successive approximations to the truth, to be described in systematic works as a “ pha- neros,” or “ a dead part or product exhaled from the surface of a formative bulb ! ” The truth may be slowly but is surely established, subject to the usual attempts to mask or detract from the merit of the discovery. By no systematic authors has the hypothesis of the formation of dentine by transudation or secretion been more frequently or more ex- plicitly enunciated than by the Cuviers. Baron Cuvier repeats, in both editions of his elaborate work — the “ Ossemens Fossiles ” — “ C’est dans ce vide conpevable que se de- poseront les matieres qui doivent former la dent, savoir : la substance vulgairement ap- pelee osseuse, qui sera transudee par des pro- ductions gelatineuses venant du fond de la capsule, et l’email qui sera depose par les cloisons membraneuses,” t.ii. p. 61., ed. 1812.; t. i. p. 33., ed. 1821. See, also, M. F. Cuvier, “ Dents de Mammiferes,” 8vo, 1825. “ L’ivoire se depose par couches concentriqucs,” p. xxvii. ; “ L’email se depose dans un sens contraire a l’ivoire,” ib. p. xxviii. And Baron Cuvier again, in the second edition of his “Lecons d’Anatomie Comparee,” t. iv. 1836, p. 214 : “L’ivoire se depose par couches, par line sorte de transudation.” In the first edition of this classical work, Cuvier had illustrated the peculiarity of the teeth of certain fishes, which are at first detached and afterwards united to the jaw-bone, by com- paring their growth to that of the epiphyses of the long bones : “ Mais les dents qui ne tiennent qu’a la gencive seulement, commc eelle des Stjuales , croissent a la maniere des epiphyses des os, c’est- a-dire que toute leur substance osseuse est d’abord tendre et po- reuse, et qu’elle se durcit uniformement, et finit par devenir entierement dure eomme de Fivoire,” t. iii. 1805, p. 112. Whether the great anatomist meant to imply that the * See the Fasciculus of M. de Blainville’s great work, “ Ostdograpliie et Odontographie d’Animaux Vertebre's,” which he submitted to the Academy of Sciences of the Institute of France on the same day, December 16th, 1839, on which I communicated, on the occasion of my election as corresponding member of that body, my “ Theory of the development of dentine by centripetal calcification and conversion of the cells of the pulp.” osseous tissue of the epiphyses of bones was developed differently from osseous tissue in general, c. g. by the uniform and simultaneous hardening or calcification, obscurely referred to in the above ([notation, may be questioned, for such is not the way in which the teeth of the shark are calcified. But this is certain, that the idea, whatever it might have been, had no influence on the fixed belief of the developement of the dental tissue by trans- udation expressed in their later and more elaborate works by Baron Cuvier and his ac- complished brother ; and, in point of fact, the passage which I have quoted is expunged from the second edition of the “ Lecons d’ Anatomie Comparee,” 1835 : the successive stages of calcification in the different teeth of the same vertical series in the jaw of the shark, having probably been noticed in the interim by Cuvier. The author of the article “ Secretions ” in the “Dictionnaire Universel d’Histoire Na- turelle,” has, however, reproduced Cuvier’s ob- scure comparison of certain fishes’ teeth to the epiphyses of bone, as evidence of the need- lessness of any ulterior researches for the demonstration of the theory of dental de- velopement by conversion and calcification of the pulp. The passage from the third vol. of the old edition (1800) of the “ Lecons d’Anat. Comp.,” p. 112, is cited to show that it naturally conducts to the knowledge of such mode of developement of dentine : “ En 1840 et 1841 (the ‘ Comptes Rendus del’ Acad, des Sciences’ give the true date) l’etude des dents dc Squale par M. R. Owen, lui a de- montree leur accroisseinent par intussuscep- tion, comme elle avait ete a G. Cuvier trente- cinq annees auparavant.” How or why G. . Cuvier came to abandon the theory so demon- strated, and how it happened that none of his contemporaries adopted it, M. Duvernoy does not explain. He does give a reason for the omission, in the second edition of the “ Lecons d’Anat. Comp.” of the passage which he affirms to contain the demonstration ; “ Malheureuse- ment, le copiste de cet ancien texte pour la 2de edition a ontis ce passage, par oubli.” It was natural to conclude that its obscurity and seeming contradiction to the theory of dental developement, formally propounded by Cuvier, as well as to the facts shown by nature in the sharks, had been the cause of its omission ; but even had the misfortune to which M. Duvernoy now attributes that omission (for in the copious list of addenda and corrigenda to the fifth, 1837, and final, 1846, volumes it is not noticed) not occurred, the coincidence of such passages as the fol- lowing would still have been inexplicable and irreconcilable with the deductions that M. Dumeril is now enabled to draw from the comparison of the shark’s tooth with the epiphyses of long bones. “ L’ivoire se depose par couches, par une sorte de transudation.” Lecons d’Anat. Comparee, t. iv., 1836, p. 214. To which proposition Cuvier has himself added a note : “ Je me suis assure recemment, sur des gerines de dents d’elephant, que la substance osseuse de la dent se forme comme TEETH. les coquilles.” And the editor (M. Duvernoy), in order to obviate any possibility of miscon- ception, has himself subjoined a note to that passage, as follows : “ L 'ivoire a ete aussi substance osseuse, a cause deson analogie de composition chimique et de durete avec les os. Mais la nature inerte et inorganique de cette substance, mieux appreciee dans ces derniers temps, surtout par les travaux de M. Cuvier, ne perrnet plus de la designer, avec justesse, par cette seconde expression. Du moins est-il necessaire de premunir le lecteur contre l'idee fausse qu’il pourrait en tirer, qu’elle serait organisee, qu’elle se develop- perait a la maniere des os.” — Tom. cit. p. 201, (18.36). In the same spirit in which M. Du- vernoy sees (in 1848) that a true idea, instead of a false one, may be drawn from casual expres- sions and similies loosely applied in the old Le- cons of 1800 and 1805 ; others have sought to depreciate the value of the establishment of the truth by citing the doubts, or tentative approxi- mations made by Purkinje and Schwann to my theory, interpreting such approximations by the light of the established truth. So far from finding such a resting-place for doubt in Cuvier’s early simile, cited by M. Duvernoy in 1848, or in the interrogatories of Schwann, nothing short of the investigation of the whole of this vast subject, zootomically, develop- mentally, and microscopically, as narrated in my “ Odontography,” sufficed to settle my own doubts ; and nothing short of the evidence and illustrations given in that work appeared to me adequate to convert anatomists from the excretion-hypothesis to the intussuscep- tion theory. That the dentine is the ossified pulp is an older notion than that it is an inorganic secretion from such pulp. But an hypo- thesis, to be of any value in science, must be proved. Almost every true theory has been indicated, with various degrees of approxi- mation, before its final establishment : but he has ever been held, in exact philosophy, to be the author of a theory, by whom it has been first rightly enunciated and satisfactorily established. When time has dissipated the mists of individual or national rivalries and jealousies, the name of the true discoverer is clearly seen by the inextinguishable light of true and impartial history : and to that period I look forward with calm and confident hope. I proceed now to briefly point out the leading characteristics of the teeth in the dif- ferent classes of the vertebrate animals. Dental System of Fishes. The teeth of fishes, whether we study them in regard to their number, form, substance, structure, situation, or mode of attachment, offer a greater and more striking series of varieties than do those of any other class of animals. As to number, they range from zero to countless quantities. The Lancelet, the Am- mocete, the Sturgeon, the Paddle-fish, and the whole order of Loyhobranchii, are eden- tulous. The Myxinoids have a single pointed tooth on the roof of the mouth (fig. 559., a), and two serrated dental plates ( b ) on the Fig. 559. Myxine. ( Milller .) tongue. The Tench (fig. 514. Vol. III. p. 979. art. Pisces) * has a single grinding tooth on the occiput (c), opposed to two denti- gerous pharyngeal jaws below (i id). In the Lepidosiren a single maxillary dental plate (fig. 560., a) is opposed to a single mandibular Fig. 560. Lepidosiren. one (b), and there are two small denticles on the nasal bone (c). In the extinct Sharks with crushing teeth, called Ceratodus and Cte- nodus, the jaws were armed with four teeth, two above and two below. f In the Chimcerce, two mandibular teeth are opposed to four maxillary teeth. J From this low point the number in different fishes is progressively multiplied until, in the Pike, the Siluroids (fig. 561.), and many other fishes, the mouth becomes crowded with countless teeth. With respect to form, 1 may first observe, that as organised beings withdraw themselves more and more, in their ascent in the scale of life, from the influence of the general polarising forces, so their parts progressively deviate from geometrical figures: it is only, therefore, in the lowest vertebrated class that we find teeth in the form of perfect cubes, and of prisms or plates with three sides (Myletes), four sides ( Scarus ), five or six sides, Mylio- bates (fig. 562.). The cone is the most com- mon form in fishes : such teeth may be slender, sharp-pointed, and so minute, numerous, and closely aggregated, as to resemble the plush or pile of velvet; these are called “villiform teeth” (dentes villiformes, dents en velours §) ; ail the teeth of the Perch are of this kind : * And Odontography, pi. 57. fig. 5. t See Odontography, pi. 22, figs. 2. 6, 7. t lb., pi. 28, figs. 1, 2. 4. 6. § The French terms are those used by Cuvier and Valenciennes in their great “ Histoire des Pois- sons,” 4to. 87-1 TEETH. when the teeth are equally fine anJ numerous, but longer, they are called “ ciliiforin ” ( dentes Fig. 561. Palatine bone and teeth ( Silurus ). ciliiformes) : when the teeth are similar to, but rather stronger than these, they are called Fig. 562. as the villiform teeth, but of larger size, are called “ rasp-teeth” ( dentes rciduliformes, dents cn rape or en cardes, fig. 561.) ; the Pike pre- sents such teeth on the back part of the vomer : the teeth of the Sheat-fish ( Silurus glanis ) present all the gradations between the villi- form and raduliform types. Setiform teeth are common in the fishes thence called Chae- todonts* ; in the genus Citharina they bifur- cate at their free extremities ; in the genus Platax they end there in three diverging points {fig. 563.), and the cone here merges into the long and slender cylinder. Some- times the cone is compressed into a slender trenchant blade : and this may be pointed and * bristle j obousj tootb. recurved, as in the Murcena; or barbed, as in Trichiurus, and some other Scomberoids ; or it may be bent upon itself, like a tenterhook, as in the fishes thence called (loniodonts.* In the Bonito may be perceived a progressive thickening of the base of the conical teeth : and this being combined in other predatory Fig. 56.3. il Tandibular teeth, magnified (Platax'). fishes with increased size and recurved direc- tion, they then resemble the laniary or canine teeth of carnivorous quadrupeds, as we see in the large teeth of the Pike, in the Lophiusf, and in certain sharks. ;£ The anterior diverging grappling teeth of the wolf-fish form stronger cones ; and by progressive blunting, flattening, and expansion of the apex, observable in different fishes, the cone gradually changes to the thick and short cylinder, such as is seen in the back Fig. 56-1. teeth of the wolf-fish, and in similar grinding and crushing teeth in other genera, whether feeders on sea-weeds, or crustaceous and testa- ceous animals. The grinding surface of these short cylindrical teeth may be convex, as in the Sheep’s-head fish ( Sargus ) ; or flattened, as in the pharyngeal teeth of the Wrasse ( La - brus).§ Sometimes the hemispheric teeth are so numerous, and spread over so broad a sur- face, as to resemble a pavement, as in the pharyngeal bones of the Wrasse or Rock-fish {Labrus, fig. 564.) ; or they may be so small, as well as numerous ( dentes graniformes ), as to give a granulated surface to the part of the mouth to which they are attached (premax- illaries of Cossi/phus).\\ A progressive increase * Tot, in, an angle ; ibabs, a tooth, t Vol. in., fig. 512, p. 978. art. Pisces. X lb. fig. 510, p. 976. § lb. fig. 513, p. 978. || Odontography, pi. 45 ,fig. 1. TEETH. 875 of the transverse over the vertical diameter may be traced in the molar teeth of different fishes, and sometimes in those of the same individual, as in Labrus {fig. 564.), until the cylindrical form is exchanged for that of the depressed plate. Such dental plates {dentes lamelliformes ) may be found, not only circular, but elliptical, oval, semilunar, sigmoid, oblong, or even square, hexagonal, pentagonal, or tri- angular ; and the grinding surface may present various and beautiful kinds of sculpturing. The broadest and thinnest lameHiform teeth are those that form the complex grinding tubercle of the Diodon.* The front teeth of the Flounder and Sargus present the form of compressed plates, at least in the crown, and are true dentes incisivi. Numerous wedge- shaped dental plates {dentes cuneati ) are set vertically in the upper pharyngeal bones of the Parrot-fish ( Scants , fig. 565.). A thin Fig. 565. Superior pharyngeal hones and teeth {Seams'). lamella, slightly curved like a finger-nail, is the singular form of tooth in an extinct genus of fishes, which I have thence called Peta/odus. Sometimes the incisive form of tooth is notched in the middle of the cutting edge, as in Sargus unimaculatus. Sometimes the edge of the crown is trilobate {Aplodactylus, fig. 566.). Fig. 566. Front teeth of Aplodactylus. Sometimes it is made quinquelobate by a double notch on each side of the large middle lobe {Boops). In the formidable Sea-pike t Odontography, pi. 38, fin. 2 ; and art. Pisces, Vol. 111. p 980, _/! m • g— ^=32; and the homo- logies of the individual teeth, in relation to the typical formula, may be signified by i. 1., i. 2. ; c. ; p. 3., p. 4. ; m. 1., m. 2., m. 3. : the suppressed teeth being i. 3.*, p. 1 ., and p. 2. Examples of the typical dentition are ex- ceptions in the actual creation ; but it was the rule in the forms of Mammalia first introduced into this planet ; and that, too, whether the teeth were modified for animal or vegetable food. Fig. 576., e. g., shows the dental series The true molars in the one are tuberculate, indicating its tendency to vegetable diet; in the other, they are carnassial, and betoken a peculiarly destructive and bloodthirsty spe- cies. In the Quarterly Geological Journal, No. 13, 1848, p. 36. pi. iv., I have described and figured the entire dental series of one side of the lower jaw of an extinct hoofed quadruped, the Dichodon cuspidatus, from eocene or oldest tertiary strata, also mani- festing the normal number and kinds of teeth, but with such equalit}' of height of crown, that no interspace is needed to lodge any of the teeth when the jaws are closed, and the series is as entire and uninterrupted as in the human subject. A great proportion of the upper jaw and teeth has been discovered, and Fig. 576. Dentition of the Amphicyon major. Upper jaw. of the upper jaw of the Amphicyon major, a the marks of abrasion on the lower teeth mixed-feeding ferine animal, allied to the prove the Series above to have been as entire Bear. Fig. 577. shows the dental series of and continuous as that below. The Anoplo- the under jaw of a more strictly carnivorous therium (“Odontography,” pi. 135. Jig. 1.), Fig. 577. Dentition of the Hycenodon. Lower jaw. beast, the Hycenodon ; the fossil remains of a species of which have been discovered in the oldest tertiary deposits of Hampshire. The symbols denote the homologies of the teeth. * I have been guided by the analogy of the hare (Odontography, p. 410, pi. 104, fig. 5.) in this de- termination ; but a contradictor might indulge his instinct without liability to disproof from actual knowledge. from the gypsum quarries of Montmartre, geologically as ancient as the eocene clays of this island, long ago presented to Cuvier the same peculiar continuous dental series as is shown in the Dichodon. In his original Me- moir, Cuvier described the canines as a fourth pair of incisors, on account of their small size and their trenchant shape ; but he after- wards recognised their true homology with TEETH. 905 the larger and more laniariform canines of the Pa/cEotherium (“ Odontography,” pi. 135., tig. 4.). The Chceropotamus* * * § , the Anthraco- therium-f, the HyopotamusX, the Hyracothe- riu m § , the Oplotherium, the Meiycopotamus, the Hippohyus, and other ancient (eocene and miocene) tertiary mammalian genera presented the forty-four teeth, in number and kind according to that which is here pro- pounded as the typical or normal dentition of the placental Mammalia. Amongst the existing genera, the hog (Sits) is one of the few that retain this type. Fig. 578. shows the entire permanent series, exposed, in both molar, in. 2, has just begun to cut the gum p. 2, p. 3, and p. 4, together with in. 3, are more or less incomplete and concealed in their closed alveoli. The premolars must displace deciduous molars in order to rise into place ; the molars have no such relations ; it will be observed, that the last deciduous molar, d. 4, has the same relative superiority of size to d. 3 and d. 2 which m. 3 bears to in. 2 and m. 1 ; and the crowns of p. 3 and p. 4 are of a more simple form than those of the milk- teeth which they are destined to succeed. Teeth of each of the kinds above deter- Fig. 5 78. Dentition of the Hog (Sus). jaws, and indicated individually by their mined, and arbitrarily named “ incisors,” “ ca- symbols. Fig. 579. illustrates the phenomena nines,” “ premolars,” “ molars,” have received of development which distinguish the pre- other special names in regard to certain pe- Fig. 579. Deciduous and permanent teeth (Sus). Lower jaw. molars from the molars. The first premolar, p. 1, and the first molar, in. 1, are in place and use, together with the three deciduous molars, d. 2, d. 3, and d. 4 ; the second * History of British Fossil Mammalia, p. 416, fig. 164. f Jobert, Annales des Sciences, t. xvii. p. 139. | Quarterly Journal of the Geological Society, May, 1848, p. 103, pi. viii. § Geological Transactions, 2nd series, vol. vi. p. 203. culiarities of form or other property; and the ablest comparative anatomists have been led astray in determining their homologies when they have suffered themselves to be guided exclusively by morphological characters. The premolars in the human subject have been called “ bicuspids.” The last upper pre- molar and the first lower true molar in the Carnivora are termed, from their peculiar form, “ sectorials,” or “ carnassial teeth,” “ molaires carnassieres ” of Cuvier, Teeth 906 TEETH. of an elongated conical form, pro- jecting considerably beyond the rest, and of uninterrupted growth, are called “tusks ; ” such are the incisors of the Elephant and Dugong, the canines of the Boar and Walrus : the long and large incisors of the Rodents have been termed, from the shape and structure of their cutting edge, scalpriforrn or chisel-teeth, “ dentes scalpra.ru .” The inferior in- cisors of the flying Lemurs ( Galeo - jnthecus ) have the crown deeply notched like a comb, and are termed “ dentes pectinati.” The canines of the Baboons are deeply grooved in front, like the poison-fangs, “ dentes canaliculati ,” of some serpents. The compressed conical crowns of the molar teeth of the small clawed seals ( Stenorliynchus ) are divided either like a trident, into three sharp points, or like a saw, into four or five points ; the molars of the great extinct Zeuglodon had a similar form ; such teeth have been called dentes serrati. But the philosophical course of the knowledge of nature tends to explode needless terms of art, invented for unimportant vari- eties, and to establish and fix the meaning of those terms that are the signs of determinate species of things. The Cuviers divided the molar series of teeth, according to their form, into three kinds: “false mo- lars,” “ carnassials,” and “ tubercu- lar molars ; ” and, in giving the ge- neric characters of Mammalia, based the dental formulae on this system : thus the genus Fells is characterised as having “ fausses molaires 2-2, 2—2 carnassieres 1—1, 1—1 tuberculeuses . _ 8»* 0—0 ’ c The uninterrupted line marked “ Cuvier” in V. Felis of fig. 580., intersects the teeth in each jaw called carnassieres ; those anterior to them being the teeth called “ fausses molaires the single tooth behind in the upper jaw is the “ tu- berculeuse.” Most Zoologists, both at home and abroad, have adopted the Cuvierian system of formalising the molar teeth. It seems a very natural one in the case of the Cat * “Les Dents des Mammifferes consi- dtfrdes comnie Caracteres zoologiques,” 8vo. p. 77. In the original the numbers 4 2 2 are given f. m. c. t. ", the teeth of each side being clubbed together ; they are distinguished into right and left in the text, to facilitate the comparison with the formulae used in this Article. Fig. 580. Homo. Ursus. Can is. Mustela. Felis. Machairodus. Moschus. Homologies of the teeth in Dipliyodont Mammals. TEETH. 907 genus ; the tooth p. 4 above plays upon that, in. 1, below, which has a similar remarkable earnassial modification of form ; they fit, in- deed, almost as Cuvier describes, like the blades of a pair of scissors ; the two teeth in advance of the earnassial in the upper jaw (p. 3, p. 2) in like manner are opposed to the same number of “ fausses molaires ” (p. 4, p. 3) in the under jaw, and the canine c. above plays upon the canine below ; all seems straightforward and symmetrical, save that the little tubercular, m. 1, above has no op- ponent in the lower jaw. And, perhaps, the close observer might notice that, whilst the upper canine, c., glides behind its homotype be- low, the first upper false molar (p. 2) passes anterior to the crown of the first false molar (p. 3) below ; and that the second false molar and earnassial of the upper jaw are also a little in advance of those teeth in the under jaw when the mouth is shut. In passing to the dentition of the Dog (Jig. 580, III. Canis), formulised by Cuvier as: „ , - 3—3 1—1 “ fausses molaires carnassieres | y, tu- 2 2 12.. berculeuses ~ „ ; — vr>” it will be ob- 2 — 2 14 served that here the first upper false molar (p. 1) differs from that in Fe/is, inasmuch as, when the mouth is shut, it preserves the same relative position to its opponent below (p. 1) which the upper canine does to the lower canine, and that the same may be said of the second and the third false molars ; but that with regard to the earnassial above (p. 4) this tooth repeats the same relative position in regard to the fourth false molar below (p. 4), and not to that tooth, m. 1, which Cuvier regarded as the lower homotype of the earnassial ; and, indeed, the more back- ward position of the lower earnassial is so slight that its significance might well be over- looked, more especially as the two succeed- ing tubercular teeth above were opposed to two similar tuberculars below. Cuvier there- fore leaves us to conclude that the tooth which had no homotype or answerable op- ponent above was either the fourth “fausse molaire ” below, or else the first. How un- important size and shape are, and how sig- nificant relative position is in the determina- tion of the homologies of teeth as of other parts, may be learnt before quitting the na- tural order of Carnivora ; e. g. by the condi- tion of the dental system in the Bear ( Jig. 580, II. Ursus). Here the lower tooth, m. 1, instead of presenting the earnassial character, and resembling in form the upper tooth (p. 4), which is the homologue of the upper car- nassial in the dog, has a tubercular crown, and corresponds in size as well as shape with the upper tooth in. 1, to which it is almost wholly opposed, and with the same slight advance of position which we observe in the lower canine as compared with the upper one, and in the four lower premolars (p. \,p.2, p. 3, p. 4) as com- pared with their veritable homotypes above. F. Cuvier divides the molar series of the genus Ursus into “ fausses molaires , The tendency in every thinker to generalise and to recognise Nature’s harmonies, has led him here to use the term “ carnassiere ” in an arbitrary sense, and to apply it to a tooth above (p. 4), which he owns has such a shape and diminished size as would have led him to regard it as merely a false molar, but that the upper earnassial would then have entirely dis- appeared ; and it has also led him to give the name “carnassiere” to a tooth below, m. 1, which he, nevertheless, describes as having a tubercular and not a trenchant crown. In so natural a group as the true Carnivora it was impossible to overlook the homologues of the trenchant carnassials of the lion, even when they had become tubercular in the omnivo- rous bear ; and Cuvier therefore, having de- termined and defined the teeth so called in the feline genus, felt compelled to distinguish them by the same names after they had lost their specific formal character. And if, indeed, he had succeeded in discovering the teeth which were truly answerable or homotypal in the upper and lower jaws, the term “ earnassial ” might have been retained as an arbitrary one for such teeth, and have been applied to their homologues in Man, the Ruminant, or the Pachyderm, where they are as certainly de- terminable as in those aberrant Carnivores, in which they have equally lost their sectorial shape. But the inconvenience of names in- dicative of such specialties of form will be very obvious when the term “ tuberculeuses” comes to be applied to the three hindmost teeth in the Hycsnodon (Jig. 577.), which teeth answer to the broad crushing teeth, m. 1, m. 2, and rn. 3, in the bear and some other existing Car- nivora. The analogous term “ molar,” having a less direct or descriptive meaning, is there- fore so much the better as the requisite arbi- trary name of a determinate species of teeth. Had Cuvier been guided in his determina- tions of the teeth by their mutual opposition in the closed mouth, and had studied them with this view in the Carnivora, with the dentition most nearly approaching to the typical formula, viz. the bear, he could then have seen that the three small and inconstant lower premolars (p. 1, p. 2, p. 3) were the homotypes of the three small and similarly inconstant premolars above; that the fourth false molar (p. 4) below, which, as he observes, “ alone has the normal form,” * was truly the homotype of the tooth above (p. 4), which he found himself com- pelled to reject from the class of “ fausses molaires,” notwithstanding it presented their normal form ; that the tubercular tooth, m. i, which he calls “ carnassiere ” in the lower jaw, was the veritable homotype of his first “ molaire tuberculeuse ” above (m. 1), and that the tooth in the inferior series which had no answerable one above was his second “ tuber- * Dents des Mammifferes, p. 111. 908 TEETH. culeuse ” (my m. 3), and not any of the four false molars. The true second tuber- cular above (in. 2) is, however, so much de- veloped in the bear as to oppose both in. 2 and m. 3 in the lower jaw, and it might seem to include the homotypes of both those teeth coalesced. One sees with an interest such as only these homological researches could ex- cite, that they were distinctly developed in the ancient Amphicyon (Jig. 576.), which ac- cordingly presents the typical formula. Thus, I repeat, the study of the relative position of the teeth of the bear might have led to the recognition of their real nature and homolo- gies, and have helped to raise the mask of their extreme formal modifications, by which they are adapted to the habits of the more blood- thirsty Carnivora. But the truth is plainly and satisfactorily revealed when we come to trace the course of development and succes- sion of these teeth. The weight which must ever attach itself to an opinion sanctioned by the authority of both the Cuviers, demands that a conclusion contrary to theirs, and which seems to be opposed by Nature herself in certain instances, should be supported by all the evidence of which such conclusion is susceptible. I proceed, therefore, to show how, in the bear, my determinations of the teeth are es- tablished by their development, as well as by their relative position. As the question only concerns the molar series, the remarks will be confined to these. In the jaws of the young bear, figured in cut 581., the first premolar, p. 1 , is the only one of the permanent series in place ; similarity to p. 4 in the lower jaw (Jig. 581, Ursus), to be veritably the last of the pre- molar series, and to agree not in shape only, but in every essential character, with the three preceding teeth called by Cuvier “fausses molaires.” So, likewise, in the lower jaw, we see that the primitive deciduous series, d. 1, d. 2, d. 3, and d. 4, will be displaced by the corresponding premolars, p. 1 ,p. 2 ,p. 3, and p. 4 ; and that the tooth in. 1, called car- r.assiere by Cuvier, in the lower jaw, differs essentially from that p. 4, so called in the upper jaw by being developed without any vertical predecessor or deciduous tooth. The same law of development and succes- sion prevails in the genus Canis (Jig. 582.). Although the tooth m. 1 in the lower jaw has exchanged the tubercular for the carnassial form, it is still developed, as in the bear, behind the deciduous series, and indepen- dently of any vertical predecessor; and the tooth p. 4 above, although acquiring a relative superiority of size to its homologue in the bear, and more decidedly a carnassial form, is not the homotype of the permanent carnas- sial below, but of that premolar (p. 4) which is destined to displace the deciduous carnassial d. 4. The symbols sufficiently indicate the relations of the other teeth, and the conclu- sions that are to be drawn from them as to their homologies. It is interesting to observe in the deciduous, as well as in the permanent series, that the lower carnassial d. 4 is not the homotype of the upper one d. 3, but of the tooth which Cuvier calls the “ tuberculeuse du lait,” d. 4 in the upper jaw. Fig. 581. Deciduous and permanent dentition of the Bear (Ursus). the other grinders in use are the deciduous molars, d. 2, d. 3, and d. 4; d. 2 will be displaced by p. 2, d. 3 by p. 3, and d. 4 by the tooth p. 4, which, notwithstanding its size and shape, Cuvier felt himself compelled to discard from the series of false molars, but which we now see is proved by its developmental relations to d. 4, as well as by its relative position and In the genus Felis (Jig. 580.), the small per- manent tubercular molar of the upper jaw, in. 1, has cut the gum before its analogue d. 4 of the deciduous series has been shed ; but though analogous in function, this is not ho- mologous with, or the precedent tooth to in. 1, but, as in the dog, to the great carnassially modified premolar, p. 4. In the lower jaw the TEETH. 909 tooth (m. 1), which is functionally analogous to tition, are in. 2 in the upper jaw, m. 2 and m. 3 the carnassial above, is also, as in the dog, the in the lower jaw ; p. 1 in the upper jaw, p. 1 Fig. 582. Deciduous and permanent teeth in the Dog (Cams). first of the true molar series, and the homo- and p. 2 in the lower jaw ; thus illustrating the type of the little tubercular tooth (m. 1) above, rule enuntiated above, that, when the molar And the homologies of the permanent teeth series falls short of the typical number it is p. 4 above and m. 1 below, with those so from the two extremes of such series that the Fig. 583. Deciduous and permanen t teeth in the Lion (Felis). symbolised in the dog (Jig. 582.), teach us teeth are taken, and that so much of the that the teeth which are wanting, in order to series as is retained is thus preserved unbroken, equal the number of those in the canine den- In the great extinct sabre-toothed tiger (Ma- 910 TEETH. chair odns, fig. 580, VI.*), the series is still fur- ther reduced by the loss ofp. 2 in the upper jaw. That the student may test for himself the demonstration which the developmental cha- racters above defined, yield of the true nature and homologies of the feline dentition, — the most modifiedof all in the terrestrial Carnivora, he is recommended to compare with nature the following details of the appearance and formation of the teeth in the common cat. In this species the deciduous incisors d.i. begin to appear between two and three weeks old ; the canines d. c. next, and then the molars d. m. follow, the whole being in place before the sixth week. After the seventh month they begin to fall in the same order; but the lower sectorial molar m. t, and its tubercular homo- type above (?«. 1) appear before d.2,d. 3, andrf. 4 fall. The longitudinal grooves are very faintly marked in the deciduous canines. The first deciduous molar ( d . 2), in the upper jaw is a very small and simple one-fanged tooth ; it is succeeded by the corresponding tooth of the permanent series, which answers to the second premolar ( p. 2) of the hyaena and dog. The second deciduous molar ( d . 3) is the sectorial tooth; its blade is trilobate, but both the anterior and posterior smaller lobes are notched, and the internal tubercle, which is relatively larger than in the permanent sectorial, is continued from the base of the middle lobe, as in the deciduous sectorial of the dog and hyaena; it thus typifies the form of the upper sectorial, which is retained in the permanent dentition of several Viverrine and Musteline species. The third or internal fang of the deciduous sectorial is continued from the inner tubercle, and is opposite the interspace of the two outer fangs. The Musteline type is further adhered to by the young Feline in the large proportional size of its deciduous tubercular tooth, d. 4. In the lower jaw, the first milk- molar (d. 3) is succeeded by a tooth {p. 3) which answers to the third lower premolar in the dog and civet. The deciduous sectorial {d. 4), which is succeeded by the premolar (p. 4), an- swering to the fourth in the dog, has a smaller proportional anterior lobe, and a larger pos- terior talon, which is usually notched ; thereby approaching the form of the permanent lower sectorial tooth in the MusteVidce. In the article Carnivora (vol. i. p. 478.), the remarks on the teeth are limited chiefly to their physiological adaptations. A description of some of their more remarkable structures will here be given, according to the idea of the nature of the teeth above developed. The dental formula of the dog, jackal, wolf, and fox, is illustrated in Jig. 580, III. Canis. * Machairodus, from a sabre ; and oSou?, a tootli. This generic name was imposed by Dr. Kaup on the extinct animal which was armed with canine teeth, like that figured in fig. 580, VI. Such teeth, long, compressed, falciform, sharp- pointed, and with anterior and posterior finely- serrated edges, were first discovered in tertiary strata in Italy and Germany, and were referred by Cuvier to a species of bear, under the name of Ursus cultridens. Fossil canines of this genus have been found in Kent’s Hole cave, Torquay. In the Megalotis, or Long-eared Fox (Oto- cyon , Licht.), the deviation from the typical dentition of the Canidce is effected by excess of development ; two additional true molars being present on each side of the upper, and one on each side of the lower jaw, in the permanent series of teeth ; and an approach is made by the modified form of the sectorial molar and of some of the other teeth to the dentition of the Viverridoc. This family of Carnivora, which comprehends the Civets, Genets, Ichneumons, Musangs, Surikates, and Mangues, is characterised, with few exceptions, 3 3 j j by the following formula : — i. - — - ; c. ^ | ; 4 — 4 2—2 p. ^ ^ ; m. gZIo : = ^ differs from that of the genus Canis by the absence of a tubercu- lar tooth (m. 3) on each side of the lower jaw ; but, in thus making a nearer step to the typical carnivorous dentition, the Viverridce, on the other hand, recede from it by the less trenchant and more tubercular character of the sectorial teeth, as is shown in the figures of the teeth of the Viverra indica, in my “ Odon- tography,” pi. 126. figs. 1, 2, and 3. The canines are more feeble, and their crowns are almost smooth ; the premolars, however, assume a formidable size and shape in some aquatic species, as those of the sub- genus Cynogale, in which their crowns are large, compressed, triangular, sharp-pointed, witli trenchant and serrated edges, like the teeth of certain sharks, (whence the name Squalodon, proposed for one of the species), and well adapted to the exigencies of quad- rupeds subsisting principally on fish : the op- posite or obtuse, thick form of the premolars is manifested by some of the Musangs, as Paradoxurus auratus. The upper sectorial tooth, p. 4, is characterised by having its inner tubercle larger, the middle conical division of the blade thicker, and the posterior one smaller than in the genus Canis. This tooth advances to beneath the ant-orbital foramen in the Mu- sangs ( Paradoxurus ) : it is situated farther back in the Civets and Genets, in which the blade of the sectorial is sharper. This shows that relative position to the zygomatic or molar process of the maxillary is not a good cha- racter. In the lower jaw the sectorial tooth (m. 1) manifests its true molar character by the pre- sence of an additional pointed lobe on the inner side of the two lobes forming the blade at the fore-part of the crown : the posterior, low, and large lobe of the tooth being also tri-tuberculate, as in the dog. The last molar {in. 2) has an oval crown with four small tubercles, resembling the penultimate lower molar in the dog, with which it corresponds. The deciduous dentition consists, in the Viverrine family, of ; incisors 3—3 - — - ; canines 1—1 , 3—3 -jy— p ; molars 3IZ3 28. If the first per- manent premolar has any predecessor, it must be rudimental and disappear early in TEETH 911 both jaws ; the second premolar displaces the first normally developed deciduous molar ; the third upper premolar displaces and suc- ceeds the deciduous sectorial, which has a sharper and more compressed blade, and a relatively smaller internal tubercle, than the permanent sectorial. This tooth displaces the last deciduous molar, which is a tubercular tooth, resembling in form the first of the two upper permanent tuberculars ; these coming into place without pushing out any prede- cessors, enter into the category of true molar teeth. In the lower jaw the third premolar displaces the deciduous sectorial, which has three trenchant lobes and a relatively smaller posterior talon than the permanent sectorial. The fourth premolar displaces the third or tubercular milk-molar. The permanent sectorial and tubercular molars displace no predecessors, and are therefore m. 1 and in. 2. The first premolar, p. 1, is not developed at any period in the Mangues ( Crossarchus ), the Suricates ( Ryzcena ), or the Mangusta •paludinosa ; these Viverrines, therefore, retain throughout life more of the immature cha- racters of the family, and in the same degree approach in the numerical characters of their dentition to the more typical Carnivora. The alternate interlocking of the crowns of the teeth of the upper and lower jaws, which is their general relative position in the Carnivora, is well marked in regard to the premolars of the Viverridce {Jig. 580, IV.) : as the lower canine is in front of the upper, so the first lower premolar rises into the space between the upper canine and first upper premolar ; the fourth lower premolar in like manner fills the space between the third upper premolar {p. 3) and the sectorial tooth {p. 4), playing upon the anterior lobe of the blade of that tooth which indicates by its position, as by its mode of succession, that it is the fourth premolar of the upper jaw. The first true molar below, modified as usual in the Car- nivora to form the lower sectorial, sends the three tubercles of its anterior part to fill the space between the sectorial ( p . 4) and the first true molar (in. 1) above. In the Mu- sangs the lower ^sectorial is in more direct opposition to its true homotype, the first tubercular molar in the upper jaw ; and these Indian Viverridce ( Paracloxuri ) are the least carnivorous of their family, their chief food consisting of the fruit of palm .trees, whence they have been called “ Palm-cats.” Hycena. — The dentition of this genus pre- sents a nearer approach to the strictly car- nivorous type by the reduction of the tuber- cular molars to a single minute tooth on each side of the upper jaw, the inferior molars being all conical or sectorial teeth : the molar teeth in both jaws are larger and stronger, and the canines smaller in proportion than in the Feline species, from the formula of which the dentition of the hyaena differs numerically only in the retention of an additional pre- molar tooth, p. 1 above and p. 2 below, on each side of both jaws. The dental formula of the genus Ih/cena is: — in. 1—1 4—4 1 — 1 c-t=i> pm • 3=3’ m • r=r: = 34- 3—3 3—3’ The crowns of the incisors form almost a straight tranverse line in both jaws, the exterior ones, above, being much larger than the four middle ones, and extending their long and thick inserted base further back : the crown of the upper and outer incisor ( i . 3.) is strong, conical, recurved, like that of a small canine, with an anterior and posterior edge, and a slight ridge along the inner side of the base. The four intermediate small incisors have their crown divided by a trans- verse cleft into a strong anterior, conical lobe, and a posterior ridge, which is notched ver- tically ; giving the crown the figure of a trefoil. The lower incisors gradually increase in size from the first to the third ; this and the second have the crown indented ex- ternally ; but they have not the posterior notched ridge like the small upper incisors ; the apex of their conical crown fits into the interspace of the three lobes of the incisor above. The canines have a smooth convex exterior surface, divided by an anterior and posterior edge from a less convex inner side : this surface is almost flat and of less relative extent in the inferior canines. The first premolar above (p. 1) is very small, with a low, thick, conical crown : the second presents a sudden increase of size, and an addition of a posterior and internal basal ridge to the strong cone. The third premolar exhibits the same form on a still larger scale, and is remarkable for its great strength. The pos- terior part of the cone of each of these premolars is traversed by a longitudinal ridge. The fourth premolar is the carnassial tooth, and has its long blade divided by two notches into three lobes, the first a small thick cone, the second a long and compressed cone, the third a horizontal sinuous trenchant plate : a strong triedral tubercle is developed from the inner side of the base of the anterior part of the crown. The single true molar of the upper jaw ( m . l) is a tubercular tooth of small size : transversely oblong in the Hycena vulgaris and H.fusca ; smaller and sub-cir- cular in the Hycena crocuta ; still smaller and implanted by a single fang in the Hycena spelcea : in all the existing species of Hycena it has two fangs. The first premolar of the lower jaw (p. 2) fits into the interspace between the first and second premolars above, and answers, therefore, to the second lower premolar in the Viverridce: it is accordingly much larger than the first (p. 1) above ; it has a ridge in the fore-part of its cone, and a broad basal talon behind. The second (p. 3) is the largest of the lower premolars, has an anterior and a posterior basal ridge, with a vertical ridge ascending upon the fore as well as the back part of the strong rounded cone : the third premolar (p. 4.) is proportionably less in the Hycena crocuta than in the II. vulgaris: its posterior ridge is developed into a small cone; the last tooth (m. 1) is the sectorial. 912 TEETH. mid consists almost entirely of a blade divided by a vertical fissure into two sub-equal com- pressed pointed lobes : the points are less produced than in the Felines, but the lower sectorial of the hyaena is better distinguished by the small posterior basal talon, from which a ridge is continued along the inner side of the base, and is slightly thickened at the fore-part of the crown. According to the relative po- sition of the crowns of the premolars the third below ought to be the last, being analogous to the fourth in the Viverridce, and the sec- torial should be first true molar : we shall find this view confirmed by the test of the mode of succession of the permanent teeth. But the mode of implantation of the premolar and molar teeth may first be noticed. The first upper premolar has but one fang; the second and third have each two ; the sectorial tooth has three, the two anterior ones on the same tranverse line, the inner one supporting the tubercle. The lower premolars and sectorial have each two fangs, there being none truly answering to the first above : the anterior root of the lower (jj. 1) sectorial tooth is very strongly developed in the great extinct Cave-Hyaena. 3—3 The deciduous teeth consist of: — i. y — j i 3 3 c. — — r, m. r. — x, = 28. The figure of the 1 — 1’ 3 — 3’ b skull of the young Hycena crocuta in the posthumous edition of the “ Ossemens Fos- siles,” 8vo. 1836, pi. 190, fig. 3, shows that stage when the correspondence with the formula of the genus Felis is completed by the appearance, in the upper jaw, of a small pre- molar in the interspace between the canine and first molar of the deciduous series : but this appearance is due to the apex of the first permanent premolar which cuts the gum before any of the normal deciduous teeth are shed : whether it is preceded, as in the dog, by a deciduous germ-tooth in the foetus, I know not. The first normal deciduous molar is two-fanged, and has a more compressed and consequently more carnivorous crown than that of the second permanent premolar by which it is succeeded. The second deci- duous molar is the sectorial tooth : the inner tubercle is continued from the base of the middle lobe, and thus resembles the permanent sectorial of the Glutton ( Gulo ) and many other MusteUdee ; the deciduous tubercular molar is relatively larger than in the adult Hycena , and offers another feature of resem- blance to the permanent dentition of the Glutton. It is also worthy of remark that the exterior incisor of the upper jaw is not only absolutely, but relatively smaller in the immature than in the adult dentition of the hyaena, and again illustrates the resemblance to the more common type of dentition in the Carnivora. The first and second deciduous molars be- low have more compressed conical crowns than their successors : the third deciduous molar is the sectorial tooth, and, again, as in Gulo, has a better developed binder tu- bercle than the permanent sectorial ; it is not displaced by this tooth, but, as in other Car- nivora, by a premolar of more simple cha- racter. The permanent sectorial is deve- loped posteriorly, and rises, like other true molars, without displacing a deciduous pre- decessor. The permanent dentition of the llycena, as of other genera or families of the Carnivora, assumes those characteristics which adapt it for the peculiar food and habits of the adult, and mark the deviation from the common type, which always accompanies the progress to maturity. The most characteristic modifi- cation of this dentition is the great size and strength of the molars as compared with the canines, and more especially the thick and strong conical crowns of the second and third premolars in both jaws, the base of the cone being belted by a strong ridge which defends the subjacent gum.* This form of tooth is especially adapted for gnawing and breaking bones, and the whole cranium has its shape modified by the enormous development of the muscles which work the jaws and teeth in this operation.f Adapted to obtain its food from the coarser parts of animals which are left by the nobler beasts of prey, the hyaena chiefly seeks the dead carcass, and bears the same relation to the lion which the vulture does to the eagle. In consequence of the quantity of bones which enter into its food, the excrements consist of solid balls of a 3'ellowish white colour, and of a compact earthy fracture. Such specimens of the sub- stance, known in the old Materia Meclica by the name of “ album graecum,” were dis- covered by Dr. Buckland in the celebrated ossiferous cavern at Kirkdale. They were recognised at first sight by the keeper of a menagerie, to whom they were shown, as resembling both in form and appearance the foeces of the spotted Hyaena ; and, being analysed by Dr. Wollaston, were found to be composed of the ingredients that might be expected in fcecal matter derived from bones, viz. phosphate of lime, carbonate of lime, and a very small proportion of the triple phosphate of ammonia and magnesia. This discovery of the coprolites of the hyaena formed, perhaps, the strongest of the links in that chain of evidence by which Dr. Buckland proved that the cave at Kirkdale, in York- shire, had been, during a long succession of years, inhabited as a den by hyaenas, and that they dragged into its recesses the other animal bodies, whose remains, splintered and bearing marks of the teeth of the hyaena, were found mixed indiscriminately with their own. * An eminent civil engineer, to whom I showed the jaw of a hyaena, observed that the strong conical tooth, with its basal ridge, was a perfect model of a hammer for breaking stones for roads. t “ The strength of the hyaena’s jaw is such that, in attacking a dog, he begins by biting off his leg at a single snap.” Buckland, “Reliquiae Diluvianae, p. 23. TEETH. 913 The dentition of the Weasel tribe ( Muste - tides ) is illustrated (in Jig. 580, IV.) by that of the Otter, Mnstela Lutra of Linnaeus, and which is essentially a great aquatic Weasel or o g | j Polecat; its dental formula is i. ^ , c. - — j, 4, 4 j ] P-- — -, m. - — - : = 36. In the Martin cats ( Mustela martes, L.), the little homotype of p. 1 above is present in the lower jaw ; in the bloodthirsty stoats and weasels, p. 1 is absent in both jaws ; as it is likewise in the great sea- otter ( Enhydra ), in which also the two middle incisors are wanting in the lower jaw. In this animal the second premolar (p. 3) has a strong obtuse conical crown, double the size of that of;;. 2 ; the third premolar ( p . 4) is more than twice the size of p. 3, and represents the upper carnassial or sectorial strangely modi- fied ; the two lobes of the blade being hemi- spheric tubercles. The last tooth, m. 1, has a larger crown than the sectorial, and is of a similar broad crushing form. In the lower jaw the molar series are not separated by any interspace: the first and second premolars have oblique obtuse conical crowns. The third premolar (p. 4) is more than twice the size of the second (p. 3) and supports a large anterior hemispheric protuberance with a small internal tubercle and a posterior basal ridge. The first true molar has an oblong quadrate crown with an anterior small tubercle, a larger and more prominent inner one, and the rest of the broad horizontal surface un- dulating. The second true molar has a trans- versely elliptical crown depressed in the centre. When the teeth are in apposition, the anterior third of the first true molar below is applied to the inner tubercle of the last premolar above ; the rest of its crown plays upon that of its homotype, the first true molar in the upper jaw, leaving a small part of that tooth to receive the appulse of the second true molar below, which has no corresponding tooth in the upper jaw. The Mustelidce present great constancy in regard to the number of their true molar teeth; with one exception, the Ratel ( Melli - vora), in which m. 2 is absent below, they have one true molar on each side of the upper jaw, and two on each side of the lower jaw ; the second of these has always a broad tubercular crown, like the one above. The upper true molar is supported by one inner, and sometimes by one ( Putorius , Gulo ), sometimes two ( Mustela , Lutra, Melphitis), outer fangs. The second true molar below is also tubercular, but has a single fang. The crown of the first true molar below offers many gradations from the sectorial type, as manifested in Putorius and Gulo , to the tuber- cular type, as in the Taira, Ratel, and sea- otter. The principal varieties occur, as usual, in the comparatively less important premolars : in the Martins and Gluttons, they are as numerous as in the dog ; the first, in both jaws, being implanted by a single fang ; the rest by two, with the exception of VOL. IV. the last above, which has three roots. In the otter, we find the first premolar removed from the lower jaw ; and the second (now the first) shows its true homology by its double implantation, as well as by the position of its crown behind the first in the upper jaw (p. 1). In the Stoats, Skunks, and Ratels, the premolar series is further reduced by the loss of the anterior tooth (p. 1) in both jaws, and by the diminution of the size of p. 2, which thus becomes the first in both jaws, and which is also now implanted by a single fang. In a South American Skunk, the second premolar disappears in the upper jaw, leaving there only the homologues of the third and fourth of the typical formula, p. 4 being always the sectorial in the Mustelidce, as in other terrestrial Carnivora. This tooth, under all its modifications, retains the blade with the lobe, corresponding to the middle one in the feline sectorial, generally well developed and sharp-pointed ; the differences are principally manifested by the proportions of the inner tubercle, and the relative size of the third root supporting it. But the upper sectorial, being a premolar, and therefore requiring less modification of the crown to adapt it for its special functions, manifests a more limited extent of variety than the lower sectorial, which, being a true molar, requires greater modification of the typical form of its crown to fit it for playing upon the sectorial blade of p. 4 above. Melidce. — In this sub-family I comprise the European Badger ( Meles ), the Indian Badger (Arctony. v), and the American Badger ( Tax-idea ) ; which, with respect to their den- tition, stand at the opposite extreme of the Mustelidce to that occupied by the predaceous Weasel, and manifest the most tuberculate and omnivorous character of the teeth. The - . . . 3—3 1—1 3—3 formula is: — ?. 5 — 5; c. ~ — r; p. - — ; o — ~o 1 — I 4?- -T 1—1 m. g — q '■ — 30, The canines are strongly developed, well pointed, with a posterior trenchant edge ; they are more compressed in Arctonyx than in Meles. The first lower premolar ( p . 1 ) is very small, single-fanged, and, generally, soon lost. The first above, corresponding with the second in the dog, is also small, and implanted by two connate fangs. The second upper premolar (;j. 3) has a larger, but simple, sub-compressed conical crown, and is implanted by two fangs: the third ( p . 4) re- peats the form of the second on a larger scale, with a better developed posterior talon, and with the addition of a tri-tubereulate low flat lobe, which is supported by a third fang : the outer pointed and more produced part of this tooth represents the blade of the sectorial tooth and the entire crown of the antecedent premolars. The true molar in Meles (in. 1) is of enormous size compared with that of any of the preceding Carnivora : it has three external tubercles, and an extensive horizontal surface traversed longitudinally by a low 3 N TEETII. 91 1 ridge, and bounded by an internal belt, the cingulum of Illiger: this tooth has a similarly shaped, but relatively smaller, crown in Arc- tonyx * The second premolar below (jp. 2) is commonly the first, through the early loss of the minute one in front ; its fangs are usually connate, as in its homotype above. The third and fourth premolars slightly in- crease in size, have simple compressed conical crowns, and two fangs each. The first true molar below (m. 1) now retains little of its sectorial character, the blade being represented only by the two anterior small, compressed pointed lobes; behind these, the crown ex- pands into an oval grinding surface, narrower in Arctonyx than in Miles, supporting three tubercles and a posterior tuberculate ridge: it has generally two principal roots and a small intermediate accessory fang, as in the otter. The second molar ( m . 2), which ter- minates the series below, is of small size, and has a rounded flat crown, depressed in the centre, and with two small external tubercles; its two short fangs are connate. In the Labrador Badger, the last premolar has a larger relative size, the part corresponding with the blade of the sectorial, is sharper and more produced, and the internal tu- bercle has two lobes; the succeeding molar tooth is reduced in size, and its crown pre- sents a triangular form. The first true molar below has its sectorial lobes better developed : these differences give the North American badgers a more carnivorous character than is manifested by the Indian or European species. Sub- Ursidce. — In other allied genera, which, like the badgers, have been grouped, on ac- count of the plantigrade structure of their feet, with the bears, a progressive approxi- mation is made to the type of the dentition of the Ursine species. The first true molar below soon loses all its sectorial modification, and acquires its true tubercular character : and the last premolar above becomes more directly and completely opposed to its homo- type in the lower jaw. The Racoon ( Procyon j') and the Coati ( Nasua ) present good examples of these transitional modifications; they have the complete number of premolar teeth, the 3—3 1 — 1 4—4 dental formula being, i. ^ c. V • y — y» w-U:-40- The development of the in- ner part of the crown of the last upper pre- molar, which constitutes the tubercle of the sectorial tooth, now produces two tubercles on a level with the outer ones which represent the blade; and the opposite premolar below (p. 4), which is the true homotype of the modified sectorial above, begins to acquire a marked increase of breadth and accessory basal tu- bercles. All the lower premolars, as well as the true molars, have two fangs; the three first premolars above have two fangs, the fourth has three, like the two true molars above. The dental formula of the Indian Bentu- * See Odontography, pi. 128, fig. 13, m. 1. t lb. pi. 129, Jig. 7. I lb .Jigs. 8—13. rong ( Arctictis ) and Kinkajou ( Cercoleptes ) is . 3—3 1—1 3—3 2—2 3—3’ 1-1’ 3- -3’ m' 2- = 36. PliocidcB. — We have seen a tendency to deviate from the ferine number of the incisors in the most aquatic and piscivorous of the Musteline quadrupeds, viz. the sea-otter ( Enhydra ), in which species the two midtile incisors of the lower jaw are not developed in the permanent dentition. In the family of true seals, the incisive formula is further re- duced, in some species even to zero in the lower jaw, and it never exceeds ^ All the Phocidcc possess powerful canines ; only in the aberrant walrus ( Trichechus ) are they absent in the lower jaw, but this is compensated by the singular excess of development which they manifest in the upper jaw. In the pinnigrade, as in the plantigrade, family of Carnivores we find the teeth which correspond to true mo- lars more numerous than in the digitigrade species, and even occasionally rising to the typical number, three on each side ; but this, in the seals, is manifested in the upper and not, as in the bears, in the lower jaw. The entire molar series usually includes five, rarely six teeth on each s:de of the upper jaw, and five on each side of the lower jaw, with crowns, which vary little in size or form in the same individual ; they are supported in some genera, as the Eared Seals ( Olarice ) and Elephant Seals ( Cystophora *), by a single fang ; in other genera f by two fangs, which are usually connate in the first or second teeth ; the fang or fangs of both incisors, canines and molars, are always remarkable for their thickness, which commonly sur- passes the longest diameter of the crown. The crowns are most commonly compressed, conical, more or less pointed, with the “ cin- gulum ” and the anterior and posterior basal tubercles more or less developed; in a few of the largest species they are simple and ob- tuse, and particularly so in the walrus, in which the molar teeth are reduced to a smaller number than in the true seals. J In these the line of demarcation between the true and false molars is very indefinitely in- dicated by characters of form or position ; but, according to the instances in which a deciduous dentition has been observed, the first three permanent molars in both jaws succeed and displace the same number of milk molars, and are consequently premolars ; occasionally, in the seals with two-rooted molars, the more simple character of the premolar teeth is manifested by their fangs being connate, and in the Stenorliynchus serri- dens the more complex character of the true molars is manifested in the crown. There is no special modification of the crown of any tooth by which it can merit the name of a * Odontography, pi. 132, fig. 7. t lb- figs. 1—4. j The relation of Triclieclius to the PhocicUc is analogous to that of Machairodus to the Felidcc, and also, in the simplification of the molars, to that of Proteles to CanicUe. TEETH. 915 “sectorial” or “ carnassial ; ” but we may point with certainty to the third molar above and the fourth below as answering to those teeth which manifest the sectorial character in the terrestrial Carnivora. The coadaptation of the crowns of the upper and lower teeth is more completely alternate than in any of the terrestrial Car- nivora, the lower tooth always passing into the interspace anterior to its fellow in the upper jaw. In the genus P/wca proper ( Ca - locepha/us, Cuv.) typified by the common seal 3 3 (Ph. vitulina), the dental formula is, i. — , c. 1_1 3_3 1 — Vp- 3—3’ m‘ 2—2 2^2 : - 34. The forms and proportions of these teeth are shown in PI. 132, Jig. 1., of my “Odontography.” The first tooth above and below presents a complete confluence of the fangs ; they are separated from the second above ; but be- low they sometimes do not become free before the fourth, and sometimes the two roots are distinct in the third anJ second molars. In the P/wca anellata Kills., the principal cusp of the molar teeth is com- plicated with anterior and posterior smaller cusps, sometimes one in number in the upper molars ; the anterior accessory cusp is some- times wanting in the first, and is rudimentary in the rest ; but usually there are two small cusps behind the principal one, and in the three or four posterior molars in the lower jaw there are sometimes two small cusps be- fore and two behind the principal one.* In the P/ioca caspica the upper molars have commonly one accessory cusp before and one behind the principal lobe; the lower molars have one accessory cusp before and two be- hind. In the P/wca grccnlandica the upper molars have no anterior basal cusp and only one be- hind ; the lower molars have two cusps behind and one in front, except the first, which re- sembles that above, and, like it, has connate fangs. The condition of the molar teeth is nearly the same in the P/wca barbata, but the crowns are rather thicker and stronger, and the three middle ones above have two posterior basal cusps feebly indicated, the same being more strongly marked in the four last molars below. The following genera of seals with double- rooted molars ( Pelagius and Stenorhynchus) have four incisors above as well as below, i. e. 2 9 - — An upper view of the molar teeth in the Hooded Seal of the Mediterranean ( Pcla - gius monachus ) is given in my Odontography, PI. 132. Jig. 3., as when they are worn down in an old specimen ; the crowns are thick, obtuse, sub-compressed, with a well developed * Nillson, in Wiegmann’s Arcliiv. 1841, 313. I notice these varieties of the crown, in connection with analogous ones in the fangs of the teeth of the same species, to show the inadequacy of such cha- racters as marks of subgeneric distinction. cingulum, a principal lobe and an anterior and posterior accessory basal lobule ; the fangs are connate in the first tooth both above and below. The allied sub-genus ( Ommatophoca ) of seals of the southern hemisphere has six molar teeth on each side of the upper, and five on each side of the lower jaw, with the principal lobe of the crown more incurved. The two first molars above are closely approximated, but this may prove to be a variety. In the Stenorhynchus the jaws are more slender and produced, and the molar teeth are remarkable for the long and slender shape of the principal lobe, and of the accessory basal cusps. The incisors have sharp conical re- curved crowns, like the canines, and the ex- ternal ones in the upper jaw are intermediate in size between the canines and the middle in- cisors. In the Stenorhynchus leptonyx each molar tooth in both jaws is trilobed, the anterior and posterior accessory curving towards the principal one, which is bent slightly back- wards ; all the divisions are sharp-pointed, and the crown of each molar thus resembles the trident or fishing-spear ; the two fangs of the first molar in both jaws are connate. In Stenorhynchus serridens the three anterior mo- lars on each side of both jaws are four-lobed, there being one anterior and two posterior accessory lobes ; the remaining posterior molars (true molars) are five-lobed, the prin- cipal cusp having one small lobe in front, and three developed from its posterior margin ; the summits of the lobes are obtuse, and the posterior ones are recurved like the prin- cipal lobe. Sometimes the third molar be- low has three instead of two posterior acces- sory lobes. Occasionally, also, the second, as well as the first molar above, has it fangs con- nate ; but the essentially duplex nature of the seemingly single fang, which is unfailingly manifested within by the double pulp-cavity, is always outwardly indicated by the median longitudinal opposite indentations of the im- planted base. These slight and unessential varieties, presented by the specimens of the Saw-toothed Sterrink ( Stenorhynchus serridens ) brought home by the enterprising Naturalist of Sir J. lloss’s Antarctic expedition, accord with the analogous varieties noticed by the best observers of the seals of our neighbour- ing seas, as, for example, Nillson. The Grey Seal ( Halichcerus gryphus) of our own seas begins, by the extension of the connate condition of the two roots through a greater proportion of the molar series, to manifest a transition to the family of seals with true single-rooted molars ; the formula of this genus is, i. ^ c. - p. ^ ^ 2—2’ 1—1 1 3—3 2—2 m' c n • — 34. The four middle upper in- cisors are close set, with pointed recurved crowns ; the lateral ones are much larger and laniariform : the canines have moderate crowns, with a sharp ridge before and behind. The’ 3 n 2 91G TEETH. crowns of the molar teeth are conical, sub- compressed longitudinally and finely grooved, with an anterior and posterior edge ; those below have generally a slight notch at the fore and back part of the base. The first molars, both above and below, are the smallest, with a simple crown and a single ventricose fang ; the second and third above, and the second, third, and fourth below, have two connate roots ; the two roots are commonly distinct in the remaining posterior molars : all the roots are very thick. In the genus Otaria the dental formula is, i. 3—3 2—2’ c. 1 — 1 1—1’ V- 3—3 3—3’ m. 3—3 2—2 = 36. The two middle upper incisors are small, sub-com- pressed, with the crown transversely notched ; the simple crowns of the four incisors below fit into these notches : the outer incisors above are much larger, with a long pointed conical crown, like a small canine. The true canine is twice as large as the adjoining incisor, and is rather less recurved. The molars have each a single fang ; the crown is conical, sub- compressed, pointed ; in the two last recurved, with a basal ridge or “ cingulum,” broadest within : but, in the Otaria jubata, the molars have a pointed cusp developed from the fore- part, and in the last two molars also from the back part of the crown. In some species, as the Otaria lobata (Phoca lobata, Fischer), the single molar is not developed in the upper jaw, and the outer incisors above are not so large : in this species a thick plicated cingulum belts the base of each molar and developes a small tu- bercle from its fore-part in the molars of the lower jaw ; the crown of the last molar above is notched. In the great proboscidian and hooded Seals ( Cystophora ), the incisors and canines still more predominate in size over the molars ; but the incisors are reduced in number, the 2 2 ] 1 3 3 formula here is: i. ~ y, c. ^ y, p. - —t 2 2 m. : = 30. All the molars are single- 2—2 ° rooted, and all the incisors are laniariform. The two middle incisors above and the two below are nearly equal ; the outer incisors above are larger. The canines are still more formidable, especially in the males ; the curved root is thick and subquadrate. The crowns of the molar teeth are short, sub-compressed, obtuse ; sometimes terminated by a knob and defined by a constriction or neck from the fang ; the last is the smallest. In the Walrus ( Tnchechus rosmarus'), the normal incisive formula is transitorily re- presented in the very young animal, which has three teeth in each intermaxillary bone and two on each side of the fore-part of the lower jaw ; they soon disappear, except the outer pair above, which remain close to the intermaxillary suture, on the inner side of the sockets of the enormous canines, and seem to commence the series of small and simple molars which they resemble in size and form. In the adult there are usually three molars or premolars on each side above, behind the per- manent incisor, and four similar teeth on each side of the lower jaw ; the anterior one passing into the interspace between the upper incisor and the first molar, and therefore being the homotype of the molar. In a young walrus’s skull with canine tusks eight inches long, I have seen a fourth upper molar, (fifth includ- ing the incisor), of very small size, about a line in breadth, lodged in a shallow fossa of the jaw, behind the three persistent molars. The crowns of these teeth must be almost on a level with the gums in the recent head; they are very obtuse and worn obliquely from above down to the inner border of their base. The molars of the lower jaw are rather narrower from side to side than those above, and are convex or worn upon their outer side. Each molar has a short, thick, simple and solid root. The canines are developed only in the upper jaw, but are of enormous size, de- scending and projecting from the mouth, like tusks, slightly inclined outwards and bent backwards; they present an oval transverse section, with a shallow longitudinal groove along the inner side, and one or two narrower longitudinal impressions upon the outer side; the base of the canine is widely open, its growth being uninterrupted. The food of the walrus consists of sea- weed and bivalves ; the molars are well adapted to break and crush shells ; and fragments of a species of Mya have been found, with pounded sea-weed, in the stomach. The canine tusks serve as weapons of offence and defence, and to aid the animal in mounting and clambering over blocks of ice. For their composition and microscopic structure I must refer to my “ Odontography,” p. 51 1. et scq. The precise determination of the teeth in the walrus and some other kinds of seals, still awaits the opportunity of examining very young specimens with the deciduous series, which is very early lost. When the clew is afforded by the opportunity of studying the development and succession of the teeth, it infallibly conducts us to the true knowledge of the nature, both of the teeth which are retained, and of those that are wanting to complete the typical number. We have availed ourselves of this in deciphering the much modified dentition of the genus Felts ; and the same clew will guide us to a similar satisfactory knowledge of the nature and homologies of the teeth in the human species. The discovery, by the great poet Gothe, of the limits of the premaxillary bone in man leads to the determination of the incisors, which are reduced to two on each side of both jaws : the contiguous tooth shows by its shape, as well as position, that it is the canine, and the characters of size and shape have also served to divide the remaining five teeth in each lateral series into two bicuspids and three molars. In this instance, as in the dentition of the bear, the secondary characters conform with the essential ones. But since we have seen of how little value shape or size are, in the order Carnivora, in the deter- TEETH. 917 initiation of the exact homologies of the teeth, it is satisfactory to know that the more constant and important character of develop- ment gives the requisite certitude as to the nature of the so-called bicuspids in the human subject. In fig. 584., the condition of the Fig. 584, Deciduous and permanent teeth of a Child (Homo). teeth is shown in the jaws of a child of about six years of age. The two incisors on each side ( di .) are followed by a canine, dc., and this by three teeth having crowns resembling those of the three molar teeth of the adult. In fact, the last of the three is the first of the permanent molars ; it has pushed through the gum, like the two molars which are in advance of it, without displacing any previous tooth, and the substance of the jaw contains no germ of any tooth destined to displace it : it is therefore, by this character of its de- velopment, a true molar, and the germs of the permanent teeth, which are exposed in the substance of the jaw between the diverging fangs of the molars, d. 3 and d. 4, prove those molars to be temporal’)', destined to be replaced, and prove also that the teeth about to displace them are premolars. According, therefore, to the rule previously laid down, we count the permanent molar in place the first of its series fit. 1), and the adjoining premolar as the last of its series, and consequently the fourth of the typical dentition, or p. 4. We are thus enabled, with the same scien- tific certainty as that whereby we recognise in the middle toe of the foot the homologue of that great digit which forms the whole foot and is encased by the hoof in the horse, to point to p. 4, or the second bicuspid in the upper jaw, and to m. 1, or the first molar in the lower jaw of man, as the homo- logues of the great carnassial teeth of the lion and tiger. We also conclude that the teeth which are wanting in man to complete the typical molar series, are the first and second premolars, the homologues of those marked p. 1 and p. 2 in the bear. The characteristic shortening of the maxillary bones required this diminution of the number of their teeth, as well as of their size, and of the canines more especially ; and the still greater curtailment of the premaxillary bone is attended with a diminished number and an altered position of the incisors. One sees, indeed, in the car- nivorous series, that a corresponding decrease in the number of the premolars is concomitant with the shortening of the jaws. Already in the Mustelidce, (Jjg.o&O., IV), p. 1 below is abrogated; in EV/walso above, with the further loss of p. 2 in the lower jaw ; the true molars being correspondingly reduced in these strictly flesh-eating animals, but taken away from the back part of their series. If we were desirous of further testing the soundness of the foregoing conclusions as to the nature of the teeth absent in the reduced dental formula of man, we ought to trace the mode in which the type is progressively resumed in descending from man through the order most nearly allied to our own. Through a considerable part of the Qua- drttmanous series, e. g. in all the Old World genera above the Lemurs, the same number and kinds of teeth are present as in man ; the first deviation being the disproportionate size of the canines and the concomitant break or “ diastema ” in the dental series for the reception of their crowns when the mouth is shut. This is manifested in both the Chimpanzees and Orangs, together with a sexual difference in the proportions of the canine teeth. As the precise characteristics of the human dentition are best demonstrated by comparison with that brute species which is most nearly allied to Man, and makes the first step in the descending scale, I here subjoin the details of such a comparison, which is the more required since it is not touched upon in the article Quadrumana, and will be the more acceptable as one of its subjects is a species of Chim- panzee (Tioglodytes Gorilla)*, unknown to science when that article was written, and which, so far as its organisation is known, is more anthropoid than even the docile and smaller species of Chimpanzee ( Troglodytes niger). A side view of the teeth of a male, full-grown, but not aged, specimen of the great Chimpanzee is given of the natural size in fig. 585., and a view of the working surface of the whole series of the upper jaw in fig. 586. This dentition, though in all its principal characters strictly quadrumanous, yet, in the * Drs. Savage and Wyman, Boston Journal of Natural History, 1847 ; Owen, Transactions of the Zoological Society, vol. iii. p. 381 (February, 1848). M. F. Cuvier has not given a figure of the dentition of any species of Chimpanzee ( Troglodytes ). Be- lieving with his brother, that the Orang ( Pithecus , Geoffr.) made the nearest approach to man, the dentition of an immature Pithecus Wurmhii with one of the characteristically large permanent molars (m. 1) in place, immediately follows the plate of the human dentition in the “ Dents des Mammifhres,” 8vo. pis. i. & ii. 3 n 3 TEETH. Fig. 585. Dentition of upper jaw, Troglodytes Gorilla, adult male. ( Natural size.) TEETH. 919 minor particulars in which it differs from the dentition of the Orang, approaches nearer the human type. In the upper jaw the middle incisors {Jig. 586, i. 1) are smaller, the lateral ones (ib. i. 2) larger than those of the Orang*; they are thus more nearly equal to each other; nevertheless the proportional superiority of the middle pair is much greater than in Man, and the proportional size of the four incisors both to the entire skull and to the other teeth is greater. Each incisor has a prominent posterior basal ridge, and the outer angle of the lateral incisors, i. 2, is rounded off as in the Orang. The incisors incline forwards from the vertical line as much as in the great Orang. Thus the characteristics of the human incisors are, in addition to their true incisive wedge-like form, their near equality teeth ” *, when the mouth is closed, is appli- cable only to the female, and does not distin- guish the Chimpanzees from the Orangs. In the male of the smaller Chimpanzee ( Troglody- tes niger ) the upper canine is conical, pointed, but more compressed than in the Orang, and with a sharper posterior edge ; convex ante- riorly, becoming flatter at the posterior half of the outer surface, and concave on the corre- sponding part of the inner surface, which is traversed by a shallow longitudinal impres- sion ; a feeble longitudinal rising and a second linear impression divide this from the convex anterior surface, which also bears a longitu- dinal groove at the base of the crown. The canine is rather more than twice the size of that in the female. In the male Gorilla {Jigs. 585, 586.), the crown of the canine is Fig. 587. Dentition of adult female, Troglodytes Gorilla. ( Natural size.') of size, their vertical or nearly vertical posi- tion, and small relative size to the other teeth and to the entire skull. The diastema be- tween the incisors and the canine on each side is as well marked in the male Chim- panzee as in the male Orang. f The crown of the canine (ib. c.fi passing outside the in- terspace between the lower canine and pre- molar, extends in the male Troglodytes Gorilla a little below the alveolar border of the under jaw when the mouth is shut ; the upper ca- nine of the male Troglodytes niger likewise projects a little below that border ; the seventh character, therefore, which I had formerly assigned to the genus, “ apices of canines lodged in intervals of the opposite * Compare fig. 586. with pi. xxxii. ( Pithecus Wurmbii) and pi. xxxiv. (Pith. Morio), in vol. ii. Zool. Trans. t Compare fig. 586. with pi. xxxii. (Pith. Wurrn- hii) in vol. ii. Zool. Trans. more inclined outwards : the anterior groove on the inner surface of the crown is deeper ; the posterior groove is continued lower dowm upon the fang, and the ridge between the two grooves is more prominent than in the Troglodytes niger. Both premolars (Jig. 586. p. 3 and p. 4) are bicuspid ; the outer cusp of the first and the inner cusp of the second being the largest, and the first premolar consequently appearing the largest on an external view (Jig. 585.). The difference is well marked in the female (Jig . 587, p. 3, p. 4). The anterior ex- ternal angle of the first premolar is not pro- duced as in the Orang, which in this respect makes a marked approach to the lower Qua- drumana. In Man, where the outer curve of the premolar part of the dental series is greater than the inner one, the outer cusps of both premolars are the largest ; the alternating su- periority of size in the Chimpanzee accords * Zool. Trans, vol. i. pi 372. 3 n 4 920 TEETH. with, and contributes to, the straight line which the canine and premolars form with the true molars. The true molars (Jig. 586., m. 1, to. 2, in. 3) are quadricuspid, relatively larger in comparison with the bicuspids than in the Orang. In the first and second molars of both species of Chimpanzee a low ridge connects the antero- internal with the postero-external cusp, cross- ing the crown obliquely, as in Man. There is a feeble indication of the same ridge in the unworn molars of the Orang ; but the four principal cusps are much less distinct, and the whole grinding surface is flatter and more wrinkled than in the Chimpanzee. In the Troglodytes niger the last molar is the smallest, owing to the inferior development of the two hinder cusps, and the oblique connecting ridge is feebly marked. In the Troglodytes Gorilla this ridge is as well developed as in the other molars, but is more transverse in position ; and the crown of in. 3 is equal in size to that of in. ] or m. 2, having the pos- terior outer cusp, and particularly the pos- terior inner cusp, more distinctly developed than in the Troglodytes niger. The repe- tition of the strong sigmoid curves which the unworn prominences of the first and se- cond true molars present in Man, is a very significant indication of the near affinity of the Chimpanzee as compared with the ap- proach made by the Orangs or any of the inferior Quadrumana, in which the four cusps of the true molars rise distinct and indepen- dently of each other. A low ridge girts the base of the antero-internal cusp of each of the upper true molars in the male Chimpan- zee: it is less marked in the female. The premolars as well as molars are severally im- planted by one internal and two external fangs, diverging but curving towards each other at their ends as if grasping the substance of the jaw. I have found the two outer fangs of the second premolar connate in one female specimen of the Troglodytes niger. In no variety of the human species are the premo- lars normally implanted by three fangs ; at most the root is bifid, and the outer and inner divisions of the root are commonly connate. It is only in the black varieties, and more particularly that race inhabiting Australia, that I have found the wisdom tooth, to. 3, with three fangs as a general rule ; anil the two outer ones are more or less confluent. In the lower jaw of the great Chimpanzee the lateral incisors are broader than the middle ones, although they are smaller rela- tively than in the Troglodytes niger ; they are larger and less vertically implanted than in Man. The lower canines are two inches and a half in length, including the root ; the enamelled crown is an inch and a quarter in length, and nearly an inch across the base; it is conical and trihedral ; the outer and ante- rior surface is convex, the other two surfaces are flattened or subconcave, and converging to an almost trenchant edge directed inwards and backwards ; a ridge separates the convex from the antero-internal fiat surface; both this and the posterior surface show slight traces of a longitudinal rising at their middle part. The lower canine of the male shows the same relative superiority of size as the upper one compared with that in the female in both species of Chimpanzee. The canine almost touches the incisor, but is separated by a diastema one line and a half broad from the first premolar. This tooth ( p . 3) is larger externally than the second premolar, and is three times the size of the human first premolar (p. 3) ; it has a subtrihedral crown, with the anterior and outer angle produced forwards, slightly indicating the peculiar fea- ture of the same tooth in the Baboons, but in a less degree than in the Orang. The summit of the crown ot' p. 3 terminates in two sharp trihedral cusps, the outer one rising highest, and the second cusp being feebly indicated on the ridge extending from the inner side of the first ; the crown has, also, a thick ridge at the inner and posterior part of its base. The second premolar (p. 4) has a subquad- rate crown, with the two cusps developed from its anterior half, and a third smaller one from the inner angle of the posterior ridge. Each lower premolar is implanted by two antero-posteriorly compressed divergent fangs, one in front of the other, the anterior fang being the largest. The three true molars are equal in size in the Troglodytes Gorilla ; in the Troglodytes niger (Jig. 588.) the first (to. 1) is a little larger than the last (to. 3), which is the Dental series, lower jaw, adult male, Troglodytes niger. ( Natural Size.') TEETH. 921 only molar in the smaller Chimpanzee as large as the corresponding tooth in the black varieties of the human subject *, in most of which, especially the Australians, the true molars attain larger dimensions than in the yellow or white races. The four principal cusps, especially the two inner ones, of the first molar of both species of Chimpanzee are more pointed and prolonged than in Man; a fifth small cusp is developed behind the outer pair, as in the Orangs and the Gibbons, but is less than that in Man. The same additional cusp is present in the second molar, which is seldom seen in Man. The crucial groove on the grinding surface is much less distinct than in Man, not being continued across the ridge connecting the anterior pair of cusps in the Chimpanzee. The crown of the third molar is longer antero-posteriorly from the greater development of the fifth posterior cusp, which, however, is rudimental in comparison with that in the Semnopitheques and Macaques. All the three true molars are supported by two distinct and well developed antero-pos- teriorly compressed divergent fangs, longitu- dinally excavated on the sides turned towards each other ; in the white and yellow races of the human subject these fangs are usually connate in in. 3, and sometimes also in m. 2. The molar series in both species of Chim- panzee forms a straight line, with a slight ten- dency in the upper jaw to bend in the opposite direction to the well-marked curve which the same series describes in the human subject. This difference of arrangement, with the more complex implantation of the premolars, the proportionally larger size of the incisors as compared with the molars ; the still greater relative magnitude of the canines ; and, above all, the sexual distinction in that respect, illus- trated byjftgs. 585. 587., stamp the Chimpan- zees most decisively with not merely specific but generic distinctive characters as compared with Man. For the teeth are fashioned in their shape and proportions in the dark re- cesses of their closed formative alveoli, and do not come into the sphere of operation of external modifying causes until the full size of the crowns has been acquired. The formid- able natural weapons, with which the Creator has armed the powerful males of both species of Chimpanzee, form the compensation for the want of that psychical capacity to forge destructive instruments which has been re- served as the exclusive prerogative of Man. Both Chimpanzees and Orangs differ from the human subject in the order of the de- velopment of the permanent series of teeth ; the second molar ( m . 2) conies into place before either of the premolars has cut the gum, and the last molar (in. 3) is acquired before the canine. We may well suppose that the larger grinders are earlier required by the frugivorous Chimpanzees and Orangs than by the higher organised omnivorous spe- cies with more numerous and varied resources, and probably one main condition of the earlier * See my Odontography, pi. 119, fy. 2, m. development of the canines and premolars in Man may be their smaller relative size. In the South American Quadrumana, the number of teeth is increased to thirty-six (art. Quadrumana,Vo1. IV. p.210.; Cebhnx *), by an addition of one tooth to the molar series on each side of both jaws. It might be concluded, a priori, that as three is the typical number of true molars in the placental Mam- malia with two sets of teeth, the additional tooth in the Cebince would be a premolar, and form one step to the resumption of the normal number (four) of that kind of teeth. The proof of the accuracy of this inference is given by the state of the dentition in the young Cebus in Jig. 589., which corresponds with that of the human child in Jig. 584-., i. e. the whole of the Fig. 589. Deciduous and permanent teeth of Cebus. deciduous dentition is retained, and the first true molar (in. 1) is in place on each side of both jaws. The germs of the other teeth of the permanent series are exposed in the upper jaw ; and the crown of a premolar is found above the third molar in place, as well as above the second and first. As regards number, therefore, the molar series, in Cebus, is interme- diate between that of Mustela (Jig. 580., IV.) and Felis (ib. V.) ; the little premolarj9.fi in Mustela tells plainly enough which of the four is wanting to complete the typical number in the South American Monkey, and which is the additional premolar distinguishing its dental formula from that of the Old World monkeys and man. By reference to Prof. Vro- lik’s article (Quadrumana) it will be seen that the eighth genus, including the little Marmoset monkeys (Hapale, Ouistiii ), “ have only the same number of teeth as the monkeys 4 1 — 1 of the Old World, viz. 32, i. t, c. m. -f 1 — i 5—5 „ 5—5' But the difference is much greater than this numerical conformity would intimate. In a young Jacchus penicillatus I find that there are three deciduous molars displaced by three premolars, as in the other South Ame- rican Quadrumana, and that it is the last true molar, m. 3, the development of which is sup- pressed, not the premolar p. 2, and thus these diminutive squirrel-like monkeys actually differ * The dental series seems, unluckily, not to have been complete in either of the skulls represented by the distinguished author of that able article ( das. 132, 133). 922 TEETH. from the Old World Quadrumana more than th eCebidce do ; i.e. they differ not only in having four teeth ( p . 2 | — j), which the monkeys of the Old World do not possess, but also by wanting four teeth (m. 3 . .), which those monkeys, as well as the Cebidee, actually have. It is thus that the investigation of the exact homologies of parts leads to a recognition of the true characters indicative of zoological affinity. 3—3 Most of the Lemurina have p. ^ m. 3—3 3—3’ together with remarkable modifications of their incisive and canine teeth, of which an extreme example is shown in the pectinated tooth (Jig. 556.) of the Galeopithecus. The inferior incisors slope forwards in all, and the canines also, which are contiguous to them, and very similar in shape. In the Chirogaleus these canines are entered as in- cisors in the dental formula of the genus ( Vol. IV. p. 215), and the laniariform premolar (p. 2) is entered as a canine : M. Vrolik also describes four teeth on each side of the upper jaw, and four on each side of the lower jaw, as true tuberculated molars. They have tuber- culated crowns, but the value of shape as a character is too small to permit our accepting •so great an anomaly without the requisite proof of their order of development and suc- cession. Even in the hoofed quadrupeds with toes in uneven number ( Perissodactyla ), whose premolars, for the most part, repeat both the form and the complex structure of the true molars, such premolars are distinguished by the same character of development as those of the Artiodactyla, or Ungulates with toes in even number ; although in these the premolars are distinguished also by modifications of size and shape. The complex ridged and tuber- culate crowns of the second, third, and fourth grinders of the Rhinoceros, Hyrax (Jig. 590.), tooth be determined, and its proper symbol applied to it. In pi. 136, 5, of my Odontography, the three posterior teeth of the almost uniform grinding series of the horse’s dentition are thus proved to be the only ones entitled to the name of “ true molars and, if any one should doubt the certainty of the rule of count- ing, by which the symbols, p. 4, p. 3, and p. 2, are applied to the three large anterior grinding teeth (ib. Jig. 19), which are commonly the only premolars present in each lateral series of the horse’s jaws, yet the occasional retention of the diminutive tooth,/;. 1 (ib.y%. 6). would establish its accuracy, whether such tooth be regarded as the first of the deciduous series unusually long retained, or the unusually small and speedily lost successor (/;. 1) of an abortive d 1. The law of development, so beautiful for its instructiveness and constancy in the pla- cental Dipliyodonts, is here illustrated in the little Ilyra.v (Jig. 591.), in which the d. 1 is Fig. 591. Deciduous and permanent molars of the Hyrax. normally developed and succeeded by a per- manent p. 1, differing from the rest only by a graduated inferiority of size, which, in regard to the last premolar, ceases to be a distinction between it and the first true molar. The elephant, which by' its digital characters belongs to the odd-toed, or perissodactyle, group of Pachyderms, also resembles them in the close agreement in form and structure of the grinding teeth representing the premolars, Fig. 590. and horse, no more prove them to be true molars, than the trenchant shape of the lower carnassials of the lion proves them to be false molars. It is by development alone that the primary division of the series of grinding teeth can be established, and by that character only can the homologies of each individual with those that answer to the true molars of the Hyrax, Tapir, and Rhinoceros. The gi- gantic Proboscidian Pachyderms of Asia and Africa present, however, so many peculiarities of structure, as to have led to their being located in a particular family in the Systematic Mammalogies. And this seems to be justified TEETH. 293 by no character more than by the singular seeming exception which they present to the Diphyodont rule which governs the dentition of other hoofed quadrupeds. In fact, the elephant, like the Dugong, sheds and replaces vertically only its incisors, which are also two in number, very long, and of constant growth, forming tusks, with an analogous sexual dif- erence in this respect in the female of the Asiatic species. The molars, also, are suc- cessively lost, are not vertically replaced, and are reduced finally to one on each side of both jaws, which is larger than any of its pre- decessors. These analogies are interesting and suggestive in connection with the other approximations in the “ Sirenia” to the pa- chydermal type, which I have pointed out in the “ Proceedings of the Zoological Society.” * The dentition of the genus Elephas, the sole existing modification of the once numerous and varied Proboscidian family, includes two long tusks {fig. 592.), one in each of the Intermaxillary bones, and large and complex molars (ib. m. 3, 4, and 5) in both jaws : of the latter there is never more than one wholly, or two partially, in place and use on each side at any given time ; for, like the molars of the Mastodons, the series is continually in progress of formation and destruction, of shedding and replacement ; and in the ele- phants all the grinders succeed one another like true molars horizontally, from behind forwards. The total number of teeth developed in the 2—2 G— 6 elephant appears to be vi-qIIq = 28. The two large permanent tusks being pre- ceded by two small deciduous ones, and the number of molar teeth which follow one another on each side of both jaws being at “ The socket of the permanent tusk in a new-born elephant, is a round cell about three lines in diameter, situated on the inner and posterior side of the aperture of the temporary socket. The permanent tusks cut the gum when about an inch in length, a Fig. 592. Section of cranium and tusk of the Elephant month or two, usually, after the milk-tusks are shed. At this period, according to Mr. Corse *, the permanent tusks are ‘ black and ragged at the ends. When they become longer, and project beyond the lip, they soon are worn smooth bv the motion and friction of the trunk.’ Their widely open base is fixed upon a conical pulp, which, with the capsule sur- rounding the base of the tusk and the socket, continues to increase in size and depth, ob- literating all vestiges of that of the deciduous tusk, and finally extending its base close to the nasal aperture (fig. 592.). The tusk is formed by successive calcification of layers of the pulp in contact with the inner surface of the pulp cavity ; and, being subject to no habitual attrition from an opposed tooth, but being worn only by the occasional uses to which it is applied, it arrives at an extraor- dinary length, following the curve originally * Loc. cit., p. 212. least six, of which the last three may, by analogy, be regarded as answering to the true molars of other Pachyderms. I have shown in my Odontography that : — “ The deciduous tusk makes its appearance beyond the gum between the fifth and seventh month ; it rarely exceeds two inches in length, and is about a third of an inch in diameter at its thickest part, where it protrudes from the socket ; the fang is solidified, and con- tracts to its termination, which is commonly a little bent, and is considerably absorbed by the time the tooth is shed, which takes place between the first and second year.f * 1838, p. 40. f See Mr. Corse’s “ Memoir on the Teeth of the Elephant,” in Philosophical Transactions, 1799, p. 211 : a good figure of the deciduous tusk is given in plate 5. TEETH. 92-1 impressed upon it by the form of the socket, and gradually widening from the projecting apex to that part which was formed when the matrix and the socket had reached their full size. “ These incisive teeth of the elephant not only surpass other teeth in size, as belonging to a quadruped so enormous, hut they are the largest of all teeth in proportion to the size of the body ; representing in a natural state those monstrous incisors of the Rodents, which are the result of accidental suppression of the wearing force of the opposite teeth.” The tusks of the elephant, like those of the Mastodon, consist chiefly of that modifi- cation of dentine which is called “ ivory,” and which shows, on transverse fractures or sec- tions, striae proceeding in the arc of a circle from the centre to the circumference, in op- posite directions, and forming by their decus- sations curvilinear lozenges. This character is peculiar to the Proboscidian Pachyderms. In the Indian elephant the tusks are always short and straight in the female, and less deeply implanted than in the male : she thus retaining, as usual, more of the charac- ters of the immature state. In the male they have been known to acquire a length of nine feet, with a basal diameter of eight inches, and to weigh one hundred and fifty pounds ; but these dimensions are rare in the Asiatic species. Mr. Corse, speaking of the variety of Indian elephant, called “ Dauntelah ” from its large tusks, which project almost horizontally with a slight curve upwards and outwards, says, “ The largest I have known in Bengal did not exceed seventy-two pounds avoirdupois; at Tiperah they seldom exceed fifty pounds.” There are varieties of the Dauntelah in which the large tusks of the male are nearly or quite straight ; and in a more marked breed called “ Mooknah,” the tusks are much smaller, are straight, and point directly downwards. These ascertained varieties in an existing species ought to weigh with the observers of analo- gous varieties in the teeth of fossil Probos- cidians, before they pronounce definitely on their value as characters of distinct species. More anomalous varieties occasionally pre- sent themselves in the Indian Elephant, as when one tusk is horizontal, the other ver- tical; or when, from some distortion of the alveolus, a spiral direction is impressed upon the growth of the tusk, as in that specimen figured by Grew in the “ Rarities of Gresham College,” Tab. 4., and which is now in the Museum of the Royal College of Surgeons, London. The tusk of the elephant is slightly moveable in its socket, and readily receives a new direction of growth from habitual pres- sure ; this often causes distorted tusks in captive elephants, and Cuvier * relates the mode in which advantage was taken of the same impressibility, in order to rectify the growth of such tusks in an elephant kept at the Garden of Plants. The tusks of the extinct Eleplias primi- * Ossemens Fossiles, 4to. 1821, tom. i. p. 47. genius , or Mammoth, have a bolder and more extensive curvature than those of the Eleplias indicus: some have been found which describe a circle ; but, the curve being oblique, they thus clear the head, and point outwards, downwards, and backwards. The numerous fossil tusks of the Mammoth which have been discovered and recorded, may be ranged under two averages of size: the larger ones at nine feet and a half, the smaller at five feet and a half in length. 1 have elsewhere* as- signed reasons for the probability of the latter belonging to the female Mammoth, which must accordingly have differed from the exist- ing elephant of India, and more resembles that of Africa in the development of her tusks ; yet manifesting an intermediate cha- racter by their smaller size. Of the tusks which are referable to the male Mammoth, one from the newer tertiary deposits in Essex, measured nine feet ten inches along the outer curve, and two feet five inches in circum- ference at its thickest part ; another from Eschscholtz Bay was nine feet two inches in length, and two feet one and a half inches in circumference, and weighed one hundred and sixty pounds. A Mammoth’s tusk has been dredged up off Dungeness which measured eleven feet in length. In several of the in- stances of Mammoth’s tusks from British strata, the ivory has been so little altered as to be fit for the purposes of manufacture ; and the tusks of the Mammoth, which are still better preserved in the frozen drift of Siberia, have long been collected in great numbers as articles of commerce.f Cuvier J states that the elephant of Africa, at least in certain localities, has large tusks in both sexes, and that the female of this species, which lived seventeen years in the menagerie of Louis XIV., had larger tusks than those in any Indian elephant, male or female, of the same size which he had seen. The ivory of the tusks of the African ele- phant is most esteemed by the manufacturer for its density and whiteness. The molar teeth of the elephant are re- markable for their great size, even in relation to the bulk of the animal, and for the extreme complexity of their structure. The crown, of which a great proportion is buried in the socket, and very little more than the grinding surface appears above the gum, is deeply di- vided into a number of transverse perpen- dicular plates (Jig. 557), consisting each of a body of dentine (cl), coated by a layer of enamel (e), and this again by the less dense bone-like * History of British Fossil Mammalia, 8vo. 1844, p. 244. j- In the account of the Mammoth’s bones and teeth of Siberia, published in the “ Philosophical Transactions ” for 1737 (No. 446), tusks are cited which weighed two hundred pounds each, and “ are used as ivory, to make combs, boxes, and such other things; being but little more brittle, and easily turning yellow by weather and heat.” From that time to the present there has been no inter- mission in the supply of ivory, furnished by the tusks of the extinct elephants of a former world. J Eoc. cit., p. 55. TEETH. 925 substance (c) which fills the interspaces of the enamelled plates, and here more especially merits the name of “ cement,” since it binds together the several divisions of the crown before they are fully formed and united by the confluence of their bases into a common body of dentine. As the calcification of each plate begins at the summit, they remain de- tached from each other and like so many se- parate teeth or denticules, until their base is completed, when it becomes blended with the bases of contiguous plates to form the common body of the crown of the complex tooth from which the roots are next developed. The plates of the molar teeth of the Si- berian Mammoth ( Elephas primigenius ) are thinner in proportion to their breadth, and are generally a little expanded at the middle ; and they are more numerous in proportion to the size of the crown than in the existing species of Asiatic Elephant. In the African Elephant, on the other hand, the lamellar divisions of the crown are fewer and thicker, and they expand more uniformly from the margins to the centre, yielding a lozenge-form when cut or worn transversely, as in masti- cation. The horizontal as well as vertical course of development of the elephant’s grinder is well illustrated by the Mammoth’s molar, the last of the lower jaw. The separate digital processes of the posterior plates are still distinct, and adhere only by the re- maining cement ; a little in advance we see them united to form the transverse plate ; and, at the opposite extremity of the tooth, the common base of dentine is exposed by which the plates are finally blended into one individual complex grinder*; this never takes place simultaneously along the whole course of the tooth in the larger molars of the existing Indian elephant, or its extinct congener, the Mammoth. The African ele- phant, and some of the extinct Indian species, as the El. planifrons, manifest their affinity to the Mastodon by the basal confluence of the hindmost plates before the foremost ones are worn out. The formation of each grinder begins with the summits of the anterior plate, and the rest are completed in succession ; the tooth is gradually advanced in position as its growth proceeds; and, in the existing Indian elephant, the anterior plates are brought into use before the posterior ones are formed. When the complex molar cuts the gum the cement is first rubbed off the digital summits: then their enamel cap is worn away, and the * Some anatomists describe the divisions of the crown of the elephant’s grinder as so many “ distinct teeth ; ” and Mr. Corse (loc. cit. p. 213.), who first propounded this view, calls each complex grinder “ a case of teeth,” and states “ that these teeth are merely joined to each other by an intermediate softer substance, acting like a cement.” But this description applies only to the imperfectly-formed tooth ; and the detached eminences of the crown of any complex tooth, at that stage of growth when they are held together only by the still uncalcified supporting matrix, might with equal justice be regarded as so many distinct teeth. central dentine comes into play with a promi- nent enamel ring ; the digital processes are next ground down to their common uniting base, and a transverse tract of dentine with its wavy border of enamel is exposed ; finally, the transverse plates themselves are abraded to their common base of dentine, and a smooth and polished tract of that substance is pro- duced.* From this basis the roots of the molar are developed, and increase in length to keep the worn crown on the grinding level, until the reproductive force is exhausted. When the whole extent of a grinder has successively come into play, its last part is reduced to a long fang supporting a smooth and polished field of dentine, with, perhaps, a few remnants of the bottom of the enamel folds at its hinder part. When the complex molar has been thus worn down to a uni- form surface it becomes useless as an instru- ment for grinding the coarse vegetable sub- stances on which the elephant subsists ; it is attacked by the absorbent action, and the wasted portion of the molar is finally shed. The grinding teeth of the elephant pro- gressively increase in size, and in the number of lamellar divisions, from the first to the last; and, as the rate of increase in both respects is nearly identical in both jaws, I shall describe them chiefly as they appear in the lower one. The first molar, which cuts the gum in the course of the second week after birth, has a sub-compressed crown, nine lines in antero- posterior diameter, divided by three trans- verse clefts into four plates, the third being the broadest, and the tooth here measuring six lines across f ; the first and second plates have two mammilloid summits ; the third and fourth have three or four such ; there is a sin- gle and sometimes a double mammilloid sum- mit at the fore and back part of the crown : the base slightly contracts, and forms a neck as long as the enamelled crown, but of less breadth, and this divides into two, an anterior and posterior, long, sub-cylindrical, diverging, but mutually incurved fangs ; the total length of this tooth is one inch and a half. The corresponding upper molar, which Mr. Corse describes as cutting the gum a little earlier than the lower one, has the anterior single digital process or mammilla, and the pos- terior talon developed into a fifth plate, smaller than the fourth, with which it* middle part is confluent ; the neck of this tooth is shorter, and the two fangs are shorter, larger, and more compressed than those of the lower first molar. This tooth is the homologue of the probably deciduous molar ( d . 2) in other * In the fossil specimen figured in plate 147, of my “ Odontography,” the left molar l, exhibits all the above-descrilied gradations of use ; but the right molar, r, through some accident to the opposing tooth in the lower jaw, has not been so worn, but projects beyond the level of the left molar, with the mammillated margins of the plates en- tire. f These are also the dimensions of the first lower molar figured by Mr. Corse, loc. cit. pi. \i.flg. 1, i>, and,/?#. 3 ; but I have seen the first lower molar of smaller dimensions. 926 TEETH. Ungulates; it is not a mere miniature of the great molars of the mature animal, but re- tains, agreeably with the period of life at which it is developed, a character much more nearly approaching that of the ordinary Pa- ehydermal molar, manifesting the adherence to the more general type by the minor com- plexity of the crown, and by the form and relative size of the fangs. In the transverse divisions of the crown we perceive the affinity to the Tapiroid type, the different links con- necting which with the typical elephants are supplied by the extinct Lophiodons, Dino- theriums, and Mastodons. The sub-division of the summits of the primary plates recalls the character of the molars, especially the smaller ones, of the Phacochere in the Hog- tribe. As the elephant advances in age the molars rapidly acquire their more special and complex character. The first molars are completely in place, and in full use at three months, and are shed when the elephant is about two years old. The sudden increase and rapid develop- ment of the second molar may account for the non-existence of any vertical successor to the former tooth, or “premolar,” in the elephant. The eight or nine plates of the crown are formed in the closed alveolus, behind the first molar by the time this cuts the gum, and they are united with the body of the tooth, and most of them in use, when the first molar is shed. The average length of the second molar is two inches and a half; ranging from two inches to two inches and nine lines. The greatest breadth, which is behind the middle of the tooth, is from one inch to one inch three lines. There are two roots: the cavity of the small anterior one expands in the crown, and is continued into that of the three anterior plates. The thicker root supports the rest of the tooth. The second molar is worn out and shed before the beginning of the sixth year. The third molar has the crown divided into from eleven to thirteen plates ; it averages four inches in length, and two inches in breadth, and has a small anterior, and a very large posterior root ; it begins to appear above the gum about the end of the second year, is in its most complete state and exten- sive usg during the fifth year, and is worn out and shed in the ninth year. The last rem- nant of the third molar is shown at m. 3, fig. 592. It is probable that the three teeth above de- scribed are homologous with the deciduous mo- lars, d. 2, d. 3, and d. 4. in the Hyrax and horse. The fourth molar presents a marked supe- riority of size over the third, and a somewhat different form : the anterior angle is more obliquely abraded, giving a pentagonal figure to the tooth in the upper jaw {fig. 592. m. 4). The number of plates in the crown of this tooth is fifteen or sixteen : its length between seven and eight inches ; its breadth three inches. It has an anterior simple and slender root supporting the three first plates ; a second of larger size and bifid, supporting the four next plates ; and a large contracting base for the remainder. The fore-part of the grinding surface of this tooth begins to pro- trude through the gum at the sixth year: the tooth is worn away, and its last remnant shed, about the twentieth or twenty-fifth year. It may be regarded as the homologue of the first true molar of ordinary Pachyderms (m. 1). The fifth molar, with a crown of from seventeen to twenty plates, measures between nine and ten inches in length, and about three inches and a half in breadth. The second root is more distinctly separated from the first simple root than from the large mass behind. It begins to appear above the gum about the twentieth year : its duration has not been ascertained by observation ; but it probably is not shed before the sixtieth y ear. The sixth molar appears to be the last, and has from twenty-two to twenty-seven plates ; its length, or antero-posterior extent, following the curvature, is from twelve to fifteen inches : the breadth of the grinding surface rarely exceeds three inches and a half. The reproductive power of the matrix in some cases surpasses that of the formative development of the cavity for lodging the tooth, and the last lamellae are obliged to be folded from behind forwards upon the side of the tooth. Fig. 99, p. 2.33. of my “ History of British Fossil Mammals,” shows this condition in the last lower molar of the Mammoth. One may reasonably conjecture that the sixth molar of the Indian elephant, if it make its appearance about the fiftieth y'ear, would, from its superior depth and length, continue to do the work of mastication until the pon- derous Pachyderm had passed the century of its existence. Mr. Corse has figured the sixth molar, (which he calls the seventh or eighth,) with twenty-three plates, in tab. x. of his Memoir, and a small cavity, c, is marked as an in- cipient alveolus for a succeeding grinder. Had it actually been such, it might have been expected to contain some calcified portions of the anterior plates of such succeeding grinder. The molar teeth, in all the species of elephant, succeed each other from behind forwards, moving, not in a right line, but in the arc of a circle, shown by the curved line in fig. 592. The position of the growing tooth in the closed alveolus {in. 5) is almost at right angles with that in use, the grinding surface being at first directed backwards in the upper jaw, and forwards in the lower jaw, and brought, by the revolving course, into a horizontal line in both jaws, so that they oppose each other, when developed for use. The imaginary pivot on which the grinders revolve is next their root in the upper jaw, and is next the grinding surface in the lower jaw ; in both, towards the frontal surface of the skull. Viewing both upper and lower molars as one complex whole, subject to the same revolving movement, the section dividing such whole into upper and lower portion runs TEETH. 927 parallel to the curve described by that move- ment, the upper being the central portion, or that nearest the pivot, the lower, the pe- ripheral portion : the grinding surface of the upper molars is consequently convex from behind forwards, and that of the lower molars concave : the upper molars are always broader than the lower ones. The bony plate forming the sockets of the growing teeth is more than usually distinct from the body of the maxillary, and participates in this re- volving course, advancing forwards with the teeth. The partition between the tooth in use and its successor is perforated near the middle; and, in its progress forwards, that part next the grinding surface is first absorbed ; the rest disappearing with the absorption of the roots of the preceding grinder. There are few examples of organs that manifest a more striking adaptation of a highly complex and beautiful structure to the exigencies of the animal endowed with it, than the grinding teeth of the elephant. We per- ceive, for example, that the jaw is not en- cumbered with the whole weight of the mas- sive tooth at once, but that it is formed by degrees as it is required ; the division of the crown into a number of successive plates, and the subdivision of these into cylindrical pro- cesses, presenting the conditions most favour- able to progressive formation. But a more important advantage is gained by this sub- division of the tooth ; each part is formed like a perfect simple tooth, having a body of dentine, a coat of enamel, and an outer in- vestment of cement : a single digital pro- cess may be compared to the simple canine of a Carnivore ; a transverse row of these, therefore, when the work of mastication has commenced, presents, by virtue of the different densities of their constituent sub- stances, a series of cylindrical ridges of ena- mel, with as many depressions of dentine, and deeper external valleys of cement : the more advanced and more abraded part of the crown is traversed by the transverse ridges of the enamel inclosing the depressed surface of the dentine, and separated by the deeper channels of the cement : the fore-part of the tooth exhibits its least efficient con- dition for mastication ; the inequalities of the grinding surface being reduced in proportion as the enamel and cement which invested the dentinal plates have been worn away. This part of the tooth is, however, still fitted for the first coarse crushing of the branches of a tree : the transverse enamel ridges of the succeeding part of the tooth divide it into smaller fragments, and the posterior islands and tubercles of enamel pound it to the pulp fit for deglutition. The structure and pro- gressive development of the tooth not only give to the elephant’s grinder the advantage of the uneven surface which adapts the mill- stone for its office, but, at tbe same time, secure the constant presence of the most efficient arrangement for the finer comminu- tion of the food, at the part of the mouth which is nearest the fauces. With regard to the microscopic structure of the peculiar modification of dentine called “ ivory,” this is characterised partly' by the minute size of the tubes, which, at their origin from the pulp cavity, do not exceed -^i-j-th of an inch in diameter, in their close arrangement at intervals scarcely exceeding the breadth of a single tube, and, above all, on their strong and almost angular gyrations, which are much greater than the secondary curvatures of the tubes of ordinary dentine. The dentinal tubes of ivory, as they radiate from the pulp-cavitv, incline obliquely towards the pointed end of the tusk, and describe two slight primary curves, the first convex towards that end, the second and shorter one concave ; these curves in narrow sections from near the open base of the tusk are almost obscured by the strong angular parallel secondary gyrations. The tubes divide dieho- tomously, at acute angles, and gradually de- crease in size as they approach the periphery of the tusk. The characteristic appearance of decussating curved striae, with oblique rhomboidal spaces, so conspicuous on transverse sections or frac- tures of ivory, is due to the refraction of light caused by the parallel secondary gy rations of the tubes above described. The strong con- tour lines observed in longitudinal sections of ivory, parallel with the cone of the pulp-cavity, and which are circular and concentric when viewed in transverse slices of the tusk, are commonly caused by strata of minute opaque cellules, which are unusually numerous in the interspaces of the tubes throughout the sub- stance of the ivory, and by their very great abundance and larger size in the peripheral layers of cement. The close-set lateral branches of the calcigerous tubes unite with the tubuli of the cells. The decomposition of the fossil tusks into superimposed conical layers takes place along the strata of the opaque cellules, and directly across the course of the calci- gerous gyrating tubes. The radiated cells of the true cement are larger and more uniform in size and shape ; many of them approach nearer the circular figure than in ordinary teeth ; the long axis of the more elliptical ones is parallel with the plane of the stratum of cement ; their average diameter is Tj-gVo^1 of an inch, and their interspaces sometimes do not exceed that dimension. The cemental tubuli appear from their course, and sometimes from the overlapping of the substances in the sections examined, to be directly continued from the tubuli of the ivory ; but Retzius expressly denies the continuation, and states that the cemental tubes at both the outer and the inner surface of the cement have terminations of less diameter than their middle part. This is exact with respect to the major part of the cement. In that near the base of the tusk I have seen a few vascular canals. The contour lines of the cement are usually wavy, and not parallel with the line of the outer surface of the ivory. In the tusks of the Mastodon gigantcus the 928 TEETII. outer layer of cement is relatively thicker than in the tusks of the Mammoth or in those of the Indian elephant. The general cha- racter of the microscopic structure of the ivory of the Mastodon’s tusk is the same as that of the elephant. The peripheral ex- tremities of the dentinal tubes are, in some parts of the tusk, straighter than in the rest of their course; the straighter extremities were those which were first formed in the calcification of the peripheral part of the pulp, and this first-formed ivory is accordingly, in such parts, more like the ordinary dentine, and is analogous to the thin peripheral cap of such substance in the teeth of the Sloth and of some fishes. The pulp soon, however, becomes subject to that modification of the calcifying processes by which the more tortuous disposition of the tubuli and the more frequent interposition of opaque cellules are produced ; modifications which, in establishing the characters of ivory, present a step in the transition from true dentine to osteo-dentine. By the minuteness and close arrangement of the tubes, and especially by their strongly undulating secondary curves, a tougher and more elastic tissue is produced than results from their disposition in ordinary dentine ; and the modification which distinguishes “ ivory ” is doubtless essential to the due degree of coherence of so large a mass as the elephant’s tusk, projecting so far from the supporting socket, and to be frequently applied in dealing hard blows and thrusts. The central part ol* the tusk, especially near the base of such as have reached their full size, is occupied by a slender cylindrical tract of modified ivory, perforated by a few vascular canals, which is continued to the apex of the tusk. It is not uncommon to find processes of osteo-dentine or imperfect bone-like ivory, projecting in a stalactitic form * into the interior of the pulp-cavity, apparently the consequence of partial inflam- mation or malformation of the vascular pulp. The musket-balls and other foreign bodies which are occasionally found in ivory, are immediately surrounded by osteo-dentine in greater or less quantity. It has long ceased to be a matter of wonder how such bodies should become completely imbedded in the substance of the tusk, sometimes without any visible aperture, or how a leaden bullet may have become lodged in the solid centre of a very large tusk without having been flattened. Such a ball, aimed at the head of an elephant, may penetrate the thin bony socket and the thinner ivory parietes of the wide conical pulp-cavity occupying the inserted base of the tusk ; if the projectile force was there spent, the ball would gravitate to the opposite and lower side of the pulp-cavity, as indicated in Jig. 592. j- The presence of the foreign body * Haller seems to have been the first to notice these irregular internal deposits in the pulp-cavity of the elephant’s tusk. Elementa Physiologic, tom. viii. p. 519. f Camper, “ Description Anatomique d’un Ele'- exciting inflammation of the pulp, an irregular course of calcification ensues, which results in the disposition around the ball of a certain thickness of osteo-dentine. The pulp then resuming its healthy state and functions, coats the inner surface of the osteo-dentine in- closing the ball, together with the rest of the conical cavity into which that mass projects, with layers of normal ivory.* The portion of the cement-forming capsule surrounding the base of the tusk, and the part of the pulp, which were perforated by the ball in its passage, are soon replaced by the active reparative power of these highly vascular bodies. The hole formed by the ball in the base of the tusk is then more or less completely filled up by a thick coat of cement from with- out and of osteo-dentine from within. Traces of such a cicatrix closing the entrance have been more than once noticed : and Blumen- bach deduced, therefrom, a property in the elephant’s tusk to pour out bony matter in order to heal such wounds. The reparation is however effected by the calcification of the reproduced parts of the capsule and pulp. By the continued progress of growth, the ball so inclosed is carried forwards, in the course indicated by the arrow in Jig. 592., to the middle of the solidified exserted part of the tusk, as in the example in Blumenbach’s collection which he considered so curious. Should the ball have penetrated the base of the tusk of a young elephant, it may be carried forwards by the uninterrupted growth of the tusk until that base has become the apex, and be finally exposed and discharged by the con- tinual abrasion to which the apex of the tusk is subjected. Yet none of these phenomena prove the absolute non-vascularity of the tusk, but only the low degree of its vascularity. Blood circulates, slowly no doubt, through the minute vascular canals which are con- tinued through the centre of the ivory to the very apex of the tusk : and it is from this source that the fine tubular structure of the ivory obtains the plasmatic colourless fluid by which its low vitality is maintained. Development. — The matrix of the tusk con- sists of a large conical pulp, which is renewed quicker than it is converted, and thus is not only preserved, but grows, up to a certain period of the animal’s life : it is lodged in the cavity at the base of the tusk ; this base is surrounded by the remains of the capsule, a soft vascular membrane of moderate thickness, which is confluent with the border of the base of the pulp, where it receives its principal vessels. phant Male,” fol. p. 54. Cuvier, Annales du Mu- seum, tom. viii. (1806) p. 115. * Cuvier, “Annales du Musdum,” tom. viii. p. 115, 1806, “ Sur les defenses des ^Hphans, la structure, l’accroissement, les caracteres distinctifs de l’ivoire, et sur les maladies,” first clearly stated that the ball or foreign body in the tusk of the elephant was immediately surrounded by a substance different from the regular ivory. The great anatomist ob- serves, “ Toute la portion d’ivoire en dehors de la balle est semblable au reste ; il n’y a que ce qui l’entoure immediatement qui soit irregulier.” TEETII. 929 I had the tusk and pulp of the great ele- phant at the Zoological Gardens longitudinally divided, soon after the death of that animal in the summer of 1847. Although the pulp could be easily detached from the inner surface of the pulp-cavity, it was not without a certain resistance, and when the edges of the co- adapted pulp and tooth were examined by a strong lens, the filamentary processes from the outer surface of the pulp could be seen stretching, as they were withdrawn from the dentinal tubes, before they broke. They are so minute that, to the naked eye, the detached surface of the pulp seems to be entire, and Cuvier was thus deceived in concluding that there was no organic connection between the pulp and the ivory.* As the learned professor who has contributed the article “ Paciiyder- mata ” adopts Cuvier’s description of the formation of the teeth of the elephant by deposition and transudation of the tissues from free surfaces of the formative organs, I have the more valued the rare opportunity of testing and confirming, by examination of the recent animal, the account of the processes of conversion of those organs into the dental tissues, which I gave in my “ Odontography.” Each molar of the elephant is formed in the interior of a membranous sac — the capsule, the form of which partakes of that of the future tooth, being cubical in the first molar, oblong in the last, and rhomboidal in most of the intermediate teeth ; but always decreasing in vertical extent towards its posterior end, and closed at all points, save where it is penetrated by vessels and nerves. It is lodged in an osseous cavity of the same form as itself, and usually in part suspended freely in the maxillary bone ; the bony case being destined to form part of the socket of the tooth. The exterior of the membranous capsule is simple and vascular, as shown at m. 5, fig. 592. ; its internal surface gives attachment to numerous folds or processes, as in most other Ungulate animals. The dentinal pulp rises from the bottom of the capsule, or that part which lines the deepen part of the alveolus, in the form of transverse parallel plates extending towards that part of the capsule ready to escape from the socket. These plates adhere only to the bottom of the capsule ; their opposite extremity is free from all adhesion. This summit is thinner than the base ; it might be termed the edge of the plate: but it is notched, or divided into many digital processes. The tissue of these digitated plates is identical with that of the dentinal pulp of simple Mammalian teeth ; it becomes also highly vascular at the parts where the formation of the dentine is in active progress. Processes of the capsule descend from its summit into the interspaces of the dentinal pulp-plates, and consequently resemble them in form ; but they adhere not only by their * Annalesdu Museum, tom. viii. (180G), p. 94. Tim account is repeated verbatim in the posthumous edition of the “Ossemens Fossiles,” 183G. VOL. IV. base to the surface of the capsule next the mouth, but also by their lateral margins to the sides of the capsule, and thus resemble partition-walls, confining each plate of the dentinal pulp to its proper chamber ; the margin of the partition opposite its attached base is free in the interspace of the origins of the dentinal pulp plates. The enamel organ, which Cuvier appears to have recognised under the name of the internal layer of the capsule, is distinguishable by its light blue sub-transparent colour and usual microscopic texture, adhering to the free surface of the partitions formed by the true inner layer of the capsule. Although the enamel-pulp be in close contact with the dentinal pulp prior to the commencement of the formation of the tooth, one may readily conceive a vacuity between them, which is continued uninter- ruptedly, in many foldings, between all the gelatinous plates of the dentinal pulp, and the partitions formed by the combined enamel- pulp and the folds of the capsule. According to the excretion-view, this delicate apparatus must have been immediately subjected to the violence of being compressed in the unyielding bony box, by the deposition of the dense matters of the tooth in the hypothetical vacuity between the enamel and dentinal pulps; a process of absorption must have been con- ceived to be set on foot immediately that the altered condition of the gelatinous secreting organs took place ; and, according to Cuvier’s hypothesis, the secreting function must be supposed to have proceeded, without any ir- regularity or interruption, while the process of absorption was superinduced in the same part to relieve it from the effects of pressure produced by its own secretion. The formation of the dentine commences immediately beneath the membrana propria of the pulp: a part which Cuvier distinctly recognised, and which he accurately traced as preserving its relative situation between the dentme ami enamel throughout the whole formation of the dentine, and discernible in the completed tooth “ as a very fine greyish line, which separates the enamel from the in- ternal substance ” or dentine. The calcification and conversion of the cells of the dentinal pulp commence as usual at the peripheral parts of the lamelliform pro- cesses furthest from the attached base. It may readily be conceived, therefore, that, at the commencement, there is formed a little cap upon each of the processes into which the edges of the pulp-plates are divided. As the centripetal calcification proceeds the caps are converted into horn-shaped cones ; when it has reached the bottom of the notches of the edge of the pulp-plate all the cones be- come united together into a single transverse plate ; and, the process of conversion having reached the base of the pulp-plate, these plates coalesce to form a common base to the crown of the tooth, which would then present the same eminences and notches that charac- terised the gelatinous pulp, if, during the period of conversion, other substances had 3 o 930 TEETH. not been formed upon the surface and in the interspaces of the pulp-plates. Coincident, however, with the formation of the dentine, is the deposition of the hard- ening salts of the enamel in the extremely slender prismatic cells, which are for the most part vertical to the plane of the inner surface of the folds of the capsule to which they are attached ; these cells or moulds give a sub- transparent bluish tint to the enamel pulp. The true inner part of the capsule forms those thick transverse folds or partitions which support the enamel organ, and with it fill the interspaces of the dentinal pulps. With re- gard to the formation of the cement, Cuvier, after citing the opinion of Tenon — that it was the result of ossification of the internal layer of the capsule, and that of Blake — that it was a deposition from the opposite surface of the capsule to that which had deposited the enamel, states his own conviction to be that the cement is produced by the same layer and by the same surface as that which has produced the enamel. The proof alleged is, that so long as any space remains between the cement and the externa! capsule, that space is found to contain a soft internal layer of the capsule with a free surface next the cement. The phenomena could not, in fact, be otherwise explained according to the “ ex- cretion theory ” of dental development. To the obvious objection that the same part is made, in this explanation, to secrete two different products, Cuvier replies, that it un- dergoes a change of tissue : “ Whilst it yielded enamel only it was thin and transparent ; to give cement it becomes thick, spongy, and of a reddish colour.” * The external characters of the enamel organ and cement-forming cap- sule are correctly defined ; only, the one, in- stead of being converted into the other, is in fact changed into its supposed transudation : the enamel fibres being formed, and properly disposed in the direction in which their chief strength is to lie, by the assimilative proper- ties of the pre-arranged elongated prismatic lion-nucleated cells, which take from the sur- rounding plasma the required salts and com- pact them in their interior. Whilst this process is on foot, and before the enamel fibres are firm in their position, the capsule begins to undergo that change which results in the formation of the thick cement ; the calcifying process commences from several points, and proceeds centrifu- gally, radiating therefrom, and differing from the ossification of bone chiefly in the number of these centres, which, though close to the new-formed enamel, are in the substance of the inner vascular surface of the capsular folds. The cells arrange themselves in con- centric layers around the vessels, and act * “ Seulement elle change de tissue : tant qu’elle ne donnait que de l’email, elle dtai t mince et tvans- parente ; pour donner du cortical elle devient epaisse, spongieuse, opaque et rougeatre.” — Annales du Musduni, tom. viii. p. 99; Ossemens Fossiles, ed. 1834, 8vo. tom. i p. 514. Art. Paciiydermata, p. 8G9. like those of the enamel pulp in receiving into their interior the bone-salts in a clear and compact state; during this process they be- come confluent with each other, their piimi- tive distinctness being indicated only by their persistent granular nuclei, which now form the radiated Parkin jian corpuscles. The in- terspaces of the concentric series of confluent cells become filled with the calcareous salts in a rather more opaque state, and the con- version of the capsule into cement goes on, according to the processes more particularly described in the Introduction to my “ Odon- tography,” until a continuous stratum is formed in close connection with the layer of enamel. The uncalcified part of the capsule, always much softer than cartilage, is very readily detached from the calcified part, and to the naked eye the separated surface seems entire, and might readily pass, as with Cuvier, for a secreting surface. But the fine vascular processes which have been torn from the medullary canals of the calcified part are conspicuous, and resemble villi, when the detached surface is examined, even with a moderate magnifying power, under water. Calcification extending from the numerous centres, the different portions coalesce and progressively add to the thickness of the ce- ment until all the interspaces of the coronal plates and the whole exterior of the crown is covered with the bone-like substance. The enamel-pulp ceases to be developed at the base of the crown, but the capsule continues to be formed pari passu with the partial formation of the pulp, as this continues, pro- gressively contracting, from the base of the crown, to form by its calcification the roots. The calcification of the capsule going on at the same time, a layer of cement is formed in immediate connection with the dentine. The circumscribed spaces at the bottom of the socket to which the capsule and dentinal pulp adhere, where they receive their vessels and nerves, and which are the seat of the progres- sive formation of these respective moulds of the two dental tissues, become gradually con- tracted, and subdivided by the further localis- ation of the reproductive forces to particular spots, whence the subdivision of the base into roots. The surrounding bone undergoes cor- responding modifications, growing and filling up the interspaces left by the dividing and contracting points of attachment of the re- siduary matrix. All is subordinated to one harmonious law of growth by vascular action and cell-formation, and of molecular decre- ment modifying form by absorption. Me- chanical squeezing or drawing out have no share in these changes of the pulp or capsule; pressure at most exercises only a gentle stimulus to the vital processes. Cuvier be- lieved that there were places where the den- tinal pulp and the capsule were separate from each other. I have never found such except where the enamel-pulp was interposed be- tween them in the crown of the tooth, or where both pulp and capsule adhered to the periosteum of the socket, below the crown. TEETH. 031 Cuvier affirms that the number of fangs of an elephant’s molar depends upon the number of points at which the base of the gelatinous (dentinal) pulp is attached to the bottom of the capsule; and that the interspaces of these attachments constitute the under part of the crown or body of the tooth, the attachments themselves forming the first beginnings of the fangs. True to his hypothesis of the forma- tion of the dental tissues by excretion, he says * that the elongation of the fangs is pro- duced by two circumstances : first, the pro- gressive elongation of the layers of osseous substance (dentine) which force the tooth to rise and emerge from its socket; secondly, the thickening of the body of the tooth by the addition of successive layers to its inner sur- face, which, filling up the interior cavity, leaves scarcely room for the gelatinous pulp, and forces it down into the interior of the roots. This pulling up of the fang on the one hand, and squeezing down the pulp on the other, are forces too gross and mechanical to be admitted in actual physiology to explain the growth of the root of a tooth or of any other organised product ; such modes of explanation were, however, inevitable in adopting the excretion theory of dental development. With regard to the homologies of the com- plex molars of the Proboscidian quadrupeds, a species of insight which may come to be deemed, in the course of anatomical science, as of equal import to the knowledge of the formative processes of parts, I must admit that the mere fact of the marked and dispro- portionate increase of size of the first of the three last molars over its predecessor — the last of the first three that are developed — may appear but a feeble support to the analogical evidence on which, chiefly, I have classed the three last developed molars of the elephant, in a category distinct from that of their smaller predecessors. But the value of such indica- tion and analogy will begin to be apparent when we examine the condition of dental development in the primeval forms of Pro- boscidians. I have already shown that the typical character of the Diphyodont dentition was more closely and generally adhered to in the genera that existed during the oldest ter- tiary periods in geology than in their actual successors : it became of course highly inter- esting to inquire whether the miocene Mas- todons, the earliest of the great Proboscidian quadrupeds of which we have any cognizance, manifested any analogous closer adhesion to type than their elephantine successors, and whether they would afford any actual proof of the true deciduous nature of the first, * “ Ces racines et les pddicules qui leur servent de noyaux s’alongent ensuite par deux raisons : d’abord les progrfes des lames de substance osseuse qui, s’alon- geant toujours, forcent la dent h s’elever et a sortir de l’alveole ; ensuite l’epaississement du corps de la dent par la formation des couches successives qui, en remplissant le vide inte'rieur, n’y laissent presque plus de place pour le noyau gelatineux, et le refoulent vers l’interieur des tubes des racines.” Annales du Museum, viii. 1807, p. 108; Ossem. Fossiles, 1834, p. 527. second, or third molars, by the development of a vertical successor or premolar. Cuvier first ascertained the fact, though without ap- preciating its full significance, in a specimen of the upper jaw of the Mastodon angustidens from Dax, in which the second six-lobed deciduous molar was displaced by a four- lobed or quadricuspid premolar developed above it and succeeding it vertically.* The same important fact was subsequently con- firmed by Dr. Kaup in observations of the Mastodon longirostris of the miocene tertiary deposits of Eppelsheim.f This satisfactorily' proves the true deci- duous character of the first and second molars ; and that the third molar in order of appear- ance J, is also one (the last) of the de- ciduous series, is indicated by the contrasted superiority of size of the ante-penultimate tooth, which I regard as the first of the true molar series. The great extent and activity of the pro- cesses of dental development required for the preparation of the large and complex true molar teeth would seem to exhaust the power, which, in ordinary Pachyderms, is expended in developing the vertical successors of the deci- duous teeth. In the primeval Mastodons above cited, this normal exercise of the reproductive force was not, however, wholly exhausted, and one premolar, of more simple form than its deciduous predecessor, was developed on each side of both jaws. But even this trace of ad- herence to the archetypal dentition is lost in the more modified Proboscidians of the pre- sent day. Another and very interesting mark of adhe- sion to the archetype is shown by the deve- lopment of two incisors in the lower jaw in the young of some of the Mastodons, by the retention and development of one of these inferior tusks in the male of the Mastodon giganteus of North America, and by the reten- tion of both in the European Mastodon longi- rostris. No trace of these inferior homotypes of the great premaxillary tusks have been detected in the foetus or young of the existing elephants. In the gigantic Dinotherium the upper in- cisors were suppressed, and the two lower incisors were developed into huge tusks, which curved down from the symphysis of the massive under jaw. Most of the grinders had two transverse ridges on the crown, as in the Tapir ; two deciduous molars, if not three, were succeeded vertically by two premolars, the second of which (p. 4 of the typical series) closely resembles the true molars, as in other Perissodactyles. The typical dentition is departed from in the existing Hippopotamus by the early loss of p. 1, and the reduction of the incisors to 2—2 2—2 in both jaws : in the extinct Hippopota' mus of India p. 1 was longer retained, and the * Ossemens Fossiles, 4to. ; Divers Mastodontes, pi. iii. Jig. 2. f Ossemens Fossiles de Darmstadt, 1835, pi. 1. % Odontography, pi. 144 ,fig. 11, d. 3 3 o 2 932 TEETIT. incisors were in normal number 3—3. 3—3’ whence the term Hexaprolodun proposed for this inter- esting restoration by its discoverers, Cantley and Falconer. I have before remarked that the even-toed or artiodactyle Ungulata superadd the cha- racters of simplified form and diminished size to the more important and constant one of vertical succession in their premolars. These teeth in the Ruminants, c. g. (Jig. 580., VJL, Moscnus./j. 2, 3, 4), represent only the moiety of the true molars, oroneof the two semi-cylin- drical lobes of which those teeth consist, with at most a rudiment of the second lobe, as Cuvier very accurately describes*, and F. Cuvier figures in pi. 94. of his useful work, “ Dents des Mammiferes.” An analogous morphological character of the premolars will be found to distinguish them in the dentition of the genus Sus (figured in my “Odontography,” pi. 140.,yfgi. 1 and 2), in the Hippopotamus (ib. pi. 143.), and in the Phacochosrus (ib. pi. 141.), where the premolar series is greatly reduced in number : yet this instance of a natural affinity manifested in so many other parts of the organisation of the artiodactyle genera has been overlooked in F. Cuvier’s work above cited, although it is expressly designed to show bow such zoological relations are illus- trated by the teeth. Confiding in the accuracy of the Baron Cuvier’s division of the hoofed quadrupeds into “ Pachyderms ” and “ Rumi- nants,” M. F. Cuvier separates the non ru- minant Artiodactyles from the ruminant ge- nera of the same natural division by interposing the Tapir, Hyrax, Rhinoceros and Elephant ; whilst the horse, which, in the size and com- plexity of its premolars, as well as in many other characters, agrees closely with the other perissodactyle Pachyderms, is placed in close juxtaposition with the Ruminants. f Most of the deciduous molars of the Rumi- nants resemble in form the true molars ; the last, e.g. (Jig. 593., d. 4), has three lobes in the owerjaw J likethelast true molar (?h. 3.). They Permanent and deciduous teeth, Sheep (Ovis). (Lower jaw.') are three in number on each side, and, being succeeded by as many premolars, the ordinary , r , - 3—3 3—3 permanent molar formula is p. - — m. - — ^ : * Ossemens Fossiles, 4to, tom. iv. p. 6. f See my “ Remarks on the Classification of the Hoofed Quadrupeds ” in “ Quarterly Journal of the Geological Society,” May, 1848. } When, therefore, the third grinder of the lower jaw of any new or rare Ruminant shows three lobes, the crowns of the premolars should be sought for in the substance of the jaw below these, and above but there is a rudiment of d. I in the embryo fallow-deer, and in one of the most ancient of the extinct Ruminants (Dorcatherium, Kaup) the normal number of premolars was fully de- veloped. Sufficient, it is hoped, has been adduced to prove that the molar scries of the Diphyo- donts is naturally divisible into only two groups, premolars and molars ; that the ty- 4 4 3 3 pical number of these is — - - — - ; and that 1 4 — 4’ 3 — 3 each individual tooth may be determined and symbolised throughout the series, as is shown in the instances under cut 580. If anything were wanting to prove the artificial character of a three-fold division of these teeth, and the futility of any other classification than that founded upon development, it would be af- forded by the attempt to determine the homo- logous teeth which is exemplified by the dotted line which traverses the series, and which crosses the teeth distinguished by the name “ principales” in the great “ Osteo- graphie and Odontographie ” nowin course of publication by Prof, de Blainville. This author abandons the classification of the molar series adopted by the Cuviers, without assigning his objections to it ; and proposes another, in which he divides the series into “ avant-molaires, principales, and arriere-molaires;” he exemplifies this division by the human dentition, in which the five grinders on each side of both jaws are for- mulised as “ deux avant-molaires, une princi- pale, et deux arriere-molaires.”* With regard to the characters of these kinds of teeth, the avant-molaires are “simple or complex,” the principals is “ trenchant,” and the arriere-molaires are “ tuberculous.” f But as shape is not a constant character, especially in the “ principale,” the author pro- poses another from its position, describing it as “ being implanted below the root of the zygomatic process of the maxillary bone ” in the upper jaw ; and stating that the tooth which opposes it below, and is in advance of it, or crosses in front of it, is the lower “ principale.” In defining the dentition of the genus Felis% , M. de Blainville accordingly assigns I “avant- molaire,” I “ principale,” and 2 “ arriere- molaires ” in the upper jaw ; and 1 “ avant- molaire,” 1 “ principale,” and 1 “ arriere-mo- laire ” in the lower jaw. In another part of the same work $, he, however, proposes another formula, viz., 2 “ avant-molaires,” 1 “ princi- pale,” and 1 “ arriere-molaire ” above ; 1 “ avant-molaire,” 1 “ principale,” and 1 “ar- riere-molaire ” below ; but, taking either of these determinations, or the dental formulae which he assigns to other carnivorous genera, and comparing them with his formula of the their opponents in the upper jaw, and thus the true characters of the permanent dentition may be ascertained. * Osteographie, tom. i. p. 43. t Ib. p. 43. t Osteographie des Carnivores, p. 69. § Osteographie des Felis, p. 55. TEETH. 933 molar series in the Quadrumana and Man, we find that a tooth which displaces and succeeds a milk-tooth in one species is made the homo- logue of a tooth, which, in Man and Quadru- mana, rises above the gum without displacing any predecessor : in other words, the “ prin- cipal ” is a premolar in certain genera, and a true molar in other genera. I may refer to my Paper on the Classification of the Molar Teeth in the “ Annales des Sciences,”* and to the concluding pages of the chapter on the teeth of the Carnivora in my “ Odontography ” (p. 514), in proof that a “ molaire principale ” does not exist in nature ; that the characters by which it is defined by M. de Blainviile are artificial ; and that they fail in their application to determine the teeth in the series of pla- cental Mammalia with deciduous and perma- nent teeth. In the series of figures, Jig. 580., the continuous line traverses the tooth or its homologue, in Man and the Ruminant, which Cuvier distinguished as the “ molaire carnas- siere:” the dotted line traverses that tooth which M. de Blainviile distinguishes as the “ molaire principale : ” the letters and numbers symbolise the teeth and indicate their indi- vidual homologies, and the binary division of the molar series, which it has been one object of the present Article to illustrate. I shall conclude it by showing how these symbols may be applied to the exposition of facts in the comparative anatomy of the teeth, and for that purpose select the complex and intricate subject of the succession of the teeth in the kangaroo. The chief modifications of the marsupial dentition are described and illustrated in the article Marsupiali a ( Vol. III.pp. 258 — 298.). When that volume was published I had not had the means of tracing the period and order of the development and succession of the entire series of teeth in any of the marsupial genera. The first of the five grinding teeth on each side of the jaws of the wombat had shown, by its displacing a milk-tooth vertically, that it was a premolar ; and the adjoining molar, by its earlier development and use, was plainly the first of the four true molar teeth. In the carnivorous and insectivorous families, the marked difference of form and size of the last four teeth from those intervening between them and the canines, had also induced me to class them as true molars, although I had not got the developmental evidence of the fact, except in the case of the Kangaroos and Potoroos ( Mao-opus and Hypsiprymnus) . The analogy, however, seemed to be sufficient to justify the generalisation that the Marsupial differed from the Placental Diphyodont raam- 4 4 mats in having four true molars, i , c., m. r ° ’ 4 — 4 3 3 instead of m. - — - ; and also that they differed in having only three premolars, i. e. p. 3—3 3—3 instead of }>, 4—4 grinding series, -4 ’ 7—7 the typical number of the being the same. The genus Myrmccobius offered the most remark- able exception here, as the Manatee had done in the placental series, in the increased number . , . , 8—8 9—9 of the grinding teeth, e. g. to or — -, which, according to the shape of the crowns, were divided, in the Myrmecobius , into p. g I;, in. — jj ; but the order of development and succession may show that the number of premolars is greater, and that of the true molars less. The probably marsupial T/iy/a- cotherium or Amphitherium from the Oxford oolites — the most ancient of all known mam- mals— had as many as twelve teeth in each molar series, besides a canine and three incisors, and by their form I have grouped . 3—3 1 — 1 6—6 6—6 them as: «. c. p. m. An interesting field of observation still re- mains open in regard to the period and order of developement of the deciduous and permanent teeth, in the different carnivorous, omnivorous, insectivorous, and frugivorous Marsupials. At present I have ascertained the required facts only in the herbivorous family ( Poephaga ). The permanent dental formula of both the 3—3 Macropodida; and Hypsiprymnidce is, ; 1_] 1 — 1 4—4 c. — — - , p. - r, in. = 30. 4 he canines, U — II 1 — 1 4 — 4 which are confined to the upper jaw, are small or minute when retained ; and disappear after being represented “ en germe” in most of the true kangaroos. The deciduous dentition of the great Kan- , lr ■ v • • 3—3 1 — 1 garoo ( Macropus major) is, i. ^ yi c. ^ - 2 2 - — -^=18. The canines are rudimental, and are absorbed rather than shed. The deciduous incisors are shed before the young animal finally quits the pouch : when this takes place, the dentition is : — 1 — 1 2 — 2 12; the upper incisors being i. I, the molars 35. Canal of the epididymis partly unravelled, to show the four series of inflections which the duct undergoes in the several divisions of the epididymis, o, o, first series of inflections ; p, p, second series ; q, q, third series; r, r, fourth series. {After Lauth). termination of the former in the latter. (Figs. 632., and 633, h.) It forms a convoluted duct as large as the canal of the epididymis, which is contracted at its insertion, and ter- minates in a blind and often dilated extremity. Sometimes after being dilated for a certain distance it diminishes, and becoming very minute, is lost in the areolar tissue of the cord. It usually passes up the cord for about two or three inches, but has been found to extend as far up as the brim of the pelvis. The length of this appendage when unravelled varies from one to twelve or fourteen inches. The vasculum aberrans is not constantly pre- sent ; indeed, Monro found it only four times in sixteen ; but 1 believe, with Lauth, that it exists more frequently. Occasionally there is more than one, and as many as three have been found both by Lauth and Sir A. Cooper. Hunter regarded these ducts as supernumerary vasa deferentia, of a nature similar to the double ureters.* Muller states that their office is evidently the secretion of a fluid which they pour into the epididymis. f We have no evidence, however, that the duct serves any particular office. Vas deferens, — the excretory duct of the testicle, commences from the tail of the epidi- dymis, and terminates in one of the ejacu- latory canals behind the bladder, being in length from fifteen to sixteen inches. Arising * Works by Palmer, vol. iv. p. 24. t Physiology, trans. by Baly, vol. i. p. 45 TESTICLE (NORMAL ANATOMY). 981 from the contracted part of the canal of the epididymis at an acute angle, it ascends along the inner side of this body, from which it is separated by areolar tissue and the spermatic arteries and veins. A right or left testicle may thus always be distinguished by the circum- stance that when the testicle is in position, the vas deferens is situated on the inner or mesial side of the organ. In this part of its course, for the distance of about an inch and a half, or more, the vas deferens forms numer- ous convolutions, {Jigs. 632., and 633, i), which gradually cease as the duct mounts above the testicle. The inflected part of the vas deferens, when unravelled, was found by Lauth to measure six inches and a half. It afterwards takes a direct course (£) up the spermatic cord to the inguinal canal, passing behind and at a short distance from the spermatic arteries and veins. On entering the abdomen at the internal ring, it quits the spermatic vessels and descends into the pelvis, passing at first by the side of, and afterwards behind and below the bladder, on the inner side of the corresponding vesicula seminalis, the excretory duct of which it joins at an acute angle, to form the ejaculatory canal. The canal of the vas deferens is extremely fine, and its walls are nearly uniform in thick- ness until it reaches the vesicula seminalis. It is lined by a fine membrane of a mucous character, which is continuous with the urethra. This membrane forms longitudinal folds. The vas deferens is round and in- durated,— harder than any other excretory duct in the body, by which character it is easily distinguished, when handled, from the other parts constituting the spermatic cord. Many anatomists have entertained the opinion that the parietes of this duct are muscular. It is distinctly so in the bear, bull, and other animals. On careful examination, however, of sections of the human vas deferens with the microscope, I could discover nothing more than simple fibrous tissue. Huschke makes three layers of fibres ; two longitudinal, and one circular, situated between them ; the latter being the thickest. The duct has an external investment of condensed areolar tissue. IV. The Vessels and Nerves. — Spermatic Vessels. — The spermatic arteries, the chief vessels supplying the testicles, arise in pairs, at a very acute angle, from the fore-part of the aorta, immediately below the renal ar- teries. Their origin is subject to consider- able varieties. The twro seldom arise at the same level, and the right is often a branch of the right renal artery. Sometimes one or both come off from the superior mesenteric. Occasionally there are two spermatic arteries on one or both sides, arising in the regular way. All these deviations are more frequently met with on the left than on the right side of the body. Each artery pursues a tortuous course downwards and outwards, passing behind the peritoneum obliquely across the psoas muscle and ureter, to which, as well as to the surrounding areolar tissue, it gives off several branches. The artery then enters the inguinal canal through the internal ring, and emerging at the external, passes down the cord, being surrounded in its course by the spermatic veins. The further distribution of the artery is thus correctly described by Sir A. Cooper: “ When the artery reaches from one to three inches from the epididymis, varying in different subjects, it divides into two branches, which descend to the testicle on its inner side, opposite to that on which the epididymis is placed ; one passing on the anterior and upper, the other to the posterior and lower part of the testis. From the anterior branch the vessels of the epididymis arise: first, one which passes to its caput; secondly, another to its body, and, thirdly, one to its cauda and the first convolutions of the vas deferens, communicating freely with the de- ferential artery. The spermatic artery, after giving off branches to the epididymis, enters the testis, by penetrating the outer layer of the tunica albuginea ; and dividing upon its vascular layer, they form an arch by their junction at the lower part of the testis, from which numerous vessels pass upwards ; and then descending, they supply7 the lobes of the tubuli seminiferi. Besides this lower arch, there is another passing in the direction of the rete, extremely convoluted in its course, and forming an anastomosis between the prin- cipal branches.” The testis receives a further supply of blood from anothe" vessel, the ar- tery of the vas deferens, or posterior spermatic artery, which arises from one of the vesical arteries, branches of the internal iliac. This artery divides into two sets of branches, one set descending to the vesicula seminalis and to the termination of the vas deferens ; the other, ascending upon the vas deferens, runs in a serpentine direction upon the coat of that vessel, passing through the whole length of the spermatic cord ; and when it reaches the cauda epididymis, it divides into two sets of branches, one advancing to unite with the spermatic artery to supply the testis and epi- didymis, the other passing backwards to the tunica vaginalis and cremaster. The spermatic veins spring in three sets from the testicle, one from the rete and tubuli, and another from the vascular layer of the tunica albuginea, and a third from the lower extremity of the vas deferens. The veins of the testicle pass in three courses into the beginning of the spermatic cord ; two of these quit the back of the testicle, one at its anterior and upper part, and a second at its centre ; and these, after passing from two or three inches, become united into one. The other column accompanies the vas deferens. There is also a large vein, just above the testicle, which crosses to join the three columns. The veins of the epididymis are one from the caput, another from its body ; one from its cauda, and another from its junction with the vas deferens, besides some small branches ; they terminate in the veins of the spermatic cord. The veins, after quitting the testicle, become extremely tortuous, and frequently o R 3 982 TESTICLE (NORMAL ANATOMY). divide and inosculate in the cord, forming a plexus termed vasa patnpiniformia. These communications cease as the veins approach the ring, which they enter, and ascending along with the psoas muscle in company with the spermatic artery, unite to form a single vein which usually terminates on the right side in the vena cava inferior, and on the left, in the renal vein ; though this is subject to some variety. The left spermatic veins pass under the sigmoid flexure of the colon. Many anatomists speak of the spermatic veins as being destitute of valves, which they assign as one of the reasons for the occurrence of varicocele. I have several times injected these veins with alcohol, and on laying them open have observed valves in the larger vessels, and I have also found injections thrown into the veins arrested by the valves. They are seldom seen, however, very near the testicle, or in the smaller veins forming the plexus; nor have 1 observed them within the ab- domen. Absorbents. — The absorbent vessels of the testicle are very numerous, and arise from every part of its internal structure and coats. They unite to form four or five trunks, which ascend along the cord, and traverse the in- guinal canal, without communicating with the glands in the groin, but pass upwards in front of the psoas muscle, behind the peritoneum, and terminate in the lumbar glands on the side of the aorta. Nerves. — The nerves of the testicle are derived chiefly from the renal plexus, but partly also from the superior mesenteric and aortic plexuses. These nerves descend in company with the spermatic artery to the cord, where, being joined by branches from the hypogastric plexus, which pass along the vas deferens, they form together the spermatic plexus, the branches of which are intermingled with the vessels of the cord, and ultimately terminate in the substance of the testicle. A few twigs from the external spermatic nerve may also be traced to the coverings of the gland. The Testicle in the Fcetus, and its Passage into the Scrotum. — The testicles are first de- veloped and situated in the abdomen. They originate from the lower part of the corpora Wolffiana, and may be detected at an early period of foetal existence immediately below the kidneys on the forepart of the psoas muscles, to which they are attached by a reflexion of peritoneum. This membrane closely invests the testicles in the same man- ner as it covers the other abdominal viscera. The position of the testicle in the abdomen is nearly the same as it maintains after .its passage into the scrotum. The epididymis, however, is relatively of a larger size than in the adult, being about one-third that of the body of the organ. Attached to each testicle whilst in the abdomen is a peculiar body, which was termed by Mr. Hunter, who first described it, the gubernaculum, as it was sup- posed to serve as a guide to the testicle in its passage. It is a soft solid projecting body of a conical form, which varies somewhat in shape and size at different periods of transi- tion of the testes, becoming shorter and thicker as the gland approaches the abdo- minal ring. It is situated in front of the psoas muscle, to which it is connected by a reflexion of peritoneum. Its upper part is attached to the inferior extremity of the testicle, lower end of the epididymis, and commencement of the vas deferens. The lower part of this process passes out of the abdomen at the abdominal ring, and diminishing in substance and spreading, terminates in three processes, each of which has a distinct attachment. The central part and bulk of the gubernaculum is composed of a soft, transparent, gelatinous substance, which, on examination by the mi- croscope, is found to consist of nucleated cells, the primitive areolar tissue : this central mass is surrounded by a layer of well-deve- loped muscular fibres, which may be distin- guished by the naked eye, and which can be very distinctly recognised in the microscope to be composed of striped elementary fibres. These muscular fibres, which may be traced the whole way from the ring to the testicle, are surrounded by a layer of the soft elements of the areolar tissue, similar to that composing the central mass ; and, in the same way as the testicle, the whole process, except at its pos- terior part, is invested with peritoneum. On carefully laying open the inguinal canal, and gently drawing up the gubernaculum, the muscular fibres may be traced to the three processes, which are attached as follows : the external and broadest is connected to Pou- part’s ligament in the inguinal canal ; the middle forms a lengthened band which escapes at the external abdominal ring, and passes to the bottom of the scrotum, where it joins the dartos ; the internal takes the direction in- wards, and has a firm attachment to the os pubis and sheath of the rectus muscle. Be- sides these, a number of muscular fibres are reflected from the internal oblique on the front of the gubernaculum. It thus appears, that the attachments of the muscle of the guber- naculum, and those of the cremaster in the adult are exactly similar. I have succeeded in tracing out the former before the testicle has moved from its original position, at dif- ferent stages of the process of transition, and immediately after its completion ; and of the identity of the two muscles no doubt can be entertained. Cams was of opinion that the cremaster does not exist before the transition of the testicle; but that it is formed mecha- nically, by the testicle pushing before it the lower fibres of the internal oblique, so as to form the loops of this muscle.* This view which has been adopted by M. Jules Cloquet, and after him by many of the anatomists ot this country, is erroneous and inaccurate.)- The vessels of the testicle in the foetus * Compartive Anatomy, by Gore, vol. 2. p. 347. Vide Obervations on the Structure of the Gu- bernaculum, and on the Descent of the Testis in the Foetus, by the author, inLond. Medical Gazette, April 10. 1841, or in the Lancet, of the same date. TESTICLE (NORMAL ANATOMY). 983 arise from" the nearest largest trunks, and enter the substance of the gland at its pos- terior part. The artery of the vas deferens, from which the gubernaculum is chiefly sup- plied, is nearly as large as the spermatic. The long course taken by the arteries and veins of the testicle when in the scrotum is thus ex- plained by the original site of the organ, to which circumstance must also be ascribed the sharp turn upwards of the vas deferens from the epididymis, the two being continuous in a direct line, whilst the testicle is in the ab- domen. Fig. 636. Diagram of the gubernaculum and testicle previous to its descent. 1, the kidney ; 2, the testicle ; 3, 3, the peritoneum ’ 4, vas deferens passing down into the pelvis by the side of the bladder; 5, the bladder; 6, the abdo- minal ring ; 7, 7, Poupart’s ligament ; 8, pubic por- tion of the cremaster; 9, fibres of the cremaster arising from Poupart’s ligament ; 10, portion of the gubernaculum attached to the bottom of the scro- tum. Between the fifth and sixth month of foetal existence, sometimes later, the testicle begins to move from its situation near the kidney towards the ring, which it usually reaches about tlie seventh month. During the eighth month it generally traverses the inguinal canal, and by the end of the ninth arrives at the bottom of the scrotum, in which situation it is commonly found at birth. The testicle, both during its passage to the ring and through the inguinal canal, carries along with it its original peritoneal coat, adhering by the reflexion of this membrane, during the whole of its course to the parts behind, in the same manner as whilst situated below the kidney. The testicle therefore does not pass directly and abruptly into a pouch prepared to receive it, but carries the peritoneum with it, con- tinuing to be connected to the parts behind by the reflexion of the membrane, between the folds of which the vessels and nerves join the gland. In the passage of the testicle from the abdomen to the bottom of the scrotum, the gubernaculum, including its peritoneal investment and muscular fibres, undergoes the same change as that which takes place in certain of the rodentia at the access of the season of sexual excitement ; the muscle of the testicle is gradually everted, until, when the transition is completed, it forms a mus- cular envelope external to the process of peri- toneum, which surrounds the gland and front of the cord. As the testicle approaches the bottom of the scrotum, the gubernaculum di- minishes in size, owing to a change in the dis- position of its areolar elements ; the muscular fibres, however, undergo little or no diminu- tion, and are very distinct around the tunica vaginalis in the recently descended testicle. The mass composing the central part of the gubernaculum which is so soft, lax, and yield- ing, as in every way to facilitate these changes, becomes gradually diffused, and after the arrival of the testicle in the scrotum, contri- butes to form the loose areolar tissue which afterwards exists so abundantly in this part; the middle attachment of the gubernaculum, which may be traced to the dartos at the bottom of the scrotum, gradually wastes away and soon becomes indistinct, though slight traces of this process often remain to the latest period of life. Thus, after death, in dragging the testicle of an adult out of the scrotum by pulling the cord, the lower part of the gland, which is uncovered by serous membrane, is often found connected to the bottom of the scrotum by a band of firm and dense areolar tissue, which requires division with the scalpel. This band is the remains of the middle attachment of the gubernaculum. In cases in which the testicle has been re- tained in the groin, I have traced a cord of dense tissue from the gland to the lower part of the scrotum. After the arrival of the tes- ticle in the scrotum, the peritoneum with which it is closely invested, its original en- velope, becomes the inner layer of the tunica vaginalis ; whilst the pouch around, which is continuous with it, forms the outer layer, or vaginal sac. Immediately after the arrival of the testicle in the scrotum, this bag commu- nicates with the abdomen, and in quadrupeds continues to do so during life ; but in the human subject it soon begins to close, and when the foetus is ushered into the world, the abdominal orifice is often shut, and the whole canal from the ring to the upper part of the gland is, in general, completely obli- terated in the course of the first month after birth. The obliteration is effected by an intimate union of the surfaces of the serous membrane. It sometimes does not take place at all*, or is delayed or only partially com- Fig. 637. Diagram of the testicle immediately after its arrival in the scrotum, the cremaster being everted. 1, the testicle ; 2, the shortened gubernaculum ; 3, 3, the peritoneum ; 4 , portion of the cremaster arising from Poupart’s ligament; 5 pubic portion of the muscle. * The communication constantly remains open in quadrupeds, the chimpanzee, according to Professor 3 r 4 984 TESTICLE (NORMAL ANATOMY). pleted. Congenital hernia, or hydrocele is the result of a failure in this process ; and other forms of hydrocele are occasioned by imperfect obliteration of the canal. Much difference of opinion exists as to the immediate cause of the transition of the tes- ticle. Hunter, Meckel, and others came to the conclusion that the muscular fibres of the cremaster are insufficient to bring the testicle further than the abdominal ring and complete the passage. They were not, however, ac- quainted with the attachment of this muscle to the pubis external to the ring, or it would be difficult to understand why Mr. Hunter, after arriving at the conviction that the cremaster passes to the testicle whilst in the abdomen, chiefly from analogy, was not induced by the same process of reasoning to conclude, that a muscle capable of changing the position of the testicle in brute animals, would be ade- quate to accomplish the same office in the human foetus. The necessity for some active agent to effect this change in the latter would appear to be greater even than in the lower animals, since, in the usual position of the foetus in utero, the passage of the testicle is contrary to gravitation, * and unaided by the movements of respiration. Now, when we consider the attachments and connec- tions of this muscle in the foetus ; the per- fect development of its fibres, as ascertained by microscopical examination ; and the circum- stance that there are no other means, no other motive powers, by which this change can be effected, or in any way promoted, 1 think there is no reason to doubt that the cremaster ex- ecutes the same office in the human embryo, as that which it undoubtedly performs in cer- tain brute animals at a particular season. The fibres proceeding from Poupart’s liga- ment, and the obliquus interims, tend to guide the gland into the inguinal canal ; those at- tached to the os pubis to draw it outside the abdominal ring ; and the process extend- ing to the bottom of the scrotum, to direct it to its final destination. As the process ap- proaches completion, the muscular fibres which perform so important a part in it gra- dually become everted, and acquire the new functions of elevating, supporting, and com- pressing the gland. The Functions of the Testicle. — The sperm or fluid secreted by the testicle has been con- sidered in the article (Semen). On survey- ing the structure of this gland, we cannot fail to remark the great extent of secreting surface afforded by the numerous, long, and tortuous tubuli, and the length and complexity of the excretory duct through which the seminal fluid has to pass. The extent of this duct is, indeed, so remarkable, that many physiologists have been led to suppose that the semen is Owen, being the only brute animal in which the tunica vaginalis forms a shut sac. * For this reason I have departed from the usual custom of English anatomists, and avoided describ- ing the change in the position of the testicle, as the descent. further elaborated or perfected in its passage through the convolutions constituting the epididymis. An examination of the spermatic fluid taken from the testicle and its duct both in man and in the lower animals, under all circumstances and at all periods, and the varying state of the discharge in cases of spermatic fistula, leave little room to doubt that secretion takes place actively only dur- ing tlie periods of sexual excitement, or under the influence of sexual feelings and desires. From birth to the period of puberty the testicles remain small, and grow but little in proportion to other parts ; but as the body, on the arrival of puberty, becomes stamped with the characters of the male sex, they rapidly enlarge, their glandular structure becomes much more developed, and, being excited, these organs begin to exercise the office of secretion, no spermatozoa being found in them until this period arrives. The age at which the testicles thus become developed varies in different climates, and in different constitutions, and is influenced by the mode of life and circumstances in which the indivi- dual is placed. The inhabitants of warm climates reach the age of puberty earlier than those of cold countries. In this part of Europe the change takes place from the age of fourteen to seventeen years, according to circumstances. Unlike the inferior ani- mals, the testicles in man are ready at all seasons to perform their office. The de- sires subside, and the secretion of semen be- comes languid as life advances, though they seldom cease entirely till the age of sixty-five or seventy. Indeed, I have several times dis- covered spermatozoa in the testicles of men upwards of seventy years of age, and once in the testicle of a tailor who died at the age of eighty-seven. There are instances on record of persons retaining the procreative faculty to the age of one hundred years ; but in these cases, as in the well-known instance of old Parr, the general bodily powers were also pre- served in a very extraordinary degree.* “ To the use of the sexual organs for the continuance of his race man is prompted by a powerful instinctive desire, which he shares with the lower animals. This instinct is ex- cited by sensations, and these may either ori- ginate in the sexual organs themselves or may be excited through the organs of special sen- sation. Thus in man it is most powerfully aroused by impressions conveyed through the sight or the touch : in many other animals, the auditory and olfactive organs communi- cate impressions which have an equal power ; and it is not improbable that in certain mor- bidly excited states of feeling, the same may be the case in ourselves. That local impres- * Old Pari', who lived to the great age of 152, was dissected by the celebrated Harvey, and it is stated, “Genitalibus erat integris, neque retructo pene neque extenuato, neque scroto distento ramice aquoso ut in decrepitis solet, testiculis etiam inte- gris et magnis.” Bettus de Ortu et Natura San- guinis, p. 320. TESTICLE GNOEMAL ANATOMY). 985 sions have also very powerful effect in excit- ing sexual desire must have been within the experience of almost every one ; the fact is most remarkable, however, in cases of saty- riasis ; which disease is generally found to be connected with some obvious cause of irrita- tion of the generative system, such as pruri- tus, active congestion,” &c.* The part of the brain which is the seat of the sexual appetite is supposed by the phrenolo- gists to be the cerebellum, between which and the genital organs a close sympathy is said to exist. The grounds for this assumption, and the objections which have been fairly urged against it by sound physiologists, have been stated in a preceding article. (Nervous Sys- tem, Physiology of, vol. iii. p. 782. s.) No doubt, however, can be entertained that the mind is intimately connected with the procre- ative faculty, and that the brain controls and animates the desire for sexual enjoyment. An affection of the brain, or the mind, as sudden disgust, arrests the secretion of the testicles and extinguishes all desire as quickly and effectually as a strong mental impression stops the secretion of the gastric juice, and takes away ail appetite for food. The influence of the brain on the reproductive function is well illustrated by the occasional effects of injuries of the head. Iiildanus mentions the case of a man accused of impotency by his wife, who sued for a divorce. Nothing external was de- fective ; but the man stated that eight years previously he had received a blow on his head by a stick. From that period, “ confitebatur penem erigi non posse.” f Dr. Fisher relates the case of a gentleman who, while looking out of the window of a railway carriage, which at that moment encountered a violent collision, received a blow on the head and neck, by which he was stunned. On the se- cond day after the accident he complained of a numbness in his right arm, and experienced difficulty in passing his urine. In the course of two weeks he was able to leave his bed, and walk in the street ; but his vision was defective. Between the fourth and fifth week after his injury he made the discovery that he had lost the desire and physical power for sexual intercourse, and that no amorous sentiment, or the approach of a female could excite it. Under appropriate treatment the bladder gradually recovered its power, anti his vision became perfect ; but the numbness of the right arm continued, and the generative functions remained partially impaired. His mental powers, particularly his memory of events, were also for a time seriously affected. J Dr. Gall mentions that at Vienna he was con- sulted by two officers who had become im- potent in consequence of blows from fire-arms which had grazed the napes of their necks. One of the officers recovered his powers by * Dr. Carpenter’s Principles of Human Physio- logy, p. 619. f Opera Observationum et Curationum Medico- Chirurgicarum, p. 574. X Case by Dr. Fisher. American Journal of the Medical Sciences, Feb. 1839. p. 357. degrees, married, and became the father of several children.* When treating of Atrophy of these glands, I shall have occasion to mention cases in which the genital function has been perma- nently annihilated, and complete wasting of the testicles has resulted from injuries of the head. In respect to the mode in which these organs are called into action, they bear consi- derable analogy to the lachrymal, salivary, and mammary glands, in which secretion is excited both by the influence of the mind and by me- chanical contact or local irritation of the ex- tremity of the excretory duct, the glans penis holding the same relation to the testicle as the mucous membrane of the mouth does to the salivary glands, or as the nipple does to the mamma. The influence of the testicles and brain upon each other appears, as has been already observed, to be reciprocal ; for not only may desire be aroused by local irritation and ex- citing the testicles to secrete, but the passion itself never arises when these glands are re- moved before puberty and is extinguished by their extirpation afterwards. Nothing, indeed, illustrates more forcibly the intimate relation which the functions of the testicles bear to the mind and character of the individual, and the general organisation of the body, than the effects of castration. When it is performed in early life, the changes characteristic of puberty never ensue. There is a deficiency of the beard ; the muscles do not acquire the manly tone and vigour ; the areolar and adipose tissues abound ; the voice retains the high and clear tones of infancy ; and the mind remains deficient in energy and strength. When the testicles are removed after the period of puberty, the eunuch loses in part, though not entirely, his former masculine character. His beard grows less abundantly ; his voice becomes shrill ; and there is di- minished energy and vigour in all his senti- ments and actions. These changes in the con- stitution, as well as the loss of the sexual instinct which occur in men thus degraded, do not immediately succeed the removal of the testicles, but take place gradually ; and there are well-attested cases in which desire has been experienced, and connection with emis- sion accomplished many months after the loss of these organs. This shows that the passion is not solely dependent on the secretion of semen, though it invariably declines when the powrer of procreation becomes lost. The emis- sions in such cases are imperfect and fruitless, consisting merely of the secretions of the vesiculte seminales and prostrate. The testi- cles not being parts essential to life, are sub- ject to different laws from those which re- gulate the actions of the vital organs. Their functions may be suspended, or they may remain in abeyance for an indefinite period without injury to the glands or any material effect on the constitution. In persons of * On the Functions of the Cerebellum, tr. by Combe, p. 46. 986 TESTICLE (ABNORMAL ANATOMY). recluse and studious habits the functions of these organs often continue dormant for years. Like the mammae in the unmarried female, though inactive, they remain sound and competent for secretion when duly ex- cited and called upon to exercise their func- tions. It often happens that the passions are excited without an opportunity being afforded for their gratification. Under these circum- stances the testicles become encumbered with secretion which would prove injurious to them were they not relieved by occasional nocturnal emission, or ejaculations of the semen under the influence of dreams during sleep, which appear to be a salutary provision to obviate the inconveniences which might result as well from ungratified desires as from an accumulation of semen in the ducts. Envelopes of the testicle. — The scrotum, or pouch of integument containing the testicles, including the dartos, has already been de- scribed. (Article Scrotum). Superficial or external spermatic fascia. — Beneath the loose areolar tissue of the scro- tum is situated a delicate layer of fascia, which is continuous with the superficial fascia of the lower part of the abdominal parietes, and, descending so as to form a sheath to the spermatic cord and an envelope to the testicle, becomes continuous behind with the super- ficial fascia of the perineum. This fascia is usually very thick and distinct in cases of large and old scrotal hernia. Cremaster muscle — Directly beneath the superficial fascia is found the cremaster muscle (so named from icpep.6. w to suspend), or, as it has been appropriately termed by Mr. Hunter, the musculus testis. (For description, vide, Abdomen, vol.i. p.6.) The two attachments of this muscle, the external to Poupart’s ligament, and the internal to the os pubis, correspond, as I have previously (p. 983.) shown, to those of the muscle of the gubernaculum, being indeed the same structure, with its relations altered. The actions of the cremaster, which, with a few exceptions, are involuntary, appear to be those of giving a tonic support to the testicles, retracting them to the abdominal rings, and compressing them during the sexual act. In some instances, in boys before the approach of puberty, this muscle has been capable of drawing the gland up into the in- guinal canal. Persons are occasionally met with who possess a voluntary power over its actions in various degrees of perfection. Some are able to elevate the testicle on one side but not on the other, whilst others can retract both testicles to the abdominal rings, and retain them there at will. A very remarkable instance of the cremaster muscle being com- pletely under the influence of volition is recorded by Mr. Hutchinson.# Deep spermatic fascia. — The tunica vagi- nalis and spermatic cord are invested by a thin delicate fascia, which is situated beneath the cremaster muscle, and forms a common * Practical Observations in Surgery, second edit. p. 186. fibrous envelope to the testicle, and spermatic cord. It is attached to the back part of the gland. This membrane may be traced as a prolongation of the fascia transversals, and is probably formed in the process of transition of the testicle from the abdomen to the scrotum. The spermatic cord. — The parts composing the spermatic cord, are the vas deferens, the artery of the duct, the spermatic artery and veins, the lymphatic vessels, and the spermatic nerves. These parts are connected by loose areolar tissue. A fibro-cellular process, being the remains of the process of serous membrane originally connecting the tunica vaginalis with the peritoneum, may sometimes be perceived in the front part of the cord. The spermatic cord extends from the internal abdominal ring to the back part of the testicle. Its upper portion, therefore, lies in the inguinal canal. The coverings of the cord are the same as those of the testicle : viz., the inte- guments, superficial fascia, cremaster muscle, and deep spermatic fascia. For Comparative Anatomy, see the article Organs of Generation. Abnormal Anatomy of the Testicle. — Congenital imperfections and malformations. — Numerical excesses and defects. — Cases of su- pernumerary testicles are mentioned in the writings of the old authors, and persons have been described with four or five of them, ac- companied with a proportionate increase in the venereal appetite. Nearly all these cases are of a fabulous character. Such must be remarked of the case of -navr ipxos, or man with five tes- ticles, mentioned by Schaarf*, and with that of a man with four testicles alluded to by Blegny.-j- Blasius, an old writer not un- worthy of credit, has, however, given an account of the examination of a man, thirty years of age, and otherwise well formed, who had two testicles on the right side, of the same size and shape as that on the left, which is illustrated by a small engraved figure re- presenting a distinct artery from the aorta, and vein from the vena cava proceeding to each of the two testicles on the right side.J This is the only case of supernumerary testicle recorded by the old authors, which has any semblance of authenticity. Neither Morgagni, Haller, nor Meckel met with a single exam- ple, and they questioned the existence of such a condition. Two cases have recently been recorded as examples of triple testicle, but they were not verified by examination after death. One is related by Bliimener, an army surgeon, in Rust’s Magazin fur die Gesammte Heilkunde for 1821 : the other by Dr. Macann, a British surgeon. $ An epi- plocele, a fatty or fibrous tumour in the scrotum, or an encysted hydrocele of the cord, * Epli. Nat. Cur. Dec. 111. Ann. v. vi. Obs. 89. p. 175. •f Zodiaque Fran^ais, Ann. 11. Most of the re- puted cases of Triorchides are quoted by Arnaud, in his Memoires de Ohirurgie. Mem. iii. part i. } Ger. Blasius, Obs. Med. Anat. Obs. 20. p. 60. § Provincial Medical Journal, Nov. 5. 1842, p. 113. TESTICLE (ABNORMAL ANATOMY). might readily be mistaken for an additional testicle. Morgagni mentions that he was once deceived by a portion of omentum. In the pathological collection at St. Thomas’s Hos- pital is preserved the testicle of the eccentric Dr. Monsey, who appeared during life to be supplied with three of these glands. The sup- posed additional testicle consists of an in- durated fibrous tumour attached apparently to the tunica vaginalis. Many instances of monorchid.es, or persons having only a single testicle are also mentioned by the old authors ; but as the data are very imperfect, and as little was known respecting the transition of the testicle at the time these cases were recorded, they must be viewed with great suspicion. They were most pro- bably cases in which one of the glands was either retained within the abdomen, or, from some cause had been completely atrophied. I know no satisfactory reason why a defici- ency of one or both testicles should not occasionally occur without any other mal- formation ; but they are anomalies of which there are few authentic examples in the annals of medical science. Mr. Paget has published the particulars of a case in which he believes one testicle was deficient at birth.* * * § No account of the man is attached to the particulars of the dissection, and it is open to question whether the deficiency of the gland was not the result of atrophy. Dr. Fisher, of Boston f , has recorded a more satisfactory example of absence of both testicles. The de j ficiency was remarked from birth, and the sub- ject of the malformation was regarded as a na- tural eunuch, and died at the age of forty-five. Mr. Thurnham has published an account of the dissection of an infant who died at the age of four months. In addition to an atrophied condition of the right kidney, and a remark- able malformation of the ureters, it was found that neither of the testicles had descended. The right lay in the abdominal cavity, just above the inguinal canal. On the left side no testicle would appear to have been formed ; the spermatic vessels on this side terminated in a little mass of fat ; the vas deferens, how- ever, was present, and was apparently as well developed as that of the perfect testicle. J A case of monstrosity is related by Dr. Friese in Casper's Wochenschrift.tji The child lived only half an hour : in addition to the absence of the external genital organs, there were neither testes, vasa deferentia, nor vesiculae seminales. Cases, however, in which the whole of the genital apparatus is deficient or irregularly formed, do not come within the scope of this article. Geoffroy St. Hilaire has recorded a remarkable, and so far as I know, unique case of union of the testicles in the abdomen. || * London Medical Gazette, vol. xxviii. p. 817. f American Journal of the American Sciences, vol. xxiii. p. 352. J London Medical Gazette, vol. xx. p. 717. § Dec. 25. 1841. Quoted in the British and Fo- reign Medical Review for April 1842, p. 527. 11 Hist, des Anomal. de l’Organ. t. i. p. 542. 987 Deficiencies and imperfections of the vas deferens. — In Mr. Paget’s case of supposed absence of the testicle it is stated, that the vas deferens terminated nearly opposite the external ring in a rounded cul-de-sac; and in Dr. Fisher’s case of deficiency of both testicles, that the vasa deferentia, though properly formed and nearly of natural size, terminated in cul-de-sacs at the end of the cord. In the museum of St. Bartholomew’s Hospital, there is a preparation taken from a man fifty years of age, who died of strangulated hernia. A piece of intestine was strictured by a band of adhesion connected with the mesentery, and the testicle was detained in the upper open- ing of the ring. On dissection of the parts, the vas deferens was found to terminate near the testicle in a cul-de-sac. The gland was very small, and its structure appeared granular like the undeveloped testicle of a youth. There was no trace of the epididymis. Mr. Hunter in dissecting a male subject found the vasa deferentia not only deficient near the testicles, but terminating below in a single irregularly formed vesicula seminalis, and having no com- munication with the urethra.* There are a few other cases on record, in which the vas deferens has been defective at the extremity which joins the ejaculatory canal. Thus, Tenon, in the dissection of an infant affected with extraversion of the bladder, found that the vasa deferentia terminated separately at the bottom of the pelvis, in two white tuber- cles : the scrotum, testes, and vesiculae semi- nales were in a natural state, j But besides these imperfections at its two extremities, this duct has been found wanting throughout nearly its whole extent. Brugnoni mentions, that in dissecting the parts of generation in a robust man, from twenty-six to twenty-seven years of age, he found the right epididymis almost entirely absent, the only part remaining being the head, which formed nodules filled with semen. The rest of the epididymis and the vas deferens were wanting, without any mark of disease. The testicle was perfectly sound, and nearly of the same size as the left one. On examining the corresponding vesicula seminalis he found at its anterior extremity a portion of the canal of the vas deferens about an inch in length, and properly formed. The vesicula seminalis itself was flaccid and quite empty ; whilst the left was full of semen. He remarks, that although this vicious conforma- tion was according to all appearances con- genital, nevertheless the vesicula seminalis and ejaculatory canal had preserved their natural cavities. J In a case related by Bosscha, the left vas deferens of a robust man terminated in a blind extremity near the testicle, the rest of the canal being wanting. There was the rudiment of a left vesicula seminalis in the * Works by Palmer, vol iv. p. 23. f Mem stir quelques Vices des Voies Urinaires, Sec. n Mem. de l’Acad. Roy. des Sciences a Paris, 1761, p. 115. J Observ. Anat. sur les Yesicnles Seminales. Mem de 1’Acad. Roy. des Sciences it Turin, 1786, and 1787, p. 625. 98b TESTICLE (ABNORMAL ANATOMY). form of a blindly-ending canal running tor- tuously in the shape of the letter S. The left testicle was sound.* Mr. Paget has happily explained the origin of these several defects in the vas deferens, by reference to the mode of development of the special organs of generation. He observes t, after Miiller and Valentin, that, in the normal course of human development the proper ge- nital organs are in either sex developed in two distinct pieces : namely, the part for the for- mation of the generative substance, the testicle or ovary, and the part for the conveyance of that substance out of the body, the seminal duct or ovi-duct. The testicle or ovary as the case may be, (and in their earliest periods they cannot be distinguished), is formed on the inner concave side of the corpus Wolffianum, and the seminal or ovi-duct, which is originally an isolated tube closed at both extremities, passes along the outer border of that body from the level of the formative organ above to the cloaca or common sinus of the urinary, genital, and digestive systems below. The perfection of development is attained only by the conducting tube acquiring its just connec- tions at once with the formative organ, and, through the medium of the cloaca, with the exterior of the body. The sexual character is first established, when, in the male, the for- mative and conducting organs become con- nected by the development of intermediate tubes which constitute the epididymis ; or when in the female, a simple aperture is formed at the upper extremity of the conducting tube, and is placed closely adjacent to the formative organ. In both sexes alike, the lower ex- tremities of the conducting tubes first open into the common cloaca, and subsequently, when that cavity is partitioned into bladder and rec- tum, or bladder, vagina, and rectum, they ac- quirein each their just connections, and become in the male the perfect vasa deferentia, and in the female the Fallopian tubes and uterus. The inquiry is not without interest, what influence have these deficiencies and imperfec- tions in the vas deferens on the evolution and subsequent condition of the testicle ? In the case of the adult which occurred at St. Bar- tholomew’s Hospital, the testicle was small, and its structure appeared granular, like the undeveloped testicle of a youth, but as it had not descended into the scrotum, and was com- bined with hernia, there may have been other causes impeding its due evolution. In Mr. Hunter’s case, the testicles which were in the scrotum were very sound. In the case of the man related by Brugnone, the testicle on the side corresponding to the defective vas de- ferens was perfectly sound, and nearly of the same size as the other. So also in Bosscha’s case, it is stated, that the testicle was sound. Although either of these defects in the vas deferens renders the gland an useless organ, * Diss. sistens Obs. de vesiculse seminalis sinis- tra defeetu, integris testibus, vase vero deferente clauso, quoted by Dr. Yrolik, Handboek der Ontleed- kundige Ziektekunde, 1st Deel. p. 210. | Loc. cit. p. 818. and if it occurred on both sides of the body, would necessarily cause impotency, these cases, nevertheless, tend to shew that the absence or imperfection of the excretory duct does not prevent the development of the tes- ticle at the proper period, and has no direct influence in causing it to waste; and these inferences are fully confirmed by experiments on animals, performed by Sir A. Cooper and by myself.* These cases and experiments show, then, that the testicles maybe properly developed, though a physical obstacle to the elimination of their secretion is present from birth ; and that so long as the testicles exist entire, though to no purpose, the individual acquires and preserves all the marks of the male sex ; the secretory organ alone appear- ing to be that upon which the sexual charac- ters depend. The engorgement of the se- minal ducts with sperm is liable, it is true, to cause inflammation of the testicle, which may end in atrophy, but this is only a secondary and occasional effect of the interruption in the excretory duct. Imperfect transition. — It occasionally hap- pens that at birth one or both testicles have not passed into the scrotum, being detained either in the abdomen near the groin, in the inguinal canal, or in the groin, just outside the external ring. In a table of one hundred and three male infants, examined by Wrisbergat the time of birth, it appears that seventy-three had both testicles in the scrotum ; in twenty-one, one or both were in the groin. Of these, five had both, seven the right, and nine the left in the groin; in twelve, four had both, three the right, five the left, only in the abdomen. f According to this table, the imperfection occurs rather more frequently on the left side than on the right, in the proportion of seven to five. In twenty-five cases examined at different ages, varying from five to sixty, — sixteen of which came under my own observation, the remainder being taken from the recorded experience of others, — in thirteen the imperfection was on the right side, and in twelve on the left. Dr. Marshall states, that in the examination of 10,800 recruits, he had found five in whom the right, and six in whom the left testicle was not apparent. In two of these cases there was inguinal hernia on the side where the tes- ticle had not descended. % He met with but one instance in which both testicles had not appeared. $ The testicle sometimes remains permanently fixed in the situation in which it is placed at birth || ; but in some instances the passage, though delayed, is completed at some period previous to puberty, and often within a few weeks after birth. Mr. Hunter was of opinion that this completion most frequently * Vide Sir A. Cooper on Anatomy of the Testis, p. 51., and my Treatise on the Diseases of the Testis, p. 64, and seq. f Commentatio Soc. Reg. Scient. Goetting. 1778. | Hints to Young Medical Officers in the Army, p. 83. § Ibid. p. 207. || Persons whose testicles had not made their ap- pearance were called or testicondi, by the ancients. TESTICLE (ABNORMAL ANATOMY). 989 happens between the years of two and ten.-* Of the twelve cases mentioned by Wrisberg, in which one or both testicles were retained in the abdomen, in one the descent took place the day of birth, in three on the day after, in three others on the third day, in two instances on the fifth day, and in one on the twenty- first day : in the other cases, the testicles had not appeared at the fourth or fifth week after parturition, f My own observations lead me to believe, that if the passage does not take place within a twelvemonth after birth, it is rarely fully and perfectly completed afterwards, without being accompanied with rupture. For the causes which operate at this late period tend as much to promote the formation of hernia as the transition of the testicle. In cases where the testicle makes no appearance before puberty, uneasiness is often experienced at that period, owing to the enlargement of the gland being restrained by the rings and parts composing the inguinal canal. At the same time also, it is often protruded outside the external ring by the movements of the abdomen in respiration. The causes of a failure in the transition of the testicle have not been much investigated, and as considerable doubt has long prevailed respecting the mode and agency by which this change is effected, no satisfactory explana- tion could 'be expected of the circumstances interrupting or preventing it. When we re- flect on the nature of that process, as my researches have led me to describe it, it is clear, that there must not only be a perfect adaptation of parts, a due relation between the body displaced and the structures which it traverses, but also corresponding power in the agent by which it is accomplished. There are few muscles in the human body whose development in different individuals varies in a greater degree than that of the cremaster. And if such be the case after birth, it is not unreasonable to presume that similar differ- ences exist in the foetus before the gland changes its position, and that a failure in the process may be the result of deficient power in the musculus testis to accomplish the pas- sage. It is not improbable that this muscle is sometimes paralysed, and that the faulty transition is owing to a want of a due supply of the nervous energy, which we know is often denied to other muscles during foetal exist- ence, and is the cause of deformities in the feet and other parts, with which infants are often ushered into the world. I think, indeed, we may fairly enumerate paralysis and defective development of the cremaster amongst the presumed causes of the imperfect transition of the testicle. Peritonitis occasionally at- tacks the foetus in uteroj, and produces ad- hesions between thevarious abdominal viscera. It is well known that in congenital hernia the testicle is frequently united to a portion of * Lib. cit. p. 15. t Lib. cit. p. 203. j Vide Contributions to Intra-uterine Pathology, by Dr. Simpson, Edinb. Med. and Surg. Journal, nos. cxxxvii. and cxl. intestine or omentum, and that the formation of these adhesions previous to the transition of the testicle is sometimes the cause of the displacement, the viscera being drawn, together with the gland, into the scrotum. Many facts seem to show that similar adhesions are, on the other hand, an occasional cause of the temporary and permanent retention of the testicle, the cremaster being insufficient to overcome this obstacle to its passage. In the examination of a man, age sixty, I found the right testicle just external to the abdominal ring ; it was small in size, and closely adherent to a portion of omentum. A young man was under my care for many months, on account of an imperfect transition of the testicle on the left side. The gland moved backwards and forwards through the external abdominal ring. By pressure above, it could be forced down sufficiently to admit of being examined. This testicle was much smaller than the right, which was in the scrotum, and I could distinctly make out a portion of intestine closely adherent, which accompanied the organ in all its movements. It is probable that the smallness of the opening in the internal abdominal ring is sometimes a cause of the detention of the testicle, especially in those cases in which the organ is retained within the inguinal canal. Mr. Wilson, an accurate anatomist, was of this opinion*, which is supported by the fact, that the testicle is oftener found in the groin than in the cavity of the abdomen. M. Dela- siauve mentions a case, in which, he states, the organ was retained by the border of the outer column of the ring, f Mr. Hunter was inclined to suspect that the fault originates in the testicles themselves. It is difficult to un- derstand how this can be, for as the gland is passive in this process, it can offer no obstacle, unless it grows too large to pass the opening in the abdominal parietes ; whereas, it is ad- mitted that the gland when retained is usually below the natural size. Nor does it appear, that the interruption is owing to any want of proper length in the vas deferens, for in a case of imperfect transition in a boy, whose body I examined, I particularly noticed that this duct was so long as to be doubled on itself, and tortuous, a circumstance which has been remarked in other cases by Mr. Mayo J, Rosen- merhelj), and others. It may be concluded then, that the causes of a failure in the pas- sage of the testicle are various ; that this imperfection may result from want of power, or paralysis of the cremaster muscle; from adhesions retaining the gland within the ab- domen ; and from a contracted state of the opening of the external abdominal ring. Mr. Hunter states, that when one or both testicles remain through life in the belly, he believes that they are exceedingly imperfect, * Lectures on the Urinary and Genital Organs, p. 405. t Revue Medicale, Mars, 1840, p. 363. i Human Physiology, 3d edit. p. 411. § Ueber die Radicalcur desin der Weiche liegen- den Testikels. 990 TESTICLE (ABNORMAL AN ATOMY). and probably incapable of performing their natural functions ; and that this imperfection prevents the disposition for descent taking place. That they are more defective even than those which are late in passing to the scrotum, he infers from the circumstance, that in quadrupeds, the testicle that has reached the scrotum is considerably larger than the one which remains in the abdomen. Mr. Hunter had seen only one case in the human subject where both testicles continued in the abdomen, but this proved an exception to the above observation, since we are led to con- clude that they were perfectly formed, as the person had all the powers and passions of a man.* Professor Owen in commenting upon these observations, states, “ It seems remark- able that with this experience Mr. Hunter should have formed from inconclusive analogy, and promulgated, an opinion tending to occa- sion so much unhappiness as that which attri- butes exceeding imperfection and probable incapacity of performing their natural func- tions to testes which in the human subject are retained within the abdomen. That there is -nothing in such a situation which neces- sarily tends to impair their efficiency is evident, from the number of animals in which they constantly form part of the abdominal vis- cera ; and in those in which the testes na- turally pass into a scrotum, their continuance in the abdomen, according to our author’s own observation, is accompanied only with a difference of size or shape ; now we may readily suppose that this may influence the quantity, but not necessarily the quality, of the secretion.” There are very few accounts on record of the dissection of undescended testicles. In a case, in which M. Cloquet found the left testicle situated within the abdomen, the gland was well formed, and of the same size as the right, which had de- scended into the scrotum. The parts taken from an apprentice of Sir A. Cooper, who unfortunately committed suicide in conse- quence of the infirmity, are preserved in the Museum of Guy’s Hospital. I have ex- amined the preparation ; and the testicles, which are both within the abdomen, close to the internal ring, appear to be nearly, if not quite, the natural size, and it is stated that the ducts contained semen. In a lad, aged nineteen, whose left testicle was found, by Ur. Bright, within the abdomen, near the brim of the pelvis, the gland was considerably smaller than natural, but the ducts and se- creting structure were quite perfect.')' These are the only cases of testicles situated within the abdomen in which we have any account of the anatomical condition of the gland. In addition to the evidence they afford of the ca- pability of testicles thus placed to exercise their functions, may be adduced the case of Mr. Hunter, just alluded to, in which a person, both of whose testicles continued in the ab- domen, had all the powers and passions of * Works by Palmer, vol. iv. p. 18. f Hospital Reports, vol. ii. p. 258. a man ; and a case recorded by Mr. Poland, of a man so formed, who was aged twenty- nine. He had all the signs of virility, had married twice, and was the father of two children.* On the other hand, Mr. Wilson mentions the case of a young man, twenty-five years of age, whose testicles never descended. He had some beard, and not an unmanly ap- pearance ; but although an imprudent, and in some things a dissipated person, he had never shown the least desire for women, or disposition for sexual intercourse, f John West, a lad, aged sixteen, died in the London Hospital, in a state of universal anasarca. There was no appearance of beard, and only a few hairs were scattered over the pubes. My attention was particularly directed to the state of the genital organs, by observing that the scrotum, which was greatly distended with serous effusion, was not fully developed on the right side. I found the right testicle within the abdomen, about an inch and a half above the internal ring. It was very small, not larger than that of a child two years of age ; and on cutting into it, the gland pre- sented the granular appearance usually re- marked at that early period. Passage of the Testicle into the Perineum. — Mr. Hunter first observed that the testicle in changing its situation does not always pre- serve a proper course towards the scrotum, there being instances of its taking another direction and passing into the perineum. How this is brought about, he remarks, it is difficult to say : it may possibly be occasioned by something unusual in the construction of the scrotum, or more probably, by a peculiarity in that of the perineum itself. For it is not easy to imagine how the testicle could make its way to the parts about the perineum, if these were in a perfectly natural state. He met with two instances of this imperfection. Many years ago a little boy, one of whose testicles had thus deviated from its proper course was brought to the London Hospital. The gland was lodged in the perineum at the root of the scrotum. M. Ricord met with this singular anomaly in two instances. M. Vidal (de Cassis) observed it in two brothers : their father was exempt from it. The testicle abnormally placed was smaller than the other. J The irregularity is exceedingly rare, and the above cases are all with which I am acquainted. Passage of the Testicle through the Crural Ring.- — M. Vidal relates the case of a man, one of whose testicles, instead of passing out of the abdomen at the inguinal canal, made its exit at the crural ring. The organ was mounted upon the abdomen like a crural hernia. A portion of intestine traversed the inguinal canal, forming a rupture on that side. $ I know of only one other instance of this * Guy’s Hospital Reports. Second series, vol. i. pp. 162, 163. f Lectures on the Urinary and Genital Organs, p. 408. t Traitd de Pathologie exteme, t. v. p. 432. 2etne, edit. § Ibid p. 431. TESTICLE (ABNORMAL ANATOMY). 991 anomaly, which is reported by Eckardt. In this ease, the testicle passed out at first through the inguinal canal, but having been returned by the patient into the abdomen, it subsequently escaped at the femoral ring.* Inversion of the Testicle. — It sometimes happens that the position of the testicle in the scrotum is reversed, so that the free sur- face presents posteriorly, and the epididymis is attached to the anterior part of the gland, instead of to the posterior. The first case that I met with was that of a man who had a swelling of the right testicle, which puzzled his medical attendant. On examination 1 found this to be the epididymis thickened from chronic inflammation. I was able clearly to trace the vas deferens proceeding to it along the front of the scrotum. The body of the testicle was unaffected, and its posterior edge was quite smooth and regular. The disposition of the left testicle was normal. On visiting the Hopital de Midi in Paris, in April, 1849, M. Ricord showed me a case of epididymitis on the left side, in which the gland was thus inverted. He informed me that he had often met with this arrangement. I have since had two patients under my care, one of whose tes- ticles was thus inverted. One was a lad in the London Hospital affected with epididymitis. The other was a gentleman who consulted me for chronic orchitis confined to the body of the testicle. The epididymis being unaffected, the inversion was less perceptible than in the three preceding cases. M. Maissonneuve, in a thesis published in Paris in 1835, I believe first called attention to this irregular disposition, which he states that he had met with many times upon the dead body, and upon the living, and he mentions what I remarked myself in the four cases just noticed, that the inversion was confined to one side. Surgeons should bear in mind the liability to”this dis- position of the gland in making their diagnosis of the diseases affecting it. Atrophy of the Testicle. — The testicles, like other organs formed for the exercise of tem- porary functions, do not arrive at a perfect state of development until a certain period of life, after which their activity ceases, and they become gradually and imperceptibly diminished. Thus we find that in early life they are small in proportion to the size of the body as compared with their condition at puberty, and that as old age advances and the generative functions cease to be called into action, they undergo a diminution in size, their vessels grow less, the seminiferous tubes become small and contracted, and partially ob- literated. In the lower animals these changes are far more remarkable than in man, for as the functions of the testicle are exerted only at stated periods of the year, as the rutting or copulating season advances these organs rapidly increase in bulk, and in its decline undergo a proportionate degree of wasting. In man, it sometimes happens that the tes- * Loder’s Journal fur die Chirurg. ii. Bd. 1 Stff. s. 187. tides do not acquire their proper size at the usual period, their development being from some cause or other arrested ; and also, after the organs have arrived at their full and perfect growth, that occasionally one or both suffer a premature decay. Under the head then of Atrophy of the Testicle I shall consider : 1. Arrest of Development ; and 2. Wasting. Arrest of Development. ■ — If the congenital lesions to which the testicle is liable had not been previously treated of, the cases of ab- sence of the organ already described, might be correctly referred to the present head, as the deficiency in these cases was no doubt the result of an arrest in the early development of the organ. But the cases that 1 am now about to consider are those in which the sub- sequent evolution which the testicles undergo at puberty is delayed beyond the usual period, or never takes place at all. Mr. Wilson relates a curious instance of his having been consulted by a gentleman, twenty-six years of age, on the propriety of entering the marriage state, whose penis and testicles very little ex- ceeded in size those of a boy of eight years of age. He had never felt the desire for sexual intercourse until he became acquainted with his intended wife ; since that period he had experienced repeated erections, attended with nocturnal emissions. He married, be- came the father of a family ; and these parts, which at six and twenty years of age were so much smaller than usual, at twenty-eight had increased nearly to the usual size of those of an adult man.* Mr. Wilson mentions this singular case, as it will admit of questions whether the parts alluded to became properly formed as to size, and possessed of the power of secretion, in consequence of being, although so late in life, influenced by the passions excited b}' attachment to a particular female ; or whether the enlargement and proper action of the parts beginning, occasioned such passion first to exist. He thinks the probability in favour of the former supposition, in which opinion I certainly concur. Lallemand men- tions having seen a man about thirty years of age, extremely fat, and without a beard or hair on the pubes, whose penis and testicle ap- peared to belong to a child of from seven to eight years : he had never experienced erec- tions or venereal desires. f A young man died in the London Hospital of disease of the heart. He was seventeen years and nine months old : the body measured five feet five inches in height, and was plump and well formed. There was no appearance ofbeard, or whiskers, or of hair on the pubes. The penis and testicles were very small, not larger than they are usually found in boys of three or four years of age. The testicles were about equal in size, and one of them weighed only two scruples and one grain. Both organs were normal in structure, appearing like the glands in early life, when the tubular structure * Lectures on the Urinary and Genital Organs, p. 424. t Des Pertes Se'minales Involontaires, t. ii. p. 380. 992 TESTICLE (ABNORMAL ANATOMY). is very indistinctly developed. No sperma- tozoa could be detected. These were clearly instances of arrest of development of the tes- ticles. As these organs are chiefly excited to action by an operation of the mind, it is easy to understand that they may sometimes re- main undeveloped owing to defective organi- sation of the brain, an absence of sexual desires being invariably remarked in these cases. Cases of wasting of the testicles after injuries of the head, and the frequent absence of the venereal appetite in cretins and idiots, tend to strengthen this opinion. The follow- ing are marked examples of defective develop- ment of the sexual organs, accompanied with imperfection of the brain. An idiot, aged nineteen, subject to epileptic fits, died of typhus fever in the Hackney union. The youth was of short stature, and the form of the body was not indicative of either sex, but the contour was rounded as in the female. There was no appearance of hair about the face or pubes. The abdomen and other parts were covered with a thick layer of fat. The penis and scrotum were remarkably small, not larger than they are usually found in a child two or three years of age. Both testicles were in the scrotum, but they were of very diminutive size ; the right weighed less than a drachm, and the left not more than twenty three grains. The right gland had descended a very little way below the abdominal ring. The glandular structure and epididymis of both testicles were indistinct, and the vasa deferentia also extremely small. Nothing re- markable was observed in the structure of the brain. Mr. Hovell, the surgeon of the union, also showed me another inmate of the same workhouse, a lad aged nineteen, and of weak mind, whose penis and testicles did not exceed in size those of a boy seven or eight years of age, and who had only a few scattered hairs on the pubes. In the museum at Fort Pitt, Chatham, are preserved two undeveloped testicles about the size of those of a child six months old, but healthy in structure, which were taken from a lunatic 58 years of age. His penis was small and he had never experienced any inclination for sexual inter- course. Wasting. — In investigating the alterations in the nutritive condition of the testicle, it is very desirable to fix, if possible, some standard by which they may be estimated. The size of the gland is neither uniform nor conveniently appreciated. Its weight, likewise, varies so much in different persons and in the same in- dividual at different periods, according as it has lately exercised its functions or remained inactive, and as it is full of semen or empty, that it is scarcely possible to determine on any accurate standard of this kind. (See p. 976.) I should consider the testicle of an adult weighing less than three drachms as in a state of atrophy. A testicle in an advaced state of wasting, not arising from disease of the gland, usually preserves its shape, but feels soft, having lost its elasticity and firm- ness. Its texture is pale and exhibits few blood-vessels, the tubuli and septa dividing the lobes are indistinct, and the former cannot be so readily drawn out into shreds as before. The epididymis does not usually waste so soon nor in the same degree as the body of the testicle. It sometimes however, loses its characteristic appearance, ami I have even found it reduced to a few fibrous threads. The fluid pressed out of the wasted testicle and epididymis is entirely destitute of sper- matic granules anti spermatozoa. In many instances adipose tissue is deposited behind the tunica vaginalis, and encroaches on the epididymis and posterior part of the testicle. Fatty matter is also found in the glandular sub- stance of atrophied testicles, as in one taken from a man aged forty-six, who died of dropy consequent on disease of the kidneys, which was wasted to one fifth its natural size. In ad- dition to the presence of adipose tissue be- neath the visceral portion of the tunica vagin- alis, I recognised a quantity of yellow matter irregularly disposed amongst the wasted tu- buli. This matter on examination in the mi- croscope, proved to be oil globules, and readily dissolved on the application of ether. The structures composing the spermatic cord un- dergo a corresponding diminution ; the cre- master muscle disappears, the nerves shrink, and the vessels are reduced in size and num- ber. The vas deferens, though small, can ge- nerally be injected with mercury as far as the commencement of the epididymis. A testicle, atrophied from disease, is not only of dimin- ished size and weight, but is altered in shape, being uneven and irregular, and sometimes of an elongated form. The surfaces of the tunica vaginalis are adherent and its cavity is partly or entirely obliterated. There is no, or very little, trace of the proper glandular structure, the organ being converted into fibrous tissue of a firm texture. It loses its peculiar sensi- bility to pressure, but is sometimes the seat of morbid sensibility. All those causes which produce decay in other parts likewise occasion wasting of the testicle. Thus an impeded circulation, pressure, want of exercise, and loss of nervous influence, have been noticed as causes of atrophy of this gland. To these must be added certain causes which specially affect the testicle. The following case, related by Mr. Wal drop, is a good example of atrophy from defective nutrition. A person, both of whose testicles were completely absorbed, nothing being felt in the scrotum but a loose vaginal coat, died of an aneurism of the aorta, formed at the origin of the spermatic arteries, both of which were obliterated.* A ligature on the spermatic artery is sufficient to cause a total decay of the testicle, which induced the celebrated Harvey f to propose its ap- * Note to his edition of Baillie’s works, vol. ii. p. 315. j- Anatomical Exercitations concerning the Generation of Living Creatures. Lond. 1653, pp. 113, 114. TESTICLE (ABNORMAL ANATOMY). 993 plication for the removal of a certain form of sarcocele ; a suggestion, the credit of which has been improperly assumed in recent years by C. J. Maunoir, of Geneva. The influ- ence of pressure in causing partial atrophy of the testicle, is somtimes remarked in old cases of hydrocele and hoematocele, in which the gland has been long subjected to com- pression from the retained fluid. It has been said that the testicles waste in those persons who strictly adhere to their monastic vows, but I am not aware that there is sufficient authority for this remark. In persons who marry, after many years of ab- stinence from sexual intercourse, the testicles undergo a certain degree of enlargement. It is a great error to suppose that sexual connec- tion in early life is essential for the preservation of these organs. In cases of enlargement of the prostate the ejaculatory canals sometimes become completely obstructed. Under these circumstances, the semen secreted under ex- citement having no means of escape, encum- bers the testicles for a time, but afterwards becomes absorbed, and it is said that atrophy of these glands sometimes follows ; but I have never observed any instance of wasting of the organs from this cause. As examples of atrophy of the testicles from loss of nervous in- fluence, may be adduced cases of paraplegia, in which these organs have been known to waste. Portal mentions the case of a robust man, aged thirty-five, who was attacked with painter’s colic, attended with great debility of the lower extremities. The testicles dimin- ished considerably ; and although he after- wards recovered from the paralysis of his limbs, these glands always remained wasted ; and the man was incapable of the act of gene- ration.* In the xxth volume of the “Medical and Physical Journal,” there is an account of a case of recovery after fracture, with partial dislocation of the first and second lumbar vertebrae, followed by paraplegia, in which, three years afterwards, the testicles were found entirely obliterated. It has been stated that the testicles sometimes waste from in- juries, or from compression of the spine at the origin of the spermatic nerves. In a man who had received a blow on the lum- bar region, the testicles gradually wasted away.f The most common cause of atrophy of the the testicle is the distuibance in its organisa- tion consequent upon inflammation. As the inflammatory process ceases, the enlarged gland not only becomes reduced to its original size, but it sometimes slowly but steadily diminishes, till at length very iittle vestige of it remains Mr. Hunter has related three cases in which the testicle decayed in this way.J 1 have met with several instances of atrophy arising from this cause, and there are few surgeons of experience who have not witnessed cases of the kind. Wasting of the * Ccmrs d'Anatomie Medicale, t. v. p. 434. f Baillie’s Works, by Wardrop, vol ii. p. 315. j Treatise on the Venereal Disease. VOL. IV. testicle has been observed to occur after an attack of orchitis in mumps, arising as it is supposed from the translation of inflamma- tion from the parotid to the testicle. Two cases of\cynanche parotidea in the adult, in which atrophy took place in the gland chiefly affected, are related by Dr. R. Hamilton.* I have witnessed one case, in which the patient attributed the loss of the gland to an attack of mumps in his infancy. Wasting is more liable to occur after inflammation of the body of the gland than after consecutive inflamma- tion in which the epididymis is the part chiefly affected. One or both testicles have been found to waste in persons who have indulged too much in sexual intercourse or been addicted to onanism. Baron Larrey met with several cases of atrophy from excessive venery and abuse of strong drinks amongst the soldiers of the Imperial Guard. f Sir B. Brodie has recorded two cases in which wasting was occasioned by over-excitement ; in one from onanism, in the other from sexual intercourse. j: I have also witnessed an instance of total atrophy of the left testicle in a person addicted to excessive masturbation. In this case, and probably in the others just quoted, the wasting was preceded by an attack of inflammation induced by inordinate excitement. It is a common belief that wasting of the testicle is liable to be induced by the long- continued use of iodine. I have not met with any instance of it, and there are few cases in which the evidence is such as to render it at all clear that the decay of the gland was really occasioned by the remedy. M. Cullerier has published the case of a young man who took from twenty-five to thirty drops of the tinc- ture of iodine for a period of three months for the cure of an obstinate gonorrhaea. This was followed by a state of impotency and partial wasting of the testicles, which lasted a twelvemonth, and the organs never regained their former size and vigour. M. Cullerier mentions another case of temporary loss of virile power occurring from the use of the iodine of iron.§ I feel convinced, however, that if iodine produces wasting of the testicle at all, it does so so rarely, that the liability cannot be regarded as any objection to the free and long-continued use of this valuable remedy. Atrophy of the testicle has been remarked in elephantiasis of the Greeks, a disease in which tubercles are developed in various parts of the skin. Dr. Adams, in an account of the cases of that disease observed in Maderia, states that all those who were attacked with it before the age of puberty never acquired the distinguishing marks of that change in the constitution, and their testicles diminished in size, and that in those affected later in life the testicles became * Philos. Trans. Edinb. vol. ii. art. ix. p. 59. f Mdmoires de Chirurgie Militaires, vol. ii. p. 66. j London Medical and Physical Journal, vol. Ivi. p. 297. § Memoires de la Socie'te' de Chirurgie de Paris, t. i. 3 s 994 TESTICLE (ABNORMAL ANATOMY). atrophied, and they lost the power of pro- creation.* * * § Mr. Peacock also noticed a wasting of the testicles in several cases of elephan- tiasis in the Leper Hospital of Colombo, in Ceylon. f A similar condition of these glands was remarked in a case of this disease, so rare in this country, narrated by Mr. Law- rence and also in another case at the London Hospital, which I recorded many years ago.$ In a confirmed case however of this disease, in a boy aged thirteen, who was under my care in the year 1849, there was no diminution in the size of these glands. Wasting of the testicles is liable to occur after injuries of the head. Some years ago I saw a man who had met with an injury of this description, which had been followed by wasting of the testicles, and the development of tumours on each side of the chest, resembling mammae. He was about fifty- nine years of age, a married man, and the father of several children. He had belonged to the legion in the Queen of Spain’s service. About tvvoyears and a half previously, in an at- tempt to jump over a trench, he fell backwards and injured the posterior part of his head. Whilst on the ground he received a bayonet wound on the side, and a sabre cut on the fore- head. He recovered from these injuries and returned to England. Since the accident he had completely lost his virility. lie had no desire for sexual connection ; his penis had dwindled in size ; his right testicle had gradu- ally wasted, and was no larger than a horse bean, and the left gland was also a good deal diminished in bulk. The skull at the occiput seemed somewhat flattened. Baron Larrey records the case of a man who was wounded in the back of the neck by a musket ball which grazed the inferior occipital protuber- ance. He recovered from the injury, but the testicles were reduced to a state of atrophy, and the penis shrunk and remained inactive. He also relates the case of a man of strong constitution and vigorous passions who re- ceived a sabre wound which cut off all the convex projecting part of the occipital bone, and exposed the dura mater. The patient lost the senses of sight and hearing on the right side, and his testicles sensibly diminished, and in fifteen days were reduced, especially the left, to the size of a bean.|| Lallemaud had under his care a man thirty years of age, who, in the expedition to Algiers had received a sabre wound at the nape of the neck. His testicles were wasted, and venereal desire as well as erections had entirely ceased. II We cannot doubt that in these cases the loss of sexual desire, and the wasting of the testicles were the direct results of the injury to the brain, and they go far to prove the essential dependence of the functions of these glands * On Morbid Poisons, p. 265. j- Edinb. Medical and Surgical Journal, vol. liii. p. 139. 1 Medico-Chirurgical Transactions, vol. vi. p. 214. § Vide Medical Gazette, vol. vii. p. 447. || Me'moires de Chirurgie Mililaire, p. 262. if Pertes Semiuales Involontaires, t. ii. p. 41. upon the cerebral organ. The physiologist cannot fail to notice the rapidity with which the atrophy is stated in some of the cases to have succeeded the injury and the extent to which it proceeded. The withering of the testicles, was, indeed, so remarkable, that it can only be attributed to the sudden and complete extinction of the sexual instinct resident in the brain, and (if I may so express myself) to the immediate impression on the system of the future uselessness of these organs. In old age and in lingering diseases the decay of the testicles is extremely slow and gradual, and is never carried to the extent observed in cases of injury to the brain. In fact, men have survived the power or desire of performing the sexual act many years without the testicles being materially reduced in size. We have seen, too, that in the lower animals the testicles have been rendered use- less by interrupting the vasa deferentia, with- out any such striking effect being produced on the glands as occurred in these cases of cerebral injury. Inflammation of the tunica vaginalis , or acute hydrocele. — The inflammatory changes of the tunica vaginalis resemble those of the other serous membranes. M. Roux injected a hydrocele in a middle-aged man : inflamma- tion was developed, but on the fourth day, gangrenous erysipelas attacked the scrotum, and caused the patient’s death on the tenth day after the operation. On examining the tunica vaginalis, he found that it contained a large quantity of whitish serum, in the midst of which floated flakes of albumen ; other flakes of the same kind formed a thick coating over the testicle and internal surface of the membranous pouch. The serous membrane beneath appeared slightly thickened, and of a deep red colour. The epididymis and the lower part of the cord were swollen, and con- stituted the more solid part of the tumour produced by the inflammation. The body of the testicle was not increased in bulk, and it retained its natural consistence.* In the mu- seum of the College of Surgeons, there is a beautifully injected preparation of hydrocele, showing the effects of inflammation after the application of the caustic. It is represented in the annexed wood-cut, which exhibits the sac with part of it cut away to show the swollen state of the epididymis, and the aperture made by the caustic(l); the tunica vaginalis is coated with flocculi of lymph. The sac of an inguinal hernia is seen above the hydrocele. The sound state of the body of the testicle, though surrounded by an in- flamed serous tunic, whilst the epididymis partakes in the disease, has been accounted for by Gendrin. He says, when the sub- serous cellular tissue, which always partici- pates in the inflammation of a serous mem- brane penetrates into the interior of an organ, it becomes a ready means of communicating * Journal Gdndral de Me'dicine, &c. t. lviii. p. 25. ; quoted from Gendrin, Ilistoire Anatomique des In- flammations, t. i. p. 143. TESTICLE (ABNORMAL ANATOMY). 995 the inflammatory action ; but when the con- tiguous organ or subjacent part is of a dif- Fig. 638. ferent structure from that of the cellular tissue, the extension of inflammation inwards is checked. Thus, in the case of the inflamed tunica vaginalis, the cellular tissue readily transmitted the morbid action to the epididy- mis, but the tunica albuginea arrested its progress to the body of the testicle ; and this explains the fact that after inflammation of the tunica vaginalis, excited by injection, the body of the gland is rarely found to suffer. On the other hand, the epididymis is seldom attacked with inflammation without the disease being quickly propagated to the tunica vagi- nalis. The lymph effused in inflammation very often forms adhesions between the opposed serous surfaces, and these after some time are rendered very firm and dense, and in old cases are often converted into a fibro-cartilaginous structure. In a testicle which I examined some little while after an attack of acute in- flammation, I found the lymph on both sur- faces of the tunica vaginalis presenting a honeycomb or lace-like appearance, similar to that often met with on the pericardium. In- flammation, if violent, may end in the forma- tion of pus ; suppuration is, however, a rare occurrence, unless artificially excited, for the cure of hydrocele. Inflammation of the tunica vaginalis is not only the most frequent disease of the testicle, but it is also one of the most common affections to which the body is liable. In the different disorders of the gland this membrane usually becomes inflamed at some period or other, and adhesions between its opposed surfaces are scarcely less common than those of the pleura. In examining the testicles of twenty- four adults, I found ad- hesions of greater or less extent in one or both glands in as many as nine instances. Hydrocele of the tunica vaginalis. — The sac of the tunica vaginalis, like other serous ca- vities, is liable to dropsical effusion. The fluid effused is usually transparent, and of an amber, pale yellow, citron, or straw co- lour, and resembles the serum of the blood, but is occasionally thick. According to Dr. Marcet’s analysis*, 1000 grains of this fluid of the specific gravity 1024r3 contained 80 grains of solid matter, of which 71’5 con- sisted of animal, and 8"5 of saline ingredients : hence it appears that this fluid only differs from the serum of the blood in possessing rather less animal matter. In an analysis of the fluid of hydrocele made by Dr. Bos- tockj-, lOO'OO parts of the specific gravity 102-1 were found to contain Water ... 91-25 Albumen - 6'85 Uncoagulable matter - 1-1 Salts - •8 100-00 A quantity of flakey matter or flocculent albumen is sometimes found floating in the fluid ; and it frequently contains, especially in old people, cholesterine in the form of a multitude of minute shining particles. The quantity of cholesterine contained in nine- teen ounces of dark fluid full of these shining particles, which I removed from an old hy- drocele, amounted to nine grains. In the examination of a testicle from a man of co- lour who died at an advanced age, I found the tunica vaginalis and its investing tissues very thick and firm, and the seat of cartilaginous and osseous deposits ; it contained about three drachms of a thick brownish substance, which was almost entirely composed of cholesterine. This was no doubt a very old case of hydro- cele, in which, the more fluid parts having been absorbed, the cholesterine was left be- hind within the indurated sac. The quantity of serum which is suffered to accumulate varies considerably. In this country it seldom exceeds twenty ounces, though it has been known to amount to several pints. The largest quantity which I have met with is forty-eight ounces. Mr. Cline is said to have removed from Gibbon the historian as much as six quarts. | In simple hydrocele the testicle is usually found at the posterior part, and rather below the centre, of the sac : its situation however is subject to variations. Before the occur- * Medico-Chinu-g. Trans, vol. ii. p. 372. f Ibid. vol. iv. p. 72. j Sir A. Cooper’s Lectures, by Tyrrell, vol. ii. p. 92. 3 s 2 990 TESTICLE (ABNORMAL ANATOMY). rence of hydrocele the tunica vaginalis may have been inflamed and contracted adhesions, so that the testicle may be connected to the membrane in front ; in which case the serum accumulates on each side of or above and below the organ. The position of the testicle in front may also be owing to an original inversion of the organ, in which the free sur- face presenting backwards, the fluid collects in that direction and presses the testicle to the front of the sac. Sometimes there are several adhesions producing a sacculated ar- rangement and forming what is termed a multilocular hydrocele. Occasionally the cysts thus formed have no communication with each other. In two instances I have seen a membranous partition in the sac of a hydro- cele, separating it into two distinct cavities, formed by a layer of false membrane. There is one kind of sac or pouch often met with in hydroceles which is not commonly de- scribed. It is situated on the inner side of the testicle, but the opening into it is always found on the outer side between the body of the gland and the middle of the epididymis. This sac, which varies very much in size, is formed by the distention of the cul-de-sac which I have described as existing naturally at this part. Two examples of this kind of pouch are contained in the Hunterian Mu- seum. One of them is represented in the accompanying figure. In large hydroceles Fig. 639. 1, aperture of the poucli between the body of the testicle and middle of the epididymis. the epididymis is usually elongated and dis- placed ; and instead of a pouch being formed, the central part of the epididymis is drawn to some distance from the body of the tes- ticle. In old hydroceles the sac is often a good deal thickened, the tissues enveloping it being condensed and converted into layers of dense fascia, such as are commonly observed investing only hernial sacs. The fibres, also, of the cremaster muscle, frequently become remarkably developed. This, however, is not constantly the case ; for in some instances of hydrocele of large size I have found this muscle atrophied. The thickened sac after many years acquires a cartilaginous cha- racter, and it sometimes even becomes os- sified. In cases which have been frequently tapped, the sac is often found closely ad- herent to the skin of the scrotum at the various points perforated by the trocar. In the Hunterian Museum there is a prepar- ation showing a long narrow band of ad- hesion passing from the anterior part of the testicle across the dilated sac of the tunica vaginalis to the membrane in front, which is supposed to have resulted from a wound of the testicle in the operation of tap- ping. In all large hydroceles the spermatic vessels are separated and displaced. The glandular structure of the testicle is sound, and the organ capable of exercising its func- tions. The disease is strictly confined to the investing serous tunic. The testicle is, how- ever, frequently somewhat altered in shape, being flattened by the pressure of the confined fluid ; and in some instances has been found partially atrophied. Hydrocele is generally single, but some- times occurs on both sides. It is commonly said to form more frequently on the left side than on the right. During the last few years I have registered the new cases of hydrocele coming under my notice in public and private practice. Of one hundred and ten cases of simple hydrocele, one hundred and four were single, and six double. Of the former sixty- two occurred on the right side, and forty-two on the left. This result, which gives a decided predominance to the right side, does not agree with the observations of Velpeau, Gerdy, and Dujat, who found the disease to be more frequent on the left side. Hydrocele in young infants is usually single, and in my experience, more common on the right side. I have seen, however, a few cases of double hydrocele at this early period. When the fluid collected in the tunica vaginalis is attended with en- largement of the testicle, the swelling is termed a hydro-sarcocele. This affection is generally consequent on chronic orchitis, but it is occa- sioned by other morbid changes, malignant as well as innocent. In these cases the disease of the testicle is the original complaint and source of the irritation that excites an undue secretion from the tunica vaginalis. Congenital hydrocele. — In simple hydrocele, the original communication between the ca- vities of the peritoneum and of the tunica vaginalis is permanently obliterated ; but it sometimes happens that fluid accumulates around the testicle in cases in which the obliteration has not been completed, consti- tuting the variety termed congenital hydrocele. The opening of communication between the two cavities is usually small in size, about sufficient to admit a crow’s or goose’s quill. There is rather a rare variety of congenital TESTICLE (ABNORMAL ANATOMY). 997 hydrocele, in which the testicle is retained in the abdomen or inguinal canal, while the peritoneum, prolonged for a short distance into the scrotum, forms the cyst containing the fluid which is covered only by the inte- guments and superficial fascia. Encysted hydrocele of the testicle. — In this form of hydrocele, fluid is effused into an ad- ventitious cyst or cysts distinct from the sac of the tunica vaginalis. The cyst is composed of a thin delicate serous membrane, and may be developed in three situations: 1. beneath the visceral portion of the tunica vaginalis in- vesting the epididymis ; 2. between the testi- cular portion of the tunica vaginalis and the tunica albuginea, which are thus separated from each other ; 3. between the layers of the loose or reflected portion of the tunica vaginalis. The first is by far the most com- mon situation, the two latter being very rare. These cysts are composed of a delicate serous membrane lined with tesselated epithelium, and the fluid contained in them differs from that of simple hydrocele in being perfectly limpid and colourless, and nearly free from albumen. In the cysts formed on the epi- didymis, the fluid, instead of being limpid, often presents an opaline opacity arising from the presence of spermatozoa. 1. Small cysts not larger than a pea, and even smaller, may frequently be found beneath the serous membrane covering the head of the epididymis, in which they produce a slight depression. In several instances I have seen as many as five and six perfectly distinct cysts connected with this part. Sometimes one or two small cysts are so embedded in the substance of the epididymis, that they cannot be recognised without dis- section. Though these minute cysts generally contain a limpid fluid, I have sometimes found them filled with fluid of a milky hue, and I have even observed matter like pus tinged with blood. These accidental cysts some- times project the tunica vaginalis before them until they become so far separated from the epididymis, where they were originally deve- loped, as to be attached only by a narrow peduncle formed by a contraction of the con- necting tunica vaginalis. Such is the mode of development of those small pendulous pe- dunculated cysts containing a limpid fluid often found hanging from the head of the epi- didymis, which were erroneously supposed by Morgagni to be hydatids. I have on many occasions observed them in the different stages of their production. Thus I have seen a pedunculated cyst attached at one part, whilst close to it there was a cyst of a similar nature embedded in the substance of the epididymis. In other instances I have found the cyst very prominent, but still con- nected by a broad attachment to the tunica vaginalis reflected over it, the membrane not having as yet contracted to form the narrow neck. In all these cases the prolongation of the tunica vaginalis investing the cyst could always be demonstrated by cautious dissec- tion, and between the membrane and the cyst some minute red bloodvessels were generally seen ramifying. These pednuculated cysts never acquire a large size : I have seldom found them to exceed that of a currant. From the exposed situation of the testicle they are liable to be ruptured, the vestiges of them consisting of fimbriated folds of mem- brane ; but this is not a common occurrence. I have seen the delicate peduncle by which the cyst was attached to the epididymis as long as three quarters of an inch. M. Gosselin states that small cysts are sometimes deve- loped in the little appendage to the tunica va- ginalis so often found connected with the upper part of the testicle.* This I have never seen. So common are small cysts connected with the epididymis in the various states and stages I have described, that it is impossible to examine many testicles, especially of persons beyond the age of puberty, without finding them. According to M. Gosselin f, they are liable to be developed from the period of puberty to the age of thirty or thirty-five, but are rare at this period. After the age of forty they are very common, having been met with by him in at least two thirds of the testicles examined. Now when one or more of these cysts, instead of becoming pedunculated, en- large so as to form a tumour in the scrotum Fig. C40. * Archives Centrales des Medecine, 4e Serie, t. xvi. p. 27. f M. Gosselin has given an elaborate account of the cysts connected with the epididymis, in two pa- pers published in the 16th volume of the Archives Ge'nerales de Me'dicine. He makes two varieties of them, the small and large, and states that sperma- tozoa are found only in the latter. This distinction I consider to be unfounded, the smaller cysts being simply the early stage of the larger. M. Gosselin assumes the credit of being the first to describe the small cysts. They were, however, minutely de- scribed by me, and illustrated in my work on the Diseases of the Testis, published in 1843, of which M. Gosselin could scarcely have been ignorant, since he refers to my account of this form of hjrdrocele. 3 s 3 TESTICLE (ABNORMAL ANATOMY). they constitute the form of hydrocele, called from its original seat, encysted hydrocele of the epididymis. I have observed this description of hydrocele in all its various modifications, from the enlargement simply of a single cyst to the complication occasioned by the varied de- velopment of several. As a cyst enlarges the epididymis becomes flattened, and displaced to one side, whilst the testicle is found either in front or at the bottom. It is sometimes at the side, but rarely at the posterior part of the swelling. In the above woodcut (fig. 640.) of a spe- cimen in the London Hospital Museum, the cyst is above the testicle, which is so dis- placed by it that its anterior edge is directed downwards. The tumour is generally of smaller size than a simple hydrocele, the fluid commonly not exceeding three or four ounces in quantity. I have, however, removed as much as thirty-two ounces from a single cyst. When the hydrocele is composed of several cysts, they are seldom of large size, but form a cluster more or less complicated and irre- gular, according to their size and number. A curious sacculated arrangement produced by the development of numerous contiguous cysts may be seen in the annexed figure, (Jig. 641.) taken from a preparation dissected by Fig. 641. myself : part of the walls of the cysts are cut away to exhibit their interiors. The cysts are liable to inflammation, which causes more or less alteration in the quality and appearance of the fluid contained in them. The fluid may become albuminous and assume the straw or amber colour of ordinary hydrocele ; and the cyst may contain lymph, form adhesions, or be lined with a false membrane, the fluid being thick and turbid. The cysts sometimes also become filled with blood, constituting a variety of haematocele. 2. A cyst may form between the tunica albuginea and the visceral layer of the tunica vaginalis, separating the two membranes which are naturally closely adherent to each other. This is a very rare form of hydrocele. A spe- cimen which I discovered accidentally in dis- section, is represented in the annexed wood- cut. (Jig. 642.) The cyst contained about two Fig. 642. drachmsof fluid, and is situated along thefront of the testicle ; it is a little thickened. A sec- tion of it is preserved in the Hunterian Museum. Sir B. Brodie has described a very similar specimen.* Tn the museum of St. Thomas’s Hospital there is a specimen of a small cyst apparently developed from the epididymis : in its subsequent growth it had extended on the fore-part of the testicle, separating the tunica vaginalis from the tunica albuginea. t 3. In examining a healthy testicle I once found six or seven small cysts about the size of currants, studding the surface of the loose portion of the tunica vaginalis. Two of them were situated in a part of the membrane ex- tending up the cord. They projected in- ternally, and contained a limpid fluid. I have twice since seen a similar kind of cyst in the same portion of the tunica vaginalis. Similar adventitious cysts have also been observed on the internal surface of the sac of a simple hydrocele, and a preparation of the kind is contained in the Hunterian Museum. If a cyst developed in this membrane were to increase to any size, it would constitute a swelling which might be appropriately termed an encysted hydrocole of the tunica vaginalis. A circumstance of much interest in con- nection with encysted hydrocele of the tes- ticle, is the occurrence of spermotozoa in the fluid contents of the cyst, a discovery made by the late Mr. Liston in 1843. During the last six years I have met with them in as many as twenty cases of encysted hydrocele : indeed, in the majority of instances in which * Lond. Med. and Phys. Journal, vol. Ivi. p. 522. TESTICLE (ABNORMAL ANATOMY). 999 I have searched for them. They were found in subjects of various ages from 30 to 75, and in cysts of all sizes from that of a filbert to the largest which the hydrocele attains. The fluid in some instances contained these bodies in remarkable abundance ; in others they existed sparingly. When very numerous, they give to the fluid an opaline opacity, or an appear- ance resembling cocoa-nut milk which is so characteristic as to enable the surgeon to pre- dicate their presence from the appearance of the fluid alone without minute examination. If the fluid be allowed to remain at rest in a glass vessel, the spermatozoa subside to the bottom, rendering the lower portion more opaque than the upper. The fluid also ex- hibits slight traces of albumen, when tested in the usual way, which is not the case with the ordinary pellucid colourless fluid of encysted hydrocele. The spermatozoa were often as lively as in fresh semen. They were observed more frequently in the larger cysts than in the smaller. I once found them in fluids removed from two distinct cysts connected with the epididymis of a man about sixty years of age. 1 have detected them in the fluid from en- cysted hydroceles tapped for the first time, and also in the examination of small cysts connected with testicles removed after death. I removed from an old man aged 75, who had had encysted hydrocele for eight years, and which had never been tapped before, as much as thirty-two ounces of fluid, which contained an abundance of spermatozoa. They were also detected in fluid taken from a man aged 54*, who stated that the tumour had existed for eight years, and had never been operated on. Various opinions have been broached to account for the existence of spermatozoa in the encysted form of hydrocele of the testicle. The explanation which seems to me the most reasonable and probable, is that which I offered shortly after the occurrence of sper- matozoa in encysted hydroceles was first dis- covered*, viz. that their presence is probably owing to the accidental rupture of a seminal canal, and the escape of its contents into the cyst of an existing hydrocele. The close proximity of the efferent tubes, the slight tex- ture of the ducts and delicate walls of the cyst, and the liability of the part to contusion and injur}-, when a swelling even of moderate size exists, seemed to me to favour this view. The circumstance that spermatozoa are never found in very small cysts show that they are not originally formed there, but are a subsequent addition to their contents. Since my attention has been drawn to this subject I have investigated the history of the cases of encysted hydrocele containing spermatozoa, which came under my notice. In nearly all instances the patients assured me that the swelling had gradually formed after an injury to the tes-icle ; and in two cases it was clear that a small cystic swelling had long existed in a stationary state, but after a slight blow * Practical Treatise on Diseases of the Testis. Appendix, p. 541. had begun to enlarge. I strongly suspect that, in these cases, a duct had been ruptured by the contusion, and that the irritation con- sequent on the injury, and perhaps on the addition of such lively bodies as spermatozoa to the fluid contents of the cyst, had led to its further development. I have, it is true, failed in establishing the fact of a communica- tion between the duct and the cyst by ana- tomical examination. In two instances of large encysted hydrocele containing sperma- tozoa, which I had an opportunity of examin- ing, I injected the vas deferens with coloured size, but the duct was so clogged with semen that the fluid could not be made to reach the head of the epididymis, to which the cyst was attached. In a preparation of large encysted bilocular hydrocele containing spermatozoa, shown me by Mr. Busk, the vas deferens had been injected with mercury, but none of the metal reached the upper part of the epididymis. The cyst evidently arose from the head of the epididymis, and was embedded a little in its substance. In these cases no opening com- municating with a duct could be discovered on examination of the cysts, but this is not surprising, since the communication must be extremely minute, so as readily to escape detection, or it may even have been obliter- ated. Spermatozoa are stated to have been found in some two or three instances in fluid re- moved from the tunica vaginalis. It is not improbable that these cases may have been encysted hydrocles mistaken for simple. The diagnosis is sometimes very difficult, and in the case of the cyst examined by Mr. Paget,* this error was made before death by a hospital surgeon. I have, however, found spermatozoa in the sac of the tunica vaginalis, and the fol- lowing case will account tor their presence. A man aged fifty-four died in the London Hospital of disease of the kidneys, of one of the ureters, and of the bladder, which appeared to be consequent on a severe blow on the loins about six weeks before. The tunica vaginalis of one of the testicles contained two ounces and a half of slightly opaque fluid, in which a few spermatozoa were found. There were three small cysts containing fluid immediately connected with the epididymis, and also atone spot an irregular ragged membranous appear- ance, evidently caused by the rupture of a cyst. It is most probable that the spermatozoa had escaped from this cyst, which may indeed have been burst at the time of the injury. I have examined the fluid from the tunica vagi- nalis in a large number of instances without finding these bodies, and I believe their occur- rence in the common form of hydrocele to be extremely rare. Diffused Hydrocele of the Spermatic Cord. — Mr. Pott has given an admirable account of this affection, under the denomination of hy- drocele of the cells of the tunica communis. f It has likewise been particularly described by * Medico-chirurgical Trans., vol. 27. p. 398. j- Vide his Treatise on Hydrocele. 3 s 4 1000 TESTICLE (ABNORMAL ANATOMY). Scarpa.* The disease is of the nature of simple oedema, a watery fluid being diffused throughout the areolar tissue connecting the vessels of the spermatic cord, and enclosed in a sheath, which is invested by the musculo- aponeurotic structure of the cremaster muscle. When the complaint has lasted some time, the sheath is found more or less thickened. The areolar tissue within is infiltrated with a limpid albuminous serum of a white or yel- lowish colour, which flows out in the course of the dissection. The cells infiltrated with serum are converted into large vesicles, some of which are big enough to admit the tip of the finger. These cells are larger and more delicate towards the base of the swelling, where they sometimes disappear altogether ; so that there is only one considerable cavity at the lowest and more depending part. The base of the swelling corresponds to the point at which the spermatic vessels join the testicle, and at this part a dense septum cuts off all communication with the tunica vaginalis. In some instances the effusion extends along the cord into the abdomen, as in a remarkable case related by Mr. Pott. In the annexed figure of this affection, ( fig . 043.), taken from Scarpa, the envelope of the cremaster is laid open, ex- posing the pyramidal swelling enclosed in its sheath of condensed areolar tissue. The tes- * Memoria sull’ Idrocele de Cordone Spermatico. Bertrandi, an Italian surgeon, in a memoir pub- lished by the French Academy of Surgery, in 1778, has given an accurate description of this affection, which, however, he did not sufficiently distinguish from the encysted hydrocele of the cord. He dis- sected on the dead body a diffused hydrocele, which contained twenty ounces of fluid. tide and tunica vaginalis are seen below it. In general anasarca the areolar tissue of the spermatic cord, as well as of the scrotum, is frequently distended with serum ; but oedema of the cord alone is a very rare affection. Sir A. Cooper makes no allusion to it, and Mr. Pott, to whom we are indebted for so good and accurate a description of this species of hydrocele, probably met with a greater num- ber of cases of it than have occurred in the practice of any surgeon since his day. Encysted Hydrocele of the Spermatic Cord — A cyst containing fluid may be developed in the loose areolar tissue of the spermatic cord. The cyst is formed of a thin transparent membrane, possessing the ordinary characters of a serous membrane, and contains generally a limpid aqueous liquid, having little or no albumen, but sometimes a straw-coloured serum similar to the fluid of simple hydrocele. It is of an oval form, and its size, though variable, seldom exceeds that of a hen’s egg, and is usually smaller. It is loosely attached by areolar tissue to the vessels of the cord which are situated at its back part, but be- come separated and displaced by it. The cyst is invested by the common integuments, super- ficial fascia, musculo-aponeurotic sheath of the cremaster muscle, and fascia transversalis. It may occur either immediately above the tes- ticle, in the middle of the cord, or just below the abdominal ring, and even within the in- guinal canal. Usually there is a single cyst, but occasionally several are developed, and a chain of them has been formed along the cord. The cyst and its contents are liable to changes consequent upon inflammation. Encysted hydrocele of the cord appears to originate, in general, in a partial or imperfect oblitera- tion of the prolongation of peritoneum drawn down at the period of the transition of the testicle. I have already described the different appearances presented by the remains of this prolongation, which, it has been remarked, sometimes consists of a single cyst, or of two or more sacculi, moistened by a serous fluid. When this fluid accumulates in any quantity, an encysted hydrocele is the result. Such is obviously the mode of origin of this affection when occurring in infants, and no doubt in adults it generally originates in the same way. M. J. Cloquet has remarked that the remains of the peritoneal process accompanying the testicles in their descent were met with in male subjects of all ages, and he mentions as a singular circumstance, that they were nearly as frequently found in the old as in the young subjects.* My own dissections agree with the observations of this accurate anatomist. In the museum at the London Hospital there is a preparation showing the tunica vaginalis continued for about two inches up the cord, and, immediately above it, an encysted hydro- cele, which was taken from an adult subject. In dissecting the body of a man, aged eighteen, I found an encysted hydrocele of the cord * Description of the parts concerned in Inguinal and Femoral Hernia, tr. by McWhinnie, p. 25. TESTICLE (ABNORMAL ANATOMY). 1001 above the testicle in close contact with the tunica vaginalis. Immediately above this cyst, but quite distinct from it, there was a narrow and empty serous sac three inches in length, with a contracted neck, and communicating with the abdomen. They are figured in the accompanying engraving, with the hernial sac Fig. 644. laid open, and part of the parietes of the encysted hydrocele cut away to expose their interiors. The position of the testicle is so changed that its anterior border is directed downwards. In the examination of the body of a man who died of disease of the heart, I found on the right side a thickened and empty serous pouch, extending for about an inch and a half below the external abdominal ring. Directly below it was an independent cyst, capable of containing a walnut, similar in structure to the hernial sac, but lined by a thin false membrane. The tunica vaginalis, which was healthy in structure, extended up the cord as far as the cyst, from which it was separated by a thick and firm partition. In opening the body of a sailor who died with ascites, I noticed at the internal ring a small, delicate, transparent, pedunculated cyst, not larger than a nut, projecting into the cavity of the abdomen. In the spermatic cord, there was a large serous cyst, which extended into the inguinal canal, and contained a small quantity of transparent fluid. A small orifice at its upper part opened into the peduncu- lated cyst, which proved to be a process from the cyst in the cord. In fig. 644., I have given a representation of an inguinal hernia, combined with an elongated encysted hydro- cele of the cord; and in fig. 647 , a repre- sentation of an encysted hasmatocele of the cord, in which the tunica vaginalis remained unobliterated as far up as the cyst, whilst a hernial sac is situated immediately above it. These dissections confirm the view taken by Sir A. Cooper, and now commonly adopted, of the mode of origin of encysted hydrocele of the spermatic cord in the adult. Complications of hydrocele. — The following are the principal : 1. Simple hydrocele, com- bined with encysted hydrocele of the testicle. 2. Simple hydrocele, combined with encysted hydrocele of the spermatic cord. 3. Simple hydrocele, combined with diffused hydrocele of the spermatic cord. 4. Oscheo-hydrocele, including both simple hydrocele and encysted hydrocele, combined respectively with inguinal hernia. 1. The first is not an uncommon compli- cation. In the dissection of these parts, I have often found the tunica vaginalis distended with three or four drachms, and even an ounce or two of serum, two or more small distinct cysts being at the same time connected with the upper part of the epididymis ; and I have twice met with this complication in both sides in the same individual. The small adventi- tious cysts appear to be the original disease, the irritation produced by them being in all probability the cause of the increased quan- tity of fluid in the tunica vaginalis. 2. The second complication is somewhat rare. In the pathological collection at the London Hospital, there are two specimens of a collection of fluid in the tunica vaginalis as- sociated with an encysted hydrocele of the spermatic cord. In one of them the tunica vaginalis is unobliterated for about two inches along the spermatic cord, and the encysted hydrocele is immediately above it. In the other preparation it is apparent that both sacs have been the seat of inflammation, false mem- branes being contained within them. This complication sometimes occurs in infants. 3. Simple hydrocele associated with dif- fused hydrocele of the cord is also rare. A good delineation of this complication is given in Scarpa’s work. 4. Scrotal hernia may be combined with hydrocele. A voluminous hydrocele, if un- Fig. 645. TESTICLE (ABNORMAL ANATOMY). J002 supported, appears to be highly favourable to the occurrence of hernia and the extension of the sac, by dragging down the peritoneum. Oscheo-hydrocele is not an uncommon complication. In most of the cases which I have met with, the hydrocele was placed be- low and free of the rupture, and in a few only in front of it. I have never found the hernial sac covering the fore part of a hydrocele. The ordinary relations of hydrocele and scro- tal hernia may be seen in the accompanying woodcut. In figure 638., the sac of an in- guinal hernia is represented at some little distance above a small hydrocele. Dupuytren states that, when a hydrocele is placed in front of a hernia, a part of the omentum or intestine sometimes descends into a cyst, which projects into the hydrocele, and is formed of the hernial sac and serous fold of the tunic of the testicle.* This complica- tion is of the nature of the hernia infantilis, described by Mr. Key, and called by Sir A, Cooper encysted hernia of the tunica vaginalis. Hcematocele. — This is a term applied to the swelling occasioned by effusion of blood in the sac of the tunica vaginalis, or in a cyst connected with the testicle ; it is also applied to tumours produced by extravasation, either in the sub- stance of the spermatic cord, or in the sac of an encysted hydrocele of this part. Hcema- tocele of the testicle, in which blood is effused into the tunica vaginalis, is by far the most common form of this affection. The extra- vasation may take place in a healthy state of the parts, or it may succeed, or be combined with hydrocele. The first variety occurs from the accidental rupture of some blood-vessel, probably one of the vessels ramifying between the tunica albuginea and tunica vaginalis testis, owing either to a blow or a violent straining effort. The second variety, in which the extravasation takes place in combination with hydrocele, is of more frequent occur- rence than the first. It may also be produced by a blow, or by the wound of some vessel, in the operation of tapping. A blow occa- sions a slight rupture of the tunica vaginalis, and of some of the enlarged vessels ramifying outside it, and the blood which escapes passes into the sac and mixes with the fluid of the hydrocele, producing a sudden increase in the size of the tumour. The liability to this ac- cidental effusion of blood is increased by a diseased condition of the arteries, such as is commonly met with in old people. The quan- tity of blood effused under these circum- stances varies considerably. It may be merely sufficient to impart a red tinge to the serum. In general, however, it is greater in amount, and coagula are formed, which remain undis- solved in the fluid. A haematocele maybe produced in the operation of tapping a hydro- cele, in two ways. It may be occasioned by the accidental wound of some vessel rami- fying over the tunica vaginals, which, instead of bleeding externally, or into the areolar tissue of the scrotum, pours its blood into * Leyons Orales. Brussels edit. t. iv. p. 233. the sac of the hydrocele ; or it may be caused by the trocar or lancet penetrating too far, and wounding the testicle or spermatic artery. In haematoceles which have existed for a long period, the blood becomes changed into a substance resembling coffee grounds, of a brownish-red, or chocolate colour, and more or less fluid. The coagula sometimes present a cellular or honeycomb appearance, the cells being filled with a reddish serum. Occasion- ally the blood is found converted into a solid fibrinous substance, of a yellow or fawn colour, arranged in firm layers, similar to the coagula lining the sac of an aneurism. In many in- stances the effused blood is felt as a foreign body, and produces inflammation in the tunica vaginalis, which becomes coated with lymph, and this mixing with blood and serum modi- fies the appearance of the contents of the cyst, rendering it turbid and of a lighter colour. Sometimes the inflammation goes on to suppuration, in which case pus is also found in the sac. The inflammation usually extends from the tunica vaginalis to the areolar tissue and fascia external to the sac, which in recent cases are found infiltrated with serum and lymph, and in cases of old standing be- come greatly thickened, indurated, and com- pacted. In a case of haematocele, occasioned by the wound of a vessel in tapping a hydro- cele in which I was consulted, the inflamma- tion which ensued caused, in the course of a fortnight, great thickening of the tissues ex- ternal to the sac, and the formation of an abscess in the scrotum on one side of the hasmatocele. I have found the tunica vagin- alis and tissues investing it as much as half an inch in thickness, and very firm and dense. These changes in the sac are produced by a more chronic form of inflammation of the fascia and areolar tissue investing the sac. In these old cases, the internal surface of the tunica vaginalis instead of presenting its na- tural smooth and polished surface, is rough, granular, and irregular, and feels as dense and tough as a piece of leather, having lost all the characters of a serous membrane. In haematocele, the testicle preserves the same relation to the remainder of the tumour as in simple hydrocele, being situated at the posterior part, and rather below the centre. Its position, however, is liable to similar al- terations as occur in hydrocele, and they are dependent upon the same causes. A young man had a hydrocele, which had succeeded to an attack of secondary orchitis, occasioning an adhesion of the gland to the front of the sac at its lower part. The case became con- verted into a hsematocele by the wound of a vessel in the operation of tapping. Inflam- mation ensued, and it became necessary to lay open the sac. The surgeon, in carrying the incision to the lower part of the tunica va- ginalis, divided the vas deferens and severed the sound testicle nearly in two with his bis- toury, the thickening around the sac having prevented him from detecting the gland in its unusual situation. In hrematocele, the TESTICLE (ABNORMAL ANATOMY). 1003 glandular structure of the testicle sometimes disappears in the same manner as in old cases of hydrocele, atrophy being occasioned by the long continued pressure arising from the ex- travasated blood. Sir B. Brodie has recorded two cases of old haematocele, in which the testicle was completely atrophied.* In the examination of a large haematocele which had existed for many years, and was removed by operation, under the impression that it was a solid enlargement of the testicle, I found the tunica vaginalis nearly half an inch thick, and full of a soft friable substance of a chocolate colour ; the testicle, which was situated at the posterior part of the cavity, was some- what flattened, and partly imbedded in the thickened cyst ; but the glandular structure was perfectly healthy, and the bulk of the organ scarcely less than natural The haema- tocele, with the sac and testicle laid open, is represented in the accompanying figure. The Fig. GIG. structure of the testicle is usually indeed sound in haematocele, but its nutrition becomes im- paired when the disease is of very old stand- ing. Encysted hcematocele of the testicle, or effusion of blood in a cyst connected with the testicle, is an extremely rare affection. The following is the only case of the kind that I have met with. I was requested by one of my colleagues at the London Hospital to examine a case of painful tumour connected with the left testicle. The patient, aged eighteen, had injured the part three months before. The scrotum was much swollen at the time of the accident, and the tumour formed afterwards. It was about the size of a chesnut, * Lond. Med. and Phr^s. Journal, vol. Ivin. p. 299. quite moveable, but attached to the epididymis. The cyst was opened with a lancet, and exit given to a quantity of dark coagula lodged in a thickened cyst, the interior of which was lined by a rough false membrane. No doubt the cyst existed before the injury, which caused effusion of blood and inflammation, and thickening of the cyst. Hcematocele of the spermatic cord is an affection which was first noticed by Mr. Pott. It is generally produced by the accidental rupture of a spermatic vein, during violent and sudden exertion, as in straining to lift a heavy weight, when blood immediately es- capes into, and infiltrates the loose areolar tissue along the cord, where it accumulates, its further diffusion being prevented by the fascious envelope of this part. Mr. Pott has related three cases, all of which happened in this way. I have met with this variety of haematocele, coupled with extravasation in the scrotum, in two or three instances of contusion, of this part. In one case in which the effusion in the cord was on the left side the spermatic veins were varicose. Encysted hcematocele of the spermatic cord results from the effusion of blood into the cyst of a hydrocele of this part. But it is an affection only known to me from preparations. In the Museum of St. Bartholomew’s Hos- pital there is a specimen of the kind. The cyst is empty : but it is described to have contained blood, and its walls are deeply stained with the colour of partially decom- posed blood. Its lining membrane is wrinkled and coarsely granular, and the tissues around Fig. 617. 1, testicle ; 2, hernial sac ; 3, encysted haematocele. 1004 TESTICLE (ABNORMAL ANATOMY). it are thickened, brawny, and adherent toge- ther. In the Hunterian Museum there is a specimen (No. 2460.) of old encysted haema- tocele of the spermatic cord. A good-sized cyst, lined by a membrane, polished and a little wrinkled, is filled with a soft, tawny- looking granular matter, resembling the altered coagulum of blood observed in ordinary haematocele after long maceration in spirit. The tissues around the cyst are thickened and indurated, just like those around an old haematocele of the testicle. There is a hernial sac immediately above it, and a hydrocele below, with the sac open for some distance tip the cord as far as the cyst of the haema- tocele. The latter does not communicate either with the tunica vaginalis, or the hernial sac. In the Musee Dupuytren at Paris, I also saw a preparation of this affection, which occurred in the practice of the late M. Blandin. Orchitis. — Inflammation of the testicle occurs in two forms, acute and chronic ; and it may commence either in the body or secre- ting part of the organ, or in the epididymis. Inflammation beginning in the body of the testicle may be idiopathic, or may be excited by external violence : the disease is at first confined to the interior of the organ, the epididymis and tunica vaginalis being affected only secondarily, and sometimes entirely es- caping. Orchitis is far more frequently a consecutive affection than a primary, the in- flammation being transmitted from the urethra along the vas deferens. In this latter form of orchitis, which is familiarly known by the term hernia humoralis, the epididymis is first attacked, and the tunica vaginalis generally participates in the disease. Acute Orchitis. — Few pathologists have examined a testicle in a state of acute inflam- mation, and I am unacquainted with anj au- thentic account of the alterations in structure from inflammation originating in the body of the gland. I have twice had the opportunity of examining a testicle affected with acute se- condary orchitis ; and the following description of the pathological appearances is drawn up from these investigations, and from the ac- count of the dissection of two testicles affected with gonorrhoeal inflammation recorded by M. Gaussail.* The tunica vaginalis is more or less distended with lymph or albuminous matter, infiltrated with reddish serum, which form loose adhesions between the opposed surfaces of the membrane ; these adhesions are so slight as easily to admit of being broken down with the finger. The membrane is in- jected with a multitude of minute red vessels which ramify in various directions and form a compact network. At a later period red ves- vels may be traced proceeding from the free surface of the tunica vaginalis to the false membranes forming the adhesions. The vo- lume of the testicle appears very little if at all increased, the great bulk of the tumour * Memoire sur 1’Orchite Blennorrhagique, Ar- chives Generales de Me'decine, tom. xxvii. p. 210. being occasioned by the swollen epididymis and effusion into the serous sac. When cut into, the gland appears somewhat darker than natural, from a congested state of its vessels. The epididymis, particularly the lower part, is enlarged to twice and sometimes thrice its natural size, and feels thick, firm, and in- durated. This enlargement is produced by the effusion of a brownish deposit in the areolar tissue between the convolutions of the duct. The coats of the vas deferens are thickened, and the vessels ramifying near them injected, sometimes along the whole extent of the duct. Albuminous deposit is found in the areolar tissue around the tortuous part of the vas deferens and tail of the epididymis, which frequently forms the bulk of the swelling ob- served in these cases. Owing to the epidi- dymis being the part chiefly and most con- stantly affected in consecutive orchitis, some of the modern French writers have denomin- ated the disease epididymitis. In treating of the acute inflammatory changes in the tunica vaginalis, I particularly remarked that the inflammatory action was very liable to extend to the substance of the epidi- dymis, but not to the body of the testicle, and I noticed the pathological law enunciated by Gendrin, by which the circumstance was ac- counted for. We find, too, that inflammation of the epididymis is much more readily pro- pagated to the tunica vaginalis than inflam- mation originating in the glandular structure of the testicle. When inflammation com- mences in the body of the gland, the enlarge- ment takes place slowly, and is seldom con- siderable until the disease has existed for some length of time, which is easily explained by the unyielding texture of the tunica albu- ginea, and the circumstance of the tunica vaginalis remaining unaffected. Suppuration occasionally takes place in this form of orchitis, whereas in consecutive inflammation the form- ation of pus in the substance of the gland is of rather rare occurrence. I do not mean, however, to assert, that the glandular struc- ture of the testicle never suffers in consecutive orchitis, for I believe that it does so in some instances ; but, according to my observations, and I have paid some attention to the sub- ject, it very commonly escapes, the inflamma- tion not extending further than to the epidi- dymis. When inflammation terminates in suppuration, the matter is so slow in making its way externally, owing to the density, thick- ness, and low organisation of the tunica al- buginea, that it generally burrows in vari- ous directions, producing numerous sinuses throughout the gland, and disorganising its delicate structure. The matter sometimes be- comes encysted, forming a separate abscess. In these cases, when the matter effused is small in quantity, after all inflammation has subsided, the more fluid particles are absorbed, and the pus remains for a considerable time in the form of ar indolent concrete mass, which has been mistaken, after death, for tu- bercular deposit. The pus when found in this concrete state appears at first sight very TESTICLE (ABNORMAL ANATOMY). 1005 like crude tubercular deposit ; but on further examination it will be found to be contained in a distinct cyst, from which it may easily be separated, and the structure of the testicle will be perceived to be more or less altered from its healthy state; whereas in tubercular disease, the morbid deposit is in immediate contact with the tubular structure, which, though atrophied by pressure, is usually in other respects sound. Concrete pus may likewise be mistaken for the firm yellow mat- ter effused in chronic inflammation. It differs from it, however, in being friable and easily broken up, and also in being enclosed in a cyst, whereas the yellow fibrinous substance is homogeneous and consistent, and almost inseparably diffused amongst and connected with the convoluted tubuli around it. The distinctive characters just described will be easily recognised on comparing the accom- panying representation of concrete pus en- cysted in the testicle withj%. 651. Fig. 648. I examined two enlarged testicles taken from a man who died suddenly. Both glands had formerly been attacked with acute inflammation, and for some months before death they had been the seat of chronic pain. In the left testicle, which was the larger of the two, from two to three drachms of thick yellow inspissated pus were contained in a distinct cyst, which occupied the centre of the gland. There was no trace of tubuli, but the remainder of the organ was composed of a fibrous tissue : the sac of the tunica vaginalis was obliterated by close ad- hesions. The tunica vaginalis of the right testicle contained about half an ounce of yellowish serum and in the centre of the gland there was a small concrete abscess, but the tubular structure was apparent and very little diseased. Pus existing in this concrete or in- spissated state often keeps up pain and irrita- tion for a long period, and renders the testicle liable to repeated relapses of inflammation. Suppuration occasionally takes place in the epididymis. In several cases of consecutive orchitis which have come under my care, at a late period of the disease an abscess formed in the areolar tissue around the termination of the epididymis and inflected portion of the vas deferens, and burst at the most depending part of the scrotum. In many instances, after acute orchitis has subsided, the testicle is restored to its natural condition ; in other cases, permanent changes of a serious nature are the consequence. I have observed in testicles that have been affected with inflam- mation some time before, that the septa ap- pear to be more distinct, and to enter more largely into the composition of the gland than is natural; that the small seminal tubes are less numerous and apparent ; and that a great part of the organ is converted into a dense white fibrous tissue, without the presence of tubuli. In these cases the fibrinous matter effused in the areolar tissue connecting the tubuli, not having been absorbed after the cessation of inflammatory action, had occa- sioned partial atrophy of the proper structure of the organ, and been converted into the dense tissuejust described. Complete atrophy is one of the most serious results of acute inflammation of the testicle. I have already remarked that the disturbance in the organisa- tion of the testicle consequent upon inflam- mation is the most common cause of wasting. Consecutive orchitis, if not checked in the early stage, seldom subsides without leaving behind distinct traces of its existence, which never disappear entirely during the remainder of the patient’s life. The epididymis fre- quently remains enlarged, presenting an in- durated irregular knotty swelling, seated usually at its lower part, which is occasioned by the presence of a dense hard deposit be- tween the convolutions of the duct and around the inflected portion of the vas de- ferens. On making a section of the epidi- dymis in this state, I have often observed not only a highly thickened condition of its duct, but also, in some instances, very considerable dilatation ; so that the point of a fine probe might be introduced into the canal without difficulty, its area being increased four or five times. These effusions about the duct rarely if ever produce its obliteration, the yielding nature of the tissues preventing this injurious result. In old cases the epididymis acquires the density and consistence of cartilage, and sometimes even of bone. These changes are rarely found without the presence of old ad- hesions, obliterating partially or completely the sac of the tunica vaginalis. The coats of the vas deferens are also found for some ex- tent thickened and indurated. The alterations noticed in the body of the testicle have been observed, in some instances, coexisting with those in the epididymis ; but in by far the majority of cases, the glandular structure is unimpaired. In only two cases in which the epididymis was thus diseased, have I remarked a decidedly atrophied condition of the organ. The absence of pressure, owing to the unre- sisting nature of the membrane investing the 1006 TESTICLE (ABNORMAL ANATOMY). epididymis, appears to prevent the oblitera- tion of the duct of which it is composed, and thus accounts for atrophy occurring much more rarely after consecutive orchitis than after inflammation originating in the body of the gland, where the delicate seminal tubes are enclosed in the firm unyielding tunica albuginea. Chronic orchitis. — The testicle is liable to a form of inflammatory swelling of a distinct and chronic character, which occasionally succeeds acute orchitis but far more com- monly arises spontaneously. The disease is of importance ; for, if unchecked, it tends to disorganise and destroy the gland. The chief anatomical character of this form of inflam- mation is the deposit of a peculiar yellow, homogeneous, inorganic matter in the struc- ture of the testicle. This substance when first formed is of soft consistence, but after- wards becomes firm and solid, and so closely adherent and intimately blended with the proper structure of the organ as not to admit of separation without much difficulty. In some instances there is a single deposit of this substance in the centre of the glandular structure, as in the preparation from which the annexed woodcut was taken. In others Fig. 649. several are interspersed throughout the tes- ticle, portions of sound gland intervening. In a case of chronic enlargement of both testicles taken from a patient who died of ramollissement of the medulla spinalis, I found six or seven separate deposits of this yellow matter in the substance of the right testicle, and a single one only in the body of the left. The small masses as they enlarge coalesce, or the single one increases, until the whole testicle presents an uniform yel- lowish-white appearance. The epididymis is frequently invaded at the same time by a similar kind of morbid deposit, which also tends to obliterate its tubular structure. This, however, is not, as some pathologists suppose, a constant occurrence ; for in the majority of testicles thus diseased that 1 have examined, the epididymis had entirely escaped. I have never succeeded in injecting this deposit, or in tracing vessels into it. But the vessels of the testicle generally are enlarged. Patholo- gists have differed as to the particular tissue in which this yellow matter is deposited. Sir A. Cooper and Cruveilhier describes it to be seated in the areolar tissue between the tubuli; whilst Sir B. Brodie is of opinion, that it is secreted from their inner surface, as he discovered the yellow substance in the canal of the epididymis and also in the vas deferens which are continuous with the tubuli. I have had the opportunity of in- specting a testicle affected with this disease, in what seems to me to be its early stage from which examination I think I have been able satisfactorily to confirm this opinion. The testicle was injected with red size, and a section then made of it. The surfaces of the tunica vaginalis were partly adherent, and about three drachms of serum were collected in one part of the sac. The body of the tes- ticle was not much enlarged : it contained, however, an abundant deposit of a firm opaque matter. Near the anterior edge of the testicle this deposit appeared in the section like round isolated yellowish-grey bodies, separated from each other by portions of the sound structure of the gland : about the centre of the organ it assumed a beaded arrangement, and towards the mediastinum formed a number of closely- set yellow lines or processes, radiating towards the posterior part of the testicle, where they were amalgamated into one uniform mass. Further examination perfectly satisfied me that this matter was lymph deposited in the tubuli seminiferi. The isolated and beaded appearances in the section resulted from breaks in the lymph thus deposited. The real seat of the effusion was very evident, from the arrangement described near the mediastinum. With a good lens some of the convoluted tubuli could be distinctly seen, filled with and dilated by the morbid deposit. A portion was carefully examined in the microscope with a similar result. The epididymis was Fig. 650. 1, fistulous sinus leading to the suppurating ca- vity in the head of the epididymis ; 2, concrete ab- scess in the tail of the epididymis. TESTICLE (ABNORMAL ANATOMY). 1007 much enlarged ; its head was filled with soft concrete matter, surrounding an irregular cavity with which a fistulous sinus com- municated ; its tail contained a similar sub- stance without any external opening. The various appearances described are depicted in the adjoining figure, which was taken from the recent specimen. Similar appearances to those noticed in this case have been described and figured by Cruveilhier, in his “ Anatomie Pathologique.”* He considers that the dis- ease proceeds from the head of the epidi- dymis towards the tail, and that the body of the testicle is affected only consecutively. I believe, myself, that the yellow deposit is the ordinary result of chronic inflammation of the testicle in whatever way produced ; but that the peculiar appearances noticed in the case just related and likewise described by Cru- veilhier, — I mean the small isolated masses in the substance of the gland, and radiating towards the mediastinum, — are only observed in those cases in which the disease originates in the epididymis, and thence spreads to the body of the testicle, and in which the part is examined before the organ has become ex- tensively diseased. These appearances are not often seen, because it is not often that it becomes necessary to remove a testicle in such a condition, which is indeed a curable one unless complicated with suppuration. Cruveilhier supposes that this matter is effu- sed in the areolar tissue of the testicle, and radiates along the fibrous prolongations from the corpus Highmori. I feel satisfied, however, from my own observations, that he is mis- taken, and that the interior of the tubuli is the original seat of the deposit. This yellow substance has been called the yellow tubercle of the testis ; but, as it differs from tubercular deposit, the term is objectionable and liable to lead to error. It is evidently coagulable lymph, which becomes more solid in the testicle than in most other parts, owing, per- haps, to the condensation consequent on the firm resistance offered to any enlargement of the gland by the unyielding tunica albuginea. This disease is often accompanied with effu- sion of serum into the tunica vaginalis, seldom amounting, however, to more than three or four ounces. Lymph also is sometimes de- posited, and the sac may become partially, or totally obliterated by adhesions. The peculiar matter effused in this disease under appropriate treatment undergoes com- plete absorption, the testicle being left in a condition to perform its natural functions. It sometimes happens, however, that ulcera- tion ensues in its tunics and integuments, and that a fungous-looking growth gradually pro- trudes through the opening which is thus formed. This fungous growth is sometimes termed granular swelling ; it has also received the name of hernia testis, being formed in a manner very analogous to that of a hernia cerebri, in which the substance of the brain is protruded through an ulcerated opening in * Liv. v. pi. b., and liv. ix. pi. i. the dura mater. It appears that the yellow deposit after some time excites ulceration in some part of the tunica albuginea. The tunica vaginalis, and afterwards the skin, become adherent at this spot, and likewise inflame and ulcerate. The resistance afforded by the dense unyielding tunica albuginea being thus removed, the adventitious deposit gradually presses out the tubular structure, which forms a projecting tumour consisting of the tubuli mixed up with this yellow substance, and also of ordinary granulations which spring up from the seminiferous structure. This projecting growth presents an ash or yellowish-white ap- pearance, varied by irregular patches of a pale red hue, and sometimes of black. It is closely girt by the scrotum, the ulcerated edges of which are often thickened and everted. (fig. 651.) Fig. 651. The mass often projects so much that scarcely an)' part of the organ is contained within the scrotum. Though this hernial growth occurs most frequently in an advanced stage of the chronic form of inflammation, it is developed in other diseases of the organ which occasion ulceration of the tunica albuginea, and thus afford an opening for the escape of its con- tents. It is occasionally the result of an attack of acute inflammation supervening upon the chronic disease, and terminating in suppuration in the substance of the gland. In a case of this kind, in addition to the glan- dular swelling, there are sinuses more or less numerous, which burrow in the interior of the organ, and discharge pus mingled with the yellow matter. An attack of orchitis, origin- ally acute, going on to suppuration, is also liable to be followed by a fungous protrusion of the secreting structure of the gland. In the latter case, the growth is not so exube- rant, and the seminiferous structure is more distinctly apparent, owing to the absence of the yellow matter ; but there are generally sinuses which furnish a purulent discharge, sometimes mixed with semen. Tubercular matter deposited in the testicle may also lead to suppuration, and the formation of a granu- lar swelling. A testicle after becoming somewhat en- larged from chronic inflammation, often con- tinues indolent and stationary for years, giving rise to very little inconvenience. On examining the organ in this state, the yellow adventitious deposit is found to possess con- 1008 TESTICLE (ABNORMAL ANATOMY). siderable firmness and consistency ; the tunica albuginea is thickened, and in some places as dense and indurated as cartilage ; and the surfaces of the tunica vaginalis are closely connected by old adhesions. The glandular structure is partly displaced and atrophied by the pressure of the yellow matter ; and it often happens after some time, that both undergo a slow process of wasting, so that an enlarged and indurated gland is progressively reduced, until scarcely any thing remains beyond a mere nodule of the size of a nut at which the spermatic cord terminates. I found, on examination of the body of a man who some few years previously had suffered from chronic inflammation of the testicles, both glands much indurated, but about the natural size. In both, the tubular structure was very deficient, its place being supplied by a dense fibrous tissue. At the upper part of the right testicle there was a yellowish de- posit almost as dense as cartilage, and ex- hibiting very little trace of vascularity. In these indurated testicles the epididymis often escapes the morbid alteration affecting the body of the gland ; in other cases, however, the epididymis is also found nodose, irregular, and hard. It will be perceived, from the pre- ceding observations, that the tendency of this chronic disease is gradually to destroy the integrity of the testicle. If the inflamma- tion be checked in an early stage, the gland is left unimpaired ; if its course be not arrested until a later period, the secreting structure is partly disorganised and reduced in size ; but if the disease be allowed to continue un- checked by treatment, the organ is totally destroyed, either by ulceration of its tunics and the escape of the glandular structure in the shape of a fungous growth, or by the slower process of wasting and absorption. Syphilitic orchitis is essentially of the same nature as the chronic orchitis just described. It commonly commences in the body of the gland and rarely terminates in suppur- ation, or in the production of a hernial fungus. Sir A. Cooper states that in the majority of cases the disease attacks both testicles. The eight examples recorded in his work do not, however, bear out this remark; for in only two of them does it appear that both organs were attacked. According to my observation, the disease is more commonly confined to a single gland, though it occasion- ally affects both ; this appears to be the opinion also of Ricord.* The appearances on dissection correspond with those observed in chronic inflammation. Tubercular Disease. — In the testicle,' this deposit is met with in the crude state, form- ing a yellow caseous substance similar to the tubercular matter occurring in the lymphatic glands. It is sometimes developed in a single mass ; at other times several distinct deposi- tions are formed in different parts of the organ : in both cases at the expense of its glandular structure, which becomes atrophied * Traite' Pratique des Maladies Ve'ndriennes, p. 640. as the disease advances. The epididymis is more frequently affected than the body of the gland. In a specimen taken from a man who died of phthisis, I found the whole of the epididymis occupied by tubercular matter, with scarcely any trace of tubuli; whilst the body of the gland, though small, was perfectly sound and unaffected, (fig. 652.) In some Fig. 652. cases I have seen two, three, or more distinct tubercular deposits, separated by portions of healthy gland. This was the case in both testicles removed from a middle-aged man who died of phthisis. In some instances these isolated masses appeared to be con- tained in cysts formed by the processes from the tunica albuginea which separate and sup- port the lobules. Sometimes the separate deposits seemed to be coalescing and joining together, so as to form one continuous mass ; and I have found a single mass of tubercular matter surrounded by glandular structure ex- panded into a thin layer. In other specimens the whole testicle was occupied by a homo- geneous cheesy mass, without any trace re- maining of the original structure of the gland. In some instances in which the disease was thus advanced, there was very little increase in the size of the testicle ; it only felt heavier and harder than in the natural state. In others, again, there was either a general uni- form enlargement, or an irregular swelling at some part, commonly at the head of the epi- didymis. Some of these testicles, in which the disease was not much advanced, when injected made beautiful preparations, the yellow inorganic tubercular matter contrasting in a marked degree with the vermilion hue of the intervening sound portions of the organ. On several occasions I found a small quantity of serum in the tunica vaginalis, with partial adhesions and depositions of lymph. In a further stage of the disease, the characteristic deposit becomes softened down, and converted into a yellow pultaceous substance, evidently tubercular matter mixed with pus. The ab- scess extends to the scrotum ; and after it has burst and the matter has escaped externally, cavities and sinuses are left which may be said to resemble the tubercular cavities in the lungs. The course of the disease, however. TESTICLE (ABNORMAL ANATOMY). In the testicle, more nearly resembles the changes which ensue in tubercle of the ab- sorbent glands. It has been a question whether the tuber- cular matter is originally formed in the areolar tissue connecting the tubuli, or in the tubuli themselves. I have certainly seen this de- posit in the vas deferens near the testicle, and within the ducts of the epididymis. Dr. Carswell has given a representation of a tes- ticle containing a multitude of pale yellow- coloured granular bodies of various sizes, which, he says, were obviously formed by the accumulation of tuberculous matter in the tubuli seminiferi. The epididymis was as thick as the little finger, and its convoluted ducts were obviously filled with a similar deposit. I believe that tubercle may be de- posited in both situations, within as well as between the tubuli. Earthy matter is some- times found in the testicle, generally in the epididymis, the part most frequently the seat of tubercle. This substance is exactly si- milar to the putty-looking chalky matter often observed in the lungs and bronchial glands. It is highly probable that, in these cases, the gland had at some former period been the seat of tubercular deposit, but I have not yet been able to establish this point satisfactorily. Carcinoma. — This disease occurs in the testicle under the four forms of Scirrhus, En- cephaloid, Colloid, and Melanosis. Carcinoma seldom occurs in the testicle in the dense form which it commonly assumes in the breast. Sir A. Cooper describes a scirrhous disease of the testicle, in which the gland is invaded by a large white mass in lobes or tubercles. The spermatic cord is affected with a similar disease, and the glands of the abdomen become converted into a white solid texture, very unlike that of the fungoid disease. I have a man, 52 years of age, under my care at the present time, with this disease of the testicle. It forms a tumour about three times the natural size, and is almost of stony hardness, especially at the back part. There is also a large indurated tumour in the spermatic cord. This affection of the testicle is very rare, and is charac- terised by its slow progress as well as by its great induration. Encephaloid cancer is by far the most fre- quent form of malignant disease to which the testicle is liable. When first observed, it is found in one or two masses amongst the tubuli, which gradually become destroyed as the morbid deposit accumulates. The matter is very rarely infiltrated. The testicle at this early period is extremely firm and hard, owing, not to the solid nature of the sub- stance effused, but to the excessive distention of the unyielding tunica albuginea by the morbid growth within. The glandular struct ture soon entirely disappears, the whole organ being occupied by the new growth, inter- mixed with and sustained by the septa and fibrous processes from the mediastinum and tunica albuginea. In some instances a thin VOL. tv. 1009 layer of the tubular structure is found ex- panded around a mass of encephaloid matter. At this stage the tunica vaginalis is often dis- tended with serum ; not, however, in any considerable quantity. The tunica albuginea next gives way, and a portion of the morbid growth protrudes, forming a mass projecting from the body of the gland ; this sometimes occurs in more places than one. The epi- didymis remains for some time unaffected ; but, as the disease increases, this part like- wise becomes implicated and destroyed. In one instance I found the tubes in the head of the epididymis (the only part of the gland not destroyed) filled with white matter which, on microscopic examination, proved to be carcinomatous. The scrotum in a short time becomes fully distended by the diseased mass, which presents the well-known appearance of encephaloid cancer ; viz. a homogeneous substance of the consistence of brain, and easily broken down with the fingers, of an opaque white colour, and variegated with patches of a pinkish hue. It is sometimes mixed with small cysts containing serum ; at other times with yellow deposits of lymph, resembling that effused in chronic orchitis. These small depositions of yellow fibrine oc- casionally interspersed amongst the carcino- matous matter, are almost peculiar to this dis- ease in the testicle. I have only' once observed them in cancer of other parts, and that was in the kidney. As the enlargement goes on, the scrotum becomes adherent to the tumour in one or more places, then ulcerates, and allows the protrusion of the morbid mass, which projects as an open fungus. The scrotum admits however of great distention before ulceration ensues. The mass then becomes less firm, and its consistence varies very much in different parts, the morbid matter being in some a mere pulp, or re- sembling a creamy fluid. It is interspersed with round or irregular patches of dark look- ing coagula, and, when incised, often presents in different places dark minute spots of va- rious sizes, produced by coagulation of blood in the vascular network usually mixed up with the morbid deposit. On macerating these tumours, or on pouring a stream of water on them for some time, a granular sub- stance, the cancerous matter, is washed away, leaving behind a filamentous shreddy tissue or meshes of a delicate areolar texture, which may often be found connected to a denser fibrous substance, the remains of the tunica albuginea. The spermatic cord is often in- vaded by a similar substance; and in an ad- vanced stage of the complaint, large bodies of the same kind, originating in disease of the lumbar glands, are found on the sides of the vertebrae, reaching as high up as the dia- phragm. Masses of a similar kind are sometimes also found in the lungs. The carcinoma- tous matter is often deposited in such abun- dance as to form a tumour of very con- siderable size ; indeed, there is no other dis- ease of the testicle which occasions solid en- 3 T 1010 TESTICLE (ABNORMAL ANATOMY). largements of so great a magnitude as ence- plialoid cancer. M. P. Boyer removed a testicle converted into an encephaloid tumour which weighed more than nine pounds.* The vessels of the cord undergo great enlargement in this disease. In one case which I examined, the spermatic artery was found as large as the radial artery at the wrist. Cancerous germs have also been found in the blood contained in the spermatic veins. Encepha- loid cancer of the testicle occurs at all periods of life: no age, indeed, can be said to be exempt from it. There are examples on record of operations for the removal of tes- ticles thus affected, within a twelvemonth after birth. On the other hand I have met with the disease as late in life as the age of sixty-four. It more commonly occurs, how- ever, in the middle period of life, or between the ages of twenty and thirty. Carcinoma has, in some few instances, been found to originate from the tunica va- ginalis, the glandular part of the testicle re- maining for some time unaffected. Cases of the kind have been recorded by Sir E. ITomef and Sir A. Cooper. The other two forms of cancer, colloid and melanosis, have rarely been observed in the testicle. A preparation of the former disease is contained in the Museum of Guy's Hospital. The organ is enlarged to four or five times its natural size, but pre- serves its oval form : there is scarcely any trace of the natural structure remaining, its place being supplied by colloid matter. Cru- veilhier has related the case of a man who died of melanosis affecting the hand, lungs, heart, stomach, and other parts. There was a deposit of the same character in each tes- ticle. Cystic Disease. — The cysts developed in the substance of the testicle and constituting this disease vary very much both in number and size, and in the appearance of their con- tents. They may be only two or three in number, or they may exist in a countless multitude and occasion considerable enlarge- ment of the organ. They vary in size from that of a millet seed to the dimensions of a pigeon’s egg. At an early period they gene- rally consist of smooth and slightly vascular cysts, closely adherent, and containing a transparent light-coloured fluid. In other cases the fluid is thick, viscid, and highly albuminous, and sometimes tinged with blood. I have never succeeded in detecting sperma- tozoa in the fluid. Sometimes a small lo- ludated growth arises from the walis of the cyst, and increases until it is partly or wholly filled and obliterated. The cysts usually in- crease at the expense of the secreting struc- ture of the testicle, which disappears or be- comes much displaced. In some instances the tubular structure forms an expanded layer over the morbid mass. When inflam- mation takes place, fibrine is effused be- tween as well as within the cysts, and be- * Revue Medieale. Nov. 1839. f Observations on Cancer, p. 125. Anatomic Patliologique, liv. xix. pi. 3, 4. comes organised ; so that the tumour is partly solid and partly composed of cysts containing fluid. After some time, the sur- faces of the tunica vaginalis become more or less adherent, and in old cases the tumour is intersected with fibrous bands. In several specimens of the disease I have noticed small masses of enchondroma interspersed amongst the cysts. In sections the little pearly-looking masses appear as if contained within the cysts. They are however developed between them, and are closely connected with their walls. The occurrence of enchondroma in these cystic tumours has scarcely been noticed by pathologists. There are several specimens in the Museum of the College of Surgeons. Fig. 0.5 3. Portion o f the section of a testicle in the Museum of the College of Surgeons, with numerous masses of enchondroma between the cysts, of the exact size, a. a. enchondroma. One of the specimens of cystic disease in this collection measures five inches in its largest diameter, and three inches in its smallest. Sometimes small lobulated growths arise from a part of the walls of the cyst, and in- crease until the cavity is partly or wholly filled and obliterated by them, in the same manner as in cystic disease of the mamma. The mode of origin of these cysts has not been satisfactorily made out. It has been supposed that they are formed of dilated and obstructed seminiferous tubes ; but as in cer- tain cases the tubular structure exists in the form of a layer spread over the morbid mass, it is clear that the disease could not have originated in this way. This morbid change is evidently quite distinct from the little cysts so commonly developed in the head of the epididymis : indeed this part is rarely affected in cystic affections of the testicle. The dis- ease is considered by some pathologists to be of a malignant character. After removal of a testicle thus diseased, tumours of a carci- nomatous character have afterwards appeared in the lumbar glands and other parts. Mr. Caesar Hawkins showed me several prepara- tions of cystic sarcoma of the testicle which had been removed by operation where this happened, and it occurred also in a case which came under my own observation. The unexpected result in this instance led me to pay attention to the matter, and I am now quite satisfied that the cystic disease may be 1011 TESTICLE (ABNORMAL ANATOMY). developed under two forms. In one, it occurs in combination with carcinomatous deposit : Fig. 654. Section of a cystic tumour of the testicle, showing a multitude of cysts of various shapes and sizes, with solid matter interposed hetwen them. The natural glandular structure is wholly destroyed. in the other and more common form, the tumour is of an innocent character, and free from the risk of disease attacking other parts after removal of the organ. In the former the cysts are larger and less numerous than in the latter. By careful examination and with the aid of the microscope the coexist- ence of the two diseases may generally be made out. Ossific deposits in the testicle. — Earthy matter occurs in the testicle under two forms : 1. Laminated, and often mixed up with car- tilage ; and 2., as an inorganic deposit. In the first form it is usually deposited between the tunica vaginalis and tunica albuginea, in little bony or cartilaginous patches, in which a fibrous arrangement may be recognised. I have frequently found one or two irregularly- shaped projecting ossific bodies scarcely larger than a pin’s head attached to the upper part of the testicle. Ossific matter occurs also on the adherent surface of the tunica vaginalis in old cases of hydrocele, where it has been found so abundant as to form a complete ossific capsule. It has been said that the epididymis alone may be encased in bone, the testicle being free ; this I have never seen. Bony matter occurs, however, in the sub- stance of the epididymis as the result of ossi- fication of the product of inflammation. Earthy matter in this form is not often ob- served in the substance of the testicle. The gland, however, when atrophied and reduced to a mere fibrous tissue, occasionally under- goes both the cartilaginous and osseous trans- formation. The cysts developed in the tes- ticle, as I have already shown, are liable to similar changes. In the second form the earthy matter is deposited in an irregular mass, containing very little animal matter ; in appearance re- sembling mortar, and very similar to the earthy substance found in the lungs and bronchial glands. It is generally met with in the head of the epididymis, and sometimes in the lower part, and but very seldom in the body of the testicle. As I have already stated, it is most probable that this earthy matter results from the transformation of tubercular matter deposited in the testicle in early life. Loose bodies in the tunica vaginalis. — - Loose bodies are occasionally found in the cavity of the tunica vaginalis. They are small in size, and of an oval flattened shape, and their sur- face is smooth and polished. Their texture is in most instances elastic and homogeneous, resembling the unattached cartilages found in joints, and points of ossification are often contained in their interior. In some speci- mens I have observed the cartilaginous matter to be arranged in concentric laminae. The loose body is sometimes entirely composed of bony matter. On examining a thin lamina of one in the microscope, I could distinctly see small oval corpuscules with a number of lines proceeding from them very similar to those of bone. They seldom exceed three in number, and they occur generally in combination with hydrocele, the loose bodies being the original disease. Foetal remains in the testicle. — The remains of a feetus have been found in some rare instances, in the scrotum, in connection with the testicle. Several examples of the kind have been collected by Ollivier (D’ Angers).* In all these cases it was evident that the scrotal inclusion had succeeded to an inclusion origi- nally abdominal ; that is to say, that the organic debris were first situated in the ab- domen in connection with the testicle, and had accompaniad the gland in its passage out of that cavity. In the cases in which the particular testicle was indicated, the right was the one affected. Varicocele is a term applied to a morbid dilatation of the spermatic veins. On dis- section they are found dilated, elongated, anil more tortuous than natural, and apparently more numerous, owing to the enlargement of the smaller vessels. In an advanced stage of the disease, their coats are thick- ened ; so that when divided the vessels re- main patent, and thus present the appear- ance of arteries. The enlarged veins hang down below the testicle, and reach upwards into the inguinal canal ; and when very volu- * Memoire sur la Monstruositd par Inclusions Archives Gdne'rale de Medicine, t. xv. p. 540. 3 t 2 1012 TESTICLE (ABNORMAL ANATOMY). minous conceal the gland, encroach on the septum, and extend to the other side of the scrotum. In a specimen which I carefully examined, the vessels were arranged in three clusters ( fig . 655). One formed of the larger vessels proceeded from the inferior ex- tremity of the testicle ; the second, in which the vessels were less in size, but more numer- ous and tortuous, arose from the upper ex- Fig. 655. tremity of the testicle ; whilst the third and smallest cluster surrounded and accompanied the vas deferens ( 1). The dilatation is not con- fined to the veins exterior to the gland : even those in the organ itself are varicose, and enlarged veins may often be distinctly seen ramifying between the tunica vaginalis and tunica albuginea. The veins occasionally con- tain phlebolites which are lodged in dilatations of the vessels. The veins of the left testicle are more subject to varicocele than those of the right. In upwards of 120 operations per- formed by Breschet, in only one instance was the varicocele on the right side.* Pott met wi h this disease on both sides of the body in only one instance. The disease, however, is far from being so rare on the right side as is generally supposed, and often exists on both at the same time, although the varicose state of the right spermatic veins is always much less than that ot the left. Of the causes of varicocele, some operate on both sides, others only on one. The most influential of the former is the hydrostatic pressure consequent Lanilouzy, Du Varicocele, p. 24. upon the depending position of these veins, which have to support the weight of a column of blood extending from the testicle to the second dorsal vertebra. The absence of valves is mentioned as a circumstance conducing to this disease ; but this is an error, for the larger spermatic veins are always furnished with valves, though the dilatation which takes place in varicocele prevents them per- forming their office. There are several anato- mical circumstances, which, taken together, are sufficient to explain the frequency of vari- cocele on the left side. On the right side the spermatic vein joins the vena cava nearly parallel to the axis of that vessel, so that the blood enters in the course of the circulation ; but on the left side the spermatic vein termi- nates in the emulgent vein at a right angle, and in a direction perpendicular to the venous current from the kidney, which is less favour- able to the return of blood from the testicle, since the two currents pursue a different di- rection. The left testicle hangs lower than the right, consequently the veins must be longer, and the pressure produced by the column of blood greater on the left side than on the other. The accumulation of the feces in the sigmoid flexure of the colon previous to an evacuation tends to produce pressure on the spermatic vein, and impede the return of blood from the left testicle, especially in persons whose bowels are habitually con- stipated. Some persons subject to varicocele suffer from it only when the bowels are in this condition. But even the natural daily accu- mulation may be sufficient to produce ob- struction. To this cause, we must chiefly attribute the circumstance that a varicose di- latation of the veins of the ovary in the female is nearly always confined to the left side. In the slight degree and chronic state in which we most frequently meet with this affection, no injurious effect is produced on the testicle; but when highly or rapidly de- veloped, the dilatation of the veins interferes so much with the nutrition of the gland as to occasion wasting. A partial atrophy of the gland, coexisting with varicocele has come under my notice in more than twenty instances ; indeed, in nearly all cases in which there was a decided dilatation of the spermatic veins on one side only, the testicle of that side was the smaller of the two. In a man, aged fifty-six, with a varicocele on the left side, the testicle was so reduced that it scarcely exceeded the usual size of the organ in an infant. Some years ago, a tall sailor was under my care on account of a varicose ulcer on the left leg, who had a large varicocele on the left side, and a testicle so wasted, that it could scarcely be felt through the tunica vaginalis, which was loosely distended with fluid. The period of puberty is the time at which varicocele most cemmonly occurs. I have met with very few cases before that age. Adipose tumours. — The spermatic cord may be the seat of abnormal depositions of fat. They occur at different parts, as high up TESTICLE (ABNORMAL ANATOMY). 1013 ns the inguinal canal, and as low down as the epididymis. In examining the testicles of a young man who died of pleurisy, 1 found a quantity of fat along the cord, and around the epididymis, and some also beneath the tunica vaginalis covering the posterior part of the testicle. In another case I met with small isolated masses of fat, coupled with a small encysted hydrocele of the cord. When de- veloped in considerable abundance this de- posit sometimes forms a tumour either in the groin or in the scrotum. A tumour of this kind in the scrotum has been mistaken for omental hernia. I once dissected a lobulated fatty tumour, surrounded by the thickened sheath of the spermatic cord, on the body of a man upwards of eighty years of age, which was very similar in appearance to a portion of omentum contained in a hernial sac. A mass of fat, however, in the cord may form a more defined and distinct swelling. Such a tumour is preserved in the Museum of the College of Surgeons. (No. 2461.) It is em- bedded about an inch above the testicle, in the tissues of the spermatic cord and loosely connected with them. Its shape is oval ; it measures four inches in length, and consists of numerous lobes of soft fat, closely held together by their thin fibro-cellular par- titions. An interesting case of large fatty tumour in the scrotum, originating in the spermatic cord, was seen by several surgeons, in 1844, much difficulty having been ex- perienced in making out the nature of the swelling. The tumour, together with the testicle, was excised by Mr. Lawrence.* Another of the same character, but of smaller size, subsequent^ formed in the remains of the cord in the groin, and was excised by me in May, IS49. Collections of fat in the scrotum have been known from the time of Galen by the term steatoce/e. I suspect that they all originated from the spermatic cord. Morbid anatomy of the scrotum. — The morbid appearances presented by the scrotum, when the seat of oedema, inflammation, and mortification, so closely resemble those of other parts where loose areolar tissue abound, that they require no particular description. Elephantiasis. — This disease of the scro- tum is rarely seen in Europe, but is of very common occurrence in many other parts of the globe. It consists in a morbid thickening, or hypertrophy of the tissues of which the scro- tum is composed. The epidermis becomes thickened, rough as in icthyosis, and inter- sected with fissures, or chaps. The corium is excessively consolidated, and often nearly an inch in thickness, and very dense. The chief bulk, however, of the tumour, is formed by the conversion of the loose areolar tissue of the scrotum into a large mass of fibrous tissue, infiltrated with a thick jelly-like fluid, evidently albumen, as it coagulates on the ap- * Vide accounts of this case by Lawrence, Me- dical Gazette, May 30. 1845 ; by Brodie, Lectures on Pathology, p. 271. ; by Edwards, and myself, in Provincial Med. and Surg. Journal, June 25l 1845. plication of heat, acid, or alochol, and some- times on cooling after its removal from the body. The areolte of this tissue vary a good deal in size, but some of them have been found large enough to admit the extremity of the little finger. Examined in the micro- scope this structure exhibits the white and yellow elements of the areolar tissue, in some instances mixed with fat cells. When the part is condensed by inflammation, there are often hardened masses in the substance of the tumour, which has a lardaceous appearance when cut, or resembles cartilage ; they some- times undergo conversion into bone. The testicles are buried in the morbid mass to- wards its posterior part, but they are usually sound in structure. Occasionally there is a small quantity of serum in the tunica vagi- nalis. In a case operated on in Calcutta, there was a hydrocele on both sides imbedded in the diseased parts, the largest of which contained between five and six flints of fluid.* The spermatic cords are elongated several inches, owing to the testicles being gradually dragged downwards during the growth of the tumour, but the cords are not otherwise diseased. In the remarkable case of Idoo Loo, a native of China, operated on by Mr. Key, in Guy’s Hospital, the cremaster mus- cles were nearly as thick as the finger. The morbid growth is not very vascular. Its arteries are derived chiefly from the external pudic and perineal vessels ; but these, owing to the magnitude of the tumour, become* greatly increased in size. Tbe veins are numerous, large, varicose, and very tortuous. The integuments of the penis are often affected with a similar disease, and enlarge in the same ratio as the scrotum. In cases where the disease is confined to the scrotum, the penis becomes drawn in and ultimately disappears, being completely imbedded in the tumour ; whilst the prepuce being elongated, opens by a navel-like aperture on the anterior surface of the tumour, as may be seen in the subjoined woodcut. In confirmed cases of elephantiasis, the tumour increases until in the course of years it attains an enormous magni- tude. As this takes place, the skin is bor- rowed from the lower part of the abdomen, so that the hair on the pubes becomes thinly scattered on the front and upper part of the tumour. The tumour assumes an oval or pyramidal form, the apex being superior, and is attached to the body by a thick peduncle extending from the pubes, occupying the whole of the perineum, and terminating pos- teriorly at the verge of the anus. There is scarcely any limit to the size which the tumour may attain. It has been known to acquire such a magnitude as to weigh more than two hundred pounds f, exceeding the weight of the rest of the body. It has been found to measure more than four feet in cir- * Calcutta Quarterly Journal, No. 3. f Case cited from Ephe'merides d’Allemagne, by Larrey. Blemoires de Chirurgie Militaire, t. ii. p. 3 T 3 1014 TESTICLE (ABNORMAL ANATOMY). cumference, and almost to reach the ground when the patient is in the upright position. In a case operated on by Clot Bey in Esjypt, the morbid mass, which weighed one hundred and ten pounds, kept the patient’s legs far apart, and obliged him to remain constantly on the ground ; it was so bulky that he could even sit upon it. In the accompanying figure Fig. 656. of a black man, affected with elephantiasis, taken from Dr. Titley’s work on “ Diseases of the Genitals, in the Male,” the tumour de- scended nearly to the ankles. Elephantiasis of the scrotum is a morbid affection of the integuments, analogous to the enlargement of the extremities commonly known by the name of Barbadoes leg ; with which, indeed, in those countries where the disease is prevalent, it is liable to be com- bined. Elephantiasis of the scrotum, how- ever, grows to a greater size and makes more rapid progress than the same disease in the leg, owing to the very loose texture and de- pending state of the parts. The labia pudendi of females in warm climates are subject to a similar change, though not to the same extent nor so frequently as the scrotum. This dis- ease appears to he the result of a low form of inflammation of the veins, and to be analogous to the affection termed phlegmasia dolens. It is preceded by febrile attacks, attended with pain and heat in the part, and swelling and tenderness of the glands in the groin. After a time, the scrotum continues to enlarge, in- dependently of febrile attacks. In December, 1847, I saw a gentleman, from Barbadoes, who had this disease in the early stage. The whole scrotum was considerably enlarged, forming a doughy inelastic swelling, fissured in two or three places. A portion of skin at the root of the penis was a little red and puffy as if affected in a slight degree. The glands in the left groin were enlarged, but those on the right side were unaffected. The testicles were sound. Hypertrophy of the scrotum is an affection of the same nature as the knotty and lobulated growth of the skin occasionally observed on the nose and in other parts. In this disease the integuments appear as if composed of lobes divided by fissures. In the Museum of St. Bartholomew’s Hospital there is a pre- paration of this kind, but no history is at- tached to it. The hypertrophied scrotum appears to have been removed during life. Many years ago I saw a case of the kind at the hospital of La Charite in Paris. The patient was a young man whose scrotum was hypertrophied to about four times its natural size. This disease is liable to be confounded with elephantiasis, but differs from it in the circumstance that the morbid enlargement is entirely confined to the skin, the subcutane- ous areolar tissue being unaffected. Cancer Scroti, or, as it is commonly called, chimney sweeper's cancer, is a disease of the skin, which attacks the scrotum of persons who have been exposed to the contact of soot. It is originally developed in the form of a small pimple or warty excrescence, termed soot- wart, which often remains on the scrotum for months or even years without undergoing any change Usually, there is only a single wart at the lower part of the scrotum ; sometimes there are two or three of different sizes ; and occasionally they are so numerous and so abundantly and largely developed as to form a considerable cauliflower excrescence. After a time the wart becomes soft, excoriated and red, and exudes a thin irritating discharge, which becoming dry forms an incrustation over the excrescence. After the scab has been picked off, or rubbed off by friction against the dress, ulceration ensues, destroys the wart and produces a painful chronic sore, possess- ing the ordinary characters of a carcinomatous ulcer on the skin, — thick, indurated and everted edges, and an irregular excavated base, the surface of which discharges a thin sanious fluid. The ulcer, if suffered to proceed, in- Fig. 657. 1 small soot warts ; 2, cancerous ulcer succeeding the wart. 1015 TESTICLE (ABNORMAL ANATOMY). creases widely, invading the whole scrotum to the perineum, and laying bare the crura penis. At the same time it penetrates deeply to the tunica vaginalis, which becomes firmly connected to the morbid scrotum and ad- herent to the testicle. This organ nnay also become involved in the disease, and be the seat of a deep excavated sore. The glands in the groin often enlarge at an early period from irritation ; but at length they become indurated and diseased. The inguinal glands sometimes suppurate, and form intractable ulcers in the groin similar in character to the sore on the scrotum. The ulcer spreads to- wards its circumference widely and super- ficially, whilst in the centre it burrows deeply until in many instances it reaches the great vessels of the thigh, destroys their coats, and causes death by haemorrhage. In other cases the glands remain unaffected, but ulceration advances slowly in the direction of the cord, and a frightful sore is produced. The small excrescence in which cancer scroti usually originates is soft, vascular, and sensitive ; and in many respects similar to the soft warts which occur on the internal membrane of the prepuce and on the glans penis. The soot-wart appears, in fact, to con- sist of a congeries of morbidly enlarged papillae. The Museum of the London Hospital contains a remarkable specimen of chimney-sweeper’s cancer, in which nearly the whole scrotum is occupied by a cauliflower excrescence, which exhibits these papillae in a very ad- vanced state of developement. It was removed from an old man, about sixty-four years of age, who afterwards left the hospital cured. The morbid growth is composed of a number of projecting processes densely grouped to- gether, of variable size, but many very large, with their summits lobulated, expanded, and elevated on narrowpeduncles, more orlessflat- tened. They are represented in the subjoined engraving. The soot-wart is sometimes co- vered with a dense and thick concretion, formed Fig. 658. by successive layers of incrustation, the su- perficial still remaining attached, so as to form a projecting elongated conical process, which is not unlike the spur of the cock, and when very long is occasionally twisted like the horn of a ram. Some curious excrescences of this kind are represented in the clever etchings of Mr. Wadd.* The subjoined figure taken Fig. 659. from one of them, exhibits the process of its exact size. Upon dissecting a portion of scrotum af- fected with chimney-sweeper’s cancer, the part is found to present very similar appearances to those of carcinoma of the lip. The tissue at the base of the ulcer is dense, indurated, and distinctly laminated, and possesses very little vascularity. On examining some matter scraped from the base of a soot-wart shortly after its removal from the body, I perceived a number of caudate and spindle-shaped nucleated cells. Epithelial cells have likewise been observed in several cases, and the dis- ease is regarded as belonging to the epithelial form of cancer. On examining some diseased glands in the groin in a case of scrotal cancer, I found them enlarged and indurated, and composed of a whitish brown or yellowish white substance, mixed up in some places with a soft curd-like matter, or greyish pus, con- tained in thin white cysts. Carcinoma scroti is, with few exceptions, confined to chimney-sweepers ; and the irrit- ating action of the soot on the skin of the scrotum is no doubt its exciting cause. A similar disease occasionally occurs in other parts of the skin, but the scrotum being sel- dom cleansed and well adapted to harboursoot * Cases of Diseased Prepuce and Scrotum, pi. x. xi. xii. 3 T 4 1016 TESTICLE (ABNORMAL ANATOMY). seems more exposed to the disease. Sir James Earls has related the case of a man who had a large sore resembling chimney-sweeper’s cancer which reached from the bend of the wrist to the knuckles, occupying almost the whole of i he back of the left hand. The man was a gardener, and for several springs had been in the habit of strewing soot on the ground round the young plants to preserve them from slugs. He carried the soot in an old garden pot which hung on his left hand, while he strewed the soot with his right. The predisposition to cancer scroti appears in some instances to be hereditary. The late Mr. Earle extirpated the testicle and diseased integuments from a sweep aged thirty-five, a patient in St. Bartholomew’s Hospital, whose grandfather, father, and one brother had all perished from the effects of the disease. A father and son were once in St. George’s Hospital at the same time on account of it. Mr. Cusack mentions that he removed a soot-wart from the hand of a female who carried on the business of chimney-sweeping, and that he had previously excised an ex- crescence of the same nature from the ear of her son.* Cancer scroti occurs more commonly at the middle period than at any other time of life. In the majority of cases which I have met with the disease occurred between the ages of thirty and forty. Those exposed however to the action of soot may become affected at a much earlier period. Mr. Wadd has figured a diseased prepuce and soot-wart on the scrotum from a boy aged fifteen ; and Sir J. Earle witnessed a case of the disease as early as at eight years of age. It appears that the seeds of this malady are sown in early Lfe, but in general do not germinate untd they have remained for some time dor- mant in the system. What is the permanent effect on the scrotum produced by soot, which thus renders it in certain individuals so pecu- liarly susceptible of a cancerous action at some distant period, we cannot explain ; but that the soot, though the exciting cause of the disease, may in some instances be a remote one, is shown by several striking facts. It is known that persons who have been sweeps when young, but have abandoned the occu- pation, have afterwards been attacked with chimney-sweeper’s cancer, although they have long been removed from all contact with soot. A sailor between forty and fifty years of age, was admitted into the London Hospital, with an ulcerated sore on the scrotum, presenting all the characters of genuine chimney-sweeper’s cancer. The inguinal glands were indurated and enlarged, and subsequently ulcerated. He had been brought up as a sweep ; but for the last twenty-two years, during which period he had served at sea, he had not been em- ployed amongst soot in any way whatever. The disease first appeared in the scrotum * Dublin Journal of Medical Science, vol. xxi p. 137. about three years before. In this case, there- fore, the injurious influence of soot must have been exerted nineteen years before the ap- pearance of disease, during which long period lie was entirely removed from the effects of its exciting cause. It has sometimes hap- pened, after the morbid parts had been com- pletely extirpated, and the wound healed, the patient having avoided further contact with soot, that the disease has re-appeared as it were afresh, a second and even a third time ; not, however, in the cicatrix of the wound, but on a different part of the scrotum. These, and similar facts, lead to the conclu- sion that though abandonment of his occupa- tion may render the adult chimney-sweeper less liable to cancer, it by no means forms a satisfactory security against its occurrence. Cancer scroti chiefly extends its ravages by affecting the contiguous tissues, and has little disposition to contaminate the lymphatic glands or distant parts. An instance is on record of an old chimney-sweeper, who had been subject to this disease for forty years, and had undergone three operations for its removal, yet even then the glands in the groin were unaffected* A man aged fifty-one who had been a chimney-sweeper ever since the age of seven years, was a patient of mine on account of this disease. He had been re- peatedly attacked with it during a period of twenty-twro years, and had submitted to no less than five operations for its removal. The glands in one groin became affected only a few months previously. Ulceration took place, and the patient died from its irritative effects on the constitution. On a careful examina- tion of the body, no trace of internal disease could be detected; The cancer was strictly limited to the groin and scrotum. Mr. B. Cooper has likewise recorded a case of chim- ney-sweeper’s cancer which ended fatally; and on examination none of the glands or viscera of the interior of the body were af- fected.j- These cases show that, when the inguinal glands are indurated, they may be excised with a fair hope of a successful result. Alelanosis.- — Notwithstanding the dark co- lour of the skin of the scrotum, melanosis is an exceedingly rare affection of this part. Indeed, the only case of its occurrence there with which I am acquainted, is one that hap- pened in my own practice. The patient was a cabinet-maker, aged thirty-two, and the disease commenced as a small dark spot, ap- parently produced by some black deposit be- neath the epidermis, raising it a little above the surrounding surface. This spot increased until it formed a fungous growth. I excised the part, but the disease re-appeared in the scrotum and in the glands of the groin six months afterwards. It made, however, very slow progress, and did not destroy the patient for six years. J * Mr. Hawkin’s Lecture on Tumours. Lond. Med. Gazette, vol. xxi. p. 842. f Lond. Med. Gazette, vol. xliii. p. 532. J Vide Report of the Case in Lond. Journal of Medicine, vol. i. p. 220. THORAX. Fibrous tumours. — A small fibrous tumour is occasionally developed in the areolar tissue of the scrotum. It may acquire the size of the testicle, and being firm and of an oval form, resembles a supernumerary gland. 1 have met with only one case of this form of tumour. Dr. Mott, of the United States, excised an enormous mass from the scrotum of a man about seventy-three years of age. The scrotum was twelve to fifteen times its ordinary bulk, and was filled with tumours of a stony hard- ness, from the size of a nutmeg to that of a large pea. The tumours had all a very white appearance, and the integuments over two or three of the largest, having been ulcerated for upwards of a year, poured forth a foetid discharge, together with a white substance resembling mortar. The disease was upwards of twenty years’ duration. I have no doubt this disease was originally of a fibrous cha- racter. The calcareous matter and other changes resemble those occasionally observed in large fibrous tumours of the uterus. A tumour of a similar character and of great size was removed by operation from the scrotum of a man in St. Vincent’s hospital, Dublin, by Dr. O’Ferrall.* Bibliography. — Anatomy. — De Graaf, De Vir. Organ. Gener. Lugd. Bat. 1668. Monro, Essays and Observations, vol. i. Edinb. 1754; also De Testibus et de Semine in variis Animalibus. Diss. Inaug. Smellie. Thes. Med. ii. 317. 1755. Hunter, W. Me- dical Commentaries, 1762. Warner, An Account of the Testicles, 1774. Palletta, Nova Gubernaculi Testis Hunteriani et Tunicie Vaginalis Descriptio, 1777. Brugnoni, De Testium in Fcetu positu, &c., 1785. John Hunter, A Description of the Situation of the Testis in the Fcetus, with its Descent into the Scrotum, (Animal CEconomy), 1786. Seiler, Observ. de Testiculorum ex Abdomine in Scrotum descensu, Lepsise, 1817. Wilson, Lectures on the Urinary and Genital Organs, 1821. Sir Astley Cooper, Observa- tions on the Structure of the Testis, 4to., 1830. Lauth, Memoir de la Societe d’Hist. Nat. de Stras- bourg, t. i. 1830. Krause, Muller, Archiv. fur An- atomie, 1837. Gulliver, Proceedings of Zoological Society, 1842. Curling, Treatise on the Testis, 1843. E. Huschke, Encyclopedie Anatomique, t. v. Paris, 1845. Morbid Anatomy of the Testicle. — Pott, On Hydrocele and other Diseases of the Testicle, 1767. Bell, B. On Hydrocele and other Diseases of the Testis, Edinb. 1794. Wolf, L. De Sarcocele, Er- lang. 1799. Sir Astley Cooper, Observations cn the Diseases of the Testis, 1830. Baring, Ueber den Markschwamm der Hoden, Gbtting. 1833. Russell, Observations on the Testicles, 1833. Brodie, Lec- tures on Diseases of the Testicle, Lond. Med. Ga- zette, vol. xiii. 1834. Berard, Journal desConnaiss. Medico-Chirurgic. pour l’annee 1835. Velpeau, Diet, de Me'd. t. xv. Landouzy, Du Varicocele, Paris, 1838. Curling, Treatise on the Diseases of the Testis, 1843. Maladies des Testicules — Biblio- theque du Medicin Practicien, t. iv. Paris, 1846. Vidal ( de Cassis ), Traite de Pathologic, t. v. 1846. (T. B. Curling.) THORAX (3<5p«£ from Sropsui to leap, be- cause in it the heart beats). “ The habitation of the breathing parts.” — That part of the human body destined to contain the lungs * Dublin Hospital Gazette. Feb. 1845 1016 and heart, and by its movements to maintain the function of respiration. Generally by the term thorax is understood a cavity set apart for the respiratory organs. Such a cavity, however, is not essential to respiration : a respiratory surface only is es- sential. This must exist in every animal, whilst a separate thorax is found perfect only in mammalia. The development of the respiratory surface may take place in three ways. 1st. Either towards the intenor of the body, in the form of ramified or sacculated ca- vities ; or, Sndly. Towards the exterior, in the form of lamellated, ramified, pectinated, tufted, cili- ated, or pinnated processes called “ branchice ,” in which Nature seems to have exhausted all imaginable varieties of form ; and, 3rdly. By a system of tubes ramified to ex- treme fineness, either in an especial cavity or thorax, or in a cavity common to these organs and to others destined for the diges- tive function. The movements necessary to respiration, are modified according to the form of the re- spiratory apparatus and the nature of the medium to be respired, whether pure air or air contained in water. In some of the lowest animals, the respira- tory movements are the same as those of loco- motion, as in the monad and other infusorial animalcules. In all animals, even when the respiratory organs are contained in a true thoracic cavity, the frame-work serves other purposes besides that of drawing in and throwing out air ; it gives attachment to the largest muscles of the upper extremity, whe- ther prehensile or locomotive. In man parti- cularly, we find the respiratory muscles con- tribute to such acts as coughing, sucking, sneezing, yawning, sighing, singing, vomiting, as well as the innumerable articulate sounds of language. Distinct respiratory movements, as depen- dent upon alternate contractions and dilata- tions of a thoracic cavity, are most regular, or at least, they have been more noticed, in mammiferous animals. The thoracic cavities of mammiferous animals have much of the mechanism of respiration in common. They all possess a vertebral column or spine, and that peculiar frame-work of ribs, together with a sternum, so articulated together as to move in breathing. There is likewise a great similarity of mus- cular arrangement around the thoracic cavity; and consequently the respiratory movements closely resemble each other. Although the boundaries of the thorax are generally the parts which move in respiration, and these are generally composed of vertebrae ribs and sternum, yet some animals may have either all of these, or they may lack some of them, or, if present, they may not move in the breathing function. Frogs have a ster- num, but no ribs ; serpents have ribs, but no sternum ; tortoises have ribs, vertebras, and 1018 THORAX. sternum in one mass, rigid and immoveable : the crocodile and lizard have perfect ribs, but their sternum is almost entirely cartilaginous ; and, lastly, in man, the components of the thoracic cavity may have a mobility to com- mand or exceed a space equal to the whole cavity allotted for the respiratory organs. The relative quantity of air which he can respire for the aeration of his blood is probably greater than in any other animal, and his movements are more under the control of his will, and are greatly influenced by mental emotions. Classification of the Respiratory Movements in Animals. — It is not easy to name any particular part in the perfect thorax of the higher vertebrata, which is equally destined for respiratory motion throughout the class. Commonly with ribs and intercostal muscles, we connect the idea of a thorax, or a breathing chamber for re- spiration ; but a fish has ribs, and likewise intercostal muscles, yet not for any of the purposes of respiration, nor do we acknow- ledge them to belong to its thorax. A frog has a thorax for respiration with internal lungs, but no ribs, nor, consequently, any intercostal muscles. Nor is a diaphragm necessary to thoracic respiration ; for it is mostly absent in birds and reptiles, and quite rudimentary in the few instances (such as the ostrich, crocodile, and chelonial, in which it is met with. In the chelonia neither ribs, spine, nor sternum are concerned in the respiratory movements. The movements of respiration tend to bring before some surface, air or air contained in water ; or to bring a certain surface con- tinually into a fresh medium, In whatever way this may be accomplished, whether by moving the whole body, or part of the body to and fro, such movements, likewise, are not uniformly for the mere purpose of re- spiration, i. e. the mere purpose of aeration. All reptiles take more air into their capacious lungs than they require for oxygenating the blood, particularly in the aquatic kinds (as in the turtle), where the air serves to buoy up their heavy and slow-moving bodies in the dense element they inhabit. Serpents are provided with numerous highly-moveable ribs and powerful intercostal muscles, capable of rapid and extensive inspiration and expiration. Tney can perfectly distend their body with air. The same may be observed in the chameleon. These volumes of air cannot alone be subservient to respiration, as it cannot all come into contact with the simple undivided respiratory sacs. We see, therefore, there is no necessary rela- tion between the quantity of air an animal may inspire and the extent of respiratory surface. The long hissing sound which serpents pro- duce to alarm their prey, is effected by the expulsion of this great volume of air, by their ribs, through the narrow passages of the nos- trils. In the higher mammiferous animals, we find respiration more especially destined for the chemical purpose of oxygenating the blood. Hence a more limited quantity is taken in, and it is speedily thrown out again. Large animals make fewer respirations than small ones. Ac- cording to Scoresby*, the whale breathes four or five times a minute ; the dog, the cat, and rabbit, from twenty to thirty in the same period ; and in small birds the respirations are remarkably rapid. Whatever be the form of the aerating or- gan, “breathing” is accomplished either by, 1st, the weight of the atmosphere rushing into certain cavities, because certain parts of these cavities dilate and threaten a vacuum ; or, 2ndly, by the direct projectile or collapsing force of an organ throwing the ambient ele- ment onward. These two ways are generally more or less combined in the same animal. Nor does there appear to be any relation be- tween the grade of the animal and the order of respiratory movement obtained. We notice in the respiration of man a regular inspiration and expiration, two currents in different di- rections ; and in the lowest animal, the connecting link with the vegetable kingdom, the porifera, or sponge tribe, there are like- wise two respiratory currents by distinct channels, which are as regular as the motion of rivers from their source to the ocean, or any other movement depending upon the established order of things. In some spe- cies of medusae, there are peculiar sacs on the inferior surface of the body, which, during the expansion of the body, admit water through certain apertures, and again expel it during the succeeding contraction, re- presenting a perfect inspiratory and expi- ratory action. The complexity, therefore, of respiratory movements does not correspond with the increasing development of the breathing organs. Those animals which have an internal sacculated lung, always retain a certain quantity of the breathing element in “ reserve ” within their system ; whereas those animals which have external lungs, or gills, have no “ reserve ” respirable medium. They need none, because where there is an exter- nal lung, the ambient element answers the purpose of the “reserve”; it is always in contact with the breathing surface. This “ reserve,” in mammalia, 6tc., is not, pro- bably, so necessary to aeration as for the purpose of ejecting any matter which may obstruct the air passages — or, in more po- pular language, for “ coughing ” up any matter out of the throat. The different kinds of respiratory move- ment may be arranged as follows ; — 1. Infusorial Animalcules By projectile force. 2. Insects - Uncertain. 3. Fishes - By vacuum & pro- jectile force. 4. Amphibia - - do. do. 5. Birds - do. do. 6. Mammalia - - do. do. Of the First Kind of Respiratory Movement. Infusoria. — These animals breathe by a stream propelled in one direction, produced by the ra- El. Physiol. Wagner, 8vo. 1844, p. 670. THORAX. 1019 picl vibration of hair-like organs — cilia. ( Vid. Art. Cilia.) Of the Second Species of Respiration. In- sects.— The breathing apparatus in insects generally reaches a high degree of develop- ment. Sometimes respiratory tubes or tra- cheae penetrate every part, in the form of mi- nute ramifying vessels conveying the included air to all tiie organs. The moving power or means of the renewal of the air in these tubes is at present little known. Some insects, al- though they live in water (as, for instance, the water beetles, and also water spiders), retain a bubble of air around them ; and, according to Nitzch*, they renew the air in the irtrachae by alternately elevating and depressing the an- tennae. Beetles, before flying, seem to inflate themselves with air, so as to unfold their wings, which, like other parts of their body, are supplied with air tubes. In this case an inspirative effort must be made by some cavity. Under certain circumstances, bees emit a voice, a shrill sound, which is indepen- dent of the motion of the wings, and which appears to be connected with the existence of a current of air through the respiratory tubes or tracheae ; at least, such has been observed when the animal has been irritated and im- mersed in water, the surface of which, where it was in contact with the orifice of the stig- mata at the root of the wing, evidently vibrated at the moment the sound was produced.)" In the orthoptera particularly, there are distinct respiratory movements, alternate dila- tations and contractions of the abdomen ; in fact, respiratory motions are more distinctly perceptible in this division than in any other in- sects. In the locusta verrucivora particularly, it is easy to distinguish how the abdominal rings, which have smaller abdominal scuta between them inferiorly, are alternately elevated and depressed exactly like ribs. If we smear the great thoracic stigmata with oil, we find that numerous bubbles of air escape from it during these motions. The organs of respiratory motion, by means of which the supply of air is renewed, present many points of uncertainty. On the one hand, where large stigmata are placed opposite to each other, and connected by tracheae, it is easy to see that alternate opening and shutting of their valves may produce a current capable of renewing the supply of air. It is conceiv- able also, how, in the orthoptera, lepidoptera, and others, the expansion and contraction of the body, and the elasticity of the air-sacs contained in it, may cause the ingress of air. It is less obvious, however, how the same effect is produced in caterpillars and the larvae of beetles, where a current of air cannot very easily arise from the opposite position of the stigmata, on account of the minute ramifica- tions of the tracheae ; and consequently we must look for some peculiar mechanism, pro- bably cilia, unless we are disposed to admit * On tlie Respiration of the Hydropliilse, in Reil's Archiv. B. x. S. 440. t Hunter, Philosophical Transactions. 1702. p. 182. the stagnation of the air in its vessels. Hence it has been conjectured that the dilatation and contraction of the dorsal vessel contributes to this purpose. This, however, appears to be scarcely possible ; and it might be asked on the contrary, if the vermicular motion of the body itself, the sliding of its segments upon each other, are not the means of keeping up the constant ingress and egress of air.* In the lowest of the molluscous class, the external tunic with which they are covered is generally so elastic, that it is capable of dilating by its own properties, when it has been greatly contracted by the muscular coat that is within ; and in forcible expirations. Dr. Grant has observed these animals to contract their muscular coat, and to retract the exterior covering, so as to propel, with considerable impetuosity, and to a distance, the water that fills their respiratory cavity. The elasticity of the tunic tends to over- come the resistance of the muscular coat, and to expand, to a certain extent, the respi- ratory cavity. Without, therefore, the existence of elastic ligaments, such as we find in ccnchi- fera, there is a partial means of enlarging the respiratory cavity given to these tunicated animals. This, however, is only in occa- sional, forced, respiration ; constant and al- ternate contraction and expansion of the ex- terior tunic is not met with in any known tu- nicated, nor in a conchiferous animal, f The streams that enter the respiratory, and pass out of the anal aperture, are smooth, regular, and incessant, and are produced by ciliary movement. Of the Third Species of Respiration. Fishes. — It may be said that the thorax of fishes usually presents four elastic cartilaginous arches, which approximate and separate , open or close the gills, at the same time increasing or diminishing the capacity of the so-formed thorax. These ribs, or branchial arches, sup- port the gills, which are covered by a great flap (operculum) on each side of the base of the skull. The respiratory current enters at the mouth, passes through the fissures on each side of the fauces, and escapes through the branchial openings, placed laterally, covered by the moveable operculum. This stream is uniformly in one direction, — from before, backwards. It might be asked, why does not the water rush in by the branchial opening when the mouth “ threatens” a vacuum? It will be observed that the margin of the oper- culum, or great lateral flap, is edged with a delicate membrane, which acts as a valve, this, by the pressure of the water, is forced close round the lateral openings : thus, the water, upon the expansion of the jaws, is prevented entering behind, and consequently rushes in towards the gills by the mouth ; the jaws now close, the operculum immediately opens by the * Reimarcus, Ueber das Athmen. in Reil’s Archiv. B. xi. S. 2. ; and Nitzseh, Comment, de Respirat. p. 39. et seq. j Grant’s Lecture “ On the Respiratory Organs of Invertebrata.” Lancet, 1833 — 4, vol. i. p. 964. 1020 THORAX. force of the jaws contracting with the mouth full of water, which contraction, or expiration, forces the water through the branchial arches and ultimately out by the lateral openings. Thus the respiration is of a mixed order. The first stage by atmospheric and hydraulic pressure ; the second stage by direct muscular force, similar to that of swallowing. If we cut off the delicate fringe around the operculum the fish is suffocated, the opera- tion being analogous to puncturing the human thorax. Fishes also possess a power of regulating their respiration. We have watched fishes when in a quiescent state move their respi- ratory organs so gently that the motion was nearly imperceptible, and at times quite so ; but if at such times you alarm the animal, respiration becomes vigorous, and a compa- ratively vast body of water rushes past their respiratory organs. The same may be like- wise observed when fishes have remained long in a small quantity of water, as if the respira- tory movements became more and more vigo- rous with the deterioration of their element, but give them a fresh supply of water and re- spiration becomes quiescent again. Of the Fourth Species of Respiration. Amphi- bia.— In this class there is a gradual develop- ment of the animal formation from an aquatic to an aerial being ; so likewise is the aqueous gradually converted into aerial respiration. The respiration of some of these animals is indeed most curious, — curious as to the very limited quantity of air necessary for their well- being, and curious as to whether they have this limited quantity supplied regularly or otherwise. For instance, you may keep an aquatic turtle out of water for days, and it will keep constantly respiring air ; immerse it in water, and it will remain below the sur- face for half an hour, or an hour, without any inconvenience, and some of these animals will breathe at the surface during the day, and sleep at the bottom all night without once rising for air, while during the day the same animal cannot remain below above half an hour without showing signs of discomfort. And again, the common tortoise during hy- bernation breathes so small a quantity of air, that we have never been able to form any calculation of the quantity then respired. In frogs there are no ribs by which the lungs may be moved ; consequently there is no vacuum formed by their thorax dur- ing respiration ; they fill the lungs like the tortoise, the newt, the chameleon, &c., by the working of their jaws ; or, in other words, they swallow their air just as we swallow our food. In this respect their respiratory movements resemble those of fishes ; the first process being through the agency of external pressure, by making a vacuum with the mouth ; the se- cond, that of forcing, by the operation of the pharynx. They resemble mammalia in having an internal lung, retaining the air for some time, and in expelling it through the same channel by which it entered. The respira- tion of the frog has gained attention, and is hence better understood than that of many other animals of this class. The followingis the mechanism of its respiration, as described particularly by Townson*, though before no- ticed by Swammerdam and Malpighi. When the broad lingual bone which forms the floor of the mouth is drawn down from the pa- late by its muscles, the air of the mouth is rarefied, and an additional quantity enters by the nasal apertures, which admit of being closed by valves. The lingual bone is then raised, the nasal apertures are closed, and the air is now forced, or rather swallowed, through the rima glottidis into the pulmonary sacs, and can also fill the laryngeal pouches which open into the mouth. Expiration is produced partly by the pressure of the abdo- minal muscles, and partly by the peculiar mus- cular power of the pulmonary parietes. To the careless observer the frog does not appear to breathe : it is never seen to open its mouth ; there is no motion of its sides like breathing, and when it is provoked (or rather through fear), though it still keeps its mouth close shut, its sides and back rise, and it blows itself up ap- parently by some internal power. Upon observ- ing it more narrowly, that skinny and bag-like part of its mouth which is under the jaw, is seen to be in constant motion. While this bag is dilating and contracting, the mouth is never opened to take in new air, but it seems to live all the while on one mouthful of air, and seems to be playing it backwards and forwards between the mouth and lungs. If we now observe the nostrils, a twirling motion, which lets in air at each movement of the jaws, is apparent, corresponding to the quantity of air inspired. If we keep the mouth open we presently see the animal struggle for breath, for we by this means disable the forcing apparatus from pro- pelling the required air into the lungs. The newt breathes with the jaws and nos- trils like the frog. It has, like the frog, a constant motion, by short strokes of the bag under the jaw. This bag is formed by the membranes of the mouth, covered and moved by the genio-hyoid and mylo-hyoid muscles. Every minute, or less, it stops, as if intending some particular motion ; then gradually the bag swells out under the lower- jaw to a great size; the contained air is then pressed down into the lungs, and in propor- tion as the jaws are emptied, the sides of the animal are swelled up. The toad, the chame- leon, and the green lizard breathe in the same way, propelling mouthfuls of air down into the lungs. The chameleon can force down a greater or smaller quantity of air, as its needs or fears prompt it. At times it seems to fill its body almost to bursting with air. The tortoise, like the frog, holds its jaws close, and swallows the air ; alternately depressing and elevating the hyoid bone. The first of these motions permits the air to enter the nostrils, when, the tongue immediately closing their internal aperture, the second motion forces the air into the lungs. It is not un- * Tracts and Obs. on Nat. Hist., &c. London, 1799. THORAX. 1021 common to notice tortoises yawn ; but how different is their yawning from that of man, who makes, at that time, a deep inspiration, while, in the tortoise, respiration is impossible. We are not prepared exactly to say how the tortoise and turtle expire ; hut probably the expiration is performed by the contraction of fhe abdominal muscles between the lower shield or plastron and the posterior extremi- ties ; for either of these animals can at will, when alarmed, forcibly expel air with a hiss- ing sound, although its shell is unyielding. The most remarkable respiratory move- ment we have noticed, has been in the com- mon turtle. Sometimes this animal will swell out his hard case, the sternum or plastron yielding to some internal force ; but it is diffi- cult to say by what means this is distended and kept distended. It is clear this animal can gorge itself with air until it cannot sink in water, and that at pleasure it can disgorge itself and fall to the bottom, where it lives upon only a fraction of the quantity of air it had just previously ex- pelled. Of the Fifth Species of Respiration. Birds. — Here we have a contracting and dilating thorax, with ribs and sternum. The cavity of the chest is not divided by a diaphragm, but is common to the whole digestive organs as well as the lungs; or, as is said, they are “all chest and no beliy.” They differ from all other animals in this respect, that the lungs do not hang in the cavity of the trunk as unat- tached sacs, but are attached in the form of flattened masses, of' spongy, bright red, cellular texture, to the posterior side of the thorax, reaching to the pelvis. They have vesicles or air bags extending through the whole body ; and the cancellated structure of their bones is connected with the true lungs; so that if we tie the trachea and amputate the wing, leaving the stump of the bone exposed, the bird can inspire and expire through the humerus. In the same manner that the diffusion of air through all parts of the body in insects makes the highest extentof respiration in invertebrata, so also is it with birds among the vertebrata. The sternum and ribs, together with the immoveable range of dorsal vertebrae, all con- tribute to dilate and narrow the thorax, after the manner of a bellows movement. This di- latation and contraction draws the air through the true lungs, which never move, and imme- diately the air cells are expanded. By this means two conditions are obtained ; the air is drawn through the lungs for aeration ; and the air filling the cancellated structure, renders the bird specifically lighter. The high flying rapacious bird can thus by a respiratory movement attenuate the air in his body, when soaring in the atmosphere, and again at pleasure condense it in every inter- stice of his frame, when he drops like a can- non ball, to pounce on his prey ; but imme- diately before seizing it, again he attenu- ates the air within him to break his fall ; other- wise he would be dashed to pieces upon the pointed crag, and die along with his victim. This beautiful provision is wholly due to his respiratory movement, at one time acting as a condensing, and at another time as an exhausting syringe. Of the Sixth Species of Respiration. Mam- malia.— In this class we first meet with a perfect muscular septum (diaphragm) forming the two cavities of the trunk ; the one for the lungs, and the other for the abdominal viscera All animals which have a diaphragm, maintain respiration in a manner similar to each other ; for, indeed, it appears that the ouly use of this muscle is to maintain a movement of air — that unceasing pumping to and fro of inspi- ration and expiration. Their respiration, or at least their inspiration, is purely of the vacuum order. The diaphragm is the chief muscle of ordi- nary breathing. It can act with great power, protruding the viscera, by its descent, at each ordinary inspiration. This is strikingly seen in animals recumbent and at rest, as in the cow, horse, goat, dog, &c., when it ap- pears as if the animal was breathing with its abdomen. The ribs likewise in some degree maintain respiration in the lower mammiferous animals, particularly in disease. For instance, the respiration of the horse or dog, when the lung is emphysematous, or what is familiarly termed “ broken-winded,” is costal , and at such times the respiratory action of the ribs may be beautifully seen. It is most probable that in mammalian re- spiration we have the highest order of accom- modation for peculiar respiration, according to the condition of the animal ; i.e. an instinc- tive power to respire by different parts of the thoracic cavity, according to the needs of the animal, whether modified by health or disease. Nearly two hundred years ago, Lower changed the respiratory movements of the dog from diaphragmatic to costal, by paralysing the diaphragm through the medium of the phrenic nerve. ( Phil. Tr. Abr., vol i. p. 179.) The respiration of mammalia is the bellows action — inflation of the lungs by expansion of the thorax, or inspiration by vacuum, and ex- piration by propulsion. The projectile force in the respiration of mammalia is nearly all due to mere elastic contractility ; i. e. ordinary expirations are produced by the elasticity of the lungs and ribs, returning backwards, or collapsing, after their distension by the inspiratory muscles. This mere dead and involuntary force performs one half of our respiration. Man is not distinguished either by the force, extent, or complexity of his respiratory move- ments ; he is exceeded in all these particulars by inferior animals. The roar of the lion gives the idea of an overwhelming expiratory power ; nor are his lungs less complicated ; and the vibration of thousands of cilia, pro- moting currents around the monad, is more complex than the simple respiratory thoracic action of mammalia. The most striking dif- ference is that produced by mental influence, which appears to command the most delicate modifications of this movement, so indicative 1022 THORAX. of the passions of his mind, while in the lower animals we see none of these. Of the Thorax in Man. Anatomy of the framework of the Thorax. — A portion of the spine, the ribs, the sternum, together with numerous muscles, form the wall of the human thorax. The framework of bones is so ar- ranged as to admit of free mobility in various directions, so as to increase or diminish the cubic capacity of the thoracic cavity. Of theDorsal Vertebra;. — -That portion of the spine which enters into the composition of the thorax consists of the dorsal vertebra, which are 12 in number, intermediate in size and position, between the cervical and the lumbar vertebrae. They form the main pillar of support for the whole respiratory apparatus — the great fixed point for the chief respira- tory muscles to act against or draw upon. Their general appearance is that of increasing in size from above downwards ; but when carefully examined, they are as two cones, the apices of which touch at about the fourth or fifth vertebra, from which point, in either direction, they increase in their dimensions ; their breadth laterally exceeds their depth from before backwards. Their bodies are large and project deeply into the cavity of the tho- rax, diminishing greatly the antero-posterior diameter of the chest. Out of twenty cases, the average projection is 2-f of an inch, leaving little more than 4 inches for the heart and great blood-vessels. A deep sulcus is thus formed, which if a cast be taken of the cavity of the thorax, is very striking. In phthisis puhnonalis, the space between the bodies of these verte- bra and the sternum is sometimes less than one inch ! When the thorax changes its form by disease, this centre pillar is liable to wedge in or jam up the thoracic organs against the walls of the chest. The vertebra are connected to each other by ligaments, and jointed beautifully into each other, so as collectively to admit of extensive motion, while there is but little movement between any two vertebra. Of the bonds of union, the most remarkable are the inter-vertebral disks ( ligamenta inter- vertebralia — Weitbr.) — composed of fibro-car- tilage, and placed between the bodies of the vertebrae, each disk serving to unite two vertebra, and yet to permit a motion in any direction, yielding on that side towards which the column inclines, while on the contrary side it expands with the increasing intervertebral space. This substance is to the brain what the cushion or “ buffer ” between each railway carriage is to the traveller; it breaks a sud- den jar from being transmitted from carriage to carriage. So does this intervertebral sub- stance soften down any sudden jerk received at the lower extremity of the spine, preventing its being transmitted to the brain in the varied actions of walking, running, and leaping. Of the Sternum (os pectoris : Xiphoides ), so named from orepvov, the breast ; is a kind of flattened bone, symmetrical in shape, which occupies the anterior and middle part of the thorax. It is supported by the ribs on either side ; it is broadest at its upper part, and then narrowed ; it widens again, and finally becomes compressed and narrow where it joins the ensiform cartilage. (Fig. 660, e.) Its direction is oblique from above down- wards and forwards. This, with the curva- ture backwards of the spine opposite to it, increases the antero-posterior diameter of the thorax, as may be seen in a lateral view of a cast of the thoracic cavity. The length of the sternum, which is pro- portionably smaller in the female than the male, varies from 5 to inches. At the upper part its breadth is from to 2 inches. Its thickness above is about 6 lines ; at its lowest part it is much thinner, never exceed- ing three lines. The ancients compared the sternum to the sword of a gladiator ; and hence have arisen the denominations given to its various parts : as the handle ( manubrium ), the body ( mucro ), the point, or xiphoid appendix, ( ensiformis ) ; but the last mention- ed part now only retains the designation grounded on this circumstance. This division of the bone into three parts has been retained by some modern anatomists, who describe the three pieces of the sternum separately, as so many distinct bones ; we shall only adhere to this in speaking of the development of the bone. In anatomical language it is said, the ster- num presents two surfaces, two borders, and two extremities. Of the anterior or cutaneous surface of the Sternum. — This is subcutaneous, slightly con- vex and affords attachment to the aponeurosis of the pectoralis major and the sterno-cleido- mastoid muscles. It presents three orfourtrans- verse projecting lines, which are traces of the original division of the bone into five pieces. The union between the 1st and 2nd pieces cor- responds to the insertion of the 2nd costal car- tilage, and is frequently cartilaginous even in the adult age. The line which marks the union of the first two pieces of the bone is the most remarkable : it causes a projection of variable size in different individuals, which has been sometimes mistaken for a fracture or exos- tosis. At the lower part we sometimes find a foramen ; sometimes in place of the foramen there is a considerable aperture, to which much importance has been attached, as afford- ing a proof of the primitive separation of the bone in the median line. (Fig. 660. d.) The existence of this opening explains how puru- lent matter deposited behind the sternum may, in certain cases, make its way outwards without any absorption of the bone. This bone is covered by a strong interlacement of very numerous aponeurotic fibres. Of the posterior (mediastinal or cardiac') sur- face.— This is slightly concave, and parallel in direction to the anterior surface. The con- cavity is directed downwards and backwards, towards the cavity of the thorax, and gives attachment superiorly to the sterno-liyoideus and sterno-thyroideus muscles, interiorly to the triangularis sterni. THORAX. 1023 Along the middle line, this concavity cor- responds with the interval left by the diverg- ence of the two pleurae (anterior mediasti- num). In the young subject, transverse lines are seen corresponding to those which occupy the anterior surface ; all of these, except the two between the first and second pieces oi the bone, are effaced at a more advanced age. This surface is in relation with many organs contained in the chest, and especially the heart, in front of which the sternum forms a kind of shield. This is exemplified, as al- ready noticed, in the frog, which is provided with a sternum, though it has no ribs. At the lower part of the sternum are many nutritient foramina. Of the borders of the Sternum. — These are thick and marked at each side by seven an- gular depressions for the reception of the cartilages of the first seven ribs, which gives this bone a notched and serrated appear- ance. These angular cavities are separated from each other by semilunar notches, which are longer above than below, where the facettes closely approach each other. The uppermost of these seven cavities is shallow, triangular, and at an early age becomes ingrained with the cartilage of the first rib ; those which follow are deeper, angular, and situated at the ex- tremities of each of the transverse lines. When examined in the dried specimen, they appear more angular and deeper in proportion to the youth of the subject. Of the clavicular extremity. — This is slightly convex, and is the broadest and thickest part of the whole bone. It is slightly excavated from side to side, and presents at each corner a depression for the reception of the sternal end of the clavicle, which bears the name fourchette; this is surrounded with irregula- rities for the insertion of ligaments. It fre- quently happens that the two clavicular arti- culations are not at the same height ; a fact which was noticed by Morgagni, and which Cruveilhier attributes to the unequal wearing of the two articular surfaces. We have once seen the clavicular articulation so low as to unite with the first costal cartilage. Of the inferior extremity of the Sternum. — This is formed by the xiphoid appendix ; or ensiform cartilage, for it often remains cartilaginous to adult age. In length, shape, and direction, it presents nume- rous varieties ; it is frequently bifid, some- times pierced by a foramen, and is occasion- ally bent forwards, or to one side, and in certain cases much depressed : its summit gives attachment to an aponeurotic structure, called the linea alba; behind, it indirectly corresponds with the stomach, which rests upon it when the body is placed in a prone position. Connections. — The sternum articulates with fourteen ribs through the medium of their cartilages, and more directly with the two cla- vicles. Structure of the Sternum. — This bone con- sists of two very thin compact laminae, with an intervening cancellated structure, the cells of which are very large and have very delicate parietes. It is one of the most spongy bones of the body, and it is more than probable that to this circumstance the frequency of disease in it may be attributed. Absorption of this bone and great displace- ment by bending inwards is very common, particularly in women who wear tight stays. Under such circumstances, or by disease, we have witnessed the sternum so depressed in- wards that the depth, including all the thoracic integuments from the spinous processes of the dorsal vertebrae to the anterior surface of this bone, did not exceed three inches, in- stead of from seven to nine inches. Of the Development or Ossification of the Sternum. — As far as the middle of foetal life or a little later, the sternum is altogether cartilaginous, as represented at a. Jig. 6G0. This Fig. GGO. bone is one of the slowest in its ossification ; it exhibits no bony points or centres of os- sification up to the sixth month of fetal life. It is also of all bones the one in which the phenomena of ossification proceed with the least regularity. After the sixth month of foetal life, ossification begins with the for- mation of osseous granules in the middle of the intervals between the points at which the cartilages of the ribs are connected. “ There are five of these granules for the sternum, exclusive of the ensiform appendage, and they form as many pieces (e, Jig. 660.). The process of ossification makes its appear- ance in the first between the fifth and sixth months ; and, soon following in the second and third, it reaches the fourth at the end of fetal life- The osseous centre of the last varies considerably in the time of its appearance. It may be found soon after birth, and may not be visible for a considerable time (one or two years) after that period.” “ In many cases, one or more of the divi- sions of the sternum are formed from more nuclei than one, and there are peculiarities with respect to the number and position of these additional granules which require notice.” Ossification of the 1st piece. — This some- times presents a single nucleus (Jig. 660, b I .), rounded and transversely strong ; sometimes it presents two nuclei, and in this case they 102-1 THORAX. may he either placed one above the other, or side by side. In the former case the up- permost nucleus is the larger ; in the latter, both may be symmetrical and of equal size, or what is more common, they may be of un- equal magnitude. It may occasionally present more than two osseous points. Albinus found three in one subject, and four in another.* Mr.Quain has a preparation in Uni- versity College, where the very unusual num- ber of six {fig. 660. c. U.) are to be seen. In this case, where there is a plurality of osseous points, the largest are generally situated alone; exceptions to this rule are very rare. Ossification of the body, or the 2nd, 3rd, 4 th, and 5th pieces. — The osseous nuclei which enter into the composition of the body of the sternum have generally a rounded form when they are single, and are situated in the middle line ; where they are in pairs or are placed laterally, they are more elongated, but smaller, and appear to represent only the half of one of the single nodules. The second piece has not often more than a single granule ( b . 2, c. 2'.), but the rest are frequently formed from two nuclei, which are placed laterally to one another (c 3', 4'.), and not vertically as occurs in the first piece. These different osseous points are always so arranged as to be situated between two costo-sternal articulations, so that a portion of the sternum is developed in each of the intervals comprised between the ribs. The last piece is the only exception, being com- mon to the articulation of the 6th and 7th ribs. There are, therefore, four primitive pieces of the body of the sternum ( b . 1, 2, 3, 4.), and each of these is sometimes formed by one point of ossification ; at other times by two lateral points. The first piece may be formed of one or many ossific points, which may be arranged vertically as well as laterally To the centres of ossification here described, M. Brechet f has added two small epi-sternal granules, whose position is sufficiently shown by the indication of them, fig. 660. at d**. They occur only at rather advanced periods of life, but they do not appear to be constant. Union of the points of ossification of the body of the Sternum. — In considering the union of the different parts which compose the body of the sternum, it is necessary to make a distinc- tion between the lateral conjunction — that is, the union of the osseous points which are situated on each side of the median line- — and the vertical conjunction, or the union of the pieces of the sternum properly so called. The lateral conjunction, or the union of these osseous germs, which form a pair in the same interval, always precedes the vertical conjunc- tion. The vertical conjunction, or the union of the different pieces of the body of the sternum * Craveilhier, Descrip. Anat. 8vo. 1840. Lond. p. 87. f Recherches sur Diffe'rentes Pieces du Sque-. lette des Animaux Vertebres, &c. in “Annalesdes Sciences Naturelles.” 2de Serie, t. 10. (Zoologie) p. 91. together, commences with the two inferior portions. After this union, the body of the bone consists only of three parts. The 2nd piece then unites with the lower: the sternal foramen is formed sometimes at the junction of these last mentioned parts, sometimes at the place where the two lateral points of the 4th and of the 3rd portions of the body are united. If the interruption to the progress of ossification should occur at the point where the lateral parts of two sternal pieces would meet, the foramen is likely to have con- siderable size ; for it ma}' be the result of an “arrest of development” proceeding from four centres each constituting a part. ( Fig. 660. d.) The union of the divisions of the body of the sternum takes place precisely in the inverse order of their appearance In fact the appearance of the osseous points proceeds from above downwards, while their union proceeds from below upwards : a fact which verifies the assertion, that the order of development of osseous points is not always correlative to the order of junction. The lowest or 5th piece is joined to the 4th soon after puberty ; the 4th and the 3rd are united, between 20 and 30 years of age ; and the body of the sternum is usually not completed by the junction of the 3rd piece to the 2nd before 35 or 40 years. Lastly, the 1st division does not in general join the rest of the sternum at any period ; but should its union happen to take place, it is only to be met with in advanced age. Of the ossification of the appendix.- — -This is generally accomplished by one nodule. Some- times there are two ; and then they are rarely symmetrical. The process commences in the upper part of the cartilage, and very rarely extends through the whole. The time of ap- pearance of the osseous point is extremely variable. Sometimes it is visible towards the 3rd or 4th year; sometimes not until the 12th or even the 18th year; according to the observation of Beclard, between the 2nd and 18th years. From the 40th to the 50th year, and some- times later, the appendix becomes united to the body of the sternum. From the varieties of ossification or development of the sternum, it will be evident that it is impossible to assign to it a limited number of osseous points. Of tur Ribs. — The ribs ( Costa: from cus- todes *) extend from the dorsal portion of the vertebral column to the sternum, form- ing arches which correspond to the lateral segments of the chest. About one sixth of the ribs are cartilaginous, and the rest os- seous. The osseous portion is the rib pro- perly so called ; the cartilaginous portion is named the costal cartilage. The ribs are 24 in number, 12 on each side ; but cases occasionally occur in which this number is augmented by the addition * As if they were guardians of those principal organs of the animal machine, the heart and lungs. — Munro : The Anatomy of the Human Bones, p. 234. Edingb. 1726. THORAX. 1025 of a pair of cervical or lumbar ribs : in this case the supernumerary ribs are formed from the anterior parts of the transverse processes of either the seventh cervical or first lumbar vertebra ; which affords a strong proof of the analogy existing between a transverse process and a rib. Sometimes the usual number is diminished to 22 : this is more rarely the case. When this occurs, we sometimes find two adjacent ribs united throughout their entire length. Sometimes the first rib is in a rudimentary state, being properly formed posteriorly, but having its an- terior extremity lost among the muscles, or united to the 2nd rib. Mr. Quain has lately seen an instance in which this diminution of the number of the ribs was accompanied with the absence of a dorsal vertebra.* Classification of the ribs. — The ribs are nu- merically designated 1st, 2nd, 3rd, and so on, counting from above downwards. In the living or in the undissected subject it is easier to count the ribs from below upwards. The seven superior ribs are united by means of their own cartilaginous prolongations (Jig. 6G1. b, c, d, e,f g, and h ; and fig. 662.) Fig. 661. to the sternum, and are called true ribs or sternal ribs, or vertebrosternal ribs ; the re- maining five are not so immediately prolonged to the sternum, and are denominated false ribs, or asternal ribs, or vertebral ribs. We think it would be more judicious to classify them otherwise, and consider the five superior ribs as sternal, true, or thoracic ribs ; the jive next inferior, as diaphragmatic ribs ; the two last, being floating or false ribs. Be- cause, the first five especially encompass the cavity of the thorax ; the five next a portion only of this space, together with a large por- tion of the abdominal viscera ; and, lastly, be- cause the two last do not touch the sternum through the medium of any cartilage. The transverse shade (_/tg. 682.) represents the arch * Elements of Anatomy by Mr. Quain and AY. Sharpey, M. D. London, 8vo. 1843, p. 105. VOL. IV. of the diaphragm, or the floor of the thorax. Every rib articulates with the dorsal vertebra; ; Fig. 662. Position of the ribs and spine after deep expiration. the spine is their fixed point, or centre of motion, — the main pillar upon which they act. The superior ten ribs articulate through the medium of cartilages, the first seven through the medium of their own, the next three through that of those of their superior neighbours, (fig. 661.) with the sternum. The ribs have certain general characters which distinguish them from all other bones; and likewise certain proper or special charac- ters, by which one is known from another. I. Of the general characters of the ribs. — The ribs resemble flattened bony hoops, varying in breadth from -4 to '7 of an inch, and from -1 to •4 of an inch in thickness ; they once at- tain a maximum, and twice a minimum length (fig. 662.) Theyareof averyirregularshape. Their arch or curve is neither uniform relatively to each other, nor yet relatively to itself at different parts of the bone ; moreover they are twisted in different degrees upon themselves so that the two extremities of the same bone point in different directions, and cannot simulta- neously touch an horizontal surface. Surfaces. — These bones present two sur- faces : an external or cutaneous surface, which is convex and smooth ; and an internal or pul~ monary surface, which is concave and likewise smooth. The anterior end is comparatively flat, the posterior is more cylindrical and truncated, and is rough, particularly at the extremity. Borders. ■ — The ribs have two borders, the one superior, and the other inferior. The superior border is smooth and rounded, and gives attachment to the intercostal muscles ; 3 u 102G THORAX. the inferior border is more thin and sharp, particularly in the middle third, or body, of the bone. This thin or blade-like appearance is caused by a groove on its inner aspect termed sulcus costalis, which is commonly said to be for the lodgment of the intercostal vessels : this border also gives attachment to the intercostal muscles. The borders are irregular in their direction corresponding with the shape of the rib ; which we shall presently notice. Fig. 663. d Extremities. — (a) Posterior or vertebral extremity. {Jig. 663. c). — This is rougher and somewhat thicker than the other parts of the rib, and is hence denominated its head {capitulum costa). It presents, except in in- stances to be presently stated two articular facets, a superior and an inferior one, sepa- rated by a well-defined ridge. Each of these facets articulates with a corresponding small surface on the bodies of two vertebrae, the ridge just mentioned corresponding with the intervertebral substance. The head of the rib is supported by a narrow round part, somewhat constricted — the neck {Jig. 663. /). This is flattened from before backwards and is the weakest part of the bone. Behind the neck there are some inequalities, which correspond to the trans- verse process of the dorsal vertebra below. Externally to the neck is an eminence known as the tubercle of the rib (tuberos- ity, tuberculum costce , Jig. 663. g), which is smooth in one part for its articulation with the transverse process of the lower of the two vertebrae to which the head is connected, and rough in the other, which is posterior, and in some ribs superior to the above, for the inser- tion of the posterior costo-transverse liga- ment. The tubercles are most prominent in the four or five superior ribs. Anterior to the tubercle the rib suddenly bends forwards, leaving this part the most convex, making what is termed its angle. {Jig. 663. //) The interval which separates the tuberosity from the angle, is the thickest, roundest, and strongest part of the bone. (b) Anterior, or sternal extremity (Jig. 663. d). — The anterior extremity of the ribs is broad, flat, and deeply hollow'ed out at its tip into an oval pit, into which is implanted the costal cartilage. This extremity of the rib is broader and thicker than it is an inch more posteriorly. Body. — This may be described as that part intervening between the angle and the anterior extremity. We have stated that the posterior end is more round than the anterior ; the body, therefore, may be considered as of a transition form, passing from the cylindrical to the flat, blade-like, shape as it approaches towards the sternum. Curve. — The curve which the ribs follow is very irregular, and therefore not easy to describe. No doubt they are of the form best adapted to admit of a great increase of thoracic capacity at_the expense of a remark- ably small movement. They appear to encom- pass the thorax in a somewhat spiral manner (see dark lines Jigs. 682 and 683.) ; to accom- plish which they have three curves, one the common general arch or bend of the bone ; the others the twist of the edges near the extremities termed the curve of torsion. (A) Arch or general bend of the ribs. — This is the most remarkable feature of a rib. What- ever be the curve of the 1st rib, it may be said that each inferior rib describes a curve “one size” larger; so that one rib can be laid close within the other, like hoops of gradually increasing sizes. Two distinct curves will then be seen. It will be ob- served that the part extending between the head and the angle describes a larger cir- cle than the angle itself, which as the name im- plies, is the most acute turn in the bone. More anterior to this, the curve becomes remarkably large ; which Haller has so ex- pressively described as representing the tan- gent to the posterior curve. In connexion with the general curve of the rib should be noticed two linear measurements, viz., the chord and the versed sine. In Jig. 664. is given Fig. 664. T3 T> A Second rib. the 2nd rib ; the line a b is the chord, and d c the versed sine, or a line extending from the chord to the most prominent part of the bend of the bone. The general curve regulates the length of the versed sine. This curve of the rib gives the sides of the chest a power of enlarging, — a lateral mobility, — according to the length of the versed sine, and quite distinct from the antero-posterior enlargement, which is according to the length of the chord. The ribs do not increase the lateral dimensions of the thorax by abduction, but solely by their rotation upon the line a b (B) Curves of torsion of the ribs. — If we take thorax. 1027 the 7th rib and place it on a table it will be observed that the extremities cannot simul- taneously rest upon one plane, because it is twisted upon itself. This is due to what is called the curve of torsion. The rib is twisted at each end ; hence a posterior and an ante- rior torsion. The posterior torsion is most conspicuous, and is therefore more commonly noticed. (a) Posterior torsion. — This torsion is marked at the angle of the rib (h,fig. 663.), particularly upon the convex surface, by an oblique line or a series of faint lines directed from above downwards and forwards. Like other features of the ribs, it passes through gradations, being scarcely perceptible in the 2nd rib, more so in the 3rd, and in- creasing to the maximum in the 8th, in the 9th and 10th it quickly decreases, until it is lost in the 11th and 12th. The greater the torsion the more distinct is the angle ; where the angle is rudimentary the torsion is imper- ceptible, as in the 11th and 12th ribs. The degrees of this torsion as it passes through the ribs are most distinctly seen by having the ribs separate, and placing them on a flat surface with their superior edge upper- most, arranging them so that they do not quite touch each other, when the heads of the dif- ferent ribs will stand up at different heights from the table, forming a somewhat regular wave. This is solely produced by this posterior torsion. (b) Anterior torsion. — Rear the anterior extremity, on the convex surface, in well- developed ribs, we observe an oblique line analogous to that at the angle of the rib, but much less distinctly marked. This line may be considered as forming the anterior angle and corresponding torsion of the ribs, which, like the posterior, is intended for more favour- able muscular insertions. Although the anterior angle is comparatively feebly marked, the anterior torsion of the ribs is as well defined as the posterior torsion. It will be seen in fig. 667, that while the posterior extremity of the rib curls upwards, the an- terior extremity curls downwards. In like manner as we notice the posterior torsion by placing the separate ribs on a table, so may the anterior torsion be as strikingly seen, taking care to place the ribs upon their superior edge so that the sharp inferior edge is turned upwards. The anterior ends will be seen to stand up in different degrees from the table according to their torsion, commenc- ing with the 3rd or 4th and terminating with the 10th rib. Articulations of the ribs. — The ribs are articulated behind with the dorsal vertebrae, and in front with the sternum through the medium of the costal cartilages. This has already been noticed under Extremities of the ribs. Position of the ribs. — The ribs are arranged more or less obliquely, — about midway between the perpendicular and horizontal (. figs. 662. and 683.) ; — and they somewhat diverge from each other as they approach the sternum. (figs. 662. 680. and 681.) Not one of them is horizontal, though commonly re- presented as if they were. Their position is given in fig. 662. This is important to remem- ber, because we shall see that costal breathing altogether depends upon their obliquity. Structure. — The compact and spongy sub- stances are so distributed throughout the whole length of the ribs that they possess a certain degree of flexibility, with great power of resistance. In joung subjects the compact substance is in excess ; in the aged, and in certain diseases, the opposite is the case ; hence the extreme fragility of these bones, which are then broken by the least effort. Development. — The ribs are amongst the earliest developed bones, ossification com- mencing in them even somewhat before it has made its appearance in the vertebra. The deposition of osseous matter extends rapidly throughout them. Each rib (with exceptions to be noticed) is formed from one principal piece ; and two epiphyses. Of these two epiphyses, one forms the head of the rib, and the other the tubercle : their ossification commences between the sixteenth and twentieth years of age ; and they are united to the rest of the bone a few years after, — about the twenty-fifth year. II. Special characters of different ribs. — The differential characters of the ribs, when mi- nutely examined, are well marked ; for, strictly speaking, no two ribs on the same side are of the same shape and dimensions. Although the difference is very small between two con- tiguous ribs, as, for instance, between the cen- tral ribs, i. e. between the 6th, 7th, and 8th, yet it is very conspicuous between those of the top compared with those of the bottom of the thorax. Whatever be the peculiarity under examination, we find it most developed in the 6th or 7th rib ; and below this it becomes less and less marked, until, in the 12th rib, it appears rudimentary. In fact, the 12th rib may be considered little more than a prolonged transverse process ; but not so with the 1st rib, which possesses all the marks and uses necessary to the character of a rib. The ribs differ in their length, and in their chord and versed-sine measurements, and consequently in the area of thorax which they encompass. The thoracic dimensions vary considerably in different men and in the two sexes; yet the relative measurements and weight of the ribs will be found useful to our comprehending more perfectly the res- piratory movements. These relative measurememts are from a well-formed male thorax. The area-measure- ment is calculated from an internal cast of the thorax, cut up slice by slice through each intercostal space. These slices were traced upon paper and measured, giving the absolute area of thoracic cavity encompassed by each pair of ribs, their cartilages, and the sternum. (S eeflg. 668.) 3 u 2 1028 THORAX. Table A. — Relative Lengths and Weight of, and Area of Thoracic Space encompassed by, the respective Ribs, including the Space made up by the Sternum and Costal Cartilages. Rib. Absolute Length. Chord Length. Versed Sine Area Sq. In. Weight, Grains. i 5-25 2-00 1-75 10- 98 2 9-00 3-75 3-00 27- 134 3 11-00 5-10 3-40 40- 181 4 12-25 6-00 3-50 51- 255 5 12-50 6-90 3-50 57- 308 6 12-60 710 3-50 63- 317 7 12-25 7-50 3-30 58"5 391 8 12-10 7-90 3-25 43- 363 9 11-50 7-75 3-10 27- 280 10 10-50 7-00 2-90 20- 216 11 8-25 5-90 2-25 10- 145 12 4-50 3-75 1-00 7-5 60 Fig. G65. represents the above table by curves. The perpendicular lines represent the ribs ; and the curves the characters re- ferred to. By a general view it will be seen that all the lines curve upwards, and are at their highest at about from the 5th to the 9th rib. We shall not treat of particular ribs, but of certain characteristics as they run through the ribs. A knowledge of their shape is ne- cessary to comprehending the respiratory movements in diagnosing thoracic disease. 1. Length. — The length of a rib may be taken in three ways, — its absolute length, chord length, and versed-sine length. (a) Absolute length . — In the length from the anterior to the posterior extremity, (a c b, fig. 664.) the 12th rib is the shortest. The 1 1th rib is nearly double the length of the 12th rib ; likewise the 2nd rib is nearly double the length of the 1st rib ; therefore the 1st and 2nd, and the 11th and 12th differ more re- markably in their length than do any of the other ribs. The length (curve a, fig. G65.) suddenly increases up to the 4th rib ; and then the difference is trifling to the 8th rib ; after this the shortening is as rapid as in the four superior ribs. (b) Chord length. — The dotted line b,fig. G65, represents this measurement. This length from tip to tip (a b, fig. GG4.) of the rib is the chief modifier of the different apparent mobility of particular ribs. If we allow the range of costal movement to be the same in each rib, while each succeeding rib increases in its chord length, the apparent mobility in different ribs will increase exactly as their chord measurement increases. If a rib be three inches long, and if its free extremity by a given movement passes through one inch of space, the free extremity of a rib six inches long will, with the same absolute movement, pass through two inches. The chord length is an important element in modifying thoracic capacity. It is in this measurement that the 1st rib is the shortest and nearly one half the length of the 2nd rib, — as 2- is to 3‘75. (Table A.) The chord length (line b, fig. 665, com- pare with line a,) increases and decreases less abruptly than that of the absolute length. If we were to admit that all the ribs at their fulcra possessed the same extent of mo- tion, still the antero-posterior length of the thorax would be unequally increased, and that exactly in relation to the chord measurement ; Fig. G65. and hence the 7th, 8th, 9th, and 10th ribs advances most, somewhat representing the would advance most. It is a fact that in deep curve line b,fig. G65. inspiration the lower part of the sternum (c) Versed Sine Length (d c, fig. 664.) — THORAX. 1029 As the chord length is to the antero-posterior movement, so is this measurement to the lateral movement of the thorax. This is the most uniform measurement in the ribs. If the 1st rib be D75, the 2nd rib is to that as 3; and from this rib to the 9th rib, the versed sine never exceeds 3'5 ; hence the curve c. Jig. 665. is more horizontal than any of the other curves. So likewise it will be found that the lateral enlargement of the thorax in deep breathing is more uniform than the antero-posterior enlargement. (See dotted line, Jigs. 711, 712. compared with dotted line, Jigs. 713, 714.) The space gained by the ribs rotating must be strictly in relation to the length between the deepest part of the arch and the chord line, (d c,Jig. 664.) This mea- surement is greatest relatively in the 2nd rib, and absolutely smallest in the 12th rib, the curve here being very small. The versed sine of the ribs corresponds with the great curve: if a rib were not curved at all, there would be no versed sine. The versed sine does not increase after the 4th rib; and the curvature of the first four ribs forms smaller circles than the rest. The 5th and 6th ribs, although rapidly increasing in absolute length (see Table A.), yet present nearly the same versed sine; and while the chord line increases up to the 9th rib, from the 6th to the 9th the versed sine decreases, showing that the circle or arch of the rib becomes larger as we descend, until the 12th rib, which describes the greatest curve and the shortest versed sine. In fact there is little difference in the versed sine length from the 3rd to the 10th rib, as described by the double line c,Jig. 665. This difference of arching of the ribs constitutes the conical form of the thorax, the smaller circles being at the apex, and the larger at the base of the cavity. (2) Weight. — The ribs increase not only in their various measurements but also in their weight up to the 7th or 8th where they attain their maximum development. The faint con- tinuous curve, e. Jig. 665. is the line of the relative weight. (3) Torsion of the ribs {special characters ). — We have already mentioned that the ribs have two torsions, an anterior and a pos- rerior. No rib is entirely free from this twist. It is incorrect to believe that the 1st rib is without any torsion, and therefore that the whole rib in its length can touch the same plane. In fact the 1st rib may in one sense be looked upon as the most twisted of all the set, inasmuch as the flat sides which are internal and external in other ribs are in this rib inferior and superior. Like other features, the degree of torsion in the different ribs is progressive towards a maximum, and then towards a minimum. The 2nd, 11th, and 12th ribs are most devoid of torsion. In the last two ribs the torsion ap- pears less than it really is, because of their shortness and the large circle which they de- scribe. The two torsions in each rib are always in contrary directions, except in the 2nd rib, where they are both downwards, but the tor- sion is here very slight. In the 1st rib, as in the ten inferior ribs, they are in contrary di- rections to each other, so that its two ends cannot touch the same plane at the same time ; but its anterior and posterior torsions are respectively contrary to those of the ten in- ferior ribs ; its posterior torsion being, like that of the second rib, downwards, and its an- terior upwards. The relative torsion of the ribs maybe ex- pressed by giving the respective elevations of each extremity from the plane upon which they rest. Thus the posterior torsion is seen when the rib rests upon its inferior edge, and the anterior torsion when it rests upon its su- perior edge. In this way the following table is calculated. Table B. — Torsions of the Ribs. Ribs. Posterior End Torsion Upwards. Anterior End Torsion Downwards. i 6-0* 5‘Of 2 2-5* 3-0 a 3-0 3-0 4 12*5 4-25 5 13-0 12-0 6 12-25 21-5 7 18-00 29-5 8 21-25 28-0 9 21-25 25-0 10 9-50 17-5 1 1 1-50 5-5 12 2-00 4-5 If the posterior twist of the ribs upwards be expressed conjointly as 114, the anterior tor- sion downwards is 153 ; therefore the anterior torsion is greater than the posterior. The torsions in the 2nd, 3rd, 11th, and 12th are the least; and they are the greatest in the 7th, 8th, and 9th ribs. Moreover as the tor- sion increases at one extremity of the rib, for the most part it increases at the other like- wise. The ribs of some persons are much less twisted than those of others. This is parti- cularly the case in young subjects before the age of puberty. In infants the torsions are imperceptible ; therefore they increase as we advance to maturity. These torsions afford more favourable traction for the muscles. Where the respiratory movement is most ap- parent, as from the 4th to the 9th rib, the torsion is highest. t The posterior torsion gives the ribs, when placed in their natural position, a very oblique direction with reference to the spine. This is very important to remember; for the more oblique, the more favourable are they for mo- bility or for increasing the thoracic cavity. For the same reason the anterior torsion, being in a contrary direction to the posterior, increases still more the obliquity of the rib with refer- * Downwards. j- Upwards. 3 u 3 1030 THORAX. ence to the spine. But the relation of these torsions to the spine are different : the pos- terior torsion is relative to the spine late- rally, while the anterior torsion relates to the spine more in the antero-posterior direc- tion : they both conspire to increase the obli- quity of the rib in one given direction, — from above downwards. The torsion of the 1st rib, we have noticed, is directed in a contrary direction to that of other ribs ; and we have observed that the presence of torsion in general favours muscular traction : but the 1st rib is an exception to this ; here the torsion exists only between its two chief articulating pro- cesses, — the head and the tubercle : in the other ribs the torsion is between the tu- bercle and the body of the bone. The pos- terior torsion of the 1st rib appears to be merely destined to afford the head a more complete attachment to the body of the one vertebra (the 1st dorsal) to which that rib is fixed. A posterior torsion, in this short rib, is not needed for muscular traction, be- cause here the scaleni are placed in the most favourable position — nearly at an angle of 90° with reference to the body of the bone in question, while their other insertion into the cervical vertebras facilitates the most ex- tensive and favourable means for its mobility, independently of any favouring twist in the lib for that purpose. (4) Surfaces ( special differences). — The thorax being conical, or somewhat barrel- shaped, it follows that the surfaces of the ribs, like the hoops of a very spherical barrel, must gradually change their direc- tion ; thus the surfaces of the 1st rib are nearly superior and inferior, this bone forming the lid to the thorax, while the surfaces of the 6th or 7th rib are external and internal, and as we proceed downwards to the 10th, 11th, and 12th ribs, the surfaces are again slightly tending towards a superior and inferior po- sition, so that the internal surfaces of the 1st and 12th ribs are directed somewhat towards each other. The body of the rib, or that part which covers the lung laterally, and the anterior and posterior extremities, have also their surfaces inclined in different directions. Thus, take a perfect rib, say the 7th, laterally to the thorax the two surfaces are internal and external, while at the anterior end they are directed — external surface, forwards and downwards ; internal surface, upwards and backwards ; — at the posterior end, — external surface, upwards and backwards ; internal surface, downwards and forwards. This is produced b}' their respective torsions. In some of the lower animals the ribs overlap each other like the tiles of a house; this sometimes threatens in man, particularly in diseases of the spine (y?g. 666.), when they closely approach each other. (5) Specific differences of the extremities of the ribs. — The greatest difference is in the posterior end of the rib. The anterior pre- senting little difference. (a) Anterior extremity. — These are all hol- lowed out for their cartilage. As the ribs become more perfectly developed, for in- stance, the 5th, 6th, 7th, and 8th, the an- terior extremity is broader, but not more deeply hollowed out than some of the other ribs, which are less perfectly developed, as in the 2nd and 3rd, or 11th ribs. This extremity is most pointed in the 12th rib. Fig. 666. (b) Posterior extremity. — The posterior ex- tremity of the rib is more complicated, and has certain named parts, as the head, neck, tubercle, and angle, all of which become modi- fied as we pass from above downwards. Their differences may briefly be noticed. 1st Of the head. — On the head of the rib, articulating with the vertebrae, a surface or facet is formed. The 1st, the 11th, and the 12th ribs articulate each with the body of one vertebra, and therefore they have one arti- culating surface. All the rest articulate each with the bodies of two vertebrae, and they consequently have two such articulating sur- faces as already described. The head of the 1st rib is relatively larger than that of the others. For the most part, as the ribs in- crease in size, the head likewise increases, so that in the best developed rib the head and its surfaces are most perfectly formed, dege- nerating again to the 12th rib. 2nd Of the neck. — The neck being that part of the rib between the articulation of the rib with the bodies of the vertebra, and that with the transverse process, and these points differing but little in their distance from each other in the dorsal vertebra?, it follows that the absolute length of the neck of the different ribs is nearly the same. The necks of the ribs differ in their thickness, ac- cordingly as their respective ribs increase or diminish in size ; therefore, in the middle THORAX. 1031 set of ribs, the necks are the thickest and strongest. In the 11th and 12th ribs, the neck, according to our definition, does not exist. 3 rd Of the tubercle. — As the tubercle ar- ticulates with transverse processes, those ribs which have no such articulation have no tu- bercle; this is the case in the 11th and 12th ribs. The tubercles are most prominent in the superior ribs, gradually degenerating, or be- coming less apparent, down to the 10th, where it is almost rudimentary. \lli Of the angle. — In strict anatomical lan- guage, the 1st rib has no angle, but the tu- bercle is very prominent, and gives the bone a very angular appearance, likewise in the 2nd, 3rd, 11th, and 12th ribs the angle is almost imperceptible, whereas it is well marked in the 4th, 5th, Oth, 7th, 8th and 9th ribs. (6) Groove ( specific differences ). — The groove is not perceptible in the 1st, 11th, and 12th ribs, but distinct in all the inter- vening ones. The 1st rib has two depressions separated by a tuberosity. The anterior corresponds to the subclavian vein, and the posterior to the artery of the same name. Costal cartilages. — The flexibility and elas- ticity of the ribs is partly owing to their struc- ture, but more especially to the cartilages which prolong them in front. (Jigs. 661, 662.) There are twelve costal cartilages distinguished numerically, as 1st, 2nd, 3rd, &c. ; they are separated from each other by intervals which are very considerable at the upper part of the thorax, but gradually diminish as we proceed downwards. It is not very un- common to meet with thirteen cartilages on one side, and at other times there are only eleven. Sometimes two cartilages are joined, and so aticulate with the sides of the ster- num ; when there are thirteen cartilages, the supernumerary one generally exists be- tween the 3rd and 4th ribs ; it is thin, and as it were rudimentary ; it does not form the continuation of any rib, and terminates insen- sibly in the muscles. The cartilages from the 1st to the 7th articulate immediately with the sternum ; and hence the name of sternal given to ribs with which they are connected. Of the other five cartilages, the last two have no connection with that preceding them ; and from this circumstance, the name floating has been given to the last two ribs. General characters of the costal cartilages. — All the costal cartilages are flattened like the ribs, and precisely resemble in breadth and thickness the bones to which they are attached. The external end is received into a cavity hollowed out in the anterior extre- mity of the lib; their internal or sternal ex- tremity, which is much narrower than the external, is angular and articulates with the corresponding angular surfaces of the ster- num. ( fig. 661.) Their anterior or cutaneous surfaces are slightly convex, and covered by the muscles of the anterior region of the trunk, to many of which they give attach- ment. Their posterior or mediastinal surfaces are slightly concave. Their superior and inferior edges bound the intercostal spaces, and give attachment to the intercostal muscles. “ They are,” says Cruveilhier, “ altogether distinct from articular cartilages, and have a peculiar tendency to ossify, this process taking place partly on the surface, and partly from within outwards.” Differential characters of the costal carti- lages.— The costal cartilages, like the ribs, increase in length, from the 1st to the 7th, and sometimes the 8th, which in this case articulates with the sternum ; from this they diminish in length to the 12th rib When we recollect the conical shape of the thorax this difference is to be accounted for, and moreover, the osseous parts of the upper ribs terminate anteriorly in a line directed ob- liquely from above downwards and outwards. The sternum is only about half the length of the lateral pectoral space, so that only the first four or five cartilages could join this bone, did not the others turn upwards to reach its sides (fig. 661 .), by joining the lower edge of the immediately superior cartilage. The first three cartilages alone, therefore, fol- low the same direction as the long rib to which they articulate. The first cartilage differs from all the others by its shortness, its thickness, and breadth, and its tendency to ossify ; it is often, but not always, continuous with the sternum. The 2nd and 3rd costal cartilages cannot be distinguished from each other, but they differ from the rest in being joined to the sternum at right angles, in not being bent, and in being as broad at their sternal as at their costal extremities.. The 4th cartilage becomes bent upwards, after having followed the direction of the rib for a little way. (fig. 661. ‘ small, it 1031 THORAX. matters not which, aerates the blood from this food by movements, quick or slow, long or short ; therefore the respiratory movements only, need be relative to the abdominal cavity, in the same way as the volume of the blast from a pair of bellows is more dependent on their mobility than on their absolute size. The above remarks are applicable to the thorax of either male or female. I. Boundaries of the thoracic cavity. — The thoracic cavity, situated between the shoul- ders and below the neck, extends but a short way downwards, in the male about seven inches, and in the female about eight inches, below the clavicle, so that a horizontal line drawn about an inch below the axilla, corres- ponds (roughly) with its floor. The floor of the chest, therefore, is much higher up in the trunk of the body than is commonly supposed. The thorax is bounded anteriorly by the sternum and costal cartilages ; laterally by the bodies of the ribs and the intercostal muscles ; posteriorly by the vertebrae and angles of the ribs, and interiorly by a thin tendinous and fleshy floor — the diaphragm. The su- rior aperture of the chest is about sixteen inches in circumference, this is the smaller end, and thence called the apex of the tho- rax. It is bounded laterally by the two 1st ribs, anteriorly by the upper edge of the sternum and inter-articular ligament, and posteriorly by the last cervical and first dorsal vertebrae. The inferior aperture is about thirty or thirty-one inches in circumference, and forms the base of the chest. Anatomists describe this part as bounded in front by the cartilaginous extremity of the sternum or xiphoid cartilage, and the cartilaginous extremities of the last true and false ribs, and more laterally by the 1 1th and 12th ribs, pos- teriorly by the last dorsal and first lumbar vertebrae. But as they assume to themseives the privilege of giving a bone a surgical neck as well as an anatomical one, so may we take a similar liberty in describing the thorax for medical purposes. In the examination of the chest during life, too exclusive attention to anatomical boundary has probably led to the error, of regarding the chest as much deeper than it really is, and thence to examining for disease of the lung where really little or no lung exists. A sharp instrument, piercing the chest laterally, at the cartilaginous extremities of the last true ribs, would most probably pene- trate no lung, for the liver, spleen, stomach, &c. are contained within these points. The bottom of the chest is so moveable and so much arched (See art. Diaphragm, fig. 3.), that in the different stages of inspiration, the lung assumes different positions This may be demonstrated by percussing over the 5th rib at its junction with its cartilage, first after a deep expiration and then after a deep inspira- tion ; in the latter the sound is “ clear,” in the former it is strikingly “ dull.” Therefore, instead of taking the insertion of the dia- phragm as the bottom of the thorax, it will be found more convenient for examining the chest to take the top of the arch of this muscle as the lower thoracic boundary, or the shaded line crossing the ribs in fig. 4., for the medical base. This may be described as corres- ponding in front with the xiphoid cartilage ; laterally to different osseous portions of the 7th, 8th, 9th, 10th, 11th, and sometimes the 12th rib (fg. 682.), and posteriorly to the 8th and 9th dorsal vertebrae. This will [dace the bottom of the thorax in a very different posi- tion from what is generally supposed ; for, if we express the distance from the 1st rib, to the lowest point of the 10th rib as 13’5, that from the 1st rib to the arch of the diaphragm or medical boundary will be only 6-25, less than one half the depth of the thorax as ana- tomically described. The medical base of the thorax forms a nearly horizontal plane, which extends between the sternum and the bo- dies of the 9th or 10th dorsal vertebrae, its posterior being somewhat higher than its an- terior. But on each side of the bodies of the vertebrae there is a deep groove formed by the angles of the ribs. In that part of this groove which extends below the above-mentioned in- clined plane, a wedge-shaped process of lung is lodged, which varies in size in different sub- jects, and consequently will be found to ter- minate at different points in the dorsal re- gion, as already noticed, sometimes hanging down like a broad, thick flap, and at other times forming only an insignificant process. In examining the chest, it is of paramount importance that the student should familiarly know this medical floor of the thorax. The sign laid down by the late Dr. Edwyn Har- rison, for marking this boundary, we have found strictly correct in every normal-shaped thorax. Namely, take the xiphoid cartilage as a point to start from, anti pass the flat hand horizontally from thence to the side of the chest, the index finger, when horizontal, will distinguish a slight depression or sulcus at the maximum lateral bulge of the thorax, then from this point slide the hand slightly upwards (perpendicularly), and it will pass over a bulge, about enough to fill the palm of the hand, into another sulcus, better defined than the former one ; this groove corresponds with the medical base of the thorax, and a probe passed in here would graze the arch of the diaphragm after passing through the moveable inferior edges of the lungs. It is necessary that the hand be kept perfectly horizontal, or it will fall into an intercostal space, which does not correspond with the groove in question. With practice, the hand falls at once into the upper sulcus, without first searching for the lower one; indeed, latterly, Dr. Harrison allowed that the lower sulcus might be absent, and yet the upper one present. This groove is higher upon the right side than upon the left, corresponding to the height of the liver. By external observation, the medical base of the thorax may be known by the slight rota- tory motion made upon the diaphragm when a person is walking. A kind of great ball and socket-joint may be conceived to exist between the abdomen and thorax, and the THORAX. 1035 outer garments even exhibit a correspondence to this base of the thorax. II. Contents of the thorax.- — -Not only does the thorax contain organs proper to itself, but it lodges and protects others passing to the abdomen ; thus, the food we eat passes through the thorax to enter the stomach, while the eighth nerve both supplies the lungs and then passes onwards to the stomach. Like other cavities, the thorax is lined with a serous membrane ( pleura costa/is), which like- wise invests the lungs ( -pleura pulinonalis ) (See Pleura). The heart and its blood- vessels, the trachea, and the lungs, almost completely fill the thorax. The remaining organs, viz., the origin of the sterno-hyoid and -thyroid muscles, remains of the thymus gland, lymphatic glands, mammary vessels, triangulares sterni muscles, the phrenic, the eighth pair, and the splanchnic nerves, the oesophagus, thoracic duct, vena azygos, and venae cavae, occupy very little space. Thus the thorax is completely filled. The older anatomists, however, even as late asBenj. Headley’s time, considered that there was a considerable space containing air, between the lungs and the walls of the thorax. Now, we know that any considerable accumulation of air in this situation would be destructive sto the respiratory function. III. Shape of the thorax. — The shape of the thorax is subject to many varieties which may be conveniently studied under the fol- lowing headings : External thorax. — The thorax in the perfect subject is somewhat conical, broader above than it is below ; but when deprived of the upper extremities and their appen- dages, the contrary obtains, for it is nar- rower above than it is below (see figs. 662. and 630. et seq.). Therefore the notion we commonly connect with broad shoulders or broad back, has but a feeble relation with the absolute breadth of the thorax. In fact the diameter of the neck corresponds more correctly with the diameter of the upper part or true apex of the thorax. Freeman the American giant measured 26 inches from tip to tip of his shoulders, while the diameter at the lower part of his neck, in the same direction, was only 6 inches. In women the mammae materially add to the dimensions of the chest towards the apex. We have found the measure of a female round the thorax over the mammae 4* 5\ inches, while the root of the neck was 15 inches. Allowing two inches for muscle, &c., the true thoracic apex would not exceed 13 inches, whilst 45^ inches was the apparent circumference of the thorax. The true apex of the thorax is loaded with large muscles, sometimes a vast quantity of fat, the upper extremities, and in the female with large mammas besides. The true baseof the chest is comparatively little covered, particularly below the axilla, where the serrati are seen. This is the weakest and thinnest part of the thorax, but it is well protected by the arms. (a ) The anterior or sternal region of the tho- rax.— In a well-developed thorax the sternum appears to lie in a fossa formed by the pecto- rales and mammae. This region assumes more or less of the perpendicular, according to the carriage of the person ; a perpendicular drawn to the external plane of the sternum would, however, be directed upwards. Laterally to this, the costal cartilages articulate with the sternum ; and, still more laterally, the ribs and their cartilages unite, forming an oblique ridge from above downwards. (See fgs. 680. and 681. the line on each side of the sternum.) Still more externally, and parallel to this, may be noticed the projections formed by the anterior angles of the ribs, which bound the anterior region. (b) The posterior or vertebral region. — In the well-developed thorax the spines of the dorsal vertebrae lie in a deep groove formed by the great mass of the erector spinas on either side. These masses extend outwards to about the posterior angles of the ribs, which are nearly in a plane with the spinous processes of the vertebrae, and may be easily distin- guished, bounding the posterior region. (c) The lateral or costal region is composed of the bodies of the ribs and the intercostal spaces. Much difference has prevailed amongst writers upon various points con- nected with the ribs, and the spaces be- tween the ribs. Probably this may have arisen from their having made their observa- tions upon the dead subject, wherein the ribs have collapsed to their minimum, or the thorax of a thin subject with the ribs expanded by, perhaps, 200 cubic inches of air, or the ribs when artificially articulated in the clean skele- ton, wherein they are generally arranged too wide apart and too horizontal. In the collapsed state of the ribs, i. e. after the most ample expiration by death, we no- tice 1st, That the intercostal spaces are not of a uniform width from the vertebrae to the ster- num. They are most narrow behind, and be- come wider as they approach the sternum {fig. 680.). The 1st, 2d, and 3rd spaces upon tile whole are broader than the five next in- ferior, and the 10th and 11th spaces are the widest (fig. 682.). 2dly, Their length differs with the length of the ribs ; thus the two first and two last spaces are the shortest. 3dly, The position of the intercostal spaces is very oblique (fig. 684.), roughly speaking, about mid-way between the horizontal and the perpendicular. 4thly, They are moveable, and in the dif- ferent stages of respiration they can assume different positions and different perpendicular widths. It has been found necessary for the con- venience of auscultation, to subdivide the thorax more minutely. The subdivision pro- posed by Laennec has been generally adopted, although some of the terms, like those of the respiratory sounds, have been modified by writers of later date. The anterior and lateral superior division, J036 THORAX. Table C. — Thoracic Regions. REGION. Anterior : Clavicular (subclavian of Laennec) - Infra-clavian (anterior superior of Laennec) Mammary ------ Infra-mammary (sub-mammary of Laennec) Sternal — superior, middle, inferior - Lateral: Axillary ------ lnfra-axillary (lateral of Laennec) Inferior-lateral - Acromial ------ Posterior : Scapular, upper and lower Interscapular ------ Infra -scapular (inferior dorsal of Laennec) SITUATION. Portion covered by the clavicle. Between the clavicle and 4th rib inclusive. Between the 4th and 8th ribs. From the 8th rib to the cartilaginous border of false ribs. Over the respective parts of the sternum. All the axilla to the 4th rib inclusive. Between the 4th and 8th ribs at the side. Below the 8th to the false ribs inclusive. Between the clavicle, neck of humerus, and along the upper margin of scapula, includ- ing the root of the neck. Supra-spinous fossa and infra-spinous fossa. Between the inner margin of scapulae. Below inferior angle of scapula and border of serrati to the level of I2th vertebra. give the clearest sound upon percussion, and the back the least clear. Below Harrison’s line, there is little or no evidence, from percussion, of the presence of lung, except in deep inspiration, and then the sound on per- cussion is mixed with other sounds from the abdominal organs. Only a small part of the mammary region covers lung, scarcely any being subjacent to the anterior parts of the Cth,n7th, and 8th ribs. (See .fig. 4, wherein a transverse shading indicates the diaphragm. ) Internal conformation of the thorax. — To comprehend clearly the internal shape of the thorax, it is necessary to take a cast of this cavity. This may be done by making an open- ing in the sternal region, just large enough to admit the hand to remove the heart and lungs, filling up the whole of the cavity with plaster of Paris and returning the sternum, then opening the abdomen, cutting away the diaphragm, and so removing the cast, which wives us a clear knowledge of the internal conformation, and every kind of measurement correctly. ( Fig. 667. is a cast from the cavity of figs. 680—685, — male subject.) We have stated that the perfect thorax viewed externally, and the same when the superficial muscles and upper extremities are removed, differ widely in their relative form. The tho- racic cavity likewise differs remarkably from either of these views. The general view is that of a cone, but broader from side to side than from before backwards : therefore the cone is somewhat flattened. (a) Anterior region. — This very closely re- sembles the anterior region of the external surface, being convex in its form, precisely corresponding with the concave sternum. The upper part, immediately behind the supqior end of the sternum, is rather concave {fig. 667 ). At this part the cavity divides into two small cones, for the reception of the right and left apices of the lungs, which ascend upwards to a variable height, — an inch or an inch and a half. Both apices of the lungs are directed from below, upwards Fig. 667. a Cast of the cavity of the thorax represented in figs. 1, 2, 3, 4, 5, and 6. and forwards ; it is incorrect to consider them as directed backwards ( fig. 667. a, which is the left apex seen above the 1st rib.) In some cases, particularly where the lung presents a puckered appearance, the axis of the apex is inclined nearly to the horizontal, and at all times it is about per- pendicular to the sternum. These apices, throughout advancing life, are tending to in- cline forwards ; it is this portion above the 1st rib (fig. 667.), which is so vulnerable in phthisis pulmonalis. There is great difference in the precise character of these apices in different individuals ; in fact we have seen no two the same ; some are remarkably truncated, and broad from before backwards ; others are thin in this direction, and pointed ; some obtuse and low, others acute and high. They have the THORAX. 1037 same characters in both sexes. There is little difference in the height of the two apices. The elevation of the liver on the right side does not necessarily cause the right apex to be the higher. The right lung is more shallow than the left; but this is not because it is “ pushed up,” but because, in order to ac- commodate the liver, there is less lung- substance on the right side. It the mean of a series of observations represents the right side of the thoracic cavity as equal to 151, the left may be given as 182. The same may be said of both sexes. (Li) Posterior region. — If we examine this region upon a cast of the thoracic cavity, we observe in the middle line a deep fossa, formed by the projection, to the very centre ot the thoracic cavity, of the bodies of the dorsal vertebra. This fossa is wider towards the base of the thorax, as may be seen by comparing the dif- ferent sections of the cast (compare the notches, 10, 11, and 12, with those of 3, 4, and 5 in Jig. 668.). Fig. 669. ; Sections of a cast of the thorax showing the space encompassed by each pair of ribs respectively. The bodies of the thoracic vertebrae, form almost a complete septum ; they are certainly a central column of support for the whole trunk of the body, bearing an equal distri- bution of the superincumbent weight in all directions. There is no part of the skeleton which more strikingly demonstrates that man was destined for the erect posture, than this central position, together with the increasing dimensions from above downwards, of the vertebral column. These conditions exist only in the human subject. The groove in the cast formed by the dorsal vertebrae is directed upwards and forwards, so that at the apex of the thoracic cavity it completely divides the lungs, producing two little cones laterally for the lungs, forming the right and left apex. At the base of the thorax this perpendicular column again completely divides the lower lobes of the two lungs. The shape of the posterior part of the cast is that of a curve directed upwards, and sharply forwards, near the apex (fig. 6 67.). This curve near the apex is, like the form of the apices, very various. An inflated lung assumes the same shape as this cast, giving even the marks of the ribs. The student, in order to have a correct idea of the lungs, should remove them from the body with the heart attached ; then inflate them to their utmost, when their shape, their lobes, and relative mass before and behind, are clearly seen. If now we inspect the cavity of the thorax itself, we find that the bodies of the vertebrae by their projection as above described, divide the posterior portion of the chest into two vast lateral grooves, which lodge the posterior portions of the lungs; these two grooves, partaking of the form of the thorax, are consequently conical in their configuration. They lodge fully one half of the entire lungs. This is worthy of remembering in reference to diagnosis, particularly when pneumonia is sus- pected ; in such cases auscultation of the dorsal region demands as much attention as that of the anterior region. Though less vulnerable to phthisis pulmonalis, yet it may lodge disease in parts comparatively remote, and where in- flammation may insidiously gain serious ground upon the patient, particularly in children. (c) Lateral region. — This precisely corre- sponds with the external lateral view of the thorax (compare fig. 667. with Jig. 680.); it presents indentation of the ribs, resembling a diagonal, curved, grate. (d ) The base of the thoracic cavity has been described above. Conformation as affected by age and sex. — Age alters the conformation of the chest. In the earlier periods of existence the thorax is the smallest of the three great cavities, probably from the inactivity of the lungs. In the foetal thorax the antero-posterior dia- meter exceeds the transverse diameter, the sternum projecting forwards, and the heart and thymus gland filling up the middle of the cavity. The ribs in foetal life are less curved, and conse- quently those deep grooves, seen in the interior of the chest on each side the spine, formed by the angle of the ribs, so conspicuous in after life, are almost wanting ; the vertical depth also is much less at this period, because the lungs are unexpanded and unemployed, while the abdominal viscera, particularly the 1038 THORAX. large liver, are in activity and pushing up the diaphragm. The superior opening or true apex is greater from before backwards than trans- versely, which is the very contrary to the adult conformation. The inferior or true base of the thorax is extremely wide in every direction, from the encroachment of the ab- dominal viscera. At birth the thorax sud- denly enlarges, by the air expanding the lungs to two or three times their previous cubic dimensions. As age increases, the curvatures of the ribs increase, and, with the vertebrae, running up through the very centre of the tho- rax, form the two great lateral grooves, peculiar to man, for lodging the chief bulk of the lungs. The depth of the thorax is diminished, while its breadth is increased, and this participates in that more perfect development of the system at the age of puberty. It is at this time that malformation of the chest fre- quently becomes obvious, particularly in females. In the adult age the thorax still grows, but in a degree less apparent, until it assumes the form of what is termed an open chest, capable of expanding in any di- rection, supplying us with air under violent exercise, and resisting severe blows. As age advances, through the decline of life, the thorax has a tendency to collapse ; the bony framework threatens to unite into one rigid cage, the true apex droops forward, the shoul- ders appear higher, and the round back of old age becomes apparent, so that we may make a tolerable guess at the age of an individual by the conformation of the back. The erect thorax is absolutely necessary to healthy vigour, while the drooping-forward chest is always accompanied with proportionate feeble- ness. Sex. — The chief difference of external conformation between the sexes is due to the largeness of the mammae, and the less width across the shoulders in women than in men. There is no distinguishing the sexes by the internal form of the thorax, they so perfectly resemble each other. The chest of the female is only absolutely smaller, but not al- ways that, certainly not relatively so. The nipples are not uniformly in the same posi- tion ; those of the female are generally closer together than those of the male. Conformation of the thorax affected by disease and occupation. — The conformation of the thorax chiefly depends upon the healthy condition of the main pillar of support, the spine ; but not always so, for that deformity called “ chicken breast ” appears to be inde- pendent of the condition of the spine. And, again, emphysema of the lungs tends to pro- trude the ribs and advance the sternum. Disease, as caries of the vertebrae, or an atonic condition of the thoracic muscles, owing to which the spinal column may yield, either laterally, producing “ lateral curvature,” or an- teriorly, giving “ angular curvature,” produces the most marked distortion of this pillar of support, and consequently of the whole thorax. In youth, particularly in females, (from the pre- sent system of education,) the spinal column, which is at all times sufficiently flexible, bends under the weight of the head and arms ; and for want of proper exercise the muscles of the back become enfeebled, and unable to restore it to the erect position. When “ rickets” attack the spine, it may curve in any direction, com- pressing the ribs and projecting the sternum. It is surprising to witness to what an extent of deformity the thorax may attain, and yet life still remain (see fig. 666., where costal respiration could not exist ; and where all the abdominal viscera must have been forced up into the cavity of the thorax, for the 10th rib is nearly touching the crista of the ilium). We have noticed a case where such was the effort of nature to pre- serve the thoracic and spinal cavities, that life was maintained in a boy 14 years of age, though 7 bodies of dorsal vertebrae were com- pletely absorbed. In emphysema of the lungs, the sternum is protruded, and the antero-posterior diameter of the thorax is increased sometimes by an inch, the shoulders are raised, and the person assumes always the form of a man who has made the deepest inspiration. In phthisis pulmonalis, the thorax changes its form, which is manifested by the shoulders inclining forwards, the anterior and superior parts bending in the same direction ; the otherwise round full apex becomes flattened, collapsing upon itself; and there is an in- capacity to extend the apex ; this is a sure and delicate test of that disease threatening, before any symptoms can be detected by au- scultation. In other stages there is a loss of symmetry in the sides. In pleuritic effusion or in empyema, one side may be full and immov- able, whilst the other has to perform the respiratory functions. In fact, disease of the respiratory organs may produce a change in the form of the thorax, either downwards, upwards, or outwards, or by collapse of the apex. Frequently repeated or permanent compres- sion, may produce many varieties of conforma- tion of the thorax. Cruveilhier observes that infants, in whom the thorax was perfectly well formed at birth, have become deformed and flattened on the sides of the thorax, by pres- sure from the hands of the nurse. Slight ex- ternal pressure in early life may be productive of permanent deformity of the thorax, The effect of strong and permanent constriction, as from tight stays, occasions a distortion in the form of the chest. This kind of com- pression principally affects the lower part of the thorax ; so that the 5th, 6th, 7th, 8th, 9th, and 10th ribs are pressed forwards and in- wards, because the length of their cartilages allow them to yield readily : and the viscera corresponding to these ribs, also undergo alteration in their position and figure, en- croaching upon the thoracic cavity, com- pressing the lungs upwards, into the apices of the chest. The imprudent custom of females wearing a hard unyielding piece of wood, steel, or whalebone up the front of their corset, commonly produces a compression inwards of THORAX. 1039 the sternum. We once noticed a case where the sternum was forced inwards to such an ex- tent, that the entire depth of the thorax, by external measurement, from the middle of the sternum to the corresponding part of the back, only measured 2 inches instead of 8 or 9 inches ! Occupation likewise modifies the form of -the thorax. The clerk who writes many hours at the desk, carries himself dif- ferently to the soldier. Coal-miners have stooping chests when they work in districts where the coal seam is thin, and the roof consequently low, as in the north of Eng- land. In fact, all trades or occupations which require stooping for many hours to- gether, tend to injure and malform the chest. Pigeon- or chicken-breast. — This is a mal- formation quite distinct from any of the above mentioned, always affecting the sternal region in particular. An explanation of this curious disease has attracted the attention of Mr. Shaw, to whom we are indebted for the following remarks.* He noticed the effects produced upon the thorax by violent efforts of breathing in a child with croup. If we watch, says Mr. Shaw, the motions of the thorax in a young patient who is in danger of suffocation from an obstruction in the wind-pipe, we shall perceive that at each inspiration, while the superior ribs and sternum are raised and protruded as in com- mon costal, breathing, the lower ribs are, at first, flattened, and then drawn inwards, so as to produce a deep indentation on both sides. The depression is greatest in the line of junction of the ribs with their cartilages ; it is as if a band had been tied tightly round the waist, or resembles the indentation near the margin of the chest, often seen in women from tight lacing. The constriction lasts during inspiration ; in expiration, the ribs by their elasticity flap out and recover their form. That the lower ribs should be drawn inwards in the act of inspiration, diminishing the area of the chest at a time when their natural motion should enlarge it, will be un- derstood by considering the relative conditions of the thorax and the lungs in the laboured respiration which arises from obstruction in the wind-pipe. Under the sense of impend- ing suffocation, the young patient instinctively struggles to enlarge the cavity of the chest to its greatest capacity ; but, while that effort is making, the quantity of air that passes into the lungs is very small, because of the obstruction in the larynx or trachea : a portion of air may reach the air-cells at the apex where the bronchial tubes are short, but little or none penetrates so far as the base of the lungs ; consequently the lungs are imperfectly dilated. If the child succeed in enlarging the area of the chest in proportion to its powerful efforts, while the lungs were at the same time but partially dilated, it would follow that a vacuum would be produced in the space between the * Deformity of the Chest from Dyspnoea, Oct. 1841. bond. Med. Gaz. New Series, vol. i. 1842. parietes of the thorax and lungs. But owing to the great flexibility of the ribs near the lower margin of the thorax in childhood, the atmospheric pressure overcomes the action of the muscles, and thrusts in the sides so as to preserve the balance of the air w'ithin and that without : in common language, the walls of the chest on each side are “ sucked ” inwards, like the valve in a pair of bellows. When we look at the general shape of the chest during the continuation of the con- striction, we perceive at once a resemblance to the pigeon-breast deformity ; there is in both the same protrusion of the sternum, and the same depression of the cartilages on each side. The question therefore arises, can the de- formity have a similar origin to the change in the figure of the chest which is caused by difficult respiration ? Dupuytren wrote a memoir upon this form of distortion, and he has shown that difficult respiration and pigeon- breast deformity are frequently associated to- gether, so that he has almost constantly found that patients who are pigeon-breasted have at the same time enlargement of the tonsils ; but Dupuytren does not profess to explain why the two complaints should go together. Some years ago Mr. Shaw had under his care a little boy with greatly enlarged tonsils, which were very low down in the throat, owing, as it appeared, to their having got within the grasp of the constrictor muscles of the pharynx. He had constant dyspnoea, and occasional fits of suffocation, in one of which Mr. Shaw performed laryngotomy: on his admission into the hospital, and for several weeks afterwards, it was observed that he had the “pigeon-breast” form of chest; but after his tonsils were excised, and his breathing had been perfectly free for some time, the sternum subsided to its proper level, and the thorax recovered its natural shape. These facts prove that a connection, like cause and effect, exists between obstruction of the air passages and pigeon-breast de- formity. It is not necessary that such impe- diments should be so great as to produce strongly marked symptoms of dyspnoea ; for, while the distortion is being produced the child is growing, — both the size and shape of the chest are undergoing a natural change. Mr. Shaw justly considers it quite possible that a cause which may have very slight in- fluence in changing the figure of the thorax, if operating only for a week or a month, will, if continued longer, disturb and modify the pro- cess of growth ; so that after intervals of half- years or years, a decided effect will be exhibited in the form of the chest. It is not impossible that continued disease in the air passages of children, which may fail to attract much at- tention, or at least may not be thought capa- ble of producing distortion, may nevertheless gradually and insidiously give rise to the per- manent deformity of “ pigeon-breast.” Mr. Shaw particularly refers to enlargement of the tonsils, attended even with slight incon- venience; to enlargement of the lymphatic low THORAX. glands in the course of the trachea or bronchi ; to pressure upon the trachea by the thymus gland, when later than natural in being ab- sorbed, or when hypertrophied ; and to mor- bid thickening of the mucous membrane of the larynx, or of the trachea and bronchi succeeding croup or cynanche pharyngea. We concur with these views upon this sub- ject, the more so as we likewise have noticed the pigeon-breast in children where enlarged tonsils have been present. We must not imagine from this that, where there is dyspnoea, there we shall always find the deformity in question ; for difficult breathing may be caused by other circumstances than those which dis- turb the counter-pressure of the atmosphere in the thorax. IV. Dimensions of the thorax. — The mea- surement of the thorax may be considered externally and internally; and, what is most remarkable, the one class of measurements may not have any relation to the other class. Moreover, the external measurements bear a certain proportion to the whole frame, whilst the internal do not. (a) External measurements of the thorax. — The external dimensions of the thorax differ much in different men ; this is obvious to all. There is the broad-chested and the nar- row-chested man. Mr. Brent has calculated, from an extensive number of observations, the following proportions, which we arrange thus : — Table D. — Relation of the External Chest to the Height, measured over the Nipples. Minimum chest : £ of the stature — of the stature = circumference of chest. Medium chest : of the stature + fg of the stature = circumference of chest. Maximum chest : 4 of the stature = circumference of chest. For example, let us suppose a height of Cl inches, as follows, — Minimum chest : height 61 in., £ = 30‘5 in. — J, = 29-5 in. circumference of chest. Medium chest: height Cl in., 4 = 30-5 in. + Maximum chest : height 61 in., § = 40’7 in. Thus, by taking the most perfectly propor- tioned chests, either from living figures or from the classical athletce of ancient sculptures, the following is the result. Table E. — External Thoracic Dimensions, (in three classes according to weight) in rela- tion to the height, obtained from calculation. MALES : CIRCUMFERENCE OF TIIORAX. Height. Minimum Weight. Medium Weight. Maximum Weight. Ft. In. Inches. Inches. Inches. 5 0 29f 34. 374 5 1 304 344 374 5 2 30J 354 38f 5 3 3H 354 39 5 4 31f 364 39f 5 5 324 37 404 5 6 32f 374 404 5 7 334 384 414 5 8 33 f 38f 424 5 9 344 394 42f .5 10 34f 39^ 434 5 11 354 404 44 6 0 35f 404 44| From this the minimum chests increase on an average nearly f (3'9), the medium chests rather more than £ (4’2), and the maximum a of an inch for every increasing inch of stature. We have found from observation, upon 1276 cases of all various classes conjoined, a re- gular arithmetical progression of the thoracic circumference over the nipples in relation to weight. By the total mean of our observations the chest increases exactly one inch for every 10 lbs. increase of weight, sinking the effect of height, which, however, cannot well be omitted. ,V ( — 4 '07 ) = 34 '5 7 in. circumference of chest. = circumference of chest. because, as a general rule, the height increases with the weight. Mr. Brent has found that twice the breadth of the shoulders equals the circumference of the thorax over the nipples — i. e. from point to point, or the caliber of the broadest part of the shoulders. Thus, if the caliber be 18 inches, the thorax will be 36 inches in circumference. Four times the distance between the nipples is equal to the circum- ference. Four times the antero-posterior diameter is equal to the circumference : there- fore the distance between the nipples is equal to the depth from before backwards of the ex- ternal thorax. At the height of 5 feet 9 inches this antero-posterior diameter varies from 71- inch. to 124 inches. (b) Internal measurement of the thoracic cavity. — Before entering into details we may observe, that the thoracic cavity is much smaller than we might, perhaps, be led to expect ; that the depth from above down- wards is, when compared with the body, very shallow. It is, however, capable of enormous dilatation or mobility, even to 100 per cent ; 80 per cent is common. The absolute dimensions of the thoracic ca- vity of females are obviously smaller than those of males, because they are altogether of smaller conformation, both in stature and weight ; but, relatively, the difference is probably little. Although the proportion of some of the diameters may differ, yet that of the total cubic measurements appears not to do so. A certain rude relation of necessity must exist between the size of a man and the dimensions of his thoracic cavity. A man 7 feet high will have a larger chest than one 5 feet or 6 feet high. But there is no constant and uniform relation of the size of the chest, either to the height or weight of THORAX. 1041 the body. The function of the chest, how- ever, as indicated by the quantity of air which we can expel, is in strict relation to the mi- nute difference of a single inch of stature, or to 10 lbs. of weight. It appears probable that the function of an organ may be exactly re- lative to the size of the body, increasing or decreasing with it, while the organ itself bears no visible relation of volume either to its own activity or to the dimensions of the body. The greatest perpendicular depth of the thoracic cavity, nearly corresponds with the greatest lateral measurement ; or if the depth be 8'7 the breadth is 9'7, and allowing for the mobility of the base of the thorax, the depth may yet more closely correspond to the breadth. The average perpendicular depth of the female thorax exactly corresponds with the average breadth, being 8-l inches in both measure- ments. The greatest antero-posterior dia- meter in both sexes, i. e. from the sternum to the deepest part of the great lateral groove at the angle of the rib, is always less than the greatest lateral breadth, being as 6 to 9 in the male, and as 6 to 8 in the female. These diameters, however, in no way cor- respond to the stature. A man, 5 feet 4 inches high, measured from the apex of the chest to the base 104 inches, whilst' a man of 5 feet 10 inches, only measured 7 a inches in the same direction, or the shorter man exceeded the taller by 3 inches in the per- pendicular depth of his thoracic cavity: — but the taller man could exceed the shorter by a volume of 77 cubic inches of air at one deep expiration. In fact, the whole of the Table F. — Average Measurements of the Thorax. (The mean of the measurements of fourteen males and six females, — given in detail in Med. Chirurg. Trans. 1846. Vol. 29. p. 176.) MALES. FEMALES. Age -------- 51 years 40 years Height -------- 66 in. 62 in. Weight (without clothes) - 110 lbs. Weight of heart ------- 13 oz. Weight of right lung ------ so „ 19 „ Weight of left lung ------- 25 „ 17 „ External circumference over nipples - 32 in. 30 in. Internal circumference (maximum) - 32 „ 24 Internal circumference of right half - 15 „ 13 „ Internal circumference of left half - 15 „ 1 3 , Greatest depth, from before backwards, of thorax - 6-5 „ 6 „ Distance between sternum and bodies of dorsal vertebrae - 4 ,, 4 „ Projection of dorsal vertebras into thoracic cavity - 2'5 „ 2-5 „ Greatest breadth of cavity of thorax - 9 „ 8 „ Internal superficies of costal walls of thorax ... 258 sq. in. 212 sq. in. 35 „ Superficies of diaphragm ------ 49 „ Superficies of entire boundaries (diaphragm and costal — ) - 307 „ 247 „ Volume of right half of thorax ----- 151 cub. in. Volume of left half of thorax 182 „ 141 Volume of entire cavity ------ 333 „ 250 Depth of right lung from apex to arch of diaphragm 7 in. Depth of left lung from apex to arch of diaphragm 9 „ 8 „ Depth from between apices to diaphragm - 8 „ 7 „ Depth from before backwards — right lung (maximum) 6 „ 5-5 „ Depth from before backwards — left lung (maximum) 6-5 „ 5'5 „ Distance between centre of apices of lung ... 2-5 „ 2-3 „ Vital capacity ------- 205 cub. in. 187 cub. in. In the males the left apex was highest in 6, the right in 6, and in 2 the summits of the apices were on the same level ; in the females, the left apex was highest in 2, and the right in 4. VOL. IV. q Y 1042 THORAX. internal measurements (cubic or diameter) clearly bear no relation to the height or weight of the man, whilst vital capacity * does so in an exact ratio. If we take a cast of the thoracic cavity and view the base, it presents the shape of the figures in diagram fig. 669. which gives a mean measurement, in the males of forty-six, and in females of thirty-five, superficial inches In the diagram (reduced by scale), we affix the height of each case, and the area in su- perficial inches of such section. But the base of the thorax presents another measurement, that of the absolute area of the diaphragm. By the Jigs. 2. and 3., art. Dia- phragm, this muscle will be noticed as a large muscle of a vaulted form. C .Jig. 670. repre- ents a section of a thorax, the measurement of Fig. 670. Sup. Squ. in. 133 Dimensions of the diaphragm m three stages. C, ordinary stage. B, spread out A, completely extended. I), relative difference between expiration and inspiration. which is forty superficial inches; the figure B, next above, is the diaphragm of the same per- son spread out, which is extended to 110 square inches, being nearly three times the area of the former figure ; even in this con- dition the centre is quite free, and not upon the stretch, though the circumference is so. The full measurement is nearly obtained, by slitting up the sides, as shown in figure A. and this condition gives it an increase of twenty-two superficial inches, making alto- gether 133 square inches ; but even in this con- dition the entire arched muscle is not perfectly spread out. This was the diaphragm of a man five feet six inches high, with an exceedingly * By “ vital capacity ” is meant the measure of the mobility of the chest, as more fully explained hereafter. (P. 1056.) small chest, only twenty-nine inches in ex- ternal circumference, and whose vital capacity was 188 cubic inches. The section, therefore, of the thorax to the area of the diaphragm is as 40 to 133, or 1 to 3'3. This renders the base of the thorax highly mobile. There is, perhaps invariably, a difference in the dimensions of the two sides of the thorax, in favour of the left side. The least difference which we observed was one cubic inch, but we think there must have been some error in this observation. Passing this over, we may say that the difference between the two sides varies from 10 to 77 cubic inches, and that, in all cases examined by us, the left side was larger than the right. This difference, also, we have found not to bear any relation to sex or stature. One female of 5 feet 4 inches in height had a difference of 77 cubic inches, which exceeds by 10 inches any of the males which we examined, up to 5 feet 10 inches high. Of the Respiratory Muscles. — There are certain muscles especially destined to expand and contract the thoracic cavity, and there are others which act in different degrees as ac- cessories, they may be classed as direct and indirect respiratory muscles. -The direct respiratory muscles are, inter- costales externi and interni, levatores costarum, infra costales, triangularis sttrni, and the dia- phragm. The indirect respiratory muscles are all those which straighten the' spine or aid in fixing the whole body for the thoracic mus- cles to act from as a fixed point, whilst by their other attachment they elevate or depress the ribs ; these are particularly the muscles of the neck and upper extremities, and those composing the walls of the abdo- men. More indirectly still, the muscles of the limbs assist in respiration; — in difficult respiration, the patient seizes hold of any fixed object, whilst he employs his whole muscular force to assist in inspiration, or, as Boerhaave has expressed it, “ scarcely any particle remains in the body which is not more or less concerned in the business of respiration.”* The indirect respiratory mus- cles, in fact, comprise nearly all the muscles of the body ; therefore we shall only no- tice the direct respiratory muscles. The di- aphragm has already been described (art. Diaphragm). 1. The intercostal muscles are arranged as two thin laminae between the ribs ; one lamella is external to the other, hence they are named external and internal. The fibres of each layer are oblique in their direction in reference to the ribs, and each layer has its fibres disposed in a contrary direction to those of the other ; thus they are said to decussate. The twelve ribs form eleven intercostal spaces, conse- quently there are eleven such decussating lamellae on each side of the thorax, and twenty- two in all. Their attachments are to the in- ferior border of one rib, and to the superior * Prselect. ad Instit. 601. Morgagni. By Alex- ander, vol. i. p. 357. THORAX. 1043 border of the next below. They do not ac- company each other throughout the entire intercostal space. These muscles, therefore, differ from each other in two ways, in the direction of their fibres, and in the extent of their attachment, for neither set are prolonged throughout the entire length of an intercostal space. (a) Intercostales extern i. — These have their fibres running obliquely downwards and for- wards ; they are continued throughout the whole osseous intercostal space, i. e. from the tubercles of the ribs, to where the cartilages commence ; here they terminate. Haller once noticed these fibres “continued without interruption to the sternum, filling up the in- tercartilaginous spaces.”* A thin aponeurosis is prolonged from the free anterior margin of this layer, up to the sternum. This muscular layer is thicker than the internal layer. Fig. 671. represents the anterior extremity of this Fig. 671. Fig. 672. External intercostals. — Posterior view. in their degree of obliquity relatively to those of other intercostal spaces Thus, broadly, it may External intercostals. — Anterior view. layer, where it terminates with the osseous part of the rib, and Jig. 672. the posterior view, commencing at the vertebrae. (b) Intercostales interni. — These, as their name implies, are internal to the above layer. Their fibres are likewise oblique, and have a contrary direction, downwards and backwards crossing the former layer. They commence at the sternum, fill up the intercartilaginous spaces, and part of the interosseous spaces, and terminate at the angles of the ribs. Fig. 671. represents them commencing at the sternum, and disappearing behind the ex- ternal layer. Figs. 673. and 674. show them for the remainder of their course ; in Jig. 673. they will be seen to terminate short of the verte- bral column. A thin aponeurosis is pro- longed from their free margin backwards, to the end of the intercostal spaces. . All the intercostal fibres are oblique in their direction, with reference to the spine and ster- num. The fibres of one intercostal space differ * El. Phys. tom. iii. p. 29. Fig. 673. Internal intercostals. — Posterior view. be stated that the external intercostal fibres in- crease in the degree of their obliquity as they Fig. 674. Internal intercostals. — Anterior view. proceed from the first to the last intercostal space ■, and that the internal intercostal fibres, 3x2 low THORAX. on the contrary, decrease in the degree of their dicular to the two bars ; now move the bars obliquity as they proceed in the same direc- up to p 3, ‘also at an angle of 45° with e e, tion. Moreover, for the most part the ex- and the fibre l k becomes more oblique than ternal fibres increase in their obliquity in the at the position p 2. Therefore a tension same intercostal space as you proceed from may change from the oblique to the perpen- the vertebra; towards the sternum, and the dicular relatively to the ribs ; but it can internal intercostal fibres, on the contrary, never so change its relation to the spine, increase their obliquity from the sternum Thus h" k" and i/ k' between the bars towards the vertebra;, therefore they seldom at p 3 cross each other, in the same direc - decussate at right angles to each other, or tion, but in different degrees of obliquity; form a perfect cross like the letter X. This is when the bars are at p 4., they decussate in their general relative position at death, but, directions contrary with reference to the bars, during life, in every stage of respiration, their but not with reference to the body e e. The degree of obliquity varies. The obliquity of position of the ribs is similar to the bars at the intercostal fibres should be viewed more P 4; therefore the decussation of the inter- with reference to the spine than to the ribs, costal muscles must be viewed with reference because we shall show that their action is to the spine. The intercostal fibres never relative to the spine, and not to the ribs cross each other like the lines i/k' and and that they may be perpendicular to two t,"n" {fig. 675.), nor can they, by any change ribs, while they are oblique to the spine, Gf movement, ever assume thatposition ; i. e. because the ribs are themselves oblique, if they do not decussate in a direction con- We have never seen any of the external trary with relation to the spine, in no change intercostal fibres perpendicular to a rib, but Qf position, throughout the range of a semi- we may see that arrangement in the internal circle, can they ever become directly decus- layer of the lower intercostal spaces {fig- sating fibres but when they directly cross 673.). The omission of the relative posi- each other as vd and v'u {fig- 676.) relative to tion of the spine with reference to the ob- E E) ;n every other position to which the bars liquity of these muscles has led to many false conclusions as to their action in respiration. pig. <37(5. Let e e {fig. 675.) represent a spine or a rigid body, and a c, b d two levers representing can be moved, they will be seen still to main- ribs, allowing of free rotation at their centres of tain the same decussation, motion a and l). These two bars are per- Action of the intercostal muscles. — There pendicular, or at 90°, with reference to the is, probably, no subject in the whole range of body EE; let l k represent a connecting science which has excited more violent con- tension or elastic fibre of any kind, this is tention and acrimonious dispute, than that oblique with reference to the two bars ac of the action of the intercostal muscles. The and bd, but move these bars down to the illustrious and learned Haller could not enter position of p 4, at an angle of 45° to the this field of inquiry without pausing to ob- body e e, and the fibre l k becomes perpen- serve : “ Let it be allowed me to deplore, & THORAX. 1045 among the miseries of human life, that such anger and bitter quarrels should be forced upon us on account of matters wherein we are so little personally concerned.”* * * § Yet, strange to say, Haller opposed with extreme violence his contemporary Hamber- ger, whose investigations on this subject, though still extant, fell, consequently, into oblivion. We know not who discovered the two sets of intercostals. There appears to be no ac- count of them prior to Galen, a. d. 131. He observes, “ the intercostal muscles help the midriff, that they might draw the chest in- ward.”f Albinus (a.d. 17701 considered that both the internal and external layers “ raise the ribs.” J H. Cooke, a learned compiler of 1651, believed, they “ constrained and dilated the chest,” — “ that the external layers bear down the ribs, and that the internal separate the ribs, so enlarging the thoracic cavity.” $ Strange to say, after this Cooke divests these muscles of all thoracic motion whatever. In 1685 it was the received opinion that the external layer dilated, and that the inter- nal layer contracted the thorax. || John Al- phonso Borelli led the way to. a different opinion, which prevailed amongst most phy- siological writers. He believed, from mathe- matical reasoning, that “ the fibres crossing each other produced only one effect, viz., the drawing of the ribs together,” — acting in the diagonal of the decussation. It is curious that he never considered the proba- bility of the two forces acting separately, as other antagonising muscles can do. IT w. Cheselden believed that both these muscles dilated the thorax, acting as elevators of the ribs, when the 1st rib was fixed by the scaleni and serratus posticus posterior. ** * * §§ Cooke follows the views of Cheselden and Borelli. ff Benjamin Hoadly takes another view ; and, in so doing, illustrates the subject with diagrams, and comes to the conclusion that the external layers elevate, and that the internal depress the ribs ; and that their com- bined action is to arrest the respiratory move- ment at will. He also says, “ neither range can by their action push the ribs asunder. Winslow agrees with Borelli : presupposing, as usual, that the first rib is fixed. §§ Still the subject continued to be warmly dis- puted, when Haller published a controversial paper in 1746. In his “Elements” he treats the * El. Phys. vol. iii. p. 36. t De Usu Resp., ch. 15., 5 lib., De Usu Partium. t Tr., fol., ed. 1777. Tab. xvii. 9, 10, et seq. § Cooke’s Descrip. Anat., fol., 1651., p. 257. || Samuel Collins’s System of Anat., fob, 1685, vol. ii. p. 825. If De Motu Animalium, pars secunda. Lugduni Batavorum, 1710, p. 106., Prop. 84., Tab. xviii. Fig. 2. ** Anatomy of the Humane Body, 3rd ed. 8vo., Lond. 1726, p. 117. . tt Cook’s Anat. and Mechanical Essays, Lond. 1730, vol. i. p. 282. et seq. It Gulstonian Lect. on Resp. 4to., Lond. 1740, p. 6. §§ Anatomical Exposition, 4to,. Lond. 1749, vol. i. p. 318. subject at length, siding with those whom he thinks are right, and confirming the same by many direct experiments.* Haller's view is, that the external layers elevate the ribs, be- cause their superior attachment is nearer the vertebrae than their inferior one. Franciscus Boissier de Sauvages agrees with him ; and the same is held by the majority, yet some doubt it. His opinion touching the internal layer is, that they likewise act as associates and ele- vators of the ribs with the external layer, be- cause “ their superior attachment is nearer the sternum, and further from that bone in the lower ones likewise, that “ that por- tion of the internal layer placed between the bony parts of the ribs, cannot have a diffe- rent action from that portion placed between the cartilages.” Joh. Swammerdam, Francis Bayle, J. Wilhelmus Pauli, Christianus Vater, Francis Nicholls, J. Fredericus Schreiber, differ from this, believing that the internal layers draw down the ribs. Now follows a sharp antagonist to Haller, viz. Hamberger, whose disputes with Haller we gather from Haller’s writings, and not from Hamberger’s writings. Hamberger breaks out with an entirely new view, which excites Haller to controversy .j- Hamberger, says Haller J, believes that the external intercostal muscles have one action, — that they would raise the sternum: “ that the internal layer would depress it.” Ham- berger makes a machine “ to demonstrate, that when the ribs are raised by these muscles their intervals are dilated ; when depressed, on the contrary, they are diminished.” He furthermore gives, as his own discovery, that “ the internal intercostals conjoining the os- seous portions of the ribs, and that portion which is between the cartilages, will raise them, and are therefore associated in action with the external layer.” Hamberger was the first to assign a double action to the same class of muscles : he likewise believed that the whole ribs were lifted simultaneously^ Haller disputes the validity of Hamberger’s experiments, upon the ground of his not con- sidering the relative mobility of the first and second rib ; because, says Haller, if the de- pressing power of the intercostal muscles is to the first rib as 20, the elevating power on the second rib, by reason of the difference of length and mobility, is as 380, nearly nine- teen times greater ; and the lower rib is to each superior rib, as far as . the seventh, more moveable, in the ratio of 109 to 79. ]| We cannot see, with Haller, how the ten- * Vide Elementa Physiol. Corporis Humani, tom. iii., p. 28., et seq. Lausan. 4to., 1766. f Hamberger was bom 1697, and died in 1755. Haller’s first anatomical paper upon respiration appeared in 1746, and his Elementa Physiol. Cor- poris Humani, in 1757-66. x El. Phys. ib. p. 37. § Hamberger’s writings on this subject were an essay De Respirationis Mechanismo, J ense, 1727, and also'Physiologia Medica, Jense, 1751. — Ed. || Loc. cit. p. 39. et seq. 3x3 1016 THORAX. dencyof action of a muscle can be affected by the degree of mobility of a joint ; for it is not necessary to the direction of the action of a muscle that a bone should move. Haller also denies that the two crossing fibres lengthen and shorten inversely to each other ; or that the intercostal spaces widen by their action. Haller performed many experiments ; he ap- plied strings to the ribs of a wet preparation, representing the muscles, and pulled the strings, and the intercostal spaces diminished. By vivisections he determined, that in inspir- ation the internal intercostals, “ simultane- ously with the external layer, contract, swell, and wrinkle, become perpendicular and hard, with united lifting of the ribs in rotation, the turning of the lower border forwards, the protrusion of the sternum, the descent of the diaphragm,” &c. On the other hand, he observed in “ expiration, relaxation of the whole series of intercostal muscles, increased length and obliquity, increased distance be- tween the spaces, relaxation of the diaphragm, repression of the sternum, the descent of the ribs, narrowing of the chest,” &c.* It is curious to see that he makes the cubic space of the thorax diminish with the inter- costal spaces widening. Nor do we wonder at his observing, in his vivisections, a contrac- tion of both sets of these muscles, for he not only skinned his animals, but “ cut down and destroyed the external layers of intercostals, to lay bare the internal layer.’ “Besides lap- plied (says Haller) pain and fear , being more efficient than mere pain itself,” by puncturing the diaphragm to cause dyspnoea! Under such circumstances — an animal tied down, divested of all superficial muscles, with a pierced chest, — in pain and fear,” — and writhing under the scalpel, — producing tetanic convulsions, and then a death-like relaxation from syncope, — surely in such a condition the action of the respiratory muscles, so sensitive to the least mental emotion, could not well be determined. Although Haller appears positive, yet he concludes his controversy with a brilliant question, — a vivid picture of his master mind, — “ Why has nature made two, rather than one set of intercostal muscles, if, indeed, the function of each is the same?”-)- Haller’s views have, however, prevailed to this day, and are still taught in our schools. ~ Some authors have assigned but little to these muscles, counting them as mere associate muscles; others, that they are “wholly and solely ” to form the thoracic parietes ; others that they are rather movers of the spine. Dr. John Barclay, a standing authority, observes, that the supposition of the two sets being antagonists in their actionr “ is now ob- solete,” and must “ have been formed by the very witchcraft of imagination, in defiance of all observation and experiment.” J Lastly, Dr. Sibson has made a commu- * El. Phys. ib. p. 43. •f Ib. p. 44. f Barclay “ On Muscular Motion,” 8vo. Ed. 1808, pp. 533, 534. nication upon this subject. He observes, that “ the scaleni invariably act during the whole time of inspiration and that the function of the intercostal muscles is complicated ; thus, “ th e external intercostals, between the thoracic set of ribs, are throughout inspiratory ; those portions between their cartilages are expiratory, between the diaphragmatic set of ribs they are inspiratory behind , expiratory to the side and in front, and between their cartilages they are inspiratory ; between the intermediate set of ribs they are for the most part s/ight/y in- spiratory between the ribs, and expiratory in front between the cartilages.” “ The internal intercostals of the thoracic ribs are expiratory behind and inspiratory in front, if the ribs approach there, and are in- spiratory between the costal cartilages. Be- tween the diaphragmatic and intermediate set of ribs, and between the cartilages, they are thought expiratory”* From this view of Dr. Sibson’s, we venture to gather, that different fibres of the same layer of intercostal muscle have diametrically opposite actions. We do not understand upon what ground it can be demonstrated that one muscle having a given action between two ribs, shall, between the same ribs, and observing the same obliquity and same attachments, present a directly con- trary action ; the conditions are the same, and therefore the action must be the same. These views, however, of Dr. Sibson, in the paper in question, are not borne out by the narra- tion of any experimental facts. Insufflation on the dead body is not the movement of inspiration in the living subject. It is better to assign to these muscles the terms of ele- vators or depressors of the ribs, instead of inspiratory and expiratory muscles. All these observers, as far as we have seen, pre-suppose that the 1st rib is fixed by the scaleni (this is the view now taught) ; and that according to the fixing of the 1st rib, all the intercostal muscles are either elevators or depressors of the ribs. It is curious to contemplate that, out of elements so few, two ribs and two muscles, opinions so contrary should be held with regard to the action of these muscles. They have nevertheless an action as definite as any other muscle in the body. We may here observe, that, although the chest is conical, the ribs segments of circles, and the spine mobile, yet treating them as planes and lines will not lead to error. Two parallel bars, rotating on a centre, will increase and decrease the perpendicular distance be- tween them ; so they will, if curved like the ribs. This we have determined by experiment. Although the rib has two movements, ele- vation and rotation, yet these are associates, and do not obstruct each other. We shall employ the same diagrams as used by Dr. Barclay', when describing the same muscles. The intercostal muscles act as a force be- tween two moveable ribs or levers ; therefore let us consider — T* Phil., Pt. 4, 1846, pp. 543, 544. thorax. 1047 1st. The movement of such levers, when rotating. 2nd. The effect of forces, oblique, perpen- dicular, and decussating, upon such levers. 1st. The movement of ’ the levers. — Let fig. 677. a represent a series of parallel bars, Fig. 677. R A allowing of free rotation upon a rigid per- pendicular body a a ; let the free extremities of these bars be kept apart, so that the bars may at all times be parallel to each other. In this condition a certain distance exists between the bars, and a certain distance be- tween their free extremities and the perpen- dicular body a a. Let b represent the same bars moved into another position, resembling that of the ribs ; in this position, the two conditions seen at A are altered. The perpendicular distances between the bars are diminished, and the distance between the free extremities of the bars and the body b b is likewise diminished. If the direction of this motion were still continued, the bars would ultimately touch each other, and their free extremities would be still nearer to the body b b. But let the bars be elevated, as in c c, and the same condition obtains as in the bars at b b, viz., they approximate each other, and the free ends come nearer to the body, c c. In this case the bars only have moved ; but the same effect can be obtained without moving the bars. Let a b {fig. 678.) be two bars at their maximum distance, while horizontal ; at a b, and a' b', they have nearly attained their minimum perpendicular distances, though still hori- zontal, because the rigid bodies c c and c' o' have been moved respectively. Now, if we join these hree last figures into one, as in fig. 67 9., an then move the bars simulta- neously, some bars will approximate each other, whilst others will recede. The superior four are at their maximum perpendicular dis- tance from each other ; while the 4th, 5th, and 6th are at a medium perpendicular dis- tance, and the 6th, 7th, and 8th bars at their minimum distance. The distances of these bars are regulated by the position of the rigid body representing the spine. If all of them were moved upwards Fig. 678. c (• 3J Diagram representing the position of the ribs affected by the position of the spine. simultaneously, the first four would approxi- mate, whilst all the rest would recede from each other. Therefore the positions of the different parts representing the spine in fig. 679. command and regulate these changes. Fig. 679. Diagram as in fig. 678. with the three portions conjoined # From this we learn, that the bars cannot rotate without changing their distances, and that when they are at 90° with reference to the body a a {fig. 677.), they are at their maximum distance from each other, and as they pass this position on either side, this dis- tance diminishes. In the human body the spine may represent the body to which the bars are attached {fig. 677.). The movement of the ribs will obey the same law in receding or approaching each other, and whether they increase or diminish their intercostal spaces, will depend upon the relation they bear to the spine. Fig. 682. is a cast, from a dissection of the thorax of a male subject, weight 1071bs., height 5ft. 4in. This correctly represents the natural position of the ribs, when the thorax is in a state of complete expiration, or with only the residual air in the lungs. The position of the 3x4 1048 THORAX. ribs is very oblique ; the spine is curved ; therefore the relation of the ribs to the spine is different according to the curve, as are the bars to the body representing the spine ( Jig . 679.). It will be seen that the inferior six or seven ribs are at a more oblique angle to the spine than the superior ribs. The spine does not curve sufficiently to bring the upper ribs to an angle of 90° with the spine; there- fore, if all the ribs were raised simultane- ously, they would all increase the breadth of their intercostal spaces, whilst their sternal end would recede from the vertebras, and thus, by their elevation, the thoracic cavity would be enlarged, until they attained the angle of 90 ° to the spine. But if the elevation were carried beyond this point, the intercostal spaces would diminish, and thus the thoracic cavity would decrease. Fig. 684. is a pos- terior view showing the sloping position of the ribs more clearly. Now, if the spine were perfectly erect, the ribs would have a greater range, and consequently the upper ribs could be elevated higher, and thus still more increase the thoracic cavity. A man Fig. 680. Thorax as at death. can expire a greater volume of air when perfectly erect, than in any other position. On the other hand, if we curve the spine, we limit the divergence of the ribs, because then we bring the ribs more into the po- sition of ah and a' b' { fig. 678.). Tlius, in diseases of the spine, when angular cur- vature is extensive, the ribs are materially limited in their capability of increasing the perpendicular depth of their intercostal spaces, and consequently the perpendicular depth of the thorax. Fig. 666. is an instance of angular spine, reducing the ribs to their minimum distances without their moving. We have found by ex- periment, that the greatest volume of air which persons with angular spine can expire, is little more than equal to the volume of air of an ordinary respiration ; i. e. from 20 to 40 cubic inches, instead of 180 to 200 cubic inches. The following experiment proves that the ribs are all elevated when the chest is inflated, and that the spine is straightened. Into the thorax {Jig. 680. et seq .) we insufflated, or forced into the lungs 310 cubic inches of air, and a second cast was taken. The changed position of the ribs and spine is represented in Jigs. 681. 683. and 685. where it will be seen that all the ribs are raised ; their perpendicu- lar distances or intercostal spaces are all increased, and the spine is more erect. This experiment, therefore, demonstrates two things : 1st, that by artificially inflating the chest, the intercostal spaces are widened, and 2dly, that the spine becomes more erect. It is an experiment most unfavour- able for showing these two points, because the altered shape of the thorax by insufflation is not to be compared with the exceedingly enlarged condition produced by vital inspira- tion ; in which case the spine becomes more erect, and the intercostal spaces consequently wider. By placing the fingers in the inter- costal spaces of a living subject during deep inspiration and expiration, it may easily be perceived that in the former they widen. Fig. 681. Thorax artificially inflated with air. and in the latter they collapse. From 3000 observations we have found that, in deep in- spiration, the body becomes more erect, and less so in expiration. Insufflation is not the same, in effect, as inspiration. In the former we force air into the chest, until the parts most yielding, as the diaphragm and abdominal parietes, are rendered so tense that their tension is suffi- cient to overcome the elastic force of the ribs, their cartilages, and the lungs ; then, and not until then, do we move the costal part of the thorax. On the other hand, in the living and deep inspiration, we lift the ribs and sternum, the most unyielding portions, first. These solely produce the threatened vacuum which inflates the lungs, whilst very little, if any, is accomplished by the diaphragm. The following table shows the measure- ments of the thorax, when expanded by in- spiration and insufflation. THORAX, 1049 Fig. 682. Fin 683. Thorax as at death. Thorax artificially inflated with air. Thorax as at death. Thorax artificially inflated with air. Table G. — Table of the Dimensions of the Thorax and Abdomen, in the Dead and Living Sub- ject, with the same Quantity of Air distending them. Thorax. Abdomen. Conditions at the time of observation. Circum over nipples. Diam. lateral. Diam. ant. .post. Circum. Diam. lateral. Diam. ant.-post. in. in. in. in. in. in. Dead — Natural collapse 29f 10 8 29 i 8* n Insufflated 31* 10* 8-3- 31* 10 9f Alive — Expiration 32 11* 94 25 10* 7 3 ' T Inspiration 37 m Hf 25* 11 8f Difference — By insufflation, dead H _i 3. If LJ By inspiration , alive 5 1 i 93. ^ 8 1 T 3 3 ¥ 1050 THORAX. These facts show that we should be guarded in determining the living respiratory move- ments by experiments upon the dead subject. It should be constantly borne in mind, that to increase or diminish an intercostal space is to elevate or depress the ribs, and that to elevate or depress the ribs is to increase or diminish their intercostal spaces : the one cannot be accomplished without the other. Some au- thors have spoken of these as distinct ; thus, that in inspiration the" superior ribs ap- proximate each other, whilst they are raised, or that their rising or falling does not neces- sarily involve an increase or diminishing of the intercostal spaces ; but these two changes are simultaneous and cannot be done sepa- rately. 2nd. The effect of tensions , oblique, perpen- dicular, and decussating, between the moveable levers or ribs. — We employ a strip of vul- canised Indian-rubber for a force representing muscular contraction. A strip of this sub- stance, of uniform thickness, 4 of an inch broad and 10 inches long, increased its length, with an increasing weight, as follows : — 1 + the pan holding the weight = 850gr. = runner, gr. inches. 1287a A 2 do. = 1725 3 4 do. = 2600 1 8 do. = 4350 If 16 do. = 7850 4 32 do. — 14850 12a 64 do. = 28850 2&1 Fig. 680. demonstrated by a model, using a spring or Indian-rubber as the tension, and may be Although not exactly in accordance with the law of perfect elasticity, yet it is roughly so and enough for our purpose, viz. the tension is greatest when most stretched, and weakest when least stretched, corresponding with muscular contraction. Let e e (fig. 686.) be fixed, a b and c d two moveable bars as before, t an oblique tension ; if t shortens, it has been supposed that the two bars would assume the position of a b' and c d ; but not so : they both rise like a b" and C v>'' until the two bars touch each other.* If we prevent this touching of the two bars by a rigid link, like that on parallel rulers, placed as at s fig. 687., then the tension will still raise the bars to o o'. In this experiment three circumstances may be noticed. 1st, that the bars have been elevated ; 2dly, that the perpendicular distance between them has been diminished ; and 3dly, that the tension t has been shortened in attaining the position o o'. Place the tension in a contrary direc- tion, as between the bars a' b' and c' o', and the bars are brought into a contrary position, — drawn downwards to o' o'". This can be * This appears to have been known to Hamberger ; but the author of this article was not aware of it until four years after he first introduced this move- ment to notice. (See Med. Chirurg. Trans, vol. 29, p. 213.) It is certain that Hamberger’s views were not taught in any physiological school in this coun- try, Germany, or France, nor noticed in any of our philosophical works. Fig. 687. explained as follows. Let a b ,fig. 688., repre- sent one bar, c d the perpendicular fixed body; b is the free extremity of the bar; k an axis from which a parallel bar has been re- moved. Let e, i, and o be other fixed points ; connect e to b by an elastic tension, and the bar b will be moved towards e. Let the ten- sion be fixed at i or o, still the bar b will be raised towards the respective points. Let the tension be fixed at k (the centre of mo- tion of the bar which we suppose is removed), and still the bar a b will be raised upwards towards k, and assume the position of a b, ic l (fig. 689.) at M. But it is not necessary to this that the elastic force should extend from Fig. 688. THORAX. Fig. 690. 1051 k to l in order to produce this motion : half of it might be wood, bone, or iron, provided the other half retained its elastic power. The effect would be the same, and the bar a b at N would be elevated by the tension between t l. Fig. 689. connecting the fixed point k with L by the rigid body k t. It is the omission of the fulcrum k, in calculating such oblique forces, which has hitherto obscured the explanation of the intercostal muscles. This may be illustrated in another way ( fig. 690.). Let a b and c o represent bars as before upon a c ; t' the tension ; let c d and a c be fixed ; withdraw the pin at a, and the bar a b is drawn forwards into the position b', and the tension t becomes perpendicular to the two bars. On the other hand, reverse the experiment, as in fig. 691.; supposing c d and the perpendicular body c a fixed, withdraw the pin at a, and the bar a b is drawn backwards to b'. This presupposes the bars kept apart, otherwise the free bar would approximate the fixed bare d. Therefore, one fulcrum is pushed upon by one bar, and pulled upon by the other. If the bars were kept fixed, and the body re- presenting the spine was left free , the tension would draw this last mentioned body into the Fig. 691. position of c c and c c fig. 678. Therefore, the element of the two fulcra is the chief agent for directing their upward or downward move- ment, under an oblique tension. If we arrange two bars with one fulcrum {fig. 692.), and allow Fig. 692. the tension to act as before, then the effect is only to draw the two bars together, as o b and o' d {fig. 693.). If we have an arrange- ment to substitute two fulcra at a a' fig. 692. and withdraw the centre fulcrum, then the two bars rise as before. Fig. 693. Now we shall suppose the bars at an angle of 90° to the body representing the spine. A perpendicular tension (l o , fig. 694.) ad- mits, of course, of no variation ; oblique ten- sions admit of two variations : thorax. a, obliquity in contrary directions. b, degrees of obliquity in each direction. Fig. 694. The perpendicular tension (l o, Jig. 694.) produces but one effect, that of approxi- mating the two bars a c and b d, because the force of l o is acting upon a l and b o, levers of the same length, their movements being the same they would meet in the middle dis- tance at s. But if the bars are kept parallel by a rigid link like s, fig. 687. the perpendicular ten- sion would produce no apparent effect upon the two bars. They might be rotated in any direc- tion, and the tension would remain of the same length ; for example, in fig. 695. let t 2 be the perpendicular tension between the bars a b c d, move the bars to s or s', and the ten- Fig. 695. sion is the same length, hick, &c., may represent different places in the rotation, at each of which the tension t or k is the same length, although the bars at s, t 2, and s' are at different perpendicular distances from each other. A rigid connective, as wood or wire, may be substituted for the tension, an- this will equally allow of the bars being rod tated, and consequently changing their per- pendicular distances to each other. Hence it will be seen, that each of the lines k k k, are of the same length, although the two se- micircular lines describing the revolution of the bars are constantly changing in their re- lative distance to each othe We then seer, the possibility of having a rigid body connect- ing two bars, which shall nevertheless recede and approximate each other. From this we may gather, that though the sternum is rigid, and the cartilages, perhaps, ossified, the ribs may nevertheless maintain the capability of altering the breadth of their intercostal spaces. Perpendicular tension, therefore, like l o, (parallel to a b,) cannot rotate the bars, be- cause they never change their length. All tensions are oblique which have one of their attachments nearer to the spine than the other, therefore, in fig. 694., l ic and l t are oblique tensions. An oblique tension, hence, is acting on bars at dissimilar distances from their fulcra ; thus in fig. 696., Fig. 696. Diagram showing that perpendicular fibres neve? alter their length. tension t ' is oblique to the line a a, and the points on the lines a b, ad, to which the tension t' is attached, is represented by the lines a m and A m. And the law of action of such tension is, that it tends to move both bars or ribs towards that fulcrum which is near- est to one of its attachments. Therefore ten- sion l k (fig. 694.) would rotate the bars towards B, and tension L t towards a. The force of a given oblique tension between such bars is modified by two circumstances, — by the degree of obliquity, and by the obliquity of the bars in reference to the body which re- presents the spine. Of the degree of obliquity of a tension. — Let fig. 697. a b, c d, represent bars as before, the different connecting lines tensions of different degrees of obliquity, but of the same power of tension. L k is perpendicular, and has no rotating power, l k1 possesses a certain amount of power, l ks more power, and l a the maximum power, or the power of rotating. THORAX. 1053 Fig. 697. the bars increases with the increasing obliquity of these tensions. By experiment we found that equal tensions at the following angles, pro- duced the following difference of power in rotating the bars : — Table H. — Power gained by a given Tension, as an intercostal Muscle, Obliquity. in relation to its Angle of tension. Tension. Resistance. At 90° 2-5 0 „ 75° 2-5 1-50 „ 46° 2-5 2-25 „ 15° 2-5 4-25 „ 7° 2-5 5-50 The power descreases as the tension ap- proaches the perpendicular l k', and increases as it approaches l a ; this is the maximum point : if the tension be attached to the body e e, either above A or below it, the system is changed into that of a single lever. From this we gather, that the power of an intercostal muscle, as an elevator and depressor of the ribs, increases with its obliquity ; and that this movement entirely depends upon its obliquity. This is the only instance in the body where the power of a muscle increases with its obliquity. Of the obliquity of the ribs or bars with re- ference to the spine. — A given tension, say at the angle of 45°, will, when the lever is at 90° to the spine act more powerfully than when the lever is at an angle similar to that of the ribs. We found by experiment, that the bars in the following positions required an increased power to sustain them. The tension being uniform, and the resistance to be overcome acting from the same point. This gain of power is dependent upon the obliquity of the bars and change in the direc- tion of the tension, for in each of these posi- tions the tension was maintained the same. But if the tension be not kept uniform, still the resistance is increased as the bars rise ; thus, if the bars are at the angle of 50° {Jig. 699. m") somewhat similar to the position of the ribs, and these under a certain tension allowed to resist a power of 4, when they are moved upwards to 90°, through which revolution the tension has kept diminishing (because it has kept shortening), it will resist a power of 5. In this we see a beautiful compensation to the muscular contraction, viz. that while an in- tercostal muscle is losing power as it con- tracts, this loss is made up by the change in position of the ribs. We feel conscious that we can exert a retaining power at the ter- mination of a deep inspiration as great, if not greater, than at any other intermediate posi- tion of the ribs, at all of which the muscular power actually exerted is greater. All these remarks apply equally if the spine be curved ; for change of obliquity of the ribs, or change of curvature of the spine to the ribs, is the same thing. Table I. — Change of Power, from the Obli- quity of Bars or Ribs to the Spine. Angles of the Bars with the Body representing the Spine. Tension. Resistance. 30° 2-5 4 60° 2-5 12 90° 2-5 22 120° 2-5 33 Of oblique tensions in contrary directions. — We have shown that an oblique tension between parallel levers moves them in a cer- tain course. Now it is evident that tension in a contrary direction (all other things remain- ing the same) must likewise move such levers in a contrary direction. This is so clear that although Haller asserted absolutely that cross- ing muscles have the same action, yet he was not comfortable under such an opinion, “ for,’ ’ says he, “ why do they cross ?” We have shown that a tension in the di- rection of l t fg. 694., will raise the bars, and one in the direction of l k will depress them; they are, therefore, antagonistic forces, and when the tensions are similar, they pro- duce an equilibrium of contrary force. If the bars a b, c d, {fig. 676.) be rotated, the lines will have directions contrary to each other, and will lengthen and shorten inversely to each other. Thus of the crossing tensions {fg. 676.) v d and v' b, t' b becomes short- ened to n b', and v d, on the contrary, becomes lengthened to n b' ; and on the other side of 90°, v d is shortened to s d, and v' b lengthened to s' b. Therefore muscles circum- stanced like the intercostals and crossing each other, or observing contrary directions to each other, cannot be associates in action, for when one contracts, the other must relax, as the ribs move. We represent this more clearly in Jig. 698. where a b and c d represent bars as before, rotating upon e/ e, and t t' two ten- sions in contrary directions. As the bars are raised towards m, t' lengthens, and if depressed towards in' it shortens, while t lengthens to- wards n, and shortens towards n'. We re- present the tensions t t, & c., and t' t', &c., by the white lines, in the different positions they would assume if the two bars were rotated to those places in the half cir- cle. It will likewise be observed, that while either tension gradually lengthens or shortens, the two bars pass through their maximum perpendicular distance from each other at b d, on either side of which they attain their minimum distance. Therefore, if we examine tension t at n' , the bars would there be closer to each other than they are at b d ; nevertheless, this tension in ascending must contract while the bars are increasing their perpendicular distances as they move to b d ; beyond which the tension still 1054 THORAX. shortens, while the bars now decrease their perpendicular distance. Therefore it is per- fectly compatible for an intercostal fibre to separate the two ribs, between which it is at- tached, by its contracting ; and, if above a certain point (90° to the spine), to approxi- mate the same ribs by its further contraction. Fig. 698. In deep inspiration it will be found that the ribs increase the breadth of their intercostal spaces (as was mentioned years ago by Ham- berger) ; and that by the contraction of an intercostal fibre. The bars ( fig . 698.) in ro- tating, twice attain a minimum, and once a maximum, distance from each other; while the oblique tension in that revolution once attains its maximum, and once its minimum length. Of tensions at different parts of the bars or ribs. — Parallel tensions of equal power pro- duce the same effect, whether near the ful- crum or more distant from it ; an intercostal fibre near the vertebrae, has the same power as a fibre near the anterior extremity of the ribs. Let Fig. 696. represent ribs as before, with two parallel tensions at different distances from the body, E e, then t' + a m — t' -\-am—t' -\-x(am — am)—t'+ a o t + a n — t+a n — t+(A N — (I»)=t + A0. Therefore the tension l t ( fig . 694.) acts with the same power as tensions p p', which is much nearer to the fulcra a b. Knowing now the effect of a single oblique tension, it is easy to consider an indefinite number of tensions, for they follow the same law of action. In Jig. 699. the tensions x acting on a c, lift Fig. 699. the bars to in', and, by the same reason, ten- tions observing a contrary direction and acting upon a' c' lift the bars to in'". Therefore tensions, although observing contrary direc- tions, may be made to conspire to the same action, and may therefore be associates when acting upon different fulcra. We have shown that tensions in contrary directions, but acting upon the same fulcra, are antagonists. If we join the levers ( fig. 699.) and increase their number, we may represent the thorax as in Jig. 700., k/c representing the spine, bb the sternum, the bars a a the ribs, and the bars a' a' the costal cartilages united to the bars representing ribs by a movable joint ; let r represent the external intercostals, these, we know, will act as elevators, while those at h, representing the internal intercostals, are asso- ciates in action, although they observe a con- trary direction, because they act upon the fulcra in b b ; in fact, they are elevators of the levers representing the cartilages. What now is the combined action of a series of two such tensions ? The whole body of levers will be raised, and the part b b re- presenting the sternum will have two motions : it will be raised and moved forwards into the position of b'b'. This is precisely the mo- tion of the sternum in deep inspiration. In a model of this kind, certain means must be used to limit the motion, or the movement is continued until the tensions are at rest. Or, if the bars representing the ribs a a ( fig . 700.) be fixed, then the tensions representing the internal intercostals h would depress the short bars representing the car- tilages, because b b is free, and k k is fixed. And were either set of tensions continued over the joints representing the union of the cartilages with the ribs, such fibres would THORAX. 1055 antagonise each other. In nature the external intercostals are not continued over to the in- tercartilaginous spaces. Fig. 700. In this model all the ribs are elevated with- out the first bar being drawn up by any ten- sion representing the scalenii muscles. In fact the fulcra are the fixed points ; therefore there are here six fixed points for the tensions to act upon, and hence each row of oblique tensions acts quite independently. This application of force and disposition of the bars representing the ribs is after the manner of that great engine of power the “genou lever.” (Vide Potter’s Mechanics.) Tensions in the first space {Jig- 700.) act with a greater power in pushing out the body b than do the tensions in the 5th space ; but, on the other hand, the motion is less in the 1st than in the 5th space. It will also be seen that these six bars, though moving all equally, will produce an unequal effect upon the body b b, forcing out the lower end more than the upper end. The ribs of man, in the same manner, increase in their length from the 1st to the 8th, and, therefore, by an equal mobility, an unequal protrusion of the sternum is produced, advancing the lower end more than the upper end. We have reason to believe that the mobility of all the ribs is the same, and that it is by their different lengths that the different degrees of protrusion of the anterior part of the thorax may be accounted for. Having investigated the effect of artificial tensions acting on bars made to represent the ribs, we can now return to the consider- ation of the action of the direct respiratory muscles. Action of the intercostal muscles (resumed). — The intercostales externi are all elevators of the ribs. Inspiratory muscles. They separate the ribs in the act, and they can do this indepen- dently of any other muscle fixing the first rib. The intercostales interni have a double action. All those portions between the ribs depress the ribs and are expiratory muscles ; they also approximate the ribs and in every way an- tagonise the external intercostal muscles. Those portions between the costal cartilages are elevators of the cartilages, and associates with the external intercostals, and, thence, in- spiratory muscles. These muscles also can act independently of any other muscle fixing the first or last rib. The intercostal muscles being antagonists, they yield to each other, the same as any other flexor yields to an extensor muscle. We possess a perfect and definite command over the ribs, and can stop their respiratory movements at any stage of breathing, more readily than we can those of the diaphragm. It is necessary to healthy breathing that we should raise all the ribs ; they are there- fore all mobile, and all their intercostal spaces are increased in their perpendicular distance during inspiration, and diminished during ex- piration. II. Levatores costar um (Levatores breviores costarum. Alb.). — These are narrow, tendinous, and fleshy fasciculi {Jig. 672.) covering the pos- terior end of the rib, and extending obliquely downwards and forwards, in the same di- rection as the external intercostals. Their superior attachment is to the extremities of the transverse processes of the dorsal ver- tebrae ; their inferior to the margins of the ribs between their angles and tubercles. These fibres spread out and become flat at their insertion. Each rib receives one from the vertebra next above ; there are therefore twelve muscles on each side ; and that for the first rib is derived from the last cervical vertebra. The inferior muscles of this series divide into two parts ; one of which is distri- buted as above stated ; but the other, consist- ing of longer fibres, passes over one rib and tc-r ininates on the second below ; and thus each of the lower ribs receives muscular fibres from the transverse processes of two vertebrae. The long bands have been described as separate muscles under the name levatores longiores costarum (Albinus). Action. — The same as the external inter- costals. Elevators of the ribs and inspi- ratory muscles. Acting directly upon their fulcra, the transverse processes of the ver- tebras. III. Triangularis sterni ( Sterno-costalis , Ver- heyen). — A thin flat plane of muscular and tendinous fibres (fig. 674.) placed within the thorax, immediately behind the costal carti- lages. This muscle is attached to the inner surface of the ensiform cartilage, lower part of the sternum, and the cartilages of the lower true ribs. From these origins its fibres pass laterally along the inner walls of the thorax, diverging upwards, horizontally, and down- wards, and are attached by digitations (which give to the outer margin a serrated appear- ance) into the cartilages, lower border, and inner surface, of each of the true ribs, from the 5th to the 2nd inclusive. Action. — This muscle varies considerably in the extent and points of its attachment in different bodies, and even in the opposite sides of the same body. Hence, it aids in drawing down and drawing up (according to the di- 1056 THORAX. rection of its fibres) the ribs. It may be said to be both inspiratory and expiratory. IY. Infra-costales (Verheyen). — In connec- tion-with the inner surface of the ribs {fig. 673.) several small bundles of fleshy and tendinous fibres, which are thus named, will be found ex- tending over two, and in some instances over three, intercostal spaces. They have the same direction with the internal intercostals, and are (properly) often described as parts of those muscles. The fasciculi vary in size and number, and may be found on any of the intercostal spaces, except, perhaps, the first ; but they are most constant on the lower ribs. Action. — The same as the costal portion of the internal intercostals, depressors of the ribs and expiratory muscles. Of the elasticity of the ribs. — Elasticity depends upon reaction, and restores in a contrary direction the force which have been impressed ; the effect produced is com- mensurate with the amount of the cause, and the reaction can never take place so long as the cause continues to be applied ; but immedi- ately that cause ceases, the elasticity comes into action. Inspiration is performed by the true inspi- ratory muscles, and expiration, by the expira- tory muscles, and the elasticity of the ribs and their cartilages, together with the elasticity of the lungs. We find a broad difference manifested between the inspiratory and ex- piratory power (Table R.), the latter exceed- ing former by about one third. This differ- ence is due to the elasticity of the ribs and lungs associating their power with the ex- piratory muscles. The combined elastic power is very great ; we have examined it in two fa- vourable cases, an hour after death, when the bodies had not fallen one degree in temperature. X. H., a young man, slightly built, erect and well formed, eet. 22, weight 9ist., height 5ft. 10in., vital capacity 235 cubic inches. The absolute capacity of his chest was 248 cubic inches ; internal area 256in.; circumfe- rence of the chest, over the nipples, in the or- dinary state, alive 33 inches, dead 30A inches. After death we forced air into his lungs, whilst the temperature of the body was still at 97°. The force resisting the introduction of this air must havebeen due to the elasticity of the ribs and their cartilages, together with that of the lungs. By an arrangement, we could force in different quantities of air, and measure the collapsing power of the elastic parts, through the medium of the confined air pressing upon a column of mercury : the following was the result : — Table K. — Costal elastic Collapse. X H. Inch of cub. in. mercury. Air forced in 70 Resisting elasticity T20 Ditto 90 ditto T25 Ditto 160 ditto 2’50 We could not force in more air, for with this pressure it was impossible to prevent the air escaping with great rapidity through the ne- cessary wounds. This experiment was re- peated three times with the same result. It will be remembered that X. H. had drawn into his lungs, when alive, 75 cubic inches of air more than we could force in, after death. If, therefore, 160 cubic inches pro- duced a collapsing elastic force equal to 2-5 we may suppose that 235 cubic inches would produce an elastic force equal to not less than 3‘9 in. of mercury. This chest, mea- suring 256 superficial square inches, it fol- lows that X. H., in breathing out 235 cubic inches of air, with no more sensible effort than that of a mere sigh, had to overcome with his inspiratory muscles a gross elas- tic resistance of about 499lbs., and with a force equal to this weight would the thoracic walls recoil for expiration upon the air in his lungs. N. C., height 5ft. 8in., weight lOst. 10lb., aet. 21: vital capacity, 200 cubic inches; ab- solute capacity, 245 cubic inches; superficial measurement of the entire thoracic cavity, 256 square inches ; circumference of the chest, alive, 33 inches, dead, 34^. Temperature of the body, when examined, 97° F. Tempera- ture of the air forced into the lungs, 63° F. This man was what is termed “ thick set,” firm, erect, and well built, a porter by trade, a very different case from the former. The fol- lowing was the elastic power of his ribs : — Table L. — Costal Collapse in N. C. Inch of cub. in. mercury. Air forced in 70 Resisting elasticity l'OO Ditto 90 ditto 1-50 Ditto 180 ditto 3-25 Ditto 200 ditto 4-50 The first ninety inches of air introduced ruptured the lungs ; therefore the elasticity of the lungs did not interfere with our experi- ments. In both cases this resistance must be referred only to the ribs, their cartilages and ligamentous attachments ; also, in both cases, the bodies were kept erect, or in the sitting posture ; this should be attended to, for the mere weight of the body upon the ribs when recumbent would increase their collapsing power. These tables express a dead power al- ways in reserve, equally powerful whether we are in robust health, or emaciated by age or disease. Dead or alive, this is ready to be put into force ; and, in fact, it is never at rest, never at zero, until death ; we may even go farther, and say, not until de- composition has weakened the collapsing ten- sion of these parts. Cut through a costal cartilage, or take out a small portion of the sternum, say corresponding to the 3rd, 4th, and 5th intercostal spaces, and the opening by the elasticity of parts will retract , and we never can restore them again to their original fit, because the thoracic parietes are still not at rest. The bony cage-work of the chest is THORAX. 1057 so tightly knitted together, that at its mini- mum contraction there still remains an elastic force in operation. In fact we might expect this, because the respiratory movements are so small that it is necessary that an extensive elastic power should be ready at all the re- spiratory stages ; and therefore the parts are upon the stretch before we begin to inspire in order to increase to the geometrical degree re- quired, of two, three, or four pounds to the inch, by a very limited movement, which would not be the case did we begin to in- spire when the thoracic boundaries were at zero, at least, if it did, the walls, &c., would have to be much stronger. Supposing inspiration to be the result of muscular force equally distributed over the whole thorax, the inspiratory power is easily calculated. Taking the walls of the chest at 206 superficial inches, and the area of the diaphragm as 51 superficial inches, and placing them separately, it would appear as follows: — Table M. — Inspiratory Muscular Power re- quired to overcome Costal Elasticity, mea- sured by the Insufflation of 200 Cubic Inches of Air. (Case, N. C.) Air forced into the Chest. Resistance manifested by Inches of Mercury. The same reduced to Ounces on the superficial Inch over the Thorax. The same, given as a total Force in lbs. Total Power required by the Diaphragm to resist the Collapse of the Ribs, in lbs. Total Powersof the Walls and Diaphragm conjoin- ed, in lbs. 70 1-00 7-8 1044 24-8 129-2 90 1-50 11-7 150-6 37-3 187-9 180 3-25 25-3 326-3 80-6 406-9 200 4"50 35" 1 451-9 111-8 563-7 At the same time it must be remembered that this result is produced by insufflation which would excite an undue elastic tension in the diaphragm and abdominal muscles. Yet, on the other hand, in life a greater expansion would be produced by the ribs, and thence a greater resistance. It may be questioned how far we are entitled to add a resistance as due to the dia- phragm. But let us suppose a thoracic cavity collapsed to rest, with a fleshy floor or dia- phragm also quiescent; let us suppose the ribs expanded by some power from without ; the air within the chest would be attenuated, and the diaphragm would be forced upwards, by atmospheric pressure, with a force exactly commensurate to the rarefaction of the air within the chest (presupposing that no air is allowed to enter the chest when we expand the ribs). In this case the diaphragm is resisting the same force per inch as the walls of the chest. Or on the other hand, fill the chest with air to perfect distension, allow the ribs to collapse, the diaphragm would have to resist this collapse with a power exactly commensurate with the recoiling elasticity of VOL. IV. the ribs ; therefore the diaphragm participates, in common, in such resistances in the tho- racic cavity. But, as the question may be open to objection, we shall chiefly notice that power in reference to the parietes of the chest, given in the 3d and 4th columns in the last table. This table shows that the man, when alive, exerted a muscular power with the walls of the chest, when he inspired 200 cubic inches of air, equal to a total weight of 451"9 lbs. avordupois. Independently of the collapsing elasticity of the lungs, which would be not less than 128 lbs. more (see Table O), his inspiratory muscles lifted a weight of 32 stones, — a weight which he could not have lifted with his arms : and yet the animal economy is not conscious of this exertion. We have supposed a uniform mus- cular traction, which is not the case, because the distribution of muscular fibre and tho- racic mobility, is not equally applied in ex- panding the chest. In diagram fig. 670, d represents a section of the thorax : the portion shaded is the range of thoracic mobility be- tween extreme inspiration and expiration. The mobility is unequal ; more is on the anterior than on the posterior part ; therefore w-e may presume muscular traction to be more at one part than at another. This man could exhale 300 cubic inches of air ; and there is every reason to think, from this extensive mobility, according to our last estimate, that the elastic collapse of his ribs, at the termina- tion of deep inspiration, would be not less than 1000 lbs. In the superficial measurements of the thorax we have included every part, even that covering the vertebras. Now certainly we cannot think the elastic collapse over the vertebra equal to that from the sternum ; therefore, if we allow one-third of the chest to be inactive, and the remainder elevated by the respiratory muscles (which we think is within the mark, because every part of the chest is mobile), then in the case of N. C. in deep inspiration the muscles would have to overcome 301 lbs., or 23 ounces on the super- ficial square inch of the thorax. The last act of life is a deep expiration. During life the ribs are always kept under a certain degree of distension, which is ready to send out from 70 to 100 cubic inches of air at any moment ( Reserve air, p. 1067). Our inspiratory muscles, in fact, are always antagonising an elastic thoracic collapse ; and this is always increasing or decreasing, ac- cording to the stage of respiration, as quiescent or forced, &c. There are cases, as in hang- ing, where a man may die, at the moment of full inspiration, from fear, making an effort to resist the dreaded shock which he is about to receive. N. C. died thus in a state of inspira- tion. Making allowance for unequal elasticity of the boundaries of the thorax, of -J- as above stated, it may be safely said that the dif- ferent stages of respiration or breathing re- quire the following muscular power to antago- nise the elastic power of the ribs throughout life. 3 Y 1058 THORAX. Table N. — Inspiratory Muscular Power (corrected). Different stages of inspiration. Elastic resist- ance in ounces on the super- ficial square inch to be over- come by the respiratory muscles. Total re- sistance of the same in lbs. la 1 5* \ Reserve air 5-G 09-G l Breathing air 7*8 104-4 Qi . o . Vital capacity 23-9 301-0 Thus we see that in the mere act of or- (Unary breathing there is an elastic resistance, independently of the elastic force of the lungs, equal to more than 100 lbs. This is to be lilted 18 or 20 times every minute of our life. Of tiie Elastic Power of the Lungs. — Independently of the powerful collapse ol the ribs and their cartilages, expiration is greatly aided by the elasticity of the lungs themselves, which at all times', and in all the stages of respiration, are tending to collapse upon themselves ; and hence, immediately upon puncturing the thorax, the lungs col- lapse to half their dimensions. From the earliest period of physiological re- search, as usual, totally opposite opinions have alternately prevailed as to whether the lungs themselves are active in the respiratory move- ments. Averroes, Riolan, Planter, and Bre- mond#, were in favour of their independent action ; and Bartholin, Diemerhoeck, Mayow, and Haller f, opposed to it. Their elastic con- tractility can only have been lost sight of by reason of their quick contractible power ; for immediately the thorax is punctured, before parts are cleared away sufficiently to give a view of the contents of the thorax, the lungs have collapsed to their minimum, and a vast space is always presented between the lungs and the thoracic walls, which, by the old anatomists, even in the time of Hoadly (1740), was con- sidered to contain air necessary for respiration. Dr. Carson of Liverpool appears to have first noticed this elastic power of the lungs. He judiciously observes : “ Breathing is, in a great measure, the effect of this intermin- able contest between the elasticity of the lungs and the irritability of the diaphragm.” + In his experiments upon the lungs of some lower animals (bullocks), he found a collapsing power equal to a column of from 12 to 18 inches of water; in a calf about 18 inches; and in a dog about 10 inches. In these experiments, the lungs, when in situ, were inflated to their maximum. Pro- bably the ribs interfered by their resistance in aiding the collapse of the lungs. Never- * Mem. de l’Acad. des Sciences, Paris, 17S9 ; Muller, p. 346. t El. Phys. t. iii. 1. viii. p. 226. | Phil. Tr. 1820, part i. pp. 42, 43. theless, at all times of nidation, even when the residual volume only was in the lungs, there was an elastic power in operation. Mr. Gulliver informs us, that from an examination of the lungs of man and the lower mammalia he has been led to infer that the elastic tissue is an important agent in expiration. This tissue, he says, may be seen to invest the entire surface of the lungs, forming a strong, elastic, though delicate, capsule to the organ. This investment of the lungs in the horse, he informs us, resembles the fibres of the ligamentum nuehae and the fibrous coat of the aorta of the ox, as depicted in Gerber’s Anat. pp. 54, 55. The longitudinal fibres which enter into the structure of the air-tubes throughout their entire extent are very elastic, like the coats of the arteries, and these are justly supposed to possess the power of contracting each mi- nute ramification of the lungs. When this elastic power is at rest, and the lungs are col- lapsed to their minimum, no external pressure can discharge the remaining volume of air, because the very pressure, to accomplish this, compresses the exit tube in some part of its course. The elastic contraction of each tube acts somewhat like the vermicular motion of the intestines, causing a specific diminution of calibre upon each part of the column of air in a ramification, driving it forward. But when the elasticity has arrived at its mini- mum, and this tissue is quiescent, we cannot extract any more air from the lungs, because the vermicular expelling power derived from this elastic tissue ceases to act. The col- lapsing power of the lungs acts in the same di- rection as that of the ribs, but with less force. According to Tables O and P. the total elas- tic collapse of the male lung was equal to about 4301 grs. or nearly 10 oz. avoirdupois (9-8) upon the superficial square inch of that organ, and in the female about 50G0 gr. or 1P3 oz. upon the superficial square inch. We think, taking all things into consideration, that it is safe to say, in making a deep inspiration for the vital capacity-volume, that we may estimate the elastic collapsing power of the lungs at one half lb. avoirdupois, per superficial square inch ; therefore, allowing the mean superficial mea- surement of the male lung to be 300 in. and the female 247 in., that the grow resistance, by the elasticity of the lungs against the inspiratory muscles, would be in the male 150 lbs., and in the female 123 lbs. This is to be added to the elastic force of the ribs (Table N). In the female an unknown portion of the residual volume escaped before we could connect the hsemadynamometer ; for the next volume added, of 90 cubic inches in the man with all his residual volume, the collapsing power was 7*2 in., and in the female, with the addition of 100 cubic inches, it was 5‘5 in., which about makes up the difference of 2 in. of collapsing power lost by the accidental escape of the residual volume. In the case of two healthy persons ex- amined immediately after death, — E. F. M., male, height 5 ft. 9 in., weight 10 st. 10 lbs.. THORAX. 1059 circumference over the nipples, alive, 38 in. ; dead, 36 in. — died with an expiration, — we, by means of the hoemadynamometer, contain- ing water, attached to the trachea, found, with different volumes of air in the lungs, the following elastic collapsing power (tem- perature— of body 98‘5° Fahr. — of atmo- sphere 59‘5°, barometer 29-753). Table O. — Elasticity of the Lungs (male, aat. 29.). Elastic col- lapsing power, * Volumes of air. in. of water- Residual vol. - 2‘5 Reserve vol. ( + 90 cubic inches) 7'2 Breathing vol. ( + 20 ditto) - 8‘2 Vital capacity (+ 25 ditto + 150 ditto) 17-0 M. M, female; sudden death; temperature of body 97-5°Fahr. ; ast. 28; height 5 ft. 9 in.; circumference of chest over nipples 37 in.; below 32) ; lungs healthy. Table P. — Elasticity of Lungs (fern., set. 28.). Elastic col- lapsing power, Volumes of air. in. of water. Residual vol. - 0-7 Reserve vol. (+ 100 cubic inches) 5 5 Breathing vol. (+100 ditto) - 10‘0 Vital capacity (+ 90 ditto) 20'0 At the commencement of “ordinary breath- ing” the collapsing power of the lungs in our experiment was 7-2 in., or nearly * of a lb. per superficial square inch. This is a very notable power, not less in the gross, oftentimes, than 100 lbs. of dead uncounter- balanced resistance to the respiratory mus- cles. In the female, with nearly an arith- metical increase of 100 cubic inches per vo- lume, the collapsing power increases 5 to 10 and 20. The insufflated volume in the male being less regular, the collapsing power ma- nifested is also less regular. But, taking the mean resistance of the reserve and breathing volumes in the male combined (160 cub. in.), the power of collapse was 7’7 inches. In the female, the mean of nearly the same quantity of air in the lungs (within 10 cubic inches) allowing for little or no residual volume at the starting point when we inflated, is likewise 7-7 inches. We believe that the elastic power of the lungs in the two sexes is the same ; — indeed why should it not be so? because the office of the elastic tissue is to drive out of the lungs volumes of air no longer required ; and it is probable that the resistance given by the air, against the sides of the air tubes, in both sexes, is the same; and unless the number and calibre of the air tubes are different, the resistance, by friction, to the elastic collapse of the lungs, from the trans- mission of similar volumes of air in the two sexes, must be the same. In three experiments we found the elastic collapse of the lungs cease at different degrees; i. e. different volumes of residual air were displaced when the elastic force had come to its minimum. * For definition of these terms see p. 1065. Table Q — Volume of Residual Air displaced by the Elastic Collapse of the Lungs when the Thorax was opened, in three Males. Height. Weight. Circum. of chest. Weight of Lung6. | Vital capa- I city. Volume dis- placed. Bronchial expansion. H. ft, in. 5 10 St Il)S. II 10 in. 30i lbs in- 240 in. 30 in. 7 C. 5 8 10 10 34* 16J 200 60 1-5 M. 5 9 11 0 36 36 238 45 12-5 There is no order in the numbers 30, 60, and 45, relative to the other measurements. We do not know what quantity of air remained after these volumes were displaced. When we ex- hausted the remainder of the residual volume, which is not affected by the elastic collapse of the lungs, the sides of the air tubes themselves collapsed by the atmospheric pressure. They likevvise are elastic, but in a contrary direc- tion ; an expanding elasticity keeping them open. We found that the expanding elasticity acted so as to draw or suck inwards the air with the different powers represented by 7, T5 and 12'5 inches of water in the haemadynamo- meter, when we attempted to withdraw out of the lungs more air than the lungs themselves naturally displace by their collapsing elasticity. Therefore these figures may represent the ex- panding elasticity of the air tubes. In these cases there is no apparent order ; but we learn the fact that such elasticity^ exists. In the case C there was a tubercular condition of lung, in the milliary form, in one apex ; in II there wras extensive pleuritic adhesions ; but in the case of M the lungs were remarkably healthy. It is interesting to notice that there are here two elasticities in contrary direc- tions,— an elastic collapse which has its limit at a certain point, and an elastic expansion of the air tubes, which likewise have their limit of expansion at the same point, protecting the calibre of the air tubes from any further collapse. In the case of M the expansion of the air tubes was equal to 12 '5 inches of water ; by calculation it appears that the collapse of the elastic tissue upon the vital capacity volume would be about 14 inches. These antago- nistic forces are quite independent of the will, or any nervous stimuli : one is for maintain- ing an expiratory current of air, and the other for preserving an open channel in the lungs for inspiration. The lungs are very delicate organs, and can resist but little artificial force ; for, if once inflated to the ordinary state of either the breathing volume or vital capacity volume, they do not appear able to collapse again to their original size ; — probably intra-lobular emphysema is produced. In our experiments we forced air into the lungs; they were expanded because we inflated them. We now think it would be better to 3 v 2 10G0 THORAX. inflate them by expanding them (removing the external atmospheric pressure), and allow the air to drop into the air vesicles by its own gravitation (as in living respiration), when they would in all probability collapse freely to their original position. When they are in- flated by expansion (the natural way of life) the delicate cells of the lungs can safely resist a force of from 3 to 9 inches of mercury, or from 40 to 121 inches of water (see next column) ; but when expanded bp inflation , their collapsing power was damaged so that it could sustain only 17 or 20 inches of water. This is worthy of notice in resuscitating the apparently asphyxiated person, at which times we have long been of opinion that bellows and pumps are highly dangerous instruments to use for maintaining artificial respiration. Of the muscular contractility of the lungs. — In the trachea transverse muscular fibres extend across posteriorly, connecting the tips of the incomplete rings of cartilage. In the smaller bronchi they encircle the whole tubes, and there appears to be little doubt but that these circular fibres are to be found in every part of the air tubes as far as the terminal air vesicles. Physiologists have disputed whether these fibres are muscular or not ; if muscular, they are important agents in respiration, acting as a series of little expiratory muscles. Dr. C. J. B. Williams lately read a paper at the meeting of Glasgow (September 1840), upon the subject.* He experimented upon the lungs of some of the lower animals, — several dogs, a rabbit, a bullock, a horse, &c\, — as soon as possible after death, submitting their lungs to galvanic stimuli, and securing a hmmadynamometer with a stop-cork to the trachea. He found that, upon applying this stimulus, the fluid in the bent tube rose from 1 to 2 inches, and it immediately fell on break- ing contact. This effect could only be pro- duced by muscular contraction. Kdlliker, a very accurate observer, confirms these views, j- He found in man, in the larger and finer bronchial tubes, a coat formed of annular fibres, in one or more layers according to the size of the tube, consisting of unstriped muscular fibres ; and over this coat a thin layer of fibro-cellular tissue with nucleus-fibres. He found no mus- cular fibres directed longitudinally. He ob- serves, “ In former observations I thought I had convinced myself of the existence of unstriped muscular fibres in the air-cells; but in my resumed examination of the lungs of man and mammalia, I can with certainty see nothing distinctly characteristic as such mus- cular tissue.” Our knowledge of these cir- cular muscular fibres was first chiefly derived from the researches of Reisseissen. Laennec considered spasmodic asthma to be assignable * The Pathology and Diagnosis of Diseases of the Chest, 8vo. by Dr. C. J. B. Williams, 1840, Lon- don, p. 320. f Beitrage zur Kenntniss der glatten Muskeln in the Zeitschrift fur Wissenschaftliche Zoologie. H. i. S. 40. 8vo, 1848. to a spasm of these circular fibres. We are as yet ignorant of the possible extent of contrac- tion of these fibres. The discharge of air is paramount, and that from the most remote vesi- cle ; and we know that by no mechanial means can we obtain this, and therefore a molecular power is necessary, which we readily imagine can be obtained by these tissues acting so as to give a peristaltic motion, and thus dis- placing from every individual vesicle the de- licate stream of air necessary to be dis- charged. We do not need these tissues for inspiration, because the atmosphere, by its mere weight, can penetrate into the most remote air-cell, overcoming all the friction against the sides of the air-tubes. The in- spiratory volumes of air are but for one pur- pose, to aerate the blood ; but the expiratory volumes are for the voice and other purposes sometimes requiring great force to aid in cer- tain expulsive efforts. Of Respiratory Muscular Power. — Young falls into an error in supposing “ that in muscles of the same kind the strength must be as the number of fibres, or as the extent of the surface which would be formed by cutting the muscle across ; and it is not improbable that the contractile force of the muscles of a healthy man is equivalent to about 500 lbs. for every square inch of the section.” * When we examine men we find no such calculations are to be relied upon. It is very common to find two men of cor- responding dimensions produce very different effects upon any dynamic instrument. The respiratory power mayor may not cor- respond with the general development of mus- cular force. We have submitted 1500 men of various classes to an experiment upon the inspiratory and expiratory power. The resistance to this power was a column of mercury, — th ehcemady- namometer, or bent tube, first used by Dr. Hales. He observes, “ A man, by a peculiar action of his mouth and tongue, may suck mercury 22 inches, and some men 27 or 28 inches, high ; yet I have found by experience that, by the bare inspiring action of the dia- phragm and dilating thorax, I could scarcely raise the mercury 2 inches.” f Hales appa- rently never tested the expiratory power. We connected the column of mercury with the index on a dial plate, which represented the inches and tenths of inches of mercury lifted. A tube was adapted to fit the nostrils through which the inspiratory or expiratory effort was made. By the former the index was moved in one direction, and by the latter in the con- trary direction ; each half of the dial plate representing, respectively, inspiratory and ex- piratory power, with expressive words at- tached, as follow: — (See top of next page.) It will be observed that the figures on each side of the same word differ in their value, those of the expiratory side ranging about one- third higher than those on the inspiratory side. * See Nat. Phil. Loud. 8vo, 1845, p. 99. f Stat., vol. i. p. 267. THORAX. 1061 Power of Inspiratory Muscles. Table R. Power of Expiratory Muscles 1*5 in. Weak - - 2-0 in. 2-0 „ Ordinary - 2 5 „ 2 ’5 „ Strong - 3-5 „ 3‘5 ,, Very strong - 4’5„ 4-5 „ Remarkable - 5-8 „ 5'5 „ Very remarkable - 7-0 „ 6-0 „ Extraordinary - - 8’5 „ 7-0 „ Very extraordinary - io-o „ Indeed when these powers are the same, it indicates disease. We subjoin the following table of the result of these cases. (Table S.) To illustrate one of the points so striking in these experiments (viz., the difference be- tween the inspiratory and expiratory power), we refer to diagram 701., which represents by curves their relative position. The upper line is the expiratory power, and the double line below, the inspiratory power. The per- pendicular lines are the different heights of the cases examined. The position of these curved lines indicates the power they re- present, — the higher the curve the greater the power. The two rows of figures at the bottom are the inches and tenths of inches of mercury elevated. (I. for inspiration, and E. for expiration.) According to this, at the height of 5 feet 7 inches, and 5 feet 8 inches, the inspiratory power is greatest, and thence the inspiratory power gradually decreases as the stature increases. The men of 5 feet 7 inches anil 8 inches elevate a column of 3 inches of mercury : this may be considered a healthy power ; and the men of 6 feet high elevate about 2J inches of mercury as their healthy power. Fig. 701. ft. in ft. in. ft. in. ft. in. ft. in. ft in. ft. in. ft. in. ft. in. ft. in. ft. in. ft. in. ft. in. ft. in. 5051525354555S5758595 10 5 11 606 + Expiratory. Inspiratory. E. 3-28 3-36 3'23 3 15 4'32 4'33 3'37 4‘13 4'13 4'28 5'94 3 63 448 4'4l I- 2-55 2'0 2-52 2'31 2'70 2'84 2'70 3-07 2‘96 2‘91 2‘83 2'77 265 2'67 Inspiratory and expiratory power in healthy cases. It may be asked, why connect this with the height? Because it was found in six collateral observations that this was the only physical condition which presented a relation so as to throw the experiments into an or- derly position.* By Table S we see that the respiratory power varies in different classes. The “gentlemen,” for instance, are below most of the other classes : at the height of 5 feet 8 inches, they elevate by inspiration 2‘35 inches of mercury. This may account for the fact why Dr. Hales could only raise 2 inches of mercury by this effort. The expiratory power is normally more irregular — more apt to vary — than the inspi- ratory power. The expiratory muscles par- ticipate in other duties besides that of mere expiration ; the vocation of the glass-blower, the trumpeter, the wrestler, the jeweller (blow-pipe), and the sailor, especially call these muscles into use, increasing their na- tural power. They thus oftentimes become excessively strong. The inspiratory muscles are exclusively for supplying us with air, in which act they have only to oppose the uniform resistance of elasticity. The inspira- tory power is therefore the best indication of the “ health ” — the “ vis vitce.” As an instance of the effect of vocation chang- * For the other observations, see p. 1068, and Med. Chir. Trans. 1846. Yol. 39. p. 143 et seq. ing one of the respiratory powers and not the other, we may notice the Metropolitan po- lice and the Thames police. The inspiratory power of these two classes is nearly equal, whilst the expiratory power of the Thames police exceeds that of the Metropolitan police, — the former using their upper extre- mities, whilst the latter use their lower ex- tremities most : — the former chase the thief by the use of the oar ; the latter by the swiftness of their legs. Compositors and pressmen stand low the former are the lowest in their respiratory power ; the pressmen are much higher. The order in which some of these classes come is as follows : — the most powerful are the Thames police ; next, the sailors ; the pau- pers and the gentlemen are nearly equal ; and lastly, diseased cases. The two last lines is the mean of the four healthiest classes, — the seamen, firemen, Thames police, and pugilists : their maximum is 3 inches ; the mean of the whole classes together is little more than 2£ inches. The measure of this power when expressed by inches of mercury appears small, yet, when hydrostatically con- sidered, it is very great. Men have wondered that they could not elevate more mercury in the tube; but all surprise vanishes when it is recollected, that, by the law of hydrostatics, when a column of 3 inches height of mer- 3 y 3 TaSle S. — Inspiratory aild Expiratory Power in relation to the Stature. 1062 THORAX. + •sasR^ i- - 00 d Z Cl cl i to CO i 00 to o •dxa |« o oo r^. r- CO o O’ 5o co —■ tp o p tb © p d p o co f 1 3p to •dsui 1 o Is o CD tO to to cb 1 - o CM to p CM o ■S3SU3 110 » •S9SRQ Is 2 Tp to Cl CM - : o ■« CO oo tJ» CM to CO TP O o •dxg II CD CO o O’ oo co co to to co 3 CO cb o cb p CM p CO o d to d CC tO eb to ■dsiij II CO © CO p d CO Cl © o CD CM TP . 7 o o CM p CM 0-791 cb p co iO p to •SdSRQ ;|s : ; Cl to CM CO - Cl l'- CO to Cl = d j o o •dxg 4 25i Tp N CO cb O p CM to o CO 06 Vi CO to o CO p CO 3-87 1 So co to •dsui II s? CM o O 1^- to CO o co CO p tO to tP 5 to d p o p 1 G CM to "S9SBJ3 1=0 CD oo co © Cl ■^* CO 2 i o ■dxa 1” C p 3-05 310; Cl to r : o co p ; c p o 'dsui Is |D O O p : 00 o s 31 •SSVTQ < n o Q W in d rs -■ id s 6 6 1 K j Seamen ... Firemen ... Metropoli- tan police... | Thames police Mixed class Grenadier guards....... j Pugilists ... Draymen... Horse guards Paupers ... Compositors | Pressmen Mean of j printers ... Diseased ' cases. ...... Gentlemen. Mean of the four j healthiest 1 Mean of all the 13 classes ex- cept the | diseased ...[ THORAX. 1063 cury is sustained, the force exerted by the diaphragm alone is equal to the weight of as much mercury as it would take to cover a space of the same area as the diaphragm, three inches deep. The column of mercury raised, therefore, will not safely serve to compare the respiratory power of men of different dimensions, for the area of the thorax must also be considered. For instance, we examined a man, 4 feet 7iinches high (circum- ference of the chest 29 inches), who raised 3' 15 inches ; and another man, 7 feet high (chest 50 inches in circumference), who could only elevate 3 inches of mercury : but the dissimilarity between the area of the dia- phragm in the dwarf and giant was such, that the latter in reality lifted about 500 lbs., and the former only about 39 lbs. Suppose the base of his chest to be 57 superficial square inches ; had this man raised 3 inches of mercury by his inspiratory muscles, his diaphragm alone must have opposed a resist- ance ecjual to more than 23 oz. on every inch of that muscle, and a total weight of more than 83 lbs. Moreover, the sides of the chest, by attenuating the air within, resist an atmospheric pressure equal to the weight of a covering of mercury 3 inches in thick- ness, or more than 23 oz. upon every inch surface, which, if we take at 318 square inches, the chest would be found to resist a pressure of 713 lbs. ; and, allowing the elastic resistance of the ribs as 1| inch of mercury, this will bring the weight resisted by the inspiratory muscles of the thorax as follows : — Diaphragm - Wails of the chest Costal resistance (elastic) Lung - 83 lbs. 73 1 „ 232 „ 100 „ 1146 lbs. Or, in round numbers, we may say, that the inspiratory muscles of such a man of ordinary dimensions resisted 1000 lbs. This is a re- sistance not counterbalanced ; for were it counterbalanced, it would only be mere dis- placement. We have made a safe addition for the elasticity of the lungs. We think it may be confidently stated that nine-tenths of the thoracic surface conspire to this act, allowing the remainder to lie dormant. Although the difference between the in- spiratory and expiratory powers, when tested to their utmost, is so great, yet it must not l>e thought that these two powers aie in their ordinary action so dissimilar; and indeed, when all things are considered, the question may still be asked, is the inspiratory or ex- piratory act the strongest? In the last table (Table S.) there is uniformly a difference, because the two powers are unequally taxed with resistance. All elastic force is co-ope- rating with the expiratory power, whilst it antagonises the inspiratory power; therefore all the power manifested in inspiration is muscu- lar ; but in expiration it is partly muscular and partly elastic power. This probably causes the great apparent difference between inspira- tion and expiration ; at least, if we separate the resistance we assign to the elasticity of the ribs and lungs from the expiratory power, we shall nearly equalise the two. This can beeasily proved upon one’s own person : — partially empty the chest of air ; then forcibly test your expiration upon the haemadynamometer : pro- bably you can only elevate the mercury ]a inch; then inspire deeply, completely filling the lungs, and now test your expiratory power, — instead of If inch, it will probably be 5 inches. This difference appears due to two causes. 1st. In the deep inspiration the ribs are put more upon the stretch than in the moderate inspiration. 2d. The chest, when distended with air, presents points of attach- ment for muscular traction, to a greater me- chanical advantage. The most remarkable respiratory power, as tested by the haemadynamometer, was in the case of a Chatham recruit, who was fre- quently examined by Dr. Andrew Smith, on whose accuracy we place implicit confidence. The man’s age was 18; height, 5 feet 6 inches, weight, 10 stones 5 lbs. ; circumference of his chest, 35 inches ; vital capacity, 230; — his inspiratory power was equal to 7 inches of mercury, and his expiratory power to 9 inches ! The thoracic power of this man, according to our last calculation, was equal to a gross weight of 22CO lbs. This was the amount manifested, and we may safely consider 50 per cent, of muscular power to be lost by the obliquity of the respiratory muscles ; so that this man possessed a vital power equal to nearly 2 tons! He exhibited in no other respect any remarkable feature of strength. A dynamic instrument like the haemady- namometer would be useful to those whose duty it is to examine men for certain public services, as for the army, navy, police, fire- brigade, &c. With care, it would often detect disease. The efforts required to move the mercury test the whole trunk of the body. The inspiratory test produces a rarefaction of the air within the thorax, causing an extra (unbalanced) atmospheric pressure upon the body from without. In this way we have de- tected rupture of the membrana tympani; for the air rushing in by this opening equalised the difference otherwise produced. The ex~ piratory test is of a contrary order, increasing the pressure from within ; in this way we have detected hernia. The difference between the healthy and dis- eased respiratory powers is broadly marked. — It is shown in the annexed diagram (Jig. 702.); the lower curve is the power manifested by diseased, and the upper curve that of healthy persons. The difference is about 50 per cent., because weakness is the most prominent symptom of disease. We do not compare the expiratory power for the reason already assigned. We affix at the bottom of the diagram the relative powers in figures. 3 y 4 1064 THORAX. Fig. 702. Heights. ft. in. ft.-in. ft. in. ft. in. ft. in. ft. in. ft. in. ft. in. ft. in. ]ft. in. ft. in. ft. in. ft. in. ft. in. 0 0 5051 5 2 5 3 5 4 5 5 5 6 57 58 5 9 ilO 511 GO 50 51525354555657 58 59 5 10 5 11 606 + Healtliy. 2'55 2-00 2-52 2‘31 2'70 2'84 2'70 3'07 2'96 2 91 2+3 2’77 3'65 2 67 Diseased. .82 1‘30 1'16 l'OO 1'34 -74 L25 '79 L67 1'32 -93 -88 +0 1'65 Inspiratory power of the healthy and diseased compared. Of the Respiratory Volumes. — For 1500 years, from the time of Galen to Robert Boyle, naturalists, physicians, anti philoso- phers disputed the simple operation of draw- ing air into the thorax. There were three explanations given : — First, “ That by the dila- tations of the chest the contiguous air is thrust away, and that, pressing upon the next air to it, and so onwards, the propulsion is continued till the air be driven into the lungs, and so dilate them.” Secondly , That the chest is like a pair of common bellows, “ which comes therefore to be filled because it was dilated.” Thirdly, That the lungs are like a bladder “ which is therefore dilated because it is filled.” The great philosopher Boyle adopts the bel- lows’ action viz., that the lungs are filled with air, because the chest is dilated, and that with- out the motions of the thorax they could not be filled. “ Indeed,” says Boyle, “ the dia- phragm forms the principal instrument of ordinary and gentle respiration, although to restrained respiration, if I may so call it, the intercostal muscles, and perhaps some others, may be allowed eminently to concur.” * Co- temporary with Boyle, we find Richard Lowerf (1667) correctly understanding the respiratory action; he makes a dog breathe like a broken-winded horse, by' dividing the phrenic nerve. What Boyle and Lower demon- strated, every one now believes without dispute; yet it took 100 years’ disputation, through a number of unfounded hypothetical and contra- dictory speculations, before the truths which Boyle and Lower promulgated were received. As late as the eighteenth century, little more than one hundred years ago (a. d. 1737), it was stated in the Gulstonian Lectures before the Royal College of Physicians that there was air between the pleura? J, — a con- dition which we now know is almost instant * Boyle’s Life and Works, fol., Lond. 1744, vol. i. p. 64. f Phil. Tr. Abr., vol. i. p. 179. 1 Hoadly, Lee. on Kesp., 4to, 1740, Loud., p. 1 1, et seep death. The first great epoch in the history of respiration was at the time of Harvey (1628), when he published his first work on the circulation of the blood, though at this time he did not stand commended for his discovery ; for most persons opposed it ; others said it was old ; and the epithet “ cir- culator,” in its Latin invidious signification, was applied to him. We know respiration depends upon the weight of the air; and at a very remote period air was known to possess the quality of weight. Aristotle and other ancient philosophers expressly speak of the weight of the air. The process of re- spiration is attributed by an ancient writer to the pressure of the atmosphere forcing air into the lungs.* Galileo was therefore fully aware that the atmosphere possessed this pro- perty ; yet when his attention was so immedi- ately directed to one of the most striking effects of it, he did not see its connection with respira- tion. It was reserved for his pupil, Torricelli, to discover (1643) the true law of atmo- spheric pressure ; and as we can find no phi- losophical reason assigned, prior to this date, why air enters the lungs in inspiration, we may date this as a first step in the advance of knowledge upon our subject. Nevertheless, no less an authority than Swammerdam adopted, for upwards of twenty years after this, the unphilosophical reasoning of Des- cartes, that the air was forced into the lungs by its increased density around the breast, oc- casioned by the dilatations of the thorax, in consequence of the elevation of the ribs. In 1667 some attention was paid to respira- tion being maintained by distinct volumes of air ; for Hook kept a dog alive with common bellows by artificial respiration, f Fabricius, in the beginning of the 17th century, cor- rectly explained the action of the diaphragm. J Boreili is the earliest physiologist (1679) who * Lardner’s Cyelop. Nat. PhD. Hydr. and Pneum. p. 247. f Phil. Tr. Abr. vol. i. p. 194. j De Heap. ii. c. viii. THORAX. 1065 established an experimental inquiry into the quantity of air received by a single inspiration.* Jurin improves upon Borelli. About this time (1708) Dr. James Keile made some correct measurements of the volume ot air breathed, j- Then followed Dr. Hales, who threw more light upon the doctrine of air, the power of respiration, and the power of the heart, than all his predecessors ; yet he was quite ignorant of the use of respiration ; and at this period (1733) really very little was known upon the subject. In 1757 and fol- lowing years, Black, Rutherford, Lavoisier, Priestley, and Scheele, the chemists of the age, threw light upon the matter by discover- ing the composition of the atmosphere, and consequently the composition of respired air. It is since the time of Black that the most valuable mass of our knowledge upon respir- ation has been discovered. The functions of the thorax may be divided into two great heads, — the chemical and the physical ; for an account of the former see Respiration. Every point of the thorax can move for the purpose of respiration ; and hence has followed a division of these movements, nominated after the parts which respectively carry on their functions, viz. costal breathing, and ab- dominal or diaphragmic breathing. These motions are, in health, symmetrical, constant, regular, sensitive, and precisely the same ; otherwise disease must exist. The breathing movements are also expres- sive of mental emotions. The tragedian imi- tates them to give force to the character he represents, whether it be the stealthy breathing of the Roman conspirator sharpen- ing his knife, or the deep swelling inspiration of Ajax defying the lightning ; these repre- sentations, without such movements, would be but dull pictures of the mind of the authors who left such characters on record. It is much easier to become delicately fa- miliar with these movements and their cha- racteristic differences, than it is to describe them. The latitude of movement, performed by the walls and floor of the thorax, admits of three common degrees of division : — First, extreme expansion or enlargement. Second, extreme contraction or diminution ; and Third, an intermediate condition, — an or- dinary or quiescent state. These three divisions necessarily displace volumes of air of different magnitude. Were the respiratory movements but two in number, extreme expansion and extreme contraction, the quantity of air moved, and the character of the movement, would be easy of calculation and expression ; but the interme- diate breathing or quiescent movement being so limited, so perfectly under the control of the will, so readily affected by mental emo- tions and by the animal functions, renders * Do Motu Animalium, p. 2. prop 81. t Tentara. Med. Phys. p. 80. the calculation of the volume of air ordinarily passing through the lungs a very difficult question. The quantity of air in the thorax, together with those portions which can be added at will, may be arranged and denominated thus : — First, residual air. Second, reserve air. Third, breathing air. Fourth, complemental air. Fifth, vital capacity. 1st. Of residual air. — After death the lungs contain air, which is not displaced by the last expiration ; this quantity remains in the thorax as long as the lungs maintain their natural structure; therefore we have no control over this volume of air : to it we assign the term “ residual air." 2nd. Reserve air is that portion which re- mains in the chest after the gentle ordinary expiration, but which may be displaced at will. 3rd. Breathing air is that volume which is displaced by the constant gentle inspiration and expiration. 4th. The complemental air is that volume which can at will be drawn into the lungs by a violent exertion above the moderate effort of ordinary breathing, constituting the deepest possible inspiration. It is only occasionally demanded. 5th. The vital capacity is these last three divisions combined, being the greatest vo- luntary expiration, following the deepest inspi- ration.* This division of thoracic movements for commanding these different volumes of air may be more clearly illustrated by diagram 703. Fig. 703. Let that portion marked Id represent the resi- dual volume, or air left in the lungs, after a complete voluntary expiration ; the part next * According to physiological nomenclature, perhaps the term “ vital capacity ” may be objec- tionable ; but we adopt it, for want of a better term, to signify a capacity or volume of air which can only be displaced by living movements, and may therefore be termed a “living volume,” or “vital capacity.” 1066 THORAX. anteriorly, left white, — the reserve volume, or latitude of movement appropriated for dis- placing that air left in the lungs at the end of an ordinary expiration ; the black stripe next anteriorly represents the mobi- lity for commanding the volume of breathing air ; and lastly, beyond this another white stripe shows the extreme limit of inspiration or thoracic mobility commanding the com- plemental volume of air. These last three — viz. the complemental, breathing, and reserve volumes conjointly — we style vital capacity. The absolute capacity may be considered as all the divisions combined in one. Whatever limits the mobility of the thorax must modify the volume of air respired. This applies to any or all of the above movements. Therefore the measure of the volume of air displaced becomes a measure of the thoracic mobility ; and as disease affects the mobility of the chest, the measure of the volume of respired air becomes a measure of disease. The residual volume is entirely independ- ent of the will, and always present in the chest. The reserve volume, to use a simile, is a “ tenant at will.’’ The breathing volume is constantly passing out and in, many times a minute. The complemental volume is seldom in the chest, and then only for a very brief period. Whatever be the breathing volume ne- cessary for our well-being, the mobility demanded to maintain it is an intermediate mobility, just as the dark stripe in fig. 703. is intermediate between the white stripes ; so that at both ends of the ordinary breathing mobility there exists a spare mobility, which we can command into action according to the necessities required. This reserve and com- plemental mobility may be looked upon as a broad, spare margin which encompasses our breathing ; so that any sudden exertion may not (as it otherwise would) produce painful dyspnoea and premature death. This spare mobility, therefore, is always ready to admit of irregularities in the ordinary breathing, such asfrequent or infrequent, quick or slow, regular or irregular, great or small, equal or unequal, easy or difficult, complete or incomplete, long or short, abdominal or costal; as in coughing, running, laughing, crying, sing- ing, sighing, and vociferating, many of which are but extensions or modifications of the or- dinary mobility, infringing upon this margin — the complemental or reserved mobility. This spare mobility is not only ready for such exigencies as above mentioned, but it becomes a reservoir for “ times of need.” Thus a man can take from 230 to 300 cubic inches of fresh air into his lungs, and live upon it without inconvenience for two minutes with- out breathing. * The knowledge of this fact * It is better to inspire and expire forcibly five or six times, cleansing the lungs of the old air, and then give one deep inspiration, and there hold. For the first 15 seconds a giddiness will be ex- perienced ; but when this leaves us, we feel not the would be of much use towards rescuing a fellow creature from suffering amidst dense smoke or in an irrespirable atmosphere, as is found sometimes in mines and wells. A variation of this condition was once wit- nessed when Mr. Brunei descended to ex- amine the breach which the river had made in the Thames Tunnel. Having lowered the diving-bell nearly 30 feet to the mouth of the opening, this was found too narrow to admit the bell ; so that no further observation could be made upon the workings, which were about 8 feet or 10 feet deeper: Mr. Brunei, therefore, laying hold of a rope, left the bell, and dived himself down the opening. His companions in the bell, being alarmed at the length of his stay, now about two minutes, gave the signal for pulling up ; and the diver, unprepared for the signal, had hardly time to catch the rope, which he had let go, and was surprised to find, on coming into the bell, that he had remained below so long. On descending again, he found that he could with ease remain fully two minutes under water. In this case the atmosphere, under a pressure of 30 feet of water, charged the lungs with nearly a double volume of air compressed into the same bulk as one volume at the surface of the water. Our ordinary breathing volume can only supply us for from three to five seconds ; for if we suddenly stop breathing for that time, we experience a degree of inconvenience. Of the volumes of air expelled from the lungs. — A knowledge of this is of incalcu- lable value to the physician and to the surgeon ; for disease cannot attack the lungs or the thoracic boundaries, without diminishing the respiratory volume, which change ultimately leads to the variations of the respiratory murmurs, first noticed as a diagnostic sign of disease by Laennee. Many experimenters have measured the different volumes of re- spired air, not primarily in reference to disease, but merely as collateral to the ob- servations of the chemist : hence experiments have been few, and deductions highly dis- crepant. (a) Residual volume. — Dr. Hales notices this volume, but assigns no measure for it*; Allen and Pepjs estimate it at 108 cubic inches in stout men of 5 feet 10 inches')' ; Davy at 41 cubic inches J ; Goodwyn, by the mean of seven experiments, at 108 cubic inches ; Kite, who writes expressly upon submersion, is obscure upon this point $ ; Dr. Bostock allows 120 cubic inches || ; Dunglison gives Menzie’s estimate of 179 cubic inches ; Jurin estimates it at 220 cubic inches ; Fontana at 40; and Cuvier at from slightest inconvenience for want of air; and two minutes of time can be passed through without breathing. The most expert pearl-divers cannot re- main under water for a longer time. * Stat., vol. i., p. 239. ■j Phil. Tr., 1809., vol. xeix. pp. 404. 428. % Chem. and Phil. Remarks, p. 410. § Essays and Obs. Physical and Med. 1795, p. 8. || E . Phvs. 3d. Ed. p. 318. THORAX. 100 to 60; Mechli at 52 and 40* * * §; Dr. Herbert, of Gottingen concludes this volume to be “ very little.”')' We have found it to vary from 75 to 100 cubic inches. It must be relative to the absolute capacity of the chest, which varies from 248 to 457 cubic inches. The mean absolute capacity is 312 cubic inches. Allowing 100 cubic inches for the heart and large blood vessels, and 100 cubic inches for the parenchymatic structure of the lungs, will leave a little more than 100 cubic inches for the residual air ; therefore Allen and Pepys’s opinion may be relied upon as very near the truth. (b) Reserve volume. — Goodwyn omits this volume altogether ; and this omission was pointed out forty years ago by a phy- siologist who himself omitted any notice of the complemented air. Kite estimates this at 87 cubic inches; Davy, by an experiment upon himself, at 77 cubic inches J ; Dr. Bos- tock, from trials upon himself, at ICO or 170 Mechel at 1 10 cubic inches.|| It averages about 100 cubic inches ; our obser- vations range from 70 to 110 cubic inches. It is regulated by the point at which the or- dinary breathing movement commences. (c) Breathing volume. — This has attracted most attention ; but the discrepancies of opinion are nearly commensurate with the number of observations. It would require years of labour to determine this volume by direct experiment, in a manner to be avail- able to the physician ; and it would re- quire a long time to perfect the observation of it upon a single patient, because these movements are so delicately affected by the mind, so perfectly uncontrollable, and the volume is so small, that a little error would seriously damage the value of the observation. The volume assigned by observers, varying from 3 to 100 cubic inches, is as follows : — Abildgaard - _ Cub. in. - 3 Abernethy - - - 12 Keutsch - 6 to 12 Goodwyn - 3 and 14 Lavoisier and Segttin - 13 Wurzer and Lametheria 8 or 10 Kite - - 17 Davy - - 13 and 17 Allen and Pepys - ;i6'5 Herbst - 16 to 25 Jurin - - 20 Borelli - 15 to 40 Herdolt - 25 to 29 Dalton - - - 30 Fontana _ - 35 Richeraud, Foland, Gordon, and Ca- vallo - - 30 to 40 Hales, Jurin, Sauvages, Haller, Ellis, Summering, Thomson, Sprengel, * Mechli’s Manual Descrip, and Pathological Anat., vol. ii. p. 448. t Bostock, Op. Cit., p. 316 ; and Archives Ge'n. de Med., t. xxi. p. 412. et seq. X Op. Cit., pp. 47, 48. § Op. Cit. p. 316. j| Manual of Descrip. Anat., vol. ii. p. 447. 1067 Cub. in. Bostock, Chaptal, Bell, Monro, and Blumenbach - - - 40 Menzies - - - 42 to 46 Reil - - - 40 to 100 upon an average, it varies from 16 to 20, though we have occasionally found it vary from 7 to 77 cubic inches. Though our ob- servations upon this point are but scanty com- pared with those we made on the vital capa- city, yet from about 80 experiments we con- clude that man in a perfectly quiet state, as when sitting, reading, &c., breathes much less than he does under the ordinary excitement of moving about. We think the perfectly quiet breathing, when we can scarcely perceive any movement (which is by no means uncommon), may be from 7 to 12 cubic inches, and when under ordinary excitement and exercise, from 1 6 to 20 cubic inches ; we have known it in one case as high as 77 cubic inches. It is probable that the quantity is relative to the volume of blood to be aerated. Herbert found that adults of smaller stature breathed less than those who were taller.* It is proba- ble that phthisical patients breathe very little, — from 2 to 4 cubic inches ; but the number of their breathing movements is greater, which compensates for this small quantity. (d) Complemental volume. — Davy, from a single experiment (upon himselfj, calcu- lates this at 119 cubic inches f ; Kite, at nearly 200 cubic inches.^ It is regulated by the position of the ordinary breathing movement, which is intermediate between it and the reserve air. It averages, from direct experiment, rather higher than the reserve volume, — about 105 or 110 cubic inches. Taking the mean height at 5 ft. 8 in. the vital capacity is 230 cubic inches, that is to say — Reserve air - cub. in, - 100 Ordinary breathing 20 Complemental - 1 10 230 (<■) Vital capacity volume. — Jurin and Hales correspond in stating this at 220 cubic inches § ; Davy at 213 cubic inches || ; and he remarks in a note, “ this capacity is pro- bably below the medium. My chest is nar- row, measuring in circumference but 29 inches, and my neck rather long and slender.” It is probable the figures 29 are a misprint for 2 feet 9 inches round the chest. Dr. Thomson, from the mean of twelve experi- ments, upon men from fourteen to thirty- three years of age, states it at 186J cubic inches. Dr. Thomson himself could expel 193 cubic inches. He mentions that this volume is constant when once determined. * Muller, El. Phys., 1st ed. 8vo., Lond, p. 294> vol. i., 1847. t Op. Cit. p. 410. t Op. Cit. p. 47. § Hales’s Sat., 1732, vol. i. p. 239. || Op. Cit. p. 410. 1008 THORAX. The temperature of the respired air is not mentioned.* Goodwyn states it at 200 cubic inches-)-; Kite, at 300 cubic inches."); ; Menzies at 200 § ; Bostock||, corroborated by Dun- glison^T, omitting the complemental volume, at210cubic inches; lastly, Thackral, who takes this volume as the measure of health ; ex- amines some soldiers, who give the mean of 217 cubic inches, and some shoemakers, who average 182 cubic inches ; and he re- marks, “ a tall young cornet threw out 295 cubic inches ; this was the greatest quantity 1 ever witnessed.” ** According to this evidence, the respective volumes are, — Cub. in. Residual volume, from 40 to 200 Reserve 9 9 99 77 „ 170 Breathing 99 59 3 „ 100 Complemental 99 99 1 19 „ 200 Vital Capacity 99 99 100 „ 300 The apparent discrepancies of the breathing volumes are entirely due to the want of col- lateral observations; for there is no distinction between the sexes, nor age, nor stature, nor weight. We have determined the vital capa- city in one man as 80 cubic inches, in another 46-1 cubic inches ; therefore we might say this volume varies from 80 to 460 cubic inches ; but this discrepancy is cleared up, when we add that the height of the former was 3 feet 9 inches, and his weight 4 stone 9 lbs., while the latter measured 7 feet, with a weight of 22 stone ; and that if we arithmetically reduce the one to the other, the vital capa- city of a dwarf is within half an inch of what it actually was, viz. 79'56 cubic inches by cal- culation, and 80 cubic inches by direct expe- riment. Collateral observations clear up the experiment ; thus Kite was probably a tall man, and therefore he states the vital capacity as 300 cubic inches; Davy at 213 cubic inches, because he was of shorter stature, probably about 5 feet 7 inches; Hales, Jurin, and Goodwyn about 5 feet 8 inches. We come to this conclusion, because we find this vo- lume bear a strict relation to stature. There- fore, probably, all the observations already mentioned are correct, and only wanted an- other combination to remove the apparent discrepancies. We have especially directed our attention to one of these volumes of air, the vital capacity. Vital Capacity. — There are tw-o ways of measuring the permeability of the lungs, or the volumes of air which they can displace, viz. by measuring the actual movement or mobility of the thoracic boundaries, or by directly measuring the absolute cubic inches of the volume of air expired. The former is open to an error, but the latter is not. * Thomson’s Anim. Chem., 1843, p. 610. et seq. | Op. Cit. p. 32. note. J Op. Cit. p. 48. | Mayo’s Outlines of Pliys., p. 76. || Op. Cit. p. 321, 4f Ibid. vol. ii. p. 91. ** Thackral on the Effects of Arts, Trades, &c. upon Health, p. 21. et seq. If we take the movement as an index to the permeability of the lungs, we obtain an evidence only of movement, and not of the permeabdity of the lungs for air, for we may move the thoracic boundaries, and yet not breathe. But when we measure the volume of air, it is self-evident that this must be the measure of both the permeability of the lungs and of mobility of the thoracic bound- aries, because we cannot breathe without moving. The classes of persons we examined were as follow : — Sailors (Merchant Service) Fire Brigade of London Metropolitan Police - Thames Police - Paupers - Mixed Class (Artisans) First Battalion Grenadier Guards - Royal Horse Guards (Blue) Chatham Recruits - Woolwich Marines - Pugilists and Wrestlers Giants and Dwarfs - Printers J Pressmen 30 1 _ \ Compositors 43 J Draymen - Girls - Gentlemen - - - - Diseased Cases - No. - 121 - 82 - 144 - 76 - 129 - 370 - 87 - 59 - 185 - 573 - 24 - 4 - 73 - 20 - 26 - 97 - 360 Total - - 2430 Each individual was subjected to the fol- lowing observations : — 1st. The number of cubic inches given by the deepest expiration, following the deepest inspiration. This was taken three times, and the highest observation was noticed. 2nd. The inspiratory power. 3rd. The expiratory power. 4th. Circumference of the chest over the nipples. 5th. Mobility of the chest with a tape- measure. 6th. The height. 7th. The weight. 8th. The pulse (sitting). 9th. The number of ordinary respirations per minute (sitting). 10th. The age 1 1th. Temperature of the air expired. To determine these points, we constructed an air receiver, denominated “ Spirometer.” We used a bent tube (hsemadynamometer) for ascertaining the respiratory power, scales and stand for the height and weight, and a com- mon tape-measure for measuring the mobility of the chest. We rarely exceeded three consecutive ob- servations with the spirometer, because after this the volume of respired air diminishes from mere fatigue. To measure the vital capacity volume. — The Spirometer (fig. 704. >, consists of a vessel containing water, out of which a re- ceiver is raised by breathing into it through a THORAX. 1069 tube ; the height to which the receiver is raised, indicates the volume of the vital capacity . To Prepare the Spirometer fur Use : — 1st. Place the spirometer about three feet from the ground, upon a firm, level table. 2nd. Turn off the water-tap 4, and open the air-tap 1. Fig. 704. 3rd. Pour into the spout, behind, clear cold water, until it is seen to rise behind the slip of glass 3 (above the air-tube). 4th. Slide the moveable index 2, opposite 0 on the graduated scale 13, and add more water until it is exactly on a level with the straight edge of this index ; if too much water be poured in, draw off by the tap 4, sufficient to bring the water down to the edge of the index. 5th. Pour a little coloured spirit into the bent tube 5, until it stands about 3£ inches, as at 6. 6th. Turn off the air-tap 1, then suspend the counterbalance weights, 1 1, 1 1, from the cord over the pnllies. The spirometer is now ready for an observa- tion. The flexible tube, terminated with a glass mouth-piece, is held by the person about to be examined, and the tap 1 is to be kept open by the operator while the deep expira- tion is being made. To discharge the air out of the receiver. — It will be seen that if the tap 1 be opened, the receiver will rise out of the reservoir by the power of the counterbalance weights, until it touches the cross-head 9. To return the receiver into its original position, the con- tained air must be discharged ; this can be done by slowly depressing the receiver down into the reservoir, and so pressing the air out by the way it entered, — through the air-tube. But, in order to do so more rapidly, a large valve at 14 admits of an instantaneous escape of the air. Therefore, to discharge the air, remove the plug 15 out of the socket 14 with one hand, while the other returns the receiver into its original position. - Let the person to be examined loose his vest, and any other tight garment — for the least pressure from dress affects the mobility — - stand perfectly erect ( fg . 705.), with the head Fig. 705. thrown well back ; then slowly and effectually fill his chest with air, or inspire as deeply as possible, and then he must lift the mouth- piece of the spirometer 12 to his lips, still standing in the same erect position, and place the glass mouth-piece between the lips, holding it there sufficiently tight so as not to allow any breath to escape, lie then slowly makes the deepest expiration , displacing all the air he can out of his lungs through the mouth-piece into the spirometer, where it is measured to cubic inches, and confined there by a stop-cock, until examined. This ob- servation should be taken three times. The operator, while the experiment is going on should place his left hand upon the shoulder of the person being examined ; in this way he can determine as to the perfect inflation of the lungs and expulsion of air from them as well as the character of the thoracic expansion. The thumb of the operator should cross the clavicle, while the fingers rest on the upper 1070 THORAX. edge of the scapula, then he feels the expand- ing effect of inspiration, the swelling up of the apex of the thorax. To determine the volume of air in the spi- rometer. — The graduated scale 13 is attached to the receiver, and made to extend down- wards on the outside of the reservoir, so as always to be in relation with the index 2. On this scale 0 corresponds with the top of the receiver, or rather with the highest point to which the water can be made to rise within it. The number of cubic inches is shown by the degree upon the scale pointed to by the index 2, which corresponds with the level of the water in the receiver. But the water in the reservoir seen behind the slip of glass may not be level with the water within the receiver, just as the level of the water in a pneumatic trough may be higher or lower than the level of the water contained in a glass receiver standing upon the shelf. To know when these are level, depress the receiver until the coloured fluid in one leg of the bent tube, or inverted syphon, 5, stands level with that in the other leg, as at 6 ; then the water contained in the receiver, and that external to it, are level to each other ; and the air within the receiver is of the same density as that without. Immediately the plug 15 is replaced, and the hands withdrawn from the receiver, the latter will be seen to ascend some half-inch, the water behind the slip of glass to fall, and the coloured fluid in the bent tube to be unequal. This is caused by the excess of weight in the counterbalance (11, II,), which is what necessitates the observation of the coloured fluid in the bent tubes and the cor- rection above directed. The scale is gra- duated to degrees, each of which measures two cubic inches. To correct the respired volume for tem- perature. — The table of the vital capacity- volume is calculated at G0° Fahr. The tempe- rature of a volume of air displaced out of the lungs into the spirometer is reduced at once to the temperature of the water in the spiro- meter. This, according to the season of the year, may be 50° or 80°. Now 330 cubic inches at 50° would occupy 337 cubic inches at 00°, and 330 at 80°, would be 317 at 60°. For eight months out of the year there needs no correction. But a correction is necessary, when a thermometer in the room stands much above or below 00°. We may estimate the change in the bulk of air as for every degree (Fahr.) of variation of temperature ; thus if a man breathe, in winter, 295 cubic inches of air into the spirometer, when the thermometer in the room stands at 55°, being 5 degrees below G0°, then = 2‘95, must be added to the 295 cubic inches, making 297‘95, or, in round numbers, 298 cubic inches. On the other hand, if the vital ca- pacity be determined at 215 cubic inches, when the thermometer stands at 72°, which is 1 2° above G0°, — 5 must be deducted ; making the corrected observation 210, instead of 215 cubic inches. In the absence of the spirometer, the mea- sure of the mobility of the ribs, by means of a common tape measure is of much value * To measure the mobility of the thorax with a tape measure, pass the tape measure round the chest under the waistcoat, over the region of the nipples, request the person to in- spire deeply, and note that circumference, then to expire deeply, and again note the circumference, the difference is what we term the mobility. This is a rough measure- ment, but of no little value in doubtful cases of chest disease. This difference, or mobility, in men of all statures should be about 3 inches, if it is found only 2i inches the examination should be carried further ; sometimes the mobility extends to 5i inches, but this is excessively rare. Asa general rule, when we find the mobility three inches, we find the vital capacity volume correspond with our table. Sometimes the mobility may be good, and the vital capacity bad, because, as we have already noticed, we may move the walls of the chest without breathing. The vital capacity is a constant quantity ; habit will not increase it. But this volume is disturbed directly, and modified by five circum- stances : 1st, by height ; 2nd, by position ; 3rd, by weight ; 4th, by age ; 5th, by disease. 1st. Of the effect of height. The vital capacity volume bears a striking relation to the height of the individual exa- mined ; so that, if we take a man’s height, we can tell the volume of his vital capacity. We show this by a curve in fig. 710., as before ; let the perpendicular lines represent the heights increasing inch by inch from the left towards the right ; the single continuous line is the curve of the vital capacity, which gradually ascends as it passes over the perpendicular lines. The heights extend from 5 feet to 6 feet ; above six feet the observations are few. Whe- ther the vital capacity volume maintains the same regular progression beyond this point remains to be determined. If we draw a line in a perfect arithmetical ascent of eight units for every increasing height, the line of vital capacity will be observed to run nearly pa- rallel with it; therefore this volume increases with the increase of stature. The figures at the bottom represent the vital capacity in cubic inches, being the mean of the observa- tions under each height. The following table (Table T.) places the subject more in detail : — A cursory inspection of the table shows that the vital capacity increases with the height ; this is without any consideration as to age, weight, or circumference of the chest. For clearness, we arrange it in a more re- duced form, as in Table U. * Dr. Sibson and Dr. Quain have invented some ingenious instruments for measuring the thoracic movements externally. Table T. — Mean Vital Capacity Volume, in relation to Stature, of Fifteen different Classes of Men, or 1923 Cases, considered healthy THORAX. 1071 1072 THORAX. Table U Progression of the Vital Capacity Volume, with the Stature — from the above. Height. £> 5 10 6 0 °1 5 2 I}* i}' s}5 o}s ]5 5 11 Mean of all ") heights - J Series from Observations on 1012 cases. Series from Observations on 1923 cases. Series in Arithmetical Progression. 1st result. 2nd result. 175-0 1760 174-0 188-5 191-0 190-0 206-0 207-0 2060 222-0 228-0 222-0 237-5 241-0 238-0 254-5 258-0 254-0 214-0 217-0 214-0 Table V. — Vital Capacity Volume (temp. 60° F. ) necessary to Health at the Middle Period of Life. The first column contains the heights be- tween five and six feet, increasing arithmeti- cally two inches at a time, as 1. 3. 5., &c. ; the next two columns are the result of ex- periment ; the first upon 1012 cases at an earlier period of the investigation ; the next at a later period, when the whole cases con- joined amounted to 1923 cases. We found that the men from 5 feet to 5 feet 2 in. gave a mean vital capacity of 176 cub. in.; the men two inches taller a mean of 191 cub. inches; the next, 207 cub. in., and so on ; thus the volume increases as we descend the column. Finding the progression so regular, we arranged a fourth column, containing a series of numbers in perfect arithmetical progression, commencing with 174, and increasing sixteen at every subse- quent step, corresponding to the two inches of height successively added. We found, upon comparing the two columns of observations with the column of calculation, that there was a close resemblance. The increase of sixteen for every two inches is of course the same as eight for every single inch ; hence the rule deduced upon nearly 2000 cases (and subsequently confirmed by double that number) viz. That for every inch of stature, from 5 feet to 6 feet, eight additional cubic inches of air, at 60°, are given out by a forced expiration. This brings the detailed matter of a series of tables and calculations into a point, and easy of remembrance, the more so as extended ob- servations upon nearly 5000 men have brought the column of observation so close to the column of regular progression, that it is only necessary now to take the column of regular progression as a standard for examining the condition of the lungs as to their perme- ability for air, and the mobility of the tho- racic boundaries. If we recollect that at the height of 5 feet, Height. ft. in. 0 1 2 3 4 5 6 7 8 9 10 11 to 1 2 3 4 5 6 7 8 9 10 11 0 Vital capacity. 174 182 190 198 206 214 222 230 238 246 254 262 8 in. the vital capacity is 230, we can recollect the rest by adding or subtracting eight to or from this number, for every inch of stature above or below 5 feet 8 in., between 5 and 6 feet. These numbers may be taken as expressions of certain conditions of the thorax, an expression of mobility relative to breathing, and conse- quently an expression of the permeability of the lung. It therefore follows that whatever affects the mobility of the thoracic bound- aries, or the permeability of the lungs, the amount of that cause is expressed by the volume of the vital capacity. Incipient disease is quick in affecting the vital capacity ; the amount of the injury therefore is readily measured. We are at a loss to assign any just reason why the vital capacity is rela- tive to the height, which is regulated by the length of the limbs, and not by the length of the trunk of the body. We have found by experiment, that whatever be the standing height, the sitting height is nearly the same in all persons of between 5ft. and 6ft., and if not actually the same, yet it is not a rule that the tallest men sit the highest ; for in- stance, one man standing 6ft. 0£in. measured from his seat 2ft. llfin., whlie another who stood 5ft. 6in., sat 3ft. high ; therefore the length of the trunk bears no constant propor- tion to the length of the legs. And we found that men who stood low, breathed less than men who stood higher, but who sat the same height. Thus Jig. 706. represents two men ; A. stood 4ft. 4^in., B. 5ft. 9^in.; they were of the same age and circumference of the chest. The weight of the short man was 7st. 2^11)., that of the taller man lOst. 3lb. Yet their sitting height was precisely the same, as is shown in Jig. 707. Nevertheless, the vital capacity volume of the shorter man was 152, and that of the taller man 236 cubic inches; so that the man who stood the shorter, hut who sat as tall, if not taller, breathed eighty- four cubic inches less than the man who stood seventeen inches higher. The mobility of the chest of the taller man w'as nearly four inches, that of the shorter man three inches. We ex- amined several such cases with similar results. The average vital capacity volume at all heights is about 230 cubic inches. The greatest THORAX. 1073 we have examined was Randall’s ; height 7 ft. weight 22 st. ; vital capacity 464 cubic inches. The smallest was Don Francisco; height 29 in., weight about 401bs. ; vital capacity 46 cubic Fig. 706. inches. The highest vital capacity at the height of 5ft. Sin. was 330 cubic inches. A question arises, are the lungs and tho- racic parietes at their maximum stretch when they contain the appropriate vital capacity volume? We believe not. The vital capa- city of the person from whom the preparations figured above (Jigs. 680. et seq.) were taken, whose height was 5jft. 4 in., weight 1071b., was 198 cubic inches ; yet, after death, we forced 300 cubic inches of air into his lungs without rupturing them, being 102 cubic inches more than he could expire during life. There- fore there is still a spare mobility of parts, probably in reserve, to be exercised when dis- ease attacks the lungs. 2nd. Vital capacity affected by the posi- tion of the body. — We have said a man must hold himself erect to breathe out a good vo- lume of air ; because the mobility of the ribs is affected by the uprightness of the spine ; and, more than this, whatever touches the ribs affects their mobility, and consequently the vital capacity. Thus, standing, we have produced a vital capacity of 260 cubic inches ; sitting erect 255 cubic inches ; recumbent — supine 230, prone 220 cubic inches ; position making a difference of 40 cubic inches. This may explain why patients with emphysematous lungs sit up in bed, and why for them to lie recumbent, is “suffocating;” because they thereby diminish the thoracic mobility. It may be well to recollect this effect upon respi- “ ration, in treatment of diseases of the spine, particularly at the present time, when they are Fig. 707. The relative height of the same persons sitting. treated by laying the patient on the anterior pacity from 260 to 220 cubic inches, part of the chest for weeks and months to- 3rd. Vital capacity affected by weight. -- gether, which position reduced our vital ca- The weight affects the vital capacity ; but VOL. IV. 3 z thorax. 1074 as yet the relation does not appear so regular as that of the height. We are scarcely in a position, at present, safely to say much upon this point. As a general rule we find the weight increases with the height ; so that it is not easy to separate the effect of one from that of the other. Suppose we take two men of the same stature, say 5 feet 8 inches, the one 10 stone, the other 14 stone in weight; one of them above par, the other may be either at, or below par. If 10 stone be considered par, the 14 stone man is 4 stone in excess, or corpulent to 40 per cent. This excess weight blocks up the range of mobility, and thus, mechanically, diminishes the vital capacity volume. But let us suppose men of dissimilar heigths, one 5 feet 8 inches and the other 6 feet ; the 6 foot man should be heavier than the shorter man ; — say 3 stone heavier. This is not excess weight with him, and does not interfere with his thoracic mobility ; therefore there is an inseparable relation between the height and weight. If, in a series of experiments, we sink the height entirely, and keep the mere weight in view, we shall find that the result as to the vital capacity volume is without order. Table W. — Vital Capacity Volume in Relation to Weight. Weight. Vital capacity. Difference. st. St. cub. in. 7 to 8 ICO 8 to 9 187 21 + 9 to 10 199 12 + 10 to 11 222 23 + 1 1 to 12 233 11 + 12 to 13 238 5 + 13 to 14 237 1 — 14 to 15 278 41 + From this there is seen to be a rude increase of the vital capacity with the increase of the weight, but it is quite irregular, as 21., 12., 23., &c. We have also found the mean vital capa- city of 147 men of 1 1 stone as 225 cubic inches, and that of 32 men of 14 stone, only 233 cubic inches, an increase of 8 cubic inches for an increase of 42 lbs., or 3 stone. The over- whelming effect of height disturbs the above observation ; therefore the height must be kept in view. We have calculated the weights in relation to height, with reference to the res- piratory function, upon a number of men at the middle period of life. Besides the three classes mentioned above, we have included 1554 cases of healthy men in the prime of life, oblig- ingly furnished by Mr. Brent, viz. the Oxford and Cambridge rowers, London watermen, cricketers, pedestrians, and gentlemen (Table X). The weight now appears more regular, increasing with the height, as from 92 lbs. to 218 lbs. We may make this progression ap- pear more regular, as in Table Y, which is calculated by adding the mean weight, from the last table, of the men from 5 feet to 5 feet 2 inches (the mean of which is of course 5 ft. 1 in.), together, and taking the mean of that, which will be found 1 19 9 lbs.; and the next from 5 feet 1 inch to 5 feet 3 inches, taking their mean as 126T lbs., and so on. Table X. — Weight to Height, upon 3000 eases. Height. No. of Cases. Gross Weight in lbs. Mean Wt. in lbs. Ft. 4 In. Ft 6 to 5 III. 0 20 2,399 92-26 5 0 „ 5 1 17 1,964 115-52 5 1 „ 5 2 36 4,476 124-33 5 2 „ 5 3 43 5,497 127-86 5 3 „ 5 4 88 12,145 138-01 5 4 „ 5 5 126 17,537 139-17 5 5 „ 5 6 214 31,016 144-93 5 c „ 5 7 316 45,598 144-29 5 7 „ 5 8 379 57,822 152-59 5 8 „ 5 9 468 73,835 157'76 5 9 „ 5 10 368 61,238 166-40 5 10 „ 5 11 348 59,400 1 70-86 5 11 „ 6 0 245 43,475 177-45 6 0 „ 6 + 326 71,283 218-66 Total - - 3000 487,745 147-86 It thence follows, the range of stature from 5 feet 1 inch to 5 feet 1 1 inches is 10 inches ; and the weight rises from 119 9 lbs. to Table Y. — Difference of Weight to Stature on 2648 males, from the last table. Exact Stature. Weight lbs. Weight more exactly, lbs. Difference of Weight in lbs. Ft. In. In. 5 i or 61 120 119-9 + 6-2 5 2 62 126 126-1 + 6-8 5 3 63 133 132 9 + 5-7 5 4 64 139 138-6 + 35 5 5 65 142 142 1 + 2 5 5 6 66 145 144-6 + 3-8 5 7 67 148 148-4 + 6-8 5 8 68 155 155-2 + 6-9 5 9 69 162 102-1 + 6‘5 5 10 70 169 168-6 + 5-6 5 11 71 174 174-2 174"2 lbs., or 54‘3 lbs. ; or 5'43 lbs. with every inch of stature. To subdivide the range of height it may be said : — lbs. ft. in. ft. in. Their rise is 6"2 from 5 1 to 5 4 3-3 — 5 4 „ 5 7 6-5—5 7 „ 5 1 1 There is an inequality from 5 feet 4 inches to 5 feet 7 inches in the weight ; but this would in all probability disappear if the ob- servations were more extended ; at present it may be stated generally that the weight in- creases 6-5 lbs. (or 6^ ibs.) for every inch of stature from 5 feet 7 inches to 6 feet, and 6'2 lbs. for every inch of stature from 5 feet 1 inch to 5 feet 4 inches, and 3’3 Ibs. for every inch from 5 feet 4 inches to 5 feet 7 inches. At 5 feet 8 inches, or G8 inches of stature, the weight is 155'2 lbs., or nearly 11 stone ; THORAX. 1075 from this as a starting point the weight at any height may (so far as our limited ob- servations warrant) be readily calculated. For instance, the weight is, at the height of 5 feet 155*2 8 inches, — — — 2-282 lbs. for every inch of stature, or 27"38 lbs. for every foot of stature. The bulk or weight of bodies having the same relative proportions, is as the third power (cubes) of either of their diameters : thus, if a person 67 inches high weighs 148*44 lbs., a person 69 inches high should weigh /69\ 3 \67/ X 148*44 69 X 69 X 69 67 X 67 X 67 X 148-44=3Q076aX 148-44= 162-14 lbs. The weight at that height, from observation, was 162-08 lbs., a similarity too close to be acci- dental. The weights vary as the 2"75th power of the height, and not as the 3rd power. The rela- tion between the two is quite close enough to show, that there is a very intimate connec- tion between the height and the weight. The observation is made upon 1276 men at the middle period of life. Taking the height from 67 to 71 inches, we have as follows : — Table Z The calculated Weight compared with the observed Weight, according to the above Form. Height in Inches. Weight deter- mined by Cal- culation. Weight deter- mined by Ob- servation. in. lbs. lbs. 67 148-8 148-4 68 155-5 155-2 69 162-1 162-1 70 169-3 1686 71 176-6 174-2 We have found that the vital capacity in- creases 42 cubic inches with the weight from 100 lbs. to 155lbs., and from 155 lbs. to 200 lbs. the effect is balanced by minus 5 and plus 5 cubic inches. In the first division there is an increase of 42 cubic inches ; the weight then comes into power, and disturbs the regular progression for the next division ; therefore we may say there is in the second division a de- crease of 42 cubic inches in the vital capacity volume from the effect of weight. We repre- Fig. 708. The Effect of Weight on the Vital Capacity. sent this by a curve, fig. 708. The continuous curve is the line of vital capacity crossing the perpendicular lines of progressive weights. The curve of volume ascends, and attains its highest at 160 lbs., and from thence it is nearly horizontal to 200 lbs. According to this, the vital capacity increases nearly in the ratio of 1 cubic inch per lb. from 105 to 155 lbs., and from 155 to 200 lbs. there is no increase. This illustration of the effect of weight is cal- culated at one height, viz. 5 feet 6 inches ; therefore to this height only these points of weight (from lli to 14 stone) refer. We have noticed that the weight increases in a certain ratio with the height, and that the weight at 5 feet 6 inches affects the vital capacity in the relation just mentioned, com- mencing when the weight exceeds 7 per cent upon the average weight. We may, perhaps, connect this same relation with the other heights through the arithmetical progression of inch by inch. For example : — the weight of men of 5 feet 1 inch is 199"9 lbs. ; to this add 7 per cent (8 395 lbs.), making 128"2 lbs. ; again, the tallest men, 5 feet 11 inches, weigh 174-2 lbs. ; to this add 7 per cent (12‘2 lbs.), making 186-4 lbs. : therefore, at the height of 5 feet 1 inch a man must exceed 128 lbs., or 9 stone 2 lbs., and the 5 feet 1 1 inches’ man 186 lbs., or 13 stone 4 lbs., before weight may be expected to diminish the vital capa- city volume in the relation of 1 cubic inch per lb. for the next 25 lbs., 2^ stone being the limit of our calculation. When the man exceeds the mean weight (at each height) by 7 per cent, the vital capacity decreases 1 cubic inch per lb. for the next 35 lbs. above this weight. Beyond this it is not improbable but that the decrease of the vital capacity is in some geometrical progression. Below the mean weight we have never found by experiment, that the vital capacity is affected by weight. The cause of the difference of weight between men is involved in much obscu- rity.* We may in fact consider the usual weight of a man as his mean weight and * See Chambers, Gulstonian Lect. 1850. *3 z 2 1070 THORAX. *sasB3 : : CO Cd *0 vo O 35 j •s}saq3 02 CO 68 39 02 CO 38 41 39 39 lbs. 190 200! c. in. : 'T' 00 Cd 00 O Cl Cd Cd 237 263 W2 r- Cl 221 •S0SB3 : 1 : ^ n ; Cd VO 02 8 10 CD Cl CD •s}saq3 : 1 : 8 1 S 1 : CO CO -H I CO CO 1 CO X CO CO 1 X X 1 X X 1 X X 1 X lbs. 180 190 c. in. CO 00 02 X CM 02 Cd Cd Cl Cd CO Cd CD Cd CO Cl 261 274 226 •sdsvj - 00 *o 02 00 VO X 34 r- Cl •SJS3113 37 38 : 00 CO 00 CO 00 CO f- 1 00 co 1 co X X X 1 X 1 X lbs. 170 180 a . (j 150 Cd CO CO r- 02 Cl 00 Cl Cl Cd X Cl CO Cl 00 Cd 02 Cd •S3SB3 - rH co O CO 32 VO Cd CO cc X - Cl X •sisaiQ 37 37 00 co 36 8 36 8 CD CO X X CD X 39 CD X lbs. 160 170 c. in. 174 145 | 00 202 223 x> Cl Cd Cl Cd 'f it' Cl 217 259 02 t'- Cl 217 Cd Cd o 20 »0 Cd o T1 30 20 CD O Cl ■o X •sjsaio r- co CO CO 35 co 35| 35 36 36 CD X 35 . o o C/2 IT) O -O r-i — < O 234 t" Cl CM 207 208 Cl Cl 209 211 239 238 T CD Cl X 'O Cl X Cl Cl •sast?3 - Cd CO 20 37 09 74 50 22 X VO Cl Tj' o. Cd •S}S3l|3 CO 33 34 CO CO co CO CO CO X VO X CD X ’ X Cl X_ 02 Cl . o o % rt* vo *2 r-H r-H c. in. CO 02 Cd I> 201 206 208 CO Cl Cl Cl Cd o Cl Cl rf Cd VO Cl 'f Tt* Cd •sasuQ Cl CO 20 02 02 CO 40 Cd CO 23 O Cl Cd Cd 201 •SJS31I3 I <3 33 34 34 33 33 33 34 33 33 8 33 X X X X lbs. 130 140 c. in. 140 174 192 184 190, 00 00 216 197 213 235 208 243 o CD Cd 203 •S0ST23 Cl Cd CO i> r- CO CO Cd 02 CO Cl 117 •s^saq3 34 CM CO Cd | Cd 1 CM CO 1 CO 1 CO CO CO Cd CO Cl 1 H CO 1 CO 32 X Cl X . o o £ CM X f— < r-H c. in. 141 180 o 02 175 Cd 00 196 02 Cd 215 o o Cd TT Cl X X 196 *S0S«3 X 4 6 2 * CO 46 •SJS3113 CO Cl CO 5? Cd 1 — CO 1 CO 8 33 CO 1 CO 1 CO o X : 1 : S3 lbs. 110 120 c. in. 187| CO lO 02 CO 00 168 Oil 198 228 to 02 o o Cl »o 02 186 •S0SB3 CO | co co | Cd i •sismQ 30 CO 8 o CO 02 Cd : o X lbs. j 100 110 c. in. 177 178 CO r*- 1 CO X 00 CO CD 1> Heights. ft. in. ft. in. 5 0 to 5 1 5 1 to 5 2 5 2 to 5 3 5 3 to 5 4 5 4 to 5 5 5 5 to 5 6 5 6 to 5 7 5 7 to 5 8 02 >o o 00 to 5 9 to 5 10 5 10 to 5 11 O CD O VO + CD O o CD Total mean... the term “ gained weight” should be under- stood as weight swperadded to his usual weight, or mean weight in the above Table. Thus, if a man may lose weight below his usual weight, he should gain above his usual weight before he can be said to have gained weight. The effect of weight in diminishing the re- spiratory volume, need not in the least disturb the observer, when testing the lungs through the measurement of the vital capacity, with re- ference to phthisis or any other chest disease. For collateral observations and the history of the case, will sufficiently protect him’from such difficulty. We see that the weight increases at so much per inch ; we have no doubt that by extended observations it will be found to be regular through the whole series of heights, and that it will be found to increase 7 lbs. for every inch of stature. We know that the respiratory power increases in a similar arithmetical relation. We do not mean that THORAX. 1077 the lb. will correspond to the inch, for that is accidental, merely depending upon the units employed, but that the increase of each will be found in an arithmetical progression, and hence, probably, the reason why tall men breathe more than short men. But the weight can never be the sure guide that the height is, because the former varies at any time in life, even in a few days ; where- as the latter varies only at the extremes of life. 4th. Relation of vital capacity to the circum- ference of the thorax. — We notice this here, because the question is so natural, “ Has the size of the chest no relation to the vital capacity?” We do not find that there exists any direct relation between the cir- cumference of the chest and the vital capa- city. We have found — Hei ght. Circum. Vital Men. ft. in. in. capacity. 1 1 5 .8 35 235 10 5 8 38 226 Therefore, the men with chests 3 inches larger, breathed 9 cubic inches less, or 21 men of the same height, but of different-sized chests, breathed a mean vital capacity of 230 (the due quantity according to Table T). We have consolidated the following result upon 994 cases, the height is kept in view, calcu- lated at 5 feet 6£ inches. Table B B. — Circumference of the Chest," in Re- lation to the Vital Capacity Volume, in 994 cases (Males). Circumference of Chest. Vital Capacity. Number of Cases Cubic In. J Difference^ 1 30 to 304 200 14 — 13 304 „ 31 187 20 + 18 31 „ 31 l 206 21 — 10 31i „ 32 196 35 + 1 32 „ 321 197 32 — 7 321 „ 33 204 50 — 2 33 „ 331 202 44 0 33i „ 34 202 63 + 63 3i „ 341 213 70 + 4 34i m 35 217 78 — 2 35 „ 351 215 71 + 14 35i „ 36 229 74 — 10 36 „ 36i 219 59 + 2 36i „ 37 221 97 + 18 37 „ 37i 239 59 — 4 37i „ 38 235 57 — 13 38 ., 381 222 41 + 8 38i „ 39 230 40 — 6 39 „ 391 224 18 + 2 39i „ 40 228 37 — 11 40 „ 40i 217 14 0 There is nothing in this table to confirm that which we had thought would be the main guide to the vital capacity volume ; thus, compare together the first and last 14 men whose chests differ 10 inches, and their vital capacity only 17 inches ; or compare together the first and last columns, the one is perfectly regular and the other most irregular. There is a certain rude relation between the thoracic dimensions and the vital capacity ; if, for in- stance, one man has a chest 35 inches in cir- cumference, and 3 inches mobility, and another man has a chest 40 inches in circumference, and 4 inches mobility, then the latter will surely displace a larger volume of air than the former, but omitting this, we expect as large a vital capacity from a man with a thin and narrow thorax, as from a man with a broad and deep thorax. In fact, aeration need have no re- lation to the thoracic dimension ; and, for the same reason, the size of the chest no relation to the vigour of the whole man. Indeed we incline to the contrary, viz. that it is most likely the respiration is most vigorous in the narrow-chested man, when the mobility is greatest. The vigour of the lungs, like every other organ in the body, we believe, has no relation to the dimensions. One person may have a brain 1 lb. lighter, or £ less than an- other person, and yet their capacity and men- tal qualities shall not appear different. 5th. Vital capacity affected by age, — Age affects the breathing movements, but less re- markably than the height and weight. Indeed the influence of age was not apparent in the first calculation upon 1012 cases, nor until we took a basis of 1923 cases. Time affects life in two ways, first bringing it to perfection, and then determining that perfection. Table C C. — Effect of Age, from Observations on 1775 healthy Men. the Height being kept in View. O C. o o© ,0 -J c* >, S Age. Cubic Inches. Cases. £ Jj O O) — > ei £* 0 1 Uo k- © £ Q 15 to 20 220 283 34] 1 220 + 5 20 „ 25 220 491 34 r 25 „ 30 222 347 34 225 — 19 30 „ 35 228 242 35 ■ 35 „ 40 212 171 34 L 206 — 11 40 „ 45 201 93 35 45 „ 50 50 „ 55 197 193 55 37 35 1 36 195 — 13 55 „ 60 182 30 361 182 60 „ 66 183 26 35 J Mean of all ages 205-8 1775 35 The column of “ difference ” exhibits the effect of time upon the breathing volumes. From 15 to 35 years of age the vital ca- pacity is increased, and from 35 to 65 years of age it is decreased in the progression of 19, 11, and 13 cubic inches. We illustrate this by a curve in fig. 709. The curve of the vital capacity will be seen to rise slightly as it passes the perpendicular lines of years until it comes to 35 years of age, after which it keeps declining as it cuts all the succeeding lines of quinquennial periods down to 65 years. We may say, therefore, that the vital capacity increases with the age up to 1078 Years Vi THORAX. Fig. 709. 25 30 35 40 45 50 55 60 30 35 40 45 50 55 60 65 Vital capacity. The Effect of Age on the Vital Capacity. 30 years, and from 30 to 60 it decreases 43 cubic inches, or 1*43 (nearly 1 A- cubic inches) per year, or 7 cubic inches in 5 years, or 14^- cubic inches in 10 years. Al- though this appears by calculation, yet we do not strictly follow this ratio, as we find by experience that the effect of age may be more diminished, as follows : — Table D D. — Vital Capacity at three Periods of Life, from 4800 cases (males). Height. Vital Capa- city. Age from 15 to 55. Vital Capa- city, Age from 55 to 65. Vital Capa- city. Age from 65 to 75. ft. in. ft. in. 5 0 to 5 1 174 163 161 5 1 , , 5 2 182 173 168 5 2 , 5 3 190 181 175 5 3 , 5 4 198 188 182 5 4 , 5 5 206 196 190 5 5 , 5 6 214 203 197 5 6 , 5 7 222 21 1 204 5 7 , 5 8 230 219 2)2 5 8 , 5 9 238 226 219 5 9 , 5 10 246 234 226 10 , 5 1 1 254 242 234 5 1 1 , 6 0 262 249 241 From 55 to 65 we have deducted 5 cubic inches per cent, and from 65 to 75 years of age 8 cubic inches per cent. We have not brought in the effect of time before the age of 55 years. This is supposed to be at the mean weight. The first column* is derived from observation, the two second are derived from calculation. 6th. Of the effect of disease upon the vital capacity. — The effect of disease upon re- spiration was well known to Boerhaave and Morgagni, they considered that the disturb- ance of any organ in the body would dis- order the whole function of respiration. Morgagni devotes more than one-sixth of his celebrated work, the “ Seats and Causes of Disease ,” “ to diseases which affect respiration .” We may safely say all thoracic and abdominal diseases, as tumours, abscesses, and acute in- flammations, will affect the respiration. Of the different respiratory volumes, we select that one which requires the most extended mo- bility, viz. the vital capacity, which becomes altered to an extent commensurate with that of any disease physically affecting our respiration, it is therefore a test of the pre- sence and extent of such diseases. Such movements as command this volume, extend from the neck to the plantar muscles of the feet. One condition which we have been accus- tomed to look upon as affecting our breathing, does not affect it, viz. old pleuritic adhesions. Fig. 710. Heij ft. in. ft. in. ft. in. ft. in. ft. in. ft. in, ft. in. ft. in. ft. in ft. in. it, in. It. in. ft. in. ft. in 50 5 1 52 53 54 55 5 6 57 58595 10 5 11 60 ’ lls‘ [5 0 51 52 53 54 55 56 57 58 595 10 5 11 606 + Hta'thy. 143 175 Diseased. 69 100 177 189 193 201 101 102 105 78 214 229 223 2.37 120 g8 130 111 246 247 259 276 96 130 114 106 T ital Capacity of the healthy and diseased Cases compared. THORAX. We met with a case in which the lungs could not, in consequence of pleuritic adhe- sions, be removed from out of the thorax; in- deed there was not one square inch of pleura which was not firmly adherent. The lungs had to be torn out by little pieces, and so strong was the adhesion to the diaphragm, that in removing them this muscle was ruptured, yet the living respiratory mobility of the thoracic walls exceeded by three inches the whole thoracic space allotted for the heart and lungs, as measured after death. This space to the mobility was as 248 to 251. In other respects the lungs were healthy. Of all diseases, phthisis pulmonalis most readily affects the vital capacity, not only when the lungs are beginning to be infiltrated with tubercular matter, but probably before this. This is shown in fig. 710. Taking all the cases together, the difference is about 50 per cent. The effect of this disease upon the vital capacity in the case of Freeman was very remarkable. This man came from America in 1842 “trained for a prize fight.” He was examined when in his “ best condition,” and bis vital capacity measured 434 cub. in. (temp. 60°) ; height, 6 ft. 1 If in. ; weight, 1 9 st. 5 lbs. ; circumference of the chest, 47 in. ; inspiratory power, 5-0 in. ; expiratory power, 6'5 in. Freeman fought his battle, and for the sub- sequent two years lived a rambling and dissolute life. In November, 1844, exactlj' two years afterwards, he came to town in ill health. At this time there was no ausculta- tory evidence of phthisis pulmonalis ; but the following difference appeared in his vital capacity-volume : Vital Capacity. Weight. Inspiratory Power. Expiratory Power. Nov. 1842 - Nov. 1844 - Dec. 1844 - cub. in. 434 390 360 320 st. lbs. J 9 5 17 5 16 0 15 5 5-0 4-0 3-5 6-5 5-0 4-0 In October, 1845, he died at the Winches- ter hospital ; and Mr. Paul, surgeon to that charity, stated that Freeman died of extreme exhaustion and debility, expectorating pus ; and that his lung was throughout studded with tubercles ; his weight at death was 10 st. 1 lb.; height, 6 ft. 7^ in. Another remark- able case was that of a man of perfectly healthy appearance, and in whom there was no auscultatory or general sign of organic disease, but whose vital capacity was deficient by 47 cub. in.; and it was found, within three days of the time when he was examined, that the left lung at the apex was studded with miliary tubercles, the whole not extending beyond a square inch. In diseases of the spine, particularly in angular curvature, the mobility is changed sometimes to such a degree that the vital capacity is diminished to 20 cub. in. A full 1079 meal will even make a difference in the thora- cic mobility, of from 12 to 20 cubic inches. If the vital capacity is deficient, there must be some cause producing the effect. It may or may not be in the thoracic cavity. Collateral observations must point more definitely to the diseased part. The spirometer is only a gauge to measure the mobility and perme- ability of the lung; other circumstances must point out the cause of the mobility and per- meability being affected. Taking the observa- tions upon the diseased cases by calculation, the vital capacity volume may be arranged for all heights as follows : * Table E E, — Effect of Phthisis Pulmonalis upon the Vital Capacity. Height. Health. , Suspicious Cases, 16 per Cent. 1st Stage. 33 per Cent. 2d Stage. Mixed. 43 per Cent. ft. in. ft. in.; 5 0 to 5 i 174 146 117 82 99 5 1 „ 5 2 183 153 122 86 102 5 2 „ 5 3 190 160 T27 89 108 5 3 „ 5 4 198 166 133 93 113 5 4 „ 5 5 206 173 138 97 117 5 5 „ 5 6 214 180 143 100 122 5 e „ 5 7 222 187 149 104 127 5 7 „ 5 8 2.30 193 154 108 131 5 8 „ 5 9 238 200 159 112 136 5 9 „ 5 10 246 207 165 116 140 5 10 „ 5 11 254 213 170 119 , 145 5 11 „ 6 0 262 220 176 123 149 The question naturally arises, How far defi- cient of the standard may be the vital capacity without indicating disease? It has been found that ten cubic inches below the due quantity, i:e. 220 instead of 230 inches, need not excite alarm ; but there is a point of deficiency in the breathing volume at which it is difficult to say whether it is merely one of those physiological differences dependent on a certain irregularity in all such observations, or deficiency indicative of disease. A deficiency of 16 per cent, is sus- picious. A man below 55 years of age breath- ing 193 cub. in. instead of 230 cub. in., unless he is excessively fat, is probably the subject of disease. In phthisis pulmonalis the deficiency may amount to 90 per cent., and yet life be main- tained. The vital capacity volume is likewise a measure of improvement. A phthisical patient may improve so as to gain 40 upon 220 cub. in. Of the Respiratory Movements. — The breathing volumes have been divided into three kinds ; so likewise the breathing move- ments admit of a similar division, — one ordi- nary and two extraordinary movements. By the independent action of the intercostal muscles, every intercostal lamella can act sepa- rately, therefore we have the thorax furnished with 22 spaces by wdiich it can enlarge ; and * See “Spirometer Observations,” First Report of the Hospital for Consumption, p. 23. et sea. Lond 10 4 0 1 3 7. 4 1080 THORAX. the diaphragm acting as one muscle, makes 23 mobile regions for respiration. The respiratory movements of health may be classed as costal and abdominal. The cha- racter should be established by the order in which they follow each other. In health the walls of the thorax and the floor do not dilate simultaneously but consecutively. The character of “ the breathing" cannot always be told by the eye, but it can always be deter- mined by the touch. If we stand behind a patient, when seated and leaning against the back of the chair or against our person, and pass the right arm over the shoulder, extending it over the anterior part of the chest, until the hand rests upon the abdomen over the umbilical region, we command a delicate index of the breathing movements. It will then be found, that in ordinary male breathing the ab- domen first bulges outwards ; the ribs and sternum nearest the abdomen gently follow this movement, until the motion, like a wave, is lost over the thoracic region- The undu- lation commences at the abdomen. This is aoaomina, or diaphragmatic respiration. We here have costal motion, but as the ribs moved second it is not called costal breathing. In costal breathing the upper ribs move first, and the abdomen second. This is the ordinary breathing in women. All difficult, sudden, and extraordinary breathing is costal ; we at such times direct all our power towards the apex of the thorax, first expanding that region, and gradually those below it. When we determine the order of breathing by the sight, we must be careful to take the position of the body into account. If the pa- tient be recumbent (supine), we may notice extensive costal motion, and, indeed, it may be true costal breathing ; but place the pa- tient erect, and the breathing may be diaphrag- matic. When recumbent, all the motion is thrown forwards, the natural backward and lateral motion of the ribs being prevented ; and so sensitive are the breathing movements to impediments, that they may either take a reverse action, or all the motion being thrown forwards, will give a preternatural movement of the ribs, which may be mistaken for costal respiration. Profile view of the breathing movements — (a) Ordinary breathing (Male). — Fig. 711 was obtained by tracing the shadow of a man on paper. The back was fixed, so as to throw all the movement forwards. The anterior black, continuous line represents the ordinary breathing. This line is thicker over the ab- domen than elsewhere. The anterior margin of this line indicates the boundary of the ordi- nary inspiration, and the posterior margin the boundary of the ordinary expiration . (Female). — This is represented by the anterior continuous line in fig. 7 1 2., in the same manner as shown in the male. This line in the female is broadest over the sternum, anti narrow over the abdomen. The movement over the abdomen of the female is so small, that the number of the respirations cannot Fig. 711. Respiratory Movements. Male. Deep inspiration, dotted line; ordinary state, continuous line; deep expiration, anterior margin of the shade. be counted by the hand resting on that region as it can be on the male. The question of why women breathe costal, and men abdo- minal, we cannot pretend to answer. We doubt its being caused by any tight costume, for we found the same to exist in twenty-four girls between the ages of eleven and four- teen, none of whom had ever worn any tight dress. This peculiarity may be a reservation Fig. 712. Inspiration, dotted line. Ordinary, continuous line. Expiration, anterior margin. THORAX. 1081 against the period of gestation, when the ab- domen cannot allow of so free a descent of the diaphragm. Fig. 713. Respiratory Movements. Male. Front view. Inspiration, broken line. Ordinary, continuous line. Expiration, dotted line. The lateral movement of ordinary breathing is too limited to be represented by a line of varying thickness : the position is given by the continuous line, Jigs. 713. and 714. Fig. 714. Respiratory Movements. Female. Front view. Inspiration, broken line. Ordinary, continuous line. Expiration, dotted line. (b) Deep inspiratory . — In Jig. 711. the dotted line shows this position, as when a man is just ready to displace his vital ca- pacity-volume. The sternum is protruded and the abdomen is drawn in. This is the same in the female (Jig. 712.), the dotted line is most advanced over the sternum, while over the abdomen it is drawn inwards. So much is the abdomen drawn in- wards by deep inspiration, that the portion of the continuous line (Jigs. 711, and 712.), representing theordinary breathing is (over the abdominal region) external to the dotted line of deep inspiration. Therefore the greatest enlargement of the thoracic cavity in both sexes is made by the ribs, and not by the diaphragm, as is generally believed. It appears very questionable whether the dia- phragm is any thing more than flattened and that without descending. Of the position of the diaphragm. — It is clear that all that space between the line of ordinary breathing and deep inspiration (fig. 711.), below the ensiform cartilage, where the two lines cut each other, may be considered as just so much space deducted from the abdominal cavity ; and therefore the abdominal cavity, by deep breathing, is just so much less than it was in the posi- tion of ordinary breathing. Now, if the dia- phragm descends at this moment, whilst the abdominal parietes are being constringed on all sides, what becomes of the abdominal vis- cera? We know that in ordinary breathing the abdomen advances because the diaphragm descends, and recedes because the diaphragm ascends. We may suppose the same accom- modating movement between the diaphragm and abdominal parietes, to take place in deep breathing. There can be no doubt that the cir- cumference of the thorax is increased, as shown inD.y%. 670., and that the diaphragm must extend its borders, and consequently the arch must be flattened ; but this may be without descending. We see (fig. 670.) that the sec- tion of the thorax to the area of the diaphragm is as 40 to 133 — the concavity of the dia- phragm is enough to admit of its circumfe- rence expanding without its descending. Fig. 715. is a diagram of sections of the base of the living chest in three stages, b is the chest in ordinary : a, as in extreme expiration ; c, as in extreme inspiration. In this case the vital ca- pacity was 305 cubic inches, and the mobility of the chest was 5 inches, a range by no means common. The area of the chest varied 27 superficial inches between extreme inspiration and expiration.* In the sitting posture the same relations Sections of the base of thorax in the three stages of respiration , in the living subject. * This is the chest of jig. 711. 1082 THORAX. exist in the breathing movements ; the only difference being that these movements are more limited. (c) Of the deep expiratory position. — In fgs. 711. and 712. the margin of the shade is the position of the thoracic boundaries in deep expiration. We have supposed the figures above men- tioned as standing with the back fixed, for the purpose of making clearly manifest the relative position of these several breathing movements. In fig. 716. the body is quite free, and wholly alters its position in performing expiration and inspiration. This should al- ways be considered in noticing the breathing movements in diagnosis. j Fig. 716. Respiratory Movements. Male, standing. Expiration, dotted line. Inspiration, continuous line. ( d ) Of the change of position by extreme breathing. — In expiration the head is pro- truded and lowered (see figs. 71.3. and 714.). Therefore, by inspiration the body is raised, and the more erect the more can be inspired ; by expiration it is lowered, so much so that we have seen men when displacing their vital capacity volume stoop themselves to one-lialf their natural height, to one-sixth frequently: we speak from a large number of cases, — nearly 4000. Physiologists have reasoned that, as upon the principle of a bladder becom- ing longer when empty than when inflated, so the chest is shorter when inflated than when empty. But this example in no way corresponds. The bladder expands, because it is inflated; the chest is inflated because it expands. We have given the position of the breath- ing parts (the body fixed) : we shall describe the movement of these parts relatively in time and order to each other, and the peculiar character of these movements in health, and some of their modifications by disease. Ordinary breathing. — In men this is sym- metrical, and very limited, and commences with an advancing and receding of the abdo- men at and above the umbilical region, accom- panied with a slight lateral enlargement, and immediately followed by a bulging outwards at the cartilages of the 7th, 8th, 9th, and 10th ribs, and that part of the abdomen contiguous to them, with a slight advance of the lower third of the sternum. This is abdominal breathing, because the abdomen moves first ; and is confined to motion of the base of the thorax. In women it is likewise symmetrical, commencing with a gentle heaving of the upper part of the thorax, more or less apparent ac- cording to the fulness of the mammae. This expansion commences with the 1st and next three ribs following each other in succession, accompanied with a slight elevation of the shoulders and a slight lateral enlargement of the chest, which is immediately followed by a bulging outwards of the abdomen. So quick is this motion of the diaphragm after the mo- tion of the ribs, that at times they appear to be synchronous, especially when the individual examined is conscious of the observation, though it is only an accommodating movement of the diaphragm. This is costal breathing, because the ribs move first, and the motion is chiefly confined to the apex of the thorax. Therefore that which is a healthy respiratory movement in women is pathological in men. Of the extraordinary breathing in both sexes ( Inspiration ). — This, like ordinary breathing, is symmetrical: the clavicles, shoulders, sca- pula, and superior ribs are raised, the sternum advances, the infra-clavicular region swells re- markably upwards and outwards (particularly in females) like a rolling wave, the supra-cla- vicular region is raised but this sometimes ap- pears comparatively deepened (merely by the action of the sterno-cleido-mastoideus), the whole apex of the thorax is rendered more ob- tuse, particularly in the antero-posterior dia- meter. The lower ribs, at their cartilaginous extremities, spread outwards, increasing both the lateral and the antero-posterior diameter of the base of the thorax, the cartilaginous (go- thic) arch formed by the junction of the 6th, 7th, 8th, 9th, and 10th ribs below the sternum, becomes more obtuse by their lateral motion, the abdominal space within this arch, down to the umbilicus, sinks inwards. Therefore this breathing is costal, commencing with the superior ribs, and terminating over the ab- domen. The peculiar character of healthy breathing (and it is impossible to lay too much stress upon the movements of deep inspira- tion, because they are so indicative of thoracic disease) is that the ribs expand in succession. There is an indescribable undulating roll, pro- duced by the consecutive action of the re- spective ribs, which always commences with a superior rib ; — in costal breathing, a lower THORAX. 1083 rib never moves first. In fact when we inspire deeply we feel as if we directed all onr power to the four or five superior ribs, giving the greatest expansion to the very apex of the lungs, — that most vulnerable part in phthisis pulmonalis. When we look at the thoracic cavity we see why this great power and mo- bility is given to the upper part of the chest. We see that the six superior ribs encompass more space than the six inferior ribs. (See Jig. 668.) So that where we command most movement, there is the greatest portion of lung to be expanded. The hand can measure most delicately this healthy characteristic swelling or filling up of theapex better than any instrument, because the hand covers a large field of the chest, and can distinguish the undulating movement. Standing behind the person to be examined, the fingers of both hands should be placed over the clavicles, so that the tips rest on the infra-clavicular regions, and the thumbs over the inner borders of the scapulae. When ►. a deep inspiration is taken the fingers and thumb of each hand diverge from each other, and we thus gain a perfect knowledge of the healthy “swelling expansion.” If the deep respiratory movement is good, the ordinary movement is sure to be good likewise. The mere flat hand on the anterior and upper part of the chest (facing the patient) will likewise give the character, though less delicately. This movement or swelling of the apex by deep inspiration, is more distinctly marked on the female than on the male subject. If this fine swelling motion in deep breathing is absent disease is present. Pathological respiratory movements. — We now speak of another class of breathing move- ments, which are peculiar in this respect, that the “undulating swell” of the chest is wanting. The twelve intercostal mus- cles move in every combination, as if to meet impending difficulties, — tenacious of life, and yielding only by compulsion to the ad- vance of disease. Throughout the long list of diseases which attack man these instinctive movements have to contend, — shifting about, or growing less and less. We have noticed a man with lung disease, commence with costal respiration of the lower ribs, and, as disease advanced, he breathed with ribs higher and higher up, so that at last he said, “ I breathe with my neck;” and in truth it appeared so. His 1st, 2nd, and 3rd ribs only appeared to move. He passed through almost every variety of respiration before he died. The breathing movements are quick to change, and the inquiry is interesting, what causes the change ? One great cause is the existence of dyspnoea, a disproportion between the air passages and the volume of air to be displaced, which may be caused by an obli- terated state of lung, by tubercles, fluid in the pleurae, hypertrophy of the heart, aneu- rism of the great blood vessels, tumours of various kinds, the pain of local inflammation, pressure from the abdomen, whether ascites, obesity, distended stomach, gravid uterus, or any morbid growth bordering on the thoracic cavity, or lesion of nervous integrity "requisite for maintaining the respiratory movements. Such conditions of themselves would oc- casion deranged breathing movements. But again there are reasons for thinking that these movements may be changed from other causes not so purely physical ; because sometimes no dyspnoea is to be perceived, and yet the movements are deranged, or they may change backwards and forwards as if aerating specific portions of the lungs, acting as a curative re- medy to some incipient form of lung disease. In complicated diseases of the chest a know- ledge of the breathing movements is highly useful. There is one condition in the res- piratory act, which is indicative of a certain state of chest, which, if not useful as a po- sitive, is at least so as a negative evidence of some existing state of things in the lungs. The condition we allude to is a sinking in and bulging out of portions of integuments which cover the thoracic cavity. If we close both nostrils and make a violent inspiratory effort, the integuments between the sterno- cleido-mastoidei immediately above the ster- num, will be seen to sink inward from atmo- spheric pressure. If we open one nostril, the same is less apparent. If both are open and the passages are free, it is not perceptible. In expiration (with the same obstruction) there is a bulging outwards of these integu- ments. Sometimes, particularly in thin per- sons, this may be seen on the integuments covering the intercostal spaces. This sinking inwards is an evidence of attenuated air, and the bulging outwards of condensed air in the lungs, near to the part. It is therefore an evi- dence of some obstruction in the air passage. Difficult breathing may be attended with this feature, or not ; therefore it is an evi- dence of something existing in one state of dyspnoea which does not exist in another. Dyspnoea without this “ sinking or bulging” is a proof that there is no obstruction between the air cells and the external air. But, on the contrary, dyspnoea with this “ sinking and bulging,” is a proof that there exists some obstruction either as a direct diminution in caliber of the air tube, or that more air is drawn through certain tubes than is natural; that this obstruction must have air on both sides of it, and that the air on one side is more attenuated than on the other. For instance, when an aneurism on one of the large vessels of a well-developed chest is pressing upon one of the large bronchi, the respira- tory sounds, and those elicited by percussion, may be good, but respiration becomes la- boured,— the case is obscure, but if there is alternate sinking and fulness of the lower part of the throat, we may be sure that there is some definite obstruction in the air passages. This, in connection with the history of the case, may lead to the detection of the cause and seat of the disease ; but dyspnoea without this feature could not be caused by an aneurism or tumour. In emphysema of the lung this sinking and bulging is very manifest. This circumstance 1081 THORAX. proves simply that there is air in the chest of different density to the external air ; and if so, there must be some impediment in the air tubes, preventing the restoration of at- mospheric equilibrium. Disease of the thoracic viscera affects the breathing movements, causing them to be more limited, or non-symmetrical, reversed, massive, interrupted, partial, quick, slow, ir- regular, or double. (a) Of limited breathing movement. — The mobility of parts when disease attacks the chest may be surprisingly drawn forth. Haller allows scarcely any mobility to the first rib; Magendie asserts that the lower ribs are immovable, because they either reasoned from the healthy body, or anatomically : but it is not uncommon in phthisical patients to see strong and well-marked respiration kept up by the 1st, 2nd, and 3rd ribs, or by the 10th, 11th and 12th; — these ribs are movable, but it requires disease to bring their mo- bility forth. We are satisfied that there is a latent respiratory mobility during health, which is manifested only by disease. In disease particular parts take up ex- aggerated movements, but the sum of these movements is more limited than in health. In the earliest cognisable stage of phthisis pulmonalis the expansion of the thoracic apex is diminished ; the shoulders incline forwards and inwards, and become rounded ; the spine is less erect ; the apex cannot ex- pand. The mobility of the inferior ribs does not so diminish, but sometimes maintains life to the last. With an exaggerated move- ment, the respiration is frequently costal and abdominal at the same time, as if no part could afford to be unemployed. In 233 cases of phthisis pulmonalis (males) in the first stage we noticed that the breathing of 40 was costal, of 96 abdominal, and of 91 costal anil abdominal. The mobility by tape measure was, instead of 3 inches and upwards, as follows: — - Table F F. — Diminished Mobility over the Nipples on 233 Phthisical Males. Difference between Inspiration and Expiration. Number of cases. 4 in. - 3 3 4 - 5 1 - 54 H - 13 H - 44 if - 23 2 - 53 2\ - 12 2i - 25 - 1 (b) Of non-symmetrical breathing move- ments.— In advanced stages of phthisis pul- monalis non-symmetrical movements are no- ticed ; but this may exist without a cavity or effusion of fluid in the lung ; or a cavity may exist with symmetrical movements (but a cavity never exists without extensive dimi- nution of mobility). Generally a cavity is at- tended with non-symmetrical movements, or a dragging up of one side of the chest ; and in extreme cases there is no movement at all in the region of the cavity. That symmetrical movements may coexist with extensive disor- ganisation or solidification of one lung is con- trary to the opinion of many persons. It may be explained by the fact of our having so much spare lung. It has been found by experiment that 310 cubic inches of air could be forced into the lungs taken from a man with a healthy chest (height, 5 feet 4 inches ; weight, 107 lbs. ; vital capacity, 198 cubic inches), the absolute capacity of whose thorax at death, was 245 cubic inches : therefore there was spare lung for more than 100 cubic inches — a space which he could not command during life. May it not be possible that when a part of the lung is consolidated or disabled, this spare portion may come more completely into use, and allow of the symmetrical movement ? (c) Of reversed breathing movements. — A man’s breathing may be costal or abdominal for a month, a week, a day, an hour, a minute, and change again, — every possible alternation may occur. This may take place with or without a cavity in the lungs, with or without phthisis pulmonalis, as if a specific motion drew in air to certain parts of the lungs to excite some local change of condition. Al- though costal respiration is maintained at a greater expense of vital force, yet we see when the vital power is fast ebbing the re- spiration is always costal, and the last breath is a deep costal inspiration followed by the last expiration. (d) Of massive breathing movements. — Massive breathing is a marked feature of the presence of emphysema in the lungs. There is a total absence of that undulating, rolling, and consecutive motion of the ribs. The breathing is always costal, though it may be conjoined with abdominal breathing, and the ribs are elevated in the mass, sometimes together with the shoulders clavicle and sca- pula. Massive costal breathing is indicative of emphysema of the lungs or pneumo- thorax. In all other forms of dyspnoea the undulating movement is more or less pre- sent, though limited. (e) Of interrupted breathing movements. — In those diseases termed “ nervous,” parti- cularly in young women, the breathing, espe- cially the expiration, is sometimes interrupted and jerking. This appears to be merely a functional derangement; it may sound to the ear like deficient respiration, for the intensity of the “ murmur” is generally diminished, as if the jerking “eased away” the expiring air. This is sometimes the case in men. It is very seldom combined with organic disease of the lungs. (f) Of partial breathing movements. — By this we mean independent movement of cer- tain ribs, or of some two or three of the res- piratory regions. All the ribs may move as in emphysematous breathing, or none of them may move, or the lower, the upper, or the THORAX. 1085 intermediate set may maintain the respiratory function. Andral observes, “ The partial immobility of the ribs is not without interest in a physio- logical point of view. Does not this fact prove that, in inspiration, the ribs can move independently of each other, and that they have not merely a common movement ? If,” says he, “ as we have often seen in phthisical patients, the lower ribs can still move when the upper ones remain motionless, it proves that independently of the action of the scaleni, the intercostal muscles are capable of taking, an active part in the act of respiration.”* In this way respiration may be separately car- ried on by any of the twelve costal regions. We have seen a man ill of rheumatism, lying on his back, breathe solely with the diaphragm, and not present the slightest motion of any one of the ribs. And we have seen the con- trary, viz., costal breathing, without the slightest movement of the diaphragm. They can act quite independently of each other, ' (g) Of quick and slow breathing move- ments. — Not only thoracic disease, but most illnesses, particularly febrile conditions, quicken the respiration. In health the number of respi- rations average twenty per minute (Table G G), and it has been found that in 244 phthisical cases (males), the average number was from twenty-four to twenty-eight per minute (sitting) (Table 1 1), the highest number was forty-four per minute. There is every reason to believe that the che- mical quality of expired air is the same whether we are in health or in advanced disease, though our requirements at these two times may be very different; just as the quality of smoke from a fire is the same whether it burns briskly or slowly. — The quality is con- stant, and the required modifications are ob- tained by the difference of quantity in a given time. Quick breathing is short, and slow breathing is long, respiration. The natural time of breathing may change by habit. We have seen a man in health, whose ordinary respirations were six per minute. This extra- ordinary slowness was induced by an attack of asthma, during which attack (lasting about six years), his character of breathing changed from eighteen short, to six long and deep, respirations per minute ; though the asthma entirely left him the character of the re- spiration remained as first changed by the dyspnoea. In this case the return of eighteen respirations per minute, would be to him the rapid respiration of fever, although formerly the respiration of health. Time and volume, in respiration, are the great modifiers of the energy of aeration. (h) Irregular breathing. — Irregular breath- ing movements are less common when organic disease is present. A nervous person, as well as a phthisical person, may have every form of irregular breathing, but in the phthisical per- son the change is less frequent, and is probably due to some change in the disease ; in the * Andral, Clinique Me'dicale, tom. iv. 3d ed. 8vo. Paris, 1804. nervous person the change is frequent, some- times once or twice during an examination of the chest, Nervous breathing is generally well marked in hysteria. (i) Double breathing. — By this is meant cos- tal and diaphragmatic breathing synchronous with each other ; this is not uncommon in severe cases of emphysema, when the mobility of the ribs is much diminished. It is fre- quently met with in phthisis pulmonalis ; — in ninety-one cases out of 233. We have no voluntary power to command this form of breathing in health. It is to be looked upon as a serious modification of respira- tion. All the modifications of the respira- tory movements, induced by disease, may return to healthy breathing again, if the derangement has not been kept up too long. As a general rule, the respiratory movements become natural soon after restoration of the diseased parts to health. Of the number of respirations in a given time. — The ordinary respirations should be counted without the individual being con- scious of the observation ; otherwise they be- come disturbed in number, and sometimes in character. Table GG. — Number of Respirations per Minute (sitting) in 1897 males. Respirations per minute. From 9 to 1G Number of cases. 79 16 - - - 239 17 - - - 105 18 - - - 195 19 - - - 74 20 - - - 561 21 - - - 129 22 - - - 143 23 - - - 42 24 - - - 243 24 to 40 - - 87 Out of 1897 cases, 1731 of them breathed from sixteen to twenty-four times, and nearly one-third of them twenty times a minute. The mean relative velocity of the breathing and the pulse is about one respiration to four pulsations of the heart (twenty to eighty), and the variation in health in the number of respirations is from sixteen to twenty-four, and of the pulse from sixty-four to eighty- eight per minute. Table H H. — Relation between the Respiration and the Pulse (sitting) 1407 males. Number of Respirations per Minute. Pulse. Number of Cases. 16 - - 64 - - 218 17 - - 82 - - 102 18 - - 70 - - 176 20 - - 82 - - 546 22 - - 83 - - 135 24 - - 88 - - 230 From Table I I, phthisis pulmonalis in- creases the velocity of the breathing move- ments from twenty (the healthy mean) to twenty-eight, and cases are numerous up to thirty-six respirations per minute. 1080 THORAX. Table II. — Number of Respirations, of 255 Phthisical Patients, per Minute (sitting). Respirations per Number of Minute. Cases. 12 to 14 - _ 41 4, 1 4 11 „ 16 - - o. 16 ,, 18 - - 13 id . 21 18 „ 20 - - 4. 20 „ 99. _ _ 44' 22 24 - - I' 24 „ 26 - _ 49 ' - - . 1 10 26 „ 28 - 6J \ 65 J 28 „ 30 „ 30 32 - 47' “1 l 32 „ 34 „ 34 36 " ; 39 - 42. 90 36 „ 38 „ 38 40 “ - 16 ”1 1 40 „ 42 - - r \ 17' 34 42 „ 44 - _ 17J * A sudden change in atmospheric pressure affects the number of breathing movements in a given time. We found the following limited but sudden increase of atmospheric pressure increase them as follows. In South- Hetton coal-mine in the county of Durham, • — Depth of the mine 1488 feet. At the level of the sea At the bottom of the mine Barom. 28-72 30-26 Thermom - - 39 c - - 49 c Difference 1-54 10c The additional pressure of the of an atmosphere increased the ordinary breathing from one to three times per minute. This difference was purely the effect of pressure, and not that of fatigue or mental emotion. It might only be temporary. Aeronauts inform us that diminished pres- Tahle KK. — Effect of increased Atmospheric Pressure on the “ordinary” Respirations upon six healthy men. ON THE SURFACE. IN THE MINE. Respira Pulse. tions. Respira- Pulse. tions. M. P. 50 15 50 16 — S. 98 20 98 24 — II. 72 16 68 19 — L. 90 14 88 15 — W. 88 185 93 22 — T. 85 18 100 20 Mean - 83 1 6-9 84-3 19-3 sure increases the number of respirations ; but with them there is this difference, that with diminished pressure there is a sensation of a want of air. When the barometer is low we feel lassitude, and call the “ day heavy,” when in truth the air is lighter, and we ourselves are heavier ; when the barometer is high, we generally experience an indescribable sensation of pleasure — the vital energies seem doubled. With a sudden and considerable fall of the barometer there is a transient plethora. The blood-vessels become distended, owing to which, together with certain hygrometric changes in the air, we feel listless, and the least exertion produces perspiration. Du- hamel observed that, in the month of De- cember, 1747, the barometer in less than two days fell 1-J- in., producing a change of pressure on the body of a man, of 1400 lbs. ; this he ob- serves was accompanied with many sudden deaths. It is evident that with an increased pressure we get more air into the lungs with a given mobility; for, eastern paribus, air, with the barometer at 30 in. must be more dense than the same air with the barometer at 29 in. In the mine in question, we experienced a sensa- tion of lightness and vigour. The number of respirations are always increased when there is a preternatural increase in the temperature of the body. Of the Sounds of Respiration. — The breaking up of the air into minute streams was discovered by Laennec to produce certain sounds, named “breathing sounds:” which sounds are now made available in detecting organic disease in the lungs. As the air penetrates the lungs, it is divided and sub- divided until it enters the minute air vesi- cles. The air passes, 1st, through the trachea, producing “ tracheal sounds,” — a hollow rough blowing ; 2nd, through the next divi- sion of vessels (bronchial), producing “ bron- chial sounds,” less hollow and termed “whiff- ing or tubular and, 3rd, into the air vesicles, producing “ vesicular sound,” — a soft, silky murmur like a gentle breeze among the leaves of trees. Dr. Jackson discovered that which Laennec overlooked : — this murmur is not heard in expiration, while the other two sounds are. Hence the expiratory murmur is a morbid sign, and if heard on the left side below the acromial end of the clavicle, is a sure sign of some altered condition of the air tubes, not compatible with a healthy lung. This expiratory mur- mur may sometimes be heard faintly on the right side, and not be a morbid sound ; but if strongly heard there, it is a morbid sign. A question now arises : Why is there a murmur- ing sound with inspiration and not with expira- tion ? First, let us inquire what is the dif- ference between the inspiratory and the expiratory act ? They differ in two ways : 1st. In Inspiration the lungs are passive ; the chest threatens a vacuum, and the air enters a rarefied space. In Expiration the lungs are active ; there is no rarefied space ; the air is squeezed out into the atmosphere. This does not affect our question. 2dly. In Inspiration a volume of air is broken up into smaller and smaller streams. In Expiration these small streams are collected up into the original volume by larger and larger streams. This answers the question. The hollow blowing sound in the trachea is caused by the friction of the air against the sides of the tube. The relation of the friction THORAX. 1087 to the stream is the same whether the air passes into or out of the lungs, therefore the tra- cheal sounds are equally heard in expiration and in inspiration. But not so in the lungs ; here, as the stream of air proceeds it is subdivided, and with every subdivision the friction is increased ; so that with every advance of the stream into the substance of the lung the sound is increased, and becom- ing more and more buried in the substance of the lung is heard as in a continual murmur. In expiration the very contrary happens. The friction is as quickly diminished, until the substance of the lung entirely masks what remains. In the larger vessels when the volume of the returning air becomes great, and the diameter of the tube more uniform, the friction is the same whichever way the air passes, and here tracheal and bronchial ex- piration are audible, during inspiration as well as expiration. If we take a sheep’s lung and inflate it, we hear the inspiratory murmur; let go the air and we do not hear it ; but contract part of the lung, say with the edge of a paper knife, and 3 0U hear the mur- mur during the lung’s collapsing, showing that by increasing the friction you produce the expiratory murmur. When any disease thickens or diminishes the diameter of the air tubes, or when one part of the lung is obliterated and another part has to do double work, then the friction is increased, and thus expiratory murmur is a true sign of some change in the minute air tubes of the lungs. Sometimes the breathing murmur is so gentle and the thickness of the muscles so great that we have even in health known the inspiratory murmur quite inaudible. In organic change of the lung these sounds become changed in their intensity, rhythm, and character. The cause of the change of sound is yet involved in much obscurity ; hence some persons have been said to have had tubercular lungs, when such has not been the case; or even extensive cavities, &c., yeftime has shown that there never hail been cavities. All the morbid true sounds yet require to be verified as to their cause. As we have natural changes in the character of breathing, so are there changes in the sounds of breathing, as follows : — I. In its Intensity II. In its Rhythm 1. Frequency 2. Duration III. In its Character When there is fluid or disorganisation in the substance of the lung, there are certain crack- linos, crepitations, and gurglings, causing certain other sounds not included in the above list. Unfortunately authors differ in the ap- plication of the names for these sounds. They may be all classed under two heads, the dry and the moist, whether the tubes be large or small in which the sounds are pro- duced. For the Bibliography see that of art. “ Respiration,” p. 366. (./. Hutchinson.') THYMUS GLAND.— (French, Be thymus; Italian, Tinio; German, Die Brustdruse; Lat., Thymus; Greek, Bvyoe.) — It is proposed in this article to adopt the following arrange- ment : First, to treat of the gland as it exists in the human subject, comprehending its ordi- nary and structural anatomy, and its develop- ment. Secondly, to give a sketch of the comparative anatomical history of the organ. Thirdly, to treat of its physiology. Fourthly, to mention what has been observed of morbid changes occurring in it. Human Anatomy. — Sir A. Cooper’s de- scription of the gland in the human subject is as Strong or exaggerated. Feeble. Absent or suppressed, f Quick. \ Slow. Jerking or interrupted, f Long. -I Short. I Expiration prolonged. t Harsh. Bronchial or tubular. Cavernous. Amphoric. follows: — “This gland is formed of a tho- racic and cervical portion on each side. The former is situated in the anterior mediastinum, and the latter is placed in the neck, just above the first bone of the sternum, and behind the sterno-hyoidei and sterno-thyroidei muscles.” “ Between two and three months of foetal life, as will be seen in the plate (Jig. 717.), it is so Fig. 717. The thymus , heart, larynx, 8fc., of the human foetus at rather more than two months. ( After Sir A. Cooper .) small as to be but just perceptible. At three months (Jig. 718.) its increase is in propor- tion to the relative magnitude of the foetus, and thus it continues to grow gradually and equally (.fig. 719.) to the seventh month, when it en- larges out of proportion to its former growth. At eight months it is large, but at the ninth 1088 THYMUS GLAND. Fig. 718. Thymus, Sfc., of human foetus at third month. ( After Sir A. Cooper .) month {fig. 720.) has undergone a sudden change, becomes of great size, and is said to weigh half an ounce, from which circumstance, however, on account of the cavities which it Fig. 719. Thymus, Sfc., of human foetus at fifth month. ( After Sir A. Cooper .) contains, and the varieties to which it is sub- ject, no judgment of its bulk can be formed. It increases after birth, and continues large to the first year, when it slowly disappears to the time of puberty ; and in after age it ceases to have cavities, and becomes a body of very small dimensions.” He next notices the following varieties in configuration : — “ Although the gland is usu- ally double, and the one side united to the other by cellular membrane only, yet it some- times happens that a third thoracic lobe exists, which appears to join one lobe with the other, but which allows, under a careful dissection, of their being separated. There are also two other varieties I have seen ; the first is the vena innominata passing through the gland, and the second, the same vein placed anteriorly to the cervical lobes. Indeed, I scarcely find two organs alike in form ; sometimes they are round, whilst others are of great length, and are so thin that the serpentine disposition of their lobes may be seen without dissection. The left gland is often larger than the right ; but even in this respect so much variety is observable, that it appears if the bulk of the Fig. 720. Thymus, 8fC.,of human foetus at ninth month. ( After Sir A. Cooper. ) whole be the same, that it is of little import- ance which may be of the greater magnitude, the right or left gland, as its secretion will be equally abundant.” The relative situation of the thymus gland to the adjacent parts is described as follows : — “In cutting through the sternum in its long axis, and then separating its two lateral portions, so as to give a good view of the mediastinum, the thymus gland appears situ- ated behind the first and part of the second bone of the sternum ; and posteriorly to the origins of the sterno-hyoidei and sterno-thy- roidei muscles. It reaches more than half way down the sternum at birth, viz. to the fourth rib, and extends from thence into the neck near to the thyroid gland. It is con- nected to the sternum and origins of the sterno-hyoidei and sterno-thyroidei muscles by cellular tissue ; it adheres strongly, by a coarse cellular membrane, to the pericardium ; an- teriorly and laterally the internal mammary arteries and veins take their course. The reflection of the pleura descending from the cartilages of the ribs on each side, and con- tinued to the fore part of the pericardium forming the anterior mediastinum, makes its lateral boundaries, and separates it from the lungs; posteriorly it rests upon the vena in- nominata, and upon the fascia of the thorax, which descends from the sternum and first rib to the curvature of the aorta, and to the three large vessels which spring from it.” “ Such, then, is the relative situation of the gland in the chest. In the dissection of the cervical THYMUS GLAND. 1089 portion of the thymus, the platysma myoides and external jugular vein are first turned aside, and the origins of the sterno-mastoidei muscles are raised; when this has been accom- plished, the sterno-byoidei appear covering and passing over the thymus gland. The sterno-thyroidei muscles . . . cover this organ anteriorly; but when they are removed, the cervical portions of the thymus are seen on the anterior and lateral parts of the trachea, and just below the thyroid gland, where it passes on the fascia on the fore part of the air tube, and unites with the larynx by liga- ment.” “ The internal jugular veins are placed an- teriorly and laterally to the cervical portion, and the carotid arteries, with the par vagum, appear more externally.” “ The first bone of the sternum and sternal ends of the clavicle cover the junction of the cervical with the thoracic portion of this gland.” “ In many of the subjects which I have ex- amined, the cervical portion of the thymus passes higher upon the right than on the left side, and I have generally seen it joined by a ligament to the larynx, and by vessels to the thyroid gland.” In a human foetus, at about the fourth-and- a-half month, I found the thymus consisting of two lateral portions, of which the right was the larger (in another of similar age the left was) ; this portion extended downward, lying upon the pericardium, as far as opposite the Fig. right auricular appendix, and reached upwards only to the left brachio cephalic vein, which it did not cross ; the left extended downwards, over the pericardium, to a point opposite the middle ot the trunk of the pulmonary artery, and passed up, lying upon the vena transversa, and afterwards upon the side of the trachea, be- tween it anti the common carotid, till it arrived at the level of the bifurcation of the arteria innominata. The appearance of the gland in the foetus about the middle of utero-gestation is precisely similar to that of the salivary gland in the same ; it is beautifully lobulated, and sur- rounded by an atmosphere of nascent areolar tissue. In the more perfectly formed con- dition it is surrounded by' an envelope of coarse cellular membrane, which penetrates the intervals of its larger divisions, unites the right and left portions together, and forms a general envelope, by which it is connected to the surrounding parts. In examining the structure of the thymus, we are conducted by two eminent guides to conclusions almost identical, though by dif- ferent modes of proceeding. This coincidence is of great value, and we can scarcely enter- tain a moment’s doubt of its being founded on real truth ; it may therefore be well to notice separately the modes of investigation above referred to. Sir A. Cooper, by skilful manipulation, suc- ceeded in unravelling the gland, and showed each lateral part to be composed of a 721. 1090 THYMUS rope, on which the lobes and lolnili are set somewhat like the beads on the string of a necklace (7%. 721.). By injecting also the glandular cavities with some fluid, as alcohol, capable of hardening the tissue, or with co- loured gelatine, which sets and permanently distends them, he demonstrated the existence of a central cavity or reservoir, communicating with the glandular cavities by orifices leading into pouches situated at the roots of the lobes (Jig- 722.). The central cavity forms a Fig. 722. Section of thymus showing the reservoir, cells, and pouches. ( After Sir .1 . Cooper.) general communication between the different lobes ; it does not maintain a straight course, but passes in a somewhat spiral manner, be- ginning from the lower part of the thoracic portion, and extending even into the extremity of the cervical part of the gland : its size varies in different parts, being largest near the centre of the thoracic, and least at the communication of the thoracic with the cervical, part of the gland. Sir A. Cooper conceived the reservoirs to be lined by a very vascular mucous mem- brane of somewhat villous character, but this does not appear in reality to exist. Such were the principal results obtained by a most skilful and eminent anatomist, with all the appliances and aids that his science could at that day supply ; they were truly valuable facts, but not so “ luciferous,” not so exhibit- ant of physiological meaning, as those ob- tained bv a subsequent inquirer, who, availing himself of the more penetrating ken of the modern achromatic lens, and seeking rather to learn from the instructive examples which Nature herself sets forth, than from results of his own devising and producing, has both confirmed the conclusions drawn from a less refined scrutiny, and invested them with a more correct bearing and interpretation. I refer, of course, to the admirable researches of Mr. Simon, which I now proceed to detail, respecting the structure of the thymus, as illustrated by its developement. Developement. — The first trace of the or- GLAND. gan which has been discovered is in the form of an exceedingly delicate tube, lying along the carotid vessels in the neck, not straight, but wavy at one part, and termi- nating by closed extremities at both ends (Jig- 723.). Its wall is formed by a transpa- Fig. 723. Primary tube. ( After Simon.) rent homogeneous tunic, marked at regu- lar intervals with elongated thickenings (the remnants probably of the nuclei of primor- dial cells), and enclosing granular matter, but no distinct corpuscles. There seems some probability that this tubular form, though found to prevail in very early embryos, may not be the really primitive one, but that a linear series of cells is first developed, which are afterwards blended together by fusion, so as to constitute a tube (see Jig. 724.); this opi- Fig. 724. Supposed origin of primary tube. ( After Simon.) nion however, I suspect, will not be confirmed ; the limitary membrane of glandular and other structures has generally appeared to me to be produced quite independently of cells, so far, at least, as that it should be regarded identical with their coalesced envelopes. In the next stage of developement, the homogenous wall of the tube begins to bulge, and swell out into vesicular cavities, which at first have wide communications with the central canal or tube, and are quite sessile, but afterwards become attached by short and rather narrow THYMUS GLAND. 1091 pedicles ( Jigs. 725. and 726.). This budding Fig. 725. Fig. 726. Second stage of developement of primary tube forming follicles. ( After Simon.') out of the primary tube does not occur simul- taneously at every part, or uniformly, but chiefly at those situations which are ulti- mately to attain the largest size ; thus in the fatal calf we find tolerably well developed bulgings of the primary tube opposite the angle of the jaw, the upper part of the trachea, and the pericardium, while the intervening portions have smooth and undulated margins ; and it is just the parts of the gland corre- sponding to the above points, which ulti- mately attain the greatest magnitude. The third stage of developement consists in the ramification of the follicles which have budded out from the central cavity; — they do not usually elongate much, before they throw off fresh offsets, and these are completely sessile, so that they have the appearance of vesicles or imperfect spheres grouped together : the mode in which the primary offset divides is either dichotomous or quaternary (Jigs. 727. and 728.), probably also often with some degree of irregularity and inequality in the size of contiguous offsets. By the extension Figs. 727, 728. Third stage of developement. Ramification of follicles by dichotomous and quaternary division. ( After Simon.) of this follicular growth to all parts of the primary tube, and bv successive lateral rami- fications, occurring, as we have seen, to a greater extent in some parts than in others, the gland attains its mature size and complex structure. In this state however it consists, in very great measure, of vesicular cavities, which cluster around and completely obscure the primary tube from which they have origi- nated ; yet this primary tube or reservoir does exist, and is capable, as we have seen, of being demonstrated, so that the term which Mr. Simon has proposed, as expressing the type of the mature structure, viz. tubulo- vescicular, is sufficiently correct (Jig. 729.). Two varieties have been observed in the seeond stage of the process ; one is, that “ the tube sometimes bulges uniformly in its whole cir- cumference for some extent, forming a very distinct ampulla;” the other, “ that in parts where there are yet no bulgings, it is some- times flexuous, or even contorted.” The observations now detailed respecting the progressive developement of the thymus, are so important in the elucidation of its structure, that I thought it very desirable to repeat them, if possible, and confirm their ac- curacy by independent testimony. I have not, however, been able to procure a fetus at a sufficiently early period to discover the primary tube of the thymus, with its smooth 4 a 2 1092 Fig. 729. THYMUS GLAND. Fig. 730. Diagram of fully developed thymus. Showing how the primary central tube is covered and concealed by the lateral developements, each of which constitutes a conical mass, a, b, c, d, with a very wide base. ( After Simon.) unbulging wall, but 1 have seen it distinctly at a period somewhat later, when the process of lateral extension had but recently commenced. This was in the embryo of a sheep, not more than two inches long, where the thymic cavi- ties were bounded by a well-marked limitary membrane, and filled with nuclei. At the extremity of the cervical portion, thedevelope- ment of bulging offsets was much less ad- vanced than towards the middle of the gland, so that here the central tube was very appa- rent, terminating by a closed extremity, and having its margins rendered irregular and wavy by the vesicles which had begun to rise from it (Jig. 730.). The developing or- gan was formed in a nidus of homogeneo- fibrous tissue, interspersed with nuclei, which was seen stretching across between the promi- nent convexities of the bulgings. At the end of the cervical portion this tissue was more abundant, and there was seen running into it a prolongation of the central cavity, which appeared exactly like a short tube, pushing on in a straight direction, and not expanding nto a vesicular cavity. In a young chicken the condition of the thymus was very similar, and the central cavity was larger than the small lateral offsets. These details, though in- complete, leave scarcely a shadow of doubt that Mr. Simon’s account is perfectly correct, that the central cavity is the primary part from which the vesicular offsets successively develope themselves. This central cavity may, I am inclined to believe, in some cases disappear more or less completely ; at least, in an em- bryonic sheep, three inches long, it not only bore a smaller proportion to the multiplied offsets, but its wall no longer exhibited the investing limitary tissue, and it seemed as if it The end of the tube is closed, the central cavity is larger, the walls present numerous follicular pro- trusions of irregular size and form. Towards the middle the follicles are very much more developed. were in some measure diminishing, and losing its original distinctness. From what I have seen in the sheep, I should be led to think that the cervical and thoracic portions of the thy- mus had, in that animal at least, distinct pri- mary tubes as centres of developement, so completely independent have the two parts seemed to be of each other. Mature structure of the gland. — The results of minute scrutiny into the structure of the fully-developed thymus, accord well with those arrived at by other modes of inquiry. Its surface, when freed from investing areolar tissue, exhibits, though in a rather coarser manner, the minutely-divided appearance so characteristic of the conglomerate glands, and this is especially evident when fat cells have formed in the interstices of the lobules, pat- terning the surface over with a network of white streaks. In a thin section taken from the gland and prepared for the microscope, the outlines of the vesicular cavities are rea- dily seen ; they are much larger than those of the salivary glands, and vary very much in size ; in a human foetus, at about the mid- period, they averaged Jg inch, in a calf about Jg inch, in a young guinea-pig they varied from to TJ¥ inch. Their form is oval or spherical, their outline distinct for about two- thirds of their circumference, but in the remaining part blended with adjacent ones, so that there is never seen any thing resembling THYMUS GLAND. 1093 a detached and closed vesicle. The sharp definition of the outline by a clear dark line, gives full assurance of the presence of an in- vesting limitary or basement membrane ; this constitutes a general envelope, forming the boundary of each of the glandular cavities, surrounding, therefore, the whole mass, but no- where prolonged into an efferent canal, through which the contents might escape. In structure it is truly homogeneous, that is, considered per se, but as it is closely invested by a very thin layer of areolar tissue on its exterior, it has sometimes a kind of fibrous, striated, as- pect. In all respects it closely resembles the basement tissue of other glands, and, as in them, I have never been able to perceive in it anything corresponding to the germinal cen- tres of Mr. Goodsir. The contents of the thymic cavities next demand our attention. They consist almost entirely of corpuscles, very closely resembling (in fact identical with) the nuclei of glandular cells ; the only difference which the most careful scrutiny can detect between them, I believe, is this, that they present more nume- rous nucleoli than the nuclei of gland cells usually do. I doubt, however, whether even this is constantly the case. Their form is, I think, for the most part spherical ; Mr. Simon speaks of them as generally flat and circular, but I have never observed one, if this be their real form, presenting its thin edge to the eye, as blood-discs frequently do. They vary a good deal as to the condition of their interior spots or nucleoli, some contain two or three, some as many as four or five, a few have one only, and some of the smaller none at all, but are filled with a dimly molecular substance. Their surrounding envelope is strong and well defined, as that of nuclei always is. The extreme variations in size of these corpuscles, according to Mr. Simon, are --£5-5 hich for the largest, and l°r the smallest, probably a correct average, for the generality is about s=Tnoo 'nc'h. Mingled with these I have found in the thymus of a calf, as well as in that of a young guinea-pig, a few larger corpuscles, about double the size of the former, of spherical form, filled either with granular matter alone, or containing also a nucleus or larger vesicular body.. I am by no means inclined to regard these as cells formed upon the originally-existing nuclei of the cavities, but rather as expansions of the nuclei themselves, with formation of granular matter in their interior. It is well worthy of remark, that in the fully developed organ, before any appearance of atrophy has taken place, no other contents than those now described are found in the glandular cavities. There is none of the abun- dant granular material which forms so large a part of the epithelium of most glands, no dif- fused oily matter, the nuclei aggregated to- gether into dense masses seem to fill the ultimate vesicles completely, and there is no trace of any material which can justly be re- garded as the product of secretion. * ' A * The contrast in this respect between the thy- strong’solution of bichloride of mercury, in- deed, coagulates a small quantity of diffused plasma (probably the liquor sanguinis of blood remaining in the capillaries) which adheres irregularly round the neuclei, but its effect on the contents of the thymus is very different from that which it has on the albuminoid epithe- lium of the true glands. This is a remarkable circumstance, anJ, as yet, has not, I think, been sufficiently attended to. If we en- deavour to interpret it, it would seem to im- ply that the thymus is not truly a secreting organ, that is, that it does not separate from the blood or elaborate any special product, or in fact any product at all ; but that its func- tion is limited to the formation of an appa- ratus, which conforming closely to the type of secretory glands is yet not endowed with any analogous property. * The centres around which the material of the secretion should be evolved are present in myriads, but no gran- ular substance analogous to that of glandular epithelium is formed around them. It seems, therefore, that in the case of the thynnis, the liquor sanguinis exuded from the vascular plexus through the homogeneous tunic simply solidifies into cytoblasts or nuclei, in most other glands a part takes the same organic form, — a certain number of nuclei are formed, — but these then become the centres of a dif- ferent and more complete action, or are en- dued with peculiar attractive powers, in virtue of which the materials of the several secretions collect around them in their respective labo- ratories. Such is the fact microscopic inquiry adduces, and such theinterpretation which may be offered of it; let us now turn to chemistry, and inquire whether the view we have just suggested is supported or negatived by the result of analysis. Mr. Simon gives three analyses of the thymus, which, as he states, though performed on the tissue itself, and not on its fluid contents, may fairly be depended on for conveying a sufficiently correct idea of tbe chemical constitution of the matters con- tained in its cavities. Now in none of these is there any mention of any special substance which couid be regarded as characterizing the secretion, on the contrary, the constituent elements are mere fibrinous, albuminous, or extractive matters and ordinary saline com- pounds, and there is none of these which might not exist in the blood, and be most readily derived from it. This is, in fact, the con- clusion which Mr. Simon adopts ; he believes that we may express the nature of the secre- tion of the thymus as nearly as may be by the formula of Proteine, or denominate it, in physiological language, as simply nutrient matter. nuis and the thyroid is very instructive, in both the limitary membrane forms closed cavities, which in the one are chiefly filled with secretion, in the other with nuclei, the accredited agents of secretory action. * Whatever may be the nature of the fluid said to be contained in the thymic cavities in which the nuclei float, it is too small in quantity, and too little apparent, to make it necessary to take it into account ; certainly it never collects after the man- ner of a secretion. 4 a 3 1091 THYMUS GLAND. Sir A. Cooper describes the vascular sup- ply of the thymus as follows: — “With re- spect to the arteries of this organ, they are principally derived from two sources. Each thoracic portion is supplied by a branch which is sent off by the internal mammary. It enters at the junction of the cervical with the thoracic part, generally on their outer side, but sometimes between the cervical portions, and, descending upon the middle of the gland, divides to supply the spirally disposed lobes. The other principal artery of the thjmus is sometimes derived from the superior thyroi- deal, at others from the inferior thyroideal artery, and, descending upon the lobes of the cervical portion, passes into them, and ulti- mately anastomoses with the branch from the mammary artery. The thymic arteries may also arise from the trunk of the subcla- vian, the vertebral, or the carotid artery, or even from the arch of the aorta. The ca- pillary network in which the arteries termi- nate, is stated by Mr. Simon to be of “the completest description. It is so arranged as to include each individual vesicle within a vascular capsule ; the capillaries are closely applied upon the transparent texture (limitary membrane) which bounds the cavities, and so exceedingly dense is their network that the meshes are of even less diameter than the vessels themselves. Every portion of the glandular substance is thus exposed in the completest manner, and at every point of its surface, to the penetration of the fluid ingre- dients of the blood.” “The venae thymicse” Sir A. Cooper states “ have a different course to the arteries ; for although the internal mam- mary and thyroideal veins receive small branches from the gland, yet the principal veins are those which end in the vena innominata. A considerable vein springs from each thoracic portion, and passes from the posterior surface of this part of the thymus into the vena inno- minata; having received a branch from the cer- vical portion, and vessels from the thoracic: it is found near the centre of the gland. A very small vein enters the thyroideal from the cer- vical portion, and this vein anastomoses with that of the thoracic part.” Respecting the absorbent vessels of the thymus very little seems to be known ; we may, however, fairly conclude from the analogy of other parts, that they commence by a network of minute vessels, which have no communication whatever with the glan- dular cavities, and cannot, therefore, serve the purpose of excretory ducts as has been sup- posed : the glands to which they proceed are those of the anterior mediastinum. Mr. Simon describes the nervous supply of the thymus “ as mainly derived from the plexus which surrounds the first part of the subclavian artery, and which has its chief origin from the inferior and middle cervical ganglia. A small twig detaches itself from this sympathetic plexus, just opposite the origin of the internal mammary artery, accom- panies that vessel in its course, and, on arriving at the point where the thymic branch arises, sends filaments along it into the sub- stance of the gland. A second source of supply is the cardiac branch of the pneumogas- tric, which gives on each side a minute fila- ment to the superior part of the gland.” “ In one instance I have seen a very minute fibril of the descendens noni emerge from the sub- stance of the sterno-thyroid muscle, and reach the cellular investment of the thymus ; and I have sometimes seen delicate twigs of the phrenic also detached towards the gland ; but in each case the nerve has appeared to restrict its distribution to the surface and coverings of the organ, and has not accompanied any of its vessels.” The exact arrangement of the nervous fibrils, both tubular and sympathetic, in the substance of the gland is yet unknown ; but it seems tolerably certain that they accompany the vessels, enlace them with their plexiform divisions, and terminate, in part at least, in a looping manner. Early development. — The following quota- tion from Professor Goodsir’s paper in the Philos. Transactions, contains his view's re specting the development of the thymus and two others of the ductless glands; I am un- able from my own observation to confirm or dispute the accuracy of his opinion, but can- not do otherwise than refer to the labours of so distinguished a physiologist. “ That portion of the membrana intermedia which is separated from the rest of the mem- brane, and included in the body of the embryo by the umbilical constriction, and which has not already been devoted to the formation of the heart, liver, pancreas, and external portion of the intestinal canal, is found massed along the trunks of the primitive venous system, the sides of the arches of the aorta, the terminal portion of that vessel, and the origins of the omphalo-mesenteric arteries. The portions of the membrana intermedia which are last in being converted into special organs, the Wolf- fian bodies, are the parts which project one on each side of the aorta along the posterior part of the cardinal veins of Rathke, between the intestinal plates and visceral laminae. The portions of the membrana intermedia, which remain between the upper extremities of the Wolffian bodies and the heart and liver, and which surround the origins of the omphalo- mesenteric arteries, do not become converted into organs of special structure, but retain during life the original constitution of the membrana intermedia of the blastoderma, and increase rapidly in the embryo constituting the supra-renal capsules. That portion of the membrana intermedia which is situated be- tween those two aortic arches the extremities of which become the carotid and subclavian arteries, remains during life as the thyroid body. It receives its blood from the first and second aortic arches by two large trunks on each side, the superior and inferior thyroid arteries. That portion of the membrane which passes in two parts from near the base of the cranium back as far as the ductus Cuvieri and anterior portions of the veins of Rathke, and THYMUS GLAND. 1095 which are united and concentrated in front of the heart, by passing from behind forwards in harmony with corresponding motions of the neighbouring part, becomes the thymus. The structure of these organs is identical with that of the blastoderma (?). Their probable func- tion, namely, to prepare by the action of their nucleated cells, and to throw into the vascular system a matter necessary for the nutrition of the animal during the period of its active growth, a function which the observations and opinions of the majority of physiologists have assigned to them, is also essentially the same with that of the blastoderma.” Development of Size. — Having now examined the anatomy of the thymus, and traced its development with a view to the exact elucida- tion of its structure, we have next to follow out the successive periods of its growth, in order to determine whether it be an organ having special relation to foetal or to extra- uterine life. The former alternative was that to which the older anatomists, and even Sir Astley Cooper, inclined ; but the correctness of the latter seems now abundantly established. Meckel, Hewson, Cloquet, and Sir A. Cooper himself, all concur in stating that it continues to grow at least up to the end of the first year after birth ; and more recently the evidence accumulated by Mr. Simon from his own ob- servations and those of Hangsted have quite set this important point at rest. The following details have been selected from the copious table of instances contained in Mr. Simon’s essay, they show conclusively that the gland does not attain its greatest size for some time after birth, and that after a va- riable period it gradually again diminishes. Thus in the dog, at birth the gland weighs 4'75 grs. ; from 3 4 months to H year after it varies from 360 to 780 grs. ; from 3 to 4 years it varies from 150 to 46 grs. In the cat, at birth its weight=64 grs. ; from 19 to 37 days after it= 30 to44grs. ; 4 to 6 years after=20 to 3 grs. In the human foetus of 7 months the gland weighed 33 grs. ; at 8 months 40 grs. ; at birth 84to240 grs. ; 9 months after, 270 grs. ; at 21 years 40 grs. The weight of the thymus is subject to considerable varieties, which pro- bably depend, as Mr. Simon points out, partly on original differences, some individuals hav- ing naturally a larger proportion of thymic structure than others ; partly also on tempo- rary alterations in the activity of the nutrient processes, as is well exhibited in the effect of over-exertion on the thymus of lambs re- marked by Mr. Gulliver ; the size of the gland is known also to diminish when the develop- ment of the muscular system is promoted, it being found to waste away much more rapidly in young oxen used for draught, than in others not so employed. The general conclusion, which the able physiologist from whose work I have drawn so largely adopts, is, I think, truly judicious and accurate ; he estimates the period, during which the thymus persists and is active, not so much according to the space of time which has elapsed, but according to the state of the general functions of the frame : if the assimi- lating processes are active and vigorous, and the supply abundant, and the demand only mo- derate, the gland will be large and will persist longjif onthecontrary thefirst processesof nu- trition are imperfectly supplied, or if great mus- cular exertion creates a considerable demand, then the thymus ceases earlier to discharge its function and becomes atrophied, because the conditions no longer exist which are favoura- ble to its subsistence. Now it is obvious that in almost every individual these circumstances which so greatly affect the nutrition of the thymus may vary exceedingly, and it is there- fore impossible to state an exact numerical age as the period of the highest development of the gland ; a physiological age may how- ever with much certainty be named, and it is, as Mr. Simon states, “ the age of early growth.” The date of the earliest appearance of the thymus in the human foetus is still little more than matter of conjecture, it has not been po- sitively detected before about the 9th week, when it is quite distinct to the naked eye, consisting of two lateral elongated portions lying parallel to each other on the upper part of the pericardium. Its structure at this time is distinctly tubulo-vesicular, but there is doubtless an earlier stage, when it corres- ponds exactly to the simple primary tube dis- covered, as before mentioned, in very early mammalian embryos. The epoch of its entirely vanishing is very variable and uncertain “ about puberty it seems in most cases to suffer its chief loss of substance, and to be re- duced to a vestigiary form but for several years later, even up to 20 or 25, distinct rem- nants may still be discovered of its structure amid the areolar tissue of the mediastinum. Comparative Anatomy. — In presenting a sketch of the comparative anatomy of the thymus, I can but follow the elaborate ac- count given by Mr. Simon. Mammalia. — Among the Quadrumana the thymus has, in the more anthropoid Apes, nearly the same general shape and relations as in the human subject, the cervical portion seems to be variously developed in different genera. Among Cheiroptera the gland seems to be persistent in the genera Vespertilio and Ga- leopithecus, at least so far as anatomical in- quiry has yet proceeded ; it consists of a thoracic portion embracing the base of the heart, and two cornua ascending parallel to each other on either side of the windpipe In a Bat which I dissected on the 20th of March, and which was then in a wakeful state, I could find no organ which I could positively conclude to be a thymus. On each side, however, of the root of the neck there existed a pretty large yellowish lobulated mass, resembling a good deal the aspect of a conglomerate gland. It consisted of conical lobes which were bounded and defined by a distinct homogeneous membrane exactly re- sembling the limitary tissue ; this was I think continued by reflection from one lobe to an- other, so as to form a common envelope to 4 a 4 1096 THYMUS GLAND. all the cavities {fig. 731.). The lobular ca- consisted chiefly of aggregations of oil drops vities were completely filled by aggregations and molecules. Within the thorax at its of celloid particles, which were not manifestly upper part there was a similar lobulated grey- nucleated, nor provided with an envelope, but ish white mass, resting upon the lower part of Fig. 731. Convexity of lobe from oil gland of Bat. A homogeneous membrane encloses a multitude of celloid par tides, — the exterior row of which alone is visible, the rest of the mass being quite opaque. the trachea and the great vessels, and ex- tending round so as to come in contact on each side with the lung ; the structure of this was precisely the same as that of the masses at the root of the neck, with which however it was not continuous. I am much inclined to regard these organs as representatives of the thymus, both from their structure and situa- tion, and because I know not what else they could be ; they are not for a moment to be confounded with the ordinary adipose tissue. Among Inseclivora the thymus forms two nearly equal lobes, lying on the base of the heart and origin of the large vessels, with greater vertical than transverse dimensions. In some individuals, at least, it is not persistent throughout life, nor does it appear to be spe- cially developed. In two Hedgehogs which I dissected, one of which had been in a state of torpor until three days before death, and the other had been active and wakeful for several weeks, I found at either side of the root of the neck two roundish masses almost precisely similar in appearance to those existing in the same situation in the bat, and also two broader and thinner ones lying in the ax- ill® ; but there was no trace of any such tissue in the thorax. The celloid particles were more loaded with oil than in the bat, especially in the dormant one, and in some parts they were more or less broken up and the oily matter diffused in the cavity. Re- specting the existence of a real thymus distinct from these glandular masses I am in doubt, it is not altogether easy to distinguish the structure from that of lymphatic glands several of which lie upon the great vessels at their origin from the heart. However this be it is well worth remarking, that in two hi- bernating animals belonging to different orders, peculiar organs of precisely similar structure were found ; while, on the other hand, in a mole (an animal which I believe does not hibernate) I could find no unequivocal trace of thymus, nor of the peculiar oil glands which I have described as existing in the bat and hedgehog. This would indicate the existence of the oil gland to have reference to hiberna- tion, but a more extended inquiry on this head is of course necessary before this sug- gestion could have much claim to be received. Among Carnivora the thymus, except in the cat tribe, where it seems generally to vanish at an early period, is entirely thoracic, resting upon the upper part of the pericar- dium and the origin of the vessels. When mature “it has considerable thickness and substance in the direction from before back- ward, and its right and left lobes irregularly overlap each other, so as to render the sepa- ration between them indistinct.” When the gland becomes attenuated it assumes the form of a triangle, with the apex much pro- longed upwards. The thymus has been found by Mr. Simon in (young) seals, though other ana- tomists, including Meckel, who, as he says, was little likely to overlook its presence, had not observed its existence ; from this he concludes that it declines and disappears in this family, as in most other mammalia. Its form in the common seal, when pre- sent, is nearly symmetrical, consisting of two broad thickish lobes, which prolong themselves upwards to the root of the neck, and abruptly terminate by clubbed extremi- ties, which are deeply grooved in front by the left vena innominata. In the order of Marsupialia, three most eminent anatomists had failed to recognise the existence of a thymus, Mr. Simon has, however, discovered this gland in several in- stances, it is mostly placed on the pericar- dium, not reaching into the neck. In the foetus of the Kangaroo it has a peculiar con- formation, being provided with a third, me- dian, lobe projecting outwards between the two others. Among Rodents the thymus differs in shape in the various genera. It consists in the rat of two elongated parallel lobes, reaching from the base of the heart to the root of the neck. In the hare it is much thicker, but still only extends to the root of the neck. In the hibernating rodents the thymus is believed to undergo at the approach of winter a re- markable alteration, apparently as a prepara- tion for the long sleep of that season. Tie- dentann describes in a Marmot, which he examined in the month of November while in a state of torpor, the gland as “ filling the whole of the anterior and posterior medias- tina, extending along the great vessels of the THYMUS GLAND. 1097 neck to the vicinity of the lower jaw, spread- ing itself out above the clavicles on each side of the neck, and even passing behind the clavicles and pectoral muscles into the axil- lary spaces.” Mr. Simon in his dissections of the same family finds the masses described by Tiedemann, as existing in the anterior and posterior mediastina, but not those in the neck, and states from microscopic examination the remarkable fact, that they all consisted of aggregations of fat vesicles. I do not ga- ther clearly from his description whether these fat cells were surrounded by a limitary mem- brane, preserving the form of the thymic cavities, in all the situations where the fat masses are mentioned as existing ; i. e. whe- ther all this fatty tissue was actually deve- loped from the thymus, or a mere accumula- tion in the ordinary way : nor does Mr. Simon state whether the specimens he examined were in a state of torpor at the time of their death or not. I confess I should wish to have fur- ther evidence concerning the accumulations of fat in the marmot’s thymus. — I have never seen a really nucleated fat cell, nor have I ever ob- served any approach to such a development of nuclei. Tiedemann’s description indicates so strongly a great difference between the conditions of the masses in question at the commencement of winter and in the summer, that it seems to me quite necessary that a comparative examination of their minute structure at both periods should be under- taken before the question of their relation to the thymus can be decided. In Edentata the thymus is principally thoracic, the Sloth and Armadillo present small cervical prolongations connected to the larger mass by very slender strips. In Monotremata a thymus is found resting on the origin of the great vessels, and scarcely extending into the neck. Among Pachydemiata there are marked differences in the form and development of the thymus. A foetal Elephant presented a flat mass resting on the upper two-thirds of the pericardium, and sending upwards a short prolongation from its right lobe. In a Peccary the cervical portions were of great length, not only reaching to the angle of the jaw, but folded down again beside the trachea. So- lipeds have a thymus either entirely thoracic or reaching but a little way into the neck. Among Ruminants, the Calf is usually re- ferred to as exhibiting a thymus, which may serve as a type for the family. The gland presents cervical cornua which are highly developed, reach within the angle of the jaw on each side, and form large complicated masses up to the base of the cranium ; below, these prolongations are narrowed, and united in close juxtaposition to form an isthmus, which passes behind the first bone of the sternum, inclines to the left side, and expands into another considerable mass of glandular substance situated on the upper part of the pericardium and covered by the left pleura. In the Reindeer the submaxillaryr enlargements are absent, and the tracheal are of compen- sative size. In the Fallow deer, again, the cer- vical portions are more developed, extending up to the cranium, but not reaching below quite to the pericardium. A thymus has been found in several Ce- tacea. In the foetal Dolphin there are two large median portions, pericardiac and tracheal, with deep seated lateral connecting cornua : in the Mysticete whale there were two peri- cardiac lobes, from the right one of which a prolongation extended backwards across the arch of the aorta, between the art. innomin. and left carotid till it reached the trachea, and ascended a small distance in front of that tube to terminate in two little cornua : the left lobe was of much smaller size. Aves. — In the class of birds no organ unequi- vocally possessing the characteristic structure of a thymus had until lately been shown to exist. Meckel, indeed, described in diving birds an organ which he supposed to be peculiar to them, and which he considered to be the thymus. The microscope, however, in Mr. Simon’s hand has demonstrated this organ to be merely a mass of fat, and that, too, even in the youngest specimens ; the same observer has succeeded in discovering a real thymus, which corresponds closely in structure with that of mammalia at an early period of deve- lopment. It is found in the neck of very young birds, lying along the outer side of the superficial cervical vessels, extending from within a line or two of the base of the cra- nium to just above the inlet of the thorax. It appears as a semi-transparent ampullated tube closed at both extremities, and rather broader at its upper than at its lower part. Under the microscope it is seen to have walls formed by a distinct limitary membrane, and contents consisting of nuclei. The period of its dis- appearance varies somewhat, being earliest in the tribes of powerful and active flight, but in all occurring very much sooner than in mammalia. This discovery of Mr. Simon’s appeared to me of so much interest, both as regards the existence of the organ in birds, and the fur- ther elucidation of its structure which might be expected from the examination of the or- gan in a lower grade of organized beings, that I was anxious to repeat the observation. The result was entirely confirmatory of Mr. Simon’s description. In a chick about one week old I found on each side of the neck a tube, which appeared ampullated to the naked eye, and which under the microscope exhibited a large central cavity with numerous irregular and slight lateral bulgings {fig. 732.). It was filled with imperfect nuclei, and with granular globules, which last were more nu- merous than usual ; there was also a quantity of oily matter in the form of minute drops or molecules. It was remarkable that on the right side the tube was divided into a number of separate portions, which seemed to have become quite isolated from each other ; this, I conceive, to have been the commence- ment of a process of degeneration, an idea which seems also favoured by the existence of 1098 THYMUS GLAND. a quantity of oily matter as a deposit in the glandular cavities. Fig. 732. Lower end of thymic tube from chick one week old. Diameter at a l-lo in. lieptilia. — In the class of reptiles much un- certainty has prevailed respecting the existence of a thymus gland ; it has by some been con- founded with the thyroid, by others denied to exist at all. The microscope has again in the same skilful hand cleared away the doubt, and rendered it certain that a true thymus is found in almost all reptiles, distinct from, and inde- pendent of, the thyroid. In young specimens of Chelonia there is found, extending upwards on each side along the carotid, or between it and the subclavian, an elongated white or yellowish mass, possessing the characteristic thymic structure, and easily distinguishable by this from the true thyroid, which lies in the median line between the carotids, near their origin. I have repeated Mr. Simon’s obser- vation on a tortoise, said to be about a year old, and found in the situation lie indicates an organ, which, though having to the naked eye somewhat the appearance of fat, is shown by the microscope to have the characteristic structure of a thymus. The lateral cavities are considerably more developed than in the brid, they are of very various size and some- what irregular, bounded by a distinct limitary membrane, and filled with well formed nu- clei, together with a quantity of opaque gra- nular-looking matter consisting of minute oily molecules. In Emydosauria the thoracic portions of the thymus are large and of pris- matic shape, they meet on the base of the heart, overlapping the thyroid, and thence ex- tend upwards along the carotid vessels to the base of the skull where they terminate ; in the lower part of the neck they diminish somewhat in size, but afterwards continue of uniform diameter. In several Saurians ( Lacerlidae , Geckos, Chameleons ) the thymus resembles that just described, save that the pericardiac por- tion is absent ; in adult specimens of others, as Isturius and Scincidae, no thymus has been detected, but a mass of fat exists just above the base of the heart, which may perhaps result from a transformation of the gland. In Ophidia the thymus observes one un- deviating type of arrangement, it is found lying on each side along the carotid, often not strictly symmetrical, its lobes elongated and sometimes broken into two or more pieces. Most serpents possess a peculiar mass of fat which is developed in connection with the thymus, and often obscures or conceals it ; in two specimens of rattlesnakes Mr. Simon found this fat body was absent, but is inclined to believe it exists in those which inhabit the temperate latitudes. The thymus of serpents is supposed by Mr. Simon to be persistent, and to undergo transformation into fat. From the Batrachian reptiles it was natural to expect, that in consequence of the remark- able transformation which some of them un- dergo, and the intermediate condition main- tained by others between reptile and piscine life, some important information would be gained respecting the true relation and import of the thymus. So it has proved ; for in the Frog only a mass of fat is found existing in the adult animal in the situation of a thoracic thymus, the very young animal, however, pre- sents, in the same situation, true thymic struc- ture, and the evidence of a real transformation of the gland, — not a mere replacement of it by fat, — seems more perfect than in the case of the hibernators before referred to. It was now a point of much interest to determine the condition of the thymus in the fish-like batrachian larva before its transformation had occurred ; in none of these was any trace of thymus detected, while in the youngest indi- viduals in whom pulmonary respiration had commenced the “ commencement of the or- gan” was always to be found. Mr. Simon remarks ; “ The essential step in reptile me- tamorphosis is a higher developement of the respiratory system : as a part of this pro- THYMUS GLAND. 1099 cess we here find occurring the superaddition of a thymus gland, —its first appearance in the ascending scale of organization.” Among the Perennibranckiata it is very interesting to observe, that the gland is gradually suppressed in proportion as the respiration becomes more completely aquatic, a thymus is found in the Menopoma, Amphiuma, Axolotl, and Meno- branchus, but not in the Siren or Proteus ; its position is rather peculiar, it lies in the neck, on each side, along the lateral aspect of the spine, just behind that prolongation of mucous membrane which unites the branchial cavity to the pharynx. Pisces ■ — In fishes Mr. Simon has been unable to discover any trace of a thymus, after search- ing, carefully, in more than twenty genera ; this result accords well with the absence of the gland in the fish-like batrachian larva, and with its disappearance in the lowest Perenni- branchiata. The following are the conclusions which the eminent physiologist, so often referred to, deduces from a survey of his detailed and elaborate investigation. (1.) The presence of the thymus gland is co-extensive with pul- monary respiration. (2.) Its shape and po- sition are variable and unimportant. (3.) Its size and duration are, generally speaking, in proportion to the habitual or periodical inac- tivity of the animal. (4.) Where it remains as a persistent organ, it is usually but one of several means for the accumulation of nutri- tive material ; its continuance, under such circumstances is generally accompanied — though in some instances superseded — by a peculiar accessory contrivance, the fat body. Physiology. — The time is now past when an eminent physiologist could declare of the organs usually known as glands without ducts, “that in regard of their intimate structure and physiological meaning, they are all equally and utterly unknown to us.” With respect to their structure, it may, I think, be said, that they are as well understood, or perhaps even better than the true glands, being in fact less complex, and their constituent parts less in- dependent. Their physiological meaning, it must be confessed, is still obscure ; yet even on this dark part of the demesne of our science light is beginning to break, which we may fairly hope will continue to brighten. The results afforded by examination of the thymus in the lower animals seem certainly to connect the gland most closely with pulmo- nary organs of respiration, and it would, therefore, seem a natural conclusion, that it subserves some purpose which has to do with the aeration of the blood. It is also found that the size of the gland may vary in a short space of time very considerably, that is, that its contents are capable of being absorbed very quickly, as proved by the fact mentioned by Mr. Gulliver, that in over-driven lambs, the thymus will soon shrink remarkably, and be nearly drained of its contents, but will be- come as quickly distended again during rest and plentiful nourishment. This seems to imply that the material necessary for the supply of the respiratory process is furnished by the thymus, which thus, in Mr. Simon’s words “ fulfils its use as a sinking-fund in the service of respiration.” The persistence of the gland, moreover, is observed to vary considerably according to the muscular ac- tivity of the animal, thus it disappears quickly in young oxen put to the plough, it endures longer in animals of quiet habits than in the restless and energetic beasts of prey, and vanishes at a very early period in the class of birds, while it persists long in that of reptiles. From this it seems to follow, that the use fulfilled by the gland in the service of res- piration is more or less superseded when the muscular system is called into a high state of activity, i. e. when there is considerable waste of tissue yielding fuel for respiration. In the hibernating animal, where the gland, pre- parative to the winter sleep, is transformed into a mass of fat, its application to the de- mands of the respirtory process seems scarcely doubtful, as the chemical nature of the contents of its cavities is then peculiarly' appropriate to neutaralise theoxydising agency of the air. Probable, however, as these views may' ap- pear, they have been confronted by the fol- lowing weighty objections. An able physio- logist, in the Brit, and Foreign Med. Re- view', observes, that the condition of young, rapidly growing animals, and that of hiber- nating animals, are rather opposite than pa- rellel, that whereas in the latter, the waste of the tissues is reduced to a minimum, in the former it is certainly greater than in the adult, so that there can be no deficiency of effete material to feed the respiratory furnace. The demand in the young creature is for plastic materials, out of which the rapidly growing and rapidly changing structures may be built up and renewed. “ On the other hand, in the hibernating animals all the nutritive actions are at zero, and the respiration for a long period is entirely dependent on the stores of fatty matter which have previously been set apart from the food. The demand is here for combustible materials The writer then observes, that the che- mical nature of the contents of the thymus correspond so exactly at the two periods of active growth and hibernation to the kind of demand which must then exist in the system, that he conceives it more probable that the use of the gland at these times is different ; in the one slowly yielding up its hydro-car- bonous contents to supply fuel to the respi- ratory process, in the other performing the principal part in elaborating, by means of its myriad nuclei, fibrine from albumen, the plastic from the non-plastic element. “ As the de- mand for plastic material becomes less ener- getic the thymus diminishes in size and dis- appears, the production of plastic matter within the absorbent and sanguiferous vessels being then sufficient for the wants of the sys- tem. Or if the organ remains,” its struc- ture “ and the nature of its function changes, 1100 THYMUS GLAND. and it cannot be deemed unreasonable to sup- pose that its use in the system should change also. In fact, that its use should be the same in the two cases, where its functions are so different, appears to us a very improbable supposition.” Consonant with the above view is that of Mr. Paget, who remarks in his Report, that the fatty transformation of the thymus is an atrophy or degeneration of the gland, “ analogous to that atrophy by di- minution or total removal of substance, which takes place once for all in the animals in which the thymus is not persistent. In each case the atrophy is an indication that the ne- cessity for the ordinary acts of the thymus has ceased ; but in the hibernants it is, for new circumstances, made to minister to a new purpose, till at the expiration of the winter sleep, and the recommencement of new growth it begins again to be truly developed, and to form the more highly azotized organic com- pounds which it may restore to the blood for the nutrition of the fresh growing tissues.” On a careful consideration of the theories now noticed (and no other are worthy of any examination), it seems to me, certainly, that the latter is nearest the truth ; and that we cannot regard the thymus in the young animal as a mere preparer of material fitted to sup- port the respiration. The following argu- ments must be allowed to weigh strongly against Mr. Simon’s view. (1.) The chemi- cal constitution of the thymus, consisting chiefly of proteine and not of fatty matters, seems by no means to be such as would be best adapted to sustain the supply of com- bustible material required in respiration. (2.) The office of serving as a reservoir for ma- terial to be used in respiration may be attri- buted with much more probability to the liver*, the construction of which, as also in some measure its position relative to the cir- culatory system, point it out as peculiarly adapted for the reception of superfluous re- spirable material from the blood, and equally so for rendering it up again, when the demand again begins to be felt in the circulating cur- rent. Of this, the condition of the liver in fish, and generally in all animals, in whom the respiration is of a low type, is sufficient proof. Now as the liver is of greater relative size in the young than in the adult animal, it is not likely that this one of its functions is in any measure discharged by the thymus. (3.) The anatomical constitution of the thymus is very unlike that of an organ which serves * I may just briefly mention here the results to which I have been led by a long and careful study of the liver in vertebrata. Its lobvdes (if it is so divided) are not penetrated by excretory ducts, nor are the secreting cells contained as in most other- glands in the cavities of ducts, they lie naked in the interstices of a close plexus ot most deli cate- walled, capacious, capillaries, from which they readily re- ceive the materials they are intended to act on ; and to which they as readily render up their elaborated products when these are called for. The excretory ducts, consisting at their origins almost solely of nuclei, attract into their cavities the oleo-biliary secretion with which they are bathed; probably, however, in so doing altering it to some extent. as a reservoir of respirable matter. For this purpose we should expect to find a fluid stored up in cavities, such as the oil of the fat vesicles, or the oleo-biliary matter which collects within the cells of the liver ; the ana- tomical elements, however, of the thymus are totally different, being mere nuclei, with no trace even of commencing cell development, in fact, just that part of a glandular appa- ratus which is not the secretion, however im- portant a part it may play in the elaboration of it. (4.) The transformation of the thymus into fat previous to the winter sleep, con- currently with the formation of other fat masses in the axilla;, indicates, as above shown, very strongly that the gland in its natural state fulfils some purpose different from that to which it is subservient during hibernation. But as there can be no doubt that it undergoes this change for the sake of the respiratory function, — to fit itself for supplying those de- mands during the long period when the waste of the tissues is reduced to a minimum, and no ingesta are taken,— it seems tolerably cer- tain that while the gland continues in its normal unchanged state, its action must be of a different kind, not having special reference to the function to which during hibernation it un- doubtedly ministers. The circumstance quoted by Mr. Simon from the writings of Mr. Gulliver, respecting the remarkable shrinking of the thymus in over-driven lambs, cannot be re- garded as proving that the contents of its cavi- ties are thus absorbed solely for the use of re- spiration. It is more probable that they are resumed into the blood, which has begun to be impoverished by fasting and exercise, in order that they may go to supply the nutrition of all parts indifferently. With regard to the argu- ments adduced by Mr. Simon from Compara- tive Anatomy, to the effect, that a thymus has some essential connection with pulmonary organs of respiration, I would remark that though it is certainly of weight, yet it can- not be regarded as proving absolutely that the two organs are co-related in function. It may be that they are only simultaneously developed, — connected together in virtue of some law of organized being which requires their coeval appearance, and yet not intended to minister to a common pupose.* I grant that observing their consentaneous appear- ance, one should inquire whether they be not essentially linked together in function, but if this be not proved by subsequent inquiry, or a fortiori, if it be shown to be unlikely, then the argument arising from their co-develop- ment ceases to have much force. But if we decline accepting the theory pro- posed by Mr. Simon, are we to close, uncon- ditionally, with the other which has been above expounded, and which is but a modifi- * This is perhaps the more probable, seeing that the thymus does not assert its connection with organs of respiration taken generally, but only with a particular modification of them, so that its exist- ence is determined not so much by the degree in which the function is fulfilled as by the mode. Hence it is absent in the higher fishes and in insects. TIIYMUS GLAND. 1101 cation of a former opinion, that of Cowper and Haller, who regarded the thymus as belonging to the class of conglobate glands. It appears on the whole more consistent with the various facts bearing on the subject which are in our possession, and yet it is by no means proved, and is open to some objections. In the first place, one is inclined to look sus- piciously on any hypothesis, which assigns the production of a material almost universally diffused throughout the body to any separate organ, it seems far more truth-like to regard the manufacture of the plastic element (ftbrine), as taking place in the blood itself by the agency of the white corpuscles, as Drs. Addison, Williams, and Carpenter, have well nigh demonstrated to be the case. It their view be correct, it becomes still more impro- bable that the thymic nuclei should be the producers of fibrine, seeing that they are al- together dissimilar in appearance and struc- ture from the white granular corpuscles. Moreover the early disappearance of the thymus in birds, long before the demand for plastic material can have materially dimi- nished, makes it unlikely that in them its function is the elaboration of fibrine. The same observation applies to mammalia though in a less degree; and, generally, 1 think there can be little doubt that the self-forming, self- sustaining blood, while supplied with an ade- quate quantity of proper nourishment, is fully capable of evolving within itself all that is requisite for the nutrition of any part of the system. It seems almost unwise to broach any further speculations respecting this ignotum quid, especially after stating objections to the views of others ; and yet while ideas are ot- tered as mere suggestions, to serve if they may as aids to the discovery of truth, they are not without utility, since none can say without trial which of these “ scintillas” may kindle the light of truth. From the careful investigations which have been made respecting the age at which the gland attains its highest develop- ment, and the conditions which chiefly affect its size and repletion, it certainly appears to be a very exact exponent of the state of the nu- trient processes generally, — a delicate barome- ter of nutrition, as Mr. Simon terms it. More- over its anatomical constitution, as 1 have insisted, seems to show that it does not truly secrete, i. e. elaborate and separate some pe- culiar principle from the blood, but that it is a congeries of (nuclear) particles, which can only be regarded as solidified liquor sanguinis, and not in anywise as a true secretion, espe- cially when we remember that in every such fluid the nuclei of the producing cells sooner or later disappear. Chemical analysis, as we have seen, confirms this position ; the formula expressing the nature of the contents of the thymic cavities being identical with that of proteine. Now if one of the organs which belong to the class of ductless glands have for its func- tion to act as a living attractive recipient or reservoir for the blood en masse, may not an- other fulfil its destined purpose by serving as a reservoir for that part of the blood which ministers to nutrition, perhaps for the plastic element of the liquor sanguinis in particular? When such plastic material is in superabund- ance in the circulating current, a quantity of it passes off, and solidifying in the thymic cavities, assumes that most universal of all organized forms, the form of nuclei.* When there is again a demand for such material, the solidified particles would again liquefy, and re-enter the impoverished blood. It is not difficult to understand that such a func- tion may be most necessary during the pe- riod when growth is most active, the sup- plies of nourishment most frequent, and the waste of the tissues most rapid, but that as the several nutrient processes, both of the assimilative and destructive kind, attain to more steadiness and equilibrium, diminishing somewhat in their intensity and rapidity, but increasing in real strength, firmness, stability, and perfection (one is obliged to use somewhat metaphorical language), it may no longer be requisite, and the organ will therefore undergo a gradual atrophy. This hypothesis, which is really little else than an expression of the facts above noticed, has been principally suggested by the con- sideration of the nature of the secretion (so called) of the thymus, wherein it differs ab- solutely from all other glands, in as much as the nuclei constantly remain in then- primitive state, and are not even mingled with granular matter ; while it agrees in this respect with another organ of similar kind, the spleen, whose parenchyma consists of similar bare nuclei, which exert so far as we know no real secretory action. It is however by no means improbable, that, even if this guess at the use of the thymus be correct, we are yet very far from being fully acquainted with all the rea- sons why it exists, and why in such a situa- tion, and under such a form. If Mr. Goodsir’s account of its origin, from a portion of the blastoderma, with the suprarenal capsules and thyroid, be correct, it is possible that its formation may be demanded by some recon- dite law of development, in virtue of which the extraction of one organ out of the pri- mitive blastema necessitates, by a kind of compensating action, that another should arise in some sense complementary to it. This idea, originally stated by Treviranus, has been developed very ably and pleasingly by Pro- fessor Paget, to whose lectures I refer for a full exposition of it. Morbid Anatomy. — Not much is known, and probably there is not much to be known, respecting the morbid conditions of the * I would here direct attention to the remarkable fact, that in all glandular, and in fact in almost all, organs, the nuclei are almost precisely similar in size and appearance, and do not differ from each other in different parts more than individual ones do in the same. Does not this indicate strongly a tendency of liquor sanguinis effused in conditions of healthy nutrition, to assume the form of nuclei, irre- spective of the situation or special endowment of the part where it is effused ? THYMUS GLAND. 1102 thymus. Absence of the gland has only been observed in cases of acephalistn, where the brain and many other parts are simultane- ously deficient, while in cases of anence- phalism, where the brain is also wanting wholly, but the general development much more complete, the thymus is present; no- thing therefore can be concluded from its absence in cases of extreme monstrosity as Mr. Simon has well observed. Inflammation of the gland, if it ever happens, is of rare occurrence. Professor Hope, however, refers to a case by Mason, in which an abscess of the thymus is said to have opened into the trachea. The same author states that Becher and Hangstadt have collected about fifteen ex- amples of persons, of different ages, affected with more or less general tubercular disease, in whom the thymus was found involved. “ It was for the most part considerably en- larged, very firmly united with surrounding parts, and either converted by tubercular in- filtration into a hardened mass, or else par- tially destroyed by tuberculous softening. In three or four instances calcareous concretions, probably resulting from the retrogression of tubercle, were discovered in the gland.” Haller speaks of the thymus as being fre- quently affected with scirrhus along with the conglobate glands ; but though Becher gives an instance on his own authority, and refers to others, there can be no doubt that true malignant disease of the gland is extremely rare. Sir A. Cooper gives a case, in which death was produced by the pressure of an enlarged thymus upon the vena transversa and upon the trachea, probably also upon the vagi nerves ; there was severe dyspnoea and oedema of the lower extremities. He considers the disease to have been of the fungoid kind, i. e. encephaloid. Atrophy of the thymus occurs as a normal event ; if, however, it should take place long before the usual period, determined, as we have seen, not so much by the lapse of time as by the condition of the system, it must be regarded as morbid. Yet in every such case it is almost certain that the atrophy of the thy- mus would be but part of a general malady, wherein the nutrition of every organ was greatly impaired. Hypertrophy of the thymus has attracted more attention. Dr. Kopp having noticed several cases of suddenly fatal dyspnoea oc- curring in children, in whom the gland was found of large size, concluded that there was some essential connection between the glan- dular enlargement and the suffocative pa- roxysms. The fallacy of this opinion has been well pointed out by Mr. Simon and others. I must refer to his work, and that of Professor Hope, for a full account of their arguments, and will only mention two circumstances, which seem to me conclusive upon the point. The first is, that “thymic asthma” may occur with an unnaturally small thymus ; the second, that when a thymus, enlarged by malignant disease, as in Sir A. Cooper’s case, does oc- casion dyspnoea, it is not sudden and pa- roxysmal, but constant and exhausting. For the history of the thymus, and for a copioits list of authors who have written upon it, I can do no better than refer to the Historical Introduction to Mr. Simon’s essay. (C. Handfleld Jones.) THYROID GLAND. (French, glande thyroide ; German, Die Schilddruse ; Italian, Tiroidea glandola ; Latin, Glandulathyroidcea.) The organ which has received this name is a bilobed glandular body, situated in the human subject in close proximity to the larynx, from the prominent cartilage of which it has pro- bably derived its appellation. Its size varies considerably in different in- dividuals, according to unknown peculiarities. In the female it is generally larger than in man ; reversing thus the proportion which obtains between the vocal apparatus in the two sexes, and so far negativing the idea, that the larynx and the thyroid gland are in any wise intimately connected. The normal weight of the thyroid is about one ounce, according to Cruveilhier. Any great excess above this must be regarded as indicating a pathological condition. Its form, as has been said, is bilobed ; the lateral lobes being united by a thinner and narrower portion termed the isthmus. It would appear (from the circumstance that variations of form are most frequent in the isthmus, which sometimes is even wanting) that the lateral lobes are the primary parts of the gland, and, in fact, in one entire class (that of birds) the lobes lie entirely separate, one on each side of the trachea. In the human subject they are large and solid, presenting an anterior convex surface, a posterior concave, an external and inferior border which is con- vex, and runs up to join the superior interior concave border in a pointed cornu, which reaches as far as the origin of the inferior con- strictor pharyngis from the ala of the thyroid cartilage. From the upper border of the isthmus, or from the adjacent part of one of the lateral lobes, there stretches upwards a narrow strip of glandular tissue, which has been called the pyramid or mesian column, and which may have been sometimes mis- taken for a muscle, as Cruveilhier asserts ; though it is distinguished perfectly from the so called levator gland, thyroid, by Haller. This prolongation sometimes extends to the hyoid bone, but generally not so far, and is subject to numerous modifications of shape and structure. The following list of the various forms which the thyroid may pre- sent, is taken from the catalogue of the mu- seum of Guy’s Hospital, which Dr. Birkett, the curator, most kindly allowed me to inspect, together with the preparations. 1. Thyroid without an isthmus, but having two mesian columns. 2. Thyroid almost without an isthmus, and having one mesian column. 3. Thyroid with broad isthmus and one mesian column. 4*. Thyroid with no isthmus, but having one large mesian column. 5. Thyroid THYROID GLAND. 1103 without isthmus, having one column (right), anti an isolated portion on the left. 6. Thy- roid with one lobe only developed, and a little glandular body below the middle of thyroid cartilage. 7. Thyroid gland replaced by a membranous substance, two small por- tions only remaining. 8. The gland with isthmus and two mesian columns. It is important to ascertain accurately the situations and relations of the thyroid. I give them as they are stated by Cruveilhier, and confirmed by my own observation. The isthmus lies across the first four rings of the trachea, the first not being completely co- vered.*' Its upper margin is about half an inch below the inferior border of the cricoid carti- lage : from it the mesian column passes up- ward, lying upon the crico-thyroid muscle, the thyroid cartilage, and the thyro-hyoid membrane. The lower border of the isthmus is free, and occasionally descends so low, that there is not space between it and the sternum to perform the operation of tracheotomy. Posteriorly, the isthmus is firmly attached to the rings of the trachea by close and dense areolar tissue. The sterno-hyoid and sterno- thyroid muscles overlap the greater part of the isthmus ; a small portion, however, in the median line is covered only by deep cervical fascia, and perhaps crossed by some branches of origin or communication of the anterior jugular veins. The lateral lobes, concave posteriorly, embrace, and rest against the sides of, the trachea, the cricoid cartilage, the in- ferior and lateral parts of the thyroid car- tilage, and the lower part of the pharynx and upper part of the oesophagus. “ These lobes form, with the connecting isthmus, a half or sometimes three fourths of a canal, which surrounds all these parts. This re- lation, one of great importance, explains how certain goitres flatten the trachea late- rally, hinder deglutition, and finally bring on a real asphyxia from strangulation. ”j~ The posterior border of the lateral lobes corre- sponds to the vertebral column, and rests upon the carotid artery ; but, if enlarged, it extends further outward, and lies upon the jugular vein. Both recurrent nerves ascend behind the lateral lobes, and are closely in relation with them as they pass under the lower edge of the inferior constrictor muscle. Anteriorly, the sterno- and omo-hyoid muscles pass in front of the lateral lobes, the sterno- thyroid is stretched as a thin band over their surface, and in cases of considerable hyper- trophy may be seen sunk in a deep groove formed in their substance, or, as Cruveilhier states, expanded to a width double or treble its natural size. These muscles separate the thyroideal lobes from the sterno-cleido-mas- toid, which, with the mastoid artery and the superficialis descendens on its inner surface, overlaps their greater extent, as it passes backwards and upwards to its cranial attach- ment. “ The superior extremity of each of * There is probably some variation in this, ac- cording to the varying depth of the isthmus. t Cruveilhier, Anat. Descr. the lateral lobes terminating in a point, whence the bicorned form which has been attributed to the thyroid body, corresponds on the inside of the carotid artery to the lateral and posterior part of the thyroid car- tilage, and extends sometimes even to the neighbourhood of its upper border. The inferior extremity, thick ami rounded, descends more or less low in different subjects, and corresponds to the fifth, sixth, or even to the seventh ring of the trachea; it is situated between the trachea and the common carotid artery. By the inferior extremity the inferior thyroid artery reaches the gland.” “ The superior border is concave, and skirted by the superior thyroid arteries.” The inferior is convex, and has branches of the inferior thyroid running along it. The thyroid gland is of a red or reddish yellow colour, of tolerably firm consistence, and gives to the touch the sensation of granulations. Cruveilhier, thus describing, proceeds as follows : “ This organ presents all the anatomical characters of glands, and, like them, is separated by dissection into glandular grains ” (doubtless meaning the acini of Malpighi) ; “but there is, be- tween these glandular grains and those of ordinary glands, this difference, that in the thyroid gland the glandular grains communi- cate with each other, while in the others they are independent.” He then details the result of mercurial injection, to show that the glan- dular grains, or granulations, have a vesicular structure, and communicate with each other ; this latter statement, however, is certainlv erroneous, as we learn from more accurate modes of investigation. The presence of a certain amount of secreted fluid, in the natural condition of the tissue of the thyroid, and the accumulation of a similar material in larger quantities under certain morbid con- ditions, the eminent French anatomist justly regards as evidence of the thyroid possessing a secreting apparatus ; but, at the same time, faithful to the results of accurate dissection, he acknowledges that no excretory duct can be found leading either into the trachea, the ventricles of the larynx, or the foramen caecum of the tongue, whither earlier ob- servers had, with too nice refinement, sought to trace its course. Far truer and more phy- siological than such straining after uniformity is the conclusion he adopts : “ I think that there exist, in the economy, glands without excretory ducts, such as the thymus, the supra- renal capsules, and the thyroid gland. The li- quid produced in the gland is absorbed entirely, and fulfils unknown uses.” I have thought it worth while to follow this accurate and trust- worthy anatomist through his account of the structure of the thyroid", though it be some- what antiquated, partly for the sake of the confirmation it affords to the results of a more recondite and powerful analysis, and partly that we may observe how securely we may trust Nature’s own teachings, even when they may appear, for a time, contradictory to established doctrines, as doubtless it must 1104 THYROID GLAND. once have been considered that a gland should exist unprovided with an efferent duct. I now proceed to give a more detailed account of the structure of the thyroid gland. Its surface is somewhat uneven, — a natural condition which is often greatly exagge- rated in hypertrophy of the gland ; it is tra- versed by several large branches of the nutrient arteries, which ramify over it before they plunge into its substance. A thin fibrous expansion, continuous with the sheath of the cervical vessels on each side, forms a capsule which invests the gland, and from whose inner surface septa dip into the interior, dividing its substance into lobes and lobules much after the manner of a conglomerate gland ; these fibrous septa are often well seen in sections of hypertrophied specimens. A thin slice of the thyroid, examined under a low power of the microscope, displays its con- stitution very perfectly and readily (Jig. 733.) It is seen to be made up of closed vesicles, aggregated together in groups of various size by the fibrous expansions just described. The form of these vesicles is primarily spherical ; but many, perhaps the majority, are more or less affected by mutual pressure, being trian- gular, elongated, ovoid, or oblong. They are all perfectly closed, the wall being formed by an homogeneous limitary membrane, which is easily traced all round, and can never be seen passing off into a neck, or blending with the envelope of an adjacent vesicle. Where a number of vesicles lie closely crowded to- gether, the homogeneous envelopes are of course in contact, or separated only by the interjacent vascular plexus ; but those form- ing the surface of a group are invested by a thin expansion of fibrous tissue derived from the general capsule. The diameter of the vesicles of the human thyroid I have found to range from inch to ^ Fig. 733. inch ; in the bullock, from inch to inch ; the greater number averaging about -jvU. inch, in this animal as well as in the pig. In the mesian column I found, at least in one instance, that the structure was essentially the same as that of the thyroid itself, only that there was a much greater amount of fibrous stroma, which resembled more nearly ordinary areolar tissue, containing both the white and yellow element. The vesicles are lined internally by an epithe- lial stratum, consisting usually of nuclei set closely together in a scanty basis substance (Jig. 734.), which is either feebly granular, or of a somewhat oily aspect. The nuclei are at once recognised by the practised eye as exactly resembling those of the true glands. Their nucleoli are not always visible, and vary Fig. 735. Epithelium from thyroid, of bullock. Epithelial particles fro thyroid of rabbit Diameter 1 2000 in. very much in number — from one to four or five. The nuclei are, however, always vesicu- lar, bounded by a strongly marked envelope and have a mean diameter of -a^i-yth inch. It has been observed by Mr. Simon, and I have occasionally had the opportunity of THYROID GLAND. 1 105 confirming the remark, that the nuclei, instead of remaining in their primitive condition, pro- ceed to the further stage of cell development ; this he has noticed both in man and in several of the lower animals. I should say that it is certainly a circumstance of rather rare oc- currence ; but it is worth remarking, that it may be artificially produced by adding to the specimen some coagulating re-agent, which speedily solidifies a film of albuminous plasma around the nuclei, and thus produces very good imitations of cells. The epithelium of the thyroideal cavities often assumes the form of small vesicles larger than the nuclei (see figs. 736, 737, 738.), and easily distinguished Fig. 736. Vesicular epithelium from Human thyroid. Diameter of vesicles, j in 3-2000 Fig. 737. Persieidar epithelium from thyroid - of Pig. Diameter of vesicles, 2-Tooo in- Fig. 738. Vesicle from thyroid of Hedgehog, lined by an epithelium consisting of a double row of pellucid delicate vesicles, 55t_ in. diam. from them.* The diameter of these in a hu- man subject averaged inch; in a bullock, about T7Vir inch They are, in their natural state, perfectly spherical, but often somewhat angular from mutual pressure. Their contents are a very faintly granular or pellucid material, which does not surround a nucleus except iu some rare instances, where there may be seen an imperfect trace of one. These vesicles, which I thus name to distinguish them from the nucleated cells occasionally met with, exist in the glandular cavities, sometimes alone, sometimes mingled with the ordinary form of epithelium in varying proportion. I am in- clined to believe that they originate in the nuclei, which undergo a kind of expansion, at the same time losing their nucleoli. This opinion needs further confirmatory evidence; * I am obliged to use tlie same word (vesicle) in speaking of the large glandular cavities, and of the epithelial particles which line them : the dis- tinction between them should, however, be carefully borne in mind. VOL. IV. it is, however, certain, that they are not de- veloped upon pre-existing nuclei. The layer of epithelium is generally of no great thick- ness, not occupying more than one eighth or one sixth of the distance from the envelope to the centre of the cavity ; in the rabbit, however, it appeared to be more abundant, encroaching considerably on the interior, which, in this instance, was not filled with the characteristic glistening secretion. In a sec- tion prepared in the ordinary way, a large quantity of epithelium is broken up, and may be seen strewn over the field. Not unfre- quently, however, the nuclei adhere firmly together; and sometimes, as in the pig, I have seen the greater part of the lining of a cavity detached entire. The contents of the cavities are for the most part a clear, somewhat refracting, homo- genous material, which is manifestly the pro- duct of secretion, and fills all the spaces not occupied by the epithelium : this fluid is some- times contained in small vesicles Ti-;r to inch diam. {figs. 739. and 740.) which have a Fig. 739. o Two vesicles containing a transparent matter and no epithelium. From thyroid of Bullock; the larger in., the smaller in. diam. Fig. 740. Two vesicles from thyroid of Bulloch, having a thicker lining of epithelium than usual, and each containing a single vesicle, whose wall, of homo- geneous membrane, surrounds the central cavity of the original vesicle. well marked, structureless envelope, but are destitute of any thing like epithelium. They may be seen occasionally in the interior of the glandular cavities, and also floating free in the field of view, having been perhaps detached from cavities opened by the section. The exact import of this circumstance does not appear ; for I cannot regard them as newly formed glandular vesicles, developed within the original ones in an endogenous manner. Were this the case they would occur more frequently, and w'ould exhibit some traces of epithelial lining. Large crystals, sometimes 4 B 1 106 THYROID GLAND. of well marked prismatic, sometimes of oeto- hedral, form, are seen occasionally in the glandular cavities. They are generally single in each, and I have no other guide than their form to lead me to any opinion respecting their chemical constitution. I have seen, in a human thyroid, some large oval or circular corpuscles about inch diam., consisting of coarse granular matter not surrounded by any distinct envelope, and of an opaque dead white colour. These were perhaps ab- normal formations ; yet in a tortoise, where the gland was quite healthy, similar corpuscles, and more numerous, were observed. The clear fluid material, contained within the glandular cavities, is generally spoken of as of an albuminous nature. This opinion seems con- firmed by two analyses of the gland, made by my friend Mr. Beale, which may be regarded (after allowance is made for the areolar tissue, vessels, envelopes, and epithelium) as express- ing pretty correctly the chemical nature of the secretion which forms so large a part of the whole bulk. These analyses I will presently quote, but will first detail a few observations of my own, as to the effects of certain re- agents on the fluid in question. Liq. Potasses, added to a thin section pre- pared for the microscope, rendered it much more transparent, partially dissolving the epi- thelium, and leaving a quantity of oily matter diffused throughout it. Acetic acid now added to the specimen pretty7 nearly restored it to its former appearance, but did not bring into view any precipitated protein. Acetic acid, alone, dissolves in part the epithelium of the vesicles, and renders the fibrous tissue more transparent. Liq. Ammonia dissolves the epithelium in great part, but does not alter the transparent contents of the cavities ; nor does liq. potass® or acetic acid. Solution of iodine does not materially affect the epithe- lium of the cavities, but renders it more opaque. Strong nitric acid at first renders the epithelium more opaque and granular, but does not manifestly affect the contained secretion. After a time it colours this material bright green or yellowish green, and disengages a great many bubbles of gas. A saturated solution of bichloride of mercury , even after long maceration, does not seem materially to affect the secreted contents of the vesicles ; it makes their peripheral stratum of epithelium quite opaque ; but the interior still appears transparent and glistening. The chief conclusion deducible from the above results is, that the secreted material of the glandular cavities of the thyroid is not ordinary fluid albumen ; as otherwise it would certainly be coagulated by the agents em- ployed. The effect produced by nitric acid is also worthy of notice, though I cannot ex- plain the meaning of it. Analysis of thyroid gland. Human. Ox. Water ... 70-6 71-34 Solid matter - - 29-4 28'66 Solid matter. Animal (fibrinous and albuminous) matter, Human. Ox. vessels and fat - 26-384 24-628 Extractive matter 1-7 Extractive matter with gelatine 2-888 Alkaline salts 0-5 0-642 Earthy salts 0-816 0-502 29-400 28-660 The analyses given above testify to the presence of a large quantity of fibrinous and albuminous matters in the gland, and leave no doubt that its secretion is a protein com- pound ; it is, however, unfortunately impos- sible to procure a sufficient quantity apart from other substances to analyze correctly ; and the exact nature of the thyroideal secre- tion consequently still remains unknown. Thus much, however, seems to be ascertained, or rendered very probable. (1) That the secreted material is of an albuminoid nature. (2) That it is not in the state of ordinary fluid albumen. (3) That gelatine is sometimes an ingredient of the secretion; (it was found in the gland of an ox, but not in that of the human subject, and consequently could not have been derived from the fibrous tissue). (4) That though crystals of triple phosphate and of oxalate of lime occur in the cavities, no urea nor lithic acid, nor in fact any special organic compound, can be detected.* Vessels. — The vascular supply of the thy- roid is very abundant, and completely justifies Cruveilhier’s opinion, that more than a mere process of nutrition is carried on in the gland. The arteries which are distributed chiefly to this organ are very constant in their number, and tolerably so I think in their respective dimensions, though in this respect they vary inversely with regard to each other. They ordinarily arise, as has been well remarked by Mr. Simon, just beyond the points where the arteries to the brain are given off from the large trunks,- — a circumstance which he con- ceives to be very significant of the function of the gland which they supply; — the two superior thyroideal arising one on each side from the external carotids, almost immediately after the bifurcation of the common carotids, and the inferior thyroideals from the intra- scalenal portion of the subclavian, almost opposite the point where the vertebrals are given off. A fifth thyroideal artery occa- sionally exists, — that named after Venbauer; taking its origin from the arch of the aorta or th earter. innominata. The superior thyroid not unfrequently takes origin a little lower down from the division of the common carotid, or even from its trunk ; or it may arise higher up from a common trunk with the lingual. It courses first forward and inward, when it is * I would not omit to express here my obligations to Mr. Beale for undertaking the analyses, and for the care and skill with which he has performed them. 100 100 1107 THYROID GLAND. covered only by the deep fascia and platysma ; but it soon turns vertically downwards, and runs beneath the sub-hyoidean muscles to the upper extremity of the gland, where it divides into three branches; one of these runs be- tween the thyroid gland and the trachea, a second skirts the external border of the lateral lobe, while the third, running along the inter- nal border, forms an anastomosis with the cor- responding branch of the opposite side. The inferior thyroid is noticed by Cruveil- hier as one of the arterial branches most liable to vary in its origin, — an opinion which, emanating from a less high authority, I should have been inclined to question. It may arise, acccording to him, from the common carotid, the arch of the aorta, or the arleria innomin- ata. (The supra-scapular often, less commonly the posterior scapular, and sometimes even the internal mammary, spring from the com- mencement of the inferior thyroid, which is therefore called the thyroid axis.) Its course is peculiar ; it runs at first straight upwards, then comes downward, and again ascends to reach the inferior extremity of the lateral lobe of the gland. It passes in front of the trachea, and behind the great vessels and vagus nerve : t he connecting cord ofthe sympathetic descends behind it to the middle cervical ganglion when it exists, which is then almost constantly found, as it were, seated astride upon the vessel, exactly on the convexity of its first curve. Like the superior thyroid, it has three terminal branches, one running along the in- ferior border of the gland, another breaking up over the posterior face of the lateral lobe, and a third which penetrates between the gland and the trachea, and anastomoses with the one of the opposite side along the upper border ofthe isthmus. (Cruveilhier). The capillary plexus, in which the minute branches of these arteries terminate, is dis- posed in the form of hollow spheres around the glandular cavities, closely applied upon the limitary membrane and forming a continuous network throughout the gland. It is tolera- bly close-meshed, but not nearly so much so as that of the liver or kidney. The diameter of the capillaries, in a recent injected specimen, varied from -g- .^Voo inch, and the interspaces were, I think, two or three times as large. There are corresponding vence comites to the superior and inferior thyroideal arteries. The superior thyroid or thyro-laryngeal returns its blood either into the internal jugular vein, or into the common trunk of the facial and lingual, before it joins either of the jugulars. The middle thyroideal runs down and turns aside, crossing the common carotid to enter the internal jugular. Besides these there exist constantly another pair of veins, which run down in front of the trachea involved in the deepest layer of cervical fascia, and terminate either by opening both into the vena transversa, or the left into this trunk, and the right into the junction of it with the right brachio-cephalic. Ihese veins run down, gradually diverging from each other ; so that, from being at their origin no more than one third of an inch apart, they are separated at the lower part of their course by an interval of about an inch, or rather more. In this situation they are often united by a transverse branch, and are said, by Cruveilhier, to form, with the tracheal and laryngeal veins proceeding to unite with them, a considerable plexus, which it is impossible to avoid in the operation of tracheotomy. These veins correspond in some measure with the thyroideal artery of Venbauer, but are much more constant, and are sometimes three or four in number; so that the blood they re- turn is not proportioned to that conveyed by the artery. The lymphatics, originating probably in a closed network, proceed to enter the deep cervical glands. They may sometimes be seen filled with a concrete albuminous substance, which they have probably taken up from the glandular cavities. Nerves. — The recurrent laryngeal, shortly before it passes under the margin of the in- ferior constrictor muscle of the pharynx, gives off some filaments to the thyroid gland ; some are also furnished by the external laryngeal ; while a plexus, derived from the middle cervical ganglion, proceeds along the inferior thyroid artery, and is distributed to the gland along with its branches, forming communications with the preceding. In thin sections of the thyroid treated with acetic acid, I have seen the nucleated bands of the sympathetic, con- taining one or two cselio-spinal tubules, running for some distance in the interspaces of the vesicles ; they probably terminate by forming a looping plexus ; but I have not been able to ascertain anything certain on this head respecting either these or the tubular fibres. Development. — The thyroid is said by Cruveilhier to be developed by two lateral halves, which are subsequently united by means of the isthmus. This statement seems to be confirmed by the condition ofthe gland in several of the lower animals, where the lateral lobes continue separate, lying on each side of the trachea ; and is also supported by the occasional occurrence of a similar dispo- sition in the human subject. In my own researches it has not occurred to me to observe this mode of development, perhaps because I have not examined spe- cimens at a sufficiently early period ; however, in an embryonic sheep only two inches long, where the thyroid was distinctly visible, it presented the usual appearance — the lateral lobes being connected by a narrow isthmus ; the same was the case in a human foetus of 4i months ; the isthmus, however, being wider, and not appearing to be of at all more recent development than the lateral lobes. In the embryo of the sheep just mentioned, the gland was of an opaque whitish aspect, differing materially from its natural reddish colour ; it consisted principally of nuclei, with a small quantity of granular matter. Scarce any trace of a vesicular arrangement existed ; but the whole mass was surrounded by an investing membrane very nearly homo- geneous in texture. In another embryonic 4 b 2 1108 THYROID GLAND. sheep, three inches long, the thyroid was much more of its natural reddish, semi-trans- lucent colour ; still there was scarcely any vesicular arrangement, the mass consisting almost entirely of nuclei aggregated together. The thyroid of the human foetus just men- tioned was of the same grayish aspect as that of the smallest of the embryonic sheep. It also consisted chiefly of nuclei, but these were to some extent collected together so as to form solid globular masses (Jig . I'll.), not Fig. 741. >©ee©ffi^o